Importance of Environment Design in Dementia Care

My time with Epoch has made me see design in a very different perspective. The role of design in a dementia care environment is about about creating something which is primarily for an audience who may or may not understand, but it sure does play a very crucial element in dementia care, as it not only improves the well being of residents with dementia but also enables care providers to create a conducive environment.

Design of an elder-friendly home determines how a resident can relate specific places for specific activities, understand the time of the day and ability to register that with vision and be more oriented. This does not necessarily involve new build but can be as simple as rearranging furniture.

For me working on environment design for dementia care has come to revolve around 4 basic principles;

• Reduce risk
• No monotony
• Reduce obstruction of vision
• Simulation

Reduce Risk

Eliminating risks is the first principle of elder care design. Usage of grab bars in washrooms and safety rails in beds, no loose rugs & mats, making sure items of furniture do not have sharp corners or if they are, cushioning them as per requirement, making the floors non slippery, making the doors unlockable so that in case the person with dementia has a fall and is unable to unlock the door are some of the basic to-dos in the first stage of creating a safe environment for an elderly even for someone who is not suffering from dementia. Exit doors must have a discreet padlock for additional safety. All of this while still keeping them aesthetically pleasing i.e. not making them feel restricted or have any kind of negative impact on their well being.

No Monotony

Bland, boring and repetitive environment is actually confusing for someone affected with dementia. Using solid bright colours for distinctive things like couches, specific walls helps residents associate walls and things with their location and uses. Patterns could trigger confusion and disorientation. Keeping different places in an assisted living home distinctly different helps to know the way around easy and oriented and dissuades wandering and confusion.

Reduce Obstruction of Vision

Enabling the resident to have clear visual access to what's around and the direction of other locations is very crucial as it helps them understand where they are in their environment. For example, setting up a living area the residents can see through an open door to the hallway or to the dining area and when at the dining area can see to the kitchen or the living area or other rooms, having large windows to look outside.

Additionally having a circular hallway allows for wandering without encountering a door every few minutes which often results in increase in anxiety.

Ample natural lighting is another important consideration. Evening lights must be tested to rule out poor reflections which can aggravate confusion.

Simulation

Simulation is the process of imitating of an environment or process. An unhelpful simulation may distress and confuse residents with dementia, and this includes all of the senses. Solutions to this may include painting murals to hide doors that are not to be used and reducing excessive signages. Another example would be a bathroom done up too fancily with decor et al can take away the focus from it is actual purpose.

Whereas in case of helpful simulation, environmental cues such as colour, objects or a view enable people with dementia to better find their way around and made environments more meaningful. Rightful engagement of simulation will encourage more accurate wayfinding in the homes, drive the desire to engage in activities at different locations of the home and distract them from agitation. Use of familiar or same furniture from home can be a huge help in reassurance and building orientation.

It is very important to understand what could be the trigger points in the environment which accelerate behavioural symptoms or repetition . While the above-mentioned points have been pivotal for me around which I have worked on design for dementia care, but every new day I learn something new about dementia and work on how to tackle it through design and at Epoch, everything has to be evidence-based, for it to be considered as a part of the whole personalised care process.