HaroldUrman
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Nov 5, 2010, 11:06 AM
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Environments That Enhance Quality of Life for People with Dementia
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By Harold N. Urman, Ph.D.
In the past twenty years, the importance of the physical and social environments in supporting people with dementia has gained a much higher profile in dementia care. Yet, despite efforts to move away from the medical model to a more balanced person-centered model of care, we still struggle with the dominance of an institutional context which impedes individuality and choice.
The design of facilities can play an important role in ensuring that people with dementia living in residential facilities retain maximum independence and dignity.
Marshall (2001) found in his review of the literature on principles for designing dementia specific facilities that accommodations for people living with dementia should:
Compensate for disability
Maximize independence, reinforce personal identity, and enhance self-esteem and confidence
Demonstrate care for staff
Be orienting and understandable
Welcome relatives and the local community
Control and balance stimuli.
Marshall also found that the following design elements should be incorporated into environments for people with dementia:
Small size, in terms of the number of people in a dementia unit
Familiar building style that is domestic and home-like
Plenty of space for ordinary activities
Unobtrusive safety features
Rooms for different functions that are equipped with furniture and fittings familiar to the age and generation of the residents
A safe outside space
Bedrooms big enough for a reasonable amount of personal belongings
Good signage and multiple cues where possible (e.g., sight, smell, sound,)
Use of objects rather than color for orientation
Enhancement of visual access
Control of stimuli, especially noise.
While some of these design features can be very costly, there are a number of cost-effective changes that facilities can implement in the areas of safety, physical space, stimulation and signage, which have been shown to have significant effects on the quality of life of residents with dementia.
Unobtrusive Safety Features
For many people with dementia, the need to move around for long periods of time can be very important. Some residents feel trapped when faced with obstacles that restrict their ability to move around freely. However, creative design approaches to balancing a sense of freedom while still addressing safety needs is possible. In fact, researchers have found that unobtrusive and disguised safety features results in lower depression and fewer attempts to exit the unit. For example, it has been found that placing a simple beige cloth over the doorknob of an exit door was very effective in reducing exit attempts. Another study found that a door left opened onto a safe outside area, was better than one left closed. In general, research indicates that facilities with too great an emphasis on safety have been found to have a negative association with resident quality of life indicators.
Physical Space
People with dementia are challenged by large, unstructured spaces. Large activity rooms, for example, tend to be noisy and confusing when multiple activities going on at the same time. Providing multiple smaller spaces that accommodate between 8 to 12 residents gives people with dementia the impression that they have more choices, which in turn increases their sense of independence. Rearranging furniture in large rooms and adding dividers or partitions have been found to provide residents with a choice of different spaces, which has a positive effect on quality of life. One study found that disruptive outbursts in the dining room were reduced after the room was divided into smaller segments. In another study, when researchers arranged a large room into four rooms for watching TV, reading, activities, and social interaction they found that there was an increase in resident-staff interaction and a decrease in such behaviors as talking to oneself. In summary, providing an environment that supports a variety of activities for people with dementia can increase social interaction and independence and decrease resident anxiety and depression.
Stimulation and Signage
It is important to insure that dementia care residents are given optimal levels of stimulation. Environments that neither over-stimulate nor under-stimulate are preferable. When designing environments for people with dementia, consider the impact of light, color, contrast, texture, aroma, and sound on all five senses.
Also, people with dementia are losing cognitive and intellectual skills and becoming more dependent on sensory cues. Therefore, pictures work better than words, but the pictures need to be large enough for residents to see. Visual landmarks, such as large items or cues can also been very helpful. For example, placing lettering and arrows on the floor was found to be most helpful in directing people to the toilet. In addition, placing a memory box outside the bedroom can help residents find their own room.
Noise and temperature are also important factors to consider. It has been shown that quieter environments are associated with better orientation, while loud talking is associated with overstimulation.
Finally, lighting is also one of the most important features in environmental design for aging adults, and those with dementia are made even more vulnerable by poor lighting because it can impact their ability to find their way around a facility. There should be high levels of even illumination without glare. Glare is physically painful to older eyes and contributes to problems with balance and mobility, particularly when it reflects off highly polished vinyl floors. Indirect lighting that reflects light from the ceiling or walls provides better light distribution.
In conclusion, there are a number of cost-effective environment chances that can be implemented in a facility which can have a significant impact on the quality of life of residents with dementia. These small but impactful chances can increase residents sense of independence and social interaction while decreasing agitation and depression.
References:
Marshall, Mary (2001) Environment: how it helps to see dementia as a disability in Care Homes and Dementia (ed S. Benson) The Journal of Dementia Care
Harold N. Urman, Ph.D. is an educational psychologist and co-founder of Vital Research, a consulting firm specializing in research and evaluation. Established in 1982 and based in Los Angeles, Vital Research is a national research and consulting firm with expertise in senior living services satisfaction measurement.
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(This post was edited by HaroldUrman on Nov 5, 2010, 11:16 AM)
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