Designing for dementia

A prominent architect said to me recently that he couldn’t remember things as well as he used to, which made him anxious, because his greatest fear was that he would develop dementia. If he feared losing his independence, dignity and self-esteem, he was not alone. Many older people conceal their problems and resist intervention for exactly those reasons. We must respect and understand those feelings, and do all we can to provide good enough care for our elders, in appropriately designed buildings, so they feel safe, secure and independent enough to retain their sense of self-worth.

Inside, a care home is very like a town or city. One can remember where to go when there are distinct enough landmarks and clear circulation

Over the past few years, both my partner Sandy and I have found ourselves with relatives in their 90s who have high care needs, and we found ourselves taking a closer interest in how the environments in which they live were conceived, and in what ways these spaces might be improved by both architects and the clients who employ them.Dementia, mobility problems or a combination of the two are the most common reasons for moving to a care home, but the communities found there encompass a very wide range of cognitive abilities and physical needs, which can be stressful for both residents and staff. Understanding the symptoms of dementia, and the human response of all the individuals affected, is key to creating a good home for people in this phase of life.

Inside, a care home is very like a town or city. One can remember where to go when there are distinct enough landmarks and clear circulation. Being able to see into public rooms that are associated with a distinct activity is helpful. Views out can give a sense of the time of day and the seasons, as well as local events, such as children going to and from school. One in eight people over the age of 75 has a high degree of visual impairment. Many older people need three times the usual light levels to see adequately. High light level throughout, with appropriate colour contrast – such as for personalised doors to residents’ rooms – helps with orientation. Scope for people to create their own environment helps them retain their sense of self, with the ticking of a clock, the smell of a familiar perfume or the sound of a favourite piece of music. Their room must be large enough for a favourite chair to be set out without hidden obstacles, and within easy reach (and sight) of their bathroom, to allow independence.

High levels of stress are common in people with dementia and this affects their ability to function. Most people would find it stressful to be compelled to sit in a crowded common room through which people pass, with chairs lining the walls, feeling viewed and obliged to interact (or shut down), while being bombarded with noise and activity from a television. Some people want to sit in a communal room, alone. Many like to go outside for a wander, with the assurance that it will not be slippery, with a handrail for support, on an interesting path. They want to enjoy hearing birdsong, and experience the familiar signs of the changing seasons. They want to aim for a destination where they can sit and rest and contemplate; or, better still, do something useful, like watering the plants or weeding a flowerbed, arranged for easy physical access.

For most elderly people, day-to-day activities like getting dressed or eating become more difficult, and this is particularly true for those with dementia. They can be very slow, which can be stressful for the staff helping them. It is easier to ‘just do it for them’. However, well-designed, clearly visible storage with easy access can extend self-sufficiency. For most people, food has meaningful, positive memories, and preparing food and eating together provides an environment conducive to encouraging these. Arranging the kitchen and dining accommodation in a way that feels intimate can be a great boon. The kitchen can be split, with safe activities for residents, such as washing vegetables or setting the tables, kept separate from more hazardous activities.

One in four of those over 75 has difficulty walking. A fall is the most common reason for going into care. Many types of dementia will gradually affect the areas of the brain responsible for balance and motor control. It is of paramount importance that the environment is designed to promote safe mobility, with such things as support rails throughout circulation areas, distinct contrasts in horizontal and vertical planes and plenty of space for negotiating with a wheelchair or walking frame. When we look back a generation at the child who was ‘seen and not heard’, we are shocked. It is now time that we listen and see the humanity in our elderly community, and design with sensitivity for their needs.

Clare Wright is a founding partner of Wright & Wright Architects