Outcomes of home design to support healthy cognitive ageing: modified e-Delphi exercise with older people and housing-related professionals.

BACKGROUND: There is emerging agreement that living in a home designed to support healthy cognitive ageing can enable people to live better with dementia and cognitive change. However, existing literature has used a variety of outcome measures that have infrequently been informed by the perspectives of older people or of professional in design and supply of housing. The DesHCA (Designing Homes for Healthy Cognitive Ageing) study aimed to identify outcomes that were meaningful for these groups and to understand their content and meanings. METHODS: A presurvey of older people and housing professionals (n = 62) identified potential outcomes. These were then used in three rounds of a modified e-Delphi exercise with a panel of older people and housing professionals (n = 74) to test meanings and identify areas of agreement and disagreement. Descriptive statistics were used to present findings from previous rounds. RESULTS: The survey confirmed a wide range of possible outcomes considered important. Through the e-Delphi rounds, panellists prioritised outcomes relating to living at home that could be influenced by design, and clarified their understanding of the meanings of outcomes. In subsequent rounds, they commented on earlier results. The exercise enabled five key outcome areas to be identified - staying independent, feeling safe, living in an adaptable home, enabling physical activity and enabling enjoyed activities- which were then tested for their content and applicability in panellists' views. CONCLUSION: The five key outcome areas appeared meaningful to panellists, whilst also demonstrating nuanced meanings. They indicate useful outcomes for future research, though will require careful definition in each case to become measures. Importantly, they are informed by the views of those most immediately affected by better or poorer home design.

Othering Older People's Housing: Gaming Ageing to Support Future-Planning.

The 'othering' of ageing is linked to an integrated process of ageism and hinders planning for the future for both individuals and practitioners delivering housing and health services. This paper aims to explore how creative interventions can help personalise, exchange knowledge and lead to system changes that tackle the 'othering' of ageing. The Designing Homes for Healthy Cognitive Ageing (DesHCA) project offers new and creative insights through an innovative methodology utilising 'serious games' with a co-produced tool called 'Our House' that provides insights into how to deliver housing for older people for ageing well in place. In a series of playtests with over 128 people throughout the UK, the findings show that serious games allow interaction, integration and understanding of how ageing affects people professionally and personally. The empirical evidence highlights that the game mechanisms allowed for a more in-depth and nuanced consideration of ageing in a safe and creative environment. These interactions and discussions enable individuals to personalise and project insights to combat the 'othering' of ageing. However, the solutions are restrained as overcoming the consequences of ageism is a societal challenge with multilayered solutions. The paper concludes that serious gaming encourages people to think differently about the concept of healthy ageing-both physically and cognitively-with the consideration of scalable and creative solutions to prepare for ageing in place.

Minimally invasive surgical treatment of lumbar spinal stenosis: Two-year follow-up in 54 patients.

OBJECTIVE: Minimally invasive surgery has seen increasing application in the treatment of spinal disorders. Treatment of degenerative spinal stenosis, with or without spondylolisthesis, with minimally invasive technique preserves stabilizing ligaments, bone, and muscle. Satisfactory results can be achieved without the need for fusion in most cases. METHODS: Fifty-four consecutive patients underwent bilateral decompressions from a unilateral approach for spinal stenosis using METRx instrumentation. Visual Analog Scale (VAS) pain scores were recorded preoperatively and patients were interviewed, in person or by phone, by our office nurse practitioner (LD) to assess postoperative VAS scores, and patient satisfaction with the clinical results 21-39 months postoperatively (median 27 months). RESULTS: Fifty-four patients underwent decompression at 77 levels (L4/5 = 43, L3/4 = 22, L5/S1 = 8, L1/2 = 4, L2/3 = 4), (single = 35, double = 16, triple = 2, quadruple = 1). There were 39 females and 15 males. The average age was 67 years. The average operative time was 78 minutes and the average blood loss was 37 ml per level. Twenty-seven patients had preoperative degenerative spondylolisthesis (Grade 1 = 26, Grade 2 = 1). Eight patients had discectomies and four had synovial cysts. Patient satisfaction was high. Use of pain medication for leg and back pain was low, and VAS scores improved by more than half. There were three dural tears. There were no deaths or infections. One patient with an unrecognized dural tear required re-exploration for repair of a pseudomeningocele and one patient required a lumbar fusion for pain associated with progression of her spondylolisthesis. CONCLUSIONS: Minimally invasive bilateral decompression of acquired spinal stenosis from a unilateral approach can be successfully accomplished with reasonable operative times, minimal blood loss, and acceptable morbidity. Two-year outcomes in this series revealed high patient satisfaction and only one patient progressed to lumbar fusion.