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Many elderly with senile dementia living in an old people's home or nursing home have problems with spatial orientation and finding their way. The same holds true for confused and disturbed elderly who still live at home. To a large extent these problems result from cognitive and perceptual impairments. However, another important and often underestimated factor is the influence of the built environment. The design of many buildings and outdoor spaces offers insufficient environmental support for route-learning, route-finding and topographical memory, which promotes disorientation. Disorientation is enhanced by repetition of identical units, little differentiation in form, colour and material, and a lack of places with striking perceptual characteristics. This review of the literature on spatial orientation of the frail elderly focuses on dementia patients. It turns out that many guidelines can be offered to reduce spatial disorientation, such as a clear layout of the building, clear functions of spaces and places, adequate contrasts of forms and colours, personalization of places and application of the so called Gestalt Laws. However, empirical research to evaluate the effects of application of these guidelines is still scare.