Designing spaces for people living with dementia

When you design for people living with dementia, you design for everyone.

This, says Karen Cmiel, is one of the overarching principles in designing a better world for people with dementia. Karen is a learning designer and facilitator at Dementia Australia’s Centre for Dementia Learning. She works with Chris Frazer, who in August will present on this topic at the ANMF (Vic Branch) Safety in workplace design conference.

‘Because of changes in the brain that occur with dementia, sometimes people living with dementia process visual information and therefore view the world differently to the way people who don’t have dementia view the world,’ Karen says. ‘For instance, people living with dementia can see the world in 2D rather than 3D. So things like size, shape and distance can become a challenge to process, along with colour and contrast.’

Currently, there are 10 key principles recommended to follow when designing spaces for people living with dementia, although these are being reviewed with the aim of updating them in 2024. But for now, the principles are:

1. Unobtrusively reduce risks – provide safety discreetly so it isn’t constantly front of mind for a person that you’re keeping them safe.
2. Provide a human scale – not too large but large enough that they feel they can fit into it, and where they fit.
3. Allow people to see and be seen so that they can engage with their world –when people come out of their room, can they see something that’s engaging, that draws them out to explore the world and to connect with others.
4. Reduce unhelpful stimulation – there’s a lot of unhelpful stimulation that people living with dementia can’t process, so what we can turn down, what we can turn off, what we can minimise.
5. Optimise helpful stimulation – conversely, how can we introduce helpful sounds and sights, such as a bread maker or coffee machine for smells that increase appetite.
6. Support movement and engagement – increase signage and other intuitive wayfinding features to allow people to move freely, given the right supports.
7. Create a familiar place – when you enter a space, is it obvious what the space is for?
8. Provide a variety of places – spaces to be alone, spaces to be with others, spaces to connect in smaller groups, spaces to be outside.
9. Provide links to the community – it’s important to maintain that connection socially.
10. Design in response to a vision for a way of life –what is your care model? Is it a person-centred model, a Montessori model, or is it some other kind of model?

‘There’s a lot of research in terms of outcomes and benefits, and the difference that it makes when the above principles are in place,’ Karen explains. ‘We see it every day when we do education and staff say: “I made this little change, and it made a big difference.”’

The benefits of even small changes can include everything from increasing residents’ independence, participation and engagement while reducing occurrences of incontinence, agitation, anxiety, conflict, confusion, depression, and falls ‘as well as a decrease in staff incidents – whether it be injury or burnout – leading to better staff retention.’

Karen gives the example of a residential aged care home where residents were entering other residents’ rooms, which created feelings of unease and anxiety. ‘So they did some work on personalising doors and door handles, and colour coding the doors with more contrast so they stood out from the wall. It made a huge difference in terms of far fewer occurrences of people going into other people’s rooms.’

This is key. In an ideal world, design-for-dementia principles would be embodied within our healthcare and community spaces from the very start, but the reality is far from ideal.

‘If you can’t do it from the very beginning – which is most places – there are many smaller steps you can look at,’ Karen says. These could involve changing or embellishing colours, signage, furnishings and artwork. ‘You can personalise spaces. You can introduce contrast, or better lighting. You can paint doors or change the sheets so you’ve got different coloured bottom and top sheets so that residents’ can see the contrast to get into their bed.’

Members looking to implement change at their workplace, or within their home, can visit dementia.org.au for tips and advice. The national organisation offers help sheets, design audits, education for healthcare professionals (as well as designers and architects) and more.