DESIGNING TO
R E M E M B E R
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DESIGNING TO
R E M E M B E R
The impact of environment and product design on Alzheimer’s and dementia patients
A Master’s Project By: Marissa Wilson
D E S I G N O PT I O N A P P RO VA L Design Project Title: Designing to Remember: The impact of environment and product design on Alzheimer’s and dementia patients
Student’s Name: Marissa Wilson We verify that this design project satisfies the requirements of the Graduate School as approved by the Graduate Faculty on 04/20/17
Lindsey Fay Director of Master’s Project
Patrick Lee Lucas Director of Graduate Studies
4/20/17 Date
An interior design master’s project based on research to help improve the quality of life for people with Alzheimer’s disease and dementia by designing a dementia village, dementia daycare and GPS tracking device for dementia patients.
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Dedicated to the families, caregivers, volunteers, and
staff at healthcare facilities that spend an endless amount of time caring for Alzheimer’s and dementia patients. Also dedicated to the researchers, physicians, nuerologists, and other healthcare professionals that devote their time to find ways to help relieve symptoms and find a cure for Alzheimer’s disease and dementia. I hope this project will provide insight on how design can influence the health, well-being, and quality of life for everyone.
- Marissa Wilson
Master’s Project Author
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M E ET T H E AUTHOR
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Hi. I’m Marissa and my goal in life is to design to help improve the lives of others. Marissa Wilson recieved her Master’s of Arts in Interior Design from the College of Design at the University of Kentucky in May of 2017. As a graduate student, she discovered she is interested in solving complex problems that involve science, art, health, and design. Together, these four areas can merge to form one solution that can improve the well-being and quality of life for others. Marissa has been researching how to design environments and products to improve the quality of life for people with Alzheimer’s disease and dementia for her graduate thesis project.
Through her research, she learned that Alzheimer’s disease and dementia already affect over 46 million people worldwide, and this number will continue to rise unless a cure is discovered (Alzheimer’s, 2016). Marissa saw this worldwide problem as an opportunity to positively impact the lives of those dealing with this disease through the power of design. Marissa is also interested in Universal Design in regards to people who have cognitive disabilities. She has taken psychology, theories of learning, and human development graduate level courses to have a better understanding of human behavior and cognitive development.
Although Marissa has a degree in interior design, she has also worked as a graphic designer and artist. She also recently discovered her interest in product design, business, and entrepreneurship. This led her to become a team leader for her idea called, i-Remember™, in the UK Venture Studio Bootcamp. i-Remember™ will be a website and app designed to help Alzheimer’s and dementia patients keep their memories alive (see on pg.160). Marissa is passionate about helping people through the power of design and hopes to invent products and design environments that can improve the lives of others.
see Marissa’s work at: marissalwilson16.wixsite.com/mwdesign
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P ROJ ECT C O M M I TT EE 1 MARISSA WILSON Graduate Student Master’s Project Author University of Kentucky College of Design School of Interiors 2015-2017
1 LINDSEY FAY
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Assistant Professor
DR. ALLISON CARLL-WHITE
CoD, School of Interiors
Committee Member
Committee Chair
Professor, CoD, School of Interiors; Chair of Historic Preservation, Clay Lancaster Endowed Professor
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3 CHRIS BIRKENTALL Committee Member Lecturer CoD, School of Interiors
BEST FRIENDS Volunteers and staff members at an adult daycare center for people with Alzheimer’s disease and dementia.
4 PATRICK LEE LUCAS Committee Member Director of the School of Interiors; Associate Professor CoD, School of Interiors
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P ROJ ECT T I M ELI N E
SEMESTER
spring 2015
Started graduate school
Classes: ID 655/GEO 509: Issues In Creativity & The Design Process COM 571: Interpersonal Communication in Health Contexts EDL 571: Design Thinking
Interested in Healthcare design
SEMESTER
spring 2016
Classes: ID 659: Interior Design Graduate Studio (product design class) EDP 600: Life Span Human Development & Behavior
Wrote literature review about product design, Universal Design, Alzheimer’s disease and dementia, and the impact of music. Wrote literature review about aging, Alzheimer’s disease, and care environments.
SEMESTER
summer 2016
Received IRB approval to conduct studies at Best Friends adult daycare center in June.
Analyzed data in August and created graphic illustrations revealing study results.
Conducted observations, questionnaires, and focus group interviews for 8 weeks during June and July. 10
SEMESTER
fall 2015
Classes: ID 650: Survey Of Current Theories & Literature EDP 610: Theories of Learning EDP 548: Educational Psychology
Wrote literature review about designing for Alzheimer’s and dementia.
Researched topics of interest through article reviews. Further researched Alzheimer’s disease and dementia for graduate thesis topic.
Met with Dr. Jicha (Alzheimer’s disease specialist) and a social worker at the UK Sanders Brown Clinic on Aging in March.
Designed an iPad/tablet case, and app called i-Remember™ in a product design class that helps connect families and caregivers to a person with Alzheimer’s and dementia.
Started Volunteering at Best Friends, an adult daycare center for people with Alzheimer’s disease and dementia in April.
SEMESTER
fall 2016
Classes: ID 700: Research Applications In Interior Design ID 595: UK Venture Studio Bootcamp (Further developed i-Remember™)
Presented Master’s project research study results at IDEC conference, and to Best Friends in October.
Submitted research studies for Master’s project to IRB.
Began design phase for graduate thesis project.
Conducted color scheme studies at Best Friends in November
SEMESTER
spring 2017 Finalized design & defended thesis in Spring 2017
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1 RESEARCH phase
TA B LE O F CONTENTS
Analysis phase
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Introduction & Background
Issues & Justification
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PAGE
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Best Friends Approach
Research Location
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PAGE
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60
Design phase
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Design Objectives
Concept & Design Issues
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PAGE
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Conceptual Framework
Literature Review
Precedent Studies
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PAGE
PAGE
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50
Site & Sun Analysis
Building Analysis
Research Studies
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PAGE
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66
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Village Design
Daycare Design
Product Design
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PAGE
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RESEARCH PHASE
+ BACKGROUND RESEARCH
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Introduction + pg. 16 Stats & Facts + pg. 18 Issues & Justification + pg. 20 Research Question(s) + pg. 22 Ecological Model + pg. 24 Conceptual Framework + pg. 26 Literature Review + pg. 28 Precedent Studies + pg. 50 15
Over 46 million people were living with dementia worldwide in 2015 (Prince, Wimo, Guerchet, Ali, Wu, Prina & A, 2015).
Data from 2016 says an estimated 5.4 million Americans were living with Alzheimer’s disease (Alzheimer’s, 2016). Dementia is a neurocognitive chronic and progressive disorder of the brain. It disrupts the brain’s ability to function properly due to the decline in a person’s memory, thinking, orientation, comprehension, calculation, learning capacity, language, and judgement (Breslow, 2012).
Overall, dementia and Alzheimer’s disease take away the ability for people to recognize who they are in present day, and who they once were. The memories people once had become almost impossible to recall and leave them feeling lost in life. With the baby boomer population entering into older adulthood, and the longevity of life increasing, the number of people expected to develop dementia will double to almost 65 million by the year 2030 (Alzheimer’s, 2015).
This is why it is important to design environments, products, and technologies to help improve the quality Although there are four of life for those with different types of dementia, Alzheimer’s disease and Alzheimer’s disease is the most dementia. common (Breslow, 2012).
QUALITY OF LIFE Health Related Quality of Life (HRQOL) is measured by a person’s mental and physical health perspective. On an individual level, it is associated with health risks and conditions, functional status, social support, and socioeconomic status. On a community level, it is associated with resources, conditions, policies, and practices that influence a population’s health perceptions and functional status (HRQOL Concepts, 2011). 16
Image 1: Elderly Couple
The EuroQuol EQ-5D is a scale used for measuring the quality of life for patients with Alzheimer’s disease. The scale includes five areas: mobility, self-care, daily activity, physical pain, anxiety, and symptoms of depression (Pongan, Freulon, Delphin-Combe, Dibie-Racoupeau, MartinGaujard, Federico & Rouch, 2014)
M. Powell Lawton (2001) divides quality of life into categories addressing a demented person’s autonomy, individuality, dignity, privacy, enjoyment, meaningful activity, relationships (interactions), security (safety), comfort, spiritual well-being, and functional competence. 17
STATS & FACTS
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Alzheimer’s disease is the sixth leading cause of death in America. (Alzheimer’s, 2016).
Data from 2015 stated that over 46 million people had Alzheimer’s disease or some form of dementia worldwide
Data from 2016 revealed that 5.4 million Americans were living with Alzheimer’s disease in the United States
(Prince et al., 2015). (Icon 1)
(Alzheimer’s, 2016). (Icon 2)
18.1 BILLION A person develops Alzheimer’s disease every 66 seconds in America
Families spend over $5,000 a year caring for a loved one with Alzheimer’s disease
(Alzheimer’s, 2016).
(Alzheimer’s, 2016). (Icon 5)
Over 15 million caregivers provided an average of 18.1 billion hours of unpaid care in 2015 (Alzheimer’s, 2016).
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Y EA R 2030: 65.7 MILLION 2050: 115.4 MILLION The number of people with Alzheimer’s is expected to double every 20 years (Breslow, 2012).
3.2 million women make up the 5.1 million people age 65 and older who have Alzheimer’s
Those who are between 75-84 years old make up 43% of those with Alzheimer’s (Alzheimer’s, 2015). (Icon 4)
(Alzheimer’s, 2015). (Icon 3)
$$$ The nation spent around $236 billion on Alzheimer’s and other dementias in 2016 (Alzheimer’s, 2016)
1 of out every 3 seniors dies with Alzheimer’s disease or another dementia
There is no cure or successful treatment for Alzheimer’s disease or other dementias
(Alzheimer’s, 2016). (Icon 4)
(Alzheimer’s, 2015). (Icon 6)
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Image 2: Aging Hands
There are no current treatments, preventions, or cures for dementia that are successful (Alzheimer’s, 2015).
The problem is there are currently over 46 million people living with dementia worldwide, and this number is expected to double every 20 years because there is no cure (Breslow, 2012). This estimates that about 65.7 million in the year 2030, and about 115.4 million in 2050 will be living with some form of dementia (Breslow, 2012). The number of cases is increasing because of the large number of the aging population (baby boomers); 20
however, dementia is not a normal part of aging. Biomedical researchers have also been able to increase longevity of life and the quality of life for the aging population (Crandell, Crandell, & James, 2012). Because of the increase in the years of life, neurocognitive disorders, such as Alzheimer’s disease and other disabilities, have increased as well, and require constant care from family and caregivers (Crandell et al., 2012). It can be hard to care for a loved one whose behavior has changed because of the disease. Disruptive behaviors are associated with Alzheimer’s disease and dementia (Morgan & Stewart, 1997).
Behaviors are built up and learned over time through stimuli in the environment. Eventually, these learned behaviors become habitual and are either appropriate or inappropriate responses to one’s physcial or social environment (Morgan & Stewart, 1997). When the executive control function of the brain is damaged like it is in dementia, a person may become confused, and has to rely on environmental cues for help (Morgan & Stewart, 1997). Designers, architects, and other healthcare professionals should have knowledge of this so they can design a successful environment for people with Alzheimer’s disease and dementia.
Image 3: Older Adults Laughing
By using research already available and conducting new research studies, designers can use evidence-based design to inform proper design decisions to enhance the care and quality of life for people with Alzheimer’s disease and dementia. Designers can use this knowledge to create an environment that can improve the behavior, cognition, function, well-being, social abilities, orientation, care outcomes, and quality of life for families, caregivers, and people with Alzhimer’s disease and dementia (Marquardt, Bueter, & Motzek, 2014). As the American population increases, and as people live longer, the number of people with disabilities
will increase as well. This is why it is essential to create products, environments, and technologies that are universally designed for all (McAdams & Kostovich, 2011). Universal design is the design of products, environments, and services that can be used by all people, including those with disabilities, to the greatest extent possible. (Connell, Jones, Mace, Mueller, Mullick, Ostroff, Sanford, Steinfeld, Story, & Vanderheiden, 1997) (McAdams & Kostovich, 2011). A disability may involve cognitive differences, such as having Autism or Alzheimer’s disease, or it can be something physical, like being in a wheelchair.
With this knowledge, architects, designers, and healthcare professionals can begin to properly care and design to improve the lives for both those living with Alzheimer’s and dementia, and for the family and caregivers who are caring for them.
The purpose for this research is to design a product and environment that will help improve the care, well-being, and quality of life for those living with Alzheimer’s disease or dementia.
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R ES EA RC H QU EST I O N
PRIMARY QUESTION: How can we design environments and products for those with Alzheimer’s disease and other dementias to improve care, well-being, and enhance quality of life?
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To achieve this, the design will include a dementia-friendly community village for those with Alzheimer’s and dementia. It will also be designed for the surrounding community and will integrate a product into the environment.
To achieve this, the design will also include an adult daycare center for people with Alzheimer’s and dementia. It will be located within the dementia village and will integrate a product into the environment.
To achieve this, a product will be designed that will provide staff and volunteers a device to enhance care and encourage independence for those with Alzheimer’s disease and dementia.
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EC O LO G I CA L M O D ELS AN ECOLOGICAL MODEL is based on the belief that a person’s health and well being are influenced by biological, behavioral, and environmental factors, including the individual’s lifestyle and the physical and social environment he or she interacts with (Satariano, 2006).
Lawton specialized in aging and the physical and psychological needs of older adults. His Environmental Press-Competence Model was created from The Environmental Docility Hypothesis (Figure 2) that he and researcher, Lucille Nahemow, formed (Satariano, 2006).
Figure 1, “An ecological model from The U.S. Department of Health and Human Services”, is based off of M. Powell Lawton and Lucille Nahemow’s Environmental Press-Competence Model seen in Figure 2.
Lawton and Nahemow claim that people who have health or cognitive impairments cannot always change the environment to meet their specific needs, but rather they are dependent on external environmental cues for help (Marquardt, 2011; Morgan & Stewart, 1997).
Figure 1. Ecological model from The U.S. Department of Health and Human Services (Satariano, 2006)
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By using parts of these two models, a conceptual framework was created to describe how the physical and social environment surrounding an individual influences his or her biological and behavioral makeup. The conceptual framework (Figure 3) is on the next page. It is designed for an individual with Alzheimer’s disease.
Figure 2. Ecological model from M. Powell Lawton and Lucille Nahemow’s Environmental Press-Competence Model (Satariano, 2006).
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C O N C EPT UA L F R A M EWO R K This conceptual framework (Figure 3) starts with the individual, - the purple circle – which is a person with Alzheimer’s disease. This person has been born with his or her own unique biological makeup, and has been influenced by his or her physical and social environments, which in return, have influenced his or her behavioral responses over time. This conceptual framework starts with the: 1. PERSON: The individual with Alzheimer’s is defined by his or her own life story, autonomy, identity, agency, well-being, and quality of life. 2. BIOLOGY: The individual’s biological makeup is defined by his or her behavior and functioning abilities which include: the biological, physical, cognitive, sensory, motor, and genetic factors that he or she was born with and has adapted over time (Crandell et al., 2012). In this framework, Alzheimer’s is part of the person’s biological makeup. 26
3. BEHAVIOR: The individual’s behavior is influenced by his or her actions in response to the environment. An individual’s actions respond to different environmental stimuli and experiences he or she has been exposed to over time (Calkins,2001). In this framework, the individual has developed disruptive behaviors that are associated with Alzheimer’s disease and dementia. 4. SOCIAL ENVIRONMENT: An individual’s social environment influences his or her biological makeup and behavioral responses. The social environment is developed by humans and includes living arrangements, marital status, social networks, and the interaction of individuals that make up society as a whole (Social Environment, 2017). In this framework, the individual’s social environment would include: Family, Friends, Caregivers, Volunteers, Healthcare Staff, Alzheimer’s Participants and their communication patterns.
5. PHYSICAL ENVIRONMENT: The individual’s physical environment also influences his or her biological makeup and behavioral responses. The physical environment is made of land, air, water, plants, animals, buildings and other structures that are part of the built environment. It also includes natural resources that provide basic needs for human survival (Physical Environment, 2003). In this framework, the individual’s physical environment is made up of these characteristics: design, function, comfort, efficiency, accessibility, care, and the natural environment including nature, gardens and the outdoors.
This project is focusing on designing both the physical and social environments, as well as the natural environment for people with Alzheimer’s disease and dementia to improve care, well-being, and quality of life.
Actions
Au to
my no Identi ty
Motor
Genetic Diseases
SOCIAL INTERACTION
Family
Friends
Caregivers
Volunteers
Healthcare Staff
Alzheimer’s Participants
Communication
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Adult daycare center
Sensory
social environment
Experiences
disruptive behaviors Stimulation
How one acts in response to the environment.
ry
Behavior e Sto Lif
Person
Cognitive
Factors that influence behavior and functioning abilities of humans
biology
Wel lbe i
BUILT ENVIRONMENT
Design Function Comfort
physical environment
Physical
Dementia/Alzheimer’s DISEASE
Biological
fe Quality of Li
ng
Efficiency Accessibility Care Outdoors/Gardens Nature
Figure 3. Conceptual Framework adapted from the Ecological model from The U.S. Department of Health and Human Services (Figure 1) and Lawton and Nahemow’s Environmental Press-Competence Model (Figure 2) (Satariano, 2006).
ency Ag
Adult daycare center
L I T E R AT U R E R EV I EW
HUMAN AGING PROCESS From the day a human is born, he or she is constantly aging and developing throughout the different stages of life (Tabbarah and Seeman, 2005)
Successful aging is defined by Tabbarah and Seeman (2005) as preventing common age-related diseases, maintaining high levels of physical and cognitive functioning, and engaging in social and psychological events in life. As one ages, it is important to have a positive outlook and attitude about life when physical and biological changes occur. Having a positive and optimistic outlook on life can lead to happiness and well-being in general. Many people in late adulthood report having good-to-excellent health and are able to still function. However, the body’s functioning starts to decline, creating health risks due to the biological and physical factors of aging (Crandell et al., 2012). HEALTH RISKS Health risks that accompany aging consist of lack of nutrition and exercise, bone weakness and fractures, medications and absorption effects, and mental health and depression (Crandell et al, 2012). Bones start to lose their mass between ages 25-30, which can contribute to bone fractures and Osteoporosis from lack of Image 4: Literature
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calcium and other minerals over time. However, engaging in physical activity can improve muscle strength and mobility, which can help reduce falls. Staying physically active and eating well can lead to better cognitive functioning (Tabbarah & Seeman, 2005). The body’s ability to absorb medications also decreases with age. This makes it hard for the elderly to understand the proper dosage amount, which may cause them to overmedicate, mix medications, and even skip medications due to their lack of comprehension or memory decline. Mental and depressive behaviors affect a small number of the elderly, and many do not seek treatment if they are depressed (Crandell et al., 2012). Those who adapt well to change and loss are more likely to have good mental health, but those with chronic disease or pain will be more likely to develop mental and depressive disorders (Crandell et al., 2012). Tabbarah and Seeman (2005) found that higher cognitive functioning older adults reported less anxiety and depression, and scored higher in self-efficacy and mastery than low functioning older adults. Having high self-efficacy, and social and emotional support also affect cognitive and physical functioning (Tabbarah & Seeman, 2005). While many of these behaviors can be avoided or dealt with, there are many biological factors that affect the natural aging process for all humans.
BIOLOGICAL CHANGES Biological aging consists of changes that happen throughout life in the structure and functioning of a human being. Biological changes enable humans to make adaptations to the environment in which they are living; however, later biological changes also impair one’s ability to adapt to an environment (Crandell et al, 2012). Tabbarah and Seeman, (2005) suggest that when a person’s brain can adapt, accommodate, and adjust to the environment, the cognitive status that enables a person to do so is part of successful aging. Biological factors for aging consist of changes in physical, sensory and functional abilities, vision and hearing, taste and smell, dental issues, swallowing and breathing difficulties, touch and temperature sensitivity, sleep pattern changes, and sexuality (Crandell et al., 2012). PHYSICAL CHANGES Physical characteristics that change as one ages are the thinning and greying of hair, loss of skin texture, muscles, collagen and elasticity, producing folds and wrinkles in skin, spot pigmentation of skin, and changes in body height, shape, and weight. Following physical changes, sensory and functioning changes occur as well. They involve a decline in the five senses: hearing, vision, taste, touch, and smell (Crandell et al., 2012).
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SENSORY CHANGES
SLEEP CHANGES
A decline in vision and hearing can lower a person’s quality of life because it contributes to a lack of independence. Glasses can enhance vision for the elderly, but there are other vision problems that require surgery or other medical solutions. Hearing aids can be worn to fix hearing impairments, but many of these devices are too expensive for the elderly (Crandell et al., 2012).
Sleep changes with age and the elderly may have issues with other illnesses and medications that affect their sleep cycles. Being in facilities also can disrupt sleep patterns because of artificial lighting, frequent awakenings, earlier bed times, shorter duration of sleep, which all cause sleepiness during the day. Many sleep cycles are disrupted with age because of the change in the body’s circadian rhythms and other sleep disorders, such as sleep apnea (Crandell et al, 2012).
A change in taste due to a decline in taste buds occurs as people age, which then creates issues with proper nutrition because of the inability to enjoy and want food. The ability to smell decreases with age, making it hard for elderly people to distinguish certain smells and odors in the environment and amongst themselves (Crandell et al., 2012). Although taste and smell contribute to eating problems, loss of teeth and other dental issues also cause challenges with eating properly. Oral health is also linked to Alzheimer’s disease due to the connection that oral bacteria has with the trigeminal nerve that reaches the brain (Crandell et al., 2012). Changes in ability to touch include a decline in hand dexterity and grip strength, making it harder for one to grasp an object and control it. Temperature sensitivity is also a big factor in aging because it can lead to hypothermia. Older adults have a hard time feeling the change of nine degrees of temperature; therefore, they may not realize that their body is too cold or too hot, causing serious complications (Crandell et al., 2012). 30
COGNITIVE CHANGES One might associate cognitive functioning as being able to remember, think, solve problems, and make appropriate decisions with age (Crandell et al., 2012).
Tabbarah and Seeman (2005) explain cognitive functioning as one’s memory, language, intellectual ability, perception, and complex problem solving.
Cognitive functioning can begin to decline starting at the age of 40. In late adulthood it is categorized by stability, decline, and improvement. The aging process is correlated with a decline in abilities; however, many older adults have few declining abilities because of their overall lifestyle choices and good health conditions (Crandell et al., 2012).
Image 5: Shows the human aging process from birth to old age.
Successful cognitive aging is crucial for the cognitive aging process as a whole (Tabbarah & Seeman, 2005). However, older adults who show a strong decline in cognitive and intellectual abilities, are often diagnosed with symptons of dementia and other nuerocognitive disorders that affect their memory (Crandell et al., 2012). MEMORY AND AGING Memory is one of the most fundamental parts that make up human beings. If humans did not have a memory, then they would not be able to function, which is why diseases like Alzheimer’s require constant care and support (Crandell et al., 2012). Being able to remember things declines as people age. Middle-aged and older adults may experience difficulty with their memory. The executive cognitive functioning and working memory functioning of the brain begin to decline around age 40, and continues into the 80’s, and the later stages of life (Crandell et al., 2012).
However, some elderly maintain a healthy and functioning memory. This could be because of the connection that cardiovascular exercise has with memory from the increased blood flow to the brain. Older adults can improve memory, interests, abilities, and outcomes through motivating factors, time, instruction, and by being in a motivating environment. (Crandell et al., 2012). SHORT-TERM VS. LONG-TERM MEMORY Many older adults have issues accompanied by short-term memory, especially if they are taking certain medications. Short-term memory only impairs a person’s ability to remember whether or not they did routine daily activities and tasks. Serious memory loss, like not being able to remember longterm information such as children’s names or how to get home, may be associated with Alzheimer’s disease and dementia (Crandell et al, 2012).
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UNDERSTANDING DEMENTIA Dementia is a neurocognitive chronic and progressive disorder of the brain. It is classified as a disturbance of the brain’s ability to function properly because it causes a decline in a person’s memory, thinking, orientation, comprehension, calculation, learning capacity, language, and judgement. One’s consciousness is not disturbed, but a person’s cognitive functions are impaired, which can lead to deterioration of emotional control, social behavior, and motivation (Breslow, 2012).
There are four different kinds of dementia, but Alzheimer’s disease is the most common making up 6080% of the cases (Breslow, 2012). TYPES OF DEMENTIA The four different types of dementia include Alzheimer’s disease, vascular dementia, dementia with Lewy bodies (DLB), and frontotemporal lobar degeneration (FTLD). Two forms of dementia may occur together, making that particular form of dementia a mixed type. Other brain disorders that might occur are Parkinson’s disease (PD), Dementia Creutzfeldt- Jakob disease, and normal pressure hydrocephalus (Alzheimer’s, 2015). Dementia is under-diagnosed worldwide only one-fifth to one-half of dementia cases are diagnosed and documented (Breslow, 2012). Researchers believe early detection is 32
important for slowing the process, and might help prevent and even stop Alzheimer’s disease in the future (Alzheimer’s, 2015). For early detection to occur, family and medical professionals should notice a person’s change in behavior, and should be aware of the different symptoms of dementia (Breslow, 2012). STAGES OF DEMENTIA Dementia occurs in three stages with different symptoms making up those stages. The early stage makes up the first two years, the middle stage makes up the second to fourth or fifth year, and the late stage occurs after the fifth year of having dementia. Being aware of the stages can provide a guideline for diagnoses; however, all people are different and their symptoms may progress faster than others (Breslow, 2012). SYMPTOMS OF DEMENTIA Symptoms commonly seen in those with Alzheimer’s include: memory loss that interrupts daily life, challenges in developing or solving problems, difficulty achieving familiar tasks at home, at work or at leisure, confusion of time or place, trouble comprehending visual images and spatial relationships, difficulty with new problems involving words in speaking or writing, misplacing items and losing the ability to retrace steps, poor judgment, removal from work or social activities, and changes in mood, behavior, and personality, including apathy and depression (Alzheimer’s, 2015).
AGE AND GENDER One in nine people who are age 65 and older have Alzheimer’s disease (Alzheimer’s, 2016). Data collected from the 2010 census and the Chicago Health and Aging Project, revealed that 44% of people between the ages of 75-84 make up the majority of those with Alzheimer’s disease. People who are younger than 65 make up 4%; those who are 66-74 years old make up 15%; and those who are 85 and older make up 37% (Alzheimer’s, 2015).
Women make up 3.2 million of the 5.1 million people age 65 and older living in America with Alzheimer’s disease, while men only make up 1.9 million. Women are more vulnerable to developing Alzheimer’s disease and other forms of dementia because they tend to live longer due to living a healthier lifestyle. Dementia is also a costly disease, and this is a challenge worldwide (Alzheimer’s, 2015).
Image 6 : Top row shows the aging of a brain with dementia. Bottom row shows the normal aging of a brain.
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COST OF DEMENTIA An estimate of about 604 billion dollars was spent worldwide on dementia care in 2010. Only 16% of this global cost contributed to the direct medical care that was being received (Breslow, 2012).
About 85% of unpaid help for people with dementia in the United States is coming from family members and friends (Alzheimer’s, 2015).
This is not only an issue in the United States, but also for those worldwide living in lowincome and middle-income countries. These costs are coming from informal care provided by family members and other unpaid caregivers (Breslow, 2012). Americans provided almost 18 billion hours of unpaid care in 2014 to people with Alzheimer’s disease and other dementias. This calculated out to $217.7 billion in the United States alone (Alzheimer’s, 2015). In high-income countries, one-third to onehalf of those with dementia are living in resource- and cost-intensive residential or nursing homes, where the social care they are receiving accounts for half of all costs (Breslow, 2012). Providing universal social support through pensions and insurance schemes can help aid families who face the significant financial challenges. These challenges may range 34
from the cost of providing health and social care, to the loss of income due to the time they must take to care for their relative. Some governments have set up policies and plans that will improve dementia care and enhance quality of life (Breslow, 2012). Factors and areas of action that should also be addressed within policies and plans for dementia include: increasing awareness, early diagnosis, commitment to quality continuing care and good services, caregiver support, workforce training, and prevention and research (Alzheimer’s, 2015). Expanding the awareness of dementia across all levels of society is important because of the increasing number of those developing dementia, and the influence it can have on increasing the strategy and quality of care for all those who are affected by this disease (Breslow, 2012). SUPPORT FOR DEMENTIA Dementia not only affects those who have the disease, but also the health and well-being of their family members and caregivers.The quality of life for people with dementia, their family, and their caregivers is affected by the behavioral and psychological symptoms of dementia (Alzheimer’s, 2015). Caring for a loved one with dementia can affect family members and caregivers medically, emotionally, and psychologically. Family members account for a large number of informal caregivers for those with dementia (Breslow, 2012).
Three reasons family members wish to help a loved one with Alzheimer’s include, the desire to keep a family member or friend at home, having easy access to the person with dementia, or the caregiver’s obligation to take care of their spouse or partner (Alzheimer’s, 2015).
This can put a lot of stress on family caregivers, and can have harmful effects on both the
person with dementia, and his or her family (Breslow, 2012). Support is important to provide for families so they can have a role in the lives of their loved one with dementia for as long as they can. Extra support can be offered from formal caregivers and from other family members. Formal caregivers can provide information to help understand dementia, and can teach skills to assist with care. Having time to engage in activities and having financial support is an important factor for family caregivers (Breslow, 2012).
Image 7: Elderly Couple
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PROFESSIONAL HELP The majority of those with dementia prefer to live in their own homes and familiar communities for as long as possible. When the middle and late stages of dementia occur, institutionalized and formal caregiving becomes a priority, and professional help is needed (Breslow, 2012). In the later stages, dementia is associated with complex needs that require high levels of dependency and professional help. These complex needs challenge the skills of the workforce and its services to properly identify, diagnose, manage symptoms, and provide long-term support (Breslow, 2012).
Image 8: Patient and Caregiver
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It is essential that care provided by health and social care services is organized and incorporated throughout the process, and can be adapted to the changes that occur throughout the course of the disease (Breslow, 2012). Chenoweth, King, Jeon, Brodaty, SteinParbury, Norman, Haas, and Luscombe (2009) state that when the behaviors of people with dementia start to get hard to manage, it is time to place family members in residential care facilities. Providing longterm formal care, and community support in residential homes is an effective, and appropriate way to care for the needs of people with dementia (Breslow, 2012).
Formal caregivers must be aware of how they treat dementia patients so they do not damage their personhood. Treating them with respect, recognition, and trust can enhance their well-being (Chenoweth et al., 2009). Certain models of care can enhance the quality of life for people with dementia. PALLIATIVE CARE & MEMORY CARE The quality of residential care should be improved to provide palliative care, which is,
... an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual� (Breslow, 2012, p. 56).
In other words, Golembiewski (2015) says the approach of person-centered care considers the person as a whole, and focuses the care based on his or her own needs.
Olinger and Baker Barrios Architects (2012) explain that the memory of a person with dementia slowly deteriorates; therefore it is one of the most important factors a design team should consider.
Providing memory anchors that create cues to bring back memories is a valuable technique in facilities that care for Alzheimer’s residents (Olinger & Architects, 2012).
Pot (2013) suggests having an environment that allows people with dementia to go about their daily routine in a familiar household is the best care model to follow. In order to enhance memory care, and practice a person-centered care model, the current and future healthcare facilities offered for those with dementia need to be improved and designed better. The environment, in general, acts as a stimulus that produces a behavioral response; therefore, the physical and social environment can influence the behaviors of people with Alzheimer’s disease and dementia (Morgan & Stewart, 1997).
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ENVIRONMENTS DESIGNED FOR DEMENTIA Improvements have been made to the social and physical environments in healthcare settings because of the ability to live longer (Crandell et al., 2012). The advancements in care and design interventions have allowed for the aging population to ‘age in place’, in which they can comfortably age in their own homes. Many of those who wish to age in their own home still require some assistance from family or caregivers (Crandell et al., 2012).
Only 4 percent of people that are 65 and older live in a care facility; but as they age, complications may develop sending them to long-term care facilities (Crandell et al., 2012). If one has to be taken care of 24 hours a day in a facility, it is important to maintain his or her sense of personhood. The most important factors for living a healthy lifestyle are having personal control, independence, and high self-efficacy in the later stages of adulthood (Crandell et al., 2012) Researchers Marquardt, Beuter, and Motzek (2014) say there is a relationship between the design of the physical environment and the behaviors of those with dementia.
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THE ENVIRONMENTAL DOCILITY HYPOTHESIS Many design researchers, including Calkins (2001) and Marquardt and her team (2014), have used Lawton and Nahemow’s Environmental Docility Hypothesis to help inform design decisions. Lawton’s ecological models have helped create design interventions for those with Azlehimer’s disease and dementia (See Ecological Models and Conceptual Framework, pgs. 24-27). An ecological model is based on the belief that a person’s health and well-being are influenced by the biological, behavioral, and environmental factors including one’s individual lifestyle and the physical and social environment he or she interacts with (Satariano, 2006). Calkins (2001) uses Lawton’s Environmental Docility Hypothesis to explain that people who have health or cognitive constraints cannot always manipulate the environment to meet their specific needs, but rather they are dependent on external environmental cues for help (Marquardt, 2011) (Morgan & Stewart, 1997). ENVIRONMENTS AND BEHAVIOR From Calkins’ (2001) research, early design interventions based on The Environmental Docility Hypothesis were used to alter the behaviors of people with dementia.
Some interventions tried to minimize unauthorized exiting and wandering, and tried to strengthen orientation within a building for dementia residents. Many design strategies have been tested to help facilities with the behavioral challenges of dementia residents. Some examples of these design strategies consist of hanging photos or small mementos of residents on their bedroom doors, and making toilets more visible to residents. All of these interventions improved the residents’ ability to remember what they were doing, and helped orient them within the building (Calkins, 2001). Lawton (2001) believes it is important to keep these key behavioral elements in mind when designing for dementia:
... decrease disturbing behavior and negative feelings, increase social behavior, increase activity, and increase positive feelings.
To reduce these unwanted behaviors, the physical and social environment should be designed to create desirable behaviors for people with dementia (Morgan & Stewart, 1997). However, disruptive or confusing behavior can occur with dementia. Morgan and Stewart (1997) say disruptive behavior consists of verbal and physical actions, wandering, self-abuse, resisting care, hoarding, throwing objects, general agitations, and aggression. Disruptive behavior occurs when a person’s stress threshold is surpassed; therefore designing facilities that lower levels of stress can have drastic improvements on behavior. The environment can decrease this disruptive behavior, and increase functional ability for people with dementia (Morgan & Stewart, 1997). Understanding the physical and social environment is crucial for the quality of life for people with dementia, their family, and the well-being of the formal caregivers (Pot, 2013).
Image 9: Personalized doors for wayfinding strategies
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EVIDENCE-BASED DESIGN FOR DEMENTIA Marquardt (2014) and her team of researchers collected and analyzed data over the past 20 years. Findings indicate that the physical environment has a therapeutic effect on people with dementia, and can enhance well-being, behavior, independence, and functionality. These findings were developed from the concept of evidence-based design. In evidence-based design, architects and designers use research findings to help them make appropriate design decisions to meet the needs of the users they are designing for (Marquardt et al., 2014). As Marquardt et al. (2014) conducted studies of the built environment, they found that appropriate design decisions can be made when designing for dementia by involving these key elements in the design process: behavior, cognition, function, wellbeing, social abilities, orientation, and care outcomes. These key elements are encompassed by four major categories important to the design process, which are: basic design decisions, environmental attributes, ambience, and environmental information. Within these categories, Marquardt et al. (2014) address building layout, floorplan type, wayfinding, noise influence, room temperature, color, contrast and pattern, and light influence.
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All of these environmental factors can affect the outcomes of dementia patients. These factors provide a framework that is useful when developing a design for people with dementia. BUILDING LAYOUT Creating a building layout is one of the first steps when designing any healthcare environment. Resident rooms and common spaces, as well as the shape and sizes of the hallways, are all important factors involved in the design process (Marquardt et al., 2014). People with memory problems rely on what they see to help make sense of an environment. Designing a clear layout with visual cues, and avoiding complex layouts will help orient dementia residents within an environment (Halsall & MacDonald, 2015). Earlier studies from Marquardt (2011), have shown that floorplans with longer routes for residents make it more difficult for them to find their way around on their own. Designing to enhance visibility and to provide certain cues for residents to find their way can be implemented through an open floorplan (Calkins, 2001). Floorplans with straight circulation patterns make is easier for residents to navigate than layouts with many changes in direction (Halsall & MacDonald, 2015). The floorplan layout should have enough space to accommodate the spatial needs of the occupants, which includes having extra
circulation for wheelchairs, walkers, and other assistive devices (Halsall & MacDonald, 2015). Marquardt et al. (2014) studies revealed that long corridors triggered negative effects on the residents’ behaviors. When there are multiple doors on a long a corridor, it can become confusing for residents, causing them to become more restless, anxious, and violent. Designing with fewer doors and exit points, and making communal areas more adjacent, can support positive behavioral outcomes (Marquardt et al., 2014). People with dementia may forget where they are going and can get lost, so orientation factors are significant to the building layout and floorplan (Marquardt et al., 2014). Identifying areas with different zones and functional purposes allows residents to reference these areas, which helps them make simple decisions in deciding where to go (Marquardt, 2011).
WAYFINDING CUES Marquardt (2011) describes wayfinding as knowing where you are, knowing your destination, knowing the best route to travel, recognizing the destination once you have arrived, and knowing how to get back from the destination. A resident’s ability to orient themselves within a space is a prerequisite for maintaining quality of life for people with dementia. Designing wayfinding cues can establish a location, and can eliminate unsafe wandering of dementia residents (Marquardt, 2011).
Environmental cues that provide wayfinding include signage, landmarks, murals, artwork, furnishings, lighting, colors, and windows with views of nature (Halsall & MacDonald, 2015) (Marquardt, 2011).
To help acheive this, the design should consist of public and private zones with appropriate separation between quiet and noisy areas (Halsall & MacDonald, 2015). The design should be open to provide direct visual access to areas within the space, but also provide privacy in areas where it is needed (Halsall & MacDonald, 2015) (Marquardt et al., 2014).
Other features that support wayfinding include displaying personal items on residents’ doors, such as a photograph, a resident’s name, a small memento and photographic labels (Marquardt, 2011). All of these provide memory cues so residents can not only identify themselves, but also identify the space.
Researchers found that integrating points of reference and having different zones provides wayfinding cues (Marquardt et al., 2014).
However, having too much information can clutter an area, making it more confusing for residents to orient themselves within the environment (Marquardt, 2011).
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NO ISE INFLUENCE
COLOR, CONTRAST & PATTERN
Marquardt et al. (2014) studied noise levels in environments for those with dementia. Her team found that high noise levels led to an increase in wandering, aggressive, and disruptive behaviors among residents. However, a pleasant level of sound is beneficial for residents because it stimulates their mind, preventing boredom.
As people age, their visuo-perception changes, and the ability to judge distance becomes more challenging due to the aging of the eye. The ability for the aging eye to perceive color is reduced, as well as ability to see contrast (Halsall & MacDonald, 2015).
When noise levels from distractions such as electronic devices and staff talking were reduced, behavioral disruptions decreased. Well-being, quality of life, and orientation improved overall when noise was reduced. However, studies revealed that intake of food and fluid increased in noisier environments. One way to reduce noise is to use acoustical design elements to help absorb or block unwanted sound (Marquardt et al., 2014). ROOM TEMPERATURE Room temperature studies indicated that a comfortable room temperature was important for the well-being and quality of life of the residents (Marquardt et al., 2014). Older adults can be senstive to temperature because they have a hard time feeling a change of nine degrees, and will not realize their body is either too hot or too cold (Crandell et al., 2012). A comfortable room temperature was not defined by Marquardt and her team (2014); however, health professionals should take notice to see if a resident is displaying signs of feeling too hot or too cold. 42
People with dementia may have trouble distinguishing blues and greens, but not yellows and reds (Marquardt, 2011). This is because the lens of the aging eye starts to yellow, causing colors to appear less saturated. Blues and greens lose their color first, so it is better to use warmer colors when designing an environment (Halsall & MacDonald, 2015). (Figure 4) All colors, including blues and greens should be brighter and more vivid so they can be seen by the aging eye (Halsall & MacDonald, 2015). Marquardt (2011) says bright color coding may also improve functional ability and increase short-term memory. Color, contrast, and patterns were studied by Marquardt et al. (2014) in environments for people with dementia. Studies concluded that strong contrast around the dinner table showed improvements in residents’ functional behavior, and lower contrast on the floor is more beneficial for walking (Marquardt et al., 2014).
Busy textures and contrasting patterns can disorient those with dementia as well as reflective surfaces and contrasting changes in flooring. Using proper signage and tonal contrast between walls and floors can help distingiush an environment for a person with dementia (Halsall & MacDonald, 2015).
Figure 4. Color Perception of the Aging Eye (Halsall & MacDonald, 2015). Normal Eye
Aging Eye
Yellowing of Lens
Studies also revealed that color cues provided an easier understanding for residents to identify different rooms. Researchers found that painting walls and woodwork to highlight certain areas and doors decreased undesired and disruptive behavior, and allowed residents to identify their location (Marquardt et al., 2014). Overall, designers should use warmer, brighter and more vivid colors for distinguishing certain areas. Use contrasting colors for furniture and flooring, but should avoid complex patterns, textures, and contrasting flooring changes. Figure 4 shows how the aging eye starts to become dull, seeing colors with less saturation, and how the yellowing of the lens can change color perception for the aging population, especially for those with dementia. (chart based on illustration from Halsall & MacDonald (2015).
eye losing saturation & yellowing
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LIGHT INFLUENCE The impact of daylight control, light therapy, and overall light level were investigated by Marquardt et al., (2014). Results showed that providing residents with high-intensity light sources can have positive effects on their outcomes. This is because exposure to bright light has been identified as a nonpharmacological treatment of dementia. Light studies indicated that bright light improves the mood and function of residents, lowering symptoms of depression. Light studies also revealed that brighter light reduced agitation, restlessness, and aggression in residents; however, some behaviors were not affected at all. Having lower light levels were found to have more negative effects on the mood and well-being of dementia residents (Marquardt et al., 2014).
Researchers found that light therapy had a positive impact on residents’ cognition, causing them to be more awake, verbally competent, and showed an increase in their overall functional performance. (Marquardt et al., 2014). Other studies revealed that increasing light at the dinner table can decrease disruptive behavior. It can provide visual contrast for tableware and placemats, which was shown to improve eating habits. However, some studies indicated that eating was improved
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when lighting was lower, but noise levels were higher (Marquardt et al., 2014). An overall brighter light level within these environments has shown positive effects on the behavior, function, and care outcomes of dementia residents. However, it is important to note that increased lighting can cause an increase of wandering residents. (Marquardt et al., 2014). SUNLIGHT Behavior was also improved when indoor lighting mimicked natural light from the outdoors. (Marquardt et al., 2014). Connellan, Gaardboe, Riggs, Due, Reinschmidt and Mustillo (2013) revealed that natural light can influence health outcomes in Alzheimer’s disease, eating disorders and depression. Allowing natural light into an indoor space offers therapeutic design strategies, stimulates sensory information, and can effect the circadian rhythm of all users in an environment. Having views and access to the outdoors can improve the behavior of dementia residents (Marquardt et al., 2014). OUTDOORS & GARDENS
The physical, cognitive, social and psychological benefits of being outside can improve the well-being of people with dementia (Halsall & MacDonald, 2015).
Evidence-based research indicates gardens have helped dementia residents feel calmer when designed with these five major goals in mind: provide a safe outdoor environment, a place for reflection, a place for relaxation, a place for socialization, and a place for people to interact with nature through gardening (Halsall & MacDonald, 2015).
Having access to daylight and participating in outdoor activities with sensory stimulation and interaction with nature, has had positive effects on patients with dementia (Conellen et al., 2013). However, if the temperature is too cold or too hot for dementia residents, having plants indoors can add the feeling of being outside surrounded by nature (Halsall & MacDonald, 2015).
During warmer months, staff and volunteers should be encouraged to help residents plant and maintain gardens (Conellen et al., 2013). Gardening outside will encourage exercise, which will reduce stress, anxiousness and agitation (Halsall & MacDonald, 2015). Many family members also use gardens to relieve stress when visiting relatives with dementia. Providing and maintaining the aesthetics of a garden is key, and having landscapes that have pathways, and areas for families and residents to gather is also beneficial (Conellen et al., 2013). It is important that the design of an environment should encourage dementia residents to go outside and enjoy the sunlight and interact with the natural environment (Halsall & MacDonald, 2015).
Image 10: Flower Garden
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SENSORY GARDENS Research says residents prefer sensory variation between spaces within a building (Conellen et al., 2013). Providing stimulating environments that use sensory enhancement design has shown a positive effect on the mood and behavior of those with dementia (Marquardt et al., 2014). Balode (2013) explains that most gardens are for aesthetically pleasing purposes, but sensory gardens and environments can affect a person’s thinking and intellectual development.
Sensory gardens are designed to improve mental and physical health, and please the five human senses, which include vision, touch, smell, taste, and hearing (Balode, 2013).
Image 11: Sensory Garden
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1. Smell includes formal perfumes, herbal plants, fungi, mosses, and other scents (Balode, 2013). Pleasant aromas can help decrease blood pressure, slow respiration, lower pain perception levels, and can decrease anxiety, fear and stress (Marquardt, 2011). 2. Taste includes herbs, vegetables, berries, fruit, and other tastes that are pleasant to humans (Balode, 2013). 3. Vision includes landscape scenes, views from indoors, color and light, sculptures, and other aesthetically pleasing views. 4. Touch consists of surface structure, the temperature of an object, plant leaves, and other surfaces including braille text. 5. Hearing includes water sounds, bells, wind violins, songs of birds, and other pleasing environmental sounds (Balode, 2013).
Image 12: Sensory Garden
While sensory gardens cannot heal dementia, they can improve the health of residents through the healing powers these therapeutic gardens offer. They can help residents find peace and spiritual balance within the environment (Balode, 2013). Providing direct access to outdoor spaces, such as a courtyard that is contained within a secure perimeter, is one way to ensure safety and security while providing residents with a connection to sunlight and nature’s healing properties (Calkins, 2001). SUN PATTERN Sun direction should be considered when orienting a building and creating a layout. Each room should be laid out considering which room should have views and access out to nature. The sun rises in the east and sets in the west, so the majority of sunlight will occur on south facing rooms (Halsall & MacDonald, 2015).
East facing rooms are rooms that are used in the mornings, such as bedrooms and kitchens. South and west facing rooms are best for communal areas, including living rooms, dining areas and gardens. The north side of a building should be for parking or for other rooms that do not need sunlight, like a storage room (Halsall & MacDonald, 2015). Allowing an abundance of natural sunlight into an environment can create a lot of issues including glare, overheating rooms during the summer, and cool air entering into rooms warm during the winter. Overhangs, special screens or glass might need to be considered to help eliminate these issues (Halsall & MacDonald, 2015).
Image 13: Sun Pattern
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AMBIENCE & HOME-LIKE ENVIRONMENT Creating ambience involves designing a pleasant and stimulating environment for people with dementia. Different environments were exammined by Marquardt et al. (2014), which included non-institutional, personalizable, and multi-sensory environments. A home-like and non-institutional environment in long-term care facilities can have positive effects on residents, improving their well-being and overall quality of life (Marquardt et al., 2014).
A home-like environment may be described as one that gives residents the opportunity to engage in activities and interactions, and one that allows them to have control and privacy as they would within their own homes (Calkins, 2001). Allowing residents to personalize their individual environments is a characteristic for home-like and non-institutional environments. Both staff and families noticed more positive behaviors of dementia residents living in a more homelike environment because of their ability to personalize their individual environments with decorations, pictures, and other objects (Marquardt et al., 2014). Studies also suggested that changing the seating and dining room arrangements improved eating behavior, and encouraged 48
social activities to take place among residents. Having the dining room closer to the living area, and providing smaller dining tables gives a more home-like feel and can reduce disruptive behavior (Marquardt et al., 2014). The kitchen can become a place that provides therapeutic activity for residents by allowing them to cook and prepare meals. However, non-familiar environments can cause problematic behavior for residents, especially in the bathing area (Marquardt et al., 2014). Designing a more home-like and noninstitutional environment can support and encourage residents to engage in more activities and social interactions, and can improve the overall well-being and quality of life for those with dementia (Marquardt et al., 2014). Studies from the Living Arrangements for people with Dementia (LAD-study) in the Netherlands revealed that living in group homes, rather than nursing homes, can have positive benefits for people with dementia and formal caregivers (Pot, 2013). People with dementia need safe and familiar environments, which new care models have been trying to address (Pot, 2013). SAFETY Safety is an important element when designing an environment for dementia residents. Creating a safe and secure environment can eliminate stress, and can create an area that is pleasing and
stimulating for all users (Marquardt, 2011). Preventing residents from escaping through exit doors can be achieved through design interventions (Marquardt, 2011). Studies have revealed that placing mirrors on exit doors, or on the floor in front of exits, reduced the number of residents wandering and exiting the building (Lawton, 2001).
Using blinds on glass doors and even hiding the door knob, or painting the door to match the wall color, can intervene in the escape of dementia residents (Marquardt, 2011).
Hogewey, a community designed to be a dementia village only has one entrance and exit for all users of the community village. There are two sets of glass sliding doors that allow the users in and out, and they are monitored at all hours of the day (Dementia Village, 2013) (Hurley, 2012). This new model of care has shown to be successful in creating a dementia-friendly village that residents enjoy living in, and has also improved the care, well-being, and quality of life for the residents living there (Hurley, 2012).
Image 14: Senior Living Facility
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P R E C ED EN T S T U DY The Netherland’s Dementia Village named Hogewey In the Netherlands, a gated community called Hogewey has transformed into what is now known as the dementia village, where residents who live there are in the advanced stages of Alzheimer’s disease. It was the first community village in the world for people with Alzheimer’s and other degenerative disorders (Hurley, 2012).
LIFESTYLE & LIVING ARRANGEMENTS
The village houses 152 residents who live in small group homes that were designed to look old-fashioned and caters to seven different lifestyles. The different lifestyles include: urban, domestic, cultural, Christian, craft, Indonesian, and upper-class. Instead of grouping residents by medical needs, they are grouped based on their lifestyle needs. The idea is that residents would be placed in the home that best fits the home environment they were living in before they had advanced Alzheimer’s (Hurley, 2012).
How you lived as a younger person is much more important than how you function now. It must be familiar. We create a surrounding and a way of living that they recognize and feel comfortable with” (Hurley, 2012, p. 13).
Despite having Alzheimer’s, providing residents with an environment they are used to allows them to live out their normal life, and go about their usual daily activities like they once did before (Hurley, 2012). 50
A critic of the dementia village said,
CAREGIVING METHOD Formal caregivers try to form relationships with their resident based on his or her social class level. For example, working-class residents will have a more casual and friendly
Image 15: Hogewey Dementia Village
relationship with their formal caregiver, and may cook meals together and eat them while watching television. Formal caregivers who take care of upper-class residents may act more as servers, bringing meals to residents where they formally dine using glassware and fine tablecloths (Hurley, 2012). Each resident is looked after by four formal caregivers, who dress in casual clothes to minimize the feeling of being in a medical institution. Residents need to be looked after at all hours by formal caregivers and physicians who are always on staff and available when needed (Hurley, 2012). OPPORTUNITIES Residents have the choice to visit the different places within the village with their caregivers so they do not feel trapped or
constrained within the facility. Being able to make these choices as a resident lowers the usage of medication, and creates a sense of dignity because residents are able to choose how to live their everyday lives (Hurley, 2012). The rate of antipsychotic medication usage has gone down from 50 percent to 20 percent in the new village model of care. Many residents have anxiety that is treated with medication. However, many do not realize that the environment itself can create anxiety. To reduce feelings of anxiety, the village model is designed to have homes that look real, has a grocery store, and other stores, as well as areas that create social interaction among residents (Hurley, 2012).
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P R EC ED EN T S T U DY The Netherland’s Dementia Village named Hogewey BUILDING LAYOUT AND DESIGN Building layout is important when designing for people who have dementia. Habib Chaudhury, who specializes in architectural design for people with dementia, talks about how important it is to design a safe wandering path for them. He explains that a complex building layout can cause frustration and confusion for people with dementia (Hurley, 2012). A successful building layout should have areas that provide options, and have different sitting areas, and activity areas that encourage engagement and interaction among residents (Hurley, 2012). Research from over the past ten years has led to this transformation in creating more home-like environments in the healthcare field, and developing more innovative building layouts that allow users to function properly within the building (Hurley, 2012). Other dementia villages have recently been completed in Italy and Canada, and there
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are two being planned in Germany and Switzerland. This village model of care has not been used in America yet, but Miami Jewish Health Systems in Florida is working on building one (Adams, 2015). DEMENTIA VILLAGE COST Dementia is also a costly disease, and the cost for each resident in this village is equivalent to what it would be in a nursing home in the United States, which is around 200 dollars a day (Hurley, 2012). DEMENTIA & UNIVERSAL DESIGN Although this village-like model of care has shown great success, it is also important to start universally designing environments and products for everyone. If designers begin to integrate universal design into their design process, then the elderly and those with disabilities will experience more independence and have an improved quality of life (Hurley, 2012).
Image 16: Hogewey Garden and Courtyard
Image 17: Hogewey Courtyard
Image 19: Hogewey Lifestyle Apartment Image 21: Model of Hogewey Village
Image 18: Hogewey Only Entrance/Exit
Image 20: Hogewey Lifestyle Apartment Image 22: Small Market in Village
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P R EC ED EN T ST U DY Canada’s Georgian Bay Retirement THE DESIGN AND CONCEPT OF THE FACILITY INCLUDED FIVE IMPORTANT Home for Dementia Residents Physical therapist and dementia care advocate, Reshawn Devendra, wanted to build a memory care facility in Ontario, Canada similar to Europe’s villages designed for people with dementia (Vittone, 2016).
One in 20 people in Canada age 65 and older suffer from Alzheimer’s or dementia, so the need for safe environments is in high demand. Reshawn was given the opportunity to transform a long-term care facility into a carefully designed memory care facility (Vittone, 2016).
Image 23: Beach themed room.
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FEATURES:
1. Having almost as much outdoor space (18,000 square feet) as indoor space (20,000 square feet) allowing residents to safely wander around. 2. Having greater staff to resident ratios. 3. Training for nursing and activities staff complete with a multi-media library for staff and families. 4. High-quality tech equipment that utilizes Snoezelen therapy, a mutli-sensory environment to stimulate senses by using lighting effects, music and different scents. 5. Programs that invlove using music therapy, gardening, hobbies, storytelling, and many others.
Image 24: Dementia residents crafting.
MEANINGFUL DESIGN & THEMES Reshawn and other contributers aimed to design rooms by using different themes that would create meaning for the residents. The purpose for creating themes was to provide residents with ways to recognize and enjoy their surroundings. For example, some residents love golf, so a putting green was installed for them to use. Some residents enjoy gardening and sewing, so spaces for them to continue pursuing these hobbies were designed (Vittone, 2016). Rooms were designed to be comfortable for both seniors and Alzheimer’s and dementia residents, and included access to outdoors in many of these spaces. Some of these spaces included: A barber shop, a vintage kitchen, a garage with a 1947 Dodge car, a
nursery with life-like babies, gardens, and a themed beach room. Another special design feature that was aimed to help reduce confusion and the risk of residents wandering or escaping was designing doors to look like bookshelves to hide them from residents (Vittone, 2016).
By providing Alzheimer’s and dementia residents purpose in life, everyone is happier,”...“Our task is to provide quality care that also includes a fun atmosphere for residents living with Alzheimer’s and dementia. It’s a delicate balance”, says Reshawn (Vittone, 2016).
Image 25: Snoezelen Figureroom 1.5
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+ SITE LOCATION + RESEARCH STUDIES + ANALYSIS
ANALYSIS PHASE 56
The Best Friendsâ„¢ Approach + pg. 58 Research Location + pg. 60 Site Analysis + pg. 62 Sun Pattern + pg. 64 Building Analysis + pg. 66 Images of Interior Spaces + pg. 68 Research Studies + pg. 76 57
B EST FR I EN D S Best Friends is an adult daycare center for people with Alzheimer’s disease and dementia. It is located right outside of Lexington in Nicholasville, Kentucky and is adjacent to a senior assisted living facility called Bridgepointe at Ashgrove Woods. Best Friends is the site for this thesis project. The adult daycare center is just under 4,000 square feet and is connected to a small narrow garden. For this project, the adult daycare center will be relocated behind the existing senior assisted living facility where there is open land. Image 26: Best Friends Logo
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Image showing the exterior entrance of Best Friends Adult Daycare.
The Best Friends™ Approach is a model of care that has been adopted by many adult day care facilities for people with dementia or Alzheimer’s disease.
The Best Friends philosophy emphasizes understanding each person’s life story and recognizes the importance of forming relationships based on these characteristics of friendship:
Respect, Empathy, Support, Trust and Humor.
Bridgepointe at ashgrove woods The staff and volunteers are encouraged to attend trainings that explain the Best Friends Approach™ at the Bridgepointe at Ashgrove Woods facility. Overall, learning about life stories helps when getting participants to engage in activities, promotes interaction, and brings out the best in everyone who spends time at Best Friends (The Best Friends™ Approach, 2016).
These characteristics contribute to the person-centered style of care and allow for each participant’s needs to be met. At Best Friends, each participant has a life story that is documented for volunteers and staff to read to get to know each participant (Alzheimer’s/dementia daycare patient).
LIFE STORY. It is important to read each participant’s life story because they can no longer remember it on their own - they need triggers to recall past memories - and volunteers can act as those triggers to help them remember their life story. Knowing a little bit about each Alzheimer’s or dementia participant can not only help them remember their past, but can also improve social interaction, and can help build friendships between volunteers and participants.
Image 27: The Best Friends Approach book.
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R ES EA RC H LO CAT I O N Best Friends is an adult daycare center for people with Alzheimer’s disease or dementia. It is adjacent to a senior assisted living facility called Bridgepointe at Ashgrove Woods in Nicholasville, KY.
LEXINGTON, KY
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SITE A N A LYS I S The Best Friends adult day care center (orange square) is attached to the Bridgepointe Senior Assisted living facility.
CLARK LEGACY CENTER
The site is located right outside of Lexington, Kentucky in a newly developing part of town that was once farmland.
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S I T IEOANN A L Y S I S EX I ST I N G LO CAT
SUN PATT ER N CLARK LEGACY CENTER
The sun rises in the East and sets in the West, so the majority of the sunlight occurs on the South side of the building.
GREY O AK LA
NE
The current location and orientation of Best Friends adult daycare center does not recieve much direct sunlight.
E BR
BAPTIST URGENT CARE
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ANN
ON R
D.
NORTH
GREY
OAK L A
NE
ASHGROVE WOODS NEIGHBORHOOD
BEST FRIENDS ADULT DAYCARE CENTER
RE
LAN
E
CHILDCARE NETWORK
R.
ED
AL RD
E UD LA
BRIDGEPOINTE SENIOR ASSISTED LIVING FACILITY
PAT MO
E BRA
NNON
RD.
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EX I ST I N G B U I LD I N G A N A LYS I S 1 Best Friends Entrance
Best Friends Garden
Parking Lot Sidewalk Pathways
2 Bridgepointe
Entrance & Benches Entrance from Grey Oak Lane
Backside of Bridgepointe
Image 31: Google Maps image of the front of Bridgepointe & Best Friends.
49
66
1
Exterior Entrance of Best Friends
NORTH
Images 30: Google Maps image of the site.
2
Exterior Entrance of Bridgepointe at Ashgrove Woods
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I N T ER I O R S PAC ES Image taken from main entrance looking into front room.
Image showing front room main entrance and cozy corner.
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FRONT ROOM The front room is where the only entrance to the building is located. This room is mostly used in the mornings and for activities and crafts. There is a cozy corner that has a sofa, loveseat, bookshelf, and a TV. The main office, a bird cage, and storage for volunteers and participants are also in the front room as well.
Image showing activity area, main entrance and front office door. Image showing activity area and volunteer storage closet.
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BACK ROOM The back room is where the kitchen is located with more tables and chairs. The back room is mostly used for eating lunch and in the afternoons to gather around in a circle of chairs to chat, exercise play piano, sing songs and dance. There are more storage areas, a laundry room, a quiet room and a nurse’s exam room in the back room as well. Image showing dining and music/gathering area. Image showing kitchen, dining area and hallway.
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Image showing piano and music/gathering area. Image showing kitchen area.
Image showing kitchen window & dining area.
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SUPPORT AREAS
The only hallway at Best Friends connects the front room and the back room. The restrooms and water fountains are located in the hallway. The Restrooms are ADA compliant but still create issues.
Image showing restroom doors. Image showing restroom sinks.
Image showing restroom doors in hallway. Image showing ADA restoom stall.
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Image showing inside kitchen.
Image showing nurse exam room. Image showing nurse exam room.
Image showing view looking out kitchen window. Image showing quiet/relax room.
SUPPORT AREAS The kitchen, nurse’s exam room, laundry, and quiet room are located 73 in the back with other storage areas.
Image showing outdoor garden, walking path and seating.
Image showing outdoor seating.
OUTDOOR PATIO &74GARDEN
Image showing vegetable garden
The garden at Best Friends is along the north side of the building. It is contained within a fence and has chairs, benches, and two tables. The garden is a popular place during the spring and
Image showing outdoor garden and seating.
summer, or anytime when it is sunny and feels nice out. Staff, volunteers, and participants work hard to plant and maintain the garden with plants, vegetables, and flowers, and make sure the bird feeders are 75 filled with food. Everyone at Best Friends enjoys being outside surrounded by nature when they can.
R ES E A RC H M ET H O D O LO G I ES Multi-methodologies were used to collect data for this project. These methods included: observations, questionnaires, and focus group interviews. Collecting this valuable data helped to better understand the needs of staff, volunteers, and participants of the adult daycare center. All of the research was collected at Best Friends adult daycare center for people with Alzheimer’s disease and dementia over a time span of 8 weeks from June 10th through July 29th, 2016. All research was approved by IRB (see approval letter on right), and Marissa was human-subject certified before conducting the studies. The study population included: those with Alzheimer’s disease or dementia who currently attend the daycare as well as the volunteers and staff who work there. Note: At the adult daycare center, they refer to all of the Alzheimer’s and dementia daycare attendees as ‘participants’ to avoid labeling them as patients so they are not reminded that they have Alzheimer’s or dementia. This book will refer to the people with Alzheimer’s or dementia as ‘participants’. Limitations: 1. Data was only collected at one adult daycare center in Nicholasville, Kentucky (Best Friends). 2. Research was only collected on Friday’s during June and July over an 8 week time period. 3. On Friday’s the volunteer to participant ratio is low, it is usually one volunteer per participant. On other week days, they typically have 20 participants and 20 volunteers. 76
EXEMPTION CERTIFICATION MEMO:
Marissa Wilson, Arts & Sciences Administration 195 Sioux Rd. Louisville, KY 40291 PI phone #: (502)403-7128
FROM:
Institutional Review Board c/o Office of Research Integrity
SUBJECT:
Exemption Certification for Protocol No. 16-0387-X4B
DATE:
June 6, 2016
On June 6, 2016, it was determined that your project entitled, Designing to Remember: Designing Environments and Products to Improve Quality of Life for People with Dementia, meets federal criteria to qualify as an exempt study. *** PLEASE NOTE - ORI/IRB HAS ACCESS TO THE RESEARCH DATA IN THE FILING CABINET*** Because the study has been certified as exempt, you will not be required to complete continuation or final review reports. However, it is your responsibility to notify the IRB prior to making any changes to the study. Please note that changes made to an exempt protocol may disqualify it from exempt status and may require an expedited or full review. The Office of Research Integrity will hold your exemption application for six years. Before the end of the sixth year, you will be notified that your file will be closed and the application destroyed. If your project is still ongoing, you will need to contact the Office of Research Integrity upon receipt of that letter and follow the instructions for completing a new exemption application. It is, therefore, important that you keep your address current with the Office of Research Integrity. For information describing investigator responsibilities after obtaining IRB approval, download and read the document "PI Guidance to Responsibilities, Qualifications, Records and Documentation of Human Subjects Research" from the Office of Research Integrity's IRB Survival Handbook web page [http://www.research.uky.edu/ori/IRB-Survival-Handbook.html#PIresponsibilities]. Additional information regarding IRB review, federal regulations, and institutional policies may be found through ORI's web site [http://www.research.uke.edu/ori]. If you have questions, need additional information, or would like a paper copy of the above mentioned document, contact the Office of Research Integrity at (859) 257-9428.
An Equal Opportunity University
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ST U DY PO P U LAT I O N Subject: Participants, Volunteers & Care Staff Setting: Best Friends Adult Daycare Center
Method: Observations collected from June 10th - July 29th, 2016 Limitations: Data only collected on Friday’s at Best Friends
Average Number of Participants
(Icons 9)
78
11
STUDY RESULTS: The average participant attendance was 11; the average volunteer attendance was 5; and the average number of staff was 3.
Average Number of Volunteers
5
Average Number of Staff
3 79
QU EST I O N N A I R E M ET H O D A questionnaire was distibuted to 44 volunteers and care staff members at volunteer education meetings during the week of June 13th - July 17th, 2016. The first question asked if they have or had a family member that has Alzheimer’s disease or dementia. Results revealed that 18 people said no, and 23 people said yes they did. Three people did not answer. Overall, only a few more people either had, or currently have a loved one with the disease. The second question asked volunteers and care staff how long they had been volunteering at Best Friends. Results ranged from one month to as long as 32 years. Volunteers and staff members were also asked 8 questions using a 10 point Likert scale (with 10 was the highest ranking) followed by four open-ended questions. They were asked questions addressing the function, comfort, efficiency, accessibility, and overall design of the physical environment at Best Friends. The overall average ranking was 7.2 out of 10, which is high, assuming they think the design of Best Friends is successful. However, the responses on the four open-ended questions and discussions during the focus group interviews were filled with many thoughts and opinions on how to improve the design of Best Friends. 80
Questionnaire Thank you for your time, your answers are important! These questions are about the care environment for participants, care staff, and volunteers at Best Friends. The physical environment refers to the inside of the building and the rooms and objects/products that occupy the space. The garden and outdoors are also a part of the environment at Best Friends. 1. Do you have a family member who has Alzheimer’s? (Circle/highlight YES or NO) 2. Please circle/highlight whether you are part of the care staff or a volunteer, and write how long you have been working, or volunteering for Best Friends. ________________________________
10-point Likert Scale Questions Please circle/highlight a number indicating your choice. (1 = lowest, 10 = highest) 3. To what degree would you rate the impact of the physical environment on the behaviors of humans? 1
2
3
4
5
6
7
8
9
10
4. How well do you think the physical layout (floorplan and rooms) of Best Friends meets the needs of the participants (those with Alzheimer’s)? (1 = does not meet needs, 10 = does meet all needs) 1
2
3
4
5
6
7
8
9
10
5. How well do you think the physical layout (floorplan and rooms) meets the needs for the care staff and volunteers? 1
2
3
4
5
6
7
8
9
10
6. How well do you think the design of the physical environment functions at Best Friends? (e.g. how well each room/area operates and functions in relation to one another) 1
2
3
4
5
6
7
8
9
10
7. How comfortable is the physical environment at Best Friends? (e.g. furniture, windows, nature, fabric, lighting, etc.) 1
2
3
4
5
6
7
8
9
10
8. How efficient is the physical environment at Best Friends? (e.g. is the environment organized, does it make sense, does it flow well with daily activities and needs?) 1
2
3
4
5
6
7
8
9
10
9. How accessible is the design of the physical environment at Best Friends? (ease of access – for all participants and staff - with wheelchairs, walkers, in bathrooms etc.) 1
2
3
4
5
6
7
8
9
10
10. How would you rate the overall design of the environment at the Best Friends facility? (e.g. aesthetics, floorplan, different rooms, colors, furniture, garden, etc.) 1
2
3
4
5
6
7
8
9
10
Open-ended Questions. Please answer to the best ability you can. Thank you for your time, your answers are important! 1. What do you think could be improved to enhance the care and design of the physical space and environment for the participants (Alzheimer’s participants) at Best Friends?
2. What do you think could be improved to enhance the care and design of the physical space and environment for the care staff and volunteers at Best Friends?
3. Please list any objects/products you notice participants use on a daily basis, and/or list any you wish Best Friends had.
4. List any rooms or areas you notice participants use most on a daily basis, and/or list any you wish Best Friends had.
*** Note: When finished, either turn into Bobby Potts’ Office, or email back to Marissa Wilson at marissa.wilson@uky.edu or marissalwilson16@gmail.com
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VO LU N T EER QU EST I O N N A I R E Subject: Volunteers and Care Staff - 44 people total Setting: Best Friends Adult Daycare Center
Method: Questionnaires distributed during volunteer education meetings June 13th-17th, 2016 Limitations: Data collected only from people who attended meetings
QUESTION: Do you have/had a family member that has Alzheimer’s disease or dementia?
STUDY RESULTS: 18 people responded “no” 23 people responded “yes” 3 people did not respond.
NO 18
yes 23
QUESTION: How long have you volunteered at Best Friends?
one month STUDY RESULTS: Ranged from one month to 32 years. The majority - 16 out of 44 people - have volunteered for an average of 5-10 years.
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5-10 years
32 years
VO LU N T EER QU EST I O N N A I R E Note: Subject, setting, method, and limitations are the same
OVERALL AVERAGE: 7.2 / 10
for this study. However, this questionnaire asked about the function, comfort, efficiency, accessibility, and overall design of the physical environment at Best Friends.
To what degree would you rate the impact of the physical environment on the behaviors of humans?
8.3
How well do you think the physical layout (floorplan and rooms) at Best Friends meets the needs of the participants?
7.1
How well do you think the physical layout (floorplan and rooms) at Best Friends meets the needs of the care staff and volunteers?
7.4
How well do you think the physcial layout functions at Best Friends? (e.g. how well each room/area operates and functions in relation to one another?)
6.9
How comfortable is the physical environment at Best Friends? (e.g. furniture, windows, nature, fabric, lighting, etc.)
7.4
How efficient is the physical environment at Best Friends? (e.g. is the environment organized, does it make sense, does it flow well with daily activities and needs?
7.2
How accessible is the physical environment at Best Friends? (e.g. ease of access - for all participants and staff - with wheelchairs, walkers, in bathrooms, etc.)
7.4
How would you rate the overall design of the environment at the Best Friends facility? (e.g. aesthetics, floorplan, different rooms, colors, furniture, garden, etc.)
7.1 0
2
4
6
8
10 83
FO C U S G RO U P I N T ERV I EWS Focus group interviews were conducted during volunteer education meetings during July 11th-15th, 2016. The interview was semi-structured and responses were written down and documented later. Volunteers and Care Staff were asked: 1. What do you think could be done to improve the design of the physical environment at Best Friends to improve care and quality of life for the participants - and the care staff/ volunteers? 2. What do you like about the design of physical environment at Best Friends? 3. Are there any objects/products you wished Best Friends had that could help the participants or care staff and volunteers? What are they? Volunteers and Care Staff answered these questions, which led to 10 common themes that were talked about in the open-ended questions, and in the focus group interview sessions. These were either current issues or things that could be designed to improve the daycare center. The most talked about topics were: the garden, lighting, restrooms, acoustics, needing a sense of community, kitchen, exit/entrance, institutional feel, more areas for activities, and the table/chair arrangements.
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and volunteers? What are they? ** Areas to consider: a. The front room – the chairs, tables, couch, birds, access to outdoors, exits, windows, small kitchen, office, closets, restroom, flooring, wall color, pictures, artwork, lighting, etc. b. The back room – the chairs, tables, doors to garden, exits, doors/hallways leading to other areas, windows, large kitchen, kitchen window opening, flooring, wall color, pictures, artwork, piano, lighting, etc. c.
Support rooms: restroom, office, storage, nurses, other, etc.
d. The garden/outdoors
Focus Group Interview Questions about the Design 4. What do you think could be done to improve the design of the physical environment at Best Friends to improve care and quality of life for the participants - and the care staff/volunteers? 5. What do you like about the design of physical environment at Best Friends? 6. Are there any objects/products you wished Best Friends had that could help the participants or care staff and volunteers? What are they? ** Areas to consider: e. The front room – the chairs, tables, couch, birds, access to outdoors, exits, windows, small kitchen, office, closets, restroom, flooring, wall color, pictures, artwork, lighting, etc. f.
The back room – the chairs, tables, doors to garden, exits, doors/hallways leading to other areas, windows, large kitchen, kitchen window opening, flooring, wall color, pictures, artwork, piano, lighting, etc.
g. Support rooms: restroom, office, storage, nurses, other, etc. h. The garden/outdoors
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FO C U S G RO U P S U M M A R I ES Subject: Volunteers and Care Staff
Setting: Best Friends Adult Daycare Center
Method: Interviews were held during volunteer educational meetings July 11th-15th, 2016 Limitations: Data collected only from people who attended meetings
1. GARDEN
2. LIGHTING
“An outdoor walking path and garden would be nice like the one at The Homeplace. They have one that is fenced in but is open so they cannot get lost while walking. There, they can go on their own and know they won’t get hurt. Also have chairs, benches, areas for shade along paths.” - Volunteer
“Need more light in space, both natural and artificial, and something needs to be done about the glare from windows.” - Volunteer
3. RESTROOMS
4. ACOUSTICS
“Need higher toilets – maintenance decided to use the pull over toilets with handles because they didn’t want to rip out the old toilets and put in new ones – but the pull over toilets get really dirty.” - Volunteer
“Sound is better, but could have more acoustical tiles.” - Volunteer
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“Need acoustical ceilings – absorb sound better.” - Volunteer
Top 10 Overall Common Themes from greatest (1) to least (10)
* Note: only a few responses were chosen to document.
5. COMMUNITY
6. KITCHEN
“We used to walk to Woodland Park, it was nice. We need an outdoor area to walk around - need more community engagement.” - Volunteer
“Kitchen is not right – noisy, needs to be bigger – if anyone wants to do anything in there it is so narrow, would be nice if participants could use kitchen to bake or help cook with volunteers.” - Volunteer
“Best Friends used to be attached to a preschool and kids came over and played with the participants and everyone really enjoyed it.“ - Volunteer
7. ENTRANCE & EXIT
“Liked the church (old Best Friends location) because it had many options and was in more of a community setting.” - Volunteer
“Front door placement – front room was meant to be used for more activities but back room is used more now because the front door confuses people and makes them anxious” - Volunteer
8. INSTITUTIONAL FEEL
9. ACTIVITY AREAS
“Wall colors are institutional, too dark – need better paint choices – light turquoise, yellows.” - Volunteer
“Make and have things more visible for activities and games.” - Volunteer
10. TABLE ARRANGEMENT
“We used to do puzzles and other activities and games but they are put away and we don’t know where they are.” - Volunteer
“Improve table arrangements, separated is good.” - Volunteer “What about using round tables instead of having the long table?” - Volunteer 87
O B S E RVAT I O N A L M ET H O D
dy Questionnaire: Volunteers and staff members were also Observations were collected 8 weeks from June d 8 questions using aJuly 10for point scale through 3 toLikert 4 hours at a time. Half were h 10 was thedone highest ranking) by AM fourand half in the in the morningfollowed from 10-12 n-ended questions. afternoon from noon to 3 or 4 PM.
Volunteers and staff were questions Observations wereasked recorded using the template ressing the function, acces- every 15format oncomfort, the right,efficiency, and were conducted ity, and overall design oforthe physical environ30 minutes, each time a new activity occurred. nt at Best Friends.
To begin, the date was recorded, the number of and volunteers, the number Overall: staff the average ranking was 7.2 out of participants, and the number of assistive devices being used 0, which is on the higher end and led me to walkers, wheelchairs, canes, etc. me they think the design of the physical envi-
ment is successful.
Next, the time, room location, and area we were in the activity taking place was However,were the recorded. responsesThen, on the four written and down, along with how many participants n-ended questions at the focus group were engaged and how many were not engaged. rview sessions, the volunteers and staff had
nty of opinions and thoughts on how to imve the designFinally, of Bestbehaviors Friends. were recorded that were chosen from a set list, along with any other useful notes.
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Observations Template Behavioral Observations of Alzheimer’s participants at Best Friends happy/content affectionate
confused wandering
aggressive irritable
anxious mad/frustrated rude/mean
calm/relaxed aloof
repetitive disruptive
sad tired
quiet/loud other
Date:__________________________ # of Care staff/volunteers:__________ # of Participants:_________________ Assistive Devices: ________________ _______________________________
Time:___________________________________________
Time:___________________________________________
Room: _________________________________________
Room: _________________________________________
Activity: ________________________________________
Activity: ________________________________________
Engaged:______________Not Engaged:______________
Engaged:______________Not Engaged:______________
Behaviors: ______________________________________
Behaviors: ______________________________________
_______________________________________________
_______________________________________________
______________________________________________
______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
Notes: _________________________________________
Notes: _________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
Time:___________________________________________
Time:___________________________________________
Room: _________________________________________
Room: _________________________________________
Activity: ________________________________________
Activity: ________________________________________
Engaged:______________Not Engaged:______________
Engaged:______________Not Engaged:______________
Behaviors: ______________________________________
Behaviors: ______________________________________
_______________________________________________
_______________________________________________
______________________________________________
______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
Notes: _________________________________________
Notes: _________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
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O B S ERVAT I O N S: RO O M LO CAT I O N Subject: Participants, Volunteers, and Care Staff Setting: Best Friends Adult Daycare Center
Method: Observations collected from June 10th - July 29th
Limitations: Data was only collected on Friday’s and is based on my own observations STUDY RESULTS: Based on the observation recordings, we were in the Back Room a total of 55 times, in the Garden 25 times, and in the Front Room only 14 times.
25
14
Back Room
Outside Garden
55
Image showing Front Room & Table and Chairs.
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Front Room
.
Image showing Back Room & Table & Circle of Chairs.se
* Note: Floorplan from Reese Design Collaborative from Louisville, KY, who designed Best Friends.
Outside Garden
Back Room
Front Room
Image showing Outside Garden at Best Friends.
e.
Image showing Bridgepointe entrance & benches.us
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O B S ERVAT I O N S: RO O M A R EA Subject: Participants, Volunteers, and Care Staff Setting: Best Friends Adult Daycare Center
Method: Observations collected from June 10th - July 29th
Limitations: Data was only collected on Friday’s and is based on my own observations STUDY RESULTS: Based on the observation recordings, we used the Table & Circle of Chairs 36 times, the Table & Chairs 25 times, and were in Outside areas 24 times.
9
25
15
Table & Circle of Chairs Table & Chairs Outside Garden
36
Image showing Front Room & Table and Chairs.
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Bridgepointe Entrance/Benches
.
Image showing Back Room & Table & Circle of Chairs.se
* Note: Floorplan from Reese Design Collaborative from Louisville, KY, who designed Best Friends.
Outside Garden
Back Room
Front Room
Image showing Outside Garden at Best Friends.
e.
Image showing Bridgepointe entrance & benches.us
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PA RT I C I PA N T B E H AV I O RS Subject: Participants
Setting: Best Friends Adult Daycare Center
Method: Observations collected from June 10th - July 29th
Limitations: Data was only collected on Friday’s and is based on my own observations
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# OF TIMES IT OCCURED
MOST
BEHAVIOR
CONTENT 78
LEAST <---------- FREQUENCY OF OCCURANCES ---------->
KEY:
RELAXED 61
CALM 75 HAPPY 35 TIRED 18 QUIET
6
ANXIOUS
3
ALOOF
2
AGGRESSIVE
2
REPETITIVE 1 WANDERING 1 CONFUSED 1 IRRITABLE 1 MAD 1 LOUD 1 DISRUPTIVE 1
STUDY RESULTS: The majority of the beahviors that occured most (teal & some purple) were positive behaviors. The more aggressive and disruptive behaviors (orange & some purple) occured the least. This shows that the participants seem to show more positive behaviors while interacting with their environment.
EN GAG EM EN T & ACT I V I T I ES Note: Subject, setting, method, and limitations are the same for this study. Through my own observations, engagement was measured by seeing if participants were interacting with one another or with the activity taking place. If they were quiet or not taking part in an activity then they were counted as not engaged.
LEAST ENGAGED
ACTIVITIES
• finishing lunch • playing road trip game • playing ice cream ABC game • circle chat • drink break • listening to piano and music, singing [back room ] • sitting outside, relaxing, and enjoying weather [garden] • walked outside to Bridgepointe [outside] • hanging out [outside and back room] * Note: many participants enjoy these activities but are limited to participate because of mobility issues (trouble walking, wheelchair, walker, etc.).
MOST ENGAGED • outdoor walk to Bridgepointe entrance/ benches, enjoying weather • outside to look at an old car for “car week” [outside] • circle chat time • dancing, singing, listening to music • storyteller • snack time; ice cream, smores • eating lunch • talking about birthdays and news • playing birthday game • talking about ice cream; ice cream social • playing with the parachute [back room] •talking and hanging out • hanging out • waiting for family member to pick up [front room]
ALL ENGAGED • getting ready to eat lunch; eating lunch; or finishing lunch [back room] • snack time; ice cream, popcorn, fruit, etc. [back room] • moving outside to relax, talk, and enjoy weather [garden] STUDY RESULTS: Participants were either all or mostly engaged when they were eating or outside, and when a planned activity was taking place, such as singing, dancing, or playing games. Participants were least engaged when relaxing, playing a game that required higher cognitive thought, or because of a mobility issue holding them back. 95
C O LO R S C H EM E ST U D I ES Subject: Volunteers and Care Staff
Setting: Best Friends Adult Daycare Center
Method: These 3 images & a questionnaire (see below) were distributed November 14th -18th, 2016 Limitations: Data collected only from people who attended meetings
* Note: Further research on color was done in the literature review after these studies were distributed.
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3 1 M O D E RN RE T RO : 5 0 â&#x20AC;&#x2122;s- 6 0 â&#x20AC;&#x2122;s 96
OVERALL RESULTS: It was a tie between option number 1 and 2, however, through discussion and questionnaire responses, volunteers and staff indicated that they liked the brighter colors in option 1 and the idea of bringing 50â&#x20AC;&#x2122;s and 60â&#x20AC;&#x2122;s elements into the space. They also suggested adding more pops of color and contrast into the space to create a stimulating atmoshphere for the participants.
10
1 3 N AT U R E : L I G H T & A I R Y
16
2 N AT U R E : R I C H & N AT U R A L 97
DESIGN
DESIGN PHASE
+ VILLAGE + DAYCARE + PRODUCT
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Design Objectives + pg. 100 Design Concept + pg. 102 Design Issues + pg. 104 Users of Environment + pg. 111 Spatial Requirements + pg. 112 & 126 Adjacency Matrix + pg. 113 & 127 Bubble Diagrams + pg. 114 & 128 Blocking Diagrams + pg. 116 & 130 Spatial Zones Diagram + pg. 118 & 132 New Site Proposal + pg. 119 & 133 Dementia Village + pg. 120 - 123 Best Friends Floorplans + pg. 134 - 141 Best Friends Renderings + pg. 142 - 149 Materials + pg. 150 Furnishings + pg. 154 Product Design + pg. 158 i-Rememberâ&#x201E;˘ + pg. 160 GPS Device for Dementia + pg. 162 How it all Connects + pg. 166 Conclusion, Thanks, References + pg. 168 - 177 99
DESIGN O BJ ECT I V ES
OVERALL OBJECTIVE: To design a physical and social environment that also incorporates nature to help improve the health, well-being, and quality of life for those with Alzheimerâ&#x20AC;&#x2122;s disease or dementia. The environment should also include a product that encourages independence and enhances comfort and care.
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To design a dementiafriendly community village in which the dementia adult day care center will be located.
To design an adult day care center for people with Alzheimerâ&#x20AC;&#x2122;s disease and dementia.
To design a product that is integrated into the dementia adult day care center and dementia village.
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D ES I G N C O N C EPT Combining the physical, social, and natural environments to design one holistic environment that will improve the care, health, well-being, and quality of life for people with Alzheimerâ&#x20AC;&#x2122;s disease and dementia.
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(Icons 10,11,12)
P HYS I C A L The physical environment is made of land, air, water, plants, animals, buildings and other structures that are part of the built environment. It also includes natural resources that provide basic needs for human survival (Physical Environment, 2003). For this project, the physical environment is made up of the design, function, comfort, efficiency, accessibility, care, nature, and outdoor gardens that are a part of the dementia daycare center and dementiafriendly community village.
SOCIAL
N ATU R AL
The social environment is developed by humans and includes living arrangements, marital status, social networks, and the interaction of individuals that make up society as a whole (Social Environment, 2017).
The natural environment encompasses all living and non-living things that occur naturally from the Earth or are some part of Earth. The natural environment is comprised of all living species, climate, weather, and natural resources that influence human survival and economic activity (Natural environment, 2017).
For this project, the social environment includes the family, friends, caregivers, volunteers, care staff, Alzheimerâ&#x20AC;&#x2122;s participants (patients), and other visitors at the dementia daycare center and dementia-friendly community village.
For this project, the natural environment consists of the natural landscape, courtyards, and gardens that are a part of the dementia daycare center and dementia-friendly community village.
Combining these three concepts, and using evidence-based design strategies for Alzheimerâ&#x20AC;&#x2122;s and dementia environments, a holistic design can be acheived that will improve the care, health, well-being, and quality of life for people with Alzheimerâ&#x20AC;&#x2122;s disease and dementia.
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D ES I G N I SS U ES D ES I G N G O A L : The environment should be designed to meet the needs of those with Alzheimer’s or dementia, the staff, and others who visit the daycare and community village. 1. FAMILIARITY & MEMORY TRIGGERS: The design should help trigger memories for Alzheimer’s and dementia users by using familiar designs based on their past lifestyle. For example, many of these users will remember the 50’s, 60’s and 70’s because they are more likely to recall memories from their younger years, so the design should mimic styles from those time periods. Providing users with an environment they are used to allows them to live out their normal life, and go about their usual daily activities like they once did before (Hurley, 2012). 2. HIDDEN ELEMENTS: The design should have hidden elements to reduce wandering and unauthorized exiting to keep Alzheimer’s and dementia users safe. Studies have revealed that placing mirrors on exit doors, or on the floor in front of exits, reduced the number of residents wandering and exiting the building (Lawton, 2001). Using blinds on glass doors and even hiding the door knob, or painting the door to match the wall color, can intervene in the escape of dementia residents (Marquardt, 2011). Areas that are safe for Alzheimer’s/dementia users should be highlighted with bright colors, landmarks, signage or other elements that will attract users. 3. NATURE, GARDENS & OUTDOORS: The design should have a view of nature and access to the outdoors where gardens are located. The physical, cognitive, social and psychological benefits of being outside can improve the well being of people with dementia (Halsall & MacDonald, 2015). Evidence-based research indicates gardens have helped dementia residents feel calmer when designed with these five major goals in mind: provide a safe outdoor environment, a place for reflection, a place for relaxation, a place for socialization, and a place for people to interact with nature through gardening (Conellen et al., 2013). Having sensory gardens can also have positive effects on mood and behaviors. Sensory gardens are designed to improve mental and physical health, and please the five human senses, which include vision, touch, smell, taste, and hearing (Balode 2013). 104
F U N C T I O N G OA L: The environment should work, operate, and flow appropriately in response to each of the user’s needs. 1. AREA & ROOM LOCATION: The environment should be laid out and planned according to the needs of the Alzheimer’s and dementia users, as well as the staff and visitors. Each area should be purposefully placed in relation to other areas to promote an overall functional working environment. Identifying areas with different zones and functional purposes allows residents to reference these areas, which helps them make simple decisions regarding where to go (Marquardt, 2011). The design should consist of public and private zones with appropriate separation between quiet and noisy areas (Halsall & MacDonald, 2015). The design should be open to provide direct visual access to areas within the space, but also provide privacy in areas where it is needed. (Halsall & MacDonald, 2015) (Marquardt et al., 2014). 2. INTUITIVE CUES: The environment should be designed to provide environmental cues that are intuitive, meaning they are designed to change behavior and guide users throughout the space without them realizing it. An example of this would be highlighting doors by painting them a bright color, or a different color than the wall to draw attention to these doors to indicate that they are for Alzheimer’s and dementia patients to use. This helps users navigate around the environment with little confusion and stress. 3. WAYFINDING & SIGNAGE: The design should help users orient themselves within the building, and help them identify where they need to go. People with dementia may forget where they are going and can get lost, so orientation factors are significant to the building layout and floorplan (Marquardt et al., 2014). Designing wayfinding cues can establish a location, and can eliminate unsafe wandering of dementia residents (Marquardt, 2011). Environmental cues that provide wayfinding include signage, landmarks, murals, artwork, furnishings, lighting, colors, and windows with views of nature (Halsall & MacDonald, 2015) (Marquardt, 2011). 105
D ES I G N I SS U ES C O M F O RT G O A L : The environment should create physical and psycological comfort for all users, especially for Alzheimer’s and dementia users who are experiencing different behavioral reactions. 1. COLOR: The selection of colors should be chosen based on the needs of the aging population - those with Alzheimer’s or dementia. Wamer colors should be used because blues and greens fade due to the yellowing of the lens of an aging eye (Halsall & MacDonald, 2015). Brighter and more vivid colors tend to be preferred by the aging population because they stimulate activity and are more visible (Marquardt, 2011). 2. TEMPERATURE: The room temperature should remain comfortable for Alzheimer’s and dementia users. They are more sensitive to extremely hot and cold temperatures because it is hard to them to feel a temperature change of nine degrees (Crandell et al., 2012). 3. MATERIALS & FURNISHINGS: Materials should be healthcare grade, easily cleanable, and appropriate in color, pattern, and contrast. Busy textures and contrasting patterns can disorient those with dementia as well as reflective surfaces and contrasting flooring changes (Halsall & MacDonald, 2015). Furnishings should be made for senior living facilities, or should be ADA compliant. Furniture should be strong and durable, and should provide proper support and safety for aging users (i.e. arms on chairs, higher seat level, etc.) 106
E F F I C I E N CY G OA L: The environment should be designed to function in the most efficient way for all users. 1. CIRCULATION: The design should provide circulation patterns that are open and safe, with a clear sense of orientation for users. Floorplans with straight circulation patterns make it easier for residents to navigate than layouts with many changes in direction (Halsall & MacDonald, 2015). The floorplan layout should have enough space to accommodate the spatial needs of the occupants, which includes having extra circulation for wheelchairs, walkers, and other assistive devices (Halsall & MacDonald, 2015). 2. LIGHTING: The design should have bright lighting levels, light therapy, and access to natural sunlight. High-intensity light can have positive effects on Alzheimer’s and dementia users because it is a non-pharmacological treatment of dementia (Marquardt et al., 2014). An overall brighter light level and light therapy have shown positive effects on the behavior, function, and care outcomes of dementia residents. Indoor lighting that mimics natural sunlight also offers therapeutic design strategies, stimulates sensory information, effects the circadian rhythm, influences positive behavior and functional performance in users (Marquardt et al., 2014). 3. NOISE, SOUND LEVEL & ACOUSTICS: Noise levels should be balanced and maintained by using acoustical materials, which includes ceiling tiles, screens and material finishes that eliminate and control unwanted sounds and noise. High noise levels can increase wandering, aggressive, and disruptive behaviors among Alzheimer’s and dementia users (Marquardt et al., 2014). A pleasant level of sound is beneficial for patients because it stimulates their mind, preventing boredom. Well-being, quality of life, and orientation improved overall when noise was reduced (Marquardt et al., 2014).
107
D ES I G N I SS U ES A C C E S S I B I L I TY G OA L: The environment should be accessible for all users, and should be ADA compliant in regards to wheelchairs, walkers, canes, and other assistive devices. 1. SAFETY: The environment should be designed to keep the Alzheimer’s and dementia users safe, both inside the facility and outside. The design should avoid having long corridor hallways to reduce wandering, and should limit or disguise doors to eliminate unauthorized exiting. Designing with fewer doors and exit points, and making communal areas more adjacent, can support positive behavioral outcomes (Marquardt et al., 2014). 2. ADA COMPLIANT: The bathrooms, kitchen, and furnishings need to be carefully designed to allow for a person with a wheelchair, walker or other assistive device to use easily. These rooms should follow the ADA Standard Guidelines for Design (found at www.ada.gov) to allow Alzhiemer’s and dementia users to operate with comfort and ease. 3. VISIBILITY/CONTRAST: The environment should provide clear site lines into each area that Alzheimer’s and dementia users will be in. Designing to enhance visibility and to provide certain cues for residents to find their way can be implemented through an open floorplan (Calkins, 2001). It should also highlight certain areas, objects, and furnishings by using contrasting colors to help make certain things, such as chairs and tables, more visible to Alzheimer’s/dementia users. Designing a clear layout with visual cues, and avoiding complex layouts will help orient dementia residents within an environment (Halsall & MacDonald, 2015).
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CA R E G O A L: The environment should promote the highest quality of care for Alzheimer’s and dementia users by having stimulating activities, promoting interaction, and utilizing technology. 1. CARE STAFF & VOLUNTEER AREAS: The design should have designated areas for staff and volunteers that support their needs to work and function to their highest potential. This includes having appropriate storage, support, and areas for staff and volunteers to relax or take a break in. These areas should be separate and private from the Alzheimer’s and dementia areas, but should provide clear sight lines and easy access into these areas in order to keep an eye on Alzheimer’s and dementia users. 2. ACTIVITIES & INTERACTION: The environment should promote social interaction amongst all users including those with Alzheimer’s or dementia, staff, and visitors. Each area should be designed to provide access to some form of an activity to promote interaction among all users. Having areas with arranged tables, seating and visible activities/games can help promote interaction. 3. TECHNOLOGY: The design should incorporate the use of technology into the environment. This includes using computers, TVs, iPads, tablets and other electronic devices that will help improve care outcomes. The daycare should use iPads or tablets to sign in visitors and participants. Caregivers and healthcare staff can use iPads, tablets, smart phones or computers to pull up participant profiles using i-Remember™ (read about on pg. 160).
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DEMENTIA-FRIENDLY COMMUNITY VILLAGE
Schematic Design
110
USERS O F TH E EN VI RO N M ENT ALZHEIMER’S PARTICIPANTS: This includes people who attend the Best Friends daycare center that have Alzheimer’s disease or dementia. Participants range in age from 50-100 years old and the majority of them are women. Participants are experiencing different stages of the disease, and vary in social and physical functioning abilities. (Icon 4) VOLUNTEERS: This includes anyone who comes to volunteer at Best Friends. They do not have Alzheimer’s disease or dementia, but may have had a loved one who suffered from the disease. Volunteers range in age from 18 and up. The majority of volunteers are college students who need hours for school courses, or older adults who are retired or work part time. Volunteers are required to sign a form for HIPAA regulations and are trained using the Best FriendsTM Approach to care before they start to interact with participants. (Icon 13) CARE STAFF: At Best Friends, this includes the program manager, activity coordinator, nurse, and volunteer coordinator. These four people are the four main members of the care staff at Best Friends. Other staff members work with Best Friends and are next door at the senior assisted living facility. (Icon 14) FAMILY: This includes the family of the Alzheimer’s or dementia participant who attends the daycare center. The participant usually lives with one of their children or grandchildren and his or her family. The families are the ones who take care of them and bring them to the daycare center because they have to go to work, or to receive respite from their loved one with the disease (Icon 5) VISITORS: This will include anyone who would come visit the businesses in the dementia-friendly community village. It is open to the public with only one main entrance and exit that is monitored at all times. Visitors range in age from children to older adults, and even includes dogs and other trained pets. (Icons 5 & 15) 111
S PAT I A L R EQU I R EM EN TS
SOCIAL/ ACTIVITY EXERCISE RELAX NATURE/OUTDOOR ACTIVITIES
* Dementia-Friendly Community Village: square footage requirements vary according to building type.
SPACES
SQ FT.
TOTAL
Existing Bridgepointe Facility
2 levels
25,000+
50,000+
Assisted Living Memory Studios (extension)
2 levels
12,500
25,000
New Best Friends
1 level
8,000+
8,000+
Music Activity Area (35sqft x 50ppl)
1
1,750
1,750
Children’s Classroom (45sqft x 10ppl)
1
450
750
Art Studio (15sqft x 20ppl)
Dance/Exercise Studio (20sqft x 30ppl) Small Occupational Therapy Gym -
(50-65sqft per machine+ 35sqft per person)
1
1 1
300
combine =
600+
600+
350+
950+
600+
combine=
Diner Restaurant
1
4,000
4,000
Sunroom/Conservatory
1
3,000+
3,000+
Veggie Garden
2
n/a
n/a
Courtyard
n/a
n/a
n/a
Outdoor Dining Areas (15sqft x 20ppl)
Sensory/Butterfly Garden Water Feature
Tricycle Bike Stands - (3 bikes per stand) (70”L x 50”W = 24 sqft) Sensory Playground
3
2 3 2 2
300+
n/a n/a
48 x3
900+
n/a n/a
144+
1
300+
300+
Public Entrance/Exit
1
150
150
Garden Storage Area
1
120
120
Public Restrooms
112
QTY.
3
120-150
360 -450
A DJAC EN CY M AT R I X KEY Adjacent
Semi-Adjacent
Not Adjacent
Neutral
Existing Bridgepointe New Best Friends Ast. Liv. Memory Studios Music Activity Area Art Studio Childrenâ&#x20AC;&#x2122;s Classroom Dance/Exercise Studio Small O.T. Therapy Gym Diner Restaurant Outdoor Dining Sunroom/Conservatory Veggie Garden Sensory/Butterfly Garden Courtyard Water Feature Tricycle Stand Sensory Playground Public Entrance/Exit Public Restrooms Garden Storage Area
113
B U B B LE D I AG R A M SOCIAL/ ACTIVITY
ADJACENT
EXERCISE
SEMI-ADJACENT
RELAX
VIEW TO NATURE
BUILDINGS
Existing Bridgepointe 25,000/50,000+
NATURE
Diner Restaurant 4,000 Public Entrance into Dementia-Friendly Community Village
Main Entrance/Exit 150
Restrooms 240-300
Outdoor Dining 300+
Assisted Living Memory Studios 12,500/25,000+
Sunroom/ Conservatory 3,000+
Childrenâ&#x20AC;&#x2122;s Classroom 450
Art Studio 300
Small O.T. Gym 950+
Dance/Exercise Studio 600+ 114
Music Activity Area 1,750+
New Best Friends 8,000+
Entrance into Best Friends Daycare Center
*Note: spatial requirement shown on bubbles, but not to scale.
C O U R T YA R D & G A R D E N S
Outdoor Dining 300+ Diner Restaurant 4,000
Existing Bridgepointe 25,000/50,000+
Public Entrance into Dementia-Friendly Community Villages Tricycle Stand/Storage 144 Main Entrance/Exit 150
Veggie Garden
Assisted Living Memory Studios 12,500/25,000+
Butterfly Garden
Water Feature
Restrooms 240-300
Childrenâ&#x20AC;&#x2122;s Classroom 450
Storage n/a
Veggie Garden Sunroom/ Conservatory 1,000+
Tricycle Stand/Storage 144 Water Feature
Sensory Playground 300+
Butterfly Garden
Small O.T. Gym 950+
Dance/Exercise Studio 600+
New Best Friends 8,000+
Art Studio 300 Music Activity Area 1,750+
Entrance into Best Friends Daycare Center 115
D EM EN T I A V I LLAG E S K E T C H E S
Image: Dementia-Friendly Community Village sketch 1
Image: Dementia-Friendly Community Village sketch 2
116
Image: Dementia-Friendly Community Village sketches 3 & 4
Image: Dementia-Friendly Community Village Sketch 5
117
S PAT I A L ZO N ES D I AG R A M CONCEPT: Combining the physical, social and natural environments to improve the care, health, well-being, and quality of life for people with Alzheimerâ&#x20AC;&#x2122;s disease and dementia. The Dementia-Friendly Community Village is made up of buildings (physical environment) where users can live, receive care or engage in social activities and exercise (social environment). Enclosed is a giant sunroom/conservatory surrounded by a courtyard with gardens and pathways to promote a relationship with the natural healing environment.
SOCIAL/ ACTIVITY EXERCISE RELAX NATURE
Natural Environment Parking
Bridgepointe Senior Living Facility
Parking
Sunroom/ Conservatory
Public Entrance/ Exit
Gardens
Social Activity Areas
Exercise Areas Parking
Natural Environment 118
Assisted Living Memory Studios
New Best Friends
Natural Environment
Natural Environment
Natural Environment (Courtyard)
N EW S I T E P RO PO SA L & S U N LI G H T PATT ER N The new Best Friends Adult Daycare Center and the Dementia-Friendly Community Village are located directly behind the existing Bridgepointe Senior Assisted Living Facility. The businesses and social activity areas (orange) are located on the Southern side so they can be easily seen from the street to attract visitors. The new daycare and assisted living memory studios (light grey) are located on the Northern side and in are the back to provide more security. The daycare is oriented to receive the majority of the sunlight into the spaces that the Alzheimerâ&#x20AC;&#x2122;s and dementia participants will be in most to promote overall health, well-being, and quality of life.
NORTH
NEW BEST FRIENDS
DEMENTIA VILLAGE ENTRANCE/EXIT Image 32: Google Maps image of the site.
119
D EM EN T I A-FR I EN D LY C O M M U N I TY V I LLAG E D ES I G N NEW DEMENTIA VILLAGE DESIGN The new Dementia-Friendly Community Village has businesses, places for exercise, a diner, and many other spaces that the residents of the memory assisted living, senior assisted living, and participants of the daycare can enjoy. The village only has one main entrance that allows outside visitors from the community to enter and exit. The entrance is monitored at all times in order to keep the seniors and dementia participants safe and secure. The seniors and dementia participants are contained within the village by the buildings and tall brick walls to eliminate escaping. The residents and dementia participants also wear GPS tracking name tags that will bring up their location in the village on their i-RememberTM profile (read about on pg. 160) PUBLIC ENTRANCE/EXIT At the public entrance and exit there is a reception desk where visitors check-in before entering the village. 50’S DINER & OUTDOOR DINING There is a 50’s diner to the left of the entrance with outdoor dining. The idea for this was to create a familiar dining experience for senior residents and dementia participants who are most likely familiar with this time period. The 50’s diner also creates a fun atmosphere for visitors to dine in. ART STUDIO & CHILDREN’S CLASSROOM The art studio and children’s classroom are conjoined spaces. The art studio allows senior 120
residents, dementia participants, and village visitors take art classes. The children’s classroom is a space that children can come learn or play in, and have birthday parties or other events in. The classroom can also help trigger memories for dementia participants who used to teach children. OCCUPATIONAL THERAPY CLINIC & GYM The small Occupational Therapy clinic is attached to a small O.T. gym where senior residents and dementia participants can develop, recover, and maintain daily living and functioning skills with Occupational Therapists. Anyone from the community can set up an appointment with the clinic as well. EXERCISE/DANCE STUDIO The exercise/dance studio is specifically designed for seniors and people with dementia. This means it is ADA compliant and has chairs and other equipment made for seniors and dementia participants to use while exercising or dancing. The exercise classes would be catered towards seniors and dementia participants during the day; however, village visitors can take other exercise classes that would be offered for anyone at night.
MUSIC & DANCE STUDIO The music and dance studio is a large dance area for senior residents, dementia participants, and village visitors to gather in and dance. There is a piano and other instruments available for anyone to play. During the morning, there are music classes and dance lessons for senior
residents and dementia participants. During the afternoon, there is a music program in which a piano player comes to play old-time music and familiar songs that senior residents and dementia participants can listen, sing, and dance to. This space also doubles as a large area people can book for events. SUNROOM/CONSERVATORY The sunroom/conservatory is a giant 3,000 square foot glass building surrounded by gardens and water features. The sunroom can be accessed from 3 outdoor walking pathways, and through a corridor that is attached to the memory studios. This allows seniors and dementia participants access to the sunroom/ conservatory during the winter months because the memory studios are attached to both the senior assisted living facility and dementia daycare. GARDENS & PLAYGROUNDS There are gardens throughout the core of the dementia village, which include vegetable gardens and sensory/butterfly gardens. This allows senior residents and dementia participants to help plant and maintain the gardens, which also provides an activity for them to be engaged in. There are also four wandering paths that surround the gardens and playgrounds to allow people to “wander” off the main pathways. There is a playground for children that is located next to the children’s classroom, and a sensory playground designed for all ages to stimulate the 5 senses: sight, touch, taste, hearing, and smell. TRICYCLE BIKE STANDS There are two tricycle bike stands with three bikes in them for senior residents, dementia participants, staff, volunteers and village visitors to use. The tricycle bikes have 2 seats that are parallel to one another. This allows a staff member or daycare volunteer to pedal and
drive the bike while a senior resident or dementia participant sits next to them and pedals as well. This creates an alternative way for seniors and dementia participants to exercise and get around the village instead of walking everywhere. COVERED PATHWAYS Some pathways are covered by a roof to allow people to walk under when it is raining, snowing, or during other inclement weather. BUILDING ENTRANCES AND PARKING Bridgepointe, the existing senior assisted living facility, has one main entrance into the facility that will also allow access into the new memory assisted living studios in the dementia village. The dementia daycare has one main entrance that is divided into two smaller entrances - the clinic entrance and daycare entrance. There is a covered overhang that allows family members to pull up and drop off their loved one at the daycare. There is parking in front of Bridgepointe for the facility and memory studios, and there is parking along the southeastern perimeter of the dementia village for visitors, staff, and volunteers. ASSISTED LIVING MEMORY STUDIOS The assisted living memory studios are attached through corridors to the senior assisted living facility as well as the dementia daycare. They were added because the existing senior assisted living facility has been using the senior studios as memory studios due to the increase of dementia residents. The majority of the people living in the memory studios are people who have later stages of dementia and need 24/7 care. The daycare is catered more towards dementia participants who are in the early to middle stages of the disease, and are still able to engage in activities. (See dementia village graphic on next page and read about dementia daycare on pg. 136) 121
D EM EN T I A - F R I E N D LY C O M M U N I TY V I L L AG E KEY
FIGURES
1. Dementia Village Public Entrance 2. Check-in and Reception for Village Visitors
Water Features
3. Public Restrooms 4. Diner Restaurant
Gazebos
5. Outdoor Dining 6. Art Studio & Children’s Classroom
Benches
7. Public Restrooms 8. Small Occupational Therapy Clinic 9. Small O.T. Gym
Brick Walls
10. Exercise/Dance Studio 11. Public Restrooms
Covered Roofs
12. Music and Dance Studio 13. Tricycle Bike Stand
Pathways
14. * Best Friends Adult Daycare Center 15. Outdoor Deck/Patio/Dining
Covered Pathways
16. Connects Daycare with Memory Studios 17. * Assisted Living Memory Studios 18. Connects Memory Studios to Bridgepointe 19. Outdoor Garden Storage
Wandering Paths
20. * Bridgepointe Senior Assisted Living Facility 21. Sunroom/Conservatory 22. Corridor to Sunroom/Conservatory 23. Tricycle Bike Stand
Empty Spaces
24. Outdoor Sensory Playground 25. Outdoor Children’s Playground 26. Vegetable Garden 27. Sensory/Butterfly Garden 28. Courtyard with Seating 29. Public Parking 30. Daycare Parking and Drop-off 122
* Note: The dark grey squares labeled A, B, & C are empty spaces that will allow the facility and its users to vote on what to build there that will benefit the Alzheimer’s and dementia participants.
18 *20
*17
19 22
27
15
16 28 *14
21 26
26
5
27
23
4 A
28 13
24 3 1
29
2
12
25 B
30
6
C
11 10
7
9 8
123
124
BEST FRIENDS ADULT DAYCARE CENTER FOR ALZHEIMER'S AND DEMENTIA
Schematic Design
125
S PAT I A L R EQU I R EM EN TS
SOCIAL/ ACTIVITY EXERCISE RELAX NATURE/OUTDOOR ACTIVITIES
* Best Friends: (35 sqft per person, 40 people) = 1,400 sqft
SPACES
126
QTY.
SQ FT.
TOTAL
Participant Entrance/Exit into Building Other Entrances/Exits into Building Hidden Entrances/Exits
1 2 1
100 n/a 100
100 n/a 100
Memory Room Living Room/Comfy Corner Library Sunroom Relax/Snoezelen Room
1 1 1 1 1
150 350+ 150 180 150
150 350+ 150 180 150
Activity Area (circle of chairs/music) Dining Area Open Kitchen (for participants) Closed Kitchen (for staff & volunteers)
1 1 1 1
1,400 1,400 400+ 120+
1,400 1,400 400+ 120+
Restrooms (2 stalls) Restroom (single or w/shower) (5’x3’=15)
2 1
120- 150 100
240- 300 100
Nurse Exam Room Offices Copier Room Consult Room
1 3 1 1
120 120-180 100-120 120
120 240 - 360 100-120 120
Support/Storage Areas Laundry Room Volunteer Storage
3+ 1 1
20-100 50+ 50+
60 - 300 50+ 50+
Courtyard Access Gardens (Sensory/Butterfly, Veggie)
1 1
n/a n/a
n/a n/a
A DJAC EN CY M AT R I X KEY Adjacent
Semi-Adjacent
Not Adjacent
Neutral
Participant Entrance/Exit Hidden/Other Entrances Waiting Room Activity Area Memory Area Living Rm./Comfy Corner. Library Sunroom Relax/Snoezelen Room Dining Area Open Kitchen Closed Kitchen Restrooms w/2 stalls Restroom/single & shower Nurse Exam Room Offices Copier Room Consult Room Support/Storage Areas Laundry Room Volunteer Storage Courtyard Access Garden(s) Outdoor Patio
127
B U B B LE D I AG R A M SOCIAL/ ACTIVITY
RELAX
SUPPORT
NATURE
Support/ Storage 120
Living Room/ Comfy Corner 350+
*Note: spatial requirement shown on bubbles, but not to scale.
use.
ADJACENT SEMI-ADJACENT
Support/ Storage 100
Back-of-house Entrance n/a
Restroom with Shower 100
Closed Kitchen (hidden ent.) 120+ Open Kitchen 400+
VIEW TO NATURE
Memory Area 150
Laundry Room 100
Relax/ Snoezelen Room 150 Men & Womenâ&#x20AC;&#x2122;s Restrooms w/2 stalls 240 + 300
Library 150 Activity Area/ Circle of Chairs 1,400+
Dining Area 1,400+
Support/ Storage 50+
Sunroom 180 Oudoor Patio 400+
Courtyard
128
Veggie Garden
Water Feature
Sensory/Butterfly Garden
Administration Areas
Restroom with Shower 100
Support/ Storage 70
Copier Room 100-120
Office 120 -180
Office 120 -180 Main Entrance 100
Support/
Storage (lounge)
20-120
Hidden Entrance into admin. area 100
Hidden Entrance into Daycare 100
Nurse Exam Room 120
Consult Room 100
Single Restroom 100
Waiting 100 Clinic Entrance
Participant Entrance 100
Daycare Entrance
Office 120-180 Volunteer Storage 20-120 Parking Lot
Courtyard
129
B LO C K I N G D I AG R A M S
Image: Blocking Sketch 1
Image: Blocking Sketch 3
130
Image: Blocking Sketch 2
RELAX
SUPPORT FOR DAYCARE
NATURE
Hallway/exit Storage 120+
Closed RR w/s Kitchen Lndry Storage 100 100 100 120
Living Room 350+
Lib/nook 150
Hidden Exit
Sensory Rm 180
Relax/ Stg.70 snoez. RR w/s 150 100 RR 120
Open Kitchen 400
Dining Area 1,400
Sunroom 180
ADMINISTRATION AREAS
RR 120 Activity Area 1,400
Copier Support/ Rm lounge Consult Office 100 120 120 100 N.Exam Office Waiting 120 120 100 Hidden Entry Hidden Entry Stg. 100
Daycare Entrance
SOCIAL/ ACTIVITY
Clinic Entrance
Office 120
Vol. Stg. 100 Outdoor Patio Parking Lot
Courtyard & Gardens
Blocking Diagram 4
131
S PAT I A L ZO N ES D I AG R A M CONCEPT: Combining the physical, social, and natural environments to improve the care, health, well-being, and quality of life for people with Alzheimerâ&#x20AC;&#x2122;s disease and dementia. The social environment, which is where the majority of interaction and activities will occur, is encompassed by both the physical and natural environments.
SOCIAL/ ACTIVITY SUPPORT RELAX NATURE
Natural Environment (Land behind Best Friends) Physical Environment Support Areas
Relax Areas
Social Environment Parking Lot
OutdoorPatio Natural Environment (Courtyard)
132
N EW B EST FR I EN D S LO CAT I O N & S U N PATT ER N The new Best Friends is located on the Northeast side of the Dementia-Friendly Community Village. It is located in the back for safety and security reasons and because of the sun’s pattern. The sun rises in the east and sets in the west, so the majority of the sunlight will project on the building’s south-facing rooms. Because of this, the rooms used most by the daycare participants were laid out to face south. These include: the sunroom, dining area and music and activity area.
NORTH
NEW BEST FRIENDS
DEMENTIA VILLAGE ENTRANCE/EXIT
Image 33: Google Maps image of the site.
133
EX I ST I N G B R I D G EPO I N T E FLO O R P LA N * Note: Floorplan from Reese Design Collaborative from Louisville, KY, who designed Bridgepointe and Best Friends.
134
The existing Bridgepointe floorplan is not to scale. The existing Best Friends floorplan and the new Best Friends floorplan are scaled to compare sizes. This shows that the new Best Friends is twice the size of the existing Best Friends.
EX I S T I N G B EST FR I EN D S FLO O R P LA N
NEW B EST FR I EN D S FLO O R P LA N
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DAYCA R E D ES I G N NEW BEST FRIENDS DAYCARE DESIGN The new Best Friends Adult Daycare Center for people with Alzheimer’s and dementia is twice the size of the existing daycare at 9,500 square feet. The existing daycare can become crowded when there are 20 participants combined with 20 volunteers and staff members. The new Best Friends facility gives the users more room and allows for more people to occupy the space. This is important because the amount of people with dementia is expected to increase every year, so more space is needed to accomodate future participants. DAYCARE LOCATION The new Best Friends is located behind the existing Bridgepointe facility and connects to the new addition of the assisted living memory studios, which are studios for Alzheimer’s and dementia residents. The memory studios connect to Bridgepointe, so these three buildings are all connected and allow access to each through corridors. BEST FRIENDS CLINIC ENTRANCE The new Best Friends design has two entrances - the clinic entrance and the daycare entrance. The clinic entrance is for new families and their loved one with dementia who are interested in sending their loved one to the daycare. It is also available for daycare participants who need to see the nurse. DAYCARE ENTRANCE The daycare entrance was designed to be a simple room that family members can checkin their loved one, and lead them to the entry door of the daycare. The entry door is locked at
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all times and requires either a swipe of a staff member’s ID card, or the reception desk worker can unlock the door. DAYCARE ENTRY When a participant enters the daycare, they will immediately see a “welcome” sign and the theme board on the wall displaying what the theme of the week is. There will be accessories available that match the theme participants can wear or use for fun. A staff member or volunteer will help the participant get ready, place their belongings in the coat closet, and put on their GPS name tag (read about on pg. 162). MUSIC/ACTIVITY AREA The first room the participant will see is the music area. This area was enjoyed most by the participants based on my research study observations. This is because they can remember old song lyrics, and enjoy singing and dancing. Because of this, it was laid out to be the first room participants see to hopefully trigger a sense of comfort, familiarity, and fun. OTHER DAYCARE AREAS The rest of the daycare includes an activity/ crafting area, a kitchen, a dining area, a living room/cozy corner, a small library and a sunroom. All of these spaces are part of an open floorplan so they are easily viewable by the participants, and provide clear sight lines for volunteers and staff. HIDDEN DOORS There are also “hidden doors” within the daycare, meaning they are painted to match the wall color and require an ID bagde to open.
This will eliminate dementia participants from escaping or going into rooms that are for staff. (They are the doors with dotted lines on the floorplan. See on next page).
and thermal insulated glass to reduce solar heat gain to create a more energy efficient building. Solar panel screens would also be used to block any extra glare from the sun.
QUIET/SNOEZELEN ROOM There are also separate rooms behind doors that include a quiet/snoezelen room, which is a therapeutic environment that has reclining furniture, a TV, fish tank, lighting effects, aromas, colors, textures and sounds to deliver high levels of stimuli to help relax agitated participants.
FURNITURE & ACCESSORIES The furniture and accessories that were chosen were aimed to look like retro styles from the 1950’s through the 1970’s, while also meeting the requirements for senior-living facilities.
MEMORY ROOM Another area is the memory room, which is a room set up to mimic the look of a home from a certain decade. This room will be updated every 5 to 10 years to look like a kitchen, dining room and living room from the time period the majority of the participants are familiar with. This one would be from the 1950’s because the majority of the participants were children or teenagers during this time, and this is the time they remember the most. RESTROOMS There are restrooms throughout the daycare that are all ADA compliant. They will be designed to help participants see the toilets and sinks by using contrasting colors and flooring that will help make the toilets and sinks stand out. GLASS WALLS/DOORS The southern side of the daycare has sliding glass windows and doors that allow access to the large patio area. The glass wall (nanawall) can be opened all the way up during the warmer months to allow the natural environment in. The glass walls are made with solar smart glass to help reduce the sun’s glare
COLOR PALETTE The colors chosen for the daycare were bright and more vivid colors because of how the aging eye perceives color. Warmer colors were chosen for the seating because they can still be easily seen by the aging eye. Cooler colors were chosen for some areas, but they are bright and more vivid to increase their visibility for participants. BEST FRIENDS LOGO Since the Best Friends logo is red and teal, these two colors, and a red brick veneer became the main colors of the waiting room and reception areas. The teal color and brick veneer were also used in the daycare to visually connect the two spaces. Bright yellow and yellow-green colors were also chosen as wall colors to highlight certain areas of the daycare to provide wayfinding cues to help participants orient themselves and identify which area they are in. AGING EYE RENDERINGS Each area has a rendering of what the space might look like to the aging eye. To achieve this look, the rendering was dulled with less saturation and a yellow filter was applied to mimic the yellowing eye lens of an aging eye. (Renderings on pages 142-149).
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B EST FR I EN D S FLO O R P LA N
Total square feet: 9,500 Patio square feet: 2,485
COVERED OUTDOOR WALKWAY exit
exit
hallway
corridor leading into assisted living memory studios
QUIET water SNOEZELEN feature neon TV 157
STG. 38
Corridor leads to Assisted Living Memory Studios
lights
DW
sink
235
ADA R.R. 85
food carts
ovens
living
REF. REF. MW. MW.
DINING AREA 420
LIVING/COZY CORNER
sink
CLOSED KITCHEN
fish
planters
fireplace
exit
DW
MW.
ADA sink
REF.
ice
bookshelf ADA
360
counter
OPEN KITCHEN 485
planters
ADA counter
bookshelf chess table
LIBRARY
dotted line =
DINING AREA
bookshelf
945
115
built-in storage
SUNROOM 378
TV
planters
pian
birdcage
COVERED PATIO
outdoor dining
outdoor bench swings
420
outdoor rocking chairs dotted line = roof overhang
UNCOVERED PATIO 665
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NORTHEAST CONFERENCE
FILES & STORAGE 126
TV/ computer
105
CONSULT 115
copier
files
UTILITY & STORAGE
TV/
computer
OFFICE
files files
180
140
built-in storage
exit
MEMORY
ADA R.R. 85
230
old TV
STG.
storage
dining
exam bed
OFFICES
NURSE EXAM
172
140
108
kitchen
CLINIC WAITING & RECEPTION 400
built-in storage
AREA 450
hidden hallway to nurse exam room & staff areas
ADA R.R. 120
water fountains
built-in storage
LOUNGE REF.
STORAGE 275
oven MW
sink
KITCHEN DW
cork board wall
ceiling height change
ADA R.R. 62
built-in storage
ADA R.R. 120
built-in ADA sink storage ACTIVITY
no
B.F. logo sink
participant closet
MUSIC/ACTIVITY AREA 784
theme board dotted line = hidden door
W
Clinic Entrance
256
D
volunteer sink storage LAUNDRY
95
B.F. logo
daycare DAYCARE RECEPTION entry/exit & WAITING check-in desk 292
Daycare Entrance
files
planters
OFFICES
copier
177
nanawall (glass doors)
100 OFFICE
KEY outdoor living room
COVERED PATIO 1,400
tables
STAFF/VOLUNTEER AREAS ALL USER AREAS
ALZHEIMER’S & DEMENTIA PARTICIPANT AREAS * Square footage of each area is underneath each room label
COVERED DROP OFF AREA
5’ ADA Turning Circle Hidden Door (dotted line) Roof or Ceiling change (dotted line)
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B EST FR I EN D S FLO O R P LA N ZO N ES
Corridor leads to Assisted Living Memory Studios
140
NORTHEAST
Clinic Entrance
Daycare Entrance
KEY Staff/Volunteer Areas
All User Areas
Alzheimer’s & Dementia Participant areas
Outdoor Areas
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B EST FR I EN D S R EC EPT I O N & WA I T I N G RO O M S
1
2 142
3 CLINIC ENTRANCE The clinic waiting room has a coffee bar, along with refreshments and healthy snacks for families and patients to enjoy while waiting. Families can also create an i-Remember™ profile for their loved one with dementia by using the iPad’s attached to the side of the reception desk.
4 AGING EYE This rendering shows how the colors might appear to the aging eye. The colors are less saturated and a yellow filter was applied to show how the lens of the aging eye starts to yellow as one ages.
1 CLINIC ENTRANCE The clinic entrance was designed for new families who are interested in bringing their loved one with dementia to the daycare. New families and their loved one will come to the clinic for a consultation about Best Friends, and will also be examined by the nurse. Best Friends Daycare participants will come to the clinic when they need to see the nurse for check-ups. Families will also be able to meet with the nurse or Best Friends staff to talk about the progress of their loved one in the conference or consultation room if needed. * Design elements: The Best Friends logo is a dark red and teal color, which informed the color palette and design for this space. The brick was chosen because of the red color and for the “homey” feeling it provides.
2 DAYCARE ENTRANCE The daycare entrance was designed for families to drop off their loved one with dementia who is a participant at the daycare. The waiting room and reception desk are small in this area because the family member will only be signing in their loved one and a staff member will then scan their ID or unlock the “entry” door to let them into the daycare. * Design elements: The reception desk and waiting room design mimic the clinic entrance color palette to compliment the Best Friends logo and connect the two spaces.
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B EST FR I EN D S EN T R A N C E & M U S I C & ACT I V I TY A R EAS
1
2
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3 ACTIVITY AREA The Activity Area is for participants to create artwork and crafts.
* Design elements: Yellow was used to stimulate happiness and creativity.
* Craft materials are in clear containers to encourage participants to use.
3 ACTIVITY AREA * The tables and chairs can be arranged to accommodate the number of participants. * There is a cork wall around the right corner to hang artwork. * The Restrooms and water fountain are teal and labeled to provide wayfinding cues for participants.
4 AGING EYE This rendering shows how the colors might appear to the aging eye. The colors are less saturated and a yellow filter was applied to show how the lens of an aging eye starts to yellow as one ages.
1 ENTRANCE VIEW INTO DAYCARE
2 MUSIC AREA
The entry door to Best Friends is hidden behind the wall that has records on it. It is hidden because it causes problems with participants who crowd around the door waiting for their loved one or try to escape. Once the participant turns the corner they will immediately see the music area.
Based on my research study observations, participants enjoy the Music Area the most. The music helps them remember lyrics to songs and encourages them to dance. Singing, dancing and listening to music brings staff, volunteers and participants all together, and is incorporated into the daycare program every afternoon.
* Design elements: Participants will see all of the bright colors and different areas when they enter into the space. This will help them feel as if they are in a fun environment rather than an institution. They will see the music area first, which will have a piano and old-time music memorabilia to help trigger memories.
* Design elements: Yellow and teal were chosen to create a happy and energetic environment. There are old records on the wall and pictures of singers and dancers from 1920â&#x20AC;&#x2122;s flappers to Michael Jackson in the 80â&#x20AC;&#x2122;s. There is a piano for participants to play, and the glass doors (nanawall) can be opened during the warmer months 145to extend the dance space onto the patio.
B EST FR I EN D S K I TC H EN & D I N I N G 1 KITCHEN The Open Kitchen was designed for participants, staff and volunteers to use to help prep small meals and snacks.
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The kitchen counter height meets ADA requirements so a person with a wheelchair can help prep meals and sit comfortably at the counter.
4 AGING EYE This rendering shows how the colors might appear to the aging eye. The colors are less saturated and a yellow filter was applied to show how the lens of an aging eye starts to yellow as one ages.
2 KITCHEN A large dining table is next to the kitchen, and is connected to the living room to create a more homelike feel. Smaller round tables and chairs are also next to the kitchen for dining. * Design elements: An orange-red fabric was chosen to stimulate appetite and is complimented with a bright yellow-green color, which is associated with health. The green and red combination make the kitchen and dining area distinct from the other areas to help orient participants. The areas are also labeled as “Kitchen” and “Best Friends Diner” to provide wayfinding cues that will help participants identify the areas.
3 DINING AREA The dining area tables are round and separated instead of being all pushed together as one long table. This helps create a more personal dining experience that is less institutional. This was a suggestion made by many volunteers and staff during the focus group discussions. * Design elements: The dining area colors and furniture were also chosen also to mimic the colors and styles of a 1970’s kitchen. The chairs were chosen to differentiate the area and to provide a more home-like feeling. The glass doors (nanawall) can be opened during the warmer months to extend the dining area onto the patio where other outdoor dining tables are located.
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AGING EYE 4
B EST FR I EN D S S U N RO O M & C OZY C O R N ER
1 3
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This rendering shows how the colors might appear to the aging eye. The colors are less saturated and a yellow filter was applied to show how the lens of an aging eye starts to yellow as one ages.
3
1 SUNROOM
2 LIVING ROOM/COZY CORNER
The sunroom was designed to allow as much natural light into the space as possible. There are glass doors (nanawall) that can open all the way to expand this area to the outside during the warmer months.
The living room/cozy corner was designed for participants, volunteers and staff to comfortably gather in to relax or to enjoy one another’s company.
* Design elements: A yellow-green color was chosen to mimic the greens found in nature. Teal furniture was chosen to mimic the bright colored retro furniture of the 1960’s and 1970’s. Other teal accents were chosen to connect this area with the living room color. Indoor plants are hanging all over the sunroom to help bring the natural environment inside. There is also a bird cage in the corner, which will give the feeling of being outside by hearing birds chirp.
* Design elements: The furniture and accessories mimic the retro style of the 1960’s and 1970’s. The teal color and brick fireplace finish were chosen to connect the space to the waiting room finishes and Best Friends logo colors. The room is also labeled as the “Best Friends Cozy Corner” to help participants identify the area.
3 LIBRARY The library is between the sunroom and living room. * Design elements: There are bookshelves filled with books, games, and other objects participants can interact with. There is also a small table with a chess game and two chairs.
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M AT E R I A LS FABRICS
Manufactuer: Maharam Name: Fluent Crypton Model #: 4466073–018 Patch Application: Dining Chair Backs
Manufactuer: Maharam Name: Pitch- Vinyl Model #: 466186–022 Brick Application: Dining Chair Seat
Manufactuer: Maharam Name: Fluent Crypton Model #: 466073–011 Ash Application: Living/Comfy Corner Sofa & Armchairs
Manufactuer: ArcCom Name: Buttercup #4 Type II Vinyl Model #: ACW-52024 Application: Activity Chair Backs
Manufactuer: Maharam Name: Micro - Vinyl Model #: 466099–013 Zest Application: Activity Chair Seats
Manufactuer: Crypton Name: Bella Chive Model #: Bella Application: Sunroom Sectional Sofa
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Manufactuer: ArcCom Name: Caribbean #11 Polyurethane Model #: 11 AC-62490 Application: Chess Chairs
Manufactuer: Maharam Name: Fluent Crypton Model #: 466073–019 Bounce Application: Waiting/ Reception Chairs & Sofas
*Note: These are not all of the materials used in the daycare, but they are the main finishes.
Manufactuer: Armstrong Name: Woodworks Linear Acoustical Ceiling Model #: 6660W1 Natural Variations Oak Application: Ceiling in Dining, Music, Living & Sunroom
CEILINGS
FLOORING
Manufactuer: Armstrong Name: ULTIMA Lay-In& Tegular Acoustical Ceiling Tiles Model #: 1900 - White Application: Ceiling in all Areas of Daycare
Manufactuer: Armstrong Name: Fruitwood Natural Model #: TP071 - LVT Application: Main Flooring Material
COUNTERTOPS
Manufactuer: Wilsonart Name: Leche Vesta Model #: 4987 Application: Waiting/ Reception & Office countertops
Manufactuer: Formica Name: Jamocha Granite Model #: 7734 Application: Open Kitchen
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M AT E R I A LS PAINTS & WALL FINISHES
Manufactuer: Porter Paints Name: Commercial White Model #: PPG1025-1 Application: Main Wall Color for all Areas
Manufactuer: Porter Paints Name: Montego Bay Model #: PPG1233-6 Application: Living/Comfy Corner, Music Area
Manufactuer: Porter Paints Name: Citrus Punch Model #: PPG112-5 Application: Activity Area
Manufactuer: Porter Paints Name: Funky Frog Model #: PPG1221-7 Application: Open Kitchen and Dining
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Manufactuer: n/a Name: Brick Veneer Model #: n/a Application: Waiting/Reception Areas, Daycare area: Kitchen, Window/Door Wall, Fireplace
*Note: These are not all of the materials used in the daycare, but they are the main finishes.
CABINETS & BUILT-INS
Manufactuer: Formica Name: Mission White Model #: 933 Application: Open Kitchen Cabs
Manufactuer: Formica Name: Oxidized Beamwood Model #: 9484 Application: Waiting/ Reception & Office Built-in’s
Manufactuer: Formica Name: Planked Urban Oak Model #: 9312 Application: Open Kitchen Cabs & Built-in’s
WINDOWS/GLASS WALL
Manufactuer: Formica Name: Caribbean Model #: 4172 Application: Clinic Waiting/Reception
Manufactuer: Nanawall Name: Aluminum Framed Doors Model #: SL45 Application: Dining area, music area and sunroom glass walls * Made with anti-glare “smart” glass and thermal performace glass.
Manufactuer: Insolroll Elements Name: Crete Solar Screen Fabric Model #: Linen Application: Along the Nanwall (windows/doors) & living room windows * 30% Polyester, 70% PVC * UV blockage: 92% * Openess to light: 8% * (Not shown in renderings) 153
FURNITURE INDOOR CHAIRS
Manufactuer: Kwalu Name: Levanzo Dining Chair Model #: LE112 Midnight Oak Finish Room Location: Music, Activity & Dining
Manufactuer: Kwalu Name: Carrara Bariatric Model #: CRB112J0 Midnight Oak Finish Room Location: Music and Activity 154
Manufactuer: Kwalu Name: Camarina Dining Model #: CAM1 Room Location: Dining
Manufactuer: Kwalu Name: Carrara Pull-Out Sleepover â&#x20AC;&#x201C; Single Model #: CRBCB Room Location: Quiet/Snoezelen
Manufactuer: Kwalu Name: Volterra Lounge Model #: VOL1B1 Room Location: Living/Comfy Corner
*Note: These are not all of the furnishings used in the daycare, but they are the main pieces of furniture. Also, furniture may slightly diï¬&#x20AC;er in renderings depending on what was available in the SketchUp Library.
INDOOR SOFAS & CHAIRS
Manufactuer: Herman Miller Name: Swoop Plywood Lounge Chair Model #: OA200- OU-MS Room Location: Waiting/Reception Areas
Manufactuer: Kwalu Name: Volterra Sofa Model #: VOL3B1 Room Location: Living/Comfy Corner
Manufactuer: Kwalu Name: Volterra Love Seat Model #: VOL2B1 Room Location: Waiting/Reception Areas
Manufactuer: Thomasville Name: Mercer Sectional Model #: 1803 SECT Room Location: Sunroom 155
FURNITURE INDOOR TABLES
Manufactuer: Kwalu Name: Lumio Base Medium Model #: LUM113 Espresso Finish w/square table Blackwood Finish w/round table Room Location: Music, Activity & Dining
Manufactuer: Kwalu Name: Table Legs Country Model #: 3075FR Espresso Finish w/rect. table Room Location: Dining
Manufactuer: Kwalu Name: Table Tops Rectangle Model #: D136RWAS Midnight Wild Oak Finish Room Location: Dining
Manufactuer: Kwalu Name: Table Tops Square Model #: D14848BUS Espresso Finish Room Location: Activity
Manufactuer: Kwalu Name: Table Tops Round Model #: D136RWAS Midnight Wild Oak Finish Room Location: Dining 156
*Note: These are not all of the furnishings used in the daycare, but they are the main pieces of furniture. Also, furniture may slightly diï¬&#x20AC;er in renderings depending on what was available in the SketchUp Library.
OUTDOOR FURNITURE
Manufactuer: Kwalu Name: Arezzo Lounge Chair Model #: AREL1 Room Location: Patio
Manufactuer: Kwalu Name: Arezzo Lounge Love Seat Model #: AREL2 Room Location: Patio
Manufactuer: Kwalu Name: Arezzo Rocker Chair Model #: ARER0 Room Location: Patio
Manufactuer: Kwalu Name: Arezzo Glider Chair Model #: AREG1 Room Location: Patio
Manufactuer: Kwalu Name: Arezzo Glider Love Seat Model #: AREG2 Room Location: Patio 157
P RO D U CT DESIGN
PRODUCT DESIGN Product design includes “material objects that we physically interact with, and these interactions are constrained by our sensory and bodily characteristics” (Rompay & Ludden, 2015, p. 2).
Our world is consumed with products everywhere. A chair, a blanket, an iPhone, a toothbrush, a car, Facebook, Netflix, the Internet – all of these things are products. The only thing that is not a product is nature. Humans form relationships with products. Designers can use these relationships to inspire future product designs (Rompay & Ludden, 2015). For example, a user can form a unique and meaningful relationship with a product based on many things - how it makes the person feel, the material or texture it is made of, how one interacts with it, what it is used for, along with many other reasons (Rompay & Ludden, 2015). There are five types of embodiment in product design. Embodiment is a term that is used to represent an idea or feeling that is associated with human experiences. The five types are: anthropomorphism, familiarity and literal resemblances, relational properties, meaningful sensorial experiences, and product movement and action (Rompay & Ludden, 2015).
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By using embodiment and empathizing with the product’s end-user, designers can acheive succesful product designs. EMPATHY
and it can be applied to any problem, not just a design problem. It is about believing in, and making a positive difference in the world through designing new and innovative solutions (IDEO, LLC., 2012).
Empathy “reflects the natural ability to perceive and be sensitive to the emotional states of others, coupled with a motivation to care for their well-being” (Decety, Bartal, Uzefovsky, Knafo-Noam, 2016, p. 1). It is a complex cognitive ability that allows one to be able to put the perspective of another person in mind in order to understand and feel what the person thinks and feels (Decety et al., 2016).
Tim Brown, president and CEO of IDEO explains, “Design Thinking is a human-centered approach to innovation that draws from the designer's toolkit to integrate the needs of people, the possibilities of technology, and the requirements for business success” (IDEO, 2016).
It is crucial for designers to understand the users they are designing for. Whether it is an environment or product, designers need to understand the needs of the people who will be using it in order for it to be a successful design. Empathy is also the first step in the Design Thinking Process, which is a process many product designers use (IDEO, LLC., 2012)
DESIGN THINKING Design Thinking is a human-centered methodology, meaning it is allencompassing in its approach to understand human needs and behavior (IDEO, LLC., 2012). The creators and founders of the design firm IDEO, David Kelly and Tim Brown, developed the Design Thinking Process,
Using the design thinking approach can benefit designers, and can help organizations develop successful products, services, processes, and strategies (IDEO, 2016). THE 5 STEPS OF DESIGN THINKING: 1. Empathy: empathize with the user to understand and feel what their needs are. 2. Define: define the problem or challenge that needs to be solved. 3. Ideate: brainstorm and come up with ideas to solve the problem. 4. Protot yp e: create a model of the design solution. 5. Te st:test out the prototype with user to see what works and what does not work. Repeat all steps again until a successful design is acheived for the end-user (Brown, 2008).
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i-REMEMBER™ ORIGINAL IDEA
i-REMEMBER™ SOCIAL NETWORK
i-Remember™ is an idea that started in a product design class. Originally, the idea was to invent an app that would help people with Alzhiemer’s disease remember their life story through familiar photos and songs. The goal was to help trigger memories for people with Alzheimer’s disease. An additional idea was to design a gripper handle-like case that would go around a tablet or iPad. The goal was to help older adults who have a decline in motor functioning skills fully grasp the device with comfort and ease.
i-Remember™ is a website and app that healthcare facilities and providers will have for families, caregivers and healthcare staff to use while caring for a person with Alzheimer’s or dementia.
After completing the product design class, I was recruited to join the Venture Studio Bootcamp for Entreprenuers at UK for my idea. In the bootcamp, I learned how to create a business model and plan, how to start a business, how to pitch an idea to investors, and competed in competitions. During the Venture Studio, the idea for i-Remember™ began to change, but the goal was still the same - to help those with dementia and Alzheimer’s disease remember their life story. After researching other products similar to i-Remember™, and empathizing with dementia patients, the idea expanded into something bigger...
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There are two different operating versions for i-Remember™ – the family version and the healthcare version. The family version will allow family members to create a personal profile account for their loved one with Alzheimer’s or dementia. There will be different features that will help family members trigger memories for their loved one with Alzheimer’s or dementia. Through the healthcare version, caregivers and staff will be able to see patient profiles, and can utilize their patients’ personal profile information to help them form better relationships while caring for their patients. Caregivers and staff will also have the option to communicate with family through the website and app. Premium features will also be added to expand i-Remember™ in the future. One of the premium features includes a GPS tracking device that dementia patients will wear (read about on next page.)
Images of orginal i-Remember™ idea
™
Images of social network for i-Remember™
KATHLEEN OSBORNE “KAY”
LIFE FACTS
LIFE STORY
GAMES
PLAYLIST
ABOUT KAY
Birthday: October 15, 1936 - 80 yrs Occupation: Beautician Loves: flowers, sewing, church events, seeing grandchildren, and Moose Club
PHOTOS
i-Remember
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G PS D EV I C E FO R PA RT I C I PA N TS The idea is that families of the Best Friends daycare participants will set up a profile account using i-Remember™ before their loved one attends the facility. One of the premium features is the GPS tracking device. The GPS tracking device that dementia patients will wear is a name tag that will sync to their i-Remember™ profile. Currently at Best Friends, the dementia participants, staff members, and volunteers wear a name tag. This GPS name tag will allow family members, volunteers, and staff to locate their loved one or dementia participant at all times by using i-Remember™. In addition, anyone with the app can scan a barcode on the nametag, and it will bring up the participant’s name and picture on their i-Remember™ profile. The name tag also has other features that are explained on the next page.
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Image 34: Lanyard
V I C E F O R V I L L AG E
* Beth Elizabeth Baker
* Beth Elizabeth Baker
Likes baking sweets, knitting and reading. Loves her necklace with her daughterâ&#x20AC;&#x2122;s baby picture. Was a pediatric nurse.
Likes baking sweets, knitting and reading. Loves her necklace with her daughterâ&#x20AC;&#x2122;s baby picture. Was a pediatric nurse.
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G PS N A M E TAG The ID nametag will have a 10mm x 3.8 mm GPS nano tracking chip on the inside. The nametag is an ID card Alzheimer’s and dementia daycare participants and senior residents will wear. It has many functions - GPS tracking only being one of them. The card will have the participant’s nickname, full name, likes, fun fact information, occupation, safety dots, an emergency contact number, and barcodes to scan.
CARD DIMENSIONS: 2.125 in Height 3.370 in Length 4 mm Thick
G PS D EV I C E FO R V I LLAG E
Nickname Full Name
GPS nano tracking chip inside card.
Likes, Fun fact and Occupation
The Best FriendsTM Approach Logo
Barecode that connects to i-RememberTM profile. Scan using smart phone app. Safety Dots. Each color has a meaning indicating the participant’s needs.
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Needs help walking
Has wheelchair, walker or cane
Needs help in restroom
Has medical condition
Needs help eating
Wanderer
Extreme hearing or vision loss
Needs 24/7 care
1
FRONT
* Beth Elizabeth Baker Likes baking sweets, knitting and reading. Loves her necklace with her daughterâ&#x20AC;&#x2122;s baby picture. Was a pediatric nurse.
BACK
Daycare Participant
Unique barcode for each participant that care staff can scan for certain purposes at the daycare and village
Scan ID code to bring up i-Remember profile or call (859) 555-1234 if found
ID #10698223
ID Number given to participant
Issued by The Best Friends TM Institute 08/2017
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H OW I T A LL C O N N ECTS INDIVIDUAL WITH ALZHEIMER’S Figure 5 shows how the individual is encompassed by all three environments social, physical and natural. This diagram stems off of the conceptual framework and starts with the individual in the purple circle who has Alzheimer’s disease or dementia. SOCIAL ENVIRONMENT This individual is surrounded by his or her social environment (orange), in which he or she interacts with and receives care from. This includes the family, friends, caregivers, volunteers, care staff, Alzheimer’s participants (patients), and other visitors at the dementia daycare and dementia village. PHYSICAL ENVIRONMENT Surrounding the individual and his or her social environment is the physical environment (teal). This includes all of the buildings and structures that make up the built environment. It involves the design, function, comfort, efficiency, accessibility, care, nature, and outdoor gardens that are a part of the senior assisted living facility (Bridgepointe), the Dementia-Friendly Community Village, the new memory assisted living studios, and the new Best Friends daycare center.
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NATURAL ENVIRONMENT Surrounding the individual’s social and physical environment is the natural environment (green) that encompasses all of the buildings and structures that are a part of the dementia village. This includes the courtyards and gardens that make up the inside of the village, and the land that surrounds the outside of the village. TECHNOLOGY The dotted lines represent the technology that virtually connects everything together. This includes i-Remember™ and the GPS tracking name tags that all participants will wear that will allow staff and family to track their location throughout the village. HOLISTIC DESIGN This diagram demonstrates how the design concept - “combining the physical, social, and natural environments to design one holistic environment that will improve the care, health, well-being, and quality of life for people with Alzheimer’s disease and dementia” - was achieved. These three environments combined with technology, create one holistic design that will hopefully improve the care, health, well-being, and quality of life for people with Alzheimer’s disease or dementia.
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Figure 5. “How it all Connects”
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R EFLECT I O N Throughout this experience, I have learned that being able to empathize with the user I am designing for is the key to creating a successful design. Being able to observe, interact with, and form relationships with the Alzheimer’s and dementia participants at Best Friends helped me to understand the disease as best as I could - given the circumstances that I cannot truly feel what it is like to experience dementia. However, I did learn more than I ever could about Alzheimer’s disease and dementia by interacting with the people who have it, than from reading articles or listening to professionals talk about the disease. Also, being able to integrate the graduate classes I took, both inside the School of Interiors and outside of the school, helped guide the design process for this project. Everything began to connect to create one holistic design that I hope will influence the lives of others dealing with a loved one who has Alzheimer’s disease or dementia.
Most importantly, I learned that good design takes time, dedication, empathy, and passion. After completing my project, there are things I would change, and suggestions I was given to help better the design. Those include: + Having more circulation space to allow wheelchairs, walkers and other assistive devices to navigate around in. + Using either a different color wood flooring, or a brighter yellow chair fabric to provide more contrast between the chairs and floor 168
to make the chair is more visible to dementia participants with aging eyes. + Add another room for dementia participants to relax and take naps in if needed. + Choosing a different sectional sofa for the sunroom, or adding portable armrests to help provide support for dementia participants when manuvering up or down from the sofa. + Adding a medication feature to i-Remember™ for caregivers and healthcare
professionals to keep track of medications for dementia participants. CONCLUSION There are currently over 46 million people living with some form of dementia worldwide, and this number will double in size every 20 years (Prince, 2015). This is because the baby boomer population is entering into older adulthood, and the longevity of life is increasing, allowing people to live longer with dementia (Alzheimer’s, 2015). Because there is no cure or successful treatment, designers need to create environments that help improve the behavior, cognition, function, well-being, social abilities, orientation, care outcomes, and quality of life for families, caregivers, and people with Alzhimer’s disease or dementia (Marquardt, Bueter, & Motzek, 2014). Therefore, architects, designers, and healthcare professionals should start designing to help improve the care, health, well-being, and quality of life for all people affected by Alzheimer’s disease or dementia.
A special Thank You to my committee chair, Lindsey Fay, who dedicated her time and guidance throughout this entire project, and to the rest of my committee in the School of Interiors at the University of Kentucky.
A very special Thank You to the staff, volunteers, and participants at Best Friends Adult Daycare Center for People with Alzheimerâ&#x20AC;&#x2122;s and Dementia. Words cannot express how thankful I am for your generosity and ability to welcome me into your community. Everyone I spoke with provided tremendous support and valuable feedback throughout this project. Without the caring people at Best Friends, this project would not have been possible. Thank you again.
- Marissa Wilson
Masterâ&#x20AC;&#x2122;s Project Author
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+ REFERENCES
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R EFER EN C ES Adams, R. (2015). Planned Expansion at Miami Jewish Health Systems will Cater to Needs of Dementia Patients. Retrieved from https:// miamijewishhealthsystems.org/news/planned-expansion-at-miami-jewish-health-systems-will-caterto-needs-of-dementia-patients/ Alzheimer’s, A. (2015). 2015 Alzheimer’s disease facts and figures. Alzheimer’s & dementia: The Journal of the Alzheimer’s Association, 11(3), 332. Alzheimer’s, A. (2016). 2016 Alzheimer’s disease facts and figures. Alzheimer’s & dementia: The Journal of the Alzheimer’s Association, 12(4). Balode, L. (2013). The design guidelines for therapeutic sensory gardens. Landscape Architecture, 2, 114-119. Breslow, L. (Ed.). (2012). Encyclopedia of Public Health: SZ (Vol. 4). MacMillan Reference Library, 1-112. Brown, T., (2008). Design thinking. Harvard Business Review, 84-96. Calkins, M. (2001). The physical and social environment of the person with Alzheimer’s disease. Aging & Mental Health, 5(1), 74-78. Chenoweth, L., King, M., Jeon, Y., Brodaty, H., Stein-Parbury, J., Norman, R., & Luscombe, G. (2009). Caring for aged dementia care resident study (CADRES) of person-centred care, dementia-care mapping, and usual care in dementia: A cluster-randomised trial. The Lancet Neurology, 8, 317-325 CNN’s World’s Untold Stories: Dementia Village. (2013, July 30). Retrieved from https://www.youtube. com/watch?v=LwiOBlyWpko Connellan, K., Gaardboe, M., Riggs, D., Due, C., Reinschmidt, A., & Mustillo, L. (2013). Stressed spaces: Mental health and architecture. Health Environments Research & Design Journal, 6(4), 127-168. 172
Crandell, T. L., Crandell, C. H., & James, V. Z. (2012). Human development. New York: McGraw-Hill Decety J, Bartal IB-A, Uzefovsky F, Knafo-Noam A. 2016 Empathy as a driver of prosocial behaviour: Highly conserved neurobehavioural mechanisms across species. Phil. Trans. R. Soc. B371 :20150077. http://dx.doi.org/10.1098/rstb.2015.0077 Halsall, B., & MacDonald, R., Dr. (2015). Design for Dementia . Volume 1 - Design for Dementia - A Guide with helpful guidance in the design of exterior and interior environments., 1, 1-120. HRQOL Concepts. (2011, March 17). Retrieved from http://www.cdc.gov/hrqol/concept.htm Hurley, D. (2012). ‘Village of the Demented’ draws praise as a new care model. Neurology Today, 12-13 IDEO, LLC., 2012. All rights reserved. http://designthinkingforeducators.com/ IDEO (2016). About | IDEO. Retrieved from https:// www.ideo.com/about Lawton, M. (2001). The physical environment of the person with Alzheimer’s disease. Aging & Mental Health, 5(1), 56-64 Marquardt, G. (2011). Wayfinding for people with dementia: A review of the role of architectural design. Health Environments Research & Design Journal, 4(2), 75-90. Marquardt, G., Bueter, K., & Motzek, T. (2014). Impact of the design of the built environment on people with dementia: An evidence-based review. Health Environments Research & Design Journal, 8(1), 127-157. Morgan, D., & Stewart, N. (1997). The importance of the social environment in dementia care. Western Journal of Nursing Research, 19(6), 740-761. Natural environment. (2017). Retrieved from https:// en.wikipedia.org/wiki/Natural_environment Olinger, M. (2012). Making a difference: Resident-focused models for memory care facilities. Journal of Interior Design, 37(3), V-Xii.
Physical Environment. (2003). Retrieved from http:// socialreport.msd.govt.nz/2003/physical-environment/ physical-environment.shtml Pongan, E., Freulon, M., Delphin-Combe, F., Dibie-Racoupeau, F., Martin-Gaujard, G., Federico, D., & Rouch, I. (2014). Initial and long-term evaluation of patients with Alzheimer’s after hospitalization in cognitive and behavioural units: The EVITAL study design. BMC Psychiatry, 14(308), 1-6. Pot, Anne Margriet. (2013). Improving nursing home care for dementia: Is the environment the answer? Aging & Mental Health, 17(7), 785-787. Prince, M., Wimo, A., Guerchet, M., Dr., Ali, M., Wu, Y., Dr., Prina, M., Dr., & A. (2015). World Alzheimer Report 2015 The Global Impact of Dementia An Analysis of Prevalence, Incidence, cost and trends, (pp. 1-88, Rep.). London, England: Published by Alzheimer’s Disease International (ADI).
Satariano, W. (2006). Aging, Health, and the Environment: An Ecological Model. In Epidemiology of Aging: An Ecological Approach (pp. 39-84). Sudbury, MA: Jones and Bartlett , Inc. Social environment. (2017). Retrieved from http:// www.dictionary.com/browse/social-environment?s=ts Tabbarah, M., and Seeman, T. (2005). Successful cognitive and physical aging. Neurocognitive disorders in aging. Thousand Oaks, CA: Sage Publications. The Best Friends™ Approach. (2016). Retrieved from http://www.bridgepointeassistedcare.com/about-us/ best-friends-approach Vittone, T. (2016). Dementia Care Built Into Canada’s Georgian Bay Retirement Home. Retrieved from http://www.crisisprevention.com/Blog/July-2015/Cutting-Edge-Dementia-Care-Built-Into-Canada-s-Geo
FI G U R E R EFER EN C ES Figure 1: “Ecological model from The U.S. Department of Health and Human Services.” Satariano, W. (2006). Aging, Health, and the Environment: An Ecological Model. In Epidemiology of Aging: An Ecological Approach (pp. 39-84). Sudbury, MA: Jones and Bartlett , Inc. Figure 2: “Ecological model from researchers, M. Powell Lawton and Lucille Nahemow’s Environmental Press-Competence Model.”
Figure 3: “ Conceptual Framework” Made by author Figure 4: “Color Perception of the Aging Eye” Halsall, B., & MacDonald, R., Dr. (2015). Design for Dementia . Volume 1 - Design for Dementia - A Guide with helpful guidance in the design of exterior and interior environments., 1, 1-120. Figure 5: “ How it all Connects” Made by author
Satariano, W. (2006). Aging, Health, and the Environment: An Ecological Model. In Epidemiology of Aging: An Ecological Approach (pp. 39-84). Sudbury, MA: Jones and Bartlett , Inc. 173
I M AG E R EFER EN C ES
* Note: Image captions with no number are original images taken by the author.
Image 1: https://www.google.com/ search?q=alzheimer%27s+disease&source=lnms&tbm=isch&sa=X&ved=0ahUKEwiqsdnMzOLQAhUK42MKHfdECFoQ_AUICSgC&biw=1319&bih=723&dpr=0.8#q=elderly+people+with+dementia&tbs=islt:xga,itp:photo,isz:l&tbm=isch&imgrc=xRithg3IwjWmYM%3A
Image 6: https://www.google.com/ search?q=universal+design&source=lnms&tbm=isch&sa=X&ved=0ahUKEwi4k9Hvm-XQAhVK-GMKHQ4eBCUQ_AUICCgB&biw=1319&bih=723&dpr=0.8#tbs=isz:l%2Citp:photo&tbm=isch&q=dementia+brain&imgrc=8saOTpI5q7VEBM%3A
Image 2: http://www.catholiclane.com/five-thingsmy-mother-and-daughter-taught-me-about-caringfor-people-with-dementia/
Image 7: http://scholar.uwindsor.ca/cgi/viewcontent.cgi?article=1188&context=uwilldiscover
Image 3: https://www.google.com/ search?q=alzheimer%27s+disease&source=lnms&tbm=isch&sa=X&ved=0ahUKEwiqsdnMzOLQAhUK42MKHfdECFoQ_AUICSgC&biw=1319&bih=723&dpr=0.8#q=elderly+people+with+dementia&tbs=islt:xga,itp:photo,isz:l&tbm=isch&imgrc=csQ6TXd9NKwKWM%3A
Image 8: http://www.safehandsliveincare.co.uk/dementia-live-in-care/ Image 9: http://www.faulknerdesign.com/solana. php Image 10: https://www.pinterest.com/sheilaspins888/garden-the-enabled-garden/
Image 4: http://literature-essays.com/how-to-do-aliterature-review/
Image 11: https://jyldyzai.wordpress.com/assignment-2/tips-for-designing-the-sensory-garden/
Image 5: https://www.google.com/ url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwiI376yzIPRAhUk_4MKHbmSBcoQjRwIBw&url=http%3A%2F%2Fwww.elveflow. com%2Fhuman-ageing-longevity-and-life-span%2Fbiological-causes-of-aging-and-lifespan-limitation%2F&psig=AFQjCNH6e7uYG_CF9cERdzxfgF75_Hu1cQ&ust=1482351648476558
Image 12: https://www.apollocreative.co.uk/portfolio-items/sensory-garden-corner-of-the-world/
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Image 13: http://www.thesolarplanner.com/array_ placement3.html Image 14: https://www.google.com/ search?q=senior+living&source=lnms&tbm=isch&sa=X&ved=0ahUKEwiZmunlnd7SAhUC2BoKHXNjDf4Q_AUICCgD&biw=1390&bih=775#tbm=isch&q=senior+assisted+living+interior+design+&*&imgrc=kspF9CIISba9gM:
Image 15: http://www.digitalflaneur.co.uk/pn132-Dementia-Villages Images 16-22: http://hogeweyk.dementiavillage.com/en/ Images 23-25: http://www.aplaceformom.com/ blog/7-2-15-canadian-dementia-village/ Image 26: http://www.healthpropress.com/product/ the-best-friends-approach-institute-for-master-trainer-certification/ Image 27: https://www.amazon.com/Dignified-Life-Approach-Alzheimers-Caregivers/dp/075730060X Images 28 - 33: https://www.google.com/maps/ place/Bridgepointe+at+Ashgrove+Woods/@3 7.9536073,-84.529843,2795m/data=!3m1!1e3 !4m13!1m7!3m6!1s0x88425bf63c883ebb:0xf9afc39952df194!2s5220+Grey+Oak+Ln,+Nicholasvill e,+KY+40356!3b1!8m2!3d37.9499894!4d-84.5215233!3m4!1s0x88425bf5970b4643:0x72c51f8a80ee7412!8m2! 3d37.9536073!4d-84.5210883 Image 34: https://www.badgeexpress.com/3-4-Flat-Lanyard-with-Swivel-Hook-p/nfw-9s.htm Image 34: https://www.badgeexpress.com/3-4-Flat-Lanyard-with-Swivel-Hook-p/nfw-9s.htm
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I C O N R EFER EN C ES
ICON 1. Created by Mattia Lomnardini from Noun Project
ICON 4. Created by Milton Rapose C Rego Jr. from Noun Project
ICON 7. Created by Aaron Bacon from Noun Project
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ICON 2. Created by Bohdan Durmich from Noun Project
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ICON 8. N/A
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ICON 15. Free icon from Noun Project
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THE END. See more of Marissaâ&#x20AC;&#x2122;s work at: marissalwilson16.wixsite.com/mwdesign issuu.com/marissawilson instagram: marissawilson_design
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A Masterâ&#x20AC;&#x2122;s Project by Marissa Wilson University of Kentucky | College of Design School of Interiors | 2015 - 2017
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