Dementia and your environment

Being able to see things accurately requires different parts of the brain and body to work together. For example, the eyes take in light and send signals to the brain. The brain then makes sense of this information and tells us how to interact safely with the things around us. Because of the effects of dementia on the brain, this information can get lost or jumbled, leaving the person struggling to make sense of what they see in front of them, or seeing things that are not really there.

Glossy surfaces are one area which can cause difficulties. For example, the reflected glare from a glossy floor can be perceived by a person with dementia as liquid on the floor. A matte finish can reduce these illusions. Other visual problems experienced by people with dementia are judging depth and differentiating contrast.

Depth perception is our ability to identify how far away something is. For example, how deep a bath is or how far away a step is. A brightly coloured bathmat may be used to help identify where the bottom of the bath is.

Contrast sensitivity refers to the difficulties people with dementia may have with differentiating between surfaces with a similar colour or texture, for example, having a sofa that is the same colour as the carpet. To help with these visual difficulties strong contrasts are recommended between furniture, walls and flooring to help the person locate themselves and objects in the environment.

It is also recommended that patterned carpets are avoided as this can give the impression that the floor surface is uneven or moving. Similarly black or a very dark coloured matt could appear like a black hole for someone with a rarer type of dementia.

Strong contrasts in the home can also help people to remain more independent. For example, a red toilet seat that contrasts with the walls and floors can help the person locate the toilet easily. In addition, strong contrasts can be used for signs to help a person locate rooms. Using coloured electrical tape can help make an object more distinguishable such as a handle or switch.

People with dementia experience what is called “rollback” memory. Memories of recent events are lost first, and as dementia progresses memories from further and further back are lost. The person’s perception of how old they are and the year they are living in will depend on how far back their memory has rolled. Because of this, some people with dementia do not recognise themselves when they see themselves in the mirror. If this happens then covering up or removing mirrors can help.

Someone with dementia may have trouble remembering what different rooms are for, or which room is their room. Placing reminders on the door can help a person with dementia find their way around more easily. For example, placing a toilet sign on the toilet door.

A person with dementia may also forget how to use certain household items, as this requires access to previous memories of using the item. It can be helpful to have items from the time period the person recalls as most recent around the house.

As our eyesight diminishes, having adequate lighting around the house is important, particularly so for people with dementia. Good lighting will help you find your way around the environment and help reduce agitation and anxiety so ensure that the lumens of your light bulbs are as bright as possible. This can be particularly important during times of low natural light, such as dusk.

Most importantly, regular eye tests and checking the person has an up-to-date prescription on their glasses/contact lenses can ensure their sight is not hindered. In rarer dementias such as posterior cortical atrophy, an optician can discuss with you if prisms inserted in your lenses could help correct your vision.

If your eyesight has been affected due to your Dementia a good source of information, help and support is the charity Sight for Surrey www.sightforsurrey.org.uk which can provide specialist help and assessment to help you overcome day-to-day challenges living with sight loss. You can also visit them to try types of devices that might make your life easier and discuss technology in smartphones,  telephones, computers and iPads that could also help you.

People with dementia can become easily distracted. A noisy environment can make it even more difficult for them to concentrate on what they are doing or what is being said to them.

It may help to ensure that there aren’t too many background noises occurring at the same time.

For example, only one person talking at a time, or turning off any music/television while having a conversation.

In the later stages of dementia a person might have difficulty recognising a carer or family member. This can make providing personal care challenging. Whilst it can be uncomfortable and upsetting for you, explaining who you are and what is about to happen ("I’m going to wash your face now"), can help to reduce anxiety and fear for the person with dementia.

Regular changes in care staff or too many people providing personal care at the same time can also be confusing. Using your knowledge of the person and their usual routine can reduce any anxiety, as the process is more predictable for them.

With the onset of dementia, an individual might notice a decline in their sense of taste and smell, which can reduce appetite at mealtimes. It is important to know the types of tastes, textures and portion sizes the person prefers when preparing meals. Strong food smells around meal times can also trigger appetite and encourage eating.
People with dementia may have trouble handling cutlery or other utensils or grasping a particular cup. It is important to make sure that they are comfortable using the items they are given to eat and drink with. Because people with dementia can forget how to use everyday objects, other people can model how to use cutlery.

The progression of dementia can vary from one person to another. A functional and environmental assessment can be carried out by a qualified Occupational Therapist to provide more personal advice and guidance in meeting the changing needs of the person and their carer(s).

You may want to apply for a 'Disabled Facilities Grant' via your local council. This can be used to pay for works such as widening doorways and installing ramps for wheelchair access; improving or installing a suitable heating system; altering heating or lighting controls; providing access to bathroom facilities, either with a stair lift or a new ground floor bathroom; improving access to and around the home to make it easier to care for someone.

Each council will also have a Home Improvement Agencies (HIAs) and Care and Repair which help disabled people and other vulnerable people make adaptations to the homes they own.