Aspects of designAspects of designDesigning and adapting the

living environment for people with dementia

Sylvia Cox

Being at home with Being at home with dementiadementia

‘sharing and being alone ‘sharing and being alone too’too’

Sylvia Cox 2006

Moving from specific to Moving from specific to generalgeneral

Shore Green is:Shore Green is: Smaller scaleSmaller scale See how brief See how brief

translated into translated into designdesign

Shows relationships Shows relationships between different between different elementselements

Demonstrates key Demonstrates key featuresfeatures

Sylvia Cox 2006

Think dementia friendly- Think dementia friendly- adaptable housingadaptable housing

Many people in extra care will Many people in extra care will have/develop dementiahave/develop dementia

AccessibilityAccessibility for mental as well as for mental as well as physical impairmentphysical impairment

More vulnerable to physical and social More vulnerable to physical and social environment- -reduce environment- -reduce ‘excess disability’‘excess disability’

Design features relevant to specialist and Design features relevant to specialist and non-specialist non-specialist

Quality of life and care, effective Quality of life and care, effective outcomes and costsoutcomes and costs

Sylvia Cox 2006

Limitations of designLimitations of design

Design can’t Design can’t compensate for compensate for poor planning poor planning management and management and practicepractice

Not a substitute for Not a substitute for thinking through thinking through values, objectives values, objectives and outcomesand outcomes

International International consensus on consensus on design principlesdesign principles

Research patchyResearch patchy

But we can apply But we can apply the knowledge the knowledge we have!we have!

Sylvia Cox 2006

Dementia is most Dementia is most common in older peoplecommon in older people

Interaction of different types of Interaction of different types of dementia with other disabilities of dementia with other disabilities of old age such asold age such as impaired mobilityimpaired mobility impaired visionimpaired vision impaired hearing impaired hearing Also other conditions e.g. mental health Also other conditions e.g. mental health

problems, brain injury, alcohol problems, brain injury, alcohol problemsproblems

Sylvia Cox 2006

Prevent- regain-maintainPrevent- regain-maintain maintain best health, maintain best health,

safety and dignitysafety and dignity Retain/regain mobility Retain/regain mobility

& continence& continence Use preserved skillsUse preserved skills Support relationshipsSupport relationships Creative opportunitiesCreative opportunities

People live with People live with dementia 7-10 dementia 7-10 years or moreyears or more

Problems not Problems not always due to always due to dementiadementia

Better Better environments also environments also better for staff & better for staff & families & friendsfamilies & friends

Sylvia Cox 2006

Don’t replicate problemsDon’t replicate problems

Dark or glare in Dark or glare in corridorscorridors

Long distancesLong distances Deafening Deafening

communal spacescommunal spaces Not being able to Not being able to

get outdoorsget outdoors Getting lost trying Getting lost trying

to find placesto find places

Sylvia Cox 2006

Disability increased by Disability increased by failure of buildings to failure of buildings to

compensate for…compensate for…

impaired memoryimpaired memory impaired reasoningimpaired reasoning impaired learningimpaired learning high levels of stresshigh levels of stress adjusting to the sensory and adjusting to the sensory and

mobility impairments of old agemobility impairments of old age

Sylvia Cox 2006

Impaired memoryImpaired memory

High levels of visual High levels of visual access access

Disguise danger Disguise danger areasareas

Highlight important Highlight important spaces and light wellspaces and light well

Avoid corridors or Avoid corridors or keep them very short keep them very short and wideand wide

Avoid mixed Avoid mixed messages messages

Sylvia Cox 2006

Impaired memoryImpaired memory

Multiple cuesMultiple cues Toilet doors always Toilet doors always

visiblevisible See the toilet from See the toilet from

the bed- acts as the bed- acts as promptprompt

Improves Improves continencecontinence

Sylvia Cox 2006

Impaired memoryImpaired memory

As much visualAs much visual

information as information as possiblepossible

Lots of light- Lots of light- natural light where natural light where possiblepossible

Create points for Create points for land-markingland-marking

Simple – easy to Simple – easy to read environmentsread environments

Sylvia Cox 2006

Impaired reasoningImpaired reasoning Problems with 3D Problems with 3D

requires clear contrast requires clear contrast Assists with Assists with

positioning for seating positioning for seating and direction for and direction for standing malesstanding males

Contrast toilet roll Contrast toilet roll holder and paper.holder and paper.

Traditional cisterns Traditional cisterns and handles where and handles where possiblepossible

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Impaired learningImpaired learning

Good signageGood signage Large sizeLarge size Right heightRight height Multiple cuesMultiple cues Use of objects and Use of objects and

contrast for contrast for orientationorientation

Cultural cuesCultural cues

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Increasing dependence Increasing dependence on the senseson the senses

Sight Sight avoid glare and reflection-shiny surfacesavoid glare and reflection-shiny surfaces avoid dark shadowsavoid dark shadows

Touch- good grip /avoid sharp edges Touch- good grip /avoid sharp edges Smell and TasteSmell and Taste Sound-Sound-impaired hearingimpaired hearing

sound absorbing ceiling tilessound absorbing ceiling tiles carpets and fabricscarpets and fabrics

Sylvia Cox 2006

Design should enhance Design should enhance self esteem and self esteem and

confidenceconfidence Opportunities to maintain past skills Opportunities to maintain past skills

and new onesand new ones Opportunities to make a Opportunities to make a

contribution- creativitycontribution- creativity

Sylvia Cox 2006

Personal spacePersonal space

Know your cohort: Know your cohort: age, cultural age, cultural background and background and diversitydiversity

Reinforce identity Reinforce identity with familiar with familiar furnishings & furnishings & décor/objectsdécor/objects

Help to provide cues Help to provide cues at front door/garden at front door/garden ornaments/plantersornaments/planters

Sylvia Cox 2006

Designing for reducing Designing for reducing stressstress

Quiet environments Quiet environments greater orientationgreater orientation

Low light levels- Low light levels- poor orientation poor orientation and higher agitationand higher agitation

Visual barriers - Visual barriers - increased increased concentration on concentration on tasks – e.g. dining tasks – e.g. dining rooms, activitiesrooms, activities

Sylvia Cox 2006

Problems with Problems with halls/corridorshalls/corridors

Vanishing point feel-institutional Vanishing point feel-institutional Often badly lit or subject to glareOften badly lit or subject to glare Create interest and way markingCreate interest and way marking Create contrast between carpet & Create contrast between carpet &

walls/doorswalls/doors Make doors different in Make doors different in

design/colour/featuresdesign/colour/features

Sylvia Cox 2006

Communal and shared Communal and shared spacesspaces

Who do they Who do they belong to?belong to?

Need to be ‘easy to Need to be ‘easy to read’read’

Dining rooms Dining rooms /cafes/cafes

Living roomsLiving rooms In-between spacesIn-between spaces ‘ ‘Activity areas’Activity areas’

Sylvia Cox 2006

Boundaries-exits and Boundaries-exits and entrancesentrances

These are often These are often contentious areascontentious areas

Safety and securitySafety and security Stairs and liftsStairs and lifts Autonomy and Autonomy and

choicechoice

Sylvia Cox 2006

Functions/Scale/LocationFunctions/Scale/Location Number & grouping Number & grouping

of different functions of different functions will impact on size will impact on size and layoutand layout

Specialist/Specialist/integrated/integrated/

clustercluster Location and Location and

communitycommunity Site and planning Site and planning

constraints create constraints create challengeschallenges

Sylvia Cox 2006

Outdoor spacesOutdoor spaces

Positive benefits Positive benefits on stress levels on stress levels and circadian and circadian rhythmrhythm

Good effects on Good effects on mood. sleep and mood. sleep and agitationagitation

Sylvia Cox 2006

Enabling environmentsEnabling environments

Design features can enhance quality of Design features can enhance quality of life of alllife of all

Design to increase chances of people Design to increase chances of people remaining in familiar surroundings for remaining in familiar surroundings for as long as possible as long as possible

Need for awareness raising - design Need for awareness raising - design features may need explanation and features may need explanation and demonstrationdemonstration

Spirit of negotiation and compromiseSpirit of negotiation and compromise

Sylvia Cox 2006