21: Environment Issues: The Human Environment

This program will help you:

  • Understand how the quality of life of those with dementia is affected by people around them
  • Improve human interactions
  • Design environments for comfort
  • There are no easy answer when its comes to the care of another
  • Our hope is to offer you useful information and guidelines for caring for someone with dementia
  • These guidelines will need to be adjusted to suit your own individual needs
  • Includes all the people involved in the person’s care
  • Promote love, respect, autonomy, self-esteem, health, and safety
  • Requires knowledge of the disease and the person
  • Provide a sense of control by offering choices
  • Promote autonomy by encouraging self-care
  • Provide assistance only when needed
  • Allow them to perform activities alone if safe and able
  • Show respect
  • Do not treat them as children
  • Avoid topics that trigger unwanted behavior
  • Be sensitive to signs of challenging behaviors
  • Use non-verbal forms of communication
  • Be flexible and patient
  • The human environment at home
  • Immediate family
  • Pets
  • Extended family
  • Involved friends
  • Family members should be involved in important decision-making
  • Families can be invited to participate in various activities with residents such as listening to music, watching movies, talking with residents during tea or snack time, making cookies, or birthday celebrations
  • In care facilities, families and friends need space for activities and visiting
  • Caregiving requires teamwork
  • Different strategies work for different people at different times
  • Requires natural observation and caring skills and ongoing training
  • Important members of the caregiving team in care facilities
  • Need to be screened, trained, and monitored
  • Deserve respect and appreciation

Why is Robert ignoring Sally?

  • A. He does not realize that Sally is speaking to him.
  • B. He is having difficulty understanding what Sally is saying.
  • C. He is depressed and does not want to do anything.
  • D. All of the above.

Choice A: He does not realize that Sally is speaking to him, is a good possibility.

  • Before speaking, gain the person’s full attention and maintain eye contact

Choice B: He is having difficulty understanding what Sally is saying, is also a good possibility.

  • The ability to understand words can fluctuate from moment to moment
  • Gain their attention
  • Use short, simple sentences, and repeat and rephrase things as needed
  • Use gestures and pantomime to help convey meaning
  • Give them time to understand and respond
  • Watch their body language and actions for signs of understanding

Choice C: He is depressed and does not want to do anything, may also be a possibility.

  • Many people with Alzheimer’s disease develop depression
  • If there is concern about depressive symptoms, you should consult a healthcare professional

Choice D: All is the above, is the best answer

  • Comfortable room temperature, lighting, and noise level
  • Create a home-like atmosphere
  • Care facilities should not be based on a medical model of care but rather on habitats that promote human growth
  • Incorporates plants, children, pets, fragrances, and music to create a comforting atmosphere

Click here for more help in placing animals in a care facility

  • Relaxing fragrances
  • Lavender oil
  • Melissa oil (lemon balm)
  • Music therapy
  • Human environment consists of everyone involved in caregiving
  • Promotes love, respect, autonomy, comfort, happiness, health, and safety
  • Good communication skills are critical
  • Plants, pets, fragrances, music, and children can help create a comforting environment

Written by:
Catherine M. Harris, PhD, RNCS.
Mindy J. Kim-Miller, MD, PhD

Edited by:
Sasha Asdourian


20: Environment Issues: Designing Safe Enviroment

Select the best answers from the list of choices following each question.

Click here to open Certificate of Completion
  • Bowlby, C. (1993). Therapeutic activities with persons disabled by Alzheimer’s disease and related disorders. Gaithersburg: Aspen Publishers. pp. 165
  • Brawley, E. C. (1997). Designing for Alzheimer’s disease: Strategies for creating better care. John Wiley& Sons, Inc.: NY
  • Brawley, E. C. (2004). Gardens of memories. Alzheimer’s Care Quarterly. 5(2). 154-164.
  • BS-Engineering, J. N., Kujoth, J., & Torgrude, S. (2002). Using postoccupancy evaluation to guide bathroom design in a dementia-specific, assisted living facility. Alzheimer’s Care Quarterly, 3(1):32-37
  • Calkins, M. P. (1989). Designing dues for wanderers; Special needs in nursing homes. Architecture. 78(10), 117-118.
  • Calkins MP & Namazi KH. (1991). Caregivers perceptions of the effectiveness of home modifications for community living adults with dementia. Journal of Alzheimer’s Care and Related Disorder Research, 6(1):25-29.
  • Cohen, Uriel & Weisman, Gerald D. (1991). Holding on to home: Designing environments for people with dementia. Baltimore. The Johns Hopkins University Press.
  • Couzens, J. (1999). Giving new life through the Eden Alternative. Michigan Health Hospital, 35(2), 13.
  • Delta Society. (2008). Pet Partners® program. Retrieved on March 31, 2009 from https://www.deltasociety.org/Page.aspx?pid=259.
  • Gerdner, L., A. & Swanson, E., A. (1993). Effects of individualized music on confused and agitated elderly patients. Archives of Psychiatric Nursing.7(5), 284-291.
  • Gitlin, L. N. & Corcoran, M. (2000). Making homes safer; Environmental adaptations for people with dementia. Alzheimer’s Care Quarterly, 1(1), 50-58.Grau, L., Teresi, J., & Chandler, B. (1993).

Demoralization among sons, daughters, and other relatives of nursing home residents. Research on Aging,
13, 324-345.

  • Hamilton, N., & Tesh, A. S. (2002). The North Carolina Eden Coalition: facilitating
  • environmental transformation. Journal of Gerontolical Nursing, 28(3), 35-40.
  • Harvath, T. A., Archbold, P. G., Stewart, B., Gadow, S., Kirschling, J. M., Miller, L., Hagan, J., Brody, K., & Schook, J. (1994). Establishing partnerships with family caregivers: Local and cosmopolitan knowledge. Journal of Gerontological Nursing, 20(2), 29-35.
  • Hiatt, L. (1981). Designing therapeutic dinning. Nursing Homes, April/May, 33-39
  • Kayser-Jones (1989). The environment and quality of care in long-term care: Research and practice (NLN Publication No. 202292), New York: National League for Nursing.
  • Kayser-Jones, J. S. (1991). The impact of the environment on the quality of care in nursing homes: A social-psychological perspective. Holistic Nursing in Practice, 5(3), 29-38.
  • Keen, J. (1989). Interiors: Architecture in the lives of people with dementia. International Journal of Geriatric Psychiatry, 4, 255-272.
  • Kitwood, T., & Bredin, K. (1992). Toward a theory of dementia care: Personhood and well-being. Aging and Society, 12, 269-287.
  • Laxton, C. (1985). The John D. French Center for Alzheimer’s disease. Caring. Dec. 22-24
  • Lawton, M. P.(1981). Sensory deprivation and the effect pf the environment on management of the patient with senile dementia. In Miller N, E., Cohen,G. D.(Eds). Clinical Aspects of Alzheimer’s Disease, Aging Series. New York. Raven Press : 15: 227-249
  • Liss, L. Letter to the Editor- benefit of access to outdoors. Ame J Alzheimer Dis Res CARE. 1(4): 5
  • March, S. D. (2002). Creating an environment for community, 3(1):61-66
  • Meyers A. (2004). Richmond VA Medical Center first to achieve Eden Alternative registration. Virginia Nurses Today. 12(2), 16.
  • Morgan, D. G. & Stewart, N. J. (1997). The importance of the social environment in dementia care, Western Journal of Nursing Research, 19(6), 740-761.
  • Nagy, J. W. (2002). Kitchens that help residents reestablish home. Alzhiemer’s Care Quarterly, 3(1) : 74-77
  • National Institute on Aging. (February 5, 2009). Home Safety for People with Alzheimer’s Disease. Retrieved on March 30, 2009 from http://www.nia.nih.gov/Alzheimers/Publications/homesafety.htm.
  • National Institute on Aging. (November 7, 2008). Falls and older adults: preventing falls and fractures – home safety. Retrieved on March 30, 2008 from http://nihseniorhealth.gov/falls/homesafety/02.html.
  • Norberg, A., Melin, E., & Asplund, K. (1986). Reactions to music, touch, and object presentation in the final stage of dementia: An explanatory study.International Journal of Nursing Studies, 23(4), 315-323.
  • Peak, T. (2000). Families and the nursing homes environment: Adaptation in a group context. Journal of Gerontological Social Work, 33(1), 51-66.
  • Perris, S. M., Kinney, J. M., & Osgrocki, P. (1991). Stressors and well-being among caregivers to older adults with dementia: The in-home versus nursing home experienced. The Gerontologist. 31, 217-223.
  • Ragneskog, H., Kihlgren, M., Karlsson, I., Norberg, A., Gerdner, L., & Buckwalter, K. (1996). Dinner music for demented patients: Analysis of video recorded observations. Clinical Nursing Research, 5(3), 262-277.
  • Rantz, M., Popejoy, L. & Zwygart-Stauffacher, M. (2001). The new nursing homes: A 20-Minute way to find great long-term care. Fairview Press:Minneapolis.
  • Roach, M. (1984). Reflections in a fake mirror. Discover, 8, 76-85
  • Ross, M., Rosenthal, C., & Dawson, P. (1998). Spousal caregiving in the institutional setting: Visiting. Journal of Clinical Nursing, 6, 473-484.
  • Ross, M., Creswell, A., & Dalziel, W. (2001). Family caregiving in long-term care facilities. Clinical Nursing Research, 10(4), 347-363.
  • Rowles, G. D. & High, D. M. (1996). Individualizing care: Family roles in nursing home decision-making. Journal of Gerontological Nursing, 22(3), 20-25.Saperstein, A. R., Calkins, M. P., Haitsma, K. V., & Curyto, K. (2004). Missed opportunities; The disconnect between physical design and programming
    and operations. Alzheimer’s Care Quarterly, 5(4), 324-331Stolley, J., M., Koenig, H., & Buckwalter, K. C. (1999). Pastoral care fort the person with dementia. Journal of Health Care Chaplaincy, 8(1/2), 7-23.
  • Ruckdeschel, K., & Van Haitsma, K. (2001) The impacts of live-in animals and plants on nursing home residents: a pilot longitudinal investigation.Alzheimer’s Care Quarterly. 2(4),17-27
  • Snyder, L. (1984). Archetypal place and the needs of the aging. In M. Spival (Ed). Institutional settings: An environmental design approach. New York :Human Science Press
  • Snyder, L., Rupprecht, P., Pyrek, J., Brekhus, S., & Moss, T.,(1978) Wandering. Gerontologist, 18(3), 272-280
  • Tesh, A. S., McNutt, K., Courts, N. F., & Barba, B. E. (2002). Characteristics of nursing homes adopting environmental transformations. Journal of Gerontological Nursing, 28(3), 28-34
  • Thomas, W. (1998). Long-Term Care Design: Cultural expectations & locale creating the edergarden. Journal of Healthcare Design, 10, 63-66.
  • Warner M & Warner E (1996). The caregiver’s guide to home modification. In M L Warner: The complete guide to Alzheimer’s proofing your home.Purdue University Press.
  • Zeisel, J. (2000). Architecture and Design: Environmental design effects on Alzheimer symptoms in long term care residences. World Hospitals and Health Services, 36(3), 27-31.