How to Create a Dementia Friendly Environment

There are currently 850,000 people living with dementia in the UK, more than ever before; that is one in 79 of the whole population. One in 14 people over 65 have dementia in the UK and this number is projected to increase to over 2 million people living with dementia by 2051.

Increasing life expectancy is the driving force behind this projected rise because age is the biggest risk factor for dementia. The higher life expectancy of women accounts for a higher prevalence of dementia in female older age groups.

Alzheimer’s Research UK have predicted that 1 in 3 people born in the UK this year will develop dementia in their lifetime and other surveys show that dementia is the disease we fear more than any other, even cancer.

What is dementia?

Dementia is an umbrella term for several brain diseases that affect memory, thinking and cognition. Alzheimer’s disease is the most common cause of dementia, but not the only one.

In Alzheimer’s disease, an abnormal protein surrounds brain cells and another protein damages their internal structure. In time, chemical connections between brain cells are lost and cells begin to die.

Problems with day-to-day memory are often the first thing to be noticed, but other symptoms may include difficulties finding the right words, solving problems, making decisions, or perceiving things in three dimensions.

Other forms of dementia

Vascular dementia – If the oxygen supply to the brain is reduced because of narrowing or blockage of blood vessels, some brain cells become damaged or die. This is what happens in vascular dementia. The symptoms can occur suddenly, following one large stroke or they can develop over time, because of a series of small strokes. Vascular dementia can also be caused by disease affecting the small blood vessels deep in the brain, known as subcortical vascular dementia. The symptoms of vascular dementia vary and may overlap with those of Alzheimer’s disease. Many people have difficulties with problem-solving or planning, thinking quickly and concentrating. They may also have short periods when they get very confused.

Mixed dementia – This is when someone has more than one type of dementia, and a mixture of the symptoms of those types. It is common for someone to have both Alzheimer’s disease and vascular dementia together.

Dementia with Lewy bodies – This type of dementia involves tiny abnormal structures (Lewy bodies) forming inside brain cells. They disrupt the chemistry of the brain and lead to the death of brain cells. Early symptoms can include alertness that varies over the course of the day, hallucinations and difficulties judging distances. A person’s day-to-day memory is usually affected less than in the early stages of Alzheimer’s disease. Dementia with Lewy bodies is closely related to Parkinson’s disease and often has some of the same symptoms, including difficulty with movement.

Frontotemporal dementia (including Pick’s disease) – In frontotemporal dementia, the front and side parts of the brain are damaged. Clumps of abnormal proteins form inside brain cells, causing them to die. At first, changes in personality and behaviour may be the most obvious signs. Depending on which areas of the brain are damaged, the person may have difficulties with fluent speech or forget the meaning of words.

It is important to remember that dementia is not a natural part of ageing. The updated Lancet Consortium on Dementia Prevention, published last year, concluded that 40 per cent of dementia cases could be prevented or delayed by targeting 12 modifiable risk factors, including obesity, type 2 diabetes, physical inactivity, excess alcohol intake, smoking and air pollution.

Dementia symptoms

It is perfectly normal for your memory to be affected from time to time by stress, tiredness, lack of concentration, certain illnesses or medicines and many people experience some amount of normal cognitive decline as they age, perhaps forgetting a computer password or having a bit of difficultly putting a name to a face.

However, if you are becoming increasingly forgetful, particularly if you’re over the age of 65, or if it is affecting your daily life, or it is worrying you, or you are worried about someone you know, you should talk to your GP about the early signs of dementia.

Dementia is not only about memory loss. It can also affect the way you speak, think, feel and behave.

Dementia symptoms may include problems with:

• Memory loss.
• Thinking speed.
• Mental sharpness and quickness.
• Language, such as using words incorrectly, or having trouble speaking.
• Understanding.
• Judgement.
• Mood.
• Movement.
• Difficulties doing daily activities..
• Losing interest in usual activities.
• Seeing or hearing things that other people do not – hallucinations.
• Personality change.
• Losing empathy.
• Losing interest in relationships and socialising.
• Finding planning and organising difficult.
• Difficulty with making decisions.

The most common types of dementia, Alzheimer’s disease, vascular dementia, Lewy body dementia, and frontotemporal disorders, are all progressive. People lose their cognitive skills over time, finding it more and more difficult to meet the demands of everyday life.

Dementia progresses differently in everyone. Many people will experience the following stages:

• Mild cognitive impairment (MCI) – This is a condition that can affect older people. Some people will go on to develop Alzheimer’s disease. MCI is characterised by losing things often, forgetfulness and having trouble coming up with words.
• Mild dementia – People may still be able to function independently in mild dementia. However, they’ll experience memory lapses that affect daily life, such as forgetting words or where things are and trouble organising or expressing thoughts.
• Moderate dementia – People experiencing moderate dementia will likely need more assistance in their daily lives. It becomes harder to perform regular daily activities and self-care as dementia progresses.
• Severe or late stage dementia – People will experience further mental decline as well as worsening physical capabilities once the disease progresses to the point of severe dementia. In the late stages of dementia, people will not be able to take care of themselves and may lose their ability to communicate.

Although there is no cure for dementia at the moment, an early diagnosis means its progress can be slowed down in some cases, so the person may be able to maintain their mental function for longer. With the right help and support when they need it, many people can, and do, live well with dementia for several years.

Why is it important to create a dementia friendly environment?

All the problems associated with dementia, including agitation, sleeplessness, wandering and aggression, are made worse by stress; however, this stress can be reduced with a few environmental changes. In the early stages of dementia, many people are able to live at home and enjoy life in the same way as before their diagnosis.

Creating a dementia friendly environment at home can play an important part in supporting people living with dementia. Each person with dementia is different, so work at finding solutions that best suit the individual, and the changes do not necessarily need to be big changes to make a real difference.

Here are a few simple changes that can make life easier for people with dementia:

Improve lighting

Most people with dementia, and older people in general, benefit from better lighting in their home; it can help to avoid confusion and reduces the risk of trips and falls.

• Reduce glare, shadows and reflections – these can confuse and even frighten people with dementia.
• Keep curtains open in the day – natural light is important as it can help people with dementia make sense of their environment.
• Ensure that there are no unnecessary nets and blinds blocking the natural light.
• Cut back hedges and trees if they overshadow windows and block out sunlight.
• Good lighting is particularly important on the stairs and in the toilet – ensure these areas are well lit, perhaps with automatic light sensors that come on automatically when someone passes the sensor.
• Light switches should be easily accessible and straightforward to use – consider labelling these with on/off labels.
• Eyesight can deteriorate with age, so encourage older people to have regular eye tests so that any problems can be spotted and treated.

Remove clutter

So frequently used items are easier to see and to minimise trip hazards.

• Organise frequently used items so that they are close at hand; when there is a lot of clutter around, it can be difficult for someone with dementia to see the items they need – organising things helps them easily get what they need.
• Add photos or keepsakes that evoke positive memories. Placing photos and mementos that bring up positive memories around the house encourages reminiscing and creates a pleasant environment.

Flooring

The best flooring to choose is something matt and in a colour that contrasts with the walls.

• Try to avoid using mats or rugs on the floor, as some people with dementia may become confused and think the rug or mat is an object that they need to step over, which could lead to trips or falls.
• Avoid shiny or reflective flooring, as this may be perceived as being wet, and the person with dementia may struggle to
  walk over it.
• Avoid colours that can be mistaken for real things, such as green (grass) or blue (water).

Contrasting colours

Dementia can affect how well someone can tell the difference between colours; try to choose:

• Contrasting colours on walls and floors.
• Furniture and furnishings in bright or bold colours that contrast with the walls and floors, including beds, tables and chairs.
• Contrasting colours for doors and banisters to make them stand out.
• A toilet seat in a contrasting colour to the rest of the bathroom.
• Crockery in contrasting colours to the tablecloth or table, help to define the edges of plates and dishes.
• Avoid bold patterns and stripes as they can be confusing and disorientating.

Leave doors open and/or add simple signs

People with dementia may not remember where rooms are in their home, so it is important to leave the interior doors open. When the inside of a room is visible, it is easier to navigate the house.

• Consider putting up simple one-word signs (FOOD or KITCHEN) or pictures (a toilet or a bed) with an arrow pointing the way to those essential items or rooms.
• If there are rooms that they should not go into, make sure to keep those doors closed and avoid calling attention to those areas.
• Label the contents of drawers and cupboards using colourful photo images, cards or Post-it notes; do the same with doors, placing signs at eye level.

Add orienting items

Feeling oriented to time and days of the week can support cognitive function.

• In the room where they spend the most time and/or on their bedside table, consider adding an easy-to-read clock that clearly states the time, time of day (morning, evening, etc.), day and date.
• They may also benefit from a large print calendar to keep track of days and important events.
• Keep a list of phone numbers with the telephone. If necessary, add photos to the numbers so that they are recognisable – try telephones with big buttons.
• Use a small bulletin board for the person’s daily routine and to-do list, and direct them to it every day.
• Place the TV remote(s) in visible reach, keeping them in the same place.

In the bathroom

With so many shiny surfaces in a small space and a variety of tasks to complete, the bathroom can be a challenge to navigate. Going to the toilet or having a bath or shower should be, if not enjoyable, at least stress-free.

• Consider adding a contrasting toilet seat cover to draw attention to it. White toilets often blend in with the floor and walls and are not as noticeable.
• Toilet target aids, for some older men with dementia (and/or low vision); it can be difficult to keep the toilet area clean and missing the bowl may also mean caregivers have to clean up afterwards. Adding a highly visible target inside the bowl helps men with dementia clearly see where they should be aiming.
• Clearly label the hot- and cold-water taps, whether they are separate taps or a mixer tap.
• Check mirrors and cover or remove them if they are likely to cause confusion in the person with dementia – they may be distressed if they do not recognise themselves in the mirror.
• Keep household water temperature at or below 120 degrees Fahrenheit to prevent scalding.
• Keep household cleaners in a locked cabinet.

In the kitchen

Eating and drinking are always important, but a person with dementia may lose their appetite and their ability to care for themselves in this way.

• A clear layout and appealing cooking smells, stimulates the appetite and encourages people to do as much as possible for themselves.
• People with dementia will open and close many kitchen cabinets and drawers as they can’t remember where things are kept, so attach labels and pictures to help them find what they want or perhaps replace cupboard doors with glass doors.
• Keep kitchen surfaces as clutter free as possible and put the larger items that they use most in visible, accessible places.
• In some cases, someone with dementia will become overly focused on something accessed in the kitchen, for example constantly feeding a pet. Just telling them that the pet has already been fed probably won’t work, so try locking away or hiding these items – “out of sight, out of mind” often works with people with dementia.
• Eating can become a challenge for someone with dementia, so at mealtimes limit distractions like noise or TV, use plates that make food highly visible, and be flexible to adapt to their food preferences.

In the bedroom

This should be a private, cosy and safe place which promotes a good night’s sleep. People with dementia may need help with finding and recognising their bedroom.

• Ensure that there are familiar items such as photos around.
• Position the bed so that the person can see the toilet during the night. Leave the bathroom light or night-light on to show the way.
• Remove locks from internal doors so that they can’t lock themselves in.
• Reduce or eliminate floor clutter – keep shoes and slippers in the cupboard when not in use.
• Place a lamp with a touch base at the bedside.
• Consider motion sensors fitted to the bed or wall – movement sensors detect, for example, when someone has fallen out of bed.

Using assistive technology

There is now a wide range of products and services to help those with dementia or other long-term conditions live independently and safely.

These include:

• Portable alarms or fixed position alarms – when activated these make a high-pitched sound to alert someone.
• Pill dispensers – these release medication at appropriate intervals.
• Telecare systems, sensors or detectors that automatically send a signal to a carer or monitoring centre by phone.
• Reminder devices such as Alexa to prompt the person when to take medication or to give appointment alerts, answer questions and give updates such as the news and weather reports.
• Voice activated telephones pre-programmed with frequently used numbers.
• Apps for smartphones and tablets specifically designed to help people with dementia and their carers including dedicated games, digital photobooks and reminiscence aids.

Making everyday tasks easier helps people with dementia stay as independent as possible and reduces frustration, stress and anxiety. If the person is still able to make their own decisions, it is a good idea to make plans for appropriate adjustments together so that their wishes for their future care can be respected.