GHP August 2015

ghp August 2015 | 17 industry insight The scale of the challenge In 2009 an Alzheimer’s Society report (1) estimated that over 25% of people accessing general hospital services were likely to have cognitive problems or dementia. This figure is now believed to be an underestimate, with hospitals reporting nearer 40% of the over 75 year olds receiving hospital care being affected though many will not have received a formal dementia diagnosis. Unfortunately too many of these patients still lose the ability to undertake activities of daily living while in hospital and are unable to return home. An outcome that is both devastating for them and their families and has cost consequences for the care system. The Prime Minister’s challenge on dementia 2020 (2) and the Dementia-friendly Health and Social Care Environments Health Building Note 08-02 (3) both attest to the need to continue to develop more dementia friendly care environments. However, there remains a significant knowledge gap about the critical role that relatively straightforward and inexpensive environmental improvements can play in improving care and supporting the independence and well-being of people with dementia. Why are dementia friendly environments needed? Normal ageing has an impact on the senses, par- ticularly sight and hearing, and this is exacerbated by the distortions in perception associated with dementias such as Alzheimer’s disease, the most common form of dementia, and poorly designed care environments can lead to further disablement. People with dementia may therefore experience increased agitation, disorientation and distress in hospitals as they are likely to: - be confused and agitated in unfamiliar environ- ments particularly if they are visually over-stim- ulated for example by a plethora of signs and notices - be unable to see things, for example, handrails and toilet seats if these are the same colour as the wall or sanitary ware - experience shadows or dark strips in flooring as a change of level and therefore try to step over them - resist walking on shiny floors because they think they are wet - want to explore and walk around. However, if hospital environments are appropriately designed it is possible to reduce confusion and agita- tion, encourage independence and social interaction, and enable people with dementia to retain their ability to undertake activities of daily living. Developing dementia friendly design principles Key principles for dementia friendly design have been developed by The King’s Fund through a Department of Health commissioned programme (4). Working with over 25 clinically led multidisciplinary teams from NHS trusts, each of which included estates managers and carers, a set of overarching principles were developed and tested. (Fig 1) Each team completed an environmental improve- ment project based on the principles which involved: de-cluttering; maximising natural light and improved lighting; laying matt flooring; easing way-finding using colour and contrast, art and better signage. Large nurses’ stations have been removed with the staff now working in bed bays making them more visible and easing distress. Creating social spaces and better access to gardens has improved general well-being as well as providing opportunities for meaningful activity. Estates colleagues report that incorporating these design principles has cost no more than similar sized schemes, provided better value for money and improved sustainability. The completed schemes also demonstrate how the care experience for people with dementia can be improved and show how cost effec- tive design can help to reduce falls and incidents as well as supporting increases in non-pharmacological approaches to managing challenging behaviour. There have been consequent improvements in staff morale, engagement, recruitment and retention. Dementia friendly environmental assessment tools Following the programme a suite of evidence based assessment tools have been developed which focus on those aspects of the physical environment known to impact on people with dementia. They assess not only the physical environment, such as floor coverings and use of paint colours, but also the way that the environment encourages people to behave and interact. A service user led approach was taken to their design so that the assessments can be un- dertaken by people with dementia, family carers and staff together. Over 8,500 copies of the tools have been downloaded and they are in use nationally and internationally. They have evaluated very positively and have helped to educate staff and to secure increased funding for environmental changes. Further development of the tools, including an ap- plication for smartphones and tablets, is now being taken forward through the Enabling Environments Programme by the Association for Dementia Studies, University of Worcester. For further information and to download the tools for wards, hospitals, care homes, health centres and specialist housing, free please visit http://www. worcester.ac.uk/dementia Fig 1 (above) – Overarching design principles (Copyright The King’s Fund 2014) References 1. Alzheimer’s Society. Counting the cost. London: Alzheimer’s Society, 2009 2. Department of Health, Prime Minister’s challenge on dementia 2020, Depart- ment of Health, February 2015 3. Department of Health, Health Building Note 08-02, Dementia-friendly Health and Social Care Environments, Department of Health, March 2015 4. Waller, S, Masterson, A, Finn, H, Improving the patient experience: devel- oping supportive design for people with dementia : the King’s Fund’s Enhancing the Healing Environment Programme 2009-2012. London: The King’s Fund, 2013