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Mitigating Behavioral Health Issues in Memory Care Through Design

By Becky Trybus CHID, EDAC, RID, IIDA

Alura Senior Living ALF/MC, Rockledge, Florida

With hundreds of diagnosed dementias, it’s essential to know which types are presenting more frequently in today’s memory care communities and how design can create safer environments for residents and staff.

Forum recently attended the

Florida Senior Living Association’s ENGAGE 2024 conference. It was a high-spirited success as we met many new people, connected with familiar clients, attended sessions, and exhibited. One of the sessions I attended was Untangling the Vines: Managing Behavioral Health Challenges in Memory Care Units.

It piqued my interest as behavioral health is not typically considered a programming component of senior living design. It should be, though, particularly with memory care.

Because dementia causes a decline in cognitive functioning (thinking, remembering, and problemsolving), it stands to reason that this will affect one’s behavior. According to a 2020 study cited on healthline. com, “90% of people with dementia have some kind of behavioral and psychological symptoms, including psychosis, agitation, aggression, and depression.”

To understand how designers and developers should program for this, we need to know what behavioral health challenges exist in today’s memory care communities. One of the session presenters, Dawn Platt, National Director of Memory Care Programs for Discovery Senior Living, shared the top five behavioral health challenges surfacing in today’s memory care: 1. Alzheimer’s disease and related orders (ADRD), 2. Mixed dementia with psychosis, THOUGHT LEADERSHIP

3. Alcohol-induced dementia, 4.

Veterans with trauma history, and 5. Sexual disinhibition with other persistent behavior disorders. I’ll briefly explain these and suggest a few ways design programming can safely support residents and staff while mitigating further issues.

Alzheimer’s Disease and Related Disorders (ADRD) According to the National Institute of Neurological Disorders and Stroke, Alzheimer’s disease is the most common cause of dementia, accounting for at least two-thirds of dementia cases in people 65 and older. Other common causes of dementia include vascular dementia, Lewy Body dementia, frontotemporal dementia, and dementia due to Parkinson’s disease.

Common behavioral symptoms include agitation and frustration.

Design Intervention: In the book Design Innovations for Aging and Alzheimer’s, author Elizabeth C. Brawley writes, “The potential findings of neuroscience and their application to the interior design of buildings bring great possibilities for better, more appropriate building design for those whose needs are the greatest.

By understanding how brain damage changes perception, we can improve building

design for those suffering from neurodegenerative disorders such as Alzheimer’s disease.”

Two ways to help lessen resident stress through design are improving mobility and wayfinding. Creating ample clear floor space and consistent, low-pattern, neutral flooring with minimal transitions and contrast between the floor and wall boundaries will help support aging eyes and mobility. Wayfinding with feature walls, art, windows with pleasant outside views, and other visual cues will also help offset common behavioral symptoms and encourage independence within the environment.

Mixed Dementias with Psychosis One complication of dementia is psychosis, a mental state that includes paranoia, delusions, and hallucinations.

Design Intervention: Design can help residents remain calm and safe in two ways: an accessible courtyard with access to nature, sunshine, and physical activity to improve circadian rhythm, our critically important 24-hour psychological cycle. Circadian cycle disturbances can result in increased mortality, deterioration of cognitive function, immune dysfunction, cardiovascular issues, and an increased risk of institutionalization and depression. Another design intervention is to provide a quiet room.

This environment is low-pattern with soothing color, lower ceilings, soft-touch finishes, psychoacoustic therapy sound (nature, water, birds chirping, etc), soft, natural light with blinds between the window panes, heavier weighted furniture, rounded, ligature-resistant items, fixtures and art without glass, double swing hinges on the entry door, and more.

Alura Senior Living ALF/MC Rockledge, Florida

Alcohol-Induced Dementia Damage can occur to the brain from

excessive, long-term alcohol use.

The effects can cause problems with short-term memory issues, language impairment, spatial cognition, and everyday tasks that impact daily life, social skills, mood, and personality. It can also damage nerves in the arms and legs, which can also lead to an increased risk of stroke.

Design Intervention: Universal Design applications can profoundly impact people with cognitive disabilities, regardless of the cause. It considers the diverse abilities of all by creating products, environments, and communication that are useful, flexible, simple and intuitive, perceptible, comfortable and efficient, sized and spaced appropriately, and minimize risks and accidents. Some examples in buildings are anti-skid floor surfaces, handrails, automated doors, integrated power in furniture, wide corridors, and much more.

Universal Design applications can profoundly impact people with cognitive disabilities Veterans with Trauma History In a study of more than 180,000 older veterans, cited on Todaysgeriatricmedicine.com, researchers found that veterans who experienced traumatic brain injury had a 60% higher risk of developing dementia compared with veterans who hadn’t experienced traumatic brain injury. The site also states that while veterans are on track with the same shared risk factors as the general population, such as

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diabetes, high blood pressure, and lack of physical activity, they are more vulnerable to additional risk factors related to military service, such as traumatic brain injury, posttraumatic stress disorder, heavy alcohol consumption, and sleep disturbances and deprivation.

Design Intervention: Taking a cue from Mixed Dementias with Psychosis, providing a calm, safe environment is key. This includes utilizing a quiet room, offering community through common spaces for social support, and giving access to the outdoors, physical activity, sunshine, and fresh air to naturally balance the circadian cycle, offsetting sleep disturbances and deprivation.

Sexual Disinhibition and Other Persistent Behavior Patterns Due to dementia-related changes in the brain, confusion, disorientation, misinterpretation, and a lack of impulse control, inappropriate sexual behaviors can occur.

Design Intervention: One of the best ways to lessen the chances of this behavior causing harm is to separate the

Alura Senior Living ALF/MC Rockledge, Florida men and women through the built environment. Memory care wings or neighborhoods specifically for women provide a safer environment where women feel more naturally at ease amongst their female peers and foster friendships through daily social activities and interactions with purposeful aesthetics geared toward feminine sensibilities.

12 million by 2040. We can’t ignore the critical role the built environment plays in creating safer spaces for residents and staff. Research and focused programming early in the design process helps ensure that the unique behavioral health and physical needs of the afflicted and caregivers are adequately supported.

According to Prb.org, there are projected to be 9 million Americans with dementia by 2030 and nearly

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