Natassja Wynhorst from Interite Healthcare Interiors explores the design of nursing homes and clinic environments and how it’s found to be regarded as having therapeutic capabilities in which promote and sustain the wellbeing of those with Alzheimer’s disease and varying types of dementia.
The physical environment of nursing homes and clinics play essential roles in the aid and care of those with Alzheimer’s disease and varying types of dementia. The design of these environments is found to be regarded as having therapeutic capabilities in which promote and sustain the wellbeing and functionality among those with dementia. The design of these spaces is beneficial to not only the patients living with dementia, but also to their visitors, family members and staff by increasing the mobility, wayfinding and functionality of the said space.
Designing for complexities
As we know, dementia is a term in which is used to describe a disease comprised of multiple impairments and it is these specific interactions between the numerous impairments in which present the challenges for the design of the physical surroundings. With impairments, comes compensations for living lifestyles, behaviours and the day-to-day environment to make these lifestyles and habits easier. As we mentioned, dementia being a term for multiple impairments, means there will be multiple compensations made to the environment. In other words, “The most vulnerable, need the greatest attention to their environment.”
Inclusive of these impairments is often memory deterioration, meaning people often don’t know where they are unless the surroundings look, feel and seem familiar. From a design and construction perspective, this presents a challenge for a dementia facilities and other mixed use facilities associated with dementia patients, as not one person originates from the same background as the next. Designing in a way in which incorporates a traditional style which is common for most people is key, so they are able to personalise it to their familiarities; yet those whom are from specific cultures, need specific attention.
The impairment of learnings presents a challenge to designers, as the patients struggle to learn where objects in the room are, unless they have a constant visual of them. This presents the design approach of open-planned spaces with extra signage to enable wayfinding and the ability to locate where certain objects are stored.
Designers must highly take into consideration the impairment of reasoning. Such an impairment forms a lack of understanding in how understand how a simple object works or is used. This causes a challenge when incorporating taps, flush systems, and switches into the building, as they must be systems in which the patient is familiar with.
It is not surprising to most that with dementia, comes stress. Because of high levels of stress and anxiety within the patients, a calm environment is critical. The challenge with this design concept is that the environment must not only be calm, but it also must be, to a degree, stimulating. This aspect follows into another challenge for designers as the sensory inputs of patients may lead them to misinterpret a perceptual problem. Designers must be aware that to individuals suffering from dementia, the slightest change in the flooring colours may be perceived as stairs.
Designing for dementia incorrectly
An environment that is well designed and planned with cognitive impairment in mind, can support the abilities and provide purposeful engagements by administering critical prompts and accessibility, whilst also reducing any risks. On the other hand, a poorly designed environment can be highly disorientating and dangerous.
It’s widely recognised that spaces have a strong and impactful effect on an individual with dementia. Creating enabling environments through the promotion of self-reliance and the support of wellbeing is critical. Therefore, it is not uncommon to assume that if the physical environment is design wrongly, then there will be serious ramifications for the patients physical and mental wellbeing.
To say it simply, a few of the ramifications of incorrectly designing for dementia are slips, trips, falls, unnecessarily making patients dependent, high levels of distressed behaviours through both excess and omission, the reduction in the patient’s quality of life and as one might say, “death by boredom.”
Design elements to consider
The colouring and contrast within an environment have a significant role in aiding dementia design. When the colours are used correctly, colour assists in making the surroundings clearer. Yet, when used incorrectly, colour can make the surroundings more confusing prompting agitation and stress. Therefore, it is essential when designing for dementia, that colour needs high consideration. Colour in the design sense can be understood by “colour and pattern,” and “colour perception and contrast.”
When incorporating a pattern into a design for dementia, the pattern and its colours should be subtle and low, rather than be bold and prominent to avoid confusion. Those with dementia are able to perceive large and bold patterns as physical objects. Flooring and carpeting colour with a high contrast in colour can be perceived as changes in floor levels, depths or holes in the ground and patterns in which consist of zig-zags or stripes, should always be avoided, as they can be perceived as moving objects which may become increasingly distracting.
Yet, incorporating prominent colour contrast can be utilised to give a greater clarity to the foreground objects. For example, chairs should contrast with floors and sinks and toilets should contrast with the bathroom walls and floor.
Another design element to consider when designing for dementia is the ease of cleanliness and durability of materials. In the modern day it is increasingly easier for designers to source materials in which are aesthetically pleasing and also easily maintained while avoiding the clinical stereotype of medical layouts. Hard surfaces, such as vinyl, are now made durable, long-lasting and are easy to clean. They are slightly soft and not too smooth in order to avoid inviting any slips and falls, whilst also reducing any impact sounds and improving acoustics throughout the area.
Furthermore, into the acoustic considerations, soft materials in which absorb sounds are highly recommended when designing for dementia. Traditional hard wood floorings in high traffic areas have the ability to reflect sounds and echoes, which can have a negative effect on patients. Soft materials, such as wall hangings and durable rugs and carpets absorb sounds and in turn improve the acoustic performance within the space.
When designing, getting the light right can directly contribute to a reduced number and the harshness of falls, behaviour changes, stress and improve sleeping patterns and overall better health. People with dementia have a reduced ability to see the blue end of the light spectrum and take a longer amount of time to adjust to changes in lighting; hence consistent and even lighting throughout the building is essential. Maximising the amount of natural lighting throughout the surroundings is highly recommended, meaning designers must take into consideration the sun orientation of all rooms and windows, the transmission of light and allow for shading.
As discussed earlier, those with dementia often don’t know where they are unless the surroundings look and feel familiar. Due to this fact, the concept of personalisation within design is critical. This is done by allowing spaces to reflect the identity of the person and place through the bedrooms and lounge areas by incorporating elements of their personalities and lives.
These personalisation’s throughout the spaces have been shown to improve way-finding capabilities and stress by providing a safe and familiar environment. Like this, the implementation of signage to assist in way finding is essential as it draws attention to communicate a message whilst competing with the surrounding environment. Good enabling dementia signage can have great benefits for patients when put in line of sight, as it gives independence and confidence. These signs must be designed in way to be clearly visible with a good colour contrast, have symbols which are easily recognisable and should not be surrounded by other signs or information.
With the number of Australian dementia sufferers on the rise, it is increasingly important that not only dementia facilities and aged care homes incorporate specific design and construction aspects that assist with dementia support, but also that other mixed use facilities, medical clinics and hospitals integrate key design aspects to cater for their dementia clients and patients. The numerous design and construction elements in which should be taken into account, go much further than the colour theory and safe-to-use equipment, as it is encapsulates the understanding of designing for not just a “disease,” but old-age and a vast number of impairments. Without taking on these key design understandings when creating a facility or clinic associated with dementia patients, the ramifications can potentially lead to an unsafe, unhappy and unwelcoming environment.
Views, information or opinions expressed within this article are solely those of the author rather than the ‘individuals involved.’ This article does not necessarily represent the official policy or position of any other agency, organisation, employer or company and includes information obtained from third parties. These views are subject to change and revision.
Optimise your practice space
If you want to talk to a design specialist about how you can optimise your practice space for both your business, patients and you staff, please contact us for an introduction to Natassja Wynhorst.