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Dementia Care: The Vital Importance of the Built Environment
Most buildings are designed to meet a rather specific requirement of use. Care homes and hospitals are designed to fulfil an institutional purpose, a purpose which does not enrich life for persons with physical disabilities, memory, perceptual or behavioural challenges.
Most buildings, especially those designed to hold large numbers, disable the person living with a dementia and lead to a level of challenge and stress that often increases the symptoms of their illness. This leads staff to become controllers of institutes rather than facilitators of care and to thus offer care and medication regimes that seek to remedy institutionally created responses – sadly further disabling those we seek to help.
Understanding how our built and social environments disable and distress those in our care is another building block in creating excellence of dementia caring and the next couple of blogs will be about removing these built barriers.
It would seem sensible and necessary to design or redesign our environments using a ‘model’ that considers the abilities of the person living with dementia, as well as their disabilities, and which facilitates the ability of the staff group to care for people in these environments, where their remaining abilities are enhanced rather than challenged.
Such a model does exist in the form of the strengths based approach and using a strengths based approach to understanding environmental pressures on individuals was described by Antonovsky (1987) as being ‘salutogenic’. This described a ‘method’ of caring moving away from a sole focus on risk factors and looking at a more whole person model and focusing on the health preserving features of care.
Using built and social environments to decrease physical and psychological limitations and to enhance abilities is termed ‘prosthetic’ and for our purpose and is a means of reducing the pressure of adaptation on the individual by decreasing the demands of the environment and increasing the means of coping and mastery.
Type of design features?
Based on the evidence of the degree of dementia in varying age groups, most large- scale dementia design should be geared towards the older individual. As such, design must also account for the varying needs of the older, oft times frail, intended population.
Older body systems have a predisposition to present in a number of distinct ways as they age. Before we design with consideration to meeting the needs of persons living with dementia, design must also address the general requirements of older persons and what it is they require from built environments.
By taking this route design will present a ‘home’ that begins with a basic living environment that can be mastered by all. It is only at this point that we can begin to provide specific adjustments, or additions, that will allow the built environment to adapt to the more specific needs of the person with dementia by the use of prosthetics.
Buildings are not designed with the intention of constructively supporting cognitive impairment.
Many cognitively impaired residents also experience diminished capacity in one or more of the following areas:
- Memory for facts: names, numbers, and sequences
- Action and motion: ability to balance, coordinate, swallow, and manoeuvre utensils
- Emotion: capacity to match emotions with situations
- Social behaviour: ability to relate to people in conventional ways, need for smaller groups
- Judgement: ability to plan, anticipate, change behaviour midcourse, override situations, and anticipate danger.
As more and more healthcare settings attempt to serve a resident population that consists of large numbers of people living with Alzheimer’s disease in particular and other related dementias, and for longer periods, it is becoming increasingly clear that design is not just an incidental concern, but integral to a well- balanced approach for the provision of dignified caring, for this vulnerable and discriminated population.
Now that I have whet your appetite, in the next blog we begin to explore the specific features of good dementia design and in subsequent blogs we will look at a) how you can assess your own environments b) how, for very little cost, you can make meaningful adaptations and finally c) how your organisation can create award winning dementia caring environments.
Till next time
Paul Smith – Dementia Care Expert