Colour and Contrast
Colour and contrast can be used to help people with sight loss and dementia to identify key features and rooms. Good use of colour and contrast can facilitate independent living, for example, by supporting people to find their way around and to use fixtures and facilities such as lighting unassisted.
Bear in mind that due to natural thickening of the lens of the eye with age, older people may experience colours as ‘washed out’ and find blues, greens and purples harder to differentiate.
What do the ticks mean?
helps or is of benefit to most people
helps or is of benefit to some people
helps or is of benefit in specific circumstances
means that this aspect of design needs to be considered carefully before being adopted
Thinking about colour and contrast
Experts use a combination of the terms ‘hue’, ‘saturation’ and ‘tone’ to describe colours. ‘Hue’ is what most people mean when they talk about colour, and shows its place on the colour spectrum i.e. red, blue, or green. ‘Saturation’ refers to how vivid colours appear, from bright to ‘muted’. Finally, ‘tone’ is a measure of how light or dark a colour is. Colours can be contrasting if they are different hues, e.g. yellow on blue, or the same hue but different saturation or tone, e.g. dark blue against pale blue. It is important to discuss people’s personal preferences before making decisions on how to create contrast. For some situations, people may consider contrasting hues more appropriate, e.g. where the aim is to highlight a hazard, but often in living rooms, bedrooms and other living spaces people may prefer to use contrasting tones.
Bathroom doors of a different colour to the doors to other rooms in the house help people identify the bathroom.
Having bedroom doors in a range of colours in care homes assists people to find their rooms. It may help if the colour used is similar to that of the front door of a resident’s previous home.
Contrasting key features
Using a colour that contrasts with the background draws attention to key features. For example, it can be easier to locate and use switches and sockets, railings and handrails that are of contrasting colour to the wall.
Having furniture in colours which contrast with walls and flooring helps people with dementia and sight loss to recognise where they are and to find their way around.
Having doorways that are in a contrasting colour to the surrounding walls, and door/window handles that contrast with the doors/windows help people to use them.
Contrast can be used to help define objects more clearly. For example, using contrast in the kitchen to highlight the edges of cabinets helps people to locate themselves within their surroundings and to avoid accidental injury from edges. Using coloured rubber mats and/or crockery that contrast with tablecloths helps to define the edge of plates and dishes and might be helpful for some people.
Toilet seats in colours that contrast with the toilet and with other nearby surfaces can help make these more visible and identifiable.
Contrasting potential hazards
Colour and contrast can be used to highlight hazards. For example, highlighting sharp edges with colour draws attention to the danger that they may pose.
Step edges that are contrasted to stair treads and risers improve safety by helping to visually reinforce the change from flat surfaces to steps.
Points for reflection and further consideration
Contrasting edges could be perceived as a barrier by some people with dementia. In such circumstances stark contrasts at floor level might become a hazard. In making changes to a person’s home or living spaces it is important to consider what that person needs and wants and to achieve the appropriate balance between protecting them from potential hazards and supporting their independence and freedom of choice.
Consideration should be given to how contrast is used to highlight key features and hazards. Using the same colours or ways of contrasting both could lead to confusion. Care must be taken to ensure there is no risk of hazards being mistaken for important features and vice versa.
People may not always find it easy to remember the significance of colours, so it may be helpful to have other visual cues in addition to colour and/or contrast differentiation, e.g. appropriate pictures or signage.
We conducted a structured literature review which involved systematic searches of a wide range of electronic databases, complemented by consultation with expert informants who were asked to recommend materials (such as reports) that the searches might not have identified. The searches yielded 14,616 ‘hits’. 14,043 were discarded as either duplicates or not relevant, and the remaining 573 were scored for relevance on the basis of title and abstract. In total 33 publications were included for full text review: 28 based on relevance scores, and 5 items recommended by expert informants.
These were systematically evaluated using a proforma which enabled assessment of the quality of the research reported, and assembled key information regarding the subject matter, results and conclusions of each item. The quality criteria used to assess different types of research were drawn from standard protocols including Centre for Research and Development (CRD) Report No 4, Cochrane Effective Practice and Organisation of Care (EPOC) checklists and, as appropriate, Critical Appraisal Skills Programme (CASP) assessment criteria (NHS CRD 2001; Cochrane EPOC 2002; CASP undated). Each publication was rated as being of High, Medium or Low quality, based the extent to which the research as reported in the publication meets the relevant quality criteria, and an overall rating was provided for each of the sections within the guidelines. Publications rated as being of lower quality are still of evidential value, but should be regarded as providing suggestive rather than definitively evidenced findings.
We assessed the overall quality of published evidence for guidelines in this section as Low. We based the guidelines on evidence contained in the following publications:
- Brunnström, G., Sörensen, S., Alsterstad, K. and Sjöstrand, J. (2004) ‘Quality of light and quality of life -- the effect of lighting adaptation among people with low vision’, Ophthalmic and Physiological Optics, 24(4), 274-280.
- Cooper, B. A. (1999) ‘The utility of functional colour cues: seniors' views’, Scandinavian Journal of Caring Sciences, 13(3), 186-192.
- den Brinker, B.P.L.M., Burgman, L.J., Hogervorst, S.M.J., Reehorst, S.E., Kromhout, S. and van der Windt, J. (2005) ‘The effect of high-contrast marking of treads on the descent of stairways by low-vision people’, International Congress Series, 1282(0), 502-506.
- Goodman, C. and Watson, L. (2010) ‘Design guidance for people with dementia and for people with sight loss’, Thomas Pocklington Trust Research Findings Number 35 [document on the internet]. December 2010 [cited 2013 Nov 29]. Available here (and full report available on request from Thomas Pocklington Trust).
- Kelly, F., Innes, A. and Dincarslan, O. (2011) ‘Improving care home design for people with dementia’, Journal of Care Services Management, 5(3), 147- 155.
- Lawrence, V. and Murray, J. (2009) ‘Promoting independent living among people with dementia and sight loss’, Journal of Care Services Management, 3(3), 261-274.
- Littlefair, P. (2010) ‘Daylighting and windows in homes of people with sight loss’, Thomas Pocklington Trust Research Findings 30 [document on the internet]. March 2010 [cited 2013 Nov 29]. Available here (and full report, available on request from Thomas Pocklington trust).
- Long, R.G. (1995) ‘Housing design and persons with visual impairment: Report of focus-group discussions’, Journal of Visual Impairment & Blindness, 89(1), 59-69.
- Marquardt, G. (2011) ‘Wayfinding for people with dementia: a review of the role of architectural design’, Herd, 4(2), 75-90.
- Torrington, J. and Lewis, A. (2011) Extra Care Housing for People with Sight Loss: Lighting and Design Issues. Thomas Pocklington Trust Research Findings 36 [document on the internet]. December 2011 [cited 2013 Nov 29]. Available here (and final report, available on request from Thomas Pocklington Trust).
- Unwin, B.K., Andrews, C.M., Andrews, P.M., & Hanson, J.L. (2009) ‘Therapeutic home adaptations for older adults with disabilities’, American Family Physician, 80(9), 963.
- Utton, D. (2009) ‘The design of housing for people with dementia’, Journal of Care Services Management, 3(4), 380-390.
Our expert interviewees said
- People with sight loss and dementia might benefit from high contrast hand rails, toilet seats, and door frames.
- Contrasting edging to units may also be beneficial for people with sight loss
- Wall finishes could be modified to ensure an appropriate level of contrast with other surfaces
- Contrast of stair nosings (edgings) can help to highlight these as a hazard
- Colours on doors in care homes might replicate those of previous home doors to aid with way finding
People with dementia and with sight loss and their carers
taking part in interviews and focus groups told us
- Contrasting coloured doors and contrasting bright coloured furniture can help these features stand out
- Black handrails against a white background or yellow handrails are helpful as they stand out
- There should be consistency in the colour used so that, for example, people know that when they see yellow it is a handrail. It is good to have handrails in standard colours throughout inside and outside homes
- A strip of colour on the edge of the stair helps people to identify the last step up or the first step down
- Neutral colours are important and lighter, brighter colours on the walls are preferable
- Individually decorated lounges in a care home can help people with dementia find the lounge in their unit
- There is a need to consider how colour schemes can impact on mood. Light and bright colours can make things seem cheerful
- It is important that residents in care homes have a say on the colour scheme and decoration
- Yellow and navy blue are easier for people to see and are better for handrails. Yellow bathroom doors can be seen more easily
The survey found
- Out of 145 people who answered questions on this section, 78% thought that guidelines on colour and contrast would be ‘very helpful’ and a further 22% thought they would be ‘helpful’
- When people were asked to either agree, disagree or say that they were unsure about a series of statements, the highest levels of agreement were in relation to: use of contrast to highlight edges and key features (97% agreed); the importance of colour choice in residential design (94% agreed); the potential benefit of using coloured doors for bathrooms (91% agreed); and the importance of considering the effects of colour on mood (91% agreed)
- The highest levels of disagreement or uncertainty were in relation to: the superiority of dark against light background as a means to achieve contrast (12% disagreed, 26% not sure); warmer colours as the best choice for contrast, e.g. reds, oranges, yellows (16% disagreed, 30% not sure); neutral colours being a good choice to achieve contrast in residential settings (38% disagreed, 30% not sure)
Selected quotes from people completing the survey
- ‘Colour contrast is extremely important and planners will prefer to be aesthetic to the environment; however an individual who has lost their central vision will also have lost most or all of their colour perception. A red used against a neutral background may look like a good contrast but to the sighted individual, however anyone with sight loss who uses peripheral vision may perceive the red as a ‘diminishing grey’ whilst ‘black’ will be the better contrast. This is always a challenging area for planners.’
- ‘Sometimes it does not necessarily need to be stark contrast, it can be about tonal contrast changes.’
- ‘The ageing eye struggles with differentiating colours so contrast is much more important than colour itself. I would expect bedroom doors to be individualised rather than relying on colour. I think a lot of stuff about particular colours and mood etc is very culturally determined.’
- ‘As a supplier I quite often present fabrics to the residents of care homes and they tend to go for bright colours that their eyesight can pick out. Also, in the past I was advised that florals are unsuitable, however I find that patients with dementia very often select floral designs. Bold stripes of equal proportions can be mistaken as bars when closed so if selecting striped curtains we advise stripes of different widths and or colours and this has proved very popular with residents of care homes. I recommend putting a leading edge on bed throws or curtains in a different colour as they can find it difficult to know where the bed throw and the carpet meet or where the curtain edge is. Also, chair fabrics should be a different colour to the carpet to identify where the edge of the seat is. Also, I have found from experience that the patient will pick at small flecks on upholstery as they think it is dirt so I tend to advise against that.’
- ‘We changed to blue crockery as a colour contrast but one lady with dementia would not drink from the cups, sometimes we solve problems which are not there. All these ideas need to be tried, monitored and revoked if necessary. Knowing options which have worked elsewhere is useful though.’