November 1, 2003
Paying attention to the way a nursing home or other long-term care facility for Alzheimer's is designed can make a big difference in the quality of life for persons with dementia, a new study reports. Residents in accommodations that offered such features as well-designed physical surroundings, safety and autonomy, a home-like environment and access to outdoor space were less depressed and agitated, remained more independent and had a better quality of life than those who did not have access to these amenities.
The study looked at over 400 men and women with Alzheimer's and other forms of dementia who lived at 15 residential facilities in New England and eastern New York. The facilities were rated in terms of such "Alzheimer's friendly" factors that past research had indicated may improve the mood and behavior of persons with dementia. Such factors include:
*Camouflaged exits. Exit doors equipped with small signs and invisible alarms, handles and lock devices, painted to look like the surrounding room, and located along the side of corridor walls as opposed to the ends of hallways. Solid, rather than windowed or glass, doors and silent locks that do not attract attention.
*Walking paths. Well designed walking paths, with plenty of light and windows, long sight lines, few corners, wide corridors that can easily accommodate two persons, little clutter, and visual cues, such as photos and visible landmarks, to orient residents about where they were heading.
*Private space. Private bedrooms and bathrooms, with separate access and decorated with personal photos, artwork, linens and other personal objects, spread naturally around the room (not confined to pegboards). Sinks in bedrooms, an easy chair beside the bed and, in shared bedrooms, plenty of space between beds with a solid divider, such as a bookcase (not a curtain).
*Well-designed common rooms. Three to five uniquely decorated common rooms that are not too crowded and with home-like features, such as kitchens, living rooms, activity centers or family rooms furnished with room-appropriate dcor and homey furnishings, lighting and mood.
*Outdoor freedom. Ready access to outdoor space, including "therapeutic gardens" that allow patients to walk, sit and smell the plants and flowers. Fenced outdoor spaces that offer safe and interesting activities, such as gardening, with ready access from the indoors.
*Home-like character. Furniture and dcor that feel homey and lack an institutional feel, including generous use of personal objects, little crowding, warm lighting, soft linens and staff dress that does not feel oppressive.
*Autonomy and support. Well-placed furniture, lack of clutter, unobtrusive staff supervision and nursing stations, and removal of sharp or unsafe objects. Physical supports in bedrooms and bathrooms, such as handrails, raised toilet seats, and bathtub and shower support rails that encourage independence and minimize the chance of falls.
*Sensory comfort. Surroundings that provide comforting and familiar sounds, smells, sights and textures and that avoid over-stimulation. Moderate levels of background noise.
Residents were assessed in terms of frequency of disruptive behaviors like cursing, hitting, kicking, biting, destroying property, wandering, restlessness, inappropriate dress, complaining, strange laughter or crying, paranoid delusions and screaming, as well as negative emotional states such as depression, anxiety and stress, social withdrawal and boredom. They were also rated in terms of such positive behaviors as smiling, being in good spirits, social interaction, paying attention to their surroundings, remaining busy and helping others. Variables such as the length of time a person had been in a facility, staffing levels and the kinds of medications patients were taking were also factored in.
Those facilities that offered the greatest number and degree of "Alzheimer's friendly" features led to better resident outcomes. Privacy and personalization in bedrooms, a home-like character, and an environment that residents found easy to navigate, for example, correlated with less aggression and agitation and fewer psychological problems among those with Alzheimer's. Similarly, common areas that varied in ambiance and camouflaged exit doors led to less depression, social withdrawal and hallucinations among residents.
"Photos and videos from the past, where memories are intact, can be soothing and comforting for persons with Alzheimer's," comments Samuel E. Gandy, M.D., Ph.D., Chairman of the Scientific Advisory Board at the Fisher Center for Alzheimer's Research Foundation. Although further research is needed, the researchers speculate that such features give residents a greater sense of control and empowerment, leading to less depression and agitation among patients and contributing to less stress among staff as well.
Placing a spouse, parent or other loved one in a nursing home or assisted-living facility is never an easy choice. While various measures can help to keep a person with Alzheimer's home longer residential care may become inevitable as the mind continues to deteriorate. Although many factors come into play when providing appropriate care, including selecting the right medications and providing appropriate behavioral therapy and counseling, taking environmental design issues into consideration may be an important factor when choosing an appropriate long-term care facility.
The study appeared in the October 2003 issue of The Gerontologist, a medical journal from The Gerontological Society of America, a non-profit association devoted to issues of aging.
By Toby Bilanow, Medcial Writer for www.ALZinfo.org. The Alzheimer's Information Site. Reviewed by Samuel E. Gandy, M.D., Ph.D., Chairman of the Scientific Advisory Board, Fisher Center for Alzheimer's Research Foundation.