4.2 History and fundamentals of Dementia Friendly Environments.

4.2.1 Short Introduction of Environmental Design.

Physical environment has a special influence on people in a situation of dependency, and on people who suffer from cognitive impairment. It is necessary to design environments that promote maximum autonomy and integration, as well as physical and psychological well-being and maximize people’s capacities that is facilitating environments.

Personal competence depends on factors such as health, sensory abilities, cognitive and motor skills. Environmental demand, on the other hand, is determined by the real physical characteristics of the surroundings, and by the subjective ones.

There are several environmental factors and characteristics that are related to objective and subjective well-being, for example: accessibility, security, light, noise, type of access, view to the outside, decoration, privacy, spaces of socialization, the size of the rooms, their organization or vision, etc.

The environments must respond to the realization of the activities of daily life, leisure, socialization and in short the day-to-day in them. They must give a specific response to the particular needs of each person, allowing them to be able to use the skills they maintain and reducing their frustration, so that they achieve the highest quality of life.

There are certain key aspects that will be developed below that promote the objectives pursued: family sensation, social interaction, personalization or sensory stimulation are essential for a person in a situation of dependency to make use of their capacities, to be able to orient themselves within a space or remain calm and collected.

In this sense, the environmental adaptation of the spaces must be part of a complete care process to be able to adapt to the needs of the people and improve their quality of life, which should cover all the areas that determine a new model of care: organizational, structural, environmental, functional, professional, etc.

4.2.2 Dementia and environments.

As you have already seen, dementia is a clinical syndrome characterized by a persistent and progressive deterioration of higher brain functions (memory, language, orientation, calculation or spatial perception, among others).

This deterioration entails a loss of the autonomy of the patient, who becomes increasingly dependent on others, as well as a detriment to the social, work and leisure activity of the patient and the their caregivers.

All the symptoms of dementia are related in some way to the environments around people. Let’s see some examples.

1-MEMORY LOSS: CHARACTERISTICS

Memory loss is the main and most characteristic symptom of this disease. There are several types of memory:

-Immediate memory. It is what we use to retain important or necessary information for a certain time (a few seconds).

-Recent or short-term memory. Data storage ranges from a few days to several weeks. The loss of this type of memory implies that the person will not be able to remember events that have occurred recently. At first, you will forget events that happened a few days ago and that time will gradually shorten until, in advanced phases, you will not remember what you did a few hours or a few minutes ago.

-Remote or long-term memory. This type of memory is capable of storing large amounts of data from our biography until we remember distant events, who we are, what we have done, how our life has happened.

In the person suffering from dementia, remote memory lasts longer, with short-term memory and closer events being lost earlier.

People with dementia will have difficulty remembering and organizing events that occurred in their lives. At first, distant memories will remain intact, while more recent events will be lost early.

Sometimes, the patient remembers his past life as if it were a current event and therefore may forget that he has grandchildren, children or they believe that they still live in the town.

LOSS OF MEMORY: RELATIONSHIP WITH THE ENVIRONMENT

These memory deficits impair the learning capacity of people with dementia, which can lead to problems such as great disorientation in new places, forgetting where certain rooms are or where things are stored, as well as difficulties in learning new routines or using objects not relatives.

All of these problems are aggravated when the person with dementia is institutionalized and thus introduced to a new environment. One way to alleviate the effect of a new environment is by introducing nostalgic elements that encourage the reminiscence of vital events (photo albums, memory boxes, etc.).

2-DISORIENTATION: CHARACTERISTICS

-Temporary orientation: you begin to lose track of the date you are on, not recognize the exact day, month and year, etc.

-Spatial orientation: begins to become disoriented in spaces that are not very familiar or known and gets lost. Later it will be lost in more well-known places. Finally, they lose their orientation within their own home and do not know how to locate the different rooms.

-Personal orientation: the dementia patient, already in moderate stages, ceases to have knowledge of his self and does not know who he is: nor his likes and hobbies, what he has worked on or by which members the environment is composed and his family.

People with dementia lose their temporal orientation first, later their spatial orientation, and finally their personal orientation.

DISORIENTATION: RELATIONSHIP WITH THE ENVIRONMENT

When the environment of a person with dementia is simple and hardly changes, the feeling of security increases, and therefore orientation difficulties are alleviated.

In this sense, visual signals, indications, and posters – drawings, words, arrows, etc. – they will favour not only the orientation in the usual environment, but also they will remind the function of for example the cabinets.

In addition to these considerations, it is important that the main pathways are clear of obstacles.

3-WANDERING WALKING: CHARACTERISTICS

When a person with dementia can still walk or support himself, another possible form of expression of the anxiety described is through erratic walking or wandering.

People walk and walk without a specific destination, moving from one place to another without any purpose. This erratic ambulation has an added risk such as the risk of falls or flight and loss.

WANDERING WALKING: RELATIONSHIP WITH THE ENVIRONMENT

The actions against this behaviour are directed towards three key aspects:

-The need to establish safe itineraries where they can wander erratically.

-The necessary removal of obstacles and barriers in these areas.

-The control of the risk of leakage.

An environment free of hazards must be created, where the person can move freely and safely, and prevent the person from leaving through doors that allow the exit of the residential centre or into dangerous places, either with appropriate supervision, through surveillance or other strategies such as conceal the doors so that they look like part of the wall.

In the same way, adequate planning of the spaces must be carried out, clearing the line of sight of obstacles, with spatial continuity, which in turn will facilitate the orientation of the person with dementia. The ideal solution is usually loop-shaped circuits