Environmental considerations

What are they?

Here, the environment refers to any setting where communication takes place. These might include a person’s home, a hospital, a care home or a doctor’s office.

Why are they important?

Communication doesn’t occur in a vacuum – things like décor, background noise and distracting activities all impact on communication in informal and formal care environments.

We all relate different types of communication – for example, an informal chat or a consultation – to different types of environment.

Ideally, the environment for communication involving people living with dementia should provide cues and reinforcement – familiarity is helpful and minimizes anxiety.

The environment for communication involving people living with dementia should help to reinforce and convey meaning. It should not distract or make interaction between people difficult.

The wrong kind of environment increases distraction, makes communication more difficult, and so increases anxiety.

Key implications

In both home and formal care environments, calmness, a lack of distractions and continuous reinforcement are sound basic principles.
In the home of a person living with dementia, as far as possible, leave things (décor, furniture, etc) how and where they are – maximize familiarity.
When communicating, turn off radios, TVs, etc.
You should be able to sit comfortably facing the person you are speaking to.
Both space and lighting should be adequate.

In formal care situations:

For particular types of communication choose, if possible, related ‘reinforcing’ environments. Formal interviews and consultations should take place in offices, informal chats should take place in lounges, and eating should take place in designated dining areas.
Distracting background noise (from TVs, for example) should be minimised, or it should be possible for people to withdraw from the distraction.
As far as possible, ‘de-institutionalise’ – have seating in public areas in ‘islands’ for little groups, and try to provide a variety of types of chair (to promote choice and comfort). Colour schemes should be calming and ‘non-busy’.