There are ten million new cases of dementia each year. Hospitals are an intimidating environment for patients and carers. Sensitive, well-designed architecture can help. In one of our handbooks we explore the subject. As a short introduction, here are five rules for designing appropriate spaces.
Text: Björn Rosen
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1. Design for everyone
Those with dementia lose their short-term memory faster than their long-term memory, which makes many people think spaces for dementia patients should remind them of earlier times. This is a problematic idea, not least because people get ill with dementia at different ages. What time period should be the point of reference for a diverse group of people? Architecture for dementia patients is successful precisely when it cannot immediately be recognised as such. Discreetness can also help reduce stigma. The spaces should work for as many kinds of people as possible. They should be aesthetically appealing and enable orientation and safety. This benefits everyone – visitors and patients alike.
2. Create visual anchors
Hospitals are large, complex buildings, and almost everything looks basically the same inside them. Even cognitively healthy people can find it hard to find their way, but they can at least create a mental map, while people with dementia cannot. It’s too much for them to visualise turning three corners in order to reach their destination. And so, it’s helpful if there is a particular design element in each of the places where patients need to decide which direction they will go. This way, they can trace their path from one point to the next. Helpful reference points might include a window that looks onto a tree-lined courtyard or a wider section in a hallway where there’s an alcove in which to sit.
3. Enable flexibility
Of course, standardisation is important in a hospital, but there should also be room for individual adjustments. It can make a huge difference for example if a patient can position their bed differently, pushing it up against the wall, because this reminds them of home and makes them feel safe and well. They might all of a sudden sleep much better! It’s also good to leave space for things that patients bring from home, such as a photo that can be hung on the wall where it can be seen. And regarding space: it’s very important to create a pleasant space for the family members and visitors, who play a very important role for patients with dementia. They should not feel like they are always in the way.
4. Think about light
As mentioned above, hospitals are complex structures, and it is difficult to illuminate all rooms and all sections of the corridors with natural light. But the more this is possible, the better. Daylight helps people keep a sense of time and improves their sleep, which is why balconies are also a desirable architectural element. When it comes to light more generally, including artificial light, one should bear in mind that eyes change later in life and lose the ability to absorb as much light. This is why it’s important to ensure that the lighting is sufficiently strong for those with dementia. Moreover, light can help them more intuitively find their way, for example, when they’re going to the bathroom.
5. Help the staff keep track
People with dementia have a tendency to wander. They feel uneasy because they do not know where they are and go searchingly walking around. This presents a huge challenge for the hospital staff. What can be done to help them? You might deliberately hide the exits of course, but that would become a safety hazard in some situations. And sensors would be an intrusion on the patients’ privacy and autonomy. Tying them to the bed is obviously not an option. A solution that often works well is to design the station such that the staff can easily keep an eye on the patients, even while doing other tasks (like paperwork). There should be a pleasant space for the patients at a central location near the staff room.