At least 20% of those over the age of 85 live with some form of dementia. The largest group develop Alzheimer’s disease followed by Lewy body dementia and vascular dementia. It is a fact that there are increasing numbers of people who develop dementia as the population ages. However, about one in ten people over 60 also develop dementia. The total number of people with Dementia in the UK is set to rise by 38% over the next fifteen years and 154% over the next 45 years.
In the past, people with dementia whose care needs exceeded the capacity of their family or friends’ capacity to provide it, lived in large psychiatric hospitals. These are now being phased out worldwide and a greater emphasis is being placed on alternative facilities such as nursing homes or extra care homes where retaining independent living within the family home is no longer sustainable.
Dementia can affect short-term and long-term memory and lead to disorientation, frustration, and inability to make judgements, depression and often aggression.
Most family homes, plus most sheltered housing schemes and nursing homes do not offer any facility for dealing with dementia sufferers. The environment generally is not secure, does not allow for wandering (a common trait of dementia), and does not aid reminiscence, privacy, dignity or individual expression. Corridors in sheltered schemes in particular, tend to be long narrow spaces, poorly lit with dead ends. No attempt is made to aid orientation and staff facilities, for which there is a greater need, are minimal. During the progression of the illness the visual field diminishes, together with problems or inability to see colour clearly. All of this leads to an increased risk of falls and more importantly, affects confidence to move around.
The designer must start from the premise that good design can have a profound and positive effect on the way that people lead their lives. If careful thought to the designed environment is not given at the outset then any impairment can become a major disability. Good design can, in many instances, reduce the effects of physical and mental impairment and go a long way to assisting sensory impairments.
Having said that, it is extremely difficult to categorise each impairment and complete a design which will satisfy all of them. There is every likelihood that a specific design solution for any given impairment may be completely at odds with another. The aim must therefore be to design to the lowest common denominator and to produce an environment which suits the majority, i.e. the more fit and able but which can support a degree of general frailty and is ultimately adaptable to specific Extra Care needs.
The built environment can have a fundamental effect on a person living with dementia, probably greater than on people who are mentally fit. There is now an increased understanding of the impact the built and social environment has on people with dementia. In the past, there has been great dependency on medication to try and control people with dementia even though it has been proven that it only works with a minority.
Only recently has this more optimistic approach emerged, reinforcing the sense of well-being in those living with dementia. The right environment can provide opportunities for people to continue their remaining skills and help them to function at their greatest potential. This can also be applied in many cases to alterations in family homes where attempts can be made to keep the sufferer remaining at home for as long as possible.
There are significant design implications, although the physical residential accommodation does not change to any large degree from Extra Care accommodation. Personal identification with the environment enhances the sense of familiarity and of home. These senses can be reinforced further by the use of the sufferers own belongings such as their own bed, perhaps a table or dresser.
Building design should not rely on the person having any memory of where they are or indeed how they got there and should seek to minimise stress. There should be good signage and multiple cues such as sight, smell and sound, the use of objects as well as strong colour to aid orientation. The design should compensate for this most depressing disability and maximise as far as possible independence, self-esteem and confidence.
The environment must be safe and this is probably the area which causes the greatest conflict. Much effort should be put into providing a safe and secure environment both inside and out. This can require alarmed or locked doors and secure boundaries as people with dementia can wander excessively causing risk to themselves and others. This level of security causes problems in promoting independence, autonomy and dignity. It is very much a question of management of risk not necessarily the elimination of it.
There is a need for clearer visual access allowing discrete supervision which in turn is the device by which residents are able to get to communal living areas. Cueing is the means by which they will be able to find their way back. There is a strong case for variation in decoration, furniture, carpets, curtains and cueing because it assists orientation, is enriching and increases the pleasure of living in a safe, secure and familiar environment.
Access to a well-designed garden should not just be available but should be the right of all those who live with any disability. Gardens offer such a rich and varied range of sensory experiences that their therapeutic value should not be ignored. Most outside spaces leave a great deal to be desired and mostly conceived as add-ons with a distinct lack of funding that ensures that gardens will remain token gestures. Easy access to a secure garden to allow wandering and gardening activities is an absolute must. Security, shelter from the sun and shade, all need to be planned and designed as carefully and expertly as the building itself.
KJ Architects specialise in special needs architecture to help dementia sufferers and individuals with long-term disabilities or impairment to live to their maximum potential. Further articles will cover this subject in an effort to make it more understandable about what can be done from design stage. KJ Architects can make alterations to current buildings, renovations, or work with sheltered schemes for very little or no extra cost to bring them up to an extra care standard.
KJ Architects offer sustainable architectural services in London that are completed with the user in mind. We bring an innovative approach to our designs and ensure that each and every user is considered when creating a space. To speak to a member of the KJ Architects team, please contact us online or call us directly on 01638 662393.