The Multi Sensory Environment (MSE) in dementia care: the role of design

The proposal builds on previous research carried out by Kingston University's Designed Environment Research Group with its successful track record for investigating the environmental needs of people with dementia, and prior research undertaken by the Co-I exploring engagement strategies for the latter and the effect of MSEs on functional performance. This new project will conduct a focused investigation into the concept and design of MSEs and their current and future demanding role within homes caring for residents with dementia.

The timely relevance of this research rests on a broader consideration of the rapid growth of an ageing population, the rising number of people affected by dementia, and the over-prescribed use of antipsychotic medication in dementia treatment. Cost-effective interventions supporting dementia care are urgently needed. Carers, therapists and designers are therefore keen to investigate the MSE in this context.
The observed benefits of MSEs within dementia care are improved function and alleviated psychological and behavioural symptoms e.g. challenging behaviour, depression, increased appropriate communication, improved staff morale (Collier et al 2010). MSEs, incorporating sensory equipment which targets the primary senses, are now widely used and specified but evidence suggests that they often fail to succeed because of inadequate/poor design and haphazard arrangements (Dalke et al 2010). Conversely, there has been a lack of research into design innovations regarding the future development of MSEs for those living with dementia.

The project will investigate to what extent the above criticisms can be substantiated via a study involving 15 care homes in Greater London with some type of MSE facility. The facilities will be examined and staff observed/interviewed (using a specifically designed questionnaire). The intention is to evaluate service and usage in relation to MSEs' joint function as both a resource for meaningful leisure activity and a therapeutic intervention for users with dementia. This study aims to establish whether the improved overall design of MSEs could add value to the experience on offer maximising the benefit for these particular users and their carers.
More importantly, because little documented design guidance for MSEs for older people with dementia exists, the overall purpose of the proposed research is to establish new knowledge from which coherent, user-centred design solutions can be developed. The proposed study has the potential to inform the development of design ideas and recommendations for a MSE template tailored towards people with dementia, their physical and emotional needs. In order to improve the MSE experience the design development would not be confined to solutions that place additional technology in a room. It would involve designing the space as a whole to achieve aesthetically inspiring, stimulating environments which are sufficiently flexible and adaptable to the specific individual needs of users. Embracing an inclusive design approach, such spaces should generate a sense of wellbeing and engagement not only for people with dementia but also for staff and relatives sharing the experience of the service users.

The research findings and results will be written up in a Design Sourcebook, and assist occupational therapists, activity co-ordinators, managers and designers of care homes by informing their practice and strategic planning, particularly when making improvements to existing MSE facilities or setting up new ones. Another main output will be an exhibition-related event at the end of the project where the research results will be presented to a wider audience of professionals in the field, policy makers and the general public.
Societal and economic impacts would increase during the course of a follow-on research project linked to performing trials with focus groups and subsequently providing proof-of-concept and implementation strategies.

This project examines the design of MSEs used in dementia care and investigates whether and how the benefits of MSEs can be maximised through design interventions. Anticipated impacts include:
1) contribution to improved quality of life, health and wellbeing of individuals living with dementia, their carers and relatives
2) increased awareness of the needs of people affected by dementia
3) greater knowledge and expertise which feeds into the development of cost-effective treatment and therapy methods in dementia to reduce expensive and health-threatening drug dependency
4) fostering the dialogue between practitioners in design and health care

The research will contribute towards improved services and environments for those living with dementia. Hence they and their carers will be the ultimate beneficiaries of the research. As a design-led project about aesthetic and sensory experiences it will provide easier access to the problems surrounding dementia and improve the wider public's engagement and understanding of the latter.

The project will also support the national economy and contribute to solving a problem on a national scale by influencing evolving care strategies that encourage alternative therapy and treatment in dementia care in order to reduce the burden of cost-intensive and health-threatening drug dependency. Policy makers in the Department of Health/Adult social care, the NHS and the private sector are therefore potential beneficiaries of this research.

Other important beneficiaries are care homes and day centres (e.g. Worcester Snoezelen Centre, The Space Centre Preston) directly involved in caring for older people with dementia and integrating MSEs in their daily routine. Effective interventions including enhanced sensory experiences for older people can improve services offered by care homes and day centre's - potentially increasing the number of residents or visitors and subsequently the organisation's income. For this reason leading UK and international providers of health and social care services (e.g. Project Partner Care UK, BUPA, Sunrise) will be interested in the project findings, as they have the means to invest in further collaborative research and development optimising care practice in their homes.

Organisations fostering research and/or offering support, consultation, networks, training, or counselling to those affected by dementia will find the research helpful as it will inform their practice and advisory services. This includes community interest companies e.g. Innovations in Dementia CIC, private consultancies e.g. Age Matters, and charities e.g. Dementia UK, Alzheimer's Society, Age UK, and the King's Fund.

Occupational therapists, care professionals, and health care managers will benefit from the research presented via their professional forums such as the British Association of Occupational Therapists, the Institute of Healthcare Management, and the International Snoezelen Association. The latter also represents a potential pathway to international impact, in regions such as the Middle/Far East and South America, where the use of MSEs is accelerating, and in Europe and USA where MSEs are widely established.

Disseminated through their professional organisations and networks (e.g. Design Council, RIBA) the research will inform and benefit the practice and work of designers, architects, and project managers directly or indirectly involved in healthcare design.

Beyond the funding period, impacts will amplify through the involvement of stakeholders, existing/new partnerships with some of the beneficiaries mentioned above, and essential collaborations with other researchers strengthening international links. The project will provide the rationale needed to perform more extensive and deeper investigations, incl. a large-scale, multi-centred study exploring the therapeutic design of MSE - both within the client group as well as others such as autism and learning disabilities.