(De)signs of Confusion: Architectural Environments Causing Confusion for People with Advanced Dementia During Wayfinding

Background/Objectives: People with advanced dementia experience difficulties in navigating, while wayfinding is essential for a level of autonomy. A properly designed building has the strength to facilitate this target group in wayfinding. While understanding their wayfinding needs and experiences, and the spatial characteristics (both facilitating and confusing) during the wayfinding process is crucial, this knowledge is still limited. This study mapped challenges that people with advanced dementia encounter on a route to an irregular destination in their familiar nursing home environment, specifically addressing confusing spatial characteristics. Methods: An observational study design with a mixed-method approach was applied. First, a navigation task was conducted to identify places of confusion on the way to the destination (n = 15 participants in four nursing homes). Affective states were captured by observations combined with biometric measurements. Second, both manual and space syntax floorplan analysis techniques were used to identify the spatial characteristics of potentially stressful spaces in nursing homes. Results: Nine participants reached the destination. The most observed wayfinding behaviors were looking at various things and stops on the route, and they were often accompanied by verbal navigational cues. Furthermore, most participants experienced some signs of stress or concentration. In total, eighteen confusing places in the nursing homes were identified. Conclusions: Regarding spatial characteristics supporting or hindering wayfinding skills for people with advanced dementia in nursing homes, this study confirmed some of the findings in the existing research (e.g., minimizing shifting directions for supporting wayfinding), contradicted the existing research (e.g., confusion arose at places with high visibility values), and added new findings (e.g., significantly widening corridors may be confusing). This study revealed that high-visibility areas and squares on the route confuse people with advanced dementia while wayfinding.