Designing for Dementia 20 th November 2014 Damian Utton RIBA Partner, Pozzoni LLP Architects

What is dementia? Dementia in the UK context Principles of dementia design Evidence base How do these principles work in practice? Conclusion Current best practice Key Points Priority Areas Agenda

What is dementia? (Alzheimer’s Society 2012) Dementia is an umbrella term for a range of diseases of the brain Dementia describes a set of symptoms including: Loss of (short term) memory Mood changes Communication problems These symptoms occur when the brain is damaged by certain diseases Dementia is progressive and will depend on the individual and what type of dementia they have.

What is dementia? Impairments of dementia are: Impaired memory Impaired reasoning Impaired ability to learn High level of stress Acute sensitivity to the social and the built environment (Stirling University 1997) In the later stages of dementia the person affected will have problems with everyday tasks and will become increasingly dependent on others.

Dementia in the UK Context

The UK Context National Dementia Strategy (2009) Strategic framework for making improvements to dementia services and addressing health inequalities Care Act 2014 Health and Social Services to work together Cap on care fees of £72,000 Threshold of £118,000 before state pays care fees Housing support for older and vulnerable people Helping carers to stay healthy Help people to make informed choices about health and social care Housing Standards Review Three categories of housing: Visitable dwellings Accessible and adaptable dwellings Wheelchair user dwellings Planning process determines which option applies Focus on mobility impairments

The UK Context Prime Minister’s Challenge on Dementia (2012) Improve Health and Care Creating dementia friendly communities Research National Dementia Declaration / Dementia Action Alliance Dementia Friends Demos report - Commission on Residential Care Housing with care is an asset Create a flourishing market of supply Separate ‘what’ care and support people need from ‘where’ this care is delivered Funding

Principles of Dementia Design

Older people, and older people with dementia, can be very sensitive to the built environment People with dementia may not remember or understand their surroundings. Design can compensate for these impairments Design can facilitate the efficient delivery of care in a non-institutional way Other impairments can be compensated in a straightforward way with established guidelines, but dementia affects people in different ways.

Principles of Dementia Design Consensus that good design - should compensate for impairments should maximise independence should enhance self esteem and confidence should demonstrate care for staff should be orientating and understandable reinforce personal identity welcome relatives and the local community allow the control of stimuli (Marshall et al 1997)

Principles of Dementia Design Kings Fund – Is your housing dementia friendly? The environment should promote: Meaningful interaction and purposeful activity between residents, their families and staff Well-being Encourages eating and drinking mobility Continence and personal hygiene orientation Calm, safety and security

Principles of Dementia Design -Evidence base Published research Universities of Stirling, Worcester, Bradford, etc. University of Stirling DSDC Publications Housing and Dementia Research Consortium Housing LIN Post-Occupancy Evaluations Kings Fund Enhancing the Healing Environment Tools – is your housing dementia friendly? Talk to people!!

How do these principles work in practice? Whilst these photographs are from new build extra care environments, the principles are applicable to all building types

Compensate for impaired memory, reasoning, learning open plan - high levels of visual access wc visible from bed ‘event’ at a dead end

Compensate for impaired memory, reasoning, learning contrast between junctions hidden service doors visible cupboard contents similar floor tone

Maximise independence access to external space accessible kitchen graphical signage shop

Enhance self-esteem and confidence flexible space for purposeful activities wardrobe cue for doors

Demonstrate care for staff dispersed storage open plan: discreet monitoring break-out space technology

Orientating and understandable familiar domestic homely

Reinforce personal identity

Welcome relatives and the local community cafewell-beinghair and beauty community roomgym

Control of stimuli daylight without glare natural ventilation sound absorbing buffer from noisy areas

Conclusions

Current Best Practice Non-institutional environments Manage risks Community hubs Dementia friendly communities Conflict with other regulations (infection control, fire, food, etc) Emphasis on home adaptations and domiciliary care to keep people at home Government funding for extra care housing and to ‘pepper-pot’ people with dementia around a housing scheme

Conclusion – Key design points 1.Familiar environment, fixtures and fittings 2.High levels of lighting 3.Easy to understand built environment 4.Clarity and simplicity: where things are and where to go 5.Appropriate signage (1200mm above floor) 6.Contrast to increase visibility 7.Similar floor tones 8.External space is as important as internal space

Conclusion - Four Priority Areas 1.Improve lighting 2.Ensure good contrast 3.Similar floor tones 4.Ensure the toilet is easy to find

Design for Dementia in Practice 20 th November 2014 Damian Utton RIBA Partner, Pozzoni LLP Architects