What an architect should consider when he or she designs a home or a caring center for people with dementia or Alzheimer’s disease? Architecture and interior design can not inhibit patient’s progressive decline in mental capacity, but if they are properly planned, may alleviate some of the symptoms, such as night-time restlessness, sense of loneliness or being lost. That is something that matters.
Alzheimer’s disease is a form of dementia: it is one of a range of conditions that progressively degrade the synaptic connections within our brains. It brings about a loss of those faculties that allow us to orientate ourselves, to navigate and to remember. Dementia erodes the ability to remember where you have come from and to plan where you would like to go.
The exhibition ”Losing Myself” inside the Irish Pavilion at the 2016 Venice Biennale explores the lessons learned through designing and revisiting buildings for people with dementia by architects Níall McLaughlin and Yeoryia Manolopoulou.
At the heart of the exhibition space stands a complex drawing machine that appears to sketch out imagery onto the floor. Sixteen projectors show the entire plan of a building designed for people with Alzheimer’s disease located in Dublin, Ireland.
– The coherent, fixed plan an architect depends upon can never be fully brought into being by the buildings occupants: they cannot use memory and projection to see beyond their immediate situation and can no longer synthesise their experience to create a stable model of their environment. This produces a fragmentary world – we can learn at the exhibition.
The most informative and interesting part of the ”Losing Myself” exhibition is the list of sixteen lessons by Níall McLaughlin and Yeoryia Manolopoulou learned through designing and revisiting buildings for people with dementia. Here you can find an abstract of what they shared.
All architects need to understand dementia
Hellen Rochford-Brennen, chair of the Irish Dementia Working Group and vice-chair of the European Working Group of People with Dementia, has dementia. She finds that people often misunderstand what that means. When she books airport service to assist with her navigational difficulties, she is invariably presented with a wheelchair despite her lack of physical disability. – It’s my brain that’s slow, not my feet – she tells.
The tragedy of dementia is that the brain is hidden: we cannot see the physical degeneration caused by the condition. Architects need to design houses, public buildings, and cities with a full understanding of the cognitive difficulties that people with dementia face every day.
Risk and autonomy
There is a tension between the need to keep people safe and the need to preserve their quality of life. We are preoccupied with health and safety, the reduction of risk and controlled institutional environments that can eventually devastate the individual.
Lesley Palmer challenges the notion of the balcony as a risky building element for older people: ”We’re depriving everybody of daylight, for fear of someone jumping”.
When we remove opportunities for exploration and decision-making, we dehumanise people. It is easy to identify the physical damage of a broken arm, but it is difficult to quantify the mental damage inflicted by the loss of autonomy due to excessively restrictive policies.
Daylight is critical
Night-time restlessness is the main reason why people with dementia are committed to full-time institutional care. The person’s partner can no longer cope with the disruption.
For very many people with dementia, just increasing the light level in the place where they live can make more difference than medication. A combination of high levels of light during the day and melatonin supplements greatly ameliorates night-time restlessness by helping to regulate circadian rhythms.
The design of buildings with high levels of daylight must go hand in hand with careful management of that light to minimise confusing glare and shadows.
Like all of us, people with dementia need a connection to the outdoors. They should be enabled to go outside freely, to feel the sun on their skin, through the provision of safe external space. The effect of vitamin D on improving bone density in older people is well known. Vitamin D deficiency increases the risk of depression in older people.
Minimise visual and physical barriers
”Wandering” is a characteristic behaviour of many forms of dementia. Instead of trying to prevent wandering, we must strive to create an environment in which it is safe to wander.
Do not tuck bathrooms away at the back of the building. Think of people who experience navigational difficulties. If they can see the toilet from their bed, they can work out how to get there.
Routes should be composed to allow people to move through a building independently without getting lost. Where possible, the number of doors should be reduced. Clear visual connections between spaces facilitate passive surveillance, and the removal of physical barriers, such as locked gates, reduces the potential for frustration.
We need connections
Isolation is endemic among people with dementia. This is an important emotional issue but also a significant risk factor for health. There is much anecdotal evidence to suggest that interaction with babies and children enriches the lives of people with dementia. Sabina Brennan, a dementia expert, says: ”We should care for our older adults in the same places that we care for our young children”. Successful models for this exist in Japan and Holland.
Life with purpose
Dr. Atul Gawande, surgeon, writer, and public health researcher, stresses the value of giving older people a living thing to care for. Care and respite buildings for people with dementia must accommodate and facilitate meaningful activity, fulfilment, and creativity: for example, through singing, painting, dancing, gardening or cooking.
In Hammond Care facilities in Australia, clients spend time cooking. If the care staff believe there is a food hygiene issue, they simply serve a different meal.
My personal daisy-chain
The care environment and assistance for people with dementia should draw a lot on a person’s biography. It is common for dementia care facilities to prohibit users from decorating their rooms. But the provision for personal object placement (a spatial ”daisy-chain”) in the building is vital for the individual’s emotional well-being, their sense of personhood and ease of navigation.
Consider the city
Architects of public buildings are now required to consider physical accessibility from the outset. The same should be true for dementia. On our streets, as in building interiors, we should prioritise clarity of signage and routes. Buildings themselves with distinct identities may act as landmarks.
Assistive technologies can promote independence, autonomy, and confidence for a person with dementia and limit their exposure to risk. Movement and energy consumption sensors within the house or wearable location devices are very common and allow a degree of independence to be retained. Crucially, tools like these may reassure and empower carers.
The best place for someone with dementia is at home. Lesley Palmer, an expert in design for dementia, stresses that ”you shouldn’t have to leave your own home until your care needs are so acute that it is absolutely required”.
Allowing people to stay at home and in their communities reduces the risk of loneliness and isolation. The familiarity of the home is vital for a sense of belonging. As little is changed as possible.
Support at home can be enhanced by engagement with day-care centres, which provide daily stimulation and sociability and give carers much-needed respite.
Learn from other disciplines
Maintaining a constant dialogue with expertise outside our own field is key to developing a better understanding of dementia. The best work is done when architects speak directly to people with dementia, their families and collaborate with experts in other fields – from neuroscientists, carers and graphic designers to anthropologists, philosophers and furniture designers.
More information, including conversations, drawings, stories and experiments around the subject of dementia you find at www.losingmyself.ie.
Photography by TrendNomad.com
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