Designing for Dementia 8 th October 2014 Damian Utton RIBA Partner, Pozzoni LLP Architects

1. Designing for Dementia 8th October 2014 Damian Utton RIBA Partner, Pozzoni LLP Architects www.pozzoni.co.uk

2. Agenda What is dementia? Dementia in the UK context Principles of dementia design Evidence base How do these principles work in practice? Conclusion Current best practice Key Points Priority Areas

3. What is dementia? (Alzheimer’s Society 2012) • Dementia is an umbrella term for a range of diseases of the brain • Dementia describes a set of symptoms including: • Loss of (short term) memory • Mood changes • Communication problems • These symptoms occur when the brain is damaged by certain diseases Dementia is progressive and will depend on the individual and what type of dementia they have.

4. What is dementia? In the later stages of dementia the person affected will have problems with everyday tasks and will become increasingly dependent on others. • Impairments of dementia are: • Impaired memory • Impaired reasoning • Impaired ability to learn • High level of stress • Acute sensitivity to the social and the built environment • (Stirling University 1997)

5. Dementia in the UKContext

6. The UK Context • National Dementia Strategy (2009) • Strategic framework for making improvements to dementia services and addressing health inequalities • Care Act 2014 • Health and Social Services to work together • Cap on care fees of £72,000 • Threshold of £118,000 before state pays care fees • Housing support for older and vulnerable people • Helping carers to stay healthy • Help people to make informed choices about health and social care • Housing Standards Review • Three categories of housing: • Visitable dwellings • Accessible and adaptable dwellings • Wheelchair user dwellings • Planning process determines which option applies

7. The UK Context • Prime Minister’s challenge on dementia (2012) • Improve Health and Care • Creating dementia friendly communities • Research • National Dementia Declaration / • Dementia Action Alliance • Dementia Friends • www.dementiafriends.org.uk • Care and Support Specialised Housing Fund • Phase 1 Affordable Housing bid round July 2013 • Phase 2 Private Market Housing fund 2014

8. Principles of Dementia Design

9. Principles of Dementia Design Older people, and older people with dementia, can be very sensitive to the built environment People with dementia may not remember or understand their surroundings. Design can compensate for these impairments Design can facilitate the efficient delivery of care in a non-institutional way Other impairments can be compensated in a straightforward way with established guidelines, but dementia affects people in different ways.

10. Principles of Dementia Design • Consensus that good design - • should compensate for impairments • should maximise independence • should enhance self esteem and confidence • should demonstrate care for staff • should be orientating and understandable • reinforce personal identity • welcome relatives and the local community • allow the control of stimuli (Marshall et al 1997)

11. Principles of Dementia Design • Evidence base • Published research • Universities of Stirling, Worcester, Bradford, etc. • University of Stirling DSDC Publications • http://dementia.stir.ac.uk/information/bookshop • Housing and Dementia Research Consortium http://housingdementiaresearch.wordpress.com/ • Housing LIN • www.housinglin.org.uk • Post-Occupancy Evaluations • Talk to people!!

12. How do these principles work in practice? Whilst these photographs are from new build extra care environments, the principles are applicable to all building types

13. Compensate for impaired memory, reasoning, learning wc visible from bed open plan - high levels of visual access ‘event’ at a dead end

14. Compensate for impaired memory, reasoning, learning hidden service doors contrast between junctions visible cupboard contents similar floor tone

15. Maximise independence graphical signage accessible kitchen access to external space shop

16. Enhance self-esteem and confidence cue for doors wardrobe flexible space for purposeful activities

17. Demonstrate care for staff dispersed storage technology open plan: discreet monitoring break-out space

18. Orientating and understandable familiar domestic homely

19. Reinforce personal identity

20. Welcome relatives and the local community cafe well-being hair and beauty community room gym

21. Control of stimuli daylight without glare natural ventilation buffer from noisy areas sound absorbing

22. Conclusions

23. Current Best Practice • Non-institutional environments • Manage risks • Community hubs • Dementia friendly communities • Conflict with other regulations (infection control, fire, food, etc) • Emphasis on home adaptations and domiciliary care • to keep people at home • Government funding for extra care housing and to ‘pepper-pot’ people with dementia around a housing scheme

24. Conclusion – Key design points • Familiar environment, fixtures and fittings • High levels of lighting • Easy to understand built environment • Clarity and simplicity: where things are and where to go • Appropriate signage (1200mm above floor) • Contrast to increase visibility • Similar floor tones • External space is as important as internal space

25. Conclusion - Four Priority Areas • Improve lighting • Ensure good contrast • Similar floor tones • Ensure the toilet is easy to find

26. Design for Dementia in Practice 8th October 2014 Damian Utton RIBA Partner, Pozzoni LLP Architects www.pozzoni.co.uk