Dementia care


Encouraging discussion about accessible design


Disabling environments make life with dementia harder than it needs to be, but problem- solving and designing with people with dementia can help eliminate most of those problems, says Dr Julie Christie, service manager (international) for HammondCare


The importance of design in residential environments for people living with dementia is increasingly recognised as an essential component of care. There are some wonderful examples of good design, but there are also many examples of design that does not work for people with the condition.


Design is an integral part of our lives. When it works well, it is an intuitive thing and on the whole we are unaware of it. The opposite is true of poor design. When design is thoughtless, it becomes disabling and even frightening, resulting in stress and distress, anxiety, frustration and unnecessary dependence. Design experts working with people with dementia know about dementia ‘the condition’ and there are many design schools to inform on the impact of light, noise, signage and so on. However, when you speak to people with dementia you begin to see the human cost of getting design advice wrong.


One example of this is the rise in the inappropriate use of murals in environments where people with dementia live. Thinking about design from a co- production perspective can help us to avoid design clichés and misinformation (such as red toilet seats) and re-focus the discussion on the disabling feelings and experiences that occur when environments do not work for everyone.


Co-production


Co-production is a new way of working that makes the best use of the skills and knowledge of everyone in a community affected by a problem, using everyone’s resources to develop a solution. This might sound like common sense, but for people living with dementia, assumptions are made that they are not able to contribute to complex subjects such as design and planning; they can be seen as the recipients of care rather than as co- contributors.


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Co-production is an authentic relationship between the people involved. Therefore, it is not the same as consultation or participation. Instead, it addresses environmental,


communication, information sharing and decision-making inequities, for example, those that would make it difficult for people with dementia to engage in a meaningful way. When we do this we think about design in terms of the personal, for example, fear of falling, getting lost, feeling stupid or frightened, embarrassed, overwhelmed or angry and not knowing why.


People with dementia are very different from one another and their needs can be extremely varied. Dementia is a disability. Many people with dementia are older and also experiencing health and biological changes associated with ageing. Sensory changes are a good example of this. Many people also live with other health conditions. Dementia does not


exist in a vacuum. Some people with dementia may not wish to participate in formal events and meetings and some may not be able to if appropriate preparations are not undertaken. However, on principle, it should be the norm for people with dementia to be part of the discussion when it comes to design that affects their lives. Many people with dementia have voiced frustration at being “researched upon” or involved in evaluations or events, but never being told about the results.1


This is no longer acceptable. People living with dementia need to be involved in design not as an ‘additional extra’ or ‘something nice to do’, but because we know that what works for people with dementia will help everyone.


A new perspective


The Design School hosted by the Dementia Centre at HammondCare provides a forum where people with dementia can learn about research on


www.thecarehomeenvironment.com • March 2020


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