Dementia Environment Audit
This tool should be used to highlight ways in which environment changes can be made to make life better for a person with dementia. The aim of the tool is to look at:
- How an individual’s difficulties impact on the way the person navigates the environment
- How the environment supports or hinders a person’s sense of self
- How the environment poses potential risks to the person’s wellbeing
- How small changes can be made to different rooms to improve independence
- How assistive technologies could be used
Changes to the physical environment have the potential to make big differences. For example, in prompting the person to eat more, find their way to the toilet, to reduce the risk of falls and improve ability to maintain personal hygiene. One in four people who are admitted to hospital in the UK have dementia, and many physical problems are associated with poor nutrition and infections (resulting from poor hygiene). When a person is admitted to hospital it may highlight concerns around how a person is managing in their home environment, and for some this may mean a transition to residential care. Therefore, by making small changes to the environment you may make the difference as to whether a person remains at home. It is however important to be mindful about the scale of the changes you make, as familiarity is important. For example, if you need to change a chair because it is the same colour as the walls and the floor and the person cannot see it (because of problems with colour contrast), you should try to replace this with a similar style (but a different colour) to reduce confusion. Some changes, such as changing the flooring, may cost a lot of money to make, and so may not be possible in the short term, but highlighting these as areas of concern will still inform the support plan, and so enable people to forward plan. Many changes, however, can be made more simply and cost-effectively.
Within this document there have been some recommendations made about possible assistive technologies. However, assistive technologies should be used with extreme care. For example, balanced decisions need to be made as to whether technologies are used to replace human contact/support and if these technologies impact or infringe on the persons rights, choices and wishes. Perhaps some of the most controversial uses of technologies is the use of surveillance style monitoring or electronic tagging used for ‘safer walking’. For a more comprehensive look at assistive technologies, use the following link http://www.atdementia.org.uk/
There are over one hundred different types of dementia and even within a particular form of dementia such as Alzheimer’s, a person’s symptoms may vary considerably. Therefore, whilst we have attempted to consider the range of difficulties and possible solutions a person might experience functioning in their environment, it is not possible to know every eventuality. Therefore, the tool should be used as a guide, and observation and reporting should be used alongside to determine how best the environment can be manipulated to improve wellbeing. It is also important to work with occupational therapists for independence and mobility aids.
Why do we need this tool?
A person with dementia may face several sensory challenges which affect the way in which they are able to find their way round their environment. We use both our sensory skills and our cognitive skills (thinking skills) to navigate our environment. If a person has experienced damage to their cognitive skills because of dementia then they will rely more on their sensory skills to interpret their environment. Therefore, we need to make sure that we make things more obvious. As many people with dementia are older they might also have problems with sight or hearing. Sight naturally deteriorates with old age; we lose our ability to focus at close range from midlife, and it slowly worsens over a period. We also have difficulty, as we get older, seeing things at a distance, and are more likely to develop age-related eye diseases as we get older, such as cataracts, glaucoma or age-related macular degeneration. The aging eye also has more difficulty discriminating blue colours. If a person has had a cerebral vascular accident (CVA) they might have a visual field loss which would impact on the way they navigate the environment in very specific ways. Some of the cognitive challenges (thinking) a person might experience because of their dementia are things like using memory to find their way around, recognising certain objects or being able to see the items that are placed against the same or similar objects (colour contrast).
Instructions on how to use the tool
There is a list of questions that follows. This is divided into the following parts
- Questions about the person’s difficulties
- Questions about the person’s strengths
- Room Audits
1. Understanding someone's strengths and difficulties will help to identify how care and support should be provided. If too much support is provided the person can quickly lose skills, if too little is provided it could lead to harm. This information can also be used to get to know the person, as developing relationships is an important part of support.
2. In the section all about the person difficulties just answer YES or NO for the first part, after which it will ask what the difficulties are from the person's perspective. This is because people are all different and have different ideas about what is most challenging. Make sure that you include that in the assessment. If you have clicked YES the report will identify measures that you could take in the environment to support these difficulties. The suggestions might include changing and/or replacing things, or might make suggestions for an assistive technology solution. Any changes must always be with the person's consent. The audit should be supported by an observation of the ‘difficulty’ to be sure that the change is necessary, as sometimes changes can make things worse.
3. After you have completed the sections on the strengths and difficulties move to the room audits. These work better if you are directly observing the room, rather than observing from memory.
4. When you have completed your audit don't forget to save it! You can update this again when the person changes.
5. Once the audit is completed you can print this and leave it in the home for people who are involved in the care and support to read it. Alternatively, you can download it and email it to yourself so that you can look at it later, or use some of the links to suggested suppliers. (Please note that Home Spirit does not endorse any of the suppliers but are given in good will as a suggested resource)
You should review this and ensure that your care staff team observe and report on the changes highlighted in the report.