Chalfont, G., et al. (2018).
Whole Systems Dementia Treatment: An Emerging Role in the NHS? Morecambe Bay Medical Journal 8(2): 58-61.
(Whole Systems Dementia Treatment PDF)
Alzheimer's disease is increasingly understood as a disease state determined by multiple factors and mechanisms. Besides the usual risk factors of diet, exercise, cognitive stimulation and sleep hygiene, one recent review lists a wide range of other risk factors.  Although non-pharmacological treatments for dementia are perhaps less known among medical practitioners, the latest NICE guidance calls for these as a first point of call.  An integrative, complementary or 'whole systems' approach is designed to activate the body's inherent healing mechanisms and treat the root cause of illness as well as associated symptoms.  Dementia often precedes other chronic conditions such as diabetes and heart disease, and improves through similar pathways of diet and lifestyle changes. Therefore, targeting the causative factors for dementia would have the added benefit of addressing more broadly a wide range of common morbidities in older adults. We aim in this paper to introduce the concept of multimodal treatment for dementia (MT4D), share findings from the literature including case studies, review current NHS treatment in the Lancaster-Morecambe Memory Assessment Service (MAS), identify precedents for transformation in the NHS and offer a research collaboration as a step forward.
White, P.C.L., Wyatt, J., Chalfont, G., Bland, J.M., Neale, C., Trepel, D., Graham, H. (2017).
'Exposure to nature gardens has time-dependent associations with mood improvements for people with mid- and late-stage dementia: Innovative practice'
Exposure to green space and nature has a potential role to play in the care of people with dementia, with possible benefits including improved mood and slower disease progression. In this observational study at a dementia care facility in the UK, we used carer-assessed measures to evaluate change in mood of residents with mid- to late-stage dementia following exposure to a nature garden. We found that exposure to nature was associated with a beneficial change in patient mood. There was a non-linear relationship between time spent outdoors and mood outcome. Improvements in patient mood were associated with relatively short duration exposures to nature, and no additional measureable increases in mood were found with exposures beyond 80-90 minutes duration. Whilst further investigation is required before causality can be determined, these results raise important questions for policy about the integration of outdoor space into the design of dementia care facilities and programmes.
Chalfont, G., et al. (2018).
A mixed methods systematic review of multimodal non-pharmacological interventions to improve cognition for people with dementia.
Dementia: The International Journal of Social Research and Practice 0(0): 1-45.
(Link) (Download PDF)
Objective: Multimodal non-pharmacological interventions have been argued to have the potential to complement current pharmacological approaches to improving quality of life for people living with dementia. The aim of this review was to identify, synthesise and appraise the evidence for the effectiveness of multimodal non-pharmacological interventions for improving cognitive function specifically.
Method: After a comprehensive search strategy including grey literature, 26 studies were reviewed. The inclusion criteria concerned adults with a primary diagnosis of dementia. Studies used two or more different modes of intervention, and measured a cognitive outcome. Due to differences in the conceptualisations of the term 'multimodal', a typology of modes and methods was developed to facilitate classification of candidate studies. Results: Twenty-one group studies and five case studies were found. Group studies used two or three modes of intervention and multiple methods to implement them. Interventions utilised were cognitive, physical, psychological and psychosocial, nutrition, fasting, gut health, sleep hygiene, stress reduction, detoxification, hormonal health and oxygen therapy. Five individual case studies were found in two separate papers. Each personalised patient treatment utilised in-depth assessments and prescribed up to nine different modes. In 19 (90%) of the 21 group comparisons, participants were reported to have cognitive improvements, stability with their dementia or a delay in their decline. The extent of these improvements in terms of meaningful clinical change was variable.
Conclusion: Multimodal non-pharmacological interventions have the potential to complement singular therapeutic approaches by addressing multiple modifiable risk factors currently understood to contribute towards cognitive decline.
Chalfont, Garuth and Alex Walker (2013). Dementia Green Care Handbook
of Therapeutic Design and Practice. Mesa, Arizona USA: Safehouse Books.
Three reasons for this Handbook
We are now seeing some very good general guidance about gardens and outdoor spaces for
people with dementia. This handbook takes these environments a step further, being specifically
about therapeutic use of these spaces for beneficial outcomes. Secondly, it draws insight from
research and observations by the authors over a period of time, rather than relying on information
from owners or operators about their own facilities. Thirdly, this work has a particular emphasis
on the environmental needs of people with dementia and distressed behaviour. This term is used
instead of ‘challenging behaviour’ because a person becomes a challenge to others once they are
distressed in themselves, and we wanted to keep the focus on the person's experience.
Our approach is to address the causes of distress using nature as a therapeutic tool,
rather than trying to manage or change the behaviour solely through care practice indoors.
This handbook is aimed at managers, owners and operators of care homes, nursing homes and day care facilities. It will also be helpful to
landscape architects, architects, commissioners of services for older people and all those involved in the provision of dementia care services.
Funding & Support
This Handbook is one output of a design and research project entitled ‘Therapeutic Dementia Care’ which was funded by
the HIEC (Health, Innovation and Education Cluster) of the NHS in Central Lancashire, UK. Further funding came from Hica who generously
supported Garuth's work on site at the Lodge, Buckshaw Retirement Village in Chorley. Age Concern Central Lancashire was our partner
in the delivery of this project. Sincere thanks go to our sponsors and partners for their support enabling this work to be carried out.
The residents and service users whose expert knowledge has largely informed this work are living at The Lodge or at home and attending
enhanced dementia day care at Charnley Fold in Bamber Bridge.
Dementia Green Care Handbook (PDF)
Chalfont, G. E. (2011). Charnley Fold: A Practice Model of Environmental Design for Enhanced Dementia Day Care.
Social Care and Neurodisability. (Emerald Insight article)
Chalfont, G. E. (2011). Connection to Nature at the Building Edge: Towards a Therapeutic Architecture
for Dementia Care Environments. (LAP Lambert, 2011)
Chalfont, G. E., & Trish Hafford-Letchfield, (2010).
Leadership from the bottom up: Reinventing dementia care in residential and nursing home settings.
Social Work & Social Sciences Review.
Chalfont, G. E. (2010). Naturgestützte Therapie. Bern: Verlag Hans Huber.
Chalfont, G. E. (2010). The role of the outdoors in residential environments for aging.
Susan Rodiek and Benjamin Schwarz - Book Review - Aging & Mental Health. (PDF)
Chalfont, G. E. (2008). Design for Nature in Dementia Care. London: Jessica Kingsley Publishers.
Chalfont, G. E. (2008). The Living Edge: Connection to nature for people with dementia in residential care. Chapter Six
in Froggatt, K. A., Davies, S. & J. Meyer (Eds.) Understanding Care Homes: A Research and Development Perspective. London: Jessica Kingsley Publishers.
(Jessica Kingsley Publishers link)
Chalfont, G. E. (2008). The Dementia Care Garden: innovation in design and practice. Journal of Dementia Care, Jan-Feb 2008, 18-20 (PDF)
Chalfont, G. E. (2007). The Dementia Care Garden: part of daily life and activity. Journal of Dementia Care, 15 (6), 24-28 (PDF)
Chalfont, G. E. (2007). Wholistic design in dementia care: Connection to nature with PLANET. Journal of Housing for the Elderly special issue Outdoor Environments for People with Dementia. Volume 21, Numbers 1/2 2007 153-177.
Chalfont, G. E. (2006). Connection to Nature at the Building Edge: Towards a Therapeutic
Architecture for Dementia Care Environments.PhD Thesis. University of Sheffield, Sheffield.
Chalfont, G. E., & Rodiek, S. (2005). Building Edge: An ecological approach to research and design of environments for people with dementia. Alzheimer's Care Quarterly, Special Issue - Environmental Innovations in Care, 6(4), 341-348. (PDF)
Chalfont, G. E. (2005). Creating enabling outdoor environments for residents.
Nursing and Residential Care (Vol. 7, pp. 454-457).(PDF)
Chalfont, G. E. (2005). Reconnecting with nature. Journal of Dementia Care, 13(2), 35. (PDF)
Chalfont, G. E. (2004). Current research on connection to nature: Implications for garden design in dementia care.
American Society of Landscape Architects, Therapeutic Garden Design Newsletter (4:1), Fall/Winter 2004 (PDF)
Chalfont, G. E. (1995). Residential Gardenmaking as a Manifestation of English Cultural Diffusion. MA thesis, Dept of Geography, School of Behavioural Sciences, University of Maryland, USA.
Flat 1, The Old Rectory
Lancaster LA2 0ED
garuth @ chalfontdesign.com