The importance of orientation and signage

The impairments of dementia are usually in memory (especially recent memory), learning and reasoning. People with Alzheimer’s disease also often experience perceptual problems which mean they misinterpret some things they see.

They might see wavy lines moving, for example, or a change in floor colour as a step. These impairments are often combined with sight and hearing impairments so the world becomes a confusing and stressful place. No longer can you understand where things are or how to work out how things work. People show you, for example, where the toilet is and then you cannot remember the next time. You go to the toilet and you cannot work the tap to wash your hands. You cannot find the breakfast cereal and the new kettle looks like a jug.

Most of us use our ears for a lot of orientation. We can hear familiar noises and know what is going on: the central heating boiler roars into action, the traffic outside starts getting noisier with the rush hour. But with impaired hearing and a poor memory this can be simply upsetting. The environment starts being hostile rather than supportive; and the more impaired we are the less we are able to fix it. We may not know we cannot see well enough to understand where we are and that the solution is to switch on more lights. We may not know that we can leave the bedroom door open so we can find it next time and so on. We may no longer remember to put on our watch or we may no longer be able to see it and we have not asked anyone to get us a bigger clock. In the old days the church clock told the time but this is rare today.

Disorientation and bewilderment are a common experience for people with dementia and they are very distressing and frightening. Many people with dementia have had to change where they live by, for example, going to live in a special housing unit or a care home. It is really very hard indeed to adjust to a new space because adjustment needs memory and learning. It needs a capacity to work out where you are and how to behave. Even people who stay at home often have well-meaning relatives who buy new furniture and fittings.

The environment can be made more supportive and enabling with quite simple additions. The first is to make sure that what is important is highly visible.

There must be enough light and enough colour contrast to allow people to see properly. If it is a new building for people with dementia, it needs a very simple layout where you can see where you need to go without needing memory, learning or reasoning. Signs can be very helpful if they are clear, mounted low enough, have words and a picture and contrast with the background. Signs can be directional with a finger or arrow showing where to go, or can be on the door of the room. Large analogue clocks are important.