Designing for Dementia
Designing for memory care is unlike designing for any other space and takes knowledge and understanding about dementia. An environment is perceived very differently by someone with this disease than someone without. People with dementia have increased vision, motor, and hearing loss making it difficult to perform daily tasks and making their environment that much more impactful. It is especially important to create a clean, organized environment with clearly defined spaces to help dementia residents better understand their environment. The goal in designing a memory care community is to keep residents active and engaged in the community which has been shown to decrease the progression of the disease. Important factors to consider while designing a memory care community includes lighting, artwork, color, finishes, security, safety, and furniture.
Lighting
Due to increased loss of vision, proper lighting is essential to help people with dementia make sense of their environment with whatever abilities that remain. A bright and airy setting helps people see faces and understand body language better, know where they are going, and helps them see and understand objects better. Poor lighting contributes to accidents such as falls, and causes unnecessary stress brought on by various things like misinterpreting shadows (Andrews, Bartlett n.d.). A rule of thumb is to double the normal light levels and control the sources of glare because elderly eyes see half the amount of light than a younger person (Pollock, Fuggle, 2013).
Daylight in particular delivers the best color interpretation and has been linked to increased mood and body rhythms, and better sleep. Elements that support this need include large, clean windows, open blinds, sunrooms, outdoor patios, outdoor courtyards, and greenhouses. Maintaining the residents’ circadian rhythms keeps them active during the day and improves their quality of sleep at night.
Artwork
While artwork can often enhance the aesthetic of a space, it can just as easily cause fear and harm to a person suffering with dementia. Abstract art leaves room for interpretation which causes memory care residents to believe that they see things that aren’t there in the art. Literal art such as nature scenes, animals, and clear objects can help avoid misinterpretation. Tactile art is also helpful in keeping residents busy and moving about.
Color
Colors and patterns have a significant impact on wayfinding and the ability for residents to distinguish different parts of a space. A key design decision is to create color contrast between the floors and walls to help residents see different surfaces. Another factor that contributes to wayfinding is using color to signal where a resident is. Color coding doors, hallways, or different wings in a large community can help as a visual guide. Like the artwork, it is important to keep patterns relatively simple and small in scale to help avoid misinterpretations of large patterns. For example, a dark square in middle of a lighter floor may be mistaken for a hole, causing residents to walk around it or avoid the area entirely. Strong colors can be used because dementia causes visual impairments that makes colors appear duller (Pollock, Fuggle, 2013).
Finishes
Finish selection is important especially in a setting that caters to people with limited abilities and those who are at a greater risk of injury. It is required to specify slip resistance flooring (Pollock, Fuggle, 2013). Carpet may be allowed if it is inset to match the height of the other flooring so that elderly individuals who drag their feet when they walk or use a walker do not trip and fall. One symptom of dementia is the loss of bladder and bowel movement which makes it common for residents to soil themselves. For this reason, carpet should be limited and fabrics and other finishes should clean easily. Matte finishes should be used on all surfaces because reflections cause confusion (Pollock, Fuggle, 2013). Keeping the material selections simple yet contrasting helps residents better understand their environment.
Security & Safety
Security is arguable the most important aspect of the design because it has a huge factor in the safety of residents. Individuals suffering with dementia wander unconsciously. If a resident were to wander out the doors of a memory care community it would be very dangerous and would likely lead to lawsuits. For this reason, secure doors with alarms that are visible to the staff are essential. Rooms that are not meant for the residents’ use must be lockable along with the cabinetry. As previously stated, dementia causes people to wrongly perceive objects. Some objects, like soap and other household chemical cleaners could be mistaken for a drink because the packaging is similar and may be drank by the residents. For this reason, items must be secured at all times, only to be used in the presence of a caregiver.
Accessibility
Dementia is only seen in the elderly population which makes accessibility an important factor in the design. ADA codes and regulations must be followed in a memory care setting which helps cover a large majority of the accessibility standards. There are, however standards specific to memory care that are not covered in the ADA codes. For example, the pile height of carpet in relation to a different flooring is lower in a memory care setting than many other spaces because it must be inset. Corridors and doors are typically larger than average to accommodate for walkers and wheelchairs. Other aspects of the design, such as lean rails in the residence halls are specific to senior living.
Furniture
Furniture in memory care communities is very specific to its setting. The chair and sofa depth is shallower and the seat is firmer to allow residents to stand up easier. The arms of a chair or sofa should be full length and curved at the end which further supports this need. Because it is common for dementia residents to soil themselves, the furniture must be durable and be easy to clean. Several companies make chairs that allow caregivers to take out the seat for cleaning. There are also chairs that are open in the crack which allows food to fall through to the floor. Tables must be able to fit wheelchairs comfortably underneath. Several chairs are often missing from a table to allow room for wheelchairs. Many senior living furniture companies have started to use a durable plastic that looks like wood helps protect the furniture from bang marks and other damage. In the residents’ bedrooms, wardrobes or very small closets are commonly used. The smaller the better, because people with dementia become overwhelmed easily when faced with having to choose from many different options. A small display compartment where caregivers can set out a couple of options helps support this idea (Timlin, Rysenbry 2010).
Conclusions
Designing for memory care requires a deep understanding of the disease and its effects on the daily lives of its victims. With the loss of almost all major senses and motor abilities, the design must be able to support these needs. A clean, active, and engaging environment can help reduce the progression of dementia and give those who suffer with the disease a better quality of life.
References
Andrews, J., & Bartlett, R. (n.d.). Dementia-friendly environments: Lighting. Retrieved February 25, 2019, from https://www.scie.org.uk/dementia/supporting-people-with-dementia/dementia-friendly-environments/lighting.asp
Pollock, A., & Fuggle, L. (2013). Designing for dementia: Creating a therapeutic environment. Nursing and Residential Care,15(6), 438-442. doi:10.12968/nrec.2013.15.6.438
Timlin, G., & Rysenbry, N. (2010). Design for Dementia. Royal College of Arts.
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