Preparing the Environment for Dementia: The Importance of Contrast
In Montessori based dementia care, we focus of the Montessori principle of creating a prepared environment. This is my first entry in my series with tips, called “Preparing the Environment for Dementia,” which focuses on how to prepare an environment for a person with dementia to ensure as much independence, success, and decreased frustration as possible.
One thing that care partners often do not know is that elders in general and most people with dementia have a loss of contrast perception. This means their ability to see the edges of things when they are the same color or shade as what is around them is diminished.
Why does this matter? Let’s use an example from a common issue found in caring for people with dementia, incontinence:
When I talk to a care community or a family about a person with dementia, I am often told that the person with dementia has “become incontinent,” which means they do not have enough voluntary control over urinating and defecation. The things people believe indicate incontinence are that the person seems to forget to go to the bathroom and has accidents, they get to the toilet but miss the toilet, or they are going to the bathroom in things other than a toilet such as urinating in a potted plant. These people are then often immediately put in adult diapers and are often told not to use the bathroom. Sometimes in care communities the person with dementia is prevented from going to the bathroom because it is easier for the caregivers to clean up an adult diaper than a toileting accident.
I have seen far too many people with dementia have to go to the bathroom, only to have a care partner say to them, “It’s okay, you can go to the bathroom right here in your diaper.” The devastated and ashamed look on the persons face as they are expected to go to the bathroom in their own pants, in front of people, is heartbreaking. This does not always need to happen!
Contrast can be a main contributing factor to incontinence. Often bathrooms have a white toilet with white, grey, or cream floor tile and walls. Since people with dementia have loss of contrast perception, they often cannot see the toilet because of the white toilet in the white or cream bathroom. Then they either do not use it or attempt to use it and miss the toilet. Sometimes other things look more like a toilet to them, like a potted plant in the corner of the white bathroom. You can often decrease incontinence by simply paining the wall behind the toilet a contrasting color like red, blue, or green. You could also just try to change the toilet seat and lid to a different color, which can be found in your local home improvement store. I would not recommend putting a rug of a contrasting color down on the floor by the toilet because that could cause a falling hazard. Another way that contrast matters in toileting is that the door handle to the bathroom door may be too close to the same color as the door. You could try replacing the door handle with a red handle, or paint the handle to provide more contrast.
In my book, Creative Connections in Dementia Care®, we note: “Contrast helps people with low vision distinguish between different objects in the environment. It can also help draw the attention of people who have difficulty staying on task or establishing orientation. Use contrast as a tool whenever you can. Provide color contrast at the table edges and level changes so they are easy for people to see. Use color to emphasize what's important.”
Elders also have a hard time distinguishing between colors in the cooler range, so it is good to avoid using yellow for much of anything or using blue and green together. I also recommend varying things that are close together not just by color but by also by size, texture, and shape. As seen in the photo in this article, the buttons being used for the art project are not only different colors, but different shapes. For example, for some people, having the handle of a fork in blue and the handle of a spoon in red will provide not only contrast, but differentiation so it is easier for them to use the utensil they are looking for.
Here are some contrast tips for common issues:
Trouble with eating enough, interest in food, or agitation during eating: Serve food on red plates that contrast well with the food and put the plate on a white or tan tablecloth so the plate of food is easy to see. Also, do not serve foods that are all the same color, such as white mashed potatoes and white fettuccini alfredo pasta.
Trouble finding or putting away dishes or clothing: Often the handles for cabinets and drawers are too close to the color of the cabinet. Change out the handles to provide contrast. (Or, just take the doors off the cabinets in the kitchen so they can see the glasses.)
Trouble finding their way or identifying rooms: Make sure signs are at least 16 or 18 point font and the background of the sign is a light color to contrast with the black letters and that the color of the sign is not the same color as the wall or door it is posted on.
Trouble remembering names: Everyone- family and friends- can wear a nametag. Simple tags with large black font on a white background work.
Trouble with tripping often: Look at the flooring in the room. Some rugs have too much contrast or too much pattern so a person with poor vision may think there are holes in the floor or items in their way. However, a change of flooring color from room to room can help with finding and differentiating rooms from one another.
I hope these suggestions help you improve the environment for your care partner with dementia. If you have questions about the how to improve contrast in the environment for your loved one with dementia, please fill out the contact Rev. Katie form on the right side of my site. I offer in-person and skype consultations by the half or full hour.