Fixtures and fittings
The design of fixtures and fittings within the home is important. Good design can ensure that those people with sight loss and dementia are able to easily identify and use fixtures and fittings in their homes. Well designed fixtures and fittings can facilitate independent living. For example, providing user-friendly kitchen devices may encourage people to prepare their own food, and suitable handrails and grab rails will support people to move independently around their homes.
What do the ticks mean?
helps or is of benefit to most people
helps or is of benefit to some people
helps or is of benefit in specific circumstances
means that this aspect of design needs to be considered carefully before being adopted
Handrails and grab rails
Handrails and grab rails can be helpful throughout the home but are particularly important near external and internal stairs and in bathrooms or toilets. Where these are positioned at stairs they should extend beyond the first and last steps before coming to a clearly defined end.
Having handrails and grab rails in a colour which contrasts with the background can make them easier for people to locate and to use.
Some people with sight loss and dementia may find tactile markers useful as a way to navigate round their homes, e.g. plastic bumps stuck to the underside of handrails to signal key points such as the proximity of doors on the opposite side.
Rugs and mats
Rugs and mats present potential tripping hazards and removing them can contribute to greater safety in the home. For a variety of reasons some people may wish to retain particular rugs or mats despite the hazard that they pose, and an appropriate balance should be sought between managing potential risk and respecting people’s rights to choice in their own homes.
Controls (e.g. on appliances or for central heating)
Providing the most appropriate types of controls and switches in the home supports independence.
Positioning controls for ovens and cookers at the front of the appliance makes it easier for people to identify the controls and to operate them safely.
People find that control panels with tactile markings, and audible confirmation when keys are depressed, are easier to operate.
Larger LCD screens and print sizes make digital controls easier to use.
Some people may find that analogue controls are easier to use than digital controls. Consideration should be given to individual preferences when deciding on the type of control that will be used.
Some people may benefit from heating controls which allow for the manual entry of a desired temperature.
Light switches and electrical sockets
Light switches and electrical sockets should be positioned to be easily accessible. Sockets which are raised off the floor are easier to locate and use. Switches with clear on and off positions allow users to feel more confident that a switch is appropriately set.
Flexible accommodation enables people with changing needs to remain in their homes for longer. Additional electrical sockets placed around the room allow mobile lighting or assistive technology to be used.
People find colour contrast with the background helpful in locating and using fittings. Contrasting coloured fittings or coloured back plates should be used to highlight switches and sockets within the home.
Some people may find switches on double sockets difficult to operate and single sockets may be a better option.
Full control of lighting is important, because people’s lighting needs change throughout the day. Some people may prefer dimmer switches to allow more control of lighting levels.
People feel more at home when they have familiar objects around them. In care home settings it is important that residents are able to personalise the furnishings in their rooms.
There may be times when it is necessary to move care home residents into different bedrooms (e.g. to provide access to particular facilities or a higher level of care). People may find this transition easier where the furnishings in one room are consistent with furnishings in the other room.
People benefit from appropriate assistive technology and both individual homes and care homes should be designed to allow for this. For example, the provision of technologies such as emergency assistance alarms, gas monitors in kitchens and water overflow sensors in bathrooms can provide peace of mind both for people in whose homes they are installed and for their carers.
Care homes should make use of appropriate signage as this helps people to find their way around.
Meaningful symbols and signifiers used around the home can help people to locate particular rooms and objects more easily. For example, a sponge or facecloth on the bathroom door acts as a prompt as to the room’s purpose.
In care homes and group accommodation with many similar doors, numbering helps some people to identify their own rooms more easily. Numbers can be incorporated with other signage, such as name plates, and signifiers such as a photograph of the room’s resident.
Signage may also help people living in their own family homes to find objects more easily, e.g. on labels identifying contents on the outsides of storage containers and kitchen cupboards.
Colour and contrast
Colour and contrast help people to identify specific furnishings and fittings more easily.
Having electrical sockets, lighting controls, heating controls, control panels, and furniture in colours or shades that contrast with the walls helps people to locate fittings and to orientate themselves to their surroundings.
Points for reflection and further consideration
People’s views should always be sought and due consideration should be given to individual choice. For example, it is suggested that in the interests of safety, rugs and mats should be removed, but this may not be the person’s own preference. In such circumstances there is a need to balance management of risk against people’s rights to make independent choices.
The information about controls and switches used to create these guidelines came primarily from the findings of research on the needs of people with sight loss, rather than on studies which looked at people with both sight loss and dementia. Those people who completed the survey carried out as part of this study were unsure about their applicability to some people with dementia. Users of these guidelines should give due consideration to this when considering potential changes.
We conducted a structured literature review which involved systematic searches of a wide range of electronic databases, complemented by consultation with expert informants who were asked to recommend materials (such as reports) that the searches might not have identified. The searches yielded 14,616 ‘hits’. 14,043 were discarded as either duplicates or not relevant, and the remaining 573 were scored for relevance on the basis of title and abstract. In total 33 publications were included for full text review: 28 based on relevance scores, and 5 items recommended by expert informants.
These were systematically evaluated using a proforma which enabled assessment of the quality of the research reported, and assembled key information regarding the subject matter, results and conclusions of each item. The quality criteria used to assess different types of research were drawn from standard protocols including Centre for Research and Development (CRD) Report No 4, Cochrane Effective Practice and Organisation of Care (EPOC) checklists and, as appropriate, Critical Appraisal Skills Programme (CASP) assessment criteria (NHS CRD 2001; Cochrane EPOC 2002; CASP undated). Each publication was rated as being of High, Medium or Low quality, based the extent to which the research as reported in the publication meets the relevant quality criteria, and an overall rating was provided for each of the sections within the guidelines. Publications rated as being of lower quality are still of evidential value, but should be regarded as providing suggestive rather than definitively evidenced findings.
We assessed the overall quality of published evidence for guidelines in this section as Low. We based the guidelines on evidence contained in the following publications:
- Goodman, C. and Watson, L. (2010) ‘Design guidance for people with dementia and for people with sight loss’, Thomas Pocklington Trust Research Findings Number 35 [document on the internet]. December 2010 [cited 2013 Nov 29]. Available here (and full report available on request from Thomas Pocklington Trust).
- Kiata, L., Kerse, N M., Hughes, W.E., Hayman, K J., Robertson, M.C., La Grow, S. and Campbell, A.J. (2008) ‘Agreement and compliance with advice on removing mats or rugs by older people with visual impairments’, Journal of Visual Impairment & Blindness, 102(3), 167-172.
- Kondo, T., Mann, W.C., Tomita, M. and Ottenbacher, K.J. (1997) ‘The use of microwave ovens by elderly persons with disabilities’, American Journal of Occupational Therapy, 51(9), 739-747.
- La Grow, S., Robertson, M.C., Campbell, A.J., Clarke, G.A. and Kerse, N.M. (2006) ‘Reducing hazard related falls in people 75 years and older with significant visual impairment: how did a successful program work?’, Injury Prevention, 12(5), 296-301.
- Lawrence, V. and Murray, J. (2009) ‘Promoting independent living among people with dementia and sight loss’, Journal of Care Services Management, 3(3), 261-274.
- Littlefair, P. (2010) ‘Daylighting and windows in homes of people with sight loss’, Thomas Pocklington Trust Research Findings 30 [document on the internet]. March 2010 [cited 2013 Nov 29]. Available here (and full report, available on request from Thomas Pocklington trust).
- Long, R.G. (1995) ‘Housing design and persons with visual impairment: Report of focus-group discussions’, Journal of Visual Impairment & Blindness, 89(1), 59-69.
- McNair, D., Cunningham, C., Pollock, R. and McGuire, B. (2010) ‘Light and lighting design for people with dementia’, Stirling: University of Stirling, Dementia Services Development Centre.
- Mihailidis, A. and Fernie, G.R. (2002) ‘Context-aware assistive devices for older adults with dementia’, Gerontechnology, 2(2), 173-188.
- Percival, J. (2007) ‘Lighting the homes of people with sight loss: an overview of recent research’, Thomas Pocklington Trust Research Findings 15 [document on the internet]. November 2007 [cited 2013 Nov 29]. Available here
- Torrington, J. and Lewis, A. (2011) Extra Care Housing for People with Sight Loss: Lighting and Design Issues. Thomas Pocklington Trust Research Findings 36 [document on the internet]. December 2011 [cited 2013 Nov 29]. Available here (and final report, available on request from Thomas Pocklington Trust).
Our expert interviewees said
- High contrast handrails can be useful for people with sight loss and dementia
- Using raised tactile markers could allow people easier control of switches
- Digital outputs should be avoided as people with sight loss might find these more difficult to use
People with dementia and with sight loss and their carers
taking part in interviews and focus groups told us
- High contrast hand and grab rails are easier for people to use. Yellow handrails against a cream background are visible to people with sight loss and dementia, and tactile markers under the handrails can help some people to find their way around
- Sometimes where there are double light switches these can be difficult to use and to know which light is being switched on
- Using brightly coloured and contrasting furniture can help these stand out
- In care homes, having a standard layout for furniture in bedrooms can make it easier for people to settle in when they have to move to a different room
- In care homes, sometimes people with dementia will move furniture and this can make it difficult for residents with sight loss
- Portable lamps can be used where there is a need for additional task lighting
- In care homes, residents like being able to personalise their rooms with their own bedding
- Care home residents find having pull cords and buzzers in bedrooms and elsewhere reassuring as thse are helpful in case they need to gain the attention of carers, particularly at night
- It can be helpful to use contrast, e.g. using coloured table cloths so that crockery stands out and is visible
- It is possible to use reminders on doors to help people with room identification and way finding, for example hanging a facecloth, sponge, or hair accessory on a bathroom door. Some care home residents also find having a number on their bedroom door is helpful.
The survey found
- Out of 92 people who answered questions on this section, 64% thought that guidelines on lighting would be ‘very helpful’ and a further 34% thought they would be ‘helpful’
- When people were asked to either agree, disagree or say that they were unsure about a series of statements, the highest levels of agreement were in relation to: the use of colour and contrast to highlight key fixtures and fittings (99% agreed); the importance of having electrical sockets available for extra lighting or assistive technology (97% agreed); using appropriate types of controls and switches (97%) the importance of allowing personalisation of bedrooms in care homes (96% agreed); the use of light switches with definite on/off positions (95% agreed)
- The highest levels of disagreement or uncertainty were in relation to: consistency of furnishing and layouts in bedrooms of care homes (23% disagreed, 30% not sure); preferability of dimmer switches, since these allow full control of lighting (17% disagreed, 32% not sure); avoidance of digital controls (11% disagreed, 39% not sure)
Selected quotes from people completing the survey
- ‘Allowing the user to set their own controls (e.g. heating) may be beneficial in terms of autonomy. However perhaps any controls should be within a limited "safe" range to prevent accidents (e.g. scalding hot water), especially if the user no longer has a concept that, ie 30C is very hot. Also sockets & switches, where easy-reach may risk objects being inserted into sockets - like a cotton bud, for instance? Socket covers might help, but they might deter a user who doesn't recognise them. Digital displays may tend to confuse users who grew up in a pre-digital, but as the population as a whole ages most users who may develop dementia/sight-loss will have grown up in a digital age in any case, so the position will change over the next 2-3 decades.’
- ‘Handrails are useful only if needed, also can be a hazard, only useful if they are in the right place. Bumps under handrail have worked but the texture can also be distressing, if you have impaired sight your brain tries to make sense of it, it can mean the person thinks that there are bugs in her room. Rug and mats are a fall hazard so would recommend be removed however I have seen people orientate around a room using the texture of the floor and walls. I have disagreed that voice prompts SHOULD be used, as they are useful for some but other people with dementia and sight loss may interpret the voice as someone in the room and become fixated, I have had experience of this.’
- ‘It is important to keep a person's own home they way they wish to have it and not to change it to look like a medical or residential facility. However, if equipment and assistive technology was more appealing from an aesthetic point of view then homes may be safer for people.’
- ‘I feel that fixture and fittings are a difficult area to control within a housing setting. Individuals will have preferences and will decorate a home as they wish. Therefore we can only have a minimal impact here. Also, there is a danger of houses starting to look too institutional. We are a long way from dementia design being accepted within housing as the `norm` and there will be a battle to implement some design features within developments - even within housing services there are disagreements on fitting contrast grab rails as standard instead of white. Also, we fit white bathroom suites against white tiles. There will be a battle to change this to coloured tiles as difficult to replace when damaged we have to think long term of maintenance issues.’
- ‘I think that all people need to be treated as unique individuals and a “one size fits all” approach may not always be appropriate.’