Words: 1961
NMIH306 The Challenges of Ageing 3463205 Michelle James Assignment (Essay) 40% The ageing of the world’s population is a global phenomenon increasing the demand for adequate health care services available to older people. It continues to challenge those who plan and manage the services for older people and even more importantly those who deliver the professional and clinical care within the system such as Nurses.
The Australian Bureau of Statistics (2009) predicted that the number of older Australians, as a proportion of the total population, will double over the next 40 years and in addition to this the World Health Organisation (2006) estimated that there are 18 million people living with dementia, which is expected to double to 37 million by 2025. Dementia is a general term indicating changes to cognitive function that result from a range of specific, usually progressive and irreversible disorders of the brain.
The most common of these disorders is Alzheimer’s disease (50-70% of cases) (Alzheimer’s Association 2007). The symptoms of dementia include loss of memory, confusion and problems with speech and understanding (Alzheimer’s Association 2007). Innovations in care for older people aim to demonstrate major shifts in the aged care workforce to improve the future supply and adaptability of the workers, therefore enhance and improve older peoples’ health outcomes and health services.
This paper will address and discuss the issues and challenges involved with creating environments that enhance dementia care, a key innovation in care of older people. ‘Design of the physical environment is increasingly recognised as an important aid in the care of people with Alzheimer’s disease and other dementias. … Design is regarded as a therapeutic resource to promote well-being and functionality among people with dementia. ‘ Day, Carreon & Stump (2000) According to Nay & Garrett (2009) the impact of the social and physical environments on older people who have dementia is critical to their care outcomes.
An effective innovative concept aims at providing a physical environment for people with dementia in order to achieve their full potential and avoid causing disability. Research and practice has and continues to gain a better understanding of dementia and design innovations in regards to specialised dementia care. This innovative notion of providing dementia friendly environments is emerging, with significant evidence that it has a positive impact on the lives of people with dementia (Nay & Garrett 2009).
The Alzheimer’s Association (2007) supports this innovation, and acknowledges that the environment should support the functions of people with Alzheimer disease, accommodate behavioral changes, maximize abilities, promote safety and encourage independence. They acknowledge that care settings for people with dementia should provide positive, therapeutic stimuli. Alzheimer’s Association (2007) highlights that best practices in dementia care have been developing for close to two decades and during this period the physical environment has been considered a fundamental component of best practice.
The physical environment in an aged care residential facility can become a challenge to people with dementia, however this innovation to design an environment to specifically meet the needs of people with dementia enables them to utilise their retained abilities with minimal frustration, and experience the highest possible quality of life (Alzheimer’s Association 2007). According to Nay & Garrett (2009) a dementia-friendly environment can be achieved through providing an appropriate physical, social and organisational environment.
It is acknowledged that a home or home like physical environment is beneficial. The appropriate environment design for personally meaningful activities should be established as it aims to reinforce the individual’s identity and sense of autonomy in areas such as dining, grooming, dressing and bathing, offering a range of abilities and experiences during these times (Nay & Garrett 2009). Underpinning the social environment in order to support personhood is also important as a sense of self is preserved during dementia, though the ability to communicate it may be hindered.
In order to promote independence for people with dementia, the physical environment should offer support and orientation cues so that they can find their way around the facility along with the essential hand rails and resting spots to adequately promote and support mobility (Nay & Garrett 2009). Outdoor spaces provide diverse stimulating opportunities for people with dementia but must be planned with appropriate safety precautions and wayfinding cues to avoid falls and ensure orientation (Nay & Garrett 2009).
According to Blackman, Schaik & Martyr (2007), older people with mild to moderate dementia should be encouraged to be active outdoors, as this can be facilitated by small environmental modifications. Over 20 years worth of research into the design of environments for people with dementia has proved that people with dementia can either be helped or harmed by the environment in which they live (Fleming, Forbes, & Bennett 2003). In recognising this reality Fleming, Forbes, & Bennett (2003) have developed and executed an empirical study for ‘Adapting the ward for people with dementia’ under the NSW Department of Health.
From this study they developed a manual consisting of ten principles from which the design of environments for people with dementia can be derived. The manual is based on following ten principles in order to offer an environment to provide care and maintain the abilities of people with dementia (Fleming, Forbes, & Bennett 2003). The first principle acknowledges the need to be safe and secure due to the confusion which accompanies dementia, therefore there is a need for safety features to be built into the environment such as a secure perimeter, hot water control and safety switches in the kitchen.
Secondly, be small, referring to that fact that the larger a facility, the more confusing it is likely to be for patients. High-quality care for the mobile, confused and disturbed is easier to provide in small groups of 8-14 (Fleming, Forbes, & Bennett 2003). The third principle addresses the need to be simple and provide good ‘visual access’ as a uncomplicated environment may reduce confusion . The simplest environment is one in which the patient can see everywhere she wants to get to or from wherever she is.
This principle limits the inclusion of corridors in the design and results in staff being able to see the patients almost all the time. This reduces anxiety in both staff and patients (Fleming, Forbes, & Bennett 2003). Fourthly, the need to reduce unwanted stimulation is acknowledged, as people with dementia may find it difficult to cope with a large amount of stimulation. The unit must be designed to reduce the impact of stimulation that is unnecessary for the well-being of the patient, and can be achieved with entry and exit points and noise must being kept to a minimal (Fleming, Forbes, & Bennett 2003).
Highlighting helpful stimuli is the next principle in the manual and involves highlighting toilet doors, exits to safe outside areas, aids to recognition on bedroom doors and some light switches. Blackman, Schaik & Martyr (2007) concur with this principle and address the need for planners and designers to make more use of simple text signs as aids for navigation in identifying the purpose of objects and places in the environment. The sixth principles suggests that it is important to provide for planned wandering as wandering is sometimes a feature of the behaviour of people with dementia.
The design should allow it to take place safely but should not encourage it (Fleming, Forbes, & Bennett 2003). The seventh principle suggests the need to provide surroundings that are familiar to them. This may mean that the decor should be such that it would have been familiar to the patients in their early adulthood as people with dementia can associate more so with their distant past than the present. The eighth principle advices that opportunities are provided for both privacy and community as people with dementia require a range of opportunities for social interaction (Fleming, Forbes, & Bennett 2003).
Providing links to the community is the next principle, which gives people with dementia the chance to remain part of their social network after admission. This can simply be achieved with amenities available to visitors, so that links with family and friends are not broken. Finally, be domestic. Providing an environment for people with dementia that is homelike as possible can help to maintain the person’s abilities for as long as possible (Fleming, Forbes, & Bennett 2003).
This is also researched and encouraged by Anne Conner (2009), as she notes that the physical environment can also act as a means to enhancing a positive sense of self. She gives the example of a kitchen setting being a familiar feeling of the warm sense of home, activating memories and conversations (Connor 2009). Zeisel et al. (2003) performed a study to describe the associations found between seven special care units’ environmental design features and agitation, aggression, depression, social withdrawal, and psychotic symptoms of residents with Alzheimer’s disease.
The environmental features associated with the care units included privacy and personalisation in bedrooms, residential character and an ambient environment that residents could understand and resulted in both reduced aggressive and agitated behaviour and fewer psychological problems (Zeisel et al. 2003). Characteristics of the environment associated with reduced depression, social withdrawal, misidentification and hallucinations included common areas that vary in ambiance and exit doors throughout the care unit.
It was found that there were in fact associations between each behavioural health measure and particular environmental design features, thus demonstrating the potential that environment has for contributing to the improvement of Alzheimer’s symptoms (Zeisel et al 2003). This study concluded that a balanced combination of pharmacologic, behavioural and environmental approaches is likely to be most effective in improving the health, behaviour, and quality of life of people with Alzheimer’s disease.
This is just the beginning for further exploration into environmental design as one important non-pharmacologic treatment for people with Alzheimer’s disease (Zeisel et al 2003). As for implementing this innovation into practice it is imperative that we address reasons why dementia friendly design features are dismissed, with existing regulations being the common cause, including building codes, fire regulations and aged care regulations (Nay & Garrett 2009).
It is therefore an important recommendation that collaborative approaches are taken to gain partnership to advance regulations and ensure that care providers continue to advocate and educate about the essential need for enhanced environments for people with dementia (Nay & Garrett 2009). Future studies are needed in order to identify the optimum balance and arrangement of treatment for those with dementia, including drug treatment, supportive environments, and focused caregiving (Zeisel et al. 2003).
It is clear through current research and studies that environmental factors have the potential and do improve Alzheimer’s symptoms. The greatest likelihood for this approach of environment to make a significant contribution to those with dementia is to provide it as part of their care in collaboration with pharmacologic and behavioral care. This will enable the quality of life, health, and behaviour of people with Alzheimer’s disease to improve, and will therefore enable them to live more satisfying lives (Zeisel et al. 2003). References Alzheimer’s Association 2007, Designing a Care facility, Viewed 01 August 2010,
Blackman, Schaik & Martyr 2007, Outdoor environments for people with dementia: an exploratory study using virtual reality, Ageing & Society, Vol. 27, pp. 811–825 Australian Bureau of Statistics 2009, Population by Age and Sex, Australian States and Territories, no. 3201. 0, ABS, Canberra Connor, A 2009, Design & Environment: Dementia friendly environments and wellbeing, Dementia Supplement, Vol. 12, No. 2, pp. 52-54 Day, Carreon & Stump, 2000. ‘The Therapeutic Design of Environments for People with Dementia: A Review of the Empirical Research,’ The Gerontologist, Vol. 0, No. 4. Fleming, R Forbes, I & Bennett, K 2003, Adapting the ward for people with dementia, NSW Department of Health, Sydney, Australia. Nay, R & Garratt, S 2009, Older people: issues and innovations in care, 3rd ed, Churchill Livingstone, Sydney. World Health Organisation 2006, Age-Friendly Environments Programme, Viewed 08 August 2010, Zeisel, J, Silverstein, N, Hyde, J, Levkoff, S, Lawton, M and Holmes, W 2003, Environmental Correlates to Behavioral Health Outcomes in Alzheimer’s Special Care Units, The Gerontologist, Vol. 43, No. 5, pp. 697-711.