Academic journal article Perspectives in Public Health

Specialised Design for Dementia

Academic journal article Perspectives in Public Health

Specialised Design for Dementia

Article excerpt


dementia; Alzheimer's; elderly care; design; movement; memory trails; light therapy; behaviour cues; housing; environment


Demographic trends point to a fast-rising demand for elderly dementia care - but ordinary elderly care environments are unsuitable for dementia, which requires specialised accommodation. This paper concerns itself with the health and behaviour benefits of the special environment and not the available care and medication. Compared with traditional elderly care, space requirements are larger, there are security and care issues, as well as light, sleep, sensory and exercise aspects. The internal environment can be used for therapeutic benefit, using movement, memory trails, behaviour cues, signage, sun light therapy, light spectrum control and landscape. Special planning can mitigate antisocial behaviour, agitation, anxiety and confusion. It can provide scope for family involvement. To date, care has made blanket unspecialised provision. There is a need for a coherent and comprehensive approach to the total environment and to view it as a tool for care. This paper records the features developed in the design of specialised dementia care buildings by the author as part of a sequence of care homes evolved and adapted with feedback.

INTRODUCTION AND METHODS Elderly care needs are not static; they evolve as new influences come to bear.

The emergence of dementia as a major need1 demands reappraisal of the elderly care buildings provided. Designing for this use is difficult as the parameters of dementia are often vague.2

The concepts described here are the result of incremental design development over approximately 20 care environments designed by the author, developing the solutions to date. In the UK, a typical process from inception to proven and testable operational care home takes approximately three to four years. Trusted performance feedback is therefore long term.

The evolution of the approach recorded here began with the development of flexible spaces with movement trails in care homes for private and public sectors. This evolution has been recorded in earlier papers.3-5 These ideas have now been developed further on recent models for severe dementia between 2008 and 2012, utilising carer input at the design and commissioning stages.


Data from the Alzheimer's Society Report of 20076 commissioned by the LSE and Kings College London show that the UK has 700,000 people suffering from dementia and this is projected to rise to one million by 2025. Meanwhile much of current care provision was never designed for the purpose. Only 57% of 142,000 current care home residents with dementia as a known cause of admission are in accommodation dedicated to the condition.7 Many residents of care homes do not have dementia diagnosed for a variety of reasons; sometimes it is simply due to the higher charges this might incur. As a result dementia sufferers can represent a surprisingly high, unrecognized proportion and in non-specialist homes as a whole, 75% of residents have dementia.8

Policies to maximise living in the community to ease pressure on beds are a fundamental plan of UK government policy. This has had great success in keeping the fitter older person out of a care home, but the maintenance of independent or semi-independent living in the case of medium to severe dementia has security, support and selfharm issues that are very difficult to address on this basis. The dramatic rise in numbers seeking care homes will therefore be defined as dementiabased and serves as the predominant defining characteristic of new care homes.


There is a general lack of public perception of the different types of dementia. The industry itself tends to ignore the different characteristics and their environmental implications.9

Mild cognitive impairment

This is a term for conditions not severe enough to be diagnosed as, for example, Alzheimer's. …

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