Across the generations — bringing together service design for younger and older people
The cornerstone of innovation is the bringing together of ideas from seemingly disparate worlds. To mark Dementia Action Week, let’s look at what can be learnt when we think about designing with and for younger and older people — with and without dementia.
When I joined Barnardo’s Innovation Lab as a Service Designer six weeks ago, I was keen to get to grips with all things children’s social care. I came to the team from Alzheimer’s Society, where I spent six years in evaluation and innovation roles, improving and co-designing products and services for people affected by dementia.
I’d like to share some of my musings so far on service design practice across these groups in the hope that they provide some food for thought.
A note about dementia:
- We all get more forgetful as we get older. Dementia is not a natural part of ageing however the likelihood of having dementia does increase with age.
- Dementia is a progressive disease which causes problems with memory, thinking and language, as well as changes in mood, perception and behaviour.
- There are many types of dementia but Alzheimer’s Disease is the most common.
- There are 900,000 people in the UK living with dementia, that’s 1 in 14 people aged over 65.
(visit alzheimers.org.uk for more information and support around dementia)
Living well
There is no cure for dementia. This has led to a strong focus in dementia-care around living well — supporting people to maintain their day-to-day wellbeing regardless of their dementia symptoms. It takes a holistic view, acknowledging that whilst their circumstances are challenging, as service-providers, we can do whatever we can to support people to maintain their wellbeing. It’s worth mentioning however, that the living well agenda can be contentious as some people feel it sugar-coats what can be an incredibly debilitating condition.
If we look at the type of challenges that young people often face, there are a surprising number of overlaps with those experienced by older people, and those affected by dementia:
- Wellbeing
- Mental health
- Loneliness
- Being part of a community
- A sense of purpose
- Independence
- Physical health
Could a similar approach to living well be helpful for children and young people? Those who have been though adverse childhood experiences can’t change the past, but with the right support, they can live as well as possible now and in the future.
Indeed, Barnardo’s Care Journeys work in Plymouth includes the concept of positive destinations— feeling like you are in, or working towards being in, a good place in your life. Being in a positive destination is helped by feeling safe, feeling in control and living independently, having a positive support network, and most importantly that you are happy and well.
I am drawn to intergenerational initiatives such as GoodGym which bring together different age groups to tackle loneliness and provide mutual support. Other models include intergenerational housing and home sharing, voluntary ‘adopt a grandparent’ schemes, or more formal adoption of young people by older adults who take on a grandparent role.
Enfield Council put it well in their architectural brief for an intergenerational housing competition:
“We believe intergenerational housing could be a model that successfully combats social issues such as social isolation for the elderly, lack of adequate social housing provision and housing typologies that support children, young adults and the elderly, cost of living and childcare. There are many successful example and models of intergenerational housing in the UK and Europe that create resilient communities and nurture positive relationships between different ages.”
A complex history
Trauma-informed practice is central to Barnardo’s philosophy. This means recognising the impact that trauma and adverse experiences can have on mental health and wellbeing across the life course, focusing on people’s strengths, and avoiding any triggers which may re-traumatise them. This requires supporters and carers to understand an individual’s circumstances so they can tailor their response accordingly. In dementia-care, this is referred to as being ‘person-centred’.
It is common for people with advanced dementia to lose recent memories, while maintaining strong recollections about events a long time ago — they may experience the world as if they are living in their past. This can be very distressing for those who have experienced childhood trauma such as loss, conflict, or abuse. For example, a lady may go missing searching for her mother who passed away when she was young.
The majority of my time at Barnardo’s so far has been spent on a strategic partnership to reimagine children’s residential care in Essex. This has been an eye-opening experience for me. One insight we’ve found is the importance of record-keeping for care-experienced people in providing a sense of identity.
It got me thinking, if a care-experienced young person goes on to develop dementia later in life, how will those caring for them know their history?
Perhaps we could take inspiration from ‘This is Me’ — a simple tool designed to share details about a person with dementia with those in various care settings. This prevents someone from having to repeat their story again and again — an issue which is also common in children’s services. It includes things such as their personal history, important people in their lives, and their likes and dislikes.
Barnardo’s aims to give everyone the best start in life, so how might we design services which set young people up for success throughout their whole life to come, rather than just the immediate future?
Making the most of digital
When it comes to digital innovation, it’s important to challenge the common misconception that kids are tech savvy and older people are not. According to 2019 ONS figures, almost half of those aged 75 and over (47%) were recent internet users. For those aged 65–74 it rose from 52% in 2011 to 83% in 2019, and this trend looks set to continue, especially with the pandemic driving people online.
Although many young people have grown up as ‘digital natives’, factors such as poverty and disability can prevent people of all ages from accessing or using technology. As noted in the GDS service standards, any digital service must be designed to be inclusive. We must think carefully about how digital-first services might incorporate offline components and ensure content and interfaces account for different sensory needs and neurodiversity.
Looking to the future, there is much excitement about emerging technologies like artificial intelligence and virtual reality, although it seems to me that no one has quite nailed it for either audience. Another output from Plymouth Care Journeys — LifeLabs — started out using VR to give young people an opportunity to ‘fail’ safely when learning life skills, for example not burning the kitchen down. As the project progressed however, the group found accessible YouTube videos were what was really needed. In dementia care, several organisations are looking at using ‘smart’ devices in the home to promote independence, for example collecting health data, providing reminders, or facilitating communication with loved ones. I wonder how smart technologies could be implemented to support children, especially those with experience of the care system, as they build their independence through adolescence and then into early adulthood?
What do you think?
These are just some initial thoughts — if I find answers to them in the coming months I’ll let you know! I’d love to hear your thoughts around this — what other aspects of older people’s social care do you think we could learn from? Email me at Natasha.morgan@barnardos.org.uk or tweet @barnardoslab.
