Dementia and Design
by Jamie Wilson
Originally published in Insights in Construction, a publication of Meyer Najem
Picture your favorite room in your house. Why is it your favorite? My favorite room is a back bedroom that has big windows and a beautiful view of our yard, lots of sunlight and a mostly cream palette with just a hint of lavender for color. Now imagine a setting that you find unpleasant, or depressing or confusing. For me, Chucky Cheese, a hospital and a Las Vegas casino come to mind. Next, imagine having to live in that environment. Also imagine that you could not come and go as you please, you were not always able to communicate with those who worked there and you had to depend on them for some or all of your basic care needs. And just for fun imagine that you were often in pain and usually confused. How would that affect your mood, behavior and temperament? Clearly, our environment plays a big part in our mood, sense of well-being and quality of life. Environment is even more important to the cognitively impaired. Our brain is responsible for taking all of the information in our environment and sorting and processing it. It engages our senses and past experiences and determines how we perceive something, it tells us if something is a threat or pleasant and triggers the emotions appropriate to that perception. When a person has Alzheimer’s disease or another dementia, the perception and processing of an environment can be dramatically impacted. This is due to the fact that many dementias are progressive disease processes that cause degeneration and failure of different parts of the brain. This brain failure can cause:
- Visio-spacial issues
- Inability to see or distinguish colors
- Inability to recognize objects
- Misinterpretation of objects
- Decreased depth perception
- Sensitivity to light and sound
- Sensitivity to stimuli
In addition, most people with dementia are seniors over the age of 65. Many seniors have issues with vision and mobility, which increases with dementia and thus greatly effects how they utilize and perceive their environment. So when a property is being designed specifically for the care and housing of those with dementia or brain disorders there are many more considerations than a nice view and pleasing color palette. Design, layout and décor can significantly impact the mood and behavior of those with dementia positively or negatively. Here is a practical example: Resident incontinence is a common issue in care settings. Staff will often talk to us about Mr. X who continues to urinate in waste baskets and planters and will not use his toilet. Below is a photograph of Mr. X’s bathroom.
Question: Why is Mr. X not using his toilet?
Answer: It is likely that he has some damage to the occipital lobe and cannot easily see the toilet since the entire bathroom is white or neutral in color. Dementia impacts ones ability to see neutral colors and subtle contrasts. Simply adding some contrasting color will help Mr. X identify the toilet. Also as we age, the decrease of cones in the retina can result in less color perception, especially for blues, greens and violets. Thus, red is a good choice for contrast as red hues are perceived even as cones decrease.
This can pose a potential problem since the nature of care settings assumes that a room or apartment will be occupied by several residents over the life of the building. Therefore most of these settings are designed with intentionally neutral color palettes, similar to a rental property, with the intent of creating a pleasing appearance to the masses. As the above example shows, this can cause issues for the cognitively impaired. Other examples in this vein would be lack of contrast between floors, walls and handrails and furniture. Handrails are of little use if they cannot be easily seen.
Question: So if use of red is good, should your fire exit doors be red?
Answer: No, not in a dementia setting where exit seeking is a common problem and safety risk. Exits are better off being camouflaged so they do not encourage exiting. Some memory care settings will paint a lovely garden scene over the door and surrounding walls to make the exit blend into the wall and hide the exit. On the flip side we would want to consider painting the bathroom door red or using very bold signage to allow people to more easily find the toilet. Somewhat contrary to popular design, yes? Layout and architecture of a care setting can also contribute or detract from quality of life for those with cognitive impairment. A common floor plan for a residential care facility will be shaped like an X and have a nurses station, dining and activities as the center of the building with the apartments along the exterior walls.
Question: What are some pros and the cons of this layout in a memory care setting?
- Center placement of nurses station, dining and activities allows staff good visual of rooms and common areas.
- Rooms against exterior walls allow each room to have windows and natural light.
- X shape does not allow for free wandering. Residents will eventually come to the end of the hall and may get stuck there if they no longer have the ability to navigate turning around which can cause agitation.
- Residents can easily get lost looking for their room if each hall way is not distinctively marked.
- There is no outdoor secured common area.
- This is a very institutional layout. People’s homes are not laid out this way.
- Common areas are all in the middle which does not allow for a person to be out of their room and in a low stimuli common area.
This floor plan caters more to the staff with the intent to make supervision of residents easier which is a logical consideration. However, if the environment promotes agitation and behaviors it will not benefit the staff or the residents. Lay outs that allow for wandering (circular or square), have secured access to the out doors, have natural lighting and a more home like setting have been proven to be more “dementia friendly” siting reduced behaviors, lower usage of antipsychotics, and lower turn over among staff and residents. These are just a few examples of the many considerations that need to be addressed regarding the architecture, design and décor when developing a dementia care setting. A safe and pleasing living environment is especially crucial for those with dementia as many of them do not have the opportunity to leave the care setting very often. Creating the proper home environment for those who are cognitively impaired will significantly improve quality of life. However, be warned, dementia is not always easy to understand and how it impacts a person varies by person as well as the type of dementia and stage of the disease process. In this scenario a professional may find some dementia training as valuable as their understanding of flow and their natural sense of style. My Mother suffered from Alzheimer’s Disease for 6 years and I watched how her environment changed and her perception of it changed as she progressed. I am pretty sure I will always find Chucky Cheese, the hospital or Vegas to be disturbing environments regardless of my cognition. But what about my peaceful cream room? It is likely the light would be too bright, the view frightening and I would be unable to tell the bed from the floor. I hope there is a nice care setting that will work for me if I need it someday.
About the Author
Rev. Jamie Wilson Headley – CDP, CDI, CSA, MBA President & CEO Dementia Services Group is a full service dementia consulting company that works directly with families dealing with a dementia diagnosis, acting as a navigator, advisor and advocate. DSG also provides dementia training to industry professionals and the community at large. Ms Wilson is a sought after public speaker on dementia and aging. Jamie has been trained by the Alzheimer’s Association of America as a Dementia Professional, and has been certified by the National Council of Certified Dementia Practitioners as a Certified Dementia Practitioner and as an Instructor. Ms Wilson has also been trained as a Certified Senior Advisor and is an ordained non -denominational minister. Jamie has a great deal of personal experience with dementia as well as her professional training. Jamie’s mother died of Alzheimer’s disease. As her Mother’s caretaker and advocate, Jamie gained a wealth of knowledge, much of it she quips, on “what NOT to do”. In addition, Jamie holds a BA and MBA from Dominican University in River Forest, IL and spent her “former life” as an operations executive working with fortune 500 companies. Jamie was hired by companies for her expertise in crisis management, strategic planning, leading through change and training and development. This expertise transfers into her work as an advocate, advisor and educator. The mission of DSG is to improve the lives of those living with dementia by offering support, advocacy and advice to individuals and families and by providing education to healthcare professionals and senior providers. This is Jamie’s passion, her purpose and her ministry.