This article from The Guardian from last year gives an insight into the issues that people living with dementia experience around navigation. In it, Wendy Mitchell – who was diagnosed with Alzheimer’s 4 years ago at the age of 58 – describes the difficulties that she has with finding her way around, even within her own home, and the solutions she has used to combat them. Knowing the effects of dementia and even undergoing a facsimile such as the Virtual Dementia Tour are helpful but learning from the first-hand experience of someone with dementia is extremely valuable.
Spatial disorientation particularly characterises Alzheimer’s disease but is experienced across many forms of dementia. In the article Wendy speaks about how difficult it was for her to ‘learn’ her new home when she moved house. All the houses looked the same apart from the number and her memory loss issues made her forget her number. Inside she had some doors removed because she couldn’t remember where they led. This can be the same for people when they move to a care home or sheltered housing setting, where all doors and corridors look the same. Wendy’s answer was to use picture tiles on either side of her door as she was able to recognise these better than numbers.
This ability to interpret images more easily than numbers is a factor that we have incorporated into our dementia signage, which uses a combination of pictures and text. Bedroom signage uses unique images that people can recognise as their own and signage for communal rooms, such as dining rooms or activity rooms, should have pictures that are representative of what you will find within. We even developed a door sign that had an aperture so that the home could insert actual photographs of the room beyond the door for one client. Obviously doors in care spaces such as these can’t be removed, like Wendy did, for health and safety reasons so this offers a good alternative. Memory boxes also work well, as 3D objects are even more likely to be recognisable, as does having different coloured doors.
Wendy also talks about how specific surfaces can be disorienting. Reflective surfaces and glare can be difficult: aside from the fear of reflection that we know about with mirrors, she says that it can be disconcerting to suddenly see a reflection, and shiny flooring can look like water. Black items, such as a doormat, can appear like a black hole and patterned flooring can look like steps or appear to move. She finds that contrasting colours help: she painted a blue border around light switches and yellow stripes on steps to make them easier to see. We use this colour contrast tool in dementia signage, making sure there is a minimum light reflective value (LRV) of 30 between text and background as well as sign and wall colour. We’ve spoken on the blog before about the dangers of not incorporating enough contrast in care homes, including in the use of furniture, walls and flooring.
Wendy’s experiences relate to how she has adapted her home but the principles are just as applicable to dementia care environments and definitely ideas that they should be looking to include in their spaces.