This evidence theme on dementia-friendly environments is a summary of one of the key topics identified by a scoping review of dementia research. If you need more information on this topic, try using the PubMed search below.
Multiple reviews focus on the impact of dementia-friendly environments. [2, 4-14] Some have focused on the fixed architectural features of the environment such as size and layout. Others have investigated interior features that can be modified such as furnishings, lighting, the colour of the decor, and levels of noise.
Smaller facilities
Small-scale environments accommodating around 5-15 people living with dementia have shown some promise in:
- Supporting people to undertake daily tasks and maintain physical function. [5, 11]
- Improving mood and reducing depressive symptoms. [2, 5]
- Increasing quality of life. [6]
- Engaging people in tasks, leisure, and outdoor activities, including exercise. [4, 5, 11]
- Encouraging social interaction and communication, possibly through the closer proximity of communal areas with activities. [2, 4, 6]
- Creating opportunities for staff to provide more individualised attention and care. [2]
Findings were inconclusive about the impact of this type of accommodation on responsive behaviours such as agitation. This is because the smaller homelike environment decreased agitation in some studies [2], but increased agitation in others [5], or showed no effect either way. [2, 9]
One review suggests that small-scale shared housing may best suit people at the earlier rather than later stages of dementia. [5]
Interior design features
A homely character
Numerous studies have described a positive relationship between physical living spaces with a homelike, non-institutional character and improvements in the quality of life and wellbeing of people living with dementia. [6] People also appear to spend more time in home-like communal areas where they are more socially engaged and independent in their activities. [4] Several studies found an increase in food consumption by people with dementia at mealtimes when the atmosphere of the dining room was made more homelike. [11]
Some other dementia-friendly design features supported by evidence include:
- Furniture set out in an arrangement that stimulates social interaction [6]
- Areas with clear access to outdoor areas and nature [11, 12]
- Homelike décor that includes personalised objects such as photographs, visual stimuli such as colours, mood lamps, and fish tanks, and occupational stimuli including books, games, and magazines. [6]
Personalised spaces
There is strong evidence that providing residents with private, rather than shared, bedrooms increases the satisfaction of families and staff while improving residents’ quality of life and their ability to perform daily activities. [6]
Environmental cues for navigating the space
Several reviews found that it was important to provide people with dementia with ways to orient themselves in the space and find their way around the home. Wayfinding strategies backed by some evidence include:
- Using informative pictures such as posters and murals on walls [9]
- Installing furnishings that clearly indicate the purpose of each room
- Labelling cupboards, and drawers to indicate their contents [4]
- Providing plenty of access to natural sunlight and views to the outside in places where people move from one space to another (e.g., hallways) [6]
- Having a straight or L-shaped circulation system [2, 11], but without long corridors [2]
- Creating direct visual access to important places such as toilets [9]
- Zoning different areas and giving each its own unique character [9]
- Setting up a small number of doors and exit points [9, 11]
- Having communal spaces close by [2]
- Using contrasting colours between furniture or handrails and the walls behind them if you want these features to stand out as visual cues. [1]
- Installing assistive technology with lights and remote-controlled sounds to cue wayfinding. [11]
The home environment might also be modified to deter people with dementia from using certain areas, such as external exits. [9] For example, putting horizontal grids of black tape on the floor in front of exit doors and camouflaging doorknobs have shown moderate effectiveness in discouraging people from using them. [9] However, staff might want to consider the impact on people’s wellbeing of restricting freedom of movement in this way. [11]
Freedom of movement
Compared to closed residential aged care homes, semi-open and open homes have been shown to have a positive influence on bodily functions, mental functions and perception, quality of life and social participation. The influence on daily functioning and spiritual/existential health are unclear. Having access to a garden has also been found to be beneficial in reducing agitation in people with dementia. [13]
Sensory features
Some reviews reported on the benefits of modifying ambient noise, light, heat, and colours to reduce responsive behaviours. [4, 6-8, 10]
Noise levels
Studies of noise levels in residential aged care have found them to exceed recommended thresholds and to be at levels likely to have a negative effect on both staff and residents. [8] This high level of noise was usually made by staff, other residents, and electronic appliances. [8]
For people living with dementia, daytime and night-time noise in the facility has been shown to lead to increased agitation and apathy, fewer social interactions, and sleep disturbance. Meanwhile, staff report feeling more irritable, anxious, and lacking concentration during times of high noise. [8]
There is moderate evidence that noise reduction in residential aged care settings can reduce responsive behaviours such as agitation in people living with dementia. [9, 14] Specific types of noise can also have a beneficial effect. For example:
- Natural sounds, recorded or otherwise, have been shown to reduce agitation and aggression.
- The sound of a care worker singing along to music during morning care tasks can increase positive emotions and reduce aggression.
- Soothing background music during dinner times can increase food intake and reduce irritability and depressed mood scores. [8]
Light levels
There is no conclusive evidence that the level of indoor light can influence responsive behaviours or improve sleep quality. However, several studies have demonstrated that indoor light may influence mood [7, 9], and quality of life [1], and help people orientate their space. [2] Furthermore, a very cool light of moderate intensity has shown some promise in reducing agitation. [7] However, at its most basic, people need good, strong lighting (preferably natural and without glare) to be able to see properly.
