- Dementia is a growing epidemic in the U.S.
- Evidence-based design in the form of private rooms, home-like features, and furniture positioning can improve the lives of dementia patients.
- Conventional practices such as ADA wayfinding and bedrails may actually be ineffective and dangerous in dementia settings.
- The application of evidence-based design principles in long-term care settings is just beginning to develop.
If you’ve ever had a relative or friend who’s dealt with dementia, you know how difficult and painful the condition can be. But dementia isn’t only an individual challenge. In the U.S. alone, Alzheimer’s and other forms of dementia are expected to cost $1.1 trillion and impact 14 million people by 2020.
Tackling the dementia “epidemic” requires an enormous amount of research and investment, on top of dedication from providers and caregivers. It’s also going to take rethinking how we look at long-term care environments. That’s where evidence-based design comes in.
Daily Life of Dementia Patients
Any facility interested in improving the daily lives of dementia patients should pay close attention to the benefits evidence-based design has to offer.
Dementia’s impact on simple, day-to-day tasks is possibly the most challenging aspect of the disease. Thankfully, there is increasing evidence that a focus on the built environment as a part of a larger dementia management plan can have a real impact on psychosocial and physical outcomes for dementia patients.
Over the past 20 to 30 years, the size of nursing units has shrunk considerably from 60 beds down to “households” that can cap out at as few as 20 residents. Researchers have linked this shift in size from larger units to adverse patient outcomes including:
- Higher aggressiveness
- Elevated rates of depression
- Faster deterioration
- Increased use of medication
In contrast, units designed for accommodating less patients produce more friendships, less anxiety and depression, and even greater mobility.
On the design front, there’s a consensus on settings that feel more “homelike” and avoid colors and patterns that are monotonous are best for resident well-being. Some literature even suggests including a residents’ home belongings and furniture as part of design efforts to improve emotional well-being and functionality. Since residents who can’t find their way to their desired locations sometimes exhibit anxiety and even mutism and panic, wayfinding can be especially effective for helping reduce confusion and frustration.
Overall, evidence-based design for dementia patients often requires rethinking “normal” in care settings. For example, some residents might see high-contrast floor patterns as barriers, and patients who have a low field of vision might miss signs set at heights specified by the American with Disability Act (ADA) guidelines.
The Importance of Individual Rooms
Much of the recent conversation around nursing home and assisted living space design has focused on the inclusion of more private rooms. Studies found that when dementia patients moved from shared to private rooms: their sleep improved, conflicts with other residents decreased, rummaging behavior dropped off, and patients required fewer psychotropic medications.
Benefits don’t stop there though. Evidence points toward a drop in nosocomial infections and hospitalizations on top of a boost to operational savings resulting from less staff time used cleaning rooms and bathrooms. Other research has even pointed to lower staff turnover in units and households with higher percentages of private rooms, likely due to decreased stress from managing conflicts.
Private rooms hold a lot of potential for improving the lives of dementia patients, but of course, also come with challenges. Drug diversion is a severe concern in long-term care environments, and the use of private rooms shift the dynamic. One way to both simplify medication use tracking and monitor drug diversion in private rooms is with the use of access-controlled cabinets equipped with activity monitoring that opens the door to greater transparency, improved security, and reduced medication errors for your residents and staff.
Dementia Safety and Evidence-Based Design
The evidence-based design conversation always eventually points back to safety.
Long-Term care facilities observe dementia patients for falls not only because of the risk but also the fact that falls can dramatically increase the cost of care. With around 89% of residents with dementia living in long-term care facilities dealing with some mobility impairment, the safety question is one that’s always present.
Research shows dementia patients are most likely to fall at night when they’re trying to get out of bed and use the bathroom. While bed rails are supposed to be preventive features, research suggests that they can also be associated with increased risk of fall and injury. Other environmental interventions though, like repositioning furniture, using floor mats to cushion falls, and even anti-slip mats to boost traction are possible alternatives.
Over time, it’s become more evident that a dynamic approach to interior design in long-term care environments can have a considerable impact on patient experience. For patients who have dementia, that impact is exponentially higher since they rely on design for so many essential functions in life. As the study and application of EBD for dementia patients move forward, expect to see more efforts around the integration of dementia patients into general resident populations and more formal approaches to “evidence” and research.
Want to learn more about reducing risk at your long-term care facility? We’ve got you covered.