Internal environment
Over the last years, studies on quality of life for people with dementia have given a lot of attention on non pharmacological approaches. Even if pharmacological therapies are recognized as fundamental in order to slow down the effects of the desease, when possible, sensory and environemental stimulations are considered to be particularly positive for people with dementia.
It is for this reason that specialized units for dementia are often (or should be) organized in ways that enhance autonomy of movement and create an evironment rich of opportunities, though not chaotic. The activities proposed are often oriented towards everyday life routine, such as preparing morning coffee, setting the table, cooking, washing clothes, listening to music, etc. and person with dementia should be involved in these activities on the base of their own aptitudes, capacities and life history.
During the day the person with dementia should have the possibility of being involved in routine activities that are usually familiar because they take place in domestic-like environment. In addition to the actions promoted by the staff, the elderly should find themselves living in a context that gives them opportunities for stimulation through the environment. In fact, dedicated corners should be available such as a corner where the elderly can find a basket with a set of clothes to fold, a table with a vase and flowers that can be manipulated, a corner where one can stop and listen to the music, some panels with objects of various types that can be manipulated as well as hats, scarves or bags that people can take and carry with them.
In the corridor it might be possible to find clothes horses with freshly-laundered clothes or an ironing board to iron dry clothes. All these elements enrich the context and can affect the quality of life of the resident under several aspects. First, they make the living environment much more like a home than an aseptic place, so that spatial orientation is facilitated and this makes the person calmer and peaceful. Having the possibility to eat meals in a place that it is very similar to one’s own home kitchen is certainly more confortable than a restaurant-like environment. Moreover, when the kitchen is full of cooked food aromas, temporal orientation is facilitated along with spatial orientation: the smell of food indicated that it is time to eat, thus helping the person to recover a sense of the time.
Availability of objects with which the person can spontaneously interact can also interrupt the boredom that often leads people with dementia to be passive or restless.
Images on the wall like paintings or posters can also make the space confortable and, at the same time, stimulating. They can represent moments of past life, dear places or can be photos of the residents themselves or of their family members.
Beyond making the place more lively, plants and flowers can represent a kind of sensory and occupational stimulation. The Eden Alternative philosophy suggests that taking care of a plant can help defeat the boredom and the feeling of uselessness that people living in a nursing homes often suffer. The same meaning is attributed to domestic animals, which, thanks to the positive sensations of caring for them and the unconditional affection they give, seem to constitute real therapies against depressive symptoms.