MORE than 350,000 Australians currently live with dementia, with the number expected to almost triple by 2050.
In light of these figures, Alzheimer’s Australia has called on the retirement living sector to turn its attention to building more dementia-friendly communities.
At the Retirement Living Summit in November, the charity’s ambassador Ita Buttrose said the sector must focus on creating communities “where people can live lives of meaning, purpose and value – and that help them remain part of the broader community”.
Ms Buttrose’s comments are echoed by two of the country’s leading experts in environmental designs for people with dementia. Jason Burton from Alzheimer’s WA and Professor Richard Fleming from the University of Wollongong have been working on the Dementia Enabling Environments Project (DEEP) since 2012.
“I’ve been working with people with dementia for nearly 26 years, and in my experience most behaviour is not due to the pathology of the dementia, but the physical and social environment the person is in,” Mr Burton said. “If you can change this, you can help.”
Mr Burton said DEEP can provide practical, inexpensive and useful ideas to architects, designers, landscapers, aged care providers and families to make the necessary changes.
“In the same way we think about how to adapt an environment for someone with a visual impairment, we need to think the same for people with cognitive impairments such as dementia.”
He said while the principles of dementia-enabled design had been around for a few years, it is still relatively new in practice. “Its not just educating people and the industry about what we need to do, but why.”
- SIZE MATTERS The scale of a building will have an effect on the behaviour and feelings of someone with dementia, from the size of doors, rooms and corridors to the number of people that person will encounter. Large buildings can be confusing and alienating. Many aged care residences are divided into village-like clusters of “cottages” with fewer residents. Smaller home sizes are associated with familiarity, improved orientation and feel less institutional.
- FAMILIARITY Personal identification with space, such as decorating a resident’s room with photos and personal and familiar belongings is encouraged. Having kitchens nearby that produce familiar smells and sounds of cooking are a good feature of a dementia service.
- GOOD VISUAL ACCESS To minimise confusion, it is vital for a person with dementia to be able to recognise where they are, where they’ve come from and where they’re going to. They need to be able to read – not remember – the environment. When they can see key places, such as the lounge room, the toilet or their bedroom, they are more able to make choices and find their way to where they want to go. This line of sight gives them the confidence to explore their environment and can reduce anxiety.
- TAKE A CUE Passive “cueing”, such as using different materials for doors, natural lighting or putting a “memory box” of collectables at bedroom doors, can give someone with dementia a cue to where they are and what they can do to minimise confusion.
- SUPPORT MOVEMENT AND ENGAGEMENT Aimless wandering can be minimised by providing well-defined pathways free of obstacles and complex decision points, making every choice a “right” one. This means no dead-ends or obvious locked doors (which could be disguised in the same colour/decoration as the wall). This path should take people past points of interest and opportunities to engage in activities or social interaction.
- REDUCE UNHELPFUL STIMULATION Because dementia reduces the ability to filter stimulation and attend to only those things that are important, a person with dementia can become stressed by prolonged exposure to large amounts of visual or auditory stimulation. When choosing colours and material for interior design, avoid bold patterns and motifs that people with dementia may perceive as actual objects. For example, a carpet with a pattern of white specks on a dark background may be distracting to a person with dementia who may try to pick the specks off the carpet, or stripes and zig-zag lines must could be perceived as moving objects. Similarly, highly contrasting colours on the floor (like in a checker-board pattern) may be perceived to be changes in floor level or holes in the ground. Highly contrasting patterns on vertical surfaces may be perceived to be changes in depth, and so should be avoided.
- SAFETY FIRST We’re not talking building high walls with barbed wire, but people with dementia need a safe environment that is easy to move around in. However, obvious safety features and barriers will lead to frustration, agitation and anger so potential risks need to be reduced unobtrusively. Think colour-coded taps, non-slip mats, and remote switches for kitchen appliances. n QUIET SPACES The creation of “quiet spaces” and nooks for a chat with friends or where they can be by themselves or read a book is important, both indoors and outside.
- LINKS TO THE COMMUNITY Without constant reminders of who they were, a person with dementia will lose their identity. Frequent interaction with friends and relatives can help. Communal spaces the visitors and residents can spend time together, such as community gardens, play centres and lounge rooms, are encouraged.
While it was vital aged care providers got on board, Mr Burton said many ideas could be adapted for home environments.
“It is a bit of a stereotype that people with dementia are all old, frail and live in residential aged care.
“What is really happening is more are living at home and accessing the community.” Mr Burton also gives tips to individuals and carers on how they can adapt their own homes.
WANT to know more about dementia- friendly design? www.enablingenvironments.com.au National Dementia helpline – 1800-100-500, www.fightdementia.org.au
