Alzheimer’s disease is a top public health priority for the United States. With more than 5 million Americans diagnosed with the disease, cutting-edge medical treatment and innovative research is critical to providing the highest quality of care and moving towards a cure. Research has also shown that environment can significantly contribute to the wellbeing of Alzheimer’s patients, making it essential for memory care organizations to outfit their facilities with appropriate interior design and flooring for patients with the disease.

A 2003 study in Gerentologistin concluded that good design could reduce the anxiety, depression, social withdrawal, hallucinations and agitation experienced by residents living with Alzheimer’s disease. 

Until recently, the long-term care environments available for people living with Alzheimer’s disease and dementia were the same environments that also accommodated patients with a wide range of other medical conditions. While facilities had evolved to offer different levels of assisted care, they were not specializing the design of their interiors to suit the specific living needs of their residents. People with Alzheimer’s disease and dementia inhabited the same style of resident rooms, used the same common areas and toured the same hallways as patients who had suffered strokes and those who were afflicted with emphysema, diabetes and other chronic ailments. 

As the importance of design in dementia treatment has become more widely acknowledged, and the number of people living with Alzheimer’s disease grows, a movement for designing long-term senior living spaces specifically tailored to the needs of residents living with Alzheimer’s and dementia is gaining momentum.  The name for this dementia-centric design is memory care. A memory care facility is specifically designed and staffed to support people suffering from Alzheimer’s disease and other forms of dementia. 

Demand for these facilities is on the rise. Memory care is the fastest growing segment of the senior care market, growing 23 percent since 2006. In fact, the growth rate of memory care facilities is two times higher than the growth rates for other types of senior housing.

Memory care facilities provide an environment that meets the unique needs of residents living with Alzheimer’s disease and dementia. The overall goal of these facilities is to improve the quality of life for people with these conditions. The design of the facility can make a material difference in quality of life by reducing the anxiety, depression, social withdrawal, hallucinations and agitation that these patients experience.

Recent figures show that there is a sharp increase in Alzheimer’s disease in correlation with ageing populations. According to Alzheimer’s Disease International (ADI), more than 35.5 million people worldwide are affected by problems linked with Alzheimer’s disease. In 70 percent of cases it’s an Alzheimer’s type condition. This figure could nearly double to 65.7 million by 2030 according to the ADI report and even rise to 115.4 million by 2050.

Creating adapted environments

Alzheimer’s units must provide an environment adapted to the needs of the patient and care staff, as well as offering visitor comfort. These units must therefore be designed taking into account everyone’s requirements and specific usage. The parameters should include: designs, colours, acoustics, lighting – with rules defined according to the function of specific areas such as bedrooms, corridors, communal areas and treatment areas.

The unexpected role of colors, patterns and lights
 
The role of colors
Color appears to perform an important function in how Alzheimer’s patients perceive their environment. Studies show that certain colors can cause behavioral problems. On the other hand, some colors seem to encourage a sense of wellbeing and help to create a setting that patients find reassuring. Color can also be decisive in ensuring that an environment remains familiar to a patient, even as their condition evolves.
 
The role of patterns
Patterns on walls and floors are important in helping to create a comfortable and familiar environment in an Alzheimer’s unit. However, some patterns can cause confusion in patients, while others create a sense of well-being by reminding them of daily life.
 
Some sources suggest that it is preferable to avoid patterns that could disturb the patients, such as:
● Large stripes
● Repetitive geometric patterns including circles, checks, lozenges, cross-hatching
● Flakes of strongly contrasting colours
● Typographical motifs
● Imitations of natural materials such as grass, pebbles, leaves and straw, because these could be confused by a patient as real materials in an exterior environment.
 
The role of lights
Studies of Alzheimer’s disease show that management has an important role to play in managing the living experience of patients. Its function varies according to the time of day and should be adapted to suit the spaces where patients find themselves during waking hours but also according to the rhythm of their daily habits.
Very white or very dark flooring should be avoided because the reflected light can disturb or dazzle patients with Alzheimer’s according to the stage of their condition.
 
We recommend:
● Using the building’s orientation (north, south) to make the most of natural lateral and bright light
● Using flooring in patient rooms to reflect light without dazzling
● Leaving on lights in ambulation areas at night
● Lowering lighting at the end of corridors to deter patients from wandering
 

How flooring contribute to residents, families and staff wellbeing

Flooring can be a decisive factor in spaces designed for people with Alzheimer’s. It has real technical added value and helps to provide Alzheimer’s patients with a suitable environment in terms of acoustics, hygiene and safety. The flooring also offers added value at a psychological and sensory level. In particular, colours and patterns can reassure patients and give them confidence, and also help to relieve the upset of a new environment by making them feel at home.
 
Facilitates walking
Patients with Alzheimer’s experience disorientation, particularly in the later stages of the disease. Because of this, it is essential to create a sense of familiarity and comfort that will make it easier for them to move between the different living spaces. The flooring has an important role to play in providing patients with spatial markers.
Color contrasted slip-resistant floorings can be chosen according to the type of room or movement, but also the specific needs of the patient and care staff.
We recommend the use of slightly contrasting colors in patient rooms, and medium contrasts for communal areas. Pastel colors with little or no pattern should be used to avoid the risk of hallucinations. Flooring in a single color is the best way to indicate ambulation areas. A slip-resistant surface is also recommended to reduce the risk of falls, because Alzheimer’s patients often suffer from motor problems. Glittering effect finishes should be avoided as they can give the impression of walking on water.
 
Provides acoustic comfort
Acoustic quality is an important element that should be carefully considered in designing an environment for patients with Alzheimer’s. Noise can cause problems particularly in the advanced stages of the disease. An environment where sound levels are comfortable and reassuring can favour the well-being not only of patients but also care staff.
Background noises should be reduced as much as possible. They can be a source of anxiety and, according to some studies, lead to behavioural problems in patients with Alzheimer’s. Sharp and medium frequency noises can also disturb patients and should be avoided.
We recommend the use of sound absorbing partitions and flooring to reduce the noise of falling objects and footsteps in particular.
 
Promotes intimacy and memory
Alzheimer’s disease is characterised by numerous memory problems. Flooring can be used to help stimulate memories and recreate a setting that patients find more familiar.
Flooring has a role to play in re-creating an intimate space in which Alzheimer’s sufferers can feel comfortable and safe. This can be done by using designs that provide patients with familiar references.
In practice, designs such as wood, traditional hexagonal tiles or square tiles can be a reminder of home and evoke childhood memories. This can create familiar surroundings that will help to reassure patients.
 
Secures danger zones
Risk areas include doors to the exterior (risk of exiting or wandering), balconies, offices, kitchens and utilities. Protecting patients is a priority in these areas and effective and suitable lighting can help to ensure safety. In addition, the more comfortable patients feel in living areas, the less temptation there will be to wander into risk areas.


Risk areas should:
● Be kept dark or with lower lighting to discourage patients from entering unauthorised or dangerous areas
● Be equipped with dimmer switches so that lighting levels can be reduced around the perimeters
 
For the bathroom area we recommend:
● Specially designed lighting that will faithfully reproduce colors
● Bright lighting, particularly around the hand basin, to help patients to orient themselves
 
Aids on hygiene
Urinary and faecal incontinence are a symptom of Alzheimer’s disease, so it is essential to choose flooring that is practical and easy to maintain, particularly in patient rooms and bathrooms.
Certain colours should be avoided, including grey, brown, black and yellow. Light colours such as sky blue or neutrals (like beige) that give an impression of cleanliness are recommended.
 
Follow the circadian rhythm
Insomnia is one of the most frequent psycho-behavioral problems to affect Alzheimer’s patients. More characteristic, still, is the inversion of the wake/sleep pattern called the circadian rhythm.
The choice of a suitable flooring can play a part in helping to re-establish the wake/ sleep pattern. Improving the use of light, which studies show affect the secretion of melatonin and cortisol hormones, is important in regulating the wake/sleep balance. Preference should therefore be given to light, clear flooring colors that offer better light reflective properties.