Some aspects of colour perception among patients with Alzheimer's disease

Ageing- and dementia-friendly design: theory and evidence from cognitive psychology, neuropsychology and environmental psychology can contribute to design guidelines that minimise spatial disorientation

Many older people, both with and without dementia, eventually move from their familiar home environments into unfamiliar surroundings, such as sheltered housing or care homes. Age-related declines in wayfinding skills can make it difficult to learn to navigate in these new, unfamiliar environments. To facilitate the transition to their new accommodation, it is therefore important to develop retirement complexes and care homes specifically designed to reduce the wayfinding difficulties of older people and those with Alzheimer’s disease (AD). Residential complexes that are designed to support spatial orientation and that compensate for impaired navigation abilities would make it easier for people with dementia to adapt to their new living environment. This would improve the independence, quality of life and well-being of residents, and reduce the caregivers’ workload. Based on these premises, this opinion paper considers how evidence from cognitive psychology, neuropsychology and environmental psychology can contribute to ageing- and dementia-friendly design with a view to minimising spatial disorientation. After an introduction of the cognitive mechanisms and processes involved in spatial navigation, and the changes that occur in typical and atypical ageing, research from the field of environmental psychology is considered, highlighting design factors likely to facilitate (or impair) indoor wayfinding in complex buildings. Finally, psychological theories and design knowledge are combined to suggest ageing- and dementia-friendly design guidelines that aim to minimise spatial disorientation by focusing on residual navigation skills.

A Scoping Literature Review of Dementia-Friendly Hospital Design

Purpose

We report the findings of a knowledge synthesis research project on the topic of dementia-friendly acute care (D-FAC) design. This exploratory project systematically mapped what is known about D-FAC physical design in hospitals. We discuss our challenges in locating reportable evidence and the implications of such design for maximizing independent function while ensuring safety and harm reduction in older people living with dementia.

Design and Methods

Exploratory iterative design utilizing scoping literature review methodology.

Results

A total of 28 primary studies plus expert reviewers' narratives on the impact of design and architectural features on independent function of hospitalized older people with dementia were included and evaluated. Items were mapped to key design elements to describe a D-FAC environment. This scoping review project confirms the limited nature of available acute care design evidence on maximizing function.

Implications

Physical design influences the usability and activity undertaken in a health care space and ultimately affects patient outcomes. Achieving safe quality hospital care for older people living with dementia is particularly challenging. Evidence of design principle effectiveness is needed that can be applied to general medical and surgical units where the bulk of older persons with and without dementia are treated.

Vision in Alzheimer's disease: a focus on the anterior afferent pathway

Visual dysfunction has long been recognized as a manifestation of Alzheimer's disease (AD), particularly in the form of visuospatial impairment during all stages of disease. However, investigations have revealed findings within the anterior (i.e., pregeniculate) afferent visual pathways that rely on retinal imaging and electrophysiologic methodologies for detection. Here we focus on the anterior afferent visual pathways in AD and the measures used for assessment, including optical coherence tomography, electrophysiology, color vision testing and threshold visual field perimetry. A brief summary of higher order visual dysfunction is also included to allow the reader to keep in context the broader findings of afferent visual dysfunction in AD.

Environmental Cues in Double-Occupancy Rooms to Support Patients With Dementia

OBJECTIVE

The purpose of this study was to evaluate the effectiveness of different environmental cues in double-occupancy rooms of an acute care hospital to support patients' abilities to identify their bed and wardrobe.

METHODS

The quasi-experiment was conducted on a geriatric ward of an acute care hospital. Patients with dementia were included (n = 42). To test the effectiveness of environmental cues, two rooms were enhanced with the environmental cue "color," two rooms with the cue "number," and two rooms with the cue "patient's name". Four rooms were not redesigned and were used as control rooms. For analysis, we pooled the intervention groups color and number (n = 14) and compared it with the control group (n = 22).

RESULTS

The environmental cues color and number were significantly effective to improve the identification of the wardrobe from the third to the fifth day after admission. However, for the 10th-12th day after admission, we found no difference in results. Furthermore, results indicate improvements in the ability to identify the bed by using the environmental cues color and number.

CONCLUSIONS

As this study indicated, the environmental cues color and number are helpful for these patients to identify their bed and wardrobe. However, these cues were most effective from the third to the fifth day after admission. To sustain their effectiveness on patients' identification abilities during their hospital stay, we discuss, whether verbal prompting and an ongoing mentioning of such cues, embedded in the daily work of nurses, could be beneficial.

Geriatric drug therapy: neglecting the inevitable majority

Demographic evolution will considerably increase the number of people aged 65 years and beyond in the coming decades. The elderly not only represent the most heterogeneous population, but also are a major user group for prescribed medicines, a predominance that will continue to further increase. Medicines and medication management are much more complex and challenging in the elderly and can only be addressed through a multidisciplinary approach. There is strong evidence that the elderly are able to properly manage their medication; however, their medications require different features than the standard medications used by adults. The elderly are exposed to several chronic disease conditions and their treatments, as well as experience age-related changes and limitations that need to be reflected in their medication management strategies. Geriatric drug therapy remains a multidisciplinary task. The health care industry, physicians, pharmacists, nurses and care givers provide and guide the patient's therapy according to individual needs, while the health care system and regulatory authorities build the necessary framework of support and resources.Any realistic and significant enhancement to the elderly patients' medicines and medication management needs to be addressed by all disciplines and stakeholders involved since the absence of any of the stakeholders in the overall process negatively impacts the achievable enhancement in geriatric drug therapy.

Semantic networks for odors and colors in Alzheimer's disease

OBJECTIVE

Impairment in odor-naming ability and in verbal and visual semantic networks raised the hypothesis of a breakdown in the semantic network for odors in Alzheimer's disease (AD). The current study addressed this hypothesis.

METHOD

Twenty-four individuals, half patients with probable AD and half control participants, performed triadic-similarity judgments for odors and colors, separately, which, utilizing the multidimensional scaling (MDS) technique of individual difference scaling analysis (INDSCAL), generated two-dimensional configurations of similarity. The abilities to match odors and colors with written name labels were assessed to investigate disease-related differences in ability to identify and conceptualize the stimuli. In addition, responses on attribute-sorting tasks, requiring the odor and color perceptions to be categorized as one polarity of a certain dimension, were obtained to allow for objective interpretation of the MDS spatial maps.

RESULTS

Whereas comparison subjects generated spatial maps based predominantly on relatively abstract characteristics, patients with AD classified odors on perceptual characteristics. The maps for patients with AD also showed disorganized groupings and loose associations between odors. Their normal configurations for colors imply that the patients were able to comprehend the task per se. The data for label matching and for attribute sorting provide further evidence for a disturbance in semantic odor memory in AD. The patients performed poorer than controls on both these odor tasks, implying that the ability to identify and/or conceptualize odors is impaired in AD.

CONCLUSION

The results provide clear evidence for deterioration of the structure of semantic knowledge for odors in AD.

Caring or uncaring - meanings of being in an oncology environment

AIM

This paper reports a study illuminating meanings of being in the physical environment of an oncology centre as narrated by patients, significant others and staff.

BACKGROUND

The physical environment of hospitals can convey different messages. For example, landscape pictures, plants and comfortable chairs can convey positive messages, while sparsely decorated and run-down environments can convey negative values. Traditional healthcare environments may be experienced as unfamiliar, strange and alienating, fostering feelings of stress and vulnerability. The majority of research on care environments has employed experimental designs to test different environmental variables, for example sound, colour and architecture, in relation to patient outcomes such as recovery, pain and blood pressure. There is, however, little research-based understanding of the meanings of being in these environments.

METHODS

A phenomenological hermeneutic approach was applied to analyse 17 interviews with patients, significant others and staff carried out during the spring of 2004 at an oncology centre in Sweden.

FINDINGS

The physical environment was found to influence experiences of care in four ways: first, by being a symbol expressing messages of death and dying, danger, shame and stigma, less social value and worth; second by containing symbols expressing messages of caring and uncaring, life and death; third, by influencing interaction and the balance between being involved and finding privacy; and fourth, by containing objects that could facilitate a shift of focus away from the self: being able to escape the world of cancer, and finding light in the midst of darkness. The comprehensive understanding illuminates the physical environment as not merely a place for caring, but as an important part of caring that needs to be accounted for in nursing care.

CONCLUSION

To promote well-being among patients, we need to ask ourselves if the environment imposes rather than eases suffering. Our findings also suggest the importance of not limiting our conceptions of nursing to nurse-patient relationships, but of using the therapeutic potential of the total environment in nursing care.

Colour perception among the very elderly related to visual and cognitive function

Colour perception was studied among a representative sample of 95-year olds and compared with previously examined 80-year olds and a group with Alzheimer's disease (AD), mean age of 80 years. The 95-year olds' results were on a significantly lower level than the other two groups but showed a similar pattern as to colour -discrimination, -naming, -preferences and colour/form recognition. Visual function among 95-year olds had only minor influence on their result in contrast to cognitive function which had a more profound impact. Most interestingly though, the subjects with Alzheimer's diagnosis, younger than the 95-year olds but with a conclusive diagnosis of dementia, performed on an overall higher level than the 95-year olds. This advantage for the Alzheimer group remained even when compared with a sub sample of the 95-year olds with possible dementia diagnosis excluded. On the other hand, only including 95-year olds with a Mini Mental Examination score of >26 in comparison with the Alzheimer group made the differences between the two groups disappear. It is suggested that colour perception as measured in this study is well preserved throughout life. The overall lower colour perception ability in 95-year olds compared with both 80-year olds and subjects with AD may be an expression of the complexity of very high age rather than any isolated concomitant factor.

Color and form as support for picture recognition in old age

This study examined the effect of color and form as support for picture recognition measured immediately and after a period of 20 minutes in two groups: a random sample of 80-year-old men and women, with a Mini-Mental-State-Examination (MMSE) score of >26 points (N=142), and individuals with confirmed diagnosis of Alzheimer's disease (AD) with a MMSE score ranging from 7-26 points (N=50). The result showed that individuals with AD could make use of spatial support for recognition at a significantly lower level than among the cognitively intact 80-year olds, but most interestingly with a similar pattern. Chromatic pictures had an advantage over achromatic ones on immediate recognition measured as less time consumption and a higher number of correct answers in both groups. However, after 20 minutes' retention time, achromatic pictures were better recognized than chromatic ones by both the 80-year olds and the individuals with AD. It is suggested that immediate recognition had most support from self-generated cues concerning color, in contrast to retained recognition where instead cues concerning form had the strongest impact. Gender and age had no influence on recognition. Visual function and abstract vs concrete objects showed a slight impact on the result. Factors of intelligence and memory in the group of 80-year olds only had a minor influence on recognition, contrary to dementia which had a profound impact. It is concluded that spatial support as to color and form could be used for recognition in old age groups. The result will encourage further experimental research in using coding and cueing strategies for future implications in clinical practice.

Responses of family caregivers and family members with Alzheimer's disease to an activity kit: an ethnographic study

This qualitative evaluation research focused on individuals with Alzheimer's disease cared for at home by a family caregiver. It aimed to assess the responses of family caregivers and family members to an activity kit containing 20 therapeutic activities (The BAG or 'Be Active with Games' kit). In-depth interviews with and observations of 21 caregiver/member dyads were analysed according to Spradley's ethnographic method. Responses to The BAG were contingent upon the family member's symptoms, prior experience, and time of day. For some caregivers The BAG was useful in filling time, inspiring additional activities, facilitating connections with the family member, and connecting family members with their past; for others it was an additional burden in an already frenetic life. The BAG engaged some family members with AD while it 'insulted' others. The value of activities for individuals with AD requires more theoretical and methodological exploration.