Guest Blog by Rita Newton, Care & Repair England sponsored PhD researcher

During the recent COVID-19 pandemic we’ve learnt about the importance of data and information from scientists in helping the government to make decisions on such things as mask wearing, the rules on social distancing, and on timing and extent of lockdowns – to name but a few! This approach of using the best available evidence to inform healthcare decisions is nothing new, and over recent years’ it’s been rapidly expanding beyond healthcare into other fields including housing. This is good news for people living with dementia because all too often the science is about diagnosis and prognosis, rather than looking at ways to make a difference to everyday lives.

One way to make a difference to the lived experience of dementia – for both the person with dementia, and their family and carers is by adapting the home to make it more ‘dementia friendly’. We therefore looked at the international scientific evidence, including from the UK, to see how home adaptations may be able to impact on peoples’ lives.

So what does the scientific evidence tell us?

Common adaptations

Adapting the home to compensate for physical limitations of the person with dementia is common, particularly to help prevent falls. Common adaptations include:

• Re-purposing rooms (such as moving a bedroom downstairs)
• Installing a downstairs toilet that is well lit, and is easy to use
• Removing the bath, and installing a walk-in shower
• Providing additional handrailing to stairs and steps.

This over-emphasis on physical limitations means that it’s not easy to find information on how to adapt the home to help with difficulties of cognition and remembering, although using colour to denote different places within the home, or to make important areas (such as the toilet) stand out can be beneficial.

Who decides?

The scientific evidence also suggests that input from health and social care professionals is useful, but that there is often a difference of opinion between family members and carers and professionals as to what might work, and in what ways. Whilst an advantage of professional input is the opportunity to think outside the box, and to come up with individual solutions to problems in the home, there’s a further challenge because each home environment, and each person with dementia are unique, so it’s not about ‘one size fits all’ – which is so often the case!

Timing

Timing of the housing adaptation is important, yet there is a tension between whether to make the change to the home early in the lived trajectory dementia or whether to make the change only when necessary. The simple answer is that we don’t know when it’s best to make changes – there is no evidence one way or the other, although there is a suggestion that implementing changes early would give the person with dementia more time to adjust and make using the housing adaptation a part of their everyday routines. 

What next?

The sparse evidence base that we have briefly summarised here clearly demonstrates the challenges of adapting the home to improve the lives of people living with dementia when there are so many gaps in the knowledge-base. It is important that more research is undertaken because without evidence and data about outcomes (what works for whom, and in what ways etc), and the cost benefits of them, commissioners of these services may be less likely to pay for them. Similarly, the people and families who are paying for their own adaptations need to know how to make the best use of their own resources rather than just guess what might work for them!

 

Key points to note

• Adaptations are usually focused on help with physical symptoms rather than specifically for dementia
• People living with dementia and their living situations are all unique – what works for one person might not work for someone else
• Family carers and professionals often have different viewpoints – listening to both can bring best outcomes
• Timing of when adaptations are installed is important – but this can differ for different people

 

For more detail about what is known about adaptations for people living with dementia read the review article