When most people are asked about the symptoms of dementia they know it is related to memory loss. But when you live with dementia every day or support someone who is living with dementia you quickly realise that memory loss is just one part of the complex nature of dementia. As well as causing changes in communication and sometimes in behaviour, when structural changes happen in the brain it impacts on how the individual understands and moves through their environment. These challenges can sometimes lead to isolation, loss of independence, decreased mobility, and faster cognitive decline. However, research has shown us that there are ways in which we can make the environment more easily understood, and more supportive of independence in people living with dementia.
There are a few basic principles that can be particularly helpful when applied to the environment in a domestic setting. One of the first things to consider are ways of reducing anxiety caused by the environment for the person living with dementia. One of the impacts of dementia is increased levels of stress, especially as the person with dementia is having to work harder and harder to process the sensory information they are taking in. Because of the overall increased levels of stress it becomes more important to find small ways of reducing stress caused by the environment for the individual. This can take the form of increasing light levels so the person can better see where they are going, or it may entail leaving the toilet door open when not in use to make the location of the toilet more visible. It may also mean covering highly reflective surfaces like mirrors and TV screens (when not in use) as for some people it can be difficult to process those reflections and lead them to believe that strangers are in their home.
A second consideration is that of clear visibility. This is essential in supporting independence and confidence as well as aiding short term memory. For instance, if someone is an avid tea drinker, and has always made themselves cups of tea throughout the day, this activity can be supported by leaving the needed supplies and equipment in view. That way no searching is needed and the person can focus on the task of making tea without becoming distracted. Particularly in the kitchen this consideration can help the individual maintain their independence. By installing glass fronted cupboard doors (or removing the doors altogether) it becomes easier to locate where items are stored in the kitchen, reducing the need for searching.
An element of visibility that is not always understood and recognised for its disabling affect, is the decreased sensitivity to colour contrast that some people experience. This means that if a colour is close in tone to the items around it, the individual may have difficulty ‘seeing’ the boundaries of the object. This is not necessarily due to eye function (though it can be impacted by eye function) but is related to visual processing in the brain. In order to support better independence, pay attention to things that need to be seen. For instance if you have an all white porcelain bathroom suite, it may benefit the individual to have a coloured toilet seat, coloured toilet paper, a coloured bar of soap, and a coloured hand towel. When there is not enough colour contrast present, important elements may be indistinguishable from the items around them.
Another thing to consider within the home environment is how to reduce confusion and minimise distractions by controlling the level of sensory information. When there are too many kinds of sensory input for the brain to process, it can make concentration on a single task much more difficult. Ways that this can be altered can be as simple as turning off the television or radio before having a conversation to reduce the amount of audio information present in the environment and helping the individual to concentrate on what is being said. The individual may also find it easier to manage tasks without background noise distracting them. Equally, trying to concentrate on a task with many ‘to-do’ notes posted around can also be very distracting. Make sure that any reminders that are in view are essential and in the appropriate place to remind the person at a time when it is needed. But try to keep areas when complex tasks happen (such as cooking) relatively free of distracting memos.
A further element to take account of is how to make changes to the environment easy to use and understand. Though this might seem unnecessary given that the individual makes their home in this space and has likely created habits and systems for the use of that space, but consider what can happen when new elements are introduced. For instance when a new television remote is purchased, the individual may struggle to learn new sequences of buttons that need to be pressed. If you cannot find a an exact replica of the old remote, then make sure that the new remote is easy to use and simple to understand as this is going to be essential to aid the learning process and maintaining independence when using the television. As is probably the case for most of us, the fewer buttons, the better! But this should also be a consideration when purchasing new furniture, or moving around the arrangement of a room, which can be particularly disorienting if an individual has forgotten about the change.
For more top tips on improving the home environment, visit our environment section on the dementia information hub, or find more practical solutions in our resource: 10 Helpful Hints for dementia design at home.