The Quiet Power of Familiarity

Image used under license from Canva

“Familiarity” is one of those words we all nod along to in dementia care. Of course rooms should feel familiar. Of course homes should feel like homes. But when researchers, architects, care providers and family members each picture what “familiar” means, they often picture very different things, a comfy armchair, a particular smell, a small cottage, the sound of the kettle. That gap matters. If we can’t agree on what familiarity is, we can’t reliably design for it. A scoping review led by Dr Joanna Sun at the Wicking Dementia Research and Education Centre (University of Tasmania), with Dr Sumiyo Brennan in Tokyo and Dr Therese Doan in San Francisco, takes that problem head-on. Published in Frontiers in Dementia in February 2025, the review pulls together more than three decades of evidence to ask a deceptively simple question: what does “familiar” actually mean in a nursing home for someone living with dementia?

The Key Findings

The team systematically searched six databases for peer-reviewed studies from 1991 to 2023 on familiarity, dementia and the nursing home environment. They screened 245 publications and included 46 from 19 countries, using a recognised scoping-review framework (Arksey and O’Malley) and PRISMA-ScR reporting. Only 63% of the included papers offered a clear definition of familiarity. Three consistent themes still came through: a homelike environment, a connection to wellbeing, and multisensory integration within the built environment. Together, they describe a place that feels like home, supports emotional and social wellbeing, and uses sight, sound, smell, touch and temperature to reduce confusion and distress.

Familiarity is not nostalgia. It is a design strategy with measurable effects on stress, agitation, mood, mealtime intake and personal care. It is built from small-scale, non-institutional layouts (think cottage, not corridor), personal artefacts and belongings, soft household-style lighting, recognisable sounds and smells, and technology that connects residents to family and culture. Crucially, familiarity is personal, what feels like home for one resident may feel foreign to another so design has to make room for individual identity, not just a generic “homelike” look.

Implementation and Action

For people living with dementia and families: bring meaningful objects, photos and routines into the care setting. Ask staff to note what sounds, smells, foods and music feel like home. For aged and dementia care workers: use familiarity as a clinical tool. Soft lighting, quieter dining rooms, recognisable cutlery and personalised soundscapes can reduce responsive behaviours and support nutrition and hygiene. For designers and architects: prioritise small-scale dwellings, domestic-style finishes, good acoustics, and bathrooms and dining rooms that look and feel like the ones people grew up with. Avoid long monotonous hallways. Plan for technology; Wi-Fi, televisions, tablets, as part of the built environment, not an afterthought. For policymakers and providers: write a clear, shared definition of familiarity into design briefs, accreditation standards and staff training so everyone is building toward the same thing.

The Critical Messages