Table 6.

Orientation to space.

Study, country	Theme, environmental strategy	Sample/setting	Research design	Main findings
Netten (1989), UK	Architectural layout: Standardised measures of social, personal and architectural features administered to staff at different residential settings	One hundred and four people with moderate–severe dementia. Six group homes and seven communal homes	Staff rated wayfinding to four significant locations	Communal homes: Physical disability, medication, number of zones/exits, simple decision points accounted for wayfinding (p < .03) Group homes: orientation, mental ability, physical disability, light, elaborate decision point and length of routes accounted for wayfinding (p < .06).
Elmståhl et al. (1997), Sweden	Architectural layout: Compared units for general design, space, lighting, noise, communication area, floor plan using screening scale	One hundred and five people with dementia (MMSE 11.3–15.7) Eighteen group living units	Observed patients before, six months and one year rated using disorientation measure	Corridorlike design associated with higher disorientation/confusion overall. L-shaped corridor associated with less disorientation
Marquardt and Schmieg (2009), Germany	Architectural layout: Existing architectural layout of different facilities	Four hundred and fifty people with mild–severe dementia (global deterioration scale) Thirty nursing homes	Nurses rating residents’ abilities to employ wayfinding skills in five tasks based on observation	Increased number of residents affected orientation abilities but not for mild stage (p < .05) Straight circulation over changes in direction improved orientation (p < .05). One kitchen/dining area improved wayfinding (p < .05)
Namazi and Johnson (1991), USA	Familiar cues: Cueing to public toilet, including (1) sign ‘restroom’, sign ‘toilet’, (2) picture of toilet/tank, (3) arrows and word ‘toilet on floor’	Forty-four people with probable dementia Alzheimer’s type, early to advanced stages Two specially dementia units	Observation using checklist with three questions (look at sign, enter toilet and use toilet), any help recorded	Descriptive statistics: Arrows most effective for observing, entering and using toilet. Sign with word ‘toilet’ second effective. Graphic least effective Yellow background and blue writing more effective for signs
Nolan et al. (2001), USA	Familiar cues: Portrait-type photograph of each participant from early childhood plus large print sign with residents name on bedroom door	Three people with severe dementia (MMSE M = 5.7) Forty bed locked special care unit in residential home	Direct observation of residents’ ability to locate their room	Room finding abilities increased from 34 to 85% for all three residents. Stabilised at 100% accuracy for all residents within a few days of trial beginning
Namazi et al. (1991), USA	Familiar cues: Significant and familiar objects of personal memorabilia versus non-familiar objects (chosen by staff) displayed outside bedroom	Ten people with mild–severe dementia (clinical dementia rating scale) Corinne Dolan Alzheimer’s Centre	Observations of ability to find room in 3 min when asked by observer	For people with severe dementia, neither cue helped. Those in mid stages showed mixed results across cue types. Ability to locate bedroom for those mildly impaired was benefitted equally by both sets of objects on display
Gibson et al. (2004), Canada	Familiar cues: Environmental renovation including texture/colour/structure at entrance to each room being individualised	Nineteen veterans with moderate dementia (MMSE) Secure dementia care facility within chronic care hospital	Measured ability to find own room and intrusion into others’ rooms monitored. Pre/post, interviews	Eight-four per cent could find room first time, three couldn’t after three attempts (no p values available). Reported using structure/colour of entrance to help
Caffò et al. (2014), Italy	Familiar cues: Compared (1) assistive technology with lights and remote controlled sound, (2) familiar objects and right/left location instructions along two familiar routes	Four people with moderate–severe dementia (MMSE) Residential care facility	Wayfinding measured by number of sections travelled correctly and cues needed	Assistive technology significantly improved orientation over the familiar objects condition (p < .01). Familiar objects rated significantly less environmentally disruptive (p < .001)
Chafetz (1990), USA	Distracting cues: Grid made of black tape on white floor near exit doors	Thirty people with moderate–severe dementia (global deterioration scale scores/MMSE scores) Thirty bed dementia care unit	Frequency of door openings per 24 h measured by staff. ABA repeated measures	No effect of intervention. Found significant differences in door contacting over time (p < .001) with more contact in grid condition
Hewawasam (1996), UK	Distracting cues: Black insulation tapes in two different grid configurations (vertical/horizontal) on floor in front of exit doors	Ten people with various dementia diagnosis (MMSE) NHS trust hospital ward	Observation: Crossings versus non-crossings of the grid, repeated measures design	Horizontal grid significantly effective in reducing contact with exit door (p < .01), vertical grid less so (p < .05)
Hussain and Brown (1987), USA	Distracting cues: Masking tape in different grid patterns in front of exit doors, laid by authors	Eight males with dementia, one moderate dementia, seven severe (MMSE) Mental hospital ward	Observation by researchers, whether crossed grid. Repeated measures design	Eight-strip grid reduced crossing significantly from baseline (p < .01). Trend towards reduced crossing for three, four, six strips of tape (from 98 to 45%)
Dickinson et al. (1995), USA	Distracting cues: Horizontal mini blind and cloth barriers to cover up the panic bar/doorknob of exit doors on a corridor	Seven people with dementia	Observation of frequency of exit attempts and behavioural notes	Blind reduced exit behaviours but not significant (p < .07). Cloth barrier significantly reduced exiting (p < .001)
Mayer and Darby (1991), UK	Distracting cues: Full length mirror versus reversed mirror versus no mirror 1 foot from exit door	Nine people with severe dementia (MMSE < 12) Psychogeriatric ward	Observational behavioural measure of mirror/exit door contact	Less contact with door for mirror compared to no mirror (p < .02). Less contact with door in reversed mirror condition but not significant (p < .062). Higher number of approaches in mirror condition
Kincaid and Peacock (2003), USA	Distracting cues: Wall mural painted over exit door to disguise the doorway. Sea scene	Twelve people with dementia Special care residential unit in nursing home	Observational measure of reduced exiting behaviours at the doorway. Pre/post renovation	Significant decrease in door testing overall (p = .024) and in two particular door testing behaviours: calmly testing doors (p = .024) and employing a team effort to exit (p = .033)

MMSE: Mini Mental Status Exam.