Access to everyday activities in public space : views of people with dementia

Abstract: The general aim of this thesis was to increase knowledge about problematic situations in public space as experienced by community-dwelling people with dementia, and about how they meet these situations when doing everyday activities there. The aim also included increasing knowledge about transactions between people with dementia and public space. In Study I experiences of accessibility in public space in people with AD were illuminated, with particular focus on places, situations and activities that they found important for daily life. Study II discovered and described problematic situations and critical incidents that took place when people with AD performed grocery shopping, and how these incidents were met by them. Study III identified characteristics of the space of a grocery shop and how these characteristics meet the prerequisites of people with dementia. Study IV identified problematic situations at zebra crossings in roads, and how people with dementia would understand, interpret, and act in these problematic situations based on their previous experiences, and linked to the film sequences. The findings of Study I showed that accessibility was experienced as a constantly changing experience, characterized by changes in the relationship between the public space and the informants. Changes in the relationship occurred in use of place and activities and related to comfort and familiarity, interests and motives and protecting and planning. Other changes occurred in problematic situations related to crowded places with high noise and tempo, everyday technologies and change of landmarks. A challenging and unstable process of meeting critical incidents was the core category of Study II. The informants used creativity and reflection to achieve relative harmony in each critical incident. The critical incidents and actions to meet these when doing grocery shopping were described in the categories of remembering to bring things when leaving home, finding the way to and from the grocery shop without getting lost, finding a way through traffic when not feeling safe, finding objects when organization is disrupted, choosing when several objects and products are available and finding a method to pay when payment opportunities are restricted. In Study III a variety of characteristics that could influence if a shop was experienced as accessible was found: stressors, colour and auditory stimuli, information overload, spatial issues, layout variations and visual illusions. The core category of multi-faceted and multi-sensory crowding and clutter described the informants’ prerequisites and the shop’s characteristics. These were related to each other and influenced how the person with dementia coordinated with the place. In Study IV, problematic situations were illuminated when informants crossed a street with or without a traffic light. The situations became problematic when layers of the problematic situations were added to each other and created a problematic situation as a whole. These layers were related to vehicles and crowding of pedestrians, weather conditions, design and layout of streets and zebra crossings. The informants experienced difficulties in coordinating with the problematic traffic situation as a whole. The actions they used were to avoid problematic situations, use traffic lights as reminders and security precautions, follow the flow at the zebra crossing and be a cautious pedestrian. In the core category – the hazard of meeting unfolded problematic traffic situations when only one layer at a time can be kept in focus – the constant interplay was described. This thesis presents new knowledge about problematic situations related to grocery shopping and being a pedestrian for people with dementia. Common characteristics of problematic situations in these activities were related to unpredictable changes, crowding and clutter and layout variations. The thesis also offers new knowledge about how they met these situations with different actions, and how the process worked to meet problematic situations that came to the fore. Their actions were characterized by using time, using familiar activities in familiar spaces and places, avoiding situations leading to new problematic situations and getting help from people. Furthermore, new knowledge was developed about the relationship between persons and environments by using a transactional perspective. The knowledge of how people with dementia access activities in public space could be translated into clinical practice for supporting people with dementia doing activities in public space, and for creating a more accessible and usable public space on a societal level.