Feeling a bit lost?
Having no idea exactly where you are on a map isn’t a big deal most of the time. But knowing the way – home, to the bus stop, or to the nearest bathroom – can be very scary indeed – Waylosing and wayfinding in the outdoors: a typology of wayfinding approaches to problem-solving when temporarily lost. For millions of older adults, that disoriented feeling is all too familiar.
70% of people living with dementia will experience at least one episode of being lost during the progression of the disease, with an estimated 600,000 of community-dwelling adults going missing every year – Realising The Benefits. And the longer they’re gone, the greater the chance of serious harm, desperate worry for loved ones – and the increased pressure on hard-pressed police and emergency services: around one in 15 of all missing person cases in the UK are linked to dementia – Dementia Friendly Emergency Services Guide, Risk Factors Associated with Missing Incidents among Persons Living with Dementia: A Scoping Review.
Perhaps those stats aren’t so surprising, as the brain cells that encode our position, known as ‘place cells’, are located in the hippocampus. That’s one of the key structures implicated in Alzheimer’s Disease – Hippocampal spatial view cells, place cells, and concept cells: View representations, linked to difficulties in wayfinding – an early warning sign – Identifying older adults at risk for dementia based on smartphone data obtained during a wayfinding task in the real world.
At the same time, the systems that help us to tell the time – and therefore what we should be doing – start to break down, with a bidirectional relationship between sleep and progression of the disease – Sleep Disorders in Neurodegenerative Diseases with Dementia: A Comprehensive Review. Night-time wandering and disrupted sleep is linked to falls and is one of the most often-cited factors in caregiver burnout – The relationship between burden and caregiver’s sleep disturbances in dementia: a systematic review.
Wandering with purpose affects around 60% of those living in residential care, linked to late-day agitation or ‘sundowning’ – Sundowning Syndrome in Dementia: Mechanisms, Diagnosis, and Treatment. Around half of those experiencing sundowning syndrome can become irritable or aggressive, placing a significant strain on formal care teams – Understanding the Burden: Exploring Key Factors in Dementia Caregiving in Residential Care Homes.
So what’s that got to do with lights? – and what can healthcare professionals do to help?
1/ Set the clock
There is a well-established association between access to daylight and sundowning, linked to circadian entrainment, improved sleep and mood – Light, sleep-wake rhythm, and behavioural and psychological symptoms of dementia in care home patients: Revisiting the sundowning syndrome. One study found that taking a walk outside for 30 minutes had a significant effect on agitation within 16 weeks – Effects of walking on sundown syndrome in community-dwelling people with Alzheimer’s disease.
Another study looked at the link between low light levels in the 15-30 minutes before an episode of motor agitation. Interestingly, they found a similar link between variation in sound levels and vocal agitation – Environmental Triggers of Specific Subtypes of Agitation in People With Dementia: Observational Study.
2/ Create a sense of place
Current guidance for designing for dementia focuses on decluttering and simplicity, but a growing number of studies highlight the need for emotional content and personalisation at key decision points or junctions, including shadow-boxes with familiar objects and images – not only for the resident but for staff and loved ones too – Finding Your Way Home: A Systematic Investigation of Shadowboxes on Room Recognition in Memory Care.
People with mild cognitive impairment rely more on directional signs and architectural features – doors and windows, while eye tracking suggests that those without MCI are more likely to be guided by informational signage – Visual Attributes of Wayfinding in Care Facilities by Individuals With Mild Cognitive Impairment (MCI).
3/ Consider different user needs
While the needs of the resident or older person is obviously central to every decision, making sure a space is supportive and comfortable for other stakeholders is important too. This recent study looked at the relative importance of an upgrade to colour and lighting for different users in a hospital. Their survey captured a range of parameters from navigation and comfort to privacy and efficiency. Interestingly, colour added most value to those who were unfamiliar with the environment – patients and families – while staff valued the functional qualities of lighting and enhanced controls – Assessing the Supportiveness of Healthcare Environments’ Light and Color: Development and Validation of the Light and Color Questionnaire (LCQ).
Bottom line
There is no tick-box solution.
If you want to discover how easy it is to get lost where you live or work, try explaining the route to a stranger, or take your mobile phone for a walk to see the space through different eyes.
I’ve been invited to run a couple of visual audits for clients recently – if that sounds useful for your organisation, do get in touch.
One for the diary
Please come along to the Design in Mental Health conference in June.
Lots of brilliant practical content there and a chance to meet some of the leading lights in the sector. If you’re there on the 3rd, please join me at 12:30 – I’ll be talking about Part L and how upgrading the lights to deliver better environmental performance could be good for people too.
Best Christmas card this year
I know we’re supposed to have put all the decorations away until next year, but I’ve kept this card on the shelf. Designed by a dear friend Priscilla Heard, it’s a brilliant demonstration of the Cornsweet Illusion – the way our brains interpret tones relative to a boundary.