Therapeutic principles


  • Safety and security
  • Support functional abilities
  • Awareness and orientation
  • Stimulation and challenge
  • Privacy and links to the past
  • Adapt to changing needs

Verifying Safety and security

People with dementia are exposed to adverse accidents by the nature of the cognitive impairment and the physical disabilities associated with Alzheimer’s disease on the top of aging process. Therefore, Safety features are the most vital therapeutic requirement that should be considered in designing and planning for Alzheimer facilities. Such features include:
  • Avoid residents’ falls by installing Grab bars, railing for tub and stairs. Also, equip the facilities with appropriate furniture that reduces falls such as near to the ground and mattresses, and the use of bath chairs instead of regular tubs.
  • Prevent residents from leaving the facility by using mirrors in front of the exit door; illusion strategy using 2D grid on floors as 3D barriers; disguising doors handles to reduce attempts to go out; using blinds on doors and windows to avoid attraction to outside views; another successful strategy is allowing residents to exit to a secure space instead of restricting them.
  • Enhance staff surveillance and supervision in order to maintain residents’ safety, and promote staff interaction with residents at the same time.

Supporting Functional Ability

Design features such as prosthetic devices, handrails, grab bars help maintain control and functional ability in everyday tasks and activities. Such support has significant consequences on patient’s confidence and independence.

Enhancing Awareness and Orientation

Program and design should reduce Patient confusion and disorientation regarding time and place. Daily routine and well designed landmark promote awareness for dementia patients. Wandering problems should be handled in design by helping dementia patients to identify surrounding spaces and track clear paths to desired destination.
Researchers support the use of signage to enhance orientation and way-finding including the use of room numbers and dedicated colors for residents’ rooms and doors, personalized display cases by room entrances to help residents find their rooms, and the use of large scale signage improved orientations

Balancing Sensory Stimulation

Facility design should moderate stimulation exposed to people with dementia without being subject to stress, and compensate for the sensory loss associated with aging and Alzheimer’s disease at the same time.
People with dementia have sensory problems such as hearing loss which may increase agitation and anxiety and reduce confidence and social integration. They also suffer from vision deficits such as depth, contrast, Glare, and color perception problems. Therefore, it is essential to balance sensory levels for residents by eliminating high levels of visual and auditory distractions, and at the same time maintaining certain levels of sensory stimulation in order to promote engagement and interaction.

Design strategies:
  • The use of fabric partitions between residents to prevent distraction helps them concentrate on any task.
  • Reduce glare, lessen confusion associated with depth perception, and increase contrast where appropriate (e.g. high contrast tablecloth, place mats, dishes to enhance clarity).
  • Enhance overall lighting and bright light exposure as it improves resident’s behaviors and regulates sleep patterns.
  • Non-institutional settings and the provision of private therapeutic spaces could help lessen patient anxiety. Non-institutional character represents home-like environment such as personalized rooms, domestic furnishings, and natural elements. These features are associated with enhanced performance of people with dementia intellectually, emotionally, and socially.

Supporting Privacy and Links to the past

Facility design and policy should support “personalization” of patient’s environments such as, bringing personal belongings and photo frames, which promote independence, privacy and control for dementia people.Ties to healthy and familiar environments can mitigate confusion and anxiety for people with dementia. Link to their past lives could also provide the “soft transition” from home to institutional setting.

Adapting to changing needs

Facilities should have the capacity to adapt to the different stages of Alzheimer’s disease and determine the level of care they are able to provide for people with dementia.

Cohen, U., & Weisman, G. D., Steiner, V. L., Ray, K., Rand, J., & Toyne, R. M. (1988). Environment for people with dementia: Design guide. Milwaukee, WI: The Health Facilities Research Program.
Cohen, U., & Day, K. (1993). Contemporary environments for people with dementia. Baltimore: The Johns Hopkins University Press.
Day, K., Carreon, D., & Stump, C. (2000). The therapeutic design of environments for people with dementia: A review of the empirical research. The Gerontologist, 40(4), 397-416

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