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What Features to Look for in an Alzheimer's Community
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Editor’s Note:The following is excerpted from I’m Still Here by John Zeisel, Ph.D. All rights reserved. Copyright © John Zeisel, 2009.
There are eight major characteristics of places that support people living with Alzheimer’s to be all they can be:
- exit control
- walking paths
- privacy
- shared space
- gardens
- homelike quality
- sensory understanding
- supports for independence and empowerment
Next I discuss the design qualities to look for in residential settings that present themselves as Alzheimer’s-competent. You can, however, take the same information and use it to look at your own home or the home in which the person lives with Alzheimer’s.
Exit Controls in an Alzheimer's Community
Look for homes, assisted living residences, and gardens that are safe and completely secure with unobtrusively locking doors, windows, fences, and other potential exits. Research has shown reduced depression among people living with Alzheimer’s in settings with camouflaged exits that lead to places that may be dangerous. The hormone oxytocin is released in the brain when people feel safe. This in turn contributes to lower stress and to greater trust and sociability in such settings. In environments with secure and camouflaged exterior exits, partners and care staff can be more relaxed and can spend more time with residents.
Moving in the Right Direction: Walking Paths in an Alzheimer’s Community
Look for destinations at the end of corridors and hallways that encourage walking rather than wandering. When the destination is clearly understood and visible, like a dining room or kitchen, the person knows where they are going. Landmarks located at points where a decision must be made, such as at a corner or going through a doorway, reduce the chance that someone with impaired way-finding will get lost. Elements that evoke what we believe to be hardwired memories and functions, such as music, smells of food, and a hearth are excellent landmarks. People with Alzheimer’s walking on a path with a destination clearly are walking with more decision and direction than when there is no destination visible. Simple observation lets you know that. Our research, however, did not find that having well-planned walking paths was correlated with reduced agitation, aggression, or other symptoms we studied. We don’t know why not. Further research is obviously needed.
How Privacy & Personalization Reduce Anxiety & Aggression
Look for private places with surfaces on which mementos and other personal objects that belong to the person can be easily displayed. Like everyone else, people living with Alzheimer’s are more at ease when they have memory-evoking personal objects around them. There is a natural tendency for all living creatures to want some territory that is their own. Research clearly shows reduced anxiety and aggression as well as fewer psychotic symptoms in settings with greater opportunities for privacy and personalization. The safety, familiarity, and predictability of personal territory can also be linked to the positive effects of the body’s calming oxytocin production.
How Environment Sets the Tone: The Importance of Shared Spaces
Look for kitchens, dining rooms, living rooms, and other group activity spaces that look and feel different from one another. Decoration and furnishings that clearly differentiate one place from another help promote appropriate behaviors in each room. When the environment tells us what is expected of us, we tend to hear it. Research shows that in settings where each shared space is decorated to evoke a different mood, people living with Alzheimer’s are less likely to withdraw and isolate themselves. The desire to be with others, and to help and care for them, is a universal instinctive feeling that knowledgeable, creative design can evoke.
How Gardens Can Help with Sundowner’s Syndrome & Agitation
Look for porches, patios, and gardens that provide people living with Alzheimer’s continuous and safe access to the out-of-doors. Such outdoor places ameliorate time-related disorders. Early in the progress of Alzheimer’s disease people’s internal sense of time is disturbed, resulting in sleep-wake disturbances, sundowning, and other time disorientations. Physical contact with nature, and thus with the time of day, the weather, and the passing of the seasons helps people living with Alzheimer’s remain aware of time passing. My own observations—as well as those of others—clearly indicate that gardens have positive effects, though it is difficult to capture these effects in research. Research is needed to determine the behavioral impacts of gardens taking into account physical accessibility, the presence or absence of horticultural therapy programs, the timing of doors to the garden being open or locked, and how safe the garden fence is. When you visit what is presented as an Alzheimer’s-competent garden, look for these things as well. Just having a garden may not be enough to influence symptoms.
Learn about how homelike quality, sensory understanding and supports for independence and empowerment are integral to a successful Alzheimer's community in How Design Can Foster Independence in Alzheimer's Communities.
Posted in: How to Choose the Right Community, How to Choose the Right Community
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