An aging population and the social and economic effects of dementia are key challenges for the NHS and therefore areas of concentration by the Minister. Dementia friendly design is essential for all new health and social care buildings particularly primary care premises and those used mainly by older people. It is emphasised as part of Design Quality in the Policy on Design Quality for NHSScotland (p20) and should be considered as part of compliance with the Disability Discrimination Act and Disability Equality Duty. We spoke to Professor June Andrews of The Dementia Services Development Centre to find out more.
Dementia affects over 700,000 people in the UK and costs us more than cancer, heart disease and stroke put together, around £11 Billion in 2010, and much of that spend is futile, or caused by avoidable incidents. The majority of people with dementia live in the community and access everyday services in buildings not specifically intended for them. With increasing pressure to keep people living at home, dementia friendly design in non-dementia specific buildings is an increasingly important consideration for all public buildings. The Dementia Services Development Centre at the University of Stirling is dedicated to helping health boards and healthcare providers to produce dementia friendly buildings and has an international reputation in this area. In addition to providing extensive guidance via their website, they have provided training for key representatives from each NHSScotland health board so that boards have expertise in house. They also operate an accreditation scheme for dementia friendly design in new projects.
Healthcare buildings will be used by an increasing number of people with dementia, and it is critical that this is considered when they are designed and equipped. Research has shown that the cognitive impairment which affects people with dementia can be aggravated by building design, causing problems that could be rectified easily or avoided at very low cost.
It is easy to find out how to make a dementia friendly building. Older buildings can undergo a “makeover”, or it can be designed in from the start. There are examples of fantastic buildings around the world, and even in Scotland there are places which demonstrate one or more of the dementia-friendly features that are essential to minimise adverse incidents such as falls, unwanted exiting, incontinence, disturbing behaviour and anxiety. The science is not complete, but there is over twenty years of research to start off with, and lots of ways to keep in touch with developments as they arise. The one off design decision can reduce the burden of care for staff, and thus reduce the cost of the services provided in any building over a long period of time.
The science is based on a small number of general principles
- The person with dementia has difficulty in remembering things, so your building cannot rely upon them building up a familiarity with where things are with implications for wayfinding and other aspects. More recent memories are lost first, so if your toilet signs are a variation on the “stick man” that became common in the sixties, it might be meaningless to the person with dementia whose memory stops before then.
- The person with dementia has difficulty in working things out. They may not understand how to use clinical style taps and mixer faucets in toilets. Unfamiliar plumbing will give rise to delays and confusion that will lead to incontinence and distress.
- The person with dementia has difficulty in learning new things. For example, if way finding uses a colour code, or strips on the ground you create a range of issues. Firstly this person cannot easily learn the new colour code. They’ve forgotten which strip they are following after a few paces. Second, the person may have developed problems with depth perception and other visual processing issues that make a pattern on the floor appear to be a trip hazard and this momentary confusion can cause them to stumble and fall.
- The person will have the normal changes of aging but a difficulty in adapting to them. If you want to make the building safer and easier to use you should extrapolate from sensory and physical impairment, and compensate for well known problems that cognitive impairment will additionally present the person with dementia.
- The person will suffer from crushing stress and fatigue and your building can compensate for that, allowing them to stay independent for as long as possible.
Making the building dementia friendly need cost no more than the alternative. Finding out how to do it is easy. The first step should be to contact the person or people from your board that was trained in dementia friendly design. A great deal of information and help can also be gained from the University of Stirling directly including:
- Information on their website
- Free downloadable guides on technology and design, and a design audit checklist
- A simple ten hints booklet for use by householders to improve their own or their relatives home at little cost.
- Consultancy advice on projects from the planning stage forward from our own architects, engineers and designers
- An on line library with two full time librarians who can answer questions or provide references on dementia design and technology related issues on 01786 467740
- Books on specific issues such as the acoustic environment, balconies and roof terraces, and lighting and dementia for sale from the dementia shop
- A design audit service which awards bronze, silver and gold certificates to buildings, or sections of buildings, or design features such as a lift (elevator compartment)
- A regular three day design school for architects and planners incorporating training in the use of a design audit tool, based on research
- Degree module distance learning courses lasting one semester, delivered and assessed online on design and technology.
The principles and best practice promoted by The Dementia Services Development Centre are true Evidence Based Design. Following them can save the health board money, as well as help maintain the dignity of people with dementia, for example, the ability to see the WC from the bed can save nursing time dealing with incontinence. Therefore ensuring that clients understand the principles of dementia friendly design, and the design and development teams have an in-depth knowledge of the subject, are key requirements to produce successful buildings that will support their users.
Image – The garden of the Iris Murdoch Building at the University of Stirling by Arterre
For more information see the Dementia Services Development Centre’s website
Health Facilties Scotland has published a checklist for designing for dementia.