Dementia care
Good design can reduce agitation in residents
Karen Clayton, dementia environment specialist, Find Memory Care, considers how good design principles can reduce agitation and aggression in people living with dementia, significantly reducing the need for antipsychotic drugs
You may have seen a recent report stating that a ‘chemical cosh’ of powerful drugs is still being used in people living with dementia despite the Government’s 2009 National Dementia Strategy calling for a review of the use of antipsychotics in light of their side effects. The study from five universities found
no overall reduction in the drugs being prescribed in UK care homes between 2009 and 2012. In the latest study led by Coventry University and published in the journal BMJ Open, prescribing data from more than 600 care homes found no significant decline in antipsychotic prescribing rates over the period. Jeremy Hunt said in 2014 that the “attitude towards dementia must and will change,” but what changes are needed to promote new attitudes? Statistically, about 90 per cent of
people with dementia are said to experience symptoms that affect their behaviour, which can present as aggression and agitation. Symptoms can develop as part of their condition, but may also be caused by other factors, such as pain, discomfort or unmet need, which can often be managed quite easily. In fact, a study several years ago stated that 90 per cent of ‘challenging behaviours’ displayed by people living with dementia are actually caused by people and their environment. The right dementia care environment can reduce falls by 70 per cent, aggression and agitation by 60 per cent and incontinence by 50 per cent.
Living well So, what changes can be introduced into the care environment that will reduce agitation and aggression, lessen the need for antipsychotic drugs and improve overall wellbeing and quality of life for people living with dementia? We all want to live well with dignity,
independence and confidence for as long as possible and when something
Ashlands Care Home has a spacious entrance hall with points of interest
prevents us from being in control or reduces our choices, it can be frustrating and distressing, leading to changes in behaviour. The challenge when caring for
someone living with dementia is to understand what causes their mood changes and address their unmet need. Environmental issues can certainly have a huge impact on a person’s mood and behaviour and if these problems are addressed correctly, the improvements are immediate and will result in less need for interventions. I have worked with many clients over
the years, identifying issues within the environment and finding solutions that put the person with dementia at the heart of any change. Many homes are not purpose built, but in all fairness we have learned so much about the environment over the past decade that even recently built homes are often less than ideal; they have been designed without a full knowledge and understanding of how surroundings can impact on a person’s confidence and ability to live well with limited support.
January 2017 •
www.thecarehomeenvi ronment .com Poor lighting and shadows, particularly
in corridors with no natural light can increase anxiety levels. Fear of tripping over something (real or a shadow) and falling, getting lost or not being able to find a particular room – perhaps the toilet or bedroom - can be very distressing. Reaching a dead end in a corridor can
be so frustrating and potentially tiring, again perhaps increasing the risk of falls as well as raising levels of agitation. It is important that anything in the
environment is appropriate, so reduce clutter, notice boards and anything that is not of benefit to residents. I would recommend reducing noise levels, which can be distracting and music should be relevant and not just a matter of leaving the radio on all day. Televisions should only be on if they are being watched.
Simple solutions Behaviour and mood changes can be a common problem, but there is often a simple solution that can reduce the state of agitation in residents. Lighting is a prime example of where increasing the wattage can make an immediate
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