Home Style
With 1 in 11 people over the age of 65 in the UK having dementia, it is becoming increasing important – and urgent – to ensure their safety, health, and quality of life.
To find out the impact that interior design can have on people living with dementia, we speak with Diana Celella, Managing Director, Drawing Room Interiors (DRI), Dr Emma Williams, Consultant Behaviour Analyst, Positive Ageing Consultancy & Training, Jacqui Smith, Managing Director, HomeSmiths Ltd., and Melissa Magee, Managing Director and Architect, Carless + Adams Ltd., to ask them what their experience in this sector has taught them.
(this feature is available as a flip-book here, and also downloadable as a pdf via the link under the images on this page.)
Tell us a little about a recent project you've worked on?
Diana: Recently, I worked on a new-build Care Home facility. The goal was to create an environment that felt both homelike and safe for residents living with dementia. My favourite part of the project was collaborating with a local artist to produce stunning wallcoverings that featured local architecture.
Incorporating local features into the design not only enhanced the aesthetic appeal but also evoked memories and sparked conversations among the residents. This approach helped create a sense of familiarity and comfort, making the environment more engaging and meaningful for them.
Emma: I recently worked on a project focused on the strategic rearrangement of furniture within a communal living space in a care home for people living with dementia. The aim of the project was to increase engagement between residents and engaging with activities, providing measurable outcomes. This thoughtful redesign was aimed at facilitating easier, more meaningful interactions among residents by ensuring that they could see and hear each other better and had readily available access to enjoyable and purposeful activities.
The outcomes of this initiative were immediate. Following the rearrangement, there was a noticeable increase in the indices of happiness among the residents, as observed through their increased social interactions, enhanced engagement in activities, and overall more positive demeanour. Communication and engagement incidences went from 0-10% of observed sessions to 15-71% after the rearrangement.
Simple interventions such as environmental modifications can be powerful in supporting the emotional and psychological well-being of older adults with dementia. My favourite part of the project was being able to facilitate an improved quality of life for the older adults living in the care home from a simple, zero-cost intervention.
Jacqui: Being part of the design team for the new Blind Veterans UK Rustington Centre for Well-being was a genuine privilege. As an interior designer with a visual impairment and an understanding of how surroundings play such a key role in maintaining independence, this project was special for me.
The client had purchased an existing building, and we were engaged to collaborate with the architect to transform it into a centre which truly reflected the needs of the charity and supported all the work they do for Blind Veterans.
Our scope covered all communal areas from reception, café, lounges, dining, library, therapy room and salon, as well as the bedrooms. My favourite part was being there on the day some of the permanent residents moved in, seeing them enjoy their new home. I was one big goosebump!
Melissa: The design we created for Green Trees in Exeter keeps us proud as it achieved Stirling Gold a decade ago and has helped pave the way for future and current designs. Research gathered by the University of Stirling enabled a decision from Dementia Services Development Centre (DSDC) to award the building accreditation 'Gold' award for dementia design. Many architects in the UK query the Stirling Gold standard however currently this is the only standard that can be used to measure such elements.
Green Trees was the first C2 building in the UK with a green wall and we feel was ahead of its time. Green walls are now an integral part of many residential and commercial buildings as the benefits of green therapy are well known and supported. An inspirational project whose phase 1 has just welcomed residents has green walls designed within the space which illustrates the longevity and impact of this element.
The visual impact has a far reaching positive effect on residents, many of whom have been within an integrated NHS vanguard site and moved to the relationship centred care element. Alongside PV, green walls and roofs play a constant design element due to their positive benefits.
Many of the care homes Carless + Adams designs for often have a dementia wing or floor. Sadly as 1 in 11 people over the age of 65 have dementia in the UK, and with this number increasing as people are living longer, this is a fundamental consideration in our designs.
What do you most frequently find has been overlooked in the brief when you are surveying a new project?
Emma: As a behaviour analyst, I assess environmental factors to analyse their effect on people's behaviour. I find that wayfinding cues and clear signage are commonly overlooked within some care environments. People with dementia benefit greatly from an environment that supports with orientation through a variety of visual cues, such as pictures, symbols, or photographs that can help them navigate their living spaces more easily and with greater confidence. It is beneficial to have different versions of a wayfinding sign (e.g. signs, symbols, photographs etc) so that it is more easily understood at different stages of dementia.
Incorporating different elements into the design and layout of care homes can create a more supportive and engaging environment for individuals with dementia, ultimately leading to a reduction in distressed behaviour, an increase in independence, and improved quality of life. It's essential to view the care environment through the perspective of the person living with dementia, ensuring that the space is not only safe and functional but also enriching and enabling.
Jacqui: Acoustics! As we age, our hearing changes and it can become very difficult to hear properly. Noisy environments just make this worse and too much noise can be incredibly overwhelming and stressful, especially for residents living with cognition issues. Acoustics play a vital role in care home design. Dining rooms with lots of hard surfaces and corridors without carpet can be problem areas. We have used acoustic voiles in dining rooms, noise absorbing acoustic art panels and usually specify carpet in corridors or a cushioned vinyl.
Melissa: Elements that may have been overlooked in the brief are often naturally included by our architects due to their inquisitive, creative nature with the desire to provide residents and care givers with the best possible environment. The home in which people live has a big impact on their health, and this is more so with those who have a form of dementia. Consideration is made to the individual's needs no matter how unique or specific to ensure that their surroundings help, not hinder them.
Circadian rhythms – the most known one being the awake-sleep cycle – alongside temporal orientation enables people to distinguish between day and night plus year and season. Designing to incorporate light as much as possible will give natural clues to highlight changes in daylight which distinguish time of day and also what time of year it is. Access both physically and visually to the outside has a big impact on individual's awareness and independence.
Ensuring that people are integrated rather than separated by dementia can be achieved by designing areas with a specific purpose. Encouraging people to find their own way through familiar areas to designated areas can be made easier with this designated pathway, borders and colour schemes. Independence is important to the individual as it can provide confidence and lessen anxiety, however we must be mindful that everyone has different experiences with dementia and this needs to be taken into account.
Diana: One element that is often overlooked is proper wayfinding. Many facilities do not initially consider how crucial clear and intuitive wayfinding can be for residents with dementia. It's essential to have easily recognisable signs and visual cues that help residents navigate the space independently and safely. These small details can significantly reduce anxiety and confusion for residents.
What element(s) have you specified that have not been previously considered by your client?
Jacqui: At a care home completed this year, we specified a preserved moss wall in a double height reception/café space. The client was not sure at first, but we felt it would add to the scheme as a biophilic design feature as well as improving the acoustics in the space. We were delighted with the result, as was the client.
Melissa: Design plays a huge part in the wellbeing of care home residents and even more so for those who have dementia. Consideration of the dementia residents' needs are a priority for Carless + Adams and often clients rely on our experience to advise specifics to them in order for this to be achieved.
Something that is rarely discussed but of paramount significance is way finding. Enabling people living with dementia in care homes to navigate their way around the home, and identify areas for their purpose, is so very important. Simple design solutions such as having a destination or something of interest at the end of a corridor will engage the person and avoid confusion.
Similarly, not opening their bedroom door onto a door opposite will ensure that the person leaves their room and joins the flow of the corridor rather than be confused as to whether they should enter the opposite door.
Smaller scale areas are less likely to cause disorientation, so this is considered when designing communal areas such as dining rooms or activity areas. Clear lines of sight enable the environment to be understood and items within that area identified for their purpose, for example having the ensuite in view of the bed so that people can see where it is.
Diana: I think that sometimes people underestimate the impact that dressing the finished design with artwork and accessories can have. In our projects, we use a mix of artwork and accessories, including tactile objects that people can feel and touch. These elements add a sensory dimension to the environment, enhancing the overall experience for residents. Clients have been particularly pleased with how these finishing touches bring warmth and personality to the space, making it feel more homelike and engaging.
Emma: I was asked to carry out an initiative at mealtimes on a hospital ward for people with dementia to maintain independent feeding skills and enhance the experience. Typically, when people with dementia enter hospital, some vital skills (such as feeding or washing etc) can rapidly decline if people are not given the opportunity to engage in those behaviours. The intervention was the introduction of 'Family-style Dining Experiences.'
This method involved serving meals in a communal setting, where dishes are placed at the centre of the table, allowing people to serve themselves or be assisted by staff. Easy to use utensils and a variety of visual cues were placed in prominent positions that indicated how to serve dinner.
This approach not only aimed to replicate the familiar and comforting atmosphere of a family meal but also encouraged independence and choice, providing a sense of control over their dining experience.
On the ward, people with dementia who previously experienced distressed behaviour during conventional mealtimes became more engaged with others around them. This increased engagement led to a noticeable improvement in food intake and a reduction in distressed behaviour at mealtimes. I was particularly pleased with this intervention because it demonstrates simple low-cost considerations that improve quality of life with purposeful and meaningful interactions.
Do you have any advice regarding interiors that is beneficial to those living with dementia?
Melissa: For those living with dementia we must remember that cognitive function is impaired but also so are their senses. Perception can change for people and this includes misperceptions and misidentifications, hallucinations, delusions, and time-shifting all of which can make for upset, distress, anxiety and anger. Designing for dementia must consider what the individual could be experiencing to ensure that this upset is not amplified.
The strength of relationship between interior and structural design can help. Having clear boundaries, such as hand rails or skirting boards in a different colour to the walls enables people to identify between the functions. Ancillary doors do not need to be identified differently by colour as this can create confusion about whether they should be used or not – neutral colour is better.
Way finding and clear lines of sight are so very important to those with dementia as these enable them to function independently, avoiding anxiety and confusion and ensuring their safety at all times.
Emma: There is a wealth of information available about the design of homes for people living with dementia. Having items around which are familiar and comforting makes the environment more homely and person centred.
In my experience, some of the most useful intervention developments in is the application of smart home technology and the way it can be used to enhance and maintain independence for someone living with dementia. For example, the use of motion activated lights that guide the way and help prevent falls at night in the dark, or the use of personalised voice activated prompts to help complete tasks. This is an area I would like to explore further.
Jacqui: Flooring, whether carpet or vinyl should have minimal pattern and adjacent flooring surfaces should be very similar in tone so as not to suggest a step which might cause a resident to fall. We use a mixture of paint and wall coverings in our projects, depending on the budget and brief. Every colour choice we make is made with tonal contrast in mind ensuring that residents can make sense of their environment and navigate independently and safely.
Selecting adjacent surfaces with a minimum of 30 LRV point difference will ensure that residents can make sense of their environment. Examples include handrails contrast with the wall and skirting with floor. Surfaces in general should be matte rather than shiny so as to avoid glare.
With the average 85 year old requiring three times the amount of light to see properly as an average 18 year old, good light levels are important for all residents, especially those living with dementia. Lighting should be selected so as to minimise glare which can be very disorientating to residents.
For acoustics, see my previous reply. Furnishings should be practical of course, and with the wide range of fabrics and softer vinyls available these days, designers have plenty of options to choose from. A range of chair styles and seat heights will offer residents choice and make a space less institutional. By selecting fabrics which contrast with the rest of the room or piping that contrasts with the main fabric of the chair, furniture provides another opportunity for supporting independent movement as residents will able to better understand their surroundings. Clusters of seating will promote resident engagement which is so important in supporting cognitive health. I always use warm palettes rather than cooler ones as warmer tones feel more inviting and homely.
When it comes to wayfinding, people navigate by objects over colour or numbers and this really help in a care home through accessories, pieces of furniture and of course distinctive art.
Any final words?
Diana: It's important to remember that designing for dementia is not just about safety and functionality, but also about creating spaces that promote dignity and independence. Engaging with caregivers and residents themselves during the design process can provide invaluable insights.
Everyone's experience with dementia is unique, so personalised solutions often yield the best results. Creating a sense of community and connection through thoughtful design can greatly enhance the quality of life for those living with dementia.
Jacqui: A sense of home should be at the heart of all care home design. People living with dementia need to feel calm, safe from falls, safe from infection, be able to navigate with ease, see as well as possible, encouraged to eat and hydrate well and be able to sleep. A homely well-designed environment will do all of these things. And as a last word, interior design should always support the care.
Melissa: Knowledge and experience gained by designing for dementia needs to be shared across different markets as it provides such valuable insights. There are some similarities of peoples requirements for those who are neurodiverse and the learnings made for dementia can benefit here too.
Want to contact any of the participants in this forum?
Diana Celella
www.drawingroomint.co.uk
info@drawingroomint.co.uk
Dr Emma Williams:
www.positiveageingconsultancy.co.uk
emma.williams@positiveageingconsultancy.co.uk
Jacqui Smith:
www.homesmiths.co.uk
Melissa Magee:
www.carless-adams.co.uk/
enquiries@carless-adams.co.uk