'As much freedom as possible': Innovations in dementia care

MUNICH, Sabine Dobel (dpa)- Alzheimer's: those affected by the incurable disease may stumble over words and cease to recognize their family. But patients' lives can be improved - with architecture and the design of their surroundings.
First, it's the misplaced key. Then an appointment is forgotten. Later on, finding the way home becomes a struggle. And then one's own children become strangers. With dementia, people sink into forgetfulness. Some will repeatedly run away because even their own home is suddenly a strange place.

Some nursing homes have come up with ways to cope with patients' need to move around. A bus stop will be set up where the residents will wait, although no bus will come. Or, in the gardens, a path is laid that simply goes in a circle, so getting lost is impossible.
After decades of efforts trying out therapy and even hoping for a vaccination to curb the disease, many caregivers, doctors and architects for a few years now have increasingly worked on the design of facilities to help those whose mental faculties are weakening.
"When a person can no longer adapt to the environment, then the environment must adapt to the person," says Birgit Dietz, head of the Bavarian Institute for Geriatric and Dementia-Sensitive Architecture. The architect has just published a book on the subject in time for World Alzheimer's Day on Friday.
Light, colours, scents, sounds and pictographs can help, Dietz says. "It's about how people can develop a kind of personal urban map in their own head - to recognize their own home or room, how to find the toilet." She says that sometimes it is "the totally banal things" that can make a difference. For example, if there is a mirror opposite the door to the toilet, a person with dementia, seeing his own reflection, might think that the toilet is occupied. A simple solution would be to hang the mirror elsewhere.
In the department for psychiatry and psychotherapy at Munich's Technical University Clinic, Janine Diehl-Schmid, who is in charge of dementia outpatient service, and architect Dietz are trying out different things to give people more security and orientation.
One feature are floors. Should they be one solid colour like a light grey, or grey with black cross stripes? Often, patients see the latter as some kind of step which can mean danger of falling down, especially when the illness is progressing. This would make it even more difficult for patients to take part in the life of the facility. "We just know too little. That is the crux of this illness - people can no longer tell us," Diehl-Schmid says. "We can only observe very closely."
Motion detectors and light strips can point the way, while coloured markings can help people to better recognize light switches, wash basins, toilet seats or plates. Labels or pictures on cupboards can make it easier to find things. Electrical appliances that automatically shut off can ward off danger.
"The next question will be, how can digitalization and smartphone-apps help out?" Diehl-Schmid said. "I have more and more outpatients who have trackers attached to them."
It was more than 100 years ago that Alois Alzheimer recognized the brain disease that now bears his name. Doctors were puzzled by the loss of memory of a 51-year-old woman, Auguste Deter. In talking with her, Alzheimer would take his place in the annals of the history of medicine: "What is your name?" he asked. "Auguste" came tha answer. "What is your last name?" - "Auguste." Then the question, "What is your husband's name?" She answered, "I believe Auguste."
After her death, Alzheimer discovered that there had been a massive loss of cells in her brain and unusual protein deposits. These are now regarded as the main cause for Alzheimer by destroying nerve cells, triggering inflammation reactions and thwarting the transmission of signals between the nerve cells.
At issue today is how far may caregivers go in dealing with confused people? May systems be set up to lock doors when they approach? Do fake bus stops violate a resident's dignity? Are dementia villages such as Svendborg in Denmark, De Hogeweyk in The Netherlands and Hameln in Germany the solution?
In many nursing homes facilities are adapted, tried out, re-designed. In the park of the Muenchenstift nursing home in Munich, they have dismantled the fake bus stop. Those who still recognize it come to realize that a bus will never stop there and so become frustrated, said Laura Otto head of the closed area of the home. Also, the frosted glass on the bus stop doors was removed. "Now the residents can see what is happening outside," says Susanne Krempl of the Muenchenstift management. This could create yet more unrest, she admits. "But we want as much freedom as possible."
Now, instead of the bus stop, plans are for a pen for small animals. "Animals, like music, are often the key to reaching demented people," Otto said.
Besides the design of nursing home surroundings, says Diehl-Schmid, there is also a further "very important issue - the nursing crisis" of a shortage of qualified staffing. "Before I adapt the architecture I would hope for sufficiently many nursing staff well-versed in dementia." Adds Dietz: "We need both, for architecture can support and relieve caregivers." Her wish now would be joint research projects and an inter-disciplinary professorial chair.

Monday, September 24th 2018
Sabine Dobel (dpa)

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