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Home design to aid Alzheimer's patients

Design choices may be more important than medication for patients with dementia.

The Philadelphia Inquirer

February 18, 2017 at 1:00PM

Can design help people with dementia age in place? Neurologists say yes. Designer Theresa Clement made this her mission after her father was diagnosed. She calls this “design prescription,” and makes a presentation at the Pennsylvania Convention Center in Philadelphia on January 20, 2017. (The Minnesota Star Tribune)

A few weeks ago, Mary McCreesh got the kind of news that makes your heart sink: Her 82-year-old father was officially diagnosed with Alzheimer's.

So McCreesh, of Wayne, Pa., spent that Friday afternoon at, of all places, the Philadelphia Home Show. She figured she can't change her father's diagnosis, but she can make it easier for him to stay at home, in the house McCreesh grew up in.

"We can see the house through his eyes and find ways to make it easier for him, not knowing what's ahead," she said.

She was at the show for a presentation by Theresa Clement, a designer and aging-in-place specialist whose own father succumbed to Alzheimer's disease in September. Clement learned along the way that her line of work was surprisingly relevant to managing certain symptoms of the disease.

"If I had known at the start what I know now, my dad would have been able to live at home with my mom a year or so longer than he did," Clement said. So, consulting with experts including Dylan Wint, a neurologist and psychiatrist at the Cleveland Clinic, she's developed what she calls Design Prescription.

"I'm giving people some simple things that are inexpensive to do that can save so much stress, so much time, and make you be able to enjoy your loved ones even as they start to fade away," she said. "If you're living with someone with Alzheimer's, you don't have time to read all the scholarly research to say, for example, 'What can I do to stop my loved one from peeing in the trash can?' So I try to distill it down."

One in three senior citizens dies with dementia, according to the Alzheimer's Association.

And it doesn't affect just memory. Many people with the disease also have challenges perceiving colors, contrasts and depth, and organizing visual information.

"The brain takes things the eye sees and executes a wonderfully complicated task of telling us how far one thing is from another and knowing where one thing ends and another begins," said Jason Karlawish, a professor, physician and associate director of the Penn Memory Center. "As Alzheimer's disease affects the part of the brain that organizes visual images, people have a hard time understanding that."

For some, those are the first symptoms of the disease; others don't suffer visual-spatial challenges until later. Either way, caretakers can help.

"A lot of the challenges people face with Alzheimer's disease could perhaps be more easily solved with design choices as opposed to medication," Wint said.

At the Home Show, Clement pointed out an area rug on the stage.

"This rug is a big trip hazard. This beautiful modern pattern can be an optical illusion," she said.

Contrasts in flooring, like a light rug on a dark wood floor, might appear to be an elevation change. A patterned rug might appear as uneven terrain, and small tiles might appear as scattered objects to be picked up. On the flip side, people may have trouble distinguishing actual elevation changes between rooms, or judging the height of a step; in those cases, a ramp might be helpful.

And in the bathroom, the lack of contrast can have messy results.

"The white toilet on a white floor with a white wall — that's what all the pictures on Houzz show, and it's a beautiful look," Clement said. "But for people with Alzheimer's, it can be hard to see white on white on white. So a hamper is often used, or a trash can."

Painting a contrasting color behind the toilet can be an easy fix, she said.

Other ideas she learned from her father: Keep essentials in plain sight. "If you take a door off one cabinet and put the plate, bowl, spoon and cup there, they can see it."

Also, try to maintain even lighting throughout the day, because changes in lighting can be confusing, and dark shadows can appear as an abyss.

Wint, who is collaborating with the University of Nevada-Las Vegas' architecture program on a new health care interior-design program, said research on the issue so far is scarce. His advice to caregivers includes avoiding multipurpose tools, which can be hard for people with dementia to identify and navigate. He also prescribes minimizing clutter — including the visual kind. At mealtime, that means avoiding patterned plates, which can be confusing, and serving one food item at a time.

But, mostly, said Clement, it's about "having giant empathy."

She learned to look at things through her father's eyes, to recognize what might be strange or confusing.

"One day, I went to visit my father, and he was so agitated. The nurses couldn't calm him down. I went into his room, and I noticed that across the way, there was an ambulance with its light flashing. So I pulled the shade down, and within a couple minutes, he was fine," she said.

She's been giving presentations at home shows, senior centers and conferences, and hopes to start offering one-on-one consultations. She wants to prove that accommodations don't have to be hospital-like, especially in an era when grab bars, for example, can be disguised as stylish towel racks, soap dishes or toilet tissue holders.

"I think the process of updating your house is absolutely crucial," she said. And the sooner the better. "Introducing these things and creating a safe environment in stage one, where they can participate in what happens in the house, is really important."