Dementia reduces the ability to filter stimulation and attend to only those things that stand out. A person living with dementia becomes stressed by prolonged exposure to large amounts of stimulation. The environment should be designed to reduce unhelpful stimulation, such as unnecessary or competing noises or signs, posters, spaces, and clutter that are of no use to the resident. The full range of senses must be considered. Too much visual stimulation is as stressful as too much auditory stimulation.
Conversely, some stimulation is vital to provide clues about where they are and what they can do, which can help minimise their confusion and uncertainty. Using text and images in signs is a simple way to do this, such as an image of a plate with food for the dining hall. Encouraging a person to recognize their bedroom through the presence of furniture, the color of the walls, the design of a light fitting, and/or the bedspread is a more complex one. These clues need to be carefully designed so that they do not add to clutter and become overstimulating.
It is also not enough to ensure that doors to residents’ rooms are painted in a bold and distinctive color. At Lydia Eva Court, a residents’ room door resembles a typical house front door, complete with paneling and numbers, to help residents associate them with doors they may recognise from their past. However, instead of door handles being above locks in a conventional manner, the arrangement is reversed so that the lock is not obscured by the handle. This ensures residents do not forget where it is.
One of the most moving aspects of the design is a recessed ‘memory box’ beside the entrance to each resident's room. These are filled with sentimental objects from residents’ past lives, such as photographs or jewellery, to help trigger their memory.
Finally, the design of the rooms themselves makes provision for the dementia condition. Cupboard and drawer doors are often glass fronted to ensure that residents do not forget what is inside them, and in each room, the door to the en-suite bathroom is visible from the bed, to avoid a resident waking in the night and forgetting where the bathroom is.
Lydia Eva Court’s occupants are ‘residents and not patients’. Links to the wider community through frequent interaction with friends and relatives can help to maintain their sense of identity. Without constant reminders of who they are, a person living with dementia loses this identity. An attractive and comfortable environment encourages visitors to come and spend time. For staff, an environment that embodies the philosophy of care becomes a message of the values and practices required, while providing them with the tools they need to do their job.
Understanding the impact of dementia on individuals, their carers and families, is a way in to exploring the impact of the built environment on people, and their standard of living. There are things we can all do as individuals to reduce the risk of developing dementia, such as drinking less alcohol, stopping smoking, maintaining a healthy weight, and being physically and socially active. The quality of our built environment can support this preventative approach and have an impact on how easily we can make these behavioural changes. While social support, and problem-solving approaches can help to compensate for less supportive physical environments, Inclusive Design encourages and enables people to take decisions concerning their own lives- to live freely, independently, and with dignity.
* World Health Organisation description
** World Alzheimer Report 2020, Design, Dignity, Dementia: Dementia-related design and the built environment, Volume I