Designing Dementia-Friendly Environments

There are many things that can be done to promote independence and ease of use of spaces that can also reduce frustrations of being unable to locate items (glass fronted cupboards and drawers can give easy visual access) or navigate space (e.g. being able to locate a toilet through signage, and being able to go outside easily via visual access to outside areas) and actually access outside space (for example ensuring doors to outside gardens in care homes are not blocked by other furniture and that they are unlocked enabling a care home resident to easily choose to go outside into a safe outside space). Outside space is important - having a garden area with seating to rest, points of interest to admire, plants that are safe to smell and touch.

In wider society it is often difficult to navigate say a hospital, museum or other public external building. Good signage helps us all to find our way around. Our research looking at accessing leisure opportunities has shown that being able to locate toilets is key to both the person with dementia and their care partners when going out. Parking or public transport links close to the locations of home and external venue of choice is important for people who also have mobility issues. In many ways good dementia design is also good disabled accessible design, getting it right for everyone who may have some physical or cognitive difficulty will enable society as a whole to use public spaces. Participating in social life is key to the well-being of the person living with dementia, and also their care partners, it reduces the potential for loneliness and isolation and creates the opportunity for pleasure, inclusion and enjoyment, and this is perhaps the biggest thing we can do to help compensate for cognitive difficulties an individual may be experiencing.

There are three elements that I think are key to a dementia friendly space - accessible, useable and understandable. So a garden has to be accessible (can I get out there independently) and once out there can I walk or use any aides I have to use that space? and do I understand it? can I find my way around, can I sit and touch plants, watch nature? The physical design is key to a dementia friendly space, but so are the people who support a person to use the space and it is often the combination of physical and social that leads to successful use of a space.

Colour contrast is the key. Some people/companies have argued that for example a blue toilet seat is best, but the real thing is colour contrast ie for the toilet seat to be a different colour from the bowl. For walls to be a different colour to the floor. If there are areas you would like to avoid people using then use colour to blend in, if you want people to be attracted to a certain area use colour as one way of drawing attention. Brighter, primary colours may help with this. While using white to draw attention away from areas can help as with the picture of the kitchen units attached. Light is important too, as are other visual cues, words, pictures.

This approach will work for some, but not for others. Dementia villages that are specifically built to enable the person living with dementia to have all they need to live well in one relatively small geographical area may be great for some, but not for others who wish to remain and age in the place of their choice rather than move. 'Time-travel' based designs can be very helpful for some people as assist in orientating individuals to place and to be able to use everyday items that were common at the point their memories appear to have reverted to/or are just easy to recall. But again, this would not suit everyone. Any design that benefits people has to have its place, but there is no one size fits all. We need to ensure choice for everyone - reflecting that we all have preferences - so just as we all choose to live in different locations; for example urban with cafes, shops and other services at our doorstep, or in rural locations with space, walks, scenery and a distinct way of life; or even the style of property we might prefer to live in - period or ultra modern; people living with dementia and their families will have different preferences and needs. What works for some may not work for others. Choice is key.

Mirrors can sometimes show an image of the person that they do not expect to see. In their minds they may still be 30 years old, and not 80. Light can be reflected in mirrors in ways that distort vision too. Or at night shadows can look like an intruder on a mirrored door, or even on other reflective surfaces such as glass. This is why some people living with dementia can react with surprise when they see their reflection. There are mirrors that are available that have been designed so that they can easily be covered up, for example it may look like there is a wooden door over the mirror that can easily be opened. It is really dependent on the individual as to what works in their own home. In care homes, or other public settings finding a way to have mirrors available for those who would like to use them, but where they can be covered when in an area (eg communal bathroom) is a good solution.

Just as any room might need to be designed to take into account the preferences and care needs of an individual is the quick answer. The more granular answer is that it depends on the care needs and if it is in a group setting or in an individual home. Signage and other visual cues to orientate a person to the function of a room is important. Using colour contrast to help use the toilet independently (ensure the seat is a different colour to the floor and toilet bowl). Avoiding patterns on the floor that may be confusing, look like spills/holes. Non slip flooring! Having sinks with taps that one can understand and operate (especially if physical difficulties from other issues such as arthritis) and soap that one can dispense easily and a way to dry hands that is understandable. So many places have taps, soap dispensers and hand driers that may struggle with - observe the next time you are in an airport toilet for example!

Many academics, architects and interior designers are interested in good design for people living with dementia. I'd suggest that you reach out locally and see who and what resources are available. I have been involved in consulting on the design (or re-design) of spaces that have had others who are 'experts' in dementia friendly design in before me, and what I think would work and what they think are not always the same! But the proof is in the pudding as the things I am asked to try and sort have been identified as problematic. This is because elements of design can be subjective and based on particular knowledge that can be interpreted in different ways. For example I have visited homes that look like beautiful boutique hotels, but I wouldn't know how to operate the taps in the kitchen or toilet areas, or that the fire is a fire (piles of artfully placed pebbles look lovely but don't always immediately make one think - oh thats the fire!). I've also visited places with gorgeous heavy wooden doors, that are problematic as all look the same and very heavy to open. I'd also advise thinking about particular areas of the home you feel are problematic? consider why this is so? consider the options you might want to receive some advice on.