Housing adaptations for people with dementia. Professor Mary Marshall

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1 Housing adaptations for people with dementia Professor Mary Marshall

2 Information and Education Library The DSDC library houses a collection of around 12,000 items and provides information to anyone who has a personal or professional interest in the care of people with dementia. Consultancy service Our consultancy service offers the expertise an organisation needs to plan and develop a high quality service for people with dementia. Bookshop The DSDC publishes a wide range of DVDs, training packs and books relevant to everyone from carers and nurses to architects and designers. Browse and buy online at

3 Training, education & research Training Short courses at Stirling Workplace-based training Healthcare support workers Best Practice programmes Education Distance learning programmes Undergraduate module Postgraduate programme (Certificate, Diploma, Masters) Research Social and cultural contexts of dementia Policy and practice in dementia care Non-pharmacological interventions

4 The Iris Murdoch Building Purpose built, opened in 2002 Design example of demen:a friendly public buildings

5 Dementia Design Publications

6 Design telecare e-books

7 Publications / Training

8 Most people with dementia are older They have all the impairments which are common in late life They often have additional conditions They may not understand they have these impairments Optimal health is really important

9 Muscles and bones Normal age related impairment Older people experience Common conditions for older people Older people experience Diminished muscles (Sarcopenia) Very variable: commonly drooping neck, slower gait, diminished grip, poorer reach Arthritis Pain in joints Parkinson s Jerky gait, poorer coordination Osteoporosis Stoop, higher risk of fractures, falls, reduced mobility, breathing problems

10 Lungs Normal age related impairment Older people experience Common conditions for older people Older people experience Diminished lung capacity Need for more oxygen in the air to function well COPD Wheezing, breathlessness, cough Asthma Wheezing, breathlessness, cough Lung cancer Wheezing, breathlessness, cough Limited exercise tolerance

11 Ears Normal age related impairment Older people experience Common conditions for older people Older people experience Presbycusis Loss of high frequencies, louder low frequencies Blocked ear canal Poor hearing Sensorineural damage Poor hearing Vestibular damage (e.g. Meniere's) Dizziness, poor balance Tinnitus Persistent noise in the ear

12 Hearing impairments are common Note: Proportion of people with hearing impairments increases with age 60-80% of people with Down s Syndrome have hearing deficits, some because of blocked ear canal. They have a high risk of dementia but also a high risk of being assessed as more impaired than they are because of hearing problems

13 Eyes Normal age related impairment Older people experience Common conditions for older people Older people experience Thickening lenses A hazier world, diminished ability to discriminate between colours, sensitivity to glare Glaucoma Macular degeneration Cataracts Hemianopsia Loss of peripheral vision Loss of central vision A hazier world Seeing only half

14 Types of Dementia

15 Alzheimer s disease Accounts for about 55% of cases Slow gradual change with shrinkage of the cerebral hemisphere and reduction in brain weight Neurones degenerate, especially at their connections senile plaques and neurofibrilliary tangles The more plaques the more impairment Some people have visuospatial/perceptual problems

16 Vascular Dementia (multi-infarct) Accounts for 20% in western societies Cardio-vascular causes Blood supply impaired clot forms Can be gradual period of decline with sudden episodes Can affect some areas of the brain but not others Implicated in all dementias

17 Lewy Body Dementia Accounts for at least 20% of cases Lewy bodies (abnormal aggregation of protein, especially in substantia nigra) Tremors, rigidity Slowness of movement, unexplained falls Delusions, hallucinations Fluctuation Neuroleptic sensitivity

18 Impairments of dementia usually include: Impaired memory, especially recent memory Impaired learning Impaired reasoning Perceptual problems are common High levels of stress Difficulty adjusting to the sensory/mobility impairment of normal ageing

19 So what happens when we get design wrong?

20 What happens when we get it wrong? Slips, trips & falls Behaviour which challenges Death by boredom Reduction in quality of life

21 Slips, trips & falls

22 Slips, trips and falls Compared with older people without dementia, those with dementia are: Twice as likely to fall Three times as likely to fracture a bone Have a poorer prognosis (less likely to make a satisfactory recovery)

23 Slips, trips and falls Spend longer in hospital (at great personal and financial expense to everyone) Five times more likely to be institutionalised subsequently Three times more likely to be dead after 6 months

24 Behaviour which challenges

25 Behaviour which may relate to design Examples: Walking a lot (lost, hot, in pain) Frustration at dead ends Anger at feeling imprisoned Humiliated because cannot understand and use normal things like taps and toilet flush Withdrawal from too much noise

26 Very impaired people with dementia These are people at the end stages of dementia And people with other terminal conditions or extreme frailty, who have dementia Need extra attention to their close environment (bedroom or even just bed) to provide a good multi-sensory experience Space for other people to be there.

27 By design, it should be possible to allow for: Lots of very familiar objects close by the bed Textures to touch Access to nature and good views to the outside Enough room for care staff, and someone sitting by the bed Enough sockets for electrical equipment e.g. for music, lighting, etc.

28 Adapting housing Ten top housing adaptations for people with dementia Plus two at the start which are keys points from the book: Improving the design of housing to assist people with dementia

29 First key point It is discriminatory to fail to meet the needs of people with dementia. Their needs should be given the same priority as those of other groups with impairments E.g. those in wheelchairs

30 Fourth key point When considering modifications, avoid changing too much at once. People with dementia may have difficulty adjusting to change

31 Top ten housing adaptations 1. Double the usual levels of lighting in the home

32 Top ten housing adaptations 2. Pay attention to the acoustics and reduce noise pollution

33 Top ten housing adaptations 3. Ensure there is good* signage mounted low enough for older people *6 rules of good signage: words and picture, words with capitals and lower case, contrast (with back of sign/sign with what it is fixed to),mounted no more than 1.2 metres from the floor, attached to the door if a door sign, only use a sign if it helps.

34 Top ten housing adaptations 4. Use contrast in tone (rather than colour) to differentiate between walls, skirting boards and floors.( 30 LRVs) Ensure that the tone of flooring/paving is consistent throughout the house and also in outside areas (less than 10 LRVs difference between any flooring)

35 Top ten housing adaptations 5. Use contrast of colour or tone to make switches and objects easily visible E.g. a white toilet seat on a white WC on a white or pale floor is invisible E.g. chrome shower controls on a chrome back plate are invisible

36 Top ten housing adaptations 6. Do not rely on colour for orientation and way-finding Use objects or pictures rather than colours to differentiate between rooms and different doors

37 Top ten housing adaptations 7. ensure that kitchens and bathrooms are easy to understand. Avoid modern, unfamiliar fixtures and fittings such as taps or kettles

38 Top ten housing adaptations 8.ensure that people can see important rooms such as the toilet, as easily as possible, and that furniture and fittings clearly indicate the purpose of each room.

39 Top ten housing adaptations 9. Place illuminated clocks in each room indicating whether it is am or pm

40 Top ten housing adaptations 10. All doors should ideally be visible on entering the dwelling. Crucial cupboards e.g. for tea and coffee in the kitchen, should be glass fronted or open

41 Thank you