# Chapter 9

## Creating a More

### Dementia-Friendly Environment

> As residents age in place, many will experience dementia in themselves
> or their spouses. A dementia-friendly environment allows these
> residents to remain independent far longer than in an unfriendly
> environment. Dementia-friendly designs accommodate both the sensory
> changes associated with normal aging and the cognitive changes
> associated with dementia.

### General Principles of Good Design for Older Persons

+----------------+---------------------------+-------------------------+
| **Body         | **Changes Commonly        | **Design Implications** |
| System**       | Observed**                |                         |
+----------------+---------------------------+-------------------------+
| Vision         | -   Less light reaches    | -   Use brighter        |
|                |     retina                |     illumination        |
|                |                           |                         |
|                | -   Slowed adjustment to  | -   Provide a place to  |
|                |     changes from dark to  |     stand or sit at     |
|                |     light                 |     entrances and       |
|                |                           |     brighter light at   |
|                | -   Altered color         |     transition areas    |
|                |     perception            |                         |
|                |                           | -   Blues and greens    |
|                | -   Greater sensitivity   |     are hard to         |
|                |     to glare              |     differentiate       |
|                |                           |                         |
|                |                           | -   Use matte           |
|                |                           |     treatments on       |
|                |                           |     surfaces and        |
|                |                           |     control light from  |
|                |                           |     windows             |
+----------------+---------------------------+-------------------------+
| Hearing        | -   More difficulty       | -   Use sound-absorbing |
|                |     hearing higher        |     materials,          |
|                |     frequencies           |     particularly in     |
|                |     (including voices)    |     public areas        |
|                |                           |                         |
|                | -   Reduced ability to    | -   Minimize            |
|                |     discriminate between  |     unnecessary noise   |
|                |     sounds                |                         |
+----------------+---------------------------+-------------------------+
| Thermal        | -   Increased sensitivity | -   Keep temperatures   |
| regulation     |     to drafts and chills  |     warm                |
|                |                           |                         |
|                |                           | -   Seal windows and    |
|                |                           |     doors               |
+----------------+---------------------------+-------------------------+
| Tactile        | -   Decreased manual      | -   Avoid small door    |
| sensation      |     dexterity             |     handles, latches,   |
|                |                           |     and key rings       |
+----------------+---------------------------+-------------------------+
| M              | -   Diminished strength,  | -   Chairs should have  |
| usculoskeletal |     more difficult to     |     arms that extend to |
|                |     rise from a chair     |     front edge of seat  |
|                |                           |     and no cross bar    |
|                | -   Lowered stamina,      |     between front legs  |
|                |     cannot walk as far    |                         |
|                |                           | -   Provide seating     |
|                |                           |     along paths         |
+----------------+---------------------------+-------------------------+
| Balance        | -   Greater difficulty    | -   Use night-lights    |
|                |     maintaining balance,  |                         |
|                |     particularly in the   | -   Provide things to   |
|                |     dark or on uneven     |     hold on to near     |
|                |     surfaces              |     bed, bath, and      |
|                |                           |     toilet              |
+----------------+---------------------------+-------------------------+
| Gait           | -   Feet raised less      | -   Fix uneven floors   |
|                |     during walking        |     and tape down rugs  |
+----------------+---------------------------+-------------------------+

#### Additional Environmental Design Tips For Dementia

#### Doors and hallways

-   Hang pictures, photos, or novelty items to personalize apartment
    doors to help residents differentiate their living space from
    everyone else's.

-   Use realistic graphics and keep signs simple, because the person may
    not be able to comprehend complex language.

-   Use prominent numbers and distinctive artwork at the entryway to
    elevators to help residents distinguish one floor from another

#### Hallways and floors

-   Make hallways distinct by placing artwork or pieces of furniture at
    key intersections (if allowed by code).

-   Provide handrails in hallways and grab-bars in bathrooms.

-   Make sure that floors are not slippery or do not have the appearance
    of being slippery by being highly polished.

-   Provide gradual transitions when changing flooring material (e. g.,
    a transition from a hard surface to carpeting) to minimize falls,
    and provide a handrail or other support in these areas.

-   Avoid using very dark-colored rugs or dark color patches on a
    patterned rug. The person may interpret these areas as a hole and
    either attempt to step over (risking a fall) or refuse to traverse
    (freezing in place).

-   Avoid wallpaper and borders with strong, busy patterns.

-   Avoid the use of mirrors or mirror tiles.

-   Have baseboard treatment (often vinyl) match the color of the lower
    part of the wall as opposed to the floor.

#### Windows and Steps

-   Place contrasting colored rugs in front of doors or steps to help
    the individual anticipate staircases and room entrances, but avoid
    very dark colors.

-   Apply colored decals to glass doors and large windows.

-   Place a colored stripe on the edge of steps to help the person see
    each step.

#### Kitchen and Appliances

-   Provide separate power controls for stoves and ovens, and consider
    automatic shut-off devices for appliances such as an iron, toaster
    oven and coffee maker.

#### Lighting

-   Create an even level of lighting. Add extra lighting in entries,
    outside landings, areas between rooms, stairways and bathrooms
    because changes in levels of light can be disorienting to the
    individual with Alzheimer's.

-   Diffuse bright light. Reduce glare by covering windows with blinds,
    shades or sheer draperies to block bright sunlight. Avoid using bare
    light bulbs or clear decorator bulbs without shades.

-   Install special lighting. Place night lights in hallways, bedrooms
    and bathrooms to prevent accidents and reduce disorientation.
    Illuminated light switches and timers for lights in these areas can
    also assist the person at night.

#### Bathrooms

-   Locate a toilet adjacent to each public area.

-   Increase the contrast between the toilet and floors and walls by
    changing the color of the flooring or walls or by using a colored
    toilet seat.

-   Increase the contrast between the sink and counter top.

-   Use large, easily visible sink handles.

-   Set hot water temperatures at 120 degrees and consider installing
    automatic-mixing or anti-scalding devices to the faucet.

#### Furnishing

-   Minimize crowded furnishings and visual clutter. It will confuse and
    overstimulate the person.

-   Maximize the contrast between the floor and chairs (particularly
    seats) and between the floor and table surfaces by differences in
    both color and hue.

Source

1.  *Key Elements of Dementia Care,* Alzheimer's Association and Related
    Disorders Association, Inc., 1997.

# Resources And Further Reading

1.  *The Complete Guide to Alzheimer's-Proofing Your Home,* by Mark L.
    Warner, Purdue University Press, 1998.

2.  *Homes That Help,* by Richard V. Olsen, et al., New Jersey Institute
    of Technology, 1993.