Design for Dementia: Creating a Place Called Home

By Warner, Mark | Aging Today, March/April 2009 | Go to article overview

Design for Dementia: Creating a Place Called Home

Warner, Mark, Aging Today

Senior housing design has evolved in bold and positive ways. Current residential facilities for elders can be carefully considered environments where all inhabitants, especially those with dementia, have a choice to interact with others, be in solitude or participate in life's daily activities.

Designing environments for elders with dementia is a complex architectural specialty that calls for pioneering ideas and improvement. Good residential design for elders still seems to depend on creating marketable environments, even though there are designers who work hard to recognize and respond to needs of this

There are many conditions common to aging, including dementia, which often are slow and progressive. Sensitive design should address age-related conditions such as visual and hearing impairment, as well as reduced strength, balance and stamina. Effective design for dementia minimizes confusion and emphasizes a simpler, more easily manageable environment.

How should environments for people with dementia differ from those of other residential healthcare environments? Adaptable or universal design is a positive start, but not the sole design solution. Obvious design elements such as grab bars, railings, ramps, wheelchair-accessible spaces, forgiving flooring and sufficient lighting help create livable places for elders who can be confused, distracted or disoriented. But to create truly homelike and effective living spaces, designers need to intuitively comprehend life with dementia. While providing the basic attributes of home, they must adjust design to address the cognitive gaps characteristic to dementia disease.

Subtle design features, sometimes barely noticeable and even subliminal, can make elderly residences seem more like home. Scale is important: rather than being huge metropolises, where a person can get lost within a larger population, residences for elders are often divided into smaller areas - called neighborhoods - that are less overwhelming. Otiier elements, such as sloping roofs, shutters and window boxes are also employed to create a welcoming ambience.

One of the most common mistakes made in designing for dementia is to create'environmental overstimulation. Too many colors, patterns, sounds and images in the overall interior décor present too much information to process. As a mind is increasingly hindered by dementia, opportunities for misinterpretation and delusion abound: coats in closets and mirrored reflections can be perceived as people and flowers in the wallpaper seem real.


Spaces need to be simple, safe and uncluttered. They should be forgiving, open and logically arranged. I once was asked to help a gentleman whose wife had Alzheimer's disease. Every night tiiey would sit on the couch and watch TV, but soon she began to experience incontinence. When I suggested removing the coffee table from in front of the couch, the problem went away. The coffee table represented a huge barrier that blocked her way to the bathroom.

Colors that are too well-coordinated can also cause problems. For those who have macular degeneration or cataracts that cloud eyesight, visual fields lacking sufficient contrast blend into one another. This makes it more difficult to negotiate floor surfaces and around furniture, walls and comers.


The world can be difficult to navigate: imagine how obstacles increase when dementia enters the picture. Responsive design must address what architects call wayfinding, which is finding your way, without getting lost, from place to place. For those with dementia, successful journeys, however small, are important for independence and socialization.

Typically, people do not journey directly from point A to point D; they go from A to B to C and finally to D. Many times, senior housing design does not adequately emphasize visual cues and landmarks, orientation and guidance points, shorter travel paths and more defined destinations. …

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