Senior care / Quality improvement
Include dementia-friendly design in national plans, countries urged
By Andrew Sansom | 24 Sep 2020 | 0
Design for dementia in the built environment needs drastic improvement, and governments and multilateral bodies should overtly recognise dementia as a disability.
That’s the message from Alzheimer’s Disease International (ADI), which this week issued what it hails as the world’s most comprehensive report ever into dementia-related design.
The report, ‘World Alzheimer Report 2020: design, dignity, dementia; dementia-related design and the built environment’, is authored by Prof Richard Fleming, from the University of Wollongong, Dr John Zeisel, founder of the Hearthstone Institute and the I'm Still Here Foundation, and Australian architect Kirsty Bennett. It calls for dementia to be more overtly recognised by governments globally as a disability, including as part of national dementia plans, to help ensure that the therapeutic benefits of good dementia design are felt by people living with dementia at home, in residential and day-care facilities, in hospitals, and in public buildings and spaces.
According to the ADI, about 152 million people are forecast to be living with dementia by 2050, and it’s already the fifth leading cause of death worldwide. Most countries, however, are lagging woefully in making the built environment accessible for those living with dementia.
Dementia and disability
The ADI believes that recognising the illness as a disability would help ensure that similar strides are made in dementia design as have been made over the last 30 years in making the bult environment more accessible for those with a physical disability.
“We need to apply design guidelines and principles for people living with dementia in the same way as design guidelines are provided for people living with a physical disability,” says ADI chief executive Paola Barbarino. “When I was in my first job, I remember people saying that accessible lifts and ramps were impossible to install in old buildings, but look at it now! If we can cater for those with visible disabilities, how can we refuse to cater for those with invisible disabilities? We need to start working now, with new builds, and consider this new way of thinking at planning stage, and also look at cost effective retrofit options for older buildings.”
Barbarino argues that dementia design doesn’t have to be a costly exercise and can be as simple as considering things like carpets and decor, the removal of hazards, reducing stimulation, and ensuring clear wayfinding – all measures that can reduce anxiety and agitation and improve social interactions.
“It comes down to simple things,” she insists. “I recall during a site inspection of a venue for a conference, the black areas on colourful carpets could look like holes in the floor, people living with dementia might walk around them as they could be worried of falling into them.
“Things like mirrors on the walls can be an issue, as people with dementia can be disoriented by seeing their own reflection, especially at night. Design is effectively a non-pharmacological intervention, adding to the number of things we can do – in absence of a cure – to make the lives of those living with the condition easier and more fulfilling.”
Recommendations and commitments
The report sets out a number of recommendations and commitments to achieve improvements in dementia design. They include:
- A pledge from the ADI to facilitate discussions on the development and adoption of a common set of design principles that will be used to structure the exploration of designing well for people living with dementia and the formulation of future recommendations.
- More overt and considered inclusion of dementia-related design as a non-pharmacological intervention should be included in national dementia plans, in response to the World Health Organization’s (WHO’s) ‘Global action plan on the public health response to dementia 2017–2025’.
- A commitment from the ADI, alongside the Dementia Alliance International and other advocacy groups, to promote the arguments contained in the Convention on the Rights of Persons with Disabilities (CRPD) for the recognition of dementia as a disability, and the consequent need to apply design guidelines for people living with dementia in the same way as design guidelines are provided for people living with a physical disability.
- Educators should include designing for people living with dementia in the curricula of schools of architecture and design.
- Health economists should engage with the field of designing for people living with dementia to clearly establish the cost benefit of investment in dementia-related design translating to savings in health and care costs, through helping people to live in their own homes and communities for as long as possible.
- Governments and academic institutions should engage researchers to translate knowledge on designing for people living with dementia – an action that will help support and service development in low- and middle-income countries.
- National Dementia Associations should better inform themselves about the available knowledge on designing for people living with dementia, consider its relevance to their contexts and priorities, and advocate for relevant knowledge to be implemented by planners, designers, architects, care operators and developers.
- Governments and the international community should be proactive in engaging designers, architects, developers, operators and innovators, in the construction and IT sectors, in designing for people living with dementia.
Advances in knowledge
Co-author of the report, Richard Fleming, says dementia design is needed urgently, and our knowledge of how to do it has grown over the years.
He comments: “The rising number of people living with dementia requires that their needs are considered at the beginning of every building project that is likely to be used by elderly people. Dementia design should never be an afterthought.
“We need more architects and designers who are switched on to the challenges of designing for people living with dementia. This means that they should be introduced to them in their training when they’re looking for areas that inspire them. Designing for people living with dementia should be made an attractive option in the curriculum of every school of architecture and design.”
In the report, Kate Swaffer, chair, co-founder and chief executive of the ADI’s partner Dementia Alliance International, says the link between disability and environment is clear.
“The environment’s influence in creating disability or in increasing it has been well established and is seen as integral to the definition of disability,” she says. “If the environment changes, then the experience of someone living with a disability will also change.
“People with physical disabilities have made major progress as substantial, influential members of society, borne out of society’s response to changes in the built environment becoming the norm in many countries. Yet people with dementia are still being left behind, not only in terms of health and social care but in terms of recognition of dementia as a condition causing disability. It’s vital that planners, designers and architects embrace dementia-related design at the outset and include people living with dementia in the whole design process.”
Restrictions owing to COVID
COVID-19 has disproportionately impacted people with dementia, with around a quarter of virus deaths in certain countries being those of people with dementia. Care facilities, where many people with dementia live, have been hard hit by virus.
“COVID-19 restrictions implemented to protect residents in long-term care may have resulted in interventions that could have accelerated physical and cognitive decline, or indirectly contributed to the deaths of some residents,” says Barbarino. “Better design could have absolutely helped to minimise the spread of the virus in care facilities. Dementia design needs to be a crucial part of how countries rebuild following COVID-19.”
He went on to highlight the recommendation in the report to incorporate dementia-related design into national dementia plans, as a response to the WHO’s ‘Global action plan on the public health response to dementia 2017–2025’.
“The first target in the WHO plan is for 75 per cent of the member states to have developed or updated national policies, strategies, plans or frameworks for dementia by 2025,” says Barbarino. “Presently, only 30 member state countries out of 146 have met this goal. The analysis of these plans available through the ADI website shows that only about 25 per cent of these currently include designing for people with dementia.”
Australia, England and Scotland are global leaders in dementia-related design, leading the way in translating existing research into practice. He also pointed to the work of Swedish furniture giant IKEA.
“In 2019, IKEA partnered with a construction company to launch flat-pack housing for people living with dementia. The homes feature key elements of dementia design, including mirrorless bathrooms, old-fashioned appliances, traditional cupboard handles in kitchens, simply adapted bathrooms and, importantly, dementia-friendly outdoor spaces and gardens,” he explains. “Their focus has been to encourage accessibility and engagement with activities that promoted socialisation and wellbeing. With over 100 simple adaptations – many dementia specific – this is an innovative new model for living independently at home for longer.”
But, in Barbarino’s view, it still comes back to having strong national planning for the disease.
“We cannot stress enough how important it is for countries to develop and implement national dementia plans, and to include dementia-friendly design into these plans,” she says. “Design considerations can make a world of difference for people living with dementia, helping them to live with dignity and respect.”
A series of pioneer videos, conducted by co-author of the report, John Zeisel, are available to view via YouTube.