In conjunction with World Alzheimer's Day, it's important to recognise and address how we can make the environment more accessible and user friendly for those with dementia writes Meera Murugesan
FOR a person living with dementia, moving around in a building, whether a shopping mall, living space or any other facility can be a confusing, scary and overwhelming experience.
For example, the black areas on colourful carpets may appear as holes in the floor to them and they might walk around them for fear of falling into these "holes".
Mirrors on walls can be an issue too as people with dementia can become disoriented by seeing their own reflection, especially at night. Unnecessary noises or signs and posters can also be confusing for them.
Despite these obvious challenges for those with dementia, most countries are woefully behind in terms of making the built environment accessible for people with the condition.
Approximately 152 million people will be living with dementia by 2050. It is already the fifth leading cause of death worldwide.
In Malaysia, the number of people with dementia is projected to be 261,000 by 2030 and will continue to increase to 590,000 in 2050.
Recognising dementia as a disability will help ensure that similar strides are made for dementia design as have been made over the years for the physically disabled, such as accessible lifts, ramps and safer pedestrian crossings.
Drastically improved dementia design in the built environment is needed across the globe according to Alzheimer's Disease International (ADI), which is calling on governments and multilateral bodies to overtly recognise dementia as a disability following recommendations from the world's most comprehensive report into dementia-related design - "World Alzheimer's Report 2020: Design, Dignity, Dementia; dementia-related design and the built environment".
ADI chief executive, Paola Barbarino, says dementia design provides an opportunity to adapt built environments in the same way that physical disability design has led to great innovation.
"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. If we can cater for those with visible disabilities, how can we refuse to cater for those with invisible disabilities?," questions Barbarino.
Barbarino adds that dementia design does not have to be a costly exercise and can be as simple as considering things like carpets and décor, the removal of hazards, reducing stimulation and clear wayfinding - measures that can reduce anxiety and agitation and improve social interactions for those with dementia.
Design is effectively a non-pharmacological intervention, explains Barbarino, adding to the number of things we can do to make the lives of those living with dementia easier and more fulfilling.
Co-author of the report, Richard Fleming, says that dementia design is needed urgently, and our knowledge of how to do it has grown over the years and we are now in a position to be more proactive in implementing it in practice.
START AT THE BEGINNING
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.
Fleming says dementia design should never be an afterthought and we need more architects and designers who are switched on to the challenges of designing for people living with dementia.
In the report, Kate Swaffer, Dementia Alliance International's chair, co-founder and CEO, says the link between disability and the environment is clear.
The environment's influence in creating disability or in increasing it has been well established. If the environment changes, then the experience of someone living with a disability will also change.
Covid-19 has also disproportionately impacted people with dementia, with around a quarter of virus deaths in certain countries being among those with dementia. Care facilities, where many people with dementia live, have been hard hit when exposed to the virus.
Barbarino says better design could have absolutely helped to minimise the spread of the virus in care facilities and dementia design needs to be a crucial part of how countries rebuild following Covid-19.
In 2019, Ikea partnered with a construction company to launch flat pack housing for people living with dementia.
The homes featured key elements of dementia design, including mirrorless bathrooms, old-fashioned appliances, traditional cupboard handles in kitchens, simply adapted bathrooms and more importantly, dementia-friendly outdoor spaces and gardens.
Barbarino says that is just one example of how dementia design can be adopted, but ultimately it 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 those plans. Design considerations can make a world of difference for people living with dementia, helping them to live with dignity and respect."
Principles of Dementia Design
Unobtrusively reducing risks
Minimise risk factors such as steps and ensure safety features are as unobtrusive as possible.
Providing a human scale
The scale of buildings can impact the behaviour of people with dementia, so provide a human scale to minimise intimidating features.
Allowing people to see and be seen
The provision of an easily understood environment will help to minimise confusion. A literal line of sight should be clear for both residents, and staff.
Reducing unhelpful stimulation
Environments should be designed to minimise exposure to stimuli that are unhelpful, such as unnecessary or competing noises and the sight of unnecessary signs, posters, spaces and clutter.
Optimise helpful stimulation
Enabling the person living with dementia to see, hear and smell things that give them cues about where they are and what they can do, can help minimise their confusion and uncertainty.
Support movement and engagement
Providing a well-defined pathway of movement, free of obstacles, can support engagement with people and opportunities.
Create a familiar place
The use of familiar building design, furniture, fittings and colours affords people with dementia an opportunity to maintain their competence.
Provide opportunities to be alone or with others
A variety of spaces, some for quiet conversation and some for larger groups, as well as spaces where people can be by themselves, gives people with dementia a choice on how they spend their time.
Link to the community
The more an environment enables visitors to drop in easily and enjoy being in places that encourage interaction, the more the sense of identity that comes from spending time with loved ones and others is reinforced.
Design in response to vision for way of life
The way of life offered needs to be clearly stated and the building designed both to support it and to make it evident to residents and staff.