Icon for Key Principle 7

PRINCIPLE 7: Supportive care environments for older people with confusion

NSW hospitals will provide a supportive care environment for the older person with confusion.

Key strategies

Creating supportive care environments

Seven key strategies for creating supportive care environments for older people with confusion have been identified (1-6). A list of specific strategies and tips are included.

An audit of the supportive care environment should be conducted to highlight potential risks and identify potential improvements.

Promote meaningful interactions between the older person, their carer and family and staff

  • The look and feel of the ward is welcoming (clean and tidy, not cluttered) with an obvious reception.
  • Social areas with activities encouraged (not just TV) and the provision of activities.
  • Staff are able to observe patients in all ward areas unobtrusively.
  • Ensure space for carers and family members.

Promote wellbeing

  • Natural light available.
  • Lights that can be adjusted for time of day and care needs, and support sleep.
  • Personal items able to be found/reached, ie glasses, toiletries.
  • Access to safe outdoor area.
  • Views/links to nature maximised (materials, artefacts, colours, artworks).
  • Hearing assistance equipment available.
  • Single sex bays and toilet/washing facilities.

Encourage eating and drinking

  • Access to hot and cold drinks for patients and carers/ families.
  • Access to snacks or finger food.
  • Familiar design of glassware and crockery in contrasting colours and textures to tables and trays.
  • Space to eat away from bedside.

Promote mobility

  • Flooring mat, consistent colour (without speckles, pebble effect or multiple colour blocks/stripes), in contrasting colour to walls and furniture and limits shadows/wet look.
  • Handrails in corridors that contrast with wall colour and are able to be grasped.
  • Space for independent mobility.
  • Small seated rest areas available around ward.
  • Points of interest along corridors such as photographs, tactile artworks etc.

Promote continence and independence

  • Toilet signs visible for all patient areas.
  • Clear signage with pictures and words.
  • Doors painted in single distinctive contrasting colour.
  • Toilet seats, flush buttons and rails in a colour that contrasts with walls and floor in the bathroom.
  • Design of flushes, taps, basins and fittings are traditional and familiar design.

Promote orientation

  • Signs use pictures and words and are hung at patient height.
  • The name of the hospital and ward is displayed.
  • Signs are clear and understandable, in contrasting colours.
  • Pictures and objects are placed to assist orientation.
  • Large clock face with day and date visible from bed.
  • Bedspace that can be personalised – large bed numbers, memory boxes, photographs.

Promote calmness and security

  • Staff notices should be minimised in ward area.
  • Spaces free of clutter.
  • Noise absorbent surfaces used e.g. on floors.
  • Low noise levels.
  • Exits and ‘Staff Only’ areas disguised – doors and handles painted same colour as walls.
  • Least restrictive environment – restraints and bedrails minimised.
  • Safety and security measures in place and as discreet as possible.
  • Hazardous materials locked away.


  1. Australian Institute of Health and Welfare. Dementia Care in hospitals: costs and strategies. Canberra: AIHW, 2013.
  2. Royal College of Psychiatrists. Report of the National Audit of Dementia Care in General Hospitals. London: 2011.
  3. Dementia Services Development Centre. Design features to assist patients with dementia in general hospitals and emergency departments Stirling: 2012.
  4. Fleming R. FI, & Bennett K. Adapting the ward for people with dementia. Sydney: 2003.
  5. Bennett KaFR. The environmental audit tool handbook. Dementia Training Study centres & University of Wollongong, 2013.
  6. Fleming R. An environmental audit tool suitable for use in homelike facilities for people with dementia. Australasian Journal on Ageing 2011;30(3):108-12.