A better environment for those with dementia

Prof Richard Fleming.

During the Alzheimer’s 25th anniversary symposium titled “Towards a dementia-friendly Singapore”, Prof Richard Fleming, who is part of the Faculty of Science, Medicine and Health at Australia’s University of Wollongong and director of the NSW/ACT Dementia Training Study Centre, shared the 10 design principles to creating a better environment for people with dementia:

1. Unobtrusively reduce risks – People with dementia require an internal and external environment that is safe, secure and easy to move around if they are to make the best of their remaining abilities. However, obvious safety features and barriers will lead to frustration, agitation and anger, and so potential risks need to be reduced unobtrusively. “The magic word is unobtrusive,” said Prof Fleming.

2. Provide a human scale – The scale of building will have an effect on the behaviour and feelings of a person with dementia. The experience of scale is determined by three factors – the number of people that the person encounters, the overall size of the building, and the size of the individual components such as doors, rooms and corridors. A person should not be intimidated by the size of the surroundings or confronted with a multitude of interactions and choices. Rather the scale should help the person feel in control.

3. Allow people to see and be seen – An environment that allows people to see their destination will help to minimise confusion. It should also enable staff to see the patient from where they spend most of their time. This assists with the monitoring of the patient and reassures the patient of their safety.

4. Reduce unhelpful stimulation – Because dementia reduces the ability to focus on only those things that are important, a person with dementia can become stressed by prolonged exposure to large amounts of stimulation. The environment should be designed to minimise exposure to stimuli that are not helpful. The full range of senses must be considered. Too much visual stimulation, for example, is as stressful as too much auditory stimulation. “Balance stimulation, and take out clutter and replace with those that are helpful like signage and aesthetically-pleasing things,” said Prof Fleming.

5. Optimise helpful stimulation – Ensuring that those things that patient needs to be aware of are strongly highlighted will increase the chance of them being noticed and used. Providing multiple cues using vision, hearing, smell and touch will help to compensate for sensory losses.

6. Support movement and engagement – Aimless wandering can be minimised by providing a well-defined pathway, free of obstacles and complex decision points, that guides people past points of interest and gives them opportunities to engage in activities or social interaction. The pathway should be both internal and external, providing an opportunity and reason to go outside when the weather permits.

7. Create a familiar space – The person with dementia is more able to use and enjoy spaces and objects that were familiar to them in their early life. The environment should afford them the opportunity to maintain their competence through the use of familiar furniture, fittings and colours. The involvement of the person with dementia in personalising the environment with his or her own familiar objects should be encouraged.

8. Provide a variety of spaces to be alone or with others – People with dementia need to be able to choose to be on their own or spend time with others. This requires the provision of a variety of spaces that prompt a range of activities, e.g. reading alone, conversing with one or two others or engaging in larger group activities.

9. Provide links to the community – Without constant reminders of who they were and are, a person with dementia will lose their sense of identity. The best people to remind them are their family and friends. The environment should therefore provide comfortable opportunities for visitors to spend time interacting with the patient.

10. Support the values and goals of care – An environment that embodies the values and goals of care, e.g. provides opportunities for engagement with the ordinary activities of daily living to support rehabilitation goals, will assist the person with dementia to respond appropriately and the staff to deliver the desired care.

Prof Fleming also shared about two volunteer alternatives happening in Japan:
Dementia Friends – started in 2005 and is government funded. The scheme, where people get trained to become dementia friends so they can spot the signs of the illness and help sufferers, has grown from a mere one million Dementia Friends in 2008 to now six million Dementia Friends, and by 2018, they have plans for eight million friends. UK has launched a similar scheme in their country.

A ‘watch’ network – led by volunteers – who act in partnership with the police, local businesses and charities to steer ‘wanderers’ safely home. It provides invaluable support and reassurance for carers and families – as well as the essential safety net for those living with dementia. Evidence of its need and success is reflected in the fact that 61.3 percent of Japan’s 1,741 local authorities embrace this scheme.

Useful related resources (first three provided by Prof Fleming and last two provided by another symposium participant):
• www.enablingenvironments.com.au
• BEAT-D (Built Environment Assessment Tool: Dementia) by University of Wollongong (available on iPhone/iPad) – This app will guide you through the use of the Environmental Audit Tool (by NSW Health), invite you to photograph key parts of the environment and send your data for processing. A report comparing your facility with 56 other facilities and identifying areas for improvement will be e-mailed to you along with an invitation to discuss the results with an expert in the design of facilities for people with dementia. This service is provided by the NSW/ACT Dementia Training Study Centre, which is supported by the Australian Government. There is no charge.
• Dementia Friendly Community – Environment Assessment Tool booklet – can be downloaded on this website – www.enablingenvironments.com.au/audit-tools.html
• Nollvision – Anhörig – an iPhone app with information/course on dementia
• Home-like environment checklist for a dementia-friendly environment – www.health.vic.gov.au/dementia/strategies/home-like-environment-checklist.htm




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