Building with dementia in mind
Architects who consider the needs of people with the condition when they design homes, public buildings and cities can make a world of difference
Dementia is on the brink of becoming one of the biggest social issues of this century - so isn't it about time that we started to design our buildings and cities with the condition in mind?
Remaining in their own homes and interacting with their own community has benefits for a person with dementia - and we should be making it easier for them to do so.
That's the message from Niall McLaughlin, architect of the widely praised Alzheimer's Respite and Day Care facility at the Orchard Centre in Dublin.
There are currently just under 50,000 people living with the condition in Ireland. By 2026, experts predict, this figure will reach 82,000.
McLaughlin believes that while there is clearly a need for traditional residential care for people with dementia, research has shown that there are benefits for people with the condition to remain in their homes - provided they are supported with the relevant day and respite care.
McLaughlin and his collaborator Yeoryia Manolopoulou are representing Ireland at the Venice Biennale, the prestigious global architecture and visual arts competition that takes place every two years. Their project, which is the result of groundbreaking research the duo carried out with an inter-disciplinary group of neuroscientists, psychologists, health workers and those caring for dementia sufferers, explores the need to improve the homes and urban environment for people with Alzheimer's so they can enjoy a better quality of life.
The presentation, which runs until next November, is an art installation which examines how Alzheimer's sufferers perceive their physical environments, and the corresponding need for architects, carers and family members to adapt the home of a person with the condition, to improve their quality of life and enable them to feel independent.
The installation plays on themes of situation and memory - constant issues for Alzheimer's sufferers - and offers a range of ideas for how to make day-to-day living simpler for someone with dementia.
The design of public buildings can help make life easier for people with dementia - and McLaughlin and Manolopoulou believe architects have an important part to play here. Many architects don't know about dementia, they say, and those who do, have focused, understandably enough, on the design of traditional care homes and respite centres.
However, McLaughlin says it's necessary to design all buildings - everything from supermarkets to train stations - with dementia in mind, and not just facilities that are specifically tailored to the needs of people with the condition.
"It's about a way of thinking about the kind of obstacles that present themselves to a person with dementia - orientation, navigation and clarity of signage, making services of different kinds, such as public toilet facilities for example, easily accessible for someone.
"Architects need to design houses, public buildings and cities with a full understanding of the cognitive difficulties that people with dementia face every day," he says.
Home, as they point out, is our most deeply-ingrained environment - dementia design expert Lesley Palmer says that allowing people with dementia to stay at home in their communities reduces the risk of loneliness and isolation and is vital for a sense of belonging.
June Andrews, head of the Dementia Services Development Centre at the University of Stirling in Scotland, recommends that as little be changed as possible - support at home can be enhanced by use of the facilities of day-care centres, which provide daily stimulation and sociability and give carers much-needed respite. "When dementia affects people, it takes longer to impact on our more deeply ingrained memories and our oldest habits," McLaughlin explains.
"Therefore, the home is a very good place for people to be because it is the most familiar environment to us," he says, adding, however, that people with dementia in the home need to avail of the necessary stimulation.
His suggestions are practical, but simple - don't change the furniture around too much, for example. Install glass fronts on kitchen cupboard doors so a person can easily see where things are.
Instead of storing items throughout the kitchen, it's a good idea to have a unit containing all the basics one needs to cook. Also it can be useful to minimise physical and visual barriers; for example being able to see the toilet from one's bed.
Simple accessories such as a smart wrist-band which is connected to an app on a carer's phone, indicating the location of someone with dementia, can eliminate huge amounts of stress.
Movement and energy-consumption sensors within the house, or wearable location devices are very common, and allow a degree of independence to be retained on behalf of the individual with dementia, while these tools can also act as a reassurance for carers.
They also suggest the construction of a 'daisy chain' to help people with dementia navigate their environment with greater ease.
In care centres, the provision for the placement of personal objects can often be prohibited for fear of theft or damage, but, McLaughlin points out, these objects have memories which are important to a person's emotional well-being, their sense of place and ease of navigation.
A 'spatial' daisy-chain of vivid, landmark objects can help a person with the condition navigate their way around a building, he explains: "It's a good idea to find a sequence of interesting objects that are tried and tested to be memorable and which will act as reliable landmarks - for example a fish tank, an unusual piece of furniture, a clock on the wall or a very vivid painting."
This applies to town and cityscapes as well he says - on our streets, just as in the interiors of our buildings, we should prioritise clarity of signage and routes - architects of public buildings are now required to consider physical accessibility from the outset - and the same should be true of dementia, says McLaughlin, who adds that he also believes that workers in face-to-face contact with the public - shop assistants, bus drivers, publicans - should receive training to help them recognise the general signs of dementia.
Building design, he says, should focus on the free-flow of people through a building - so reduce the number of obstacles such as doors and locked gates, he suggests, and make it more easy to navigate, while the prioritisation of abundant light and minimal glare is also very important.
Design for neurological impairment should be as integral to architecture as design for mobility.
For all of this, he says, architects need to understand the demands of dementia - and the best way to do this, is to speak directly with people with dementia and their families, and collaborate with experts in other fields, such as neuroscientists, carers and furniture designers.
Interestingly, he also believes, architects should also allow for more collaboration between the builder, the client and the end-users - from the outset, and then stay close both in the design.
Then, as the buildings are used, they should be prepared to make any 'tweaks' or improvements that appear during use and that clearly need to be carried out.
Health & Living