Neuropsychiatry of old age

Neighbourhoods and dementia in the health and social care context: a realist review of the literature and implications for UK policy development

John Keady^a1 c1, Sarah Campbell^a1, Helen Barnes^a1, Richard Ward^a1, Xia Li^a2, Caroline Swarbrick^a1, Simon Burrow^a1 and Ruth Elvish^a1

^a1 Dementia and Ageing Research Team, School of Nursing, Midwifery and Social Work, University of Manchester, UK

^a2 Public Health Department, NHS Northamptonshire, UK

Summary

The National Dementia Strategy in England has performed an essential role in transforming health and social care services and improving the commissioning architecture. However, to date, little attention has been paid to understanding the ways in which the outdoor and built environment impacts and intersects with the lives of people with dementia and their carers. One way of better understanding the outdoor and built environment is through a focus on the ‘neighbourhood’ as this is an area of public policy where attempts are being made across disciplines to unpack its meanings, significance and identity. This paper adopts a realist review method to detail the key findings and messages from the body of work that links the experience of living with dementia to the neighbourhood. Our findings from this review are assimilated and defined/presented under three headings, namely: outdoor spaces, built environment, and everyday technologies. These headings and our definitions are not discrete properties and there is some overlap in content. We found no research that sets out to enquire about how people with dementia might define their neighbourhood or that explores everyday neighbourhood practices for those living with the condition. Emerging concepts such as citizenship and, in the UK, the Coalition Government advancement of the ‘Big Society’, promote a vision of civic responsibilities and networked, dementia-capable communities, but evaluation of such initiatives are virtually absent from the literature. The review did uncover some interesting and innovative research methods that extend neighbourhood working, such as the ‘walking interview’. In order to develop a neighbourhood model for dementia, future research should examine the relationship and interaction between the neighbourhood as a social space and as a physical space alongside the active role of people with dementia as ‘place-makers’.

(Online publication January 16 2012)

Key words:

• dementia;
• neighbourhoods;
• outdoor spaces;
• built environment;
• public health

Correspondence:

^c1 Address for correspondence: John Keady, Professor of Older People's Mental Health Nursing, Dementia and Ageing Research Team, School of Nursing, Midwifery and Social Work, University of Manchester, University Place (Room 6.321), Oxford Road, Manchester M13 9PL, UK. Email: John.Keady@manchester.ac.uk