Falls
signage, which is an additional element which needs to be decoded and interpreted.
The need to be holistic There is a lack of awareness and understanding of the issue and the scale of the need within the design profession and the general population.
As designers and commissioners, we often put too much emphasis on aesthetics and fail to recognise the importance the functionality of the design has on occupants and staff. The former creates first impressions, the latter creates lasting long-term impacts on ease of use, comfort, accessibility, and ultimately wellbeing. You can design for both if the challenges are understood. If done correctly interventions will work seamlessly into the chosen design aesthetic.
It is imperative that care home operators brief and commission designers with the required knowledge, expertise and understanding to ensure facilities are fit for purpose and do not inadvertently put residents at risk. Too often care homes look nice, claim to be inclusive and ‘dementia friendly’, but in reality have very little functional and cognitive knowledge designed in.
Physical obstructions can and do result in falls, but it is only when we take a holistic view of an environment and the elements within it can we begin to see other contributing factors which might account for unexplained falls. What the abled bodied among us adapt to or even ignore can pose a real and dangerous fall hazards for many living with CSI. At DDS, we aim to design familiar and
intuitive spaces with minimal unnecessary visual and auditory distractions. This will allow people to read and understand their surrounding with minimal effort and allows them to use their remaining available capacity to enjoy and engage in their surroundings and the people within it. Inclusive design is a specialist design field which has evolved and advanced greatly in recent years, long past simple interventions like increasing contrast. I hope that designing for the needs of those with cognitive or sensory additional needs will become a ‘new normal’. It is an evolving science with 40 plus years of supporting evidence and research. A specialist design discipline that needs to be integrated into the design process. It takes deep understanding and subject matter expertise to design an environment to reduce falls
February 2023
www.thecarehomeenvironment.com
and make them truly inclusive for people with CSI. It is far better to design with this understanding from the outset than to try to compensate for poor design at a later stage of the design process. You can always improve on an existing facility, but there is no substitute for getting the layout and design principles right from the start. This will allow people to live with greater dignity and independence and will reduce the impact on our stretched health and social care services. There will be less reliance and pressure on carers and more efficiencies for operators. Good design benefits all. Not every fall can be eliminated. There are far too many factors involved. But given that design changes are relatively simple and affordable with expert analysis and understanding of the issues, there is no good reason why design solutions should not be included in any major falls strategy or at the initial design of a new building or refurbishment. To not do so would be a lost opportunity.
Direct visual access to key facilities, such as a toilet upon leaving a dining room, reduces pressure on short term memory.
n
References 1
M.Montero-Odasso et al: Age and Ageing 2022; 51: 1–36
https://doi.org/10.1093/ageing/ afac205
2 Ibid 3
https://laterlifetraining.co.uk/wp- content/uploads/2011/12/FF_Effective- Interventions-in-health-and-social-care.pdf
4 Ibid 5
https://www.nhs.uk/conditions/falls/ 6
https://www.england.nhs.uk/south/wp- content/uploads/sites/6/2017/03/falls- fracture.pdf
7
https://www.ncbi.nlm.nih.gov/pmc/ articles/PMC27279/
8
https://www.ncbi.nlm.nih.gov/pmc/ articles/PMC4808743/ Allan, L. M., C. G. Ballard, et al. (2009) Incidence and prediction of falls in dementia: a prospective study in older people PLoS ONE [Electronic Resource] 4(5): e5521
9
https://pubmed.ncbi.nlm.nih. gov/20522279/
10
https://www.ncbi.nlm.nih.gov/pmc/ articles/PMC5366266/
11
https://www.ncbi.nlm.nih.gov/pmc/ articles/PMC2677107/
12
https://www.sciencedirect.com/science/ article/abs/pii/S0167494308001118
13
https://pubmed.ncbi.nlm.nih. gov/24132840/
14
https://www.building.co.uk/cpd/cpd-6- 2018-colour-considered-design-for-the- visually-impaired/
5093217.article
Fiona Walsh
Fiona Walsh is the co-founder and principal architect for DDS, a specialist consultancy designing spaces for cognitive and sensory accessibility and inclusion. Fiona is responsible for setting new best practice for the design and development of best-in- class spaces for cognitive and sensory accessibility and inclusion. She is a practicing chartered architect (
B.Arch FRIAI RIBA ARB) of distinction and holds two Fellowships, one in architecture and one in Brain Health, from the Global Brain Health Institute. Her work has been published in the Lancet Neurology and the American Journal of Geriatric Psychiatry, and she has written audit reports and community design guides for the National Dementia Office, Ireland, and blogs on design for Alzheimer’s Disease International.
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