Transcript
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[Title card: Dementia Australia]
[Title card: At home with dementia – Creating a supportive and enabling environment]
Cathy: Hello, and welcome to the “At Home with Dementia: Creating a Supportive and Enabling Environment” webinar. I'm Cathy, and I'm a dementia support specialist here at Dementia Australia. I'd like to start the webinar with an acknowledgement of country. In the spirit of reconciliation, Dementia Australia acknowledges the traditional custodians of country throughout Australia and their connections to land, sea, and community. We pay our respect to the Elders, past, and present, and extend this respect to all Aboriginal and Torres Strait Islander peoples today. I would particularly like to acknowledge the Ngunnawal people, the traditional custodians of the ACT and surrounding land from which I'm presenting.
So today, I'm going to explore with you how a well-thought-out home environment can help you to live well by supporting independence, engagement, safety, and comfort. The webinar is designed for people living with dementia, and carers, who live in the community. And welcome to those of you who are joining and watching. The aim of this session is to help you to understand what makes a supportive home environment, and to provide some ideas and guidance that you can use to think about, and apply in your own home.
Through watching the webinar, I hope that you develop your understanding of how changes due to dementia can affect the way the home environment is experienced, that you gain awareness and understanding of the environmental design principles. These are evidence-based principles which you can use to help you think about your home, the things that might be difficult, and changes that might be helpful. And I will also provide you with some examples, so that you understand the design principles and how they can be used at home.
Before we launch into the principles and examples, I'd like to take a step back and touch on why this is such an important topic. It's important because in Australia, regular homes in the community are where most people diagnosed with dementia live. In fact, two-thirds of people with dementia live in the community, and the very strong message that we get from our clients is that they want to continue to live at home for as long as possible. And very often, this is for life. Clients identify their homes as very important to them, supporting a sense of identity and belonging, and allowing them to be independent, comfortable, and engaged. Supporting people to continue to live well at home, even with changing cognition and needs, enhances wellbeing and supports choice. And I think we can all agree that that's really important.
The other thing I want to mention briefly is that it's important to note that people living with dementia have an increased risk of falls and accidents at home, either due to dementia, or sometimes due to coexisting conditions. In some cases, structural modifications to the home or more complex equipment are needed to address safety concerns. These might include things such as rails, ramps, and mobility aids. Major and specialised environmental modification is not covered in this webinar. If you have concerns around the physical safety of your home, it's important to get professional advice. And there are a number of programs that support the assessment of home safety, including through My Aged Care and the NDIS. These programs are often heavily subsidised or free, so I would encourage you to follow up through the appropriate system if this is applicable to you.
To understand why the environment is important for you to think about, it's important to understand the changes that are commonly experienced by people living with dementia. These changes will vary depending on the type of dementia. However, there are some that are fairly commonly experienced, and these include changes to both a person's abilities and sensory changes. In terms of abilities, cognitive changes impact how people process, understand, and use information. Changes to things such as memory, planning, initiation, and sequencing of tasks are common, and these make it difficult to do the things that would previously have been easily managed. For example, most people take day-to-day tasks like making a cup of tea or putting on a load of washing for granted, but these tasks involve a lot of steps, and can become challenging. Think about a task around the house that you manage easily, and think about what's involved. You might be surprised at how complex it is when you break it down. Our brains work hard all the time and we don't even realise it. Changes in ability can also include physical changes. For example, to mobility, and this can be either directly due to dementia or due to other factors. This is particularly the case for older people who may be living with coexisting age-related conditions. Both cognitive and physical changes impact your ability to use and make sense of the environment. Simple adaptations to the home, which we'll talk about in a little bit, can make a big difference in supporting independence, safety, and wellbeing. And just to illustrate how many steps simple tasks can involve, here are the steps involved in making a cup of tea. These steps need to be done in order and rely heavily on remembering where things are, being able to put the steps together, and remembering where you're up to in the process. It often surprises people how complex tasks are when they break them down into all the small steps involved. And you can see how much even simple tasks rely on cognitive ability.
As well as changes in cognitive and physical abilities, changes in the way information from our sensors is perceived and interpreted can change. There are two aspects to this. A person's sensors might have less security due to age related factors. In other words, they may not work as well as they used to. For example, hearing or vision may be impaired, making it difficult to get useful information and cues from the environment. The other aspect of sensory change that is important to think about is how dementia impacts on our ability to interpret information from the environment. Information from our sensors is processed in our brain. Our brain makes sense of what we see, hear, feel, touch, and taste, and it understands where we are in our environment. Our brain uses this information to direct how we move around and use our environment.
For people living with dementia, the way sensory information is processed and interpreted changes, and this impacts on the way the environment is experienced. For example, the depth of a step might be misjudged. Pattern surfaces may appear to be moving. It may feel cold even on a warm day, or conversation may be difficult to filter out of background noise. Changes to sensory perception can make a regular home environment confusing and uncomfortable, and can create safety issues. Here are some examples of that; wavy lines or similar patterns, as seen in the first image, can appear to be moving. Dark patches on the floor, as seen in the second image, can look like holes. This can be quite disconcerting and post potential safety risks.
All of these changes impact the way that the environment is experienced, and your ability to do the things that you want and need to do. It can make the experience of home frustrating and uncomfortable. It can also sometimes be difficult to communicate this experience, adding to frustration. Considering this in the context of your home environment is especially important, because it's where we spend most of our time and do lots of things. The home environment can present challenges, but it can also present opportunities, because we know what is supportive, and we have the ability to make small changes that can make a big difference.
So, in thinking about common changes to abilities and sensory information that you might experience, in using research around what causes difficulty in the environment and what's helpful, there are some general principles that have been developed to guide people to create environments that are supportive and to maximise participation in independence. These principles were specifically developed for larger residential care settings, so not all of the most relevant home environments. However, several are very relevant and useful to help you think about your environment, how supportive it is, and how it could be enhanced. These principles have been used for very many years and they're very well recognised within home environments.
It's important in applying the principles to think about the environment generally. For example, good lighting and safe flooring are important to everybody. It's also important to think specifically about areas or tasks that might be difficult for you, and changes that might help. Everyone has different interests and needs, and it's important to think about your situation and what you want to achieve. Here are the principles that are most relevant to residential homes. If you're interested in exploring the principles further, there's more information available through the links on the launch page for this webinar. The first principle is to unobtrusively reduce risk. For example, simple things like organising cords so they are not a trip hazard, and storing medicines appropriately. The principal talks about unobtrusively reducing risk. This is important, because rather than creating obvious barriers, it aims to maintain a very normal, familiar environment. For example, I had a client who was a real handyman and used to chainsaw all his life. However, he was no longer able to safely use the chainsaw. His family might have locked the shed so that he couldn't access it, but this would've created a frustrating barrier, and stopped him from accessing other tools that he could still use safely. Instead, they lent the chainsaw to his son on a permanent basis, removing the safety risk, but supporting access to the shed.
The second principle is to reduce unhelpful stimulation. We talked earlier about sensory changes and changes in abilities. It can be really difficult for a person with dementia to pick out the useful cues and items in the environment if there's too much information to take in and sort out. Some good examples of this principle are reducing clutter, limiting background noise when engaging in conversation, and avoiding patterns on carpets and crockery.
The third principle to think about is optimising helpful stimulation. Providing helpful information and cues in the environment is a really powerful tool to support engagement and independence. Some examples of this principle are grouping items that are used together and storing them in view where they are to be used, using colour and contrast to contrast useful environments from the background, and to help with depth perception, increasing light, using aids for orientation, such as a large face day/night time clock, and a whiteboard with activities listed, and dinner smells at dinnertime.
The fourth principle is supporting movement and engagement. It's important to think about whether spaces in your home are safe and accessible. This includes placing furniture and other items to allow good circulation space and creating lines of sight so that one area can be seen from another. For example, the bathroom from the bed. Supporting movement and engagement is also about supporting engagement with activities and tasks. And we'll have a look at this through some of the examples in the next section of the webinar.
The fifth principle that we're going to consider today is creating a familiar space, and I would add a familiar and comfortable space. It's important to think what makes a space comfortable to you. Familiar objects and smells, furniture, photos, temperature and music might all be a part of this. The principle of creating a familiar space can be particularly useful for people when they're moving house or downsizing, to create familiarity and comfort. It's important to have engaging spaces and places to engage with others in the home, but also, to provide the opportunity for quiet time alone. It can help to create quiet spaces that are still within the line of sight to other areas of the home. So, that's a quick overview of the principles that can guide you to think about the home, and what might be helpful and unhelpful for you. It's important to make the point that using the principles of dementia-friendly design doesn't mean creating a boring cookie cutter a home. One client commented to me that she couldn't live without colour, and this is absolutely key that the things that make a house a home, to you, are central to any changes that you might consider making. Changes have to fit with your lifestyle and preferences. In terms of colour, for example, use thoughtfully, this can be very helpful. As an example of this, here's the very unique purple toilet seat at our north right office. The contrast to the toilet itself is helpful with depth perception. I'm not suggesting that you rush out and change all your bathroom fittings to purple, but hopefully, this gives you an idea that colour can be helpful. It's just important to think about how it's used.
I'd now like to take you through some examples of where the design principles are put into practice, to demonstrate their use. As we go through, think about your home environment, and how some of these ideas might be relevant for you. The examples that I'm using involve really simple, inexpensive changes. Remember that these are just examples, and there's lots more that can be done depending on your needs and situation, including using equipment and aids, or making more significant changes.
The first example is a kitchen. This is a fairly typical kitchen. It's clean and functional, but perhaps you can see how it could be difficult to use? We've talked earlier about the idea that a previously taken for granted task like making a cup of tea can become difficult, and that the environment can contribute to this difficulty. In this example, you can see that the kitchen is a bit cluttered, and this isn’t uncommon. Lots of regularly used items are out and within easy reach, and there's some nice greenery to brighten up the space, but that setup isn't necessarily helpful for people trying to perform particular tasks.
By applying the principles, we can make the space more supportive and useful. So here's the same kitchen set up to facilitate ease of use and activity. In this case, making a cup of tea. You can see that the principles have been applied here. Risks have been reduced by putting away hand cream, medication, and detergent, which didn't need to be on the bench with food items. Other examples of risk reduction in a kitchen might be reducing water temperature, or putting timers or cutoff switches on stoves. Unhelpful stimulation has also been reduced. The bench was quite visually cluttered. Removing items that didn't need to be there makes useful items more visually accessible. You can see how this makes it a much easier environment to understand and use. Helpful stimulation has been increased. The blind in this kitchen was broken and stuck half open, and this was reducing the amount of light available. The blind's now been removed to increase lighting. Swapping light globes for higher wattage globes can also be helpful.
In the new setup, the items on the bench have been limited to those that are required, and they're now grouped by their function. In this case, to create a drink station. Contrast has been introduced through the mat under the tea making items. Labels have also been used on some of the cupboards. Labelling, either with pictures or words, can be really helpful. You don't have to label everything. A good way to use labels is to store high use items together and label that cupboard, rather than labelling multiple cupboards. There are usually limited number of items that are regularly used, so this is quite easy to achieve. And here's just a closeup of the tea station. Going back to when we looked at the steps involved in making a cup of tea, you can hopefully see how simplifying the environment, grouping items, using contrast, and labelling can make this task easier.
Moving on to a second example. This is a living space. I'd like you to squint and look at this image. The squint test helps to illustrate how a space may appear for somebody with changes in sensory perception. You'll probably notice that it's difficult to see that this is a chair, and to use the space. There are a number of unhelpful features here – clutter presents a potential trip hazard and detracts from the usefulness of the space. The lack of light makes it difficult to navigate and access, glare from behind reflecting off the blinds, and the pattern of the blinds are problematic. The pattern that the blinds create could potentially create an illusion of movement. And the chair carpet and background are all similar colours. There's a lack of definition and contrast to help with perception of position and depth. The result of this is that it's difficult to pick out the chair and to safely use it. It's also not a setup that looks comfortable or appealing.
So, here's the same space with a couple of simple changes. The good things about the space are that it's a comfortable outward facing space with a nice window view, and a sturdy chair that's easy to get in and out of. We've enhanced the usability of the space, and maximised those features with a few little changes. We've reduced unhelpful stimulation by moving clutter and distractions, which were also potentially causing trip hazards. We've opened the blinds to reduce glare, visual clutter, and potential visual distortion. We've increased helpful information and cues. The blinds are opened to provide better light. A light-coloured cushion and a throw rug have been added for contrast and to define the chair. A side table with some books of interest, it has been included to make the space more inviting and engaging. Try squinting and looking at the space again. You'll see that even with reduced visual information, it's an easy and inviting space to understand and use.
The final example I'd like to share with you is an outdoor space. This is the view from the back door of a house. You can see that, again, there's a lack of contrast and cues to indicate what the space could be used for. However, we know that spending time outside is beneficial and enjoyable, so it would be great if we could set it up to be more engaging. Here's the same space set up to invite somebody out and to invite use of the space. We've added some plants – sensory plants such as herbs can be particularly good for this purpose. We've also added some gardening tools, and defined the space by simply adding a cushion to the chair. Having spaces around the home that encourage activities of interest can be really helpful in providing a sense of purpose and achievement and enhancing wellbeing. So, those are just some really simple examples, but I hope you get a sense of how small changes in your home might be helpful to you. It's important to note that you need to continually think about and adapt your environment as your needs change. The beauty is that the dementia-friendly design principles apply regardless of the stage of dementia, or the outcome you want to achieve. You might just come up with a different approach or solution depending on your situation.
I hope you've enjoyed the “At Home with Dementia” webinar, and that you now have a better understanding of how changes due to dementia can impact the way you experience, and use your home environment. I hope that through the information I've provided, you understand the principles of good design that can help to make your home more supportive. If you're interested in exploring this topic further, there are links to some really great resources included on the webinar launch page.
Dementia Australia is also very excited to be able to offer a home consultation service, which provides you with access to an occupational therapist, to explore changes that you might make in your own home to best meet your needs. This program's available throughout Australia, so please let us know if you're interested. Thank you very much for your time today. If you would like to talk further about this topic, be referred to the home consultation service, or for further information, please contact the National Dementia Helpline on 1800 100 500. Thank you very much.
[Title card: Together we can reshape the impact of dementia]
[Title card: Dementia Australia. 1800 100 500. Dementia.org.au]
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