From Research to Application: Supportive and Therapeutic Environments for People Living With Dementia

Abstract

The evidence about the role the designed and built environment plays in supporting individuals living with dementia has been steadily mounting for almost 40 years. Beginning with the work of M. Powell Lawton at the Weiss Pavilion at the Philadelphia Geriatric Center, there are now dozens of researchers who are exploring how the environment can be either supportive and therapeutic, indeed even serving as a prosthetic for various changes in cognition, or be a barrier to independent functioning and high quality of life. Two recent literature reviews published on the impact of environmental factors and characteristics on individuals living with dementia clearly delineate evidence that the environment can have a therapeutic or a debilitating impact on individuals living with dementia. Rather than duplicate these excellent reviews, this article puts the knowledge gleaned from this research into the shifting context that is long-term care. This article begins with an exploration of the evolution of approaches to the design of spaces for individuals living with dementia from traditional or medical models, to special care units (SCUs), to person-centered care (PCC), which is the organizing theme of this supplemental issue. A novel, person-centered way of conceptualizing the domains of environmental systems is then presented and used as the framework for structuring recommendations and creating supportive and therapeutic environments for individuals living with dementia. Although there are distinct pathophysiological and behavioral manifestations of different forms of dementia, there is almost no evidence that suggests alternative environmental characteristics are better for one type of dementia over another. Thus, this article will refer to "individuals living with dementia" as opposed to Alzheimer's disease or other specific forms of dementia. Further, this article only addresses residential environments: homes in the community, independent and assisted living residences and nursing homes. It does not address other settings, such as hospitals or hospice, or work and public community spaces, such as stores. It is recognized that individuals living with dementia do spend time in all these spaces, and fortunately, there is growing interest in creating more dementia-friendly communities, but they will not be addressed in this article. Most of the research that has been done has focused on shared residential settings, so that will be the primary focus on this article.

Characteristics of care methods for daily life disabilities in Alzheimer's type dementia that respect autonomy and independence

“…These methods have been devised to make people with dementia more easily aware of their environment. It is important for people with dementia, including Alzheimer's type dementia, to live in a supportive and therapeutic environment (Calkins, ; Chau et al, ). The World Health Organization′s () International Classification of Functioning states that mutual interaction between humans and their environment is important and it presents the importance of social models to improve the environment to overcome disorders that reduce life functions.…”

“…These methods have been devised to make people with dementia more easily aware of their environment. It is important for people with dementia, including Alzheimer's type dementia, to live in a supportive and therapeutic environment (Calkins, 2018;Chau et al, 2018). The World Health…”

Person-Centered, Skilled Services Using a Montessori Approach for Persons with Dementia

“…In addition, when elders decorate and personalize their spaces with meaningful and beautiful items such as family photos, flowers, or their own handicrafts, they may create a sense of belonging to the environment. 25 Care for oneself. Within the Montessori philosophy, elders may continue to care for themselves by bathing and dressing themselves with as much independence as possible to maintain self-respect and dignity.…”

Living Well With Dementia: Factors Associated With Nursing Home Residents' Affect Balance

“…As registered nurse to licensed practical nurse (LPN) ratios increased, total deficiencies and serious deficiencies decreased . In addition to staffing mix and levels, the built environment can be either supportive or a barrier to independent functioning, physical activity and well-being (Calkins, 2018). Light, noise, and available seating areas all contribute to the fit between the facility and residents' cognitive and physical capabilities.…”