Designing for dementia: a multiple case study approach to explore how care home environments may influence wandering

Up to 60% of people living with dementia ‘wander’ in care homes. Previously perceived negatively, wandering is increasingly recognised as a meaningful activity, driven by enjoyment, routine, and social connection. Care home environments can support or hinder wandering and orientation, influencing autonomy and wellbeing. This study aimed to describe environmental features that can influence orientation and wandering within care homes. This study developed and employed an evidence-based environmental mapping tool within care homes, recruited to ensure representativeness across ownership, funding, and location. The bespoke tool integrated design criteria from existing literature, such as scale and domesticity and expert experience, addressing orientation and wandering. Visual floor plans were created, and findings were presented in alignment with environmental strategies from a realist review. The 80-item ‘Wayfinding Environmental Mapping Tool for Care Homes’ was developed and used in seven care homes in England (Midlands and the North). Size, layout, and design varied across care homes. Some closely resembled domestic settings, while others had a clinical appearance. Modifiable and non-modifiable features shaped care home environments. In some homes, residents could independently access kitchens, laundry rooms and gardens; whilst others restricted access. Clear signage, natural lighting, and visible routes were observed and have the potential to support wandering and orientation. This study applied the novel ‘Wayfind Tool’, revealing significant heterogeneity in care home environments. We found that modifiable features like personalisation and accessible seating offer cost-effective ways to create supportive, “home-like” settings, aiding orientation and wandering. Given the observed heterogeneity and the crucial environment-behaviour interaction in dementia, future care home research should increasingly integrate environmental mapping methods. Our freely available ‘Wayfind Tool’ serves descriptive purposes and has potential as an audit instrument to identify areas for improvement, highlighting the environment’s role in supporting wandering and orientation.