A better life by design

The physical environment influences the behaviour and quality of life of people with dementia. If this is not taken into account when designing a care home, residential environment or public space, that environment may, for example, cause overstimulation in people with dementia, or make it difficult for them to find their bearings.

So, which designs do actually help people with dementia?

This is why so-called evidence-based design of care homes, residential environments and public spaces is important. But what, then, are these proven effective design principles? To answer this question, researchers from UMC Groningen (including those from SPREAD+) and Hanze University of Applied Sciences (Groningen) carried out a systematic meta-review of eleven systematic reviews, based on 250 underlying studies.

DEMPACT is pleased to share the results, summarised in five design tips and a design tool.

Challenge: putting knowledge into practice where it’s needed

One of the key insights is that many design choices in dementia care are based on assumptions, whilst a great deal of scientific knowledge is already available. The biggest challenge is therefore to ensure that this knowledge reaches designers and care organisations. To achieve this, evidence-based designs must first and foremost be made accessible and applicable. The researchers have therefore created a practical tool that translates the scientific insights into practical design choices. At present, it is still an Excel tool, but it is being further developed to improve its user-friendliness and appeal.

Design tool

The research identified 124 links between environmental characteristics and positive effects on the behaviour and quality of life of people with dementia. The researchers then incorporated this knowledge into the tool for designers and clients who create designs for people with dementia.

Design tip 1: A balanced atmosphere

A balanced atmosphere with a clear, easily ‘readable’ and understandable building layout has been shown to contribute to better orientation, greater tranquillity and an improved mood amongst people with dementia, according to the meta-review. Consider an L- or H-shaped building layout. Residents find their way around more easily when there are simple floor plans, clear sightlines, recognisable spaces and orientation aids. Feelings of confusion and dependence are also reduced. Personal points of reference, such as photographs, the use of colour and contrasts in materials, further enhance the sense of safety and autonomy. Long, monotonous corridors, on the other hand, make orientation more difficult.

Design tip 2: More light

A second finding is that more light supports the activity and day-night rhythm of people with dementia and helps to limit their functional decline. Sufficient daylight and so-called bright-light therapy reduce restlessness and improve sleep quality. Light also helps people with dementia to recognise their surroundings more easily, enabling them to move about more effectively.

Design tip 3: Getting outdoors

The opportunity to go outside and take part in gardening activities is also important. This improves sleep quality and reduces the use of medication. Furthermore, unrestricted access to gardens or outdoor spaces is associated with reduced agitation, aggression and falls. Being outdoors (and active) also contributes to well-being and the day-night rhythm.

Design tip 4 Homely décor

A homely interior is also important. This is linked to fewer behavioural problems, greater well-being and more social interaction. Homely furniture, open-plan dining areas, personalised décor and recognisable elements, such as an aquarium, help to reduce restlessness and aggression and increase engagement.

Eating together in small groups also promotes social contact and stimulates the appetite. Small details can make a big difference here: high-contrast crockery helps people with dementia to eat and drink as it is more visible.

Design tip 5: Small-scale and specialised accommodation

Finally, it appears that small-scale and specialised residential care settings have positive effects on behaviour, communication, engagement, daily functioning, cognitive performance, orientation and food intake. Think, for example, of care homes with 5 to 15 residents: these see fewer instances of agitation and aggression, and there is greater social interaction between residents and carers. Residents in such care homes also use fewer psychotropic drugs.

But design alone is not enough…

Even if you manage to design (or commission designs) basedon evidence, you’re not there yet. It is not just the design itself, but also the day-to-day use of spaces that determines the effects on people with dementia. The researchers warn, for instance, that both overstimulation and understimulation can have negative effects. Care staff play a key role in creating a homely and familiar living environment and in striking a balance between too few stimuli and overstimulation.

Many design choices are still based on assumptions. This is partly because the level of evidence from many studies is still limited, and partly because there is scarcely any time in design and construction processes to consult recent scientific insights. In addition to calling for more empirical research, the researchers therefore also advocate effective collaboration between care institutions, universities of applied sciences and universities, in order to further strengthen the practice-oriented and scientific knowledge base. This will enable them, ultimately, to work together to genuinely improve the living environment for people with dementia.

SPREAD+ & Hanze

The research was carried out by

• Arnout Siegelaar, MSc, healthcare property adviser and external PhD candidate at the UMCG and Hanze University of Applied Sciences, Groningen;
• Dr Sarah Janus, senior lecturer in the Department of Geriatric Medicine at the UMCG and SPREAD+;
• Dr Mark Mobach (lecturer in Facility Management at Hanze University of Applied Sciences, Groningen);
• the late Prof. Dr Sytse Zuidema, Professor of Geriatrics at the UMCG.

Read more

• Publication: ‘The Physical Environment and the Quality of Life and Behaviour in People With Dementia: A Systematic Meta-Review’: journals.sagepub.com.
• LinkedIn.com Arnout Siegelaar or visit research.rug.nl.
• LinkedIn.com Sarah Janus or visit research.rug.nl.
• LinkedIn.com Mark Mobach or visit hanze.nl
• Ending uniformity – How do you design for people with dementia?: DementieVisie.nl (for subscribers only).
• For tips on designing living spaces: dementie.nl.
• Alzheimer Nederland has developed a ‘Dementia-Friendly Residential Building’ toolkit for designers and managers: see alzheimer-nederland.nl > building dementia-friendly.

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