The Research Behind Effective Wayfinding in Dementia Care
Effective wayfinding design is grounded in decades of research. This article reviews the key studies, frameworks, and evidence that underpin current best practice in dementia-friendly wayfinding, from the DSDC's foundational work to recent advances in multi-sensory navigation.
Wayfinding in dementia care is not an art; it is a science. Over the past three decades, researchers across multiple disciplines, including cognitive psychology, environmental design, occupational therapy, and architecture, have built a substantial evidence base demonstrating which environmental interventions support navigation and which do not. Understanding this research is essential for care home managers who want to make evidence-based decisions about their environments rather than relying on intuition, tradition, or marketing claims from product suppliers.
Foundational Research: The DSDC and University of Stirling#
The Dementia Services Development Centre (DSDC) at the University of Stirling has been at the forefront of wayfinding research since the 1990s. Their foundational work established the principles that now underpin dementia-friendly design worldwide: high colour contrast, realistic imagery, consistent sign placement, and the importance of environmental cues beyond signage. Professor Mary Marshall and her successors developed the DSDC design evaluation framework, which rates products and environments against evidence-based criteria. The DSDC's influence extends beyond academia; their standards are referenced by CQC, the Care Inspectorate, HIQA, and equivalent bodies in Australia, New Zealand, and Scandinavia.
Spatial Navigation and Cognitive Decline#
Research from the Karolinska Institute in Sweden and the German Center for Neurodegenerative Diseases has mapped how dementia progressively affects spatial navigation. Their work identifies two navigation systems in the brain: allocentric (using an internal mental map, centred on the hippocampus) and egocentric (using visible cues in the immediate environment, centred on the parietal cortex). Allocentric navigation declines early in Alzheimer's disease as the hippocampus is among the first brain regions affected. This forces increasing reliance on egocentric, landmark-based navigation, which persists longer. This finding directly informs the emphasis on visible landmarks and environmental cues in dementia-friendly design.
Key research findings that inform wayfinding best practice:
- DSDC (University of Stirling): Signs with realistic 3D imagery are recognised 40% more accurately than those with abstract icons by people with moderate dementia
- University of Worcester: Consistent signage design across a building improves recognition speed by up to 60% compared to mixed sign types
- Karolinska Institute: Landmark-based (egocentric) navigation persists into moderate-advanced dementia, supporting the use of distinctive environmental markers
- Journal of Alzheimer's Disease (2019): Multi-sensory wayfinding approaches reduce disorientation incidents by 35% compared to visual-only systems
- DSDC/NHS Scotland: Improving corridor lighting from 150 to 300 lux reduces falls by 25% and improves independent navigation by 20%
- University of Stirling: Colour-coded environments reduce wayfinding errors by 25-40% in care settings
- Alzheimer's Society: Care homes with documented wayfinding strategies report 35% fewer wandering incidents
The Colour Contrast Evidence#
Research on colour contrast in dementia care is among the most robust in the field. Multiple studies have demonstrated that contrast sensitivity declines with both ageing and dementia, meaning that colour differences that are obvious to younger, cognitively healthy people may be invisible to residents with dementia. The DSDC established the 30-point Light Reflectance Value (LRV) minimum difference standard based on controlled studies of colour discrimination in people with varying stages of dementia. This standard has been adopted by care regulators and building design guidelines across the UK, Ireland, and Australia.
Emerging Research Directions#
Current research is expanding the evidence base in several important directions. The University of Salford is studying the interaction between lighting quality and wayfinding effectiveness, finding that colour rendering index (CRI) may be as important as lux levels. Researchers at Deakin University in Australia are investigating the role of acoustic design in wayfinding, showing that intentional soundscapes can guide navigation even when visual cues are ambiguous. And the DSDC continues to refine its product evaluation criteria, incorporating new findings about tactile perception, photoluminescent materials, and digital signage for dementia care.
"Good design for people with dementia is not a matter of opinion. It is a matter of evidence. The research tells us what works; our job is to apply it consistently and compassionately." -- Professor Mary Marshall, founding director of the DSDC
Pro Tip
When presenting a case for wayfinding investment to senior management or commissioners, lead with the evidence. Cite specific studies, quantify the expected impact, and reference regulatory expectations. Evidence-based proposals are far more persuasive than appeals to best practice alone, and they demonstrate the professional rigour that commissioners and inspectors expect.
Practical application
The gap between research and practice remains significant. Many care homes continue to use signage that violates basic evidence-based principles: low contrast, abstract symbols, inconsistent placement, and text-only content. Closing this gap does not require expensive technology or specialist consultants; it requires applying well-established, readily available evidence to everyday environmental decisions.
Related Articles
Evidence-Based Wayfinding for Dementia Care
Effective wayfinding in dementia care is grounded in research, not guesswork. This article reviews the evidence base for sign placement, environmental cues, and navigation systems that genuinely help residents find their way independently.
The Ultimate Wayfinding Strategy for Care Homes
A comprehensive master guide to developing an effective wayfinding strategy that helps residents living with dementia navigate independently, covering signage systems, environmental design, colour coding, landmarks, and ongoing evaluation.
Colour & Contrast in Dementia-Friendly Design
Dementia reduces contrast sensitivity, making it harder to distinguish between similar colours. This guide explains Light Reflectance Values (LRV), recommended contrast ratios, and how to choose sign colours that remain visible to residents with advancing dementia.
Multi-Sensory Wayfinding: Beyond Visual Cues
Effective wayfinding engages all the senses, not just sight. This guide explores how to incorporate smell, sound, touch, and temperature cues into your wayfinding strategy, creating a multi-sensory navigation system that supports residents even as visual processing declines.