Environmental design effects on Alzheimer symptoms in long-term care residences

As Alzheimer's disease becomes the most extensive and expensive disease in the world, the need to broaden the definition of treatment becomes more and more necessary. Medication is presently the first, and often the last, step in "treatment." But medication alone offers meager solace for the millions of people who live daily with this degenerative disease. The world they live in becomes increasingly strange and their behavior increasingly erratic. In order for most people with this disease to live lives that tend toward normalcy, a combination of pharmacological and non-pharmacological remedies is necessary. Therapeutic settings, activities that make up for cognitive deficits, family involvement, and caregiver approaches must augment medication. One non-pharmacological treatment modality is a physical environment that helps people find their way, jogs their memory, and keeps them safe. This paper recounts an investigative journey to discover what are the components of a multi-approach treatment for Alzheimer's disease, what role the physical environment plays in treatment, and what effects the physical environment has on the behavior of people with Alzheimer's disease. This paper describes and links the work of a small group of investigators and practitioners over the last decade of the 20th century (Zeisel, Hyde, Levkoff 1994; Hyde 1987; Zeisel, 1999; Zeisel and Raia, 2000; Zeisel, Silverstein, Hyde, Powell, and Holmes, 2001).