Designing for People with Dementia

A national service provided by Dementia Training Australia

Creating a dementia friendly environment can range from designing a new building to rearranging the furniture within your current building

A dementia friendly environment is enjoyable and meaningful, taking into account a person’s lifestyle, background and interests, as well as being familiar and recognisable. It should be based on key design principles that support people living with dementia.

Our award winning Designing for People with Dementia Service can help you create a dementia friendly environment.

What is the Designing for People with Dementia service?

We provide on-site education, assessment and advice to care managers and staff, project managers, designers and architects.

We can discuss how to use an existing environment more effectively, plan a new facility or refurbish an existing one. We work in acute, residential and community settings across Australia.

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Architect and author of the Dementia Design Principles Kirsty Bennett leads our team with a combined expertise that covers architecture, strategic planning, interior design, landscape architecture, nursing, OH&S and operational management.

We can come to you! Our service is national and will typically include a detailed discussion of evidence-based dementia design principles, and an assessment of your facility or plan, with recommendations for improvement.

This assessment can be a component of DTA Tailored Training Packages

How can I access the Designing for People with Dementia Service?

Our Designing for People with Dementia Service can be accessed within a Tailored Training Package (TTP) or separately.

dementia-friendly-design,-DTA-DPD-service

   

This service may help your organisation meet the Aged Care Quality Standards:

Standard 1: Consumer dignity and choice

Standard 5: Organisation’s service environment*

Environment Design Resources

DTA’s Environmental Design Service handbook introduces the full suite of resources for the DTA Designing for People with Dementia Service

Dementia Friendly Design App, Environment Design, BEAT-D, DTA

The Built Environment Assessment Tool – Dementia (BEAT-D) will guide you through an assessment of the strengths and weaknesses of buildings used to accommodate people with dementia

Environment Design Resources Handbook

This handbook consists of 6 resources, grouped together into a single document. Access each of the individual resources below.

10 Key Design Principles

These 10 principles are the culmination of more that 30 years of research and practice. They are the backbone of the Designing for People with Dementia service.

Unobtrusively reduce risks

Provide a human scale

Allow people to see and be seen

Manage levels of Stimulation – Reduce unhelpful stimulation

Manage levels of Stimulation – Optimise helpful stimulation

Support movement and engagement

Create a familiar place

Provide a variety of places to be alone or with others – in the unit

Provide a variety of places to be alone or with others – in thecommunity

Design in response to vision for way of life

Read about each principle

People with dementia require an internal and external environment that is safe and easy to move around if they are to continue to pursue their way of life and make the most of their abilities. Potential risks such as steps must be removed. All safety features must be unobtrusive as obvious safety features, such as fences or locked doors, can lead to frustration, agitation and anger or apathy and depression.

Consider

  • Designing an outdoor fence so that it blends into the landscape
  • Using vegetation to hide a fence so it is not foreboding or institutional
  • Screening the front door of the facility from inside the unit so residents are not continually confronted with a locked door

The scale of a building can affect the behaviour and feelings of a person with dementia. The experience of scale is influenced by three key factors; the number of people that the person encounters, the overall size of the building and the size of the individual components (such as doors, rooms and corridors). A person should not be intimidated by the size of the surroundings or confronted with a multitude of interactions and choices. Rather the scale should encourage a sense of wellbeing and enhance the competence of a person.

Consider

  • Creating units for 10 people or less
  • Breaking up larger units into smaller units

The provision of an easily understood environment will help to minimise confusion. It is particularly important for people with dementia to be able to recognise where they are, where they have come from and where they can go. When a person can see key places, such as a lounge room, dining room, their bedroom, kitchen and an outdoor area they are more able to make choices and see where they want to go. Buildings that provide these opportunities are said to have good visual access. Good visual access opens up opportunities for engagement and gives the person with dementia the confidence to explore their environment. It can also enable staff to see residents. This reduces staff anxiety about the residents’ welfare and reassures the residents.

Consider

  • How clear lines of sight can between bedrooms and lounge room can be created
  • Window design to ensure windows can’t be confused with doors

Because dementia reduces the ability to filter stimulation and attend to only those things that are important, a person with dementia becomes stressed by prolonged exposure to large amounts of stimulation. The environment should be designed to minimise exposure to stimuli that are not specifically helpful to the resident, such as unnecessary or competing noises and the sight of signs, posters, places and clutter that are of no use to the resident. The full range of senses must be considered. Too much visual stimulation is as stressful as too much auditory stimulation.

Consider

  • Separating service and visitor entries so that door bell is only relevant to residents
  • Acoustic isolation measures
  • Making an obvious entry less obvious by painting it the same colour as the wall or disguising it in another way e.g. a mural

Enabling the person with dementia to see, hear and smell things that give them cues about where they are and what they can do, can help to minimise their confusion and uncertainty. Consideration needs to be given to providing redundant cueing i.e. providing a number of cues to the same thing, recognising that what is meaningful to one person will not necessarily be meaningful to another. Using text and image in signs is a simple way to do this. Encouraging a person to recognise their bedroom through the presence of furniture, the colour of the walls, the design of a light fitting and/or the bedspread is a more complex one. Cues need to be carefully designed so that they do not add to clutter and become over stimulating.

Consider

  • Introducing signs or symbols near the dinig room approch such as a painting of food on the wall, menu board, hall table
  • Promoting food smells, the sign of tables beng laid
  • Encouraging music and conversation
  • Lighting that uses dimmer, task lighting for reading and craft
  • A low level of night lighting to the toilet and ensuite area

Purposeful movement can increase engagement and maintain a person’s health and wellbeing. It is encouraged by providing a well defined pathway, free of obstacles and complex decision points, that guides people past points of interest and opportunities to engage in activities or social interaction. The pathway should be both internal and external, providing an opportunity and reason to go outside when the weather permits.

Consider

  • Designing the fence so that it is integrated with the landscape topography or is hidden by vegetation so that the height is not visually imposing
  • Where ansd when the sun will be shining in the winter and summer in relation to the building, outside structures and verandahs
  • Combinations of seats to allow people to be alone or in conversation with others
  • A variety of different seats (heights, materials and locations)

A person with dementia is more able to use and enjoy places and objects that are familiar to them from their early life. The environment should afford them the opportunity to maintain their competence through the use of familiar building design (internal and external), furniture, fittings and colours. The personal backgrounds of the residents need to be reflected in the environment. The involvement of the person with dementia in personalising the environment with their familiar objects should be encouraged.

Consider

  • Colours which reduce outside glare in the lounge and dining area
  • Materials and colours that may have special significance to the residents (sports teams, traditional colour combnations)
  • Large rocker type light switches

People with dementia need to be able to choose to be on their own or spend time with others. This requires the provision of a variety of places in the unit, some for quiet conversation and some for larger groups, as well as places where people can be by themselves. These internal and external places should have a variety of characters, e.g. a place for reading, looking out of the window or talking, to cue the person to engage in relevant activity and stimulate different emotional responses.

Consider

  • Varying corridor and hall widths to accommodate small sitting places

Without constant reminders of who they are, a person with dementia will lose their sense of identity. Frequent interaction with friends and relatives can help to maintain that identity and visitors should be able to drop in easily and enjoy being in places that encourage interaction. Stigma remains a problem for people with dementia so the unit should be designed to blend with the existing community and not stand out as a ‘special’ unit. Where possible a ‘bridge’ should be built between the unit and the community by providing a place that is shared by the community and people with dementia. A coffee shop near the unit, for example, may enable a person with dementia to go there easily without needing assistance. Where the unit is a part of a larger site, there should be easy access around the site so people with dementia, their families and friends can interact with other people who live there.

Consider

  • Flexible furnishings, flexible screening to accomodate small or large groups

The choice of life style, or philosophy of care, will vary between facilities. Some will choose to focus on engagement with the ordinary activities of daily living and have fully functioning kitchens. Others will focus on the ideas of full service and recreation, while still others will emphasise a healthy life style or, perhaps, spiritual reflection. 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. The building should be the embodiment of the philosophy of care, constantly reminding the staff of the values and practices that are required while providing them with the tools they need to do their job.

Consider

  • Ways to remove objects that could be dangerous, and so allow for unresticted use of the kitchen by residents and visitors
  • Introducing washing, drying and folding of clothes into the daily lifestyle of residents so that residents can participate as they are able
  • Managing use of the lounge and dining room to invite entry, for example by ensuring that the lights are on in the evening and temperature is apppriately controlled

Contact the Designing for People with Dementia Service