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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.

Aging in place is the term used by aging industry insiders for the 9 in 10 older adults who want to stay in their homes as independently and as long as possible. When it comes to creating well home design for those with Alzheimer’s disease or related dementia (ADRD), there are specific changes to be considered. Dementia is not just about memory loss, the disease also impairs balance, visual and spatial perceptions and causes behavioral issues that may require certain sensory therapeutics found in home design which is part of environmental wellness.

Today 6 million Americans have ADRD and by 2050 the number is projected to be 14 million. To facilitate aging in place for dementia adults, the Alzheimer’s Foundation of America published a guidebook and video on dementia-friendly design called “The Apartment.” In addition, the Lien Foundation in Singapore collaborated with designers and care professionals to create, Hack Care, an Ikea-inspired catalog of product hacks for dementia adults at home.

Many of the elements in these guides are based on universal design principles used to make homes more assistive and accessible for older adults and those with disabilities. According to a Harvard Study, 25% of all U.S. homes have someone who has a physical issue – declining eyesight or hearing; impaired cognition or decreased mobility – challenges for independent living. Yet less than 3% 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 or bath mats and walk-in tubs or no step entry showers to prevent falls at home – 80% of which happen in the bathroom
• Good lighting around task areas such as the kitchen or reading spaces since older eyes at age 60 need 2-3 times the illumination of a 20-year-old
• Avoiding furniture with sharp, hard edges and replacing 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 six key areas to address in designing a dementia-friendly home:

1. Lighting

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 Alzheimer’s adults 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 automatic or smart home lighting where bright fluorescent lighting simulating daylight can come on at dusk as shades and blinds are closed. This reduces the gloaming affect and the dusk crisis of shadows and silhouettes.

Another way to address the anxiety is with light therapy lamps. Also, when it comes to wall paint, using calm soothing colors such as 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 seem to appear wet to someone with dementia. And, avoid blue light at bedtime such as the emission from all technology like TVs, tablets, 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.

2. 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.” 

In aging in place design we use contrasting colors for the rise and tread on stairs. In dementia home design we apply contrast to a variety of areas: bright colorful front doors like red or green that create energy against lighter exterior paint and can trigger memory to enter the correct house. Create light walls with darker cabinets, floor baseboards or door frames that contrast with hallway walls and doors to easily identify rooms and make hallways less daunting .

Even using different color drawer colors or 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. And avoid busy rug patterns, the visual complexity increases anxiety.

When it comes to wall paints, green evokes nature and calm and is the trendsetting color of 2022. It is also the color that creates optimism in older adults¹ and is the longest-lasting color that someone with dementia will be able to identify².

3. Safety Modifications

A problem with dementia adults is fires in the home from a forgotten stove or cooktop. A 2020 report from the U.S. Fire Association found 50% of home fires were among people age 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.

4. Routines and Reminders

Routines become essential for dementia adults.  But there are also reminders such as 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 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 (Bedroom, Bathroom, Laundry Room, Guest Bedroom, etc.) also helps. And, lean into the 2022 home décor trend of clocks in every room – this helps someone with dementia keep track of their schedule no matter which room they enter.

5. Reminiscence Therapy

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%. 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 use apps, such as LifeBio Memory, 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 family heirlooms.

6. The Sound of Music

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 or other favorite tunes that not only restore happy times but also calm agitation and reduce pacing and wandering. Or tap into the app created for older adults including those with dementia, SingFit Studio Caregiver.

When looking to make these well home design changes for someone with Alzheimer’s, keep in mind 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.

References

¹ Mammarella, N., Di Domenico, A., Palumbo, R., & Fairfield, B. (2016). When green is positive and red is negative: aging and the influence of color on emotional memories. Psychology and aging, 31(8), 914.

² Alice Cronin-Golomb, PhD, Vision in Alzheimer’s Disease, The Gerontologist, Volume 35, Issue 3, June 1995, Pages 370–376, https://doi.org/10.1093/geront/35.3.370

©2021 Sherri Snelling

A version of this article appeared in the December “Alzheimer’s and Senior Care” supplement of USA Today