According to the WHO (1), ~55 million people live with dementia worldwide, and this number is forecast to increase in the years to come. In North-Western Europe, a significant percentage of people with dementia reside in institutional care settings, including care and nursing homes. In the UK alone, 40% of people with dementia over 65 live in care homes (2, 3). After a prolonged period of institutionalization, many older people with dementia feel lonely and socially isolated and have symptoms of depression (4), which is related to a plethora of social, physical, and psychological problems.

In recent years, research on the impact of design that aids independence and enhances self-esteem and quality of life has increasingly demonstrated the supportive role of the care home environment towards a good life (5, 6). Recent research begins to show the importance of the local environment in social health (7). The built environment is one of the factors determining the quality of life of people with dementia, who may face difficulties in recognizing and navigating the environment of the care home or accessing opportunities for social interaction and participation in daily activities (8–12). Design features, for example, the use of light, color, and contrast that compensate for sensory changes in people with dementia and aid them in way-finding, are examples of developments in care home design accepted as elements of best practice (13, 14). Non-clinical practices that have been studied in relation to the wellbeing and social engagement of people with dementia include multi-sensory stimulation environments (MSEs) (15–17). However, MSEs limited to a specific room in care homes might not effectively meet the needs of people with dementia (18). Research indicates that a stronger focus on sensory-built environment design elements is needed, especially for addressing the needs of people in the later stages of dementia (11, 12).

Furthermore, design innovations include attempts to embed technology in products used by people with dementia as well as in their living environment. Such projects range from leisure products to smart home technologies and wearables intended to support daily needs and tasks (19–24). Lately, the emergence of a broad range of assistive technology products for people with dementia, positively received by users, has been observed despite the lack of hard quantitative evidence. For example, HUG, a huggable soft object with embedded technology (25), and PARO, a therapeutic robot seal (26), were introduced as non-pharmacological treatments.

Even though studies investigating the impact of handling sensory objects on the wellbeing of people with dementia suggest their positive value in providing opportunities for engagement, storytelling, and social interactions through verbal and non-verbal communication (25, 27–30), there is a lack of research on large sensory spatial products, especially with embedded technology. The research described in this study, titled Homing Wellness, examines if embedded technology can be used in spatial objects to enhance the sensory experience of people with dementia and if such objects can interrelate to create a narrative spatial network potentially supporting communication. The emphasis of this interdisciplinary investigation is on examining art-led narrative design in the creation of sensory spatial objects that can aid residents, staff, and family members in expressing past stories or inventing new ones (31).

The term narrative design is informed by scenographic principles established in theater, which utilize design to tell stories and support audiences in engaging in narratives by employing all the senses. Narrative design incorporates elements (for instance, objects, lighting, textures, sounds, and smells) intended to encourage storytelling by those using, moving through, or observing the space. Taken from the concept of narrative design in theater—also known as scenography—it refers to the configuration of space and its contents to reinforce the narrative of the story being told (32).

The theoretical framework of this study is based on the idea that people interact with the world through all of their senses. Communication is usually studied mostly on the basis of optical (visual) and acoustic (audio) channels, although a person can interact through the full range of the five senses, which are co-organized (interrelated), leading to an effect of “intersensoriality” (33). This organization of the senses can be seen as an interactive web that allows the senses to work together. This approach allows us to see the experience of people with dementia in a holistic way, emphasizing the significance of the haptic and olfactory channels of communication as a means of enhancing interaction. Connected and interacting in this way, people with dementia can feel better supported, especially in the late stages, as they are often immobile and, in some cases, have no verbal communication.

The study's approach aligns with concepts of embodiment and embodied personhood claiming that when dementia has progressed, selfhood is still alive and demonstrates itself through the body (34–36). These concepts are based on the idea that human beings create systems of navigation—body schemas—that allow them to interact with their surroundings (37). These systems come into play even when cognition is not actively participating in our decision-making, thus facilitating ways to relate to our environment. Adhering to these theories, we can understand how people with dementia can relate to their surroundings through the mind and body as a whole. The study also adopts concepts deriving from Kitwood's notion of relational hypostasis of personhood. For Kitwood, personhood is a status one attains because of the way one is seen by others (38, 39). Communication in dementia long term care settings (LTC) is vital, for personhood needs the other to be sustained. Thus, by offering triggers for interaction, opportunities emerge for meaningful social engagement and for maintaining the status of a unique human being who is worthy of respect and dignity. The project also incorporates ideas on the importance of narratives to express personal identity and acquire agency for people with dementia (40). There is evidence that sensory engagement, especially through storytelling, benefits communication and improves quality of life for people with dementia. Research on the benefits of a free-form storytelling intervention for persons with dementia residing in care homes has shown this to include enhanced pleasure, more frequent social interactions and communication, and more positive staff views of residents with dementia (41, 42). Such findings suggest that giving people with dementia the opportunity to continually access objects that prompt storytelling is important for the improvement of communication and quality of life. This study aims to create designs for spatial objects that will provide people experiencing dementia with possibilities for individual or collaborative storytelling.

In collaboration with people with dementia and the health professionals of two partner LTC settings, Homing Wellness focuses on the question of how interactive spatial objects can be incorporated into dementia care homes, transforming the space into a comforting and playful environment that can enhance self-esteem, facilitate communication, and improve quality of life for both residents and staff members. The study aims to develop a series of spatial objects with embedded technology, examine the narrative possibilities of individual spatial sensory objects, and also examine their narrative potential as an interrelated network. The spatial objects combine functionality and aesthetics while incorporating embedded technology and soft textures implemented by textiles. A flexible set-up of the embedded technology allows for personalization. The objects, aiming to enhance a sense of empowerment and agency by providing opportunities for verbal and non-verbal storytelling (35, 40), are designed to be accessible and easy to use by people with dementia.

This research aims to apply the following actions.

The involvement of experts by experience, carers, and health professionals has shaped the underpinning research, attempting to ensure that the design derives from and responds to the needs and experiences of people with dementia. This article reports on the development and creation of the designs and the production of the spatial objects' prototypes (actions 1 and 2). The installation and data collection (action 3) are ongoing, and a report will follow after the completion of the above actions.

The creative process uses metaphors from mythology, which could elicit mnemonic references. Myths are semiotic vehicles and help people make sense of the world in which they live (43, 44). In this particular case, the Myth of Ariadne's Clew was used as a reference point for the research team to identify the context for the design approach (Figure 1). The myth is used to guide the design research process and the implementation of the design product, as well as a metaphoric clue to support finding storytelling-based communicative patterns.

Adopting a participatory methodology to involve stakeholders throughout the research process, the study is guided by health professionals and includes co-design with persons with dementia in developing new narrative design ideas for care homes (45, 46).

The research utilizes action research (AR) as the key tool for fulfilling the research aims and objectives. AR allows researchers and participants to collaboratively link theory to practice to contribute effectively to actions that drive social change (47, 48). AR employs data to solve practical problems in a particular arena in order to improve it while allowing researchers to understand their practices and generate knowledge (49, 50). AR models may vary according to context, place, and space (51, 52) with most of them accepting the spiral (or circular) process. In this research, the five-phase AR model suggested by Greeff and Coetzee (51) is employed, involving: (phase 1) identification of the problem; (phase 2) data collection and organization; (phase 3) data interpretation and action planning; (phase 4) action implementation based on data findings; and (phase 5) evaluation of the results and critical reflection (Figure 2).

All of the above five phases mark a cycle of AR, with the knowledge gained from it feeding the next AR cycle where the research process is repeated, hence the AR's cyclical or spiral process. A three-cycle, five-phase (per cycle) model, adapted to the purposes of this research, is applied (Figure 3).

Outcomes regarding the spatial object prototypes are presented here as design solutions involving embedded technology. The three spatial object prototypes developed are an interactive armchair, a wall picture frame, and a portable cover for a handrail.

An interactive armchair (Figures 5, 6). This is an ordinary armchair equipped with multiple sensors (buttons, switches, and trimmers) and actuators (fan, aroma diffuser, massage vibrator, and speakers) covered with sea-themed fabrics.

The operating switches have an intuitive interface design and are located on the arms of the chair for easy access. The design of the armchair aims to offer the experience of nature by simulating the sounds, freshness, and breeze characteristic of the seaside. The sea theme was initially suggested by the advisors with lived experience. There were suggestions from health professionals that the experience of using the armchair could provide engagement for people whose mobility is affected and who cannot go for outdoor walks.

An interactive wall picture frame (Figures 7–9). This wall picture frame can alternate visual patterns, activate motion on different parts of the picture, and produce specially composed sounds. It is equipped with three ultrasonic proximity sensors, each of which performs a different scenario depending on how close someone is. For example, the first sensor varies the blue color brightness of an embroidered area of the frame (Figures 8, 9). When someone is further away, the brightness is at its maximum. As the person approaches, the brightness decreases. The second sensor produces sounds and music as they approach. The third sensor generates motion in a specific feature (such as a flower) embedded in the frame.

An interactive portable cover for a handrail (Figures 10, 11). The interactive handrail cover is a cylindrical, flexible structure that can be placed on a handrail held by people as they walk in the hallway. The initial prototype incorporates three independent push buttons at various locations that detect a person's grip and wirelessly activate an external room speaker. When someone moves around the room while holding the handrail, they automatically push the buttons in sequence, producing a series of sounds. A pre-recorded story is embedded in an audio feature on the handrail, parts of which are played when the buttons are activated by the passing user. The concept for the function of this prototype is that on the full length of the handrail, with numerous push buttons, the narration of a whole story can take place. The health professionals in the LTC settings have suggested installing the cover on the handrail leading to a balcony, thus allowing the user to reach the outside space of the care home. There was also a suggestion that the chair could be located on this balcony to create meaningful links between the person's activity and the spatial objects.

The spatial prototypes were designed with a view to future production. For this reason, low-cost common commercial electronic components and the popular Arduino microcontrollers were used (65, 66). This practice has been successfully employed by the research team in a variety of previous research projects (67–69).

Homing wellness explores the potential of the built environment to impact the quality and outcomes of dementia care. The built environments and the infrastructure technology within them affect the users, especially in healthcare environments, including living environments for people with dementia. The research aims to find appropriate ways to enhance the built environment and to provide evidence of its built environment as a communication enabler with therapeutic potential for people living with dementia.

To date, this research has investigated how playful spatial objects can be designed and produced in order to be incorporated into LTC settings for people with dementia, aiming to transform the space into a narrative agent. Three such prototypes have been designed and produced in partnership with health professionals in dedicated LTC settings. These prototypes have been presented to the partner care homes, and positive comments have been received on the prototypes' functionality and potential impact to benefit the users through their sensory attributes.

The research has accomplished the following:

The objects are accessible, ergonomic, and safe. The design choices deriving from the participatory process led to objects with familiar forms and features that could support feelings of homeliness with significant meaning and can be utilized in everyday routines. It was essential that the objects retain functionality as a primary feature to acquire meaning both as utility objects and storytelling tools. By using scent, sound, and light, but also tactile elements, they offer a multi-sensory experience, thus supporting the continuing use of the senses (70, 71). These sensory attributes and the use of actuators such as motors and fans provide triggers for interaction. The pleasant textures, familiar soothing sounds, and possibilities of favorite music choices can offer a sense of comfort and engagement opportunities (57, 72). Even though the objects incorporate advanced technology, their user interface aims to be intuitive, easily controllable, and provide a stress-free experience suitable for people in all stages of dementia (73, 74).

With no need for the presence of carers or activity coordinators when interacting, these objects could enhance a sense of empowerment and agency (35). Specific themes have been selected that can narrate imaginative or familiar stories. As an example, the armchair was designed to evoke the seaside experience; its textures, colors, and sounds can trigger relevant storytelling. This narrative, interactive nature of the objects could provide opportunities for communication and social contact between people with dementia and their carers and family members.

The participatory process led to design choices for the spatial objects that can be integrated into the care home environment. All objects are aesthetically modified versions of objects that could be found in such an environment, thus combining the ability to attract interaction both through their familiar features and their exhibiting playfulness.

Initial ideas for the combination of the spatial objects, when installed in the care homes, have already been examined through discussions with health professionals. The installation of the objects in the LTC settings would enable their interrelation, thus expanding the narrative ability of the space. Possibilities of meaningful links that could be created between the spatial objects depending on their location within the space and the walkways leading from one to the other will be explored together with people with dementia during the next stage of the project. For example, the tactile handrail cover, which can narrate parts of a story encouraging exploration and movement, could be placed on the corridor handrail that leads to one of the care homes' balconies. The specific balcony overlooks the sea, and the sea-themed armchair could be installed there to offer a multi-sensory sea experience to people who are not able to go outdoors. The spatial objects, incorporated in such an interrelated way in the care home-built environment, could stimulate engagement and communication through storytelling, thus transforming the space into a powerful narrative tool.

The research aims to benefit the wellbeing of people with dementia and contribute to the fight against the stigma and marginalization of people living with dementia. Homing Wellness can contribute to expanding knowledge in design for dementia by examining the narrative possibilities of the care home environment. It will also enhance the knowledge of dementia product design and create design guidelines and examples for best practices in dementia LTC settings.

It is possible to achieve the design and production of spatial objects for people with dementia following guidelines derived from existing literature and guidance from health professionals and people living with dementia. The combined use of embedded technology and textile-based materials, with attention to aesthetics, can lead to the production of exciting spatial objects that could engage people living with dementia. An interdisciplinary approach and collaboration between the researchers, the people with dementia, and health professionals can successfully drive the production of interrelated objects with storytelling features that may attribute narrative agency to dementia LTC settings. It is anticipated that spatial objects offering a sequence of visual, acoustic, olfactory, and tactile stimuli will activate a sensory environment that will be both soothing and exciting for people living with dementia. This environment might offer engagement, pleasure, and fun, so people with dementia can have a good time, communicate in an embodied way, and feel creative, validated, and celebrated in their living environment.

The spatial objects will be installed in the partner LTC settings so that the next stage of the research can be carried out. During this stage, people with dementia will evaluate the prototypes. There may be additional action research cycles in future, depending on the results and conclusions of the evaluation, aiming to further develop the prototypes with co-design workshops with people living with dementia. The findings will be discussed in relation to findings from previous studies and will be compared. Suggestions for further research will be discussed.

The original contributions presented in the study are included in the article/supplementary material. Further inquiries can be directed to the corresponding author.

The studies involving human participants were reviewed and approved by the Research Ethics Committee of the University of West Attica, Athens, Greece (approval ref: AP.ΠPΩT: 32538 - 24/03/2023). Written consent of the partner care homes was obtained to participate in the research. Their participation involves consultation with their health professionals and also the participation of people living with dementia. People living with dementia will be provided with individual consent forms. The stage specified in this manuscript outlines consultations with the professionals, however the participation from the residents will come at the second stage of research.

LM was responsible for the organization of the project, the field testing, and the writing of the manuscript. AC was responsible for supervising and implementing the technical part of spatial object development and the writing of the manuscript. AT was responsible for implementing the technical part of the spatial objects' development and writing the manuscript. GP was the principal investigator of the project. JvH provided scientific consulting on the project and reviewed the manuscript. ES was responsible for developing and implementing the integrated textiles and reviewing the manuscript. ZG and ST helped with the development of the product design and the environmental arrangements and reviewed the manuscript. CD contributed to the technical part of the spatial objects' development and reviewed the manuscript. All authors contributed to the article and approved the submitted version.