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Designing Homes for Healthy Cognitive Ageing: Co-Production for Impact and Scale (DesHCA)

Lead Research Organisation: University of Stirling
Department Name: Applied Social Science

Abstract

As we age, many of us will experience cognitive changes, and for some of us, these will develop into dementia. We know that people's homes can make the experience of cognitive changes more difficult, or can enable continuing inclusion and sense of self-worth and self-esteem. DesHCA will work with people experiencing ageing and cognitive change and those who design and develop housing. We will identify housing innovations that can support living better for longer with cognitive change. Our emphasis on healthy cognitive ageing goes beyond narrow conceptions of 'dementia-friendly design' into a more expansive and inclusive approach to housing innovation.

The multidisciplinary DesHCA team involves stakeholders from all areas of housing provision, including people experiencing ageing and cognitive change, architects and designers, housing experts, planners, builders and housing providers. Older people are integral to DesHCA and their health is at its heart. The project will design and build virtual and real designs that will act as demonstrators and test-beds for innovations to support healthy cognitive ageing. These designs will be evaluated from stakeholder points of view, then considered at a larger scale to examine their real-world feasibility. DesHCA has a unique opportunity to feed directly into the UK and Scottish Government City Region Deal for Central Scotland (Stirling and Clackmannanshire), providing groundwork for local housing developments. The focus of this is sustainable, lifetime health, community and economic development, addressing deprivation and inequality.

To achieve these aims, DesHCA takes a co-production approach, with the whole team working to identify innovations that engage with their real-world experiences and aspirations. We will use exciting and involving ways to collect data which will be used to inform the design of the demonstrator houses. These designs will evolve as stakeholders interact with them and provide feedback from their different points of view. To collect data, we will ask older people to map and evaluate their own homes and to experience and comment on new design features using virtual reality (VR). They will then collaborate with builders, architects and housing providers in VR workshops to identify practical, realistic and affordable designs that can support healthy cognitive ageing, and therefore longer healthy, independent life. Partners will then come together in interactive workshops to convert designs into plans within a fictional town, building and retrofitting homes, creating services and managing budgets. We will demonstrate how designs can work out in the real world, and how to bring together the various interests involved. Throughout, we will consider issues of costs, to inform business planning and help make decisions on implementation of the new designs.

The impact of DesHCA will be achieved through showing what works in housing design for healthy cognitive ageing. Immediately, DesHCA will feed into the City Region Deal and longer term we will provide tools for future developers to inform their decisions about housing for healthy cognitive ageing. Throughout the project, we will disseminate findings to the housing, architecture and building sectors through stakeholder networks. We will publish rigorous research findings to provide a peer reviewed, high quality research base for innovation. Thus we will go beyond recommendations and guidance to provide evidence to support delivery at scale, grounded in the co-production approach that draws on the real experience, interests and imperatives that drive different stakeholders.

DesHCA's multidisciplinary team will build capacity among early career researchers in research leadership, working across disciplines such as architecture and planning, economics, sociology and across sectors with a range of different industrial and professional stakeholders, such as housing workers, planners and construction companies.

Publications

10 25 50
 
Description The project is completed 29th February 2024. These are key findings:

From the literature review:
-Tendency to focus on particular innovations or tech, rather than home design more broadly.
-Little understanding of costs or business aspects.
-Little attention to diversity of older people.
-Innovations are small scale and scalability is rarely considered.
-Most outcomes are researcher defined and quite narrow, missing the multiple positive and negative effects of environmental changes.

From the ELSA analysis:
-More people living with cognitive impairment install adaptations than people without cognitive impairment.
-Living with cognitive impairment is associated with lower quality of life scores.
-Installation of adaptations does not mediate the reduction in quality of life, even after controlling for mobility problems and difficulties with ADL/IADLs.
-These findings suggest that people living with cognitive impairment may require different types of adaptations to promote improved quality of life.

From the e-Delphi exercise:
- Five key outcomes that matter for older people and for the housing sector are staying independent, physical activity, enjoyment, feeling safe and having an adaptable, flexible home for changing needs
- Homes need to be aesthetically pleasing, however adapted
- Homes should provide support for physical, sensory and cognitive challenges.

From the EADDAT (Environments for Ageing and Dementia Design Assessment Tool) survey:
- Age is a poor predictor of having a supportive home
- The oldest old are least likely to have a supportive home
- UK homes appear therefore not to be supporting people to age in place.

Electronic monitoring of homes, complemented by qualitative interviewing, suggested:
- Homes have many issues that can affect health and well-being of occupants
- In many cases, the condition of a home is not in the control of the occupants
- Solutions for developing supportive housing need to take into account the poor state of much existing stock, and to deliver sustainable measures.

Older people's mapping of and talking about their own homes in qualitative interviews revealed:
- An emphasis on the individuality of homes, which are lifetime projects, as people make changes or move between homes
- These changes are often made to improve the supportiveness of the home at different life stages
- Aesthetics are important - and professionally provided 'adaptations' are often perceived negatively, as stigmatising markers of older age and weakness
- The home is not simply a place of maintenance, but a significant social space integral to identity and living one's desired life
- cost is a key component in decision making about housing, and can constrain whether homes are supportive.

Interviews with professionals and the ethnographic work in three design/delivery practices showed:
- Ensuring cognitively supportive design in particular could be perceived as adding to costs and complexity, and could easily be neglected
- But there is an appetite in the housing professional to improve design to be more supportive across physical, sensory and cognitive domains
- Barriers for professionals include lack of knowledge, little CPD, and importantly, lack of opportunities to engage with older people
- Tight budgets and policy and guidance constraints could be significant barriers
- There is a tendency to 'other' older people and to design homes that professionals themselves would not prefer to live in.

In developing new designs using VR, and in planning for them using the Serious Game ('Our House'), the results of an iterative series of workshops, informed by the above findings, produced detailed designs, which can be 'walked through' on the DesHCA website; a guide for individuals to assess their own homes and make appropriate changes if needed ('Tips and tricks' - on the website), a Serious Game ('Our House' ) designed to support decision making in the light of researched individual trajectories of people as they age, and a guide to assessing costs and benefits.
Exploitation Route The research is being taken forward across several stakeholder groups, using the DesHCA outputs in different ways.

For older people themselves, the 'Tips and Tricks' book is being widely circulated and provides ways for people to make their own homes more supportively, using evidence-based measures which are economical to implement. It is free and on-line, requiring little bandwidth to download. This is raising awareness and demand for supportive features. The booklet is to be translated for use in Sweden and in Francophone countries, with cultural adaptations implemented by leading organisations promoting supportive housing in each country.

'Our House' is being used by housing providers in particular, including housing associations and local authorities to inform their thinking on local housing developments. This will evolve into a business proposition in the near future, to secure continuing face-to-face delivery and use.

The video walk-throughs are being used for publicity purposes with a range of audiences, Including older people and practice professionals. They raise consciousness and provide advice. Behind them is detailed technical guidance which is going forward into business activity.

The guide to costs and benefits can be used in each of these different arenas.

In the wider policy field, the DesHCA findings and outputs can inform future housing policy and guidance, to ensure that housing developments are fit for the purposes of an ageing population: the DesHCA house is a sustainable, lifetime home that can support people to live the lives they wish across their whole lifetimes, with the support needed at each stage.
Sectors Communities and Social Services/Policy

Environment

Other

URL https://www.deshca.co.uk/
 
Description The findings have been used in various ways for different audiences. This has included: 1. DesHCA findings have informed production of a booklet for a general audience (Tips and Tricks) explaining how to adapt one's home to support healthy cognitive ageing. This has been distributed at several public conferences and shows to numerous members of the public who have welcomed the advice it provides. The booklet has also been distributed to 36,000 members of the College of Occupational Therapists, who requested material that they could use in practice to advise patients on supportive design. Since the completion of the research, the booklet has been more widely circulated through practice and community channels 2. The Serious Game, during its development, was trialled with over 100 professionals and older people to assist with decision-making about housing. Feedback has indicated that it fulfils its purpose of guiding thinking and making better informed decisions. Subsequent to completion of the research, it has been demonstrated at multiple public and professional events, and also used as a research tool in a major national evaluation of housing adaptations. 3. The VR models, developed through co-production with 94 older people and housing professionals enabled people to better visualise and understand design and therefore provide useful feedback to inform iterations of the designs. They have subsequently been used in the work of Stirling's Dementia Services Development Centre to inform the public and professionals about supportive design. 4. DesHCA findings are informing developments in the Stirling and Clackmannanshire City Region Deal development of the Intergenerational Living Innovation Hub, which will attract business investment into the region and inform design for healthy cognitive ageing nationally and internationally. This follow-on work is funded by the Stirling Social Sciences Impact Accelerator Account. To date (March 2025), we have completed plans for a Roadshow demonstrating DesHCA designs, informed by extensive stakeholder analysis; held a number of incubation events to develop impact scenarios; completed extensive advocacy work, promoting DesHCA outputs; delivered multiple external events and presentations; commenced investment leverage through building sector and business partnerships to deliver impact from 'Tips and Tricks' and 'Our House'. 5. Next steps will be consolidating the existing business partnerships and taking forward the technical aspects of DesHCA design into commercial activity.
First Year Of Impact 2023
Sector Communities and Social Services/Policy,Construction
Impact Types Societal

Policy & public services

 
Description Helping service users think through home improvements
Geographic Reach National 
Policy Influence Type Contribution to a national consultation/review
Impact This use of the DesHCA serious game has built the evidence base for Good Home Hubs, which will be a key recommendation to the UK government.
 
Description Informing the Older People's Housing Taskforce
Geographic Reach National 
Policy Influence Type Citation in other policy documents
URL https://www.gov.uk/government/publications/the-older-peoples-housing-taskforce-report
 
Description Clackmannanshire Council 
Organisation Government of the UK
Department Clackmannanshire Council
Country United Kingdom 
Sector Public 
PI Contribution We are providing early access to research findings and opportunities to participate in project workshops.
Collaborator Contribution They are local housing providers and also partners in the Stirling and Clackmannanshire City Region Deal and bring expertise in these significant real world areas of housing development and improving lives for people living with dementia..
Impact None as yet - too early
Start Year 2021
 
Description Construction Scotland Innovation Centre 
Organisation Construction Scotland Innovation Centre
Country United Kingdom 
Sector Private 
PI Contribution We involve them in discussions about the operation and future directions of the project and in workshops developing ne housing designs for healthy cognitive ageing.
Collaborator Contribution They provide expertise in the construction sector.
Impact not yet - too early
Start Year 2021
 
Description Faithfull and Gould 
Organisation Faithful+Gould
Country United Kingdom 
Sector Private 
PI Contribution They have access to findings as they emerge and learn from our various activities as the project progresses.
Collaborator Contribution They bring expertise in the construction sector including surveying and project planning.
Impact None as yet
Start Year 2021
 
Description Mediva 
Organisation Mediva
Sector Private 
PI Contribution Attended three workshops and study visits. We work closely with Mediva in Japan improving design of environments for people living with dementia
Collaborator Contribution Attended three workshops and study visits. Hosted early career researchers. They provide cross-national expertise and advice for our research.
Impact We have reported publications and additional funding (DesHCA project followed from work done in collaboration with Japanese partners).
Start Year 2019
 
Description Stirling Council 
Organisation Stirling Council
Country United Kingdom 
Sector Public 
PI Contribution They will have access to early research findings and will participate in project workshops and events.
Collaborator Contribution They are local housing providers and also partners in the Stirling and Clackmannanshire City Region Deal and bring expertise in these significant real world areas of housing development and improving lives for people living with dementia..
Impact None as yet - too early
Start Year 2021
 
Description Accessible Kitchens by Symphony at MKM Edinburgh 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Industry/Business
Results and Impact DesHCA gave an overview about DesHCA research. They gave DesHCA a demo about the accessible kitchen and said they wished to partner with DesHCA especially having an input on the VR model to have more tips and knowledge exchange from their 30 years experience on accessible kitchen for people living with physical and cognitive changes.
Year(s) Of Engagement Activity 2023
 
Description Alzheimer's Scotland 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Cate presented on DesHCA findings and resources- attendees intend to upgrade their own training and sessions around design to reflect DesHCA's insights.
Year(s) Of Engagement Activity 2024
 
Description Bath and Wiltshire Independent Living Centre 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Third sector organisations
Results and Impact Presentation of DesHCA findings to their annual general meeting, at which great interest was expressed in the findings of DesHCA.
Year(s) Of Engagement Activity 2022
 
Description Blackwood/DesHCA workshop 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Exploration of potential for collaborative activities to mutually add value to current work. We have continued to engage with Blackwood and there is mutual interest in our activities.
Year(s) Of Engagement Activity 2022
 
Description Care Show + Retirement Living Show, Birmingham NEC 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Two days exhibition of practice and products from retirement living providers, major developers, legal firms, banks, suppliers, and many other experts. Presentation on DesHCA approaches. The exhibition and presentation generated considerable interest and we distributed copies of our 'Tips and Tricks' output.
Year(s) Of Engagement Activity 2023
 
Description Commonwealth Association for the Ageing 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Invited presentation about DesHCA as part of a fact finding visit to the University and DSDC by committee members international 'Common Age' organisation.
Year(s) Of Engagement Activity 2023
 
Description DesHCA's adaptation focus group 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Patients, carers and/or patient groups
Results and Impact Held via zoom to capture data about people's lived experiences of requesting, receiving and returning adaptations. These were used to inform analysis of large datasets conducted by DesHCA and influenced the production of our outputs for the general public.
Year(s) Of Engagement Activity 2022
 
Description DesHCA's cost-benefit digital roundtable 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Held via zoom to invite insight from professional participants about what they perceived as the main barriers and facilitators to designing and providing supportive housing. The activity informed the development of DesHCA's cost-benefit framework.
Year(s) Of Engagement Activity 2022
 
Description Foundations Roadshow, Sheffield 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact The Serious Game legacy tool is being used as a methodological tool within one of the strands of the National Evaluation of Home Improvement Agencies (funded by the Centre for Ageing Better). The tool was used at a workshop for the Foundations Roadshow, Sheffield (2 hours) with housing and social care practitioners and high-level Local Authority representatives throughout England. The Serious Game changes people's thinking about design for healthy cognitive ageing.
Year(s) Of Engagement Activity 2023
 
Description HousingLIN Festival of Ideas 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Cate presented an overview of DesHCA to this annual meeting. 79 people joined on line - and HousingLIN's recordings are accessed by high numbers following events.
Year(s) Of Engagement Activity 2024
 
Description HousingLIN invited seminar 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact HousingLIN invited leading practitioners in housing for ageing to a private seminar in London. Findings of the DesHCA project were presented and discussed. The practitioners present expressed keen interest in the work and requested to keep in touch.
Year(s) Of Engagement Activity 2024
 
Description Intergenerational Living Innovation Hub - Workshop (University of Stirling) 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Hosted senior representatives from Local Authorities, business, and third sector organisations to provide demonstrations and discussions of the potential roles for the University, the DesHCA project, and partner organisations to implement research findings through interlinked planning, housing design, and community development projects.
Year(s) Of Engagement Activity 2022
 
Description Meeting with Alzheimer's Scotland 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Meeting with senior management to inform them about DesHCA research and explored recruitment opportunities for people living with dementia to participate in the research .
Year(s) Of Engagement Activity 2022
 
Description Meeting with Silviahemmet Foundation (Sweden) to present on SBDRP and in particular the DesHCA project 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Third sector organisations
Results and Impact The meeting was attended by Her Majesty Queen Silvia and board members of Silviahemmet a non-profit Foundation with the mission to spread knowledge about dementia. The most important impact was an agreement to pursue research and development of innovative housing, supporting people living with cognitive change.
Year(s) Of Engagement Activity 2023
 
Description Presentation at Foundations webinar (the national advisory body for the Disabled Facilities Grant and Home Improvements Agencies across England on behalf of the Department for levelling-up). 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact This was a webinar for professionals. Our aim was to reach a new audience, which this webinar succeeded in doing.
Year(s) Of Engagement Activity 2024
 
Description Presentation to EVH Annual Conference (social enterprise employers) 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Professors Bowes and McCall presented research findings and demonstrated the serious game ('Our House') with this audience of housing practitioners and lived experience delegates. Both the findings and the game were enthusiastically received, and there were multiple requests for further engagement of the game in particular, to aid in real world decision making.
Year(s) Of Engagement Activity 2024
 
Description Royal College of Occupational Therapists (Housing Specialists Section) keynote presentation, 'spot the adaptation' activity and workshop for delegates. 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Cate Pemble presented a keynote speech at the conference presenting research findings. this was followed by practical workshop demonstrating how the findings can be used.
Year(s) Of Engagement Activity 2024
 
Description Scottish Association of Landlords 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Industry/Business
Results and Impact In April 2024, Cate took part in SAL's 'In Conversation With' series, "In conversation with John Blackwood and Dr Catherine Pemble - future-proofing your properties" an online webinar members of the association, highlighting how private landlords can improve their properties to make them more accessible for older tenants.

She was invited back, due to considerable interest, to conduct a Q and A webinar in September 2024.

In November, this was followed up by a presentation at Scottish Letting Day.
Year(s) Of Engagement Activity 2024
 
Description Scottish Borders Council Visit at Stirling 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Policymakers/politicians
Results and Impact Junjie presented DesHCA project and VR co-design method to 6 guests from Scottish Border Council. Guests were invited to experience the DesHCA VR models.
Year(s) Of Engagement Activity 2023
 
Description Scottish Rural & Islands Housing Conference, University of Stirling 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Running two Serious Game workshops and showcasing DesHCA in the final plenary. Participants reported that the Game made them think through housing decisions more carefully.
Year(s) Of Engagement Activity 2023
 
Description Social Care Institute for Excellent Webinar (SCIE), online 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Vikki invited to speak for one of the SCIE Showcase Seminars (1.5 hours) and presented DesHCA as part of the wider lecture, showing the Serious Game video and linking group to the Tips and Tricks publication.
Year(s) Of Engagement Activity 2023
 
Description Supporting Health and Wellbeing for the Ageing Population: Scottish Ecological Design Association 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Martin presented on the VR Co-Design to approximately 65 delegates (40 in person, 25 online) who are members of the Scottish Ecological Design Association 'Green Drinks' event at the Macintosh School of Art, Glasgow.
Year(s) Of Engagement Activity 2024
 
Description Visit of HM King Carl IV Gustav and Queen Silvia of Sweden to University of Stirling 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other audiences
Results and Impact Their majesties the King and Queen of Sweden visited Stirling to find out about the DesHCA project. They were accompanied by a group of charitable supporters of HM Queen Silvia's foundation, Silviahemmet. The foundation has continued to collaborate with us and support our work, and in trun we have supported theirs.
Year(s) Of Engagement Activity 2021
 
Description Visit of Scottish Parliament Local Government Housing and Planning Committee 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact Fact finding about the DesHCA project and visit to the design and technology suite at DSDC. The Committee requested to be kept informed regarding DesHCA findings on design supporting people living with cognitive change.
Year(s) Of Engagement Activity 2023
 
Description Visit to PPR Autonomie annual meeting in Paris 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other audiences
Results and Impact Attended a meeting of all the project teams in the 'Autonomie' research programme, presented on DesHCA, contributed to several workshops, and established new links to take forward DesHCA impact.
Year(s) Of Engagement Activity 2024
URL https://ppr-autonomie.com/
 
Description Visit to Silviahemmet (Sweden) to consolidate collaboration 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Visited Silviahemmet to discuss taking forward our international collaboration on designing homes for healthy cognitive ageing. Gave a presentation on DesHCA findings and impact activities, and discussed future collaboration.
Year(s) Of Engagement Activity 2024
 
Description Webinar for NHS Health Improvement Scotland 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact 187 people attended the webinar, which presented project findings, with particular reference to the co-production aspects of the project. Feedback was extremely positive with 97% of attendees rating it Excellent/good. Comments highlighted the practicality of the work and the detailed account of innovations.
Year(s) Of Engagement Activity 2024
URL https://www.hisengage.scot/events-list/17-april-2024-webinar/