Baycrest

Impacting dementia care through design F or every patient, the space they're in plays a role in their comfort and stress levels. Numerous studies have shown that not only does the physical environment affect a patient's stress levels and safety, it also impacts staff safety and effectiveness and the quality of care provided in hospitals and healthcare institutions. "The environment can be a trigger that causes a patient to act out," says Dr. Yael Goldberg, Baycrest clinician leader and behavioural consultant. "Patients with dementia have a lower tolerance for stress and environmental changes. A loud noise can agitate them and push them over the edge." This is why when patients with dementia exhibit behavioural symptoms, such as physical or verbal aggression, agitation, restlessness or resistance to care, environmental changes are always considered a potential factor, says Dr. Goldberg. There is a growing trend among healthcare institutions to embrace evidence-based design and use the building's environment to improve patient care and reduce stress levels. One tactic that has caught some attention is painting murals or bookshelves onto walls. This artwork carries a dual purpose: it helps calm patients since the space looks homier and it deters them from seeking an exit. Meanwhile, recent research has shown that care home residents with dementia who spent time in a garden had lower levels of agitation. Green spaces, such as enclosed gardens, offer a breath of fresh air and a relaxing environment to patients, which is why easy access to the outdoors is helpful in reducing stress, says Dr. Goldberg. Patients with dementia also benefit from both open and private areas. A common room can be used to offer non-drug therapies, such as art or music therapy, that have shown to be effective and can help engage patients, says Dr. Goldberg. A quiet room can foster peace and relaxation for overstimulated patients. Careful consideration is needed when designing these spaces since what may look appealing could cause distress among patients. For example, patients with dementia may be afraid of dual-tone floor tile since their perception of depth may be affected by their condition and dark areas elicit the feeling of falling off a cliff or walking into a hole, says Dr. Goldberg. "We need to use whatever we can to help manage a patient's behaviour and there are a number of environmental cues that can help," says Dr. Goldberg. For more articles like this visit: baycrest.org/brainmatters "Patients with dementia also benefit from both open and private areas." BrainMatters FALL/WINTER 2017 3 COMMON ENVIRONMENTAL STRESSORS FOR PATIENTS WITH DEMENTIA: • Another patient intruding in their personal space • Overstimulation, such as when there's too much activity happening at once • Certain smells; for example, some patients may refuse to eat fish due to its odour • Construction, noisiness and new faces coming in may break a patient's normal routine The recently renovated Shiffman Family Neighbourhood at Baycrest is providing a space for patients with dementia to enagage with others. Dr. Yael Goldberg

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