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Designing for Age-Related Cognitive Changes

March 2015
Executive Summary
The Center For Health Design

Cognitive Skills

According to the Emory University Dementia Research Center, some cognitive (thinking) skills decline with normal aging, while others remain stable:


While some cognitive skills generally remain stable throughout the aging process, others decline, including recent memory and processing speed.

Other factors can contribute to cognitive changes:

  • Certain medications can dull thinking;
  • Sensory changes (e.g., loss of hearing) interfere with information processing;
  • Chronic pain affects concentration and attention;
  • Depression and anxiety decrease motivation to learn new things;
  • Stress; and
  • Lack of mental stimulation. 

Alzheimer’s Disease

Alzheimer’s disease is the most common form of dementia and is not part of normal aging. Symptoms worsen over time due to irreversible damage to nerve cells in the brain. 

There  are seven stages associated with Alzheimer’s disease (Alzheimer’s Association, 2015):

  • Symptoms in the very early stages of the disease (Stages 1 and 2) are often very similar to cognitive changes that occur with normal aging, making it very difficult to diagnose.
  • As the disease progresses to Stage 3, family and friends begin to notice cognitive changes such as difficulty performing tasks with a series of steps, retrieving words, losing objects, and remembering information just learned or read.
  • Memory loss, difficulty processing new information, and struggles performing complex tasks grow more pronounced in Stages 4 and 5, but activities of daily living (eating, toileting, bathing, dressing) can typically be accomplished independently.
  • Stage 6 is characterized by severe memory decline, personality changes, and the need for extensive help with daily activities.
  • Individuals with late-stage Alzheimer’s disease (Stage 7) lose the ability to respond to the environment and need constant care as they have difficulty speaking, swallowing, and walking.

The Environment and Alzheimer’s Behaviors

A number of behaviors are characteristic of Alzheimer’s disease, including aggression, agitation, disturbed sleep, confusion, sundowning, and wandering. Growing research evidence suggests interventions in the built environment can reduce these behaviors for many people (Calkins, 2001; Joseph, 2006; Ulrich Et Al., 2008).



Helpful References

Andringa, T. C., & Lanser, J. J. (2013). How pleasant sounds promote and annoying sounds impede health: A cognitive approach. International Journal of Environmental Research and Public Health, 10(4), 1439-1461. doi: 10.3390/ijerph10041439

Calkins, M. (2001).  Creating successful dementia care settings Vol. 1-4. Baltimore: Health Professions Press.

Capachi, C. (2012). Shhhh: UH project tamps down hospital noise, raises patients’ satisfaction. Retrieved from: http://www.cleveland.com/healthfit/index.ssf/2012/08/sssh_uh_project_tamps_down_hos.html

Centers for Medicare & Medicaid Services. (2014). Summary of HCAHPS survey results April 2012 to March 2013 discharges. Baltimore, MD: Centers for Medicare & Medicaid Services.

Flynn, E., Barker, K., Gibson, J., Pearson, R., Smith, L., & Berger, B. (1996). Relationships between ambient sounds and the accuracy of pharmacists’ prescription-filling performance. Human Factors, 38(4), 614-622.

Joseph, A. (2006). Health promotion by design in long-term care settings. Concord, CA: The Center for Health Design.

Ulrich, R., Zimring, C., Zhu, X., DuBose, J., Seo, H., Choi, Y., Quan, X., and Joseph, A. (2008). A review of the research literature on evidence-based healthcare design (Part II). Health Environments Research & Design Journal 1(3), Spring, 61-126.

United States Pharmacopeia (USP). (2010). General Chapter (1066) physical environments that promote safe medication use. United States Pharmacopeia, National Formulary, USP 34–NF 29.

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