Carlos G Medina-Rivera
SELECTED WORKS __ 2017-2018
MASTERʼS PROJECT HOLDING ON TO HOME
A
los que olvidaron su historia y se quedaron con el cariĂąo de los suyos
Para ti: Evelyn y a todos los olvidados.
FIG.1, “What was I going to say?”
A Terminal Master’s Project Submitted in partial fulfillment of the requirements for the degree of Master of Architecture School of Architecture and Community Design College of the Arts University of South Florida May, 2018
HOLDING ON TO HOME: Architecture, Mind and Memory by Carlos G Medina-Rivera Chair Steve Cooke
Professor of Architecture University of South Florida
Committee Dan Powers Professor of Architecture
University of South Florida
Eileen Poiley
Robert Shumake
Director of Education USF Health Byrd Alzheimer’s Architect Shumake Architecture, PA
Guest Critics Martin Gunderson Randy Teal Michael Berk Oana Stanescu
© Copyright 2018, Carlos G Medina-Rivera
II
FIG.2, “Unforgettable Moments”
ACKNOWNLEDGEMENTS This Master Project became a reality with the kind support and help of many individuals. I would like to extend my sincere thanks to all of them. Foremost, I want to offer this endeavor to our God for the wisdom, the enthusiasm and the guidance to find the answers for my project. I am grateful to my Mother, Father, Sister and Niece for always being there when I needed them the most and how they continuously encourage me to follow my dreams. I would like to express my sincere gratitude to Prof. Steve Cooke and Prof. Daniel Powers for the support, guidance, and for believing in me. I am also grateful to my all my friends that have been there through many difficult areas in my life. Lastly, I would like to express my sincere appreciation to Eileen Poiley for supporting me throughout my thesis study and her hard work fighting against Alzheimer.
IV
Content 002
ABSTRACT
004
INTUITION THESIS STATEMENT
006
UNDERSTANDING EXTRACTION FROM DATA
010
ACCOUNTABILITY INTERVIEWS AND MEETINGS
012
APPERCEPTION HOW THE BRAIN WORKS
014
MANIFESTATION ALZHEIMER SYMPTOMS
022
DENIAL | ANGER | APATHY UNDERSTANDING BEHAVIOR
026
EMPTINESS DIFFERENT TYPES OF CARE
032
MY SAFE PLACE MY LEGACY OF MEMORIES
034
SADNESS ISOLATION
036
HEAL MY SOUL HEART AND MEMORIES ARCHITECTURE + ALZHEIMER
038
REFORMATION REVIEWS AND PRESENTATIONS
040
RESURECTION NEXT STEP
042
HOPE PROCESS AND RESULTS
046
EVELYN
050
ERODITA
054
REGINA
058
LYDIA
062
SECTIONS
064
CONCLUSION
066
BIBLIOGRAPHY
068
LIST OF FIGURES
VI
FIG.3, 2016 Venice Biennale: Irish Pavilion, Losing Myself
ABSTRACT In 2013, Evelyn Maestre Cedeño was diagnosed with Alzheimer’s. She ran away from her daughter’s house to her mother’s home where she spent most of her life. She was looking for that comfortable place reminiscent to her childhood and even though she was 30 miles away, she found home. This inspired the question, can architecture help mediate Alzheimer’s? For a long time, architecture has served only to provide two basic needs; shelter and order. Creating a space that can give more than just shelter and order would help those suffering from this disease. Most medical facilities fail to alleviate the needs of Alzheimer’s patients. Alzheimers has been around for more than a century and it is a mystery for the medical field. Patients typically get diagnosed at the age of 65 and at a certain point they suffer from irreversible damages. Typically following diagnosis, patients are removed from their homes, families, and familiar environments and put in a place less conversant to them which results in them getting more ill. What elements can be used to improve their new environments? I am looking to create a place for people, like my aunt Evelyn, where they can feel comfortable and safe where they can get alleviated in the middle of their madness.
ABSTRACT | 002
INTUITION
THESIS STATEMENT
Two years ago, my aunt, Evelyn Maestre, passed away due to Alzheimer. Before she passed away, I was blessed to see her even though it was not in the best moments of her life. Seeing her ill-formed barely allowed me recognize her. It was as if an uninvited spirit had possessed her body and her previous identity had been lost. I had known her all my life as a calm and stern woman but all that came out of her mouth were curse words as she hid from us in the corner of her bed. It was also clear she was internally wounded, her body and language clearly exhibited that. She had lost more than fifty pounds in a year. Her daughter did not want her mother to be put in a Memory Care facility or anything similar to that so she did the best she could with the knowledge she had about this disease. She created a room for her that was located outside of the house, and the main access was through an enclosed garage. She lived in her daughter’s house but over the years it became
more difficult to provide security for my aunt. Consequentially my aunt was relocated to place where she was isolated from everybody and ultimately it felt as if she was behind bars. After speaking with my cousin, she mentioned that Evelyn ran away from her house to her mother’s where she grew up. She was looking for a place reminiscent to what was considered comfortable for her. Even though she was 30 miles away, she found home. At that moment, I understood the significance of architecture and its role in the lives of Alzheimer’s patients and others affected by it. I know that architecture cannot cure Alzheimer but I believe that it can slow down the illness. I hope to create a place for people that are like my aunt Evelyn; a place where they feel comfortable and safe in middle of their madness.
Throughout my research, I found that there was barely any information on the topic of how spaces affect Alzheimer patients. In America, doctors and scientists gear their research towards medicinal approaches instead of changes in the environment in which they are placed. Research such as how isolation can cause more stress, and affect the lifestyle they live is very rarely found. Even though other countries have studied the psychological areas that can cause or add up to the Alzheimer’s disease, the United States is still behind. After visiting the Byrd Institute, I confirmed that there is not direct information given to the caregivers about how to arrange a space for an Alzheimer’s patient. It makes you question how bad it could be if a patient is removed from their comfortable spaces which happened to my aunt, Evelyn.
FIG.4, In the field of Destruction
THESIS STATEMENT: Intuition | 004
UNDERSTANDING The brain disease that has come to be known as Alzheimer’s disease was first recorded in November of 1901.1 The chain of events began when Karl Deter brought his wife, Auguste, to the Städtische Heilanstalt für Irre und Epileptische (City Hospital for the Mentally Ill and Epileptics) in Frankfurt, Germany. 1 Auguste’s behavior made it almost impossible for Karl to work anymore. She would sometimes wake up in the night and scream for hours.1 Knowing what we know now of Alzheimer’s disease, she undoubtedly needed a lot of personal care.1 Upon her admission, she was interviewed by a resident at the hospital, a young
1
Alzheimer’s Disease - A Brief History & Description, 2008
EXTRACTION FROM DATA
doctor named Aloysius Alzheimer. He had joined the staff at the hospital thirteen years earlier and was pursuing his interests in psychiatry and neuropathology.1 Auguste Deter had problems with her memory and with reading and writing. She also showed signs of disorientation and therefore diagnosed with presenile dementia.1 In that initial interview, Dr. Alzheimer asked questions very similar to those that would be asked by a doctor today who was screening for the disease that was named after him. The patient file for A. Deter survives today.1 In it, a note written by the doctor on November 26, 1901 includes this paragraph:
Alzheimer’s Disease -
A Brief History & Description
2008
“She sits on the bed with a helpless expression. What is your name? Auguste. What is your husband’s name? Auguste. Your husband? Ah, my husband. She looks as if she didn’t understand the question. Are you married? To Auguste. Mrs D? Yes, yes, Auguste D. How long have you been here? She seems to be trying to remember. Three weeks. What is this? I show her a pencil. A pen. A purse, key, diary and cigar are identified correctly. At lunch she eats cauliflower and pork. Asked what she is eating she answers spinach. When she was chewing meat and asked what she was doing, she answered potatoes and horseradish. When objects are shown to her, she does not remember after a short time which objects have been shown. in between she always speaks about twins. When she is asked to write, she holds the book in such a way that one has the impression that she has a loss in the right visual field. Asked to write Auguste D., she tries to write Mrs and forgets the rest. It is necessary to repeat every word. Amnestic writing disorder. In the evening her spontaneous speech is full of paraphasic derailments and perseverations.”
EXTRACTION FROM DATA: Understanding Alzheimer | 006
NDERSTANDING
During her stay, Deter’s condition worsened. She experienced cognitive decline and hallucinations, and eventually lost almost all cognitive ability.1 When she died on April 8, 1906, Alois Alzheimer was working at Royal Psychiatric Clinic in Munich with Emil Kraepelin.1 Upon learning of her death, Alzheimer requested that her records and her brain be sent to him in Munich. Auguste Deter was 55 years old when she died.1 Later in 1906, Alois Alzheimer presented the results of the autopsy of Frau Deter’s brain to the South-West German Society of Alienists.1 In his speech he described two abnormalities or the patient’s brain, neurofibrillary tangles and amyloid plaques, the plaques and tangles that have become synonymous with Alzheimer’s disease.1 Scientists can also see the terrible effects of Alzheimer’s disease when they look at brain tissue under the microscope. Alz-
1
Alzheimer’s Disease - A Brief History & Description, 2008 Disease and the Brain, 2011
2 Alzheimer’s
heimer’s tissue has many fewer nerve cells and snaps than a healthy brain.2 Plaques, abnormal closets of protein fragments, build up between nerve cells. Plaques form when protein pieces called beta-amyloid clump together. Beta-amyloid comes from a larger protein found in the fatty membrane surrounding nerve cells.2 The most damaging form of beta-amyloid may be groups of a few pieces rather than the plaques themselves.2 The small clumps may block cell-tocell signaling at synapses.2 They may also activate immune system cells that trigger inflammation and devour disabled cells.2 Our body produces this protein but when Alzheimer attacks the brain, beta-amyloid overproduces and our body tries to fight it but the chemicals are too harsh to the point it kills the proteins and the neurons as well.
FIG.5, Comparison of a healthy brain versus a brain with Alzheimer’s Disease.
Dead nerve cells contain tangles, which are made up of twisted strands of another protein.2 Tangles destroy a vital cell transport system made of proteins.2 Using an electron microscope one can see how there are cells with some healthy areas and other areas where tangles are forming. In healthy areas, the transport system is organized in orderly parallel strands somewhat like railroad tracks.2 Food molecules, cell parts and other key materials travel along the “tracks.” A protein called tau helps the tracks stay straight.2 In areas where tangles are forming, Tau collapses into twisted strands called tangles. The tracks can no longer stay straight.2 They fall apart and disintegrate. Nutrients and other essential supplies can no longer move through the cells, which eventually die.2
EXTRACTTION FROM DATA: Understanding Alzheimer | 008
FIG.6, 2017 Alzheimer’s Disease Facts and Figures
Alzheimer's disease is currently ranked as the sixth leading cause of death in the United States, but recent estimates indicate that the disorder may rank third, just behind heart disease and cancer, as a cause of death for older people.3 In 2017, Alzheimer’s and other dementias will cost the nation $259 billion. And by 2050, these costs could rise as high as $1.1 trillion.4 Dementia is a general term for a decline in mental ability severe enough to interfere with daily life.5 Memory loss is an example. But Alzheimer's is the most common type of dementia.5
2 Alzheimer’s
Disease and the Brain, 2011 Disease Fact Sheet, 2016 4 Facts and Figures 2017, 2017 5 What is Dementia?, 2017 3 Alzheimer’s
ACCOUNTABILITY
INTERVIEWS AND MEETINGS
It is really important to gather information from different sources in a topic like this. I interviewed family members with Alzheimer’s patients, caregivers, and Alzheimer educators. One of the most helpful figures in this research has been Eileen Poiley, Director of Education of the Byrd Institute at University of South Florida. Mrs. Poiley has been working in the industry for thirty years and both of her parents have Alzheimer’s. She educates people around Florida and she helps memory care centers create better environments for their patients. After discussing for three hours about how architecture has a big role in the Alzheimer patients, I learned the dos and don’ts. I believe there is no book with as much information like she had. Even the Byrd Institute did not have direct literature for the caregivers. After talking to her, I realized my main job for this project was to provide detailed and infomation of how to design a space for an Alzheimer’s patient.
INTERVIEWS AND MEETINGS: Accountability | 010
APPERCEPTION OF THE BRAIN
HOW THE BRAIN WORKS
Neocortex Responsible for higher cognitive functions and the integration of sensory information.
Hypothalamus Controls appetite, hormonal level, and sexual behavior. Hippocampus Important for memory and the learning of facts, sequences and places.
Amygdala Responsible for anxiety, emotion and fear.
FIG.7, Paper Abstract Human Brain on Dark Background
6
How your brain works, 1998
The brain contains billions of nerve cells arranged in patterns that coordinate thought, emotion, behavior, movement and sensation.6 A complicated highway system of nerves connects the brain to the rest of the body, so communication can occur in split seconds.6 Think about how fast you pull your hand back from a hot stove.6 While all the parts of your brain work together, each part is responsible for a specific function controlling everything from your heart rate to the change in your mood.6 The cerebrum is the largest part of the brain.6 It’s what you probably visualize when you think of brains in general.6 The outermost layer of the cerebrum is the cerebral cortex, the “gray matter� of the brain.6 Deep folds and wrinkles in the brain increase the surface area of the gray matter, so more information can be processed.6 The cerebrum is divided into two halves (hemispheres) by a deep fissure.6 The hemispheres communicate with each other through a thick tract of nerves, called the corpus callous, at the base of the fissure.6 In fact, messages to and from one side of the body are usually handled by the opposite side of the brain.6
Structures deep within the brain control emotions and memories. Known as the limbic system, these structures come in pairs.6 Each part of this system is duplicated in the opposite half of the brain. Nerve cells also known as neurons, have two main types of branches coming off their cell bodies.6 Dendrites receive incoming messages from other nerve cells.6 Axons carry outgoing signals from the cell body to other cells such as a nearby neuron or muscle cell.6 Interconnected with each other, neurons are able to provide efficient, lightning-fast communication.6 A nerve cell communicates with other cells through electrical impulses when the nerve cell is stimulated. Within a neuron, the impulse moves to the tip of an axon and causes the release of neurotransmitters, chemicals that act as messengers.6 Neurotransmitters pass through the synapse, the gap between two nerve cells, and attach to receptors on the receiving cell.6 This process repeats from neuron to neuron, as the impulse travels to its destination a web of communication that allows you to move, think, feel and communicate.6
HOW THE BRAIN WORKS: Apperception | 012
MANIFESTATION Alzheimer’s affect each person differently, but there are common warning signs. Some warning signs include memory loss that disrupts daily life, and challenges in planning or solving problems.7 Difficulty completing familiar tasks at home, at work or at leisure and confusion with time or place.7 Trouble understanding visual images and relationships between objects (spatial relationships) is also an effect of this sickness.7 People also suffer from new problems with words in speaking or writing, misplacing things and losing the ability to retrace steps, and decreased or poor judgment.7 One may also notice a withdrawal from work or social activities and changes in mood and personality.7
7
Ten Warning Signs of Alzheimer, 2015
ALZHEIMER’S SYMPTOMS
There are three stages, in which the symptoms of Alzheimer’s disease worsen over time, although the rate at which the disease progresses varies. On average, a person with Alzheimer’s lives four to eight years after diagnosis, but can live as long as 20 years, depending on other factors:
FIG.8, Table: Representation of the three different stages of the Alzheimer’s Disease with some of the beneficial rearrangement for the patient.
ALZHEIMER’S SYMPTOMS: Manifestation | 014
ALZHEIMER’S SYMPTOMS
EARLY STAGE OF DESTRUCTION In the Early Stage of Alzheimer's, a person may function independently. He or she may still drive, work and be part of social activities. Despite this, the person may feel as if he or she is having memory lapses, such as forgetting familiar words or the location of everyday objects.8 Friends, family or others close to the individual begin to notice difficulties as well. During a detailed medical interview, doctors may be able to detect problems in memory or concentration. Common difficulties include:
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- Problems coming up with the right word or name - Trouble remembering names when introduced to new people - Challenges performing tasks in social or work settings - Forgetting material that one has just read - Losing or misplacing a valuable object - Increased trouble with planning or organizing8
The Stages of Alzheimer’s Disease, 2017
FIG.9, Early Stage of Destruction Graphic
ALZHEIMER’S SYMPTOMS: Early Stage of Destruction | 016
ALZHEIMER’S SYMPTOMS
MIDDLE STAGE OF DESTRUCTION The Middle Stage of Alzheimer is typically the longest stage and can last for many 8 years. As the disease progresses, the person with Alzheimer’s will require a greater level of care At this point, symptoms may include:
- Forgetfulness of events or about one’s own personal history - Feeling moody or withdrawn, especially in socially or mentally challenging situations - Being unable to recall their own address or telephone number or the high school or college from which they graduated - Confusion about where they are or what day it is - The need for help to choose proper clothing for the season or the occasion - Trouble controlling bladder and bowels in some individuals - Changes in sleep patterns, sleeping during the day and becoming restless at night - An increased risk of wandering and becoming lost - Personality and behavioral changes, including suspiciousness and delusions or compulsive, repetitive behavior like hand-wringing or tissue shredding.8
It is really important that the patient has a caregiver all the time after the person hits the middle stage and stays around with family and friends and in a known place.8
8
The Stages of Alzheimer’s Disease, 2017
FIG.10, Middle Stage of Destruction Graphic
ALZHEIMER’S SYMPTOMS: Middle Stage of Destruction | 018
ALZHEIMER’S SYMPTOMS
LATE STAGE OF DESTRUCTION Finally, in the Late Stage of this disease, individuals lose the ability to respond to their environment, to carry on a conversation and, eventually, to control movement. They may still say words or phrases, but communicating pain becomes difficult.8 As memory and cognitive skills continue to worsen, significant personality changes may take place and individuals need extensive help with daily activities.8 At this stage, individuals may:
- Need round-the-clock assistance with daily activities and personal care - Lose awareness of recent experiences as well as of their surroundings - Experience changes in physical abilities including the ability to walk, sit and, eventually, swallow. - Increase difficulty on communicating - Becoming vulnerable to infections - Becoming more agitated and aggressive - They also may suffer from hallucination, delusion, illusions and/or paranoia.8
8
The Stages of Alzheimer’s Disease, 2017
FIG.11, Late Stage of Destruction Graphic
ALZHEIMER’S SYMPTOMS: Late Stage of Destruction | 020
DENIAL ANGER APATHY
UNDERSTANDING BEHAVIORS
Above are the symptoms and behaviors caused directly by Alzheimer’s disease and the changes that are occurring in the patient’s brain.9 The person may look fine but there are changes in the brain causing this change in character. Alzheimer’s disease does not directly cause troublesome behaviors and the caregivers can learn strategies to deal with the patient so they do not escalate into more troublesome behaviors.9 They are not evident in all individuals with the Alzheimer’s disease. Some can be reduced or eliminated with effective communication skills, behavioral strategies and adaptations in the environment. In some cases, medications may be necessary.9
9
Behavior Management and Communication Strategies with Persons with Alzheimer’s, 2013 and Agitation, 2015
10 Anxiety
. Sometimes the way caregivers and others interact with the patient or the environment can cause these behaviors.9 It is important not to argue with the patient and to learn how to best communicate with them. A big issue that relates to Alzheimer is Agitation.9 Agitation is a disruptive behavior that is not specific. It can be physical or verbal.9 Agitation in a physical sense is the need to walk, wander, or pace around. Verbal agitation can be complaints, requests for attention, being negative, repeated questions, and screaming9. Agitation and anxiety may be caused by a number of different medical conditions, medication interactions or by any circumstances that worsen the person’s ability to think.10 Ultimately, the person with dementia is biologically experiencing a profound loss of their ability to negotiate new information and stimulus. It is a direct result of the disease.10 Situations that may lead to agitation include moving to a new residence or nursing home.10 Changes in the environment such as travel hospitalization or the presence of houseguests are also factors.10 More causes or agitation can be taken into account such as
changes in caregiver arrangements, misperceived threats, and fear and fatigue resulting from trying to make sense out of a confusing world.10 Some ways to prevent or reduce agitation is by creating a calm environment. By removing stressors such as moving the person to a safer or quieter place, or offering a security object, rest or privacy it can reduce agitation on the patient.10 Trying soothing rituals and limiting caffeine use also work as well.10 Another method of prevention is avoiding environmental triggers such as noise, glare and background distraction like having the television on. Monitoring personal comfort is another prevention technique such as checking for pain, hunger, thirst, constipation, full bladder, fatigue, infections and skin irritation, and making sure the room is at a comfortable temperature. Being sensitive to fears, misperceived threats and frustration with expressing what is wanted are ways to prevent tension as well.10 Some things that have proven to help as well are simplifying tasks and routines, and providing an opportunity for exercise, or going a walk, gardening, or dancing and even simply putting on music.
UNDERSTANDING BEHAVIORS: Agitation | 022
AGGRESSION Another character trait that people from Alzheimer suffer is an issue of aggression which is hostile physical or verbal behavior. Physically that can be things such as hitting, pushing, tearing, spitting, kicking, scratching, biting.9 Verbal aggression is threats, accusations, name-calling, or obscenities.9 Some causes of aggression can be caused by many factors including physical discomfort, environmental factors and poor communication.11 If the person with Alzheimer’s is aggressive, one must consider what might be contributing to the change in behavior. Some issues include physical discomfort.11 Questions such as is the person able to let you know that he or she is experiencing physical pain should be asked. It is not uncommon for persons with Alzheimer’s or other dementias to have urinary tract or other infections.11 Due to their loss of cognitive function, they are unable to articulate or identify the cause of physical discomfort and, therefore, may express it through physical aggression.11 So other things that come into question are: • Is the person tired because of inadequate rest or sleep? • Is the person hungry or thirsty? • Are medications causing side effects? Side effects are especially likely to occur when individuals are taking
9
multiple medications for several health conditions?.11 Environmental factors are another thing to consider. Loud noises and an overactive environment or physical clutter can overstimulate a person with Alzheimer.11 Large crowds or being surrounded by unfamiliar people even within one’s own home can be over-stimulating for a person with dementia as well. Another thing is knowing whether or not a person feels lost. Most people function better during a certain time of day; typically mornings are the best.11 Considering the time of day when making appointments or scheduling activities and choosing a time when you know the person is most alert and best able to process new information or surroundings is important to understand when dealing with someone who has Alzheimer.11 Poor communication can cause aggression as well. One must make instructions simple and easy to understand.11 Asking too many questions or making too many statements at once can be hard on the patient.11 Also do not allow for the person to pick up on your own stress or irritability.
Behavior Management and Communication Strategies with Persons with Alzheimer’s, 2013 and Anger, 2015 12 Hallucinations and Alzheimer’s, 2015 11 Aggression
ALLUCINATION
The patient may also have hallucinations9. Hallucinations involve the senses, the patient may hear, see or feel things that are not there. To them it is very real, and it is recommendable to not argue with the patient, because it can make them more agitated.9 To prevent or reduce hallucinations something that helps is modify the environment that they are in. One idea is to check for sounds that might be misinterpreted, such as noise from a television or an air conditioner.12 Also look for lighting that casts shadows, reflections or distortions on the surfaces of floors, walls and furniture and urn on lights to reduce shadows. Covering mirrors with a cloth or removing them if the person thinks that he or she is looking at a stranger are some good environmental modifications to help reduce hallucinations.12 Some other behavioral characteristics include delusions, illusions, and paranoia. Delusions are the belief in something that is not true.12 For example, the patient is convinced that you are not who you are. The patient may believe that someone is stealing his or her things.12 An older female patient may think her son is her husband or she may think the postman is coming to steal from her every day. The term illusion refers to a form of senso-
ry distortion. An illusion is when a person misinterprets what they see, hear, feel, or etcetera.9 Paranoia is unrealistic blaming and beliefs. Patient may accuse family members or friends of stealing items from them or people are talking about them.9 Understanding all of these different behavioral characteristics and simple modifications that have proven to help can aid with figuring how to create spaces for these patients that can affect their mood and better their relationship with others.
FIG.12 & 13, Representation of stripes can may seem to the patient.
UNDERSTANDING BEHAVIORS: Aggresion and Hallucination | 024
EMPTINESS
DIFFERENT TYPES OF CARE
I believe spaces and being surrounded by loved ones can help slow down Alzheimers. For example, Erodita Carillo, a patient diagnosed with Alzheimer twenty years ago still lives at home where she raised her two children. Erodita still lives a normal life and still remembers a lot surrounding her past even though she does not remember names and other common things. She can also function on her even though she is under supervision and lives a pretty active life such as visiting the Alzheimer Day Center which she does different activities. She also travels as well to Florida to visit her other daughter and grandchildren. Erodita is a great example in that Alzheimer can slow down if you keep a positive and active mind. She has not been invalidated due to her illness.
13
Caregiver Center, 2015
There are different types of care such as Assisted Living, Nursing Homes, Memory Care, Adult Day Center or at home with a caregiver.13 The most common and effective care is staying at home if there is a family member or a caregiver available. It would be better if the patient stays where they spent most of their lives so they do not suffer from environmental stresses of unfamiliarity.
FIG.14, Portrait of Evelyn Maestre
Evelyn was born in Bayamรณn, Puerto Rico. She was mother of two children and she had five grandchildren. Most of her life she worked in the school cafeteria in an elementary school. She had a normal life, used to use public transportation or carpooling, visit her mom and children. In 2013, she was diagnosed with Alzheimer, her life changed completely. She stopped being independent, her personality started fading away to the point she was not recognizable anymore. She moved with her son for awhile but she started attacking her daughter-in-law so she was moved with her daughter where she had a part time nurse, but there was point of their lives that her daughter could not take care of her and they created a room in the garage where she was isolated. She did not have anything besides a bed and a mirror, and they had to remove the mirror because she will start arguing with her own reflection to the point that she broke it and cut herself. She never recovered and got worse overtime until her death.
DIFFERENT TYPES OF CARE: Emptiness | 026
FIG.15, Patients in Adult Day Care.
Adult Day Centers offer people with Alzheimer’s and other kinds of dementia the opportunity to be social and to participate in activities in a safe environment. Some benefits of day centers include a fulltime caregiver, and adult day centers that can provide a much needed break.14 While the person with Alzheimer’s is at the center, you’ll have time to rest, run errands or finish other tasks. That might make someone feel guilt for attending to their own needs when the person they care for is suffering from this illness but wearing yourself out to the point of total exhaustion will not be of any good use to a person with dementia. An adult day center can be very helpful as you try to balance a job with caregiving duties. Hours of service vary at each center,but some are open from seven to ten hours per day.14 Some also may offer weekend and evening hours, and transportation and meals are often provided.14
14 15 16
Adult Day Centers, 2015 Residential Care, 2015 Assisted Living, 2015
For people with Alzheimer’s and dementia, adult day centers provide a chance to be social and to participate in staffed activities such as music and exercise programs.14 The person with dementia will need time to adjust to the experience of going to the center. Some people may resist going at first, but they often look forward to the visit after several weeks of attending, meeting people and joining in activities.14 The services provided vary depending upon the center. Common types of services are counseling, health services, nutrition, personal care, activities, behavior management, therapy and special needs.14 Before going into more detail about these services I would also like to note that very few adult day programs offer all of the services described, and not all of the services are necessary for a program to be of high quality.14 Counseling as a service at the center may provide support services for people with dementia and their families. For example, they may offer guidance on outside resources and arrange for supportive care in the home.14 Health services is required if the person with Alzheimer’s requires medical services for example insulin shots, and help with taking medication. Some centers also may provide blood pressure checks and physical, dental, foot, eye or ear examinations.14 If the center provides nutrition one would ask if the center provides nutritious meals and snacks.
It is important for the adult caring for the patient to sample a meal to find out what it tastes like. If needed, ask if the center can accommodate a special diet or provide a culturally specific menu. Some centers also offer nutritional education programs.14 Personal care such as providing help with hairstyling, toileting, eating, showering and other personal care tasks is another service that could be provided.14 And daily activities may include music, art, recreation, discussion and support groups. It is important to ask what activities are offered for people with dementia.14 Also find out if the center is prepared to deal with behavior management. Such as dealing with behaviors associated with dementia. These many include wandering, incontinence, hallucinations, and sexually inappropriate behavior or speech difficulties.14 Therapy is also included in some centers. They help arrange for needed physical, occupational or speech therapy and they may have therapists’ onsite or on-call.14 Lastly is it important to consider special needs. Making sure the center can accommodate any special needs is invaluable. For example it is important to find out if the center is equipped to deal with someone who uses a wheelchair, who is hearing or visually impaired, or who is handicapped in another way.14 Knowing about any service restrictions before using a center may help prevent problems in the future.14
As for residential care, different types of facilities provide different levels of care, depending on the person’s needs. Some types of residential care include Retirement housing.15 Retirement housing may be appropriate for individuals with early-stage Alzheimer’s who are still able to care for themselves independently.15 A person may be able to live alone safely, but has difficulty managing an entire house.15 Generally, this type of senior housing provides limited supervision and may offer opportunities for social activities, transportation and other amenities.15 Assisted living is another kind of residential care; it is also known as board and care, adult living, or supported care.16 Assisted living bridges the gap between living independently and living in a nursing home. It typically offers a combination of housing, meals, supportive services and health care.16 Assisted living is not regulated by the federal government and its definitions vary from state to state.16 Not all assisted living facilities offer services specifically designed for people with dementia, so it is important to ask.16
DIFFERENT TYPES OF CARE: Adult Day Center | 028
The third kind of residential care is nursing homes; also called skilled nursing facility, long-term care facility, or custodial care.17 Nursing homes provide round-theclock care and long-term medical treatment. Most nursing homes have services and staff to address issues such as nutrition, care planning, recreation, spirituality and medical care.17 Different nursing homes have different staff-to-resident ratios. Also, the staff at one nursing home may have more experience or training with dementia than the staff at another. Nursing homes are usually licensed by the state and regulated by the federal government.17 Alzheimer’s special care units (SCUs), also called memory care units are the fourth type of residential care.18 SCUs are designed to meet the specific needs of individuals with Alzheimer’s and other dementias.18 SCUs can take many forms and exist within various types of residential care.18 Including assisted living facilities, and they may or may not be locked or secure units.18 Such units most often cluster settings in which persons with dementia are grouped on a floor or a unit within a larger residential care facility.18 Some states have legislation requiring nursing homes and assisted living residences to disclose their fees and list the specialized services their SCU provides, including trained staff, specialized activities and ability of staff to care
17 18 19 20
Nursing Homes, 2015 Memory Care, 2015 Genworth Financial, 2016 Hospice Care, 2015
for residents with behavioral needs.18 Because laws vary, it is important to ask specific questions about what type of care is provided in a SCU to ensure that the level of care is appropriate for the person.18
The last kind of residential care is formally known as continuing care retirement communities (CCRC). CCRCs provide different levels of care (independent, assisted living and nursing home) based on individual needs.18 A resident is able to move throughout the different levels of care within the community if his or her needs change.18 Payment for these types of facilities can include an initial entry fee with subsequent monthly fees or payment may be based solely on monthly fees.18
FIG.16, Patients living in poor conditions.
As for cost it care varies widely depending on the type of facility. The national average cost for basic services in an assisted living facility is $43,539 per year.19 In a nursing home, the average cost for a private room in a nursing home is $92,378 per year and the average cost of a semi-private room in a nursing home is $82,125 per year.19 Most families pay for residential care costs out of their own pockets. Types of benefits that may cover nursing care include long-term care insurance, veterans benefits and Medicaid.19 Medicare does not cover the cost of long-term care in a care facility. Medicare only covers short-term skilled care after a hospital stay.19 Another kind of care is hospice care. It focuses on comfort and dignity at the end of life; it involves care and support services that can be of great benefit to people in the final stages of Alzheimer’s and other dementias and their families.20 Hospice is a special way of caring for people who are terminally ill and for providing support to their family.20 The primary purpose of hospice care is to manage pain and other symptoms during the last six months of life where treatments focus on comfort rather than curing the underlying disease.20 Hospice care is provided by a team of specially trained providers, including doctors, nurses, home health aides, social workers, counselors, clergy and volunteers.20 Family is also very often very involved in the care.20
DIFFERENT TYPES OF CARE: Nursing Homes | 030
Examples of the care hospice teams provide include medical care to alleviate symptoms and pain (including medications and medical equipment), counseling about the emotional and spiritual impact of the endof-life, and respite care to allow caregivers relief, and grief support for the family.20The majority of hospice care is provided at home or in a nursing facility.20 There are also some free-standing hospice facilities and hospice units within hospitals in certain parts of the country. Hospice’ are usually covered under Medicare, as well as many Medicaid and private insurance plans.20 In-home care includes a wide range of services provided in the home, rather than in a hospital or care facility.20 It can allow a person with Alzheimer’s or other dementia to stay in his or her own home.20 It also can be of great assistance to caregivers. Not all in-home services are the same.20 Some in-home services provide non-medical help, such as assistance with daily living.20 Other
20 21
Hospice Care, 2015 Atender una persona con Alzheimer, pg.#83
in-home services involve medical care given by a licensed health professional, such as a nurse or physical therapist.20 One common type of in-home services are companion services. It helps with supervision, recreational activities or visiting. Personal care services such as bathing, dressing, toiling, eating, exercising are some other common in-home services.21 Homemaker service helps with housekeeping, shopping or meal preparation.21 Lastly, skilled care help with wound care, injections, physical therapy and other medical needs by a licensed health professiona.21 Often times, a home health care agency coordinates these types of skilled care services once they have been ordered by a physician.21 Costs for home care services vary depending on many factors, including what services are being provided, where you live, and whether the expenses qualify for Medicare or private insurance coverage.
MY SAFE PLACE
MY LEGACY OF MEMORIES
...SUNLIGHT bouncing off the marble tiles and touched upon our faces.
THE warm breeze coming from the front door passing through the hallway and disappearing through my bedroom apertures.
THE smell of the rain hitting the aluminum windows.
THE cold walls and floor of my parents room.
AS I swing underneath the mango tree, the shadows of its leaves dance on the dirt ground beneath me.
AN exhausting day of play; eating sweet and tender mangoes.
ALL my memories are resting in my inviolable space waiting for me.
ISOLATION: Sadness | 032
SADNESS
ISOLATION
FIG.17, Isolation.
i·so·la·tion /ahy-suh-ley-shuh n, is-uh-/ noun: The process or fact of isolating or being isolated. “the isolation of older people"
22
Wild Child: The Story of Feral Children, 2002
It is proved that isolation would be the worst treatment for any disease and Alzheimer is not the exception. Isolating Alzheimer patients does not do them any good. It is really important that our society understands moving the patients to a lonely room would accelerate the Alzheimer’s disease. Social disconnectedness is associated with worse physical health, regardless
“Solitary confinement is, diabolically, the most severe punishment.”
-Jay Shurley, Expert on Social Isolation of whether it prompts feelings of loneliness or a perceived lack of social support. On the other hand, at all levels of social disconnectedness (or connectedness), the perception that one lacks social resources may take a toll on their physical health.22 There are plenty of case studies supporting examples of isolation and its effect on people and their brain development.22 In the 1970’s, an astounding case of child abuse was uncovered. The child, once rescued, was named Genie Wiley, and she is known today as a feral child.22 During her childhood, Genie’s parents kept her locked in a bedroom, strapped down to a chair.22 Her parents and older broth-
er did not interact with Genie, and rarely spoke to her, except to scold or beat her.22 When she was finally rescued, she was unable to speak or communicate in any way. She had been completely isolated for ten years, and during the time critical development should have occurred.22 Through extensive therapy, Genie began to show improvement, but was never able to fully recover to the level of mental functioning expected of a normal person.22 In the late eighteenth century a child of eleven or twelve was captured, who some years before had been seen completely naked in the Caune Woods in France, seeking acorns and roots to eat.22 The boy was given the name Victor of Aveyron and is often referred to as the Wild Boy of Aveyron. Jean Jacques Rousseau, a passionate critic of society of his time, saw the possibility of reforming society through the education of children.22 In his Émile he posits a natural development of the child, which must be protected from the influences of society so that the child can grow up as nature intended him to be.22 In essence, Rousseau believed that there is a natural development on which we can rely and which will inevitably take place, provided we can keep in check the “unnatural” influences of society.22 So, with Victor, the people of Paris had the opportunity to see a child who had grown up according to Rousseau’s ideals.22
ISOLATION: Sadness | 034
HEAL MY SOUL HEART AND MEMORIES
In addition to the well-tried prosthetic approach, an Alzheimer home should ideally contain three components: healing architecture, a more human approach to resource management and leading edge electronic surveillance and artificial intelligence. Haptic architecture is sense triggering. Architecture articulates the experiences of being in the world and strengthens our sense of reality and self. Alzheimer patients especially, need bodily experiences so as not to feel alienated and confused but to
ARCHITECTURE + ALZHEIMER
create a safe environment that can still enrich every day life. Henri Snel is Architect, Interior Architect and lecturer at different institutions in the Netherlands. He is head of the Bachelor programme Architectural Design at the Gerrit Rietveld Academie and the Master programme Interior Architecture at the Sandberg Institute. Since October 2010 Henri Snel is member of the academic group with the research topic: “Alzheimer and Architecture” of the Lectoraat Art & Public Space (LAPS). “Figuring out how to make the patient’s daily life easier is completely forgotten. We are among the first to do applied research to try to find ways to give people back a little of their dignity and autonomy and independence.” - Dr. Kevan Namaz
Characteristics for the Essential Alzheimer Center: Occupational Therapy Cognitive Stimulation Memory Attention Concentration Language Physiotherapy Green Areas Gardens Outdoor Visitor Area Orchards Portable Modules = can hold the patients and the caregiver Light Exercising Areas Activities Areas Cooking Music and Art Research Monitoring all the time Centro Alzheimer: Fundación Reina Sofia -The project, created within the framework of the “Alzheimer Project” took shape in 2001 with a preliminary study and the Centre was officially opened in March 2007 in the Madrid suburb of Ensanche de Vallecas. It was built on a 18.498 m2 site provided by the Madrid City Council. -A remarkable aspect of the Centre is that it houses together three essential working areas on Alzheimer’s Disease: -A Research Unit, the CIEN Foundation (Research Centre on Neurological Diseases) managed by the Carlos III Health Institute, the Ministry of Industry and Competitiveness. -A Training Centre specialized in senile dementia. -A Healthcare Centre which holds a long-term residence for 156 patients, a day centre for 40 patients and a weekend family respite centre for 20 patients. Both are run by the Social Affairs Department of the Madrid Government.
ARCHITECTURE + ALZHEIMER: Heal | 036
REFORMATION
REVIEWS AND PRESENTATIONS
Throughout the process all the reviews have been helpful. Like creating pods that attach to their houses that can be rentable so it could be reusable, or breaking apart the three different stages and detailing what things would be good for each stage. In the process my vision has been more cleared with the help of my peers. Since there are already good memory care centers. We need to create awareness of rearranging the space at home and making them more secure for the patients.
FIG.18, Proposal Sketches
I created a table as a first draft of the helpful elements to take into consideration when designing a room for a patient. It is a break down of the three different stages of Alzheimer and there are three different dots which represent should have, must have, and what is most cost effective (Fig. 8). After applying everything that I have researched for the past seven months, I have come to the conclusion that I will be recreating spaces in the patient’s homes or the caregiver’s homes. I sketched three basic diagrams (Fig. 17) with three different situations considering what stage the patient is at and what type of housing they will live in. Usually, baby boomers live in houses, but if the caregivers moved them in with them the situation might be different. The rooms were designed with direct access to the bathroom so it would be easier for patients to use the bathroom with less mess. Also, the closet is in between the shower and the toilet. They have been separated to make a spacious shower for the patient and the caregiver. There is a flat floor so that the patient does not have to lift their feet. In addition, the closet has open access with limited clothing so that it is easy for the patients to make final choices. The contrast between floors would be similar but it would have different textures since patients have a hard time walking through different thresholds. Also, the contrast of colors are an important role in the designing decisions. Floors and furniture have to have a high contrast since Alzheimer’s patients slowly loses depth recognition. Also, creating wider windows for looking out to a green area is
designed specifically for them since it is very important to keep an active life and getting some time outside for fresh air and some direct natural light. Rooms also have to be kept a little bit simple with some attached furniture to the floor and walls for security of the patient. There would also be a limited to no use of contemporary furniture since they have lost their temporary memory and their brains only can handle items from the past. Having familiar furniture that they have always owned would be helpful as long it not harmful for them. It is really important to keep an eye on them. Every single item that is new to the space could change their behavior drastically. Also, any modern graphics such as paintings, photographs, and wall sculptures could create distress on the patient especially when it contains reddish colors since patients read that color as fire in their minds. Also, the type of pictures that are cropped should have some perspective instead of having profile pictures. Rooms should not be bigger than 500 sq. ft. including the bathroom, closet and patio. For patients that are in the late stage who are not able to move, it is recommendable to have a room next to theirs to host the nurse who can give full care.
REVIEWS AND PRESENTATIONS: Reformation | 038
RESURRECTION
NEXT STEP
After my final presentation of Master Project 1, I came up with a number of new ideas. I thought of creating a module but the main focus became creating a space inside of an existing home for the patients or their caregivers adding security with a new design based on their behaviors, and provide the patients different choices depending on their financial situation, the stage that the patient is at or, the layout of their homes. Also, it was important to be involved with Eileen Poiley and the Byrd Institute, to be around more caregivers with different types of situations to understand their needs. Understanding these necessities would further my thesis more into a working project instead of just a plethora of my ideas based upon research I have gathered either online or through books. Getting more outside knowledge on people who are very informed, or care for Alzheimer patients as a profession would help in giving me more insight. My goal would be to get to the point where I can present my ideas to the Alzheimer’s Association, so caregivers like my cousin would have the knowledge on how to recreate a better space for an Alzheimer’s patient.
FIG.19, Detail Sketches
NEXT STEP: Resurrection | 040
HOPE
PROCESS AND RESULTS
After completing my research in Master Project I, I focus all my energy understanding how to make spaces more efficient for Alzheimers’ patients. Also, talking with professionals on the field, patients, and caregivers, I started making a list of factors that will improve the patients house. Stating from the patients’ room, the room should be revised and checked does not have anything dangerous such as pills unattended, pointed furniture, mirrors, etc. Also, door locks should be facing out so the patient would not lock themselves, windows should be wider and the sill should be 24” height from the floor, and furniture should be arrange and keep it to the minimal design. Colors and texture are very important since Alzheimer disease start destroying the ability of differentiate depth; for example, the walls and floors should contrast each other since the patients does not where the walls ends and the floor starts. The chairs should contrast as well with the floor since this may cause accidents. Also, the caregiver should be careful
FIG.20, “4:50 from Paddington”
with any kind of patterns and textures around the house, since hallucination plays a big role in this disease, the caregiver has to be extra careful with patterns such as stripes which it can seem as jail bars, dots may seem as bugs, red colors could read as fire and others; the caregiver needs to be aware all the time since the symptoms may vary on the three stages. A person can be on the early stage but it can experience hallucination or other symptoms that are most likely to appear on the late stage or the person could be with Alzheimer for twenty years and never experience such symptom.
Lighting is really important as well since it can put the person in a better mood especially if it is natural light also it helps to make clear any paths or for reading. Switching closets for wardrobe would be ideal since it can create more space in the bathroom and alleviate the amount of options for the patents. It is recommendable not to offer too many options to the caregiver since this can create distress; and locating dividers on the drawers, it may help to alleviate the idea of keeping stuff. The bathroom should be spacious enough to fit a second person in the bathroom and it would be recommendable to meet the ADA code. Mak-
ing the shower floor flat would help the patient and caregiver to prevent any stumbles; and the floor should be non slippery tile and contrast with the walls, toilet, and sink. Also, the toilet should be located across of the patient’s room so the first the thing the patients would see it is the toilet. The patients start forgetting to go to the bathroom, where is the bathroom, or what a toilet looks like on detail. Eileen Poiley said, “one of her caregiver’s father would stop on his way to the bathroom and pee on this oval white container instead of the toilet. The caregiver was so concerned about the matter that asked to Mrs. Poiley, she recommended to remove the container that may look like a toilet.When the container was removed, the patient stopped peeing on the container and started using the toilet again”. The Alzheimer patient’s brain starts loosing the sense of detail but since the brain does not use one only sense or neurons, it pulls different ideas like shape, color, smell, etc to build this memory about a specific object.
FIG.21, Bedroom
PROCESS AND RESULTS: Hope | 042
The center of the house should do some minor changes like making clear and simple path, at least one of the chairs should customized for the patient, make a work area for the patient relate to the hobbies of their past, having same type of flooring throughout the house since the patient’s brain activates their ‘caution’ skills every time when the flooring changes. Removing the knobs of the stove or turning off is recommendable and the important/ safest drawers should be colored in a contrast color so they can identify it.
FIG.22, Living Room
Adding a garden to the house is an ideal space for any disease as a treatment. Obviously the garden needs some security adjustment like the heigh of the fence, non slippery tile, and hand rails. Also, the plants have to be picked by a professional or by the list is attached since many plans can be poison. Adding a bird feeder may be good since it can attract animals and vitalize the environment, adding a lot of shading is really important and elements for sitting. My project was not only renovating existing houses but also new prototypes for people who do not have houses or do not want to go through the renovation process. The house includes two rooms, one ADA proof bathroom, a spacious one main space for living, kitchen, dining room and safe proof garden that can be customizable depending on their needs. My proposal for this project after Master Project II would be to collect all the information, break it down and make it user friendly, so anyone can use it to create awareness about this matter, so people like my cousin do not make any obvious mistakes that can affect more the patient.
FIG.23, Patio
PROCESS AND RESULTS: Hope | 044
EVELYN
FIG.24, Elevation
750 SQFT. | PATIO: 144 SQFT
FIG.25, Floor Plan
FINAL WORK: Evelyn | 046
FIG.26, Model.
FINAL WORK: Evelyn | 048
ERODITA
FIG.27, Elevation
785 SQFT | PATIO: 235 SQFT
FIG.28, Floor Plan
FINAL WORK: Erodita | 050
FIG.29, Model.
FINAL WORK: Erodita | 052
REGINA
FIG.30, Elevation
835 SQFT | PATIO:144 SQFT
FIG.31, Floor Plan
FINAL WORK: Regina | 054
FIG.32, Model.
FINAL WORK: Regina | 056
LYDIA
FIG.33, Elevation
810 SQFT | PATIO: 144 SQFT
FIG.34, Floor Plan
FINAL WORK: Lydia | 058
FIG.35, Model.
FINAL WORK: Lydia | 060
FIG.36, Sections.
NEXT STEP: Resurrection | 046
FINAL WORK: Sections | 062
FIG.37, Robles Falls, San Sebastian, PR
CONCLUSION Architecture has been involved in many areas and one of them has been in the medical field. In this case, architecture has played a main role in the disease of Alzheimer and even though doctors and researchers have ignored that fact; other countries have not. I concluded my Master Project stating that having the right knowledge, taking the correct procedure, and keeping a proper design will create a better environment for the patient. Moving the patient out of their environment could affect the person more than just making some simple changes in their homes. The goal of this project is to create awareness in the Alzheimer community. There is more out there than just pills to alleviate the disease and Holding on to Home can be the key to save the patient from the Alzheimer’s Disease madness.
CONCLUSION | 064
BIBLIOGRAPHY Arroyo Mena, C., Dna, Diaz Dominguez, M., Estevez Jimeno, A. D., Gil Gregorio, P., Dr., & Marti nez Lozano, D., Dra. (2008). CEAFA Atender a una persona con Alzheimer. Madrid, Es paña: ONA Indstria Grafica. Retrieved Sept. & oct., 2017, from https://www.ceafa.es/es/ que-comunicamos/publicaciones/atender-a-una-persona-con-alzheimer. Bazan-Salazar, E. C. (2005). Alzheimers activities that stimulate the mind. New York: Mc Graw-Hill. Brawley, E. C. (2006). Design innovations for aging and Alzheimers disease: creating caring envi ronments. Hoboken, NJ: J. Wiley. Calkins, M. P. (1988). Design for dementia: planning environments for the elderly and the con fused. National Health Pub.: Owings Mills, Md. Cohen, U., & Weisman, G. D. (1995). Holding on to home: designing environments for people with dementia. Baltimore: The Johns Hopkins University Press. Cohen, U., & Day, K. (1997). Contemporary environments for people with dementia. Baltimore: Johns Hopkins Univ. Press. Coons, D. H. (1991). Specialized dementia care units. Baltimore: Johns Hopkins University Press. Crandall, W. H., Crandall, R., & York, S. P. (1990). Borders of time: life in a nursing home. New York: Springer Pub. Co. Genworth Financial, Inc. Genworth 2016 Cost of Care Survey. Home Care Providers, Adult Day Health Care Facilities, Assisted Living Facilities and Nursing Homes. Help End Alzheimer’s. (2003, June). Retrieved Fall, 2017, from https://www.alz.org/ Schmid, J. (2016, May 16). Alzheimer’s Disease - A Brief History and Description. Retrieved October 28, 2017, from http://www.best-alzheimers-products.com/alzheimers-disease. html
Timon Sanchez, A., Mateos Gonzalez, A. M., Perez Sanchez, E., Gay Perez, F. J., & Navarro Meri no, I., Arq. (2013). Guía “El espacio y el tiempo en la enfermedad de Alzheimer” (1st ed.). Madrid, España: Instituto de Mayores y Servicios Sociales. Retrieved Sept. & oct., 2017, from https://www.ceafa.es/es/que-comunicamos/publicaciones/guia-el-espa cio-y-el-tiempo-en-la-enfermedad-de-alzheimer. Weisman, G., Cohen, U., & Day, K. (1992). Programming and design for dementia: development of a 50 person residential environment. Milwaukee: University of Wisconsin-Milwaukee. BIBLIOGRAPHY | 066
LIST OF FIGURES FIG 1. “What was I going to say?”, Juliane Von Kunhardt. http://www.juleskunhardt.com/ FIG 2. “Unforgettable Moments”, Juliane Von Kunhardt. http://www.juleskunhardt.com/ FIG 3. 2016 Venice Biennale: Irish Pavilion, “Losing Myself”. https://www.archdaily. com/789446/losing-myself-inside-the-irish-pavilion-at-the-2016-venice-biennale FIG 4. “In the field of Destruction” FIG 5. Comparison of a healthy brain versus a brain with Alzheimer’s Disease. https://www. brightfocus.org/alzheimers/infographic/amyloid-plaques-and-neurofibrillary-tangles FIG 6. 2017 Alzheimer’s Disease Facts and Figures. https://www.alz.org/documents_cus-
tom/2017-facts-and-figures.pdf
FIG 7. Paper Abstract Human Brain on Dark Background. https://www.dreamstime.com/ stock-illustration-paper-abstract-human-brain-dark-background-vector-illustration-image51695545 FIG 8. Table: Representation of the three different stages of the Alzheimer’s Disease with some of the beneficial rearrangement for the patient. FIG 9. Early Stage of Destruction Graphic FIG 10. Middle Stage of Destruction Graphic FIG 11. Late Stage of Destruction Graphic FIG 12. Representation of stripes could seem to the patient. https://www.truevaluepaint.
com/paint/interior/decorative_techniques/stripe_your_walls_with_paint.aspx
FIG 13. Representation of stripes could seem to the patient. https://www.vectorstock.com/ royalty-free-vector/3d-realistic-steel-prison-bars-vector-18411690 FIG 14. Portrait of Evelyn Maestre.
FIG 15. Patients in Adult Day Care. https://www.agingcare.com/articles/enrichment-programs-for-alzheimers-and-dementia-patients-193275.htm FIG 16. Patients living in poor conditions. http://carestreetnj.com/newbrunswick/elderlycare-in-east-brunswick-nj-can-good-caregiver-youve-got-bad-relationship-aging-adult/
FIG 17. Isolation. https://authenticlove789.com/2014/12/23/isolation-kills/ FIG 18. Proposal Sketches. FIG 19. Detail Sketches. FIG 20. “4.50 from Paddington”, Juliane Von Kunhardt. http://www.juleskunhardt.com/ FIG 21. Bedroom, process model. FIG 22 Living Room, process model. FIG 23. Patio, porcess model. FIG 24. Elevation, Evelyn. FIG 25. Floor Plan, Evelyn. FIG 26. Final Model, Evelyn. FIG 27. Elevation, Erodita. FIG 28. Floor Plan, Erodita. FIG 29. Final Model, Erodita. FIG 30. Elevation, Regina. FIG 31. Floor Plan, Regina. FIG 32. Final Model,Regina. FIG 33. Elevation, Lydia. FIG 34. Floor Plan, Lydia. FIG 35. Final Model, Lydia. FIG 36. Final Sections FIG 37. FIG.37, Robles Falls, San Sebastian, PR
LIST OF FIGURES | 068