The DSDC design team recently received a request to provide design guidance for an individual diagnosed with dementia with Lewy Body (DLB). The family wished to make adaptations to their home environment to support their loved one to remain at home for as long as possible. Whilst it is common for families to want to make changes to their home to support a loved one with dementia, it is not as common that the specific type of dementia is requested. To be able to advise fully, it was necessary for our team to discuss the differences which DLB presents from other dementias and the specific challenges the built environment can present. We’d like to share this with you.
Dementia is most commonly understood to be a condition which affects our memory, but dementia can also impact on sight, hearing, balance, gait disorders, visuospatial understanding, tonal differentiation, wayfinding and hallucinations. The challenges caused by these symptoms are often compounded by other general issues of ageing, such as reduced mobility, hearing loss and impaired visual acuity. For the individual with dementia living with these impairments can result in high levels of stress and frustration
Though these are common traits, people with dementia have their own unique pathway through the condition which depends on a number of factors, including the extent of brain damage. Their experience will be affected by their general health, personality, family circumstances and ability to remain independent and maintain a quality of life. Often, their challenges in functioning are attributed to their dementia rather than on a hostile or confusing environment. Being less able to cope independently will impact on self-esteem and confidence.
Dementia with Lewy Body (DLB) is a complex condition and individuals with DLB present with a wide range of cognitive, neuropsychiatric, sleep and motor symptoms. Symptoms differ between individuals and can vary over time. Executive and visuoperceptual functions are disproportionately affected in people with DLB compared to other types of dementia whereby memory can be more affected. People with DLB are more likely to present with visual hallucinations and hallucinations in other senses (e.g., smell) and experience aggression, anxiety and depression. A high percentage of people with DLB experience motor difficulties and include stiffness and slowness of movement; freezing of gait (FOG) and falls are also common.
Some key design considerations for DLB are:
- The high likelihood of visuoperceptual difficulties for people with DLB is likely to result in mirrors, windows and other reflective vertical surfaces causing confusion which often results in responsive distressed behaviour. For many, they do not recognise their own reflection and this can result in: i) assuming someone is in the room and negatively impacting on their willingness to toilet, undress, bathe etc. and; ii) become agitated that the reflection is not engaging in their demands which can lead to physical aggression towards the reflection and thus increased risk of injury as a result.
- The increased risk of hallucinations in people with DLB means that it is important to minimise patterns in items such as flooring and wall finishes.
- Ensure that there is the potential for rooms to be made dark overnight (especially in the bedroom). Use of a blackout curtain or blind is advised. To help with glare control and to reduce reflections during dusk and night time. We also recommend a sheer fabric is provided to all windows. ‘Late day confusion’ or ‘sundowning’ is a symptom of dementia and refers to an increase in confusion and agitation in the late afternoon and evening. Voile curtains or roller blinds which can be drawn during this time can help to alleviate some of the confusion associated with reflections from the glass.
- Freezing of gait (FOG) incidences are more likely in DLB and therefore it is essential that the flooring must be consistent in colour/tone throughout including threshold strips. Where contrast exists the risk of the person perceiving a step is increased, which can lead to hesitation to cross, FOG and falls.
- Given the stiffness that can occur, it is not uncommon for the individual to shuffle as they walk. If there is a high friction floor covering (such as shag or deep pile carpet) this can increase the likelihood of falls related to “catching” of the foot on the flooring, and may also contribute to FOG.
While no one set of suggestions will fit every individual, it is important when adapting a personal environment to take into account the specific challenges they face due to their cognitive changes. It is also important to gain an understanding of a specific diagnosis which has been received and especially to consider the likely changes in ability which can occur throughout the course of that disease process, but which can also be supported through the built environment.