It is reported that more than 400,000 people are currently diagnosed with dementia in Australia at a cost of nearly $15 billion to the economy.
More than half of the residents in aged care facilities are suffering from the condition including an increasing number of younger patients with early onset dementia.
With these figures set to triple over the next 30 years, the need for architecturally designed dedicated dementia facilities has never been greater.
More statistics on the increasing prevalence of dementia are detailed on Dementia Australia website.
In order to establish the specialist design requirements for dementia care, it’s necessary to understand the main symptoms of the condition.
Principally it manifests as impaired memory, reasoning and the ability to learn how to do new things. This affects a person’s thinking, their behaviour and their ability to perform everyday tasks.
These symptoms can be exacerbated by additional physical and sensory impairments associated with ageing such as reduced vision, hearing and mobility.
In addition to blurred sight and the loss of both central and peripheral vision that commonly occur with age, a person with dementia may not be able to interpret what they see correctly.
This can result in a reduced ability to discriminate textures, appreciate depth, see contrast, or process multiple elements to create a recognisable image.
The resultant disorientation and perceived instability can cause anxiety and result in accidents.
Of all the senses, hearing is the one that has the most significant impact on the quality of life for people with dementia. The condition can worsen the effects of sensory changes by altering how the person perceives external stimuli such as noise.
As hearing is linked to balance there is a greater risk of falls in an environment which is overstimulating and noisy. This is either through loss of balance, or through an increase in disorientation.
The experience of dementia is different for everybody, consequently there isn’t a “one size fits all” solution.
Successful design will engender a sense of calm, safety and familiarity, whilst minimising negative distractions.
The key considerations in designing for dementia care include:
- Colour & patterns
Uncluttered clearly defined spaces allowing the person with dementia to see and understand the function of a room before entering minimises confusion and agitation.
Open plans are ideal for this visual accessibility, but not always practical.
Incorporating glazed partitions, doors and windows greatly assists with this, however the glass should be clearly marked as it may not be visible to some people with dementia.
Minimise the use of corridors where practical as they can be particularly confusing, especially if they contain multiple indistinguishable doors. When required, corridor widths should facilitate people with walking aids being able to pass one another. Incorporating identifying landmarks assists with orientation. Make corridors bright and welcoming with a meaningful space at the ends providing a sense of purposeful arrival at a destination.
Ready access to toilets is very important for people with dementia, and they need to be strategically located and easily identified. Plan toilets in a way that facilitates someone with dementia being able to obtain assistance if required without causing embarrassment.
Access to external gardens and outdoor spaces within a secure environment are particularly beneficial to a person with dementia, providing a restful biophilic sanctuary. For more information on the benefits of Biophilia, refer to this article published recently in the Medical Link.
Exposure to natural light promotes vitamin D synthesis and the absorption of calcium in the tissues, as well as maintaining circadian rhythms assisting sleep.
They also promote orientation to seasonal change, important triggers for memory.
Colour & Patterns
Older people need about three times as much contrast as younger people to find objects in their surroundings.
Consequently, using colour and effective colour contrast or patterns can provide people with dementia increased visibility which promotes greater confidence in walking. They can also provide cues and landmarks for orientation and finding destinations, which in turn minimises confusion and agitation.
A useful tool for determining colours of suitable contrast can be accessed on Vision Australia website.
Conversely reduced colour contrast can also be used to hide objects or camouflage them, rendering them virtually invisible to the person with dementia.
This is especially useful for disguising doors within walls that access “out of bounds” areas. Too many strong patterns in any space or certain patterns may overstimulate people with dementia and trigger delusions.
Low light levels impact on a person’s ability to perform daily living activities and contributes to a major proportion of falls in care facilities. It is also associated with “sundowning”, confusion and agitation which increases in the late afternoon and evening.
Doubling the standard lighting levels is recommended, balancing natural light and artificial light to achieve even light levels whilst controlling glare sources. Incorporating light fittings with a domestic appearance also creates a more welcoming familiar environment for the person with dementia. For more on this topic, visit Dementia Enabling Environments. Windows and skylights should be incorporated where possible to promote natural light and access to external views.
The selection of materials can have a significant impact on how the person with dementia perceives any space.
Flooring plays an important role in dementia-friendly design as certain materials can contribute to falls by appearing as a trip hazard. A dark threshold strip may look like a step; shiny surfaces may appear to be wet and slippery.
A patterned floor can be perceived to be moving. A dark surface can create the illusion of a hole.
It is therefore vital to specify floor coverings that are matte and are similar in tone to adjacent surfaces. This will reduce the chance that they are misinterpreted. Non-slip floors are also essential but conversely should not provide too much grip that can resist a shuffling or unsteady walking style.
Reflections can be confusing to the person with dementia. They are known to be perceived as 3D objects intruding frighteningly into their personal space, so shiny or glossy finishes are to be avoided.
Hard surfaces also promote noise which can be totally disabling and stressful for people with dementia.
Materials should be selected that promote sound absorption but reduce sound transmission and reverberation.
Fixtures and fittings, furniture and furnishings in the healthcare setting have traditionally been chosen based on functionality and clinical suitability, rather than creating familiar home-like environments that reduce stress for people with dementia.
The type of furniture in a room will provide cues about the function of the room. Furniture pieces can act as landmarks which assist with orientation, and the placement of furniture can encourage social interaction. Placing furniture to define spaces can also be more beneficial as memory triggers.
Guidelines for dementia design will continue to evolve as our understanding of the condition improves through ongoing study and research.
The fundamental principal currently is to create a homely, familiar environment for the person with dementia that increases their sense of security and comfort without appearing institutional.
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