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Design for cognitive decline – Supporting people with dementia in care settings

Dementia design is not new; however, providers must continue to adapt and consider design experience to support people with dementia. Managing Director at Catalyst Interiors, Mike Davies, shares insights into Catalyst’s approach.

As the UK’s population continues to live longer, the needs of the elderly have become more prevalent in society as a whole and this has been noticed the most by those working in the care sector. This month, Hilary Evans, Chief Executive of Alzheimer’s Research UK said that ‘Dementia is our greatest long-term medical challenge.

Research first presented at the 2021 Alzheimer’s Association International Conference (AAIC), and published in peer-reviewed journal, The Lancet, concluded that global dementia cases are set to triple, with 153 million people living with dementia by 2050. The importance and the necessity for social care providers to strengthen their training and continue to embrace design has never been so important.

Having been in that market for over three decades, I’m passionate about creating environments that accentuate the lives of those who experience cognitive decline in the UK’s care homes. As mental wellbeing becomes more widely recognised, people are beginning to understand the impact that dementia has on the elderly.

As such, it’s becoming increasingly important to focus on things that allow us to accommodate for the comfort and care of the elderly in our community.

While interior design for care homes has been a market since the inception of care homes themselves, altering that experience for those living with dementia is still something that hasn’t been focused on enough and needs to be given more attention.

Creating an environment

I cannot stress enough that there are certain ways to provide comfortable living spaces for those living with dementia. It’s certainly not impossible to create the ideal environment catering to a specific type of dementia – but many care homes only touch the surface of catering to people living with dementia, let alone anybody living with a particular type of dementia, which brings me to the next point.

The field of interior design for those living with dementia is a particularly challenging one. This is partly because there’s a lot that society as a whole is still only beginning to understand, and partly because creating living environments becomes increasingly difficult as we learn more about the impact dementia has on those affected by it.

Catalyst has come to learn that the term ‘fit for purpose’ is not enough in our eyes. The goal should always be to create a resident experience that is unsurpassed and a delivery and support service that is unrivalled.

Wayfinding

travel corridor graphic

Spatial disorientation is amongst the first symptoms of dementia and is often the reason institutionalisation is necessary. Orientation and the ability to reach destinations (wayfinding) are the prerequisites of personal autonomy and quality of life. Studies have found that residents suffering from medium levels of the disease display problems in locating their own apartments, bathrooms, activity rooms and dining rooms.

For wayfinding to be effective, there needs to be a high level of consistency. Research has shown that even small inconsistencies, such as ashtrays on tables in corridors, can cause confusion in residents. Therefore, it is vital that cues remain in their original locations and rooms are not confused. Dining chairs being used as extra seats in a crowded lounge could easily lead a resident to believe they were, in fact, in the dining room.

When fitting out and designing the interior for one of our projects, we focused on replacing patterns on walls with a plainer but more textured surface to help residents feel more at ease by removing unnecessary stimulus. Smaller rooms were painted with darker colours to create feelings of calm, while more open spaces saw the use of greens to create some more energy and a sense of openness.

The layout was also important. Understanding that residents may struggle to get from place to place meant that we decided to bring those places to them. Many smaller rooms are located throughout every floor of the care home to make access easier and more convenient for everybody. This reduces stress and anxiety.

While we make use of wayfinding wherever possible, examples can be seen in Graysford Hall, where we added in private dining rooms, hair salons and even a cinema, all decorated with classic vintage designs to help stir memories of experiences the residents had when they were younger. These rooms created important reference points to aid wayfinding, stimulating their hearts and not just their minds. Furniture design and selection is also important. It is vital that we evaluate the furniture height, depth and width, and ensure that the fabric has the correct colour and texture as well as being waterproof. Plain Impervious (plain texture) was used to avoid over stimulation and reduce the risk of slips, trips and falls.

Our mission on every project is to ensure that we create an environment that allows the residents to live their daily lives in a way that offers safety and independence.

Business trends

While our service lends itself to focus on new-build care homes, the refurbishment of existing care homes has seen a dramatic increase as operators realise the importance of maintaining an environment that will optimise the resident experience as well as maintaining a reputation in the neighbourhood, especially if new-build care homes threaten the market. Changing the marketing strategy away from publicly funded beds to privately funded beds, where the demographic dictates, is another reason that operators are choosing to refurbish existing facilities.

Meeting the need

Most people don’t always see where interior design ends and interior design for those living with dementia begins.

While aesthetically pleasing spaces are the goal in both aspects, the specifics of them will differ. Great design must combine with comfortable living to create an overall rewarding experience for those experiencing cognitive decline, a goal which Catalyst has proven for close to a quarter of a century.

Our focus is always centred around ongoing improvements for the residents to make sure they enjoy a longer, safer and more fulfilling life in a space that’s both homely and beautiful but designed with research-backed initiatives to ensure a holistic outcome. The balance between aiding residents’ state of living while making a commercial return for those who have invested is always something to keep in mind.

Whether you’re the owner of a care home, an interior designer or a supplier, always remember that if you wouldn’t want your family living there, then you have the power to change that.

Keeping your residents in mind (and in heart) is, ultimately, what drives this field, and what drives us to grow.

Mike Davies is the Founder and Managing Director of Catalyst Interiors. Email: mike.davies@catalystinteriors.co.uk  Twitter: @catalystsupport


Jessica Noel-Smith, Senior Architect at Dementia Services Development Centre (DSDC), University of Stirling, shares commentary on Environments for Ageing and Dementia Design – evidence-based practice.

High quality dementia-friendly design is substantially more complex than just making physical changes to the physical environment. It has an impact on the way a space is interacted with, the health and wellbeing of the people who use it and overall quality of life. ‘We know that [physical environments] can make the experience of cognitive changes more difficult or can enable continuing inclusion and a sense of self-worth and self-esteem’ (Prof. Alison Bowes, University of Stirling).

Evidence-based environmental design principles which support people living with dementia to maintain activities of daily living (bathing, dressing, toileting, shopping, socialising etc.) have been in existence since the late 1980s – Fleming and Bowles (1987) and Marshall (1998) are influential (Bowes and Dawson, 2019). It is worth noting that these principles can also benefit care partners by reducing external stressors, supporting the person with dementia to be more independent and to help them sustain activities of daily living.

In 2019, a comprehensive systematic literature review and quality assessment of worldwide research in relation to dementia design, in any environmental setting was carried out by the University of Stirling (Bowes and Dawson, 2019). The report states, ‘We have previously noted that much available advice on design has mixed provenance: whilst some design measures that are widely promoted have a strong evidence base, others have little’.

At DSDC, we draw on research and practice, from across the world, to provide comprehensive, up-to-date resources on dementia and we pride ourselves on our international reputation as leaders in the field of dementia design. Our interdisciplinary team of nurses, architects, engineers and designers provide education, training and advice on products, services and the design of all environments where dementia matters. Please visit our website to find out more at www.dementia.stir.ac.uk

References

  • Bowes, A. M. and Dawson, A. (2019) Designing environments for people with dementia: A systematic literature review. Bingley: Emerald Publishing. Available: https://www.emeraldinsight.com/doi/full/10.1108/978-1-78769-971-720191004 [Accessed: 20.01.2022]
  • Cunningham, C. et al. (2008) Dementia Design Audit Tool. 1st Edition, Dementia Design Series. 1st Edition. Greenwich, NSW: University of Stirling.
  • Fleming, R. and Bowles, J. (1987) ‘Units for the Confused and Disturbed Elderly: Development, Design, Programming and Evaluation’, Australian Journal on Ageing, 6(4), pp. 25–28. doi: 10.1111/j.1741- 6612.1987.tb01001.x.
  • Marshall M. (1998) ‘Therapeutic buildings for people with dementia’. In: Judd S, Marshall M, Phippen P, editors. ‘Design for Dementia’. London: Hawker Publications Ltd.
  • Marshall, M. (2001) ‘How it helps to see dementia as a disability’, In Care Homes and Dementia: Journal of Dementia Care. Edited by S. Benson. London: Hawker Publications, 6, pp. 15–17.

Further resources

About Mike Davies

Managing Director and Founder Mike Davies has built and lead the Catalyst team to becoming the UK’s leading interior design and fitout specialist for residential care and social housing for over two decades.
He has always strived to work closely with the leading care home providers and change the way people think about the care environment, as well as providing the best possible care for the residents. Mike personally leads, and challenges daily, a passionate and experienced team of designers and project delivery specialists who have an unrivalled collective expertise and standard of design that has been recognised by on-going awards and the understanding that what the business does is fundamental to the quality of care that is ultimately delivered in every job.

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