I. ROLE OF ENVIRONMENT IN SUPPORTING THE NEEDS OF THE PERSON WITH ALZHEIMER'S DISEASE AND THE CAREGIVER IN THE HOME

At the present time there has been relatively little study of the home environment and its affect on the caregiver and the person with dementia. Preliminary research is often contradictory and points up the tremendous variability among people with dementia as well as caregivers in a variety of settings.

It is evident that certain environments are more supportive of both the caregiver and the person with Alzheimer's Disease than others (e.g., an enclosed space to wander safely). However, many other factors can influence the effectiveness of environmental modifications, such as the person's ability to provide appropriate stimulation; and the support system available.

There is a growing need for more research in this area to better understand these complex interactions. Meanwhile, there is considerable research on the significant role the environment plays in the well-being of normal older individuals as their range and type of impairments increase with age. The importance of providing an environment that is appropriately supportive as well as challenging to the individual's level of functioning becomes an essential part of his/her ability to remain independent.

We believe the same is true of a person with dementia. Persons with Alzheimer's Disease can be affected by their environment, particularly in the beginning and middle stages of the disease. Simple changes may help reinforce positive behavior and support functioning for prolonged periods of time. Persons with dementing illnesses need to get around their environment as safely as possible. While they may be less aware of environmental hazards (e.g., leaving stove burners on, noticing loose wires on the floor), they may be more sensitive to environmental frustrations (e.g., glare, overly noisy and confusing environments) that may negatively affect their behavior.

Changes in vision, hearing, mobility and strength are often associated with Alzheimer's Disease. They can often intensify and/or frustrate the actions of the person and therefore must be identified by the caregiver. For example, a person with cataracts may not see objects clearly or level changes on stairs. He/she may bump into things or trip over low curbs. A person with dementia may also have a hearing impairment which may add to his/her confusion or difficulty in understanding a caregiver's request, particularly if a room has too much background noise. Whenever possible, physical or sensory problems should be corrected so that brain impaired persons can make as much sense as possible out of their environment and function at the highest level at which they are capable. It is therefore important that the environment be tailored to the unique needs of the person as well as to his/her stage of illness.

Some of the physical and cognitive losses that make the person with dementia particularly vulnerable to his/her environment include:

  • Diminished attention span.
  • Loss of critical judgment.
  • Problems in recognition.
  • Difficulty in orientation (time and place).
  • Incontinence.
  • Difficulty in decision-making.
  • Difficulty in communicating.
  • Reduced adaptability to environmental changes.
  • Difficulty in performing daily living activities.
  • Memory dysfunction.
  • Reduced mobility/shuffling gait.
  • Reduced coordination and motor skills.
  • Reduced visual acuity and visual field which impairs depth and contrast perception and clarity of objects.

Whether the person with Alzheimer's Disease is living in a home, attending an adult day care center, or will be going to an institutional setting, the environment should be designed to:

  1. Promote dignity and independent functioning.
  2. Provide appropriate sensory stimulation.
  3. Provide security and safety for the individual.
  4. Provide appropriate level of activity/task.
  5. Provide a homelike and familiar atmosphere.
  6. Provide for individual control and privacy.
  7. Create opportunity for socializing.
  8. Be flexible and adaptable in supporting the person's behavioral and physical needs.
  9. Emphasize wellness and maintain connection with the healthy and familiar.

 

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