What environmental changes will enhance speech therapy sessions with your patients who have dementia?
In this article, you’ll find 45 practical environmental modifications for dementia treatment. Some require help from caregivers, but most are quick and easy ways to enhance any environment.
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Environmental Modifications for Dementia Treatment
Both advanced age and dementia impact vision. Improve lighting to help patients see, increase participation, and decrease discomfort and agitation.
How to improve lighting:
- Turn on more lights or move closer to a light source
- Add in some natural light (open blinds)
- Add lighting to dark spaces (closets, corners)
- When possible, choose lights that shine up but not into people’s eyes (lamps)
- When possible, avoid fluorescent lights
- Avoid flickering lights
- Avoid glare (cover shiny surfaces)
- Avoid sudden changes in light levels (instead, have consistent lighting throughout; take breaks when moving inside or outside)
Add Visual Contrast
Use high visual contrast between the target object you want a patient with dementia to focus on and the background.
Examples of visual contrast:
- A plate that contrasts with the table/placemat
- A placemat that contrasts with the table color
- A sign that contrasts with the wall
- High-contrast colors to highlight an obstacle (step)
- High-contrast colors to highlight other important items (bright-colored tape around a light switch)
- An important door painted a contrasting color (bathroom door, closet door)
Use Signs & Labels
Visual aids such as signs and labels are excellent tools to help orient and enrich the lives of patients with dementia.
How to make a good sign
- Size 14+ font
- Arial or Calibri font (sans serif fonts)
- High contrast (black ink on white paper, white ink on blue or kelly-green paper)
- Capital letter at the beginning of the sentence (not all caps)
- Use a brightly colored background vs white background (e.g. glue sign onto a brightly colored piece of paper)
- Choose a contrasting color (from the door/wall it will be posted on)
- Use consistently colored signs throughout the environment. For example, all signs in the bedroom should be the same color
- Post it where the patient can see it (if in a wheelchair, post it at the correct height)
- Train patients how to use it!
Use spaced retrieval to teach patients how to use the signs.
Improve the Auditory Environment
Support your speech therapy sessions by reducing competing sounds.
Ways to do this:
- Close the window or door
- Turn off the TV or radio
- Ask others to leave the room
- Close curtains to dampen sound
- Move to a space with better acoustics (carpets, curtains, quiet)
Make sure that your patient’s hearing aids are on and working! This not only improves engagement but may also reduce cognitive decline.
Improve the Physical Environment
Ask caregivers to help modify your patient’s physical environment.
The goal is to create an intentional yet low-stimulation and comfortable space.
Do this by showcasing items that support orientation, safety, meaningful activity, and comfort–while removing distractions.
Ways to do this:
- Reduce clutter
- Arrange furniture in an organized way
- Organize the environment with bins, shelving, etc.
- Showcase meaningful items (favorite blanket, framed photos, memory book)
- Have self-directed, meaningful activities that are organized and easy to access (hobbies, radio, reading material)
- Post a digital wall clock with large numbers in clear view of the patient
- Post signs to support safety and orientation
- Post a large monthly calendar and/or memo board
- Provide plenty of the right type of lighting
- Add visual contrast
Consider adding comfort to the environment during your treatment session to help decrease agitation and improve participation.
Use your best judgment when deciding which of the ideas below are appropriate for each individual patient.
Ways to add comfort:
- Warm blanket and mittens
- Doll or stuffed animal
- A pet
- Adjust the temperature
- Plants (non-toxic)
- Appealing smells (essential oils)
- Clear line of sight to a restroom (keep bathroom door open, add a sign)
- Remove or cover mirrors
- American Speech-Language-Hearing Association (n.d.). Dementia (Practice Portal). Retrieved August, 10, 2023, from www.asha.org/Practice-Portal/Clinical-Topics/Dementia/.
- Brush, J. (2018, April). Tips for Creating Signs – Dementia Care Training & Education | Redesigning Dementia Care. Brush Development. Retrieved August 10, 2023, from https://brushdevelopment.com/tips-creating-signs/
- Brush, J., Fleder, H., & Calkins, M. (2012). Using the Environment to Support Communication and Foster Independence in People with Dementia: A review of case studies in long term care settings. Kirtland, Ohio: I.D.E.A.S., Inc.
- Hickey, E.M. (n.d.) Interventions for Persons with Dementia: Creating Supportive Environments. Medbridge. https://www.medbridgeeducation.com/courses/details/interventions-for-persons-with-dementia-creating-supportive-environments