Creating dementia friendly environments: how to support successful orientation for people with dementia

www.bournemouth.ac.uk/dementia-institute

Creating dementia friendly environments: how to support

successful orientation for people with dementia

Mary O’Malley Bournemouth University Dementia Institute (BUDI)

www.bournemouth.ac.uk/dementia-institute 2

•  Background •  Navigation, ageing and dementia •  Dementia friendly design guidelines

•  Research studies •  Study 1: How do older people learn new

short routes? •  Study 2: wayfinding and design

experiences of residents living in a retirement complex

•  Summary

Talk Overview


Older adults: •  Take longer to learn new routes (Barrash, 1994).

•  Have difficulties using maps to navigate unfamiliar routes (Wilkiniss et al, 1997).

•  Have impaired knowledge for where landmarks are situated along a recently travelled route (Monacelli et al, 2003; Head and Isom, 2010).

Background Spatial navigation and ageing


Spatial navigation and AD

•  For those who experience Alzheimer’s disease (AD) there is enhanced degeneration of the hippocampus, the region associated with spatial and episodic memories.

•  People with early AD experience disorientation especially in new environments (unfamiliar).

•  With progression of AD: Spatial memory within familiar environments is affected.


While navigating through an environment different strategies are used:

Egocentric representation Allocentric representation

Harvard (2013) Harvard (2013)

Striatal dependent Intact during ageing and early AD

Hippocampal dependent More difficult during AD




As people with AD have difficulties accessing allocentric representations they rely on local cues (O’Brien et al., 2001). • Associative cue theory: we associate a particular landmark within an environment with an action, for example turn left at the church (Waller & Lippa, 2007). • Beaconing strategy: the most simple navigation strategy, where someone directs themselves towards a goal landmark, they have to encode a sequence of landmarks to reach their destination (Devan & White, 1999).


Dementia Friendly Design Guidelines: Orientation

“prominent landmarks for people to notice, remember and recognise, internally and externally” ( NHS wayfinding guidelines, 2007, p.15)

“Are pictures/objects and colour used to help people find their way around?” (EHE Environmental Assessment Tool, The King's Fund, 2013, p.8)

“Older people with dementia continue to plan and visualise proposed routes and tend to use landmarks and other visual cues rather than maps and written directions as wayfinding techniques” (Mitchell et al., 2004, p.2)

“memorable features that help people to navigate their way around the building” (EVOLVE tool, Orrell et al., 2008, p.8).

See O’Malley et al., (2015) for a review of existing guidelines http://eprints.bournemouth.ac.uk/22146/


2. Study 1: How do we learn new short routes?


Watching & learning a short

route

Perspective Shift/ Map

Task

Route Recall

Landmark Sequence

Task

Sequence of Directions

Associative Cue Task

Procedure


Study 1: Discussion

Effects of early atypical ageing versus typical ageing: Dissociation between route learning and route recall (post test). Strongest effect in the map/perspective shift task which is known to be hippocampus dependent Interestingly, landmark sequence task is not affected by either typical or atypical ageing Follow-up study on YAH

maps

Effects of typical ageing (young vs. typical ageing): restricted to route learning performance and route recall (post test) performance.


Study 2: What are the design preferences and orientation experiences of residents

living in a retirement development?


Speaking directly to people with memory difficulties

13 semi-structured interviews with residents with self reported memory difficulties: 7 key questions:

•  Orientation experiences in the development

•  Design preferences

All residents were aged over 65 years (Age M=81.84years) All with self-reported memory difficulties. 11 females (2 male) Thematic Analysis (Braun and Clarke, 2006) was used to analyse the transcripts.


Findings

Betty: “When I first came I found it very awkward ...

Because they (the corridors) all look the

same.”

Helen: “Well when I first came, I did get lost. I took the wrong lift and went up to the wrong floor and well in the end I walked down the stairs. I gave up with

the lift”

Spaces filled with distinct features (e.g. photographs,

and flowers on a table) were particularly

memorable.

Helen: “I go out my door here, down the corridor, and then, I do it in three

sections really. First to the bend, then the next bit, past the table with the

flowers, and then the third bit takes me to the lift”

Design issues: design of the corridors (e.g. the

colours and pictures along the walls), and reducing the distances between

locations.

Ethel: “if somebody was lost and there was sort of one bright picture, it might

help.” Colin: “the short distance

between here and the lounge is very important

and the front door”.

Disorientation as a result of interior design

features and the architectural structure

of the development

Overcoming and

avoiding disorientation using orientation

strategies and environmental cues

Residents’ design suggestions:

making spaces meaningful and

memorable


Study 2: Discussion

•  It is vital to ensure apartments are close enough in proximity to communal spaces and that unnecessary circulation areas and repetitive layouts are avoided.

•  Many of the design preferences closely resemble some existing dementia-friendly design guidelines (Chmielewski & Eastman, 2014). implementing them in other environments would result in a better design for all (Marshall, 2001).


Take home message

•  It is important to consider that as we age and, if a dementia is experienced, environments become much harder to navigate.

•  Understanding which strategies are least and most susceptible to forgetting will help inform us on how to better design environments and help further support dementia friendly design guidelines.

Thank you for listening!

Mary O’Malley

Email: [email protected]