Design & Dementia

Posted January 22, 2016

Many factors affect a person’s ability to manage and interpret their environment. This is particularly relevant for older adults with dementia and can have profound implications for falls.  This short article will highlight a few physical design interventions that can have an impact on persons living with dementia including issues from low level lighting and poor vitamin D synthesis to appropriate flooring choices. 


Persons with dementia fall at a greater rate than those without dementia, are more likely to be seriously injured, and are at a higher risk of LTC home placement due to falls.(1) Several experts identify an association between cognition and gait, and there are studies linking falls in persons with dementia to issues as diverse as the challenge of dual task performance, and inadequately treated pain.(2, 3, 4) There can be little doubt that no matter the cause of dementia-related falls, a well-designed environment that is sensitive to the needs of persons living with dementia can provide a safer, more positive experience for them and their carers.


As persons age there are a number of “normal” age-related changes to vision that may be anticipated, including a decline in depth perception, increased sensitivity to glare, increased lighting requirements, reduced contrast sensitivity, difficulty transitioning between dark and  light environments, and decreased colour sensitivity. (6,7) Additionally, age-related co-morbidities such as cataracts, glaucoma and macular degeneration can affect central and peripheral vision and visual acuity. (5,6) Age is the greatest risk factor for Alzheimer’s disease and related dementias (ADRD); therefore, changes to vision due to aging eyes coupled with problem solving and perceptual difficulties associated with ADRD,  emphasize the need for appropriate lighting to assist with positive perceptions and interpretations of the environment.  As highlighted in a Lighting Literature Review conducted by the Murray Alzheimer Research and Education Project (MAREP) and posted on the BrainXchange Design and Dementia webpage. 



  • Inadequate vitamin D (from sun exposure) is correlated with a reduction in bone density and increased risk of falls.

  • Individuals challenged with low levels of lighting (e.g., most LTC Homes) are at an increased risk of falls

  • Disrupted circadian rhythm leads to disrupted sleep patterns that may cause individuals with dementia, to have an increase in late night activity (8)


It is thus very important to provide daily access to the outdoors for persons with dementia,  to help with Vitamin D production, reduce evening behaviours and encourage better sleep routines


Regarding vision, the full extent of the effect of Alzheimer’s disease on vision and visual processing is still unclear, although problems with depth perception have been shown to worsen in persons with Alzheimer’s (9). Misperceptions and difficulty accurately interpreting the environment may be influenced by low lighting, shadows, and glare which may lead to fear and responsive behaviours as well as balance issues.


In this connection the following are suggested:



  • When using carpeting use solid colours with no large patterns and no micro patterns in order to avoid falls (e.g. if people reach down because they perceive there are objects  to pick up )

  • If using tile instead of carpet, consider that the acoustics will change and become noisier - fabric chairs or other furniture/wall hangings/drapes may help to absorb some noise.

  • If using hardwood, or synthetic wood-or stone flooring, ensure it does not have swirls, knots or discolourations that people might feel a need to step around or over. Clutter, whether visual or physical, can lead to falls.

  • Consistency in the colour and light reflective value of the flooring is important to consider (e.g. ensure similarity with nearby  flooring); in areas used by persons living with dementia, avoid thresholds and colour transitions between rooms (e.g. important to look at the visual threshold of the kitchen tile)

  • Avoid glare off of the flooring and walls

  • Consider issues related to contrast and surrounding walls


In addition to  our tools on the BrainXchange, other helpful resources include materials from Stirling University as well as a recent Canada Mortgage and Housing Corporation guide on housing options for persons with dementia. For further information on flooring, walls and ceilings please refer to the work being done in Australia by the Department of Health for the State of Victoria.


The Design and Dementia Community of Practice (CoP) meets the last Friday of every month by teleconference and web-based technology to discuss aspects of environmental design (physical, social, cultural) and its impact on persons living with dementia and those who partner in their care. We welcome all interested parties to come and join us.


Interested in this topic? Contact us:



 


References



  1. Shaw, F. (2003) Falls in Older People With Dementia. Geriatrics & Aging. Vol 6, No. 7

  2. Dr. Manuel Montero-Odasso et al. (2015), Mobility and Cognition in Seniors. Report from the 2008 Institute of Aging (CIHR) Mobility and Cognition Workshop, Canadian Geriatrics Journal, Vol 18, No 3

  3. Blyth FM., Cumming, R., Mitchell, P., Wang, JJ. (2007), Eur J Pain,Vol 11, No. 5, p 564-571

  4. Leveille SG1, Jones RN, Kiely DK, Hausdorff JM, Shmerling RH, Guralnik JM, Kiel DP, Lipsitz LA, Bean JF. (2009) Chronic musculoskeletal pain and the occurrence of falls in an older population. JAMA. Vol. 302 No. 20. pp: 2214-21 

  5. Age Related Vision Problems: The Mayo Clinic website accessed at: http://www.mayoclinic.org/healthy-lifestyle/adult-health/multimedia/vision-problems/sls-20076758

  6. Zacks D (2006). Why Does Eyesight Deteriorate With Age? Scientific American accessed at: http://www.scientificamerican.com/article/why-does-eyesight-deterio/

  7. Owsley C, (2011). Aging and Vision. Vision Research Vol. 51 No. 13. pp: 1610-1622

  8. Brawley, E.C. (2001). Environmental design for Alzheimer’s disease: A quality of life issue. Aging & Mental Health, 5(Supplement 1), S79-S83.

  9. Noell-Waggoner, E. (2002). Light: An essential intervention for Alzheimer’s disease. Alzheimer Care Quarterly, 3(4), 343-352.

Content Related To: carpet, Dementia, Design