Exploring the expression of everyday aesthetic preferences in dementia through design

A growing number of people living with dementia are challenging the predominant narrative of dependency and negative assumptions about capability. Although cognitive impairments can impact on orientation, planning, memory, verbal communication, and narrative biography, it is understood that sensory, emotional sensibilities and an embodied sense of self survives. Whilst person-centred care is advocated, there is limited evidence of how people with dementia can contribute to the personalisation of their environment. Visual access in environmental design for dementia can support function and orientation. Visual stimuli can be effective in supporting communication. Visual arts viewing and activities have been shown to improve mood, attention, communication and dyadic care relationships. Building on this evidence, this study took an assets-based approach to utilise visuo-sensory capabilities understood to be relatively unaffected by cognitive impairments. A mixed methodology drawing on design and sensory ethnography, object elicitation and cultural probes was used. In Phase 1, (in accordance with COVID19 social restrictions), an accessible framework of engagement was devised that invited individual participants to share their everyday aesthetic preferences for a mug, colours, and spaces in their homes via videoconferencing. This method was tested firstly with participants without dementia in Phase 2 and then participants with mild to moderate dementia in Phase 3. Design was used as a mode of interpretation to create personalised records of preferences. There was little difference between the ability of participants with or without dementia to express preferences. Personal meanings and associations emerged. Phase 3 participants' sustained levels of engagement suggested an enhanced sense of agency, that provoked positive emotions and reinforced a sense of self. Their colour choices elicited accounts of objects, environments and experiences that held personal significance. Spaces that enabled engagement in activities they enjoyed were preferred. The personalised images acted as a portal to reliving experiences. This study makes a methodological contribution to how designers and practitioners can collaborate with people with dementia using an accessible framework of engagement.