What is it like to grow old with dementia? Imagine that you are experiencing age-related sensory loss, in addition to changes in judgment, behavior, and memory. Not only is your visual acuity less sharp in dim lighting, but you also see frightening images in shadows. It is harder to hear conversations when you are in noisy environments, and loud sounds are agitating. You bruise easily and fail to attend to cuts and wounds. Your taste receptors are slow to detect spoilage, and you forget to throw away rotten food. You sometimes leave meals that you are cooking unattended, and more time than usual elapses before you smell the burning pan. Not only do you forget recent events as if they had never happened, but, frighteningly, you do not know what to expect will happen next. Days and nights blend together because you no longer can impose structure on your day. Navigational skills lost, you cannot find your way home, even in your own neighborhood. This is the reality of aging with dementia-without intervention.
Alzheimer's disease and related dementias significantly change how people interpret what they see, hear, taste, feel, and smell (National Institutes of Health, 2002). The extent of these changes is highly individual and in constant flux, depending on neuropathological changes, sensory loss, time of day, medication management, and the social and physical environment. A consistent observation, however, is that people with dementia are particularly affected by their physical environment (Alzheimer's Association, 2000). The amount, type, and variety of stimuli really matter; both under- and over-stimulation cause confusion, illusions, frustration, and agitation.
An environment that is suited for people with cognitive impairments does not happen spontaneously; it takes research, understanding, planning, and an abundance of individualized care. Although significant losses are associated with dementia, people with dementia retain many talents and capabilities-but these capabilities lie dormant unless they are purposely brought out. Appropriate sensory stimulation is a main avenue to awakening latent memories and abilities.
In this paper, I will discuss key environmental elements that encourage people, objects, and spaces to interact in healthy ways. I speak from personal and professional experience. I am the daughter of someone with Alzheimer's. I am also an environmental gerontologist with a private practice and a faculty position in geriatrics and gerontology at a large urban medical college and the president of the family council at the assisted living facility where my mother resides.
People with dementia often experience a number of changes in visual abilities because of neurological impairments, including problems with depth perception, glare, and visual misinterpretations, which are exacerbated by visual disorders (Mendez, Cherrier, and Meadows, 1996). Moreover, because of memory impairment, they may forget to wear glasses or not have up-to-date prescriptions. These sensory changes increase fall risk and pose many challenges for individuals, caregivers, and family members.
Familiar sights. Our world is primarily a visual one, and we all are dependent on sight to recognize and find our way in the environment, but this is especially true for people with dementia. For them, an uncluttered and small-scale environment is visually easier to navigate. My mother, who is in mid-stage Alzheimer's, lives in a dementia-specific assisted living facility (ALF) that is divided into small "households" of eight to ten residents. When she leaves her room, she sees a living and dining area, which cues her that she is in someone's home. Because there are no long hallways to get lost in, she finds her way back independently. On her door, a large photograph of a grandson, along with her own name in bold type, visually cues her that this is her room. Such "way-finding" cues vary in their effectiveness, depending on the stage of the disease and cueing materials used (Calkins, 1991). …