Wayfinding for Dementia Patients

Wayfinding refers to what people do to find their way from one place to another.  It involves knowing where you are, knowing your destination, knowing and following the best route to your destination, being able to recognize your destination, and finding your way back. People with dementia or older people in general have a harder time remembering the path to take, and have an easier time in a space where there are clues to tell them where they are and what they are supposed to do.  People with dementia are cognizant of different characteristics of a space at different states of their illness.  Stress makes it more challenging for individuals to find their way.  Being lost increases stress levels.

The worst spaces for people with dementia have long sequences of undifferentiated, repetitive elements such as doors in a long double-loaded corridor.  With deteriorating memory, individuals often have difficulty and fail to recognize their rooms.  Nameplates and room numbers are meaningless to them.  Color can be helpful in the early states of the illness, but is not enough on it’s own. 

Landmarks are features that stand out and are memorable.  In public areas, each space should have its own distinguishing element, such as a hanging quilt in one, a grandfather clock in another, a distinctive painting or sculpture in another. Cues need to be varied, distinctive, and bold.  Subtle cues don’t work.

Redundant cueing, landmarks, public space delineation through varying bold elements, architectural features such as personalized porches and doorways, changes in light levels, and changes in floor surfaces are effective means of wayfinding for people with dementia.  Music or sounds and smells offer additional cues such as the smell of brewing coffee or baked bread.  Interior windows from one space to another can also be helpful.

The use of a name plaque, personal photos and memorabilia, and other door decorations help individuals find their room.  The best clue for locating one’s room is the personalization of the space with the individual’s personal possessions, the more, the better. The most reliable cues are items with long-term memory associations.  Familiar culture codes using color, shape, texture, and lighting are very helpful.  As the illness progresses, the ability to comprehend any written words diminishes.  Adequate lighting must be provided to ensure the cues and clues can be seen by the elderly.  Glass signs, cases, or pictures are often ineffectual since the elderly see only the glare.  Matte finishes are best.

Views to the outside provide one of the principal architectural methods of orientation for wayfinding, and also helps combat depression.  Windows and views to the outside should be to the side of a pathway and not at the end of corridors where they can create glare and confusion.  Creating small seating areas in alcoves with windows can be quite effective.

The inability to find bathrooms contributes to the problem of incontinence. Signs with dark lettering contrasted against a light background is most effective.  Signs on the floor that combine a simple word such as “Toilet” with directional arrows is the most effective way of helping people find their way to the restroom. Directional arrows should be repeated to provide reassurance. Silhouetted figures of a man or woman aren’t that helpful in the middle to late stages of the illness.  Using a bright color for the door coupled with a canopy to make the doorway to the toilet stand out works well.  Cues on the floor and at eye level are preferable to cues that are higher than eye level.  Signage intended for the staff or required by building code should blend in as much as possible so as to not confuse those with dementia.

The design of an environment can either help those with dementia or it can increase their disorientation, making their lives even more challenging.

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