Those living with dementia can face unique challenges in their day to day activities. Designing or making modifications to the environment can support them in making decisions and completing tasks, resulting in a more independent lifestyle. Many design elements can be considered in creating a dementia-friendly environment. These guidelines can help provide a framework for designing a dementia-friendly environment and highlight areas of potential hazards.
How to provide a dementia-friendly environment
Whether you are designing a nursing home, hospital, retirement village or making modifications to your own home there are a few guidelines that can help you make design decisions. By using these guidelines you can design an environment that supports those living with dementia, enabling them to live safely and as independently as possible. In the World Alzheimer Report 2020, ten design principles were discussed.
Unobtrusively reduce risks: To encourage those living with dementia to continue pursuing life, internal and external environments need to be safe and allow for ease of mobility. The obvious use of safety features like locked doors or fences can cause frustration, confusion, depression and anger.
Provide a human scale: The 3 key factors to consider with scale is the overall size of the building, the size of its components (ie. the doors, corridors, and rooms) and the number of people the individuals encounter. Imagine a big hospital or care facility, the large, expansive scale of the building and the many people that could be busily going about their business. This scene may feel intimidating for anyone and those living with dementia may experience the feeling of being overwhelmed or intimidated even more.
Allow people to see and be seen: For those living with dementia, it's critical to give them the confidence to explore their environment. Creating keyspaces (ie. a lounge, garden, bedroom, dining room) that are easily seen with clear direction to such places, gives individuals the ability to recognise their surroundings and make independent decisions on where they would like to go.
Reduce unhelpful stimulation: Prolonged exposure to significant amounts of stimulation (visual and auditory) can become overwhelming for those living with dementia. To create a dementia-friendly environment it's important to reduce unnecessary or competing sounds. Also, consider removing excess clutter from the room or home.
Optimise helpful stimulation: If used correctly, stimulation can help a person living with dementia to recognise where they are, reducing confusion. Cues they can see, smell and hear need to be carefully designed as each person is different. Providing a redundant cue to one person may be beneficial in helping them recognise their bedroom, but the same cue may cause uncertainty to another.
Support movement and engagement: Movement is important in a person's well-being and health. Creating well-defined pathways that guide individuals past points of interests can be highly engaging. It enables people to walk with purpose, engage with activities and interact with others.
Create a familiar place: Having the interior and exterior of a building be a familiar design can provide comfort. Allowing individuals to personalise their spaces with items that remind them of their home, family and friends will create an environment that feels familiar to them and therefore relaxing.
Provide opportunities to be alone or with others: To support independence ensure that individuals can choose to either be on their own or spend time with others. Providing a variety of spaces can allow people to read quietly by themselves and develop social groups and clubs with others.
Link to the community: Those living with dementia benefit from the continual reminder of who they are. Frequent visits with family and friends can help maintain a person's identity. It is important to create an environment that enables these forms of visits.
Design in response to vision for way of life: The way of life that is being offered should be reflected in the building design. This stands as part of the philosophy of care and is a constant reminder to staff the values they should embody.
Potential environment hazards that can become a danger to a person living with dementia
While implementing the above guidelines to create a more friendly space for someone living with dementia it's important to be aware of potential hazards. Here are a few areas to consider more closely. Each individual will be different, approach any changes to the living environment of those with dementia with respect and dignity.
Flooring: Refrain from using flooring that has a pattern or a glossy finish. This can be confusing and disorientating for someone living with dementia who may view the colour change or glare as an obstacle or a step. Where possible keep the flooring consistent or as close to one colour. Also, consider the texture of the floor. You do not want the floor to be slippery or to have it become slippery if wet. Keep the floor level, remove any rugs as this can become a fall risk.
Stairs: Stairs can be challenging for any individual that has mobility issues. Where possible remove the need for stairs. If stairs are present in the home or facility ensure proper handrails are visible and of a pleasing texture. Additionally, adding a strip of colour to the steps enables them to be more visible and cues the individual to the first and last step.
Use of colour: As an example, a white door on a white call can be challenging for a person living with dementia to distinguish. Painting doors a specific colour can not only help a person recognise it as an exit but can also help them remember which rooms are the toilet, lounge or personal bedroom. Additionally, using colour on handrails and other items in the home can help distinguish it from the background and help it stand out. If items stand out more using colour, tone and hue they become more easily recognisable and therefore more likely to be used appropriately.
Lighting: Ensure that all areas of the home are well lit. In areas like hallways and bathrooms consider putting in motion-detecting sensors that automatically turn lights on when triggered.
Mirrors: It is important to consider the different needs of each person. Mirrors can be disorienting and confusing for some. Over time individuals living with dementia may not recognise themselves and this can affect their behaviour and emotional well-being.
Safety Features: Consider installing automatic water shut-off valves, gas decorators and shut-off valves, sensors and timer-based cooker turn-off devices and sensors to regulate water temperature to prevent burns.
There are many design elements that can be incorporated into a home or healthcare setting to make it more dementia-friendly. Each person will have different abilities and taking the time to understand their abilities will help create an environment that is best suited for them. Whether it be building a new healthcare facility, making modifications to your own home or a home of a loved one, considering the various design options will benefit the well-being, quality of life and safety of those living with dementia.
For further details on guidelines, the World Alzheimer Report 2020 and the Universal Design Guidelines are great resources to understand the modification that can be taken to create a stable, safe and independent living environment.