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

Abstract

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.