Modifying the home environment or community setting for people with cognitive impairments.

We need a great deal of work on household and day care environmental design. Systematic research, linked to the degree of impairment and to individual lifestyles, is appropriate. I have only scratched the surface of environmental considerations, with some attention to distinguishing the issues of home, community, and institutional environments. It is important that we identify some of the unique priorities in each of these settings. To draw conclusions from institutional settings and apply them to the home is to miss some of the strengths inherent in the home. We have come a long way. Once, it was pretty well accepted that older people with dementia were oblivious to their environments. Now, through observation and improvisation, we have come to understand that there are both individual reactions and patterns of responsiveness. In the future, we need to identify environmental design issues appropriate to mild, moderate, and severe levels of impairment; to different types of contexts (urban versus rural or suburban); and to different subcultures and economic groups.