Dementia writer Wendy Mitchell warns care homes nostalgic murals are 'confusing and disturbing'

A growing number of care homes in the UK are decorating their walls with nostalgic murals of street scenes, but dementia writer Wendy Mitchell warns they may be ‘confusing and visually disturbing’ to people with dementia.

The trend for reminiscent murals of 1950s high street shop fronts or quaint village and town scenes seems to be sweeping the residential care sector due to the belief they reduce stress and anxiety in residents.

However some dementia experts worry the reverse could be true and these huge images are actually causing a lot of mental distress.

Care consultant Anna Park, says: “I understand the idea of bringing reminiscence therapy to life with colourful, nostalgic murals but I think the scale, design and permanence of them are rarely dementia friendly with many commercial companies jumping on the bandwagon without an understanding of the main principles of good dementia design.”

She is concerned about the impact of these murals as they can overpower the room and over stimulate the senses.

Reminiscence has become a buzzword

“Some of the twee 1950s and 60s ‘chocolate box’ type scenes are so busy and really don’t portray the decade they claim to represent. Part of the problem is that reminiscence has become a growing trend and a buzzword without people necessarily understanding the purpose behind it.

“It is not about taking people back to a random view of a random decade and leaving them there. I wouldn’t want to feel I was daily stuck in a scene I couldn’t escape from.”

Wendy Mitchell, who wrote the powerful Alzheimer’s memoir ‘Somebody I used to know’ is living with early on-set dementia. She has seen some of these murals and says: “I really hate them. They are so confusing. What’s wrong with a nice painting or simply a window with a view? Why make us think we’re somewhere else?”

The nostalgic murals are designed to trigger memories, however Ms Mitchell points out: “Reminiscence is a dangerous subject unless you know the person as you may want to forget certain eras of your life.”

Dementia can affect people’s vision as they can become less sensitive to differences in colour and patterns can make them confused. Black tiles on a floor may be perceived as holes in the floor and people may not recognise their reflection in a mirror.

'People think things will help when they simply confuse'

Ms Mitchell says: “Many don’t realise that a switched off large screen TV mounted on the wall looks like a hole in the wall, just like a black mat on the floor can look like a hole in the floor. For the kindest reasons, people think things will help when they simply confuse.”

Instead of murals, she would like to see small pictures with details which spark conversation and which are tailored to the individuals living there. Ms Park agrees, saying: “I think it is good to have pictures of nostalgic images on the wall to trigger memories and discussion as we all do in our homes but I question the need to make these into life-size murals.

“If you are already feeling disorientated, why would you want to be in a room where you look at the wall and always see a policeman on a bike riding towards you or a large retro aeroplane parked in your dining area?

“I understand and agree that people with dementia can benefit from areas with bright contrasting colours and visual stimulation but if I had to live with a large busy mural I’m sure there’d be times when I’d want to simply ‘turn it off’.

She doesn’t discount murals entirely, conceding that some can help residents to identify certain rooms in a home like the hairdressers or a bar area including the use of door surrounds to differentiate residents' bedroom doors in a corridor of identical looking doors. “As a navigation tool to indicate the function of a room they have some purpose, but they must be contextually relevant and not add to a sense of bewilderment,” she says.

Some murals are of landscapes and nature and Ms Park believes these are “far more beneficial, we know access to nature is essential for feelings of wellbeing and as long as they have a frame around them to show they are a picture rather than the real thing then they can enhance a wall with no windows or view”.

Think about 'the perspective of the person with dementia'

Rachel Thompson, Admiral nurse professional & practice development lead at Dementia UK, advises care homes to always think about any room layout or decoration from “the perspective of the person with dementia”.

She says: “Large murals for example, which depict snapshot scenes of a different place or reality, may cause confusion or anxiety for someone with dementia if they are unable to interpret the image, or think they are in a different place to where they currently are.

“It is important to make sure that murals are not too big and relate to the context in which people with dementia live.”

She agrees that pictures with frames may be much more beneficial.

'Extraordinary images may cause distress'

Professor June Andrews, who spent a decade as head of Stirling's Dementia Services Development Centre, an international centre of knowledge and expertise dedicated to improving the lives of people with dementia, also urges caution when using murals in care homes.

She says: “Experiencing artworks could help to reduce stress, but the effect is very personal so you must be careful in communal settings. Not everyone will like what you choose, so something neutral makes common sense, even if others might think it is boring. Extraordinary images may cause distress. I’ve seen a wall painted to look as if there is a welsh dresser. When I asked, I was told ‘if there was a real welsh dresser they might break the plates and cut themselves’.

“Hyperreal pictures, also known as "trompe l'oeil" are meant to deceive the eye. It can be fun for those of us who are well and like to be teased. In dementia, it is only justifiable if, for example for safety, you want to disguise the exit door to look like a book case, to prevent unwanted exiting. Otherwise it just adds to confusion. No one with dementia wants to live in a film set or be made more confused.”

Martin Quirke is an architect and interior designer at the Dementia Services Development Centre at the University of Stirling.

He says: “Myself and my colleagues at the Stirling have a strong view that design for dementia should be normal and familiar, but certainly not patronising – as many of the false pubs and shop murals we keep seeing more of, tend to be.

“Formal published research on the matter is fairly slim but what knowledge there is available leads us to believe that false-reality (or false perspective) murals are likely to be the most problematic, with potential negative impacts on the person’s spatial perception, and balance arising as a result.

“There have been some informal reports of circumstances where people with dementia have been confused and frustrated as a result of their attempts to operate a false window or door, or when trying to take a false book from ‘library’ wallpaper.”

A care home should feel like a home

In the absence of a robust research evidence base, he suggests that an important first step for a care home when thinking about whether to have murals on their walls is to listen to “people with dementia who are willing and able to tell us about their experiences of murals”.

Above all, it is crucial, as Anna Park says “to remember a care home must feel like a home”.