Environmental Design and Dementia

Achieving the just right challenge

Living, working or caring for a person with dementia can be challenging. Adapting the environment so a person with dementia can make more sense of it is essential.
It is important for any professionals involved to take a holistic view. This needs to include personality, biography (life history and skills), neurological state and social psychology.
There is a need to focus on ability not disability so as not to disable the person.


The person’s attention must be captured – a person needs to be able to focus on something so they are then able to recall it. We need to ensure that features in the environment will capture their attention.

Creating a therapeutic physical environment

  • Audit what is already in place.
  • Plan to improve on what is there and to make changes..
  • Try not to replace things, try to mend where possible to keep familiar items around. New learning is difficult for someone with dementia.
  • Orientation – signs are helpful. They should be clear and prominent with familiar words and pictures. They should be high visibility, with contrasting colours. People with dementia are more able to work with strong colours. Black on yellow is the best because as a person gets older and their eyes change, they see more yellow in things. Signs should be personalised to help raise awareness.
  • Signs can be directional, use arrows to make it clear.
  • Words should be written with a capital at the beginning and then lower case (Toilet). This creates a shape to a word and the person may recognise the shape rather than the word. If it is all in capitals it just looks like a rectangle.
  • Have pictures of the actual object i.e. toilet.


  • Colour code areas – bright primary colours for where they can safely spend time.
  • Blend to reduce awareness – i.e. sluice room could have the door painted the same colour as the walls in a bland colour. Fire extinguishers should not be on bland walls as they are the only bit of colour and the person will be aware of this and go toward it not realising what it is.
  • Use contrasting colours to distinguish things, i.e. coloured toilet seat so person can tell it is not part of the floor.
  • Careful use of patterns – figure ground discrimination can be difficult. Dark patterns can look lower than light patterns, creating “holes”. Lines and stripes can be seen as barriers.
  • Colour for mood – strong colours to stimulate awareness, paler for calm. I.e. in dining room, have strong colours to encourage mood for eating.

Red Toilet Seat

Objects to aid recognition

  • Place objects at key places, the person must be informed.

I.e. place a vase on table beside the stairs so you can say go past the vase and turn to go up stairs.

  • Have individual bedroom doors with meaningful objects or colour i.e. the door knocker on family home, or paint it the colour of what they are used too.
  • Traditional Furniture – have familiar furniture in traditional settings.
  • Corridors with interest – in residential settings, have wide corridors with space to set things up such as a fruit stall or sweet shop.

Accessible areas and objects

  • No visible barriers i.e. on window panes, bars across like sash windows, or thresholds between rooms. We plan ahead when making a journey, but someone with dementia is not able to. When they come to a threshold or some other barrier, they see it as something they cannot pass and stop at it. Sometimes a runner of carpet of one colour can help.
  • Plain carpets are easier.
  • Ensure rails are visible – different colour to wall or put a wall paper boarder behind them.
  • Coloured toilet roll and roll holder and flush handle assist with using the toilet.
  • Glare of white tiles can make things difficult.
  • Commodes might not be recognised as do not look like a toilet. The ones with black seats are the best.
  • Have open or glazed cabinets so people can see what is inside them, and have visual access at all times.
  • Create work stations for activities i.e. set up everything a person needs to make a cup of tea in one area.
  • Provide easy access to food and drink.
  • Have highly visible tools, like coloured cups etc.


  • Polished floors with windows at the end attract people toward the light. If this is a door or there is a door near by, they will go through it.
  • The light shining through onto polished floor may look like puddles to the person who will then try to avoid them and may fall.
  • Older people struggle with light changes i.e. going from a dark room outside into the light.


  • Open shelves
  • Glazed wardrobes etc
  • Think about physical difficulties and keep things within reach.
  • Consider space for storage, do they need equipment nearby by like walking frames?
  • Variety of textures required like different cushions for sensory input.
  • Position furniture to promote good social opportunities i.e. chairs 90 degrees to each other with a coffee table.


  • Paths should guide people down the garden.
  • Objects to stimulate activity i.e. washing lines, garden sheds
  • Planting can stimulate and orientate a person as well as provide a sensory experience.


If you work or are part of a family who is looking for meaningful engagement with their loved ones or people with dementia who are looking for a different form of engagement at home, have a look at this link.