For many people living with dementia in long-term care homes and hospitals, showering isn't just uncomfortable — it can feel overwhelming and even frightening.
They're undressed by someone else, led into a cold, echoing room, and asked to go under the water, without the experience feeling familiar and without understanding why it's necessary. Showering often becomes a source of stress for both residents and the staff who assist them.
To improve comfort for patients, the shower space in the Specialized Dementia Unit at UHN's Toronto Rehab University Centre was redesigned to create a warmer, more calming environment.
While the impact of the redesign and training is currently being evaluated, Dr. Andrea Iaboni, medical lead of the Specialized Dementia Unit who led the project, says anecdotally, the unit is already seeing benefits.
"Our impression is that this new shower space has made a big difference and had a big impact," she says.
"It's more serene, calming and less claustrophobic, and provides lots of options to support patients who are receiving their showers."
The changes were shaped by a recent review from UHN's KITE Research Institute, in collaboration with Associate Professors Maya Desai and Bruce Hinds in the Design for Health graduate program at OCAD University, which shows that thoughtful design can have a profound benefit for patients.
"The OCAD team came and evaluated all the spaces in our unit in terms of how they could be improved for design in dementia, and the shower rooms really stood out as a particular pain point," says Dr. Iaboni, who is also a scientist at KITE and a geriatric psychiatrist.
But there wasn't good evidence around how to design bathrooms for dementia patients. So, Dr. Iaboni led a study that identified 34 best practices for shower and bath design in dementia units.
The research, titled
Best practices for the design and evaluation of bathing spaces for older adults with cognitive impairment in residential care settings: A scoping review, was published in the issue of the Journal of the American Medical Directors Association.
Warmer, more private spaces in bathrooms for patients
Its recommendations include offering music or sounds; concealing institutional elements and storage; installing temperature-regulated, detachable showerheads; creating warmer rooms; providing privacy barriers; and minimizing glare, noise and echoes.
It also covers areas unrelated to design, such as staff training programs, offering residents more choices and mindful communication.
Those principles informed the redesign of the shower room in the Specialized Dementia Unit including:
- A soothing visual design
- A large, accessible shower
- A towel warmer
- Soft lighting that reduces glare
- A designated area for sitting and changing
- Calming art installations
- A spacious layout including an accessible toilet
- A dedicated grooming station
- A heating panel for added warmth
- Slip-resistant flooring
Along with the new shower room, unit staff are being trained on improved dementia shower care procedures. The training includes using personalized approaches and building trust with patients.
Changing environments can be treatment
The bathroom is the latest design change the team has studied. Previous interventions included adding decals to the unit doors and posting pictures of clouds and blue sky to the ceilings for a brighter, friendlier feeling.
"We're constantly trying new design innovations to make things better," says Dr. Iaboni.
The shower renovation is part of a larger design overhaul in the Specialized Dementia Unit that the team hopes to complete over the next few years.
Future changes include creating a quiet activity room that offers patients a place to decompress; making cooking and food more visible in the dining room to provide cues that support eating well and staying hydrated; and improving lighting across the unit to help reduce falls and support good sleeping habits.
Although it's not always top of mind, design can have a large influence on behaviour for people with dementia, says Dr. Iaboni.
"Many people come to our unit because they have responsive behaviours [like aggression or restlessness], and the environment can contribute to that," she says.
However, patients' unwanted behaviours often improve when they are transferred from acute care to dementia-friendly units, Dr. Iaboni adds.
"The treatment, in many cases, is to change the environment."
