Use of the Physical Environment to Support Everyday Activities for People With Dementia: A Systematic Review

Dementia

Woodbridge, R., Sullivan, M. P., et al. (2018).

Dementia, 17(5), 533-572.

This systematic review investigates the impacts of environmental modifications (e.g., lighting, spatial layouts) on daily functioning of people with dementia. 

Brunel University London (United Kingdom)

Not specified

Published studies (not otherwise specified)

72

Environmental modifications were associated with positive effects on meal-related outcomes for individuals with dementia. Specific findings included:<br /> <ul> <li><span style="color: #333333;">Tailored individual adaptations were associated with improved drink preparation and table setting (1 study). </span></li> <li><span style="color: #333333;">Assistive technology was associated with improved meal preparation; however, users reported the technology to be confusing and irritating (1 study). </span></li> <li><span style="color: #333333;">Increased light and contrast was associated with increased oral intake (3 studies). </span><span style="color: #333333;">One study found positive effects in assistive living facilities, but not in skilled nursing facilities. </span></li> <li><span style="color: #333333;">Improved quality of environment (e.g., home-like environments, no television, relaxing music) was associated with increased oral intake (3 of 4 studies). </span></li> <li><span style="color: #333333;">Increased environmental ambiance (e.g., aquariums in dining rooms, tailored music) was associated with improved oral intake (2 studies). </span></li> <li><span style="color: #333333;">Self-serve meals were associated with more positive mealtime behaviors and engagement with fellow residents (2 studies). </span></li> <li><span style="color: #333333;">Visible snacks did not affect independent snacking (1 study), however, study design may have impacted these results.</span></li> </ul> <span style="color: #333333;">This review has several limitations, including a limited number of studies within each modification category, reduced methodological rigor of included studies, potential for confounding variables (e.g., staff practices, multiple environmental changes at once, novelty effects), and heterogeneity between studies.</span>

Familiar cues (e.g., rubber duck for bath time, tablecloths for meals, clocks) and assistive technologies (e.g., digital day/night calendar, digital planning board) were associated with improved orientation to time for people with dementia (5 studies). However, some individuals experienced difficulties using assistive technologies. <br /><br />This review has several limitations, including a limited number of studies within each modification category, reduced methodological rigor of included studies, potential for confounding variables (e.g., staff practices, multiple environmental changes at once, novelty effects), and heterogeneity between studies.

Environmental modifications were associated with improved orientation to place for people with dementia. Specific findings included:<br /> <ul> <li><span style="color: #333333;">Familiar cues (e.g., hallway signs, family photos near bedroom door) were associated with improved way-finding.</span></li> <li><span style="color: #333333;">Changes to architectural layout (e.g., reduced number of exits, clear pathways) were associated with improved way-finding (7 studies). </span></li> <li><span style="color: #333333;">Distracting cues (e.g., murals, mirrors) around doors were associated with reduced exit-seeking behaviors (5 of 6 studies).</span></li> </ul> This review has several limitations, including a limited number of studies within each modification category, reduced methodological rigor of included studies, potential for confounding variables (e.g., staff practices, multiple environmental changes at once, novelty effects), and heterogeneity between studies.

Environmental modifications were associated with improved communication in people with dementia. Specific findings included: <br /> <ul> <li><span style="color: #333333;">Home-like meal settings enhanced communication between staff and residents with dementia (6 studies). </span></li> <li><span style="color: #333333;">Home-like environments increased interaction and active participation in two dementia units (1 study). </span></li> <li><span style="color: #333333;">Availability of a mix of private and public spaces supported different types of communication (1 study).</span></li> </ul> This review has several limitations, including a limited number of studies within each modification category, reduced methodological rigor of included studies, potential for confounding variables (e.g., staff practices, multiple environmental changes at once, novelty effects), and heterogeneity between studies.

Assistive technologies demonstrated mixed usefulness in supporting everyday activities. While some technologies (e.g., locator device, medication carousel, simple mobile phone) were found to be useful, others (e.g., automatic phone alerts to family members, digital calendars) were identified as less useful and confusing to use.<br /><br />This review has several limitations, including a limited number of studies within each modification category, reduced methodological rigor of included studies, potential for confounding variables (e.g., staff practices, multiple environmental changes at once, novelty effects), and heterogeneity between studies.

Tailored, individual environmental modifications (e.g., labeling objects, clutter management) were associated with improved ADL or instrumental ADL (iADL) performance in people with dementia. Specific findings included: <br /> <ul> <li><span style="color: #333333;">When combined with recommended adaptive equipment and care partner education/ training, tailored adaptations had small, short-term effects for people with moderate-severe cognitive deficits. These effects were not maintained at 12 month follow-up (4 studies).</span></li> <li><span style="color: #333333;"> Task-specific modifications (e.g., adaptations for setting the table or folding laundry) were associated with improved task performance for 5 individuals with moderate-severe dementia (1 study).&nbsp;</span></li> <li><span style="color: #333333;">Tailored modifications were associated with improved ADL (2 studies) and iADL (1 study) participation and performance.</span></li> </ul> This review has several limitations, including a limited number of studies within each modification category, reduced methodological rigor of included studies, potential for confounding variables (e.g., staff practices, multiple environmental changes at once, novelty effects), and heterogeneity between studies.

General environmental modifications were associated with positive effects on activities of daily living (ADLs) for people with dementia: <br /> <ul> <li><span style="color: #333333;">Improved environment quality was positively associated with ADL performance (2 studies). </span></li> <li><span style="color: #333333;">Smaller facilities were generally associated with greater participation and improved/maintained ADL performance. However, this finding may be due to selection bias (i.e., smaller facilities only admitting patients with higher functional status; 4 out of 5 studies).</span></li> <li><span style="color: #333333;"> Home-like atmospheres were associated with improved engagement and ADL performance (3 of 4 studies). </span></li> <li><span style="color: #333333;">Open-plan living spaces within private homes were negatively associated with ADL performance, suggesting the potential benefit of enclosed rooms with clear functions (1 study)</span></li> </ul> <span style="color: #333333;">This review has several limitations, including a limited number of studies within each modification category, reduced methodological rigor of included studies, potential for confounding variables (e.g., staff practices, multiple environmental changes at once, novelty effects), and heterogeneity between studies.</span>