Environment Improvement of Dementia

Environment Improvement of Dementia

Dementia has a wide variety of effects on the patient’s cognitive ability making even the most mundane tasks such as coordinated movement and navigation difficult. Various forms of dementia such as Alzheimer’s disease in the medium to advanced stages make movement in a coordinated manner hard      (Baldwin, 2009). Additionally, the patient’s short and long term memory become compromised meaning they cannot navigate in areas that require one to remember their route.

Indeed, some forms of dementia also affect the cognitive abilities associated with information processing meaning the patient cannot associate signage and other symbolic imagery with the meaning (Cameron-Taylor, 2012). Therefore, the patient cannot understand the symbol for danger, or that that reads exit and entry. These problems make dementia patients undergo tough times when in large complex spaces such as aged care facilities where there is a need for memory, coordination, and the ability to process various sensory and mental information appropriately.

When offering supportive care for patients suffering from dementia, one aspect that forms an important part of the care is provision of an enabling environment. Due to the impairments that affect these patients’ cognitive and coordinative faculties, such considerations could prevent them from placing themselves in danger due to falls and other forms of serious injury such as fire (Evans & Robinson, 2009). Other circumstances require that the patients be prevented from accessing certain facilities because their impaired judgment or coordination places them in danger should they attempt to use them (Garber, Gross, & Slonim, 2010). Therefore, supportive care aimed at offering an enabling environment for patients suffering from dementia is a two-fold affair; one that is meant to ensure safety while accessing certain facilities, and prevent these patients from accessing other facilities completely.

Before engaging in the discussion to identify the supportive care considerations that could improve the experiences of patients with dementia in aged care facilities, one must assume a certain mindset (Hughes, Lloyd-Williams, & Sachs, 2009). The exercise requires that the person offering supportive care consider dementia as a form of disability that affects the patient’s cognitive and sometimes coordinative faculties. This mind set is important in order to prevent the inherent empathy one may direct at some of the lesser forms of dementia thus compromising the entire process of supportive care (International Conference on Smart Homes and Health Telematics & Biswas, 2013). Understanding that dementia compromises some of the highest human faculties sets the precedence that the care provider will be impartial in their work.

Environmental safety features

One of the most basic considerations that providers of supportive care for patients with dementia at aged care facilities have to make is the environmental safety. Because majority of dementia cases present with aggressive symptoms of agitation exemplified by wandering, the care givers have to make sure that the aged care facility has a sturdy perimeter wall encompassing the entire compound (Jones & Miesen, 2006). Although the wall must be high enough to deter would-be climbers, it does not have to be imposing so as to create feelings of imprisonment. Research shows a strong correlation between the feeling of imprisonment in some patients with relatively mild forms of dementia and high imposing walls. Care givers in the aged care facility must remember that the facility is not an asylum therefore creating the same feeling among dementia patients not only erodes the level of care, but may aggravate some patients’ states (Lee & Adams, 2011). In any case, most of the patients at such facilities are elderly and do not need ten-food walls.

Another consideration associated with the perimeter wall is that it should offer unrestricted access to a huge recreational area. Research has shown that dementia patients, especially those suffering from Alzheimer’s disease prefer to have access to a recreational facility outside the building (Lloyd-Williams, Abba, & Crowther, 2014). Additionally, the recreational area provides the dementia patients with a chance to interact accordingly as dementia patients have demonstrated on many occasions to form bonds with each other. While  the perimeter wall exists, there is need to disguise it as much as possible to prevent the least affected dementia patients with considerable cognitive ability from identifying its role.

The management of exits and equipment used to control them also provides another avenue for care givers in aged care facilities to enhance the patient’s welfare. While care givers must always strive to observe each patient keenly, some circumstances cannot allow for a limited number of eyes to watch a large numbers of individually affected patients. Therefore, exists and equipment used to handle them must be managed appropriately (Lohrman, 2012). One body of research states that placing reflective mirrors in front of emergency exits discouraged wanderers and other adventurous patients from attempting to make exits. Such moves could prevent them from getting injured through falls or even making egress out of the facility. Additionally, covering door knobs with cloths the same color as the doors and walls deters majority from attempting to use them.

Variety of spaces provided

Majority of aged care facilities grapple with the choice of providing enough living and engagement space to their dementia patients against according them the appropriate level of privacy. However, research has demonstrated that manipulating the living spaces accordingly has the potential to improve the level of care that patients with dementia enjoy (Manthorpe, 2009). Indeed, the existence of most of these patients relative to healthy people is such that their lives are predetermined by others making the need to make them as comfortable as possible ideal.

Re-arranging the furniture in the common areas where the patients in the aged care facility engage has the potential to make them feel like they have more space (Sloane & Zimmerman, 2009). Some forms of dementia predispose the patient to wandering and seeking out freedom making such an initiative important. Additionally, the use of low level dividers in these spaces also provides access to various parts of the living space without creating a feeling of restriction which would be disastrous for aged facility care patients with dementia (Molloy et al., 1991). However, some forms of dementia create a vegetative state where the patient cannot even move meaning large spaces would not work. Combining these dementias with large recreational halls might instigate certain behaviors such as rocking and head motions. In such circumstances, switching to more but smaller spaces makes more sense as it serves to prevent the patients from feeling immobilized.

While there is an emphasis on provision of recreational space for patients of dementia in aged care facilities, care providers must remember that these are elderly people. Therefore, hand rails, padded carpeting, and other forms of safety precautions must be included in the care regimen to prevent serious injury in case of falls and slips.

Level of stimulation and appropriate signage

Patients suffering from dementia have been shown to benefit from some form of audio-visual and even mental stimulation. However, the same type of patients in aged care facilities must be provided with some form of stimulation in order to compensate for the common occurrence of vegetative state and inability to actively move. Research on the matter reported that verbal aggression is a common occurrence among dementia patients in aged care facilities (Moore, 2009). Verbal aggression comes in the form of vulgar language and some degree of verbal abuse. However, with stimulation, the patients’ minds become preoccupied leading to some degree of comfort and a reduction in such types of aggression.

While stimulation is an important part of the care regimen among patients with dementia in the aged care facility, care givers must be careful not to over-stimulate or under-stimulate the patients (Sloane & Zimmerman, 2009). Overstimulation has been studied among patients with dementia and several researchers reported that it increased the level of agitation among these patients (Moore, 2009). Loud noises, bright light, and activities such as dancing and clapping must be avoided in such circumstances. On the other hand, under-stimulation led to regression among majority of the patients; a state that counteracts the benefits of supportive care in the aged care facility. Therefore, the care givers must be keen to strike the right balance relative to their patient’ needs.

Signage and orientation cues make an important part of the supportive care regimen aged care facilities could use to optimize the experience of patients with dementia. In case the patient’s long terms memory is not compromised, memorabilia that alludes to their younger days would be helpful in calming them down while creating a peaceful nostalgia (Shega & Sachs, 2009). Other forms of signage that complements the old patients of dementia living in these facilities include placement of symbols or letters on the floor in the direction of useful facilities such as toilets. The floor-based choice compensates for the downward gaze or stoop most of the elderly patients with dementia assume while standing or sitting in wheelchairs.

One of the most important considerations that aged care facilities have to make is visitation from family and friends. Patients with dementia might not remember these visitors, but research shows some degree of recognition in the subconscious that allows the patient to relax even when they cannot recognize the visitor. Such interaction plays an even greater role if the patient’s memory functions are not so compromised as to forget their loved ones (Shega & Sachs, 2009). In such circumstances, the patient’s brain produced chemicals that induce a happy feeling with calming and restorative effects. These effects greatly optimize the patients’ quality of life.

Conclusion

Various forms of dementia such as Alzheimer’s disease in the medium to advanced stages make movement in a coordinated manner hard. Additionally, the patient’s short and long term memory become compromised meaning they cannot navigate in areas that require one to remember their route. Indeed, some forms of dementia also affect the cognitive abilities associated with information processing meaning the patient cannot associate signage and other symbolic imagery with the meaning. Therefore, the patient cannot understand the symbol for danger, or that that reads exit and entry. Therefore, patients in aged care facilities suffering from dementia might benefit from improvement on their environmental safety features, the variety of spaces provided, and provision of adequate stimulation through signage and interaction with loved ones. However, research on the needs of aged care facilities patients with dementia continues. Part of the problem with the issue emanates from the complexity of dementia making the provision of adequate care difficult.

References

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