The physical environment can play a significant role in maximizing independence for people with dementia. The following are therapeutic goals:
1. Ensure safety and security. Safety includes preventing access to toxic substances and sharp objects, providing staff to walk with residents who are unsteady, and eliminating fall hazards. Security includes providing safe, secured areas to walk, and using devices to deter people from entering unsafe places, and mitigating sudden loud noises that can be startling.
2. Support functional ability through meaningful activity. The design of the space should allow for getting to the activities that are meaningful to people with dementia by providing good lighting, safe floor surfaces, and handrails for support.
3. Provide heightened awareness and orientation. This includes providing a clear path to destinations and adequate cues and landmarks to help people get where they want to go, displaying personal memorabilia at unit entrances, providing access to outdoors and windows to see the outdoors which with orienting to time and season.
4. Provide appropriate environmental stimulation and challenge. Sensory deprivation can be as debilitating as too much stimulation. The design should provide sensory and social stimulation and interest without overstimulation. Texture, pattern, and color can be introduced, but it must be done in a skillful way with an understanding of dementia.
5. Develop a positive social milieu. Settings should provide opportunities for both passive and active socializing. Seating can offer a view to the outside and activities, or to actively engage in conversation. Window views of people leaving the property, however, may stimulate residents to leave themselves.
6. Maximize autonomy and control. Access to safe and secure outdoor areas gives residents options. The opportunity to make decisions about the décor of their unit allows offer residents more control.
7. Adapt to changing needs. Characteristics of dementia patients change over time, so the environment must adapt.
8. Establish links to the healthy and familiar. Fireplaces, comfy seating, and other links to home and the past help provide comfort and familiarity.
9. Respect the need for privacy. People should have an opportunity to choose from a variety of spaces to spend time just as they did in their previous homes. Shared bedrooms or large rooms don’t offer a place to be alone with special friends or family, whereas a small private niche with a table and two chairs can provide an intimate space for visiting.
10. Encourage family involvement. Settings that encourage family members to visit and participate are important.
