Designing living environments that promote independence and control are important for people with dementia and sight loss

Bowes A, Dawson A, Greasley-Adams C, et al.  Developing best practice guidelines for designing living environments for people with dementia and sight loss  Ageing & society. 2017; 38(5): 900-925.

Review question

•      What is the best way to design environments where people with dementia and sight loss are living? 

Background

•      It is widely known that most people experience visual changes in later life, including reduced visual acuity, increased need for light, decreased depth perception, reduced periphery vision, and even sight deterioration or blindness due to disease.

•      Previous research has shown that modifying the living environment can make a substantial difference in the quality of life of sight-impaired individuals. Although best practice guidelines exist for individual conditions, such as dementia or sight loss, there is currently a dearth of literature advising those living concurrently with both conditions. In many cases, different sets of guidelines diverge or conflict in their recommendations for each condition.

•      This systematic review aimed to develop user-friendly guidelines for the design of living environments for individuals with both dementia and sight loss.

How the review was done

•      A detailed search of selected bibliographic databases was conducted to find literature on environmental design for people with dementia and sight loss. A total of 33 studies were included in the systematic review after assessment for eligibility.

•      The systematic review of literature was complemented by consultations with patients, caregivers, experts and professionals. More specifically, the researchers conducted eight interviews with experts, two discussion groups, five focus groups, and consultations with 360 stakeholders in order to develop the best-practice guidelines.

•      This study was funded by the Thomas Pocklington Trust in the United Kingdom. The authors reported no conflicts of interest.

What the researchers found

•      The systematic review identified a variety of key design features of the living environment, including colour and contrast, lighting, fixtures and fittings, kitchens, bathrooms, entrances and exits, and outdoor spaces.

•      Examples of guideline recommendations for colour and lighting include: 1) lighting of an appropriate intensity supports and promotes independence; 2) buildings and interiors should be designed to allow a sufficient intensity of light throughout; 3) the preferred intensity of light depends upon individual needs and preferences as well as the tasks being undertaken; and 4) people’s preferences and needs for lighting differ. It is important that homes are designed or adapted to be flexible in terms of lighting provision, and that people are regularly consulted to identify any changes in their individual preferences and needs.

Conclusion

•      This project used research evidence and real patient and caregiver experiences to develop design guidelines for living environments for people with dementia and sight loss.

•      The review highlights the challenges of improving environments where people with dementia and sight loss are living.

•      The literature emphasized the need for the living environments to promote the independence of people with sight loss, as well as the need to promote a sense of control for people with dementia.

•      The authors call for innovative approaches to better understand the complexities of design for people with dementia and sight loss.