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
Appropriate |
Is
the colour scheme, fittings and furnishings in accord with
the residents previous lifestyle.
|
| Lighting |
Avoid
too bright (glare and shadows) or too dark
|
| Acoustics |
No
reverberating sounds, possibly best to avoid large (intrusive)
public address systems
|
| Size |
Dementia
specific units are usually between 6 to 15 residents
|
| Security |
Secure
doors, electronic tags (if needed)
|
| Sightlines |
able
to view most important areas (bedroom, dining room, toilet)
from community areas. Avoid long corridors, many corners
to navigate
|
| Floors |
non-slippery,
no distracting patterns, no steps
|
| Toilets |
good
signage, wheelchair access, grab bars
|
| Living
rooms |
more
than one needed, different sized and comfortable chairs,
TV, radio, video
|
| Dining
areas |
allow
for both community and individual meals
|
| Outside
space |
gardens,
paths, seats, security, shade, garden features (japanese
garden, fountains)
|
| Activities |
appropriate
social and activity program, community (school groups, church)
and carer involvement
|
| Staff |
ask
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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