Dementia-Friendly Design: A Set of Design Criteria and Design Typologies Supporting Wayfinding

2024 Alzheimer's disease facts and figures

This article describes the public health impact of Alzheimer's disease (AD), including prevalence and incidence, mortality and morbidity, use and costs of care and the ramifications of AD for family caregivers, the dementia workforce and society. The Special Report discusses the larger health care system for older adults with cognitive issues, focusing on the role of caregivers and non-physician health care professionals. An estimated 6.9 million Americans age 65 and older are living with Alzheimer's dementia today. This number could grow to 13.8 million by 2060, barring the development of medical breakthroughs to prevent or cure AD. Official AD death certificates recorded 119,399 deaths from AD in 2021. In 2020 and 2021, when COVID-19 entered the ranks of the top ten causes of death, Alzheimer's was the seventh-leading cause of death in the United States. Official counts for more recent years are still being compiled. Alzheimer's remains the fifth-leading cause of death among Americans age 65 and older. Between 2000 and 2021, deaths from stroke, heart disease and HIV decreased, whereas reported deaths from AD increased more than 140%. More than 11 million family members and other unpaid caregivers provided an estimated 18.4 billion hours of care to people with Alzheimer's or other dementias in 2023. These figures reflect a decline in the number of caregivers compared with a decade earlier, as well as an increase in the amount of care provided by each remaining caregiver. Unpaid dementia caregiving was valued at $346.6 billion in 2023. Its costs, however, extend to unpaid caregivers' increased risk for emotional distress and negative mental and physical health outcomes. Members of the paid health care and broader community-based workforce are involved in diagnosing, treating and caring for people with dementia. However, the United States faces growing shortages across different segments of the dementia care workforce due to a combination of factors, including the absolute increase in the number of people living with dementia. Therefore, targeted programs and care delivery models will be needed to attract, better train and effectively deploy health care and community-based workers to provide dementia care. Average per-person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are almost three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 22 times as great. Total payments in 2024 for health care, long-term care and hospice services for people age 65 and older with dementia are estimated to be $360 billion. The Special Report investigates how caregivers of older adults with cognitive issues interact with the health care system and examines the role non-physician health care professionals play in facilitating clinical care and access to community-based services and supports. It includes surveys of caregivers and health care workers, focusing on their experiences, challenges, awareness and perceptions of dementia care navigation.

Exploring the impact of care home environments and culture on supporting residents to 'wander' safely

OBJECTIVES

Up to 60% of people with dementia living in care homes will 'wander' at some point, which has typically been seen by staff as a problematic behaviour. A range of non-pharmacological interventions have been tested to either support or prevent wandering. However, even recent innovative practice continues to maintain a focus on reducing or preventing wandering. This study aimed to identify, for the first time, care home staff perspectives on home level factors that facilitate or hinder them supporting residents to wander safely.

METHOD

Semi-structured qualitative interviews were conducted with 19 care home staff, working in the North of England. Framework analysis was used to analyse the data.

RESULTS

A range of environmental considerations were identified by staff. Care home design influenced how residents were able to move safely around, and inclusion of points of interest encouraged walking to different locations, such as a garden. Staff worried about managing access to other residents' rooms by people who wander. Within the care home culture, prioritising safe staffing levels, training and awareness, involving external healthcare professionals where required and mentorship from experienced staff members, all contributed towards safe wandering. Staff support for positive risk-taking within the care home was key to promote person-centred care, alongside careful oversight and management of relationships between residents.

CONCLUSION

We identified a range of cultural and environmental factors that contribute towards safe wandering. A positive approach to risk-taking by staff is required to support residents to engage in wandering as an enjoyable activity, whilst acknowledging that there are inherent risks associated with this.

Navigating the twilight years: Supporting older adults' orientation and wayfinding in senior living facilities

In their twilight years, spatial disorientation can cause significant challenges for older adults, leading them to become perpetually disoriented or rely more on environmental cues and others for navigation. Unfortunately, wayfinding within senior living facilities is often an afterthought for senior living facility planners. This study explores the lived experiences of older adults coping with spatial disorientation and wayfinding in senior living facilities and the consequential impact on their physical, social, and psychosocial well-being. Data were collected from 28 older adults in six senior living facilities within three urban locations. The study used one-on-one, semi-structured, in-depth interviews and the Modified Stevick-Colaizzi-Keen analysis method guided by Moustakas' transcendental phenomenology. Five primary themes emerged: spatial disorientation, wayfinding, self-evident stimuli, visual cues and constancies, and digital wayfinding decision junctions. Through a "looking out from the inside" approach, the findings have valuable implications for academics, senior-friendly environments, government policymakers, hospitality and healthcare industries.

Navigating the Maze: Caregivers Perception on Design Elements to Improve Wayfinding for Older Adults With Dementia in Long-Term Care Facilities

AIM

The main purpose of this research is to understand the wayfinding experience of older adults with dementia in long-term care facilities and identifying environmental design elements that support older adults' spatial abilities.

BACKGROUND

Wayfinding problems are the earliest symptoms of dementia, and older adults with cognitive impairment are more likely to get lost in the community and consequences cause psychological responses such as insecurity, agitation, and falling in their environment.

METHOD

The research used data collected from 30 caregivers of two long-term care facilities in the Midwest through a survey and interview on their perceptions of wayfinding design elements.

RESULTS

The research findings highlighted on caregivers' perception on wayfinding experience of older adults with dementia. The findings show a significant difference between importance and satisfaction on floor pattern and visibility in the facilities. Study indicated that glass partitions in the middle of the hall and corridor can create visual obstruction for older adults and barrier for staff as well to keep visual track on them. The qualitative study revealed that different colored doors for individual patient room in a memory care enhance older adults' wayfinding abilities. In addition, in case of multisensory stimuli, noise and smell can improve their wayfinding abilities as well.

CONCLUSION

The conclusion of the study highlights the importance of understanding the design elements that can be effective in creating a safer environment for older adults with dementia.

Toward an Integrated Context-Based Design Approach for Dementia Residential Care Homes: A Review of Key Operational Design Problems

OBJECTIVES, PURPOSE, OR AIM

This article seeks to develop a context-based management system focusing on assessing key operational and design problems and affecting wayfinding in dementia residential care homes.

BACKGROUND

Dementia is multifaceted neurocognitive impairments largely attributed to cognitive deterioration manifested in memory loss and visuospatial deficit which have wider practical implications to both environmental safety and wayfinding and navigation of dementia user. Two key questions were addressed in this context: (1) How can cognitively facilitating assistive technology (AT) be made more user-focused to mitigate the impacts of cognitive impairments on environmental safety and wayfinding? (2) How can design intervention and changes in design topology, colors and texture, and internal finishing aid wayfinding, navigation, and orientation in dementia residential care homes?

METHOD

A systematic literature review and analysis was undertaken to assess the efficacy of key cognitively-related AT to support activities of daily living and environmental safety of dementia sufferers in a care home and aid wayfinding, navigation, and orientation.

RESULTS

Several key design variables to facilitate wayfinding and spatial orientation were identified which include design topology, floor finishing, signposting, and use of color and texture strengthened by meaning, emotional connection to places and cognitively focused intervention via memory cueing and objects-centered recognition.

CONCLUSIONS

Key operational and design guidelines were proposed to assist built environment, care home developers, clinicians and healthcare professionals, and care services providers. There is a need to move toward a dementia-centered design to address the challenges facing people living with dementia in care homes. This should be based on the interrelated behavioral, cognitive, and communication factors.