More than 70,000 Kiwis currently live with dementia — and by 2050, our fast-ageing population is expected to push that number to upwards of 170,000.
But dementia doesn’t just affect the people who suffer from it. It impacts their partners and children, their immediate family, their friends — anyone and everyone involved in caring for them or making decisions about that care, swelling that impending 170,000 to at least double the number.
In the approaching decades, these hundreds of thousands of people within the sphere of dementia and dementia care will bring new expectations to and put increased pressure on New Zealand’s care facilities — and as they stand, many of these facilities require upgrades to accommodate the coming wave of need and to meet market demand for elevated quality of care.
Numerous studies have testified to the mental health and quality of life benefits enjoyed by dementia care patients as a result of considered, thoughtfully designed built environments — 169 of which are collated and evaluated in this October 2014 piece by Gesine Marquardt, Kathrin Bueter, and Tom Motzek, published in the Health Environments Research & Design Journal.
These studies lend themselves to the adoption of evidence-based design within the dementia care sector. Luckily, most (if not all) of the needed upgrades are within reach, thanks to recent advancements in design thinking around dementia care and innovative, affordable design solutions that simultaneously improve the resident experience, satisfy customer (read: family) desires around comfort and care, and future-proof our nation’s vitally important aged care assets.
But one thing is certain: the way we design for dementia needs to shift if we’re to avoid a dearth of appropriate facilities in the near future. Using fresh thinking in the sector, we can better provide for those in need and offer greater comfort to their loved ones.
As Context prepares to work with clients to address these needs, we’re looking to better understand the design requirements of New Zealand’s retirement and aged care players. Led by Senior Architect Judith Taylor, our team of specialist designers is turning to global best-practice to underpin their thinking and solutions for the sector.
These practices are anchored by the key principles of designing for dementia, outlined below by Taylor and Context Interior Designer Danielle Wai — who led the award-winning spatial design programme for the groundbreaking Chocolate Works Care Village dementia facility.
Whether we’re introverts or extroverts, regular human interaction is critical to our mental health. Once they enter a care facility, it’s essential that residents feel they belong to a community. Creative workshops such as painting, pottery, music, gardening, and dancing can boost morale, stimulate the mind, and enable vital social interaction. These cognitively invigorating activities have also been clinically shown to improve communication capabilities and quality of life amongst dementia patients.
Alternatively, successful community environments within care facilities can be created via thoughtfully designed ‘care villages’. This revolutionary design thinking, pioneered by De Hogeweyk in the Netherlands, brings the shops, café, salon, and cinema into the home — creating a community that allows residents to buy their own chocolate, birthday cards, manicures, and other staples of ‘normal’ life whilst offering familiarity, dignity, and independence.
Within any form of long-term care, the perception of freedom is fundamental to resident happiness and empowerment — and key to that freedom is in-built design solutions that reduce fall risk. Chief amongst these are floor finishes; as older people tend to shuffle, low-pile carpet or slip-resistant finishes should proliferate.
Appropriate furniture, such as pieces that eliminate sharp edges and chairs that promote mobility rather than inhibit it, must also be considered. A 2018 study published in SAGE Open Medicine underscores this, having found that ‘residents, experts, and carers all prefer chairs…above the recommended height for older people’, allowing them easier ingress and egress. Seating in aged care should also account for depth, enabling residents to rest comfortably without having to slump.
In addition to being hazard-free, aged care environments should facilitate movement as much as safety considerations allow. If a resident wishes to walk from their bedroom to the café, for instance, they should be able to follow clearly defined, well-signposted, amply lit pathways with obvious handrails.
It’s unfortunately relatively common for less-than-dignified features (design elements that lend themselves more to stage sets rather than real homes) to be included in dementia care facilities.
Treating patients with dignity is one of the foundational ethics of nursing, and numerous studies — including this 2008 piece from BMC Nursing, which explores the relationship between dignity and autonomy and the means through which aged care practitioners and facilities can foster the two concepts — have shown that dignity is critical to our identities, our mental health, and our understanding of ourselves.
It’s an essential component of resident satisfaction and, by extension, the satisfaction of their families. As these families are often the technical ‘clients’ of aged care organisations, dignity is therefore vital to the long-term viability and sustainability of any given facility.
Aged care environments should, wherever possible, eschew the clinical and lean into the fresh, the homely, and the comfortable. If friends and family are visiting their loved ones in a warm, inviting space, they’re more likely to make frequent trips that have a resulting positive effect on the mental state of a resident.
Moreover, studies have proven that intergenerational dementia programmes — such as bringing children into dementia care homes to participate in activities like reading or art — stimulate memory and communication and generally improve resident quality of life.
Dementia care residents run the demographic gamut and bring with them a colourful slew of pastimes and hobbies that, if continued while in the home, can dramatically improve their mental health and cognitive states.
Resources from the Alzheimer’s Society suggest that regular activity and exercise that remind residents of their lives pre-care facility can help them maintain cognitive and motor skills and provide them with a sense of achievement that, in turn, furnishes them with a sense of purpose.
Architecture and design should accommodate this via fit-for-purpose spaces for the likes of art and walking, as well as the integration of nature and the outdoors with safe indoor areas.
In a 2012 study published in JAMA Psychiatry, researchers found a positive correlation between a sense of purpose and the delay of cognitive decline in dementia patients. The conclusion of this study — that ‘higher levels of purpose in life reduce the deleterious effects of AD [Alzheimer’s disease] pathologic changes on cognition in advanced age’ — has been corroborated by other research efforts and points to the importance of activities and stimulation that promote a sense of purpose in dementia sufferers.
Even simple things — such as providing residents with bird feeders or plants that require their personal tending and care, asking them to set the table for dinner, or forming sports and arts clubs for them to actively participate in — can offer critical meaning to a person’s day.
As a proven method for the elevation of awareness and the enhancement of concentration and attention in those with memory dysfunction, multi-sensory stimulation (MSS) has recently gained recognition and popularity as an effective technique within dementia care facilities.
As it pertains to design, integrating the five senses — sight, smell, hearing, feel, taste — within care facility interiors can create calming balance and a harmonic setting for residents. This can be accomplished through the implementation of design thinking and elements such as tailored spaces for music therapy, aromatherapy, and pet therapy.
Sleep disturbances and the behavioural problems that arise as a result are noted symptoms of dementia. Within care facilities, consideration should be given to lighting solutions that replicate the look and feel of nature, promote the preservation of normal circadian rhythms, and foster, as much as possible, the observance of typical sleeping hours and patterns.
The benefits of these natural lighting solutions have been summarised in various recent journal pieces, including a 2017 Neurodegenerative Disease Management study that found that ‘timed light exposure can consolidate and improve nighttime sleep efficiency, increase daytime wakefulness, and reduce evening agitation without the adverse effects of pharmacological solutions’ and a 2019 study in the journal Working with Older People that outlined the physical, emotional, and social benefits of ‘green dementia care’.
As far as design solutions are concerned, examples include lounges with ample light that are designed to prevent overheating, easy access to the outdoors that takes all safety considerations into account, and the integration of new lighting technology within residents’ rooms that mirrors natural outdoor light patterns.
Dementia sufferers tend to experience short-term memory loss more intensely than longer-term, meaning they feel deep connections to memories from their younger years. Dementia care should aim to trigger relatable memories and a sense of familiarity through design — for instance, by incorporating interior design elements such as memory boxes at bedroom door entrances or by surrounding residents with images from their youths of recognisable cultural figures, important historical moments, or local seaside resorts from their hometowns.
These memory linkages are referred to as reminiscence therapy, which studies — such as this 2018 entry in the International Journal of Geriatric Psychiatry — have shown significantly decrease depressive symptoms in dementia patients.