Why Is a Dementia-Inclusive Environment Important?
Researchers have predicted that the number of persons living with dementia around the globe is set to almost triple to more than 150 million by 2050.1
While dementia already presents a set of challenges for persons living with dementia and their families, stigma and discrimination worsen the psychological, social, emotional and financial impacts on them, such as social rejection, financial insecurity, internalized shame, and isolation.2 Similarly, with the rising prevalence of dementia in Singapore, where one in 10 people aged 60 and above is diagnosed with dementia, these ramifications are relevant and of growing concern for the nation with an aging population.
Dementia-inclusive environments are pertinent in mitigating the stigma and discrimination against those affected by dementia.2 Such environments enable them to continue living well and be involved meaningfully in the society for as long as possible, to enjoy a good quality of life.
Ensuring the inclusivity of different spaces to persons living with dementia and their families is a society-wide endeavour. Like anyone else, they can participate in many kinds of activities and have access to different spaces when the environment is designed to support their inclusion.
Physical and social environments can be continually designed and altered in dementia-inclusive ways. These environments include both places frequented most by persons living with dementia (e.g., their own homes, centre-based services, long-term care facilities) and the wider environment (e.g., public infrastructure, transport systems, arts and religious spaces, healthcare institutions, public offices).
Defining the Physical & Social Environments for Persons Living With Dementia
There are mainly two types of environments to consider when designing a dementia-inclusive environment for persons living with dementia – the physical environment and the social environment. It is also important to take into account the ways these two types of environments interact with each other.
The World Health Organization (WHO) defines the physical and social environments as such:
Physical Environment
Refers to the immediate physical surroundings and spaces, including built infrastructure and elements, and industrial and occupational structures2
Examples (but not limited to):
• Roads, pathways, etc.
• Outdoor spaces
• Spatial layout
• Safety features
• Visual cues to orientation
• Lighting
Social Environment
Refers to the social relationships and cultural contexts within which a person lives2
Examples (but not limited to):
• Social and economic processes
• Healthcare and community care programmes and services (Please refer to our article on Programmes & Services in the Community to find out more about the efforts to make Singapore’s social environment more dementia-inclusive.)
• Cultural practices
• Religious institutions and practices
Benefits of a Well-Designed & Supportive Physical Environment
As dementia causes changes in the brain, it affects one’s perception and experience of their environments, and consequently the way they interact with the environments and vice versa. Physical environments can thus either support persons living with dementia well, or create bigger problems for them.
Designing and building the physical environments to the experience, cognitive and functional abilities, sensory changes, needs and preferences, lifestyle patterns and life history of persons living with dementia can yield positive outcomes for them.
A well-designed supportive physical environment can have several benefits for persons living with dementia, such as:3
• Reduce behavioural changes, e.g., anxiety, agitation, disorientation, social withdrawal, etc.
• Support remaining cognitive and functional abilities (lower level of dependence in activities of daily living)
• Encourage positive behaviours, e.g., increased social contact
• Enable positive and meaningful engagement
• Provide a sense of comfort and continuity of care
Aspects of Physical Environments to Address for a Dementia-Inclusive Design
A physical environment has four types of elements: (1) Fixed, (2) Semi-fixed and (3) Non-fixed features, and (4) Sensory qualities:1,2
Fixed
Features which are not movable and rarely change
Examples: Building structure, Walls, Floors, Built-in cabinets, etc.
Semi-Fixed
Features/objects which are movable and changeable
Examples: Flooring material, Window and door materials, Pieces of furniture, etc.
Non-Fixed
Features/objects which are movable and changeable
Examples: Wall decorations, Pictures, Activity materials, etc.
Sensory Qualities
Attributes of an environment that interact with our five senses
Examples: Lighting, Sound, Smell, etc.
The four types of elements are further illustrated below:
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- Fo, A. (2021, July 27). Dementia cases ‘set to almost triple worldwide to more than 150 million by 2050’. Yahoo! News. https://sg.news.yahoo.com/dementia-cases-set-almost-triple-140000242.html?guccounter=1
- World Health Organization. (2021). Towards a dementia inclusive society: WHO toolkit for dementia-friendly initiatives (DFIs). https://www.who.int/publications/i/item/9789240031531
- Chaudhury, H., & Cooke, H. (2014). Design matters in dementia care: The role of the physical environment in dementia care settings. In M. Downs & B. Bowers (Eds.), Excellence in dementia care: Research into practice (pp. 144-158). Open University Press.