Dementia Friendly communities (DFCs) to improve quality of life for people with dementia: a realist review

Abstract

Background: Currently, there are more than 55 million people living with dementia worldwide. Supporting people with dementia to live as independently as possible in their communities is a global public health objective. There is limited research exploring the implementation of such interventions in the community context. The aim of the review was to create and refine programme theory - in the form of context mechanism-outcome configurations - on how the characteristics of dementia-friendly communities (DFCs) as geographical locations interact with their social and organisational contexts to understand what works for whom and why.

Methods: This realist review sourced literature from 5 electronic databases: Cochrane Library, CINAHL, Medline, Scopus, PsychINFO and Google Scholar, as well as relevant websites such as Alzheimer's Society to identify grey literature. Methodological rigour was assessed using the Joanna Briggs Institute critical appraisal tool.

Results: Seven papers were included in this realist review that focused on DFCs in a geographical context The implementation of DFC interventions emerged as a process characterised by two pivotal implementation phases, intricately linked with sub-interventions. The first intervention, termed Hierarchy Commitment (I1a/b), involves the formalisation of agreements by businesses and organizations, along with the implementation of dementia-friendly action plans. Additionally, Educational Resources (I1c) play a significant role in this phase, engaging individuals with dementia and their caregivers in educational initiatives. The second phase, Geographical/Environmental Requirements (I2), encompasses the establishment of effective dementia-friendly signage, accessible meeting places, and community support.

Conclusions: This realist review highlighted a theoretical framework that might guide the development of dementia-friendly communities to enhance the experiences of individuals with dementia and their caregivers within DFCs. Emphasising the need for a theoretical framework in developing geographical DFCs, the review outlines contextual elements, mechanisms, and outcomes, providing a foundation for future studies. The ultimate goal is to establish a robust body of evidence for the sustainable implementation of dementia-friendly communities, thereby improving the quality of life for those with dementia.

Study registration: This study is registered as PROSPERO 2022 CRD42022317784.

Keywords: Dementia; Dementia friends; Dementia-friendly communities; Quality of Life; Realist review; Realist synthesis.

Fig. 1

PRISMA flow diagram

Fig. 2

A theoretical model of how DFC interventions for people with dementia are thought to work. Legend: Theoretical model of the Context +Mechanism = Outcome (CMO) configuration. Context is shown as either helping (C+) or hindering (C-) implementation. The intervention is divided into two phases, facilitation (I1) and display (I2), activating underlying mechanisms (M) that result in improved outcomes (O)