PED | Personalized Environmental Design for Patients with Dementia | Open source

Personalized Environmental Design for Patients with Dementia Sahar (Ghazal) Tabandeh

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Personalized Environmental Design for Patients with

Dementia

Aging Population | Integrated Studio Project II Designer: Sahar (Ghazal) Tabandeh Supervisors: Joanna & Jamie Brassett Anhalt University of Applied Sciences January 2016

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Table of Contents Research Process _____________________________________________________ 7 Rationale _____________________________________________________________13 Design Process (Initial Ideas) ___________________________________________ 16 Design Brief __________________________________________________________ 21 Design Goals _________________________________________________________ 23 Master Plan and Layout ________________________________________________ 26 Birdview Perspective __________________________________________________ 27 Design Details _________________________________________________________ 28 References ___________________________________________________________ 35

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Research Process The research for this project started with a group of six MAID students planning to cover the topic of �Socialization� within the aging population society of 50 to 80 years of age in Dessau, Germany.

Among the initial issues chosen to be addressed in this context were: Loneliness and Isolation, Mental Health, Social Belonging, Sense of Purpose, Keeping connected, Leisure and Accessibility.

In October, the group developed a research plan to be followed during the next month. In November, the students started different activities including observations, interviews and readings to collect the necessary data out of which they later developed insights and ideas for their design workflow. Beginning in December, the group categorized the collected information into Macro/Micro issues considering the current concerns of the society and the relevance of each issue:

MACRO

Mental illness Bridging the generation gap Learning technology Sense of purpose

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MICRO

Relationships Experiences Financial Status and Saving Independence

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Later the students started their individual design process splitting between the conjun ction of specific macro and micro issues to come up with innovative design outcomes.

A brief categorized summary of my observations in an elderly computer club at the Volks Hochschule in Dessau.

Telephone: Some have always their cell-phones with them, incase of potential accidents, etc.

Some say they don’t like to be available all the time and don’t have cell-phones.

Communication: Their first and foremost wish is to be able to be in contact with their children and grandchildren all the time(everyday).

One lady said there should be a place for grandmother/fathers in the kindergartens so that they can join their grandchildren in their freetime!

Transport to their family places is another issue.

They mostly use telephone and email to plan their meetings.

They print announces in the local newspaper to find mates.

This booklet focuses on the intersection of “Macro issue: mental illness” and “Micro issue: experiences”. The goal is to provide a distinct daily experience for a person suffering from Dementia.

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Activities: Some go to fitness.

One person sings in a choir.

In their meetings there are no young people.

They say they are always looking for what makes them activer.

They are unsatisfied with the few number of programs for them to join in Dessau.

One lady had an analogue camera with a kodak film. She even showed me her analogue photos. She believed digital photography is not real and is also very expensive!

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Financial Issues: being able to save money is very important to them.

Most services seem o be expensive for them(sport, music, learning, etc.). They remember that in the past everything was paid and the elderly didn’t have to pay.

They liked my idea of “elderly card” or “elderly ticket”, but it looks like there is already something similar being planned in dessau.

Transport: Being able to go to the doctor easily is crucially important to them.

They are not happy with the transport system in Dessau. Most of them don’t have cars. The train is expensive for them, so they have to take the bus most of the time.

Fears: Without hesitation, all of them mentioned sickness, dependence and not being able to look after themselves as their biggest fear.

They also don’t seem to like the fact that most people think the elderly cannot learn, since they believe they are constantly learning new things (e.g. computer software, etc.) and they feel more confident.

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Rationale Everyone has a relationship with their environment. Each day we move about in space and time, relating to people, objects and places of meaning. Much of how we think about ourselves is reflected in our environment. Environments of our daily lives give us resources for presenting ourselves to the world around us.

It is the same for people with dementia. Even if their perception of time and space has changed, they live in a world where relationships, objects and situations matter. People with dementia may not be able to speak about the meaning environments have, but a sense of meaning and importance remains in their lives.

The experience of a person with dementia tends to be overlooked in the design of residential and respite facilities. Living with dementia should frame design.

This involves seeing the world through the eyes of people living with dementia, or �looking out from the inside�.

People with dementia do not experience themselves and their physical and social environments as separate. Each part, personal, physical and social, is in a lived relationship to the other. The physical and social environments of life are interlinked and equally important. They should be designed together to engage people, support independence and give meaning, comfort and safety.

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People with dementia find it harder and harder to interpret the environment and over time become more limited in movement and agility. Their environment can enable them to live well, and should provide discrete support. They should be encouraged to be active and keep their skills and abilities for as long as possible.

The environment can support or hinder social connection and a sense of self: it can give utmost independence or force dependency. So too can management styles, approaches to care, and connections with families and the local community. Design for people with dementia should be in line with people’s social and cultural activities, their needs and capabilities, and organizational policies and procedures.

To be dementia-friendly, residential and respite facilities need to have a home-like environment. The language of home is very different from the language of healthcare.

A home-like environment adds continuity and familiarity to everyday life, encourages continued family involvement and strengthens family and friendship. It involves: personal control and decision making, individualized care, meaningful relationships, smaller scale living arrangements, greater environmental texture, personalization of care and discrete medical support.

Residential facilities are where people live, and people should feel at home. Home environments can take many forms, but they all have certain domestic qualities.

A home-like setting reminds people of home, lets them continue the tasks of daily living, uses their existing skills and gives choice and independence with familiarity and comfort. A familiar environment has recognizable features: furnishings and furniture, building layout, room size, view and exterior.

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”The social model of care seeks to understand the emotions and behaviors of the person with dementia by placing him/her within the context of his/her social circumstances and biography. By learning about each person with dementia as an individual with his/her own history and background, care and support can be designed to be more appropriate to individual needs.”5 Life stories help care givers understand a person with dementia as a person with unique needs and interests. Gathering information for a life story can help shape enjoyable daily experiences in line with a person’s past roles and interests. Recording a person’s life story and gaining a social understanding is basic to dementia-friendly care. A life story should have information about a person’s previous jobs, domestic interests, recreational pastimes, religious views, family members, family history, homes and neighborhoods, nationality and countries of residence.

To build a picture of the whole person designers and care givers should talk with family members, friends and past neighbors to help give a background to how a person lived before residential or respite care.

People with dementia have different interests and pastimes. Designing daily life around interests and pastimes gives people pleasure, makes use of their skills and abilities, makes important links with people and places that were/are important in their lives, adds variety and interest, and is stimulating, reducing boredom, anxiety, stress and frustration. ”Design for dementia should not just address the disabilities, but utilize the remaining abilities”1 by creating environments that build on the strengths of a patient giving a sense of place and domestic affection, respect and dignity.

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Design Process Initial Design Ideas

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Design Brief The PED project (personalized environmental design for patients with dementia) tries to focus on the experience of every patient as a unique user with a unique story. By putting the patient’s preferences in the center of the design process, PED tends to provide individualized care service to the person and his/her family.

In order to illustrate how the service works, a sample character has been chosen as an example user who will go through the design procedure together with her family and utilizes the final design outcome.

The PED’s approach tries to turn the focus to the family members of the patient, as they are the most vulnerable during the process of their loved one’s disease.

During the first stages, the family members go through many brainstorm sessions with the designers to bring in as much data as possible about the patient’s life.

They continue to contribute to the project during all the next stages, as they are the most authentic sources connected to the patient.

Later, the design team starts to design a whole new home-like environment for the patient based on the collected data on her previous experiences, jobs, relationships, interests, religious views, family history, homes and neighborhoods, nationality, countries of residence, etc. taking into account the medical and residential regulations and requirements of a dementia-friendly environment.

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Design Goals Design Goals to be acheived: 1. Reducing anxiety & stress, decreasing agitation & restlessness, improving sleep 2. Improving the quality of life, finding things they can still enjoy and engage in, because joy is not dependent on memory & is experienced in the present moment.

3. Recollection of memories, reminiscence, life reviewing/conflict resolving approach, providing ways to connect with long term memories that are wellpreserved, helping to remember facts/procedures using reminders/memory aids 4. Providing sensory stimulation, through a sensory garden with water features, gardening tools, scented edible plants, birds, etc. Since brain turns environmental stimulation into senses, sensory stimulation leads to brain stimulation.

5. Focusing on the family members, developing brainstorm sessions between family members & designers to bring in as much data related to the patient’s life, including objects, photos, videos, voices, belongings and even verbal stories which will be later used to both reconstruct a personalized living space for the patient based on his/her past and help her/him remember and continue a meaningful life 6. Personalizing the living space, reconstructing the living environment based on personal preferences, life story and past experiences

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When it comes to Agnes -our favorite character-, the story starts 82 years ago.

Introducing Agnes 82-year-old widow British Catholic Retired school teacher Deceased husband: Matthew Children: Andrias, Eva, Alex Grandchildren: Anna, Felix, Emily Domestic interests: cooking, sewing, singing, gardening, reading, tea party!

Condition: Middle stage Dementia Current abilities: planting, cooking, singing lullabies, accepting visitors

Agnes is dealing with the middle stage of dementia which will cause her a substantial challenge in managing everyday life. She may need frequent reminders about activities or how to complete basic tasks. Gradually, the tasks of daily living will begin to become more difficult and she may need help or encouragement with eating, dressing or going to the toilet. She may become more socially withdrawn or less comfortable in group situations.

Other difficulties include awareness of the environment. She can often become confused about where she is and wander off and get lost. She may no longer be able to complete some activities independently. Activities such as shopping, cooking or anything else that requiree a sequence to be completed will become more challenging. She will require regular visits to ensure she is eating well, taking their medication and not at risk.1 The facilities designed for Agnes are all based on her abilities and needs as well as her background, interests and preferences. Among these, are the following: Bringing her own familiar pieces of furniture and cherished objects to the residence Providing possibilities to engage in activities that she likes and is able to do Leaving space for her family and loved ones in her new living environment Recreating a room layout similar to her bedroom when she was young Relying on her remaining abilities when providing opportunities Providing enough reminiscence and sensory stimulation Decreasing environmental inconvenience Being open to future changes Agnes has lived and will continue to live a wonderful life.

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Master Plan Layout

Birdview Perspective

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Toilet is visible from the bed.

Reminiscence wall

Big distinct wardrobe handles

Design Details

Guiding pictures serve as memory aids to help Agnes find her room among other spaces in the building.

Distinct door handles using color contrast

Wheelchair friendly doors open outside and prevent accidents.

Floor edges have sharp color contrast to promote visual perception in the space.

Flooring is soft, using carpet.

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Reminiscence shelf is filled with familiar objects that have special meanings to Agnes, reconnecting to her past.

Original pieces of furniture brought from her home add to the home-like quality of the environment.

Gardening has always been one of Agnes�s biggest interests.

Supplied with plastic tools, vases and tables, the gardening corner is designed to allow her plant and watch her plants grow and keeps her connected with her favorite pastime activities and past memories.

Walls and furniture feet have sharp color contrast with the floor and all edges are visible.

Hanging gown is used as a memory aid to remind the location of dressing closet.

Bathroom floor is obviously seperated from room flooring both in color and material.

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The dinning area on the roofed terrace is a space for Agnes to sit and relax, have meals, enjoy the sun, experience various sensory stimulations through smells, voices, colors, light, air or even receive guests and relatives.

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Toilet and bathroom are wheelchair friendly. Aiding handles are provided were necessary. The floor, walls and toilet furniture have obvious color contrast with each other.

The playing area keeps the grandchildren busy while Agnes and her family can sit, enjoy watching the children play and communicate with each other.

Wardrobe handles are all distinct in color and accesible while seated. Out-of-reach drawers have been avoided.

Water features, non-toxic scented and edible plants, birds and other gardening activities provide sensory experiments and brain stimulation.

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References 1. Timlin, G., Rysenbry, N., 2010. Design for Dementia, Improving Dinning and Bedroom Environments in Care Homes, Helen Hamlyn Centre, Royal College of Art. 2. Dementia-Friendly Environments, Good practice for quality care: an A-Z of strategies, checklists and tools, Aged Care Branch, Victorian Department of Health.

Retrieved from www.health.vic.gov.au/dementia 3. Kennard, Christine, 2006. Introduction to creative and sensory therapies for Alzheimer›s disease. Retrieved from: alzheirmers.about.com 4. Wegerer, Jennifer, 2014. How sensory stimulation can help alzheimer›s patients. Retrieved from: www.alzheimers.net 5. A NICE–SCIE Guideline on supporting people with dementia and their carers in health and social care, National Clinical Practice Guideline Number 42, National Collaborating Centre for Mental Health, commissioned by the Social Care Institute for Excellence National Institute for Health and Clinical Excellence, published by The British Psychological Society and Gaskell 6. Bourn, John, June 2007. Improving services and support for people with dementia, Comptroller and Auditor General, HC 604 Session , National Audit Office 7. National Institute of Mental Health, www.nimh.nih.gov/index.shtml 8. Best Alzheirmer›s Products‫ و‬www.best-alzheimers-products.com

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