A dementia-friendly bathroom is one where simple but careful consideration of design can reduce the barriers that people with dementia can face in carrying out daily living activities, greatly improving their safety and preserving their independence for as long as possible.
An estimated 800,000 people in Britain have dementia, with 163,000 new cases diagnosed in England and Wales each year. Dementia can lead to a diminishing ability to perceive danger, and as a consequence, the bathroom can become a dangerous and confusing place. People with dementia are twice as likely to fall, and these falls result in significantly higher mortality rates than for others in the same age group.
The first consideration of a dementia-friendly bathroom must be safety and protection for the individual. Over time, people with dementia are likely to become less aware of risks such as scalding, while the increased likelihood of falls requires a series of adaptations that go beyond simply installing grab rails. Another key consideration is familiarity. If the adaptation results in significant changes, the person with dementia may fail to recognise their own bathroom, leading to confusion and distress, so adaptations for newly-diagnosed residents should be made as soon as possible after diagnosis to allow them to familiarise themselves with their new surroundings.
Similarly, while short-term memory is impaired, people with dementia usually retain good long-term memory, and may therefore be more comfortable with traditional fixtures and fittings rather than modern designs. Push-button flushes or infrared controls, for example, should generally be avoided in favour of familiar-looking handles. Deluge or ‘rainfall’ shower heads are also not recommended as being unable to see where water is coming from can be a cause of distress.
The increased risk of scalding to people with dementia means thermostatic taps and showers are essential, allowing the temperature to be set at a safe level. Any object affixed to a wall could be used as a grab rail in the event of a fall, meaning that low surface temperature (LST) radiators or where possible underfloor heating should be preferred to traditional radiators as a means of preventing burns, and for the same reason all pipework should be covered or boxed in.
People with dementia are also likely to become more sensitive to touch and light, meaning that showers should have an adjustable flow to suit the individual user and harsh lighting should be softened. Lighting that creates shadows can be distressing, and cleverly positioned task lighting above the basin, shower and toilet draws attention to these areas to help users find them easily.
While falls are a risk for all frail elderly people, those with dementia face a fall-related mortality rate three times higher than average. Stepping into a bath or shower tray, with the added danger of a slippery surface, therefore becomes a serious hazard for people with dementia. Installing a level-access shower (with non-slip flooring) in preference to a bath therefore reduces the fall risk, as does the inclusion of a shower seat with sturdy arms. Trips can also occur where there is no change in floor level, as people with dementia often perceive a change in floor colour as a step up or down. The safest solution is therefore a wet room with a consistent floor colour throughout, without a high shine which could lead a user to assume it is wet. Flooring with flecks or small patterns, which could be perceived as dirt or items which need to be picked up, should also be avoided as it could lead to the additional risk of falls.
As well as fall prevention, dementia-friendly bathroom design should also reduce the hazards in the event that a slip or trip does occur. Sharp edges should be avoided as a matter of course. If shower curtains are required, it is recommended to use breathable fabric to prevent suffocation if a person pulls down the curtain as they fall, while PET plastic shower screens are preferable to glass, which is more likely to shatter. Non-reflective or frosted shower screens may be required in a minority of cases, as some individuals with dementia lose the ability to recognise their own reflection which may lead them to believe another person is using the bathroom. For the same reason, any mirrors in the room should be capable of being covered to cater to users with this specific need.
While the primary consideration in a bathroom adaptation must be the safety of the individual user, steps must also be taken to reduce the risk of damage to the building. Memory loss in those with dementia may cause them to forget to switch off taps or showers leading to unintentional flooding. Automatically shutting down after 30 minutes of continuous operation, dementia-friendly showers ensure water is not left running.
Typically, grab rails and toilet seats for those with dementia have always been specified in red as this has been seen as the preferred colour. However, leading design experts, occupational therapists and academics specialising in dementia now agree that this is a myth. In fact, any colour can be used so long as they contrast strongly enough with the wall behind them. Using different colours is vital in clearly defining each section of the bathroom and assisting the user to differentiate between shower and toilet areas. A high light reflecting value (LRV) between different surfaces is essential, with a minimum of 30 points of difference providing the required contrast. The toilet should be a different colour to the wall behind it, and the seat should be in a third colour. Toilet roll holders and grab rails need to contrast strongly with the walls they are attached to, which also provides a visual reminder to use them. Similarly, the shower curtain and seat should be in different colours, each contrasting with the wall behind, to make the shower area easy to locate.
Products designed for users with dementia don’t cost any more than those needed for a standard adaptation. However, it is imperative that the right products are selected, following the guidelines carefully, to maximise safety and comfort for residents with dementia.
• You can download AKW’s helpful guide to designing a dementia-friendly bathroom as a PDF, by clicking here
• Visit the AKW showcase page for a range of thoughtfully designed accessible bathroom and kitchen products
• Independent Living has an area dedicated to bathing, showering and toileting for people who need assistance