The Science Behind Why Small Environments Are Better for People with Dementia

Feb 20, 2023 | Signs, Symptoms and Science of Dementia

At first glance, a larger traditional care community can be appealing to a caregiver looking for long-term dementia care for a loved one. The thought pattern often is, “It is a bigger place. Even though it seems impersonal or clinical, it must be better. Right?”

Size does matter, and bigger is not better. Smaller environments are much healthier for people with dementia, and research backs this up.

Why Small Dementia Care Communities are Better

We, at Sundara, believe that small environments matter in memory and dementia care. Smaller settings minimize visual and aural overstimulation, as opposed to larger living spaces which provoke disorientation and higher levels of agitation.

We pay attention to what matters, the small things, such as our resident’s preferences, families, resident histories and stories, natural and frequent interaction, and we believe in the power of touch. All of which are much less obtainable in a larger memory care community.

Research reports that a smaller and more intimate environment, as we have, results in healthier residents with a lower level of anxiety.

Five of the most common causes of anxiety with dementia are:

  1. Changes in routine
  2. Perceived threats
  3. Discomfort or pain
  4. Fear and fatigue
  5. Change in environment

All of these common causes of anxiety can be difficult to spot, monitor, and avoid when a person with dementia resides in a larger memory care environment, which is often a loud, distractive, and confusing space for everyone involved – from residents to staff.

A compilation of studies published in the National Library of Medicine (NLM) compared traditional long-term care to small-scale living facilities and identified that the physical environment is crucial to the overall well-being of people with dementia and that smaller care facilities are more beneficial for daily life.

Small-scale living facilities are found to give residents with dementia the ability to age in place. Smaller environments diminish agitation and reduce harmful behaviors. Reaching full potential, supporting autonomy, quality of life, well-being, and obtaining a possible level of independence are also indicated as important benefits obtained by residing in smaller memory care facilities.

A separate study review published in the NLM reports additional ways that smaller environments positively support dementia care:


Smaller home-like settings are associated with higher participation in activities amongst residents with dementia, and higher involvement in preferred activities (such as hobbies).

ADLs (Activities of Daily Living)

Living in a smaller facility promotes higher functioning in ADLs (e.g., eating, drinking, dressing, toileting).

Private bedrooms, personalized rooms, and larger windows in a more home-like setting add to better eating habits and social engagement (e.g., wanting to stay in the dining area, finish meals, and socialize).

A much slower rate of deterioration in overall daily activities is found in people living with dementia in smaller spaces compared to much larger facilities.


Fewer pathways, a smaller number of exists, and shorter lengths of walking routes lead to less confusion and better orientation.

The highest scores in the studies supporting smaller environments were found in orientation in space, meaning, the ability to navigate through an area and be familiar with the surroundings (i.e., less wayfinding). The scores for eating and drinking closely followed (by about 12.5%), and similar scores were found in orientation in time, communication, and games/leisure activities (about 30% less).


A relaxed and soothing environmental ambiance (e.g., less noise, more home-like settings) leads to more relaxation, less unhealthy sitting for periods of time, less wandering around, less distractive behaviors, and lowered anxiety.


Smaller and home-like environments affect both staff well-being and the way they support residents with dementia.

A smaller environment allows staff to adjust and tailor activities to the different coping capabilities, preferences, and cognitive and physical conditions of individuals. In turn, a person-centered care approach is supported in smaller spaces, which helps to arouse the cognitive abilities of people with dementia.

Staff is a key element when you are looking for a dementia care facility for your loved one. If a residence invests in their staff, they are investing in your loved one’s care needs. Frankly, the best care starts with a well-trained and caring staff as well as leadership. The staff is a telling reflection on the care that is being provided. A smaller working environment (compared to a large-scale memory care facility) makes individual care possible.

See more at What to Look for When Choosing a Memory Care Community

We Are Here for You

The process of searching for the best memory care for your loved one can feel incredibly confusing and frustrating. We understand. We want to help you with your questions, and we welcome you to visit our facility.

If you reside in the Round Rock or North Austin, Texas area, or if you are planning a visit, we encourage you to schedule a tour with us.

Request an tour online, or give us a call at 512-399-5089.