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Long-term care for people with dementia: environmental design guidelines

  • Richard Fleming (a1) and Nitin Purandare (a2)

Background: A large and growing number of people with dementia are being cared for in long-term care. The empirical literature on the design of environments for people with dementia contains findings that can be helpful in the design of these environments. A schema developed by Marshall in 2001 provides a means of reviewing the literature against a set of recommendations. The aims of this paper are to assess the strength of the evidence for these recommendations and to identify those recommendations that could be used as the basis for guidelines to assist in the design of long term care facilities for people with dementia.

Methods: The literature was searched for articles published after 1980, evaluating an intervention utilizing the physical environment, focused on the care of people with dementia and incorporating a control group, pre-test-post-test, cross sectional or survey design. A total of 156 articles were identified as relevant and subjected to an evaluation of their methodological strength. Of these, 57 articles were identified as being sufficiently strong to be reviewed.

Results: Designers may confidently use unobtrusive safety measures; vary ambience, size and shape of spaces; provide single rooms; maximize visual access; and control levels of stimulation. There is less agreement on the usefulness of signage, homelikeness, provision for engagement in ordinary activities, small size and the provision of outside space.

Conclusions: There is sufficient evidence available to come to a consensus on guiding principles for the design of long term environments for people with dementia.

Corresponding author
Correspondence should be addressed to: Richard Fleming, Director, Dementia Services Development Centre, HammondCare, Judd Avenue, Hammondville, NSW 2170, Australia. Phone: +61 2 8295 0380; Fax: +61 2 9825 1044. Email:
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This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

D. Forbes , D. Morgan , J. Bangma , S. Peacock and J. Adamson (2004). Light therapy for managing sleep, behaviour, and mood disturbances in dementia. Cochrane Databases of Systematic Review, 2, CD003946.

J. Zeisel (2003). Environmental correlates to behavioral health outcomes in Alzheimer's special care units. The Gerontologist, 43, 697711.

K. H. Namazi (1989). Psychological well-being of elderly board and care home residents. Gerontologist, 29, 511516.

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International Psychogeriatrics
  • ISSN: 1041-6102
  • EISSN: 1741-203X
  • URL: /core/journals/international-psychogeriatrics
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