This article is written with inspiration from a lecture by Beate Terzis and her book Support for Dementia and Cognitive Impairment: A Handbook in Response

Design and decoration of premises in nursing homes - Adaptation for people with dementia

The environment in a nursing home plays a crucial role in the well-being and quality of life of the residents, especially for people with dementia. A thoughtful and adapted interior can help reduce anxiety, confusion, and behavioral symptoms in the residents. Here we go through important aspects of design and decoration of premises in nursing homes and how the environment can be adapted to support individual needs.

Simplicity and clarity - keys to a safe environment

People with dementia may have difficulty interpreting complex environments and many impressions at once. Therefore, the decor should be stripped down and functional, with clear signals about what different spaces are used for.

Basic guidelines for design:
Avoid unnecessary visual and auditory stimulation, such as strong patterns, mirrors, and high noise levels.
Create clear boundaries between different spaces by using colors and materials that mark transitions.
Ensure that each room has a clear and consistent function - for example, that the dining room is only used for meals.
Place TVs and other screens in secluded places to reduce distraction.
Avoid shiny and reflective surfaces, as they can be perceived as water or holes in the floor by people with cognitive impairment.

Colors and contrasts - a tool for orientation

Colors affect how we perceive and navigate in an environment. For people with dementia, the right color choice can facilitate orientation and reduce the risk of confusion.

Recommendations for color scheme:
Contrasts between floors, walls, and furniture make it easier to perceive distances and contours.
Blue background with white text is the most readable color combination for signage.
Colors like purple and pink are difficult to perceive, while green tones work well if they are not too dark.
Avoid colors that blend together, such as beige floors and walls in the same shade.
Mark doors with clear colors, but use neutral colors on doors to staff areas to reduce the risk of residents trying to open them.

Important to consider: Too strong contrasts on the floor can be perceived as obstacles or level differences, which can create uncertainty during movement.

Signage and visual information

Signage should be simple and clear to help residents orient themselves. Digital screens with information like "Meatloaf is served at four o'clock" can be useful, but images should be avoided unless they are extremely clear.

Guidelines for signage:
Use uniform and easily readable fonts.
Signs should be placed at eye level and have good contrast.
Avoid small or detailed images that may be difficult to interpret.
Signage should be relevant – unnecessary signs can create confusion.

Nameplates on doors can sometimes create more disorder than benefit. The question should always be asked: "Who is this for?" The environment should be inclusive and adapted for the resident with the most fragile brain.

Lighting - an important part of the environment

The right lighting can help reduce anxiety and confusion in people with dementia.

Important aspects:
Avoid glaring light and sharp shadows.
Use warm white light for a calm atmosphere.
Dimmer functions can adjust the light according to the time of the day.
Good general lighting reduces the risk of falls.
Night sensors in corridors and bathrooms can facilitate nocturnal movements.

There is a lot of research on how lighting affects food intake and circadian rhythm in people with dementia. A well thought out lighting plan can contribute to better appetite and a more stable sleep rhythm.

Furniture and decor

Furniture should be both functional and safe for people with dementia.  

Recommendations:
Avoid furniture with wheels, unless necessary.
Ensure that seating furniture has good support and is easy to get up from.
Create room within the room to make large spaces more manageable.
Choose materials that are easy to clean and keep fresh.
Offer seating opportunities along corridors to facilitate rest during walks.

Friday cozy time or evening snacks in front of the TV can be a good idea, as many have such habits from home. Starting from what is familiar creates security.

Individual customization and observation

Each individual has different needs, and therefore it is important to observe and test what works best for the individual. If a resident eats poorly, adjustments in the dining room can be made to see what promotes better appetite.

Examples of individual customization:
Some may need peace and quiet during meals while others enjoy company.
Adapt seating according to needs - people with visual impairments may, for example, need to sit near a window.
For people with motor difficulties, ergonomic cutlery and mugs can facilitate meals.

Remember that many of those living with dementia will find life increasingly difficult. The environment should therefore be adapted to those who have the most advanced dementia. This can help them maintain various functions, such as eating independently, for longer.

Reflection Questions - Good Care Environment for People with Dementia

Care staff:  
- How can you contribute to creating a safe and calm environment for residents with dementia?  
- Are there areas in the residence where the decor can be improved to increase the orientation ability of the residents?  
- How do you use non-verbal communication to create security?  

Manager, nurse, occupational therapist, and physiotherapist:  
- Do you have a clear plan for the design of the environment in the residence?  
- How do you ensure that the decor supports the residents' need for structure and calm?  
- Have you noticed how lighting and color scheme affect the residents?  

Residents and relatives:  
- Do you find the environment in the residence to be calm and safe?  
- Could something in the decor be changed to create better comfort?  
- Are there clear and easily readable signs for orientation?  

Erland Olsson
Specialist nurse
Sofrosyne - Better care every day