Aspects of design Designing and adapting the living environment for people with dementia Sylvia Cox

Being at home with dementia ‘sharing and being alone too’ Sylvia Cox 2006

Moving from specific to general Shore Green is: Smaller scale Smaller scale See how brief translated into design See how brief translated into design Shows relationships between different elements Shows relationships between different elements Demonstrates key features Demonstrates key features Sylvia Cox 2006

Think dementia friendly- adaptable housing Many people in extra care will have/develop dementia Many people in extra care will have/develop dementia Accessibility for mental as well as physical impairment Accessibility for mental as well as physical impairment More vulnerable to physical and social environment- - reduce ‘excess disability’ More vulnerable to physical and social environment- - reduce ‘excess disability’ Design features relevant to specialist and non-specialist Design features relevant to specialist and non-specialist Quality of life and care, effective outcomes and costs Quality of life and care, effective outcomes and costs Sylvia Cox 2006

Limitations of design Design can’t compensate for poor planning management and practice Design can’t compensate for poor planning management and practice Not a substitute for thinking through values, objectives and outcomes Not a substitute for thinking through values, objectives and outcomes International consensus on design principles Research patchy But we can apply the knowledge we have! Sylvia Cox 2006

Dementia is most common in older people Interaction of different types of dementia with other disabilities of old age such as Interaction of different types of dementia with other disabilities of old age such as impaired mobility impaired mobility impaired vision impaired vision impaired hearing impaired hearing Also other conditions e.g. mental health problems, brain injury, alcohol problems Also other conditions e.g. mental health problems, brain injury, alcohol problems Sylvia Cox 2006

Prevent- regain-maintain maintain best health, safety and dignity maintain best health, safety and dignity Retain/regain mobility & continence Retain/regain mobility & continence Use preserved skills Use preserved skills Support relationships Support relationships Creative opportunities Creative opportunities People live with dementia 7-10 years or more Problems not always due to dementia Better environments also better for staff & families & friends Sylvia Cox 2006

Don’t replicate problems Dark or glare in corridors Dark or glare in corridors Long distances Long distances Deafening communal spaces Deafening communal spaces Not being able to get outdoors Not being able to get outdoors Getting lost trying to find places Getting lost trying to find places Sylvia Cox 2006

Disability increased by failure of buildings to compensate for… impaired memory impaired memory impaired reasoning impaired reasoning impaired learning impaired learning high levels of stress high levels of stress adjusting to the sensory and mobility impairments of old age adjusting to the sensory and mobility impairments of old age Sylvia Cox 2006

Impaired memory High levels of visual access High levels of visual access Disguise danger areas Disguise danger areas Highlight important spaces and light well Highlight important spaces and light well Avoid corridors or keep them very short and wide Avoid corridors or keep them very short and wide Avoid mixed messages Avoid mixed messages Sylvia Cox 2006

Impaired memory Multiple cues Multiple cues Toilet doors always visible Toilet doors always visible See the toilet from the bed- acts as prompt See the toilet from the bed- acts as prompt Improves continence Improves continence Sylvia Cox 2006

Impaired memory As much visual As much visual information as possible information as possible Lots of light- natural light where possible Lots of light- natural light where possible Create points for land- marking Create points for land- marking Simple – easy to read environments Simple – easy to read environments Sylvia Cox 2006

Impaired reasoning Problems with 3D requires clear contrast Problems with 3D requires clear contrast Assists with positioning for seating and direction for standing males Assists with positioning for seating and direction for standing males Contrast toilet roll holder and paper. Contrast toilet roll holder and paper. Traditional cisterns and handles where possible Traditional cisterns and handles where possible Sylvia Cox 2006

Impaired learning Good signage Good signage Large size Large size Right height Right height Multiple cues Multiple cues Use of objects and contrast for orientation Use of objects and contrast for orientation Cultural cues Cultural cues Sylvia Cox 2006

Increasing dependence on the senses Sight Sight avoid glare and reflection-shiny surfaces avoid glare and reflection-shiny surfaces avoid dark shadows avoid dark shadows Touch- good grip /avoid sharp edges Touch- good grip /avoid sharp edges Smell and Taste Smell and Taste Sound- impaired hearing Sound- impaired hearing sound absorbing ceiling tiles sound absorbing ceiling tiles carpets and fabrics carpets and fabrics Sylvia Cox 2006

Design should enhance self esteem and confidence Opportunities to maintain past skills and new ones Opportunities to maintain past skills and new ones Opportunities to make a Opportunities to make a contribution- creativity Sylvia Cox 2006

Personal space Know your cohort: age, cultural background and diversity Know your cohort: age, cultural background and diversity Reinforce identity with familiar furnishings & décor/objects Reinforce identity with familiar furnishings & décor/objects Help to provide cues at front door/garden ornaments/planters Help to provide cues at front door/garden ornaments/planters Sylvia Cox 2006

Designing for reducing stress Quiet environments greater orientation Quiet environments greater orientation Low light levels- poor orientation and higher agitation Low light levels- poor orientation and higher agitation Visual barriers - increased concentration on tasks – e.g. dining rooms, activities Visual barriers - increased concentration on tasks – e.g. dining rooms, activities Sylvia Cox 2006

Problems with halls/corridors Vanishing point feel-institutional Vanishing point feel-institutional Often badly lit or subject to glare Often badly lit or subject to glare Create interest and way marking Create interest and way marking Create contrast between carpet & walls/doors Create contrast between carpet & walls/doors Make doors different in design/colour/features Make doors different in design/colour/features Sylvia Cox 2006

Communal and shared spaces Who do they belong to? Who do they belong to? Need to be ‘easy to read’ Need to be ‘easy to read’ Dining rooms /cafes Dining rooms /cafes Living rooms Living rooms In-between spaces In-between spaces ‘Activity areas’ ‘Activity areas’ Sylvia Cox 2006

Boundaries-exits and entrances These are often contentious areas Safety and security Stairs and lifts Autonomy and choice Sylvia Cox 2006

Functions/Scale/Location Number & grouping of different functions will impact on size and layout Number & grouping of different functions will impact on size and layout Specialist/integrated/ Specialist/integrated/cluster Location and community Location and community Site and planning constraints create challenges Site and planning constraints create challenges Sylvia Cox 2006

Outdoor spaces Positive benefits on stress levels and circadian rhythm Positive benefits on stress levels and circadian rhythm Good effects on mood. sleep and agitation Good effects on mood. sleep and agitation Sylvia Cox 2006

Enabling environments Design features can enhance quality of life of all Design features can enhance quality of life of all Design to increase chances of people remaining in familiar surroundings for as long as possible Design to increase chances of people remaining in familiar surroundings for as long as possible Need for awareness raising - design features may need explanation and demonstration Need for awareness raising - design features may need explanation and demonstration Spirit of negotiation and compromise Spirit of negotiation and compromise Sylvia Cox 2006