Housing

Housing for Patients With Dementia

I study Interior Design and was naturally drawn to 'Chapter 11- Community Well-being: Living Arrangements and Social Interactions' because it discussed housing options and design. One of my favorite Interior Design courses was Universal Design, and I often referred back to what I learned while I watched my grandparents struggle while living in a condo that was not built with aging in mind. For this post, I decided to explore a topic other than Universal Design. I chose to research Dementia Friendly Design, which combines two of my greatest passions, Sociology and Interior Design! This type of design provides environmental treatments for elders with dementia.



(Salford Institute for Dementia)

 

Just as there is an increasing availability of housing options for seniors, there is also increasing research indicating the importance of design on quality of life. For seniors with dementia living in special care units, a supportive environment can make a difference in a patient’s health and the ability for staff to manage their care (Hunt, 2011).

Over 3 million elders have problems with activities of daily living (ADL’s) due to dementia (Hooyman et al, 2015). While most people relate dementia with loss of memory, it is not the only deficit associated with disease. “Dementia is characterized by an impaired identification of incoming stimuli (perceptual deficits), resulting in distorted perceptions,” (van Hoof et al, 2010, p 1247). These perceptual deficits can lead to anxiety, disorientation, and confusion which is likely to prompt paranoid or aggressive behavior.

Patients with Alzheimer’s disease can be sensitive to environmental frustrations because they are more affected by their environment, especially at the early and middle stages of the disease. Behavioral problems associated with dementia can be treated with environmental techniques especially by creating supportive environments. “The environment should be used to reinforce behavior and to help people follow through actions and decisions,” (Hunt, 2011, p 16).

There is a large body of research that supports creating spaces for seniors with dementia by using a number of design techniques. These techniques include:

(Chmielewski, 2014)

• Residential scale and features
• Variety of social spaces and personal places
• Sensory Comprehensibility
• Proper daylighting and daylight exposure
• Air quality
• Acoustical materials
• Open floor plans
• Walking paths and healing gardens
• Independence

Residential Scale and Features

It is important for care facilities to remain as homey as possible (Barnes, 2006) (van Hoof et al, 2010) (Hunt, 2011) (Schwarz and Brent, 1999). The use of art and design to create a more homely space can create a calming environment for seniors. Seniors should have the option to bring their own personal items, including furniture, into their personal living spaces. Small residential scales will also assist with patient’s wayfinding--ability to navigate the space (Passini et al, 2000). Residential features will also help patients feel a sense of belonging while creating a positive mood in which residents may have access to memories.

(Chmielewski, 2014)

 

Variety of Social Spaces and Personal Places

Findings from Barnes’ (2006) study “highlight the importance for design guidance to emphasize the need for a variety of spaces- some quiet, some stimulating, some that foster small groups- enabling residents to exercise their need for personal space,” (p 600). This is because patients in special care units can easily become overly stimulated due to the impaired identification of incoming stimuli associated with dementia. Because patients in special care units spend so much of their time around other patients, it is important to have at least three common spaces of different scales as well as personal places including private bedrooms and quiet sitting areas where patients can still observe other elders (Schwarz and Brent, 1999).

Sensory Comprehensibility

While it is true that Alzheimer’s patients can easily become overly stimulated from sensory stimulations, it is important that the indoor environment is not bland. There are several design techniques that can create a calming yet quality environment. Lighting and “the supply of fresh air, elimination of bad odors, reduction of background noise and other aspects of the acoustical environment are recognized as being important to behavior and well-being of people with dementia,” (van Hoof et al, 2010, p 1259).

Adequate daylight in dementia care settings is one of the most effective environmental techniques for managing behavior in seniors with dementia. Sundowning, “a confused state when persons with Alzheimer’s disease become fatigued later in the day when natural light levels are lower” (Hooyman et al, 2015, p 125) can be offset by design that allows for adequate daylighting in living spaces. An increased level of light can improve cognition, mood, behavior, and vision (van Hoof et al, 2010). Proper lighting can also limit the number of falls for seniors, especially those with dementia.

 

(Chmielewski, 2014)

Air quality can effect a patient’s senses and should be kept in mind during design. “Unpleasant smells are known to cause overstimulation, and should be removed from the home as much as possible,” (van Hoof et al, 2010, p 1252). Materials such as flooring, should be easy to clean to help eliminate unpleasant smells. While some smells may be over stimulating, there is also research as to the benefits of aromatherapy. When smells are familiar to residents, they enjoy them (Schwarz and Brent, 1999) and in some cases may provide cognition benefits. Smells can assist with wayfinding, i.e. the smells of cooking may help residents navigate towards the kitchen.

Acoustical materials also provide an important aspect of design for dementia facilities. Since quieter environments are more calming and enjoyable for residents, facility design should account for acoustical solutions. Sound absorbing flooring, curtains, and wall coverings can limit reverberation and drop overall noise levels. These materials will also make the care unit feel less institutional and homier.

Open Floor Plans

Open floor plans allow increased daylight while also assisting with wayfinding (van Hoof et al) (Passini et al, 2000). Open floor plans allow residents “who have lost their cognitive mapping abilities [to] obtain the information to make their wayfinding decisions,” (Passini et al, 2000, p 697). Open floor plans allow for reference points to be easily seen, a design technique that is especially important to Alzheimer’s patients who operate on a sequential basis. Design techniques that assist with wayfinding increase the independence for residents and lower anxiety and agitation.

Walking Paths and Healing Gardens

(An inspirational healing garden in Toronto)

Access to outdoor environments can increase the overall health and quality of life for seniors with dementia. For facilities that have access to safe and secure outdoor environments, healing gardens can create a sanctuary for patients that often feel confined by their indoor environment (Schwarz and Brent, 1999). Healing gardens can also create sensory stimulation that may help elders reminisce on old memories. Special architectural arrangements including patios, terraces, and gardens can also increase an elder’s exposure to daylight. Outdoor walking paths can transform wandering, which is commonly associated with dementia, into an activity while allowing seniors the benefits of the outdoor environment.

 

Independence

The most important part of designing for dementia is that residents remain as independent as possible. Accessibility techniques such as slip proof flooring, handrails, ­­and ramps will create a safer environment in which staff members are more likely to allow residents to move about by themselves making independent choices (Schwarz and Brent, 1999). Open floor plans, proper daylighting, outdoor access, and personalization of the space can all lead to independence and a better quality of life for residents.

 

The following video discusses dementia friendly design and shows examples of how to utilize it in everyday environments.

 

 

Additional Resources

For more information on this topic, please visit the following websites.

Excellence in Design: http://bit.ly/1i5tUiA

This is a detailed design report that lists great examples of Alzheimer's Care Facilities and dementia design. There are great examples and images.

Dementia Friendly Environments: http://bit.ly/1Og1dPa

The Department of Health, Victoria, Australia provides great information about designing environments for elders with dementia. This page discusses lighting and how colors effect patients and wayfinding, as well as surface and furniture options.

 Dementia Enabling Environments: http://bit.ly/1bxWJSV

This website introduces an interactive tool that walks the viewer through considerations when designing a care environment garden. Such things as outdoor musical instruments are often overlooked when planning a supportive environment, yet they provide many residents with rich sensory stimulation.