Results of this review indicate that, with the exception of cognition, specific design interventions are beneficial to the outcomes of people with dementia. Overall, the field of environmental design for people with dementia is well researched in many aspects and only few gaps in knowledge were identified.

For the creation of a supportive, dementia-friendly environment, both aspects of architectural design must be considered. Design guidelines to support the wayfinding abilities of people with dementia were developed to synthesize both.

Spatial disorientation is a prime reason for institutionalization. The autonomy of the residents and their quality of life, however, is strongly linked with their ability to reach certain places within their nursing home. The physical environment has a great potential for supporting a resident's wayfinding abilities. For this study, data were collected from 30 German nursing homes. Skilled nurses rated the resident's ability to perform 5 wayfinding tasks. The architectural characteristics of the homes were analyzed and their impact on the resulting scores was tested for statistical significance using the Mann-Whitney U test (P < .05). Results confirm that people with advancing dementia are increasingly dependent on a compensating environment. The significant factors include a small number of residents per living area, the straight layout of the circulation system without any changes in direction, and the provision of only 1 living/dining room. These and additional results were transformed into architectural guidelines.

This study describes home environmental features, safety issues, and health-related modifications in a community dwelling sample of 82 elderly people with dementia. Main barriers to the accessibility of the homes were steps, both inside and outside the house. The majority of the caregivers had made home modifications, which pertained mainly to physical limitations. Home modifications to support cognitive deficits were made to a lesser extent. The main barrier to the implementation of home modifications to accommodate the care recipient’s memory loss was skepticism about their usefulness. Regarding the removal of physical barriers, financial constraints were most frequently mentioned.