A DEMENTIA VILLAGE Investigating the relevance of sensory & curative architecture for dementia care

A DEMENTIA VILLAGE Investigating the relevance of sensory and curative architecture for dementia care

July, 2022

A DEMENTIA VILLAGE Investigating the relevance of sensory and curative architecture for dementia care Navi-Mumbai, Maharashtra

By Jumana Parawala 17SA124

Thesis Submitted to Arvindbhai Patel Institute of Environmental Design (APIED) D.C. Patel School of Architecture,

July, 2022

APPROVEL CERTIFICATE This is to certify that the Thesis titled

A DEMENTIA VILLAGE Investigating the relevance of sensory and curative architecture for dementia care has been submitted by Jumana Parawala 17SA124 Towards Partial fulfillment of requirements for the award of Bachelor of Architecture Degree At D.C. Patel School of Architecture, APIED Affiliated to Sardar Patel University Vallabh Vidyanagar

Approved by

Thesis Chair

Prof. Mona Desai

Guide

Ar. Nayan Shah

Examiner

Type in Name

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UNDERTAKING I, Jumana Prawala The author of the thesis titled A DEMENTIA VILLAGE : Investigating the relevance of sensory and curative architecture for dementia care Hereby declare that this is an independent work of mine carried out towards partial fulfilment of the requirements for the award of the Bachelor of Architecture Degree at D.C. Patel School of Architecture, Vallabh Vidyanagar, India.

This work has not been submitted to any other institution for the award of any Degree.

All views and opinions expressed in this dissertation reports are mine, and do not necessarily represent those of the institute.

Jumana Parawala 17SA124 4th July, 2022 A.P.I.E.D, Vallabh Vidhyanagar

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ACKNOWLEDGEMENT I'd like to take this opportunity to thank everyone who contributed to the completion of my undergraduate thesis as well as the critical and enduring academic years. Thesis is more than simply the work of the final semester; it incorporates the learnings of all previous semesters into this one endeavor, and I am grateful to everyone who has taught me and helped me get to this point.

I would like to express my heartfelt appreciation to my mentors, Prof. Nayan Shah and Prof. Priyanshu Shrivastava, who continually directed me throughout my thesis and assisted me to attain the desired outcomes. I am also grateful to all of the professors from whom I have benefited over the last five years.

I am immensely grateful to my Papa , Kutbuddin Parawala, Mummy, Tahera Parawala, my bhai, Burhanuddin Parawala , and Hamza for always believing in me, encouraging me to work harder to achieve my desired outcome, being there for me, being so supportive, and motivating me not only this semester but throughout my life.

Last but not least, I'd want to thank all of my friends who have always had my back and have always supported me academically and emotionally, especially Rumana P, Mohammed T, Murtaza D, and Nafisa.

Furthermore, I am grateful to everyone, both named and unnamed, who helped me.

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Fig 0.1 Dementia elderly Source www.deviantart.com

ABSTRACT One of our generation's major health concerns is the growth in dementia and Alzheimer's disease diagnosis.

Around 55 million individuals worldwide suffer from dementia, with more than 60% residing in low- and middle-income nations. As the percentage of the population that is over the age of 65 increases in practically every country, this figure is predicted to climb to 78 million in 2030 and 139 million in 2050. (World Health Organization, Dementia)

With this growth comes the need for additional support systems, as well as concerns about care quality. Current medical research includes not just therapies for the body and brain, but also the significance of architectural design.

Along with the medical profession, architects have the potential to create spaces that can positively improve people's well-being by paying particular attention to the specific sensory needs of Dementia and Alzheimer's patients.

This thesis suggests that sensory and spatial design research on Dementia, be used to provide design guidelines for promoting and increasing well-being.

Despite the fact that each individual is unique, the shared experience of possessing the senses of sight, touch, hearing, smell, and taste provides a common beginning point for design guidelines.

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TABLE OF CONTENT i. ii. iii. iv. v. vi.

Tittle page Approval certificate Undertaking Acknowledgement Abstract Table of content

03 05 07 09 11 12

Chapter 1 – INTRODUCTION 1.1 Need for the study

19

1.2 Introduction : Research problem and motivation

20

1.3 Solution

22

1.4 Thesis purpose and thesis question

23

1.5 Aim and objectives

24

1.6 Methodology

25

Chapter 2 – BASE STUDY 2.1 What is dementia?

29

2.2 How is dementia different from normal ageing ?

31

2.3 Problem faced by dementia patients

32

2.4 What are different types and causes of dementia ?

33

2.5 What are different stages of dementia ?

38

2.6 What are the characteristics of dementia ?

41

Chapter 3 – FACTS AND FIGURE

12

3.1 Global scenario of dementia

45

3.2 Indian scenario of dementia

47

3.3 Prevalence of dementia by age and gender

48

3.4 Future projection of dementia

48

3.5 State wise estimates of number of PWD in India.

49

Chapter 4 – CURRENT INDIAN SCENARIO 4.1 Residential care services in India.

52

4.2 Resources necessary for dementia care.

54

4.3 What does India lack ?

56

4.4 Cost of dementia in India

57

Chapter 5 – DEMENTIA AND FIVE SENSE 5.1 Sensorial architecture: Influence of the Senses in Architecture 5.1.1 Sight

60

5.1.2 Touch

61

5.1.3 Hearing

62

5.1.4 Smell

63

5.1.5 Taste

64

5.2 Dementia and Five sense

65

Chapter 6 – CASE STUDY 6.1 International case study 6.1.1 Alzheimer’s Respite Centre, Dublin 6.1.2 The Hogeweyk – Dementia Village 6.1.3 Alzheimer's Village / NORD Architects 6.2 Indian case study 6.2.1 Jagruti Rehabilitation Center, Pune 6.2.2 Dignity Foundation Day Care Center, Byculla, Mumbai 6.3 Comparative Analysis

68 72 78 84 92 96

Chapter 7 – DESIGN DETERMINANTS 7.1 Sensory design: spaces for the senses

100

7.2 Space sequence and arrangement

101

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Chapter 8 – SITE SELECTION AND SITE ANALYSIS 8.1 Why Mumbai and Navi - Mumbai ?

107

8.2 Site selection

108

8.3 Location and connectivity

110

8.4 Hospitals in site proximity

112

8.5 Site photos

114

8.6 Site analysis

116

8.7 Detail site parameters

122

8.8 Climate analysis

124

8.9 SWOT

128

Chapter 9 – PROGRAM DERIVATION 9.1 User group 9.2 Overall layout of the dementia village 9.3 Area statement

132 132 133

Chapter 10 – CALCULATIONS AND DESIGN FOR DEMENTIA 10.1 NBC guidelines 10.2 Design for dementia

142 152

Chapter 11 – DESIGN DEVELOPMENT 11.1 11.2 11.3 11.4 11.5

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Space-sense relation Conceptual stage – 1 (form derivation) Refining the form (form derivation) Conceptual stage – 2 (form derivation) Conceptual diagram : refreshment and recreational space

161 162 164 166 168

Chapter 12 – FINAL DESIGN PROPOSAL 12.1 12.2 12.3 12.4 12.5 12.6

Roof top plan Ground floor plan Section and Elevation Day care center plan Severely dented cluster plan : stage 4th 3rd stage cluster plan

172 174 176 178 180 182

12.7 Day care and visitors stay cluster plan

184

12.8 Stage 1st cluster plan

186

12.9 Stage 2nd cluster plan

188

12.10 Stage 1st and 2nd stay cluster plan

190

12.11 Individual unit layout : patient accommodation

192

12.12 Individual unit layout : care taker room type-1

196

12.13 Individual unit layout : care taker room type-2

198

12.14 Cluster unit layout

200

12.15 Isometric view of the site and shopping street

202

12.16 Cluster 3D views

204

Chapter 13 – APPENDIX 13.1 List of figures

210

13.2 List of tables

224

13.3 References

226

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Chapter

01

INTRODUCTION This cahpter summarizes the current scenario, as well as some of my philosophy and ideas about it, as well as the project's vision, goal, and objectives.

•

NEED FOR THE STUDY

•

INTRODUCTION : RESEARCH PROBLEM AND MOTIVATION

•

SOLUTION

•

THESIS PURPOSE AND THESIS QUESTION

•

AIM AND OBJECTIVES

•

METHODOLOGY

Fig 1.1.1 An old man Source https://www.pinterest.co.uk/pin/636414991105572376/

1.1 NEED FOR THE STUDY • In India, increasing lifespan and decreasing fertility rates have resulted in a growing number of older persons. By 2050, people over 60 years of age are predicted to constitute 19.1% of the total population. In India, there are more then 5.3 million people today suffer from some form of dementia / Alzheimer's disease and at least 44 million people live with mental illness worldwide. Despite the magnitude: there is gross ignorance and lack of awareness in India which are the main source for very low diagnosis.

• In India, the current capacity of treatment centers and aid organizations are pathetically insufficient compared to desired needs. The lack of such specialized care facilities forces people to place dementia and Alzheimer's patients in non-specialist care homes that do not specialize in dementia.

• Most care facilities do not offer the necessary medical requirements. Most of the existing facilities are bungalows or rental apartments in a building run by private NGOs. Despite the efforts of these organizations, architectural interventions that could benefit the healing process are lacking.

• The ageing population is growing as well as changing, so it is time we think about the architecture for them.

Fig 1.1.2 ADI report on dementia in India Source The times of India

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1.2 INTRODUCTION RESEARCH PROBLEM AND MOTIVATION This thesis will study sensory architectural spaces and their potential to improve the quality of life for those living with Alzheimer's disease.

Sensorial environments give a form of therapeutic benefit in the aged, particularly those suffering from dementia and Alzheimer's disease, resulting in improved well-being.

The current 2018 World Alzheimer’s Report states, “Dementia, including Alzheimer’s disease, is one of the biggest global public health challenges facing our generation. Today, over 55 million people worldwide currently live with the condition and this number is expected to double by 2030 and more than triple by 2050 to 139 million.”

•

Dementia-friendly design may account for inadequacies faced by persons suffering from the condition, which is particularly important given that they spend the majority of their time indoors (Passini et al, 2000; Joesph, 2006).

•

A well-designed physical environment can create a legible, user-friendly and enjoyable environment which can support wayfinding, independence, wellbeing and quality of life (Cohen and Weisman, 1991; Day et al, 2000; Bonner, 2005; Bonneyfoy, 2007).

According to the research, the physical environment may be a therapeutic domain for people living with dementia by providing enough lighting, decreasing noise levels, creating homey surroundings, enhancing the layout, and giving landmarks to facilitate navigating.

Although guidelines and regulations were discussed previously as a manner of imposing design principles, there is some concern about environmental determinism and the influence of the social environment, so there must be some cooperation. (Broady, 1966).

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Furthermore, guidelines may enhance architects' knowledge of dementia design, but the design process should actively consider these concepts rather than simply treating it as a tick-box exercise.

Although many dementia design principles are cost neutral, they are rarely used due to a lack of understanding.

Recognize that a lack of empirical research and convincing evidence may lead to the neglect of dementia design. While interior design may be easily corrected during a renovation, architectural design, layout, and structure are more difficult and costly to change.

When designing for dementia, it is critical that principles are ingrained from the beginning of the project, especially during conceptual design and planning.

“This thesis provides a more holistic approach to caring for persons with dementia by understanding the importance of architecture and the design of the physical environment of long-term care homes.”

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1.3 SOLUTION There is a considerable absence in the literature that specifies the framework for the research problem. This gives incentive and support for further research into dementia wayfinding and the significance of spatial layout planning in long-term nursing facilities.

This project aims to contribute to architectural study and experimentation by promoting consciousness of dementia designing and contributing to the existing resource base that designers can utilize and refer to. The principal advantages are intended to enhance the experience of facility users, such as dementia residents, staff, and visitors. To tackle this issue, it is suggested that a range of appropriate approaches be employed, including the direct participation of people with dementia in the thesis.

This is performed to evoke authentic responses and achieve a positive knowledge of their opinions. The aim is for this to inform design principles particular to dementia. As part of the project, existing dementia design standards will be examined. This will be enhanced by including care home personnel and next of kin, who will contribute additional material that will benefit in generating a comprehensive overview of the issues being studied.

The thesis will evaluate the architectural design needs for dementia-specific long-term care facilities.

As a result, the thesis will produce design guidelines and design solutions for developing long-term care facilities for persons with dementia.

The inquiry focuses on the inhabitants' wayfinding experience and how the architecture of the physical environment influences this and how it might be improved.

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1.4 THESIS PURPOSE AND THESIS QUESTIONS It is important to ensure that the research does not undermine existing design or the relevant guidelines for dementia care architectural design.

Instead, it incorporates a holistic approach to investigate architecture and its significance for people living with dementia. The objective of this research, based on the theoretical framework, is to explore architecture framework and their meanings in dementia care, in order to metaphorically motivate architects to undertake better design practices.

•

How do the spatial environments in dementia care improve the lives of the residents?

•

What do spatial environments mean to people with dementia?

•

How can the architecture be applied to design in order to improve the design quality for dementia care?

THESIS QUESTION: “How sensory-engaging architectural environments have the potential to enhance the quality of life for individuals diagnosed with Dementia and Alzheimer’s Disease? ” “How can perceived spaces within a structure affect memory retention?”

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1.5 AIMS AND OBJECTIVES: Through a design that acknowledges the physical, emotional, and mental needs of Alzheimer's and Dementia patients and responds to factual knowledge of the disease, the built environment could trigger changes in memory.

The goal of the thesis is to inspire, raise awareness and provoke change.

The primary objective is to have a better understanding of how the architecture of the physical environment impacts persons suffering from dementia and Alzheimer’s Disease.

THE OBJECTIVES OF THE THESIS ARE: •

To identify and explore the extent to which current thought and design tools assist architects in designing for people with dementia.

•

To establish design features of the physical environment that positively or negatively impact wayfinding success for residents with dementia.

•

To design space in such a manner that it reduces stress and eliminate environmental stresses, such as noise, poor air quality, lack of privacy and enhance the patients feeling by offering design options and choices e.g. Privacy verses socialization.

•

To make the life of the patient easier and better using architectural design and its elements.

•

To study about various factors like color schemes, materials, smells, textures, etc. And then implement the same in the design program.

“Even though a building doesn’t have the ability to cure dementia and other disorder under its umbrella, it can improve the quality of life of the user.”

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1.6 METHODOLOGY

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Chapter

02

BASE STUDY This chapter summarizes the research I performed to have a thorough understanding of dementia and its stages. This leads to a deeper understanding of the project and is a step forward in the research.

•

WHAT IS DEMENTIA?

•

HOW IS DEMENTIA DIFFERENT FROM NORMAL AGEING ?

•

PROBLEM FACED BY DEMENTIA PATIENTS

•

WHAT ARE DIFFERENT TYPES AND CAUSES OF DEMENTIA ?

•

WHAT ARE DIFFERENT STAGES OF DEMENTIA ?

•

WHAT ARE THE CHARACTERISTICS OF DEMENTIA ?

DIFFICULTY WITH SIMPLE TASKS

MISPLACING THINGS

COMMUNICATION PROBLEMS

POOR JUDGMENTS

CHANGE IN MOOD OR BEHAVIOR Fig 2.1.1 Signs of dementia Source Author

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PROBLEMS WITH LANGUAGE

DIFFICULTY SOLVING PROBLES

CONFUSION OF TIME AND PLACE

CHANGE IN PERSONALITY

2.1 WHAT IS DEMENTIA ?

Dementia is the loss of cognitive functioning — thinking, remembering, and reasoning — to such an extent that it interferes with a person's daily life and activities. Some people with dementia cannot control their emotions, and their personalities may change. It is a brutal condition that has been affecting people for over a hundred years.

Dementia is not a single disorder, but it is an umbrella term used to describe over 100 different conditions that impair memory, behavior and thinking and cognitive strength of the person.

— Worldwide, at least 50 million people are believed to be living with Alzheimer's disease or other dementias.

— According to Dementia in India 2020 report, has estimated 5.3 million Indians aged >60 years had dementia in 2020, and this number is projected to exceed 14 million by 2050.

Disorders grouped under the general term “dementia” are caused by abnormal brain changes. These changes trigger a decline in thinking skills, also known as cognitive abilities, severe enough to impair daily life and independent function. They also affect behavior, feelings and relationships.

Fig 2.1.2 Dementia patients Source hopehospice.com/blog/boredom-and-dementia-patients/

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NORMAL AGEING

Fig 2.1.3 Normal Ageing Vs Dementia Source Author

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DEMENTIA

2.2 HOW IS DEMENTIA DIFFERNET FROM NORMAL AGEING ?

Dementia and memory loss are closely related, but while identical symptoms might arise with different forms of memory problems, there are some key differences.

IS DEMENTIA A NORMAL PART OF AGEING ?

• No, dementia is not a normal part of the ageing process. Dementia is a chronic illness that involves abnormal cognitive function, resulting in cognitive and physical symptoms that deteriorate with time.

• Normal ageing is far milder, with changes resulting from the body's normal slowing or decline in efficiency.

NORMAL AGEING VS DEMENTIA ?

• In the normal aging process, the brain and body begin to slow, although a person’s intelligence level remains relatively steady.

• You or your relative may begin to experience some changes in memory that can manifest as trouble recalling names of places and people.

• You also may find that it takes longer to register certain information and that mental and physical flexibility decreases. Dementia, on the other hand, manifests itself in more frequent and disruptive ways.

How can you know if memory problems are the result of dementia and the need for memory care, rather than normal ageing?

Fig 2.2.1 Dementia Home Care Source https://tribecacare.com/

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2.3 PROBLEM FACED BY DEMNTIA PATIENT

PROBLEM FACED BY PERSON DIAGNOSED WITH DEMENTIA

MENTAL

• • • • •

32

Language struggle Difficulty with familiar task Agitation to outside noise Aggression Visuospatial impairment (inability to recognize faces or common objects or to find objects in direct view despite good acuity, inability to operate simple implements, or orient clothing to the body.)

EMOTIONAL

• • • • • •

Depression Anxiety Confusion / distrust Sudden mood changes Forgetfulness Social withdrawal

PHYSICAL

• • • • • •

Risk of falls Mobility impairment Eye degeneration Loss of muscle control Hearing impairment Insomnia

2.4 WHAT ARE DIFFERENT TYPES AND CAUSES OF DEMENTIA ?

Dementia is not a single condition or a disease, but a term used for group of disorders.

Every type of dementia has its own characteristics and patients react differently, which makes it difficult to characterize the disease in general.

Fig 2.4.1 Different types of dementia Source Author

Alzheimer’s disease (62%): Being the most common type of dementia, Alzheimer’s disease results in apathy, depression and anxiety. In the initial phases the symptoms are minor, but as the cognitive abilities of the affected deteriorates, the effects of the disease increases.

Vascular dementia (17%): The second most common type of dementia is known as vascular dementia that – like Alzheimer’s disease – results in depression and apathy, but with a more recurrent and unpredictable frequency (Prince et al. 2016).

Mixed Alzheimer’s disease and vascular dementia (10%): Less frequent, a patient may suffer from a mix of both Alzheimer’s disease and vascular dementia with above mentioned characteristics as a consequence.

Lewy body dementia (4%): Characterized by sleep disorder and visual hallucinations.

Frontotemporal dementia (2%): Severe neurodegenerative disease, that can result in impaired judgement towards physical consumption. The patients often get a tendency to eat, drink or smoke exaggerated and therefore require pedagogical help to control consumption.

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Alzheimer’s disease (62%): Alzheimer’s disease is a condition that affects the brain. The symptoms are mild at first and become more severe over time. It is named after Dr. Alois Alzheimer, who first described the condition in 1906. It is the most common cause of dementia, Alzheimer's disease accounts for 60-80% of dementia cases.

Common symptoms of Alzheimer’s disease include memory loss, language problems, and impulsive or unpredictable behavior.

Alzheimer's worsens over time. Alzheimer's is a progressive disease, where dementia symptoms gradually worsen over a number of years. In its early stages, memory loss is mild, but with late-stage Alzheimer's, individuals lose the ability to carry on a conversation and respond to their environment. On average, a person with Alzheimer's lives 4 to 8 years after diagnosis but can live as long as 20 years, depending on other factors.

Fig 2.4.2 With severe Alzheimer’s disease, brain tissue shrinks significantly.

Source https://www.drugwatch.com/health/alzheimers-disease

SYMPTOMS: Alzheimer’s disease is a progressive condition, meaning that the symptoms get worse over time. Memory loss is a key feature, and this tends to be one of the first symptoms to develop.

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•

Memory loss: A person may have difficulty taking in new information and remembering information : forgetting name.

•

Cognitive deficits: A person may experience difficulty with reasoning, complex tasks, and judgment : difficulty with money or paying bills or driving a car.

•

Problems with recognition: A person may become less able to recognize faces or objects or less able to use basic tools. These issues are not due to problems with eyesight.

•

Problems with spatial awareness: A person may have difficulty with their balance, trip over, or spill things more often, or they may have difficulty orienting clothing to their body when getting dressed.

•

Problems with speaking, reading, or writing: A person may develop difficulties with thinking of common words, or they may make more speech, spelling, or writing errors.

•

Personality or behaviour changes: mood swings.

Viscular Dementia(17%): Vascular dementia is a decline in thinking skills caused by conditions that block or reduce blood flow to various regions of the brain, depriving them of oxygen and nutrients.

SYMPTOMS: Memory loss may or may not be a significant symptom depending on the specific brain areas where blood flow is reduced.

Symptoms may be most obvious when they happen soon after a major stroke. Sudden post-stroke changes in thinking and perception may include: •

Cognitive decline is likely to have a clear start date and symptoms tend to progress in a series of steps following each attack, suggesting that small strokes have been occurring

•

May include severe depression, mood swings and epilepsy

•

Some areas of the brain may be more affected than others.

Consequently, some cognitive abilities may be relatively unaffected

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Lewy Body Dementia(4%): Lewy body dementia (LBD) is a type of progressive dementia that leads to a decline in thinking, reasoning and independent function because of abnormal microscopic deposits that damage brain cells over time.

Fig 2.4.3 Progression of Lewy body dementia Source https://thebrielle.com/memory-loss-differentiating-dementia-normal-aging

SYMPTOMS: Symptoms of Lewy body dementia include: •Changes in thinking and reasoning.

•Confusion and alertness that varies significantly from one time of day to another or from one day to the next.

•Slowness, gait imbalance and other parkinsonian movement features.

•Well-formed visual hallucinations.

•Delusions.

•Trouble interpreting visual information.

•Sleep disturbances.

•Malfunctions of the "automatic" (autonomic) nervous system.

•Memory loss that may be significant but less prominent than in Alzheimer's.

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Frontotemporal Dementia(2%): Frontotemporal dementia (FTD) is one of the less common forms of dementia. The term covers a range of specific conditions. It is sometimes called Pick’s disease or frontal lobe dementia.

Age at diagnosis may be an important clue. Most people with FTD are diagnosed in their 40s and early 60s. Alzheimer's, on the other hand, grows more common with increasing age.

SYMPTOMS: A person may have one of three types of frontotemporal dementia: • Behavioral variant Frontotemporal Dementia : lose their inhibitions, lose sympathy or empathy, crave sweet or fatty foods, lose table etiquette, or binge on ‘junk’ foods, alcohol or cigarettes.

•

Progressive non-fluent aphasia: initial problems are with speech_slow, hesitant speech, errors in grammar,

•

Semantic dementia: speech is fluent, but people begin to lose their vocabulary and understanding of what objects are

Mixed Dementia(10%): In this type of dementia, the person is diagnosed with one or more type od dementia. In some cases, a person may have brain changes linked to all three conditions — Alzheimer's disease, vascular dementia and Lewy body dementia.

SYMPTOMS: Mixed dementia symptoms may vary, depending on the types of brain changes involved and the brain regions affected. In many cases, symptoms may be like or even indistinguishable from those of Alzheimer's or another type of dementia.

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2.5 WHAT ARE THE DIFFERENT STAGES OF DEMENTIA ?

Global Deterioration Scale (GDS) is an assessment tool used to determine which stage of dementia a person is experiencing. While not everyone will experience the same symptoms there is a 7-stage progression most individuals will follow. These 7 stages are then categorized by 4 diagnosis, No dementia, early-stage dementia, mid-stage dementia and late-stage dementia.

Fig 2.5.1 7 Stages of dementia Source https://carehomeselection.co.uk/7-stages-signs-of-dementia-what-to-look-for/

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― • •

•

No Dementia, Stages 1-3 Stage 1 – In this stage there are no signs of dementia. The person functions normally and there are no signs or symptoms.

Stage 2 – Very mild cognitive decline. In this stage people start to experience ‘normal’ forgetfulness. This is sign is normally associated with aging resulting in loved ones and professionals not noticing the underlining cause.

Stage 3 – Mild cognitive decline. In this stage, loved ones may begin to notice the increase in forgetfulness, difficulty in concentration and speech difficulty. This is the final stage in this category prior to the onset of dementia.

Decreased work performance

Increased memory loss

Trouble in problem-solving

Mood swings

Verbal repetition

Fig 2.5.2 Symptoms of no dementia Source Vectorstock

― •

Early-Stage Dementia, Stage 4 Stage 4 – Early-stage dementia. In this stage, professionals can detect cognitive decline problems during a patient appointment. This stage lasts an average of 2 years and cognitive issues can be detected during a medical interview and exam. The person will begin to have trouble concentrating, performing daily tasks such as finances, increase in forgetfulness and memory issues

Misplacing items

Forgetting recent conversatio ns or events

Losing track of time and date

Social withdrawal

Increased feeing of anxiety, irritability & depression

Increased trouble planning or organizing

Fig 2.5.3 Symptoms of early-stage dementia Source Vectorstock A DEMENTIA VILLAGE Investigating the relevance of sensory and curative architecture for dementia care

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― •

•

Mid-Stage Dementia, Stages 5-6 Stage 5 – Moderately severe cognitive decline. In this stage, signs and symptoms will be easy to identify. The person will have major memory issues and they will now need assistance with daily living activities.

Stage 6 – Severe cognitive decline. In this stage the symptoms of dementia will be having a profound effect on the individual. They will start to forget names and have little memory of events or earlier memories. In this stage the individual will have personality/ emotional changes, bladder control issues and anxiety.

Problem sleeping and confusing day & night

Wandering or lost

Delusions or hallucinations

Aggression and irritability

Fig 2.5.4 Symptoms of mid-stage dementia Source Vectorstock

― •

Changes in sleep patterns may begin

Late-Stage Dementia, Stage 7 Stage 7 – Very severe cognitive decline. Stage seven is the final stage of the dementia progression. At this stage, most people will have no ability to speak or communicate. They will require assistance with most daily activities including walking, dressing, bathing, and toileting. This stage requires 24-hour care and assistance.

Difficulty eating and swallowing

Changes in weight

Gradual loss of speech

Fig 2.5.5 Symptoms of late-stage dementia Source Vectorstock

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Inability to recall personal history, address, phone no.

Restlessness

Angry outbursts due to confusion

Bad eyesight

2.6 WHAT ARE THE CHARACTERISTICS OF DEMENTIA ?

Problem faced by dementia patients •

CONGNITIVE EFFECTS

• • •

•

FUNCTIONAL EFFECTS

• •

BEHAVIOURAL EFFECTs

PSYCHOLOGICAL EFFECTS

They have a weak short-term memory, making it difficult for them to recall familiar objects and faces.

They have trouble recalling phone numbers and addresses.

They are easily puzzled and overwhelmed by anything.

It becomes extremely difficult for them to absorb new information.

They may require assistance with daily tasks such as cleaning their teeth, combing, and so on.

If they skip a step in their daily routine, they may get confused and frustrated.

They may struggle to convey their feelings, wants, and requirements.

• • • •

Become sensitive to loud noise .

They may show repetitive behaviour.

They could become physically aggressive.

They may seem disinterested in activities and chores.

• • •

They may show hostile behavior.

They may experience extreme mood changes.

They may experience depression or anxiety if they are not adequately cared for or if their medications are not appropriately monitored.

Because their emotional levels are strong, they may feel neglected if sufficient care is not given.

•

Table 2.6.1 Characteristic of dementia Source Author A DEMENTIA VILLAGE Investigating the relevance of sensory and curative architecture for dementia care

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Chapter

03

FACTS AND FIGURE This chapter aims at studying the global impact and Indian impact of dementia by providing extra statistics from reliable sources.

•

GLOBAL SCENARIO OF DEMENTIA

•

INDIAN SCENARIO OF DEMENTIA

•

PREVALENCE OF DEMENTIA BY AGE AND GENDER

•

FUTURE PROJECTION OF DEMENTIA

•

STATE WISE ESTIMATES OF NUMBER OF PWD IN INDIA

Fig 3.1.1 Global impact of dementia Source https://www.alzint.org/about/dementia-facts-figures/dementia-statistics/

Fig 3.1.2 Increase in numbers of people with dementia worldwide (2010-2050), comparing original and updated estimates Source https://www.alzint.org/about/dementia-facts-figures/dementia-statistics/

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3.1 GLOBAL SCENARIO OF DEMENTIA: Someone in the world develops dementia every 3 seconds. There are over 55 million people worldwide living with dementia in 2020. This number will almost double every 20 years, reaching 78 million in 2030 and 139 million in 2050. Much of the increase will be in developing countries.

Already 60% of people with dementia live in low and middle income countries, but by 2050 this will rise to 71%. The fastest growth in the elderly population is taking place in China, India, and their south Asian and western Pacific neighbors.

There are over 10 million new cases of dementia each year worldwide, implying one new case every 3.2 seconds.

Estimation of numbers of people with dementia worldwide • Considering age-specific or age and sex-specific prevalence estimates and UN population forecasts, it was estimated that 35.6 million individuals globally had dementia in 2010. Western Europe has the most dementia patients (7.0 million), followed by East Asia (5.5 million), South Asia (4.5 million), and North America (4.5 million) (Dementia: A Public health Priority) • According to the WHO dementia study from 2012, America has the highest number of 4.4 million individuals living with dementia. China (5.4 million), the United States (3.9 million), India (3.7 million), Japan (2.5 million), Germany (1.5 million), Russia (1.2 million), France (1.1 million), Italy (1.1 million), and Brazil had the highest number of persons with dementia in 2010 (1 million or more) (1.0 million).

• The global dementia population is expected to nearly quadruple every 20 years, surpassing 65.7 million in 2030 and 115.4 million in 2050.

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8.9%

19.4%

44.1%

23 % 14.0% 8.3 % 4.9%

Fig 3.2.1 Indian population is ageing Source https://www.alzint.org/about/dementia-facts-figures/dementia-statistics/

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3.2 INDIAN SCENARIO OF DEMENTIA: In India, increasing lifespan and decreasing fertility rates have resulted in a growing number of older persons.

By 2050, people over 60 years of age are predicted to constitute 19.1% of the total population.

This ageing of the population is expected to be accompanied by a dramatic increase in the prevalence of dementia.

In India, the proportion of persons aged 60 years and above is projected to be 19.1% — that is, around 316 million, or approximately the size of the current US population — in the year 2050.

Many families in India live with dementia

Fig 3.2.2 Families in India live with dementia Source https://www.alzint.org/about/dementia-facts-figures/dementia-statistics/

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3.3 PREVALENCE OF DEMENTIA BY AGE AND GENDER: 2010 estimate •

In 2010, an estimated 3.7 million Indians over the age of 60 had dementia (2.1 million women and 1.5 million men). The prevalence of dementia increased gradually with age, with older women having a greater frequency than older males.

•

The reason that older women have a higher prevalence of dementia than males may be mainly due to the fact that women live longer in India. However, studies of the age-specific incidence of dementia in the elderly demonstrate no significant difference between men and women.

Fig 3.3.1 Prevalence of Dementia in India, 2010 Source The dementia India report 2010

Fig 3.3.2 Estimation of number of PwD over 60 years in India between 2000 and 2050 Source The dementia India report 2010

3.4 FUTURE PROJECTION OF DEMENTIA : 2010 estimate

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•

Future projections are based on the assumption that dementia prevalence remains consistent over time, which may not be the case.

The prevalence of dementia will increase if the incidence of dementia increases or if the number of elderly persons increases as life expectancy increases.

•

In India, for example, the number of persons with Alzheimer's disease and other dementias is growing year after year due to a continuous increase in the elderly population and a consistent increase in life expectancy.

3.5 STATE WISE ESTIMATE OF NUMBER OF PwD IN INDIA: 2010 estimate •

Fig 3.3.5 Projected changes between 2006 and 2026 in number of people living with dementia

by State Source The dementia India report 2010

•

•

•

Meta-analyzed prevalence estimation for India and future projections from the 2001 Census data were used to generate state-specific estimations (Census, 2006). The expected number of persons aged 65 and older with dementia in India varied by state and area for the years 2011, 2016, and 2026, with similar fluctuation in the number of people with dementia observed.

The percentage change in dementia was estimated between the base year of 2006 and each following time period.

More than 500,000 older people are predicted to living in Uttar Pradesh and Maharashtra by 2026. In other states, 200,000 to 400,000 PwD are expected in the following 26 years in Rajasthan, Gujarat, Bihar, West Bengal, Madhya Pradesh, Orissa, Andhra Pradesh, Karnataka, Kerala, and Tamil Nadu.

Over the next 26 years, Delhi, Bihar, and Jharkhand are predicted to have a 200 percent (or higher) increase in the overall number of dementia cases compared to 2006. Other states (Jammu and Kashmir, Uttar Pradesh, Rajasthan, Madhya Pradesh, West Bengal, Assam, Chhattisgarh, Gujarat, Andhra Pradesh, Haryana, Uttaranchal, Maharashtra, Karnataka, and Tamil Nadu) are expected to have a 100 percent (or greater) increase in the number of persons aged 65 and over.

The increased number of people with dementia will have a significant impact on state infrastructures and healthcare systems, which are already underfunded in many regions. The projected increases in the Southern area are not as significant as those in other parts of India; but, a large proportion of persons over the age of 65 would result in increased PwD.

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Chapter

04

CURRENT INDIAN SCENARIO This chapter lists the various resources that are necessary for the treatment of the people suffering from dementia, and what India lack ?

•

RESIDENTIAL CARE SERVICES IN INDIA.

•

RESOURCES NECESSARY FOR DEMENTIA CARE.

•

WHAT DOES INDIA LACK ?

•

COST OF DEMENTIA IN INDIA

4.1 RESIDENTIAL CARE SERVICES IN INDIA :

Table 4.1.1 Residential care services in India Source Author

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Fig 4.1.1 Dementia care services in India Source google earth.com

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4.2 RESOURCES NECESSARY FOR DEMENTIA CARE: EXCLUSIVE FULL-TIME RESIDENTIAL CARE FOR DEMENTIA: •

•

•

•

Full-time residential care services are facilities that provide long-term care to persons living with dementia. These facilities differ from old age homes in that persons living with dementia may require round-the-clock medical support.

As a result, it is critical that all staff members receive particular training in order to care for people with disabilities. These full-time care services are as good as last resting places for the folks who live there.

The majority of full-time care centers in India are rented, so they lack the pleasant site of a caregiver caring for the patients infrastructure and the personal touch the location need to make the individuals who live there feel at home.

As a result, caring for a person living with dementia at home becomes tough, which is why individuals prefer long-term residential care where their loved one is not lonely and receives medical attention around the clock.

HELPLINE: Over the phone, helplines solve problems and gather information about dementia. The majority of resource centers handle this. The major reason for assistance lines is because persons with dementia have a tendency to wander, which can result in their becoming lost. There are dedicated helplines for such situations that might assist in locating the missing individual.

Fig 4.2.1 National dementia helpline - ARDSI Source The dementia India report 2010

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MEMORY CLINIC : •

Memory clinics are specialized facilities that perform further diagnostics and memory tests as well as providing care to patients suffering from dementia. The concept behind the memory clinic is that the doctors at the memory clinic specialize in dementia and would provide a comprehensive examination as well as various tests to assist determine more about the illness.

Fig 4.2.2 Memory clinic for dementia Source google.com

DAY-CARE CENTER: •

•

Day-care centers for persons with dementia are comparable to day-care facilities for children. Such a facility is advantageous not only to the individual living with dementia, but also to their career.

For those suffering from dementia, this becomes a location where they may communicate with new faces every day and participate in various activities organized by the day-care center.

RESOURCE CENTER: •

Resource centers are simply places where relatives of persons living with dementia may get the support they need. These centers should ideally be established in all cities since most of the time, families visit such centers to obtain information on dementia and to ask questions regarding the illness.

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4.3 WHAT DOES INDIA LACK ?

•

Apart from India, every other country in the world has particular government policies in place to assist reduce the prevalence of dementia. In India, the Kerala government has launched a full-time care center in Cochin in collaboration with ARDSI. It is time to tackle dementia seriously by making a few adjustments in society with the government's assistance.

•

In India, services are not even proportionate to the number of individuals diagnosed with dementia.

•

It is commendable that some non-governmental organizations (NGOs) are attempting to make India dementia friendly, but the existing facilities in India are lacking in terms of infrastructure, as the locations are generally rented bungalows or nursing homes that cannot be remodeled as ideal dementia homes.

•

Thus, infrastructure is a huge issue in India, as compared to other nations where particular dementia care institutions with appropriate architecture assist dementia patients. Good architecture, for example, the respite center in Dublin, Ireland, has the ability to function as a catalyst to enhance the health of persons living with dementia.

Lack of awareness

Lack of Policies for dementia

Lack of Infrastructure in the field of dementia

Lack of funds for dementia services

Lack of Training facilities for care givers and nurses

Fig 4.3.1 Facilities India lack for dementia Source Vectorstock

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•

As previously said, the government should enact measures that would decrease the social cost and assist families in taking better care of the PWD.

•

Training centers for caregivers are essential because people with dementia require specialized care that is not the same as care provided in nursing homes.

Stigma

Lack of specialized manpower to manage them

4.4 COST OF DEMENTIA IN INDIA •

According to previous studies, the biggest impact of dementia is on the individual living with dementia, their family or job, and society.

•

Dementia care is classified into two types: official care and informal care. Formal care is now defined as care provided by care centers, nursing homes, hospitals, or even day care centers. These formal care centers typically have specified entrance standards as well as monthly or annual fees. The Alzheimer's and Related Disorders Society of India runs the majority of dementia care centers and institutions in India (ARDSI).

Almost all ARSDI facilities charge adjustable fees based on the income of the family enrolling the person with dementia. Otherwise, because ARDSI is a non-profit organization, they welcome charitable contributions and donations from families who are able to do so.

•

Fig 4.4.1 Dementia care: total societal costs (billion US$) India, 2010 Source Author

Informal care imposes a lot of strain on one's career and family, both mentally and financially, because one needs to give up their job to be with a loved one who requires roundthe-clock support.

•

It has been investigated and found that dementia affects developing countries far more than industrialized countries. Dementia is unquestionably a bigger issue in low-income nations like India. The dementia burden is growing by the minute, as are the number of people living with dementia.

•

"The impact and cost analysis clearly foresees a 'wake-up call in terms of planning and providing services, infrastructure, capacity building and training at every level.“ - ARDSI report 2010. KS et al)

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Chapter

05

DEMENTIA AND FIVE SENSE While the eye/sight has traditionally dominated architectural practice, a growing number of architects and designers have begun to consider the role of the other senses, namely sound, touch (including proprioception, kinesthesis, and the vestibular sense), smell, and, on rare occasions, taste, in recent decades. It is therefore evident that we must go beyond the mainly visual (not to mention modular) concentration in architecture outlined in the writings of Juhani Pallasmaa and others, and explore the contribution given by each of the other senses (e.g., Eberhard, 2007; Malnar & Vodvarka, 2004).

Source : Senses of place: architectural design for the multisensory mind

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SENSORIAL ARCHITECTURE: INFLUENCE OF THE SENSES IN ARCHITECTURE

1.

SIGHT

2.

TOUCH

3.

HEARING

4.

SMELL

5.

TASTE

•

DEMENTIA AND FIVE SENSE

SIGHT Individuals may use their eyes to take in their environment when they have a sense of sight. Sight senses depth, shadow, light, colour, and form.

Fig 5.1.1 Sense : Sight Source Author Reference : The Eyes of the Skin by Juhani Pallasmaa

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The sense of sight may be encouraged by the architecture of a senior living community for those living with Dementia disease using a variety of techniques such as the positioning of openings to manipulate the quality of light in a space.

• The usage of shade devices can also enable the elderly to engage with and manage their surroundings.

• Throughout the design, the use of colour, texture, and patterns on walls, floors, and surfaces may give orientation and navigation methods.

• Different colors or themes can be used to make each room unique, which may awaken residents' memories of the places they frequent.

• Our sense of sight may also be used to keep the elderly brain active by observing individuals pass by at the facility or on the neighborhood street.

• Images from memory, imagination, and dreams can be triggered by our sense of sight.

TOUCH •

•

•

Fig 5.1.2 Sense : Touch Source Author Reference : The Eyes of the Skin by Juhani Pallasmaa

•

•

•

•

Physical contact and engagement are provided via the sense of touch.

The sensation of touch and its contact with human bodies within the built environment has the ability to elicit mental and physical reactions.

This might involve witnessing shadows and light on a textured surface, which may prompt a person to reach out and touch the wall.

When interacting with objects, one touches or feels them, which causes the brain to engage in order to comprehend.

We sense not just textures such as rough or smooth, but also temperatures ranging from hot to cold.

A distinct texture from a forgotten past may be remembered by the process of touching and experiencing a familiar texture again as one ages.

Walls, handrails, doorknobs, furniture, and textiles all present the opportunity for interactive touch involvement in the design of an ageing dwelling.

Touch is the 'mother of the senses,' our bodies' sensory mode that combines our perception of the environment and ourselves.

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HEARING •

Hearing, whether it be the chirping of a bird or the echo of a wide area, has the capacity to make an individual pay notice and feel their environment.

•

John Zeisel emphasizes in his book I'm Still Here: A Breakthrough Approach to Understanding Someone Living with Alzheimer's that even if a someone has Alzheimer's disease, they are still living in the present moment and all have unique abilities.

Zeisel, the founder of the ARTZ (Artists for Alzheimer's) initiative, believes that music and the arts can reach out to those living with the disease in ways that nothing else can.

Music has been proved to stimulate memories and allow sufferers to express themselves freely. Through music and the arts, staff, family, friends, and residents may engage and collaborate as a group.

Musical and artistic areas can be incorporated in architectural design to assist these activities. Acoustics, seating, and stage-like characteristics may all be used to enable for and participate in many forms of performances.

• Fig 5.1.3 Sense : Hearing Source Author Reference : John Zeisel - I'm Still Here: A Breakthrough Approach to Understanding Someone Living with Alzheimer's

•

•

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SMELL •

•

•

•

Fig 5.1.4 Sense : Smell Source Author Reference : John Zeisel - I'm Still Here: A Breakthrough Approach to Understanding Someone Living with Alzheimer's

•

•

•

•

Smell is a sense that is sometimes neglected in the architectural experience.

Material selections in the design and construction of spatial settings have the power to generate a scented atmosphere.

Architectural aromas may be produced by various hardwoods and surface treatments like as paint, varnish, and plaster.

Some of the aromas that may be present in the senior house design may evoke distinct recollections from past inhabitants.

The fragrances of the kitchen and the outside garden are likewise unique and aromatic locations.

The familiar smell of cooking may be used in wayfinding strategies to guide people to the kitchen area.

Gardens in the outdoors may give fresh air as well as the aromas of flowers, fruits, vegetables, and herbs.

A medical researcher at Tottori University in Japan observed in 2009 that exposing Alzheimer's patients to rosemary and lemon in the morning and lavender and orange in the evening resulted in better cognitive functioning.

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TASTE •

•

•

•

Fig 5.1.5 Sense : Taste Source Author Reference : John Zeisel - I'm Still Here: A Breakthrough Approach to Understanding Someone Living with Alzheimer's

•

•

•

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One cannot engage one's sense of taste unless they participate in the dining experience.

The materials utilized to build the environment are incapable of evoking the sensation of taste.

Kitchens and dining rooms, for example, can be supplied via architecture to allow for the sensation of taste.

Architecture has the power to construct environments in which interactions, engagements, and experiences, such as dining, may take place.

Adequate nutrition is an important aspect of an Dementia treatment plan, and providing proper meals can help to enhance and maintain an individual's health and welfare.

A communal dining area may bring residents together while also stimulating all five senses.

It is obvious that objects, design components, and food may be offered through the sense of taste; however, it is up to the individual to engage in order for any of the senses to be engaged.

5.2 DEMENTIA AND FIVE SENSES :

•

•

•

•

Ongoing study and acquired knowledge about Dementia continue to aid in the formation of a basic understanding of the disease, its symptoms, causes, and preventative techniques.

While we are all unique, research does point to several basic wellbeing ideas that have the potential to minimize the impacts of Dementia disease. The fact that the disease is deadly, and that there are no survivors, is heartbreaking.

Keeping this in mind, we do know that there are still strategies to treat the condition by supporting a healthy lifestyle, sensory cognitive engagement, and social interaction.

All of these elements may be achieved through sensory-engaging design.

Regardless of our individual mind and body, we all have access to the senses.

•

Skin's Observations Juhani Pallasmaa writes about this dance in architecture through the interaction of senses. Architecture allows you to experience sight, touch, hearing, taste, and smell.

•

The eye, nose, skin, tongue, skeleton, and muscle are used to measure the properties of materials, space, and scale in architectural settings.

An engagement of the senses raises awareness of oneself as well as the quality of one's surroundings.

Architecture that stimulates all five senses keeps occupants busy, both physically and mentally.

• •

•

•

Pallasmaa writes in Hapticity and Time, "haptic and multi-sensory architecture improves the experience of time, healing, and joyful." This architecture does not fight against time; rather, it concretizes and accepts the passage of time. It strives to accommodate rather than astonish, to evoke domesticity and comfort rather than wonder and respect.“ All of the haptic multi-sensory characteristics that architecture provides are aspects that older people suffering from Alzheimer's disease can benefit from.

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Chapter

06

CASE STUDY This chapter discusses the projects that I used as a guideline to grasp the elements and scale of the project.

1

ALZHEIMER’S RESPITE CENTRE, DUBLIN The day care and respite center was commissioned by the Alzheimer Society of Ireland to provide flexible short term care for people suffering from Alzheimer’s disease and offer a means of support for the affected families. A series of interconnected pavilions incorporating social spaces, serene gardens and courtyards.

2

THE HOGEWEYK – DEMENTIA VILLAGE. It is the world first village in Netherland which resides people suffering from dementia. This project helps elderly to live a normal lifestyle. The village accommodates 152 residence with dementia.

It is a village setup with houses, supermarkets, movie theatres and medical facilities.

3

Alzheimer's Village / NORD Architects The Copenhagen-based firm Nord Architects is building a series of centers for patients with Alzheimer’s and dementia that feel more like villages or cities, rather than bleak institutions.

The goal was to create a free and open atmosphere, to avoid any associations with force and power.

4

JAGRUTI REHABILITATION CENTER, PUNE Certified rehabilitation center which is operated by Dr, Amar Shinde. Their main objective is to give quality consideration to persons experiencing Psychological, Addictive and Geriatric issues.

Jagruti began as a little Psychiatric Clinic in 2006 and from 20 bed adult to a 120 had relations with, one of the greatest private Psychological Health Care Center in Maharashtra Purpose for this case study is to examine and study the existing conditions of the care facilities in India.

5

DIGNITY FOUNDATION DAY CARE CENTER, BYCULLA, MUMBAI It is the only day care center in Mumbai that caters to people living with dementia.

Purpose for this case study is to understand the working and the concept of the day care centers and also to learn about the program of the day care.

6

COMPARATIVE ANALYSIS

6.1 CASE STUDY 1 : ALZHEIMER’S RESPITE CENTRE, DUBLIN (Building for a Longer Lifetime)

Client: The Alzheimer Society of Ireland

Architect: Niall McLaughlin Architects.

For further information on the design and delivery team, please contact the Architects.

Date of Completion: February 2009 Contract value: £3.9m Site Area: 1500 sqm Fig 6.1.1 Respite center plan Source https://architizer.com/projects/alzheimers -respite-centre

Strength : 16

OVERVIEW

Niall McLaughlin's Alzheimer's respite center in Dublin is a project of the Alzheimer's Society of Ireland. The society chose an outsider to design a structure for Alzheimer's sufferers, so they divided the project into two phases: phase 1 included in-depth study on Alzheimer's, and phase 2 included a design proposal for the same.

Following a thorough investigation, the architect concluded that the structure will serve two primary functions: • Encourage communal cooperation.

• Improve a person's sense of direction CONCEPT The facility was created with Alzheimer's patients' characteristics in mind.

Some of them are: • The cognitive ability of the mind is affected, and their memory is impacted, causing them to forget certain things.

• They can also become disoriented and roam.

• On top of that, they are elderly and occasionally have difficulty walking.

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DESIGN PARAMETERS The design's primary goal is to frame a community and help with orienting.

Planning is essential because the individuals need to be reminded of where they are at all times because they are prone to wandering and may become lost.

•

The facility is designed in such a manner that the interconnecting pathways that run through the courtyards, gardens, and rooms are all linked to one other, bringing anybody who follows any route back to the building's social core. This allows individuals to explore or roam throughout the property without getting lost.

ENTRANCE KITCHEN DINNING STAFF OFFICES CONTEMPLATION ROOM BEDROOMS HAIRDRESSING ALZHEIMERS SOCIETY OFFICES ACITIVITY ROOM

CENTRAL SPACE SITTING ROOM Fig 6.1.2 Floor plan Source Author

THERAPEUTIUC REMEDIES MAGNOLIA COURTYARD ORCHARD WORKERS GARDEN HERBS AND SCENT GARDEN MORNING TERRACE

UPPER TERRACE AFTERNOON TERRACE EVENING TERRACE

Fig 6.1.3 conceptual planning Source https://drawingmatter.org/niall-mclaughlin/ A DEMENTIA VILLAGE Investigating the relevance of sensory and curative architecture for dementia care

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• •

•

•

As a result, there is a continual movement or flow from the inner to the outside spaces, with no sensation of being lost or overwhelmed.

The series of brick walls that create a labyrinth-like environment that surrounds the gardens that follow the person who passes through is an unique aspect of the design. The labyrinth-like walls provide a sense of security to those who live within.

It is surrounded by a series of gardens, each oriented in a different direction (north, south, east, west), and each planted appropriately to its orientation (courtyard, orchard, allotment, lawn).

Throughout the structure, there are windows. They provide a great perspective of the gardens, and as one goes around the facility, one can follow the sun around like a clock, experiencing different lighting and shadows throughout the day.

Fig 6.1.4 View of Admin block Source https://architizer.com

Fig 6.1.5 View of Multipurpose hall Source https://architizer.com

ELEMENTS KEPT IN MIND WHILE PLANNING Another most important element of designing is the material and the colors used.

People suffering from Alzheimer's disease may have visual impairments because the majority of them are above the age of 65, therefore colour coordination is essential.

• • • • •

70

Shiny floors can appear to be wet, and people will feel unsafe walking on them, and they may feel disoriented and fall.

The hallway is large enough to accommodate wheelchairs and the distances between seating areas are minimal.

Windows and lighting have been designed to minimize glare and shadow Toilets are positioned extremely close to social spaces and are visible from beds in bedrooms.

The use of colour and tones clearly distinguishes the floor, skirting, and wall, as well as the door.

.

• • • •

• •

•

There are no patterns on the flooring.

There are no dark passageways or dead ends in the plan, which promotes simple, safe way-finding.

Continuous handrails are installed on walls throughout the building.

Although it is not a residential structure, the bedrooms are designed with window seats and built-in workstations to allow for easy filling with familiar souvenirs and things.

The entrance is simple to spot on the way in, but practically invisible once inside. Clients are less anxious as a result of this.

Rooms are linked by entrances and openings, but they may be isolated if necessary to separate loud, angry, or violent customers, allowing them to settle down in a secure location without disturbing the rest of the community.

The staff rest room is separated from the client area to allow for complete wind down and relaxation.

Fig 6.1.6 The bedroom wing corridor and bench Source https://architizer.com

Fig 6.1.7 View of Living room Source https://architizer.com

Fig 6.1.8 View of Central space Source https://architizer.com

INFERENCE • •

•

•

The case study helped in understanding the significance of minor touches that might help the design stand out and be dementia-friendly.

It emphasized the significance of colour schemes while designing a memory care facility, and it assisted in understanding the type of planning required for the design.

The center also helped people understand the value of green areas and the relevance of having a connection between nature and architecture. It helped in getting a general idea of all the places that must be developed for a dementia care facility.

The Respite Center is a functional example that demonstrates how important it is to have the correct architecture and infrastructure in place to enable individuals with dementia live better lives.

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6.2 CASE STUDY 2 : THE HOGEWEYK – DEMENTIA VILLAGE (Bringing life to those who have forgotten)

Architect: Moleanaar and Bol and VanDillen Architekten, Vught Location : Weesp, the Netherlands Date of Completion: 2009 Strength : 23 houses for 150 residents suffering from dementia.

Site Area: 15,310 sqm Fig 6.2.1 View of central space Source https://www.dementiavillage.com/projects/ dva-de-hogeweyk/

OVERVIEW Dementia Village, located on the outskirts of Weesp, the Netherlands, is a village-style area for older persons with dementia.

• •

The village allows the elderly to live a normal life with maximum mobility and normalcy. Dementia affects around 152 people in the area.

Because each person has a unique lifestyle, the idea of Dementia Village emphasizes the significance for a space that is welcoming to all lifestyles.

The basic idea behind the Dementia Village is to offer people with familiar building blocks that complement their various lifestyles. The area was designed to give senior residents with situations that challenge their motivations to live an active life.

Residents are divided into groups and live with people who share similar interests and backgrounds. The homes are designed to be tailored to the chosen lifestyle.

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CONCEPT Hogeweyk is a one-of-a-kind facility in the world. The fundamental idea of Hogeweyk was to provide persons suffering from dementia a second chance in life.

•

•

The dementia village is a facility constructed along the lines of a city, with all residents being persons with dementia. Other residents include a doctor, nurses, and caretakers who are available 24 hours a day, seven days a week.

The most noticeable characteristic is that the goal of this initiative is to provide persons suffering from dementia with a normal existence, thus all of the employees, including nurses and caretakers, are dressed in clothes other than their uniforms.

DESIGN PARAMETERS •

•

Hogeweyk is designed as a full-fledged village or township with streets, alleyways, large squares, fountains, and a park so that people may enjoy the life they would otherwise be unable to experience outside the locked gates. It occupies 15,310 sq m, of which 7,702 are not built on.

The facility is designed to include all of the services that people need on a daily basis, such as a theatre, a restaurant, a café, a grocery, a barber/beauty shop, and a post office.

The design is divided in two part : a. b.

Traditional design Modern design

Where traditional design includes housing units and open green pockets for distinct activities, modern design includes all amenities like grocery store, pub, restaurant, theater, and hairdresser.

Fig 6.2.2 HOGEWEYK a dementia village model (3 large courtyards and 4 smaller squares and gardens) Source https://hogeweyk.dementiavillage.com/

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The planning is done in such a manner that all of the areas flow into one another and are well connected, with no dead ends.

Fig 6.2.3 Site plan Source https://www.leadingageny.org/

Cluster planning of one household with introvert looking outdoor space

Fig 6.2.4 Household module Source https://www.leadingageny.org/

•

•

• •

•

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Each apartment is around 220 sq. m in size and can accommodate 6 to 7 people. It is preferable for people to live in small groups in one house since it allows them to feel at home and like they have their own family again.

The solid-to-void ratio is carefully considered during the design process, since each complex is planned to open up into a courtyard or a green leisure space.

All of the roads and streets are interconnected, as are the green spaces, allowing residents to roam freely without feeling overwhelmed.

Each planned green space serves a different purpose. The theatre square, for example, may be utilized for street theatre, while the green space outside the nursing home can be used for physical therapy.

There are three common spaces in each house: a kitchen, a lounge, and a dining room.

COMMUNAL AREA 1 SUPERMARKET 2 THEATRE FACADE 3 RESTURANT

4 CLUB SPACE

Fig 6.2.5 Communal space and main entrance Source Exploring the potentials of dementia village architecture

•

All of the commercial areas are centered in one area of the town, forming a hierarchical structure, with a more vibrant section focused around the theatre plaza, the covered space, and the main street.

•

There are three common spaces in each house: a kitchen, a lounge, and a dining room.

Each home is assigned a team of caretaker to assist residents with daily duties such as washing and cleaning, as well as to keep an eye on each individual living in the house.

Every unit has a large glass window that looks out into the street or a garden.

The interiors of these residences are designed to reflect the preferences of the individuals who live in them. The house's layout is straightforward and classic.

• • •

Fig 6.2.6 View of the bridge and residential apartments Source https://www.dementiavillage.com/projects/dva-de-hogeweyk/

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Fig 6.2.7 View of out door sitting Source https://www.dementiavillage.com

Fig 6.2.8 View of human size chess board Source https://www.dementiavillage.com

Fig 6.2.9 View of city square Source https://www.dementiavillage.com

Fig 6.2.10 Bird eye view Source https://www.dementiavillage.com

• •

The residential regions are divided into distinct lifestyles for the elderly based on their previous choices.

For this reason, an opinion research institution examined the seven most prevalent habitats in the Netherlands, yielding the following categories: traditional, city, wealthy, cultural, Christian, Indian, and homely.

View of out Indian interior

View of wealthy interior

Fig 6.2.11 Interior styles Source https://www.dementiavillage.com

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View of homely interior

INFERENCE : •

In terms of idea, typology, and design, the two international case studies are significantly distinct from one another. The Alzheimer's Respite Centre in Dublin is a modest facility for approximately 10-20 individuals, but the De Hogeweyk is significantly larger — more like a village than a Respite Centre.

•

This case study provides a unique viewpoint on the design of a dementia care facility. This case study aids in understanding the project on a bigger metropolitan scale.

•

Various planning aspects, such as the necessity of solid-voids, green spaces, and the notion of not having gates but constructing a border with the aid of homes that create a boundary, have shown to be extremely useful.

•

The idea of providing multiple architectural types for people with different tastes makes people feel more at ease and at home.

•

As a result, both case studies have contributed to a better understanding of the role of design and architecture in the progression of dementia.

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6.3 CASE STUDY 3 : Alzheimers Architects

Village

/

NORD

Architect : Champagnat & Gregoire Architects, NORD Architects

Location : Dax, France Year : 2020 Site Area : 10,700 sq. m Strength : Up to 120 patients can live there alongside caretakers, volunteers and scientists (approx. 340 residence)

Fig 6.3.1 View of Arched pathway Source https://www.archdaily.com/

OVERVIEW

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•

The average nursing home can be depressingly institutional. For the growing number of people suffering from dementia, these facilities are even worse:

•

Their repetitive architecture makes it easy to get lost, and they look nothing like the places where patients have lived their entire lives.

•

So how do we rise to the challenge and create built environments to accommodate the significant trends we are currently witnessing, while providing space for efficient, soothing, healing treatment?

•

The Copenhagen-based firm Nord Architects is building a series of centers for patients with Alzheimer’s and dementia that feel more like villages or cities, rather than bleak institutions.

DESIGN PARAMETERS •

•

•

•

Alzheimer's Village in France is similar to a gated community, while architects in Norway are designing a whole city around a new nursing facility, where the residents function as guides to help patients with dementia find their way home again if they become disoriented ; and it will be intended to improve people's walking, memory, and sense of direction.

The Alzheimer's Village in Dax is meant to provide a comfortable atmosphere in which residents, family, and health care professionals may all feel at ease, which is also a necessary condition for delivering skilled care.

A recognizable environment, devoid of alienating or obstructive elements, is required for living a meaningful life.

Alzheimer's Village has incorporated familiar services within the complex, such as a grocer's, a hairdresser's, a restaurant, and a market square, that are reminiscent of the inhabitants' past life in their neighborhood.

Fig 6.3.2 Site plan Source https://www.archdaily.com/

Fig 6.3.3 Site zoning Source https://www.archdaily.com/

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• • •

•

•

•

Residents of the village, rather than patients, will have their own store, health center, hairdresser, brasserie, gym, library, and farm.

Staff housing quarters are integrated within the village to make it easier for them to care for patients.

The village in Dax, southwest France, will be self-contained yet designed like a complete small community, with people free to roam. The hearts (seen on the top) signify meeting places.

This architecture also has a very unique flavor to it, since it incorporates aspects from the local architectural style. The constructed environment acts as a cultural extension, easing the transition from living at home to living with a serious mental disease in an Alzheimer's care facility.

Interactions with others and recreational activities .When it comes to connecting the Alzheimer's Village into the local environment and strengthening the feeling of continuity and cohesiveness across diverse life patterns, everyday ties between generations, institutions, and the town are critical.

The architecture of Alzheimer's Village is designed to meet the requirements of both communities and individuals, offering each resident with reassuring and various alternatives.

Fig 6.3.4 Cluster planning and section Source https://www.archdaily.com/

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Fig 6.3.6 Unit plan Source Author

Fig 6.3.5 Household cluster planning Source Author BEDROOM COMMON WASHROOM

•

• •

DINNING AND SITTING

GREEN SPACE

CAFÉ AND RESTAURANT

The complex is blended with nature, changing the existing environment with its distinctive historic pine trees into a recreational place where inhabitants may rest or go for a walk.

A trail winds across the terrain, creating its own loop, ensuring that none of the occupants encounter dead ends or become lost along the journey.

The complex is divided into four clusters, each holding around 30 inhabitants who live in little "families" with all necessary facilities and outdoor.

Fig 6.3.7 View of arched walkways and central space Source https://www.archdaily.com/

Fig 6.3.8 View of green pocket Source https://www.archdaily.com/

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AMENITIES

Fig 6.3.9 Auditorium Source https://www.archdaily.com/

Fig 6.3.10 Gardening Source https://www.archdaily.com/

Fig 6.3.11 A small farm Source https://www.archdaily.com/

Fig 6.3.12 Green pockets with sitting Source https://www.archdaily.com/

Fig 6.3.11 Refreshment zone Source https://www.archdaily.com/

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Fig 6.3.12 Green areas, which will help to make it feel less enclosed, developers say.

Source https://www.archdaily.com/

Fig 6.3.13 An on-site supermarket will mean residents can shop for themselves Source https://www.archdaily.com/

Fig 6.3.14 on-site gym to encourage people to keep active and healthy.

Source https://www.archdaily.com/

Fig 6.3.15 Bed room having visual and physical connection with green pockets.

Source https://www.archdaily.com/

Fig 6.3.16 Continuous handrails are installed on walls throughout the building.

Source https://www.archdaily.com/

INFERENCE • •

• •

This case study aids in understanding the project on a bigger urban scale.

Various planning aspects, such as the necessity of solid-voids, green spaces, amenities required for care facilities were kept in mind while designing.

Recreational spaces and breathing pockets are well connected to residential block.

As a result, all 3 case studies have contributed to a better understanding of the role of design and architecture in the progression of dementia.

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6.4 CASE STUDY 4 : Jagruti Rehabilitation Centre, Pune Founder : Dr. Amar Shinde Location : Hadapsar, Pune

Year : 2015 Typology : Residential Building Strength : 200 beds, dementia patients

approx. 90

Staff : 10

Fig 6.4.1 View of the center Source Author

JAGRUTI REHABILITATION CENTER

Bird eye view of the center

SOLARPUR – PUNE HIGHWAY

SECONDARY ROAD

RESIDENTIAL

TERTIARY ROAD

Fig 6.4.2 Location Source Author

Fig 6.4.3 Bird eye view of the center Source google.com

OVERVIEW • •

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The purpose of this case study is to achieve a better knowledge of how existing dementia facilities function.

The Jagruti Rehabilitation Center is a new program launched by Dr. Shinde in 2015, following the successful operation of the facility he established in 2008 for those suffering from mental disorders.

• • • •

The facility is around 10 km from Pune on the Pune-Solapur road, and a few kilometers from Hadapsar.

The facility is in a quite residential location, yet it is still located outside of Pune.

It is housed in a residential structure with stilt + 4 floors, 16 apartments, and 90 dementia patients.

The institution is divided into two buildings: one for psychiatric patients suffering from mental diseases such as schizophrenia and manic depression, and the other, which was recently opened, is specifically for persons suffering from dementia.

SITE AND SURROUNDING •

The facility is purposefully located just outside of Pune's bustling city limits, on the outskirts of the village. The reason for this is because persons suffering from dementia are particularly sensitive to their environment.

Fig 6.4.4 The site and the surrounding context Source Author

• •

Throughout the day, there is a lot of rush and bustle in the city, which may disrupt people's well-being.

As a result, the facility is built up among the greenery of Manjiri fields, providing residents with a lovely view of the farmland surrounding them.

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PLANNING AND DESIGN DETAILS STILL LEVEL • • •

• •

The stilt area is accessed by a gate that is kept locked by a security officer throughout the day.

It is easily assessable due to the presence of ramps and steps.

The stilted area is planned to include a consultation room where persons concerned about dementia may come for check-ups and scans, as well as a waiting space.

This floor also includes a fully equipped kitchen with a dining area accessible via a ramp.

There is also a place designated for yoga or other leisure activities, which is accessible through a ramp.

DINNING ROOM

WAITING ROOM

FEMALE DOCTORS QUARTERS

BALCONY

KITCHEN YOGA / ACTIVITY ROOM

TOILET

MALE DOCTORS QUARTERS

TOILET

CONSULTATION ROOM

ICU CARE

Fig 6.4.5 Still level plan Source Author

Fig 6.4.6 First floor plan Source Author

FIRST FLOOR •

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The building contains one lift via which the residents commute, as well as a stairway that the patients are unlikely to use.

•

• •

The first floor is presently under construction as well. The first level would accommodate a female doctor's ward where the on-call female physicians could rest. It will also include a male physicians ward where on-call male doctors may recuperate.

The first floor has an intensive care unit (ICU) room that would be utilized if a patient became seriously ill and required emergency first aid or medical attention.

The ICU or first aid room is an important aspect of the design or planning since the patient is usually above the age of 65 and will have other illnesses as well. As a result, this room would accommodate for scenarios when any patient would require intensive care.

SECOND –FORTH FLOOR •

Each level has a caregiver or nurse who tends after the individuals who live there.

TOILETS

BED

Fig 6.4.7 Typical floor plan Source Author

•

BALCONY

View of the room and different activity throughout the center

Fig 6.4.8 View of the room and different activity throughout the center Source Author

The layout is the same on the second through fourth floors. The second and third floors are occupied by males suffering from dementia, while the fourth floor is occupied by women suffering from the same condition.

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ROOMS • • • • •

Each floor contains a total of 4 flats, three of which are shared by six people and one of which is a solitary unit for one person.

The flats are built with balconies that overlook the lovely Manjiri farmland. The flora has a calming impact on the residents of the institution.

The caregiver locks the door to the floor from the outside at all times using a floor-to-ceiling grill.

Each apartment features one bathroom, one kitchenette, a television, and patios with grills.

All of the beds are single hospital beds with a little barrier to keep the patient from slipping off the bed. People can utilize the railings and grips on each toilet to save themselves from falling.

DAILY SCHEDULE The day care facility adheres to a strict schedule that is followed by both caretakers and dementia patients:

88

•

7:00 am

•

8:00 am

•

9:00 am

• • •

11:00 am 12:30 pm 12: 30 to 4 pm

•

4:00 pm

•

6:30 pm

•

7:00 pm

: The patients are awakened, then cleaned and dressed for the day. : They are taken to the garden for a morning fitness routine of yoga and walking (for those who are able to walk). : Breakfast and medications are served in the canteen area for those who are able to walk, while the rest patients have breakfast in bed. : Lectures and reading activates : Lunch and medications. : They each take a nap in their own rooms in the afternoon. : They are taken back to the garden for tea and refreshments, as well as evening activities such as walking, yoga, and games. : Dinner is brought to them in bed, along with their medications. : Bed time.

ACTIVITIES

Special Room for activities, Yoga, meditation etc.

Listening to music and music therapy, reading, religious activities, nature and bird watching from the living room, and playing in-house games are examples of activities. On occasion, our residents will choose to watch a tv show together, such as a cricket match.

Fig 6.4.9 Residents playing carrom Source Author

Fig 6.4.10 Wellness activates : Yoga Source https://www.jagrutirehab.org

Fig 6.4.11 Residents involved in cultural activities Source https://www.jagrutirehab.org

Fig 6.4.12 Residents involved in day to day activity Source Author

Fig 6.4.13 Residents involved in awareness program on dementia Source https://www.jagrutirehab.org

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INFERENCE •

This case study assisted me in understanding the current state of the amenities in the Pune area.

•

This institution was distinct from the others I studied since it was constructed as a residential structure for patients suffering from dementia.

•

The facility's location is beneficial for those with dementia because it is distant from the sprawling city.

•

The facility's goal of providing individuals with a home to share works well, but they only communicate with their roommates.

SCOPE OF IMPROVEMENT • • •

• • •

90

The facility's main gates, as well as the passage entrances, are always locked.

This gives the entire place a jail-like atmosphere, where individuals are just locked in and wandering is prohibited.

People living with dementia have a tendency to wander, and a facility should be designed in such a manner that it encourages roaming in such a manner that the people are safe but do not feel like they are being monitored.

There were no particular accommodations for patients' family to stay overnight or in situations of emergency at the institution.

It is necessary to keep in mind the patients' family as well as the persons suffering from dementia.

The dining area is on the ground floor, and there is only room for one person, so bringing everyone down at the same time for lunch or dinner would be quite tiring.

•

• •

As of present, everyone is served meals on their beds, which prevents individuals from communicating with one another because the hospital lacks a common room where all of the patients may connect with one another.

There is no colour identification in the toilets.

The colour of the floor is the same as the colour of the toilet equipment, which may cause confusion in the minds of those who live there.

Fig 6.4.14 View of the main gate Source Author

Fig 6.4.15 View of the washroom Source Author

•

The material utilized is not anti-skid, which might be extremely harmful for persons suffering from dementia.

Fig 6.4.16 View of the Parking Source Author

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6.5 CASE STUDY 5 : DIGNITY FOUNDATION DAY CARE CENTER, BYCULLA, MUMBAI Founder : Dr. Sheilu Sreenivasan Location : Byculla east, Mumbai Fig 6.5.1 Residence at Dignity Source www.theparentscare.com/

Year : 2004 Typology : Day-care centre for people suffering from dementia Strength : 10 to 15 people

Fig 6.5.2 Location Source Author DIGNITY FOUNDATION DAY CARE CENTER

BYCULLA WEST RAILWAYS

EASTERN EXPRESS HIGHWAY

MANDLIK BRIDGE TERTIARY ROAD

SECONDARY ROAD

OVERVIEW Dr. Sheilu Sreenivasan founded the dignity day care center in 2004. Even now, this is the city's sole daycare center for adults suffering from dementia.

The center had 15 patients at one point, but that number has since been reduced to 10. The day care center has a total capacity of roughly 20 persons at any given moment. The center is open from 9 a.m. to 4 p.m., Monday through Friday. The center employs professional personnel such as a general physician, a psychologist, a social worker, and trained attendants.

The center's aim is also to provide a stimulating atmosphere for patients suffering from dementia through various therapies, in order to keep their minds engaged.

The function involves in a 3M X 9M leased space at the Byculla service industries building.

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PLANNING AND DESIGN DETAILS • •

Due to the fact that the day care center is rented, there isn't much planning seen in the infrastructure.

The facility is a 3m X 9m column-free area with one side blocked by grills and the opposite side of the facility's entrance. As a result, just one side receives natural light and ventilation.

Fig 6.5.3 Still level plan Source Author

Because the facility lacks attached toilets, caretakers accompany every individual and go all the way outside the room when the person with dementia has to use the bathroom.

ENTRANCE AND WAITING AREA ACTIVITY AREA KITCHEN

•

• •

The facility has been dementia proofed by the use of soft vinyl tiles, which ensures the safety of those who use it.

The space is large enough for folks to wander about in if they need stimulation or want to stretch their legs.

Because a full-fledged kitchen is not necessary, a modest kitchenette is provided for the users to make tea and coffee.

ACTIVITIES There are several activities available for individuals to participate in at the center, some of which are as follows: • •

• •

Carom boards are always occupied by patients and their caregivers.

Memory games such as Sudoku and children's games such as puzzles are encouraged since they keep persons with dementia active and assist to improve their memory abilities.

There is also yoga and physiotherapy. Other hobbies, such as dance and singing, are also practiced.

During the holiday season, activities relating to the festivals are observed, such as the production of rangoli and the coloring and painting of lamps

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Fig 6.5.4 Residence involved in different activities Source Author

DAILY SCHEDULE The caregivers and persons suffering from dementia follow a set schedule at the day care center every day.

• • • • • • •

9:00 a.m. - 11:00 a.m. :The center has two vehicles. These two automobiles pick up and drop off dementia patients at their homes.

11:00 am - 11:30 Am: Around 11:00 a.m., the automobiles arrive at the facility, tea and coffee are provided, and a prayer is said.

11:30 Am - 1:00 Pm: Patients participate in various workouts such as cycling or yoga.

1:00 PM - 2:00 Pm: The patients are served lunch and then taken one by one to the restrooms.

2:00 Pm- 3:30 Pm: The dementia patients then participate in a variety of activities.

3:30 Pm - 4:00 Pm: Tea and coffee are provided, and they are taken to the restrooms one by one before returning home.

4:00 Pm: The vehicles then depart to drop the patients to their respective homes.

INFERENCE • • •

94

The dignity day care facility is located in the heart of the city.

Car services for pickups and drop-offs are available at the facility.

There is sufficient staff to care for each individual, and the staff members look after the people who are registered at the facility.

• A variety of activities and games are conducted at the facility to assist those suffering from dementia.

• There are different physiotherapy exercise devices, such as cycling and band exercises, that are good to patients .

SCOPE OF IMPROVEMENT • •

The center's programmed is excellent, although it lacks key elements.

The day care center has one large opening for natural light and ventilation, which is closed by grills

• •

The structure's other sides are solid walls with no openings.

Dignity Daycare Centre is housed in a commercial building and lacks any open space or greenery that might assist those who use the service. As a result, the Mumbai center lacks the surrounds and environment required to care for dementia patients.

The Kerala day care center had beds for individuals to relax during the day, something the Mumbai day care center did not have.

People were unable to use the associated bathrooms at the Mumbai Centre.

Every time someone needed to use the restroom, the caregiver had to accompany the individual outside the care center to the public common restrooms.

• • •

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6.6 COMPARATIVE ANALYSIS FACTORS

Alzheimer’s Respite Centre

The Hogeweyk – Dementia Village

ARCHITECT

Niall McLaughlin Architects

Moleanaar and Bol Architects

LOCATION

Dublin , Ireland

Weesp, Netherlands

SITE AREA

1500 m²

15,310 m²

STRENGTH Patients Care Takers

11 5

152 35

TYPOLOGY

Respite centre

Village

PLANNING

Clustered planning

Axial planning

COMPONENTS

• • • • • •

• •

• • •

NO. OF FLOORS

Kitchen - Dinning Activity Room Terraces / Courtyard Different Gardens Contemplation Room Therapeutic Remedies Room Bedroom Alzheimer's Society Offices Hairdresser

Ground

Table 6.6.1 Comparative analysis Source Author

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• • • • •

Activity Room 3 large courtyards and 4 smaller squares and gardens Theatre Commercial unit : Grocery and other Shops Residential units Medical facilities Hairdresser

Ground + 1

Alzheimer's Village / NORD Architects

Jagruti Rehabilitation Center

Dignity Foundation Day Care Center

NORD Architects

Founder : Dr. Amar Shinde

Founder : Dr. Sheilu Sreenivasan

Dax, France

Hadapsar, Pune

Byculla east, Mumbai

10,700 m²

1500 m²

27 m²

120 220

200 10

15-20 5

Village

Residential building

Day care center

Central planning

Linear planning

Linear planning

• • •

• •

•

• • • • • • • •

Residential units Medical facilities Café and restaurant Hairdresser Auditorium Gardening space Green pockets with sitting Small firm Gym Supermarket Activity room Administration

Ground + 1

• • • • • •

Kitchen - Dinning Activity Room / yoga Garden Bedroom Consultation Room ICU Male and female doctors quarters

Ground + 4

• •

Entrance and waiting room Activity area kitchen

Ground

Table 6.6.2 Comparative analysis - II Source Author A DEMENTIA VILLAGE Investigating the relevance of sensory and curative architecture for dementia care

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Chapter

07 DESIGN DETERMINANTS Architecture has a significant impact on people's lives.

Architecture, when used appropriately, may serve as a starting point in the treatment of people.

Through its design, architecture may elicit emotions such as rage or calm. People's behavior can be affected by the usage of specific architectural elements. Certain characteristics of architecture, such as colour and lighting, can be used to influence the user's behavior or mood.

This chapter was written after researching and drawing conclusions from various case studies. This chapter seeks to help readers understand the many design aspects that must be considered while designing a center for dementia patients.

• SENSORY DESIGN: SPACES FOR THE SENSES • SPACE SEQUENCE AND ARRANGEMENT

7.1 SENSORY DESIGN: SPACES FOR THE SENSES

SENSORY • • • • •

SIGHT : Color, light, exterior design, interior, architectural elements (they are highly sensitive so soothing colour scheme will give them calming effect and evoke there brain and memories) TOUCH : Material, Finishes , Texture, Temperature.

HEARING : Music, Acoustics, Nature.

SMELL : Kitchen, Food, Nature, Herbs and Smelling Trees/Flowers Gardens, Architectural Aromas like paint, varnish, and plaster.

TASTE : Kitchen, Garden.

RESIDENTIAL CHARACTER • •

individual space, personalization unique features(recognition / remembering the built)

PROVIDE SPACES THAT ENCOURAGE INDEPENDENCE AND FREEDOM • • • •

continuous railing for support bath room supports / bars Sittings at proper height and distance Wide corridors

WALKING AND WANDERING PATHS • • • •

Avoid falls No dead ends Well connected pathways Non skit material

COMMON SPACES (WITH DIFFERENT CHARACTERS) • • • • • • •

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Dining area and Living room Activity room Gym or exercise center Gardens Entertainment room Common entrance Music room/ game room

7.2 SPACE SEQUENCE AND ARRANGEMENT

Sequence of space in house (homely , noninstitutionalized atmosphere)

Location of entrance door

the

The route inside the structure should be in the line of entrance, living room and then individual room. So the transpiration of the space will be semi-private to private.

The location should not be at the end of the corridor, but it should be placed better at the alongside of the wall.

Because people with dementia have a tendency to wander, the living room should be located in a prominent location where they can easily reach it if they are disoriented.

Location of the living room

Visual access between

Entrance and Living Room Living Room and Corridor Sanitary and Individual Room The living room ,the entrance and corridors should be visually connected cause it can increase the sense of orientation and will give the feel of home.

Table 7.2.1 Sequence and location of spaces Source Author A DEMENTIA VILLAGE Investigating the relevance of sensory and curative architecture for dementia care

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Lengths of the route

Short routes in relation to orientation

The corridor should be broad enough for two patients to walk freely next to each other and wheelchair to pass without incident.

Width of the corridor

Shape of the corridor

More use of the articulated architecture (recoronation and sense of orientation and wayfinding).

Reduce the duration of the moment to reduce confusion.

Moments of decision on the route

Make use of natural daylight and ventilation in the design .

Entrance of daylight

Table 7.2.2 Sequence and location of spaces - II Source Author

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Windows should be design in a manner that it has more function then just letting light in.

“Good lighting conditions, which stimulates the patient’s circadian rhythm and orientation ability”

Windows

Plans can oblige to wandering and wayfinding

Connection to outdoor area and activity room / square

A small, manageable environment in which the patient may orient himself or herself.

It is essential to allow for easy navigation and orientation.

More use of the articulated architecture (recoronation and sense of orientation and wayfinding).

Table 7.2.3 Sequence and location of spaces - III Source Author A DEMENTIA VILLAGE Investigating the relevance of sensory and curative architecture for dementia care

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Chapter

08

SITE SELECTION AND SITE ANALYSIS This chapter discusses the ideal location for a project like this (dementia village: a residential facility with a day care facility for dementia patients) would be on the outskirts of town but well connected to the city by all modes of transportation, where users can enjoy the serenity of nature away from the fast city life without the noise and pollution, as well as the site analysis and other major factors.

• WHY MUMBAI AND NAVI - MUMBAI ?

• SITE SELECTION • LOCATION AND CONNECTIVITY • HOSPITALS IN SITE PROXIMITY • SITE PHOTOS • SITE ANALYSIS • DETAIL SITE PARAMETERS • CLIMATE ANALYSIS • SWOT

Fig 8.1.1 Location of Navi-Mumbai Source google earth.com

8.1 WHY MUMBAI AND NAVI MUMBAI ?

•

•

•

•

It is estimated that by the year 2026, Maharashtra would have close to 5 lakh dementia patients. Mumbai, although being the hub of all activities, nevertheless falls behind in the field of dementia, where most families are burdened by work with unpredictable office hours and are in need of services to assist them in caring for their loved ones.

Having said that, there is a wave of awareness about dementia in Mumbai today, and as a metropolitan city, Mumbai has the ability to provide an infrastructure framework that other cities may use as a model.

As a result, the institution would operate and grow better in Mumbai, where there is already a sense of awareness and a severe need for dementia care facilities to meet the expanding number of dementiaridden individuals, rather than in a less-aware location.

Mumbai and Navi Mumbai have one or two residential dementia care facilities, one day care facility, and one research center, but this is insufficient to serve 5 lakh patients in the near future.

PROBABLE SITES •

• •

•

•

•

According to the site criteria and an in-depth study of dementia and its consequences, the most likely locations would be on the outskirts of Mumbai's main city.

CIDCO has started developing brownfield sites in Navi Mumbai alongside greenfield sites.

Navi Mumbai is a planned township off the west coast of Maharashtra developed by CIDCO (city Industrial Development Corporation of Maharashtra).

It's beautiful, with hills on one side and a creek on the other. The Mumbai-Pune Highway connects it to the city, making travel fast and convenient.

There are 14 well-planned nodes in Navi Mumbai. In addition, 45 percent of the land is set aside for green spaces. This ensures that Navi Mumbai has plenty of green breathing spaces.

Navi Mumbai also has a number of super specialty hospitals with memory clinics and dementia screening camps

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8.2 SITE SELECTION

Fig 8.2.1 Location of site A Source google earth.com

Fig 8.2.2 CIDCO development plan for site A Source CIDCO

SITE A : 8.98 hectors Location : KHARGHAR , Navi Mumbai • • • • •

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Major residential in the surrounding.

In close proximity to mangroves and water body In terms of transportation, the site is well connected to the MumbaiPune highway. The Kharghar railway station is a short distance away.

There are a lot of medical institutions nearby, such as eye clinics and super specialty hospitals.

In CIDCO's land use map, the site is labelled as "future development."

Fig 8.2.3 Location of site B Source google earth.com

SITE B : 2.98 hectors Location : VASAI – VIRAR • • • •

Major residential in the surrounding.

The area is near to the Vasai fort and has a river body running through it.

In terms of transportation, it can be a issue.

The site is located on the outskirts of the city limit.

Fig 8.2.4 Location of site C Source google earth.com

SITE C : 7.5 hectors Location : Between Mankhurd And Vashi.

• • •

There is no development around the site.

The Mumbai-Pune highway connects the city to the intended location by road. The railway stations of Kharghar and Mankhurd are also near to the location.

No hospital aur medical care facility in the close proximity or with in 5 min distance.

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8.3 LOCATION AND CONNECTIVITY NAVI MUMBAI

Fig 8.3.1 Location of site Source Author

The site is at Kharghar, Navi Mumbai. It is quite near to the Mumbai-Pune expressway. The location is accompanied by a major residential population as well as institutional buildings. It is conveniently located near other facilities.

CIDCO is in charge of the neighborhood's development.

The site falls under future development by CIDCO

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Fig 8.3.2 Connectivity Source Author

CONNECTIVITY •50 minutes drive from Chattrapati Shivaji Terminus (Central Mumbai).

•The nearby Kharghar Railway Station is a well connected station connecting to many major parts of Mumbai.

•Well-connected with NMMT buses to Panvel, Thane, Sion, Vashi, Kamothe.

•Located on the Sion-Panvel Highway.

•Close proximity (<5kms) from NH48 (Mumbai-Pune Expressway) •5-station Metro line for Navi Mumbai.

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Fig 8.4.1 Hospitals in site proximity Source Author

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8.5 SITE PHOTOS Fig 8.5.1 Site location Source Author

SITE AREA : 22.1 ACRE

Fig 8.5.2 Current site condition Source Author

Fig 8.5.3 Current site condition Source Author

Fig 8.5.4 Khargar sewage plan Source Author

Fig 8.5.5 Road network Source Author

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Fig 8.5.6 1. Sion –Panvel Toll way

Fig 8.5.9 4. Spaghetti Society

Source Author

Source Author

Fig 8.5.7 2. Foot over bridge Source Author

Fig 8.5.10 5. Secondary road near KPC Source Author

Fig 8.5.8 3. Dav International school

Fig 8.5.11 6. Vastuvihar housing

Source Author

Source Author

Fig 8.5.12 Isometric view towards site

Source Google.com

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8.6 SITE ANALYSIS FIGURE GROUND

Fig 8.6.1 Figure ground Source Author BUILT

OPEN

ROADS

SITE

TALOJE RIVER

Built = 45% Open = 55% Looking at the figure, a substantial built-up area can be observed on the left side of the site, while the right side features ESZ. The urban fabric appears to have a fine grain with ample open spaces in between.

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LAND USE

Fig 8.6.2 Land use Source Author RESIDENTIAL

MIXED-USED

INSTITUTIONAL

PUBLIC BUILDING

COMMERCIAL

INDUSTRIAL

TALOJE RIVER

SITE

The site's land use is open to the public (by CIDCO).

The majority of the land is privately owned: pure residential buildings, followed by mixed residential buildings.

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ROAD NETWORK

Fig 8.6.3 Road network Source Author MUMBAI – PUNE HWY : 48 M

PRIMARY ROAD : 36 M

SECONDARY ROAD : 18 M

TERTARY ROAD : 9M

TALOJE RIVER

SITE

A variety of vehicles, ranging from trucks to cars to scooters, operate in parallel.

The site is connected to a 36-meter-wide major road and an 18-meter-wide minor road.

Traffic appears to be light; two vehicles pass by the main road in a minute.

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HEIGHT MATRIX

Fig 8.6.4 Height matrix Source Author G – G+1

G+2 – G+3

G+4 – G+6

G+7 – G+10

G+11 – G+15

G+16 – G+20

TALOJE RIVER

SITE

The height near the site (Kharghar, Navi Mumbai) ranges from ground to g+20 floors.

The majority of the buildings in the area have g+6 or g+2 store's.

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NATURAL FEATURES

Fig 8.6.5 Natural features Source Author GARDERNS

PLAY GROUNDS

MANGROVES

CIDCO RESERVED LAND

TALOJE RIVER

SITE

CREEK

There are a variety of breathing spaces on the left side of the property, such as private society gardens and play grounds, while on the right side, there are mangroves and the Taloje River running.

The site features a creek and a range of trees, which provides it with its unique microclimate.

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TRESS

Fig 8.6.6 Trees Source Author Type of trees : Palm Tree Neem

Rain Tree Mangroves

Amra Indian Laburnam

There is a dense amount of plantation on neem, amra and rain tree along the primary road side of the site and on the other side there is dense plantation of mangroves.

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8.7 DETAIL SITE PARAMETERS SITE MEASUREMENTS AREA : 89,800 m² 8.98 hectors 22.1 acre

22.1 acre

Site measurements are represented in fig. The majority of the property is accessible to the road side, while the right side is exposed to mangroves.

The shape of the site is trapezium.

Fig 8.7.1 Site measurements Source Author

SETBACK AND BUILT-ABLE AREA SETBACK FROM ROAD: A : 12m B : 12m C:6m D:6m According to the GDCR of Mumbai, there are a setback margin to be left in the site.

The total build-able area after excluding the setback is 77500 m2.

Fig 8.7.2 Setback and built-able area Source Author

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LEGALITIES FSI : 1.5

FSI

1.5

Access road minimum width

Plot area

Permitted FSI

9m

1000 sqm

1.5

15m

1000 sqm

2.0

Permissible Building Heigh : 30 m (G+9 floors) Permissible Built-up Area : 134,700 m² The buildings along the road are major low-rise (G+6 - G+5) society.

Fig 8.7.3 Legalities Source Author

DISTURBANCE The primary road (Vastu Vihar road), which contains institutional and residential, generates the majority of the noise.

The mangroves, as well as the other two sides, emit no audible noise. .

Fig 8.7.4 Disturbance Source Author

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8.8 CLIMATE ANALYSIS Latitude : 19.0330° N Longitude : 73.0297° E Altitude : 14 m City : Mumbai Climate type : Tropical Average annual temperature : 26.3°C | 79.3 °F Precipitation : 1915 mm | 75.4 inch per year.

Fig 8.8.1 Average temperatures and precipitation Source https://www.meteoblu e.com/

Fig 8.8.2 Monthly temperature Source https://www.meteobl ue.com/

With an average of 29.4 °C | 84.9 °F, May is the warmest month. The lowest average temperatures in the year occur in January, when it is around 23.5 °C | 74.3 °F.

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Fig 8.8.3 Cloudy, sunny, and precipitation days Source https://www.meteobl ue.com/

Fig 8.8.4 Precipitation amounts Source https://www.meteob lue.com/

The precipitation varies 627 mm | 25 inch between the driest month and the wettest month. The variation in temperatures throughout the year is 5.9 °C | 10.6 °F. The month with the highest relative humidity is July (89.37 %). The month with the lowest relative humidity is March (52.97 %).

The month with the highest number of rainy days is July (29.00 days). The month with the lowest number of rainy days is March (0.17 days).

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Fig 8.8.5 Wind speed https://www.meteobl ue.com/

Fig 8.8.6 Wind rose Source https://www.meteob lue.com/

The wind blows from the south-west (SW) to the north-east (NE).

The wind speed rises throughout the months of March, April, May, and June.

The month of May has the greatest wind speed.

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SUN PATH DIAGRAM

Fig 8.8.7 Sun path diagram Source https://www.meteoblue.com/

INFERENCES : • • • • • •

Open public places should be enclosed by a structure or vegetation.

The wind direction would be taken into consideration when planning the activities.

All functions would be designed to receive adequate day lighting and ventilation.

Strategies for passive design Reduction in humidity levels.

To establish a temperature difference between the outside and indoor environments t o aid evaporation and heat dissipation.

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8.9 SWOT ANALYSIS • • •

• Fig 8.9.1 Strength Source Vectorstock

• •

• • • Fig 8.9.2 Weakness Source Vectorstock

•

• •

Fig 8.9.3 Opportunities

•

Source Vectorstock

•

• Fig 8.9.4 Threats Source Vectorstock

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The neighborhood is dominated by residential and institutional buildings.

The Mumbai-Pune highway is easily accessible.

We have healthcare care facilities near to the site.

Natural elements such as mangroves and river are present.

There is very little disturbance due to the moderate flow of vehicles.

The presence of various amenities in close proximity.

The site is relatively far from the Kharghar railway station.

The only way to get to the site is via car.

At certain times of the day, traffic from the school and guests might cause noise and congestion (school hours).

Walk ways are not well developed.

The neighborhood is currently in developing stage.

There are no medical facilities or nursing homes in the neighborhood for people suffering from dementia.

Because the site is relatively vast, some of it can be set aside for future development.

The existing buildings that surround the site do not provide shade.

People have a poor knowledge and awareness about the subject

Fig 8.10.1 The last station nursing home Source https://www.pinterest.co.uk/pin/1970393574755108/

Chapter

09

PROGRAM DERIVATION This chapter talks about detail area program for the project.

• USER GROUP • OVERALL LAYOUT OF THE DEMENTIA VILLAGE • AREA STATEMENT

9.1 USER GROUP Long stay (Strength : 300-310) •

Person Diagnosed With Dementia (approx. 200)

•

Professionals Caring For The Residents /Caretakers (40, 1 caretaker on 5 patients)

•

Volunteers and amenities owners (approx. 12-15)

•

In house doctors : neurologist , psychiatrist, geriatric doctors, physiotherapist (10 doctors)

Short stay •

Visiting doctors (5-6) and Visiting volunteers (5-6)

•

Visiting family members + visitors

•

Day care facilities patients 15-20

The overall layout of dementia village with the three overall facilities being the public facilities, residence and day care center

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9.2 AREA STATMENT RECEPTION : administration (public) ROOM

No.

Area m²

Total area m²

Head office

1

15

20

Personal office

1

10

20

Conference room

1

12

12

Washroom

2

16.5

33

Waiting area

1

15

15

Total

6

100 m²

Table 9.2.1 Reception unit Source Author

ADMINISTRATION (residential) ROOM

No.

Area m²

Total area m²

Head office

1

15

15

Conference room

1

25

25

Washroom

2

16.5

33

Waiting area

1

30

30

Consultant office

1

30

30

Cleaning

1

12

12

Clinic : primary test

1

30

30

Total

8

175 m²

Table9.2.2 Administration unit Source Author A DEMENTIA VILLAGE Investigating the relevance of sensory and curative architecture for dementia care

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RESIDENCE (personal space) ROOM

No.

Area m²

Total area m²

Private entrance

1

6

6

Living room

1

20

20

Bedroom

1

12

12

Bathroom

1

7

7

Balcony

1

9

9

Total

5

54 m²

Table 9.2.3 Residence (personal space) Source Author

COMMON AREA (personal space) ROOM

No.

Area m²

Total area m²

Kitchen

1

18

18

Living room

1

40

40

Dinning room

1

40

40

Entrance

1

6

6

Lounge

1

30

30

Common toilet

2

7

14

Total

7

Table9.2.4 Common area (personal space) Source Author

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148 m²

COMMON UNIT (personal space) 6 - 7 patients and 1 caretaker ROOM

No.

Area m²

Total area m²

Personal space

8

54

432

Common area

1

200

200

Total

9

632 m²

1 cluster will include 3-4 units (24 residences), for a total of 2 clusters for stage 1 and 2 dementia residences.

Table 9.2.5 Common unit Source Author

COMMON AREA AND RESIDENCE FOR SEVERELY DENTED (personal space)

ROOM

No.

Area m²

Total area m²

Private entrance

1

6

6

Personal space

6-8

45

270

Common space/ kitchen

1

40

40

Laundry

1

4

4

Common toilet

2

7

14

Emergency room

1

12

12

Observation room

1

12

12

Total

13

362 m²

1 cluster will include 4 units (28 to 30 residences), for a total of 1 clusters for stage 4 dementia residences.

Table9.2.6 Common area and residence for severely dented Source Author A DEMENTIA VILLAGE Investigating the relevance of sensory and curative architecture for dementia care

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RESIDENCE FOR SEVERELY DENTED (personal space for 3rd and 4th stage) ROOM

No.

Area m²

Total area m²

Private entrance

1

6

6

Living room

1

20

20

Bedroom

1

12

12

Bathroom

1

7

7

Total

4

45 m²

Table 9.2.7 Residence for severely dented Source Author

FLATS : IN-HOUSE DOCTORS (personal space) ROOM

No.

Area m²

Total area m²

Living room

1

40

40

Dinning room

1

40

40

Kitchen

1

25

25

Powder toilet

1

7

7

Master Bedroom

1

36

36

Guest bedroom

1

25

25

Personal washroom

2

12

24

Balcony

2

9

18

Vestibule

1

6

6

Total

7

Table9.2.8 In-house doctors (personal space) Source Author

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221 m²

DAY CARE FACILITIES (semi-public space)

ROOM

No.

Area m²

Total area m²

Vestibule

1

7

7

Café + restaurant

1

150

150

Cultural club

1

50

50

Neurologist clinic

1

30

30

Psychiatrist clinic

1

30

30

Geriatric doctor clinic

2

30

60

Gym / physiotherapist

1

110

110

ICU

1

25

25

OPD

2

25

50

Emergency room

1

12

12

Pharmacy

2

12

24

Laboratory

1

20

20

Observation room

1

12

12

Workshop

1

20

20

Therapeutic Offices

2

80

160

Living room

1

30

30

TV room

1

25

25

Toilets

4

16.5

66

Total

25

Fitness / wellness

Approx. 1000 m²

Table9.2.9 Day care facilities Source Author A DEMENTIA VILLAGE Investigating the relevance of sensory and curative architecture for dementia care

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AMINITIES (semi-public space)

ROOM

No.

Area m²

Total area m²

Grocery / Super market

1

100

100

Auditorium / Theatre

1

240

240

Hairdresser / Barber

1

70

70 410 m²

Total Greens and open spaces Vegetable garden / gardening

1

800

800

City square with out door games and activities

1

3500

3500

Water body + sitting

1

2000

200

Café plaza

1

2750

2750

Yoga space / wellness space

1

1300

1300

Garden C

1

1400

1400

Garden A

1

1400

1400

Outdoor gym

1

1000

1000

Garden B

1

780

780

Shopping street + commercial space

1

5580

5580

Total Table9.2.10 Amenities Source Author

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approx. 18800 m²

RESIDENCE FOR VESITORS (personal space 15 units) ROOM

No.

Area m²

Total area m²

Private entrance

1

6

6

Living room + kitchenette

1

20

20

Bedroom

1

12

12

Bathroom

1

7

7

Balcony

1

9

9

Total

5

54m²

Table 9.2.11 Residence for visitors Source Author

PARKING (public space) ROOM

No.

Parking for personal and guest Car

40

2 wheelers

40

Ambulance

4

Table9.2.12 Parking Source Author

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Chapter

10

CALCULATIONS AND DESIGN FOR DEMENTIA This chapter outlines NBC guidelines for the elderly, disabled and dementia sufferers , as well as dementia design factors to be applied in interior design for a homey atmosphere.

NATIONAL BUILDING CODE Anthropometrics And Requirements For Accessibility In Built – Environment For Elders And Persons With Disabilities • Nomenclature of basic elements of wheelchair • Wheelchair : range , reach and vision • Site planning and development • Access at entrance and within the building : corridor width and turns • Doors • Wheelchair : range , reach and vision • Space allowances for accessible bedroom • Lifts • Washrooms DESIGN FOR DEMENTIA • Private domain • Saturation • Visual degeneration - tone and contras • Understanding changes in colour perception

10.1 NATIONAL BUILDING CODE Anthropometrics And Requirements For Accessibility In Built – Environment For Elders And Persons With Disabilities

Fig 10.1.1 Nomenclature of basic elements of wheelchair Source NBC 2016 volume 1

Manual wheelchair dimensions are as follows : a) Overall length: 1000 mm-1100mm b) Overall width, open: 650 mm-720mm c) Overall width, 300 mm-330 mm folded d) Overall height: 910 mm-950 mm f)Distance between: 400 mm-450 mm seat and footrest e) Seat height from: 480 mm-510 mm floor at the front g) Arm rest height: 220 mm-230 mm from seat h) Seat depth: 420 mm-440 mm i) Clearance of foot-:90 mm-200 mm rest from floor j) Clearance of frame: 90 mm, Min from floor k) Wheelchair footrest: 350 mm (deep) 1) Wheelchair castor: 12 mm width

m) Weight of the: 25 kg, Max wheelchair (basic model)

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Fig 10.1.2 Necessary space under counter or stand for ease of wheelchair users

Fig 10.1.3 Clear floor space Source NBC 2016 volume 1

Source NBC 2016 volume 1

Fig 10.1.4 Preferred comfortable turning radius Source NBC 2016 volume 1

Fig 10.1.5 Passage way required for people who uses walking aids Source NBC 2016 volume 1

Fig 10.1.6 Space allowance (radial range) for people using white canes Source NBC 2016 volume 1

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Wheelchair : range , reach and vision

Fig 10.1.7 Ranges of reach of wheelchair users Source NBC 2016 volume 1

Fig 10.1.8 Forward reach over obstruction Source NBC 2016 volume 1

Fig 10.1.10 Vision zone Source NBC 2016 volume 1

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Fig 10.1.9 Side reach over obstruction Source NBC 2016 volume 1

Site planning and development Walk ways and pathways

Key 1 and 2 for two-way traffic 3 and 4 for one-way traffic 5 passing and Turing space every 25 m Fig 10.1.11 Different walk way width depending upon the user traffic Source NBC 2016 volume 1

Access at entrance and within the building : corridor width and turns

Fig 10.1.12 Different corridor widths determined by intensity of use Source NBC 2016 volume 1

Fig 10.1.13 Space required for 90° turn Source NBC 2016 volume 1

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Doors

Fig 10.1.14 Minimum clear opening of doorway Source NBC 2016 volume 1

Fig 10.1.16 Front approach Source NBC 2016 volume 1

Fig 10.1.15 Door hardware location Source NBC 2016 volume 1

Fig 10.1.17 Latch side approach Source NBC 2016 volume 1

Fig 10.1.18 Position taken by a wheelchair user when negotiating door in passage way Source NBC 2016 volume 1

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Fig 10.1.19 Space allowances for accessible bedroom Source NBC 2016 volume 1

Fig 10.1.20 Storage space Source NBC 2016 volume 1

Fig 10.1.21 Space around bed Source NBC 2016 volume 1

Fig 10.1.22 Requirements for windows Source NBC 2016 volume 1 A DEMENTIA VILLAGE Investigating the relevance of sensory and curative architecture for dementia care

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Lifts and table heights

Fig 10.1.23 Lift size Source NBC 2016 volume 1

Fig 10.1.24 Inclined lifting platform Source NBC 2016 volume 1 and https://www.pinterest.co.uk/

Fig 10.1.25 Heights of counters suitable for wheelchair users and people standing Source NBC 2016 volume 1

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Washrooms

Key 1 minimum 900 mm 2 foldable grab bars , both side 3 washbasin 4 independent water supply

Fig 10.1.26 Type A toilet room : lateral transfer from both side Source NBC 2016 volume 1

Key 1 minimum 900 mm 2 foldable grab bar 3 independent water supply 4 grab bar on wall 5 washbasin

Fig 10.1.27 Type B toilet room : lateral transfer from one side only Source NBC 2016 volume 1

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Fig 10.1.28 Positioning of grab bar, water supply and other toilet accessories in type B conner toilet Source NBC 2016 volume 1 Key 1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

150

Drop down support grab bar at seat height plus 200 to 300 mm Wall-mounted horizontal grab bar at seat height plus 200 to 300 mm Wall-mounted vertical grab bar Mirror, top height minimum 900 mm, bottom height maximum 900 mm above the floor Soap dispenser 800 to 1 000 mm above the floor Towels or dryers 800 to 1 100 mm above the floor Waste bin Toilet paper dispenser 600 to 700 mm above the floor Independent water supply Small finger rinse basin 350 mm maximum projection

Fig 10.1.29 Self contained changing room for individual unit Source NBC 2016 volume 1

Key 1.

2.

3.

4.

5.

6.

7.

8.

Hand held shower head Horizontal grab bar Vertical grab bar Foldable shower seat Towel hooks Transfer area Wet shower area Shower controls

Fig 10.1.30 Shower place with grab handle Source NBC 2016 volume 1

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10.2 DESIGN FOR DEMENTIA 10.2.1 PRIVATE DOMAIN FUNDAMENTALS OF EFFECTIVE LIVING SPACES • • • • •

Simple - layouts should be free of clutter and simple to understand.

Designs should be logical in order to facilitate navigation.

Spaces should be functional and acceptable for their intended usage.

Quiet - because noise may be unpleasant, sound should be reduced.

'Living well' - design should encourage flexibility and independence as much as possible, while also providing stimulation via all of the senses.

FACTORS TO BE CONSIDERED The eyesight of the elderly and those suffering from dementia alters, as does their perception of their environment. Understanding this is an ideal base when discussing the design of the internal environment.

• • •

TONE - the amount of light reflected by a colour.

HUE - colour wheel position SATURATION - the depth or 'vividness' of the colour

COLOUR AND TONAL VALUES Since people with dementia have a lower capacity to notice contrast, significant tone contrast between walls and floors is essential. Because colour perception may be impaired, the choice of colour finishes or signs is important.

SATURATION By using strong colors and keeping in mind the appropriate age of the era intended, safe, soothing, familiar interiors can be created, that can both reduce stress and aid perception at the same time. Choose more vivid colors to compensate for the dullness of the aging lens.

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10.2.2 SATURATION Safe, relaxing, familiar interiors may be produced by choosing vibrant colours and keeping in mind the suitable age of the targeted era, which can both decrease tension and help perception.

To compensate for the dullness of the ageing lens, use more vibrant colours.

Colour intensity

greater intensity

Colour saturation

greater saturation Fig 10.2.1 Colour intensity and saturation Source Aged Care DESIGN GUIDE

Fig 10.2.2 Warmer hues Source Aged Care DESIGN GUIDE

Using stronger, more vivid colors is more interesting and attractive, as long as the environment is still familiar to the end user. Beautiful interiors can still be created which can be appreciated by older people and people living with dementia as well as visitors or family members.

Private spaces should be personalized, taking care not to create a hotel or institutional feel. Small personal details create familiarity and help to reinforce identity.

‘Persons with Alzheimer's Disease frequently show a number of visual disfunctions including impaired spatial contrast sensitivity, motion change discrimination, and colour vision as well as blurred vision, even if they have normal visual acuity and have no ocular diseases'. (Van Hoof, 2010) ‘The main feature of a surface, which appears to be strongly correlated with the ability of blind and partially sighted people to identify differences in colour, is the amount of light the surface reflects, or its light reflectance value (LRV).’ (BS 8300 : 2009)

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10.2.3 VISUAL DEGENERATION - TONE AND CONTRAS Understanding the significance of tone and contrast and how to apply it is a valuable tool as well as a design benefit.

The incorporation of minor classical designs will assist maintain the interior familiar to the end users' era. Avoid utilizing striped or whirling strobing patterns, which may induce distress and agitation.

Fig 10.2.3 Material in full color Source https://www.pinterest.co.uk

Fig 10.2.4 Monochrome image demonstrating comparative light reflectance value (LRV) of materials Source https://www.pinterest.co.uk

Non accessible doors painted out the same colour as the walls

Contrast between walls and floors, skirting boards, architraves, and doors will assist persons with dementia understand and navigate their surroundings more effectively.

Accessible doors can also be identified from non-accessible doors, such as service rooms, by the use of colour.

Highlighting accessible doors with contrasting architrave and door colour

154

Fig 10.2.5 View of passage Source Aged Care DESIGN GUIDE

10.2.4 EXAMPLES OF COLOUR SCHEMES FOR VARIOUS SPACES: Darker flooring (with an LRV between 10 and 40) are recommended to create the comforting look of a simple, solid surface that is safe to walk on. The walls should be painted in contrasting colors and have an LRV disparity of at least 30 points.

Wet Room

Bedroom

Corridor

Wet Room

Bedroom

Corridor

Fig 10.2.6 Example of colour schemes for carious spaces Source Author

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10.2.5 USE DEMENTIA-FRIENDLY WOOD DESIGNS Wood patterns are essential for creating a pleasant home-like feeling, but not all woods are suitable. This is why dementia-friendly wood designs with no knots are recommended in accordance with dementia recommendations.

• Calm & subtle grain without knots > to avoid misinterpretation (busy patterns, holes or waves on the floor) • Medium size bevel type > for easy identification of the floor to wood • Matt finish > to avoid glare and shiny effect surface that could be assimilated to slippery floor FAVOUR PLAIN DESIGNS AND SUBTLE MARKINGS

Tissage-Soft Grey

Twine-Indigo

Uni Intense Jean

Fiber Wood-Natural

CHOOSE WOOD PATTERNS ASSESSED AS DEMENTIA-FRIENDLY BY EXPERTS

Fiber Wood Grege

Brushed Oak Medium

Oak Tree Beige

Serene Oak Warm Brown

AVOID BUSY PATTERNS, DARK COLOURS AND HIGH-CONTRAST DESIGNS

Terrazzo-Terracotta

Bubbles-Cold Mix

Fig 10.2.7 Example of dementia friendly materials Source Author

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Facet-Black & White

Cubic-Bright Anis

10.2.6 UNDERSTANDING CHANGES IN COLOUR PERCEPTION

Normal vision

Ageing vision

Fig 10.2.8 Change in colour perception Source Author

As the lens of the eye yellows with age, colour perception diminishes. Colors become less bright and more monochromatic in the elderly (red may begin to seem pink), and they have difficulties distinguishing between hues of blue or green.

Color contrast is consequently essential in providing visual signals for doors, knobs, switches, and furniture, helping people with limited vision to better perceive their surroundings.

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Chapter

11

DESIGN DEVELOPMENT This chapter discusses design development and its various stages, as well as specific architectural determinants that I incorporated into my design approach.

• • • • •

SPACE-SENSE RELATION CONCEPTUAL STAGE – 1 (FORM DERIVATION) REFINING THE FORM (FORM DERIVATION) CONCEPTUAL STAGE – 2 (FORM DERIVATION) CONCEPTUAL DIAGRAM : REFRESHMENT AND RECREATIONAL SPACE

160

11.1 SPACE-SENSE RELATION

Fig 11.1.1 Space-sense relation Source Author A DEMENTIA VILLAGE Investigating the relevance of sensory and curative architecture for dementia care

161

11.2 CONCEPTUAL STAGE - 1 FORM DERIVATION

Fig 11.2.1 Step 01 Source Author

1

Creating a central axis which will serves as a major circulation, and a

horizontal split that separates the site according to the program: public, semipublic, and private.

Fig 11.2.2 Step 02 Source Author

2

Building volumes are developed with optimum ground floor area: each volume serves to a particular series of activities and amenities.

Fig 11.2.3 Step 03 Source Author

3

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The units are further subdivided as necessary.

Internal courtyards are made.

Fig 11.2.4 Step 04 Source Author

4

The heights are adjusted to meet the needs of the users, and the day care facility is opened up.

Fig 11.2.5 Step 05 Source Author

5

The units and typology have been adjusted to become more familiar to the users. In each cluster, a public area and amenities are built.

Fig 11.2.6 Step 06 Source Author

6

Walkways and green zones are designed based on the user demand.

The walkways are well connected throughout the design, allowing dementia individuals to wander without getting lost.

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11.3 REFINING THE FORM FORM DERIVATION

Fig 11.3.1 Phase 1 Source Author

Phase 1 • Grid-planned central linear walkway.

• Designing several introvert pockets for distinct clusters.

• Introvert daycare facility at the design's entryway.

Fig 11.3.2 Phase 2 Source Author

Phase 2 • Zig zag central circulation with introvert cluster is developed for different stages of patients.

• Despite this zig zag circulation, many introvert pockets arose throughout design zoning.

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Fig 11.3.3 Phase 3 Source Author

Phase 3 • Integrating a central community area with pockets of less engaging space.

• Giving shared space near parking for events and participating in activities with NGO's

Fig 11.3.4 Phase 4 Source Author

Phase 4 • The facility is accessible from the center, with the day care facing the road, making the unit available to other NGOs. • Developing a core communal space, as well as designing more participatory spaces.

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11.4 CONCEPTUAL STAGE - 2 FORM DERIVATION for phase 4

Fig 11.4.1 Step 01 Source Author

1

Dividing the site along the central spine, which will serve as the primary circulation.

Fig 11.4.2 Step 02 Source Author

2

Building volumes are designed to maximize ground floor area while adhering to the zig-zag central axis: each volume serves a certain set of activities and amenities.

A peripheral vehicular road runs throughout the site for ease of access and emergency service.

Fig 11.4.3 Step 03 Source Author COMMUNAL SPACE

3

The horizontal circulation helps to further divide the built form and create a core communal space.

The waterbody is reinvented such that it is accessible and can be used for sound therapy and fish feeding.

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DAY CARE CENTER RESIDENCE FOR SEVERLY DENTED RESIDENCE FOR 3rd – 4th STAGE RESIDENCE FOR 1st – 2nd STAGE COMMUNAL SPACE

Fig 11.4.4 Step 04 Source Author

4

Internal courtyards are developed for each cluster.

Fig 11.4.5 Step 05 Source Author

5

The heights are adjusted to accommodate the users' requirements, and the day care facility is opened.

The inner courtyards are further opened out towards the central axis, creating introvert space. In each cluster, a public area and amenities are built.

Fig 11.4.6 Step 06 Source Author

6

The units and morphology have been adjusted to provide dementia sufferers with a sense of belonging.

The walkways are linked throughout the design, allowing dementia sufferers to wander without being confused.

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Fig 11.4.7 Modules Source Author

The modules are further segmented, and the units are organized in such a way that they form a central courtyard that is approachable from all directions, functioning as the unit's heart or gathering area..

11.5 CONCEPTUAL DIAGRAM : REFRESHMENT AND RECREATIONAL SPACE

Fig 11.5.1 Café plaza Source Author

Fig 11.5.2 Outdoor GYM Source Author

Fig 11.5.3 Mini farm (vegetable and fruit farming + fish feeding area ) Source Author

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Fig 11.5.4 Garden A (severely dented unit)

Fig 11.5.5 Garden B

Source Author

Source Author

Fig 11.5.6 Garden C

Fig 11.5.7 Garden D

Source Author

Source Author

Fig 11.5.8 Yoga and wellness space

Fig 11.5.9 Common gathering space for in house and others NGOs Source Author

Source Author

Fig 11.5.10 Shopping space (left side) and communal space with prayer hall and small water body.

Source Author

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Chapter

12

FINAL DESIGN PROPOSAL This chapter discusses my final design proposal as well as all of the drawings, perspectives, details, and other project-related materials.

• • • • • •

ROOF TOP PLAN GROUND FLOOR PLAN SECTION AND ELEVATION DAY CARE CENTER PLAN SEVERELY DENTED CLUSTER PLAN : STAGE 4TH 3RD STAGE CLUSTER PLAN

•

DAY CARE AND VISITORS STAY CLUSTER PLAN

•

STAGE 1ST CLUSTER PLAN

•

STAGE 2ND CLUSTER PLAN

•

STAGE 1ST AND 2ND STAY CLUSTER PLAN

•

INDIVIDUAL UNIT LAYOUT : PATIENT ACCOMMODATION

•

INDIVIDUAL UNIT LAYOUT : CARE TAKER ROOM TYPE-1

•

INDIVIDUAL UNIT LAYOUT : CARE TAKER ROOM TYPE-2

•

CLUSTER UNIT LAYOUT

•

ISOMETRIC VIEW OF THE SITE AND SHOPPING STREET

•

CLUSTER 3D VIEWS

12.1 ROOF TOP PLAN

In a dementia-friendly facility, the allocation of outdoor space is essential.

Internally, the accommodation buildings first and foremost create a safe and sheltered place. A huge green area specifically for the nursing home is not an option due to the high plot ratio and the high density of development in the city. As a result, the safe enclosed places have been maximized, and the diversified context may be used instead.

The different typologies allow the healthcare organization to extend into the community, allowing residents to go for a wander in places with recognizable characteristics, either with the support of staff or volunteers, or on their own if considered possible.

The parking space in the center of the property is built out with a spacious turning area and a simple drop-off zone, going into the extrovert facing day care center available to outsiders and in-house patients. The landscaping and paths lead up to the square in front of the day care facility, where there is easy access to the housing blocks.

The areas between the housing blocks are kept as green as possible while allowing emergency vehicles to pass through the openings (see drawing folder for more details).

A central street is designed for all other day-to-day activities, making it accessible to residents from all across the cluster and serving as an example of a CITY WITHIN A CITY.

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12.2 GROUND FLOOR PLAN

The project is divided into seven clusters, with 23 individual built units and eight shared spaces with varied activities, identities, and textures to stimulate various senses.

Number of patients room : 112 Number of caregivers room : 18 In house doctors flats: 5 Total number of accommodation Number of patients room : 302 Number of caregivers room : 47 In house doctors flats: 11

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12.3 SECTION AND ELEVATION

The residential cluster and day care center's façade and roof are similar to those of the housing buildings.

Different roof styles are developed to implement a sensation of uniqueness, and various forms of wooden arches are used to offer a good sense of navigation and a comfortable ambiance.

The facades are a recreation of traditional Mumbai architecture. The gables are made of brick and wooden shingles, while the long rare façade and roof are made of traditional brick and concrete texture.

A huge glass panel connects the café space to the outside by making it transparent. By emphasizing how the brick tiles wrap around, the thin, grey zinc profile elegantly frames the windows and the building shape.

Fig 12.3.1 Slopping roof detail Source https://www.pinterest.co.uk

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12.4 DAY CARE CENTER PLAN

The day care center is located on the west side of the property, with a central entrance, creating an extrovert cluster where outsiders and various NGO's may participate in activities or during festivals.

The parking lot in the property's center is designed with a large turning area and a straightforward drop-off zone.

The facility includes a refreshment zone as well as a wellness and fitness facilities with several physicians clinics (neurologist, psychiatrist, geriatric doctors, physiotherapist).

The day care center serves as a liaison not just between the dementia village's inhabitants and visitors, but also between the current and new dementia facilities in the area.

The program is a set of various services ranging from administration to public functions to severely demented residences. Even though the design of the dwelling units and the day care facility are separated into distinct phases, it is crucial to note that both were designed simultaneously, and therefore any modifications made in one location would effect the whole.

LEGENDS 1 . Parking 2. Parking For Mini Vans 3. Central Common Green Space With Steeped Sitting 4. Administration Block 5.Refresment Block : Restaurant 6.Auditorium 7.Wellness And Fitness Centre 8.Waiting Area For Visitors

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4

5

Fig 12.4.1 Day care centre plan Source Author

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12.5 SEVERELY DENTED CLUSTER PLAN : STAGE 4TH

According to the user of the severely dented cluster, the design is done in an introvert looking for a sense of enclosure and security.

In addition, the center green area has a small refreshment zone with open seating so that users may enjoy themselves throughout the day or when ever taken out for a walk.

The cluster comprises 27 patient rooms and 4 caregiver rooms, as well as a shared area in each unit that opens out to the greens (ground floor).

LEGENDS 1 . Housing Units 2. Refreshment Unit : Cafe 3. Open Sitting 4. Human Size Game Zone

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1

3 1

2

4

1 1

Fig 12.5.1 Severely dented cluster plan : stage 4 Source Author

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12.6 3RD STAGE CLUSTER PLAN

The design is done in an introvert looking for a sense of enclosure and security, according to the user of the third stage.

Furthermore, the central green area offers a separate small zone for various activities such as gyming and leisure space.

The cluster comprises 20 patient rooms, 3 caregiver rooms and 2 2BHK flats for in house doctors, as well as a shared area in each unit that opens out to the greens (ground floor).

LEGENDS 1 . Housing Units 2. Doctors Accommodation : 2BHK 3. Shared Green Space With GYM Equipment's

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1 2

Fig 12.6.1 3rd stage cluster plan Source Author

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12.7 DAY CARE AND VISITORS STAY CLUSTER PLAN

The cluster is conveniently located the day care facility and is close to all of the residential clusters for patients and doctors.

The cluster comprises 25 patient rooms, and 4 caregiver rooms as well as a shared area in each unit that opens out to the greens (ground floor).

LEGENDS 1 . Housing Units 2. Shared Space : Stepped Sitting And Central Green

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1

Fig 12.7.1 Day care and visitors stay cluster plan Source Author

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12.8 STAGE 1ST CLUSTER PLAN

The cluster comprises of 3 built units with 18 patient rooms, and 3 caregiver rooms as well as a shared area in each unit that opens out to the greens (ground floor).

LEGENDS 1 . Housing Units 2. Refreshment Zone : Café With Open Sitting 3. Flower Bed (Summer Flowers) 4. Green With Aromatic And Summer Trees

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3

4

2

3

1

Fig 12.8.1 Stage 1st cluster plan Source Author

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12.9 STAGE 2ND CLUSTER PLAN

The cluster is made up of three built units, 2 for patients and another for inhouse physicians, containing 9 patient rooms and 2 caregiver rooms, as well as a communal space that leads out to the greens (ground floor).

LEGENDS 1 . Housing Units 2. Doctors Accommodation : 2BHK 3. Green With Aromatic And Summer Trees 4. Pathway With Different Texture 5. Worship Space 6. Small Water Body With Sitting

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4

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2 3

1

Fig 12.9.1 Stage 2nd cluster plan Source Author

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12.10 STAGE 1ST AND 2ND STAY CLUSTER PLAN

The cluster is made up of three built units, 2 for patients and another for inhouse physicians, containing 13 patient rooms and 2 caregiver rooms, as well as a communal space that leads out to the greens (ground floor).

The cluster opens with into 2 different types of shared spaces with defend types of plantation and textures to activate the sense of touch, smell and sight.

The cluster faces towards the central communal space and the shopping street.

LEGENDS 1 . Housing Units 2. Doctors Accommodation : 2BHK 3. Shared Space With Fountain And Sitting 4. Shared Space For Fitness And Wellness Activities And Gathering 5. Small Farm For Vegetation Practices 6. Small Creek

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1

6

4

2 3

5 1

Fig 12.10.1 Stage 1st and 2nd cluster plan Source Author

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12.11 INDIVIDUAL UNIT LAYOUT : PATIENT ACCOMMODATION APPLICATION OF DEMENTIA TECHNOLOGY IN PATIENT ROOM

Bed Exit Matt Senses the pressure change when the patient exits and return to bed.

Infrared ceiling receivers Picks up any help required, emergency or staff attack calls made by a carer’s infrared transmitter.

Enuresis (bed wet) Sensor.

Triggers a call when moisture is detected in the patients bed.

PIR Movement Sensors Sense patients movement and instruct the controller to switch lights on , off or dim and to raise a call dependent on the status of the behaviour pattern selected.

Enuresis / bed exit Interface socket

Highlighting the seat of the WC so that they don’t get confused.

Door contacts Can be set up to trigger a call when the bedroom door is opened.

Corridor display Indicated the location and type of incoming calls.

Handrail Handrails for independent moved of patient in the room as well as in the common areas.

Fig 12.11.1 Application of dementia technology in patient room Source Author

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Room status controller Allows carers to arm / isolate the system and reset and active calls. Optional door bell will be trigger a call when pressed by the patient.

Material used Floor Bed area

Living 1 5m²

Wet area

Furniture

Wall Bedroom 13m²

Washroom 5m²

deport 3m²

AREA : 36m² PLAN L x B : 6500 x 5000 DEPORT : 1500 x 2250 Fig 12.11.2 Plan : individually decorated patient room Source Author

Fig 12.11.3 Section : individually decorated patient room Source Author

ALTERNATIVE COLOUR SCHEME FOR ROOM

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PATIENT ACCOMMODATION

Fig 12.11.4 Isometric view : two individually decorated patient room Source Author

An isometric view of two differently themed patient rooms. Each room has its own niche in front of the door, large enough for furniture and serving as the space's unique entrance. Each room's niche is enclosed by depot and is outfitted with a washing and dryer.

The room's exterior and inner walls have hand drills enabling independent wandering.

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Fig 12.11.5 Plan : two individually decorated patient room Source Author

Depending on the cluster unit, each housing unit consists of 5-10 single-room units that are organized for flexibility in terms of decoration and individuality.

It is essential for dementia sufferers to be able to withdraw to a private dwelling with a domestic ambiance, complete with their own personal items and furnishings, if necessary.

Each dwelling is 36 sqm and has the option of adding a demountable partition to split it into a bedroom space and a living area. Each apartment features a small entryway with space for mobile storage as well as a small kitchenette with a sink and refrigerator.

Each homeowner gets their own mail box in the niche, which adds to the comfortable atmosphere. Because the personal things serve as a navigational landmark, the niche also assists the inhabitant in finding their way back to their unit.

The windows on the façade are low enough that people may look immediately outside from any posture.

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12.12 INDIVIDUAL UNIT LAYOUT : CARE TAKER ROOM TYPE- 1 APPLICATION OF DEMENTIA TECHNOLOGY IN PATIENT ROOM

Infrared ceiling receivers Picks up any help required, emergency or patient attack calls made by any patient throughout the day

Door contacts Can be set up to trigger a call when the bedroom door is opened.

Corridor display Indicated the location and type of incoming calls.

Fig 12.12.1 Isometric view : care taker room type 1 Source Author

Material used

ALTERNATIVE COLOUR SCHEME

Floor Bed area Wall

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Wet area

Furniture

Fig 12.12.2 Plan : care taker room type 1 Source Author

PAREA : 68m² PLAN L x B : 10150 x 6500 DEPORT : 1500 x 2250

Fig 12.12.3 Section : care taker room type 1 Source Author

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12.13 INDIVIDUAL UNIT LAYOUT : CARE TAKER ROOM TYPE- 2 APPLICATION OF DEMENTIA TECHNOLOGY IN PATIENT ROOM

Door contacts Can be set up to trigger a call when the bedroom door is opened.

Corridor display Indicated the location and type of incoming calls.

Infrared ceiling receivers Picks up any help required, emergency or patient attack calls made by any patient throughout the day

Fig 12.13.1 Isometric view : care taker room type 2 Source Author

Material used

ALTERNATIVE COLOUR SCHEME

Floor Bed area Wall

198

Wet area

Furniture

Fig 12.13.2 Plan : care taker room type 2 Source Author

PAREA : 48m² PLAN L x B : 7100 x 6500 DEPORT : 1500 x 2250

Fig 12.13.3 Section : care taker room type 2 Source Author A DEMENTIA VILLAGE Investigating the relevance of sensory and curative architecture for dementia care

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12.14 CLUSTER UNIT LAYOUT

Fig 12.14.1 Isometric view of cluster Source Author

Each housing unit has its own common space, which includes a kitchen, dining area, living room, and lounge. The kitchen is positioned around a corner, making it more visible from the hallway and a convenient navigation point.

The design of the common space is open, with few walls, making it visible from all residential units and simple to access.

A TV room and an area behind the toilet where you may sit alone and relax without being bothered. It accommodates the occupants and their various lifestyles by splitting the communal space into zones.

The dining room is an outgrowth of the kitchen, providing space for residents to dine and engage in everyday activities. For everyday activities, an L-shaped common room is developed at the conner of the facility, and various equipment is given. A vast aquarium and a piano are also provided for therapeutic purposes.

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2 1

3

4

5

1 . Entrance 3. Living Room 2. Shared Space 4. Kitchen

5. Dinning + Activity Tables

Fig 12.14.2 Plan : cluster Source Author A DEMENTIA VILLAGE Investigating the relevance of sensory and curative architecture for dementia care

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12.15 ISOMETRIC VIEW OF THE SITE AND SHOPPING STREET

THE SHOPPING STREET: COMMUNAL PLACE The street is designed in such a manner that it could be visible from all directions and is centralized so that anyone who gets lost while wandering may effortlessly approach the central shopping street.

It offers daily necessities and refreshments, as well as leisure space and a secular prayer hall.

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Fig 12.15.1 Site isometric Source Author A DEMENTIA VILLAGE Investigating the relevance of sensory and curative architecture for dementia care

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12.16 CLUSTER 3D VIEWS FOR ENGAGING SENSES, DIFFERENT MATERIALS AND FLORA ARE USED.

Fig 12.16.1 Severely dented cluster Source Author

SEVERELY DENTED CLUSTER : STAGE 4 The cluster has an introverted-looking shared green space with a small refreshment zone and a game area (to keep there mind activate). The cluster is encircled by aromatic blossoming and fruiting trees, as well as artificial trees, to arouse the senses of smell and sight, as well as to spur memory recall when they are taken out for a stroll or for daily activities

Trees planted

Orchid

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Kadamba

Jasmine

Cassia Fistula

Rain Tree

Fig 12.16.2 Stage 3rd residential care cluster Source Author

STAGE 3 RESIDENTAL CARE CLUSTER To keep them amused and active, the cluster offers an introverted-looking communal green area with a modest recreational zone and open gym. The cluster is surrounded by aromatic flowering and fruiting trees, as well as fake trees, to stimulate the senses of smell and sight, as well as to stimulate memory recall when they go for a walk or engage in everyday activities.

Trees planted

Orchid

Cassia Fistula

Blue Jacaranda

Neem Tree

Amra

and other on site tree

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Fig 12.16.3 Stage 1st and 2nd residential care cluster Source Author

Different pavement texture used

SATGE 1 and STAGE 2 RESIDENTAL CARE CLUSTER Both clusters are designed in such a way that they formed a large shared space with the influence of the shopping street. As a result, the clusters are both visually and physically connected.

Various textures are used for pavements in each cluster to activate the sense of touch, and different façade treatments and roofs are designed to ease cluster identification by the dementia suffers.

Trees planted

Cassia Fistula

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Blue Jacaranda

Orchid

Oleander Tree

Gulmohar

Neem Tree and other on site tree

Fig 12.16.3 Visitors and day care stay Source Author

VISITORS AND DAY CARE PATIENTS STAY : SATGE 1- 3 The cluster is conveniently located the day care facility and is close to all of the residential clusters for patients and doctors. In the shared space, different textures such as wood, brick, and concrete are used to activate the senses of touch and sight, and flowering trees and plants are given for a beautiful sight.

Trees planted

Orchid

Cassia Fistula

Blue Jacaranda

Neem Tree

Amra

and other on site tree

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Chapter

13

APPENDIX This chapter contains a comprehensive listing of figures, tables, references, and credits for the sources that contributed me in developing this thesis.

• LIST OF FIGURES • LIST OF TABLES • BIBLIOGRAPHY

LIST OF FIGURES Fig 0.1 Dementia elderly Source www.deviantart.com

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Chapter 1 – INTRODUCTION Fig 1.1.1 An old man Source https://www.pinterest.co.uk/pin/636414991105572376/ Fig 1.1.2 ADI report on dementia in India Source The times of India

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Chapter 2 – BASE STUDY Fig 2.1.1 Signs of dementia Source Author Fig 2.1.2 Dementia patients Source hopehospice.com/blog/boredom-and-dementia-patients/ Fig 2.1.3 Normal Ageing Vs Dementia

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Source Author

Fig 2.2.1 Dementia Home Care Source https://tribecacare.com/ Fig 2.4.1 Different types of dementia Source Author Fig 2.4.2 With severe Alzheimer’s disease, brain tissue shrinks significantly.

Source https://www.drugwatch.com/health/alzheimers-disease Fig 2.4.3 Progression of Lewy body dementia Source https://thebrielle.com/memory-loss-differentiating-dementianormal-aging Fig 2.5.1 7 Stages of dementia Source https://carehomeselection.co.uk/7-stages-signs-of-dementiawhat-to-look-for/ Fig 2.5.2 Symptoms of no dementia Source Vectorstock Fig 2.5.3 Symptoms of early-stage dementia Source Vectorstock Fig 2.5.4 Symptoms of mid-stage dementia Source Vectorstock

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Fig 2.5.5 Symptoms of late-stage dementia Source Vectorstock

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Chapter 3 – FACTS AND FIGURE Fig 3.1.1 Global impact of dementia Source https://www.alzint.org/about/dementia-facts-figures/dementiastatistics/ Fig 3.1.2 Increase in numbers of people with dementia worldwide (2010-2050), comparing original and updated estimates Source https://www.alzint.org/about/dementia-facts-figures/dementiastatistics/ Fig 3.2.1 Indian population is ageing Source https://www.alzint.org Fig 3.2.2 Families in India live with dementia Source https://www.alzint.org Fig 3.3.1 Prevalence of Dementia in India, 2010 Source The dementia India report 2010 Fig 3.3.2 Estimation of number of PwD over 60 years in India between 2000 and 2050 Source The dementia India report 2010 Fig 3.3.5 Projected changes between 2006 and 2026 in number of people living with dementia by State Source The dementia India report 2010

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Chapter 4 – CURRENT INDIAN SCENARIO Fig 4.1.1 Dementia care services in India Source google earth.com Fig 4.2.1 National dementia helpline – ARDSI Source The dementia India report 2010 Fig 4.2.2 Memory clinic for dementia Source google.com Fig 4.3.1 Facilities India lack for dementia Source Vectorstock Fig 4.4.1 Dementia care: total societal costs (billion US$) India, 2010 Source Author

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Chapter 5 – DEMENTIA AND FIVE SENSE Fig 5.1.1 Sense : Sight Source Author Fig 5.1.2 Sense : Touch Source Author Fig 5.1.3 Sense : Hearing Source Author Fig 5.1.4 Sense : Smell Source Author Fig 5.1.5 Sense : Taste Source Author

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Chapter 6 – CASE STUDY

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Fig 6.1.1 Respite center plan Source https://architizer.com/projects/alzheimers-respite-centre Fig 6.1.2 Floor plan Source Author Fig 6.1.3 conceptual planning Source https://drawingmatter.org/niall-mclaughlin/ Fig 6.1.4 View of Admin block Source https://architizer.com Fig 6.1.5 View of Multipurpose hall Source https://architizer.com Fig 6.1.6 The bedroom wing corridor and bench Source https://architizer.com Fig 6.1.7 View of Living room Source https://architizer.com Fig 6.1.8 View of Central space Source https://architizer.com

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Fig 6.2.1 View of central space Source https://www.dementiavillage.com/projects/dva-de-hogeweyk/ Fig 6.2.2 HOGEWEYK a dementia village model (3 large courtyards and 4 smaller squares and gardens) Source https://hogeweyk.dementiavillage.com/

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Fig 6.2.3 Site plan Source https://www.leadingageny.org/ Fig 6.2.4 Household module Source https://www.leadingageny.org/ Fig 6.2.5 Communal space and main entrance Source Exploring the potentials of dementia village architecture Fig 6.2.6 View of the bridge and residential apartments Source https://www.dementiavillage.com/projects/dva-de-hogeweyk/ Fig 6.2.7 View of out door sitting Source https://www.dementiavillage.com Fig 6.2.8 View of human size chess board Source https://www.dementiavillage.com Fig 6.2.9 View of city square Source https://www.dementiavillage.com Fig 6.2.10 Bird eye view Source https://www.dementiavillage.com Fig 6.2.11 Interior styles Source https://www.dementiavillage.com

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Fig 6.3.1 View of Arched pathway Source https://www.archdaily.com/ Fig 6.3.2 Site plan Source https://www.archdaily.com/ Fig 6.3.3 Site zoning Source https://www.archdaily.com/ Fig 6.3.4 Cluster planning and section Source https://www.archdaily.com/ Fig 6.3.5 Household cluster planning Source Author Fig 6.3.6 Unit plan Source Author Fig 6.3.7 View of arched walkways and central space Source https://www.archdaily.com/ Fig 6.3.8 View of green pocket Source https://www.archdaily.com/ Fig 6.3.9 Auditorium Source https://www.archdaily.com/

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Fig 6.3.10 Gardening Source https://www.archdaily.com/ Fig 6.3.11 A small farm Source https://www.archdaily.com/ Fig 6.3.12 Green pockets with sitting Source https://www.archdaily.com/ Fig 6.3.11 Refreshment zone Source https://www.archdaily.com/ Fig 6.3.12 Green areas, which will help to make it feel less enclosed, developers say.

Source https://www.archdaily.com/ Fig 6.3.12 Green areas, which will help to make it feel less enclosed, developers say.

Source https://www.archdaily.com/ Fig 6.3.14 on-site gym to encourage people to keep active 83 and healthy.

Source https://www.archdaily.com/ Fig 6.3.15 Bed room having visual and physical connection with green pockets.

Source https://www.archdaily.com/ Fig 6.3.16 Continuous handrails are installed on walls throughout the building.

Source https://www.archdaily.com/

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Fig 6.4.1 View of the center Source Author Fig 6.4.2 Location Source Author Fig 6.4.3 Bird eye view of the center Source google.com Fig 6.4.4 The site and the surrounding context Source Author Fig 6.4.5 Still level plan Source Author Fig 6.4.6 First floor plan Source Author

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Fig 6.4.7 Typical floor plan Source Author Fig 6.4.8 View of the room and different activity throughout the center Source Author Fig 6.4.9 Residents playing carrom Source Author Fig 6.4.10 Wellness activates : Yoga Source https://www.jagrutirehab.org Fig 6.4.11 Residents involved in cultural activities Source https://www.jagrutirehab.org Fig 6.4.12 Residents involved in day to day activity Source Author Fig 6.4.13 Residents involved in awareness program on dementia Source https://www.jagrutirehab.org Fig 6.4.14 View of the main gate Source Author Fig 6.4.15 View of the washroom Source Author Fig 6.4.16 View of the Parking Source Author

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Fig 6.5.1 Residence at Dignity Source www.theparentscare.com/ Fig 6.5.2 Location Source Author Fig 6.5.3 Still level plan Source Author Fig 6.5.4 Residence involved in different activities Source Author

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Chapter 8 – SITE SELECTION AND SITE ANALYSIS Fig 8.1.1 Location of Navi-Mumbai Source google earth.com Fig 8.2.1 Location of site A Source google earth.com

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Fig 8.2.2 CIDCO development plan for site A Source CIDCO Fig 8.2.3 Location of site B Source google earth.com Fig 8.2.4 Location of site C Source google earth.com Fig 8.3.1 Location of site Source Author Fig 8.3.2 Connectivity Source Author Fig 8.4.1 Hospitals in site proximity

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Source Author Fig 8.5.1 Site location

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Source Author Fig 8.5.2 Current site condition

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Source Author Fig 8.5.3 Current site condition

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Source Author Fig 8.5.4 Khargar sewage plan

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Source Author Fig 8.5.5 Road network

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Source Author Fig 8.5.6 1. Sion –Panvel Toll way

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Source Author Fig 8.5.7 2. Foot over bridge

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Source Author Fig 8.5.8 3. Dav International school

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Source Author Fig 8.5.9 4. Spaghetti Society

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Source Author Fig 8.5.10 5. Secondary road near KPC Source Author Fig 8.5.11 6. Vastuvihar housing Source Author Fig 8.5.12 Isometric view towards site Source Google.com

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Fig 8.6.1 Figure ground

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Source Author Fig 8.6.2 Land use

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Source Author Fig 8.6.3 Road network

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Source Author Fig 8.6.4 Height matrix

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Source Author Fig 8.6.5 Natural features

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Source Author Fig 8.6.6 Trees

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Source Author Fig 8.7.1 Site measurements

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Source Author Fig 8.7.2 Setback and built-able area

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Source Author Fig 8.7.3 Legalities

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Source Author Fig 8.7.4 Disturbance

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Fig 8.8.1 Average temperatures and precipitation

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Source https://www.meteoblue.com/ Fig 8.8.2 Monthly temperature

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Source https://www.meteoblue.com/ Fig 8.8.3 Cloudy, sunny, and precipitation days Source https://www.meteoblue.com/ Fig 8.8.4 Precipitation amounts

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Source https://www.meteoblue.com/ Fig 8.8.5 Wind speed https://www.meteoblue.com/ Fig 8.8.6 Wind rose Source https://www.meteoblue.com/

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Fig 8.8.7 Sun path diagram

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Source https://www.meteoblue.com/ Fig 8.9.1 Strength

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Source Vectorstock Fig 8.9.2 Weakness

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Source Vectorstock Fig 8.9.3 Opportunities

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Source Vectorstock Fig 8.9.4 Threats

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Source Vectorstock Fig 8.10.1 The last station nursing home

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Source https://www.pinterest.co.uk/pin/1970393574755108/

Chapter 10 – DESIGN DEVELOPMENT Fig 10.1.1 Nomenclature of basic elements of wheelchair

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Source NBC 2016 volume 1 Fig 10.1.2 Necessary space under counter or stand for

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ease of wheelchair users Source NBC 2016 volume 1 Fig 10.1.3 Clear floor space Source NBC 2016 volume 1 Fig 10.1.4 Preferred comfortable turning radius Source NBC 2016 volume 1 Fig 10.1.5 Passage way required for people who uses walking aids Source NBC 2016 volume 1 Fig 10.1.6 Space allowance (radial range) for people using white canes Source NBC 2016 volume 1 Fig 10.1.7 Ranges of reach of wheelchair users Source NBC 2016 volume 1 Fig 10.1.8 Forward reach over obstruction Source NBC 2016 volume 1 Fig 10.1.9 Side reach over obstruction Source NBC 2016 volume 1

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Fig 10.1.10 Vision zone Source NBC 2016 volume 1 Fig 10.1.11 Different walk way width depending upon the user traffic Source NBC 2016 volume 1 Fig 10.1.12 Different corridor widths determined by intensity of use Source NBC 2016 volume 1 Fig 10.1.13 Space required for 90° turn Source NBC 2016 volume 1 Fig 10.1.14 Minimum clear opening of doorway Source NBC 2016 volume 1 Fig 10.1.15 Door hardware location Source NBC 2016 volume 1 Fig 10.1.16 Front approach Source NBC 2016 volume 1 Fig 10.1.17 Latch side approach Source NBC 2016 volume 1 Fig 10.1.18 Position taken by a wheelchair user when negotiating door in passage way Source NBC 2016 volume 1 Fig 10.1.19 Space allowances for accessible bedroom Source NBC 2016 volume 1 Fig 10.1.20 Storage space Source NBC 2016 volume 1 Fig 10.1.21 Space around bed Source NBC 2016 volume 1 Fig 10.1.22 Requirements for windows Source NBC 2016 volume 1 Fig 10.1.23 Lift size Source NBC 2016 volume 1 Fig 10.1.24 Inclined lifting platform Source NBC 2016 volume 1 and https://www.pinterest.co.uk/ Fig 10.1.25 Heights of counters suitable for wheelchair users and people standing Source NBC 2016 volume 1 Fig 10.1.26 Type A toilet room : lateral transfer from both side Source NBC 2016 volume 1 Fig 10.1.27 Type B toilet room : lateral transfer from one side only Source NBC 2016 volume 1

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Fig 10.1.28 Positioning of grab bar, water supply and other toilet accessories in type B conner toilet Source NBC 2016 volume 1 Fig 10.1.29 Self contained changing room for individual unit Source NBC 2016 volume 1 Fig 10.1.30 Shower place with grab handle Source NBC 2016 volume 1

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Fig 10.2.1 Colour intensity and saturation Source Aged Care DESIGN GUIDE Fig 10.2.2 Warmer hues Source Aged Care DESIGN GUIDE Fig 10.2.3 Material in full color Source https://www.pinterest.co.uk Fig 10.2.4 Monochrome image demonstrating comparative light reflectance value (LRV) of materials Source https://www.pinterest.co.uk Fig 10.2.5 View of passage Source Aged Care DESIGN GUIDE Fig 10.2.6 Example of colour schemes for carious spaces Source Author Fig 10.2.7 Example of dementia friendly materials Source Author Fig 10.2.8 Change in colour perception Source Author

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Chapter 11 – DESIGN DEVELOPMENT Fig 11.1.1 Space-sense relation

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Source Author Fig 11.2.1 Step 01

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Source Author Fig 11.2.2 Step 02

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Source Author Fig 11.2.3 Step 03

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Source Author Fig 11.2.4 Step 04

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Source Author

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Fig 11.2.5 Step 05

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Source Author Fig 11.2.6 Step 06

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Source Author Fig 11.3.1 Phase 1

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Source Author Fig 11.3.2 Phase 2

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Source Author Fig 11.3.3 Phase 3

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Source Author Fig 11.3.4 Phase 4

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Source Author Fig 11.4.1 Step 01

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Source Author Fig 11.4.2 Step 02

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Source Author Fig 11.4.3 Step 03

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Source Author Fig 11.4.4 Step 04

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Source Author Fig 11.4.5 Step 05

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Source Author Fig 11.4.6 Step 06

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Source Author Fig 11.4.7 Modules

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Source Author Fig 11.5.1 Café plaza

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Source Author Fig 11.5.2 Outdoor GYM

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Source Author Fig 11.5.3 Mini farm (vegetable and fruit farming + fish feeding area )

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Fig 11.5.4 Garden A (severely dented unit)

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Source Author Fig 11.5.5 Garden B

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Source Author Fig 11.5.6 Garden C

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Source Author Fig 11.5.7 Garden D

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Source Author Fig 11.5.8 Yoga and wellness space

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Source Author Fig 11.5.9 Common gathering space for in house and others NGOs Source Author Fig 11.5.10 Shopping space (left side) and communal space with

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prayer hall and small water body.

Source Author

Chapter 12 – FINAL DESIGN PROPOSAL Fig 12.1.1 Roof top plan Source Author Fig 12.2.1 Ground floor plan Source Author Fig 12.3.1 Slopping roof detail Source https://www.pinterest.co.uk Fig 12.3.2 Section and elevation Source Author Fig 12.4.1 Day care centre plan Source Author Fig 12.5.1 Severely dented cluster plan : stage 4 Source Author Fig 12.6.1 3rd stage cluster plan Source Author Fig 12.7.1 Day care and visitors stay cluster plan Source Author Fig 12.8.1 Stage 1st cluster plan Source Author Fig 12.9.1 Stage 2nd cluster plan Source Author

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Fig 12.10.1 Stage 1st and 2nd cluster plan Source Author

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Fig 12.11.1 Application of dementia technology in patient room Source Author Fig 12.11.2 Plan : individually decorated patient room Source Author Fig 12.11.3 Section : individually decorated patient room Source Author

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Fig 12.11.4 Isometric view : two individually decorated patient room Source Author Fig 12.11.5 Plan : two individually decorated patient room Source Author

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Fig 12.12.1 Isometric view : care taker room type 1 Source Author Fig 12.12.2 Plan : care taker room type 1 Source Author Fig 12.12.3 Section : care taker room type 1 Source Author

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Fig 12.13.1 Isometric view : care taker room type 2 Source Author Fig 12.13.2 Plan : care taker room type 2 Source Author Fig 12.13.3 Section : care taker room type 2 Source Author

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Fig 12.14.1 Isometric view of cluster Source Author Fig 12.14.2 Plan : cluster Source Author

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Fig 12.15.1 Site isometric Source Author

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Fig 12.16.1 Severely dented cluster Source Author

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Fig 12.16.2 Stage 3rd residential care cluster Source Author Fig 12.16.3 Stage 1st and 2nd residential care cluster Source Author Fig 12.16.3 Visitors and day care stay Source Author

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LIST OF TABLES

Chapter 2 – BASE STUDY Table 2.6.1 Characteristic of dementia Source Author

41

Chapter 4 – CURRENT INDIAN SCENARIO Table 4.1.1 Residential care services in India Source Author

52

Chapter 6 – CASE STUDY Table 6.6.1 Comparative analysis Source Author Table 6.6.2 Comparative analysis - II Source Author

96 97

Chapter 7 – DESIGN DETERMINANTS Table 7.2.1 Sequence and location of spaces Source Author Table 7.2.2 Sequence and location of spaces – II Source Author Table 7.2.3 Sequence and location of spaces – III Source Author

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101 102 103

Chapter 9 – PROGRAM DERIVATION Table 9.2.1 Reception unit Source Author Table9.2.2 Administration unit Source Author Table 9.2.3 Residence (personal space) Source Author Table9.2.4 Common area (personal space) Source Author Table 9.2.5 Common unit Source Author Table9.2.6 Common area and residence for severely dented Source Author Table 9.2.7 Residence for severely dented Source Author Table9.2.8 In-house doctors (personal space) Source Author Table9.2.9 Day care facilities Source Author Table9.2.10 Amenities Source Author Table 9.2.11 Residence for visitors Source Author Table9.2.12 Parking Source Author

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BIBLIOGRAPHY 2021. "Alzheimers Village / NORD Architects" ArchDaily. December . <https://www.archdaily.com/973948/alzheimers-villa-nord-architects>.

2020. Aged Care DESIGN GUIDE. Tarkett .

2022. Alzheimer's association . https://www.alz.org/alzheimers-dementia/whatis-dementia.

2020. Alzheimer's disease international .https://www.alzint.org/about/dementiafacts-figures/dementia-statistics/.

Architects, Alzheimer's Respite Centre by Níall McLaughlin. 20156. issuu.

December. https://issuu.com/bartlettarchucl/docs/mclaughlin_02_alzheimers_s07_update.

B.A.S, Jessica M. Hickling. 2014. "Haptically Healing Architecture for Alzheimer’s."

Høj, Louise Dedenroth. 2019. "Exploring the potentials of dementia village architecture ."

L. P. G. van Buuren, PDEng, MSc1 , and M. Mohammadi, PhD, MSc. 2021.

"Dementia-Friendly Design: A Set of Design Criteria and Design Typologies Supporting Wayfinding."

2020. Memory Loss: Differentiating Dementia from Normal Aging. https://thebrielle.com/memory-loss-differentiating-dementia-normal-aging/.

2016. National building code of India 2016 volume 1. Bureau of Indian standards .

Pallasmaa, Juhani. n.d. The Eyes of the Skin .

Shaji KS, Jotheeswaran AT,Girish N,Srikala Bharath, Amit Dias, Meera Pattabiraman, Mathew Varghese. 2010. "THE DEMENTIA INDIA REPORT 2010."

Sundarakumar, Vijayalakshmi Ravindranath and Jonas S. December 2021.

"Changing demography and the challenge of dementia in India."

2022. Types of dementia . https://www.alz.org/alzheimers-dementia/what-isdementia/types-of-dementia.

Zeisel, John. n.d. I'm Still Here: A Breakthrough Approach to Understanding Someone Living with Alzheimer's.

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