Editor’s Note:The following recommendations are courtesy of John Zeisel and is excerpted from I’m Still Here by John Zeisel, Ph.D. All rights reserved. Copyright © John Zeisel, 2009.
What Kind of Design is Best for an Alzheimer's Community?
Look for homelike environments. People living with Alzheimer’s at home are already in a residential setting. Residential quality in assisted living and similar group residences for people living with Alzheimer’s can reduce symptoms. By this I mean homelike rooms that are not too big, with regular shape and familiar decor on the walls. There is little doubt that the territorial imperative, also linked to oxytocin, is centered at "home" for all living creatures. It is not surprising, therefore, to find that research shows reductions in both verbal and physical agitation in such settings.
Integrating All Five Senses in Designing an Alzheimer’;s Community
Look for environments that are designed so that people living with Alzheimer’s glean the same information about the environment from what they see, hear, touch, and smell. Such settings are understood best. All living creatures employ all their senses simultaneously to understand their surroundings. If a kitchen is intended to be the social hub of a group, the more it looks, feels, sounds, and smells like a social hub the more it will be used that way. If a garden is to be used frequently, it needs to be inviting, highly visible through a window, and accessible through an easily located and unlocked door. The more fragrant, flowering plants there are, the more it feels like a garden. Each of us naturally develops coping strategies that triangulate our sensory awareness to compensate for diminished sight, hearing, or other sensory loss as we age. This is also true for people living with Alzheimer’s disease. Research shows that where people have multiple sensory cues to understand the environment in which they live, verbal agitation and psychotic symptoms are reduced.
Fostering Independence & Empowerment
Look for settings that are designed to enable people living with Alzheimer’s to do by and for themselves things that foster independence, as much as possible. For example, walking is much easier when simple, inconspicuous rails to lean on are incorporated into a setting for support. The more the lean rail looks like a wide residential chair rail instead of an institutional grab bar, the better. Bathroom doors that are highly visible with a readable sign, with toilet seats high enough for even those with weak legs to sit down and get up easily, ensure more frequent independent use. Safe, secure gardens with doors that enable views outside also invite independent use. Our minds naturally provide us with awareness of how our bodies relate to the environment, a process called proprioception, and maintaining a sense of control over our environment leads to a greater sense of empowerment. In sum, wherever you and your partner live, if you find these eight characteristics, you will find a designed physical environment that profoundly influences how people living with Alzheimer’s feel, behave, and function.
About the Author: John Zeisel, Ph.D has a background in design, which is how he first entered into the world of Alzheimer’s and dementia care. His book I’m Still Here covers design principles that make a lasting impact on the daily lives of Alzheimer’s patients and also touches upon other aspects of providing care, safety and understanding to those with Alzheimer’s. His work gives readers insight into how to view those with Alzheimer’s disease and gives real-world examples of how to find new venues for communication, mainly via art appreciation and expression. Zeisel champions the idea that people with Alzheimer’s are very much in the present, but need to have their environment and audience structured to allow them to be able to share their thoughts and emotions. Besides tailoring the environment, Zeisel points out how caregivers, both professional and family, can ensure that apathy or agitation is alleviated or eradicated. He gives his audience the tools to be nothing short of a social anthropologist for the Alzheimer’s community at large.