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Overall challenges and the role and impact of the built environment

This article examines how our built environment impacts people living with dementia

Since most of us spend a vast majority of our time in buildings or out and about in our towns and cities, it is inevitable that our immediate physical environment will impact and influence us in profound ways on daily basis.

Through the layout and circulation of buildings, the number of floors we have in our houses, the amount of light or fresh air within internal spaces, and at a larger scale the layout and quality of our streets, neighbourhoods, towns and cities; the built environment impacts our health, wellbeing, independence, and ability to carry out activities in myriad ways.

For a person living with dementia or an older person experiencing the common symptoms of dementia and age-related issues as outlined in the previous article, the impact of the built environment can be even greater.

A Cognitive impairment may result in a person not recognising familiar objects or places, or cause disorientation or navigation difficulties in certain environments. Cognitive impairment may be accompanied by visual and auditory hallucinations and altered perception of environments and therefore result in stress and reactive behaviours such as incessant walking or agitation. This can be exacerbated in busy environments with multiple sensory stimuli or lots of activity. Meanwhile, dysfunction in activities of daily living (ADL) can affect a person’s ability to operate within their environment or cause difficulties using objects or features, or facilities within a setting.

Gait disorders can impair mobility and stability and therefore cause difficulties for a person when walking on corridors or footpaths or when using stairs or steps. Muscular strength loss can again cause problems on stairs or steps, while also reducing a person’s ability to arise from their bed or a chair, open doors or windows, lift objects, or operate mechanisms within a building. Visual and perception issues will cause obvious challenges when navigating in buildings and public spaces, but there are also implications for natural and artificial lighting in a setting so that spaces and objects are visible and legible. In addition, the use of certain colours, tonal contrasts, or patterns on internal finishes will affect how well a person sees and perceives spaces and objects within their environment.

Age-related changes such as frailty, mobility difficulties, or sight loss will deeply influence how a person interacts with the built environment and these have been discussed above. Hearing loss is a common age-related impairment that impacts on a person’s relationship with their physical setting. Sounds are used in many situations to aid navigation, alert people to hazards, or provide environmental information; a person with hearing loss will require alternative information cues such as visual information. Furthermore, a noisy environment will negatively affect a person with partial hearing loss; on the other hand a well-balanced acoustic environment will help to amplify useful sound while dampening background noise.

Finally, circadian rhythms are influenced by environmental factors such as natural and artificial light. Good natural light in a building will help regulate circadian rhythms, while too much artificial light at night can negatively affect sleep and sleep patterns.

This section has briefly examined the impact of the built environment on the common symptoms of dementia and age-related issues. Of course, there are many other issues, but these examples have been selected to provide a basic understanding of the person-environment interaction, and more importantly to highlight the important role the built environment plays in the functioning, independence, health and wellbeing of people living with dementia and older people in general.

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Dementia Inclusive Hospitals from a Universal Design Approach

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