British hospitals are having a dementia-friendly makeover


THE three inpatient wards that take up the ninth floor of St Thomas’ Hospital in London look like children’s quarters. The walls and doors are brightly coloured. Large pictures of showers and toilet bowls on some doors make it easy to guess what is behind. There are hardly any written signs. Instead, giant arrows matching each room’s colour point the way.

But these wards are not for toddlers: this is the hospital’s Older Persons Unit. The layout and decor have been designed for dementia patients. In recent years, dozens of other hospitals around Britain have refurbished wards and other areas to make them dementia-friendly. Other countries are looking to Britain, already a leader in dementia care and research, says Hugo de Waal, an academic clinician at the Julian Hospital in Norwich. St Thomas’ recently hosted a tour for health officials from Australia and Singapore.

Going into hospital is stressful for anyone. But for people with dementia, even in a mild form, admission can cause extreme distress, for three reasons. First, the clutter and bustle in a typical hospital ward can be overwhelming. This often leads to agitation, fear and aggressiveness—signs of delirium, which is the reason for most admissions of people with dementia to begin with. Another problem is that the featureless corridors in a typical ward make dementia sufferers feel lost. And many get anxious about being confined to their rooms because dementia increases their desire to explore and walk around.

Layout and design can alleviate all three problems. A common alteration to make a ward calmer is replacing the nurses’ station—hub of activity and chatter—with several small reception desks. Bright lighting throughout is another popular change, not only because it helps older people see better. Light pooling causes shadows and dark corners, which may look scary. The lights at the St Thomas’ dementia-friendly unit are adjustable, which helps with sleep. “It becomes much quieter when we dim them,” says Darlene Romero, the unit’s matron.

Several tweaks can prevent confusion. Dementia patients sometimes refuse to walk on shiny floors because they think they are wet. Patterns or colour changes may appear as steps or holes to them. Matt finishes and uniform colours are therefore reassuring. Different room colours and unique pictures above each bed help with way-finding.

To accommodate restless patients, new layouts have small socialising areas, such as a couple of chairs near the nurses’ desks, or eating areas made to look like home kitchens. A few hospitals with ground-floor wards have added gardens where patients can wander safely. St Thomas’ has dog therapy to improve patients’ mood.

The effects of decor can be dramatic. At the Julian Hospital, three months after dementia patients were moved into a redesigned ward in 2012, use of antipsychotic medication fell by nearly 40%. A study of ten sites in England published in 2015 by the King’s Fund, a think-tank, found that incidents of aggression fell after dementia-friendly spruce-ups.

Such changes are becoming pressing for British hospitals. A quarter of the patients on their wards have dementia. In 2025 Britain will have 25% more people with dementia. The bright, pleasant wards and their calming effect on patients also boost staff morale, helping to attract and keep nurses and doctors in dementia care. In the past, people with dementia were usually relegated to the worst bits of hospitals; now their wards are beginning to look like the cheeriest.

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