Dementia Care

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N E W S / L E T T E R
Vol 5 No 5 October/November 2016 Australian Journal of Dementia Care 7
SHAREYOURVIEWS AJDC welcomes Letters to the Editor on any subject related to dementia care. Letters can be
emailed to Executive Editor Professor Richard Fleming at Please
include your full name, address and phone number for verification. Only your name and city
will be published. Letters may be edited, with the writer’s permission, before publication.
The HammondCare Design Smart
rating tool for the evaluation of
environments for people with
dementia was reviewed by me in
the April/May 2016 edition of the
AJDC. The review was critical of
some aspects of the tool and
provoked a response that I wish to
publish as it provides additional
information, and another point of
view, that may assist the readers in
their consideration of its use.
Professor Richard Fleming,
Executive Editor
Iam writing, rather belatedly,
to you about your review of
HammondCare’s Design
Smart: the rating tool for
environments that work for people
with dementia, published in The
Australian Journal of Dementia
Care April/May 2016 (Vol 5
No 2, p38).
You seem quite untypically
snide and inaccurate about the
Design Smart publication
which, given your status with
the journal, seems very
surprising.
I know I am biased as an
associate for the Dementia
Centre HammondCare, but
below I give some examples
from the review: “If you like
checklists then you will love
the 189-page checklist
contained in this publication”.
The actual checklist is 98 pages.
Other pages include principles,
guidance on how to use it and
an item by item explanation of
the rationale. This just seems
snide to me which is reinforced
by the last sentence of the
paragraph “Exhausted yet?”
What you might have said is
that this audit tool is unique in
that it includes the actual site of
the unit and the front entry as
well as kitchens and lifts. No
other tool includes these. You
might also have said that each
area starts with outcomes
which are really useful. You
might have explained that this
tool covers each area separately
so it is possible to do any one
area if needed.
The tone of the review is
really unfortunate. For
example, at the end of the
second paragraph you say “…
will draw the attention of users
to ideas for improvement and
might well lead on to the
development of a useful plan of
improvement”. This
undermines the whole point of
it which is to provide the detail
to enable just this to happen.
In the third paragraph you
bemoan the lack of emphasis
on principles, in spite of a
whole section on this and the
outcomes at the start of each
section. You say “the emphasis
on ticking boxes weakens the
educational value of the
publication…”. It is not an
educational tool, it is a practical
tool, although one possible
outcome is clearly better
awareness.
In the next paragraph you
direct readers to your own
online audit tool which is a
perfectly useful audit tool, but
has a different purpose. It is
very much about raising
awareness of the principles of
dementia design rather than
providing a detailed checklist
for architects, builders,
commissioners etc.
I share your view that the
literature review is not really an
adequate reference so no
complaints about this.
The giveaway is the way you
describe yourself at the end of
the review where you put in
italics that you have “ published
books and papers on
environmental design for people
with dementia”. It almost seems
as if you are promoting your
own work, rather than
providing a fair critique of this
tool.
I am sorry it has taken me so
long to write and protest about
this review. I do hope some sort
of apology or correction can be
included in the next issue.
Emeritus Professor Mary
Marshall,
University of Stirling,
Associate, Dementia Centre
HammondCare
Response to Design Smart review
Survey reveals ‘loneliest
people in Australia’
People with dementia are almost
twice as likely to have high rates of
loneliness compared to the general
public and people with dementia
and carers are significantly more
lonely than the general population,
a new survey has found. More than
1500 people took part in the
Alzheimer’s Australia survey,
including people with dementia,
carers and other members of the
community. The survey also found
that people with dementia report
significantly fewer relationships
than carers, who in turn have
significantly fewer relationships
than the general population. This
was mainly due to friendships
falling away, often leading to the
experience of being socially
isolated. They are more than twice
as likely not to see any friends
when compared with carers and
the general community and were
almost three times as likely not to
have a friend to call on for help.
A landmark trial is underway
with the hope of dramatically
improving the success rate of
clinical trials for treatments of
dementia.
Professor Lynn Rochester,
from Newcastle University in
the UK, said the trial, worth
almost $12 million, has the
potential to change dementia
research.
“It is the most in-depth study
to date to establish the best
combination of tests to identify
people with Alzheimer’s
disease at a very early stage,
tracking changes over a short
period of time.”
The Deep and Frequent
Phenotyping study is designed
to identify measurable
characteristics, known as
biomarkers, which can detect
the occurrence of Alzheimer’s
disease very early on, when a
person may have no obvious
symptoms.
These potential new
biomarkers will be used alone
and alongside tests such as
brain imaging and assessment
of memory and other cognitive
functions. They will allow the
researchers to recognise the
early stages of the disease and
those who may be suitable for
trials of possible treatments.
Between 2002 and 2012, 99%
of clinical trials into treatments
for Alzheimer’s disease failed.
It’s thought a probable reason
is that treatments are being
tested on those who already
have irreparable damage to the
brain. It is likely treatments will
be more effective in slowing or
stopping the onset of dementia
at earlier stages of the disease.
The researchers also hope
that by targeting people in the
earlier stages, it should be
possible to design better
clinical trials for treatments
that make a real difference and
improve people’s lives.
The team, led by the
University of Oxford, will work
with colleagues at eight UK
universities and the
Alzheimer’s Society. The
researchers will perform up to
50 tests on 250 volunteers,
including new tests, such as
gait, never used before to
detect dementia.
The trial is funded by the
National Institute of Health
Research and the Medical
Research Council.
Landmark biomarkers trial underway