Environmental Design for Community Dwelling Elders with dementia

Gradual decline in cognitive function is the hallmark of Alzheimer's disease with decline in memory, reasoning, calculation, language and decision making. This poses a challenge to both elders with dementia and caregivers as their day-to-day living, e.g. housework, cooking, managing money, and placing objects becomes more difficult. Most elders with dementia compensate for the deficit by following habitual routines that have been preserved in their long term memory. In the late stage, self-care ability is lost and they become fully dependent on caregivers. In addition to personal care in daily living, a structured daily routine, appropriate activities and a well designed home environment can promote safety and maintain residual skills to facilitate self care as far as possible.

A good environmental design can compensate for some of the cognitive impairment faced by elders with dementia. A familiar safe, supportive, and stimulating environment can facilitate the elder's engagement in daily activities, reduce task difficulty, enhance participation and delay further decline in daily living skills hence helping caregivers to ease stress as well. More support, encouragement and empathy from caregivers can promote wellness and dignity for elders' remaining days.

Online videos - Dementia: Environmental modification.

Strategies in Environmental Design

Maintain a familiar living environment

A familiar living environment for elders with dementia can provide a sense of security and comfort. It can help to stimulate memory and preserve residual function. Avoid changing furniture or home renovation unnecessarily.

Same location for household objects

Elders should develop the good habit of putting household objects such as clothes, shoes, wallets and keys in same designated place. This enables easy retrieval and reduces the chance of misplacing them.

• Objects for daily living should be placed in the order of use. This facilitate elders to perform task independently. For example, lay out clothes in the order they are to be put on to ensure accurate wearing, especially after bathing. This can encourage independence in dressing.

Safe Environment

Simple environmental improvements can significantly reduce the risk of domestic injuries. Examples include installing handrails in the bathroom, keeping the floor dry, using non-slip shower mat to prevent falls; reducing clutter and keeping hallway clean to reduce the risk of accidents etc. A well-lit and quiet environment avoids unnecessary distraction and enables the elder to pay attention.

• Some elders with dementia may not be able to recognize their own image in the mirror resulting in agitation. In such case, simply remove the mirror or cover it with a cloth.
• Clear French windows can be a danger. By installing window grilles or putting decorations can minimize the risk of elders bumping into them.
• Scissors, sharp objects, bleaching agents and cleaning solvents should be stored properly in order to avoid accidents.

Environmental Cues

Labeling cupboards and doors can assist elders with dementia to locate items and find their way. Such labels may use simple wordings, picture and distinctive color. Combination of colorful pictures and words can be used for easier understanding.

For example, put a label with the word "underwear" on a drawer to help elders to locate their underwear, and sticking a picture of the toilet bowl or a label with the word "toilet" can be placed on the toilet door as a reminder. By sticking a strong contrasting color strip on the toilet seat, demented men may be able to aim more accurately.

Many elders may experience distorted visual perception with strong color and light contrast, e.g. they may avoid walking near the dark shadow on the floor, believing it to be a hole in the floor, and light reflection on the floor may be misinterpreted as "wet floor". Therefore, caregivers should avoid placing dark mats on light colored floors or glossy floor surfaces. On the other hand, skillful use of color contrast can help elders to distinguish the environment, e.g. a bright yellow "anti-slip tape" on a dark threshold can highlight it clearly to avoid tripping.

Environmental Stimulation

A stimulating environment can reinforce elders' sense of identity and facilitate integration in daily living. Past photos, ornaments and other souvenirs can trigger reminiscence which would strengthen their old memories and stimulate interests in life, help to slow down the degeneration process.

Festival decorations can help elders to orientate to time and place. For examples, hang lantern during Mid-Autumn Festival, install a Christmas tree during Christmas etc. Display past photos, favorite ornaments and other souvenirs to remind elders of their past. These can also trigger for discussion and sharing. Avoid "over stimulation", display limited items, as too much decoration may confuse the elders. There is also no need to change them frequently.

Conclusion

It is a challenge to provide quality care for elders with dementia. In order to provide a safe, fulfilling and stable living, caregivers should try to understand elder's needs and be ready to adapt to changes as their condition deteriorate. Love, acceptance and patience are the essence in care for elders with dementia. However, caregivers should not neglect their own needs. They should learn caring skills to understand the disease process, seek support from family and community services and expert input wherever necessary so as to reduce caregiver stress.