4.1 Introduction to Dementia Friendly Environments.

4.1.1 Introduction

The characteristics of the built environment can constitute a barrier to the autonomy and well-being of people, or contribute to promoting the maximum degree of independence, autonomy and well-being, they can increase the limitations or help compensating them as the disease progresses.

Our society has faced multiple and profound changes during the last decades:

• the demographic changes
• the transformations in family structures
• the new role of women in society
• the modification of preferences of elderly and people with dementia regarding their own ageing

All this transformation is leading us to rethink some of the pillars on which our existing wellness model was based.

Among the factors that determine the quality of life, the environment where a person living with dementia lives is a fundamental resource, not only with regard to the physical part, but also the emotional bond that develops with the space where they live as with the neighbourhood and the connection with the world in general (Yanguas, Sancho, Del Barrio, 2012).

The importance of this “continent” where we want to live as we get older, is presented as an inescapable aspect when analysing this new scenario of ageing that is presented to us today.

The design of suitable environments for the dementia sufferer, which respond to their needs and preferences, is a discipline that has an increasing presence and impact in the design of person-centred care models, particularly in people with dementia.

These models of care are beginning to assume within their approaches the evidence that the design of the environments where people live influences deeply their quality of life and the development of the disease, if any, or the way in which it can be deal with it.

In this sense, the design of therapeutic environments is increasingly included within non-pharmacological approaches to minimize the effect that dementias produce on people’s capacities.

An environment designed specifically for people with dementia can strengthen and stimulate the use of the capacities that are maintained, slow down their loss, and replace those that are being lost.

An environment considered, designed and executed properly to respond to the specific needs of the people who inhabit and/or use it can become a very useful tool to reduce the symptoms associated with dementias such as ambulation, disorientation, agitation, social withdrawal and others.

4.1.2 Environments and quality of life.

The World Health Organization (WHO) defines the subjective dimension of the Quality of Life concept as “the perception that an individual has of his place in existence, in the context of the culture and value system in which he lives and in relationship with your goals, your expectations, your standards, your concerns. It is a very broad concept that is influenced in a complex way by the physical health of the subject, his psychological state, his level of independence, his social relationships, as well as his relationship with the essential elements of his environment.

Therefore, the importance of the environment is recognized within the essential factors that determine our quality of life and physical and emotional satisfaction: People are more autonomous and independent if the environment that surrounds us (both physical and social) not only allows it, but also facilitates it.

The World Health Organization also defines active ageing as “the process of optimizing opportunities for health, participation and safety with the aim of improving the quality of life as people age”. This applies to people living with dementia, as many are also ageing.

According to the same organization, there are multiple determinants of active ageing, which can be summarized as follows:

1. Gender
2. Culture: These two factors are transversal and directly influence the rest of the factors, the cultural factor because it establishes the way of seeing the elderly, and the person living with dementia, in a society, and gender because it is a determining factor per se.
3. Access to the health system and the social system: Aspects related to health promotion, prevention and long-term care, access to the health system are included.
4. Behavioural factors: Each person’s lifestyle and caring habits.
5. Personal factors: Biological and genetic characteristics also determine the way of ageing.
6. Factors of the Physical Environment: These factors include the development of quality accommodation and adequate characteristics, accessibility, access to clean water, sanitation systems, electricity, heating or an uncontaminated atmosphere. In general, all the aspects associated with a clean, safe and accessible environment.
7. Factors of the social environment.
8. Economic factors.

We will deal with factor number 6, the one related to the physical environment.