Building solutions for people with dementia

Almost 70% of people living with dementia continue to do so in their own homes, rather than in residential care, despite this, research about building design solutions has primarily focused on residential care.

Building Better Homes and Spaces researchers have recently published two literature reviews examining research related to dementia-friendly housing design. They identify the housing issues for those living with dementia and the gaps around the existing research.

Lead researcher Dr Bev James said housing poses a challenge for many people with dementia, since cognitive impairments can hinder their ability to engage with and adapt to their living environment.

“Ideally, housing should address and adapt to their changing needs. In the review we focussed on building design elements that address entrance and exit solutions; self-navigation; day-to-day self-management and independence; enjoyment and ambience of the home; and the mitigation of behavioural issues that might lead to institutionalisation.”

“We found that recommendations for home design have evolved from research that is actually focussed on residential care. While many design features in institutional settings may be useful in housing, there is a lack of research assessing the applicability, transferability, and efficacy of those design features to housing,” says Bev.

Bev says that building design needs to take into account the interrelated impacts of design solutions on the varied circumstances of people with dementia, their design preferences, and how they use their living environment. “However, these aspects are often missing in research or only cursorily considered. There has been a lack of consultation with people with dementia, although a more person-centred focus is evolving.”

The physical environment of the home can be a protective factor for health and wellbeing. The home can have a therapeutic effect, and addressing physical defects of the home environment can delay or reduce the need for residential care.

“It is great to see a more holistic approach to building design emerging. Several studies advocate for design features that enables social, cultural, and psychological wellbeing, in addition to physical wellbeing.

“It is important to remember though the diversity of people with dementia. No single building design solution can address the housing needs of all people with dementia. They are a diverse group with different experiences of health and disability and varied social and cultural backgrounds. Also, their needs change as they experience different stages of dementia. An important solution in New Zealand is to incorporate Māori cultural values and practices into housing for Māori whānau living with dementia.”

Characteristics, such as dwelling size, layout, number of levels, and tenure also all influence the type of design solutions that are possible and effective for people with dementia.

“Building design has the potential to reduce the burden on formal or informal caregivers and to increase their safety. It can also reduce or delay the demand for health and care services.

“Unfortunately, we identified a wide range of barriers to the take-up of building design solutions including a lack of dementia-friendly design principles and standards in housing policy and building regulations; a low awareness of dementia-friendly building design among people with dementia, their carers, professional groups and practitioners, and in the wider community; concerns about stigmatising impacts of design; and misunderstanding about costs of design interventions. Many of the building design solutions have not been well studied as to efficacy. There is good-to-strong evidence for some specific interventions but evidence about other solutions is inconclusive or contradictory. For example, there is a lack of synergy and potential conflicts between dementia-friendly design and accessible and universal design. There is some evidence of contradictions between design for sight loss, and design for controlling challenging behaviour, or regulating access. Designing for safety can also conflict with dementia-friendly design.”

The researchers identified a range of research gaps, including specific building design solutions as well as knowledge gaps. There is a particular lack of research about the housing needs and building design solutions for Māori living with dementia. Although, Bev says there is a rich platform for developing dementia-friendly housing design for Māori whānau based on Māori building design guides, and Kaupapa Māori health and wellbeing frameworks.

Despite the limitations of the research, the literature reviewed highlights building solutions where there is evidence of success. Those areas include:

• Regulating access, through camouflage, placement of locks, and limiting the number of entrance/exit points.
• The use of colour and different materials to distinguish between different spaces and functions, and to enhance visibility.
• Simple, easy to understand layout and avoidance of long corridors.
• Direct visual sightlines to relevant and important places and spaces.
• Ensuring that spaces have an unambiguous and unique character and function, which do not give confusing messages.
• Ensuring natural and artificial lighting is appropriate to the space and specific tasks, and glare is reduced.
• Appropriate siting and sizing of windows.
• Controlling unnecessary sensory stimuli such as light and noise.
• Ensuring thermal comfort.
• Universal design features such as non-slip flooring, level entrances, walk-in shower, lever handles and taps, providing these features are understandable and easy to use for the person with dementia.
• Use of systems with safety features that monitor or shut off gas or water if required.

Bev says that to develop strong New Zealand-based evidence that builds on international evidence for dementia-friendly building design solutions, there is a need for more research about the adequacy of housing in which New Zealanders with dementia live, their design preferences, and their ability to access design features that support their independence and wellbeing.

Read the literature reviews

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