Small changes to the patient environment for people with dementia can have a dramatic effect on hospital stays, experts reveal


THE SIMPLEST design interventions such as changing the colour of a toilet seat can have a major impact on the quality of the environment for dementia patients in hospitals and nursing homes, according to experts.

Sarah Waller, director of the Enhancing the Health Environment (EHE) programme at The Kings Fund, told delegates at the recent IHEEM Healthcare Estates Conference that small, relatively cheap alterations can make a huge difference to sufferers and prevent them from becoming disorientated. She said: \'There is increasing evidence that the environment of care, particularly in acute general hospitals, can have a significant and detrimental effect on people who have dementia. Many such patients lose their independence in undertaking activities of daily living when in hospital, with the result that they may not be able to return home when the acute episode of care is completed, which is both devastating for them and their families and has cost consequences for the care system. Yet relatively straightforward and inexpensive aspects of the design and fabric of the care environment can have a considerable impact on the wellbeing of people with dementia.\'

“We need to help people when they are in hospital, not disabled them. If you take nothing else away from today other than changing the colour of the toilet seats, you will have made a big impact on patients’ lives.”

Changing the colour of the seat to a shade at least 30% different to the rest of the toilet means dementia sufferers, who often have visual impairments, can see where to sit, avoiding potential falls or spills.

Relatively straightforward and inexpensive aspects of the design and fabric of the care environment can have a considerable impact on the wellbeing of people with dementia

Waller said: “It is estimated that 25% of people accessing acute hospital services are likely to have dementia and the number of sufferers is expected to double over the next 30 years. Appropriately-designed environments have the potential to reduce the incidence of agitation and challenging behaviour and the prescription of anti-psychotic medication, as well as promoting independence, improving nutrition and hydration, increasing engagement in meaningful activities, encouraging greater carer involvement and improving staff morale, recruitment and retention, all of which contribute to a reduction in overall service costs.”

The EHE programme was launched in 2000 and, in 2009, the Department of Health commissioned The King’s Fund to develop a project aimed specifically at improving healthcare environments for patients with dementia. Since then 23 clinically-led, multi-disciplinary teams have delivered a range of projects across the country. 

This is helping to create an evidence base of interventions that can make a positive difference to the patient experience and, potentially, to healthcare outcomes. An audit tool is due to be unveiled in January which will enable staff and those with dementia and their carers to assess if, and where, improvements to the physical environment are needed and how to effect simple and cost-effective design solutions.

Waller said: “The general level of knowledge in the health professions, even among those who have been trained to care for people with dementia and among estates and facilities staff, about what makes a therapeutic environment for people with dementia, is low. However, the volume of applications for the specific EHE programmes has shown there is a considerable level of interest in dementia-friendly environments and a desire across the service for practical advice to enhance the quality of the care provided to people with dementia.

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“Patients are already benefiting from the programme as the projects are showing that relatively inexpensive interventions, such as changes to lighting, floor coverings and improved wayfinding, can have a significant impact on their wellbeing. Early audit results are showing a reduction in falls, incidents of violent and aggressive behaviours and in the use of antipsychotic medication. These audits will be repeated at the end of the year.”