Wayfinding for People with Dementia: A Review of the Role of Architectural Design
Marquardt, Gesine, HERD : Health Environments Research & Design Journal
Objective: This paper provides an overview of the available literature on architectural wayfinding design for people with dementia in nursing homes. The results were to be summarized and substantiated through an interdisciplinary interpretation, taking into account changes in the orientation process of people with dementia.
Background: Spatial disorientation and declining wayfinding abilities are among the early symptoms of dementia, limiting a person's ability to perform activities of daily living (ADLs) independently and ultimately, perhaps leading to institutionalization. A prerequisite to maintaining residents' quality of life in a nursing home is their ability to orient themselves within their new environment.
Approach: The available literature on wayfinding design for people with dementia in nursing homes was reviewed. Two aspects of interventions for residents' wayfinding abilities were identified: the design of the floor plan typology and environmental cues.
Results: The design of the physical environment plays a major role in supporting the wayfinding abilities of people with dementia. The floor plan design of a nursing home in particular has a significant influence on residents' spatial orientation and wayfinding. Additional interventions such as signage, furnishing, lighting, and colors are additional supporting features but they cannot compensate for an adverse architectural design.
Conclusions: For the creation of a supportive, dementiafriendly environment, both aspects of architectural design must be considered. Design guidelines to support the wayfinding abilities of people with dementia were developed to synthesize both.
Key Words: Dementia, wayfinding, orientation, architecture, nursing home
Finding one's way is an essential ability and a prerequisite for autonomy and independence, thereby promoting self-sufficiency and self-esteem. However, spatial disorientation and declining wayfinding abilities are among the frequently mentioned early symptoms of dementia. In 2002, the prevalence of dementia among individuals aged 71 and older was 13.9% and comprised 3.4 million individuals in the United States (Plassmann et al., 2007). The prevalence increases dramatically with age: approximately 5% to 8% of individuals over the age of 65, 15% to 20% of individuals over the age of 75, and 25% to 50% of individuals over the age of 85 years are affected (Kawas & Katzman, 1999).
By definition of the American Psychiatric Association (APA, 2007), the essential features of a dementia are multiple acquired cognitive deficits that usually include memory impairment and at least one of the following phenomena in the absence of a delirium that might explain the deficit: aphasia (inability to speak), apraxia (disorder of motor planning), agnosia (inability to recognize objects, shapes, persons, etc.), or a disturbance in executive functioning (the ability to think abstractly and to plan, initiate, sequence, monitor, and stop complex behavior). Dementia of the Alzheimer's type, commonly referred to as Alzheimer's disease, is the most common dementia, accounting for 50% to 75% of the total number of cases, the percentage increasing with age (APA, 2007).
The reason for spatial disorientation in dementia might be found in memory deficits (Monacelli, Cushman, Kavcic, & Duffy, 2003), visuospatial deficits (Liu, Gauthier, & Gauthier, 1991), and dementia-specific changes in orientation strategies and in the loss of planning abilities (Passini, Rainville, Marchand, & Joanette, 1998). Getting lost in unfamiliar locations is already mentioned at Stage 3 of the Global Deterioration Scale (GDS) (Reisberg, Ferris, de Leon, & Crook, 1982). The GDS is a seven-stage rating scale used to assess whether a person has cognitive impairments that are related to dementia. It ranges from no cognitive decline (Stage 1) to severe dementia (Stage 7). …