International Psychogeriatrics

Focus on mental health issues in long-term-care homes

Long-term care for people with dementia: environmental design guidelines

Richard Fleminga1 c1 and Nitin Purandarea2

a1 Dementia Services Development Centre, HammondCare, Hammondville, NSW, and Faculty of Health and Behavioral Sciences, University of Wollongong, Wollongong, NSW, Australia

a2 Manchester Academic Health Science Centre, Psychiatry Research Group, School of Community Based Medicine, The University of Manchester, Manchester, U.K.


Background: A large and growing number of people with dementia are being cared for in long-term care. The empirical literature on the design of environments for people with dementia contains findings that can be helpful in the design of these environments. A schema developed by Marshall in 2001 provides a means of reviewing the literature against a set of recommendations. The aims of this paper are to assess the strength of the evidence for these recommendations and to identify those recommendations that could be used as the basis for guidelines to assist in the design of long term care facilities for people with dementia.

Methods: The literature was searched for articles published after 1980, evaluating an intervention utilizing the physical environment, focused on the care of people with dementia and incorporating a control group, pre-test-post-test, cross sectional or survey design. A total of 156 articles were identified as relevant and subjected to an evaluation of their methodological strength. Of these, 57 articles were identified as being sufficiently strong to be reviewed.

Results: Designers may confidently use unobtrusive safety measures; vary ambience, size and shape of spaces; provide single rooms; maximize visual access; and control levels of stimulation. There is less agreement on the usefulness of signage, homelikeness, provision for engagement in ordinary activities, small size and the provision of outside space.

Conclusions: There is sufficient evidence available to come to a consensus on guiding principles for the design of long term environments for people with dementia.

(Received November 19 2009)

(Revised January 25 2010)

(Revised February 09 2010)

(Accepted February 11 2010)

(Online publication May 18 2010)


c1 Correspondence should be addressed to: Richard Fleming, Director, Dementia Services Development Centre, HammondCare, Judd Avenue, Hammondville, NSW 2170, Australia. Phone: +61 2 8295 0380; Fax: +61 2 9825 1044. Email: