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Dementia care


Table 2. What constitutes a therapeutic environment in dementia care14 Legibility


Logical room syntax


Furnishing Fixtures and fittings


Familiarity Biographical


reference


Homogenous and small groups


finding have been explored and implemented in refurbished and newly built residential care homes. Although the design of these facilities is grounded in misconception and limited understanding, this is mainly due to a lack of evidence and data to substantiate the claims made. However, much emphasis has been given in the literature to signage and visual and environmental cues, furnishings and colours to aid way finding. Design topology and floor plans can support spatial orientation and way finding in people with dementia. While other interventions such as signage, furnishing, lighting and colour, floor surfaces, fittings and furniture provide cues and differentiation and create clear boundaries to assist orientation, they have a limited effect if the layout is complicated.


Removing the impact of both cognitive and physical impairment in way finding requires a therapeutically enhanced design and diligent intervention. Through careful design interventions daily navigation can be improved for people with dementia.12


A supportive environment Navigation and orientation of a dementia-friendly setting should not require higher analytical skills, such as reading and interpretation of signage or decision making, as most people with the condition will have a limited ability to make decisions or learn new skills. A well thought out, clear layout is necessary alongside well articulated space configuration to facilitate access, navigation and orientation. This suggests that geometrically well defined spaces are key to successful orientation and should incorporate complimentary features and spatial design and


Autonomy Barrier-free


compensating environment


Safety and security Avoidance of overstimulation


Non-institutional character Orientation cues


differentiation between floors, walls, ceilings and signage.


There is also a need to allow people with dementia to visualise and appreciate their environment, which means giving them visual access to all areas. Decision making becomes increasingly difficult for people with dementia and every effort should be made to reduce the need for it by planning corridors and transitional areas to ensure there is no crossing of hallways, lobbies or other areas and moving from one location to another is easy. There is growing recognition that sensory abilities weaken with age, potentially leading to further impairments. Visio-spatial deficits or impairments alongside fear and uncertainty, which may result from an inappropriately designed environment, can lead to increased confusion. According to RIBA guidelines, the right choice of flooring is particularly important for people with dementia who may like to wander, but are often also frail and susceptible to falls.13


According to The Alzheimer’s Society, people with dementia can mistake a dark patch on the floor for a hole and a glossy surface might be perceived as being wet, while changes in surface can be mistaken for a change in floor level. Older people may also find certain colours harder to differentiate.


Dementia-friendly flooring needs to avoid anything that causes anxiety, distraction or confusion and therefore deters people from being able to walk safely across it. This means avoiding flecks or sparkly specks, which people may try to pick up, as well as shine, dark colours and patterns, which can be seen as a physical obstruction, although strong colours can work well. Spongy, noisy floors are also not recommended.


There is growing recognition that sensory abilities weaken with age, potentially leading to further impairments


November 2018 • www.thecarehomeenvironment.com


Sense of belonging


Access to the outdoors Communication


A reduction in time spent using facilities such as kitchens and toilets without being confused and ease of navigation could lead to potential savings in the long term, despite higher initial costs. Care homes should be equipped to predict and minimise safety hazards as well as alerting staff to provide help when needed. These hazards and the risks involved should be assessed by gathering information on: behavioural patterns (anomalies, deterioration, inconsistencies); changes in sensory response; physiological parameters and indices; environmental hazards/surrounding risk awareness; visuo-spatial awareness and spatial orientation; lighting intensity and light contrast; safety and security awareness. This should be based on innovative technology platforms that seamlessly sense and integrate into the environment, collect and interpret physiological, psychological, behavioural and environmental data and respond intelligently to the needs of people with dementia.


Conclusion Dementia is a devastating


neurodegenerative condition that affects individuals and their families. Assistive technological interventions vary in terms of their scope and effectiveness. Most are limited in their scope and application due to practical considerations when addressing the multifaceted aspects of neurocognitive and visio-spatial deficit associated with the condition. However, there is a need to focus on more mature technologies and systems instead of piloting applications and an unrelenting quest for new commercially driven devices and to consider and test more mainstream devices for viability, affordability and applicability in a real life situation. This will have wider implications for otherneurodegenerative impairments. Addressing the challenges posed by dementia requires a more in-depth analysis of interrelated behavioural, cognitive and communication related factors. Several key points based on


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Sensory stimulation Encouragement


Social interaction Privacy


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