There is a need to understand how technology can best be used to facilitate well-being in people with dementia. This study sought to describe how access control technology influenced the everyday lives of people with dementia living in a secure unit. The staff members and the unit's residents participated in the study. Data were collected through ethnographic observations and semi-structured interviews over 6 months, and were analyzed using the constant comparative method. The results show how access technology supported the residents' sense of security, territoriality, orientation, and adaptation to the environment. However, certain conditions were necessary for these influences to appear. Overall, the results indicate that access control technology may be used to support the well-being of people with dementia, and to increase their opportunities to feel in place in a secure unit. However, there is an urgent need in the future for further exploration of the conditions for use of technology in the field of dementia care, and the necessity of making careful evaluations of the use of technology in this field cannot be overemphasized.

OBJECTIVE. We describe the development of a questionnaire, Participation in Activities and Places Outside Home (ACT-OUT), for older adults with cognitive impairment and align it to people with mild-to moderate-stage dementia. METHOD. ACT-OUT was developed in a cross-cultural collaboration in combination with three rounds of cognitive interviews in Switzerland with 26 older adults without cognitive impairment and five older adults with dementia. Qualitative data from the interviews were analyzed using a constant comparison approach. RESULTS. The final ACT-OUT Version 1.0 consists of three parts: (1) questions targeting places older adults visit; (2) questions on aspects influencing participation, such as transportation, familiarity, and risk perception; and (3) questions on perception of self. CONCLUSION. The development of an instrument such as ACT-OUT is more a cyclical than a linear process. This study is a first step toward a more systematic evaluation of out-of-home participation among older adults with and without dementia. O lder adults with dementia and their significant others value participation in activities outside the home, such as grocery shopping, pharmacy visits, and dog walking (Egan et al., 2006; Teitelman et al., 2010). Participation in outside activities offers numerous benefits, including maintaining cognitive functioning and autonomy, keeping in touch with others, and exercising in nature (Rao et al., 2014; Sugiyama & Ward Thompson, 2007; Winchester et al., 2013). It also involves an endless variety of places in combination with activities in which older adults want and need to engage. Being immersed in activity in places-being in place-is an ongoing life process that generates important meaning (Rowles, 2008). It is closely related to the process of place integration-the continual adjustment of person-place relationships to enhance well-being (Cutchin, 2004)-and is consistent with the transactional perspective on occupation: Participation in occupation is seen as fundamental to the functional coordination of person and place in response to problematic situations (Cutchin & Dickie, 2013; Dickie et al., 2006). Person-place relationships may change in relation to the development of dementia as the relationships that were once central to one's life are disrupted by loss of familiarity, loss of ability to navigate and access places, or fear of embarrassment. These changes can have a cascading effect on participation and amplify risk of further disengagement. Thus, having regular access to outside places and activities is critical for maintaining familiarity for people with dementia (Brorsson et al., 2011). The interdependency of places and activities can facilitate or hinder participation, for example, through distances and layout of the physical environment, availability of transportation and support, meaning of activities, risk perception, and familiarity. Maintaining a level of out-of-home participation can be a complex endeavor for people with dementia, who face challenges such as getting los...

Based on these results evidence-based products have been developed (a further education course; written recommendations for practice).

Familiarity is important for persons living with dementia who participate outside home. When familiarity is challenged, such participation may be difficult. This ethnographic study clarifies how familiarity is experienced by persons with dementia in performing activities and visiting places, and how familiarity contributes to maintaining participation outside home. Nine participants were interviewed in their home and while visiting familiar places. Data were content analysed using a constant comparative method. The findings suggest that persons with dementia experience familiarity as continuous and whole, through occurrences that support personal territories. Landmarks and objects enhance the experience of familiarity. Familiarity that is continuously challenged may render participation outside home fragile.