What we already know about design for dementia © Dementia Centre, HammondCare 2015

HammondCare – who we are, what we do A charity based in Sydney, specialising in dementia & aged care, palliative care, rehabilitation & older persons' mental health. ​Established 1995 Recognised internationally for research, teaching, consultancy, resources Focused on improving lives of people with dementia, their families and carers UK team undertakes research and delivers training, consultancy and evaluation of dementia design The Dementia Centre is a service provided by HammondCare as part of its commitment to promoting excellence in dementia care, offering impartial advice and support.

Most people with dementia are older EuroCoDe calculations of % with dementia in each age group Total population age range % with dementia 60 – 64 0.6 65 – 69 1.6 70 – 74 3.5 75 – 79 7.4 80 – 84 15.7 85 – 89 26.2 90 – 94 41.0 95+ 46.3 See Alzheimer’s Europe website

Which means….. Complexity – the challenge of designing for frailty combined with dementia People may have other debilitating conditions, e.g. MS, Parkinson’s, arthritis Younger people with dementia may also have some of the same impairments of older people such as poor sight or hearing problems

Common impairments of frail older people: 1. Muscles and bones E.g. shoulder and neck muscles may be weaker, so signs need to be lower E.g. proprioception may be impaired affecting balance and positioning, so avoid cluttered environments

Common impairments of frail older people: 2. Lungs Impaired lung function – plenty of oxygen is essential for the brain to work well Poor air quality affects everyone, so ensure good ventilation, good maintenance and avoid using air fresheners

Common impairments of frail older people 3. Ears Loss of ability to hear high frequencies Harder to distinguish lower frequency sounds e.g. voices from other sounds People can become overwhelmed by noise and either withdraw or get angry

Reduce noise by: Locating noisy areas away from living spaces and bedrooms Providing good sound insulation in the building Using plenty of sound absorbent materials, e.g. soft furnishings, carpet, cushioned vinyl Providing quiet spaces Providing easy access to outside

Common impairments of frail older people 4. Eyes Twice as much light needed to see clearly Lens yellows with age and colours seem less vivid Red, orange, yellow easier to see than blue and green More time needed to adjust to changing light levels Glare more difficult to tolerate Decrease in sensitivity to contrast

Eye conditions of older age Thickening lens Cataracts Macular degeneration Glaucoma Hemianopia

Twice the ‘normal’ level of light Plenty of light fittings Plenty of natural light

What does not contrast is invisible

Two hazardous spaces

Other possible impairments of ageing The following need to be taken into account as well: Needing to go to the WC frequently, e.g. 90% of men aged over 80 have an enlarged prostate Homeostasis (the body’s ability to maintain a state of stability or equilibrium e.g. adjust to heat and cold) Taste / smell can deteriorate

Impairments of dementia needing attention by designers are: Impaired memory, especially recent memory Impaired learning Impaired reasoning High levels of stress Sensory challenges especially perceptual problems for many Difficulty adjusting to the sensory/mobility impairment of normal ageing.

Designing for impaired memory What does this mean? Vital to be able to see important things and rooms if you cannot remember them… Familiarity is key principle Glazed doors and walls are very helpful

Designing for impaired learning What does this mean? People with dementia may not be able to learn where things are People with dementia may get distressed e.g. finding the toilet Good signs are vital

Designing for impaired reasoning What does this mean? Things need to be easy to understand e.g. taps, hand dryers, signs Signs need to be easy to work out ? ?

Designing to minimise stress What does this mean? Reduce clutter – make sure important information is obvious Provide views of nature Minimise noise

Designing for perceptual problems What does this mean? Too much contrast between floors may look like a step Wavy lines on wallpaper look as if they are moving Some patterns look like insects or litter

Two hazardous floors

Key points Provide plenty of natural light Provide twice the ‘normal’ level of artificial light Ensure plenty of contrast to make things visible But – avoid contrast between floor finishes Provide a quiet and calm environment Provide easy access to outside Provide views of nature Make sure everything is easy to understand Keep important information, e.g. signs, low enough for easy vision Avoid clutter

Designing for the future The success of our job should be governed by the enhanced quality of life for people with dementia.