Diseño para personas con demencia (Lone Sigbrand)

HOUSING IN AN AGEING SOCIETY: Designing for people with dementia DISEÑO PARA PERSONAS CON DEMENCIA – CÓMO EL ENTORNO FÍSICO PUEDE APOYAR EL BIENESTAR Y REDUCIR LA MEDICACIÓN

Lone Sigbrand, architect maa, senior consultant

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Who are we?

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Danish Building Research Institute (Statens Byggeforskningsinstitut – SBi) Institute at Aalborg University Copenhagen Research Group Universal Design: • Established at SBi in 2005 • Research, education and researchbased consulting on UD and the built environment • Focus on: users and their needs (children and elderly, people with physical, sensory an cognitive disabilities), the building process and comprehensive solutions Webpage: Universelt design og tilgængelighed

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Programme Background and status for the work in Denmark Dementia and the physical environment The main design approaches : - Homeliness and atmosphere - Orientation - Daylight and artificial light - Sensory experiences related to nature

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Designing for people with dementia

BACKGROUND AND STATUS

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The challenge Population in Denmark 2017: 5 760 694

women men

2015

2020

2025

2030

2035

2040

1.421.796

1.537.683

1.674.397

1.813.239

1.908.808

1.939.953

People with dementia

83.830

94.265

107.883

123.857

139.375

151.368

App.

5,9 %

6,1 %

6,8 %

7,3 %

7,8 %

Elderly (60+)

6,4 %

Kilde: Nationalt Videnscenter for Demens: Forekomsten af demens hos ĂŚldre i Danmark. Hele landet og de fem regioner, 2015-2040. p.6

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The challenge

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App. 26.000 elderly 80+, with moderate or severe dementia

•

6000 care homes for people with dementia.

Margrethe Kähler: Demensindretning af alle nye plejeboliger – hvorfor?

November 2014, p.1

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Work regarding dementia at SBi Start - 2015: • Ministry of Health and Elderly in collaboration with the Ministry of Immigration, Integration and Housing • 2 million DKK (app. 270,000 EUR) to SBi • 48 million DKK (app. 6,5 million EUR) to improve exsisting care homes Purpose and objectives: • To find out if and how the design of the physical environment can support the remaining abilities of people with dementia in order to • promote well-being and quality of life • reduce use of force and medication •

Develop a "tool" in interaction with building codes and other guidelines

• Target group: private and public builders, their advisors and architects • Research based!

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The result: 2 research based SBi-guidelines SBi-guideline 259: ”Nursing homes for people with dementia - introductory questions” (‘Plejeboliger for personer med demens - indledende spørgsmål’).

85 questions – for screening an excisting building or at project SBi-guideline 263 ”Nursing homes for people with dementia - details and examples” (Plejeboliger for personer med demens – detaljer og eksempler) Peer reviewed.

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www.anvisninger.dk/259

www.anvisninger.dk/263

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The Builders Association •

Model Program for Nursing Homes: Dementia Homes

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Public and private builders Focus: homeliness, safety and light plus • Sociale rooms • Outdoor spaces • Working areas

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Interesting cases: • Dagmarsminde • Torndalshave Find it: http://www.modelprogram.dk/opslagstavle n/nyheder/download-modelprogram-fordemensboliger/#.WdUzI1u0OK4

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The National Dementia Action Plan 2025 Fokus on the person behind the disease Five areas – 23 initiatives: • Early detection and better quality in investigation and treatment • Better quality in care and rehabilitation • Support and counseling for relatives of people with dementia • Dementia-friendly communities and housing • Increased level of knowledge and skills.

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National labeling scheme of care homes for people with dementia - initiativ 17 Developed criterias: • • •

Care center facilities - indoor and outdoor The housing group The private home • • • •

Homeliness and atmosphere Daylight and artificial light Orientation Contact to nature and sensory stimulation

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care philosophy caregivers WELL-BEING for the person with dementia

physical environment

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Designing for people with dementia

DEMENTIA DESEASES

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The most common of the 200 dementia diseases Lewy body and Parkinson's dementia 6%

Frontotemporal dementia 2%

Other dementia diseases 3%

Vascular dementia 17%

Mixed Alzheimers disease and vascular dementia 10% 10th November 2017

Alzheimers disease 62%

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Degrees of dementia

Hukommelse Overblik Dømmekraft Orientering Rum /retning Finde ord initiativ

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Typical symptoms Alzheimers disease Influence

Vascular dementia

Memory

Memory

Overview

Concentration

Judgement

Ability to plan

Orientation Room / direction Finding words Initiative

Room / direction Initiative

Lewy body dementia Alternating attention Visual hallucinations Slow movements

Slow movements

Sleep disturbances

Difficulty walking

Room / direction Memory Ability to plan

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Frontotemporal dementia Changes in personality and behavior Lose inhibitions Situational awareness Impulsivity Uncontested behavior Lack of empathy

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Dementia friendly housing ü Promotes residents' safety and security ü Takes into consideration the disability, living with weakened memory and altered sensory perception ü Supports the person's ability to manage himself as much as possible ü Allows the resident’s to maintain his or her autonomy by, e.g, going out in a safe environment ü Supports the resident's identity ü Promotes the possibility of meaningful activities ü Housing with the opportunity to live your life

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Designing for people with dementia

MAIN APPROACHES: HOMELINESS AND ATMOSPHERE

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Samspil med omgivelser Research supports that the design of the physical environment may influence: Everyday life, well-being, stress-level, health and orientation for people with dementia.

Homeliness is emphasized again and again in research as important.

But how do we build and create care homes that actually are homely and have a good atmosphere?

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Moving from home to a care home What is a home?

A home is a place we have control over Own things, own choices Individuality is expressed "Traces" of human activities When you have to move: Loss of control - also over physical surroundings From the inside From the outside Loss of individuality? One person among several others at the same time as demands from and care for caregivers.

Can the 'home' be transferred to the care home?

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Atmosphere - a matter of choosing and rejecting

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Choose Small scale Physical environments, where residents have the feeling of being in control Recognition in terms of ways residents have lived earlier in their lives Atmosphere, where you feel at ease.

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Homeliness and atmosphere requires space

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Reject References to "hospital" and assisting devices Large purchases of the same, e.g. furniture - anonymity

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Designing for people with dementia

MAIN APPROACHES: ORIENTATION AND UNDERSTANDING

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Orientation • Study of 450 people with light to severe dementia.

• Between 8 and 35 people in each housing group.

• Different design of corridors.

• The size of the housing group was overall crucial for persons with dementia's ability to orient beyond the design of the floor plan.

• It was the easiest for people with dementia to find their way in housing groups of 8-10 people.

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Orientation • Visibility between the door from and to private home and the community rooms was of great importance • A kitchen, together with the living room was of great importance as an "anchor point“. Even residents with severe dementia could find their way to this.

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Orientation • Doors to outdoor areas have to be visible and near the kitchen / common living rooms. • Garden furniture have to be visible from the exit door.

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Barriers • Elevator is a big barrier, which can cause anxiety attacks and frustration.

• Monotome repetitions, e.g long corridor with many similar doors.

• Many options for change of direction.

• Deep niches in corridors, from which there is no overview to the rest of the housing group.

• Multiple rooms with the same function, eg 2 living rooms, similar to each other.

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Supporting elements • Physical reference points e.g. living room, furniture, paintings, lighting, colors • Good lighting is crucial for the ability to orient and find the way • Signage only as a supplement.

An example: Clear name supplemented with individual markings eg a photo, perhaps of the resident as young, a personal item or a painting that wakes memories. Text supplemented with pictograms / drawings / colors 10th November 2017

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Supporting elements • Colors can clarify a room, e.g. doors, panels and door frames can have a contrasting color to the wall and floor. Doors for the staff same color as the walls. • Floors and other surfaces should be single-colored, as many people with dementia might think that something is lying on the floor if it is patterned due to poor depth perception.

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Use of colors • Colors, especially red and yellow, can also be used to highlight elements. This can be crucial for a person with dementia to find e.g the handrail or the toilet. • Colors should be matte, as shiny surfaces can give glare and unpleasant mirroring.

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Designing for people with dementia

MAIN APPROACHES: DAYLIGHT AND ARTIFICIAL LIGHT

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light

visual effects

visual sense

non-visual effects

visual environment

circadic system

acute system

the ability to see, well-being and health Diagrammet er udarbejdet med inspiration fra forelĂŚsning af Bianca van der Zande pĂĽ Lysets Dag 30. september 2015

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Source: Wout J.M. van Bommel: Non-visual biological effect of lighting and the practical meaning for lighting for work, Applied Ergonomics, Volume 37, Issue 4, 2006, 461–466

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Design for people with dementia

DAYLIGHT

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snit

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snit

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snit

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Clearly defined windows

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Shading against sunlight

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The view

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Designing for people with dementia

THE ARTIFICIAL LIGHT

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Emphasize homeliness and atmosphere

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Designing for people with dementia

HOVEDGREB: SANSEOPLEVELSER OG KONTAKT TIL NATUREN

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Ulrich, R. S. (1984). View through a window may influence recovery from surgery. Science, 24, 420 - 421.

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Attention Restoration Theory - Stephen & Rachel Kaplan

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Attention Restoration Theory - Stephen & Rachel Kaplan

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“The Theory of Supportive Gardens�

A stress-reducing effect of a garden is dependent on the extent to which it allows: - The feeling of being in control - Social support - Physical activity - Positive experiences - Sensory stimulation from nature

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People with dementia

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The effect of contact with nature for people with dementia Research results indicate beneficial effects on health and well-being: - improved well-being and mood - fewer cases of problematic behavior - less use of drugs fewer drops - improved sleep rhythm Nature can therefore be beneficially included as part of an economically sound and non-pharmacological strategy for improved quality of life

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Daylight

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Design and activities for people with dementia Important in order to achieve the desired effects: - The caregivers should desire to involve nature in their work - Design and activities should be aimed at people with dementia

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Control

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Social interaction

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Meaningfull activities

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Physical activities

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Sensory experiences

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Security and safety

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If you consider: • • • • •

The size of a housing group The orientation of the homes in the housing group The materials, surfaces and colors The daylight and the artificial light The elements from nature

People with dementia achieve better well-being, sleep, health and need less medicine and the caregivers have to use less force due to less frustration and agitation among the residents.

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Skriv ligningen her.

THANK YOU FOR YOUR ATTENTION! LONE SIGBRAND LOS@SBI.AAU.DK 10th November 2017

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