Better toilet facilities, consistent floor colours and access to nature and fresh air are important considerations when designing hospital and social care environments for people with dementia, experts said this week.
Speaking at the first annual Design in Mental Health Conference and Exhibition in Birmingham this week, Emeritus Professor Mary Marshall of the University of Stirling revealed she was currently drawing up guidance on the optimum environments for dementia sufferers.
The environment really does matter. Sometimes the projects we have been involved with don’t just change environments, they change lives
She told delegates: “When designing environments for people with dementia you are looking at an extremely complex set of impairments, from a loss of memory and the ability to learn, to problems with perception and reasoning, and also high levels of stress and anxiety, and all of these are in addition to the usual problems associated with old age such as sight and hearing problems.
“The remedy, in terms of design, is in the attention to detail.”
She is currently drawing up a design manual that will look at the key considerations for designers of buildings and the products installed within them.
The draft document calls for ‘simple spaces’ with noise reduction panels and soft furnishings.
She said: “Most dementia care environments are too noise, particularly dining rooms. They can have the effect of making people anxious and upset and they either act out or they become withdrawn.”
The findings of her research include calls to limit numbers in dining rooms to 10 or fewer in order to reduce noise and stress. Table cloths should be used along with padded mats to further cut down on noise.
Professor Marshall added that floor coverings should be consistent in both colour and texture.
“This is really important, because a change in floor colour to someone with perception problems can look like a step and they can hesitate and maybe fall,” she explained. “Floor coverings need to be constant and with no contrasting threshold strips. It may sound boring, but if it means people don’t fall over then it’s the best thing.
“This extends to the outside too as access needs to be level and colour contrasts inside and out kept to a minimum.”
The need to access outside spaces is also underestimated, her research has found.
“No access to fresh air and the outside means people get restless and frustrated and they are deprived of sunlight, which leads to a lack of vitamin D and their muscles are less effective and they are more likely to fall and their bones to break. Research has also shown that exercise can reduce some of the symptoms of dementia.
Most dementia care environments are too noise, particularly dining rooms. They can have the effect of making people anxious and upset and they either act out or they become withdrawn
“This means people with dementia need outside spaces where they will be safe and where staff will feel confident about. Doors handles need to be easy to operate and people need protection from the elements.”
Improved toilets are also needed, with an increase in numbers and clear signage featuring both words and pictures.
Professor Marshall said: “Often people can’t find the toilets, so they are much more dependent on staff unnecessarily.
“We need to provide plenty of toilets and we need to paint the doors a bright consistent colour and use clear signage.”
The need for design improvements was supported by Sarah Waller, programme director of the King’s Fund’s Enhancing the Health Environment Programme. It has helped dozens of hospitals up and down the country to improve accommodation for people with dementia.
She said: “The environment really does matter. Sometimes the projects we have been involved with don’t just change environments, they change lives.”
Around 25% of patients in general hospitals in the UK are likely to have dementia, and this figure is expected to soar as the population ages.
Waller said: “When people come into hospital, in particular, we stop them from being independent in terms of something as simple as going to the toilet because they can’t find it, or they can’t see the toilet seat or work the taps, or complicated sensor lights mean they are plunged into darkness, which can be particularly frightening.
“It is about helping people to know where they are, helping them to find their bed area, and giving them something familiar to do or to look at. It’s the little things that can make an enormous difference.
“A tin of coloured paint doesn’t cost any more than a tin of traditional magnolia paint, but the effect it has is significant.
Floor coverings need to be constant and with no contrasting threshold strips. It may sound boring, but if it means people don’t fall over then it’s the best thing
“The environments we have improved are helping staff to help patients to be less agitated and stressed. There is very good data showing improvements lead to a continued reduction in aggressive behaviour and an increase in staff retainment, recruitment and morale.”
One of the biggest bones of contention during the conference session was the growing trend for ‘racetrack’ corridor designs. These are thought by many to be better for dementia sufferers, who can often become anxious and frustrated when they reach the end of a traditional corridor and are faced with either a solid wall or locked fire door. Racetrack designs, in contrast, enable people to walk continuously without encountering obstacles.
Professor Marshall said: “I hate the word ‘wandering’ as it is a normal activity - that is to want to walk. Walking excessively is often due to not sleeping or stress and racetrack corridors mean people can just go round and round and get dehydrated. It is about creating places for them to walk to that are interesting so they can walk as much as they want to, but it is not relentless.”
Devereux Architects is one company that does not use racetrack designs. A spokesman told the conference: “We use a model that has moved away from the loop, where there are corridors, but there are things to do such as fish tanks to look at or nice views.”
It is about helping people to know where they are, helping them to find their bed area, and giving them something familiar to do or to look at. It’s the little things that can make an enormous difference
And Waller is calling for greater consultation with users and their carers and relatives when improvements are being made.
“Carers know what their relatives need and we do not listen to them enough,” she said.
“Consultation whenever improvements are considered is key and that’s with everybody involved, from staff to service users, their families and the local community.”
Professor Marshall concluded: “We are slowly winning the battle to create better environments for people with dementia.”
