Botilbud til personer med demens

Abstract

BAKGRUNN: Demens er en samlebetegnelse på en rekke sykdommer som varig nedsetter mental kapasitet, og er sannsynligvis den viktigste årsaken til funksjonshemning hos eldre. For å målrette og tilpasse det kommunale omsorgstjenestetilbudet bedre til personer med demens og sammensatte lidelser, har regjeringen i 2008 iverksatt et utredningsarbeid for å utvikle et sterkere kunnskapsgrunnlag knyttet til konkret utforming av bo- og institusjonstilbud. METODE: Det ble utført systematiske søk i følgende databaser t.o.m. 14.01.2009: Cochrane Database of Systematic Reviews, Cochrane CENTRAL, DARE (Database of Abstracts of Reviews of Effects), HTA, MEDLINE, EMBASE, PsycINFO, SveMed, OT Seeker og SINTEF Byggforsk publikasjoner for å identifisere systematiske oversiktsartikler og primærstudier. I tillegg ble det utført manuelle søk i referanselistene i relevante rapporter og ekskluderte oversiktsartikler. RESULTATET: Søket resulterte i 3388 unike titler. Etter gjennomlesning av tittel og sammendragene ble 161 titler identifisert som mulig relevante og innhentet i fulltekst. Ytterligere 53 artikler ble innhentet etter manuelle søk i referanselister. Kunnskapsoppsummeringen rapporterer resultater fra 8 oversikter som til sammen oppsummerte 96 ulike enkeltstudier, og 11 primærartikler. KONKLUSJONER: Forhold i fysiske omgivelser har vist bedring for personer med demens på fire hovedområder: nivå på dagligfunksjoner, adferdsforstyrrelser, positiv adferd og livskvalitet. Resultatene må tolkes med forsiktighet på grunn av metodiske begrensninger i de foreliggende studiene.

1-PAGE KEY MESSAGES:

This review examines effects of the built environment and elements therein on people with dementia.

Dementia diseases lead to degrees of disabilities that progressively involve caretakers up to stages of complete helplessness and is at present the most common reason for transfer of elderly to care programs. 80% of insitutionalized elderly in Norway have cognitive impairments. We have summarized results from 8 systematic reviews and 11 primary studies on the therapeutic design of environments for people with dementia.

The results should be interpreted cautiously because of methodological limitations in the present studies. Adaptations in the physical environment can lead to positive effects on activities of daily life, behaviors, and quality of life. The overall configuration of a building can affect level of orientation amongst people with dementia. Uniqueness in common rooms, short corridors, calm surroundings and few decision points eased orientation. Spatial orientation and accessability was better in small grouped units with associated common places. Neutral design and colours, and low sensory stimulus are associated with fewer catastrophe reactions and less medication. Visual modification and adaptions can lead wanderers to move in safe areas. There is some evidence to support camouflaging exit door or doorknob against elopement. There were not significant effects of preventing falls amongst people with dementia. Signs and colour codes have small effects on people with cognitive impairments, depending on degree of dementia. Increasing environmental lighting (towards daylight levels) reduced behavioural disturbances, supported spatial orientation and had a modest effect on length of sleep.

Small units with a noninstitutional environment gave less behavioural challenges among people with dementia, but specific features are ill-defined. Less combined multiuse spaces, greater variation and less crowding resulted in less cognitive stress, depression and social isolation amongst Alzheimers patients. Single rooms with the opportunity for individual and home-like character, personal furnishing and objects resulted in less psychiatric symptoms. Highly accessible toilets (visible, open-door and close to bed and common rooms) led to increased use among residents.

The physical environment has not been shown to affect the progression of dementia. Purpose-built environment has positive effects on quality of life.