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Improving Alzheimer’s and Dementia Care: Environmental Impact

Not using the toilet. There are many reasons a person with dementia may not use the toilet when necessary. If there is a sudden decay in their toileting behavior, they should always be checked medically (for example, for a urinary tract infection). This problem can also arise when they lose the understanding of what mounting sensations to urinate or defecate mean until it is too late.

Another reason can be that they cannot find the toilet when they need to. (Alzheimer’s Association, 2011) Imagine needing to use the toilet in a bathroom with beige floor and wall tiles, and a beige sink, tub and toilet — a common decorating scheme in many homes. A man might under those conditions decide to urinate in a nearby dark brown wastebasket, because he simply cannot figure out where the toilet is. Installing a highly color-contrasting toilet seat and a wastebasket that blends into the walls can help the ADRD patient toilet more successfully and independently.

If the problem is that they can’t remember where the bathroom is, this, too, can be addressed through improved visual cues. In a household with a long hall with several rooms leading off it — including the bathroom — shut all doors except to the bathroom. Keep a bright light on in the bathroom, even during the day. Like a moth to a flame, the person with dementia might be drawn to a well-lit area when they’re wandering around the house looking for the toilet. Consider, too, hanging a sign in a strategic location that says “Mens Room” or “Ladies Room,” with a prominent arrow pointing to the right direction. (Moore, 2010)

Unprovoked assaults. “Out-of-the-blue” assault on a family member, caregiver or another dementia patient is another common issue. This can sometimes be alleviated by understanding the loss of peripheral (or side) vision that ADRD patients undergo. It is the equivalent of “sneaking up on them” to approach dementia patients from the side when they have lost their peripheral vision. Add distorted judgment from dementia, plus maybe an age-related hearing loss, and they may have no idea there is someone else nearby. Tap them on the shoulder and say “hello” to let them know you are there, and they could become so startled that they might just strike out in panic, fear or anger.

Always approach an ADRD patient from the front to get into their field of vision. (Alzheimer’s Association, n.d., p. 163) Before you get close enough to be in their personal space (where, coincidentally, they might be able to reach to hit or kick you), make sure you have their attention. Look them in the eye and greet them by their preferred name, making sure they look back at you before you get any closer. (Snow, n.d.) Remember: moods are contagious, so put a friendly look on your face and make sure you’re showing relaxed, open body language. (Alzheimer’s Association, 2011, Snow, n.d.) If they greet you back with an open and accepting look, then you have permission to stand inside arm’s length. If the person instead looks like he or she wants to hit you, well, you know better than to get any closer just then, right? (Snow, n.d.)

Habilitation Therapy requires creativity to apply to different situations; the above examples are to be considered guidelines. Each person and their environment are unique, and always require a custom approach. (Alzheimer’s Association, 2011) At this point if readers have read through all four articles so far in this series, they possess enough information to start using Habilitation’s principles immediately, if not sooner.


Alzheimer’s Association, Massachusetts/New Hampshire Chapter. (n.d.) Caring for People with Alzheimer’s Disease: A Habilitation Training Curriculum. Watertown, MA: Alzheimer’s Association.

Alzheimer’s Association, Massachusetts/New Hampshire Chapter. (August 2, 2011) Caring for People with Alzheimer’s Disease: A Habilitation Training Curriculum [Training Course]. Lawrence, MA: Alzheimer’s Association.

Alzheimer’s Association. (2011b). 2011 Alzheimer’s Disease Facts and Figures. Alzheimer’s & Dementia, Volume 7, Issue 2.

Moore, B. L. (2009) Matters of the Mind and the Heart: Meeting the Challenges of Alzheimer Care. New York: Strategic Book Publishing.

Moore, B. L. (November 20, 2010) StilMee™ Certification for Professionals: Working respectfully and effectively with people with Memory Loss [Training Course]. Burlington, MA.

Raia, P. (Fall, 2011) Habilitation Therapy in Dementia Care. Age in Action. Vol. 25, No. 4.

Snow, T. (n.d.) The Art of Caregiving. [Video] Florida: Pines Education Institute of Southwest Florida.

Improving Alzheimer’s and Dementia Care: Environmental Impact

Deborah Bier, PhD

Deborah Bier, PhD, has been a holistic psychotherapist and homecare agency director for 25 years. Certified by the Commonwealth of Massachusetts's Office of Elder Affairs and the Massachusetts Alzheimer's Association, she trains dementia caregivers and coaches dementia families. Her particular expertise is in helping multi-generational families apply wellness approaches to managing chronic illness. She holds a doctorate in therapeutic counseling.and is a widely published writer and speaker specializing in health and healing. Find her website at

APA Reference
Bier, D. (2018). Improving Alzheimer’s and Dementia Care: Environmental Impact. Psych Central. Retrieved on February 28, 2020, from
Scientifically Reviewed
Last updated: 8 Oct 2018 (Originally: 17 May 2016)
Last reviewed: By a member of our scientific advisory board on 8 Oct 2018
Published on Psych All rights reserved.