Ellipsis - Fieldwork by Jack Sardeson

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U R B A N D E S I G N F O R A L Z H E I M E R P R E V A L E N T P O P U L AT I O N S

Case Studies

ELLIPSIS

M ap

E L L I P S I S - Ur ban Design for Dement ia

Jack Sardeson

CONTENTS Introduction.......................................................................1 Proposal......................................................... ..................5 Map.................................................................................11 Case Studies....................................................................13 Credits............................................................................39

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E L L I P S I S - Ur ban Design for Dement ia

Introduction:

ABSTRACT

‘Instead of building more homes for the elderly and importing care staff from eastern Europe, building policies, planning law, regional planning and state subsidies need to be revised in order, to put it bluntly, to upgrade our cities to meet the needs of large sections of society that are rapidly approaching old age and to learn from the widely acknowledged shortcomings of greenfield housing schemes. While the state spends its time adjusting pension schemes and care subsidies, they neglect to deal with the associated hardware, namely the need for an urban structure capable of providing needs for the elderly’ -Eckhard Feddersen and Insa Lüdtke, Lost in Space: Architecture and Dementia,

Fi gure 1. D raw i ng portray i ng the di ffi c ul ty of nav i gati ng the c i ty w i th dementi a

E L L I P S I S - Ur ban Design for Dement ia

In 2050, 3.2% of Britain’s population will be living with some form of dementia. As of yet, architecture has still to respond sufficiently to the needs of this demographic, with all existing care-home structures — despite wide-ranging internal variations across typologies — cultivating a segregative approach to care on both geographic and social planes. As such, there is an urgent need to develop evidence-based, dementia friendly architecture, integrated at the city scale. This paper hopes to address this question, analysing the need to both urbanise and integrate such communities and how architecture can uniquely facilitate this shift, to provide dementia friendly care centres within the metropolis. I nt ro

Fi g.3 Future ri s k of c arehomes i n the U K (2050)

APPROACH 12

CARE HOMES - ENGLAND Number of homes plotted = 15765 Source: Care Quality Commission Source: Office of National Statistics

Introduction:

ALZHEIMER’S IN THE UK

55° N

54° N

Fylde

Risk: 16.1 Population density: 76.6 Retired population: 21.4

Fi g. 2 The bl ue i ndi cates the area covered i f al l current dementi a pati ents i n the U K l i ved i n London. The bl ue l i ne i ndi cates the proj ected number by 2050.

Population density: 101.7 Retired population: 34 53° N

Bromsgrove

Risk: 15.3 Population density: 93.4 Retired population: 21.8

Tendring

Risk: 17.8 Population density: 148.5 Retired population: 46.6

Tandridge 52° N

Risk: 15 Population density: 83.1 Retired population: 18.2

Rother

Risk: 20.8 Population density: 89.8 Retired population: 29.9

Reigate and Banstead Risk: 15.8 Population density: 138.6 Retired population: 26.5

Hastings

Risk: 18.4 Population density: 87.2 Retired population: 18.5

Bournemouth

Risk: 15.1 Population density: 168.1 Retired population: 36.5

Taunton Deane

Risk: 16.7 Population density: 109.4 Retired population: 26.1

51° N

LONDON

E L L I P S I S - Ur ban Design for Dement ia

Alzheimer’s is not a s y mptom of aging but the probability of development does incr ease exponentially after the age of 65. In the UK, dementia currently affects approximately 5-8% of individuals over the age of 65, 15-20% of over 75 y ear olds, and 25%- 50% of over 85 year ol ds. 54% of those affected are considered to be in the mild stage of the diseas e, 32% to be moderately affec ted and 12.5% as liv ing with severe dementia. The cost to the UK economy is curr ently £26.3 billion with an average cost per patient of £32,350. With a rapidly ageing baby boomer gener ation, the number of people with Alzheimer ’s is set to increase dramatically ov er the next few decades. By 2050, two million people (3.2% of the UK population and will cost an impossible £59.4 bil lion per annum . The care force, too, will have to grow; by as early as 2025 it will require an additional 1 m illion formal care workers.(It should be noted that this estimate does not take into account the possible implicati ons of Brexit upon the care forc e, which currently relies on migrant workers for 34% of its staff.

North Norfolk Risk: 15.5

SITE Isle of Wight

Risk: 14.9 Population density: 140.5 Retired population: 39.6

Worthing

Risk: 17.4 Population density: 109.4 Retired population: 26.1

Eastbourne

Torbay

Risk: 17.2 Population density: 97 Retired population: 25.8

Risk: 17.4 Population density: 134.3 Retired population: 37.1

Hammersmith and Fulham Third lowest risk district in England Risk: 1.9 Population density: 169.7 Retired population: 20.7 Beds: 329

District of Richmond upon Thames Highest life expectancy of London districts. Source: Office of National Statistics Risk: 5.1 Population density: 190 Retired population: 29.6 Beds: 990

x4 KEY RISK CLINICS IN 2040 0%

+1 BED

NUMBER OF BEDS

100%

+215 BED

COUNTY RISK

+30

Proposal:

U R B A N I S AT I O N In 1954, Ernest Burgess explained how the topical preference for relocating the elderly to open rural spaces was due to a diminished availability of familial support in urban settings, itself the result of urbanisation’s challenge to the economi c basis of the extended - In line with Burgess’s theory, from 2001 to 2011, the rural care home population in the UK increased by 4.1% while its urban counterpart increased by only 0.8%. However, this prevailing trend for periphery living and care will become increasingly untenable as the Alzheimer population increases. With the centralization and urbanization of most civic structures within cities, important staff and medical resources as well as important familial connections are often out of reach of rural care homes.

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E L L I P S I S - Ur ban Design for Dement ia

Not only would urbanized settings for care homes enable greater and more efficient access to resources and staff but the metropolitan context in itself offers significant benefits to Alzheimer patients. Staying physically, socially active and independent is thought to ‘build cognitive reserve’ and thus reduce the severity of the condition. However, despite this, the Alzheimer ’s Society found that 35% of people with dementia got out at most once a week and those over 85 spent 90% of the time at home. While the disorientation that many Alzheimer patients encounter using public transport or busy streets are considerable disadvantages of the urban setting, its high density layout ensures all facilities are close together, enabling Alzheimer patients to move more safely between sites. As Henri Snel, a Dementia and Design specialist at the Sandberg Institute, suggests, provided simple measures were instituted in the urban setting, those with mild to moderate dementia (86% of patients) would still be able to operate independently in the public realm. Indeed, according to one ‘Neighbourhoods for Life’ study, a system structured around ‘ hubs within a ten-minute walking distance’ would enable people ‘to retain independence for longer ’. In 1981, the introduction of yellow ‘tactile flags’ in urban areas enabled two million blind and visually impaired people to independently navigate almost all road crossings in England. Now a legal requirement under the Disability Discrimination Act, it begs the question: if there is soon to be an equivalent number of those with dementia, should there not be a similar consideration in the urban fabric?

Fi gure 8. N omadi c C hangpa B uddhi s t Gompa Indi a Fi gure 9. H otel of Li berati on V aranas i Indi a Fi gure 10. C i ty S quare A l fama P ortugal Fi gure 11. S un C i ty A ri z ona USA

Proposal:

I N T E G R AT I O N integrated car e s erv ices to provide follow up support, res pite clinics can often cause long term complications.

The existing care-home typologies in the UK can be roughly organised along a continuum, with four key groups: Care Homes, Specialised Housing, Res pite Clinic s , and Adapted Mainstream Housing. Despite important design v ariations, these typologies can all be described as exam ples of segregativ e care. In each case, the consequent lac k of integration has s ignificant im plications for the quality of care experienced by dementia patients .

In Adapted Mainstream Housing (AMH, the patient’s home is retrofitted to compens ate for neurodegener ation and frailty. A MH is a partic ularly attractive solution as one retains a k nown env ironment whils t also benefiting from s pec ialist featur es us ually found in institutional car e s ettings. 60% of the over 65 population own their property outright so that, especially with the intr oduction of ‘as s istive technology ’ (sensors in the home that notify a centralised care s erv ice should you fall or leave the gas on etc ., AMH is a popular option. In 2017, Worc ester County Council began offer ing residents non-m eans tes ted grants for the purpose of adapting their homes for dementia. The private home, howev er, also inhibits integration with the local community through the very priv acy that it advocates. In recent years, technological innov ations inc luding ‘therapeutic r obots’ have been dev eloped to prov ide a companion for thos e living alone. These robots rang e from baby seals to fully interactiv e humanoids but all seek to compensate for rather than to solve the isolation barr ier. Indeed, as Dr. Carol Br ayne has sugges ted, such technological inter v en-tions tend to incr ease one’s isolation, citing E.M For s ter ’s dystopian fic tion ‘The Machine Stops’, in which technologi-cal communication replaces all genuine social interaction, generating a universal quarantine.

The most common typology, care homes, prov ide accommodation in protec ted, generally gated, environments. Predominantly consisting of single r ooms with shared comm unal spaces, they offer 24 hour care and services for residents. Despite offering a greater level of suppor t than any other typology, they tend to restrict independence and is olate individuals from previous familiarities . Indeed, a recent DICE study of care-homes found that when s afety and health were r ated highly, quality of life scores were rated low, suggesting that the protected environm ent of the care home comes at a high price.

Fi gure 12. 1900 - R emov al from c i ty 2000- P eri pheral l i v i ng 2050 - Integrated c i ty

Respite Clinics offer a break for the patient and car er. Generally well equipped with experienced staff, thes e homes operate on a hotel- like model, offering s tays of approximately 2 weeks for a fee. These do not seek to integrate the patient into the c are setting, but r ather to alleviate the press ures of home-c are, providing a nec ess ary short-term solution. However, while benefic ial for carers , moving Alzheimer patients to and from an unfamiliar environment can hav e ‘debilitating effects on their level of confusion and disorientation’. With no 7

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E L L I P S I S - Ur ban Design for Dement ia

M ore flexible than c are homes, specialis ed hous ing encompass es sheltered-living, extra-care, and a retirement village struc ture. Epitomising the ‘age- in-place’ philosophy of purpose built accom m odation, they allow people to familiaris e a custom -built env ironment whilst als o providing an ins titutional system of care, available when and if required. However, despite often including shared soc ial spaces, recent researc h by A ge UK found that a large proportion of the designs us ed for sheltered housing ‘was not always conducive to encouraging public interaction’. Additionally, as Sarah Waller CBE observ es, while modern features may appeal to buy ers they are frequently inappr opriate for the perception sens itivities of dementia.29 In this way, special ised hous ing fails to provide a care sy stem that is sufficiently integrated, or indeed, even suppor tive of patient integration within its internal s etting.

Proposal:

D E M E N T I A F R I E N D LY D I S T R I C T What Forster ’s dystopia shares with all four typologies is a c ommon desire to recompense ar tific ially for isolation rather than to challenge it. In this sense, a typology that provides integrati ve and integrated car e – as opposed to compensating or substituting within a segr egative system – is y et to be developed. S ome steps in the right direction have, howev er, been taken. For example, the ‘Hub and Spok e’ model, currently being tri alled by a the Gibeleich Alterzen community in Zurich offers independent liv ing and c are home options c onnec ted by shared serv ices – shops, a canteen, and a laundry. Vitally, the facility relies upon its proximity to local volunteer s and resourc es in order to operate. In Japan, an informal alter native to this model, known as ‘Suzunoya’ is taking shape, with volunteers offer ing locals all-day care and drop-in fac ilities within their own home. Here, I sugges t that it is possible to pres erv e and bring together the various strengths of each ty pology within a s tructure that is fully integrated within the ur ban context of London. This integrati ve s ystem would cons ider the public urban streets cape as much part of the architecture of care as the typologies themselves, generating a connec ted ‘Dementia Friendly District’ (DFD. Importantly, this would not only mediate som e of the inher ent flaws of the exis ting typologies of c are but form a durable fram ework for new ones. These new Alzheimer friendly forms could then offer a flexibility of care options enabled by their integration with the city and DFD.

E L L I P S I S - Ur ban Design for Dement ia

Fi gure 13. D FD H ammers mi th London

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Case Study:

CASE STUDY MAP

The following precedents indic ated on th e map shar e the commonalities of; their location in city centres, their architectural relevance for contemporary dementia care, and their potential applic ability for the borough of Hamm ers m ith and Fulham. However, though br oadly related, eac h c ase study uniquely address es a partic ular aspect of dementia care.

S un C i ty A ri zona

D oi ng D ementi a D es i gn Li v erpool

CDRS U ni v ers i ty of C ambri dge

DRC U ni v ers i ty C ol l ege London

E x peri mental A l z hei mer N urs i ng H ome, P ari s

A l fama D i s tri c t Li s bon P ortugal

H afenc i ty H amburg

D -C ol ogne H ous i ng C ompl ex

D e P l us s enburgh R otterdam

Gradmann H a u s S tuttgart

D e H ogew ey Wees p Open A i r S c hool A ms terdam

Gi be le ic h Alt e r s z e n t r u m Zuri c h

A l do v an E y c k P l ay grounds A ms terdam

Ne wSch o o l Sa n Die g o

The map depic ts the case studies in orange and associated research institutions in blue.

Map

E L L I P S I S - Ur ban Design f or Dem entia

L ove ll Ho u se L os An g e le s

The aim of this site researc h is therefore twofold; firstly to coherently collate these precedents into an acc ess ible recours e for dementia des ign and secondly to evaluate their potential for implementation in the DFD design proposal.

D e R ok ade Groni ngen

Case Study:

E X P E R I M E N TA L A L Z H E I M E R N U R S I N G H O M E I N PA R I S

Development Description The Rue Branche facility acc ommodates for the dependant elderly (EH PA D) with %10 of the beds allocated for thos e with AD. The developm ent occ upies a cons tricted site in the centre of an urban block. Its eastern facade and entrance fac es onto a narr ow corridor leading to the r ue Blanche, however its western facade faces onto a spacious walled garden. The treatm ent of these facades are also equally distinc t, with the western facade incorpor ating a bright green and white double skin, the outer layer of which supports large tr ee like struts s which rise up the face of the facade. The terraces formed between thes e two fac ades are disappointingly just for fire escape, however the gener ous application of gla ss allows views out into the garden. The design additionally incorporates a concept known as 'Parenteles', whic h prioritises patients wellbeing and sensor y development while simultaneously respecting human dignity. Fi g. 14 A l zhei mer N ursi ng H ome P ari s

Location: 49 rue Blanche, Paris, France Architect: Philippon-Kalt Architectes Urbanistes Built: 2012 Dementia focus of development:

- Did the security of the garden allow for greater freedom when designing the double s k in facade? - What was the underly ing concept or principle that informed the mirroring of nature in the west facade? - The tree like struts act as a louvre system to reduce glare, howev er do the stark shadows that they may c reate cause any iss ue for residents? - What was the relevance of colour in the project and how was it used effectiv ely? - The garden plays an integral role in the project and im portantly pr ovides sensory stim uli for the residents but how - if at all - was this incorporated in the interior ? - With a sensitive project such as this, to what extent do safety concerns drive design decisions? - What has been learnt from the project and how will this be incorporated in future projects?

Archite ctu r e, M ind, and M em or y : Des ign f o r A l z h e i m e r â&#x20AC;&#x2122;s

Case St udies

E L L I P S I S - Urban Des ign f or Dem entia

It is often noted that contemporary society is increasingly ocularcentric, or preferential towards vision as the primary sense. Of the five senses, vision and hearing are often the earliest and most dramatically affected by the ageing process. A greater appreciation for the senses as a complete system needs to be achieved in order to provide ageing adults with the ability to interact with the environment using the sensory capabilities they still possess. This is especial important when relating to those with Alzheimer â&#x20AC;&#x2122;s and other forms of dementia. When memory is significantly compromised, normal verbal communication may be impossible. Interaction through smell, taste, sound, and touch can keep individuals leading meaningful lives.

Development Analysis (points for discussion) - How r elevant was the site and its restrictions for the programme of the project?

Case Study:

DE PLUSSENBURGH

Development Description

Fi g. 15 D e P l ussenburgh R otterdam

Loc ation: De Plussenburgh, Rotterdam, Netherlands A rchitect: Arons en Gelauff Architecten Built: 2006

Development Analysis (points for discussion) - How r elevant was the site and its restrictions for the programme of the project? - How was the balance between independant liv ing and s upported living incor perated into the design? - What challenges did the typology of a tower present when designing for the elderly ? - How does the tower interact with the ground plane to encour-age mobilty and inclusion with the rest of the development? - What was the concept behind the facade of the building? - To what extent does the use of colour play a r ole in the projects design? - In what way has this pr oject differed from other residential schemes? - What has been lear nt from the project and how will this be incorporated in future projec ts?

Th e d esign of hous ing f or people wit h de m e n t i a

Case St udies

E L L I P S I S - Urban Des ign f or Dem entia

Dementia focus of development: There is a much misunderstood issue of colour perception. As most people get older they can lose the ability to differentiate between colour s, so colour contrast rather than c olours are the key to orientation. The ability to discriminate between colours fails ﬁr st at the violet end of the spectrum with the red/orange/yellow end failing last, so these colours may be more effectiv e for some people. Of cours e, colours can be useful to ass ist younger relatives and staff to ﬁnd their way, but usually not the people with dementia. Wall junc tions will be more easily perceived, for ex ample, if the two walls are of contrasting colour s or a colour and a neutral tone. Older people c an have a range of sight impairments. People with dementia may not understand that they hav e an impairment so may not be able to wor k out what they are seeing. S trong visual and tactile cues in handrails will help, although they may not be able to work out why there is a knob on the end of a handrail. Nevertheles s, it will probably make them stop at a door.

De Pluss enbur gh’s intended residents are seniors aged 55 and older, its design was inspired by the forthc oming retirement of the hippie generation. The project embraces its target market's approach to aging by pr oposing a playful, coloured apar tment block . The building is an iconic configuration of a tower and an elevated slab. The slab volume is elev ated 11 metres over the water and opens up a s pectac ular view onto the exis ting pond from the adjacent pre-existing nur s ing home. Th e minimum footprint of the tower creates space for a garden.The two main volumes consist of apar tments with an uninterru pted span of 9m, allowing for m ultiple floor plans and adaptability in the future. An inconspicuous elevator shaft connec ts the new building to the older one, where medical per s onnel, cook s and other help are available. The façades of the dwellings gain a strong, three-dim ensional quality through the wav y balconies. The glazed galler ies - set with self-cleaning glas s - are smooth but very colourful in over 200 different shades.

Case Study:

OPEN AIR SCHOOL AMSTERDAM Development Description Sinc e the beginning of the 20th c entury open air sc hools have been built to help phy s ically weak children gain strength aided by sun and fresh air. In 1927 Duiker and Bijvoet were commissioned to des ign such a school in Amsterdam. S tanding on the inner court of a perimeter block, it was preceded by fiv e preliminar y plans for various locations. The school consists of a squar e classroom bloc k in four levels placed diagonally on the site. This basic s quare is subdivided into four quadrants around a diagonal centr al stairc ase. East and wes t quadrants each contain one classroom per s torey and share an open air classroom on the south side.

Fi g. 16 Grandmann H aus

Location: Cliostraat 40, Amsterdam, Netherlands Architect: J Duiker Built: 1930 Dementia focus of development:

Development Analysis (points for discussion) - How relevant was the site and its restrictions f or the programme of the project? - How are materials appropriately used in the project to support engagment? - To what extent does the circulation system differ from traditional residential blocks? - How is glass used effectively in the project, in particular the control of glare and stark shadows? - In what way has this project differed from othe r schools? - What has been learnt from the project and how will this be incorporated in future projects?

Wayfind ing f or People wit h Dem ent ia

Case St udies

E L L I P S I S - Urban Des ign f or Dem entia

Several studies focused on the positive effects of artificial bright light (2,000 lux [lx]) and also of outdoor natural light on people with dem entia, both of whic h lead to positiv e effects, including increased s leep duration and less aggressiv e and agitated behav ior (Calkins, Szm erekovs ky, & Biddle, 2007; Riemersma- van der Lek et al., 2008; Sloane et al., 2005, S loane et al., 2007). The therapeutic value of lighting also has been ques tioned (For bes et al., 2004). However, from the existing empirical ev idence and practical ex perience in nursing hom es, it becomes evident that sufficient lighting (500 lx o f ambient light, up to 2000 lx in activity areas) is a prerequis ite for good vision and, ther efore, for being able to see and inter pret the environmentâ&#x20AC;&#x201D;whether it is the perception of the size and shape of rooms or of cues for orientationâ&#x20AC;&#x201D; becaus e all these elements ar e prerequis ites to way-finding and spatial orientation within a nursing home setting.

The concr ete columns are situated not at the corners but in the middle of the quadr ants' sides, producing a favourable distr ibution of forces in the facade beams, keeping the c orners free of columns and strengthening the school's open, 'floating' appear ance. Floor slabs cantilever over the main beams resulting in a c ounterbalance of mom ent. The columns are further coupled diagonally by secondary beams which expr ess in the ceiling the diagonal spatial composition of the clas s rooms . The structure's distribution of forces is demonstrated by tapers in the columns and beams. Except for a low conc rete parapet the facades are fully glaz ed and fitted with s teel-fram ed pivoted windows allowing c lassrooms to be opened up entir ely.

Case Study:

DE HOGEWEY

Development Description Hogeweyk is a specially designed village with 23 houses for 152 dementia-suffering seniors. The elderly all n eed nursing home facilities and live in houses differentiated by lifestyle. Hogeweyk offers 7 different lifestyles: Goois (upper class), Homey, Urban, Christian, Artisan, Indonesian and Cultural. The residents manage their own households together with a constant team of staff members. Washing, cooking and so on is done every day in all of the houses. Daily groceries are done in the Hogeweyk supermarket. Hogeweyk offers its dementia-suffering inhabitants maximum privacy and autonomy. The village has streets, squares, gardens and a park where the residents can safely roam free. Just like any other village Hogeweyk offers a selection of facilities, like a restaurant, a bar and a theatre. Fi g. 17 D e H ogew ey Weesp

Location: De Hogewey, Weesp, Netherlands Architect: Molebaar&Bol&VanDillen Built: 2009

Development Analysis (points for discussion) - What was the primary concept informing the arrangement of the block in relation to each other? - To what extent are shops and other facilities integrated into the development? - What factor(s) limited the height of each block? - To what extent does the developmentâ&#x20AC;&#x2122;s courtyard block typology increase navigability and sense of place?

Dementia focus of development:

- How were the 7 different lifestyle categories arrived upon and how effective have they been in providing user comfort? - Does the gated nature of the development compromise the intended environment? - How does the development integrate with its surrounding context? - How successfully do the blocks interact with the ground plane and promote mobility and interaction? - What has been learnt from the project and how will this be incorporated in future projects?

De men tia- f r iendly Cit ies : Des igning I nt e l l i g i b l e N e i g h b o u r h o o d s f o r L i f e

Cas e St udies

E L L I P S I S - Urban Design for Dem ent ia

The mai n characteristic of the landmarks was that they were either noticeable or interesting structures or places, while the overriding feature of the latent cues was that, as with building form and style, their designs were easily recognizable. Both types of cues, however, were only remembered if they were encountered regularly. To enhance the legibility of outdoor environments for older people with dementia it is, therefore, important that, wherever possible, well-established historic, civic and distinctive landmarks and places of activity be allowed to remain in situ. The legibility of public areas can also be improved by the use of street furniture, trees, ďŹ&#x201A;ower tubs, hanging baskets and publi c art providing they are placed in the same location for a long period of time and not so numerous as to cause an excess of external stimuli.

Case Study:

A L D O VA N E Y C K P L AY G R O U N D S

Development Description In 1947, the architect Aldo van Eyck built his first playground in Amsterdam, on the Bertelmanplein. Many hun dreds more followed, in a spatial experiment that has (positively) marked the childhood of an entire generation. Though largely disappeared, defunct and forgotten today, these playgrounds represent one of the most emblematic of architectural interventions in a pivotal time: the shift from the top down organization of space by modernist functionalist architects, towards a bottom up architecture that literally aimed to give space to the imagination.

Fi g. 18 A l do van Eyck P l ayground

Location: Amsterdam, Netherlands Architect: Aldo van Eyck Built: 1950

Van Eyck consciously designed the equipment in a very minimalist way, to stimulate the imagination of the u sers (the children), the idea being that they could appropriate the space by it’s openness to interpretation. The second aspect is the modular character of the playgrounds. The basic elements – sandpits, tumbling bars, stepping stones, chutes and hemispheric jungle gyms – could endlessly be recombined in differing polycentric compositions depending on the requirements of the local environment. The third aspect is the relationship with the urban environment, the “in-between” or “interstitial” nature of the playgrounds. The design of the playgroun ds was aimed at interaction with the surrounding urban tissue Development Analysis (points for discussion) - How does the project promote social interaction?

Dementia focus of development:

- To what extent is the project still in use today? - What is the accessibility of the site? - How does the design of the urban furniture promote security and/or familiarity? - Do the playgrounds follow a legible pattern? - In what way does this project differ from other regeneration schemes? - What has been learnt from the project and how will this be incorporated in future projects?

Deme ntia - f r iendly Cit ies : Des igning I nt e l l i g i b l e N e i g h b o u r h o o d s f o r L i f e

Cas e St udies

E L L I P S I S - Urban Design for Dem ent ia

In terms of style, older people with and without dementia tend to prefer more traditional designs, especially where these make clear the use of buildings and places. However, when talking about and visiting open spaces an interesting division became apparent between the participants with and without dementia. Those with dementia expressed and demonstrated a greater preference for vibrant, informal open spaces with plenty of activity, such as urban squares surrounded by shops, cafe´s and ofﬁces, and parks containing tennis courts, children’s play areas, boating ponds and so on. Those without dementia pre-ferred formal squares with empty, open expanses of ground surrounded by imposing historic architecture and more formal green open spaces such as botanical or historic gardens.

- How well does the project occupy the site within the urban fabric?

Case Study:

DE ROKADE GRONINGEN

Development Description

Fi g. 19 D e R okade Groni ngen

De Rokade sits adjacent to the nursing and care home Maartenshof. This relationship between the new tower block and care home is a vitally important one, as it enables residents to access care when needed, while retaining a level of dignity associated with independent living. The connected shops, restaurants and hall, also enable residents both security and freedom, a duality which is often weighted too heavily in favour of the former in care communities. The cruciform plan of the tower creates introverted apartments that face onto themselves, allowing one to simultaneously view the city and one’s own space, perhaps reducing disorientation. Equally the narrow depth of the floor plate allows natural light right into the heart of the structure, only to be blocked by the circulatory core. The apartments can be arranged by residents into three possible layouts, in this way enabling residents to be actively involved with the architecture of their environment, which multiple studies have shown to increase one’s satisfaction and orientation within space. Development Analysis (points for discussion)

Location: De Rokade, Groningen, Netherlands Architect: Arons en Gelauff Architecten Built: 2007

- How relevant was the site and its restrictions f or the programme of the project? - How was the balance between independant living and supported living incorperated into the design?

Dementia focus of development:

- How does the tower interact with the ground plane to encourage mobilty and inclusion with the rest of the development? - What was the concept behind the iconic facade of the building? - To what extent do residents have control over the layout of the apartment and how vital do you believe this to be for the intended demographic? - In what way has this project differed from othe r residential schemes? - What has been learnt from the project and how will this be incorporated in future projects?

Fu ture of a n ageing populat ion: ev idenc e r e v i e w, G o v e r n m e n t O ff i c e f o r S c i e n c e

Case St udies

E L L I P S I S - Urban Des ign f or Dem entia

There is recognition that robust processes are needed to develop age-friendly neighbourhoods. The World Health Organization (WHO) has responded to the twin drivers of growing urbanisation and an ageing population by building an age-friendly network of cities all over the world. It has produced a guide to the age-friendly city, which identifies eight domains or core features: outdoor spaces and buildings, transportation, housing, respect and social inclusion, social participation, civic participation and employment, communication and information, community support and health services (WHO, 2007). So called; ‘Hub and spoke’ schemes, offer supportive neighbourhood structures of specialist services that are not only available to those in care but the wider community. This framework allows for a less segregated form of care where each resident has a level of civil involvement within the wider community, strengthening social ties and reducing isolation.

- What challenges did the typology of a tower present when designing for the elderly ?

Case Study:

D-COLOGNE HOUSING COMPLEX

Development Description The D-Cologne Housing is an iteration on the rib bon development of the mid 1900’s. This type of development by its form, benefits from good lighting - due to consistent orientation good ventilation, and efficient access to each unit. However, it often creates a streetscape devoid of meaningful, social space. The ASTOC solution was to introduce a bend in the blocks that allows for a series of loosely enclosed public spaces, formed around the buildings footprint. These were intentionally designed without specific function to be appropriated by the residents as they saw fit. The Parking is situated underground and the buildings façade alternates with descending shades of green with each corner. On the ground floor of the residential quarter a group of people with dementia have access to out-patient support and sheltered outdoor area of their own. Fi g. 20 C ol ogne H ousi ng C ompl ex

Location: Buchheimer Weg Estate, Cologne, Germany Architect: ASTOC - Architectects and Planners Built: 2008-2012 Dementia focus of development:

‘That does not mean one should immediately embark on creating protected area for movement that are removed from traffic zones. Proximity and comprehensibility are the most important spatial criteria for establishing social contracts. Communal green spaces that no one makes use of, such as the green spaces trapped within perimeter block structures of between orthogonally arranged rows of buildings, are neither helpful for orientation nor uplifting; this we need to avoid.’ Eckh ard Fedder s en and I ns a Lüdt k e, Lo s t i n S p a c e : A r c h i t e c t u r e a n d D e m e n t i a , tra ns. Ju lian Reis enber ger

- What was the primary concept informing the arrangement of the block in relation to each other? - To what extent are shops and other facilities integrated into the development? - What factor(s) limited the height and length of each block? - Does the development’s kinked block typology increase navigability when compared with the former ribbon development? - Awareness of study: Dementia-friendly Cities: Designing Intelligible Neighbourhoods for Life - Has the informal undefined nature of the public space lead to residents defining the space, and if so how successful do you believe this to be, when compared with more formalised public space? - How does the development integrate with its surrounding context? - How successfully do the blocks interact with the ground plane and promote mobility and interaction? - What has been learnt from the project and how will this be incorporated in future projects? 26

Case St udies

E L L I P S I S - Urban Des ign f or Dem entia

Dementia can no longer be considered a disease afflicting a small demographic but rather a condition affecting a large section of society. It is therefore necessary for public space to reflect this shift and its design be sufficiently safe and legible for the user.

Development Analysis (points for discussion)

Case Study:

HAFENCITY

Development Description Hamburg’s HafenCity currently represents Europ e’s largest innercity development project. The new urban district, with a total area of around 150 hectares, is surrounded by river and canal channels on all sides. By the middle of the twenty-twenties, it is envisaged to provide new residential space for up to 12,000 people, as well as create 40,000 new jobs. In order to create discretely independent urban quarters, the urban magnets were not located around the center but in an outer and inner triangle, precisely placing buildings that would be able to shape the different quarters with their dedicated functions. Development Analysis (points for discussion) - What ar e the primary advantages and disadv an tages when working on the r egener ation of a port site? Fi g. 21 H afenci ty H amburg

- To what extent are shops and other fac ilities integrated into the development? - In what way does the development interact with the water front?

Location: HafenCity, Hamburg, Germany Architect: Kees Christiaanse / ASTOC Built: -Present

- To what extent does the development’s streets c ape suppor t navigability and s ense of place? - Is the water considered an extension of the infr astructur e in term s of transportation?

Dementia focus of development:

- How does the scale of the development have an impac t on the quality of space? - How successfully do the blocks interact with the ground plane and promote mobility and interaction? - What has been learnt from the project and how will this be incorporated in future projects?

Cas e St udies

E L L I P S I S - Urban Design for Dem ent ia

It was found that the people who lost their way on the accompanied walks all live in neighbour-hoods with complex street layouts and poor street connectivity, with the greatest disorientation occurring at road junctions and in spaces with poor visual access.The ﬁndings, in line with the literature, suggest that the most legible street layout for people with dementia would be short streets laid out on a deformed grid, based on an adapted perimeter block pattern rather than uniform grids with 90° turns and blind bends. The number of junctions should be kept to a minimum. Where necessary, forked junctions that create greater visual access along all routes, and T-junctions which provide a focal point at the end of the street and prevent the confusion of too many routes leading from one junction, are preferable to crossroads.

- Does the semi-segregated nature of the develo pment c ompromise the intended environment?

Deme ntia - f r iendly Cit ies : Des igning I nt e l l i g i b l e N e i g h b o u r h o o d s f o r L i f e

Case Study:

GRADMANN HAUS

Development Description

Fi g. 22 Grandmann H aus

Development Analysis (points for discussion) - How relevant was the site and its restrictions f or the programme of the project? - How was the balance between independent living and supported living incorporated into the design? - How are materials appropriately used in the project to support people with dementia? - To what extent does the circulation system differ from traditional residential blocks? - How is glass used effectively in the project, in particular the control of glare and stark shadows? - In what way has this project differed from othe r residential schemes? - What has been learnt from the project and how will this be incorporated in future projects?

App lyin g N eur os c ienc e t o Ar c hit ec t ur e

Case St udies

E L L I P S I S - Urban Des ign f or Dem entia

Location: Fohrenbuhlstrabe, Stuttgart, Germany Architect: S Heeg, Herrmann + Bosch Built: 2001 Dementia focus of development: Layout and materiality had been a prime consideration in many schemes, with careful thought given to the positioning of public and communal areas close to the entrance, the use of secure doors and lifts to separate public from private space, and the use of glazed doors to support recognition of activities within different areas. One scheme commented on the use of colour to emphasise key activities, suggesting that improvements could be made to use col our to highlight where toilets are located. If free flow of ideas is directly related to the free flow of the architecture, collaborative free flow should be served by contiguous space. Architects have conventionally grouped (glass) walls / windows into a “soft-barrier” category (like the semi-permeable membrane). Research in animal studies has shown that these are perceived by the brain as barriers nonetheless. A window may create an opportunity for visual exploration but it does not serve to unite two spaces. Though regarded as easily surmountable barriers, “soft-barriers” still disconnect the space, serve to create disparate memories of spaces, and restrict movement.

The Gradmannhaus in Stuttgart Kaltental combines a city meeting place and supervised carehome apartments with 12 respite rooms and 26 permanent places for dementia patients. The Center is particularly suited to the needs of mobile residents who are middle-aged with severe dementia. Conceptually, in the Gradmann-Haus the milieutherapeutic approach is given great importance, which assumes that a socially, organizationally and physically / physically dementified milieu has a decisive significance for the quality of life of dementia sufferers. The complex is designed according to the "village road principle". Like the houses on a street, the two-storey residential groups for stationary care and the rooms for day care are located on the ground-level glazed lobby. Betwe en the "houses" of the residential groups is the protected garden, which is also accessible from the lobby. The supervised senior apartments are located in a multi-storey building above the lobby. The divisible meeting room with cafeteria on the ground floor is available to the district and the residents of the house.

Case Study:

G I B E L E I C H A LT E R S Z E N T R U M

Development Description Gibeleich Alterszentrum in Zurich is a ‘hub and spoke’ scheme, where the services required to support specialist residential housing are also available to older people living in the neighbourhood. Gibeleich consists of two nursing homes offering different levels of care and an apartment block for independent living. The scheme has grown organically, and n ow includes a community centre with shop, restaurant, conference centre, a charity shop staffed by volunteers, sensory gardens and an aviary. An industrial-scale laundry and kitchen o n the site services the scheme and also provides a volunteer-run laundry and meals-on-wheels service to older people living locally. Integration with the community is actively promoted; the restaurant is open to all, and is used by local office workers. Development Analysis (points for discussion) Fi g. 23 Gi bel ei ch A l terszentrum

Location: Talackerstrasse, Glattbrugg, Switzerland Architect: Mutiple Built: 1990-2010 Dementia focus of development:

- How was the balance between independant living and supported living incorperated into the design? - What challenges did the typology of a tower present when designing for the elderly ? - How does the tower interact with the ground plane to encourage mobilty and inclusion with the rest of the development? - Does the development benefit from having multiple separated units, each serving a particular function? - To what extent do residents have control over their environment and does the projects location benefit staff? - In what way has this project differed from othe r residential schemes? - What has been learnt from the project and how will this be incorporated in future projects? Cas e St udies

E L L I P S I S - Urban Design for Dem ent ia

- How relevant was the site and its restrictions f or the programme of the project?

Fu ture of a n ageing populat ion: ev idenc e r e v i e w, G o v e r n m e n t O ff i c e f o r S c i e n c e

Case Study:

A L FA M A

Development Description A t the urban sc ale, the framewor k of routes, green spaces and other elements of connec tiv ity is a relational grain that defines the liaisons among open spac es and developments. The grain highlights the m orphology of the city: patterns of streets, settlements, layout of building blocks and dev elopm ent plots, dimensions and dens ities of these elements and their frequency, etc.

Fi g. 24 Al fama Li sbon

Location: Alfama, Lisbon, Portugal Architect: N/A Built: N/A

Definitel y, the urban gr ain is the first element to define urbanforms of the built environm ent. The selected areas of Alfama in Lisbon has the highes t proportion of over 65’s of any other city distric t in Europe, through arguably its urban grain is one of the most difficult to navigate. Built on a hills ide Alfama became inhabited by the fishermen and the poor in the 15th century. The great 1755 Lisbon earthquake did not des troy the A lfama, which has remained a pic turesque laby rinth of narrow streets and small s quares. Lately the neighbour hood has been invigorated with the renovation of the old houses and new restau-r ants. Development Analysis (points for discussion) - How has public infrastructure effected the streetscape of Alfama?

- What challenges does the Alfama vernacular p resent for the elderly? - Does the density of the urban fabric create a secure environment? - To what extent have social and economic factors had an effect of the concentration of this elderly demographic? - To what extent does the climate allow for such a vernacular flourish? - In what way has this project differed from other residential schemes? - What has been learnt from the project and how will this be incorporated in future projects?

Futu re o f an ageing populat ion: ev idenc e r e v i e w, G o v e r n m e n t O ff i c e f o r S c i e n c e

Case St udies

E L L I P S I S - Urban Des ign f or Dem entia

Dementia focus of development: The concept of an enabling environment is one in which the physical arrangement of the built environment is designed to facilitate social interaction, with involvement in activity being a result. For outdoor enabling environments, the combination of physical elements and human energy in the presence of nature affords a person the benefits of engagement with nature as well as social life. The overlapping of patterns of use with daily routines insures that spaces are used by the residents. Visual and physical proximity of elements is necessary since ‘out of view, out of mind’ applies in general, but it is specifically relevant to people with dementia who may forget the amenity that is unseen.The study identified several key areas valued by the participants: clean pollution-free spaces, peace and quiet, places that facilitate exercise, free from obstacles with seating and key services, places that support social interaction and places that give an emotional uplift. In the words of one participant: “Everybody wants to look at a thing of beauty.”

- To what extend does the streetscape support social interaction?

Case Study:

LOVELL HOUSE

Development Description The house consists of a series of overlapping planes that do not stick to Wright’s proportionality; rather they are a hybrid of Wright’s planar devices combined with Le Corbusier ’s stark, streamlined aesthetic. The house clings to the side of a steep cliff; it is perpendicularly suspended to take on the panoramic views of Los Angeles. Since the house is suspended perpendicularly, the volume of the house is disconnected from the street, which is bridged by a concrete walkway that brings the inhabitant into the upper level of the house, which is the living quarters, and issues them down a large staircase encased in glass that leads into the living room and to the pool outside.

Fi g. 25 Lovel l H ouse

The lower level of the house, the living room, fo llows an open plan that leads out to the patio and swimming pool. It’s outside near the pool that one begins to understand the spatial organization of the overlapping planes and the pilotis that support the cantilevering volumes.

Location: Los Angeles, California, USA Architect: Richard Neutra Built: 1927

Development Analysis (points for discussion)

Dementia focus of development:

- To what extent does the architecture promote a healthy lifestyle?

- How relevant was the site and its restrictions f or the programme of the project? - How is light used throughout the spaces?

- How does this simplicity of the floor aid with navigation and the intuitiveness of the space? - Does the simplicity of materials also help avoid the perceptual problems, such as visual clutter? - How does the architecture integrate with its landscape? - In what way has this project differed from othe r residential schemes? - What has been learnt from the project and how will this be incorporated in future projects?

Th e Architec t s Br ain

Case St udies

E L L I P S I S - Urban Des ign f or Dem entia

In 1926, in collaboration with Lovell, Schindler composed a number of essays for the LA Times on the physiological requirements of the healthy house: discussing issues such as ventilati on, plumbing, heating, lighting, furniture, exercise areas, and landscape. When, in 1927, Lovell decided to build a new home in the Hollywood Hills – the so-called Health House – he turned not to Schindler but to Neutra, who responded by designing the most biologically refined residence of the 1920’s, one that was conceived entirely around physiological, psychological, and environmental concerns. Human psychology and physiology remained principal interests for the architect, as during the 1930s and 1940s he experimented with a number of low-cost prototypes for housing and schools that focused on heath and comfort of occupants.

Case Study:

SUN CITY ARIZONA Development Description Sun City was opened January 1, 1960, with five home models, a shopping center, a recreation center, and a golf course. The opening weekend drew 100,000 people, ten times more than expected, and resulted in a Time magazine cover story. The future retirement community was built on the site of the former ghost town of Marinette. Developer Del E. Webb expanded Sun City over the years, and his company went on to build other retirement communities in the Sun Belt. Sun City West was built in the late 1970s, Sun City Grand in the lat e 1990s, Sun City Anthem in 1999, and Sun City Festival in July 2006. The community's street network design consists largely of concentric circles in four main pinwheels and its population was 37,499 according to the 2010 census. Development Analysis (points for discussion) Location: Sun City, Arizona, USA Architect: Del Webb Built: 1960

Fi g. 26 Sun C i ty Ari zona

- How relevant was the site and its restrictions f or the programme of the project? - How was the balance between independant living and supported living incorperated into the design?

- How does the circular urban grain encourage mobilty and social interaction? - To what extent can Sun City be viewed as an economic and social triumph? - To what extent do residents have control over the layout of the apartment and how vital do you believe this to be for the intended demographic? - In what way has this project differed from othe r residential schemes? - What has been learnt from the project and how will this be incorporated in future projects?

Ellipsis - U r ban Des ign f or Dem ent ia

Case St udies

E L L I P S I S - Urban Des ign f or Dem entia

Dementia focus of development: In the 1960’s, the construction of Del Webb’s Sun Cities witnessed the arrival of a metropolitan care structure to America, along with its highly successful branding of ‘social ageing and its associated idealistic imagery.’ These cities promised the elderly an exclusive sun and leisure filled retirement, entirely accessible by golf cart. However, rather than truly integrate within the urban context, Sun Cities provide their own distinct urban condition, disconnected from family and wider society in much the same way as isolated rural homes. As such, important ‘anchoring’ memories that require repeated reinforcement from wider contexts are not suitably addressed; ‘the familiar becomes all too unfamiliar.’ In this way, they are symptomatic of what James C. Scott identifies as the failure of the High Modernist City: the ‘rigid segregation of function’, and therefore do not offer a sustainable option for dementia populations of the future. What is needed is not an urban context within a care home structure but rather a care structure embedded and integrated within the urban setting, in other words: an integrated urbanisation.

- What challenges did the typology of suburban sprawl present when designing for the elderly ?

Credits:

CONTRIBUTORS This projec t is only made possible by the on-going s uppor t of the listed institutions.

Jack Sardeson Graduate Researcher Department of Architecture University of Cambridge About: http://www.arct.cam.ac.uk/people/jack-sardeson Project: https://ellipsis.blog/ e: js2277@cam.ac.uk

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E L L I P S I S - Ur ban Design for Dement ia