Environment and technology

Why is the physical environment important for people with dementia?

Dementia is associated with progressive impairments of memory, perception, orientation, information processing, planning, sequencing, performing and monitoring actions, and communication. Therefore, cues that built in or are produced by the physical environment are more important for people with dementia than for cognitively unimpaired older adults. Ideally, the environment should compensate for deficits, maximise independence and support personal identity. Environmental features that have a particular impact include lighting, noise level, temperature, clarity, stimulation, and orientation.

What are the effects of an appropriate environment?

An appropriate design of the physical environment has a number of beneficial effects on people with dementia:

• Improving of quality of life
• Facilitating spatial and temporal orientation
• Supporting meaningful activities
• Enhancing social interaction
• Reducing changed behaviours such as anxiety and agitation

Suggestions for modifications inside the home

It is not advisable to make major changes to the home overnight, because the familiar environment is important for people with dementia to feel at home. However, there are simple things that can be done to help someone with dementia to continue living independently in their home.

• Improve lighting, particularly on stairs and in the toilet
• Automatic light sensors can make lights come on automatically when someone passes by
• Reduce glare, shadows, and reflections – they may be misinterpreted as water or people in the house
• Reduce excess noise, e. g. a radio or TV constantly playing
• Remove clutter, e. g. stacks of newspapers or boxes
• Allow manoeuvring with walker and wheelchair
• Use safer flooring, avoid rugs or mats on the floor – they may be misinterpreted as objects that need to be stepped over, which could lead to trips or falls
• Increase bathroom safety, e. g. by using a walk-in shower, a shower seat, or grab bars
• Use contrasting colours, e. g. for furniture that contrasts from walls and floors, or the toilet seat
• Remove troubling reflections, e. g. mirrors – they can cause confusion as people with dementia may not recognise themselves
• Use labels and signs, e.g. on cupboards and doors; use words or appropriate pictures or photos; see-through cupboard doors may be a great help to someone with dementia, as they can then see what is inside
• Provide information, e.g., using a large clock with LCD display – people with dementia may be able to read digital information about time better than traditional clock hands (see: assistive technology below)

We would like to thank Dr. Birgit Dietz, Dipl. Ing. Architekt, Director of the Bavarian Institute for Age and Dementia Sensitive Architecture (Bamberg) for important comments and suggestions on this section.

 

Suggestions for modifications outside the home

Technical aids are devices or systems that help people with dementia to maintain or improve their independence, safety and well-being. There are numerous technical aids for people with dementia and their relatives.

• Facilitate entering the home, e. g. by safety railings on stairs
• Make sure that walking surfaces are flat to prevent trips or falls
• Outdoor spaces must be secure to prevent someone wandering off
• Raise flower beds to help people with restricted mobility look after their garden
• Provide sheltered seating areas to enable someone to stay outside for longer
• Use adequate lighting, e. g. for the garden entrance
• Automatic light sensors can make lights come on automatically when someone passes

Assistive technology

Assistive technology refers to devices or systems that support people with dementia to maintain or improve independence, safety, and wellbeing. Different kinds of assistive technology are available which address people with cognitive impairment or dementia and family carers.

The goals of assistive technology for people with dementia are:

• Ensuring safety inside and outside the home
• Supporting independent living, activity and quality of life
• Facilitate communication and social interaction
• Delivering treatment
• Keeping people with dementia cognitively fit
• Providing entertainment

Types of assistive devices for specific goals

Goal	Type of device
Ensuring safety inside and outside the home	• Alarms (e.g. bed detectors, mats, fall detectors, movement detectors, physiological monitoring) • Fire, smoke, gas, flood detectors • Door and window sensors • Electronic door locks • Automatic lighting • Automatic shut-offs on household appliances • Person locators • Alarms (e.g. bed detectors, mats, fall detectors, movement detectors, physiological monitoring)
Supporting independent living, activity, and quality of life	• Reminders • Speaking objects, object finders • Timers, calendars, clocks • Remote controls • Robots
Facilitating communication and social interaction	• Simplified telephones, smart phones, telephone amplifiers • Tablet computer applications
Delivering treatment	• Medication dispensers
Keeping people with dementia cognitively fit	• Cognitively stimulating exercises • Exergaming
Providing entertainment	• Computer games • Digital photo frames • Artificial animals (Paro) • Reading devices • Social robots

References

• Brawley EC. Environmental design for Alzheimer's disease: A quality of life issue. Aging & Mental Health 5 suppl 1: 79-83, 2001
• Marquard G, Viehweger A, (eds). Architecture for people with dementia. Planning principles, practices, and future challenges. Technical University of Dresden, 2014
• Marquard G, Johnston D, Black BS, et al. A descriptive study of home modifications for people with dementia and barriers to implementation. J Hous Elderly 25: 258-273, 2011
• Soril LJJ, Leggett LE, Lorenzetti DL, Silvius J, et al. Effective use of the built environment to manage behavioural and psychological symptoms of dementia: A systematic review. PLOS One 9: e115425, 2014
• Woodbridge R, Sullivan MP, Harding E, et al. Use of the physical environment to support everyday activities for people with dementia: A systematic review. Dementia 17: 533-572, 2018