Papers by Richard Fleming
Australian Journal of Human Rights, 2020
Human rights are increasingly being considered in Australian law reform and policy discussions on... more Human rights are increasingly being considered in Australian law reform and policy discussions on how to improve the circumstances of people living with dementia in care homes. This article enriches understanding of the views on human rights held by people living with dementia and those who support, advocate and care for them, in order to ensure that law and policy reforms that promote human rights can be meaningfully enjoyed in practice. Drawing on data from focus groups and interviews with people living with dementia, care partners, aged care workers, and lawyers and advocates, this article argues that there is general support among stakeholders for human rights. However, this support was qualified by their acknowledgement of entrenched economic, cultural and sociolegal barriers to the recognition of human rights in the everyday lives of people living with dementia. The article concludes that urgent action is required to transform the cultural, economic and social drivers of ambivalence and resistance to dementia and human rights within aged care and the broader community.
doi:10.1017/S1041610212000683
Facilities, 2021
Purpose The independence and well-being of people with dementia can be significantly influenced b... more Purpose The independence and well-being of people with dementia can be significantly influenced by the design of the physical environments around them. Several assessment tools exist to evaluate the dementia design quality of existing residential aged care facilities but, to date, none have been formally identified as suitable for use during the design process. This paper aims to examine the feasibility of re-purposing existing post-occupancy tools for use during the design process, while mapping the influence of design stages on resulting dementia design quality. Design/methodology/approach Literature searches identified audit tools for residential aged care settings. After reliability screening, three tools were analysed in-depth, mapping their suitability for use during the design process. Findings The study confirmed that existing tools can be re-purposed for design stage use and identified that early design stages have a larger influence on overall dementia design quality than ...
presented at the 30th International Conference of Alzheimer's Disease International, 15 - 18 ... more presented at the 30th International Conference of Alzheimer's Disease International, 15 - 18 April 2015, Perth, Australia
Everyone knows how bad it feels when the temperature is uncomfortably hot or cold. For most of us... more Everyone knows how bad it feels when the temperature is uncomfortably hot or cold. For most of us it doesn't last long as we can take simple steps to get comfortable, such as putting on clothes, opening a window, or switching on a heater. But what happens when you can't control the temperature where you live? This problem is faced by many residents of aged care facilities, and can be particularly difficult for those living with dementia. To find out how these residents cope we recently carried out a three-year research project on the effects of indoor environment in aged care facilities in southeastern NSW. This was part of a broader program of University of Wollongong research on the impact of indoor environment on elderly people.
presented at the 30th International Conference of Alzheimer's Disease International, 15 18 Ap... more presented at the 30th International Conference of Alzheimer's Disease International, 15 18 April 2015, Perth, Australia Disciplines Medicine and Health Sciences | Social and Behavioral Sciences Publication Details Winbolt, M., Fleming, R., Beattie, E., Cunningham, K., Stafford, A. & Baral, H. P. (2015). Advancing practice in the care of people with dementia: a national approach to education and knowledge transfer. 30th International Conference of Alzheimer's Disease International: Abstract Book (pp. 148-148). Australia: Alzheimer's Disease International. Authors Margaret Winbolt, Richard Fleming, Elizabeth Beattie, Kathryn Cunningham, Andrew Stafford, and Hannah P. Baral This conference paper is available at Research Online: http://ro.uow.edu.au/smhpapers/2836
The purpose of this guide is to enable users of the Singapore Environmental Assessment Tool (SEAT... more The purpose of this guide is to enable users of the Singapore Environmental Assessment Tool (SEAT) to confidently and successfully complete an assessment of an environment used to accommodate people with dementia. The SEAT provides a systematic framework for reviewing environments for people with dementia and identifying areas for improvement. It contains questions that have been designed to gather information on how well the ten principles described below have been put into practice. The SEAT is designed to be used by a non-design professional and can be completed by a member of staff or a person visiting the facility with a minimal knowledge of dementia care. However, it is important that the person completing the SEAT is familiar with the design principles underpinning it prior to starting the assessment, users should familiarise themselves with the principles by thoroughly reading the description of the principles below.
Architectural Science Review, 2021
A growing majority of people living in Residential Care Facilities (RCFs) for older people have d... more A growing majority of people living in Residential Care Facilities (RCFs) for older people have dementia. Yet the implementation of evidence-based Dementia Design Principles (DDPs), known to reduce symptoms and improve wellbeing, remains limited. This paper reports on the development and application of Plan-EAT, a floorplan-based method of assessing dementia design quality in RCFs. Through the analysis of 34 published architectural exemplars, the method identifies strengths and weaknesses in the layouts of residential care buildings, across 39 assessment criteria organized under 9 DDPs. The paper concludes that the Plan-EAT could benefit architectural practice by providing an evidence-based means of assessing layout planning quality, in both existing cases and emerging RCF design proposals. The findings also highlight the need for care, where reliance is placed on published case studies, to inform the design of dementia supportive environments.
Laws, 2019
This article explores how care homes—and, specifically, their common features such as dementia ca... more This article explores how care homes—and, specifically, their common features such as dementia care units and locked doors and gates—impact on the human rights of people living with dementia. We suggest that congregation, separation and confinement of people living with dementia by the care home built environment constitute ‘segregation’. In the specific context of residential aged care facilities in Australia, we draw on the United Nations Convention on the Rights of Persons with Disabilities (‘CRPD’) to frame this segregation as an injustice. We focus on the rights to non-discrimination (Article 5), liberty and security of the person (Article 14), equality before the law (Article 12), accessibility (Article 9), and independent living and community inclusion (Article 19). Our analysis shows that addressing segregation must involve structural and resource reforms that are transformative in bringing about new ways of living and relating to each other. Such reforms are directed toward...
Towards providing better care planning and environmental design for people with dementia in resid... more Towards providing better care planning and environmental design for people with dementia in residential aged care This thesis is submitted in fulfilment of the requirements for the Award of the degree of Doctor of Philosophy from the University of Wollongong March 25 th , 2013 Richard Fleming, B.Tech. (Hons), Dip. Clin. Psy.
In the coming decades, as the population ages, meeting the needs of people with dementia will pre... more In the coming decades, as the population ages, meeting the needs of people with dementia will present considerable challenges to the health and social sector in Australia. Currently, health workforce shortages, preferences to work with other patient populations, and limited attractive career pathways have resulted in problems with the quality of care for people with dementia, which will only worsen unless health professionals can be engaged to work in the sector. Initial attempts by an education provider to create clinical placement opportunities for psychology students had generated little interest with students. In an attempt to understand barriers to participation and improve student engagement, we undertook formative research utilising a social marketing approach to develop an understanding of how participation of students in an aged and dementia care placement could be improved.
Background The design of environments in which people with dementia live should be understandable... more Background The design of environments in which people with dementia live should be understandable, reinforce personal identity and maintain their abilities. The focus on supporting people with dementia to live well has omitted considering the needs or wishes for a supportive physical environment of those who are nearing the end of their lives. Using a combination of focus groups and a Delphi survey, this study explored the views of people with dementia, family carers and professionals on what aspects of the physical environment would be important to support a good quality of life to the very end. Methods Three focus groups were carried out in three cities along the East Coast of Australia using a discussion guide informed by a literature review. Focus groups comprised recently bereaved family carers of people with dementia (FG1), people with dementia and family carers of people with dementia (FG2) and practitioners caring for people with dementia nearing or at the end of their lives...
Cochrane Database of Systematic Reviews, 2019
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows:. Primary ... more This is a protocol for a Cochrane Review (Intervention). The objectives are as follows:. Primary objective. To assess the effects of various built environment interventions, in the form of hospital planning and design approaches and features, on the health and wellbeing of older inpatients with cognitive impairment including dementia and delirium. Secondary objectives. To assess the effects of built environment interventions on accompanying persons. These interventions consist of any design feature that supports an accompanying person as they assist or accompany the patient in the hospital. To assess the effects of built environment interventions on staff within inpatient wards who are providing care to older patients with cognitive impairment. To identify gaps in the evidence and outline topics for future research.
Worldviews on Evidence-Based Nursing, 2010
Literature suggests that quality of life (QOL), quality of care (QOC) and Behavioural and Psychol... more Literature suggests that quality of life (QOL), quality of care (QOC) and Behavioural and Psychological Symptoms of Dementia (BPSD) can be improved by relatively simple and inexpensive person-centred approaches to nursing care practices (PCC) and modifications to physical environment (PCE). Most research on this topic is observational and few randomised controlled trials have included an economic evaluation of PCC and PCE together. The PerCEN study aims to confirm the value of evidencebased nursing by evaluating the efficacy and cost effectiveness of implementing PCC and PCE in residential dementia care services. This article describes the PerCEN study protocol (ANZCTR 12608000095369). Design/Methods: The 3-year study commenced in 2009 in 38 eligible government-accredited residential dementia care homes in New South Wales, Australia. Study participants include 605 consented residents over 60 years of age with dementia and 380 consenting permanent direct-care staff. The study employs a factorial, group-randomised, cohort design with stratification to evaluate the main effects of PCC and PCE and their joint effects (PCC + PCE), compared with Usual Care (UC) and Usual Environment (UE) on QOL, QOC and BPSD in dementia. Results: The primary outcomes analysis will use a mixed-model analysis of covariance to determine the effects of PCC and PCE on resident QOL and BPSD, and QOC, adjusting for stratification and other potential confounders. The incremental cost of providing PCE and PCC over UC and UE will be calculated; costs and outcomes will be presented as a cost-consequence analysis and cost-effectiveness ratios will be estimated as a cost per unit change in resident QOL and BPSD. Implications: This cluster-randomised trial will rigorously test Kitwood's Social-Psychological Theory of Personhood in Dementia (Kitwood & Bredin 1992). The results will provide timely and solid evidence that can inform policy and nursing practice development in improving the person's QOL and QOC, and reducing BPSD. KEYWORDS dementia, aged care residents, behavioural and psychological symptoms of dementia, quality of care, quality of life, practice development, person centredness
Journal of the American Medical Directors Association, 2014
To evaluate the effects of humor therapy assessed using observational methods on agitation, engag... more To evaluate the effects of humor therapy assessed using observational methods on agitation, engagement, positive behaviors, affect, and contentment. Single-blind cluster randomized controlled trial. A total of 35 Sydney nursing homes. All eligible residents within geographically defined areas within each nursing home were invited to participate. Professional "ElderClowns" provided 9 to 12 weekly humor therapy sessions, augmented by resident engagement by trained staff "LaughterBosses." Controls received usual care. The Behavior Engagement Affect Measure (BEAM) touchpad observational tool was used to capture real-time behavioral data. The tool assesses the duration in seconds of agitation, positive behavior toward others, engagement, and affect (angry, anxious, happy, neutral, sad). Seventeen nursing homes (189 residents) received the intervention and 18 homes (209 residents) received usual care. Over 26 weeks, in comparison with controls, the humor therapy group decreased in duration of high agitation (effect size = 0.168 and 0.129 at 13 and 26 weeks, respectively) and increased in duration of happiness (effect size = 0.4 and 0.236 at 13 and 26 weeks, respectively). We confirmed that humor therapy decreases agitation and also showed that it increases happiness. Researchers may consider evaluating impacts of nonpharmaceutical interventions on positive outcomes. Computer-assisted observational measures should be considered, particularly for residents with dementia and when the reliability of staff is uncertain.
Journal of Gerontological Nursing, 2014
Life in residential care can be challenging for residents and staff. Bringing humor into this set... more Life in residential care can be challenging for residents and staff. Bringing humor into this setting may benefit residents, creating a more productive, enjoyable work environment for staff. The potential effect of exposure to humor therapy on staff, both as active and incidental participants, as part of a randomized controlled trial of the effect of humor therapy for aged care residents was investigated in the Sydney Multisite Intervention of LaughterBosses and ElderClowns (SMILE). The intervention involved a humor program with professional performers (ElderClowns) and trained facility staff (LaughterBosses) for a minimum of nine 2-hour sessions over 12 weeks. Methods included a staff survey at three time points, interviews with LaughterBosses, and a satisfaction rating by facility managers. There were significant positive findings for some staff subgroups, including assistants in nursing/personal care assistants and staff older than 45. LaughterBoss interviews and intervention group manager ratings of staff work enthusiasm were positive.
BMJ Open, 2013
Objectives: To determine whether humour therapy reduces depression (primary outcome), agitation a... more Objectives: To determine whether humour therapy reduces depression (primary outcome), agitation and behavioural disturbances and improves social engagement and quality-of-life in nursing home residents. Design: The Sydney Multisite Intervention of LaughterBosses and ElderClowns study was a singleblind cluster randomised controlled trial of humour therapy. Setting: 35 Sydney nursing homes. Participants: All eligible residents within geographically defined areas within each nursing home were invited to participate. Intervention: Professional 'ElderClowns' provided 9-12 weekly humour therapy sessions, augmented by resident engagement by trained staff 'LaughterBosses'. Controls received usual care. Measurements: Depression scores on the Cornell Scale for Depression in Dementia, agitation scores on the Cohen-Mansfield Agitation Inventory, behavioural disturbance scores on the Neuropsychiatric Inventory, social engagement scores on the withdrawal subscale of Multidimensional Observation Scale for Elderly Subjects, and self-rated and proxy-rated quality-of-life scores on a health-related quality-of-life tool for dementia, the DEMQOL. All outcomes were measured at the participant level by researchers blind to group assignment. Randomisation: Sites were stratified by size and level of care then assigned to group using a random number generator. Results: Seventeen nursing homes (189 residents) received the intervention and 18 homes (209 residents) received usual care. Groups did not differ significantly over time on the primary outcome of depression, or on behavioural disturbances other than agitation, social engagement and quality of life. The secondary outcome of agitation was significantly reduced in the intervention group compared with controls over 26 weeks (time by group interaction adjusted for covariates: p=0.011). The mean difference in change from baseline to 26 weeks in Blom-transformed agitation scores after adjustment for covariates was 0.17 (95% CI 0.004 to 0.34, p=0.045).
Dementia (London, England), Jan 5, 2014
While there is considerable evidence on the impact of specific design features on problems associ... more While there is considerable evidence on the impact of specific design features on problems associated with dementia, the link between the quality of the built environment and quality of life of people with dementia is largely unexplored. This study explored the environmental and personal characteristics that are associated with quality of life in people with dementia living in residential aged care. Data were obtained from 275 residents of 35 aged care homes and analysed using linear regression. The quality of the built environment was significantly associated with the quality of life of the resident measured by global self-report. Environmental ratings were not associated with proxy or detailed self-report ratings. Higher quality of life is associated with buildings that facilitate engagement with a variety of activities both inside and outside, are familiar, provide a variety of private and community spaces and the amenities and opportunities to take part in domestic activities.
International Psychogeriatrics, 2010
ABSTRACTBackground: A large and growing number of people with dementia are being cared for in lon... more ABSTRACTBackground: A large and growing number of people with dementia are being cared for in long-term care. The empirical literature on the design of environments for people with dementia contains findings that can be helpful in the design of these environments. A schema developed by Marshall in 2001 provides a means of reviewing the literature against a set of recommendations. The aims of this paper are to assess the strength of the evidence for these recommendations and to identify those recommendations that could be used as the basis for guidelines to assist in the design of long term care facilities for people with dementia.Methods: The literature was searched for articles published after 1980, evaluating an intervention utilizing the physical environment, focused on the care of people with dementia and incorporating a control group, pre-test-post-test, cross sectional or survey design. A total of 156 articles were identified as relevant and subjected to an evaluation of their...
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Papers by Richard Fleming