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How Does Open Spaces Affect Someone With Dementia

Do Try To Be Forgiving And Patient

What is the Royal Derby Hospital doing to support people with dementia?

Do not forget that dementia is the condition that results in irrational behavior and causes dementia sufferers to act the way they do. The patients demand plenty of patience and forgiveness from the people looking after them. Have the heart to let things go instead of carrying grudges around for something that the patient may not be in control of.

Aggressive Behavior By Stage Of Dementia

The middle stages of dementia are when anger and aggression are most likely to start occurring as symptoms, along with other worrying habits like wandering, hoarding, and compulsive behaviors that may seem unusual.

In most types of dementia these issues develop in the mid-to-later stages. You might see aggression spike at the same time as the person starts needing more hands-on help with activities of daily living like getting dressed and eating. About half of people diagnosed with dementia become so agitated that theyll strike back with physical abuse or verbal threats. Fortunately, these behaviors that challenge, if theyre not characteristic or normal for your loved one , have been known to fade. It may take years, but the change is not permanent, and things will probably calm down.

That said, when recall starts to fade in later stages, family and friends become harder to remember and the lack of recognition can also cause aggression. A person who cant remember people becomes confused or outright scared by the company. Paranoia can be common. This is why maintaining routine and using smart strategies to communicate are important.

General Tips For Any Room In The House

  • Keep window coverings open throughout the day to allow natural light in, and close them only as needed to complete daily routines. Keep windows clean. Close drapes at night to avoid reflections on the window and to indicate it is nighttime.
  • Tape down area rugs, or remove altogether. Remove all tripping hazards and clutter. Remove any cables or wires that are running across the floor.
  • Keep a list of phone numbers with the telephone. If necessary, add photos to the numbers so that they are recognizable.
  • If looking into mirrors becomes a problem for the one with dementia, cover or remove them.
  • Keep upholstery and floor patterns simple, and with minimal pattern. Avoid clashing colors. On floors, avoid wavy lines, stripes, or changes of color between rooms.
  • Replace socket and switch plates with ones that are a contrasting color to the wall.
  • Use a small bulletin board for your loved ones daily routine and to do list. Direct your loved one to it everyday.
  • Have a designated area to drop the keys, glasses, mail, etc.
  • Label the contents of drawers and cupboards using colorful photo images, cards or post-it notes. Do the same with doors, placing signs eye level for the one with dementia.
  • Leave internal doors to the most commonly used rooms open.
  • Keep household water temperature at or below 120 degrees.
  • Keep household cleaners in a locked cabinet.

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General Attributes Of The Environment

These studies investigate desired qualities of the overall facility environment. Studies have examined effects on well-being associated with noninstitutional character, levels of sensory stimulation, lighting levels, and design modifications for safety.

Noninstitutional Character.

Design guides frequently endorse the use of noninstitutional design features, such as homelike furnishings and personalization, to promote well-being among residents. This endorsement is supported by research findings, though studies often compare facilities in which many features vary , in addition to environmental design. Noninstitutional environments characterized as having homelike or “enhanced” ambiance are associated with improved intellectual and emotional well-being, enhanced social interaction, reduced agitation, reduced trespassing and exit seeking, greater preference and pleasure, and improved functionality of older adults with dementia and other mental illnesses . Compared with those in traditional nursing homes and hospitals, residents in noninstitutional settings are less aggressive, preserve better motor functions, require lower usage of tranquilizing drugs, and have less anxiety. Relatives reported greater satisfaction and less burden associated with noninstitutional facilities . Staff also prefer less institutional, enhanced environments .

Sensory Stimulation.

Lighting and Visual Contrast.

Safety.

Can Technological Nature Be Effective

Diagnosis Of Dementias Other Than Alzheimer

Couldnt we simply substitute aspects of the natural world with technological depictions of nature? Can technology provide an adequate substitute in places where the natural world is some distance away?

When comparing subjects reactions in windowless offices with and without plasma TV windows showing natural scenes, participants preferred the offices with plasma-display windows and noted increased psychological well-being and cognitive functioning as a result of this connection to the natural world.38 In another study comparing viewing formats, outdoor views through glass windows were more restorative than blank walls, but plasma windows were no more restorative than blank walls to the subjects sense of well-being. Subjects heart rates were lower in offices with the glass windows than in those with plasma windows and blank walls.39

It seems that artificially represented nature is not an effective substitute for directly perceived nature as it does not provide equivalent benefits and positive experiences. Such technological representations could be useful to some degree in situations where it is difficult to incorporate real nature, as in space shuttles, submarines, or other extreme environments where there is an unavoidable disconnect from the natural world.

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Manage Stress In An Alzheimers Or Dementia Patient

Different stress-reducing techniques work better for some Alzheimers patients than others, so you may need to experiment to find the ones that best help your loved one.

Exercise is one of the best stress-relievers for both the Alzheimers patient and you, the caregiver. Regular walking, dancing, or seated exercises can have a positive effect on many problem behaviors, such as aggression, wandering, and difficulty sleeping. Indoor shopping malls are vast walking opportunities protected from the weather.

Simple activities can be a way for your loved one to reconnect with their earlier life. Someone who used to enjoy cooking, for example, may still gain pleasure from the simple task of washing vegetables for dinner. Try to involve your loved one in as many daily activities as possible. Folding laundry, watering plants, or going for a drive in the country can all help to manage stress.

Remembering the past may also help calm and soothe your loved one. Even if they cant remember what happened a few minutes ago, they may still clearly recall things from decades ago. Try asking general questions about their distant past.

Use calming music or play your loved ones favorite type of music as a way to relax them when agitated. Music therapy can also help soothe someone with Alzheimers disease during mealtimes and bath times, making the processes easier for both of you.

Take time to really connect with the person youre caring for

Do Not Get Angry Or Upset

When looking after persons with dementia, practicing self-control is of utter importance. Learn how to breathe in and just relax without taking things personally or getting angry and upset. Remember that dementia patients do not act the way they do out of their own accord. It is the illness that makes them behave the way they do.

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Risk Factors With Dementia

There are different personal risk factors that cause people to fall, however, people with dementia are at greater risk because they:

  • are more likely to experience problems with mobility, balance and muscle weakness
  • can have difficulties with their memory and finding their way around
  • can have difficulties processing what they see and reacting to situations
  • may take medicines that make them drowsy, dizzy or lower their blood pressure
  • are at greater risk of feeling depressed
  • may find it difficult to communicate their worries, needs or feelings

Each person will experience dementia in their own way, and may experience all or none of these risk factors.

Planning For When Your Loved One Does Wander

The importance of communication for people with dementia

In case your loved one does wander, its a good idea to have a plan in place.

  • Notify neighbors and local police about your loved ones tendency to wander, and circulate your phone number.
  • Have your loved one wear an ID bracelet or labels in clothing. Digital devices using GPS technology can track your loved ones location.
  • In case a police search becomes necessary, have a recent photo of your loved one and some unwashed clothing to help search-and-rescue dogs.
  • In the U.S., sign up for the Alzheimers Associations Medic Alert and Safe Return Program, an identification system to help rescue lost Alzheimers patients.

How to find a missing Alzheimers patient

A person with dementia may not call out for help or answer your calls, even when trapped somewhere, leaving them at risk for dehydration and hypothermia.

Check dangerous areas near the home, such as bodies of water, dense foliage, tunnels, bus stops, and high balconies.

Look within a one-mile radius of where the patient was before wandering.

Look within one hundred feet of a road, as most wanderers start out on roads and remain close by. Especially look carefully into bushes and ditches, as your loved one may have fallen or become trapped.

Search in the direction of the wanderers dominant hand. People usually travel first in their dominant direction.

Investigate familiar places, such as former residences or favorite spots. Often, wandering has a particular destination.

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Don’t Pull People Backwards In Wheelchairs

You may think it’s the most expedient way to move someone whose legs might drag onto the ground, but pulling people backward is not acceptable unless it’s an emergency. If you’re not sure why this is a problem, try sitting in a wheelchair and not being able to see when and where you’re being moved. Then, add the confusion and decreased visuospatial awareness of dementia, and you’ll understand why this is a bad practice and doesn’t protect the person’s dignity or comfort.

Instead, explain that you’re going to help move their chair down the hall. If the person’s legs are possibly going to be dragging on the floor, don’t push the chair until you have positioned the foot pedals on the wheelchair and placed their feet on the pedals. This will prevent injury from their legs suddenly dropping or getting caught in front of the chair.

Keep Incontinence Products Out Of Sight

Don’t leave clean incontinence products out in the open. Perhaps you’ve brought some absorbent pads to your loved one’s house or are dropping them off in your resident’s room at the facility where you work. Protect privacy by putting products away in a drawer instead of leaving them out in the open for others to see.

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Balancing Independence And Safety

A dementia-friendly facility aims to support independence and mobility in a safe and secure environment. While people must be safe, and the facility secure, a persons right to free movement and non-restraint must be respected. Reduce risks through good design.

There are many ways to increase safety while encouraging independence and mobility outside.

  • Increase visibility in outdoor areas.
  • Design a circuit path with a continuous route.
  • Use appropriately designed furniture.
  • Arrange furniture so people can sit and rest.
  • Use handrails where needed.
  • Make walking paths level and hazard free.
  • Choose low-glare surfaces.
  • Use orientation and wayfinding cues, including colour and scent.
  • Put in fences that cannot be climbed.
  • Put in suitable plants beside fences.
  • Choose gates that merge with fences and have hidden handles and latches.

How A Positive Environment Changes Alzheimers Outcomes

Digital Dementia

Although it is not a cure, offering person-centered care and a positive environment can help lift seniors with Alzheimers.

If they can live in a positive, dementia-friendly environment, one that supports their health, independence and safety, seniors with Alzheimers will experience more personal control.

They are more likely to remain active and engage in activities familiar to them, which will help them live well for as long as possible.

Have you created a positive environment for your loved one with Alzheimers? Wed love to hear more about your experience in the comments below.

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Access To Health Care

Access to health care affects many facets of a persons physical and brain health. Consistent access to health care services gives people the opportunity for regular preventive health services and early diagnosis of many health conditions, such as diabetes, heart disease, and dementia. Access can also help prevent hospitalizations through the successful management of chronic health conditions. People with dementia often have one or more other chronic health conditions, and care coordination with providers and family care partners is essential to better care and improves health outcomes.

Resources

Creating A Relaxing Environment

Having dementia is very stressful and exhausting. All the problems of dementia, including agitation, sleeplessness, wandering and aggression, are made worse by stress. Stress can be reduced with environmental changes. Each person with dementia is different, so work at finding solutions that suit the individual. Remember to draw on all the senses and avoid overstimulation.

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Facility Design Improves Dementia Residents’ Social Well

Specialized design features must be considered in planning residential facilities to optimize quality of life for patients with dementia.

Multiple studies suggest a relationship between the design of a physical environment and the social interaction that takes place in that environment.1-6 Ongoing research from the University of Kansas underscores the importance of facility design for dementia residents in particular, showing that careful design can result in deeper, better quality social interaction among residentsa finding that has significant implications for improving the well-being of those living with dementia.7

“With baby boomers moving toward their golden years, the need for effective long term care facilities, particularly for those with dementia, is growing at a rapid pace,” says Farhana Ferdous, PhD, a lecturer in the school of architecture at the University of Kansas. “So far there is no established cure for Alzheimer’s disease, but architectural design can offer a lot by changing behaviors and attitudes of the residents and caregivers.”

The key finding of the pilot study was that spaces that are less accessible and less visible generate better quality social interactions among residents than spaces with greater accessibility and visibility. “Architectural configuration not only influences conversation but also the type of conversations likely to occur in certain locations,” Ferdous says.

Jamie Santa Cruz is a freelance writer based in Englewood, Colorado.

Kitchen And Dining Areas

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Eating and drinking are always important, but a person with dementia may lose their appetite and their ability to care for themselves in this way. The design of a kitchen can help a person with dementia to find and use what they need. If the kitchen and dining areas are recognisable, for example, with a clear lay-out and appealing cooking smells, this stimulates the appetite and encourages people to do as much as possible for themselves.

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Social Determinants Of Health And Alzheimers Disease And Related Dementias

The conditions in places where people are born, live, learn, work, and play are known as social determinants of health . These conditions can have a profound effect on a persons health, including their risk for Alzheimers disease and related dementias.

Differences in SDOH contribute to the stark and persistent chronic disease disparities in the United States among racial, ethnic, and socioeconomic groups by systematically limiting opportunities for members of some groups to be healthy. While public health crises and economic uncertainty may focus attention on disparities, health inequities have persisted across generations because policies and practices have systematically limited access to health care and other opportunities.

A growing body of work exists around social and economic factors that may contribute to a persons health status, including a persons risk for dementia. Although more work needs to be done to determine the exact relationship between these factors and dementia, here are a few areas that could be considered:

Trees Shrubs And Plants

Many different trees, shrubs and plants can be used in facilities. Local nurseries and landscape designers can advise on species and varieties.

  • Choose non-toxic plants.
  • Plant flowers close to walking paths.
  • Choose plants that reflect seasonal changes, like fruit trees and vegetables, to help orient people in time and place.
  • Choose plants for certain activities, such as picking fruit, pruning, growing vegetables or sitting in the shade in summer.
  • Think about colour, scent, shape and feel of flowers and leaves when choosing plants.
  • Do not plant trees that could be climbed close to fences.
  • Choose low maintenance trees, shrubs and plants.

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Living In Green Spaces Can Guard Against Mental Decline Dementia Earthcom

Living near green space has many positive effects, and studies have shown that urban green space specifically counters thenegative impacts of city pollution.

Now, a new study found that living in greener neighborhoods may also potentially guard against cognitive decline and decrease the risk of dementia among the elderly.

Researchers from the Barcelona Institute for Global Health conducted the study which was published in the journal Environmental Health Perspectives.

The results show that cognitive decline, a natural indicator of the aging process, slows down slightly among people who live near green space.

There is evidence that the risk for dementia and cognitive decline can be affected by exposure to urban-related environmental hazards and lifestyle , said Carmen de Keijzer, the studys first author. Recent evidence has shown cognitive benefits of green space exposure in children, but studies on the possible relations of exposure to green spaces and cognitive decline in older adults are still very scarce and often have inconsistent results.

For the study, the researchers followed up on 6,500 people ages 45 to 68 who were part of the UK Whitehall II Cohort Study after ten years.

The participants were asked to complete a course of cognitive tests to measure verbal fluency, short-term memory, and mathematical reasoning at three different points during the follow-up.

, Earth.com Staff Writer

Image Credit: Huy Phan

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