Is it happy hour yet? Can I have a scotch and soda? Every afternoon during his 4week stay in the dementia unit, this gracious gentleman would stop at the nurses desk, believing it to be a hotel bar, and ask for a drink. The nurses stood or sat behind a high counter that separated the staff from the patients and the public. Hospital files and stationary, and not bottles of alcohol, were always visible - but the height of the bar, and the separation of the staff, were similar enough to confuse this gentleman into believing he was somewhere other than a hospital.
This same man managed to escape from the dementia unit, and found his way back to his apartment in the suburbs of Sydney. He did this without a map, money, or a bus ticket. The distance between the hospital and apartment was approximately 15kms, and it was assumed that he did travel by bus for some of this journey. I had regularly witnessed this man getting lost while looking for the bathroom on the unit. Successfully negotiating his escape and way home from the hospital is amazing, and for me, one of the mysteries of a mind befuddled by dementia.
Getting lost is common in people with dementia. This symptom starts early and continues throughout the disease until it is constrained by a reduction in the individual’s mobility. Disorientation to place occurs when the person with dementia is unable to correctly recognize familiar landmarks that have previously oriented them to where they are and where they are going.
For the past thirty years architects, interior designers and dementia specialists have collaborated to design "dementia friendly" aged care facilities. Most of the initial work sought to improve visual queues thereby orientating people to where they needed to go. For example, making the doors of bathrooms obvious by contrasting the color of the door and placing a photo of a toilet on the door. Similarly deterring entry to restricted areas by camouflaging doors to match the walls. By controlling the environment via lighting, floor coverings, furnishings including photos, signs, images - we can enhance the independence of residents who are unable to regularly remember where the bathroom is, where their bedroom is, where the common social areas are.
Finally, imagine finding yourself in a new city where you understand neither the language nor the culture. How do you find a public bathroom? You look for the clues and associations related to the location of public bathrooms inherently learned from you own life experiences. Conventional toilet images on signs; buildings likely to have public access to bathrooms; queues of people obviously not shopping … without being able to ask directly, you look for recognizable visual queues. This is the same principle in helping people with dementia orientate to their surroundings: make it simple, obvious and familiar.
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