Health and care providers are being urged to improve environments for people with dementia following the release of new guidance.
A best practice document published by the sight loss charity, the Thomas Pocklington Trust, and the University of Stirling provides a much-needed evidence base and offers draft guidelines on ways in which residential environments can be modified to help people who suffer from both dementia and associated sight loss.
Dr Lynn Watson, head of housing research at the charity, said: “The combination of dementia and sight loss is increasingly common, yet guidelines for designing homes - both individual homes and care homes - have tended to focus on one or other of the conditions.
We wanted to review existing research and add to it the real experiences of people living with both these conditions. The result is an important new set of guidelines that can make a real difference to people's lives
“We wanted to review existing research and add to it the real experiences of people living with both these conditions. The result is an important new set of guidelines that can make a real difference to people's lives.”
The guidance reveals how seemingly-simple measures, such as use of colour and contrast, clever lighting, the design of cupboard doors, and audible and tactile control panels, can make a real difference to the lives of residents.
Other recommendations cover fixtures and fittings, layout and design of kitchens, good bathroom design, entrances and exits, and gardens and outdoor areas.
Figures show that one in five people in the UK over the age of 75 are living with sight loss, rising to half of all people aged over 90. The primary causes are age-related macular degeneration, glaucoma, cataract and diabetic retinopathy.
In addition, some of these people will be among the estimated one in 14 people over the age of 65 and one in six people over the age of 80 in the UK who have a form of dementia. Many types of dementia lead to problems with vision including misperceptions and misidentifications, some of which may be associated with optical illusions. The consequences of such mistakes are more serious for people with dementia who may not be able to rationalise what they believe they are seeing. Some forms of dementia, including Parkinson’s disease and vascular dementia, have also been directly linked to visual problems.
Prior to developing the guidelines, people living with sight loss and dementia in two care homes, and the staff supporting them, were consulted about what helped and hindered them in their everyday lives.
Despite the potential for people to develop both dementia and some degree of sight loss, how best to support people with both is a relatively neglected area of study
Professor Emma Reynish, chairman of dementia studies at the University of Stirling, said: “Despite the potential for people to develop both dementia and some degree of sight loss, how best to support people with both is a relatively neglected area of study.”
The guidance is split into eight sections. The first seven discuss key aspects of design, or areas that can be enhanced through design. These are followed by a ‘concluding remarks’ section and information on other useful resources.
Colour and Contrast
Contrasting edges could be perceived as a barrier by some people with dementia. In such circumstances stark contrasts at floor level might become a hazard.
In making changes to a person’s home or living spaces it is important to consider what that person needs and wants, and to achieve the appropriate balance between protecting them from potential hazards and supporting their independence and freedom of choice.
Consideration should be given to how contrast is used to highlight key features and hazards. Using the same colours or ways of contrasting both could lead to confusion. Care must be taken to ensure there is no risk of hazards being mistaken for important features and vice versa.
People may not always find it easy to remember the significance of colours, so it may be helpful to have other visual cues in addition to colour and/or contrast differentiation, eg appropriate pictures or signage.
Lighting is important to people with sight loss and dementia. Good lighting can make the most of people’s capabilities and help to compensate for poor eyesight; it can assist people in finding their way around both new and familiar spaces; and help them to undertake specific tasks.
Where some or all of the living space in a home is shared with others, it is important to consider how different people’s lighting requirements for the same spaces can be met.
It is important to think about whether a person has particular needs for lighting at night and, if so, how these might be met. For example, for some people leaving a bathroom light on may be helpful, but only when this is independent of any extractor fan as the noise might otherwise be disturbing. Other people may prefer to rely on lighting coming in from outside to provide background light after dark.
People’s preferences and needs for lighting differ. It is important that homes are designed or adapted to be flexible in terms of lighting provision, and that people are regularly consulted to identify any changes in their individual preferences and needs.
Fixtures and Fittings
The design of fixtures and fittings within the home is important. Good design can ensure that those people with sight loss and dementia are able to easily identify and use fixtures and fittings in their homes. Well-designed fixtures and fittings can facilitate independent living. For example, providing user-friendly kitchen devices may encourage people to prepare their own food, and suitable handrails and grab rails will support people to move independently around their homes.
Assistive technology can benefit residents. For example, the provision of emergency assistance alarms, gas monitors and overflow sensors can provide peace of mind, both for residents and carers.
Care homes should make use of appropriate signage. Meaningful symbols and signifiers can help people to locate particular rooms and objects more easily. For example, a sponge or facecloth on a bathroom door acts as a prompt to the room’s purpose.
Having electrical sockets, lighting controls, heating controls, control panels, and furniture in colours or shades that contrast with the walls helps people to locate fittings and to orientate themselves to their surroundings.
People’s views should always be sought and due consideration should be given to individual choice. For example, it is suggested that in the interests of safety, rugs and mats should be removed, but this may not be the person’s own preference. In such circumstances there is a need to balance management of risk against people’s rights to make independent choices
Good design is vital when it comes to fixtures and fittings
Good layout and design of kitchens can make preparation of food and drink easier and thus facilitate independent living for people with sight loss and dementia.
Kitchens can present many potential dangers to any person using them, from hot appliances to sharp kitchen utensils to cabinets and their contents set at head height. The risks of injury are greater for people with dementia and sight loss than for people who have good vision, but it is important to balance potential risks against people’s right to make choices about their homes and the need to facilitate and promote people’s independence.
Good bathroom design can support more independence with washing, toileting and personal hygiene. Good design can also help with identification of the toilet and bathroom, especially during the night.
Bathrooms can be hazardous places. Limited space, hard surfaces and fixture and fittings, and the potential for slipping on water, soap, shampoo etc all increase the risk of injury. When considering the most-helpful design for a bathroom, it is important to balance the reduction of potential risk on one hand and protecting people’s rights to privacy, maintaining their dignity, and fostering and promoting their independence on the other
A good layout in kitchens can make a big difference to dementia sufferers
Entrances and Exits
Good design of entrances and exits is important for people with sight loss and dementia. With good design of both internal and external entrances and exits, people with dementia and sight loss will be able to move easily between rooms and to enter and leave buildings freely.
Where house alarms are fitted, control panels which have tactile markings and audible confirmation when keys are depressed are easier for people to use.
Some may find it helpful to have equipment fitted to exterior doors which provide an audible warning whenever a door is opened.
All doorways should be wide enough to be easily accessible for people with different levels of mobility and door thresholds should be as low as possible so as not to create a trip hazard. The inclusion of handrails should be considered and larger landings at stairs are helpful to those with sight loss.
Additional interior and exterior lighting at entrances and exits makes them easier for people to use.
Entering through a front door can be made easier by providing motion or sound- activated exterior lighting which comes on as people approach their doors. Illuminating key parts of the door can also be helpful, for example by using lighted key holes and lighted doorbells.
It is important that people are able to access gardens and outdoor areas adjacent to their homes.
Going outdoors has been shown to have multiple benefits including providing physical exercise, helping to maintain normal sleeping patterns and daily rhythms, improving mood and helping people to cope with stress. A well-designed outdoor space can be enjoyed by people with sight loss and dementia, as well as their families.
Spaces should be easy and light, with well-defined pathways, no trip hazards, handrails and activities at various points.
Click here to read the full guidance.
Good lighting is crucial