Design, Dignity and Dementia Report

Front cover of the Design Dignity Dementia Report.The field of dementia and the design of the built environment is not well understood. Until now. Comprehensive Australian research has resulted in two volumes on the topic. The research looks at current best practice in design, and regional and cultural aspects. It also covers the importance of including people with dementia in the design process. The impact of the pandemic is another discussion point. People with dementia have the same human rights as others and that includes being treated with dignity.

The first volume is about the approach to the topic, the thorny issues, design processes and the 10 principles they developed. The second volume presents 84 case studies from around the world. A collection of day care centres, residential care facilities, and public buildings illustrate good design principles. The case studies include architectural detail and photos illustrate some of the design points.

The title of the report is, World Alzheimer Report 2020: Design, Dignity, Dementia: dementia-related design and the built environment. Authors are Prof Richard Fleming, John Zeisel and Kirsty Bennett.

The report launch webinar gives a good overview. Unfortunately the captions are auto-generated so they aren’t the best. However you can increase the speed and still understand the content.

Principles of dementia 

    • 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 to 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 the residents and staff.

Hospital design and dementia

Floor plan of a hospital setting showing different spaces.Hospital stays are distressing at the best of times, but for patients with dementia it is doubly so. Apart from appropriate patient care, hospital design factors can help patients feel more relaxed. The Dementia Enabling Environment Virtual Information Centre has a section on the design of hospitals. 

This interactive web tool shows a layout of a typical section of a hospital. Clicking on each room takes you to another page which is illustrated with Before and After features. A slide bar takes you between the Before and After illustrations. Design ideas for the staff station, bed area, patient or family lounge and reception area show how a few tweaks can make the place more dementia friendly. For a more in-depth guide see the guide from Ireland on using a universal design approach.

The website from Alzheimer’s WA also has sections on public buildings, gardens, care environments and homes. The Principles of Dementia Enabling Environments could be applied to most places:

      1. Unobtrusively reduce risks
      2. Provide a human scale
      3. Allow people to see and be seen
      4. Manage levels of stimulation
      5. Support movement and engagement
      6. Create a familiar space
      7. Provide a variety of places to be alone or with others
      8. Design in response to vision for way of life  

Design tool for dementia-friendly public buildings

A basic floor plan showing a meeting room, toilets, reception and lobby area.The online tool for Dementia Enabling Environments has a section on public buildings. A click on the Public Buildings picture takes you to a page with a floor plan. Clicking on a room in the floor plan brings up a 3D view of the room. Hovering the mouse over questions marks in the room brings up more detailed information about design ideas that are good for people with dementia. Of course, these designs are usable for almost anyone else who is ambulatory, including people with other cognitive conditions.

This is an excellent resource that takes accessibility beyond the access codes which don’t cover this level of design. The Dementia Enabling Environments tool also covers homes, care settings, and gardens and nature. There are links to other resources as well.

This website has lots of other information about dementia design. You can use the search facility on the menu, or to get you going here are eight references