Ageing with Alzheimer's : Designing Therapeutic Spaces _ M.Arch by Gustavo Quan

S C H O O L O F D E S I G N A N D B U I LT E N V I R O N M E N T D E PA R T M E N T O F A R C H I T E C T U R E

TITLE

•

AGING WITH ALZHEIMER’S : DESIGNING T H E R A P E U T I C S PAC E S AUTHOR

• G U S TAV O A R M A N D O Q UA N M A R T I N E Z

This thesis is presented for the Degree of MASTER OF ARCHITECTURE of Cu r t i n U n i v e r s i t y o f Te c h n o l o g y

J u n e 2018

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AGING WITH ALZHEIMERâ&#x20AC;&#x2122;S: DESIGNING THERAPEUTIC SPACES

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D E C L A R AT I O N

This thesis contains no material which has been accepted for the award of any other degree or diploma in any university. To the best of my knowledge and belief this thesis contains no material previously published by any other person except where due acknowledgment has been made.

AGING WITH ALZHEIMER’S: DESIGNING THERAPEUTIC SPACES

05 June 2018 email | gustavo_6495@hotmail.com

ACKNOWLEDGMENTS

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In completion of this milestone, with much appreciation, I will mention and thank the people that have supported me in the many ways throughout this journey, as their input towards me has been of such value that without them, this milestone would not have concluded the way it has. • • • To God. As he has guided me from before this journey, until today, in so many ways that caannot be compared. Guiding me mentally and spiritually at times that have felt difficult throughout my past five years of studies. For what he has blessed me with. Isaiah 41:10

AGING WITH ALZHEIMER’S: DESIGNING THERAPEUTIC SPACES

To my family. Dalila (mum), Mamaiya (grandmother), Armando (grandfather), Nicole (sister) and Penny (dog), for their love and detailed care towards me in even the most minimal ways, should know have really been of great appreciation. That through all conditions of mine these past five years, i would not have achieved this without them. To my partner Michelle Lee. For all she has done for me, supporting me in encouragement, her undeserved level of care towards me in my studies, outside of my university career, and until today. She is appreciated and loved so much. her presence has done more than the obvious. to my supervisor, Boon Lay. Who has guided me over the past semester with his knowledge, allowing me to understand and see things from another perspective. Apart from the practical help received, it has helped me out of my works mental stresses which has been as valuable.

TA B L E O F C O N T E N T S

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CONTENT

AGING WITH ALZHEIMERâ&#x20AC;&#x2122;S:

DECLARATION

ACKNOWLEDGMENTS

TABLE OF CONTENTS

ABSTRACT

RESEARCH STATEMENT

INTRODUCTION

LITERATURE FRAMEWORKS

OBJECTIVES

METHODOLOGY

DESIGNING THERAPEUTIC SPACES

DESIGN CRITERIA

DESIGN BRIEF

CASE STUDIES

SITE SELECTION

SITE ANALYSIS

ARCHITECTURAL STRATEGIES

FINAL DESIGN PROJECT

109

REFERENCES

144

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“The following sections of this part are extracted heavily from Gustavo Quan 2017 Thesis Proposal, and are edited for this Final Dissertation report” All illustrations are owned by the author Gustavo Quan, except for where given due credit

ABSTRAC T AGING WITH ALZHEIMER’S: DESIGNING THERAPEUTIC SPACES

As we see the population grow and particularly increase in the number of an aging population, we will also encounter a strong increase in the cases of older people suffering from Alzheimer’s disease within Western Australia. Alongside these projections, we will see the number of older people having the need for some form of dependent care program such as that of aged care facilities. As numbers of an older population grow, so will their requirements and their needs to be taken care of. This project is based in the city of Armadale, and targets elderly people suffering from early to moderate stages of Alzheimer’s disease, through the design of a short to medium term stay Alzheimer’s aged care center that is constructed on the idea of a microcosm of the neighbourhood community. This is set to be achieved through the ideas of Normalisation, Behaviorology, Nature and Sensory, in order to allow its patients to continue a lifestyle with the sense of home, community and independence. This will provide a life style that allows a management for the disease, to reduce or slow down its progression. It not only occurs within the center, but will also provide this understanding for an adjustment of their families homes when patients are able to return home.

RESEARCH S TAT E M E N T Our elderly population is growing and is expected to continue to grow significantly within the next several decades, consequently much of those elderly population will be entering a life at an aged care facility. Aligned with a growing older population, is the prevalence of Alzheimers disease which is one of the nations leading causes of deaths, at 11,000 per year, and is currently incurable. Research has demonstrated that whilst Alzheimer’s disease is currently incurable, there still remains many factors that are positively impacting the progression of this condition through delaying its process or in some cases reducing its symptoms. How can we design aged care facilities to assist the management of Alzheimer’s diseasve for elderly with early stages of Alzheimer’s, to then improve and slow down the progression of this condition, as to allow them to continue a quality of life and find the potential to return to home?

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INTRODUC TION ALZHEIMER’S DISEASE

AGING WITH ALZHEIMER’S: DESIGNING THERAPEUTIC SPACES

DEMOGRAPHICS

ALZHEIMER’S DISEASE Alzheimer’s disease (AD) is a mental health condition that is a progressive decline in the mental and physical wellbeing of a person. This person will suffer from loss of memory, disorientation, confusion, issues with identity recognition, behavioral motor functioning, poor concentration and other symptoms. Alzheimer’s disease is a particular illness categorized within dementia along with vascular dementia, frontotemporal dementia and Lewy body disease. Alzheimer’s disease is the most common form of dementia accounting for 50 – 75% of all dementia cases (Dementia Australia 2018). Dementia is Australia’s second leading cause of deaths accounting for 11,000 deaths per year. This equals to 10.6% of all deaths in women, and 5.4% of all deaths in men, per year. For 2018, it is estimated that approximately 425,416 Australians will be suffering from dementia. Male sufferers make up 45% of that population, while women make up the remaining 55%. By 2025, the occurrences of dementia are expected to rise to about 536,164 and 1,100,890 for 2056 (Dementia Australia 2018). Other consequential symptoms include depression and issues with the person’s circadian rhythm. Studies show that dementia is affecting 3 out of 10 people over the age of 85 and 1 out of 10 people aged 65 years and older. In Western Australia, it is estimated that there will be a significant increase in dementia sufferers, increasing from 23,000 to 58,000 by 2030, and that by 2050 there will be 109,000 people living with the condition (Dementia Australia 2018). Alzheimer’s disease is broken down into seven levels of severity. From level one being the least affecting, to level seven being the most sever. At each stage, a person suffering from Alzheimer’s will have a different response to their surroundings and their sensory input. Below are the major symptoms of each phase:

Ta b l e 1. Levels of Alzheimers disease

F i g u r e r e p r o d u c e d f r o m G LO B A L (19 8 3 , 113 6)

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Research conducted by Guenaelle Douaud, PhD, of the Oxford University Functional MRI of the Brain Centre in the United Kingdom, has found that Alzheimerâ&#x20AC;&#x2122;s disease physically deteriorates the condition of the persons brain specifically of the grey matter which is the part of the brain which contains nerve cells responsible for processing sensory information, intellectual capacity and long-term memory.

F i g u r e 1. Deterioration of brains grey matter F i g u r e a d a p t e d f r o m P s y c h i a t r y A d v i s o r (2 014)

AGING WITH ALZHEIMERâ&#x20AC;&#x2122;S: DESIGNING THERAPEUTIC SPACES

Figure 2. Sy m p t o m s o f A l z h e i m e r s d i s e a s e F i g u r e c r e a t e d b y a u t h o r (2 018 )

DEMOGRAPHICS

Studies are projecting that the prevalence of dementia is to increase in the next several decades. This study has been taken using the AE-DEM model which is developed from the 2006 national census taken on by the Australian Bureau of Statistics (ABS). It is expected that the WA population of the 65 years and older, is to exponentially increase from 12% to 21% from 2010 to 2050. This displays a strong increase in the percentage of the older population of WA, leading onto an expected increase in the prevalence of AD within this population (Access Economics 2010).

L I T E R AT U R E F R A M E W O R K S

FRAMEWORK 1 - NORMALISATION

Architecture for Psychiatric Environments and Therapeutic Spaces

FRAMEWORK 2 - BEHAVIOURISM

Cognitive Psychology and the Retail Environment

FRAMEWORK 3 - NATURE

Chemotherapy Space: Steadiness of mind through aspects of access to nature

FRAMEWORK 4 - SENSORY

Theory of Phenomenology

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THEORETICAL FRAMEWORK ONE

ARCHITECTURE F O R P S YC H I AT R I C ENVIRONMENTS AND THERAPEUTIC SPACES Dr. Evangelia Chrysikou

NORMALISATION

AGING WITH ALZHEIMER’S: DESIGNING THERAPEUTIC SPACES

This study explores the function and design of habitable spaces and the way they affect a person with mental health issues in order to achieve an improved therapeutic result aligned with a higher quality of life. This paper looks into psychiatric environments such as hospitals or mental rehabilitation centres and examines how they have been designed in the past to suit patients with mental disabilities (Chrysikou 2017). It describes a shift in society’s understanding of what it means to ‘cure’ mental health problems and how it alternatively could be dealt with to have an impact on the patient’s mental wellbeing. This paper demonstrates that buildings that function in relation to mental health care, should initially revolve over an understanding of what this type of building should facilitate in delivering the correct methods for mental care patients. This literature explores how a shift in living spaces can really have positive outcomes on the recuperation of a patient. It talks about mental health patients moving into homes located within residential neighborhoods, against living in rehabilitation spaces, and how this change would have a greater positive impact on their recovery as they are being treated and involved with other people within their community, as opposed to being segregated due to their conditions.

TWO TYPES OF APPROACHES: INSTITUTIONALISED FORMAT (Fig 1) o Repetitive structure o Hospital-like o No design consideration w/ furniture, colours, textures

Figure 3. Broadmoor hospital common room

DOMESTIC / RESIDENTIAL FORMAT (Fig 2) o Home-like o Natural lighting o Patients treated as a community o Spaces resemble domestic home

Figure 4. Rampton Secure Hospital lobby

Architecture for psychiatric environments & therapeutic spaces, talks about a type of design theory known as “Normalisation”. This theory encourages a shift from an institutionalised format of design, to one that resembles and is structured upon the qualities and aesthetics of a community and home. The functioning of the centre is also required to place emphasis on a community styled treatment method. This includes the furnishings of the building, the way-finding methods, signage, and other elements. This is a necessity for an architectural approach towards AD, as patient’s interaction with familiar spaces plays a significant role in the functioning and comfort of the person, both psychologically and physically (Chrysikou 2017).

Normalisation is about a persons adjustment to an environment that is familiar to them in relation to their context, and their response to it. From this research, Normalisation will be aimed for through the creation of a sense of home and community.

The impact this has on Alzheimer’s patients is that they maintain a sense of belonging, independence and become less agitated and disoriented as they are able to recognise and live within their environments. As this project is constructed over the concept of a microcosm of a community, the ideas of normalisation build this project in the form of how a person would have access and mobility around their general community, as well as particular factors that provide an environment that carries the sense of home, through certain design choices. In ‘Architectural factors influencing the sense of home in nursing homes’, by A. Eijkelenbooma, H.Verbeek, E.Felix, J.vanHoof, it discusses about the qualities that provide a sense of home for a person, and presents a number of factors that are involved in creating that outcome. The research presents a sense of home as being built upon the design of private spaces, public spaces, personal belongings, aesthetic, and nature. Therefore, this project will use this research to carry these factors through out its design both in terms of an overall planning of the center, as well as consideration of internal connections of spaces that are involved throughout this design project; looking into: • private spaces • public spaces • personal belongings (location) • nature

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BEDROOM

NATURE

e x te r i o r o nl y

p ar ticular zo n e

v isual a ccess

p hysic al a ccess

v isual + p hysic al access

PERSONAL BELONGINGS AGING WITH ALZHEIMERâ&#x20AC;&#x2122;S: DESIGNING THERAPEUTIC SPACES

none

p ar ticular zo n e

sp e ci f i e d zo n es

n e ighb o ur inte r a c ti o n

ce ntr ic

PRIVATE SPACES

none

p ar ticular zo n e

sp e ci f i e d zo n es

ce ntr ic

b o un dar y

B AT H R O O M

PR I VAT E SPACE S

4 separate enclosures

1 par tial close d wall

op en plan

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DINING / KITCHEN

NAT U R E

no access

1 side access

AGING WITH ALZHEIMERâ&#x20AC;&#x2122;S:

visual + visual access + physical access p ocket interac tions

DESIGNING THERAPEUTIC SPACES

PUB LI C SPACE S

e n cl os e d

conne c te d

fre e access

sp e cif ie d access

L I V I N G S PAC E S

NATURE

n o access

v isual a ccess

sp e ci f i e d a ccess

e x te r nal inte gr ati o n

v isual + p hysic al access

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CO M M U N A L S PAC E S

AGING WITH ALZHEIMERâ&#x20AC;&#x2122;S: DESIGNING THERAPEUTIC SPACES

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THEORETICAL FRAMEWORK TWO

COGNITIVE PSYCHOLOGY A N D T H E R E TA I L ENVIRONMENT Dorothy Goh BEHAVIORISM This paper describes the link between cognitive psychology and a retail environment and how its spaces are able to gain the attention of customers and in turn impact them in the way that they may perceive and feel within these spaces. This study looks into how these spaces are able to have a certain amount of control to the way a person may perceive, feel and behave in a certain space through specific architectural design elements. It describes the idea of cognitive psychology and architecture to be broken down into three sub categories being, perception, behaviorism, and memory recall; the aspects relating to the human that result in a change in response or reactions (Goh 2014).

AGING WITH ALZHEIMER’S: DESIGNING THERAPEUTIC SPACES

These apply in understanding what elements of a space are capable of maneuvering and affecting a person’s views or responses in the choices or behaviours that they may take. This links tightly with the idea of healing spaces, as there will have to be a developed understanding of the elements that will provoke certain emotions, or behaviours in someone living in particular spaces. This will result in a change of perception or mental state for someone to have an outcome that would positively affect their lifestyle. The desired outcome is that these spaces will be created with particular details and that over time would affect the mental health of the occupant to shift from an unstable or depressive state to one of improvement and management.

Cognitive psychology not only makes up the mental aspect of functioning of a person, but also investigates the qualities or elements that can have an influence on the secondary reaction of a person, which is their behaviour; known as behaviorism (Goh 2014). BEHAVIORISM (Understanding behaviorism within architecture consist of): • Human behaviour • Environmental psychology • Design elements for human behaviour All are focused on understanding the cognitive behaviours of a person so that a particular result can be reached. Later in this research, I will investigate the more direct design elements that are successful in influencing the response of people, in order to create a project, which will positively affect the daily health of a patient living with Alzheimer’s disease in an aged care center. A suitable environment has a significant effect on the memory recall, maneuvering, and mental health of a patient with Alzheimer’s as it will allow or not, the patient to feel and react throughout a space in a positive way. A patient with Alzheimer’s disease, may not adapt well in memory to changes of spaces, so based on this research, the goal is to create spaces that function for and adjacent with the perceptual conditions and/or improvements of the patient.

COGNITIVE PSYCHOLOGY

Two factors that are to be utilised for the integration for behaviorism, are scale and way finding.

• Perception • Behaviorism • Memory recall

• SCALE • WAY FINDING

UNDERSTANDING • Elements that affect a person’s responses / behaviours / choices • Observations of space • Perceptions

BEHAVIORISM

• Residential scale • Commercial scale Scale plays in important part in the way people feel and occupy a space, and can affect the way in which someone translates information mentally (D.K Ching 2007). For elderly with Alzheimer’s, the proportions of a room is capable of creating confusion in linking how they understand to occupy the space. Therefore, a hierarchy of spatial scale is required when distinguishing different spaces, so that elderly with Alzheimer’s can understand a space with less disorientation, as they become more prone to it. The following diagrams compare basic and general proportion of both residential spaces and commercial spaces proposed for this design project:

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PL AN

RESIDENTIAL

COMMERCIAL

AGING WITH ALZHEIMERâ&#x20AC;&#x2122;S: DESIGNING THERAPEUTIC SPACES

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SEC TION

RESIDENTIAL

COMMERCIAL

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BEHAVIORISM

WAYFINDING • Circulation type • Orientation • Landmarks

AGING WITH ALZHEIMER’S: DESIGNING THERAPEUTIC SPACES

Way finding is vital for people living with Alzheimer’s as they easily become disoriented in navigating their ways around their environments, due to the deterioration of the condition. Therefore, clear, yet stimulating types of architectural design has to be implemented as to allow patients to feel comfortable in using the space, as well as still exercise cognitive stimulation (Conellan Kathleen, 2013).

CIRCULATION TYPE The way the floor plan of a building is to be organised, makes a very important impact on the way the person will feel and behave within spaces. This is important as well as the organisation of circulation zones and also external areas. A well organised and designed structure will reduce the level of disorientation and confusion for people with Alzheimer’s. The goal for this chapter of this thesis is to understand the ways in which aged care and disability facilities have been designed, to improve the adaptability and functioning of its users or patients with Alzheimer’s (Marquardt 2011). Points of references create positive outcomes on the way elderly people with Alzheimer’s accommodate and understand their environments. This could be in the form of main gathering spaces, dining areas, administration offices or other points that stand out from the program of the building. Points of references create clarity nodes for the elderly patients to find their way around the site independently, or at least can occupy spaces with less assistance from carers to take them the entire way (Marquardt 2011). A study was conducted by Marquardt and Schmieg in understanding how patients wondered about three differing typologies of nursing homes, to see which plan allowed a clear wayfinding and which was found to be more difficult. The three types of circulating structures tested were straight paths, paths that included one change in direction, and another which had a centric courtyard circulation typology. Wayfinding results displayed positive outcomes when spaces were made up of smaller groups of people usage (Marquardt 2011). A circulation system with linear directions showed to be of most clarity for users, allowing them to see and understand the spatial program much better. The floor plan that was made up of a change in directions such as of the L-shaped diagram, increased navigational stresses for patients, whilst a courtyard like structure was of the most difficult and would create irritation and confusion in elderly suffering from Alzheimer’s.

Str aight p aths

Fi g u r e 5 . L i n e a r p a t h dr a w n b y a u t h o r 2 0 1 8

L- shap e tur ns

Fi g u r e 6 . i n c r e a s e d d i f f i c u l t y drawn by author 2018

Co ur t y ard circulati o n

Fi g u r e 7. m o s t d i f f i c u l t t y p o l o g y dr a w n b y a u t h o r 2 0 1 8

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O R I E N TAT I O N In ‘A Pattern Language’, Christopher Alexander describes a form of placement that serves as providing a clarity of direction. One that not only allows an understood form of circulation, but also one that allows the person to feel comfortable in the way they circulate, in response to the orientation of buildings. This becomes important for Alzheimer’s patients in the way they understand and circulate spaces, as it aims to reduce symptoms that irritate their condition. Christopher Alexander describes a form of design in which its users would find simplicity and have an understanding of how to move through out the spaces. AGING WITH ALZHEIMER’S: DESIGNING THERAPEUTIC SPACES

The first diagram explains how our normal human brain functions in moving from one point to another. It firstly builds up stages in between as checkpoints in order to reach a final destination. What is being looked at here is how this idea of circulation can be exercised through the orientation of spaces rather than written and simple signage. The second diagram explains another of Alexander’s methods of design. It shows how the orientation of buildings themselves can create backings which have an open face towards the next destination. This additionally gives the user a sense of protection as their packs are protected trough the wall creating the backing. It describes a movement of space from one smaller space, to the next which is larger, allowing a clear understanding of how to move through the space and letting them reach their required destination (Alexander 1977). For Alzheimer’s patients, this provides clarity in navigation, reducing disorientation and agitation.

H ow th e b r ain s e t s up a ro u te

Creatin g â&#x20AC;&#x2DC;b ack sâ&#x20AC;&#x2122; to p rov i d e v i ew of d es tinati o n

Star ting to under stand a layout

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LANDMARKS Landmarking is a form of way finding which would assist a disoriented person in navigating a site as they need. Particularly in Alzheimer’s patients, this is important for the management of progression of their condition (Nakamura 2012). Ishikawa and Nakamura describe that landmarks can be of a number of forms. Physical, Visual, objects, routes and others, as they are a sign that give the user, a memory or understanding of where they are or what the spaces are. For this design project, it is important for the users to be able to recall and distinguish particular zones or buildings to their uses, so that they can maneuver over the center with less assistance, with the aim of retaining their independence, and thus aiding the management of Alzheimer’s. Through research understanding that landmarks act as check points that are used to have an understanding of site or use of site, landmarks for this project will be categorised into several types according to their use. AGING WITH ALZHEIMER’S: DESIGNING THERAPEUTIC SPACES

As this proposed project will comprise of residential and commercial space, landmarks used will be assigned in relation to the spatial uses . landmarks will be categorised into:

• Active / social landmark • Visual landmark • Gathering landmark

LANDMARK ANDMARK S -S RESIDENTIAL - RESIDENTIAL - AC T I V E / SO CIAL L AN DM AR K

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L ANDMARK S - C AFE - AC T I V E / SO CIAL L AN DM AR K

AGING WITH ALZHEIMERâ&#x20AC;&#x2122;S: DESIGNING THERAPEUTIC SPACES

L ANDMARK S - C ARER FACILIT Y - V ISUAL L AN DM AR K

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L ANDMARK S - COMMUNAL SPACE - V ISUAL L AN DM AR K

AGING WITH ALZHEIMERâ&#x20AC;&#x2122;S: DESIGNING THERAPEUTIC SPACES

L ANDMARK S - THER APY SPACE - G AT H ER I N G L AN DM AR K

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THEORETICAL FRAMEWORK THREE

CHEMOTHER APY SPAC E:

STEADINESS FOR THE MIND THROUGH ASPECTS OF ACCESS TO NATURE Tzu-Hsien Wu

NATURE This literature review focuses on healing spaces within chemotherapy rooms and how nature can play a role in positively impacting the patient’s physical and psychological wellbeing. In this case, how it impacts patients with Alzheimer’s disease. There are several factors occurring in this idea of creating a stabilizing medical space for the wellbeing of a patient, in order to begin to have a successful impact upon the subject.

AGING WITH ALZHEIMER’S: DESIGNING THERAPEUTIC SPACES

The study breaks down the different areas that are involved to have a positive effect, such as the qualities of the space, in this case, the aged care facility. Access to nature and more de-institutionalizing design directions, prove to have an effect onto the mental health of a patient. Key factors bringing this influence are colour, natural lighting, window access and sound qualities; factors related to the natural environment that proves to positively impact the persons emotional and physical wellbeing (Wu, 2015). Although my thesis does not specifically look into chemotherapy rooms or hospital spaces as its direct focal point, rather focuses on an aged care facility, the studies taken on in Wu’s dissertation make a grounding and valuable contribution to my topic as it investigates the correlations and the effects of design and nature to have an effect on the users physical, emotional and mental wellbeing, which in the focus of this dissertation understand how nature positively impacts patients with Alzheimer’s disease.

KEY DESIGN FACTORS: • Access to nature • Interaction with nature • Plant types • Garden types

TYPES OF GARDENS • Private healing garden • Public healing garden • Residential local Park • Personal Residential Gardens

PRIVATE HEALING GARDEN SENSORY GARDEN â&#x20AC;¢ plants stimulating senses: SCENT: - Lavender - Rose Mary TOUCH: - Fountain grass SOUND: - Mat Rush - Insect attracting plants - Switch Grass

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PUBLIC HEALING GARDEN HORTICULTURE THERAPY • Sensory Plants • Seasonal Changing • Horticulture Activities • Gathering Spots

AGING WITH ALZHEIMER’S: DESIGNING THERAPEUTIC SPACES

RESIDENTIAL LOCAL PARK HORTICULTURE GARDENS • Horticulture Activities • Communal Gardening • Gathering Spots • Low Maintenance Plants • Shelter

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THEORETICAL FRAMEWORK FOUR

THEORY OF PHENOMENOLOGY Arch 630: Theory and Context

SENSORY

AGING WITH ALZHEIMER’S: DESIGNING THERAPEUTIC SPACES

This literature goes on to portraying the idea behind architectural phenomenology and how it holds an intangible but significant position in the control and atmosphere of spaces and the way in which a person would feel. ‘Theory of Phenomenology’ describes how phenomenology of architecture deals with the manipulation of materials, in addition to space, volumes, light and shadows, creating spaces that affect the human sensory and allows us to feel, remember and perceive different experiences. This theory works an architecture that is beyond the tangible and contrasts rationalism by building on the effects to the sensitivity of human perception rather than relating to a logical and mechanical direction of design (Arch 630 2017). The aim is for the creation of living spaces that are created in ways that hold significant design techniques to provoke emotions in occupant senses and memory, through a detailed understanding of which design elements are successful in impacting these senses. This is to become attached in memory and over time create an improvement in the mental health and behaviour of the person living in these spaces. This literature looks at how elements of a space impact a person in the way they are and perceive in the spaces they move in. This is significant in the way it will affect people suffering from Alzheimer’s disease, as there are qualities that have negative and positive results in their mental functioning.

The dissertation will build upon the following elements: • Materiality / textures • Lighting / natural lighting • Acoustics

use as signage imp or tant areas increases apparent ro om size

warm atmosphere asso ciate d with nature

neutral ef fe c t s

grow th + life calming rela xing

increases brain stimulation increases apparent temp useful in cooler rooms

calming increases apparent room size p erceives as cooler

USE OF COLOUR:

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OBJECTIVES The key objectives of this work is to create living spaces for elderly people suffering from Alzheimer’s disease, within a residential aged care facility in the city of Armadale. This aims to have an influence to the mental health and quality of living for the patients as well as their caretakers and families. Research into existing architectural design techniques will be as references to specific methods that are both successfully and negatively impacting the human sensory at a level to provide an improved adaption to the disease.

OBJECTIVES OF S T R AT E G I E S

This project will be based upon four main ideas introduced in the following previous theories. They explain Normalisation, Behaviorism, Nature and Architectural Phenomenology through sensory, which have an impact on the wellbeing of a person living with AD.

• Understanding of Behaviorism design approaches

Simultaneously, with these four topics will be tied together by the concept of a microcosm of the community. AGING WITH ALZHEIMER’S: DESIGNING THERAPEUTIC SPACES

• Explore the factors influencing Alzheimer’s disease • Understanding of Normalisation design approaches

• Understanding of Nature Impacts • Creation of spaces that help manage Alzheimer’s disease for patients

METHODOLOGY Through literature and evidence based research, this dissertation will focus on taking comparisons of existing aged care facilities and other projects of similar research, to have an understanding of their approaches. This paper has also looked into research that is based on medical results that may not directly come from architectural examples, but have been taken into account as that research carries a grounding base for the later outcomes of this design project. This will give an understanding of how they are designed as well as how they are impacting the wellbeing of patients with mental health conditions.

METHODS OF RESEARCH This research will be made through several resources: • Literature • Peer reviewed literature • Evidence based research • Statistic research • Sketching / Drawing testing

From an understanding of these several topics, a design project will be compiled in which will aim to achieve the objectives to provide an improved quality of life and management of the condition for elderly people living with AD. This research will be made through several resources: • Literature • Peer reviewed literature • Evidence based research • Statistic research • Sketching / Drawing testing

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DESIGN CRITERIA AGING WITH ALZHEIMERâ&#x20AC;&#x2122;S: DESIGNING THERAPEUTIC SPACES

BEHAVIORISM

SENSES MATERIALITY / TOUCH SPATIAL SCALE

SCALE

WAY FINDING

• RESIDENTIAL • COMMERCIAL • EXTERNAL AREAS

• CIRCULATION TYPE • STRUCTURE ORIENTATION • LANDMARKS

ALZHEIMER’S AGED CARE CENTER

NORMALISATION PERSONALISATION • RESIDENTIAL UNITS • COMMON ZONES

NATURE • ACCESS TO NATURE • INTERACTION WITH NATURE • PLANT TYPES • GARDEN TYPES

GARDEN TYPES • PRIVATE HEALING GARDEN • PUBLIC SENSORY GARDEN • RESIDENTIAL LOCAL PARK • PERSONAL RESIDENTIAL GARDENS

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DESIGN BRIEF This dissertation will be the designing and providing of an Alzheimer’s aged care center for an elderly group of people living with Alzheimer’s disease (AD) between stages one and four. This project aims to attend to patients suffering from the early stages of Alzheimer’s in order to manage the progression of the condition, and reduce the development long term. The Alzheimer’s aged care center will be short to medium term stay, with the aim for patients to recuperate to a stage where they can return home, as research has shown there to be positive effects on the development of Alzheimer’s through the control of particular factors. AGING WITH ALZHEIMER’S:

The project is located in the city of Armadale, Western Australia, as there is a growing number of elderly people, which in turn will result with higher prevalence of Alzheimer’s disease within the city.

DESIGNING THERAPEUTIC SPACES

This paper will look into design approaches within Alzheimer’s patient design, as well as medical research to then go onto proposing an improved approach of aged care living, in order to provide healthy living conditions through amplifying specific architectural elements to have an impact on the physical and psychological wellbeing of a person living with Alzheimer’s disease.

CASE STUDIES

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R E T I R E ME N T A ND N U RSIN G H O M E . W IL D E R KAISER Pr oject: Retirement and nursing home Architect: Dürschinger Architekten, SRAP Sedlak Rissland Location: 6351 Scheffau am Wilden Kaiser, Austria T his p roj e c t is a re tire m e nt an d nur sin g h o m e l o c ate d a djace nt to a f o r m e r re tire m e nt an d nur sin g h o m e that n o l o n g e r co mp li es w ith site s t an dards . T h e b uil din g is ma d e up of t wo main b l o ck s , w hich co nn e c t to each oth e r in th e ce ntre, creatin g an atr ium . Fro m th e s tr u c ture of th e p lan, this b uil din g creates thre e e x te r nal n o d es; a chil dre n’s p laygro un d, a p ub lic gard e n an d a gard e n sp e ci f ic all y f o r d e m e ntia p ati e nt s . Fro m this f o r mati o n, th e b uil din g gi ves a co nn e c ti o n f o r co mmunic ati o n b e t we e n it s us e r s , as we ll as creates a co nn e c ti o n f o r b oth resi d e nt s an d th e co mmunit y, w hils t all ow in g p r i v ac y in inte r i o r an d e x te r nal sp aces . T h e d esign of this p roj e c t p e r mit s a f re e f l ow in g co nn e c ti o n b e t we e n in di v i dual, co mmunal an d inte gr ati o n . All p ub lic zo n es of th e b uil din g are l o c ate d o n th e gro un d f l o o r, w hil e th e resi d e ntial an d c are unit s are l o c ate d ove r up p e r t wo f l o o r s . The central atrium permits natural light to flood the central spaces as well as allowing there to be an overall visual connection between floors, including communal areas, dinning areas and care units.

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The breaking up of the building into two main parts, successfully allows a number of open spaces to exist through out and within the site and building. This gives opportunity for open exterior spaces to be accessible from patient units that are located central of the building. The open spaces such as the green zones, are able to be particularly located d e p e n d e nt on the formation of the plan configuration. This gives potential to create linkages for patient and building zone communication as well as connections between the building, users and the community giving a sense of unity rather than a closed off community.

DESIGNING THERAPEUTIC SPACES

Figure 8. Edited floor plan of spatial orientation (Edited by author 2018)

F i g u r e 9. I n t e r n a l a t r i u m l i n k ( A r c h d a i l y 2 018 )

F i g u r e 10 . O p e n a r e a s ( A r c h d a i l y 2 018 )

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DAY CENTRE PATIENTS

FOR

AL ZHEIMER ’S

Proj e c t : day - c are ce ntre f o r Alz h e im e r ’s p ati e nt s Archite c t : Luis N av ar ro, C ar l os S án ch e z , Án g e l M ar tín e z Lo c ati o n: C all e H e r man os Q uinte ro, Alic ante, Sp ain T his Alz h e im e r ’s day c are ce ntre is an at t achm e nt to an e x is tin g s ch o o l l o c ate d o n site. It is ma d e up of t wo re n ov ate d f l o o r s an d an a d d e d f l o o r, all w hich are co nn e c te d to th e e x is tin g b uil din g w hich co nt ains th e main f un c ti o ns f o r th e ce ntre, in clu din g s timulati o n ro o ms , multip ur p os e ro o ms , dinin g ro o m an d a g y m . It has b e e n co nf igure d in a w ay that acco mm o dates f o r th e circulati o n an d o r i e nt ati o n of it s us e r s o n site. T h e b uil din gs f l o o r p lan is s tr u c ture d in a w ay that acco mm o dates th e we ll b e in g of it s Alz h e im e r ’s p ati e nt s .

AGING WITH ALZHEIMER’S: DESIGNING THERAPEUTIC SPACES Figur e 11. S t a g g e r i n g n o o k s o f e xt e r i o r (Ar c hd aily 2013)

Figur e 12 . S mall gar d e n n i c h e s (Ar c hd aily 2013)

Figur e 13 . F loor p lan (Ed it ed b y aut hor 2018)

By dividing up each zone of the building, the open spaces created in between becov me as additional opportunities. In this case small gardens have been implemented. This opportunity give rise to connections being able to be obtained between the internal and external spaces, residents having views into other areas of the building as well as with the surrounding community.

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HA ZELWOOD SCHOOL FOR THE BLIND P ro j ect : Ha zelwo o d S c h o o l f o r th e bl i n d A rc h it ec t : A la n D u nl o p Lo c a t io n : Gla sgo w Ha zelwo o d is a sch o o l th a t i s s pe c i a l l y d e s i g n e d f o r th e d e v e l o pme n t o f l i f e skills fo r a u t ist ic c h i l d r e n a n d y o u n g a d u l ts a g e d be tw e e n 2 a n d 1 9 y e a r s th a t su ffer fro m c o m p lex d i s a bi l i ti e s . T h e s e c o n d i ti o n s i n c l u d e h e a r i n g a n d v i s u a l im p a irm en t , m o b il i ty a n d c o g n i ti v e i mpa i r me n ts . D u e to th e i r c o n d i ti o n s , t h e ch ild ren will no t be a bl e to l i v e e n ti r e l y i n d e pe n d e n t l i v e s a n d w i l l req u ire co n st a n t c a r e . T h e w a y i n w h i c h th i s pr o je c t h a s be e n d e s i g n e d , p ro m o t es in d ep en d e n c e f o r th e pa ti e n ts i n th e w a y th e y c a n o r i e n t a n d n a viga t e t h em selve s th r o u g h o u t th e bu i l d i n g , r a th e r th a n w h o l l y r e l y o n th e m a n a gem en t o f t h e i r c a r e r s . T h e co r e w a l l o f t h e c i r c u l a t i o n p a t h o f t h e b u i l d i n g i s l i n e d w i t h co r k , w h i c h c a r r i e s w a r m a n d t a c t i l e q u a l i t i e s a l l o w i n g t h e c h i l d r e n to s p e c i f y e a c h s p a ce t h e y w a l k t h r o u g h a r o u n d t h e b u i l d i n g , a t t h e s a m e t i m e p r ovo k i n g i m a g i n a t i o n a n d co g n i t i ve s t i m u l a t i o n .

AGING WITH ALZHEIMERâ&#x20AC;&#x2122;S: DESIGNING THERAPEUTIC SPACES

F i g u r e 14 . H a z e l w o o d S c h o o l s e n s o r y w a l l R i n a l d i 2 016

F i g u r e 15 . Hazelwood Sc hool p l a n R i n a l di 2016

F i g u r e 16 . S p a t i a l z o n i n g R i n a l di 2016

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SITE SELECTION AGING WITH ALZHEIMERâ&#x20AC;&#x2122;S: DESIGNING THERAPEUTIC SPACES

SITE SELECTION The city of Armadale WA, holds a significant portion of its population as elderly people (60+ years), that of which continues to grow. This being the older population accounting for almost 30% of the total population. For 2018, it is expected there to be approximately 638 people living with dementia in Armadale, and this is to rapidly increase over the years. By 2030 dementia prevalence in Armadale is expected to be already at 1170, and by 2050 there will be 2268 persons suffering from dementia. That is a 473% increase of people with dementia from 2010 to 2050 (Access Economics 2010).

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ARMADALE . WA

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POTENTIAL SITES

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SITE 01 350m 5 mins walk

SITE 02 2km 5 mins drive

SITE 03 4km 6 mins drive 44 mins walk

> closest to city for accessibility

> surrounded by residential

> heavily natural surroudings

> surrounded by residential environment

> nature surroundings

> difficult access to city for patients

> close access to public transport

> dependant access to city for patients

> lessened sense of independence for patients

> integration with local

> some integration with local

> further travel for visitors

> close proximity to medical resurces (hospital ) > patients have a greater sense of independence > close proximity to main roads p

> minimal integration with locals

SITE CHOSEN

SITE 01

Armadale Revelopment Area zone Area: 7,945m2

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SITE PL AN

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NOISE: PROXIMITY

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PEDEST

TRIAN ACCESS: FOOTPATHS

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ARCHITECTURAL S T R AT E G I E S The architectural strategies are based on the f o ur maj o r i d eas of N o r malis ati o n , B e hav i o ro l o g y, Nature and Sensor y. W ith these, the concept of a neighborhood microcosm has been chosen to be the foundation of design for this project and is integrated through out the project.

AGING WITH ALZHEIMERâ&#x20AC;&#x2122;S: DESIGNING THERAPEUTIC SPACES

Following are displayed the initial design propositions as to display the progression of the designs, and will show the shift of design from each design, each one adjusting to reach the four main design ideas.

ALZHEIMER’S AGED CARE CENTRE: Proposal ONE • Observing microcosm ALZHEIMER’S AGED CARE CENTRE: Proposal TWO • Improving the Microcosm ALZHEIMER’S AGED CARE CENTRE: Proposal THREE • Refining residential scale

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ALZHEIMER’S AGED CARE CENTRE: Proposal ONE • Observing microcosm

DESIGN - CONCEPTUAL

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DESIGN - CONCEPTUAL SITE FORMATION

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DESIGN - CONCEPTUAL SITE FORMATION

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DESIGN - CONCEPTUAL SITE FORMATION

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AGED CARE AS

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S A MICROCOSM (PROJECT CONCEPT)

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AGED CARE AS A

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A MICROCOSM (PROJECT CONCEPT)

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ENVIRONM WAY FINDING

PROJEC T PURPOSE DIVISION

BEHAVIORISM - WAYFINDING

PROJECT PURPOSE DIVISION

ENVIRONMENTAL PSYCHOLOGY (BEHAVIOURISM) WAY FINDING

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MENTAL PSYCHOLOGY (BEHAVIOURISM) SENSORY - ACOUS TIC + NATUR AL LIGHT

PERCEPTIONS (ARCHITECTURAL PHENOMENOLOGY)

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1 2 3 4 5 6 7 8 9 10 11 12 13 14

resi d e ntial unit s resi d e ntial l o un g e f ro nt gard e n co mmunal gard e ns co mmunal laun dr y c are r f acilit y a dmin c af e o u td o o r s eatin g co mmunal dinin g co mmunal l o un g e lib r ar y ar t ro o m th e r apy gard e n

GROUND FLOOR 1 : 5 0 0

SCALE

1 2 3 4 5 6 7 8

k itch e n dinin g li v in g ro o m b athro o m b e dro o m laun dr y co mmunal gard e n co mmunal l o un g e

87 GROUND FLO OR 1 : 5 0 0

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ALZHEIMER’S AGED CARE CENTRE: Proposal TWO • Improving the Microcosm

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ALZHEIMER’S AGED CARE CENTRE: Proposal THREE • Refining residential scale

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FINAL DESIGN PROJEC T AL ZHEIMER â&#x20AC;&#x2122;S AGED C ARE CENTRE

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MICROCOSM + CIRCUIT

M I C R O C O S M

SERVICES

MICROCOSM + CIRCUIT

SOCIAL SPOTS

SERVICES

LOCAL STORES

LOCAL PARK

PUBLIC PARK

LOCAL PARK

PUBLIC PARK

RESIDENTIAL ZONES

WAY FINDING • CIRCULATION

WAY FINDING • 2 WAYS

B E H A V I O U R I S M

RESIDENTIAL ZONES

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TR N

AI N IO AT ST

LANDMARKS • ALL

ORIENTATION • BACKS

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LANDMARKS • LINK

LANDMARKS • TYPES ACTIVITY LANDMARKS VISUAL LANDMARKS

M A T E R I A L I T Y

GATHERING LANDMARKS

GARDENS

N A T U R E

PRIVATE HEALING GARDEN

PUBLIC HEALING GARDEN

RESIDENTIAL LOCAL PARK

CARER FACILITY GARDEN

PERSONAL RESIDENTIAL GARDENS

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RESIDENTIAL GARDENS

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RESIDENTIAL RESIDENTIAL UNITS UNIT PERSONALISATION // WAY FINDINFG

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PERSONALISATION OF UNIT

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PERSONALISATION OF UNIT

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PRIVATE + PUBLIC C AFE

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SC ALE OF SPACES + INTER AC TIONS

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WAY FINDING THROUGH INDEPENDENT CIRCUL ATION

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PRIVATE HE ALING GE ARDENS

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M A S T E R O F A R C H I T E C T U R E T H E S I S BY G U S TAV O A . Q . M . 05.JUNE.2018

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