5th International Dementia Care Conference Hosted by Sonas apc, RDS, Dublin

16 April 2013

Dr Maria Pierce and Associate Professor Suzanne Cahill, DSIDC’s Living with Dementia Research Programme, School of

Social Work and Social Policy, Trinity College Dublinpiercema@tcd.ie

www.livingwithdementia.tcd.ie

Overview Why design for dementia?

Impact of physical environment: evidence from research

Bringing in the voices of people with dementia

Concluding remarks

Why focus on physical environment? Dementia is a leading cause of disability in later life, but no known

cure for dementia

Non-pharmacological interventions will not arrest progression of condition, but are promising in lessening the effects and enhancing QOL

Built environment poses a challenge for many people with dementia, who are no longer able to adapt and instead the environment must be adapted to the person’s specific needs

Designing and modifying buildings for people with dementia holds promise and plays a role in supporting people with dementia in residential care

Residential care settings are complex

Even the best physical environment can be undermined if the structure of the organisation, the social and

physical environments are not working together in an integrated system to support the unique needs and abilities of people with dementia and their caregivers

International consensus regarding the principles of good design for dementia

compensate for disabilitymaximise independence, reinforce personal identity, and

enhance self-esteem/confidencedemonstrate care for staffbe orienting and understandablewelcome relatives and the local communitycontrol and balance stimuli

(Judd, Phippen, Marshall, 1998; Marshall, 2001)

International consensus regarding the design features for dementia

small in size familiar style: domestic and homelike scope for ordinary activitiesrooms for different functions equipped with familiar fixtures

and fittings single roomsgood signage and multiple cues control of stimulia safe outside space

(Judd, Phippen, Marshall, 1998; Marshall, 2001)

Trend towards small-scale home-like physical environments

Impact of the physical environment Research has demonstrates the potential that the

physical environment has for contributing to the improvement of behavioural symptoms associated with dementia (e.g. Zeisel et al., 2003)

Many of the principles behind dementia design are concerned with making the spatial environment more easily understood and therefore less threatening and less likely to cause the confusion and aggressive behaviour that anxiety can arouse in PwD

Available evidence strongly supports: Small groupings of residents A variety of spaces, including single private bedroomsUnobtrusive safety featuresThe enhancement of wayfinding and visual accessOptimisation of levels of stimulus, esp. increased

ambient lightingAvoidance of strong contrasts in flooring and patterns in

flooring

The ‘lived experiences’ of dementia

To create appropriate physical environments, an understanding of the ‘experiences’ of people with

dementia in everyday life is important. (Davis et al., 2009)

‘Living experiences’ that warrant consideration in designing care environments for people with dementia include:

Presentation of self Family and social connections The eating experience Staff Personal enjoymentEnd-of-life experience The bedroom

(Davies et al, 2009)

Environment as an occupational space Attention must be paid to how

therapeutically designed, beautiful, and homelike architectural spaces can be transformed into alive occupational spaces, as well as to what personal and institutional contributions and commitments are needed to make such transformations a reality

(Woods et al., 2005)

Hearing the voices of people with dementia about care buildings

Bricks and mortar versus people: Residents with dementia were quite clear in ranking what they were most concerned about: ‘the building itself was of lesser concern’.

Familiar and treasured items

Variety and choice of spaces: provide opportunities for PwD to remain engaged in everyday life in meaningful way, e.g. the bedroom for privacy

Presence of children and animals in the building

Areas with views to entrance or where staff are based most popular

Safety versus autonomy (Innes et al., 2011)

Most important features Wayfinding: people with dementia and family caregivers

spoke about the need for wayfinding cues to be able to find the toilet, their bedrooms and quiet spaces to be alone

Outside space: provides opportunities for activities and spending time with relatives outdoors

(Innes et al., 2011)

Some concluding remarks Physical environment matters, but does not in itself

guarantee quality care

Need active and focused intervention of trained staff for environmental provisions to have an effect

Physical location and connection to the wider community - “a home from home”

Listening to what people with dementia who reside in long-stay residential care buildings can help us to re-imagine the physical environment

“ … providing the best physical environment for people with dementia is not a question of money or luck, but of

good, thoughtful, person-centred design.”

Stephen Judd

(Judd, Phippen, Marshall, 1998)

Thank you

Acknowledgements