Are design choices more important than medication for Alzheimerís patients?

McClatchy-Tribune Information Services

PHILADELPHIA ó Two weeks ago, Mary McCreesh got the kind of news that makes your heart sink: Her 82-year-old father was officially diagnosed with Alzheimerís.

So McCreesh, of Wayne, Pa., spent that Friday afternoon at, of all places, the Philadelphia Home Show. She figured she canít change her fatherís diagnosis, but she can make it easier for him to stay at home, in the house McCreesh grew up in.

"We can see the house through his eyes and find ways to make it easier for him, not knowing whatís ahead."

She was there for a presentation by Theresa Clement, an Ambler designer and aging-in-place specialist whose own father succumbed to Alzheimerís disease in September. Clement learned along the way that her line of work was surprisingly relevant to managing certain symptoms of the disease.

"If I had known at the start what I know now, my dad would have been able to live at home with my mom a year or so longer than he did," Clement said. So, consulting with experts including Dylan Wint, a neurologist and psychiatrist at the Cleveland Clinic, sheís developed what she calls Design Prescription.

"Iím giving people some simple things that are inexpensive to do that can save so much stress, so much time, and make you be able to enjoy your loved ones even as they start to fade away," she said. "If youíre living with someone with Alzheimerís, you donít have time to read all the scholarly research to say, for example, ĎWhat can I do to stop my loved one from peeing in the trash can?í So I try to distill it down."

One in three senior citizens dies with dementia, according to the Alzheimerís Association.

And it doesnít affect just memory. Many people with the disease also have challenges perceiving colors, contrasts, and depth, and organizing visual information.

"The brain takes things the eye sees and executes a wonderfully complicated task of telling us how far one thing is from another and knowing where one thing ends and another begins," said Jason Karlawish, a professor, physician, and associate director of the Penn Memory Center. "As Alzheimerís disease affects the part of the brain that organizes visual images, people have a hard time understanding that."

For some, those are the first symptoms of the disease; others donít suffer visual-spatial challenges until later. Either way, caretakers can help.

"A lot of the challenges people face with Alzheimerís disease could perhaps be more easily solved with design choices as opposed to medication," Wint said.

At the Home Show, Clement pointed out an area rug on the stage.

"This rug is a big trip hazard. This beautiful modern pattern can be an optical illusion," she said.

Contrasts in flooring, like a light rug on a dark wood floor, might appear to be an elevation change. A patterned rug might appear as uneven terrain, and small tiles might appear as scattered objects to be picked up. On the flip side, people may have trouble distinguishing actual elevation changes between rooms, or judging the height of a step; in those cases, a ramp might be helpful.

And in the bathroom, the lack of contrast can have messy results.

"The white toilet on a white floor with a white wall ó thatís what all the pictures on Houzz show, and itís a beautiful look," Clement said. "But for people with Alzheimerís, it can be hard to see white on white on white. So a hamper is often used, or a trash can."

Painting a contrasting color behind the toilet can be an easy fix, she said.

Other ideas she learned from her father: Keep essentials in plain sight. "If you take a door off one cabinet and put the plate, bowl, spoon, and cup there, they can see it."

Also, try to maintain even lighting throughout the day, because changes in lighting can be confusing, and dark shadows can appear as an abyss. (Although, Karlawish noted, some special-care units use that to their advantage, placing black rugs in front of exits to prevent patients from wandering away.)

Wint, who is collaborating with the University of Nevada-Las Vegasí architecture program on a new health-care interior-design program, said research on the issue so far is scarce. For now, much of his advice to caregivers is about things like avoiding multipurpose tools, which can be hard for people with dementia to identify and navigate. He also prescribes minimizing clutteróincluding the visual kind. At mealtime, that means avoiding patterned plates, which can get confusing, and even serving one food item at a time.

But, mostly, said Clement, itís about "having giant empathy."

She learned to look at things through her fatherís eyes, to recognize what might be strange or confusing to them.

"One day, I went to visit my father and he was so agitated. The nurses couldnít calm him down. I went into his room and I noticed that across the way there was an ambulance with its light flashing. So I pulled the shade down, and within a couple minutes, he was fine," she said.

Sheís been giving presentations at home shows, senior centers, and conferences, and hopes to start offering one-on-one consultations. She wants to prove that accommodations donít have to be hospital-like, especially in an era when grab bars, for example, can be disguised as stylish towel racks, soap dishes, or toilet-paper holders.

"I think the process of updating your house is absolutely crucial," she said. And the sooner the better. "Introducing these things and creating a safe environment in stage one, where they can participate in what happens in the house, is really important."