Abstract
Difficulty with everyday activities is a key symptom and defining feature of dementia, relating to subjective reports of well-being and overall quality of life. One way to support individuals in their daily activities is by modifying the physical environment to make it easier to interact with during activity performance. This systematic review explores the range of studies available using physical environmental strategies to support performance in everyday activities for people with dementia. Seventy-two relevant studies were identified by the search. Physical environmental strategies included changes to the global environment and to architectural features, use of moveable environmental aids and tailored individual approaches. Strategies supported general everyday activity functioning (N = 19), as well as specific activities, particularly mealtimes (N = 15) and orientation in space (N = 16); however, few studies were found that focused on aspects of personal care such as dressing (N = 1) and showering or the preferred hobbies of individuals (N = 0). Overall, there appeared to be a lack of research within private home environments, and of studies which specify the dementia syndrome or the whole neuropsychological profile of people with dementia. More work is needed to extend theoretical understandings of how people with dementia interact with their environments so that these spaces can be designed to further support activities of daily living performance. Future work in this field could also incorporate the perspectives and preferences of those living with dementia.
Highlights
Dementia is one of the leading health and social economic challenges of our age (World Health Organisation, 2012) with 47.47 million people worldwide estimated to be living with dementia and this number projected to rise to 135.46 million by 2050 (Prince, Guerchet et al, 2013)
From the studies reviewed, specific activities from the Bristol Activities of Daily Living Scale (BADLS) which appeared to be most supported by environmental strategies were orientation in space and eating/drinking whereas aspects of self-care such as dressing, toileting and brushing teeth appeared to be less supported
The majority of the research identified looked at the impact of environmental strategies on overall Activities of daily living (ADL) performance without specifying which activities, in particular, may be benefiting from the strategy
Summary
Dementia is one of the leading health and social economic challenges of our age (World Health Organisation, 2012) with 47.47 million people worldwide estimated to be living with dementia and this number projected to rise to 135.46 million by 2050 (Prince, Guerchet et al, 2013). The more complex IADLs have been found to be impaired early in dementia (Barberger-Gateau, Dartigues, & Letenneur, 1993), followed by BADLs as the disease progresses (Mohs, Schmeidler, & Aryan, 2000). These findings should be taken with caution as some research has found significant differences in performance for each IADL (Giebel, Challis & Montaldi, 2014) and BADL item (Giebel, Sutcliffe, & Challis, 2015) and variation across individuals with dementia
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