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Dementia friendly features in aged care homes

For many years, the design of aged care facilities has seemed to be dictated by staff and administration considerations rather than the needs of the residents. Consequently, many of the older facilities have a sterile and institutional feel.

Over the last 15 years, a better balance has been achieved between staff, administration and resident needs. There has been the recognition that the facility should be considered as the residents home.

The following table provides you with guidelines to consider in general and specifically for the resident with dementia:

Dementia friendly features in aged care homes

Home Like

Does the food, language, culture and ambience reflect the residents previous home

Age AppropriateIs the colour scheme, fittings and furnishings in accord with the residents previous lifestyle.
LightingAvoid too bright (glare and shadows) or too dark
AcousticsNo reverberating sounds, possibly best to avoid large (intrusive) public address systems
SizeDementia specific units are usually between 6 to 15 residents
SecuritySecure doors, electronic tags (if needed)
Sightlinesable to view most important areas (bedroom, dining room, toilet) from community areas. Avoid long corridors, many corners to navigate
Floorsnon-slippery, no distracting patterns, no steps
Toiletsgood signage, wheelchair access, grab bars
Living roomsmore than one needed, different sized and comfortable chairs, TV, radio, video
Dining areasallow for both community and individual meals
Outside spacegardens, paths, seats, security, shade, garden features (japanese garden, fountains)
Activitiesappropriate social and activity program, community (school groups, church) and carer involvement
Staffask about continuing training for staff, note involvement of staff with residents and staff attitudes


Nursing-home care:

Nursing homes should be designed to reinforce orientation and to be cheerful; they should provide regular low-stress activities and minimal new stimulation. Such measures can help by giving patients a sense of some control and personal dignity.

Large calendars and clocks and a routine for daily activities help reinforce orientation; medical staff members can wear large name tags and repeatedly introduce themselves.

Changes in surroundings, routines, or people should be explained to patients precisely and simply; nonessential procedures should be eliminated. Patients should be given time to adjust and become familiar with the changes. Telling patients about what is going to happen (eg, about a bath or feeding) may avert resistance or violent reactions.

Frequent visits by staff members and familiar people encourage patients to remain social. The room should be reasonably bright and contain sensory stimuli (eg, radio, television, night-light) to help patients remain oriented and focus their attention. Quiet, dark private rooms should be avoided.

Patients with dementia are susceptible to muscle disuse atrophy, which can be delayed by adequate physical exercise and nutrition. A regular, supervised exercise program (eg, 15 to 20 min/day of walking) is recommended. Exercise can reduce restlessness, improve balance, maintain cardiovascular tone, help improve sleep, and reduce frequency and severity of behavior disorders.

Mental activities, usually focused on the patient's interests before the onset of dementia (eg, current events, reading, art), should be encouraged. These activities should be enjoyable and provide some stimulation, but they should not involve too many choices or challenges nor be used as tests of mental function.

Occupational therapy helps maintain fine motor control; music therapy provides nonverbal stimulation. Special effort may be required to ensure continuing interaction, with the same people if possible (eg, with family members or friends when available, with people in support groups, or otherwise with adult day care or companion services workers).

Group therapy (eg, reminiscence therapy, socialization activities) may help maintain conversational and interpersonal skills. Behavior disorders are best treated with individualized behavioral interventions, rather than with drugs. However, frank psychotic symptoms (eg, paranoia, delusions, hallucinations) should be treated with antipsychotic drugs, started at a low dose.

Patients must be carefully monitored for adverse effects. Because dementia is a strong risk factor for other problems (eg, falls, urinary incontinence), prevention and treatment strategies for these problems should be implemented.

source: http://www.merck.com/mkgr/mmg/sec5/ch40/ch40a.jsp

 


 

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