Environmental Interventions for Patients With Dementia Dementia is a neurocognitive disorder that has been treated in various ways throughout all history. The modern era has proposed pharmacological interventions in the past but these have proved dangerous and degrading to the quality of life that dementia patients and their loved ones prefer. For this reason, environmental interventions have emerged as an alternative method for treating elderly dementia patients. This intervention method consists of altering the environment in which the patient lives by accommodating for the needs of the patient with clearly identifiable pathways, open spaces for communication, naturalistic settings, adequate stimuli and private rooms for quiet. This paper discusses the fundamental principles of environmental interventions for patients with dementia and includes a justification for this approach as a suitable alternative to prevailing psychoactive drug interventions. It also includes a discussion of the historical context of the disorder, its current description according to the DSM-V and a guideline for home design so as to effect a proper environmental intervention.

Environmental Interventions for Patients with Dementia

Introduction

Psychotropic and pharmacological interventions can have harmful or damaging side effects on patients with dementia and for this reason health care providers are examining the possibility of environmental or psychosocial interventions in order to help manage patients with dementia (Mayo Clinic, 2015).

Dementia is a term that is used to describe "impairments in cognitive and intellectual ability, memory, language, reasoning, and judgment that interfere with everyday functioning" (Agency for Healthcare Research and Quality, 2014). This cognitive disorder is one that typically impacts the elderly community as cognitive functions deteriorate with the onset of age. As of 2010, more than $200 billion were being spent on care for patients with dementia (Agency for Healthcare Research and Quality, 2014). However, dementia remains a disorder that is inconsistently understood and therefore inconsistently treated. Moreover, the impact of pharmacological interventions introduces new and unnecessary risks into the treatment of the patient. A better approach to stabilizing patients with dementia can be found in environmental interventions, which this paper will now describe.

Environmental Interventions

Environmental interventions, such as placing the patient within a walled room structure, providing them "wandering areas," giving them access to natural or "enhanced environments" such as rooms with pictures on the walls depicting natural settings, or reduced stimulation areas, such as quiet places where the patient will not be disturbed by unwelcome sounds and/or agitations -- all of these are possible environmental interventions that can help to improve the quality of life of the dementia patient. Because there is no known cure for dementia -- and in fact it is even unclear precisely what causes dementia (i.e., whether it is a genetic disorder or a natural consequence of aging), controlling or supporting the quality of life (QOL) of dementia patients is one of the most effective strategies currently employed by care providers.

As Van Hoof, Kort, Van Waarde, and Blom (2010) point out, "the vast majority of people with dementia live at home and wish to remain doing so for as long as possible" (p. 202). Thus, in keeping with the wishes and intentions of patients and loved ones dealing with dementia, an effective strategy of environmental intervention can be as simple as re-designing the home of the loved one so that it is conducive to maintaining a quality of life that suits the elderly dementia patient. Such design would implement that strategies discussed above regarding walled rooms, quiet places, wandering areas and access to nature or to enhanced settings, as these are deemed effective means of supporting the mood and reducing the rate of behavioral incidents of elderly dementia patients (Gitlin, Corcoran, Winter, Boyce, Hauck, 2001).

What is dementia and why is an environmental interventionist approach most helpful in supporting patients and loved ones? The dementia patient is one who is more than likely to exhibit irrational or irritable behavior to others as the deterioration of the cognitive functions progresses. These behaviors can often be trying and difficult for loved ones. As pharmacological interventions utilized psychoactive drugs that impact the brain and alter the mood via chemical treatments, the loved one can often "disappear" behind a fog or screen of pharmaceuticals that completely transform the living loved one into a shadow of the former self. This can be as equally trying and difficult for loved ones and for the patients themselves as a non-interventionist strategy with no treatment whatsoever. Dementia patients typically are not completely incapable...

The nature of the disorder is that it alters from time to time and place to place; moods and behaviors come and go and change frequently or infrequently. Despite over a century of research on this phenomenon there is still no cure.
Dementia or rather the symptoms which are now associated with dementia are not new to the world. They have been witnessed and dealt with throughout all history in ever society. Different societies in different eras have had different methods of treating the symptoms now associated with dementia and it can be helpful to understand their methods in order to better justify the modern method of environmental intervention as a strategy for supporting QOL.

History

Kyziridis (2005) shows that in the past, philosophers such as Plato stated that "if head and body are to be well, you must begin by curing the soul," (p. 43). Kyziridis' study focuses on the history of "schizophrenia," but as Kyziridis notes, the term "schizophrenia" simply means "spit-mind" and it was first coined by Blueler in the first part of the 20th century in an attempt to redefine what psychologists had identified as a form of dementia. Thus, the two disorders are not so disparate, as even the DSM-V suggests in its new classification of dementia as a major neurocognitive disorder.

How then have ancient cultures and older cultures treated patients with what are now called neurocognitive disorders? The ancient Greeks had a number of methods, as Plato has indicated, and many of them were oriented towards environmental interventionist methods -- such as the placing of the patient in a natural setting that was conducive to peaceful and harmonious feelings: a view of hills, nature, birds, flowers, sky, trees, where fresh air was in abundance -- this was one approach. Another approach was to use music therapy as a mood stabilizer (i.e., music would be played so as to help calm the patient). Other cultures as in China or India, used religious ritual interventions; the Romans lent themselves more to Grecian practices. In the Middle Ages, the Christian era adopted a strategy that was a cross between the Eastern and the Western methods, as it attempted to distinguish between spiritual ailment and physical or psychological ailment and treat accordingly. The method during this era was also based on environmental interventionist orientations and was geared towards satisfying quality of life aims and reducing the rate of incidence of disruptive or unruly behavior (Kyziridis, 2005).

In the modern era, in conjunction with the rise of Industrialization and mass-production and the detachment from Old World (i.e., medieval or classical) methodology in favor of Enlightenment studies, medicine has taken a more un-natural approach in terms of utilizing laboratory chemicals as neuro-applications and treatment for patients suffering from cognitive disorders. In many cases, such treatment has not been effective in stabilizing the patient with any view towards maintaining or contributing to the patient's quality of life. Pharmacological treatment, in fact, has been a contributor in a number of the mass shootings in America in recent years, as SSRIs are one of the common characteristics to be found among these incidences. When this is considered alongside the modern era's approach to treating elderly dementia patients as though ignoring the manner in which the world throughout all history has dealt with this subject, it becomes apparent that an environmental intervention may be exactly what is needed for treating a disorder for which there has not as of yet been identified any real cure.

The Implementation and Impact of Environmental Intervention

One's environment has a profound impact on the way that one thinks and acts, as numerous studies in numerous sectors have shown, from business organizational workplace studies to urban cities and planning studies to medical studies regarding the impact of environment/communities on rate of incidence of diabetes (Shinew, Stodoloska, Roman, Yahner, 2013). The point is that environments impact everyone at a psycho-social level and can be responsible for boosting morale, elevating or depressing the mood, and effective harmonious or discordant thoughts. When such findings are applied to the treatment of dementia patients, it becomes evident that environmental intervention is a strategy that is rooted in a universal phenomenon of respecting how environments affect people.

Fleming and Purandare (2010) show that environmental design guidelines can be implemented by caretakers to provide the kind of intervention strategy that would most effectively support QOL for elderly dementia patients. These guidelines are based on their study of long-term care analyses culled from control groups, cross sectional and survey designs and pre- and post-test studies. Their finding is that when it comes to implementing environmental interventions, home…