Jill Pendleton jill.pendleton@merseycare.nhs.uk Making adjustments Jill Pendleton jill.pendleton@merseycare.nhs.uk

Most people want to stay at home How big an issue is it? 46.8 million people worldwide living with dementia in 2015. This will almost double every 20 years, reaching 74.7 million in 2030 and 131.5 million in 2050 There are over 9.9 million new cases of dementia each year worldwide, implying one new case every 3.2 seconds. There are over 850,000 people living with dementia in the UK The expected prevalence for Liverpool is over 5000 people although the actual numbers on dementia registers are 3300 Dementia costs the UK economy over £26 billion per year An estimated 670,000 people in the UK act as primary carers for people with dementia, saving the state £11 billion per year Most people want to stay at home

Dementia affects people in different ways …

How can dementia affect a person? Dementia is the name given to a group of conditions that can affect the way the brain works and can cause difficulties with: the way we think and take in information memory -remembering times and dates, events concentration Perception- distance, depth orientation- knowing the day,date,time, location communication- the way we speak and understand what others are saying carrying out everyday activities mood changes- people may appear low in mood or frustrated as it is a challenging condition to live with Everyone experiences dementia differently but these are some common challenges that people face. They can occur at different points for each person and not everyone will experience all of these changes. It’s not just about memory

With this in mind what kind of issues would someone with dementia have at home getting around Liverpool

How can dementia affect the way we interpret the environment? It can affect : the way we recognise objects eg money (visual agnosia) judge distances (spatial judgement) Judge depth -steps, kerbs, slopes , accessing buildings , transport(depth perception) know where we are in relation to other things (proprioception) The way we recognise people (prosopagnosia)or places (topographical orientation), find the way, use transport The way we can pick objects out from the background eg drawer of cutlery, cupboard full of crockery, fridge, chairs from the floor , toilet from the floor (Figure ground perception ) Being able to locate objects Remembering new information/how to work appliances

Flooring Dark patches, mats or stripes are perceived as holes Shiny and sparkly floors are perceived as wet Changes in colour and flooring can be perceived as steps

Stairs Black staircases look like a black slope Glass stairs cause huge problems Escalators look like a silver slope No differentiation on the edges of steps Makes using stairs difficult

Contrast Lack of contrast means it is difficult for people to know where furniture starts and ends so can easily walk into objects Sit down in the wrong place Judging distance is difficult Contrast is helpful

Glass Glass can’t be seen so can be walked into It is not a good idea to make doorways completely clear

Signage Signs need to be clear and unambiguous Clearly with eye line Use contrast Label rooms and cupboards Use pictures and words

Magic taps Hidden taps and sensor taps are really difficult for people with dementia to use Taps need to look like taps! Reminders to turn taps off, magic plugs, flood detectors

Rooms of the house What kind of adjustments might you need to make : Steps/stairs/lifts Bathrooms/toilets Kitchens Safety Flooring Dining / restaurants

If you are adapting the environment to help someone with dementia .. Avoid patterned flooring /heavily checked flooring /stripes Avoid changes in flooring – thresholds can look like steps Avoid shiny and sparkly floors as the light reflects and they can look wet and slippery Speckled flooring can cause people to stop and try and pick up bits off the floor Avoid black mats Any mats can cause falls Keep the same flooring on the routes you want people to take (care homes , wards etc) Two rails on stairs Marking the edges of steps with a contrasting colour can help Using stairgates can be dangerous , old habits die hard so changing patterns can be difficult ie remembering your bed is downstairs If you are blocking off stairs do it robustly, use reminders Stairlifts – need to establish can the person use it safely before you invest in stairlifts Ramps – changes in gradient may be difficult for some people , this can include kerbs Changes in texture of surface ie. Bumps to indicate crossings can cause unsteadiness for some people

So if you are adapting the environment to help someone with dementia .. Glass doors sometimes look like they are not there – be aware in shops, offices, patio doors , people can walk into them , stickers can help to show there is a door there Glass on the floor is to be avoided Use contrast – chairs against carpet , wooden furniture against laminate floor is difficult , white bath against a white wall can cause people to bump into it Technology Function of cupboards and rooms – having a change round wont help (unless you do it early) old habits die hard and learning new information is difficult so people will look for objects where they have been stored in the past Simplify the environment – de-clutter, Assistive devices and technology – ask for advice before you buy. Many helpful devices but will they work for you? Night lights at night , sensor lighting Reduce risks

Before you invest or adapt … ..ask an OT because everyone is different and everyone is affected differently