Alzheimer’s Main Title Landscape 2030
Introduction
(by Henri Snel)
The future prospects for Alzheimer’s disease looks bleak. In Western European countries, there is much research into the origin to the disease, but there is very little progress. At the same time the number of cases dramatically increase. The cause of aging is therewith. There is proportionally much less research on the present and future living conditions than the onset of Alzheimer’s disease. In addition, the current health and socio-economically are under strong pressure. What will be the life of an Alzheimer’s patient admitted to a nursing home about 20 years from now? With this research we would like to contribute to the discussion of the disease in general and generate a possible solution for improving the living situation and residence of Alzheimer patients in the future. The aim of the design assignment for the health care sector is to provide insights into accommodation facilities for this specific health care sector: an Alzheimer institutions, taking into account the various types of provisions, requirements, issues and legislation relating to health care, as well as the various building typologies and associated requirements, so that these insights can be translated into a design.
Alzheimer’s brain
Alzheimer’s brain. Computer processed vertical (coronal) slice through the brain of an Alzheimer patient (at left) compared with a normal brain (at right). The Alzheimer’s disease brain (brown) is considerably shrunken, due to the degeneration and death of nerve cells. Apart from a decrease in brain volume, the surface of the brain is often more deeply folded. Tangled protein filaments (neurofibrillary tangles) occur within nerve cells and patients also develop brain lesions of beta-amyloid protein. Alzheimer’s disease accounts for most cases of senile dementia. Symptoms include memory loss, disorientation, personality change and delusion. It ultimately leads to death.
The themes covered relate to changing demographics, where the increasing numbers of elderly people also means an increase in the number of dementia. The growing multicultural society also makes other demands on the design of health care institutions. The design concept is also influenced by changing perspectives on the way Alzheimer patients in need of care are dealt with, which frequently involves long-term hospitalisation and residential until the final phase of their lives. Prevailing attitudes frequently generate demand for other types of treatment, which has an immediate impact on the design of the interior and exterior of health care institutes. How do you translate the sometimes conflicting interests of the care provider and the patient into a sustainable and wholesome design?
Global Cost of Dementia Main Title Cpp: $868
$USD Billions
Cpp: $3,109 Cpp: $6,827
1200 Informal Care 42%
1000
high income 89% higher middle income 5%
800
Formal Care 41%
600
lower
lower income 1%
400
Medical Care 16%
Cpp: $32,865
200
0
2005'
2009'
2010'
2030'
YEAR 2010
Estimated Total Global Cost of Dementia
Percentage of Total Global Cost by Income
20 15 low income
10
lower middle income
5 0
middle income 5%
higher middle income high income
2005 2015 Prevalence of Alzheimers, per 1000, by income group
2030
Global Dementia Research • Estimated worldwide cost of Dementia US$604 billion in 2010. Set to increase 85% by 2030. • 70% of cost occurs in Western Europe and North America • If dementia care were a country it would be the world's 18th largest economy, ranking between Turkey and Indonesia. Categories for cost of care: • informal care (unpaid care provided by family and others) • social care (community care professional and in residential home settings) • medical care (cost of treating dementia and other conditions in primary and secondary care.) • Cost of informal care and social care generally contribute similar proportion of total cost (42% worldwide), while direct medical cost are much lower (16% worldwide). • In Lower and Middle income countries informal care accounts for the majority of total cost direct social care cost are negligible. • Lower income countries accounts for just under 1% of the total worldwide cost (but 14% of the prevalence). • Middle income countries for 10% of the cost (but 40% of the prevalence) • High income countries account for 89% of the cost (but 46% of the prevalence).
CONCLUSIONS: • Cost are lower in developing countries, both per person and societally (as a proportion of GDP). In these regions there is a much larger reliance on unpaid informal care by family and others. • While wage levels are low, they are increasing rapidly, hence opportunity cost or replacement cost of these informal input are set to rise. • Low and middle income countries only 6% of people with dementia live in care homes. But this is also increasing, especially in urban settings in middle income countries boosted by demographic and social change that reduce availability of family members to provide care. • Demand of care to increase due to increase awareness. • Cost in low and middle income countries are rising faster than higher income countries, because economic developments, per person cost will rise towards the high income countries plus increase in number of dementia will be sharper in these regions. • With the future population projection in 2050 one in 85 person worldwide will have alzheimer’s disease. • Asia will have it the worst with 62.85 million accounting for 59 percent of all cases. • Europe will suffer earlier. Having a huge greying population heading for retirement and dementia. The diminished labor force can not reproduce fast enough nor have enough migration to offset the need. Peak of the pupulation getting dementia is around 2038-2040.
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Dementia in NL
Looking at the prevalent profile graph, it is clear that The Netherlands aging population is heading for a steady increase of dementia cases. The pupulation of 65+ will increase at a rate of 3% per year until the peak near 2038-2040. That is a 77% increase in the amount of elderly over 65+ in 30 years. By that time close to 4.5 million people will be 65+. Within that popuplation around 273,000 will be in profile 4 or dementia. Those are the case with 24 hour care needs. Another 273.820 case under profile 3 will need asssitant living care. This give a good projection of what types of institutions will be demanded in the future. Nursing homes will need to be increased, but informal home care will be more dominant due to healthcare cost and lack of labor power. Perhaps a new typology of housing will arise that make a hybrid of traditonal housing with geriatric nursing homes with more mobile medical facilities scattered through-out the city. A decentralized medical plan.
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Living with Alzeimer 2060 What is the future like?
By (Jack) Shih-Chien Chen Diary Entry:
It is March 27, 2060, I am talking to myself. one more day and I will have survived to my 84th birthday. Not much of an achievement really, considering our average life expectancy is now 85. I wake up to the sound of woodpeckers pecking. Just like the ones in the woods behind my childhood house in New Jersey. I always like waking up to that. Where I felt safe and free, without a care in the world. I had the sound programmed it into my morning wake up ritual since I move into this smart house about a year ago. I was diagnosed with Alzheimer’s Disease last year. My son thought it best I move closer to him so we can drop by each other’s place more often. In fact he is living in the same neighborhood community. This smart home is something else. It is actually a living breathing caretaker. It monitors my body temperature, sugar level and heart rate and would adjust the room temperature or open a window for me automatically. I sometime joked that it probably will advise me when I should use the toilet. The voice of the smart home has a familiar ring to it. Often reminds me of my mother’s voice. When I am running out of milk or coffee, it would just order it for me. Though recently I wanted to shop like I was used to in my younger day, so I made the request that I would do the physical shopping which was in the same building (they just have a list for me at the store to remind me what I was
missing). The home is connected to the city. If I needed medical assistance it would make the call for me. In this neighborhood 24 hour medical service is accessible. I feel better living in my own home and knowing that I can get the help I need when I need it. In the old days they would have put me in elderly institutions, but those were not permitted after the 2020. Anyway, why do I have cravings for bubble tea? Perhaps Pada can get some for me. Oh yeah, PADA, stands for persona assistant domestic android. Yes, I have an android. It came with the house. Sometimes I confuse her for my late wife Anna. Pada’s voice sounds like Anna. She is so in sync with me it’s scary, its like she knows what I am thinking. It is like we are wired the same way. Sometimes she finishes my sentences for me. I read some statistics in the papers last week that there are 1.5 androids per household. I guess it was inevitable. Ever since the global epidemic became real. In 2050 one in 85 person worldwide had alzheimer’s disease. Asia had it the worst with 62.85 million accounting for 59 percent of all cases. I guess that was how the androids became popular. The Japanese were the first to embrace them. First with virtual pets like the (Tamagotchi) in 2010. Then it extended to robotic dogs. When they figured out how and why humans can form emotional attachments to animals and these virtual pets they naturally extended it to robots. Actually in retrospect, we have the porn industry to thank for it. The industry were making more sophisticated life size dolls we called them sexbots then. They were so life like, it became a craze. It became such a hot item after the Bono sex tapes leaked out. He was quite unabashed. Saying it was the best sex he ever had. Through such spectacles and many more like it that streamed thru the internet, the product became a big craze. I guess through the years the society’s idea of what constituted normal sex had changed. Living with androids became normal. Later as better artificial intelligence developed
android were introduced to the work force as maids to clean the house, stock your grocery, or play chess with you. The AI was so sophisticated that they really became life long companions for some people. We needed more people in the work force and they seem to be one of the answers. The other was cloning. The verdict is still not out on that one. Once in a while you get some news about someone falling in love with their sexbot and wanted to divorce their spouse. Crazy right? I can see some very ethical problems surfacing. In fact more and more films about the androids having soul are turning up. It seems a hot topic lately. Just yesterday I read about some AI scientist lobbying for robot-human marriage to be recognized. I do not know what to make out of that. I hear a knock on the door and it is Anna with a glass of bubble tea in hand. I asked, is it the red or blue pill today...
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Intelligent Environment / Smart homes can be as sentient as AI robots
Field Research: Internship Experience Location: Schalkweide | Stichting Sint Jacob It was April 13, 2011 that I started my volunteering in a nursing home at Schalkweide (Haarlem). In many respect it was a very unexpected and gratifying experience. I knew I would experience something emotionally heavy and perhaps even out of mind myself. From the stories I had already hear from my colleagues I knew it was no picnic. Before I went ahead with the actual volunteering I had prepared myself with some research about the disease itself. Understanding how the brain’s nerve cell die off (without possibility of regeneration) and how it affects certain body functions in respect to the region of the brain. I familiar myself about the different phases the alzheimer patients go through. The “Threaten Me” and the “Lost me” are the first two phases respectively that the patients I will be dealing with for the first few weeks are categorized in. I had developed a certain empathy and imagination of how the mind can begin to unravel due to memory loss and dis-orientation. Reading the book Out of Mind by Bernlef was a great gateway into the internal process
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of a dementia mind. It painted a more insightful picture for me on how the sensation of displaced memory can create such fear and confusion of losing control over oneself. These subtle transformations can translate into overwhelming stress and horror for both the patient and the caretakers. Still with all these theories ingested, I still can’t help but feel anxious and insecure about how I would interact with them, especially not in my native english but in Dutch. As it turns out, I was both surprised at my performance and happy to realize that I had actually contributed positively to their well-being during my time there. From the beginning I was introduced as a researcher that came to see how the institution functioned. I could immediately see their different personalities from their individual reactions. Some were curious and open, others did not approve; A stranger in their midst. Especially one that spoke english. I was fortunate enough to get paired up with Maria an english speaking caretaker. She had worked in England and South Africa for more than 35 years and was thrilled to be able to speak english again. As we talked in english I noticed an old couple in their 80’s complaining about the fact that we spoke english. They “are the most difficult people in the group”, I am told by Maria,“This couple is so picky about everything, nothing can make them happy. If people were talking, they complained it was too noisy. If no one talked, it was too silent. They even complained about the bread being sliced too thick and demanded to speak to the baker”. When I ask Maria how she responded to the lady in question she simple said, “we try to accommodate them ask much as we can”. As I started picking Maria’s brain as to what her personal philosophy was in terms of the approach to care she began to
point out each resident’s status (the severity of dementia) and some personal anecdotes that reveal absurd scenarios she was faced with. At first my internal alarm was ringing in reaction to the fact that Maria was speaking very loudly about them and having a bit of a laugh about the types of scenario she has encountered. I can’t help but feel that she was a bit insensitive. I quickly questioned her about what I perceived as insensitivity. She put my nerves at ease by explaining the nature of her work. The openness and connection she has with all the residents and colleagues. She made it clear that respect and dignity was the most important aspect of well-being they can offer the residents, and that in this line of work, you have to be able to laugh and cry at yourself and with each other. As to the high volume she quickly explained that most of them were quite deaf. As it would be even more disrespectful to speak in a level that they could not comprehend. It would create more stress for them to not understand what was being said regardless of the content. As she continued her stories I found the depth of her empathy amazing. In every situation, the caretakers take the patient’s requests very seriously and have adopted a non-confrontation philosophy. Each of the patients are in fact living in their own world. What the caretakers attempt to do was to get into their world and respond accordingly instead of trying to provoke the patient’s out of their own realities to our world. One favorite example was a lady that had packed her bags in the morning and said to her, “Thank you, I had a lovely vacation stay here. I will be leaving for my home now.” Instead of stopping her, Maria would walk her out and guide her around the entire building while chatting and back to her room again. When she approached her own room door, she recognized it immediately and said, “Oh, so glad to be home again”. This type of engagement and patience into the realities of the patients are indeed what they need. The non-confrontational way of dealing
with patients can facilitate a greater, positive well-being than the other way. However this also means that the psychological load on the caretakers are extremely heavy. To be always aware of the psychological state of the residents and to keep a pleasant facade regardless of how hostile or unreasonable they are is a daunting task. As I engage myself with the residents, I soon had my first hand experience.
It was lunch time and for some special occasion they decides to make pancakes instead of the usual sandwiches. Immediately, Mrs. A approached the one making the pancakes. She expresses that she preferred her usual bread and cheese and inquired if it was possible to still have it. After being reassured of it, she came back two more times confirming the same conversation. I can see that she is indeed genuinely stresses about the change in menu and needed constant assurance that all will be alright. While I sat down to join a table of two Indonesian ladies and Dutch gentleman all in their 80’s I started a conversation with Mrs. B closest to me. We conversed in dutch. She asked me if I had worked here long. She appeared to be quite clear in her mind. I replied that it was my first day here. She then asked if I lived close by and how long it took me to come by bus or car. I responded accordingly. 30 seconds gone by and she asked me the same questions again and then slowly talked about all three daughters f her’s living in Switzerland and that her husband had bought all the houses for everyone and was a big shot business man there. She stated that this house that she is in was also bought by her man. I attempted to stay with her to see where she goes from there and realizes very quickly this will last quite a long time. I attempted to distract her and change the subject, but within a minute she asked me similar questions that would lead into her loop about her husband and switzerland. It was then I noticed Mrs. C looking at me laughing. She remarked with a smile, “yeah she is a rich bitch”. “ We all know her stories, but since you are new, you get to hear all about it.” It was at this moment that both Mr. X and Mrs. C laughed out loud. I also had to laugh. I did not know how clear in the mind each of them were. It did not matter. They were each enjoying the moment. In actuality Mrs. B only had one daughter living in Switzerland. The other two lives nearby. Not knowing what to do to get Mrs. B out of her loop I try to change the subject by asked Mrs. C where she was from. She quickly
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mentioned she was from Indonesia and Filipino descent. We had a what appears to be some normal conversations but at some point something triggered her. She had memories about being a teacher in a catholic missionary school. She began her own loop about a school boy who was protestant and refused to pray the catholic way because his father forbid it. She was forced to speak with the father and force him to take the child home. I could see that she was reliving the moment again and repeated her stories again. I was beside myself. I now had two ladies looping next to me and I was not sure what to say. It can be better explained as the playing of a record player. Sometimes they get out of their own groove and you can witness either a skip in their brain process and they are stuck in a loop for a very long time. You try to guide them out of it in a very non-confrontational way so as to leave no mark or pain that they can experience. I tried to wait it out to see if the looping would stop, but ten minutes go by and I did not see much light at the end of that tunnel. So I turned to the gentleman to my right. Mr. X was the least severe case, from what I was told. He seems to be a highly educated man that keep to himself and do only two things; Read the papers in the dining room or go back to his room. I started to speak with him about how he deals with the looping. He relents and said, “Yeah, it is heavy. That is why I go to my room. I am happy to have an escape. I watch my sports on TV to get some relief.� In the end I was saved by the pancake that was presented to all of us. Later on I continued to speak with Mr. X. He slowly warmed up to me. Happy to be able to converse with some one else other than the ladies around. We talked about my research and about amsterdam and sports. Though he was the clearest resident in that group I could still feel his difficulty with discussing more abstract topics or getting more specific details. At the end of the day, this gentleman asked me if I was coming back tomorrow. I had to disappoint him, but told him that I will definitely
return. He graciously thanked me for my company and conversations and I could see he seems to be smiling a bit more. With his walker at hand he asked me to stay a bit longer so he can fetch a photograph to show me. It was an image of his younger self in his 60’s standing next to racing bike and a city sign that had the same name as his on it. He was quite proud of it. We bid our fair well and as I walked out I was so pleasantly surprised that I had manage to contribute so positively to his well-being and all in the dutch language. It did not matter that my dutch was poor. What mattered was that I gave them attention. Amazing that such little things made such a huge impact. It even inflated my ego. In a way I felt I got more out of it than they did. Through the conversations I had with Maria and all the caretakers, I attempted to abstract some form of information that would allow me to translate into spatial qualities. It was not as easy as I had hoped. Designing for alzheimer patients is near impossible due to the fact that no one case is alike. I come to the conclusion that it is better to design for behavior. We should shape the environment to enforce good behavior and avoid the bad ones. Behavior that will allow for better care. For example, what the proper way of approaching a patient is. Not from the back but from the front. It is very difficult to generalize and predict how certain space can affect some but not others. In their daily routines, the caretakers must observe what are the possible triggers that will take them off course or agitate their state of being. It could be as small as not getting their morning coffee in the proper cup or being rushed during their morning dressing ritual. These small things can fester inside them and cause a certain stress and agitation that can compound through the day. Caretakers must invest a great deal of energy into not only creating a pleasant atmosphere but to understand the triggers.
This brings me to an even more crucial point I discovered about the environment of this particular institution. The users considered in the spatial design were the patients not the caretakers. Which I find a pity considering that the quality of care is directly related to the well-being of the caretakers and the resident’s family. While the considerations of the caretakers work were quantified by the manual tasks they perform for the residents, the psychological component necessary for the qualitative care were never considered. The caretakers had no personal space to balance themselves or speak in a normalized environment with each other within the facility, given their long working hours. After a long shift they themselves are psychologically taxed and perhaps grumpy. This tends to stress the bonds between the caretakers. On a spatial level, many caretakers I had interviewed often complain about the physical load of their job. The lack of hoists or transfer benched in the bedroom or bathrooms leave the caretakers having to lift the patients themselves. Many caretakers agree that the designers do not necessarily take into account how the caretakers function ergonomically. Of course I see that some of these things are an issue of economics. However, if you take quality of care as the ultimate goal, you can not neglect the needs of the caretakers.
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Concept design by HeyTeam & Teuco Shore Tubs wants to promote socialization and gathering. A bathtube to share time and spaces in Spa areas. The elevation system, consisting in two bodies (main and offset), provides an easy access, especially for people with moving difficulties. In fact when the water, from the offset body, goes to the main body, this one will dip, eliminating every obstacle.
From pampering to well-being: our search for bathing rituals
“ If there is magic on this planet, it is contained in water.� -Loren Eiseley, The Immense Journey, 1957 The human body is made of 70% water. The human brain is 80% water, and about roughly 90% of our blood is made out of water. It is of no wonder that throughout human history water has always remained an intrinsic part of well-being and spiritual beliefs. Its spiritual and healing properties are seen in rites and rituals connected to the theme of ablution. Ablution can be exercised in many arenas. In medical practice water was seen as a facilitator of purification and rebirth. In the course of discussing about the process of confinement and the development of the idea of curing or treating madness, Michel Foucault in Madness and Civilization (2001) runs through the initial cures such as purification and immersion that relate water to the body, in its affect on both body and soul. He writes, Water, the simple and primitive liquid, belongs to all that is purest in nature; all the dubious modifications man has been able to add to nature's essential kindness cannot change the beneficence of water; when civilization, life in society, the imaginary desires aroused by novel reading and theatre going provoke nervous ailments, the return to water's limpidity assumes the meaning of a ritual of purification; in that transparent coolness one is reborn to
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one's first innocence (p158). Water is seen here as both symbolic for the soul and as an universal physiological regulator. An element that brings our bodies to equilibrium due to our own inherent body composition. While Foucault sites a series of contrived experiments performed up to the 19th century, it is important to note that madness was not seen as an illness or something that could be treated. But Foucault suggests that even when the idea of a cure developed, it was not a medical development. Madness was still seen in terms of morality and the links between body and soul that come from a theory of the passions. By the nineteenth century, a difference arose in the approach of techniques which focused on the moral improvements of the madman. In a sense the fight became more psychologically focused. In turn the valuation of water changed as well. Water with all its powers, “wane in the very excess of its qualitative versatility: cold, it can heat; hot it can cool”(p163), writes Foucault, “In medical thought, it forms a therapeutic theme which can be used and manipulated unconditionally, and whose effects can be understood in the most diverse physiologies and pathologies”. In fact, it is perhaps this polyvalence with which endless disputes were generated that finally neutralized water. Though water was still used in medical practice at that time, its qualitative overtones had disappeared. Showers, which were previously used less than baths had become the favored technique.
Japanese practice of purification rituals for the New Year
Water regains, beyond all the physiological variations of the preceding epoch, its simple function of purification. The only quality attributed to it is violence, an irresistible flow washing away all impurities that form madness; by its own curative
power, it reduces the individual to his simplest possible expression, to his merest and purest form of existence, thus affording him a second rebirth (Madness Civilization p163). This symbolic interpretation of water is often cemented in our collective minds through the stereotyping of shower rituals of inmates during the process of incarceration in mainstream films. We frequently see similar scenarios of inmates subjected to brutal forces of water to purge the corrupted and the damned out of them before they begin their rehabilitation in institutions. These bathroom facilities carry with them an uncompromising quality of sterility and economy. Contemporary healthcare institutions today often have bathrooms with similar qualities of sterility and economy. These sites bear witness to just how much we had forgotten about the qualitative values of water. While Foucault speaks about the perceptions of water's value as a possible treatment to madness, he emphasized that the development in treatment was viewed more in terms of morality than to medical developments. Along this path of thinking, western society lost its connection to water as intrinsic part of well-being and spiritual beliefs. Through new defined virtues of economy and efficiency in modern society our changing notions of reverence to water can be traced by following the evolution of the bathroom. The idea of a room in a home dedicated to personal hygiene and grooming is to some extent, a recent one. For the most part, houses built much before the turn of the century did not have bathrooms. In the span of about 100 years, the modern bathroom has evolved from a novelty into an almost-universal residential fixture. Within that time, it took little more than half a century for the bathroom to transform itself into a major player of domestic life. Reinventing itself from a tiny sanitized cell of utilitarian purpose to embrace the physical, psychological and pleasurable dimensions that go beyond basic hygiene and
Angelina Joiie , Scene from the film Changeling (2008)
grooming. Like most changes in the home, this has been a gradual process. Despite the fact that bathrooms are one of the most technically demanding rooms in the home, the drives for changes isn't in the technological development but in the changes of social and cultural attitudes. Attitude to sexuality and body, health and hygiene, physical and psychological wellbeing all influence how we position bathing in the domestic arena. In 1960s and 1970s one of most influential manuals for bathroom design in Europe and the US was ‘The Bathroom’ (1966) by Alexander Kira. In essence Kira reduced bathing to a series of ergonomic studies showing how ablutions could be carried out with maximum efficiency in the minimum space. It was a reflection of how little has changed since the 19th century's attempts to compress washing into a science of hygiene, to free from disease and naked confrontation. Kira quotes a report from the German press
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that claimed “More than half the population bathe only once a week and brush their teeth only rarely, and approximately 10% bathe once every four weeks.” In the span of 10 years after Kira's book was published, a new movement was underway. Lead by Leonard Koren, the founder of 'Wet: the magazine of gourmet bathing', launched in 1976. It was an idiosyncratic magazine from California, devoted to the free thinking counter culture that bubbled up around the hot tub. It was an initial attempt in Koren’s crusade to arouse the possibilities of more imaginary and sensually charged bathing experiences that are shaping how we think today. Adding to the changing attitudes towards bathrooms are the growing interest in fitness and the gym in the 1980s. Together with the burgeoning market for interiors magazines, this helped make the bathroom a stage for the body beautiful. Designers like Andrée Putman and Philippe Starck gave the bathroom a new gloss, helping shift ideas of luxury away from traditional style to a modern visual language. Hotels played a significant role as well. When 'boutique hotels' mushroomed out, the bathrooms were photographed as much as the bar. Although bathroom as designer icon may seem remote from most daily washing experiences, like the influence of couture on high street fashion it has percolated through to mainstream thinking. More recently interest in the non-western approaches to healing and wellbeing have profoundly influenced how we think about bathing and its increasing association with relaxation and regeneration. In the US expenditure on spas are on the rise, while surveys highlight shifting perceptions of the spa from ‘pampering’ or ‘indulgent’ to ‘important to wellbeing and staying healthy’. One factor can be contributed to the technological democratization of the spa facilities. The affordability of these services means that spas are no longer seen as a luxurious decadent
experience, but much more integrated with daily routines and ritualistic maintenance of our body and soul. The urge to reconnect with the physical and sensual is partly a side effect of our industrialized and virtual existence and the disquieting sense of spinning out of synch with natural rhythms. In Undesigning the Bath (1996), Koren defines the great bath as “a place to escape from the depredations of the technological world, not revel in them.” These sentiments and inclinations are coming home to our domestic setting not just in an appetite for essences, but in a way that metamorphosed the role of the bathroom in contemporary western society into the domestic center for well-being. In 20 years time will our concept of the bathroom change even more? Will it occupy an even greater role in our domestic ha-
Contemporary Japanese Bathroom Interior
ven? Where should we look to to inform us of our projections? If we look into Japan's refined bathing culture that has managed to endure for centuries, we can see that theirs is built around an intense relation to water and its enjoyment is characterized by an authentic simplicity designed to induce mental and spiritual repose and support a series of carefully honed rituals that make cleansing a separate activity from relaxing in the bath. Another cultural model inspiring contemporary bathing rituals is the hamam, the Islamic bathhouse that grew out of the remains of Roman bathing culture around the Mediterranean. Although it originated as a place of ritual purification attached to the mosque , this world of shadows and light is also a sensual paradise, where the majestic womb like architecture and use of marble or stone create the setting for a bathing experience that is hard to match in the contemporary world. This might seem a long way from the domestic sphere but it is exactly such places that are enriching current thinking about how we incorporate water in daily life. One of the most obvious changes in the home is how bathing is prioritized in terms of space allocation. Following the shift from a cellular room structure towards a more fluid living space, the bathroom is breaking down its component parts and reassembling in different configurations. Another obvious change is how bathing is connected to other activities. The common merger is bathing and sleeping, with bathing recast as a relaxation ritual as much about intimacy and play as body care, and often sociable rather than strictly private. Such arrangements acknowledge that rituals are different at the start and end of the day, with the shower more likely to be a morning routine and the bath takes place in the evening. Again Hotels are leading the way. For an exhibition on “Grand Hotels' Toyo Ito designed an ideal hotel room for New York City where more or less the entire floor space is occupied by two large circular
pens, one for sleeping and one for bathing and both equally playful and eroticized. When we see these developments happening it is clear that western society moving towards finding its relationship with water again. As an intrinsic part of well-being and spiritual beliefs. New typologies will rise out of this movement. Not just for our domestic settings but for institutions as well. Given the medical merits of hydro-therapy and the tactile and sensual pleasures of the spa, one can easily see the integration of these elements into not only our domestic bathrooms but healthcare institutions. As we see the notions of well-being becoming a consistent part of our personal maintenance of our body and soul; As we associate the bathroom more and more as the space of escape from the world of technology and speed; As our space of equilibrium; As our space to connect to water. We will need to define our own bathing rituals that would allow us to tap into out sense of well-being.
Toyo Ito, Concept Room for “Grand Hotell Exhibition�
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Focus
In many exisitng alzheimer institutions residents often take no more than one shower a week. The frequency in itself is troubling. However, what is more peculiar was the lack of any bathing practice. There are many benefits to bathing. It Increase blood circulation, and assist in in relaxing tense muscles. It aids in quick recovery from fatigue & injury. Especially for elderly, where bio rhythms often changes, soaking in hot water for 15 min. (approx. 90 min. before going to bed) is an effective way to naturally encourage and induce the body to sleep. Bathing in warm water will relieve stress due to the release of endorphins (which relieves tension and create a natural high). Bathing habits can greatly contribute to long term strategies for well-being. I speculated 4 common reasons for the lack of bathing practice in alzheimer instituions. 1. Most nursing homes give shower not baths (cost too much time and money) 2. The feel of the bathrooms are too clinical in nature 3. Often institutional bathrooms do not deliver a pleasurable experience 4. Often the design does not take the caretaker’s ergonomics into account. Taking account of future projections with the lack of labor force and money in our future healthcare system, the focus for this design will be to consider a bathroom facility in a group home that would engage the residents in a pleasurable bathing experiece, enough to incite a daily bathing ritual. The facility will take on merging qualities of a car wash system, sneuzzle space and relaxed spa. Automation assistance can be of great use to time management and privacy issues. Bathing can be seen as not only a cleansing ritutal but a social activity.
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Circulation Sanitair Semi Private Node Interior Green Living Room
Context
Searching for a sound plan of an existing care institute, the Zorgcentrum Beatrix te Culumborg was selected as a test case due to its simple circulation and organization. A group-house quarter for 8 residence. Living room with balcony facing North capping an u shaped corridor where each resident bedrooma are flanking east and west. 4 large bathrooms, two on each corridor shared by two residence per bathroom. In the core of the u shaped circulation space resides all utilitarian faciliites.
Main Corridor to other group quarters
Floor plan of Zorgcentrum Beatrix te Culumborg (one housing group 8 units)
Circulation Sanitair Semi Private Node Interior Green Living Room
Concept
The Concept was to take way the boundaries of the living room as the sole social space of the group quarter. By taking away the individually shared bathrooms and replace them with one larger more luxurious facility, the extra space gained can be put to use to transform the corridors to more habitable spaces where tactile architecture is applied to trigger sensoric experiences. By configuring the spa/ bathroom facility in such a way that would also rendener the corridor to feel like a interior garden, opportunities arise in thee semi-private pockets to experience tactile environments such as grass, wood, stone, wind, smell of flowers and sound of birds.
Zoning diagram
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Design: Plans 1. Fountain 2. Benches 3. Tactile seating areas 4. Bath Area 5. Changing Area 6. Automation Machine 7. Rain Shower 8. Air Dry Chamber 9. Aroma Therapy Chamber 10. Storage 11. Toilet 12. Living Room 13. Kitchen 14. Bedrooms
Jacuzzi Aroma Therapy Chamber
Automated Washing & Massage Machine
Design: Spa
Changing Area
Rain Shower & Air Dry
Bamboo Forest Pattern laminated between Glass
Vertical Garden Wall in Corridor Pockets
Main Title wheel chair frame become support system
Rollers for massage and scrubbing
Rollers for hand massage and scrubbing
scrub clean/ massage
group sensory bath salt float
scrub clean/ massage 80% automated 20% assisted
individual soaking tub
individual soaking tub
individual soaking tub
individual soaking tub
Sketches of automation process.
Design Spa: wash automation
The consideration of automated assisted cleaning is bound to time management for future prognostics of under-staffed personel and also to prolong the residence’s independence. Studies have shown that one of the factors for well-being of elderly to sucessfully age in place is the control they have over their own environment. Not having the ability to clean one’s body independently is a massive blow for anyone’s dignity. Once you cross the bridge, many things change. With the help of assisted / automated machines, this indiginty is at least prolonged and the well-being of the user improved. The automation machine offers a wide range of options to be customized for every user. Water pressure and temperature can be customized. The machine scrubs, massages,and rinse the entire body. A specialized wheel chair is outfitted for this machine. As the user is wheeled in, the wheel chair wheels are rolled out and the chair frame iteself becomes the support system that allow the users to sit through 3 positions. From seating to laying hoizontally. While the body is slowly washing, the head region is sensorically engaged via slow changing led lights, soft music of the user’s preference, and aromatherapy.
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The Tub: 4 sitting positions
Cleaning position Self or helped
Soaking position + music
Design Spa: Bathing
whirlpool position + Music & light
Air spa position + Music & light & fragrance
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Soaking in warm water has great benefit for the elderly. While washing and cleaning can be viewed as a very personal act, bathing can be a very social one. One in which both care givers and residence can enjoy. It can be a new way for both sides to relate to one another. The bath system designed is similar to the automation system in its use of wheel chairs as the means to move the resident into the tub. You simply roll into the tub. The wheels come off and and back door is closed. Water starts very slowly to rise. Four phases of soaking can be experience on an individual base. These tubs circle the main larger group tub for 4 people. If the tub is used individually, Little can go wrong as the design holds the user well in place and shifts positions of the body in relation to the water level. In terms for care givers, this feature will allow them to save time in terms of less surveillence.
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Perspectives: View from living room doorway
Perspectives: Tactile pocket: grass bench & garden wall
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Perspectives: Tactile pocket: Sand, Wind, sound of waves, sea salt smell
Perspectives: Indoor Garden Corner: Sound of birds and water, artificial sunlight above
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Perspectives: Spa Interior: Bathing Area
Perspectives: Spa Interior: Changing area