Door decals help people with dementia find their way

What are the main challenges in measuring environmental design changes for persons with dementia in residential care settings?

LS: Accurately measuring the effect of environmental design changes is difficult in dementia care settings because it can require a lot of time and resources. Traditionally, we rely on staff or researcher observations, and it can be hard to be objective and quantify changes and impact. It’s also challenging to justify costly changes or renovations when our observational methods limit our ability to draw strong conclusions.

What motivated this research?

LS: We identified two issues with the design of the unit where the study took place – first, all the patient room doors looked the same, making it hard for people with cognitive impairments to find their rooms; and second, patients were often approaching the exits and office doors, making it difficult for staff to enter and leave the unit safely.

We wanted to see whether door decals would help with these problems but also test whether location tracking systems could provide an objective, automated way to measure changes in movement on the unit that doesn’t require staff members to do additional work or the added presence of research observers.

What was the most important finding of this study, in your opinion?

LS: We found a significant change in movement around the exit and office doors after we added decals that made them look like bookshelves. While the decals did not have much effect on how well patients found their own rooms, we observed that patients approached room doors with decals less often than plain doors in environments where there were a mix of both door types.

We also showed that the location tracking system could reliably measure these changes, providing an objective, more granular way to evaluate environmental interventions.

What are the main challenges in measuring environmental design changes for persons with dementia in residential care settings?

LS: Accurately measuring the effect of environmental design changes is difficult in dementia care settings because it can require a lot of time and resources. Traditionally, we rely on staff or researcher observations, and it can be hard to be objective and quantify changes and impact. It’s also challenging to justify costly changes or renovations when our observational methods limit our ability to draw strong conclusions.

What motivated this research?

LS: We identified two issues with the design of the unit where the study took place – first, all the patient room doors looked the same, making it hard for people with cognitive impairments to find their rooms; and second, patients were often approaching the exits and office doors, making it difficult for staff to enter and leave the unit safely.

We wanted to see whether door decals would help with these problems but also test whether location tracking systems could provide an objective, automated way to measure changes in movement on the unit that doesn’t require staff members to do additional work or the added presence of research observers.

What was the most important finding of this study, in your opinion?

LS: We found a significant change in movement around the exit and office doors after we added decals that made them look like bookshelves. While the decals did not have much effect on how well patients found their own rooms, we observed that patients approached room doors with decals less often than plain doors in environments where there were a mix of both door types.

We also showed that the location tracking system could reliably measure these changes, providing an objective, more granular way to evaluate environmental interventions.

How does this change design of residential care settings in the future?

LS: Dementia care settings and memory care in long-term care homes could use decals to personalize room doors and disguise doors that patients shouldn’t enter.

Facilities should also consider embedding objective location monitoring systems to allow more informed, data-driven decisions about which design changes work best in their specific environment.

Any next steps?

LS: We’re continuing to test new ideas on the unit and will keep using the location tracking system to measure the impact on patient movement.

AI: We are also using information about location over time to assess neuropsychiatric symptoms in people with dementia such as motor agitation and circadian rhythm disturbances.

What is the major take home message for the public?

LS: Simple design changes like door decals can make residential care settings safer for people with dementia, but they should be first evaluated using objective measures. Using data from existing location systems is a practical way to test small-scale design changes directly in these care settings.

Dr. Iaboni and Ms. Shum would like to acknowledge the following organizations for their support:
Toronto Rehabilitation Institute (X; @TorontoRehab)
AGE-WELL NCE (X; @AGEWELL_NCE)
Walter & Maria Schroeder Institute for Brain Innovation and Recovery

In addition, Amy Cockburn, one of the paper’s authors and the occupational therapist on the unit at the time of the study, was the driving force behind this project—it wouldn’t have happened without her initiative. Yasser Karam, a biomedical engineering student, also made valuable contributions by supporting the study analyses and data pipeline that we still use in current studies with the location monitoring system on the unit.