Design for Nature in Dementia Care by Garuth Chalfont is the best book I have seen on how contact with the natural world can help people affected by dementia. It offers ideas for activity planning, landscaping, and environmental design in dementia care. Well-designed in format, it is easy to read and includes many helpful illustrations. Family caregivers will find lots of ideas for things that can be done at home. Institutional planners will benefit from design and landscaping tips for nursing homes and long-term care facilities. The book draws on interdisciplinary research evidence from environmental psychology, neurology, architecture, nursing and dementia care practice.
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Maintaining a connection to nature can be an important component of caring for a person with dementia. Direct access to nature has been shown to enhance verbal expression, reduce agitation and aggression, increase appropriate communication, and increase attentiveness to the environment in persons affected by dementia. Since dementia usually affects short-term memory, having a view of nature and the outdoors can help a person maintain orientation to time of day and the season of the year. It even improves staff morale!
Even if someone is unable to go outside, there are ways to bring nature inside through the use of windows, natural light, indoor plants, cooking, and cut flowers. A wide range of handicrafts and indoor horticulture activites are possible, both outdoors and indoors. Design of an indoor activity room is discussed, with many examples of simple activities that incorporate natural components.
Contact with nature includes interaction with animals and pets. Studies have demonstrated positive effects of pets. One study published in 2004 examined the effects of installing an aquarium n the dining room of a special care unit for people with Alzheimer's disease on food intake, disruptive behavior, and staff morale. Improvements in all those areas were noted after four weeks, as well as gain in body weight of the residents.
The beauty of this book, however, is not just in giving activity suggestions, but in showing how the activity can be done to give maximum benefit in the setting of dementia. Arranging flowers in a vase is an example of a simple task that can be done in almost any location by bringing the materials to the resident. When arranging flowers, conversations can develop because the task at hand and the closeness of a friendly, interested person will prompt social interaction. If seated at a table with a group, a caregiver can gently encourage social interaction during the activity. This mix of natural stimuli with human interaction is the key to the therapeutic paradigm of the book.
The activities suggested in the guide operationalize "The Prosentia Hypothesis", a model of nature-based interaction found in the professional literature. The Prosentia Hypothesis specific to dementia is that if a person with dementia has a sensory connection to nature in a supportive relationship with another person, then interaction with this triangular dynamic can help the person to maintain a sense of self, and may help contribute to their positive personhood. The mechanism is a synergystic relationship between sensory stimulation, which tends to continue to be directly perceived even in dementia, and communication with a person within the same natural context. The hypothesis is interesting in itself, but the benefit of the book is how the author gives practical suggestions for how to actually do supportive activities. There is a checklist for connection to nature in a residential care home that is easy to use to rate a facility for implementation of this approach.
The book has an entire section devoted to safety and freedom issues related to walking and mobility, including tips on path design for institutional settings. Various studies have shown that walking and strength training for people with Alzheimer's and related dementias show improvement in chair-raise time, standing time, night-time sleep, agitation, mental function, capacity to communicate, and other important metrics. Nature-based activities also can have great benefits for persons without dementia. A possible benefit of nature-related outdoor excursions in younger persons is that exercise is associated with reduced risk for incident dementia among persons 65 years of age and older. These results suggest that regular exercise is associated with a delay in onset of dementia and Alzheimer's disease. Fitness and mobility activities can be connected with nature at any age or mental status. "Use it or lose it" is the simple truth.
The book is one of the Bradford Dementia Group Good Practice Guides, a series of jargon-free, evidence-based, good practice guides for those involved with the care of people with dementia and their families.
Garuth Chalfont, PhD ASLA, is the Director of Chalfont Design, an environmental design consultancy. His recent work has focused on providing enabling environments for people with dementia and distressed behavior. This research and design project was funded in part by the National Health Service (the NHS) in the UK. Dr. Chalfont also has been creating healing environments in the USA since 1989 through Chalfont & Associates, located in Greenbelt, Maryland. He previously was associated with the School of Architecture, University of Sheffield. He is a member of the American Society of Landscape Architects, the British Society of Gerontology, the International Psychogeriatric Association, and THRIVE UK (Social and Therapeutic Horticulture).
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