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News feature: Are architects doing enough to tackle dementia?

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Dementia is one of the biggest problems facing the country’s ageing population, yet very few practices are skilled up on how design can benefit sufferers, reports Ella Braidwood 

DESIGN TIPSDUTCH APPROACH

Last week scientists revealed that the drug Trazodone, formerly used to treat depression, could help slow down the debilitating effects of Alzheimer’s disease and other forms of dementia.

The drug is not a cure, however, and won’t be available for several years given the length of clinical trials. By 2025, it is predicted that more than a million people in the UK will have dementia – soaring to two million by 2051. Already today, one in six people over 80, and 40,000 people under 65, are suffering from dementia. Could changes in design of the built environment help dementia sufferers now? Are architects doing enough to consider their needs? 

Níall McLaughlin, one of the few architects to have thoroughly researched and tackled these issues, thinks both architects and clients need to do much more. 

‘It’s extraordinary that environmental care for people with dementia [is not] considered an absolutely frontline subject for people commissioning architects,’ he says. ‘But there aren’t that many good architects working in this area.’ 

Last year his practice – in collaboration with AY Architects’ Yeoryia Manolopoulou – addressed this issue at the Venice Biennale. Their ‘Losing Myself’ exhibition for the Irish pavilion set out to communicate the different ways people with dementia perceive space. 

Pulling together the show, and his experiences of talking to people with dementia, changed McLaughlin’s way of thinking – ‘not just about ageing,’ he says, ‘but about what I am and what we are’.

But he adds: ‘I see very few interesting buildings designed for people with dementia’. 

Dementia remains one of the biggest problems facing our ageing population, causing more disability in later life than cancer, heart disease or strokes and costing the UK an estimated £26 billion a year. 

The best thing to do is to enable people with dementia to engage with architects

Support and treatment for sufferers – including well-designed environments – can help them lead fulfilled lives. Last month, the Alzheimer’s Society launched a Dementia Friendly Housing Charter, aimed at embedding best practice with professionals in the sector including architects.

Although the society’s programme partnership project manager Emma Bould says the response has been ‘positive’, she is urging the industry to engage more.

‘For real change to happen we need industry bodies like the RIBA and the Design Council to work with specialist organisations to ensure dementia and age is protected as a consideration in the early design stage for all architecture projects,’ she says. 

‘They need to embed this in training for qualifying architects to ensure that accessibility and inclusion for people with dementia and older people is a requirement.’

RIBA president Jane Duncan asserts that the institute is ‘committed to championing the importance of inclusivity and age-friendly design’.

Gna meadow view, specialist dementia residential care centre 01

Gna meadow view, specialist dementia residential care centre 01

Glancy Nicholls’ Meadow View Specialist Residential Care Centre, Derbyshire

She adds that the challenge of designing for everyone in society ‘requires architects to be aware of the specific needs of people with dementia’, and points to practical advice provided by the RIBA, including its Alternative Age-Friendly Handbook.

And it does appear the institute is increasing its support for dementia-friendly design. 

Last month a regional judging panel shortlisted a dementia care centre in Derbyshire by Glancy Nicholls Architects for an RIBA East Midlands Awards. 

And in July, the RIBA awarded £8,000 to a research project entitled Designing for Dementia: The International Architectural Challenges and Responses, by Bill Halsall and Robert MacDonald. 

The research project, being worked on with PhD student Davide Landi, will compare schemes in different countries, including The Hogeweyk, a village in the Netherlands specifically designed for people with dementia.

MacDonald, reader in architecture at Liverpool John Moores University, believes a key starting point for any architect working in the sector is to speak to people with dementia and include their experiences in designs. 

‘The best thing to do is to enable people with dementia to engage with architects,’ he says. ‘A very fruitful dialogue is brought about that modifies the nature of what you’re designing.’

Architects may not be aware what can cause distress to dementia sufferers –  a black doormat can be perceived as an impassable black hole

MacDonald, who also wants architecture students to be taught about dementia, says there are several design features of which architects may not be aware that can cause distress to dementia sufferers – for example, a black doormat in the entrance to a doorway can be perceived as an impassable black hole. 

Clare Cameron, a director within a specialist housing group at PRP, which has designed dementia-friendly buildings for more than 25 years, says open plans are key to providing visual accessibility for people with dementia, something that needs to be included in the early design stages. 

‘People talk about visual cues such as colour and artwork and objects – they are all important – but these are things you can do to the building once it’s finished,’ she says. ‘You have to get all those other more fundamental things right, for example the layout of the building, access to gardens and outdoor space within a secure environment.’

She adds that it is also important to include views out of the building ‘so people know where they are in a building, what time of day it is, what the weather is doing’.

Alzheimersrespitecentre02(c)nickkane

Alzheimersrespitecentre02(c)nickkane

Alzheimer’s Respite Centre, Dublin, by Níall McLaughlin Architects

Beatrice Fraenkel, chair of the Mersey Care NHS Foundation Trust and former chair of the ARB, says dementia-friendly design can reduce the number of ‘incredibly damaging’ accidents such as ‘trips and falls’, and create places that allow ‘the ability for recovery to take place quicker’. This could potentially lead to substantial savings in the NHS.

However, Lesley Palmer, chief architect at leading research charity Dementia Services Development Centre (DSDC), part of the University of Stirling, says the interest seen by her centre has been predominantly from clients such as NHS trusts, private nursing care providers, local authorities and housing associations, rather than from architects.

‘From our review of the interest in our centre, architects accounted for the lowest uptake in our design, training or publication services,’ she says.

John Nordon, design director at developer PegasusLife, which delivers dementia-friendly retirement homes, agrees that it is clients that are driving the growing awareness of the issue.

‘They are the people who have the vision and foresight to create these sorts of buildings,’ he says.

‘They know they need to design for their potential customer, so they are the ones setting the brief.’ 

Some architects, including Richard Murphy, argue that restrictive, tick-box procurement rules act as a barrier to socially conscious and talented architects wanting to work in the sector. 

Eight years ago, Murphy’s practice designed two hospitals in Fife for people with dementia, but it has not completed a similar scheme since.

‘People will go and look at the dementia buildings we have built – and think that they are fantastic – but they don’t offer us another one,’ he says. ‘It’s sickening. All the experience that exists in our office is being wasted. It’s part of a general level of frustration.’

C. stratheden hospital 1

C. stratheden hospital 1

Richard Murphy Architects’ dementia and mental health unit at Fife Stratheden Hospital

McLaughlin, too, says he has not been asked to do much work in dementia-friendly design since the practice’s 2009 Alzheimer’s Respite Centre in Dublin. ‘It feels as though we have a lot of stored up expertise that’s not been put to use,’ he says. 

For McLaughlin, architects have a duty to make their designs more inclusive and some of the moves (see box) are easy to achieve.

‘It’s incumbent upon you to exercise some kind of open empathy towards the people you’re designing for and to try to understand the world through their experiences,’ he says.

‘Of course dementia is terrible, but you are dealing with people who have had extraordinary lives and it can be very moving.’ 

He concludes: ‘You can create moments of great beauty.’

Top tips for dementia-friendly design

  • Use an open-plan layout that is easy to understand, orientated around a garden. 
  • Minimise the amount of long, artificially lit internal corridors.
  • Make sure there is natural daylight and views from the building.
  • Ensure there is easy access to secure gardens.
  • Use ‘landmarks’, such as plants or artwork, to help people navigate their way around.  
  • Clearly mark all glass doors; glass may not be seen by people with dementia. 
  • Use clear and attractive signage in a bold face with good contrast between the text and the background. 
  • Ensure that toilets are designed so that someone with dementia is able get assistance without causing embarrassment.  
  • Use contrasting colours – white or magnolia do not help with way-finding. Toilet seats that are of a contrasting colour to the walls and rest of the toilet are easier to see if someone has visual problems.
  • Do not use sparkly materials, stripes, dark patches or mats on floors – and avoid any variation  in flooring. 
  • Mark the edge of each step on any stairs.
  • Create a homely, familiar environment; this increases the sense of security and comfort. Try to create a safe environment without it being institutional. 
  • Don’t use swirly patterns on floors or walls; for dementia sufferers they can appear to be moving. 

The Netherlands’ radical approach to dementia 

The hogeweyk use this

The hogeweyk use this

Opened in 2009, the Hogeweyk, in the Netherlands province of North Holland, is a 1.6ha gated village designed by architect Molenaar&Bol&VanDillen for 152 elderly people with dementia. 

Residents with dementia are immersed in a ‘fake reality’ – which has been compared to that portrayed in the film The Truman Show – where they are safe to roam freely among the village’s streets, squares, gardens and park. They are also free to go shopping, visit the theatre or go to the café.

Houses are specifically designed to fit one of seven different settings offered by the village, from the Stedelijk setting – for those used to living in urban environments – to the Cultureel, which is for those brought up in a cultural and artistic environment. 

The 250 staff – providing 24 hour care – are not dressed in clinical clothing but instead ‘disguise’ in outfits ranging from cashiers to shop assistants and gardeners. 

This news feature was published in the Buildings that care issue – click here to buy a copy 

  • 5 Comments

Readers' comments (5)

  • It will be interesting to see if this eventually results in a clash with the design of retail areas which, I am led to believe, deliberately seek to cut people off from the outside world and keep them inside the shopping environment.

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  • It's not the architects that are not doing enough, in fact designing physical environments for people with dementia is an area where architects can offer real expertise and improve quality of life. I've been writing, ( Hard Architecture and Human Scale: Designing for Dementia); lecturing ( Salk Institute AIA, RIAS MIT IIT ) and harping on about this (almost everywhere) for 24 years. Until the recent advances in medicine, studies mainly from Australia and USA clearly indicated that the physical design, of homes and other care environments for example slowed the progression of dementia. Think of that architects, empirical proof that really good design matters.

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  • For architects to do enough to tackle dementia requires an understanding of the principles behind the specific design features mentioned in this insightful feature: Design should compensate for the impairments of dementia (cognitive, senior and physical impairments), create opportunities for human contact and maximise the independece of people who live with their dementia (there is no such thing as a 'dementia sufferer')

    These principles are applicable to all building typologies and, as highlighted in the Dementia Friendly Housing Charter, the inside and outside of buildings, the spaces between buildings and their location.

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  • This is a hugely welcome and timely contribution to the discussion of an important topic. The design of the built environment - interiors and exteriors, public and private - can place massive obstacles for the ability of people with dementia to live well and take part in their communities. 3 of the design professionals mentioned in the article and many more - as well as people living with the condition - will be speaking at a national conference Doing Dementia Design at Liverpool John Moores University on 14/15 September, organised by non-profit Liverpool Dementia Action Alliance www.doingdementiadesign.com

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  • True, dementia sufferer is a poor term. Also true is that the average life expectancy of someone diagnosed with Alzheimer’s disease is five years. Studies now indicate that good architecture and appropriate design of the physical environment for people with dementia slows the rate of decline.

    Which means care homes, particularly should be well planned to encourage self reliance and independence and designed with high levels of natural light and access to secure outdoor garden spaces, with visual cues, make it easier for people to find their way around without support.

    Other empirical studies on the importance of the physical environment have more recently been extended to cover many other aspects of the built environment and there are now multiple neuro-scientific studies which evidence that an individual’s well being and health are directly impacted by the quality of their physical environment.

    This research provides insights into how the mind and the brain experience architectural settings but is sometimes hidden away in academic papers or obscured by scientific jargon; impenetrable to most architects, overlooked by politicians, and easy to ignore in an industry with differing priorities.

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