Please ensure you have read the published Part 1, Part 2, Part 3, Part 4 and Part 5 of this article, and have located the relevant appendices.

Environment set up

The actual set up of an aged care home is not something we can always easily change, however majority of people including people living with dementia, respond positively to certain environments that cater to their needs.

o Create small and personal areas, as large, open spaces may be intimidating, and it may be difficult to negotiate how to get down those long, never ending corridors or wide spaces.

Sometimes people may not move or walk around their home, because they feel so intimidated by the large spaces, and this can generate feelings of insecurity and loss of confidence.

This is especially significant if a person has sight impairment or has lost their visuo-spacial ability.

o Colour and tactile pictures and wall hangings in corridors and in rooms provide sensory stimulation, and cues, so a person may enjoy strolling and walking around, thus may also benefit from a lovely environment.

o Solid blocks of colour are important – busy patterns are confusing, and objects, doors, windows, ornaments etc. may fade into or get lost amongst too much busy colour and patterns.

o Beautiful gardens are always a positive place to walk around, with leafy trees and water features that can provide a serene and relaxing get away, but also a place to take time out to breath.

o Relaxing sitting areas and nooks, with a home like ambiance, consisting of big comfortable couches, lamps, warm colours, a fire place, bookshelves and snuggly rugs. This may be effective in providing an environment that is often similar and familiar to the lounges a person may have previously been used to.

o Signage – only use words in signs if people can still read, retain decent eyesight and can still comprehend words.

  • Pictures as signage may be helpful. E.g. A picture of a toilet may indicate that this is where the toilet is. However, if a person has lost the ability to recognise objects, (agnosia), then this will not assist them in any way.
    Therefore, we must always be aware of a person’s capabilities so as not to place them at risk, nor place unfair pressure on them.
  • Signs in general should be about hip level as majority of older people often walk with their focus either at hip level or slightly downwards, so they can watch where they are going; therefore, they will not see anything that is eye level or above.
    Many older people also use walking frames and thus their vision is usually focused at the height of the top bar, which is around hip/shoulder height.
  • Black on white for signs is suggested as it is easier to read, for any person who is older or has sight impairment.

Provide sensory stimulation

We all rely on many aspects of life to stimulate our senses and mood in a positive way, and if this is removed from our existence altogether, then we are at risk of becoming detached, withdrawn, socially isolated and possibly sink into depression.

Lack of and removal of, sensory stimulation, does not promote a lifestyle that is uplifting and joyful.

Hearing

o Relaxing and soft music that a person will recognise and react positively to.

o Keep voices at a level that is not too loud or intimidating by tone and nuance.

o Music – most persons respond to music, no matter who they are or what medical conditions they have. It is a universal way of creating joy. Bring in children, choirs, musicians to make music together, and celebrate the magic, as long as the tunes are relevant and appropriate to a person’s preference.

o Singing with a person can be effective in promoting happiness, initiate connection and communication, whilst aid reminiscence.

o Ensure hearing aids are in place as required, with awareness of the hearing ability of a person, so you can interact effectively.

o Sit outside and listen to birds chirping.

o Videos and plays that are musicals and can be enjoyed visually as well.

o Listening to the tinkling of water in a fountain is relaxing, as is the sound of wind chimes.

o Avoid loud and static noises and bangs as they can cause fright.

o Do not have too much background overlapping noise, as this can be confusing, overwhelming, and create negativity.

o Always knock when entering a room.

o Some people like to relax or go to sleep with a radio or tv going.

o The sound of laughter is definitely something most people respond positively to.

Sight

o Colour stimulates positively if utilised in the correct manner – imagine the difference in mood we experience when we look at a rainbow, as opposed to a muddy puddle.

o Colourful, bright pictures and wall hangings on the walls create more awareness, can act as cues but can uplift mood.

o Flowers are usually happy and joyful and bring pleasure.

o Pretty and colourful gardens, and green leafy trees can be calming and tranquil.

o Primary colours are positive and easier to see so are great for feature walls and splashes of vivid colour.

o Colours that promote warmth are orange, red, yellow – they are considered happy colours to use in areas of increased activity.

o Colours that are calming/restful/cooling/may lower blood pressure are supposedly green and blue. These colours are great for bedrooms or areas that are designed for relaxing.

o Colours that are difficult to see, and dull our emotion are grey and brown, so are not suggested. o Red can increase brain wave activity.

o If a room is hot and needs to feel cooler, violet is an effective colour to use.

o Cooler colours may also make a room seem larger.

o Colour can be used for orientation, but people need to be able to distinguish one colour from another.

o Patterns may become very confusing. E.g. Using a patterned placemat or cloth on a table, for any person with a sight deficiency, or visual-spacial/cognitive changes, means they may not see or distinguish the meal once it has been placed on the mat. This can be due to the colourful mat and the plate of food merging as one, and the visual becoming so ‘busy’, that one fades into the other. This can also affect intake negatively.

o Colour changes at doorways may be effective, or for specific rooms to cue entrances.

o Subtle colours in rooms and hallways are preferred.

o Staff work spaces should be understated and blended colours, so other people do not feel drawn to those areas.

o Toilet seats need to contrast with the toilet bowl, and the floor given a person will not be able to negotiate where the seat is, nor see it, if it blends into the floor colour. Imagine, white on white on white, when you may have trouble with sight. Potentially this is also very dangerous as well as under stimulating. The same principle should be taken with couches and chairs. No more beige!

o It should be considered that care staff may be permitted to wear bright and happy colours to work and not foster feelings of institutionalisation by wearing formal uniform. This may provide a ‘personal’ touch and make a facility feel more like a home.

Many people enjoy touching clothes and fabric throughout the day, and love the feel of differing textures, which can initiate conversation and smiles!

o Use of colourful paints for art, dough for moulding, wools for knitting, cards for games, pencils for writing or drawing and any material for activity of choice.

o Food should be beautifully presented to encourage eating, but also remembering that ‘presentation’ is everything. Some people who have swallowing deficits may have vitamised diets, (which are as boring as they look), so kitchen staff can be inventive and purchase food moulds. All vitamised food can be placed into these moulds, and voila, the vitamised meat looks like sliced meat, the broccoli like a piece of broccoli, the potato like a piece of potato etc. Intake improves significantly with this simple tactic.

o Smile and use positive body language! Most people will mirror your body language and expression straight back at you – what we put out we get back in return! Laughter is truly the best medicine – if that doesn’t work, increase the dose!

o Dress people in their favourite or coloured clothes if they prefer this, as it makes them feel special and joyful. A splash of lipstick never goes astray.

Taste

o Provide food that a person prefers, and they have expressed liking.

o It is not acceptable to give people food they have said they dislike or is not culturally appropriate. Know allergies to any foods.

o Cooking activity is always fun, as is the tasting that is associated with it, and licking of the spoons and bowls.

o Foods that provide comfort to a person should be well documented and provided. This may include roasts, casseroles, pastas, hot food, soups.

o Desserts/sweets are always nice treats and many older people love a bit of sweetness.

o Different tasty textured food can be delectable When cutlery is difficult to use, then finger food is fabulous and fun to eat if it tastes great.

o Avoid bland food that is tasteless because this creates boredom with intake.

o Mix medications with sweet and tasty mixers.

o Bowls of fruit that are easy for a person to grab are a wonderful way to stimulate taste– e.g. Grapes, mandarin segments, strawberries, cut up apple, watermelon cubes. They are easy to manage, delicious, and have high water content, so keep people well hydrated.

o Ice poles, milkshakes, smoothies, fruit punches, are all a winner for the same reason.

o Picnics are happy times to combine food and the outdoors and reminisce.

o Hot chocolate and milk to settle, favourite breakfast foods to wake up with, and preferred meal times allow you to know the preferences of a person.

Touch

o Tactile wall hangings, furry doors, pockets with items that stimulate memories are fantastic.

o Men’s sheds for tinkering, knitting groups for the ladies, cooking, folding, painting, fixing things, and anything the person has used their hands for and enjoyed throughout their life.

o Different textures on furniture, bedding, clothes etc.

o If a person enjoys affection then holding hands, patting backs, cuddles, and hugs are extremely uplifting – physical contact with others is something we all need sometimes. Swap a red heart shaped balloon for a hug! It never fails.

o Water features that a person can dip their hand into and splash around in the water, or at each other on a hot day.

o Gardening in raised flower boxes so a person can play in the dirt, or cultivate a herb garden.

o Activities that involve touch – finger painting, clay work, Paper Mache, cooking etc.

o Animals are excellent therapy, because touching and stroking an animal links into the nurturing aspect of many people’s personality, as well as the need for attachment; plus, pets feel soft, sweet and snuggly.

o Therapeutic massage is relaxing and calming, and may aid in pain management.

Smell

o Aromatherapy. e.g. Lavender is calming, sandalwood is stimulating etc.

o Food smells wafting into public areas can create atmosphere and ambiance, comfort, and stimulate memories, such as the smell of freshly baking bread, cakes, or cinnamon.

o Ensure faecal and urine smells are kept to a minimum – assisting people on time with toileting can avoid issues of this nature.

o Odourises in all rooms and public areas on timers can ensure continued sweet odours.

o Avoid using chemicals for cleaning that are offensive and overwhelming.

o Use attractive smelling perfumes, toiletries and deodorants – this can be helpful during maintenance of hygiene as it involves a person’s preference and can be used to engage with them if you are using familiar items they prefer.

o Ensure clothes are clean, and sheets are always smelling fresh and inviting.

o Flowers and pot pourri in public areas and in gardens promotes sweetness.

o Go and hang out at the beach and smell the sea, go to the market and smell hot doughnuts, go to a park and eat delicious smelling fish n chips.

(Part 7 to follow)

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