The DCRC Assessment and Better Care, Environmental Design and Technology area has produced a series of papers drawing attention to the evidence base for a set of principles that are useful in designing and evaluating environments for people with dementia.

Principles to guide the design and evaluation of environments for people with dementia

 



  1. Safety and security 

 

The confusion which accompanies dementia determines the need for a variety of safety features to be built into the environment. They include a secure perimeter, hot water control and safety switches in the kitchen. As obtrusive attention to safety and security increases anxiety and agitation unobtrusive measures are to be preferred.

2.  Small

The larger a facility is the more confusing it is likely to be for residents. High quality care is easier to provide in small groups.

3.  Simple with good 'visual access'.

Confusion may be reduced by caring for the confused person in a simple environment. The simplest environment is one in which the resident can see everywhere that she wants to go to from wherever she is. This principle limits the inclusion of corridors in the design and results in the staff being able to see the residents almost all of the time. This reduces anxiety in both staff and residents.

4.  Reduced unwanted stimulation

The person with dementia experiences difficulties in coping with a large amount of stimulation. The unit must be designed to reduce the impact of stimulation that is unnecessary for the well being of the resident, eg. entry and exit doors used for deliveries, staff movements etc. should not be visible to the residents. Noise must also be minimised.

5.  Highlighting of important stimuli

Stimuli that are important to the residents should be highlighted. These include toilet doors, exit to safe outside area, aids to recognition on bedroom doors.

6.  Provision for wandering.

Wandering is sometimes a feature of the behaviour of the person with dementia. The design should allow it to take place safely but not encourage it. The wandering path should provide an opportunity for the person to go outside and take them past areas of interest in the expectation that they will provide the person with an alternative to repetitive wandering.

7.  Familiarity

It is well known that the person with dementia recalls the distant past more easily than the recent past. It follows then that their experience of recent furniture designs and decors must be less congruent with their present mental state than their experience of decors that they enjoyed in their younger days. To ensure that their experience of their surroundings is in keeping with their mental state the decor should be such that it would have been familiar to the residents in their early adulthood.

8.Privacy and community

People with dementia require a range of opportunities for social interaction. Spaces are needed for sitting quietly alone, with one or two intimate friends and in larger groups.

9.  Links to the community

The chances that the residents will continue to be part of their social network after admission should be maximised by providing for their care in small units in their community. These units should provide amenities that encourage visitors so that links with families and friends are not broken.  

Fleming, R., P. Crookes, and S. Sum, A review of the empirical literature on the design of physical environments for people with dementia. – evaluates and summarises the literature.

Fleming, R., The use of environmental assessment tools for the evaluation of Australian residential facilities for people with dementia. – assesses three tools that can be used to evaluate the quality of environments for people with dementia.

Fleming, R., R. Fay, and A. Robinson, Identifying and overcoming the obstacles to using empirically supported principles in the design of facilities for people with dementia. (to be released in the near future) – explores the problems that are encountered in trying to put the principles into practice and identifies the primary issue as being a lack of awareness of the principles.