Don't Forget Design

Dementia Support UK, a service delivered by HammondCare, is now available across the UK to provide advice and resources on behaviours that impact on the quality of life of people living with dementia. Here, Professor Mary Marshall shares her thoughts on the impact of design. 

Stress and Distress

One of the most neglected causes of distress to people with dementia is the design of their environment. People can feel trapped, frustrated, angry, frightened, overwhelmed and so on. Because their problem-solving skills are often impaired, people with dementia can be unable to understand the causes of their malaise or what to do about it. It is up to us to ensure they are not victims of a hostile environment. 

We do know how to reduce distressed behaviour in the design of buildings: hence new buildings have wide or non-existent corridors, easy access to outside, potential for a range of familiar activities and attention to acoustics are all important as is making the place feel familiar and understandable. However, for most people working with people with dementia, the challenge is adapting an existing environment either at home or in a care home, day facility or hospital.

A problem-solving approach

To adapt an existing environment for any individual, we need both a knowledge of dementia and the skills of a detective. Mrs O’Leary had been labelled a ‘wanderer’ and it was assumed that it was because of her dementia and of course it was to some extent, but it also could have been because she needed exercise, could not find the toilet, had a backache from her ill-fitting easy chair, was trying to find a more congenial room and so on. She needed someone who knew her background to apply some detective skills. When did she walk? What was going on? Was the toilet door obvious? Had she always been active at certain times? (You can read more about walking behaviour in Professor Marshall’s book Walking not Wandering).

Professor Marshall also addresses the important issue of bathrooms and toilets. Mr Patel went to the toilet every hour throughout the night, waking his wife who slept in the adjacent room each time and she was nearing the end of her tether. She thought it was something she just had to endure. Instead, someone should have helped her to be a detective. Was he uncomfortable in the bed? Was there a noise which was waking him? Was there a street light outside the bedroom which made the room too light so he thought it was daytime? Was he anxious about not finding the toilet and having an accident?  You can download the free Toilet Talk e-book when you visit the Dementia Support UK website (dementiasupportuk.org), part of HammondCare's Dementia Design Essentials series.    

What else is happening?

One of the most common sources of stress for people with dementia in communal settings is too much stimulation and the main source is noise. The sounds of many different things going on: TV, radio, vacuum cleaner, loud conversations, traffic, and the rattle of cutlery can all overwhelm people. They can then become withdrawn or angry or agitated. A decibel app on the phone is a good place to start – anything over 85 is likely to be problematic. Too many different kinds of noise, especially if the source is not obvious, are likely to be problematic. People often want to go outside because it is quieter.

Another source of distress is being unable to see clearly. The impact of sensory changes feature in many of our resources. The ageing eye needs at least twice the light of a 40-year-old eye. People can feel frightened, lost, frustrated and so on if they cannot do what they want to do because they cannot see well enough. Good contrast is also essential to help make things visible. The environment can become hazardous since people will fall over things they cannot see. You can find online learning resources on over stimulation and sensory changes in our e-learning suite

Design is an integral part of all of our lives. Taking the time to observe if the person you are caring for is experiencing stress and/or distress, having a problem-solving approach, and asking 'what else is happening?' can make all the difference to the quality of life of a person living with dementia. We are here to help.