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‘All the corridors are the same’: a qualitative study of the orientation experiences and design preferences of UK older adults living in a communal retirement development

Published online by Cambridge University Press:  28 March 2017

Department of Psychology, Bournemouth University, Poole, UK.
Faculty of Social Science, Stirling University, UK. Salford Institute for Dementia, School of Nursing, Midwifery, Social Work and Social Sciences, University of Salford, UK.
Department of Psychology, Bournemouth University, Poole, UK.
Department of Psychology, Bournemouth University, Poole, UK.
Address for correspondence: Mary O'Malley, Department of Psychology, Talbot Campus, Bournemouth University, Fern Barrow, Poole, Dorset BH12 5BB, UK E-mail:


Environments need to be designed such that they support successful orientation for older adults and those with dementia who often experience marked difficulties in their orientation abilities. To better understand how environments can compensate for decreasing orientation skills, voice should be given directly to those experiencing dementia to describe how they find their way and to understand their design preferences. This study explored the navigational experiences and design preferences of older adults with memory difficulties living in a retirement development. In-depth semi-structured interviews with 13 older adults experiencing memory difficulties were conducted. All participants were residents of one retirement development in the United Kingdom. Questions began broadly, for example, to describe their experiences of navigating in their living environment, before discussing any specific navigation difficulties in detail. Thematic analysis identified three main themes: highlighting environmental design that causes disorientation, strategies to overcome disorientation, and residents’ suggestions to improve the design. The design suggestions were particularly informative, heavily focusing on the importance of having memorable and meaningful spaces which were favoured more than signage as an orientation aid. The findings demonstrate the need to consider environmental design to support orientation for those with memory difficulties. Of particular importance is the use of meaningful and relevant landmarks as orientation aids which can additionally stimulate conversation and increase wellbeing. Given the range of suggestions in dementia-friendly design guidelines aimed to support orientation, it is crucial to speak directly to those living in different environments to learn how they find their way around and what design works in their environment.

Copyright © Cambridge University Press 2017 

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Alzheimer's Society 2016. Statistics. Available online at [Accessed 20 January 2016].Google Scholar
Bellassen, V., Iglo, K., Cruz de Souza, L., Dubois, B. and Rondi-Reig, L. 2012. Temporal order memory assessed during spatiotemporal navigation as a behavioral cognitive marker for differential Alzheimer's disease diagnosis. Journal of Neuroscience, 6, 32, 1942–52.Google Scholar
Bird, C. M., Chan, D., Hartley, T., Pijnenburg, Y. A., Rossor, M. N. and Burgess, N. 2010. Topographical short-term memory differentiates Alzheimer's disease from frontotemporal lobar degeneration. Hippocampus, 20, 10, 1154–69.Google Scholar
Bozeat, S., Lambon Ralph, M. A., Graham, K. S., Patterson, K., Wilkin, H., Rowland, J., Rogers, T. A. and Hodges, J. R. 2003. A duck with four legs: investigating the structure of conceptual knowledge using picture drawing in semantic dementia. Cognitive Neuropsychology, 20, 1, 2747.Google Scholar
Braun, V. and Clarke, V. 2006. Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 2, 77101.Google Scholar
Caspi, E. 2014. Wayfinding difficulties among elders with dementia in an Assisted Living Residence. Dementia: The International Journal of Social Research and Practice, 13, 4, 429–50.Google Scholar
Cherrier, M. M., Mendez, M. and Perryman, K. 2001. Route learning performance in Alzheimer disease patients. Neuropsychology, Neuropsychiatry, and Behavioral Neurology, 14, 3, 159–68.Google Scholar
Chmielewski, E. and Eastman, P. 2014. Excellence in Design: Optimal Living Space for People with Alzheimer's Disease and Related Dementias. Available online at [Accessed 20 January 2016].Google Scholar
Davis, R. L., Therrien, B. A. and West, B. T. 2009. Working memory, cues, and wayfinding in older women. Journal of Applied Gerontology, 28, 6, 743–67.Google Scholar
Day, K., Carreon, D. and Stump, C. 2000. The therapeutic design of environments for people with dementia: a review of the empirical research. Gerontologist, 40, 4, 397416.Google Scholar
Department for Constitutional Affairs 2005. The Mental Capacity Act 2005. Available online at [Accessed 10 February 2016].Google Scholar
Department of Health 2015. Dementia-friendly Health and Social Care Environments. Available online at [Accessed 10 September 2016].Google Scholar
Dewing, J. 2002. From ritual to relationship: a person-centred approach to consent in qualitative research with older people who have dementia. Dementia, 1, 2, 157–71.Google Scholar
Dewing, J. 2008. Personhood and dementia: revisiting Tom Kitwood's ideas. International Journal of Older People Nursing, 3, 1, 313.Google Scholar
Elmstahl, S., Annerstedt, L. and Ahlund, O. 1997. How should a group living unit for demented elderly be designed to decrease psychiatric symptoms? Alzheimer Disease and Associated Disorders, 11, 1, 4752.Google Scholar
Evans, S. 2009. Community and Ageing: Maintaining Quality of Life in Housing with Care Settings. Policy Press, Bristol, UK.Google Scholar
Fleming, R. 2011. An environmental audit tool suitable for use in homelike facilities for people with dementia. Australasian Journal of Ageing, 30, 3, 108–12.Google Scholar
Fritsch, T., McClendon, M. J., Wallendal, M. S., Hyde, T. F. and Larsen, J. D. 2014. Prevalence and cognitive bases of subjective memory complaints in older adults: evidence from a community sample. Journal of Neurodegenerative Diseases, 9. DOI: Scholar
Garden, S., Cornoldi, C. and Logie, R. H. 2002. Visuo-spatial working memory in navigation. Applied Cognitive Psychology, 16, 1, 3550.Google Scholar
Glaser, B. G. and Strauss, A. L. 1967. The Discovery of Grounded Theory. Aldine, Chicago.Google Scholar
Godwin, G. 2014. Colour consultation with dementia home residents and staff. Quality in Ageing and Older Adults, 15, 2, 102–19.Google Scholar
Guest, G., Bunce, A. and Johnson, L. 2006. How many interviews are enough? An experiment with data saturation and variability. Field Methods, 18, 1, 5982.Google Scholar
Harmer, B. J. and Orrell, M. 2008. What is meaningful activity for people with dementia living in care homes? A comparison of the views of older people with dementia, staff and family carers. Aging and Mental Health, 12, 5, 548–58.Google Scholar
Head, D. and Isom, M. 2010. Age effects on wayfinding and route learning skills. Behavioural Brain Research, 209, 1, 4958.Google Scholar
Helvacıoğlu, E. and Olguntürk, N. 2011. Colour contributions to children's wayfinding in school environments. Optics and Laser Technology, 43, 2, 410–9.Google Scholar
Hölscher, C., Büchner, S. J., Meilinger, T. and Strube, G. 2009. Adaptivity of wayfinding strategies in a multi-building ensemble: the effects of spatial structure, task requirements, and metric information. Journal of Environmental Psychology, 29, 2, 208–19.Google Scholar
Innes, A., Kelly, F. and Dincarslan, O. 2011. Care home design for people with dementia: what do people with dementia and their family carers value? Aging and Mental Health, 15, 5, 548–56.Google Scholar
Jonas-Simpson, C. M. 2003. The experience of being listened to: a human becoming study with music. Nursing Science Quarterly, 16, 3, 232–8.Google Scholar
Kitwood, T. 1995. The New Culture of Dementia Care. Hawker, Bradford, UK.Google Scholar
Klippel, A. and Winter, S. 2005. Structural salience of landmarks for route directions. Spatial Information Theory, 3693, 347–62.Google Scholar
Lewis, A., Torrington, J., Barnes, S., Darton, R., Holder, J., McKee, K., Netten, A. and Orrell, A. 2010. EVOLVE: a tool for evaluating the design of older people's housing. Housing Care and Support, 13, 3, 3641.Google Scholar
Lincoln, Y. S. and Guba, E. G. 1985. Naturalistic Inquiry. Sage, Beverly Hills, California.Google Scholar
Liu, L., Gauthier, L. and Gauthier, S. 1991. Spatial disorientation in persons with early senile dementia of the Alzheimer type. American Journal of Occupational Therapy, 45, 1, 6774.Google Scholar
Lynch, K. 1960. The Image of the City. MIT Press, Cambridge, Massachusetts.Google Scholar
Marquardt, G., Johnston, D., Black, B. S., Morrison, A., Rosenblatt, A., Lyketsos, C. G. and Samus, Q. M. 2011. Association of the spatial layout of the home and ADL abilities among older adults with dementia. American Journal of Alzheimer's Disease and Other Dementias, 26, 1, 51–7.Google Scholar
Marquardt, G. and Schmieg, P. 2009. Dementia-friendly architecture: environments that facilitate wayfinding in nursing homes. American Journal of Alzheimer's Disease and Other Dementias, 24, 4, 333–40.Google Scholar
Marquez, D. X., Hunter, R. H., Griffith, M. H., Bryant, L. L., Janicek, S. J. and Atherly, A. J. 2015. Older adult strategies for community wayfinding. Journal of Applied Gerontology, 36, 2, 121.Google Scholar
Marshall, M. 2001. Environment: how it helps to see dementia as a disability. Care Homes and Dementia: Journal of Dementia Care, 1, 6, 1517.Google Scholar
Meilinger, T., Knauff, M. and Bülthoff, H. 2008. Working memory in wayfinding: a dual task experiment in a virtual city. Cognitive Science, 32, 4, 755–70.Google Scholar
Mitchell, L., Burton, E. and Raman, S. 2004. Neighbourhoods for Life. A Checklist of Recommendations for Designing Dementia-friendly Outdoor Environments. Oxford Institute for Sustainable Development, Oxford and Housing Corporation, London.Google Scholar
Monacelli, A. M., Cushman, L. A., Kavcic, V. and Duffy, C. J. 2003. Spatial disorientation in Alzheimer's disease: the remembrance of things passed. Neurology, 61, 11, 1491–7.Google Scholar
Montejo, P., Montenegro, M., Fernandez, M. A. and Maestu, F. 2011. Subjective memory complaints in the elderly: prevalence and influence of temporal orientation, depression and quality of life in a population-based study in the city of Madrid. Aging and Mental Health, 15, 1, 8596.Google Scholar
Moore, T. F. and Hollett, J. 2003. Giving voice to persons living with dementia: the researcher's opportunities and challenges. Nursing Science Quarterly, 16, 2, 163–7.Google Scholar
Moschis, G. P., Lee, E. and Mathur, A. 2000. The Maturing Marketplace: Buying Habits of Baby Boomers and Their Parents. Quorum Books, Westport, Connecticut.Google Scholar
Nasreddine, Z. S., Phillips, N. A., Bedirian, V., Charbonneau, S., Whitehead, V., Collin, I., Cummings, J. L. and Chertkow, H. 2005. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. Journal of the American Geriatrics Society, 53, 4, 695–9.Google Scholar
O'Keefe, J. and Nadel, L. 1978. The Hippocampus as a Cognitive Map. Oxford University Press, Oxford.Google Scholar
O'Malley, M., Innes, A. and Wiener, J. M. 2015. Decreasing spatial disorientation in care-home settings: how psychology can guide the development of dementia friendly design guidelines. Dementia, 114. DOI: 10.1177/1471301215591334.Google Scholar
Office for National Statistics 2014. Changes in the Older Residential Care Home Population Between 2001 and 2011. Office for National Statistics, London.Google Scholar
Orrell, A., McKee, K., Torrington, J., Barnes, S., Darton, R., Netten, A. and Lewis, A. 2013. The relationship between building design and residents’ quality of life in extra care housing schemes. Health Place, 21, 5264.Google Scholar
Passini, R., Pigot, H., Rainville, C. and Tetreault, M. H. 2000. Wayfinding in a nursing home for advanced dementia of the Alzheimer's type. Environment and Behavior, 32, 5, 684710.Google Scholar
Pengas, G., Patterson, K., Arnold, R. J., Bird, C. M., Burgess, N. and Nestor, P. J. 2010. Lost and Found: bespoke memory testing for Alzheimer's disease and semantic dementia. Journal of Alzheimer's Disease, 21, 4, 1347–65.Google Scholar
Raz, N., Ghisletta, P., Rodrigue, K. M., Kennedy, K. M. and Lindenberger, U. 2010. Trajectories of brain aging in middle-aged and older adults: regional and individual differences. Neuroimage, 51, 2, 501–11.Google Scholar
Sjolinder, M., Hook, K., Nilsson, L. G. and Andersson, G. 2005. Age differences and the acquisition of spatial knowledge in a threedimensional environment: evaluating the use of an overview map as a navigation aid. International Journal of Human Computer Studies, 63, 6, 537–64.Google Scholar
Strickrodt, M., O'Malley, M. and Wiener, J. M. 2015. This place looks familiar – how navigators distinguish places with ambiguous landmark objects when learning novel routes. Frontiers in Psychology, 6. Available online at Scholar
The King's Fund 2013. Is your ward dementia friendly? EHE Environmental Assessment Tool. Available online at [Accessed 10 February 2016].Google Scholar
Utton, D. 2009. The design of housing for people with dementia. Journal of Care Services Management, 3, 4, 380–90.Google Scholar
Van Hoof, J., Kort, H .S. M., Van Waarde, H. and Blom, M. M. 2010. The indoor environment and the integrated design of homes for older people with dementia. American Journal of Alzheimer's Disease and Other Dementias, 45, 5, 1244–61.Google Scholar
Waldorff, F. B., Siersma, V., Vogel, A. and Waldemar, G. 2012. Subjective memory complaints in general practice predicts future dementia: a 4-year follow-up study. International Journal of Geriatric Psychiatry, 27, 11, 1180–8.Google Scholar
Waller, D. and Lippa, Y. 2007. Landmarks as beacons and associative cues: their role in route learning. Memory and Cognition, 35, 5, 910–24.Google Scholar
Wiener, J. M., de Condappa, O., Harris, M. A. and Wolbers, T. 2013. Maladaptive bias for extrahippocampal navigation strategies in aging humans. Journal of Neuroscience, 33, 14, 6012–7.Google Scholar
Wilkniss, S. M., Jones, M. G., Korol, D. L., Gold, P. E. and Manning, C. A. 1997. Age-related differences in an ecologically based study of route learning. Psychology and Aging, 12, 2, 372–5.Google Scholar
World Health Organization 2007. Global Age-friendly Cities: A Guide. World Health Organization, Geneva.Google Scholar
Zavotka, S. L. and Teaford, M. H. 1997. The design of shared social spaces in assisted living residences for older adults. Journal of Interior Design, 23, 2, 216.Google Scholar