Environmental Design Ideas for People Living with Alzheimer’s Disease and other Dementias: Research Updates!
Many people with Alzheimer’s Disease (or other dementias) live at home and are cared for by family, friends, or professional caregivers. They live with a variety of challenges that range from mild through severe functional limitations in nearly all areas of life (i.e. thinking skills, motor skills, safety, behaviors, communications, ect…). “Environmental design” means planning the world around a person; for people with dementia this includes this home environment in which a person lives. There are several effective ways to modify a home that can improve safety and comfort at home, as well as make caring for a loved one with dementia easier.
The American Journal of Occupational Therapy published a review about the effectiveness of environment-based interventions for people with dementias (Jensen and Padilla, 2017- *reference at end of post), here are some key points to share, along with some practical application ideas:
A “person-centered” approach with customization to each person’s unique needs is most effective.
-This is one of the reasons that many people with dementia do best staying in their own homes as long as possible because this environment is personalized to them.
-A person-centered approach is a process through which effective ideas are brainstormed and implemented that are unique to each person’s needs and preferences. There is no “right” way or manual that can tell you what to do, but instead a trained professional (like an OT) is needed to guide through the process. Learn more about OT’s role in home modification process here.
Noise regulation- Controlling the amount and type of noise in an environment can help improve behavior.
-Considering using white noise (either with a white noise machine or through speakers system) to block out undesirable noises.
-Music can be effective in improving behavior. This includes ambient music to reduce agitation, anxiety, wandering, and irritability and more stimulating music to increase activity and participation. How? Use a traditional music system with speakers or install wireless speakers in specific rooms. Create an activity area, such as a living room space, with access to familiar and preferred music (maybe favorite music selections from when a person was younger).
What is Alzheimer’s Disease and Dementia?
Alzheimer’s Disease is the most common form of dementia. Dementia is a progressive, chronic health condition of the brain that leads to declined cognitive (thinking) skills over time. Dementia generally last for many years, being most common in the last few decades of life. Loss of cognitive abilities leads to ability to do regular tasks around the home and decreased safety. Dementia will affect all areas of functioning over time, including thinking skills, motor skills, communication abilities, and safety and behavior.
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-Adding or changing one sensory component did not generally show a positive effect in the research (such using bright lights or adding aromatherapy), but using multi-sensory techniques did show positive effect.
-Enriched sensory environments provide healthy participation activities for people with dementia, but there is a need to personalize to an individual’s sensory preferences and needs. In a home, this would mean examining the sensory environment and trying to create a variety of comforting and engaging experiences through the use of lights, sounds, smells, and touch experiences. For example, imagine this sensory experience: sitting on the couch under a soft, warm blanket, watching and listening to a fireplace crackle, with a decorated Christmas tree nearby, and soft music playing.
-Plan for cues in the environment that clearly tell someone how to use the room. This means making sure dining rooms look like a place to eat, bedrooms look like a place to sleep, and that a person’s personal space looks familiar to them.
-Use unobtrusive visual barriers to reduce interest in and walking to non-desired areas. An example would camouflaging a door or hiding door knobs to prevent exiting. See some examples here.
-Making desired areas very apparent, such as a clear and well lite pathways to toilet areas and dining spaces.
There is inconclusive evidence for the following ideas (meaning they might be worth a try, but there isn’t research to say it is or isn’t effective):
-Wandering garden may help people who enjoy walking by allowing unrestricted areas for movement. Pathways that are continuous in circular formations gently guide a person while maintaining engagement in a task. See some visual examples here.
-Increasing lighting through the use of bright lights may increase attention and engagement. This may be particularly true in darker areas (such as showers) where increased light may decrease fear and anxiety.
-Making functional items available for use throughout the environment- this means planning and putting out functional activities/items to engage people. In people’s homes this means finding safe and familiar activities that can be left out in the environment for easy access. An example might be having a basket of small linens to fold sitting on the couch.
*Jensen, L. and R. Padilla (2017). Effectiveness of environment-based interventions that address behavior, perception, and falls in people with Alzheimer’s Disease and Related Major Neurocognitive Disorders: A systematic review. American Journal of Occupational Therapy, volume 71 (5). (paid access only)