We need to always focus on the person, not the illness
It is all too easy to make assumptions about the world and other people based on our own experiences and needs. When it comes to people with dementia, this can easily go wrong, especially if you fall into the trap of seeing them as a group rather than as individuals.
“Even if a person’s needs and conditions for living a good life change as a cause of dementia, their unique life story is always with them and needs to be reflected in the physical environment they live in. We need to always focus on the person, not the illness,” says Gun Aremyr.
"A physical environment that smells nice, is aesthetically pleasing and is welcoming signals that the person living in it is worthy of having nice surroundings. It can also contribute to lowering blood pressure and reducing the need for pain treatment."
Gun has worked in the area of dementia since the end of the 1980s and has encountered a great number of people and environments in her roles as work therapist, consultant for relatives, lecturer and author. And she is sure of one thing: a well-planned physical environment makes life easier for people with cognitive impairment in a number of different ways.
“For instance, people with dementia have a greater need of rest and they need to recuperate several times a day for their brains to keep functioning. Easy chairs placed along a hallway can provide balance between rest and activity, preferably with the opportunity to choose between listening to music or having a nice view of nature,” she says.
Interior design should also contribute to a sense of security, for example, through inclusive furniture that is stable and upholstered in single-colour fabric as small patterns can be perceived as insects by people with dementia.
“Even the placement of furniture affects how a room is perceived. Having furniture facing each other can be considered provocative so it can be better to place them a bit off centre from each other. It can feel safe to sit in a corner so sofas with armrests in the middle can be good. And naturally, furniture should not be obstructive.”
THE IMPORTANCE OF THE SENSES
When it comes to muscular and joint sensory input, she recommends robust furniture for sitting whose height makes it easy to get up and down. This helps give a sense of independence and the opportunity to manage without assistance. Also, by changing one’s sitting position, you activate your muscles and reduce pressure.
Gun Aremyr adds two senses to the usual five senses of seeing, hearing, touch, smell and taste – muscular/joint sensory input and balance.
“When a person’s balance deteriorates, it is important to have solid furniture that you can support yourself against. Easy chairs that rock stimulate your sense of balance and have a calming effect, so rocking chairs can be a positive addition,” says Gun Aremyr.
Rooms that are visually calm and organised have a healing effect. For example, colours that differentiate wash room doors, toilet seats and light switches help a person navigate and increase their sense of freedom and independence.
“In contrast, closed doors can give a feel of confinement and cause aggression, while glass doors can be difficult to see and can be easily walked into. A view of nature or paintings that depict nature are often positive additions,” says Gun Aremyr.
“When choosing colours, keep in mind that a person is more likely to want to sit in an easy chair or sofa upholstered in a warm colour. When using contrasting colours, it is better to use deep colours than pastels.”
She continues: “Ageing eyes have a tendency to see colour less vibrantly so if the wall and floor colours are too similar, the room can be difficult to navigate. Also, it is easier to differentiate red hues from yellow hues than it is to see the difference between some blues and greens.”
All of these factors are impacted by lighting. Good lighting that help differentiate between night and day can increase a person’s quality of life. A simple rule of thumb for improving concentration and navigability is that 80 years = 80 watts or 1200 lumens.
Fragrances that smell of home, such as the smell of freshly baked buns, also stimulate the senses, promote health and can even make food taste better. In contrast, strong smells that can be associated with hospitals, such as detergents, have the opposite effect.
“A physical environment that smells nice, is aesthetically pleasing and is welcoming signals that the person living in it is worthy of having nice surroundings. It can also contribute to lowering blood pressure and reducing the need for pain treatment,” says Gun Aremyr.
Touch can have the same effect. Rounded shapes made of well-known materials such as wood, fabric and leather feel safe and secure. Another means of making positive associations is through sounds of gentle waves or birdsong.
How can we put all this knowledge into action?
Gun Aremyr highlights the importance of involving knowledgeable, empathetic and fully present staff in designing the physical environment.
“For the people we are discussing, a health-promoting environment is one in which a person can live comfortably, even with cognitive impairment. To ensure sustainability, you need to invest in quality. The furniture needs to be aesthetically pleasing, but also flexible and easy to use, clean, renew and move.”
Functionality that is well-considered can make a great difference.
“It is easy to trigger anxiety in people with dementia. This increases the need of staff and medication, leads to a decline in health and quality of life and in poorer economics for the municipality. However, well-planned furnishings that are customised to the individual and operations create a positive trend for all.”
5 tips for care environments for those with dementia
Use contrasting colours for easier navigation. It is easier to find one’s way around in a room with contrasting colours on floors, walls, doors and furnishings. It creates a sense of security and independence and reduces anxiety and frustration.
Use calming sounds and quiet furnishings. Avoid furniture that makes scraping noises. Sound-absorbers make for calming environments. Rippling water and music can be both calming and stimulating to the senses, when a person is in a position to choose whether they want to hear them or not.
Keep in mind that vision changes with age. Lighting is important in preventing accidents, assisting in navigation, creating a schedule of day and night and creating focus at the dining table. Remember that how a person perceives colour changes with age.
Appropriate furniture creates a safe and secure environment. Sofas and easy chairs that are easy to sit down in and get out of increase a person’s independence. Honest, natural materials and rounded edges increase security. Upholstery that is easily removed and can be washed makes the environment a more forgiving one.
A home should feel like home. The residential care facility is in fact home for the residents. When the environment is homely, residents feel at peace, included and safe. Remember too to use furnishings that make children and grandchildren feel welcome!