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

2. 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 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

3. Dementia affects people in different ways …

4. 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

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

6. 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

7. 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

8. 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

9. 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

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

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

12. 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

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

14. 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

15. 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

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