It is also well established that our society is an aging one. Projections suggest that by 2056 the proportion of people aged 65years and over will represent approximately 24% of the population. The corresponding figure in 2007 was 13%. In the absence of significant medical breakthroughs, the correlation between aging and dementia would suggest a strong prevalence of the condition in the years to come.
Further to this, of those identified as having the condition, 62% were living in a health establishment such as a nursing home, an aged care hostel, or the cared component of a retirement village. This is significant as older adults with dementia encounter significant challenges in negotiating unfamiliar environments. The design of facilities for older residents is therefore crucial in supporting the ongoing function and independence of people with dementia.
The Dementia Centre founded by Hammond Care provide a number of resources inclusive of publications, guidelines, audit tools and design courses to assist in the creation of suitable environments for people living with dementia (www.dementiacare.com.au). Many of their resources and other previous research indicates that incorporating familiarity into environmental design can help augment deficits noted in dementia, this being reasoned to long-term memories remaining more intact than short term memories.
Of course with aging other co-morbidities also arise. These may include arthritis, limited mobility and fatigue due to stroke or heart condition, affected hearing and vision, amongst others. Balancing design to address ‘ease of use’ while maintaining familiarity is therefore important in achieving appropriate outcomes.
Some important considerations are summarized below:
- Increase lighting levels to assist with deteriorating vision. Maximizing natural light is especially useful as it not only assists with vision but supports people’s orientation to time. Take care not to produce sources of glare in increasing the lighting available. Locate switches consistently and provide contrasting colours to surrounding walls to assist users in finding them.
- Noise can have a detrimental effect on a person with dementia’s concentration and cognitive processing. Reducing and eliminating background noise is therefore an important consideration. Soft furnishing and finishes can assist in dampening noise. Due consideration of the age group should be applied in selecting these in order to make them as familiar as possible. The location of services within a building can impact on persistent low level noise, and of course acoustic separation via design as well as via materials used in partitioning, doors, etc. should be closely deliberated.
- Select materials and fixtures which are familiar to the age group. An example may be a capstan tap in lieu of a mixer tap lever even though levers are generally physically easier to use. Unfamiliar items and new methods to perform everyday tasks can be confusing and stressful for a person with dementia.
- Provide flooring finishes which are continuous and do not have bold patterns on them. Changes in floor finishes and patterns can be perceived as a change in level or an item forgotten in their path, sometimes becoming the precursor to a fall.
- Providing contrasting wall and floor finishes to assist in defining the shape and size of the room. This can also assist with orientation and navigation.
- Select furnishings, fixtures and fittings so that there finishes contrast against the background they will be viewed against. This is especially important in bathrooms where fittings are often white viewed against white wall tiles.
- Investigate appropriate assistive technologies which could be incorporated such as tracking devices, chair / bed occupancy sensors, enuresis alarms, motion detectors for lighting during night time toileting, etc.
- Consider suitable safety devices and strategies such as additional smoke, heat and gas alarms, tempering valves for taps, providing locked cabinets for storage of hazardous substances, monitoring devices, cooking appliances which switch themselves off, etc.
- Consider open shelving as opposed to cupboards, or cupboards with Perspex or safety glass fronts to assist with locating items.
Functional Access Solutions