Lighting, Colour and Contrast: Hidden Drivers of Safety and Behaviour in Dementia Settings
Lighting, colour and contrast are often underestimated in dementia care, yet they profoundly affect how people interpret and respond to their environment. Poor lighting increases falls risk, shadows trigger fear, and low contrast makes navigation difficult. Effective services treat visual design as part of clinical risk management. This article sits within dementia-friendly environment design and supports broader dementia service models focused on prevention and least restrictive practice.
Why visual design matters in dementia
Dementia alters depth perception, colour discrimination and contrast sensitivity. Glossy floors may look wet, shadows appear as obstacles, and poorly lit areas create fear.
Without adaptation, environments inadvertently increase distress and dependency.
Operational example 1: Reducing falls through lighting improvement
Context: A service experienced repeated low-level falls during early mornings.
Support approach: Environmental assessment identified poor transitional lighting.
Day-to-day delivery: Gradual dawn lighting was installed, glare reduced and floor contrast improved.
Evidencing effectiveness: Falls audits showed a sustained reduction and were reported to commissioners.
Colour contrast and orientation
Low contrast between walls, doors and fixtures makes navigation difficult. Strategic contrast supports independence and dignity.
Operational example 2: Supporting bathroom access
Context: Residents struggled to locate toilets independently.
Support approach: Visual contrast was reviewed.
Day-to-day delivery: Toilet doors were repainted in contrasting colours, and fixtures highlighted.
Evidencing effectiveness: Increased independent use and reduced continence incidents were recorded.
Managing glare, reflection and fear
Mirrors, shiny floors and reflective surfaces can cause fear or misidentification.
Operational example 3: Preventing distress caused by reflections
Context: A resident became distressed by their reflection in mirrored surfaces.
Support approach: Environmental triggers were reviewed.
Day-to-day delivery: Mirrors were repositioned and reflective surfaces replaced.
Evidencing effectiveness: Behaviour support plans recorded reduced distress.
Commissioner expectation: visual design reduces avoidable harm
Commissioners expect evidence that lighting and contrast decisions actively reduce falls, incidents and care dependency.
Regulator expectation: environments support dignity and safety
CQC expects lighting and visual design to enable people to move safely and confidently. Inspectors assess how environments prevent harm rather than respond to it.
Embedding visual review into quality systems
High-performing services review lighting and contrast as part of audits, refurbishment and care review processes.