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Dementia Enabling Environments

We all have a relationship with our environment. The familiar objects we place around us, the way we set up our homes and offices, the music we listen to, the places where we feel relaxed or inspired – all these create meaning and contribute to how we feel about ourselves as people and how we relate to others. The same is true for people living with dementia, even if their perceptions of space and time have altered.

For people living with dementia, the world can be a confusing, disabling, and even dangerous place. Objects that were once familiar may no longer be recognized, new places and routines can be disorienting, stress and anxiety can increase and sensitivity to noise can be heightened.

The good news is that much research has been done in recent years, and we now know much more about creating dementia-friendly, or “enabling” environments.

Through careful design, we can support those with impaired cognition to maintain their abilities and engage meaningfully and safely with the world around them.

The definition of a dementia-friendly environment which is one that:

  • promotes independence and supports well-being
  • has familiar surroundings
  • allows easy access and finding your way
  • supports meaningful tasks
  • supports participation in daily activities
  • promotes safety, security, and comfort

Dementia Australia looks to the 10 Dementia Enabling Environment Principles as a guide to providing the best environment for people living with dementia. These are based on the work of Professor Richard Fleming and Kirsty Bennett, University of Wollongong.

Principle 1: Unobtrusively reduce risks

This is about ensuring the internal and external environments are safe and easy to move around, but that barriers and safety features are not too obvious as this can lead to anger and frustration. 

Principle 2: Provide a human scale

A person should not feel intimidated by the size of their surroundings or be faced with too many choices and interactions. They need to feel in control.

Principle 3: Allow people to see and be seen

Good visual access means people can easily understand their environment. They need to know where they have come from, where they are now and where they are heading.

Principle 4: Reduce unhelpful stimulation

Too much visual or auditory stimulation can be distressing as dementia can reduce the ability to filter and focus only on what is important. Residents in aged care facilities sometimes say they are stressed by the amount of noise in their environment. Having an aural environment that is soothing rather than jarring is important. Too much going on visually can also be distressing and confusing.

Principle 5: Optimise helpful stimulation

Providing stimulation that engages and relaxes is important. In aged care settings, for example, age-appropriate and familiar music is preferred to TVs blaring bad news and loud advertisements.

Principle 6: Support movement and engagement

Clearly defined pathways that are free of obstacles and too many choices are important. Guiding people past points where they can engage with others or in activities is helpful. In residential aged care settings, this might be incorporated into garden designs to encourage outdoor walks, or in shared activities in the common lounge areas.

Principle 7: Create a familiar space

People living with dementia may enjoy spaces and objects that were familiar to them in their early life. This relates to furniture, colours, photographs, music – anything that helps personalise their environment.

Principle 8: Provide opportunities to be alone or with others

Different spaces for different purposes can help to stimulate different emotional responses. Places to be alone or to be in the company of others can be clearly defined so a choice is available.

Principle 9: Provide links to the community

The importance of connection and a sense of identity are just as important for people living with dementia as anyone else. Frequent interactions with friends, family, and others in the community are essential.

Principle 10: Respond to a vision for a way of life

A life that is meaningful and of value to the individual needs to be supported by the environment. For example, if preparing meals was an important and enjoyable part of life, then the environment should support that activity in a safe and accessible way. If music was a central part of a person’s life, then access to preferred music should be easily and readily available. If recreational activities bring a sense of meaning, then the opportunity to engage in these can be supported and encouraged to maximise quality of life.

Providing a well-designed environment for people living with dementia can mean a life continued to be lived well, with meaning, engagement, and comfort.

References:

https://www.dementia.org.au/sites/default/files/helpsheets/Helpsheet-Environment03_HowToDesign_english.pdf

Environment Principles – Dementia Enabling Environments | Alzheimer’s WA

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