When a person is in a situation of dependency or suffers from cognitive impairment, memory, thinking, movement, orientation, understanding, calculation, learning, language or the ability to make judgments other than simple can be affected. These disorders are related to reduced control of emotions, social behaviour, and motivation. According to the team from the Imserso Alzheimer’s State Reference Centre (CREA, Spain), it has been shown that some psychological and behavioural symptoms of dementia, such as depression, apathy, wandering and aggressiveness, are susceptible to improvement through environmental modifications.
People’s memory, cognitive and functional impairment problems make them more vulnerable to environmental influences (Briller et al., 2001), since these people “only know what they see”, they have great difficulties to interpret everything that they see and surrounds them, which generates great confusion and anguish. They are much more vulnerable to changes in their environment. In fact, when a person with dementia is institutionalized, going from living at home to living in a care centre, it is one of the moments of greatest anguish and stress for that person, who does not understand what is happening, what surrounds him, who is surrounding him, and they can even respond with a certain aggressiveness to that anguish.
It is in these moments when the environments play a fundamental role: depending on how these environments are thought and designed, they can minimize these bad feelings.
From the literature on environmental gerontology and design for people with dementia, we can extract the therapeutic objectives or key aspects that an environment should meet in response to the needs and the cognitive and behavioral characteristics of people.
There is a certain consensus about the key aspects that an environment designed to achieve the objectives described before must comply with: compensate as much as possible for disability, maximize independence, reinforce personal identity, improve confidence, possess qualities that allow understanding the building operation and easy orientation, controlling stimulus balance, promoting social interaction, granting privacy when the option is available, providing walking paths, both indoors and outdoors etc.
KEY ASPECT 1-The human scale and home environment.
KEY ASPECT 2-Personalization and familiar feeling.
KEY ASPECT 3-Social interaction.
KEY ASPECT 4-Privacy and personal control.
KEY ASPECT 5-Provide a sense of trust and security.
KEY ASPECT 6-Maximize orientation, both spatial and temporal.
KEY ASPECT 7-Provide balanced sensory stimulation.
KEY ASPECT 8-Paths for walking.
KEY ASPECT 9-Support the functional skills of people.
KEY ASPECT 10-Technology at the service of people.
4.3.1 KEY ASPECT 1-The human scale and home environment.
The scale of a building has an influence on the behavior of a person, especially with dementia. The scale is associated with different factors: the number of people with whom this person is related, the general size of the building, and the size of its components, such as rooms, common spaces, corridors, etc.
Small spaces similar to those of homes, domestic, the location of the dining room near the kitchen, tables with tablecloths and real plates and cutlery instead of cold trays, decoration linked to the cultural background of the patients, etc. they help people to bind more to these spaces and increase their sense of belonging.
A person should not feel intimidated by the size of the spaces around them, rather the scale, the human scale, should help the person to feel that they are in control of that space.
4.3.2 KEY ASPECT 2- Personalization and familiar feeling.
The loss of belonging to a place or a property is closely associated with life in social and health institutions.
Any intervention focused on maintaining the feeling of home on the one hand and one’s own personality on the other help to increase this feeling of belonging and reduce agitation, stress, etc. associated with these cases.
Own furniture, souvenirs, objects, photographs etc. They help maintaining this identity and are more likely to be used by people with dementia.
4.3.3 KEY ASPECT 3- Social interaction.
Social interaction contributes to the emotional well-being of people. Life in social and health institutions, in addition to the loss of identity and belonging, is associated with the loss of relationships that a new place entails.
It is extremely important that the environments contribute, facilitate and stimulate social relationships: spaces of adequate size, homelike, with comfortable armchairs, at an angle, in suitable groups, with adequate lighting, with elements that facilitate interaction and conversation, etc. They help to facilitate social interaction between residents, family members and caregivers.
4.3.4 KEY ASPECT 4- Privacy and personal control
Providing privacy when necessary and fostering an environment that supports residents’ ability to make decisions is essential to contribute to people’s quality of life.
The environment should make it possible to choose whether to be alone or accompanied in welcoming, accessible and safe spaces in both cases, to have both options and to be able to determine which of them is the one that person prefers, promote and facilitate decision-making and the independence of people.
4.3.5 KEY ASPECT 5- Provide a sense of trust and security
People and their families have to feel in a trusting and safe environment that allows them to carry out their activities.
And the family members also have to be confident that their family member is in a safe place, where nothing bad will happen to him/her, where he/she will not escape and will have the best possible quality of life.
However, too obvious measures and barriers can cause patient frustration, agitation, and anger, so measures to ensure trust should be discreet.
4.3.6 KEY ASPECT 6- Maximize orientation, both spatial and temporal
Orientation is a particularly important issue for people with cognitive impairment due to memory loss.
The spaces must be locatable and identifiable to maximize orientation, visible from different points, putting names or signs associated with their uses, using decoration and furniture easily identifiable with the use of the space, maintaining the position of the spaces and the furniture, avoiding over-stimulation of noises to avoid distractions, using sensory clues (the smell of food in the kitchen, seeing the table set, etc.), using large clocks with symbols for daily activities on the walls, etc. helps people know where they are and make decisions about where they want to go.
4.3.7 KEY ASPECT 7- Provide balanced sensory stimulation.
Excessive stimulation, especially noise, can alter behavior, stressing, reducing ability to concentrate, etc.
Insufficient stimulation can contribute to increase apathy, reduce social contact, and isolation.
The sounds, smells and lights can also be used to associate and identify the different spaces.
4.3.8 KEY ASPECT 8- Paths for wandering
The erratic wandering associated with dementias can be channeled if there are well-defined paths or routes, free of obstacles, without complex crossings, circular, with points of interest and opportunities for social interaction.
These tours should be both indoor and outdoor, giving the reason and the opportunity to go outside if the weather allows it.
4.3.9 KEY ASPECT 9- Support the functional abilities of people.
The environments should help to compensate the loss of physical, cognitive and functional capacities using different methods: adequate lighting avoiding flashes and color differences that people with dementia do not know how to interpret, natural and artificial light helping in the perception of depth of field, eliminate unnecessary colors, noise and objects to avoid distractions etc.
4.3.10 KEY ASPECT 10- Technology at the service of people
All the technology that is being developed should be able to be put at the service of people with dementia, their families and the professionals who work directly with them and could contribute to improving their quality of life by integrating it into their environments.
