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DEMENTIA FACILITIES: Improving Operational Aspects through Built Environment Solutions Dr MT (Malgosia) Zlobicki School of Design and Built Environment.

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Presentation on theme: "DEMENTIA FACILITIES: Improving Operational Aspects through Built Environment Solutions Dr MT (Malgosia) Zlobicki School of Design and Built Environment."— Presentation transcript:

1 DEMENTIA FACILITIES: Improving Operational Aspects through Built Environment Solutions
Dr MT (Malgosia) Zlobicki School of Design and Built Environment

2 Introduction The aim of this presentation is to:
overview the key fundamentals of the built environment identify the main developments in dementia design determine the built environment solutions for the operational improvement of dementia facilities

3 Explanation of Terms Dementia design refers to special considerations given to the built environment for people with dementia, who have cognitive impairments, and age-related decreases in sensory perception Dementia facilities comprise high and low care residential micro-communities, where ‘ageing in place’ tends to occur Dementia is a brain disorder, which is characterised by progressive deterioration of intellectual, functional/ behavioural, emotional and social abilities

4 Person-Environment Link
This presentation is based on the assumption: that human behaviour and the built environment are significantly interrelated that people with lower levels of bio-behavioural competences have less control over a ‘demanding’ built environment, and as such require more assistance

5 Environmental Demand and Therapy
A ‘demanding’ environment is non-supportive of people with dementia, and does not compensate them for their deficits A ‘therapeutic’ environment is a source of treatment for people with dementia, as it enhances rather than neglects their remaining abilities

6 Environmental Equilibrium
A ‘balanced’ environment has the potential to: positively influence the effectiveness of care provision reduce people’s stress and discomfort extend people’s functionality and prevent their injuries increase people’s satisfaction and happiness

7 Environmental Components and Attributes
A ‘responsive’ or enabling environment exhibits the following attributes and components: sensitivity, flexibility, diversity, variability, usability physical ‘naturalness’, aesthetic harmony, psychological compatibility with users, and socio-cultural appropriateness

8 Environment-Centred Goals in Dementia Care (Source: Calkins, MP (1988) Design for Dementia, Owings Mills, Maryland: National Health Publishing, p. 19) Maximum independence/ autonomy for ‘activities of daily living’ (ADLs), self-esteem and dignity Indoor and outdoor choices for exercise/ recreation Cues and props/ ‘landmarks’ to overcome disorientation/ alleviate distress All senses stimulation (without excesses) Small and large group interactions for social well-being Removal of unwanted stimuli and irritants (i.e. glare, noise, crowding – invasion of personal space)

9 About People with Dementia and their Built Environment
People with dementia respond best to a calm and quiet environment, which includes the following elements: small and non-congested communal areas for reduction of stress well-illuminated communal areas and toilet/ bathroom sensor-night-lights for reduction of confusion non-disturbing noise for reduction of restlessness familiar objects and uncluttered, simple surroundings for reduction of disturbed behaviour

10 An Example of Environmental Autonomy for People with Dementia
‘Non-dead-end’ corridors in dementia facilities create a continuous walking path >>> residents with dementia become more autonomous and less agitated >>> residents with dementia seek fewer staff instructions or prompts >>> staff time is more productively used on care activities

11 Current Trends in Dementia Design
Environmental simplification, interpretability/ familiarity, direction/ ‘place awareness’, negotiability, attractiveness, calmness, safety/ security, unobtrusiveness, territoriality (i.e. territorial separation), sensory meaning, belongingness, healing/ therapy

12 Environmental Performance Indicators of Dementia Facilities
Resident ease of accessibility to communal indoor and outdoor areas (i.e. spatial continuum) Staff ease of care giving, cleaning and maintenance (i.e. ergonomically planned work areas, suitable surfaces for odour control, unobtrusive surveillance, etc.) Resident comfort, confidence, safety and security (i.e. non-conspicuous exit doors, noise reduction, desirable temperature/ ventilation, appropriate flooring, simple directional cueing, etc.)

13 Environmental Performance Indicators of Dementia Facilities (cont.)
Staff proximity to utility/ therapy rooms and stores (i.e. short walking distances, better ‘workflow’) Resident anxiety prevention (i.e. adequately sized home-like communal areas and bedrooms, continuous wandering paths/ circulation freedom, sufficient illumination*, uncomplicated spatial layouts, personal spaces, etc.) * above 150/ 200 lux

14 Generic Design Approaches for Dementia Facilities
Universality and inclusiveness/ beyond ‘adaptability’/ ‘barrier-free’/ for all abilities without stigmatisation Therapeutic orientation / all senses stimulation Wayfinding/ multi-cueing Personalisation / heterogeneity / contrasts Person-environment-care management fit Sustainability/ ‘green’ built environment Indoor and outdoor meaningful/ relaxing ambience

15 Environmental Sustainability for Dementia Facilities
Smart technology readiness means: unobtrusive monitoring devices active* and passive sensors/ assistive aids energy maximisation (e.g. control of climatic conditions – higher ceilings, awnings, insulation, etc.; electrical/gas/solar efficiency; water conservation, recyclable/ renewable products) * unmodified active sensors may be unsuitable for many people with dementia

16 Environmental Effectiveness for Dementia Facilities
Reduced mechanical heating and cooling for lower energy costs Better draught and humidity controls for even temperatures Regular maintenance for minimum upkeep outlays Raised air quality for more healthy indoor living Advanced acoustic controls for quietness Enhanced people comfort and functionality (or productivity) for greater life quality

17 Core Environmental Questions for Dementia Facilities
Can all intended functions be performed in the care environment? Are the desired behaviours and movements (or circulation) achievable in the care environment? Does the care environment create any barriers or impose limitations upon people with dementia? Does the care environment positively alter the life quality of people with dementia?

18 Core Environmental Questions for Dementia Care Facilities (cont.)
Is the care environment flexible and modifiable in response to changing needs or wants of people with dementia? Is the care environment therapeutic for people with dementia? Has the care environment been assessed?

19 Environmental Measures
For the person-environment interactions to be accurately assessed, it is useful to rely upon: an observer’s appraisals (i.e. observational techniques) All users’ perspectives (i.e. post-occupancy evaluations) checklists for dementia-specific and other care environments (e.g. Physical Environment Rating Scale*) * Coulson, I (1997) “Evaluation of Physical Environments in Dementia Care Units” Australian Journal on Ageing, 16:4, pp

20 Observational Assessment of the Environment
Behavioural mapping is an observational technique that determines the type and frequency of behaviour, and records associations to the built environment Physical traces in an observational technique that is concerned with past behaviours, which are recognisable from by-products of human presence, such as surface erosion, leftovers, missing evidence and additions

21 Post-Occupancy Evaluation (POE) Types
Indicative POE is a simple appraisal, usually based on a walk-through Investigative POE is a detailed assessment reliant on researched criteria that are objectively and explicitly stated Diagnostic POE is an in-depth multi-method comprehensive investigation, usually longitudinal

22 Environmental Benefits for Dementia Facilities
Tangible benefits (i.e ‘monetary’ value) – reduced overhead costs through easier care delivery within a ‘performance-oriented’ and energy-efficient built environment Intangible benefits (i.e. ‘other’ value) – better life quality, greater comfort, less stress

23 Environmental Solutions for Dementia Facilities (Source: Zeisel, J
Environmental Solutions for Dementia Facilities (Source: Zeisel, J. (1997) “Space Design and Management for People with Dementia” Proceedings of the 28th Annual Conference of the Environmental Design Research Association, pp ) Operational improvement is achievable by: environmental design – how designers can best plan the built environment (e.g. passive solar features* - to reduce the expense associated with mechanical heating and cooling, to enhance thermal comfort, as well as to increase useable daylight environmental management – how staff can make the best use of the built environment (e.g. staff training on ‘The built environment as a vital component of the caring process’) * appropriate size and orientation of windows, effective shading, adequate insulation of walls and roof

24 Conclusion To eliminate the under-utilisation and neglect of environmental resources: the built environment’s role in the caring process of people with dementia must be fully understood the built environment’s contribution to operational improvement must be fully explored

25 Recommendations The best environmental outcomes can be reached through: recognition of unmet past needs and undesirable consequences awareness of current trends prediction of future requirements acceptance of the necessity for knowledge expansion and receptiveness to change

26 About the Network The QUT Research and Design for Ageing International Network: specialises in innovative multidisciplinary ‘person-environment-care management’ design promotion, analysis, and education coordinates projects in post-occupancy evaluation (POE), virtual reality universal smart care-home design, and therapeutic environment development offers free membership


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