Dementia care
an individual’s level of function and performance should be borne in mind and merit further investigation. These include: l spatial orientation and way finding strategies such as careful signposting of the built environment strengthened by meaning, emotional connection to places and cognitive and serial mapping (cognitively-focused)
l self management and self efficacy using visual memory cuing and object centred recognition, such as the picture exchange communication system (developed in the US), facial recognition, Talking Mats and reversible mirrors (practically focused)
l an ability to recall and carry out self help tasks accurately and consistently incorporating cognitively effective and sensory enriched activities to engage and reduce stress and anxiety
l reducing clumsiness and confusion when performing daily living activities including facilitated interventions and improving signage and visual cues
l ease of use of assistive technologies through training and reinforcement strategies and machine learning (cognitively focused)
l an improvement in strength and balance through an increase physical activity.
There is a need for professionals to change their approach by considering residents’ perception and expectations and enabling them to perform at the highest possible level in their every day activities and to move towards using evidence based design in care homes and dementia units.
Improving the environment can significantly improve health and wellbeing in people with dementia. The importance of a sensory enriched environment cannot be underestimated nor can its role in reducing stress and sustaining resilience based on enhanced therapeutic qualities that ultimately minimise overall risk to people with dementia.
References 1. Monacelli AM, Cushman LA, Kavcic V, Duffy CJ. Spatial disorientation in Alzheimer’s disease: the remembrance of things passed. Neurology 2003; 61, 1491–7.
2. Liu L, Gauthier L, Gauthier S. Spatial disorientation in persons with early senile dementia of the Alzheimer type. Am J Occup Ther1991; 45 1, 67–74.
3. Passini R, Joanette Y, Rainville C, Marchand N. Wayfinding in dementia: some research findings and a new look at design. J Archit Plann Res 1998; 15: 133-51.
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4. Passini R, Rainville C, Joanette Y, Marchand N. Wayfinding in dementia of the Alzheimer type: planning abilities. J Clin Exp Neuropsychol 1995; 17, 820-832.
5. Reisberg B, Ferris BH, De Leon MJ, Crook T. The global deterioration scale for assessment of primary degenerative dementia. Am J Psychiatry 1982; 139(9): 1136-9.
6. Public Health England. (2014) The Human Cost of Falls. [https://publichealthmatters.
blog.gov.uk/2014/07/17/the-human- cost-of-falls].
7. Carswell W, McCullagh PJ, Augusto JC et al. A review of the role of assistive technology for people with dementia in the hours of darkness. Technology and Health Care 2009; 17 4: 281-304.
8. Riley-Doucet C. Use of multisensory environments in the home for people with dementia. J Gerontol Nurs 2009; 35, 5:43-52.
9. Mason S, Craig D, O’Neill S, Donnelly M, Nugent C. Electronic reminding technology for cognitive impairment. Br J Nursing 2012; 20 14: 855-61.
10. Diaz Moore K, Dally Geboy L, Weisman GD. Designing a Better Day: Guidelines for adult and dementia day services centres. Baltimore, MD: Johns Hopkins University Press, Stirling University, 2006.
11. Marquardt G, Schmieg P. Dementia-friendly Architecture: Environments that facilitate wayfinding in nursing homes. American J Alzheimer’s Disease and Other Dementias 2009; 24: 333-40.
12. Marquardt G. Wayfinding for People with Dementia: The Role of Architectural Design 2011; 4 2: 22-41.
13. Buxton P. How to avoid Flooring Dementia Patients. RIBA J 2018; 15 March. [
www.ribaj.com/ products/flooring-for-dementia-patients].
14. Mapundu Z, Simonnet T, Van Der Walt JS. A videoconferencing tool acting as a home-based healthcare monitoring robot for elderly patients. Studies in Health Technology and Informatics 2012; 182: 180-8.
Further reading TCHE
Buettner L, Yu F, Burgener S. Evidence supporting technology-based interventions for people with early-stage Alzheimer’s disease. J Gerontol Nurs 2010; 36(10): 15-9. Carswell W, McCullagh P, Augusto J et al. A review of the role of assistive technology for people with dementia in the hours of darkness. Technology and Health Care 2009; 17 4: 281-304. Evans N, Carey-Smith B, Orpwood R. Using smart technology in an enabling way: a review of using technology to support daily life for a tenant with moderate dementia. Br J Occupational Therapy 2011; 74(5): 249-53. Evans N, Harris N, Kuppuswamy A. A smarter future: technology to enhance
an independent lifestyle for our future selves. Int J Therapy Rehabilitation 2011; 18 12: 495-9. Pilotto A, D’Onofrio G, Benelli E et al. Information and communication technology systems to improve quality of life and safety of Alzheimer’s disease patients: a multicenter international survey. J Alzheimer’s Disease2011; 23 1: 131-41. Lancioni GE, La Martire ML, Singh NN et al. Persons with mild or moderate alzheimer’s disease managing daily activities via verbal instruction technology. Am J Alzheimers Dis Other Demen2008; 23 6: 552-62. Lancioni GE, Perilli V, Singh NN et al. Technology-aided pictorial cues to support the performance of daily activities by persons with moderate Alzheimer’s disease. Res Dev Disabil 2012; 33 1: 265– 73. Lancioni GE, Perilli V, O’Reilly MF et al. Technology-based orientation programs to support indoor travel by persons with moderate Alzheimer’s disease: impact assessment and social validation. Res Dev Disabil 2013; 34 1: 286–93. Mann WC, De Mallo MAF. Assistive technology use by the elderly in Brazil and the United States. Topics in Geriatric Rehabilitation 2010; 26 1 : 62-9. Marquardt G. Wayfinding for people with dementia: the role of architectural design. HERD 2011; 4 2: 22-41. Murphy J, Gray C M, Cox S, van Achterberg T, Wyke S. The effectiveness of the Talking Mats framework in helping people with dementia to express their views on wellbeing. Dementia: Int J Social Research and Practice2010; 9 4: 454-72. World Health Organization. Dementia. WHO, 2015. Dementia.
Dr Ghasson Shabha Dr Ghasson Shabha FCIBSE, MBIFM, PG Cert Ed, FHEA, IOSH is senior lecturer, School of Engineering and the Built Environment, Birmingham City University.
Dr Bisola Mutingwende Dr Bisola Mutingwende is lecturer in biomedical engineering, School of Engineering and the Built Environment, Birmingham City University.
Dr Kristi Gaines Dr Kristi Gaines, IIDA, ASID, is associate dean, Graduate School and associate professor, Department of Design, Texas Tech University (TTU), Lubbock, Texas
www.thecarehomeenvironment.com • November 2018
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