When it comes to our health, we do not automatically think about home design. Yet more neuroscience research is being done into the emotional and brain health connections to interior home décor, or what I call “well home design.”
Corporate Gerontologist, CEO, Caregiving Club
Aging in place is the term used by the 9 in 10 older adults who want to stay in their homes as independently and for as long as possible. When it comes to creating dementia-friendly design for those with Alzheimer’s disease or related dementia (ADRD), there are specific well home design changes to be considered.
Today, 6 million Americans have ADRD, and by 2050, the number is projected to be 14 million. To facilitate aging in place for adults with dementia, the Alzheimer’s Foundation of America published a guidebook and video on dementia-friendly design called “The Apartment.” Many of the elements are based on universal design used to make homes more assistive and accessible for older adults and those with disabilities.
Planning for aging
According to a Harvard study, 25 percent of all U.S. homes have someone who has a physical issue (e.g., trouble with eyesight or hearing, cognitive issues, mobility challenges) that make independent living challenging. Yet less than 3 percent of all U.S. homes have even three elements of universal design. Experts call this the “Peter Pan Phenomenon” where homes built before 2000 were built for people who would never grow old.
Some universal design elements help all older adults, such as: lever handles instead of door knobs to avoid twisting and turning the wrist; adjustable beds to aid in sleep and address snoring issues that impact cardiovascular health; non-slip rugs, bathmats, walk-in tubs, and no-step entry showers to prevent falls at home (80 percent of which happen in the bathroom); good lighting around task areas, such as the kitchen or reading spaces, since older eyes (age 60 and over) need two to three times the illumination of a 20-year-old’s eyes; and avoiding furniture with sharp, hard edges and replacing it with curved tables, counters, chairs, and couches.
Dementia adults interpret their living environments differently from other older adults. They often have memory loss, confusion, agitation, balance issues, anxiety and disorientation which is why dementia well home design requires specific modifications. Following are five key areas to address in designing a dementia-friendly home:
Aging eyes require more light throughout the home, but for those with Alzheimer’s, shadows caused by uneven lighting where light and dark spaces occur can create anxiety, panic, and paranoia. In addition, 1 in 5 people with Alzheimer’s will experience “sundowning” or late-day confusion in the mid or late stage of the disease. These episodes happen at dusk and scientists believe it is connected to disruption in sleep patterns and circadian rhythms, the body’s internal 24-hour clock that regulates physical, mental, and behavioral changes.
Supplement natural daylight with smart home lighting where bright fluorescent lighting simulating daylight can come on at dusk as shades and blinds are closed. Another way to address this anxiety is with light therapy lamps.
Also, when it comes to wall paint, use calm, soothing colors like lighter blues and greens, especially in bedrooms or bathrooms. This helps modulate over-stimulation, which can create disorientation. Also, non-glare or matte, flat-finish paints are better than satin or glossy, which can appear wet to someone with dementia.
At bedtime, it’s important to avoid blue light, such as the emission from all technology like TVs, tablets, and even bedside lamps, which alert the body to stay awake. Again, to aid normal circadian rhythms, opt for warm amber, orange, or red lighting for nightlights in the bedroom and bathroom.
Colors and contrast
Neuroscientist and artist Bevil Conway is a leading authority on color, contrast, and its neural properties to evoke emotion. He told Fast Company “I think it’s a very powerful system and it’s completely underexploited.”
Dementia design recommends using contrasting colors for the rise and tread on stairs, and saturated colorful front doors (like red or bright green) to create energy against lighter exterior paint can trigger memory to enter the correct house. Create light walls with darker cabinets and floors that contrast with hallway walls and doors. Even using different colors for drawer pulls helps (D-rings are better than knobs as dementia adults have trouble with dexterity). The caution is in using black or very dark brown rugs or flooring. These appear to be black holes in the floor, and an Alzheimer’s adult will avoid stepping onto or over the rug or floor.
A big problem with dementia adults is fires in the home from a forgotten stove or cooktop cooking. The U.S. Fire Association reports that in 2020 50 percent of these fires were among people aged 85 and over, the most at-risk group to die in a home fire. Cooktops with heat limiting coils, or special sensor and app-based solutions that automatically shut stoves off, can help.
Balance is also an issue for those with dementia, and adding decorative chair rails in hallways at elbow level offer balance support. Mirrors may also become a problem. Alzheimer’s adults often do not recognize their older selves, and become anxious or confused when looking in a mirror. Consider removing them as décor, and using smaller mirrors for brushing teeth or putting on make-up in bathrooms.
Routines become essential for dementia adults, and so do reminders, like which drawer has pajamas versus sweaters. Channel the authors of “The Home Edit” and use large signs on the outside of drawers with words and even icons to identify the contents. Also, embrace OXO “Pop” acrylic containers, even for food. These containers are easy to open and you can see the inside contents. Using smart technology, such as a smart refrigerator with medication reminders on the door’s digital screen or putting signs on the doors of rooms to avoid confusion also helps.
Reminiscence Therapy (RT)
Various scientific studies have shown reminiscence therapy, also known as life story work or narrative care, can lower rates of depression in dementia adults by 15 percent. Since Alzheimer’s often means losing short-term versus long-term memory, display older photos of a loved one in their childhood or early adult years (they will not know photos of the grandkids as easily) or even use apps to create a life story audio archive and book. Also, use décor elements that remind them of their early childhood or first home, such as paintings, pillows, or precious items.
Beyond the power of the visual sense, tap into the aural therapeutic effect of music listening and singing along. A 2019 study in the Journal of Prevention of Alzheimer’s Disease found music has the power to actually permeate the Alzheimer’s haze and recall memories of that era for a loved one. Use smart speakers or a sound system with Frank Sinatra, Elvis, or Miles Davis tunes that not only restore happy times, but also calm agitation and reduce pacing and wandering.
When looking to make these well home design changes for someone with Alzheimer’s, keep in mind that too much change too fast is not good. It can cause confusion, and the person may not recognize it is their home. Do things gradually and always keep something from the past to connect them to the present.