Abstract
ABSTRACTEnvironments need to be designed such that they support successful orientation for older adults and those with dementia who often experience marked difficulties in their orientation abilities. To better understand how environments can compensate for decreasing orientation skills, voice should be given directly to those experiencing dementia to describe how they find their way and to understand their design preferences. This study explored the navigational experiences and design preferences of older adults with memory difficulties living in a retirement development. In-depth semi-structured interviews with 13 older adults experiencing memory difficulties were conducted. All participants were residents of one retirement development in the United Kingdom. Questions began broadly, for example, to describe their experiences of navigating in their living environment, before discussing any specific navigation difficulties in detail. Thematic analysis identified three main themes: highlighting environmental design that causes disorientation, strategies to overcome disorientation, and residents’ suggestions to improve the design. The design suggestions were particularly informative, heavily focusing on the importance of having memorable and meaningful spaces which were favoured more than signage as an orientation aid. The findings demonstrate the need to consider environmental design to support orientation for those with memory difficulties. Of particular importance is the use of meaningful and relevant landmarks as orientation aids which can additionally stimulate conversation and increase wellbeing. Given the range of suggestions in dementia-friendly design guidelines aimed to support orientation, it is crucial to speak directly to those living in different environments to learn how they find their way around and what design works in their environment.
Highlights
Older adults who are experiencing early symptoms of cognitive impairment and dementia often encounter difficulties executing day-to-day tasks
This study explored wayfinding experiences and design preferences of older adults with memory difficulties living in a communal retirement setting
Given the wide range of preferences and abilities, the findings reported in this paper highlight that one design solution does not fit all; whilst dementia friendly guidelines (Fleming 2011, The King's Fund 2013) and the recent UK policy directive on the environment and those with dementia (Department of Health 2015) provide an initial outline of concepts to consider, talking directly to the users would ensure that the design and wayfinding solutions is best suited to their needs and requirements
Summary
Older adults who are experiencing early symptoms of cognitive impairment and dementia often encounter difficulties executing day-to-day tasks. Cognitive psychology has characterised how typical ageing affects navigation abilities; older adults typically take longer to learn unfamiliar environments (Head and Isom 2010) and perform better when using landmark-based navigation strategies compared to more map-based strategies (Sjolinder et al 2005, Wilkniss et al 1997) These effects are even more pronounced if individuals develop mild cognitive impairment (MCI) or Alzheimer’s disease (Bellassen et al 2012, Bird, Chan, Hartley, Pijnenburg, Rossor and Burgess 2010, Monacelli et al 2003, Pengas et al 2010), and are often explained via the structural and functional changes that occur in the hippocampus, a brain region that is crucial for spatial learning and spatial memory (O'Keefe and Nadel 1978, Raz et al 2010). Applying this knowledge could improve independence, well-being and quality of life of older people, people with mild cognitive impairments and people with dementia (Day, Carreon and Stump 2000, Liu, Gauthier and Gauthier 1991, Lynch 1960, Orrell et al 2013)
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