Spatial disorientation is a prime reason for institutionalization. The autonomy of the residents and their quality of life, however, is strongly linked with their ability to reach certain places within their nursing home. The physical environment has a great potential for supporting a resident’s wayfinding abilities. For this study, data were collected from 30 German nursing homes. Skilled nurses rated the resident’s ability to perform 5 wayfinding tasks. The architectural characteristics of the homes were analyzed and their impact on the resulting scores was tested for statistical significance using the Mann-Whitney U test (P < .05). Results confirm that people with advancing dementia are increasingly dependent on a compensating environment. The significant factors include a small number of residents per living area, the straight layout of the circulation system without any changes in direction, and the provision of only 1 living/dining room. These and additional results were transformed into architectural guidelines.
Jakob A., Busse A., Riedel-Heller SG, Pavlicek M., Angermeyer MCPrävalenz und Inzidenz von Demenzerkrankungen in Alten- und Altenpflegeheimen im Vergleich mit Privathaushalten. Z Gerontol Geriat. 2002;35(5): 474-481.
2.
Lawton MP, Nahemow L.Ecology and the aging process. In: Eisdorder C, Lawton MP, eds. Psychology of Adult Development and Aging. Washington, DC: American Psychological Association;1973.
3.
Lawton MP, Simon B.The ecology of social relationships in housing for the elderly. Gerontologist. 1968;8(2): 108-115.
4.
Day K., Carreon D., Stump C.The therapeutic design of environments for people with dementia: a review of the empirical research. Gerontologist. 2000;40(4): 397-416.
5.
Bundesministerium für Gesundheit und Soziale Sicherung. Planungshilfe.Verbesserung der Wohnatmosphäre im Heim unter besonderer Berücksichtigung der Bedürfnisse von Menschen mit Demenz. Reihe BMGS Modellprojekte, Band 11. Köln: Kuratorium Deutsche Altershilfe; 2004.
6.
Brawley E.: Designing for Alzheimer’s Disease-Strategies for creating better care environments. New York: Wiley; 1997.
Heeg S., Goerlich C.Qualitätskriterien und Erfolgsbedingungen der Betreuung und Versorgung dementiell Erkrankter: Aktueller Stand von Forschung und Erfahrungswissen . In: Sozialministerium BadenWürttemberg , ed. Weiterentwicklung der Versorgungskonzepte für Demenzerkrankte in (teil-) stationären Altenhilfeeinrichtungen. Stuttgart, Germany; 2000.
9.
Bundesministerium für Familie, Senioren, Frauen und Jugend: Selbstdarstellung des Projekts Milieutherapie.Einführung milieutherapeutisch orientierter Demenzwohngruppen im stationären Bereich mit begleitender Evaluation MIDEMAS. Berlin, Germany: BMFSFJ; 2004.
10.
Sloane PD, Mitchell CM, Preisser JS, Phillips C., Commander C., Burker E.Environmental correlates of resident agitation in Alzheimer’s disease special care units. J Am Geriatr Soc. 1998 ;46(7):862-869.
11.
Zeisel J., Silverstein N., Hyde J., Levkoff S., Lawton MP, Holmes W.Environmental correlates to behavioral health outcomes in Alzheimer’s special care units. Gerontologist. 2003;43(5):697-711.
12.
Elmstahl S. , Annerstedt L., Ahlund O.How should a group living unit for demented elderly be designed to decrease psychiatric symptoms? Alzheimer Dis Assoc Disord. 1997;11(1):47-52.
13.
Netten A.The effect of design of residential homes in creating dependency among confused elderly residents. A study of elderly demented residents and their ability to find their way around homes for the elderly. Int J- Geriatric Psychiatry. 1989;4(3):143-153.
14.
Passini R., Pigot H., Rainville C., Tetreault MHWayfinding in a nursing home for advanced dementia of the Alzheimer’s type. Environ Behav. 2000;32(5): 684-710.
15.
Kurz A.Klinik. In: Beyreuther K, Einhäup KM, Förstl H, Kurz A, eds. Demenzen. Grundlagen und Klinik. Suttgart, Germany: Thieme Verlag; 2002:187-210.
16.
Reisberg B. , Ferris S., de Leon M., Crook T.The Global Deterioration Scale for assessment of primary degenerative dementia. Am J Psychiatry. 1982;139(9): 1136-1139.
17.
Liu L., Gauthier L., Gauthier S.Spatial disorientation in persons with early senile dementia of the Alzheimer type. Am J Occup Ther. 1991;45(1):67-74.
18.
Kitchin RMCognitive maps: what are they and why study them? J Environ Psychol. 1994;14(1):1-19.
19.
Fletcher P., Frith C., Baker S., Shallice T., Frakowiak R., Dolan R.The mind’s eye-precuneus activation in memory-related imagery. Neuroimage. 1995;2(3): 195-200.
20.
Wahl H-W., Oswald F.Projekt. Bedürfnisstrukturen älterer Menschen. 1. Forschungsbericht aus dem DZFA Heidelberg. Heidelberg, Germany: Deutsches Zentrum für Altersforschung; 1997.
21.
Zeisel J.Universal design to support the brain and its development. In: Preiser W, Ostroff E, eds. Universal Design Handbook. New York, NY: McGraw-Hill;2001.
22.
Marquardt G, Schmieg P, ed. Kriterienkatalog Demenzfreundliche Architektur. Möglichkeiten zur Unterstützung der räumlichen Orientierung in stationären Altenpflegeeinrichtungen. Berlin, Germany: Logos Verlag; 2007.
