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Master of Interior Architecture Sandberg Instituut

Insight Series #1 A Short Look Into Your Future?

Insight Series #1 A Short Look Into Your Future?

Introduction

Insight Series #1 A Short Look Into Your Future? Henri Snel, Tutor and Head of the Master, Interior Architecture

The future prospects for finding a cure for Alzheimer’s disease looks bleak. In Western European countries, a lot of research is being carried out looking into the origins of the disease, but there is very little progress. At the same time the number of cases is increasing dramatically, as people are living longer. Proportionally, much less research is carried out into the present and future living conditions of patients than into the onset of Alzheimer’s disease. In addition, the state of the health sector and socio-economic conditions are currently under great pressure. What kind of life will an Alzheimer’s patient have who is admitted to a nursing home 20 years from now? 1


Master of Interior Architecture Sandberg Instituut

Insight Series #1 A Short Look Into Your Future?

Introduction

Master of Interior Architecture Sandberg Instituut

With this research we would like to contribute to the discussion of the disease in general and generate a possible solution for improving the living situation and environment of Alzheimer’s patients in the near future. To get a realistic insight into this important topic, we started by reading the book: ‘Out of Mind’ by the Dutch author Bernlef. This is an intimate and affecting story about the dramatic decline suffered by an elderly man afflicted by Alzheimer’s disease. We visited a number of different Alzheimer’s institutions and the students did a compulsory 48-hour internship in an Alzheimer’s institute. We underwent different haptic experiments to get an insight in the world of tactile senses. This preliminary research helped students to move beyond the more theoretically based design approach and enter the world of Alzheimer’s, and gave them a strong base to start thinking about an ultimate plan for the future focusing on 2030 (the peak for Alzheimer’s-

Insight Series #1 A Short Look Into Your Future?

Introduction

related diseases in developed countries) for an Alzheimer’s institute/residence. We have drawn up a joint concept manifesto (which you can find on our blog: http://sandberg.nl/interior/downloads/) aimed at moving the dialogue that is taking place both within but also and especially outside our own field of expertise a step forward. A follow-up to the Alzheimer’s research project will definitely be included in the Master’s in Interior Architecture of the Sandberg Institute. Henri Snel, tutor

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Insight Series #1 A Short Look Into Your Future?

Contents

Master of Interior Architecture Sandberg Instituut

Insight Series #1 A Short Look Into Your Future?

Contents

Contents

Master of Interior Architecture Sandberg Instituut

INTRODUCTION ..................................... 1

> Henri Snel

OUTSIDE-IN

A Short Look Into Your Future?

........................................... 6 > Ricky van Broekhoven

THE Alzheimer’s BUS ......................... 18

> Naomi Cheung San

(IN)SIDE BY (OUT)SIDE ......................... 44 > Chanida Lumthaweepaisal SPECIAL PUBLIC ................................... 62

> Wenqian Luo

HOTEL PITSTOP .................................... 82

> Tom van Alst

IMAGE SECTION .................................. 118

> Collective visual brainstorm

ALZHEIMER’S LANDSCAPE 2030 .......... 154

> Jack Chen S.C

TACTILE MEMORY................................. 210

> Dennis Schuivens

DRAW A HOME ..................................... 242

> Sabine Ruitenbeek

Alzheimer’s Manifesto ................... 254

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> Collective Manifesto by all students

> Special Thanks......................................... 264 > Colophon ............................................. 266 > Reference List ........................................ 267


Outside-in

Alzheimer’s in 2030

Ricky van Broekhoven

Outside-in

Alzheimer’s in 2030

Ricky van Broekhoven

Outside-in consciousness which is bringing the patient back to a pure human state. Unprejudiced and untouched without a time line, but filled with emotions.

In 2030 more patients will be facilitated in day-care centres and nursing homes. We cannot keep on constructing new places since this is costly and in efficient, we have to be creative with the re-use of existing places to turn these into suitable environments to give the patients valuable final years of their lives. Their living environment should be a place where they become part of and where they take part in. A place that gives them the sense of life. Because during my internship I found sometimes the patients looked as bored guests in a hotel lobby, waiting for something but they didn’t know what. They really had nothing to do unless they were entertained. In the beginning of the project I have to be hones, I was a bit reluctant for the confrontation with the patients. But I saw that Alzheimer’s has a bright side. A state of

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1. / 2. / 3. Daylight

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Outside-in

The Future of Living with Alzheimer’s

Ricky van Broekhoven

Outside-in

The Future of Living with Alzheimer’s

Ricky van Broekhoven

The future of Living with Alzheimer’s Alzheimer’s process is proceeding and the patient is getting worse the need for help is asking even more from the carers. Alzheimer’s is a terminal disease and people suffering from Alzheimer’s have an average disease duration of 8 years. These days there is a trend of people living alone as singles. It is expected that in 2030 50% of the dementia patients will be living alone at home. When they are not able to take care of themselves anymore there is no partner to help them for the first years so they will be dependant on friends or family. In many cases they will have to move out in the early stage of the sickness to long term residential homes where they can be nursed and have physical contact with others. There are a lot of costs involved with nursing. In 2010 the global costs for dementia were $604 billion! Another big influence on the future health care system concerning Alzheimer’s will be the mix of ethnicities and cultures which will be part of the future target group.

At this moment there are an estimated 35,6 million people with dementia worldwide. The estimates are that in 2050 that amount will be more than tripled to an amount of 115 million. In the Netherlands the amount of people suffering from dementia at this point is about 270.000. An amount which is estimated to increase to 500.000 by 2050. Of that amount about 70% is diagnosed as having the disease of Alzheimer’s. This trend becomes more and more recognized as a huge problem for the Dutch society. Our society is subject to a lot of demographic shifts which are of influence to future solutions. The most important is the increase of people older than 65 and this also brings up the problem of the shortage of nurses and certified people for caring the elderly. People suffering from Alzheimer’s are very dependant on help. When the 8

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Outside-in

The Future of Living with Alzheimer’s

Ricky van Broekhoven

The Future of Living with Alzheimer’s

Outside-in

Case: The Wilg At this moment the Dutch people can be split up in over a hundred nationalities. It is estimated that in 2050 17% of the Dutch people will be non-western. During the 50’s of the 20th century many people from Indonesia came to the Netherlands and during the 70’s there was a big flow of Turkish, Moroccan and Surinam people which slowly will be a big part of the target group. Although Alzheimer’s patients are losing track of the reality it is proven that a trusted environment helps the patient being comfortable. This means that there is not a universal Alzheimer’s environment to fit all the patients needs, but a more ‘personalized’ environment. Solutions which today are beautiful and working out very good will not be lasting long. There should be anticipated on the demographic shifts which will change the face of our future. The way we take care of the elderly right now in 2011 should drastically change if we want to secure the well being of the future society.

www.levenmetalzheimer.nl www.alz. co.uk/statistics www.wikipedia.nl

1. Small living room, leftover corner 2. Hallway, circulation space 3. Wheelchair parking

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4. Living room

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Ricky van Broekhoven


Outside-in

Reflection on Location

Ricky van Broekhoven

Outside-in

Reflection on Location

Ricky van Broekhoven

Reflection on Location 2

I did an internship in de Wilg in Eindhoven, an Alzheimer’s nursing home situated on the 4th floor of a large elderly complex. The bedrooms and communal rooms are all connected to the circulation space. There is a leftover office which is used as an extra livingroom. It is very difficult for the daylight to penetrate the circulation space. On the left page there are some impressions of the space. Dark, repetitive and with a heavy low ceiling. The space really gives the feeling of being locked in. And the patiens hardly ever get out due to lack of manpower. Since they are located on the 3rd floor they cannot get out by themselves. Which is very regrettable since daylight is very important for any ones well being.

Floorplan the Wilg

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bedrooms

circulation

communal living rooms

3 4

windows

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Outside-in

Concept

Ricky van Broekhoven

Outside-in

Concept

Concept: Outside-in The diagram on the left illustrates the importance if daylight. Vitamin D makes the bones stronger. Melatonin is necessary for a good night rest. And of course energy for maintaining active. And it is daylight which de Wilg is lacking in the hallways. I found this needed to be the place of activity. So I brought the light in.

A state of consciousness which is bringing the patient back to the pure human being: Unprejudiced and without a time line, but filled with emotions. Main feature of the design is the daylight ceiling which has all the qualities of outside sky. By taking away the heavy ceiling and replacing it with true daylight, it gives the inhabitants the sense of freedom back. With doing so I want to make the patients active and undertaking. Every door is replaced with a true front door. The hallway now becomes the outside. Behind the doors is their personal private space. At the kiosk they can get their daily newspaper. Another important feature is the centrally situated minipark on the previous page. The large cinema screen projects different sceneries. Inhabitants can sit down here and enjoy the sense of being somewhere else. The illness allows and accept these gestures, which seem over the top of conventional design.

1. Central park benches

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Ricky van Broekhoven

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Outside-in

Concept

Ricky van Broekhoven

Outside-in

Concept

Ricky van Broekhoven

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1. Kiosk

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Track of time and the day-rythm are important. In the evening the daylight fades and the lanterns switch on. Nighttime has begun.

2. Hallway

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3. Hallway at sunset for daily newspaper 4. Hallway at night 5. Sunset at sea

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The Alzheimer’s bus

Introduction

Naomi Cheung San

The Alzheimer’s bus

Introduction

Naomi Cheung San

The Alzheimer’s bus When designing for Alzheimer’s patients it is important to take all aspects of this disease into account. It is not just about putting the right colours on the wall and designing perfectly sized hallways and bathrooms. When researching Alzheimer’s disease from an architectural and social point of view it is necessary to not just research spatial needs but also emotional or even financial needs. Really experience the hurt of patients, partners and family and learn about professional opinions of formal caretakers, like home caretakers, psychiatric, doctors but also for instance nursing home-project builders. On top of that it is important to know what the existing policy in the Netherlands is, considering psycho geriatric healthcare. Only when taking all of this in account it is possible to in the end come with a design hat can truly make a difference in the future of Alzheimer’s.

On the next pages I would like to take you trough the journey of my research in a nutshell. By doing internship at the psycho geriatric area of a nursing home, by visiting a nursing home that is still under construction, by talking to family of patients, by researching the different phases of the disease and by getting knowledge about future changes of Dutch healthcare policy; step by step I gained insight in the whole field of Alzheimer’s with all it’s downfalls but also it’s upsides.

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The Alzheimer’s bus

Report:Internship at a nursing home

Naomi Cheung San

The Alzheimer’s bus

Internship at a Nursing Home

Report:Internship at a nursing home

Naomi Cheung San

Lingehof also contains 57 assisted living homes, and room for somatic patients. The first meeting with the head of daytime-activities we talked a lot about the ‘Presence-approach’. The presence approach in care is about really being there for the patient on a very personal level. This approach can be seen as an answer to the strict regulations, protocols and schedules caretakers are supposed to follow. For the caretaker it means that he should know the inhabitants by name, know where his/her interests lie and know the background of a person. It is about genuine interest and attention for a person. It also means that the caregiver can jump in certain moments when he feels that the inhabitants have a certain need, for example to do some group singing instead of forcing the inhabitants to go to the singing activity every Tuesday by schedule. I think this approach is very effective and it really helps the inhabitants to feel recognized and in reaction to that not cause

‘De Lingehof’ in Bemmel has a closed of psycho geriatric area that contains 6 homes. In every home live 15 inhabitants. Each home has a big living room and each inhabitant has his or her own bedroom. Bathrooms are occasionally shared. All of the six homes are connected to a circular hallway. Because it is circular, the inhabitants can walk infinitely without bumping into dead ends. In the middle of the circle there is the ‘Lingetuin’. The Lingetuin consists of a big common area where inhabitants can get coffee and small talk two times a day. As a product of the presence-approach, the Lingetuin is a central meeting area where inhabitants, family and friends can meet. The other part of the Lingetuin is an outside area with an aviary containing small birds, some plants and some benches. Apart from the closed of psycho geriatric area, the 20

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The Alzheimer’s bus

Report:Internship at a nursing home

Naomi Cheung San

The Alzheimer’s bus

Report:Internship at a nursing home

Naomi Cheung San

That morning there were about 20 inhabitants at the Lingetuin. Our first task was to get coffee or tea for everyone. This sounds easy but it is actually pretty difficult because everyone has different wishes. Some inhabitants could tell me that they wanted milk or sugar while others couldn’t. I found out that there is a list with all the ‘coffee and tea-wishes’. Very handy, the only problem was that I didn’t knew the names of the inhabitants. Some needed a special cup so they wouldn’t spill, others needed special thickening in their coffee against choking and others got irritated when I asked them if they wanted something in their coffee. “Milk! Like always!” What a struggle just to drink some coffee! All those different needs and personalities! When I sat down and started some small talk with some of them, it struck me immediately that these are all human beings with different personalities, wishes and interests. Some of them still having very sharp moments, some of them already very lost.

disturbance. I do see that this kind of approach puts a lot of pressure on the caregivers because it takes a lot of energy to really connect to a demented person on a human level. On that account this presence-approach is also about the self-reflection of the caregiver because you cannot really be there for someone if you are not in balance yourself. The caregiver gets a bigger responsibility and should deal with lots of ethical and moral considerations. I feel that the presence-approach was always unconsciously very relevant an present while doing the internship. The first day of the internship we walked along with the people of daytime activities, which for the most part meant that we were at the Lingetuin two times a day. The inhabitants who wanted to come to the Lingetuin had to be picked up from the different living rooms and to be transported to the Lingetuin. There they would get coffee and cookies. 22

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The Alzheimer’s bus

Report:Internship at a nursing home

Naomi Cheung San

The Alzheimer’s bus

Report:Internship at a nursing home

Naomi Cheung San

1. De Lingetuin in the Lingehof, Bemmel

Some of them very sweet and complimentary, some of them a little mean and aggressive. Some of them very isolated and quiet, some of them really outspoken. Some of them wheelchair bounded, some of them walking in circles all day long. I could go on like this for another page. A colleague told me that the character of a demented person often becomes the opposite from what it used to be. A shy person can become very outgoing and the other way round. That first day, all those different people moved me a lot. I would never see and generalize them again as the old demented people. Sometimes when we left the closed off area by using a code to open the door, an inhabitant would try to follow us by ramming on the door which made me feel very sad for them being in that situation. It came to my ears that one of them escaped the week before by posing as a visitor. He spent the night in a parked car. Another sad moment I experienced talking to a women who was asking for her

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husband every 10 minutes, forgetting that he had deceased years ago. I tried to reassure her that everything would be fine but I could see by the tears in her eyes that she didn’t really believe it. An upside was when I noticed that inhabitants really appreciated me being there and asked me if I would come back. It was great when I waved or smiled at someone and they would for a moment snap out of their daze and wave and smile back at me. 24

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The Alzheimer’s bus

Report:Internship at a nursing home

Naomi Cheung San

The Alzheimer’s bus

Report:Internship at a nursing home

Naomi Cheung San

a historic estate just outside Renkum. A really breath-taking location that in a way put a blanket of relaxation over the whole institute. A downfall of the location is that there is less interaction between the villagers and the institute in contrast to the institute in Bemmel. Another difference with Bemmel is the mentality of the inhabitants. In the Lingehof, the inhabitants are more ‘village’ and easy to talk to. In Renkum they are more ‘inward’ and have higher demands off their caretakers which makes it for some less fun to work there. In Bemmel I always appreciated the moments when we took some of the inhabitants into the village to eat some ice cream at the local ice-saloon. It was always nice to see villagers react so kindly to the patients. (another interesting thing in Renkum was the failed interior architecture in the common area, but there is not enough room to discuss that in this paper) In Renkum we had an enlightening talk with the head of daytime activities about the pro’s and con’s of the ZZP-system and

The longer conversations I had with inhabitants were always about their pasts. Many times it was hard to know if they were speaking the truth, but in the end that didn’t really matter. It came to my attention that the stories were often deeply connected to memories of certain locations. For me it was sometimes hard to respond to them because I’m not from that region and I didn’t know all the places they talked about. I saw with the other caregivers but also between the inhabitants that this ‘being from the same region’ really created a bond. A colleague told me that there ones was a wall painting of the outside region which really fascinated a lot of the inhabitants. I think this is a very interesting way to connect to these people and to make them feel recognized and at ease. To illustrate the importance of the region, we also worked one day at a connected institute in Renkum where 120 inhabitants living in the PG–area. The institute is housed in the former summer residence of the royal family, situated next to a forest on 26

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The Alzheimer’s bus

Report:Internship at a nursing home

Naomi Cheung San

The Alzheimer’s bus

1. Oranje Nassau Oord, Renkum

about the approach of the Hogewey institute. On another occasion we had an interesting talk with the psychologist of the Lingehof. She defined the different types of dementia and we talked about the influence of the environment (not only architecture but also the people) on a patient. It is her task to support the patient and to find out why for example a patient is restless. She does this by observing and talking to family, caregivers and the patient himself. She also gave some comments on our first concept ideas for designing for Alzheimer’s. What struck me the most was in response to me saying that ‘society has negatively changed and we don’t want to take care of our elderly anymore’, she said that was also what she thought until she found out that informal caregivers (partner, friends, family) actually went over their own boundaries to assure the wellbeing of the patient and that it would be great to design something to unburden the informal caregiver and to make the caregiver and patient attend a relaxing or

Report:Internship at a nursing home

Naomi Cheung San

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2. Atrium psychogeriatric common area, Oranje Nassau Oord, Renkum

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inspiring activity together to restore the natural relation instead of upholding the relation of caregiver and patient. She also mentioned that patients should move more instead of sitting on a chair whole day. Furthermore we talked about the importance of stimulating the senses and the difficulty of designing for these people because of the different parties involved. (Patient, psychologist, caretaker, family, etc.) I have big respect for the caregivers who work with the demented people every day. I already found it hard to listen to the repeated stories of the inhabitants with 28

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The Alzheimer’s bus

Report:Internship at a nursing home

Naomi Cheung San

The Alzheimer’s bus

Dementia in the NL

Dementia in the NL the same patience at the third day. It is hard work. I learned a lot doing this internship but the most important things are that I now see them as individuals and that caretakers should really try to get to know a person. For the environment it is all about finding the right balance between collective and individual. A way to do this is by focusing on the home region of the patients. I believe that the way society is changing sometimes makes it hard to do what we know is morally good. I want to design a place to help society take care of their beloved ones and to take some burden of the informal caregivers shoulders.

1. / 2. Grey pressure, source: ‘Dementie in Utrecht, De cijfers: 2005-2030’

1. Grijze druk 2005 Aandeel 65+ op 100 20-64 jarigen 14-17

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2. Grijze druk 2030 Aandeel 65+ op 100 20-64 jarigen 22-25

25-29

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45-00

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Naomi Cheung San


The Alzheimer’s bus

Dementia in the NL

The amount of aging is normally expressed in ‘grey pressure’. It is a number that portrays the ratio between the amount of people of 65 years old and up, and persons who are potential caregivers between 20 and 64 years old. (professional/formal and informal caregivers). When we look at the province of Utrecht we see that the amount of demented people grows from 13.000 to 21.000 between 2005-2030 (60%) At this moment 65% of all the demented in Utrecht live at home. Only Utrecht the amount of dementia patients alone will rise with 60 % between 2005 and 2030. That is from almost 13.000 at this moment to more than 21.000 in 2030. (1.220.324 inhabitants (30 November 2009). Considering the current vision about socialization of healthcare, represented by for example the presence approach within nursing homes which is about really being there for the patients instead of seeing them as clients and numbers, a solution has to be searched within small scales by making an appeal to society.

Naomi Cheung San

The Alzheimer’s bus

Naomi Cheung San

Dementia in the NL

The Informal Caregiver – Facts ZZP • 70% of dementia patients

ZZP (care intensity package)

live at home and are

is a new system currently being

being taken care of by

introduced within the profes-

informal caregivers

sional/formal healthcare. The

• 80% of informal caregivers

ZZP is supposed to make care

is overstrained and feels

more personal and effective.

isolated

Only people who really need it

• Admission into a nursing

are admitted to a certain care

home is mostly the result

package.

of the informal caregiver

being overstrained

PGB The ‘Personally bound budget’ is an important way for people suffering from dementia and their family to stay at home as long as possible and postpone admission to a nursing home. Even though home care is hard, patients and family do their best to manage. With the PGB they can buy the help they need. Future existence of the PGB is currently at debate in the Dutch politics.

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The Alzheimer’s bus

Concept

Naomi Cheung San

The Alzheimer’s bus

The Flyer

Naomi Cheung San

The Alzheimer’s bus 1. The Alzheimer’s ­bus, front of flyer

After research I decided my target group was not just Alzheimer’s patients but especially informal caregivers. I have a lot of respect for friends and family who go over their own boundaries to take care of the patient. Busy modern society in general doesn’t make this a very easy task. I see it as my task to unburden the informal caregiver. And since about 70% of Alzheimer’s patients live (and die) at home I am indirectly helping them as well by helping the informal caregivers. We need to take Alzheimer’s out of anonymity in addition to cope with aging of society and the increasing amount of Alzheimer’s patients but also to take informal caregivers out of their isolation. We have to help each other. I decided to design a bus service, a kind of pick up service for Alzheimer’s patients, especially for those who live at home. The city bus is already a recognizable item within society. It is easy accessible and approachable. I believe it can even be a solution for the vacancy of city busses that

The Alzheimerbus On our way together..

www.alzheimerbus.nl 1

drive around without passengers and for the re-use of old city busses. I worked out the interior for one bus, focusing on the Alzheimer’s patients that are called the ’Balance seekers’. They are the middle phase of the disease and they are constantly looking for the right balance between impulses they get from the outside. Designing by means of haptic architecture is a way to make these persons feel comfortable. 34

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The Alzheimer’s bus

Concept

Naomi Cheung San

The Alzheimer’s bus

Dementia Stages

Naomi Cheung San

Dementia Stages It is impossible to design for everyone, for example ‘the wanderers’, patients who wander around all day would never adjust in the bus and others will not be able to handle the change of location. Within the group of the balance seekers the biggest difference the sense of reality they experience combined with the need they have to communicate with others. In the bus I create an experience where they can feel like they are in this world without pressure and with regulated impulses. Every interpretation is right. Past, future, the now, memory and dream and come together as a sensory memory. The informal caregiver can make a reservation for the patient, his or her beloved one, when he or she needs some time of his own. The bus will come to pick up the patient at home, in this way patient and informal caregiver are taken out of the care relation for one or two hours.

- Threatened self

->

guidance level

- Lost self

->

care level

- Hidden self

->

care level/nursing level

- Sunken self

->

nursing level

Categorized by the amount of needed care Anneke van der plaats (geriatrician) categorizes by brains and related functions and the amount of impulses different Alzheimer’s patients can handle. 1. Reflexes, singular impulses, feeling 2. Ordening and selecting impulses from the outside

to avoid chaos

3. Emotions linked to stimuli. What do I feel and how do

I process these feelings

4. All brainfunctions come together which result in a certain

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level of consciousness.

- ZEN-demented

->

turned inwards

- Wanderers

->

hunting for impulses

- Balance seekers

->

impulse-makers)


The Alzheimer’s bus

Haptic Architecture

Naomi Cheung San

The Alzheimer’s bus

Haptic Architecture

Naomi Cheung San

Haptic Architecture 1. Lonely Metropolitan, 1932, An image from the book: ‘Eyes of the skin’ by Juhani Pallasmaa

there will be chairs with built in headphones, a coffee bar for the familiar smell and taste of fresh coffee. The bus becomes a world in which we are not only spectators but in which we belong. Since peripheral vision has a higher priority than focused vision on our perceptual and mental space I made it possible to regulate the transparency of the window. The main material of the interior will be made from wood which off course is an aging, not artificial material. The chairs can turn 360 degrees so there is a choice to turn towards others to communicate or to close off. The backs of the chairs can also be put in horizontal position so the patient can look trough the skylight in the roof.

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Haptic architecture is sense triggering. Architecture articulates the experiences of being in the world and strengthens our sense of reality and self. Especially Alzheimer’s patients need bodily experiences to not feel alienated and confused. Vision is the most dominant sense. Modern society focuses mostly on vision and leaves the other senses behind. In my design I also take hearing, smelling and touch in account. For example, 38

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The Alzheimer’s bus

Categorizing Demenzia

Naomi Cheung San

Catagorizing Dementia

The Alzheimer’s bus

Our Way Together

Naomi Cheung San

Our Way Together

Dementia stages categorized by the amount of needed care: - Threatened self

->

guidance level

- Lost self

->

care level

- Hidden self

->

care level/nursing level

- Sunken self

->

nursing level

The Alzheimer’s bus is a city-bus fully designed to fit the needs of an Alzheimer’s patient. There are 3 different types of Alzheimer’s buses all suited to fit the needs of patients in different phases of the disease: ‘early,’ ‘moderate’ and ‘advanced’. A tour with the Alzheimer’s bus can take between 1 and 2 hours. On the left you will find an example of a bus designed for patients in the moderate phase. This bus is equipped with adjustable chairs with integrated massage function and built in headphones. On board will be at least two professional caretakers at any time.To make a reservation for the Alzheimer’s bus go to www.alzheimerbus.nl. You can make an online reservation up to 7 days ahead. The Alzhei-merbus drives around from 7 a.m. till 9 p.m. and will pick up the patient preferably at his home. Offline you can call one of the service points on the map to get personal help with your reservation.

Anneke van der plaats (geriatrician) categorizes by brains and related functions and the amount of impulses different Alzheimer’s patients can handle: 1. Reflexes, singular impulses, feeling 2. Ordening and selecting impulses from the outside

to avoid chaos

3. Emotions linked to stimuli. What do I feel and how do I process these feelings? 4. All brainfunctions come together which result in a certain level of consciousness. - ZEN-demented - Wanderers - Balance seekers

->

turned inwards

->

hunting for impulses

->

impulse-makers

The Alzheimerbus Looking after a person with Alzheimer’s disease is not easy. It is often difficult for an informal caregiver to combine the caretaking with his/her own busy schedule. It is important to take some time off every now and then for emotional relieve, self-reflection and relaxation. Only in balance with oneself, one can truly be there for the other. Just watching tv for an hour, taking a relaxing bath or a trip to the shopping mall can be enough to give you some piece of mind.

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1. Coupé in a nursing home, Yvonne Droge Wendel en Lino Hellings 2. Text from flyer

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The Alzheimer’s bus

Our Way Together

Naomi Cheung San

The Alzheimer’s bus

Inspiration

Naomi Cheung San

1. Inspiration for skylight in bus, installation by James Turrell

windows with adjustable transparency

2. Back of the Alzheimer’s bus

adjustable chairs with headphones and massage function

3. Inspiriation for bus interior, Old tram in Lisbon

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4. Example of advertisement on side of bus

room for one or two wheelchairs entrance

5. Sketchmodel Alzheimer’s bus 6. Sketchmodels Alzheimer’s bus coffee and sandwich bar

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7. Sketchmodel Alzheimer’s bus

seats for caregivers

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(In)side by (Out)side

Institute Inside the Park

Chanida Lumthaweepaisal

(In)side by (Out)side

Institute Inside the Park

Chanida Lumthaweepaisal

(In)side by (Out)side Today the number of Alzheimer’s and Dementia patient is increasing and tend to be more and more. It is irrefutable that this number will be higher in the coming twenty years. The consideration of how to develop and maintain their decent living condition is become more important. As our world being swallowed by the gush of technologies and simulations, the virtual borders are blurred while the physical borders are reinforced. We have less conscious about “authentic way of living”, we have less “physical human contact”, we have less relation with “genuine nature”, we are so “detached from each other”, we lost our “remembrances”, and dreadfully we anticipate that technology will cure the Alzheimer’s illness – it is too soon. In the year 2030, for me, nursing home is still the best answer for Alzheimer’s patient. But the nursing home should oper-

Increasing number of Alzheimer’s + Public Park

ate in a dissimilar manner. It should not be just a limited box to prevent Alzheimer’s patient from the brutal world as it is now, but it should embrace the ingredients of life – way of living, physical contact, nature, and remembrance, as we will have these things less and less in the future. The architecture itself should also support the diverse stages of Alzheimer’s illness. Nursing home could be a mental rehabilitation place and real home for Alzheimer’s patient, a place where they live together to salvage and exchange their memories and everyday life. The increasing number is the main reason that we decide to build Alzheimer’s institute out of the city. And you have rare chances to go and visit your family there. 44

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(In)side by (Out)side

Institute Inside the Park

Chanida Lumthaweepaisal

(In)side by (Out)side

Internship Experience

Chanida Lumthaweepaisal

Internship Experience I try to think about what kind of place that presence in the heart of the city and it is a public park, it is even embedded in every community in the city.

“We remark our senescence with anger, we decline our aging process, we escape from the truth, we misread our oldness, and our introspection will never change; eventually, we become ‘stranger to oneself’.” Florence, an organisation that gave me chance for internship. This organisation offers many forms of care and advice. They provide clinic, home care, day care, and long-term nursing home for all residents of Delft, The Hague, Leidschendam-Voorburg, Rijswijk, Voorschoten and Wassenaar. The organisation is not focusing only to Alzheimer’s or dementia cases as such but all. I have got an opportunity to work in the day care section for Chinese elderly, a place where my experience was commenced. The fiction: “The massive building with a brutal façade, the fenced freedom with a number of patrolmen, and the sobbed hall way filled with senile and declined folks, what is more…” This was my melancholy precon46

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(In)side by (Out)side

Internship Experience

Chanida Lumthaweepaisal

(In)side by (Out)side

ception to our day Alzheimer’s institute. Was this true? I was very timid to confront and discover the reality. It made my first step into the institute the hardest one. The impression: At the entrance of the building, I walked pass the ordinary automatic sliding door which acts as the first physical sphere between inside and outside world, then the old-fashioned half-circular counter with one busy receptionist behind which, to me, act as the second physical sphere. The entrance hall was not so hectic and bustling, there were some aged persons walk unhurriedly and sit aimlessly in the hall. At the very first glance, no one aware of my appearance, I was a stranger – an insignificant stranger. After awhile, some became aware of my existence, and the curiosity appeared in their gesture, I was a stranger – but now an utterly stranger. The pace: After I introduced myself to a caretaker who was in-charged of my internship, it was the time I stepped inside the sphere. On my way to the place where

Internship Experience

Chanida Lumthaweepaisal

I have to be, I walked pass several rooms – almost every room the doors were kept open for the proximity, along the small corridor people I encountered was deliberately walked back and forth, went in and came out, room by room. In this case, what is the meaning of the architectural element such as door or solid wall? Were they just a monotonous plane employed as spaces divider? Would it be a better to use architectural element in an alternate way to adjoin and split spaces in this situation? The time: Four hours per day – from ten o’clock in the morning to two o’clock in the afternoon, is the time for elderly, both rescinded in the nursing home and their own home, to presence in the day-care for the repeatedly arranged activities. Four hours is nothing for us, as a modern man, but it is a great deal for them as an aged. I experienced a longer interval of four hours in the place, and I conjectured about them to encounter a more exaggerated one. I believe that the quality of space 48

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(In)side by (Out)side

Internship Experience

Chanida Lumthaweepaisal

(In)side by (Out)side

had a great direct effect to the dwellers, and longer time experience is one of the consequences. The blend: As I mentioned in the beginning, this organisation is not focused on just dementia cases. In the nursing home and day care there were diversity in the group and also diversity in the bigger picture – the whole organisation. This brought and ushered the inside atmosphere a healthier one, compared to normal dementia institute which focused only onto the dementia cases. It was dreadful to congregate the same type of person in the same place – it is more like a gaol, not home. In the nursing home, I noticed that there are some personal and impersonal moments for every individual. They always sit at the same place and act in the same manner; I considered this as the personal moment. And when they walk and meet the others this is the impersonal moment (gathering). In Florence, it has both personal and impersonal space but in a horizontal floor distribution. What if the space

Internship Experience

Chanida Lumthaweepaisal

is also organising in a vertical floor distribution? The better enfold… The embraces: Care and safety are always needed in such a place like nursing home, but on the other hand “cared” could be simply transformed to “controlled” and “the lost of freedom”. To compensate for the freedom loss all those need both psychological and physical embraces, substantial one is vital – eye contacts, every day conversations, gentle and tender touch, familiarity atmosphere, and so on… Not just from human but also nature. The ambition: Hours by hours and days by days at the nursing home, I saw the benefit of having different programmes combine in one institute. It makes the periphery between inside and outside thinner, and even fade away. There still remain the socalled sphere but it is the translucent one. But my ambition is to wipe out the sphere, open up the institute and make it to be perceived as part of everyday life. 50

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(In)side by (Out)side

Internship Experience

Chanida Lumthaweepaisal

The everlasting: Day and night, light and dark, inside and outside, birth and death, nature and artefact… We, elderly as well, dwell on both sides, all those will come to pass, and they are part of the everlasting loop – the loop of life. Would it be better to sit side by side no matter it is day or night? Fiction, impression, pace, time, blend, embraces, ambition and everlasting. If we perceive Alzheimer’s as the process of deterioration we would have different answers to respond to the posted questions. It is the way we bring about the consciousness and awareness to our life.

(In)side by (Out)side

Alzheimer’s Institute Distribution

CITY Public Park Alzheimer’s Institute

Conceptual diagram of Alzheimer’s Institute distribution in the city in the year 2030

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Chanida Lumthaweepaisal


(In)side by (Out)side

Fragmentation

Chanida Lumthaweepaisal

(In)side by (Out)side

Transformation

Chanida Lumthaweepaisal

Fragmentation The transformation diagram of Alzheimer’s institute, to show how I see the nursing home now and what I would like to purpose in the coming years. My approach will be not so much on technological but space. The “loop” is my attention. I want to focus on the different pattern and condition of Alzheimer’s in each stage. The loop (both physical and mental) could be overlap, fasten, separate, unite, isolate, etc. The patient will have places to inhabit/dwell independently and dependently simultaneously. This means the “loop” can be fixed or flexible depends on the situations and factors. The “loop” can also refer to the relationship among patient themselves, their external and internal bond with people and places inside the nursing home and the outside world. I entitle it as “Loops of memories”

Transformation diagram of Alzheimer’s Institute

Public park in Amsterdam and 1,5 km distance radius from each park

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(In)side by (Out)side

The Loop

Chanida Lumthaweepaisal

(In)side by (Out)side

The Loop Selected park: Sarphatipark

As I mentioned before, I would like to focus on the “Loop” of Alzheimer’s patient (both physical and mental). I want to investigate the cycle and the change of Alzheimer’s illness – both sudden and dramatic, in four different stages – the threatened me, the lost me, the hidden me, and the sunken me. I each stage I consider there are some parallel condition and each condition can be overlap and the loop can be an infinite sequence. The paths, circulations, and sequence of spaces inside building are topics that I am interesting in. Since, my observation in the nursing home suggests me that the Alzheimer’s patients need more relation (but not interaction) among themselves and the outside world. I would like to initiate more intermingle (organic) sequences inside the Alzheimer’s centre, but still provide some private space for them too. To imitate the unpredictable loop/ cycle of memories lost. I want to create the joining position of different pathways as

Public Program Institute Program Institute Recreation Public Park

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The Loop

Chanida Lumthaweepaisal


(In)side by (Out)side

The Institute

Chanida Lumthaweepaisal

(In)side by (Out)side

The basic units for the institute

2. Reception 3. Nursing Home 4. Daycare

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5. Stairs & Lift 6. Familiy Room 7. Institute Garden

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Chanida Lumthaweepaisal

places that they can get together. The overlapping of each loop will provide more joining spaces. For the direction of my project, I see the project as the merging of institute, nursing home, and real home for Alzheimer’s patient. It is a place that offers the decent living condition for Alzheimer’s patient, their family, and caretakers.

1. Nurse Station

1

The Institute

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(In)side by (Out)side

The Institute

Chanida Lumthaweepaisal

(In)side by (Out)side

The Institute

Chanida Lumthaweepaisal

The Institute For the sustainability of the institute inside the public park, I integrated the surrounding programme (context of each park where it situated, in this case the Sarphatipark) and embedded them into the institute’s fundamental programme. The inhabitants of the institute (Alzheimer’s) would not feel detach to the place but like their home/neighbourhood as they stroll around and meet the recognisable environments and activities of their adulthood. Zoning shows how the institute incorporate the external programme to make it also accessible to the general public. The split-levels are connected via two alternatives means of transportations, vertical connection (stairs & lifts) and slope connection (ramp) this will provide more comfort to the inhabitants as they could decide which means they will use. The inner recreation areas (institute’s garden) are only for the institute’s usage but as I place it in the middle and create equal visual connections between the garden and the park, the inhab-

itant’s will feel less isolation but more relation. Basic units could be duplicated/ shuffled/rearranged follow the institute’s requirement and the capacity of each park. 1. 0: ground floor plan

0

2. B1 floor plan 3. -2: B2 floor plan 1

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Special Public

Introductiom

Wenqian Luo

Special Public

Introductiom

Wenqian Luo

What is Public for Me?

Special Public

1. public: Everyone can enter without any specific intent. It is more indicated to park, city square,which are create

1. Film still: Melvin Sokolsky

for the public gathering. 2. semi-public: Almost no limitation to enter, but it

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is created for some specific intents,such like the shopping mall, train station, theatre,

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public library, etc. When get

Since I worked in a nursing home for two months, I found the Alzheimer’s patients would like to be connected with the outside world, which I think is missing in the general nursing home now. To create a kind of public space can get Alzheimer’s patient involved in the society and people will get more chance to know them more. In this sense, I do not perceive Alzheimer’s disease as a strange disease. It happens when you are aging, maybe not to everyone,but we are all in the way. That is why I want to invite people to get into the world of Alzheimer’s patient: It is a process, maybe it will be your future.

there, people are gathered by the same purpose or event. 3. special public: Not an open space, but it is open to

2

everyone, needs entrance, needs security, needs specific attraction. It is special public space with invisible fence.

3

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Special Public

Site

Wenqian Luo

Special Public

Site

Wenqian Luo

Site Choose As I did my internship in this nursing home, I find this place has good context that it contain the church, primary school, apartment building,nursing home,playground,. The good combination of context will bring more public to my special public space. I decide to open the inner garden of the nursing home, And re-design it, put some Alzheimer’s experience spatial intervention inside. Special public space should be open up, but safe as well, and it should be attractive for the public. The inner garden of the nursing home fits my demand. It is a safe place for Alzheimer’s patients to meet the public, and still could be open in the daytime and closed at night.

ary

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2 1. Florence: Nursing home 2. Site: Newtonplein 100, Den Haag

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Special Public

Site

Wenqian Luo

Special Public

Interview

Wenqian Luo

Interview 1. North elevation of nursing home

What did the public say about the institution? I come here for the children,they want to play in to park. I live nearby. I come here for meeting friend of my children's. I would like to visit the garden behind nursing home. I am not sure. Because I think my kids will be noisy for the elderly. I do not need to visit the garden since I have my own garden. I would like to visit, my own garden is too small.

2. Inner garden

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South elevation of nursing home 4. Inner garden 5. Main street, east to nursing home

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6. Playground, west to nursing home 7. Small alley, between church and nursing home

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Special Public

Internship Keywords

Wenqian Luo

Special Public

Internship Keywords

Wenqian Luo

Keywords of Internship 1. Blurry sight

I do not perceive it is an experience when I worked in the institution after I get involved into their life, to understand them. Maybe in her mind, everything is a kind of creature, with live and another language. Every time when I came into the room, they smile to me , asked my name again and again. May be for them it is very interesting to know a new comer. They would like to participate in the daily routine, get involved by the group. She began to forget things, staying alone in nursing home, did not talk about her family much, in her own island. Then I realized it was not about fixing the watch, it was the way he would like to feel be in the current and be in the life cycle, still had the feeling of responsible.

2. Forgetfulness: getting out or in? 3. Silent 4. Forgetfulness: going up or down?

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Special Public

Wenqian Luo

Design / Keywords

Special Public

Wenqian Luo

Masterplan

Keywords of Design Masterplan

Get into their world, Think what they think,

Primary school

Feel what they feel, Experience what they experience, Understand the beauty of the other world.

Church

Their world: aging blurry sight Appartment

silent forgetfulness reversed world

Nursing home

CafĂŠ

Nursing home

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Routing

Wenqian Luo

Special Public

Zoning

Sound experience (sound from church and silent room)

Primary school

Blurry glass alley

Church

Wenqian Luo

Primary school

Church

Appartment

Forgetfulness experience (confusing routing)

Appartment

Special Public

Alzheimer’s forest (two glass walls to reflect the trees)

Nursing home

Butterfly house (existing building, brick wall, glass roof) Out of mind room (before entering the garden)

Café

Nursing home

Nursing home

Café

Nursing home

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Special Public

Model

Wenqian Luo

Special Public

Institution Stay

Wenqian Luo

Institution Stay 1. Model bird view

Since I worked in a nursing home in Den Haag for 2 months, the stay allowed me into another world, which is a place embraced the people in their last part of life. The nursing home is called Florence. The elderly who live here are mixed with normal elderly and Alzheimer’s patients or people who have other diseases. I worked as an assistant for the day care department. They separate the day care department into different groups by culture, which include local Dutch, people from Suriname, Indonesia, China, etc. After several times I got to know them better, I chose to write the details down as a kind of dairy. I do not perceive it is an experience when I worked in the institution after I get involved into their life, to understand them.opportunity to choose, life will become simpler?

2. Entrance and billboard

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3. Blurry glass wall alley 4. Silent alley (acoustic material) 5. Forgetfulness area(different ways to choose)

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6. Out of mind room and the small entrance for the inner garden 7. Reflected forest

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Special Public

Diary – 18/03/2011

Wenqian Luo

Special Public

Diary – 18/03/2011

Wenqian Luo

Christian Friday and Oma Zhen are out of mind, but sometimes they ask you questions to know you more. When talking about the song, we said to her that you should sing a beautiful song to us. Suddenly, she said, the song ran away, we can not find it any more. Maybe in her mind, everything is a kind of creature, with live and another language. Sometimes we played games, using her walking stick, beat back and force, not in a serious way. She enjoyed the way we play, and looked like a little girl. I heard her story before: Once she went out from the nursing home, and got lost in the street. When the police found her, she fell over in a strange place before, with hurt on her forehead. I did not know what is her feeling, but I can see she did not want to mention it. Her scar did not recover yet, which made her look vulnerable.

Most people in the group are Christian. Every Friday they do prayer together by singing the Christian song. The topic in this morning was to be charity, grateful and peaceful. I met a grandma called Oma Zhen, who is with Alzheimer’s disease. This time I sat beside her. She was smiling all the time. I talked with her, she just responded “I don’t know.” Others said she knew everything. But at some moment, she stopped laughing, with her face turning into an uncomfortable look, a little aggressive. When I was staring at her, she began to smile again. She was not very interested in other’s topic, but sensitive about other’s opinion towards her. They told me that sometimes she sat along the window, started to sing a song, which even her daughter never heard. She was not talky, most of the time observing others in a way. You think they 76

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Special Public

Diary – 25/03/2011

Wenqian Luo

Participate in the Group

Special Public

Diary – 30/03/2011

Summer Time and Oba Ho

Wenqian Luo

All of them forgot to change the time to summer time. It looked like it did not matter for them to live in the wrong time. Oba Ho’s watch was broken so that he could not adjust the watch to the summer time. He was quite annoyed by the watch because he wanted to catch up with others who already adjust the time. He tried again and again to fix the watch. I help him twice to fix it. But I found it was not repairable. I just told him that I tried but no use. He still did not stop. Then I realized it was not about fixing the watch, it was the way he would like to feel be in the current and be in the life cycle, still had the feeling of responsible.

Every time when I came into the room, they smile to me, asked my name again and again. May be for them it is very interesting to know a new comer. We sang the song together. One of the grandma said she was not afraid of illness because god is with her. Oma Zhen was very open today, still smile to me, like a little girl. Sometimes her face looked confused. When we looked at the lyrics book, She was sensitive with the bold font. When we started to prepare the lunch, every oma help us to organize the table. They would like to participate in the daily routine, got involved by the group.

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Special Public

Diary – 06/04/2011

Wenqian Luo

Special Public

Control and Hidden Alzheimer’s

Diary – 06/04/2011

Wenqian Luo

Others tell me that she liked to buy a lot of clothes to dress up when she was young. In this case, aging is more cruel to her. She told me she wanted to give me some clothes of hers. I perceived it as a kind of extend youth in my figure. She saw me in the same age of her youth, dressed up, free to go out and meet people. She began to forget things, staying alone in nursing home, did not talk about her family much, in her own island. The nursing home does not offering the living room for the regular inhabitant. The only way to communicate is to go to downstairs by joining the daycare or walking in the garden to meet people. I do not feel be locked in the place. But for her, it is. She is sad, missing her family. Why people should be end in a home like this? Life goes on. We all live in current. When we lose the opportunity to choose, life will become simpler?

Oba Ho sat alone in the room when I arrived. I told him that he needed to go to downstairs to do the excise. He seemed like had no idea about the excise which he has to attend every week. I took him to downstairs, the excise hall. He was very happy at some moment, in the other moment, he seemed lost the power to control his life, always be taken to somewhere which he “does not know” or “does not like”. But the thing was he did not express his need or requirement, so that others always made the decision for him. Oma C came to the room after we had the appetizer. She forgot to come. She told me she even forgot her son’s birthday, which is very importawnt to her. She is the one looks very healthy, quiet, kind-hearted and polite, but in distance. She looked younger than her real age, but still denied to be called grandma. 80

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Hotel Pitstop

Introduction

Tom van Alst

Hotel Pitstop

Research: Internship

Tom van Alst

Research

Hotel Pitstop

During 48 hours I have attended an internship in the psycho geriatric department of nursing home Lingehof in Bemmel and Oranje Nassau’s oord in Renkum which both are part of an umbrella organization called Zinzia care group. Other nursing home locations within this care group are de Rijnhof in Renkum and Rumah Kita in Wageningen. All nursing homes have similar departments called the psycho geriatric, somatic and day care department but the type of residents differs in each nursing home. Oranje Nassau’s oord has mainly high class residents in contrast to nursing home Lingehof which has middle class residents and Rumah Kita which has only Indian en Moluccan residents. This internship was part of a personal research about the future habitat (2030) of an Alzheimer’s patient and my aim was to understand the living circumstances of patients and their carers. Eventually the internship has really influenced my vision on the future habitat of an Alzheimer’s patient.

As home care will increase in future, I would like to focus on making home care bearable for home carers and their patients. By creating ‘pitstops’, carers and their patients can have care holidays to exchange experiences and release their care relation.

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Hotel Pitstop

Research: Internship

Tom van Alst

Hotel Pitstop

Research: Internship

Tom van Alst

The zen-demented persons are very quiet and constantly stare to what is in front of them. They often benefit from a quiet setting and soft music and do not want to participate with activities. In contrast to zen-demented persons, wanderers need to get impulses from their environment. If they do not get enough impulses, they wander around to search for impulses. Corridors are often places where you can find these type of Alzheimer’s patients. The balance seekers are often noisy by creating their own impulses. They scream or sing to constantly be aware of life and they are really addicted on creating these impulses. Those types of patients I also noticed during the daytime activities in the nursing homes. There was a man who was constantly walking to his old village (wanderer) and a woman was constantly singing her thoughts (balance seeker). I also noticed a lot of persons were sleeping in their wheelchair during the day (zen-demented person).

Instead of focusing on a nursing home as a potential architectural project, I will focus on the bearable making of home care. Alzheimer’s and vascular dementia are the most common brain diseases of dementia in the psycho geriatric department of nursing homes Lingehof and Oranje Nassau’s oord. Astrid van Kuppeveld, who works as a psychologist in Lingehof, explained the main difference between those two forms of dementia is the course of the disease. The disease course of Alzheimer’s patients has a constant decline in contrast to patients which have vascular dementia. Vascular dementia has no linear trend in decline which means the state of a patient extremely differs per day. Types of Alzheimer’s patients: Astrid suggested geriatrician Anneke van der Plaats who describes different types of patients within the different phases of Alzheimer’s called: the zen-demented person, the wanderer and the balance seeker. 84

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Hotel Pitstop

Research: Internship

Tom van Alst

Hotel Pitstop

It is important carers offers ‘space’ to patients, so every patient can behave how they would like to. Presence theory: The vision of the daytime activities department in the Lingehof gives this ‘space of behaviour’ to its patients. They believe carers should guide patients in their present moment which means there are no obliged activities which the patients have to attend. Instead carers need to be present for the patients and answer the patients demands per moment. Guus Melkert, head of the daytime activities in the Lingehof, invented this presence approach, which is really successful I think. The increase of home care: Astrid van Kuppeveld and Franka van Drost, head of the daytime activities department in Oranje Naussau’s oord, both agree with the presence approach but they think in future there should be a place which offers presence to make home care bearable. Both think home care will increase in the future. Astrid explained most of the Alzheimer’s

Research: Internship

Tom van Alst

patients already use home care because of the strict indication needed to be eligible for a nursing home. This indication is based on the ZZP care packages which will be the official indicator from the 1st of January 2012. Franka thought this eligible indication for a nursing home will be even stricter in the future which means architects have to focus on making home care bearable for a home carer and patient as well. Franka agreed to expand the day care department in the future but instead of just offering day care, patients can also stay three days per week (part time). Astrid found this solution not feasible because patients need a steady home instead of having a temporary home every week. Hotel Pit Stop: I explained Astrid the idea of having an Alzheimer’s hotel, which functions as a pit stop (holiday) for both the Alzheimer’s patients and home carers. Home carers and patients can have a holiday included assisted care and simultaneously home carers evaluate 86

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Hotel Pitstop

Research: Internship

Tom van Alst

Hotel Pitstop

Research: Home Care

Tom van Alst

Care for Alzheimer’s in the near Future

their care relation (together) with the patient. By releasing the care relation for a certain time, home carers can better evaluate their care relation from a distanced point of view. The hotel will be a platform where home carers can meet and exchange experiences so they can learn from each other. It is beside a holiday resident also an educative and reflective place where assisted care and professional help is present. The rooms which the hotel offers are made for the different type of Alzheimer’s patients Anneke van der Plaats described, home carers and tourists. The hotel will have a strong connection with the presence theory Guus inventewer the demands which patients and home carers have during this pit stop. I think as architects we need to focus on these pit stops as part of future home care instead of focusing on nursing homes!

The Netherlands will turn increasingly gray in twenty years resulting in an increase of Alzheimer’s patients. Nursing homes as for instance ‘de Hogeweyk’ in Weesp would not handle the amount of patients in future anymore. By budget cuts within the health care sector nursing homes cannot expand in the near future. So there is a need of alternatives in care for Alzheimer’s patients in the future. Home care: During the visit of nursing home ‘de Hogeweyk’ in Weesp, I noticed the closed character towards its environment. Hogeweyk wants to create a simulation of reality to give patients as much as possible a home feeling instead of experiencing the nursing environment. I found it a pity this simulation was just an ideal situation of reality. They created a separated world for the patients alienated from the real world. A question which I asked myself is in what 88

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Hotel Pitstop

Research: Home Care

Tom van Alst

Hotel Pitstop

Research: Home Care

Tom van Alst

and are not able to communicate directly anymore. Eckhart Tolle is a German-born writer and a spiritual teacher. He is the author of one of his best sellers, ‘The power of now’. The main message of Tolle’s book is to become free from the egocentric mind by transforming our mode of consciousness what results in reaching the real ‘being’. When the ‘being’ becomes deeply conscious of the present moment, it will experience ‘the moment of now’. While reading this book I realized that Alzheimer’s patients experience life in the moment of now as well. The awareness of the future and past disappears resulting in a need of guidance in the moment. Patients cannot handle large amounts of impulses anymore and need subtle changes to be not confused. If home care will increase in the future you have to find a solution how this cohabitation between home carer and patient will look. Both parties have a different perception of life which is interesting how

extent the patients can be connected to the real world? Towards the future I do not believe in the concepts of nursing homes. Budget cuts within the health care sector means an increase of home care. Patients will maybe live together with their relatives in special designed houses. An interesting question is how this cohabitation would look in the future? I think this new cohabitation will give patients in a certain extent the opportunity of being a part of society as well. To ensure that patients and their relatives still meet fellow patients, it is interesting to create collective shares for exchanging information and experiences. Spiritual needs: In my opinion the spiritual needs of people with end-stage Alzheimer’s are often ignored. I believe communication/therapy on a spiritual level, also called complementary care, will create a great comfort for patients. This spiritual contact can bring back memories to people who’s language skills have deteriorated 90

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Hotel Pitstop

Research: Home Care

Tom van Alst

Hotel Pitstop

Research: E-Nursing

Tom van Alst

E-Nursing that will be expressed spatially. Why not creating a Alzheimer’s hotel as an extension of the Alzheimer’s cafe which functions as a common share for home care during holidays? A place which provides communication on a spiritual level and where home carers and patients can release their care relation and simultaneously can evaluate and reflect their cohabitation.

Since 2010 The digitalization of Dutch society has started. Digital media have not only changed Dutch society, but also international society. The world has become smaller because of international communication networks such as internet and e-mail. As a result of the increase of the possibilities in communication, people can carry out a lot of activities from their home (housing, shopping, learning, care). The supermarket, travel agency or nursing home as a ‘physical place’ is not anymore needed nowadays in comparison to 2010. Because of digitalization, domotics or home automation is also a fact nowadays. The definition of domotics or home automation is: “Domotics are all means that are used to integrate the electrical controlled equipment in a house or apartment, with the purpose to increase the level of comfort, security and energy management in that environment.’’ This self-sufficiency of houses is ideal for home care. People who suffer dementia nowadays have to go to a nursing house. 92

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Hotel Pitstop

Research: E-Nursing

Tom van Alst

Hotel Pitstop

Research: E-Nursing

Tom van Alst

circumstances. On the one hand they can still live with their relatives or friends. On the other hand they are often confused because they do not know where they are because of the independency of a place nowadays. Why not making in these fast conditions of life where people are not conscious of time and place anymore, a slow environment for Alzheimer’s patients. A slowly-designed environment induce contemplation and ‘reflective consumption’. –‘according to slowlab’. I think the sentence above is an important statement for Alzheimer’s patients. The caring process of an Alzheimer’s patients asks for continuation in reflection to let patients better process the information. Simultaneously the experience of time will change automatically. I think for Alzheimer’s patients it is better to focus on the process to reach the aim than the aim itself. In the future it is interesting to think about how space can support this ‘slow-process’.

Because of the self-sufficient houses nowadays it is possible to have home care so patients can still live with their family. If a relative is not able to care for the patient there is digital nurse who takes over the care. So It is possible to have home care without a patient being totally dependent from their relatives. As this happens, the relation between an interior design and the outside world changes. An interior is no longer a ‘place’, instead people experience an interior as a ‘flow’ as Manuel Castells said. Through digital technology and networks, people can be in different places at the same time. The hotel will have a strong connection with the presence theory Guus inventewer the demands which patients and home carers have during this pit stop. I think as architects we need to focus on these pit stops as part of future home care instead of focusing on nursing homes! I noticed that patients who have dementia find it difficult to live in these 94

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Hotel Pitstop

Research

Tom van Alst

Hotel Pitstop

Position of a Patient

Tom van Alst

Position of a Patient Amount of Alzheimer’s patients (2010) in Millions

In madness and civilization, Michel Foucault described during the Renaissance the madman were put on boats to sail the waterways of Europe; isolated in their difference from mainstream society. It made me think of the position of the patient nowadays and the position of the patient in the future. In these times I still feel that society threat Alzheimer’s patients still as patients who have ‘a disease’. Most of the nursing homes where patients live, are still very closed off from society which does not stimulate the acceptation of the Alzheimer’s patient as ‘a normal human person’. I noticed patients are still too invisible in society which needs to turn around! I have to agree that the position of patients nowadays is not as bad as during the Renaissance but if you have the future in mind patients will live more often ‘in’ society (home care). So there is a(n) (architectural) change needed for making the Alzheimer’s patient more visible in society.

low Income lower middle income

MLNS 140 120 100 80 60 40 2010

higher middle income high middle income 2020

2030

2040

2050 Madness and Civilization, Michel Foucault

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Hotel Pitstop

Research

Tom van Alst

Hotel Pitstop

Notion of a Holiday

Tom van Alst

Notion of a Holiday The story of the boat which I earlier mentioned, I could also link to the Zonnebloem boat trip which is organized by the Zonnebloem foundation. This boat trip is meant for sick and disabled people who normally cannot have a holiday since there is a lack of assisted care which they need. The difference between those two examples is that boat trips are meant for short holiday periods and the boats which Foucault mentioned, are meant for curing the patients. Within the context of a future habitat for Alzheimer’s patients I find it interesting to think about a holiday offer to make home care bearable for both home carer and patient as well.

1. The notion of a holiday 2. Position of a patient

1

2

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Hotel Pitstop

Concept

Tom van Alst

Hotel Pitstop

Concept

Concept 2011

Hotel is included in care packages

ZZP1

1 overnight stay per half year

ZZP2

1 weekend per half year

ZZP3

2 weekend stays per half year

ZZP4

1 midweek stay per half year

Nursing home Home care Day care 2030 Hotel Pitstop

ZZP5

ZZP6

ZZP7

ZZP8

100

101

1 week stay per half year

2 week stays per half year

Nursing home

Nursing home

Tom van Alst


Hotel Pitstop

Concept

Tom van Alst

Hotel Pitstop

Concept

Tom van Alst

Concept – Care Package System Self-reliance

ZZP

Self-reliance

Care

Psychosocial functioning

Personal care

Mobility

Medical

Problem

supplies

behavior

Motor funtioning

W1

+

0

+

+

0

0

0

W2

+++

+

++

+

+

+

0

W3

++++

++

++++

+++

++

+

0

W4

++++

+++

++

+

+

+

+

W5

+++++

++++

+++++

+++++

++

+

+

W6

++++

+++

++++

++++

++++

++++

++++

W7

++++++

+++++

++++++

++++++

++++++

++++++

++++++

W8

+++++

+++

+++++

+++++

+++++

+++++

+++++

W9

+++

++

+++

+++

+++

+++

+++

+++++

++++

+++++

+++++

+++++

+++++

+++++

W10

Phase 01

Phase 02

Phase 03

Home care + care holidays

ZZP1

ZZP2

ZZP3

Phase 04

Palliative/terminal care

Nursing home

ZZP4

ZZP5

102

ZZP6

103

ZZP7

ZZP8

ZZP9

ZZP10


Hotel Pitstop

Concept

Tom van Alst

Hotel Pitstop

Concept Description My concept is an Alzheimer’s hotel which functions as a pit stop in the care process for both Alzheimer’s patient and home carer. They can have a holiday included assisted care. Home carers evaluate their care relation (together) with patients and professionals. The hotel will be integrated in a communal living group located in House Labre at the Plompetorengracht in w. The inhabitants have varying ages of 6 till 55. The overall background of the inhabitants lies in art and social work. They often celebrate their ‘being together’ by film nights, dinners or theatre plays. The hotel could be part of those activities (and communal living concept) so patients can feel more societal involved. Simultaneously the hotel could offer employment for the inhabitants who would like to have a stable income besides being an artist/social worker.

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Concept

Tom van Alst


Hotel Pitstop

Concept

Tom van Alst

Hotel Pitstop

Concept

Tom van Alst

1. / 2. Chapel, house Labres 3. Kitchen, house Labres 4. Hallway, house Labres

1

3

2

4

106

107


Hotel Pitstop

Function Scheme

Tom van Alst

Hotel Pitstop

Program / Activity

In/Outcheck

6

6

4 6

Meeting area

Room inhabitant

Room hotel guest

4

Quiet garden

5

Active garden

6

Communal areas

7

Swimming pool

8

Massage space

9

Sauna

10

Dressing rooms

11 Showers 12 Wardrobe 13

6

Entrance hotel

Monday

In/Outcheck Tuesday

Wednesday Thursday Friday

Breakfast, Breakfast, Breakfast,

8–10:00 communal communal communal living living living room room room

10–13:00 Cleaning Cleaning Cleaning rooms rooms rooms Massage,

Games,

City walk

13–15:00 Bathhouse Communal

15–18:00

18–20:00

living room Bathhouse Bathhouse Bathhouse

13

Daily activity for Hotel Weekly activity for Hotel Outsider Weekly activity for Hotel and House Labre Weekly activity for Hotel, House Labre and outsiders

7

8

11

Monthly activity for Hotel, House Labre and outsiders

10

108

109

Yoga, Communal living room

Bathhouse Bathhouse Bathhouse Bathhouse

Film night, Theater kapel play

Inhabitant

9

Yoga, Massage, Communal Bathhouse living room

Carers café, kapel

Hotel guest

12

Games, Communal living room

Carers café, Carers café, Alzheimer’s kapel café

20–24:00 kapel

Breakfast, communal living room

Cleaning Cleaning Cleaning Cleaning rooms rooms rooms rooms

Diner, Communal living room

Staff: 4 Nurses, 3 Volunteers

13

Breakfast, Breakfast, communal communal living living roomq room

Diner, Communal living room

5

6

Breakfast, communal living room

Saturday Sunday

Diner, Diner, Diner, Communal Communal Communal living living living room room room

Staircaselift

6

Tom van Alst

Diner, Communal living room

Diner, Communal living room Carers café, kapel


Hotel Pitstop

Activity in Building

Tom van Alst

Hotel Pitstop

Activity in Building

Activity in the Building High Middle Low

Time:

Time:

Time:

Time:

08:00

13:00

16:00

20:00

110

111

Tom van Alst


Hotel Pitstop

Designs

Tom van Alst

Design: Type of Alzheimer’s Patients Needed contact/activity in surrounding

Zen-demented person

Balance seeker

Balance seeker

Wanderer

Wanderer

ZZP4-6

Tom van Alst

The hotel consists of six rooms, two rooms1 are designed for the zendemented person. The zen-demented person cannot handle a lot of impulses so the rooms are located in the most quiet areas. The personal space needs to be big. These rooms have a voyeuristic connection2 with the hallways to stimulate the curiosity of the patient.

High Middle Low

ZZP1-3

Designs

Design: ZEN-Demented Person

Personal space

Zen-demented person

ZZP1-3

Hotel Pitstop

ZZP4-6

1

112

113

2


Hotel Pitstop

Designs

Tom van Alst

Hotel Pitstop

Designs

Tom van Alst

Design: Wanderer

Design: Balance Seeker The room of the balance seeker is a bit smaller then the room of the zendemented person. It has a connection via a hatch with a kitchen of house labres.

The rooms of the wandere are located near the central living room of the hotel which is one of the most active places. These rooms are the smallest.

01

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Hotel Pitstop

Designs

Tom van Alst

Bathhouse Plus Atmosphere Rooms

Hotel Pitstop

Peter Zumthor, SPA, Vals, Switzerland

01

116

117

Designs

Tom van Alst


Hotel Pitstop

Tom van Alst

p 82


Alzheimer’s Landscape 2030

Jack Chen S.C.

p 154


The Alzheimer’s bus

Naomi Cheung San

p 18


Outside-in

Ricky van Broekhoven

p 6


(In)side by (Out)side

Chanida Lumthaweepaisal

p 44


(In)side by (Out)side

Chanida Lumthaweepaisal

p 44


Alzheimer’s Landscape 2030

Jack Chen S.C.

p 154


Alzheimer’s Landscape 2030

Jack Chen S.C.

p 154


Special Public

Wenqian Luo – p 62

The Alzheimer’s bus

Naomi Cheung San – p 18


Draw a Home

Sabine Ruitenbeek

p 242


Draw a Home

Sabine Ruitenbeek

p 242


Alzheimer’s Landscape 2030

Jack Chen S.C.

p 154


Alzheimer’s Landscape 2030

Jack Chen S.C.

p 154


Outside-in

Ricky van Broekhoven

p 6


(In)side by (Out)side

Chanida Lumthaweepaisal

p 44


Alzheimer’s Landscape 2030

Jack Chen S.C.

p 154


Tactile Memory

Dennis Schuivens

p 210


Tactile Memory

Dennis Schuivens

p 210


Alzheimer’s Landscape 2030

Introduction

Jack Chen S.C.

Alzheimer’s Landscape 2030

Alzheimer’s Landscape 2030

D Billions 1200 1000 800 600 400 200 0

Global Cost of Dementia

Jack Chen S.C.

Informal care 42% Formal care 41% Medical care 16%

2005’

2009’

2010’

2030’

Year 1

Global Cost of Dementia Cpp:$868 Cpp:$3.8109 Cpp:$6.827 Cpp:$32.865

1. Estmated total global cost of dementia

The room of the balance seeker is a bit smaller then the room of the zendemented person. It has a connection via a hatch with a kitchen of house labres.

low income 89%

2. Percentage of total global cost by income

lower middle income 5% higher middle income 5%

3. Prevalence of Alzheimer’s, per 1000, by income

high income 1%

2

20

low income 89%

15

lower middle income 5%

10

higher middle income 5%

5 0

154

155

high income 1%

2005

2015

2030

3


Alzheimer’s Landscape 2030

Global Cost of Dementia

Jack Chen S.C.

Global Dementia Research

Alzheimer’s Landscape 2030

Conclusions - In Lower and Middle income

- Estimated worldwide cost of Dementia US$604 billion

in 2010. Set to increase 85% by 2030.

- If dementia care were a country it would be

countries informal care

accounts for the majority of

total cost direct social

care cost are negligible.

- Lower income countries

- 70% of cost occurs in Western Europe and North America the world's

18th largest economy, ranking between Turkey and Indonesia.

accounts for just under 1%

of the total worldwide cost

(but 14% of the prevalence).

- Middle income countries for Categories for cost of care: - Informal care (unpaid care provided by family and others)

home settings)

- Medical care (cost of treating dementia and other

similar proportion of total cost (42% worldwide),

while direct medical cost are much lower

(16% worldwide).

10% of the cost (but 40% of

the prevalence)

account for 89% of the cost

(but 46% of the prevalence).

- Cost are lower in developing

conditions in primary and secondary care.)

- Cost of informal care and social care generally contribute

- High income countries

- Social care (community care professional and in residential

countries, both per person

and societally

(as a proportion of GDP).

In these regions there is

a much larger reliance on

unpaid informal care by

family and others.

- While wage levels are low,

they are increasing rapidly,

hence opportunity cost or

replacement cost of these

informal input are set to

rise. - Low and middle income

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157

Jack Chen S.C.

Global Cost of Dementia

countries only 6% of people

with dementia live in care

homes. But this is also

increasing, especially in

urban settings in middle

income countries boosted

by demographic and social

change that reduce

availability of family

members to provide care.

- Demand of care to increase

due to increase awareness.

- Cost in low and middle

income countries are rising

faster than higher income

countries, because economic

developments, per person

cost will rise towards the

high income countries plus

increase in number of

dementia will be sharper in

these regions. - With the future population

projection in 2050 one in

85 person worldwide will

have Alzheimer’s disease.

- Asia will have it the worst

with 62.85 million accounting

for 59 percent of all cases.

- Europe will suffer earlier.

Having a huge greying

population heading for

retirement and dementia.

The diminished labor force

can not reproduce fast enough

nor have enough migration to

offset the need. Peak of

the pupulation getting

dementia is around 2038-2040.


Alzheimer’s Landscape 2030

Dementia in NL

Totaal

Profiel 4

Profiel 2

Demetie

Profiel 3

Profiel 1

Jack Chen S.C.

Alzheimer’s Landscape 2030

Dementia in NL

Jack Chen S.C.

Dementia in NL

Prevalence profile 2010-2050 for age 65+ of Dutch population

Looking at the prevalent profile graph, it is clear that The Netherlands aging population is heading for a steady increase of dementia cases. The pupulation of 65+ will increase at a rate of 3% per year until the peak near 2038-2040. That is a 77% increase in the amount of elderly over 65+ in 30 years. By that time close to 4.5 million people will be 65+. Within that popuplation around 273,000 will be in profile 4 or dementia. Those are the case with 24 hour care needs. Another 273.820 case under profile 3 will need asssitant living care. This give a good projection of what types of institutions will be demanded in the future. Nursing homes will need to be increased, but informal home care will be more dominant due to healthcare cost and lack of labor power. Perhaps a new typology of housingwill arise that make a hybrid of traditonal housing with geriatric nursing homes with more mobile medical facilities scattered through-out the city. A decentralized medical plan.

Mio 10 9 8 7 6 5 4 3 2 1 2010 2012 2014 2016 2018 2020 2022 2024 2026 2028 2030 2032 2034 2036 2038 2040 2042 2044 2046 2048 2050 2011 2013 2015 2017 2019 2021 2023 2025 2027 2029 2031 2033 2035 2037 2039 2041 2043 2045 2047 2049

Care profile

Care needs

Living situation

Profiel 1

No need for concern ordinary house

Independent Living in an

Profiel 2

Little need to (be planned) care, mobility limitations

Independent Living, in a suitable house

Profiel 3

Need to (be planned) care, and support on call

Residency care, (home care) or assisted living

Profiel 4

Non-standard care plan and 24 hour surverillance

Care to stay (intramural)

Dementie

Non-standard care plan and 24 hour surverillance

Care to stay (intramural)

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Foto title, discr


Alzheimer’s Landscape 2030

Living with Alzheimer’s 2060

Jack Chen S.C.

Alzheimer’s Landscape 2030

Living with Alzheimer’s 2060

It is March 27, 2060, I am talking to myself. one more day and I will have survived to my 84th birthday. Not much of an achievement really, considering our average life expectancy is now 85. I wake up to the sound of woodpeckers pecking. Just like the ones in the woods behind my childhood house in New Jersey. I always like waking up to that. Where I felt safe and free, without a care in the world. I had the sound programmed it into my morning wake up ritual since I move into this smart house about a year ago. I was diagnosed with Alzheimer’s Disease last year. My son thought it best I move closer to him so we can drop by each other’s place more often. In fact he is living in the same neighborhood community. This smart home is something

Jack Chen S.C.

else. It is actually a living breathing caretaker. It monitors my body temperature, sugar level and heart rate and would adjust the room temperature or open a window for me automatically. I sometime joked that it probably will advise me when I should use the toilet. The voice of the smart home has a familiar ring to it. Often reminds me of my mother’s voice. When I am running out of milk or coffee, it would just order it for me. Though recently I wanted to shop like I was used to in my younger day, so I made the request that I would do the physical shopping which was in the same building (they just have a list for me at the store to remind me what I was missing). The home is connected to the city. If I needed medical assistance it would make the call for me. In this neighborhood 24 hour medical service is accessible. I feel better living in my own home and knowing that I can get the help I need when I need it. In the old days they would have put me in elderly institutions, but those were not permitted after the 2020. Anyway, why do I have cravings

Diary Entry: What is the future like?

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Living with Alzheimer’s 2060

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Alzheimer’s Landscape 2030

Living with Alzheimer’s 2060

Jack Chen S.C.

Alzheimer’s Landscape 2030

Living with Alzheimer’s 2060

Jack Chen S.C.

virtual pets they naturally extended it to robots. Actually in retrospect, we have the porn industry to thank for it. The industry were making more sophisticated life size dolls we called them sexbots then. They were so life like, it became a craze. It became such a hot item after the Bono sex tapes leaked out. He was quite unabashed. Saying it was the best sex he ever had. Through such spectacles and many more like it that streamed thru the internet, the product became a big craze. I guess through the years the society’s idea of what constituted normal sex had changed. Living with androids became normal. Later as better artificial intelligence developed android were introduced to the work force as maids to clean the house, stock your grocery, or play chess with you. The AI was so sophisticated that they really became life long companions for some people. We needed more people in the work force and they seem to be one of the answers. The other was cloning. The verdict is still not out on that one. Once in

for bubble tea? Perhaps Pada can get some for me. Oh yeah, PADA, stands for personal assistant domestic android. Yes, I have an android. It came with the house. Sometimes I confuse her for my late wife Anna. Pada’s voice sounds like Anna. She is so in sync with me it’s scary, its like she knows what I am thinking. It is like we are wired the same way. Sometimes she finishes my sentences for me. I read some statistics in the papers last week that there are 1.5 androids per household. I guess it was inevitable. Ever since the global epidemic became real. In 2050 one in 85 person worldwide had Alzheimer’s disease. Asia had it the worst with 62.85 million accounting for 59 percent of all cases. I guess that was how the androids became popular. The Japanese were the first to embrace them. First with virtual pets like the (Tamagotchi) in 2010. Then it extended to robotic dogs. When they figured out how and why humans can form emotional attachments to animals and these 162

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Alzheimer’s Landscape 2030

Living with Alzheimer’s 2060

Jack Chen S.C.

a while you get some news about someone falling in love with their sexbot and wanted to divorce their spouse. Crazy right? I can see some very ethical problems surfacing. In fact more and more films about the androids having soul are turning up. It seems a hot topic lately. Just yesterday I read about some AI scientist lobbying for robot-human marriage to be recognized. I do not know what to make out of that. I hear a knock on the door and it is Anna with a glass of bubble tea in hand. I asked, is it the red or blue pill today ...

Alzheimer’s Landscape 2030

Intelligent Environment/ Smart homes can be as sentient as AI robots

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Living with Alzheimer’s 2060

Jack Chen S.C.


Alzheimer’s Landscape 2030

Field Research: Internship Experience

Jack Chen S.C.

Alzheimer’s Landscape 2030

Field Research: Internship Experience

Jack Chen S.C.

Field Research It was April 13, 2011 that I started my volunteering in a nursing home at Schalkweide (Haarlem). In many respect it was a very unexpected and gratifying experience. I knew I would experience something emotionally heavy and perhaps even out of mind myself. From the stories I had already hear from my colleagues I knew it was no picnic. Before I went ahead with the actual volunteering I had prepared myself with some research about the disease itself. Understanding how the brain’s nerve cell die off (without possibility of regeneration) and how it affects certain body functions in respect to the region of the brain. I familiar myself about the different phases the Alzheimer’s patients go through. The “Threaten Me” and the “Lost me” are the first two phases respectively that the patients I will be dealing with for the first few weeks are categorized in. I had developed a certain empathy and imagination of how the mind can begin to unravel due to memory

Internship experience, location: Schalkweide, Stichting Sint Jacob

166

loss and dis-orientation. Reading the book Out of Mind by Bernlef was a great gateway into the internal process of a dementia mind. It painted a more insightful picture for me on how the sensation of displaced memory can create such fear and confusion of losing control over oneself. These subtle transformations can translate into overwhelming stress and horror for both the patient and the caretakers. Still with all these theories ingested, I still can’t help but feel anxious and insecure about how I would interact with them, especially not in my native english but in Dutch. As it turns out, I was both surprised at my performance and happy to realize that I had actually contributed positively to their wellbeing during my time there. From the beginning I was introduced as a researcher that came to see how the institution functioned. I could immediately see their different personalities from their individual reactions. Some were curious and open, others did not approve; A stranger in 167


Alzheimer’s Landscape 2030

Field Research: Internship Experience

Jack Chen S.C.

Alzheimer’s Landscape 2030

Field Research: Internship Experience

Jack Chen S.C.

began to point out each resident’s status (the severity of dementia) and some personal anecdotes that reveal absurd scenarios she was faced with. At first my internal alarm was ringing in reaction to the fact that Maria was speaking very loudly about them and having a bit of a laugh about the types of scenario she has encountered. I can’t help but feel that she was a bit insensitive. I quickly questioned her about what I perceived as insensitivity. She put my nerves at ease by explaining the nature of her work. The openness and connection she has with all the residents and colleagues. She made it clear that respect and dignity was the most important aspect of well-being they can offer the residents, and that in this line of work, you have to be able to laugh and cry at yourself and with each other. As to the high volume she quickly explained that most of them were quite deaf. As it would be even more disrespectful to speak in a level that they could not compre-

their midst. Especially one that spoke english. I was fortunate enough to get paired up with Maria an english speaking caretaker. She had worked in England and South Africa for more than 35 years and was thrilled to be able to speak english again. As we talked in english I noticed an old couple in their 80’s complaining about the fact that we spoke english. They “are the most difficult people in the group”, I am told by Maria,“This couple is so picky about everything, nothing can make them happy. If people were talking, they complained it was too noisy. If no one talked, it was too silent. They even complained about the bread being sliced too thick and demanded to speak to the baker”. When I ask Maria how she responded to the lady in question she simple said, “we try to accommodate them ask much as we can”. As I started picking Maria’s brain as to what her personal philosophy was in terms of the approach to care she 168

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Alzheimer’s Landscape 2030

Field Research: Internship Experience

Jack Chen S.C.

Alzheimer’s Landscape 2030

Field Research: Internship Experience

Jack Chen S.C.

realities of the patients are indeed what they need. The non-confrontational way of dealing with patients can facilitate a greater, positive well-being than the other way. However this also means that the psychological load on the caretakers are extremely heavy. To be always aware of the psychological state of the residents and to keep a pleasant facade regardless of how hostile or unreasonable they are is a daunting task. As I engage myself with the residents, I soon had my first hand experience. It was lunch time and for some special occasion they decides to make pancakes instead of the usual sandwiches. Immediately, Mrs. A approached the one making the pancakes. She expresses that she preferred her usual bread and cheese and inquired if it was possible to still have it. After being reassured of it, she came back two more times confirming the same conversation. I can see that she is indeed genuinely stresses about the change in

hend. It would create more stress for them to not understand what was being said regardless of the content. As she continued her stories I found the depth of her empathy amazing. In every situation, the caretakers take the patient’s requests very seriously and have adopted a non-confrontation philosophy. Each of the patients are in fact living in their own world. What the caretakers attempt to do was to get into their world and respond accordingly instead of trying to provoke the patient’s out of their own realities to our world. One favorite example was a lady that had packed her bags in the morning and said to her, “Thank you, I had a lovely vacation stay here. I will be leaving for my home now.” Instead of stopping her, Maria would walk her out and guide her around the entire building while chatting and back to her room again. When she approached her own room door, she recognized it immediately and said, “Oh, so glad to be home again”. This type of engagement and patience into the 170

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Alzheimer’s Landscape 2030

Field Research: Internship Experience

Jack Chen S.C.

Alzheimer’s Landscape 2030

Field Research: Internship Experience

Jack Chen S.C.

similar questions that would lead into her loop about her husband and switzerland. It was then I noticed Mrs. C looking at me laughing. She remarked with a smile, “yeah she is a rich bitch”. “ We all know her stories, but since you are new, you get to hear all about it.” It was at this moment that both Mr. X and Mrs. C laughed out loud. I also had to laugh. I did not know how clear in the mind each of them were. It did not matter. They were each enjoying the moment. In actuality Mrs. B only had one daughter living in Switzerland. The other two lives nearby. Not knowing what to do to get Mrs. B out of her loop I try to change the subject by asked Mrs. C where she was from. She quickly mentioned she was from Indonesia and Filipino descent. We had a what appears to be some normal conversations but at some point something triggered her. She had memories about being a teacher in a catholic missionary school. She began her own loop about a school

menu and needed constant assurance that all will be alright. While I sat down to join a table of two Indonesian ladies and Dutch gentleman all in their 80’s I started a conversation with Mrs. B closest to me. We conversed in dutch. She asked me if I had worked here long. She appeared to be quite clear in her mind. I replied that it was my first day here. She then asked if I lived close by and how long it took me to come by bus or car. I responded accordingly. 30 seconds gone by and she asked me the same questions again and then slowly talked about all three daughters f her’s living in Switzerland and that her husband had bought all the houses for everyone and was a big shot business man there. She stated that this house that she is in was also bought by her man. I attempted to stay with her to see where she goes from there and realizes very quickly this will last quite a long time. I attempted to distract her and change the subject, but within a minute she asked me 172

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Alzheimer’s Landscape 2030

Field Research: Internship Experience

Jack Chen S.C.

Alzheimer’s Landscape 2030

Field Research: Internship Experience

Jack Chen S.C.

Read the papers in the dining room or go back to his room. I started to speak with him about how he deals with the looping. He relents and said, “Yeah, it is heavy. That is why I go to my room. I am happy to have an escape. I watch my sports on TV to get some relief.” In the end I was saved by the pancake that was presented to all of us. Later on I continued to speak with Mr. X. He slowly warmed up to me. Happy to be able to converse with some one else other than the ladies around. We talked about my research and about amsterdam and sports. Though he was the clearest resident in that group I could still feel his difficulty with discussing more abstract topics or getting more specific details. At the end of the day, this gentleman asked me if I was coming back tomorrow. I had to disappoint him, but told him that I will definitely return. He graciously thanked me for my company and conversations and I could see he seems to be smiling a bit more. With his walker at hand he asked me

boy who was protestant and refused to pray the catholic way because his father forbid it. She was forced to speak with the father and force him to take the child home. I could see that she was reliving the moment again and repeated her stories again. I was beside myself. I now had two ladies looping next to me and I was not sure what to say. It can be better explained as the playing of a record player. Sometimes they get out of their own groove and you can witness either a skip in their brain process and they are stuck in a loop for a very long time. You try to guide them out of it in a very nonconfrontational way so as to leave no mark or pain that they can experience. I tried to wait it out to see if the looping would stop, but ten minutes go by and I did not see much light at the end of that tunnel. So I turned to the gentleman to my right. Mr. X was the least severe case, from what I was told. He seems to be a highly educated man that keep to himself and do only two things; 174

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Field Research: Internship Experience

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shape the environment to enforce good behavior and avoid the bad ones. Behavior that will allow for better care. For example, what the proper way of approaching a patient is. Not from the back but from the front. It is very difficult to generalize and predict how certain space can affect some but not others. In their daily routines, the caretakers must observe what are the possible triggers that will take them off course or agitate their state of being. It could be as small as not getting their morning coffee in the proper cup or being rushed during their morning dressing ritual. These small things can fester inside them and cause a certain stress and agitation that can compound through the day. Caretakers must invest a great deal of energy into not only creating a pleasant atmosphere but to understand the triggers. This brings me to an even more crucial point I discovered about the environment of this particular institution. The users considered in the spatial design were the patients not the caretakers. Which I find a

to stay a bit longer so he can fetch a photograph to show me. It was an image of his younger self in his 60’s standing next to racing bike and a city sign that had the same name as his on it. He was quite proud of it. We bid our fair well and as I walked out I was so pleasantly surprised that I had manage to contribute so positively to his well-being and all in the dutch language. It did not matter that my dutch was poor. What mattered was that I gave them attention. Amazing that such little things made such a huge impact. It even inflated my ego. In a way I felt I got more out of it than they did. Through the conversations I had with Maria and all the caretakers, I attempted to abstract some form of information that would allow me to translate into spatial qualities. It was not as easy as I had hoped. Designing for Alzheimer’s patients is near impossible due to the fact that no one case is alike. I come to the conclusion that it is better to design for behavior. We should 176

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Field Research: Internship Experience

Jack Chen S.C.

Alzheimer’s Landscape 2030

Field Research: Internship Experience

Jack Chen S.C.

things are an issue of economics. However, if you take quality of care as the ultimate goal, you can not neglect the needs of the caretakers.

pity considering that the quality of care is directly related to the well-being of the caretakers and the resident’s family. While the considerations of the caretakers work were quantified by the manual tasks they perform for the residents, the psychological component necessary for the qualitative care were never considered. The caretakers had no personal space to balance themselves or speak in a normalized environment with each other within the facility, given their long working hours. After a long shift they themselves are psychologically taxed and perhaps grumpy. This tends to stress the bonds between the caretakers. On a spatial level, many caretakers I had interviewed often complain about the physical load of their job. The lack of hoists or transfer benched in the bedroom or bathrooms leave the caretakers having to lift the patients themselves. Many caretakers agree that the designers do not necessarily take into account how the caretakers function ergonomically. Of course I see that some of these 178

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Bathing Rituals

Jack Chen S.C.

Alzheimer’s Landscape 2030

From Pampering to Well-Being: Our Search for Bathing Rituals “If there is magic on this planet, it is contained in water.” 1 The human body is made of 70% water. The human brain is 80% water, and about roughly 90% of our blood is made out of water. It is of no wonder that throughout human history water has always remained an intrinsic part of well-being and spiritual beliefs. Its spiritual and healing properties are seen in rites and rituals connected to the theme of ablution. Ablution can be exercise in many arenas. In medical practice water was seen as a facilitator of purification and rebirth. In the process of discussing about the process of confinement and the development of the idea of curing or treating madness, Foucault in Madness and Civilization runs through the initial cures such as purification and immersion that relate water to the body, in its affect on both body and soul. He writes: “Water, the simple and primitive

Jack Chen S.C.

liquid, belongs to all that is purest in nature; all the dubious modifications man has been able to add to nature’s essential kindness cannot change the beneficence of water; when civilization, life in society, the imaginary desires aroused by novel reading and theatre going provoke nervous ailments, the return to water’s limpidity assumes the meaning of a ritual of purification; in that transparent coolness one is reborn to one’s first innocence.”

1. Loren Eiseley, The Immense Journey, 1957, (p158)

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Bathing Rituals

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Alzheimer’s Landscape 2030

2.(Madness Civilization, p163)

Water is seen here as both symbolic for the soul and as an universal physiological regulator. An element that brings our bodies to equilibrium due to our own inherent body composition. While Foucault sites a series of contrived experiments performed up to the 19th century, it is important to note that madness was not seen as an illness or something that could be treated. But Foucault suggests that even when the idea of a cure developed, it was not a medical development. Madness was still seen in terms of morality and the links between body and soul that come from a theory of the passions. By the nineteenth century, a difference arose in the approach of techniques which focused on the moral improvements of the madman. In a sense the fight became more psychologically focused. In turn the valuation of water changed as well. Water with all its powers, “wane in the very excess of its qualitative versatility: cold, it can heat; hot it can cool”, writes Foucault, “In medical 182

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thought, it forms a therapeutic theme which can be used and manipulated unconditionally, and whose effects can be understood in the most diverse physiologies and pathologies”2. In fact, it is perhaps this polyvalence with which endless disputes were generated that finally neutralized water. Though water was still used in medical practice at that time, its qualitative overtones had disappeared. Showers, which were previously used less than baths had become the favored technique. Water regains, beyond all the physiological variations of the preceding epoch, its simple function of purification. The only quality attributed to it is violence, an irresistible flow washing away all impurities that form madness; by its own curative power, it reduces the individual to his simplest possible expression, to his merest and purest form of existence, thus affording him a second rebirth.2 This symbolic interpretation of water is often cemented in our collective minds through the stereotyping of


Alzheimer’s Landscape 2030

Bathing Rituals

Jack Chen S.C.

Alzheimer’s Landscape 2030

Jack Chen S.C.

shower rituals of inmates during the process of incarceration in mainstream films. We frequently see similar scenarios of inmates subjected to brutal forces of water to purge the corrupted and the damned out of them before they begin their rehabilitation in institutions. These bathroom facilities carry with them an uncompromising quality of sterility and economy. Contemporary healthcare institutions today often have bathrooms with similar qualities of sterility and economy. These sites bear witness to just how much we had forgotten about the qualitative values of water. While Foucault speaks about the perceptions of water’s value as a possible treatment to madness, he emphasized that the development in treatment was viewed more in terms of morality than to medical developments. Along this path of thinking, western society lost its connection to water as intrinsic part of well-being and spiritual beliefs. Through new defined virtues of economy and efficiency in modern society

1. Angelina Jolie, Scene from the film “Changeling” (2008)

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Bathing Rituals

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Alzheimer’s Landscape 2030

Bathing Rituals

Jack Chen S.C.

and cultural attitudes. Attitude to sexuality and body, health and hygiene, physical and psychological wellbeing all influence how we position bathing in the domestic arena. In 1960s and 1970s one of most influential manuals for bathroom design in Europe and the US was ‘The Bathroom’ (1966) by Alexander Kira. In essence Kira reduced bathing to a series of ergonomic studies showing how ablutions could be carried out with maximum efficiency in the minimum space. It was a reflection of how so little has changed since the 19th century’s attempts to compress washing into a science of hygiene, to free from disease and naked confrontation. Kira quotes a report from the German press that claimed “More than half the population bathe only once a week and brush their teeth only rarely, and approximately 10% bathe once every four weeks.” In the span of 10 years after Kira’s book was published, a new movement was underway. Lead by Leonard Koren, the founder of ‘Wet: the magazine of gourmet

our changing notions of reverence to water can be traced by following the evolution of the bathroom. The idea of a room in a home dedicated to personal hygiene and grooming is to some extent, a recent one. For the most part, houses built much before the turn of the century did not have bathrooms. In the span of about 100 years, the modern bathroom has evolved from a novelty into an almost-universal residential fixture. Within that time, it took little more than half a century for the bathroom to transform itself into a major player of domestic life. Re-inventing itself from a tiny sanitized cell of utilitarian purpose to embrace the physical, psychological and pleasurable dimensions that go beyond basic hygiene and grooming. Like most changes in the home, this has been a gradual process. Despite the fact that bathrooms are one of the most technically demanding rooms in the home, the drives for changes isn’t in the technological development but in the changes of social 186

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Bathing Rituals

Jack Chen S.C.

Alzheimer’s Landscape 2030

Bathing Rituals

Jack Chen S.C.

fashion it has percolated through to mainstream thinking. More recently interest in the nonwestern approaches to healing and wellbeing have profoundly influenced how we think about bathing and its increasing association with relaxation and regeneration. In the US expenditure on spas are on the rise, while surveys highlight shifting perceptions of the spa from ‘pampering’ or ‘indulgent’ to ‘important to wellbeing and staying healthy’. One factor can be contributed to the technological democratization of the spa facilities. The affordability of these services means that spas are no longer seen as a luxurious decadent experience, but much more integrated with daily routines and ritualistic maintenance of our body and soul. The urge to reconnect with the physical and sensual is partly a side effect of our industrialized and virtual existence and the disquieting sense of spinning out of synch with natural rhythms. In “Undesigning the Bath”, Koren defines the great bath as

bathing’, launched in 1976. It was an idiosyncratic magazine from California, devoted to the free thinking counter culture that bubbled up around the hot tub. It was an initial attempt in Koren’s crusade to arouse the possibilities of more imaginary and sensually charged bathing experiences that are shaping how we think today. Adding to the changing attitudes towards bathrooms are the growing interest in fitness and the gym in the 1980s. Together with the burgeoning market for interiors magazines, this helped make the bathroom a stage for the body beautiful. Designers like Andrée Putman and Philippe Starck gave the bathroom a new gloss, helping shift ideas of luxury away from traditional style to a modern visual language. Hotels played a significant role as well. When ‘boutique hotels’ mushroomed out, the bathrooms were photographed as much as the bar. Although bathroom as designer icon may seem remote from most daily washing experiences, like the influence of couture on high street 188

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Bathing Rituals

Jack Chen S.C.

Alzheimer’s Landscape 2030

Bathing Rituals

Jack Chen S.C.

remains of Roman bathing culture around the Mediterranean. Although it originated as a place of ritual purification attached to the mosque, this world of shadows and light is also a sensual paradise, where the majestic womb like architecture and use of marble or stone create the setting for a bathing experience that is hard to match in the contemporary world. This might seem a long way from the domestic sphere but it is exactly such places that are enriching current thinking about how we incorporate water in daily life. One of the most obvious changes in the home is how bathing is prioritized in terms of space allocation. Following the shift from a cellular room structure towards a more fluid living space, the bathroom is breaking down its component parts and reassembling in different configurations. Another obvious change is how bathing is connected to other activities. The common merger is bathing and sleeping, with bathing recast as a relaxation ritual as much about intimacy and play as body care, and often

“a place to escape from the depredations of the technological world, not revel in them.” These sentiments and inclinations are coming home to our domestic setting not just in an appetite for essences, but in a way that metamorphosed the role of the bathroom in contemporary western society into the domestic center for well-being. In 20 years time will our concept of the bathroom change even more? Will it occupy an even greater role in our domestic haven? Where should we look to to inform us of our projections? If we look into Japan’s refined bathing culture that has managed to endure for centuries, we can see that theirs is built around an intense relation to water and its enjoyment is characterized by an authentic simplicity designed to induce mental and spiritual repose and support a series of carefully honed rituals that make cleansing a separate activity from relaxing in the bath. Another cultural model inspiring contemporary bathing rituals is the hamam, the Islamic bathhouse that grew out of the 190

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Bathing Rituals

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Alzheimer’s Landscape 2030

sociable rather than strictly private. Such arrangements acknowledge that rituals are different at the start and end of the day, with the shower more likely to be a morning routine and the bath take place in the

Bathing Rituals

Jack Chen S.C.

beliefs. New typologies will rise out of this movement. Not just for our domestic settings but for institutions as well. Given the medical merits of hydrotherapy and the tactile and sensual pleasures of the spa, one can easily see the integration of these elements into not only our domestic bathrooms but healthcare institutions. As we see the notions of wellbeing becoming a consistent part of our personal maintenance of our body and soul; As we associate the bathroom more and more as the space of escape from the world of technology and speed; As our space of equilibrium; As our space to connect to water. We will need to define our own bathing rituals that would allow us to tap into out sense of well-being.

evening. Again Hotels are leading the way. For an exhibition on “Grand Hotels’ Toyo Ito designed an ideal hotel room for New York City where more or less the entire floor space is occupied by two large circular pens, one for sleeping and one for bathing and both equally playful and eroticized. When we see these developments happening it is clear that western society moving towards finding its relationship with water again. As an intrinsic part of well-being and spiritual 192

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Focus

Jack Chen S.C.

Alzheimer’s Landscape 2030

Focus

Jack Chen S.C.

Focus +

I speculated 4 common reasons for the lack of bathing practice in Alzheimer’s instituions.

+

1. Most nursing homes give shower not baths

In many existing Alzheimer’s institutions residents often take no more than one shower a week. The frequency in itself is troubling. However, what is more peculiar was the lack of any bathing practice. There are many benefits to bathing. It Increase blood circulation, and assist in in relaxing tense muscles. It aids in quick recovery from fatigue & injury. Especially for elderly, where bio rhythms often changes, soaking in hot water for 15 min. (approx. 90 min. before going to bed) is an effective way to naturally encourage and induce the body to sleep. Bathing in warm water will relieve stress due to the release of endorphins (which relieves tension and create a natural high). Bathing habits can greatly contribute to long term strategies for well-being.

(cost too much time and money)

2. The feel of the bathrooms are too clinical in nature 3. Often institutional bathrooms do not deliver

a pleasurable experience

4. Often the design does not take the caretaker’s

ergonomics into account.

Taking account of future projections with the lack of labor force and money in our future healthcare system, the focus for this design will be to consider a bathroom facility in a group home that would engage the residents in a pleasurable bathing experiece, enough to incite a daily bathing ritual. The facility will take on merging qualities of a car wash system, sneuzzle space and relaxed spa. Automation assistance can be of great use to time management and privacy issues. Bathing can be seen as not only a cleansing ritutal but a social activity.

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Context/Concept

Jack Chen S.C.

Alzheimer’s Landscape 2030

Context/Concept

Jack Chen S.C.

Context / Concept The Concept was to take way the boundaries of the living room as the sole social space of the group quarter. By taking away the individually shared bathrooms and replace them with one larger more luxurious facility, the extra space gained can be put to use to transform the corridors to more habitable spaces where tactile architecture is applied to trigger sensoric experiences. By configuring the spa/ bathroom facility in such a way that would also rendener the corridor to feel like a interior garden, opportunities arise in thee semi-private pockets to experience tactile environments such as grass, wood, stone, wind, smell of flowers and sound of birds.

Searching for a sound plan of an existing care institute, the Zorgcentrum Beatrix te Culumborg was selected as a test case due to its simple circulation and organization. A group-house quarter for 8 residence. Living room with balcony facing North capping an u shaped corridor where each resident bedrooma are flanking east and west. 4 large bathrooms, two on each corridor shared by two residence per bathroom. In the core of the u shaped circulation space resides all utilitarian faciliites.

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Floorplan

Exisiting Plan

Jack Chen S.C.

Floorplan Beatrix te Culumborg (one housing group 8 units

Alzheimer’s Landscape 2030

Zoning diagram Circulation Sanitair Semi private note Interior Green Living room

main corridor to other group quarters

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Jack Chen S.C.


Alzheimer’s Landscape 2030

Designs: Plans

Jack Chen S.C.

Design: Plans

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Jack Chen S.C.

Design: Spa

New Plan

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1. Fountain 2. Benches 3. Tactile seating areas 4. Bath Area 5. Changing Area 6. Automation Machine 7. Rain Shower 8. Air Dry Chamber 9. Aroma Therapy Chamber 10. Storage 11. Toilet 12. Living Room 13. Kitchen 14. Bedrooms

1. Bamboo forest pattern laminated between glas 2. Vertical garden wall in corridor

Aroma therapy chamber Automated washing & massage machine Rain shower & air dry

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Jacuzzi

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Changing area


Alzheimer’s Landscape 2030

Designs: Spa

Jack Chen S.C.

Alzheimer’s Landscape 2030

Designs: Spa

Jack Chen S.C.

Design Spa: Wash Automation 2

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of The consideration of automated as- Sketches automation sisted cleaning is bound to time management process. for future prognostics of under-staffed personel and also to prolong the residence’s independence. Studies have shown that one of the factors for well-being of elderly to sucessfully age in place is the control they have over their own environment. Not having the ability to clean one’s body independently is a massive blow for anyone’s dignity. Once you cross the bridge, many things change. With the help of assisted / automated machines, this indiginty

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1. Rollers for massage and scrubbing 2. Wheel chair frame become support system 3. Rollers for hand massage and scrubbing

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is at least prolonged and the well-being of the user improved. The automation machine offers scrub a wide to clean/ be customized for grouprange of options massage sensory every user. Water pressure and temperature bath cansalt befloat customized. The machine scrubs, massages,and rinse the entire body. A specialized individual wheel chairindividual is outfitted for soaking tub soaking tub this machine. As the user is wheeled in, the wheel chair wheels are rolled out and the scrub clean/ massage chair frame iteself becomes the support individual individual 80% automated soaking tub soaking tub users to sit through system that allow the 20% assisted 3 positions. From seating to laying horizontally. While the body is slowly washing, the head region is sensorically engaged via slow changing led lights, soft music of the user’s preference, and aromatherapy.


Alzheimer’s Landscape 2030

Designs: Spa

Jack Chen S.C.

Alzheimer’s 2030

Landscape

Designs: Spa

Jack Chen S.C.

Design Spa: Bathing Soaking in warm water has great benefit for the elderly. While washing and cleaning can be viewed as a very personal act, bathing can be a very social one. One in which both care givers and residence can enjoy. It can be a new way for both sides to relate to one another. The bath system designed is similar to the automation system in its use of wheel chairs as the means to move the resident into the tub. You simply roll into the tub. The wheels come off and and back door is closed. Water starts very slowly to rise. Four phases of soaking can be experience on an individual base. These tubs circle the main larger group tub for 4 people. If the tub is used individually, little can go wrong as the design holds the user well in place and shifts positions of the body in relation to the water level. In terms for care givers, this feature will allow them to save time in terms of less surveillence.

The Tub: 4 sitting positions The Tub: 4 sitting positions

Cleaning

Cleaning position position: Self Self or helped or helped

Soaking

Soaking position position + + musik

music

whirlpool

Whirlpool position position + + musik Music & light& light

Air spa position Air spa + position Music & light & + musik fragrance & light & fragrance

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Section

Jack Chen S.C.

Alzheimer’s Landscape 2030

Section 1. Perspectives: View from living room doorway 2. Perspectives: Tactile pocket: grass bench & garden wall

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Jack Chen S.C.


Alzheimer’s Landscape 2030

Renderings

Jack Chen S.C.

3. Perspectives: Tactile pocket: Sand, Wind, sound of waves, sea salt smell

Alzheimer’s Landscape 2030

5. Perspectives: Spa Interior: Bathing Area 6. Perspectives: Spa Interior: Changing area

4. Perspectives: Indoor Garden Corner: Sound of birds and water, artificial sunlight above

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Jack Chen S.C.


Tactile Memory

Déjà Senti

Dennis Schuivens

Tactile Memory

Tactile Memory Déjà Senti

“We have all some experience of a feeling, that comes over us occasionally, of what we are saying and doing having been said and done before, in a remote time – of our having been surrounded, dim ages ago, by the same faces, objects, and circumstances – of our knowing perfectly what will be next, as if we suddenly remember it!”1

Dennis Schuivens

For this healthcare project an extensive collective research was done on Alzheimer’s and its implications for future generations. Numerous lectures and field trips were organised, in addition to a haptic axperiment and a 40-hour internship, all to develop a broad view on the project. The theoretical research included readings of Foucault, Merlau-Ponty, Hall, Bernlef, Benjamin, among others. What became clear, is the vulnerability of dementia patients. Alzheimer’s effects so much more than just distortion of memory. It is the disintegration of all structures, patterns that make up our lives. A point where all components become entangled, diffusing the overall composition. To develop an appropriate narrative on future living conditions of Alzheimer’s patients, is to take this vulnerability into account, while creating a safe environment that can still enrich every day experience.

1. Charles Dickens

2. / 3. Todd McLellan, ‘Disassembled’

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Tactile Memory

Location

Dennis Schuivens

Tactile Memory

Location

Dennis Schuivens

Location For the location, a temporary caretakers facilty was choosen, located near the outskirt of Haarlem. With approxomately 96 residents, divided over 12 communal groups, it offers intensive care for dementia patients in the region of Zuid-Kennemerland. National Park Zuid-Kennemerland offers a variety of distinct material and experiences. It was established in 1995 and currently measures about 40 square kilometers. Most of the area is used as a watershed for the city of Haarlem. The landscape consists of a palette of stone-, sand-, wood- and grasslands. A large variety of plants and animals are to be found in this area. During the research phase it became clear how this area is connected to the memory of local dementia residents. The unique atmosphere and materials of the national park is anchored in the being of those who have strolled here in their leisure time. For many residents, a familiair scenery, forgotten over time.

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1. National Park ZuidKennemerland 2. Location

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Tactile Memory

Location

Dennis Schuivens

Tactile Memory

Location

Corridor Living Bedroom Facilities Office 1

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4. Flower field

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First Floor

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Tactile Memory

Problem

Dennis Schuivens

Problem

Tactile Memory

Dennis Schuivens

Problem Although a lot of research has been done by the care facility to develop the current plans, its compartimentalization results in little overview. For residents suffering from dementia, this can lead to difficulty orientating through space. The monotome use of material in the current situation, further disconnects patients from their natural surrounding. The only access to the outdoor space is from the collective entry area. This disables residents to move through the complex by themselves, effecting their sense of autonomy. Furthermore, the location offers very little possibily for residents to position themselves outside the group context. It is only in their personal room, where they can retreat from the collective sphere.

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Tactile Memory

Opacity study / Contextual experience

Dennis Schuivens

Tactile Memory

Concept

Dennis Schuivens

Concept 1.–4. Opacity study pattern 5. Contextual experience

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The narrative on this assignment is to bring back the natural surrounding as an experience for dementia patients in order to stimulate physical interaction with the build environment. By imposing the plan of National Park Zuid-Kennemerland as an overlay on the floorplan of the facility, a new compartimentalization is created that is linked to specific material quality. In addition, the corridorspace is opened up - creating new routes and interaction between the build environments and its residents. A continious handrail guides patients along the total complex, connecting individual spaces. Different levels of opacity are used as a filter in collective space, securing the relative autonomy of the individual.

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Tactile Memory

Dennis Schuivens

Design

Tactile Memory

Dennis Schuivens

Design The healthcare proposal consists of a modular intervention that reconnects the interior to its natural context. It stimulates physical interaction with the built environment and lets patients experience material that is anchored in their memory. A integrated handrail connects the different area’s, helping patients to orientate and move through space. By positioning the intervention near the courtyard, new outdoor spaces are created that can be accessed from the opened corridor, even from higher floors up. The analogue to National Park is translated in use of different spheres, all characteristic for the natural landscape woodlands, grasslands, the dunescape etc. positioned accordingly their placement in the National Park.

1 1. Corridor view intervention 2. Plan + Section principle

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Section Intervention

Dennis Schuivens

Tactile Memory

500 words on future living with Alheimers’

Dennis Schuivens

Embracement To develop a narrative on the future living conditions for a phenomenon which is - at the moment - still regarded as an incurable, terminal disease, is to speculate on the future of medical progress and care itself. What is clear though, is that throughout the developed world, elderly form a growing part of the demographic structure, caused by extended aging and declining birth rates. All indicators point to a progressive increase in the prevalence of dementia and, considering the extensive care that is required during the last phases, the projections for the total ‘cost to society’ will be impossible to sustain by future generations (World Alzheimer’s Report 2010). At the beginning at the 21st century, we still measure phenomena in terms of economic consequence, as a testimony to our obsession with capital. It is illustrative for the era of production delirium. We seem to have been unable to view our elderly as an valuable, integral part of society. Since they no longer contribute to productivity, we tend

1. Longtitude section intervention 2. Rendered section of intervention 1

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Future Living with Alzheimer’s

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Tactile Memory

to overlook the human capital. By doing so, we do little right to both their dignity and the lessons we could learn from them. The mere vulnerability could humble us. In 2030, hopefully we have freed ourselves from this traditional model. We can progress towards a social structure that values human capital over economic capital. Decentralized organization, that is selfsustainable and reconnects us to the experience of consequence. this is a plead to embrace our elderly in the heart of community, reestablishing this sense of belonging. We will no longer build enclosed institutions, fragmented and detached from city life. Instead we create environments that stimulate human interaction, a place where generations meet. Formal medical care will be given by professionals, while citizens will volunteer 1 day a week, helping with practical tasks and giving personal attention. Through civic duty we can activate human capital.

Future Living with Alzheimer’s

Dennis Schuivens

Residents will not be labelled with the stigma of patient. The focus will lay on what they can still do, more than on their limitations. The process of physical deterioration is natural and requires an environment that is not primarily aimed at extending life itself, but in improving the quality of it. Spaces that soothe and relieve suffering, beyond the poignant sense of alienation. Let us refrain from creating artificial substitutes, no copy of reality without gradient. But to create space where we can have authentic experiences, that speak to all our senses. To be ‘out of mind’, is not solely the loss of mental structures and physical abilities. I believe there is bliss in a blank sheet of paper, an opportunity to view the world in a crisp light. We are surrounded by beauty, let us engage with it completely, be it the last thing we do.

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Personal focus

Dennis Schuivens

Tactile Realm

Tactile Memory

1000 words on internship.

Dennis Schuivens

Appreciation

Ashley Montagu’s: ‘[The skin] is the oldest and the most sensitive of our organs, our first medium of communication, and our most efficient protector [...]. Touch is the parent of our eyes, ears, nose, and mouth. It is the sense which became differentiated into the others, a fact that seems to he recognized in the age-old evaluation of touch as ‘the mother of the senses’. I will focus on the tactile experience of space, during end-of-life treatment. I belief it to be the most intimate perception of our physical surrounding. It offers a sense of security that is primal and intuitive. Through materiality and sculptural space we can experience nearness and intimacy. With this knowledge as departure point, I want to create an environment that has spatial quality and engages with its inhabitants and approaches them on the most personal level.

Stichting Sint Jacob comprises eight health centers and nursing homes in the vicinity of Haarlem. It aims for residents to have control over their lives as long as possible. Where this is no longer possible, they offer supervision and support to the client and family. By offering a wide range of housing, care and service arrangements, there is less need to relocate clients, creating continuity in a protected and familiar environment. The staff provides respectful care, in line with values and social beliefs of clients. In addition, there is a cultural program that consist of different activities for clients to be involved in. The facility Schalkweide is located in Schalkwijk, on the outskirt of Haarlem, just across a small shopping centre. It is housed in a renovated 12 story flat, now offering space for 250 residents. There are nine floors with care units, the top three floors being service-flats. On two floors dementia patients are housed, divided into 4 groups. Every group consists of 8-12 patients, that 226

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all have individual rooms and bathrooms, and share a communal living room. The average age is around 90, and the majority of patients are female. During my internship I’ve worked with several groups and different stages of dementia. Initially I noticed an apparent apathy with most residents when sitting together in the communal space. They seemed to be closed of from each other, some were sunken completely. The day just seemed to pass by for them, not aware of the individual moments that make up that day. Some were reacting to what was happening around them, albeit in a passive way. The overall energy was low. But when conversing with residents, simply showing personal interest, almost all opened up, briefly. They were telling about their children, their spouse or parents. I noticed that these stories were mainly about persons instead of places or situations. An elderly man spoke to me about his mother, who would be visiting that

Internship

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day at 4 o’clock. His face was worried and when I asked him about how he felt, he told me that she was in bad health. It turned out he was referring to his wife, who was living at Sint Jacob as well. After half an hour, when having lunch together, he told me the exact same story, as if the initial talk had never happened. It made me realize how dementia impacts everyday life, the simplest things we take for granted. I’ve noticed that most caretakers have an airiness about them, they tend to ‘go with the illusion’ and make jokes with patients and other staff. It is not that they don’t take clients seriously, but they simply refrain from emphasizing the limitations that are caused by the disease. This could be a coping strategy (the physical, mental and emotional burden upon staff is high indeed). Nevertheless, this light atmosphere serves as a positive counterweight and soothes the clients to some extent. Despite the good intentions of the personnel, I found that many residents were 228

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stopped crying and forgot what triggered it. My last visit has made a great impact on me. I spoke to a brittle woman (90), who had lost the volume of her voice due to pneumonia. Since this caused difficulties in communication with others, she was rather isolated from the group. I sat down next to her and she told me about her daughter, a poet now living in Tel Aviv, who had recently written a book and had sent it to her. Because of her declining sight, she could not read it and the copy was still laying in her room, untouched. Together we red the first few poems and it really lifted her energy. Afterwards, I proposed to go for a walk outside - although she could walk the distance to her room with a rollator, going outside was only possible with a wheelchair. I took her to a local park and asked her what other things she had always liked to do once more. She told me she would love to feel the grass between her toes. After helping her to take off her shoes I sat down next to her in the grass, picking

discontent, they felt out of place (rather than aware of being out of mind) “Why am I surrounded by all these old people? I am still a young woman” or “ Next year we’ll go to a different hotel, I don’t like it here”. Obviously their mental state can be considered as a cause for this, but when personal attention is paid, this feeling seems to dissolve somewhat. Is this due to the appreciation we communicate? During another session, I met a woman who had great difficulty with expressing herself. She had lost her teeth, could only mumble, and stayed to herself in a quiet corner of the living room. She stared out of the window for hours, whilst chewing on a stone, but all of a sudden broke down in tears for no apparent reason. The caretakers were busy preparing diner, so I went over to see if she was alright. Considering she lost her ability to speak, there was really nothing to do but to just hold her hand and be there with her. This intimacy was enough though, for she 230

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The Modernity of Delirium through Eyes of Classical Medicine flowers for her to smell, both of us enjoying the sun on our faces. This was such a beautiful moment, she was totally alive. No longer aware what she couldn’t do, but simply enjoying that moment, completely. After returning her to the group, we all had diner together. Just before I left, when I went to say goodbye to her, she ironically told me: “Thank you so much for today, I will never forget this” My experience at Schalkweide Haarlem has, above all, pointed out the importance of personal attention to patients. The challenge will be for architecture to do the same. To restore human dignity, by getting up, close and personal.

1. Guy Debord, Society of the Spectacle

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To place Alzheimer’s disease in 21st century context, let us try to display its parallels with contemporary society. Alzheimer’s is a neurologic disorder that causes detachment of physical and mental bodies. It leads to fluctuations in consciousness, that express themselves in reduced awareness of surroundings and distorted memory, language and perception. Could Alzheimer’s be seen as the afterimage of modern day delirium? Let us explore if a reinterpretation of classical medicine (treating madness) and contemporary philosophy can help to develop an appropriate narrative. All that was once directly lived has become mere representation.’ 1 With this statement, Debord refers to the concept of hyperreality by Baudrillard, as it is ‘the interpretation of signs of the real for the real.’ It has detached experience from what is objectively perceived. The objects


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that surround us are mere images, that in itself are signs, referring to a putative model. The airless atmosphere has asphyxiated the referent, leaving us satellites in aimless orbit around an empty center. We breathe an ether of floating images that no longer bear a relation to any reality whatsoever.2 The notion of simulacra is closely related to this. A simulacrum is not a copy of reality as objective reproduction, but an artifice that merely resemblances appearance, while its intrinsic properties are completely different to that of its model (Deleuze, Plato and Simulacrum). This general detachment of the real is both illustrative for contemporary age - and interior architecture as a discipline, as it is as much part of the system as any other. The production of (interior-)finishes, is as caught up in the same schizophrenic narrative: An attempt to synchronize optimized (...) functional requirements to authentic quality of material. This expresses itself in artificial representation;

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2. Jean Baudrillard, Simulations

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the polyvinyl chloride flooring mimicking natural grain of wood. He sinks into the world of artifice, and of anti-nature, of which his madness is only one of the manifestations. [...] 3 To develop an architectural interface that can operate as mediator and gap the the distance between what is ‘real’ and what is artifice, let us have a closer look to what Foucault is saying. In his work Madness and Civilization, he addresses three strategies commonly used to treat madness during the classical period. 1. Awakening: Since delirium is the dream of waking persons, those who are delirious must be torn from this quasi-sleep, recalled from their waking dream and its images to an authentic awakening, where the dream disappears before the images of perception. Descartes found this absolute awakening in the ‘consciousness of deluded consciousness’. This concept presupposes the ability to overlook its own deluded condition.

3. Foucault, Madness and Civilization, Return to the Immediate

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In case of Alzheimer’s, this idea conflicts with the regressive nature of the dis-ease, the process of disintegration of self, where awareness is reduced to fragmented singularities in the space-time continuum. In the classical period this awakening was inflicted upon, rather than facilitated to the deluded. It enforced itself, within the borders of its own confinement, by a system of threat and punishment as stimulus incentive: For this, the insane person, placed in a special house, will be treated, either by the doctor or by trained assistants, in such a way that he may be always maintained in his duty, in his appearance and habits, by warnings, by remonstrances, and by punishments immediately inflicted.4 To apply this method to Alzheimer’s, would result in an environment that facilitates a power relation, rather than sheltering human capital. The underlaying strategy of repression, does not facilitate their true needs. To impose ‘reality’ upon them, is to deprive them from their last experience of it.

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4. Thomas Willis, Opera omnia 1681

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We continue Foucault, on an alternative classical treatment used in addressing the delirium; 2. Theatrical Representation: To integrate the unreality of the image into perceived truth. the imagination must play its own game, voluntarily propose new images, espouse delirium for delirium’s sake, and cure a crisis which marks the point at which illusion, turned back upon itself, will open to the dazzlement of truth. Here we find ourselves on the other side of the spectrum, where the delusion itself is staged. It is simulacrum in optima forma. Deleuzian thought suggests to acknowledge that simulation is all there has ever been, and that simulation can eventually be a positivity, as it has the potentiality to overcome existing paradigm, by turning the illusion back upon itself. The challenge is to assume this new world of simulation and take it one step farther, to the point of no return, to raise it to a positive simulation of the highest degree 237


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by marshaling all our powers of the false toward shattering the grid of representation once and for all.5 Theatrical representation is a common treatment of Alzheimer’s patients today. Caretakers engage in the delusion of residents, to the extent that it contributes to their sense of wellbeing. We play along with the delirium, and are aware that we do. Modern Alzheimer’s institutions, like Hogeweyk in Weesp, thrive on this same thought. Through classification of relative position on the grid, residents are placed together in one of seven simulacra cocoons. The architectural structure is turned inwards, mimicking a autonomous community with a shopping mall, restaurant, cinema, located around a inner square, that contains a small garden. This environment leaves possibility for different scenarios, although I assume that Walter Benjamin’s bespoke Flaneur would soon be bored here.

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5. Brian Massumi, Realer than Real

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Foucault resumes his story on a third treatment for madness, according to classical thought: 3. The Return to the Immediate: The cure of madness supposes a return to what is immediate, not in relation to desire, but in relation to the imagination - a return that dismisses from man’s life and pleasures everything that is artificial, unreal, imaginary. Works of nature, which addressed all my senses in a language that neither time nor nations can corrupt. This intervention speaks of restoring a more intimate relation with our surrounding through authenticity and proximity. It connects us to what is near, to the abundance of our natural source. It dislocates from existing power structures in place. No more copy of reality without gradient. This is the true field of creation. We (still) live through our expressions, they are manifestation of self, but no longer they refer to an existing model. And thus, we start anew. Once again, we are thrown back to sensorial perception as 239


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communication. Perceiving the world as we move within it, through the hierarchy of senses. Montagu writes: ‘[The skin] is the oldest and the most sensitive of our organs, our first medium of communication, and our most efficient protector [...]. Touch is the parent of our eyes, ears, nose, and mouth. It is the sense which became differentiated into the others, a fact that seems to he recognized in the age-old evaluation of touch as ‘the mother of the senses’.6 To interpret the Return to the Immediate on Alzheimer’s treatment, would point into direction of a therapy currently known as ‘snoezelen’. It consists of a timeframe where there is 1-on-1 personal attention, comfortable posture and sensory stimulation. Currently this stimulus is still often mediated by technology, serving as response trigger. But technology is not an intrinsic part of the concept, it only operates as interface. Whereas snoezelen is a temporary activity, haptic architecture addresses the

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6. Ashley Montagu’s

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same intimate experience through enhanced materiality. It uses the tactile realm as narrative on space. It is here, in this immediacy, where we find our friend: ‘... he establishes a temporary, yet deeply empathetic and intimate relationship with all that he feels.’ 7

7. Walter Benjamin, Arcades project, the Flaneur

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Draw a Home

Introduction Alzheimer’s Worlds

Sabine Ruitenbeek

Draw a Home

Draw a Home After researching Alzheimer’s statistics, reading all prospects and science articles about this issue I felt overwhelmed to start my design assignment. It feels like this information about Alzheimer’s gave me a very distant, alienated image of the world of Alzheimer’s. I call it the world of Alzheimer’s because it felt as if I was not part of this world. But then at the same time I was confronted and dealing with my own personal Alzheimer’s world. The one were my Grandmother Verena is living in a Elderly home for people suffering from Dementia. I wanted to continue with this assignment with a more close, intimate research. Maybe it would make it possible for me and hopefully also others to feel more connected to the (different) worlds of Alzeimer.

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Draw a Home

Science Fiction essay: Alzheimer’s in 50 Years

Sabine Ruitenbeek

Draw a Home

Science Fiction essay: Alzheimer’s in 50 Years

Sabine Ruitenbeek

Back to the Future People under 30 have the believe they will stay young forever and think there immortal. So do I, and when writing some words on the topic Alzheimer’s I tend to denial my own future prospect. I somehow refuse to see myself as the 76 year old wrinkly single lady living in some elderly home or in a small apartment in the Rivierenbuurt in Amsterdam with 2 cats. So I start this forecast from my own position in this present time intact and see were I’ll go from that. As if I step in a Back to the future- time machine and step out in the world in 50 years from now. Still as a just turned 26 years old, naïve, female immortal student. What is it that makes us youngsters feel immortal, unfading, undying? Is it that our body’s are on their peak of fertility and strength? That we have not experienced the error of our legs and lungs, not being able to catch the tram when it’s almost leaving. The blank pages before us waiting to be written in. The many possibility’s of our lives to take so many shapes. Maybe because we have not

yet given birth to life, to our own children. And that we and our parents sometimes still act as if we are their babies that need care. Or maybe we feel immortal because of the hormones in our food these days. And is there a relation to this trend were kids were similar outfits as their parents? Young people are seen and listened to. Beautiful and healthy. We are addicts for the new, the refreshed. Our world seems to be build around this young never dying target group, but will that still be so in 50 years with this society aging coming up to its fullness? In 50 years youngsters will become exotic aliens. Thanks to the obsolescence they will get a special status in our society. A group of people that will always be changing its shape and dynamic’s. Everyone once wore this status and everyone will once lose it. If one does not die on this age at least. Assumed that we not yet discovered a forever-young pill that will stop the aging of our precious cells. The young people move about the city streets in small groups, never 244

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Science Fiction essay: Alzheimer’s in 50 Years

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clear minds for some covering and revealing while trying new outfits at H&M. Then one young girl steps out of the group and heads home with a bag full of new possible identities. When coming home to her family apartment she discovers her parents and aunt in their chairs around the kitchen table, listening to some old-fashioned music they welcome her. She starts to show her new outfits when the aunt starts begging her to let her try a purple sweater, moving watchfully away from her chair to the bag, looking at the soft end colourful sweater with sparkling eyes. The girl helps her putting the sweater on while she reminds her aunt it is only for now, for borrowing, that this sweater is hers. The aunt will forget this message and will be happy and believe she looks just like the girl standing in front of her. She truly believes that she is the same age as the girl and looks at the old couple looking at her. Age melts away in a soft purple sweater. Then the kitchen computer beeps. Reminding them its dinner time. Four meals arriving

alone without their age peers. Collectively they are strong and powerful against this immense senior crowd. Bushy and fertile they move the air in spaces with their light footed swinging way of walking. The old and crazy look at these striking creatures with envy and wonder. The youngsters gaze goes right trough the old crowd that blocks there view. The youngsters having only eye for their own generation and the reflection of their self in the shopping widow, not bearing in mind that the window displays products for the elderly and fragile. In the shopping street only a small division of the H&M shops will offer to the young target group. The young crowd is in one of these special stores to spend some time with each other’s firm, tight bodies and 246

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from a robot placed in the kitchen wall, one plate with the food blended for the aunt. The rest of the family unit still has their teeth in their mouth. On the other side of the street inside an elderly complex dinner is served as well, here aged people live in big living rooms who don’t have money for home care, Care TV and kitchen and bathing robots. Nor children that can share their home with them and their siblings. These people live in another dimension, shifting trough different times and collective memories. They are cared for collectively and carefully by CareBear robots from the New Asia. When the senior wants to take a walk in the building in search for something he forgot the name off. The man opens a door and finds himself walking in a glass hallway trough the complex and next to the streets. The hallway becomes part of the street and around every corner a new experience awaits him.. A train stop were soon a train will stop to bring him to his grandparents, or a secret butterfly garden.

Science Fiction essay: Alzheimer’s in 50 Years

Sabine Ruitenbeek

Then a old man opens a small window in the glass hallway, just big enough to put his head trough. He feels the wind blowing around his big ears and looks at the street were A small group of youngsters arrives at a family home. The young people all carry a light blue wrapped gift with them, making the old man fantasize about his young days. Then something pulls him back to the present, The man sees a illustration of a Stork on the house window displayed. Above it the sentence: ‘Baby Ben is born!’ He pulls his head back through the window and starts laughing intensely and loud, almost hysterically. For some reason he finds this birth the funniest thing in many days or years. Tears from laughing fall down on the grey linoleum and while slapping his hands on his thighs, he is not able to stop laughing. The other elderly in the hallway look at him with curiosity. The laughing old man found the word he lost already the hole morning. His name is Ben. 248

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Friday Mornings

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Draw a Home

Friday Mornings My research continued with Friday morning drawing sessions. I asked the inhabitants with Alzheimer’s of the elderly house ‘Vondelstede’ to draw with me. I asked them to draw their home. Some people started drawing immediately, but most people needed to think and feel the pencils for a while in their fingers. We talked about their old homes were they grew up in and the place they live in now. They did not call the elderly house they are living in now their home. I sometimes asked them to draw their ideal home, or their fantasy home.

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Draw a Home

Video

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Draw a Home

Verena Video stills ‘Verena’

My research developed in a video were I asked my own grandma Verena to draw with me, A 1-1 plan of her ideal home. While we were doing this in the park close to the elderly house she lives in, we talked about all the different home’s in from her past, now and future. At the end this video became my end product, were I experiment with different ways to research and design the Alzheimer’s issue. Video stills ‘Verena’

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The Alzheimer’s Manifesto

Collective Manifesto

All Students

The Alzheimer’s Manifesto

Alzheimer’s Manifesto

Collective Manifesto

All Students

INTEGRATE a Pathfinder. Alzheimer’s patients often have difficulty finding their way and orientating through a space. Create a sensory pathfinder that can operate as a compass, relieving stress and anxiety.

Loose the Stigma. People suffering from Alzheimer’s experience the limitations of their disease everyday. Instead of focussing on their limitations, acknowledge what they can still experience and create space improves their quality of life. Be constructive in tone.

ACCESS THE Great Outdoor. Create access to an attractive outdoor space, that celebrates flora and fauna as integral part of our natural surrounding. A place to wander & wonder. CREATE ‘Soft’ Safety. Safety is an essential condition in environments for vulnerable users. Yet simply locking doors, often leads to negative experience by patients. Instead, create different filters that maintain relative freedom to move within the complex.

EnCOURAGE Human Encounter. Create an environment that stimulates human interaction, a place where generations can meet. It contributes to a sense of belonging to society and has a positive effect on wellbeing.

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stimulate interaction and participation. - Turning nursing-homes inside out (now they are mostly turned inwards) - Stimulating participation of surrounding environment - Getting the disease out of isolation - Alzheimer’s café kind of solutions

Design for the informal caretaker. - Temporary care for the patient (f.e. daycare or Alzheimer’s bus) - Psychogeriatric home (permanent care) - Design to make home care easier (f.e. special bathroom equipment) - Holidays or activity for bonding and/or relaxation of informal caregiver and patient

OPEN THE dialogue. - Caretakers - daytime activity workers - Doctors - Psychologist - Patient - Friends and family

adDress all senses. - Taking all senses in account (sensory experiment -> which senses are most important?)sensory memory - How to translate senses and experiences to architecture collectivity and individuality

FUTURe-PROOF DESIGN. - Aging of society will come and go - Patients will come and go - Taking different phases of the disease in account - Taking different personalities in account - ‘Presentie theorie’

Design to stimulate physical movement. - Infinite routing for walking sport attributes (f.e. home-trainer or Nintendo Wii)

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The Alzheimer’s Manifesto

Rhythm of the Day. - Daylight is important to help set the body clock. - It is what keep our normal day & night rhythm. - People with Alzheimer’s often turn night into day. - Having good access to daylight will help keep the balance.

Collective Manifesto

All Students

Create Aural Filters. - Noise can be disabling for people who are confused. - Declutter the auditory environment by amplify sound and reducing noise MAKE IT VISIBLE. No more hiding, no more concealing, no more exiling, Alzheimer’s should be part of our everyday life… The visibility is essential.

Make it Dead Obvious. - Any of us have difficult moments when we are trying to find our way around unfamiliar places. - If you have Alzheimer’s it is even more difficult to work things out. - Make it easy for a person with Alzheimer’s to work things out. - Make it Dead Obvious.

RELATION TO PUBLIC. Introduce Alzheimer’s to everyday life by making parts of the institute public. CREATE Privacy. At the same time Alzheimer’s should also have their private space. The level of intervention should be controlled. ALL ARE Equal. No preconception, no hierarchy, no discrimination, we should treat Alzheimer’s as the way we want others to treat us.

go Easy on the Eyes. - Dementia patient are often older with sight impairment. - Contrast in color or material to differentiate surfaces help them see better and recognize their environment. 258

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The Alzheimer’s Manifesto

Collective Manifesto

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BLEND INTO Nature. As we put our feet on ground and breath a fresh air, we always longing for the nature, why not blended into the nature?

Let them Watch. Design the spaces so that the more observing patients can watch the more active undertaking patients.

INTEGRATE Daylight. Surround the patients with daylight. Vitamin D from the sun is good for everyones health.

Prevent Bored Tablesitting. The patients should live in a habitat where in they are tempted to not be mentally passive. Prevent them for sitting bored at a table without having anything to do.

MAINTAIN a SENSE OF Freedom. Let the patient spend time outside each day or at least get them fresh air. Give the patients the sense of freedom by giving them the space to walk around freely. If possible also let them go out.

FACILITATE Caretakers. Do not forget the (informal) caretakers within the design for an Alzheimer’s habitat! CELEBRATE THE Voyeur. Voyeuristic elements within the design stimulate the playful aspect between the patients.

multiple choice activties. Design the space for them which makes them undertake their own plans during the day. Create an environment that stimulates the people to actively participate in daily (living) activities. Provide activities.

CREATE Societal Involvement. Societal involvement is needed to make Alzheimer’s patients more visible.

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The Alzheimer’s Manifesto

Inside-Outside. Inside-outside (architecturally) relationship within the design is important.

Collective Manifesto

All Students

Take it serious. People suffering from Alzheimer’s experience loss of power in their life considering small and big decisions. Ask Alzheimer’s patients what they need and want and take their opinion serious, instead of projecting our own ideas on them.

Stage the patient. Create a platform or stage for Alzheimer’s patients, they need to be seen, heard and learned from. If communicating in the traditional way does not work, invest and experiment with other ways of expression. The design should stimulate the voice of the patient.

GO BEYONG OBVIOUS. Explore what may lay hidden Design what may exist Indicate what may ignored.

Acknowledge Differences. Rooms should be designed according to the types of Alzheimer’s patients. (Wanderer, zen-demented person, balance seeker).

GET INTO THEIR WORLD. Think what they think, Feel what they feel, Experience what they experience, Understand the beauty of the other world.

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Special Thanks to

Credits

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Special Thanks to

Credits

Special Thanks to Jetske Visser, Designer Mariska van den Berg, independent curator Sander van der Ham, city psychologist, STIPO Jurgen Bey, designer, director Sandberg Institute Sietske Sikkes, researcher, VU Alzheimer Institute Marieke Coppens, artist and psychologist

Igor Kebel, architect, owner Elastic

Special Thanks

Joke Willegers, interior architect, nursing home Sarpatihuis

Nursing home ‘De Lingehof’ in Bemmel

to Training Facilities

MultiCare center ‘Florence Jonker Frans’ in Den Haag

Lucy Cotter, tutor, Sandberg Institute

Nursing home ‘Vivium group’ in Huizen

Katy Hartley, director Philips Center for Health & Well-being

Care center ‘Schalkweide’, foundation Sint Jacob in Haarlem

Yvonne van Amerongen, staff officer, nursing home De Hogeweyk

Vitalis HomeCare Group, ’De Wilg’ in Peppelrode

Rinske Wessels, project coordinator MIA, Sandberg Institute

Nursing home ‘Oranje Nassau’s Oord’ in Renkum

Janneke van Leeuwen, artist and neuro-psychologist

Housing and Care Centre Vondelstede / Asta in Amsterdam

John Bosch, architect, director OeverZaaijer architects Lidy Meijer, architect, TU Delft/RMIT Michiel Beijer, project leader build environment, foundation Sint Jacob in Haarlem

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Credits

Master of Interior Architecture Sandberg Instituut

Insight Series #1 A Short Look Into Your Future?

Colophon

p 7 - Images: Daylight: - http://www. myvitali.com/ - http://www. narm.org.uk/ home/images/ - http:// informedfarmers.com

Insight Series #1 A Short Look Into Your Future? © Sandberg Instituut Amsterdam, 2012 Fred. Roeskestraat 98 1076 ED Amsterdam

p 10 - www.levenmetalzheimer. nl, - www.alz. co.uk/statistics, - www.wikipedia.nl

The Netherlands T +31 (0)20-588 2400 www.sandberg.nl www.sandberg.nl/interior/ Tutor and Head Master Interior

p 31 - Grey pressure: ‘Dementie in Utrecht, De cijfers: 2005-2030’

Architecture: Henri Snel Students: Ricky van Broekhoven Naomi Cheung San Chanida Lumthaweepaisal

p 38 - Lonely Metropolitan, 1932, - Image from the book: ‘Eyes of the skin’ by Juhani Pallasmaa

Wenqian Luo Tom van Alst Jack Chen S.C Dennis Schuivens Sabine Ruitenbeek Concept & Design: Anja Groten

Reference List

p 40 Images: - Coupé in verpleeghuis, Yvonne Droge Wendel en Lino Hellings - http:// trendbeheer. com/2010/ 08/13/alzheimerexpres/ p 43 Images: - Inspiration for bus interior, old tram in Lisbon - Inspiration for skylight in bus, installation by James Turrell p 53 - Conceptual diagram of Alzheimer’s Institute distribution in the city in the year 2030

Master of Interior Architecture Sandberg Instituut

p 62 - Image: Melvin Sokolsky, http://www. fyms.de/melvin-sokolsky/ - Film stills: ARDA, Alzheimer’s related Dementia Association http://www. youtube.com/ watch?v=YVYtk gTyd0g&featur e=share

p 96 - Madness and Civilization, Michel Foucault - http://upload.wikimedia.org/

p 182 - Loren Eiseley, The Immense Journey, 1957,(p158) - Images: http:// www.besthousedesign. com/2010/10/ 08/swallowedindulgingshore-tubhey-teamcollectiveteuco/

p 117 - Images: Peter Zumthor, SPA, Vals, Switzerland

p 183 Foucault, ‘Madness and Civilization, (p 163)

p 69 - Image: Melvin Sokolsky, http://www. fyms.de/melvin-sokolsky/

p 157 - Image: http://www.sciencephoto.com/

Printing and binding: Edition Winterwork Edition: 50 copies

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p 165 - Image: http://robots.nu/ robot-voorbehoefte-aanliefde-ensex/ - Images: http://www. singularityweblog.com/ smart-homesis-ai-theghost-in-themachine/


Insight Series #1 A Short Look Into Your Future?

Reference List

p 184 -Screenshots: Angelina Joiie, Scene from the film Changeling (2008)

p 213 - Image: National Park Zuid-Kennemerland www. np-zuidkennemerland.nl

p 194 - Image: http://www. hollandbloorview.ca/ programsandservices/ communityprograms/ snoezelen.php

p 214 - Pebbles © Mayang Murni Adnin, 20012010 http:// mayang.com/ textures/ - Sand © Mayang Murni Adnin, 20012010 http:// mayang.com/ textures/ - Flower field © Mayang Murni Adnin, 2001-2010 http://mayang.com/textures/ - Overview National Park ZuidKennemerland, Creative Commons: - http:// en.wikipedia. org/wiki/ File:NP-ZuidKennemerlandKaart.jpg - Overview municipality Groot-Haarlem: http:// nl.wikipedia. org/wiki/

p 201 - Vertical garden wall in corridor: http://www. verticalgardens.eu/systemen/modulair-systeem/ p 210 -Charles Dickens -Todd McLellan, ‘Disassembled’ - Images: Todd McLellan, ‘Disassembled’ http://toddmclellan.com/

Bestand:Map_ -_NL_-_ Haarlem_-Wijk_09_Schalkwijk.svg > creative commons: Bron: © 2008, Centraal Bureau voor de Statistiek/ Topografische Dienst Kadaster

Master of Interior Architecture Sandberg Instituut

p 240 - Ashley Montagu’s - Walter Benjamin, ‘Arcades project, The Flaneur’

p 233 - Guy Debord, ‘Society of the Spectacle’ p 234 -Jean Baudrillard, ‘Simulations’ - Foucault, ‘Madness and Civilization, Return to the Immediate’ p 236 Thomas Willis, Opera omnia 1681 p 238 - Brian Massumi, ‘Realer than Real’

268

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