Housing and care for people with dementia in rural communities: sustainable community developments for independent living. A scoping review

Project overview 

A scoping review will be conducted of UK and international literature published in the last 25 years on community-level interventions and targeting the care environment of people with dementia in rural settings living in their own homes. The review will examine the evidence on community-level innovations in housing and care, categorise and describe these according to their modality, intervention type and how they measured their effects, based on the conceptual frameworks developed during Phase 1. 

Status: ongoing

Contact: d.marshall@york.ac.uk 

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What is the problem?

Many older people with dementia living in rural communities experience difficulties living independently and in accessing care. Rural communities are often small and more remote, and rural housing is typically older than in urban areas. Rural housing can be particularly ill-suited to independent living for those with dementia and other needs common in later life, and is also more difficult to adapt or modernise without substantial financial cost. Furthermore, the availability of suitable care staff is more limited. Poor infrastructure, prohibitive travel costs, and lack of affordable and modern housing mean that care workers can find it harder to reach or live near those with care needs. Sources of informal and family support can be similarly interrupted, with older people with dementia potentially feeling increasingly isolated and facing the tension of remaining unsupported at home, or being uprooted from their familiar environment and local community, which can exacerbate the difficulties of living with dementia. 

Whilst many reviews have examined care innovations within established settings (e.g. in people’s own homes, specialist housing, or residential facilities), little attention has been given to community-based approaches to regenerating local infrastructure to promote ‘ageing in place’. Modern community development initiatives encourage dementia-friendly living by integrating the design and construction of the local built environment with the needs of an ageing population. This includes attention to the provision of affordable homes for family carers and the paid care workforce, as well as promoting civic and social participation. 

The need for this review was highlighted by North Yorkshire Council and Dementia Friendly Richmondshire, who, together with housing developers and local citizens, are actively seeking to address an acute shortage of sustainable care options for rural residents living with dementia.

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What are we doing?

This project has been split into two phases. As part of Phase 1, in consultation with key stakeholders, including sector experts, we mapped the breadth of the literature on interventions for people with dementia in rural settings. We used key stakeholder feedback and reflections on this mapped literature to engage with a broader group of stakeholders in local communities, and to develop the conceptual framework for the second phase of the review. In Phase 2 of the project, a scoping review of UK and international literature published over the last 25 years will be undertaken. The review will examine evidence of community-level innovations in housing and care, based on the conceptual framework of the rural care environment developed during Phase 1, taking account of the specific context of rural communities and dementia.