DEMENTIA FACILITIES: Improving Operational Aspects through Built Environment Solutions

1
DEMENTIA FACILITIES Improving Operational
Aspects through Built Environment Solutions

• Dr MT (Malgosia) Zlobicki
• School of Design and Built Environment
• m.zlobicki_at_qut.edu.au
• www.dbe.bee.qut.edu.au/research/RDesAge

2
Introduction

• The aim of this presentation is to
• overview the key fundamentals of the built
  environment
• identify the main developments in dementia design
• determine the built environment solutions for the
  operational improvement of dementia facilities

3
Explanation of Terms

• Dementia design refers to special considerations
  given to the built environment for people with
  dementia, who have cognitive impairments, and
  age-related decreases in sensory perception
• Dementia facilities comprise high and low care
  residential micro-communities, where ageing in
  place tends to occur
• Dementia is a brain disorder, which is
  characterised by progressive deterioration of
  intellectual, functional/ behavioural, emotional
  and social abilities

4
Person-Environment Link

• This presentation is based on the assumption
• that human behaviour and the built environment
  are significantly interrelated
• that people with lower levels of bio-behavioural
  competences have less control over a demanding
  built environment, and as such require more
  assistance

5
Environmental Demand and Therapy

• A demanding environment is non-supportive of
  people with dementia, and does not compensate
  them for their deficits
• A therapeutic environment is a source of
  treatment for people with dementia, as it
  enhances rather than neglects their remaining
  abilities

6
Environmental Equilibrium

• A balanced environment has the potential to
• positively influence the effectiveness of care
  provision
• reduce peoples stress and discomfort
• extend peoples functionality and prevent their
  injuries
• increase peoples satisfaction and happiness

7
Environmental Components and Attributes

• A responsive or enabling environment exhibits
  the following attributes and components
• sensitivity, flexibility, diversity, variability,
  usability
• physical naturalness, aesthetic harmony,
  psychological compatibility with users, and
  socio-cultural appropriateness

8
Environment-Centred Goals in Dementia Care
(Source Calkins, MP (1988) Design for Dementia,
Owings Mills, Maryland
National Health Publishing, p. 19)

• Maximum independence/ autonomy for activities of
  daily living (ADLs), self-esteem and dignity
• Indoor and outdoor choices for exercise/
  recreation
• Cues and props/ landmarks to overcome
  disorientation/ alleviate distress
• All senses stimulation (without excesses)
• Small and large group interactions for social
  well-being
• Removal of unwanted stimuli and irritants (i.e.
  glare, noise, crowding invasion of personal
  space)

9
About People with Dementia and their Built
Environment

• People with dementia respond best to a calm and
  quiet environment, which includes the following
  elements
• small and non-congested communal areas for
  reduction of stress
• well-illuminated communal areas and toilet/
  bathroom sensor-night-lights for reduction of
  confusion
• non-disturbing noise for reduction of
  restlessness
• familiar objects and uncluttered, simple
  surroundings for reduction of disturbed behaviour

10
An Example of Environmental Autonomy for People
with Dementia

• Non-dead-end corridors in dementia facilities
  create a continuous walking path gtgtgt residents
  with dementia become more autonomous and less
  agitated gtgtgt residents with dementia seek fewer
  staff instructions or prompts gtgtgt staff time is
  more productively used on care activities

11
Current Trends in Dementia Design

• Environmental simplification, interpretability/
  familiarity, direction/ place awareness,
  negotiability, attractiveness, calmness, safety/
  security, unobtrusiveness, territoriality (i.e.
  territorial separation), sensory meaning,
  belongingness, healing/ therapy

12
Environmental Performance Indicators of Dementia
Facilities

• Resident ease of accessibility to communal indoor
  and outdoor areas (i.e. spatial continuum)
• Staff ease of care giving, cleaning and
  maintenance (i.e. ergonomically planned work
  areas, suitable surfaces for odour control,
  unobtrusive surveillance, etc.)
• Resident comfort, confidence, safety and security
  (i.e. non-conspicuous exit doors, noise
  reduction, desirable temperature/ ventilation,
  appropriate flooring, simple directional cueing,
  etc.)

13
Environmental Performance Indicators of Dementia
Facilities (cont.)

• Staff proximity to utility/ therapy rooms and
  stores (i.e. short walking distances, better
  workflow)
• Resident anxiety prevention (i.e. adequately
  sized home-like communal areas and bedrooms,
  continuous wandering paths/ circulation freedom,
  sufficient illumination, uncomplicated spatial
  layouts, personal spaces, etc.)
• above 150/ 200 lux

14
Generic Design Approaches for Dementia Facilities

• Universality and inclusiveness/ beyond
  adaptability/ barrier-free/ for all abilities
  without stigmatisation
• Therapeutic orientation / all senses stimulation
• Wayfinding/ multi-cueing
• Personalisation / heterogeneity / contrasts
• Person-environment-care management fit
• Sustainability/ green built environment
• Indoor and outdoor meaningful/ relaxing ambience

15
Environmental Sustainability for Dementia
Facilities

• Smart technology readiness means
• unobtrusive monitoring devices
• active and passive sensors/ assistive aids
• energy maximisation (e.g. control of climatic
  conditions higher ceilings, awnings,
  insulation, etc. electrical/gas/solar
  efficiency water conservation, recyclable/
  renewable products)
• unmodified active sensors may be unsuitable for
  many people with dementia

16
Environmental Effectiveness for Dementia
Facilities

• Reduced mechanical heating and cooling for lower
  energy costs
• Better draught and humidity controls for even
  temperatures
• Regular maintenance for minimum upkeep outlays
• Raised air quality for more healthy indoor living
• Advanced acoustic controls for quietness
• Enhanced people comfort and functionality (or
  productivity) for greater life quality

17
Core Environmental Questions for Dementia
Facilities

• Can all intended functions be performed in the
  care environment?
• Are the desired behaviours and movements (or
  circulation) achievable in the care environment?
• Does the care environment create any barriers or
  impose limitations upon people with dementia?
• Does the care environment positively alter the
  life quality of people with dementia?

18
Core Environmental Questions for Dementia Care
Facilities (cont.)

• Is the care environment flexible and modifiable
  in response to changing needs or wants of people
  with dementia?
• Is the care environment therapeutic for people
  with dementia?
• Has the care environment been assessed?

19
Environmental Measures

• For the person-environment interactions to be
  accurately assessed, it is useful to rely upon
• an observers appraisals (i.e. observational
  techniques)
• All users perspectives (i.e. post-occupancy
  evaluations)
• checklists for dementia-specific and other care
  environments (e.g. Physical Environment Rating
  Scale)
• Coulson, I (1997) Evaluation of Physical
  Environments in Dementia Care Units Australian
  Journal on Ageing, 164, pp. 203-207

20
Observational Assessment of the Environment

• Behavioural mapping is an observational technique
  that determines the type and frequency of
  behaviour, and records associations to the built
  environment
• Physical traces in an observational technique
  that is concerned with past behaviours, which are
  recognisable from by-products of human presence,
  such as surface erosion, leftovers, missing
  evidence and additions

21
Post-Occupancy Evaluation (POE) Types

• Indicative POE is a simple appraisal, usually
  based on a walk-through
• Investigative POE is a detailed assessment
  reliant on researched criteria that are
  objectively and explicitly stated
• Diagnostic POE is an in-depth multi-method
  comprehensive investigation, usually longitudinal

22
Environmental Benefits for Dementia Facilities

• Tangible benefits (i.e monetary value)
  reduced overhead costs through easier care
  delivery within a performance-oriented and
  energy-efficient built environment
• Intangible benefits (i.e. other value) better
  life quality, greater comfort, less stress

23
Environmental Solutions for Dementia
Facilities(Source Zeisel, J. (1997) Space
Design and Management for People with Dementia
Proceedings of the 28th Annual Conference of the
Environmental Design Research Association, pp.
17-22)

• Operational improvement is achievable by
• environmental design how designers can best
  plan the built environment (e.g. passive solar
  features - to reduce the expense associated
  with mechanical heating and cooling, to enhance
  thermal comfort, as well as to increase useable
  daylight
• environmental management how staff can make the
  best use of the built environment (e.g. staff
  training on The built environment as a vital
  component of the caring process)
• appropriate size and orientation of windows,
  effective shading, adequate insulation of walls
  and roof

24
Conclusion

• To eliminate the under-utilisation and neglect of
  environmental resources
• the built environments role in the caring
  process of people with dementia must be fully
  understood
• the built environments contribution to
  operational improvement must be fully explored

25
Recommendations

• The best environmental outcomes can be reached
  through
• recognition of unmet past needs and undesirable
  consequences
• awareness of current trends
• prediction of future requirements
• acceptance of the necessity for knowledge
  expansion and receptiveness to change

26
About the Network

• The QUT Research and Design for Ageing
  International Network
• specialises in innovative multidisciplinary
  person-environment-care management design
  promotion, analysis, and education
• coordinates projects in post-occupancy evaluation
  (POE), virtual reality universal smart care-home
  design, and therapeutic environment development
• offers free membership
• www.dbe.bee.qut.edu.au/research/RDesAge