Haven of Human activities - Design for active aging by Ramya Tippireddy

Haven of Human activities Design for active aging

Ramya Tippireddy Master thesis Graduation Studio: Stimulating Healthy Environments (SHE) Master of Architecture, Building and Planning Eindhoven University of Technology

“The most important things are experience, the rasa, which is the subtle experience of the space that makes the place memorable.” B.V. Doshi Pritzker Architecture Prize, 2018

Master Thesis How the spatial planning can help seniors with dementia aging in place to carry their daily and social activities independently resulting in their well-being? Author Ramya Tippireddy s.r.tippireddy@student.tue.nl +31 633601311

Graduation Studio Stimulating Healthy Environments (SHE) Chair: Smart Architectural Technologies (SAT) Graduation Committee Prof.dr.ir. Masi Mohammadi Dr.ir. Olivia Guerra Santin Ir. Leonie van Buuren Sjef van Hoof Arch AvB Advisors Ir. Caro van Dijk Ir. Niek Loeters Master of Architecture, Building and Planning Eindhoven University of Technology 3

Acknowledgements One page is hardly enough to express my gratitude to every person who helped and supported me through the process of graduation. Firstly, I would like to thank my family and friends who believed in me and always been there for me even though we are a thousand miles apart. My deep gratitude goes to my supervisors who helped and guided me through the entire course to achieve these results. I would like to thank Prof. M. Mohammadi who inspired me with her take on emphatic designs and made me think about it in a new way. My sincere thanks to Leonie van Buuren and Olivia Guerra who assisted me in organizing my research properly and helped me to find my way from research to the design. I would like to thank Sjef van Hoof who provided valuable insights into the design process and helped me with understanding the Dutch way of architecture. Special thanks to the advisors Caro van Dijk and Niek Loeters who provided valuable practical inputs that helped me to further my design. I am truly grateful to my fellow students who made me feel at ease and offered me their support at times of struggle with design decisions. Last but not least, my sincere thanks to my dear Nitin who constantly helped me all along with my ups and downs and reminding that the world keeps spinning. Ramya Tippireddy June 2020 Eindhoven

Preface Growing in a place called Andhra Pradesh, located in southern India there is not much awareness about the dementia or mental problems of elderly in the society. In this vast communities older people live with their families until the end of their life and any physical or mental problems they have are treated with care from their family members. Only few people with severe health conditions were admitted to the old age homes or elderly care home where the seniors get to live with people of their own age. In my bachelors as a part of a course, I have visited few child care and elderly homes where I faced an unusual experience which demonstrated the power of space on the mind. Many of the elderly I meet can’t remember who they are or where they are from, but smiles when they are outside in nature and sun, cheers up when they find some comfortable spots to do regular activities with fellow people and appreciate the warm human touch. Seeing many elderly struggle and getting lost with activities and spaces in these old age homes naturally triggered my thoughts about what really matters in space, what are the simple, essential things in the space which makes people to feel at easy and homelike. These vivid experience had made me choose this studio SHE - Stimulating healthy environments, as it deals with providing healthy and comfortable living spaces for elderly by combining architecture and technology.

Abstract This graduation thesis aims to understand how spatial planning can help

clues provided by the environment is crucial for the elderly to carry differ-

seniors with dementia to fulfil their daily needs in order to enhance their

ent activities independently and continue their journey. Combining these

quality of life and wellbeing. Daily needs consist of day-today activities and

three research results: mixed housing typology, the transition of spaces and

actions which are done by a person to carry out their day normally. Activi-

design clues, and a residential environment with activity spaces open to the

ties provide a sense of achievement, purpose, meaning to the typical daily

neighborhood was created to help the elderly carry their day to day activ-

life and provides changes of intimate and social interaction.

ities at easy with social interactions and exchanges form the neighbourhood.

Most often, seniors with dementia find it difficult to independently carry their daily activities and depend on their surroundings for support. This leads to research about how architectural interventions can benefit seniors in fulfilling their needs and helping them carry their daily actions normally. The research is further processed with investigating the needs of the elderly as the starting point, and the outputs can be categorized into three elements: Ageing in place, ability to do daily activities and social interactions. Breaking down these three elements, further analysis was carried on each of these three elements. For aging in-place study of present housing situations for seniors in the Netherlands was done, which lead to emerging a mixed housing typology with intergenerational residences as a design guideline. For daily activities analysis on how spaces can be improved and designed, which help the elderly with their day to day, actions were investigated, and spatial guidelines were drawn. Combining the many activities elderly often do and the social interaction it provides, a timeline was developed depicting the day of a senior. From this timeline, it was understood that the transition of spaces and design 6

Contents Acknowledgements

5. Research Results 76

Preface

5.1 Defining Housing Typologies

Abstract

5.2 Spatial Design Guidelines

5.3 A day of a senior

118

Contents

5.4 Research results conclusion

123

1. Introduction 08

6. Design 124

2. Research Methodology

6.1 Site Analysis 126

3. Literature Research

6.3 Individual blocks 154

6.2 Concept 130

3.1 Dementia 14

6.4 Construction detail 184

3.2 Needs of seniors with dementia

6.5 Design guideline implementation

186

3.3 Ageing in place and housing typologies

6.6 Experience of spaces

190

3.4 Well-being 24

6.7 Research validation through the design

200

3.5 Daily and social activities

3.6 Importance of activities

3.7 Literature research conclusion

4. Case Studies 30 4.1 Case Study Analysis

7. Conclusion 202 8. Reflection 206 9. References 208

4.2 Comparative analysis 66 4.3 Timeline analysis 68 4.4 Case study conclusion

Fig 1. Illustration by Brian Cornin

1. Introduction 8

The population demographics in the Netherlands clearly shows that

Therefore, if not designed with care and understanding, the quality of

the aging community of society is increasing day by day. This aging

people’s lives can be significantly lowered. So it is vital to understand

population is considered no longer a burden but a valuable asset

the importance of such places and their influence on the demented

to society, and many actions are taken to provide independence

people to create environments that enhance people’s quality of life and

and empowerment for the elderly. Unfortunately, most of this aging

allow them to live peacefully in their last days.

population is effected with dementia, while the cause and cure are still

With this motivation as a starting point, the thesis starts with research

unknown.

on dementia, senior needs, the importance of daily activities, and housing conditions for seniors. Likewise, topics were studied to

For most people with dementia, the abilities to carry their daily

understand the current situation of seniors with dementia. With the

activities and to meet their basic needs independently are steadily

literature research and case studies, optimal conclusions were made,

decreasing day by day. With abilities and certainties slipping away,

and proper design guidelines were extracted to understand how

support from the environment is enormously important as it is the

spatial planning and housing typology can enhance the day to day

one last thing they can relate to. Due to the consequences of the

life of seniors and their activities. Later site analysis was conducted

disease, they gradually become more dependent on their immediate

to formulate the program and translate the guidelines in the form of

surroundings to guide them through, which means the influence the

architectural design.

built environment has a significant impact on their life and well-being.

“Soon our houses and streets become adaptive living organisms that ‘care’ for us, being socially intelligent environments that understand us and empathize with us” – Masi Mohammadi.

Fig 2. Illustration by Brian Cornin

2. Research Methodology 10

The framework of the research methodology consists of three elements main methods which are “literature review,” “case studies,” and “research results.” These main topics were analyzed in different subtopics, which helped to formulate and proceed with the research question.

Research results Information from literature and case studies were further analyzed to understand how the housing typology and spatial planning can help and guide the elderly with their daily activities. This information is further developed in the form of design guidelines, which were later used as the starting point for design development.

Literature review The literature review was conducted in a way to understand the perspective of an elderly with dementia. So topics like ‘senior needs with dementia’, ‘aging in place’, ‘housing typologies in the Netherlands’, ‘Activities of daily living(ADL’s)’ and ‘social activities’ were studied and analysis figures were made to translate the findings and to provide a conclusion.

Case studies The case study analysis consists of the study of five different nursing homes in the Netherlands. The spatial qualities of each of these buildings were studied in the form of analytical drawings, and a comparative analysis was done. With the help of care managers of the nursing homes, the day of a senior was researched, and data was mapped in the form of a timeline. Through comparative analysis and timelines, overall conclusions were drawn.

Fig 3. Illustration by Brian Cornin

3. Literature Research 12

3.1 Dementia 3.2 Needs of seniors with dementia 3.3 Ageing in place and housing typologies 3.4 Well-being 3.5 Daily and social activities 3.6 Importance of activities 3.7 Literature research conclusion

3.1 Dementia

Dementia is an umbrella term used to describe a range of conditions

the symptoms while giving the citizen a better position to master his life

that cause change and damage to the brain.

as long as possible.

“Dementia is a syndrome due to the brain’s disease, usually of chronic

Studies show that early intervention in the form of preventive and

or progressive nature, in which there is a disturbance of multiple

supportive measures such as training and counselling, composed of

higher cortical functions, including memory, thinking, orientation,

some socially engaging activities, can help maintain and preserve the

comprehension, calculation, learning capacity, language, and

everyday quality of life of the demented.

judgment. Cognitive function impairments are commonly accompanied and occasionally preceded by deterioration in emotional control, social behaviour, or motivation.”(Topo, 2009) Shortly, it is a “group of symptoms caused by the gradual death of brain cells. The loss of cognitive abilities that occurs with Dementia leads to impairments in memory, reasoning, planning, and behaviour”(“dementia”, 2020).

Dementia

Symptoms can be divided into three kinds: (i)

Impairment in activities of daily living

(ii)

Abnormal behaviour, and

(iii) Loss of cognitive functions (Touhy, 2012) This disease can come in 75 different types, but generally, it profoundly affects our identity and personality, resulting in a decline in physical

Alzheimer ’s Vascular dementia

and mental well being. It is a brain disorder that cannot be cured, but proper medical

Frontotemporal dementia Lewy body dementia

treatment, rehabilitative efforts, and support can help reduce and delay Abstract illustration of Dementia

Statistics of Dementia, 2019

3.2 Needs of seniors with dementia

Senior adults has been defined as a chronological age of 65 years

dementia (Zhou, Wang & Fang, 2018). Having social interactions on

old or older (Orimo, Hajime, 2006). The vast majority of older adults

daily basis and strong communal connections can decrease the issue of

after retiring wants to live at home, to be more independent and self

social isolation. It can also benefit the physical and cognitive health of

sufficient with or without a professional home care (Van Hoof & Kort,

the elderly that can lead for their well being.

2009). Most of senior citizens happily adapt to the concept of ‘aging in place’ which means they want to live independently to carry their own activities and get old in their own place. This means they have a closer connection with their houses and their surroundings. For people with dementia, stability and familiarity of the environment, and activities of daily living are fundamental to their well-being (Charras, Eynard & Viatour, 2016). The ability to carry daily actions not only indicates the physical health but also psychological. Due to physical and cognitive health declination because of age, social isolation is a real problem for senior adults. Sadly, people with dementia are also more prone to becoming isolated which at the end worsens this disease (Holwerda et al., 2012).

Social engagement among older adults positively affects the risk of

Daily activities + Ageing in place + Social interaction = WELL-BEING

Ageing in place

Daily Activities

Social Interaction

In the Netherlands about two thirds of the diagnosed people with early to moderate dementia live at home, where they are largely dependent on care from a spouse or family (Health Council of the Netherlands, 2002)

For people with dementia, stability and familiarity of the environment, and activities of daily living are fundamental to their wellbeing (Charras et al., 2011; Morgan & Stewart, 1999)

A good living environment can reduce confusion and agitation, improve way-finding and encourage social interaction among older adults with dementia (Hoof, Joost & Kort, Helianthe, 2009)

Majority of senior citizens with or without dementia choose ‘aging in place’ which means they want to live independently and get old in their own place rather than nursing homes (Hoof, Joost & Kort, 2009)

Everyday activities for the elderly, represents the primary means by which broader life goals are pursued and attained(Garling & Carvill, 1993; Kuhl, 1986)

Sadly, people with dementia are also more prone to becoming isolated which at the end worsens this disease (Holwerda, T. J., 2014)

Research shows that living at home supports personal notions of self-identity although disruptive effects of age-related, chronic illness, and personal losses (Rubinstein, 1989).

The person with dementia is no longer able to adapt to the environment but instead the environment must be adapted to the person’s specific and daily needs (Desai & Grossberg, 2001)

Social engagement among older adults positively affects the risk of dementia (Wang et al., 2002)

Elderly needs 17

3.3 Ageing in place and housing typologies

Ageing in place

Housing Typologies

The concept of aging in place is associated with improving quality of

The research paper of ‘The Evolution of Housing Typologies for Older

living for older people with provisions of care, services and amenities

Adults in The Netherlands from 1945 to 2016: An Analysis in the

in their homes and neighbourhoods (van Hees, Horstman, Jansen &

Context of Policy, Societal, and Technological Developments’, sheds

Ruwaard, 2017)). In the Netherlands about two thirds of the diagnosed

light on the advancement of the housing conditions for seniors for the

people with early to moderate dementia live at home, where they are

past seven decades. In the Netherlands, apart from living at home

largely dependent on care from a spouse or family (Health Council of

they are three types of housing typologies which are frequently used

the Netherlands, 2002). Aging in place supports personal notions of

in literature and practice: inpatient facilities with 24/7 care, inpatient

self-identity although disruptive effects of age-related, chronic illness,

facilities without 24/7 care and assisted ambulatory housing.

and personal losses (Hannum, Black, Rubinstein & de Medeiros, 2015). The notion of aging in place started few decades before when

Inpatient facilities without 24/7 care: These are residential spaces

the housing typologies for seniors were related more towards care and

in which the seniors are provided with services and care when needed

services rather than normal living or home environment.

(Mohammadi et al., 2019). These housing typology is commonly referred as residential homes and care homes in the Netherlands. Inpatient facilities with 24/7 care: The residential facilities in which the inhabitants live in a care institution where 24/7 care and/ or services are provided. These inhabitants are in need of care and support with regard to living independently at home. The two major typologies within this category are small-scale nursing homes and nursing homes (Mohammadi et al., 2019). Assisted ambulatory housing: These includes typologies that can be seen as forms between in- and outpatient housing, it is a form of

Residential homes Inpatient facilities

Care homes

Nursing homes

Inpatient facilities with 24/7 Small-scale nursing homes

Service apartment

Assisted ambulatory housing Residential care center

Inpatient facility with older adults who needs care. Later ages these became as care homes. Inpatient facility with residences. Living-bedroom, kitchen, and bathroom. Long stay for who are in need for help in order to live at home.

A large scale inpatient facility (90–120 beds) for chronically ill inhabitants. Intensive 24/7 care provided. Small-scale group living. Individual bedrooms and communal rooms/kitchens. 24/7 care and services are provided.

living

Residential building with independent apartments for older adults Communal spaces where collective or individual services can be received. Home care can be provided if required. A care center with both residential apartments and inpatient facilities. Care, living, and services are separated. This can be a service location (for care) to its neighborhood. Based on (Mohammadi el at., 2019)

(Based on Mohammadi et al., 2019)

Housing typologies in previous decades 19

‘enhanced’ independent living. Older adults live in their own home/

abilities resulting in suddenly or gradually slips into a state of complete

apartment, but this is often situated in or near a care institution or

dependence. Nursing homes with all-time care and services are offered

(collective) service provider. These older adults can use these collective

in a community and personal level.

and individual services, provided by the care institution or service provider, rather easily. The most common typologies in this category

Up until recent times the people diagnosed with dementia used to live

are service apartments and residential care centres (WoZoCo in Dutch)

at home or admitted in a care/nursing homes where medical attention

(figure 8).

was well present. Although care and medical help was well provided in care and nursing homes, most often those are the only factors which

While these typologies provide a general outline of the housing

are good. Most of the nursing homes/ care homes in the previous

situation for seniors until few decades back(Van Hoof & Kort, 2009).

decade use to have an institutional settings with long corridors, narrow

provides an overview of the living situations and support conditions

pathways, less outdoor spaces and restrictions for movement. These

available for the elderly as the stages of dementia progresses(figure 8).

buildings lack liveliness and a sense of home, seniors living in this institutional settings reflected poorly in their physical and mental well-

In the first few stages of dementia elderly won’t even know they have

being. Majority of senior citizens choose ‘aging in place’ which means

dementia as the initial symptoms can be similar with the adverse effects

they want to live and get old in their own place and neighbourhood

of ageing. Seniors are able to live comfortably at home and operate

rather than nursing homes (Van Hoof & Kort, 2009). Due to all theses

well individually and as a society. In the mild and early mid stage of

factors by 2010 the policy for senior housings have changed where

dementia the care support and family members might assist and help

elders are encouraged to live as long as possible in their own homes

the elderly with the daily things and everyday activities and assistive

which lead to decline in care and institutional elderly homes.

living forms like day care or residential care homes were provided. In the mid/moderate stage due to cognitive decline the individual loses the memory and self-identity bit by bit resulting in not able to live independently and need for assistive care as much as possible. Elderly at this stage are suggested to live in a small scale care or nursing homes with care and services available when needed. In the late stage the individual losses most of the memory and cognitive 20

Diagnosis

No Dementia

Early Dementia

Stages

Housing conditions & support systems

Stage 1 No Cognitive Decline

Own home

Stage 2 Very Mild Cognitive Decline

Own home

Stage 3 Mild Cognitive Decline

Own home. People can still perform all basic ADLs satisfactorily.

Stage 4 Moderate Cognitive Decline

Can still function independently in the community, although it is abit difficult. Some persons get institutionalised, while some stays in community for few years.

Stage 5 Moderately Severe Cognitive Decline Mid Dementia

Housing typologies

Own home

Assitive living facility

People can no longer function independently in a community setting. Assistance of a carer required. Day care programmes may be useful for the person with dementia.

Small group care/nursing homes Small group care homes

Late Dementia

Stage 6 Severe Cognitive Decline (Middle Dementia)

Full-time home health care assistance is frequently useful at this stage. Most people in this stage are institutionalised.

Stage 7 Very Severe Cognitive Decline (Late Dementia)

People live institutionally, requiring complete care at all times. Full-time assistance in a community or institutional setting is a necessity at this stage.

Nursing homes Based on (Van hoof & kort

Housing typologies for seniors according to the stage of dementia

2009)

Based on (Reisberg B., 1986); (Hoof, van, J., 2010)

Emerging typologies Currently, with the changing societal factors such as the way older

Based on the research on aging in place and housing situations for

adults and care are seen in the nation the housing typologies for

seniors in the Netherlands, it can be understood that in the recent

seniors emerged in different forms. Under the influence of technological

years buildings or spaces having normal life settings are more

possibilities, the strict division between inpatient with 24/7 care,

encouraged compared to an institutional care. This means the housing

inpatient without 24/7 care and assisted ambulatory housing is

typologies for seniors are emerging according to the current needs

fading(Mohammadi et al., 2019). Figure … explains the Dutch housing

and situation. In the further process of my design development, this

typologies classification system where current and emerging housing

emerging typology was taken as a basis for defining the housing

situations were discussed.

typology and the amenities it provides.

The classification consist of two main categories which are variations on independent living with (tele) ambulatory care and Integrated housing & care typologies. The first category consists of independent living and communal living where various housing options with informal care, multi-generational homes, age friendly communities etc. are developing. These new forms contain not only older adults living together, but also other target groups such as students or families or multi aged people. The second category consists of living in/near an institution where there is some diversification in forms of small-scale nursing homes, care communities and an increasing number of civil society initiatives. Both of these categories have emerging typologies where chances for diverse housing situations can also come up in the future according to the needs of seniors and changing societal factors. 22

living

Independent

an institution

Communal living

(tele) ambulatory care & care typologies

Living in/near

Variations on independent living with Integrated housing

Independent living at home

Independent living

Restructuring

Housing and care cooperations

Nursing homes

Small scale housing with 24/7 care

seniors complex

Independent living with informal caregiver

More generational homes

Emerging typologies

Variants of group housing

Mixed residents and age friendly communities

Emerging typologies

Private residential intiative & luxury residences

Caring communities/ care boulevard/ Care park/ All-together

Emerging typologies

Based on (Mohammadi el at., 2019)

Classification of Dutch housing system 23

3.4 Well-being

How a person derives meaning from their everyday activities and

dementia(Wang, 2002). This indicates that both social interaction

environment is central to their well-being (Kaufmann & Engel, 2014).

and intellectual stimulation provided by various daily activities may be

The ecological theory of well-being of an elderly by Kitwood states

help in preserving mental functioning in the elderly. Every day nature

that an individual has multiple personal attributes like (cultural context,

activities or functions can prompt to increases multi-sensory simulations

social network, the physical environment and medical support) which

like visual, olfactory, appetite, tactile, and many more sensations. This

bring consolation and meaning to their life and activities act as the

results in improving or at least reduce the worsening physical and

bridge between these personal attributes and meaning. Positive well-

cognitive functioning conditions caused by dementia.

being depends on the personal attributes and activities working together. When activities are done successfully, it provides confidence

Thus having a routine of daily and social activities can help people to

and independence to seniors resulting in a positive outcome.

stay active, interactive and leading a normal life. Resulting in positive

Additionally, everyday activities of the person can derive a sense of

well-being and finding meaning in daily things they do in spite of

purpose and comfort to their day-today living.

dementia.

Not only providing a sense of purpose and participation but stimulating activity, either mentally or socially oriented may protect against

Culture Social Network Activities

Meaning

Physical environment Support system Activities as a link towards obtaining Meaning for seniors 24

3.5 Daily and social activities

Activities can be defined as the state in which things are happening or being done. Activities, in general, when done in a routine process, provide a sense of responsibility and belongingness (Kaufmann & Engel, 2014). Everyday activities are familiar to people, and as such, they offer a chance to remember or keep up with what they had been doing their whole life. Cooking, watering plants, going out for walks, and many other normal activities provide them a chance to engage with things or other people increasing the sense of interaction and belongingness. Moreover, such activities provide a natural source of stimulation. These act as a therapy as well as part of a normal life. Activities can be further categorized as basic and physiological needs. Basic needs relate to survival actions, which include activities of daily living (ADL’S). These can be further categorized as Basic activities of daily living (BADL’s) and Instrumental Activities of daily living (IADL’s). Physiological needs relate to social activities, which include interactions with others, neighbours, nature, and society in general. With the right balance of daily and social activities with supportive environments spread into the lifestyle of the seniors can lead to a functioning and interactive living.

Fig 4. Illustration by Brian Cornin

Basic activities of daily living (BADL’s):

Instrumental activities of daily living (IADL’s):

Basic activities of daily living also called physical or self-maintenance

daily activities. This are life-sustaining and self-care activities such as

feeding, grooming, bathing, dressing, toileting, and ambulation (A.K.

Troyer, 2011).

Walking Walking Walking

Meal preparation

Bathing Bathing

oming

Transferring Bathing

oming

Transferring

Housecleaning Housecleaning

Meal preparation Housecleaning Meal preparation Housecleaning Feeding Toileting

Transportation Transportation

Bathing

Housecleaning Transportation Dressing and grooming

Dressing Dressing and grooming and grooming

Transferring

Transferring Transferring Medications Medications

Medications Communication Medications Dressing and grooming TransferringCommunication Medications

Meal preparation

Toileting

Meal preparation Toileting ToiletingMeal preparation

Feeding Feeding

Toileting Walking Toileting

Feeding

Communication

Finances

Medications Communication Communication

Finances Finances

House

Transportatio Transp

Comm

Finances Fin

Social Activities Social activities promotes a chance to interact with other people which helps the risk of social isolation in PWD. Not only these activities increase connections but also can stimulate the cognitive functioning to a better state.

Arts & crafts

Communal cooking

Group sessions

Music

Intergenerational interaction

Volunteer work

3.6 Importance of activities

The person with dementia finds it increasingly difficult to handle tasks for normal, daily living. Dementia impedes the brain’s ability to sequence, plan and organise multiple-step activities. Not able to do tasks or some familiar activities independently, leads to agitation, feeling of uselessness and bearing a stigma of ineffectualness nevertheless one’s previous status. With so many abilities and certainties slipping away, support from the environment is enormously important as it can be one of the last thing demented people can relate to(Östlund & Topo, 2009). Design interventions can potentially play an important part by ameliorating some problems faced by a dementia affected person while doing the activities. For instance providing a space to sit at kitchen can help senior with dementia to rest, talk and help the person who is cooking. Providing balconies and small gardens in their living spaces can help elderly to interact with surrounding environment and nature. In relation to dementia, architecture has the power to create a calm, comfortable spaces that link between the presence and past. Providing space and allowing for various daily activities is extremely important. Through activities multiple actions, sounds, smells and various tactile stimulation can be achieved. Creating spaces for these activities and their clues gives life to the building as well as to the people Fig 5. Illustration by Elisabet Ericson

3.7 Literature research conclusion

With the help of literature research, it is understood that daily and

environment is crucial for people with dementia as it provides comfort and

social activities are vital for the health and well being of people with

also induces a positive effect on their physical and mental health.

dementia. Everyday activities like ADL’s, self-care, cooking, and regular chores can make the elderly active and independent whereas social

Based on the knowledge gained from literature and case study analysis,

activities like talking to people, sharing a meal with others, going

which will come in the next chapter, guidelines for spaces that are used for

outdoors, and interacting with nature can lead to less isolation and

ADLs and social activities were developed. Along with the guidelines, the

more social participation. This results in good health and better quality

housing typology of the design (built environment) was also defined. These

of life for the elderly.

guidelines later acted as the basis for the design development to further answer my research question.

Apart from activities, housing typology also plays an essential role in the well being of the elderly. Aging in place or staying at the home-like

How the spatial planning can help seniors aging in place with dementia to carry their daily and social activities independently resulting in their well-being?

Fig 6. Illustration by Brian Cornin

4. Case Studies 30

4.1 Case Study Analysis

Case studies are a way to observe the relation between how space is used by the elders and the influence of surroundings and built environment on their well being. The visits consist of five different case studies ranging from residential care homes to nursing homes. The case studies were analyzed in a way to understand the daily activities of the senior and to see how research concepts were used in practice. The analysis section consists of three parts ‘Spatial analysis drawings’, ‘general analysis,’ and ‘Personal and social activities of residents in a day’. In the first section, subtopics like ‘green spaces and built areas of the site’, ‘various functions present in the building,’ ‘relations between residential and activity spaces’ and ‘the routing scheme of the entire building and its residential units’ were analyzed. Later a comparative analysis of these topics was done to understand the link between

Hof van naussau Boswijk nursing home De Hogeweyk De Klinkenberg nursing home De Koekoek nursing home

spatial arrangement and its influence on the residents. The second section consists of ‘general analysis’ where some topics like wayfinding, safety, technology, and pros-cons of the building were discussed. The final section consists of ‘Personal and social activities of residents in a day’ where the inputs from the caregivers and the manager for few case studies, the daily activities of the resident was observed and translated in the form of a timeline. From the results of all sections, a final conclusion of the case studies was made.

Fig 32

7. Hov van Nassau nursing home

Hof van naussau Location: Lindenburghlaan 7, 4651 TM Steenbergen, Netherlands

spaces like restaurant and café are open to public which acts as an anchor point for the social interaction between the residents and the

Category: Nursing homes and Daycare

neighbourhood people.

Residents: Senior with dementia and somatic

The building planning with internal courtyards ensure safety to the residents without compromising their independence. The design

Project time: 2018

emphasis on the free and safe movement of the residents by providing different levels of zones that they can access which range

Number of residents: 120 residents, 13 residential groups

from residential units, inner courtyards, activity spaces and whole neighbourhood.

The Hof van Nassau has a small village like character with no feeling

The private rooms of residents open to a common corridor leading

of an institution or an healthcare atmosphere designed by Inbo

towards the communal living room. This the collective space of the

architecten. The building is for seniors with dementia and somatic

residential unit where residents meet, greet and live together. Group

care and consists of 120 residents and 13 residential groups. The

of residential units open to different internal courtyards within a big

architecture is a collection of individual and recognizable houses, with

public square of the whole building. This public square consists of

different shapes and colours that features a typical street and has inner

activity spaces and acts as meeting point between activity spaces and

gardens and squares that function and resemble as a village square.

residential spaces.

Not only residential areas but the building also consists of restaurant, grocery shop, the hairdresser, the physiotherapist and few workshops on the sides of the internal squares. By distributing the facilities over the complex, residents have a chance to do everyday activities, which triggers them to go out thus stimulating the movement. Few activity 33

Activities Residences

Green spaces and built area

Proportion of residential and activity spaces in the building

Restaurant Reception Winkel Kapsalon

Activity areas

Clothes shop Physiotherapy

Communal living Area

Multi purpose

Service space

Carpentry

Bathroom

Lift & stairs

Residences

Multiple activity spaces in the building

Multiple activities in the residential unit

Route to activities Route to private space Route to shared space

Primary routing system of the building

Primary routing system in the residential units

Routing scheme of the building

Routing scheme in the residential units

Technology

Safety 1 2

3 4

Freedom of movement 1. Residential unit 2. Internal gardens 3. Cafe & other activities 4. Neighbourhood

The technology was well integrated into the nursing home design to

The building’s planning, shape, and internal courtyards ensure safety

ensure freedom and safety for the elderly. Many technological features

to the residents without compromising their independence.

were used in the building for the well being of the residents. Some of these features include

To ensure maximum safe movement to elders, different levels of mobility

- Smart bracelet

zones were proposed in the design which ranges from residential unit

- Smart flooring

to neighbourhood.

- Sensors all around the building - Smart door systems

Way finding

Diverse environment at every residential unit helps the elderly to find their individual living suites easily. For wayfinding of rooms, smart bracelet technology helps elderly to find and open their rooms and memory box was present at every door.

Pros

The presence of technology in the form of smart bands, smart floors, and sensors enables freedom, safety, and wayfinding to the users.

Freedom of movement from different parts of the building to the neighbourhood is provided to every individual according to their level of diagnosis.

Change of color and environment at every residential unit helps the elderly to find their individual living suites easily.

Multiple activities like shops, salon, and multipurpose rooms were located on the ground floor, enabling easy access to residents.

A small village like environment with exciting elements like houses, gardens, and bridges creates a calm environment.

Separate bathroom for every individual to ensure privacy and proper differentiation of rooms by colour, helps the elderly to find spaces easily.

Cons

No transition space was provided between public gardens and private residential units.

Every residential unit has a double-stacked corridor, which might be a problem for the elderly to easily find their rooms.

Corridors on the north are too long and might lack in natural ventilation due to absence of windows. 37

38 Fig

8. Boswijk nursing home

Boswijk nursing home Location: Laan van Voorburg 13, 5261 LS Vught, Netherlands

ground floor has optimal contact with the restful green surroundings and very well-natural exposure and stimuli for the residents.

Category: Nursing home When it comes to planning, the main entrance opens to a central Residents: Senior with dementia

communal area with a corridor where functions like restaurant-café, the hairdresser, library, art room, small courtyards with stimulation

Project time: 2008-2010

elements, and more were present. This corridor looks and acts like a street with seating furniture, lamps, and transition spaces where

Number of residents: 120 residents

residents meet others, roam around, and do activities together. This corridor leads to individual residential units that open to a communal living room. It consists of a kitchen, a living hall, both overlooking the

“A place where residents with dementia can be themselves and

street, and an outdoor sit-out area in the wilderness. The living room

continue enjoying their own particular way of life as much as is

leads to a small corridor where individual’s private rooms are located

possible. A nursing home that is designed to be a safe haven. A

with their personal outdoor balcony.

home for residents with a wide range of wishes and needs” (EGM Architecten, n.d.) The Boswijk nursing home consists of twelve residential units that are connected by a big communal area under one giant roof. The design looks like an anatomy of a tree with roots resembling a central communal area having activity spaces, small courtyards, and substantial common corridor leading to different residential units spread around the central area, just like how branches are spread in a tree. With this planning for the building, the full program on the 39

Activities Residences

Green spaces and built area

Proportion of residential and activity spaces in the building

Restaurant Reception Winkel Kapsalon

Multi purpose

Clothes shop Physiotherapy

Communal living Area

Multi purpose

Service space

Carpentry

Bathroom

Lift & stairs Residences

Multiple activity spaces in the building

Residences

Multiple activities in the residential unit

Route to activities Route to private space Route to shared space

Primary routing system of the building

Routing scheme of the building

Primary routing system in the residential units

Routing scheme in the residential units

Technology

Safety

Residents have a wrist band which helps the organisation to track the

The main corridor of the nursing home is designed in a such a way

person incase of care and emergency situations.

that allows the resident to wander as much as possible at the same time keeping them safe.

Cameras and alarms were installed in the main corridor and the living room of residential units for supervision incase of accident and need

Emergency exists and service doors were flushed or hides with the

for attention.

wall and surrounding, which helps the residents to not pay attention to unnecessary objects.

Recognition

Every residential unit has monotonous look and same features, which might create confusion for elderly to find their unit easily. Inside the residential unit the corridor is double stacked with doors on both sides. This can cause agitation for elderly to recognise their room door

Pros

A small village environment located in middle of nature creates a feel of non institutional settings

The connection between residential units and social spaces was well established with the help of roofed corridor

Usage of different window heights helps standing and sitting people in wheelchair to look through them and relate to objects or people

Clear differentiation of walls and flooring have been given to different spaces to help the elderly to find the places easily

Transition space between corridor and residential units are provided as a subtle change from public to private space

Every residential unit has double corridor with zig zag circulation which might be problem for elderly to find their rooms easily.

Shared bathrooms are provided in every residential unit which might be a problem for the privacy of users

There are no roofed or semi roofed structures in garden for elderly to rest

All the service lines and pipes are clearly visible in the main corridor and obstructing the light entering the building

Cons

Due to Monotonous walls of every residential units, wayfinding towards residential doors was compromised

44 Fig

9. De Hogeweyk nursing home

De Hogeweyk Location: Heemraadweg 1, 1382 GV Weesp, Netherlands

multiple activity spaces like theatre, restaurant, supermarket, and

Category: Nursing homes

various clubs and workshops were located, which are accessible to every resident to do their normal daily activities just like they use to

Residents: Senior with dementia

do in their past days. Spaces like restaurant & café are accessible to neighbourhood people, which provides a change of interaction for

Project time: 2009

outside people to interact with the elderly. This boulevard later opens to different internal courtyards where residential units are present. This

Number of residents: 152 residents, 7 residential groups

internal squares act as personal courtyards and walking spaces for the users of that particular residential unit. Every residential unit opens

The Hogewyk is an often mentioned as a successful concept where

to a communal living area where the concept of lifestyle is reflected

care meets with spatial organization which was designed by Molenaar

very well. The living rooms are decorated to their own style, familiar

Bol&vanDielen Architecten (2009). There are 23 houses for 152

objects, sounds, and smells, making a connection to the elderly with

people with dementia organized in a village-like settings. The main

dementia as it creates a familiar environment.

idea of the design is to provide an opportunity for the residents to continue their life in the way they are used to, despite their dementia. (Vivium, n.d.). This lead to the design of residential units in 7 different lifestyles: Goois (upper class), homey, Christian, artisan, Indonesian, and cultural. That gives each person a better chance to accommodate his individual life within the new environment. The design consists of main street (Boulevard), squares, internal gardens, backyards and memorable things like Dutch signs and water objects which all together creates a home environment rather than a care institution. In hogewyk, the main entrance opens to a boulevard street where 45

Activities Residences

Green spaces and built area

Proportion of residential and activity spaces in the building

Restaurant Reception Winkel Kapsalon

Multi purpose

Clothes shop Physiotherapy

Communal living Area

Multi purpose

Service space

Carpentry

Bathroom

Lift & stairs Residences

Multiple activity spaces in the building

Residences

Multiple activities in the residential unit

Route to activities Route to private space Route to shared space

Primary routing system of the building

Routing scheme of the building

Primary routing system in the residential units

Routing scheme in the residential units

Technology

Safety

Two lifts were provided in the nursing home that helps elders with the

The cluster designs of residential units create a semi enclosed space

vertical movement from ground to first floor and vice-versa.

that enables elderly to move freely in and around the cluster in a safe environment. To ensure maximum safety, the entire nursing home has only one entry and exit point.

Way finding

Diverse environment with different landscapes and elements at every residential units and different parts of site helps the elderly to find their individual living suites easily. Inside the residential unit they are too many doors which might create confusion and agitation for elderly. 48

Pros

A small village like environment with non institutionalised settings was created with main design motto as freedom and normal life for elderly

Different gardens and outdoor spaces with unique landscape were created at every residential unit which can help the elderly to find their individual living suites easily.

Various social activities like restaurant, theatre, shopping and more were provided to ensure that elderly will have as normal life as possible which promotes their well being

Every room on ground and first floors have a visual connection towards internal gardens

A frontyard is provided as a transition space between gardens and residential units as a subtle change from public to private space

Shared bathrooms are provided in every residential unit which might be a problem for the privacy of users

Individual rooms lack adequate space for free movement and storage of personal belongings.

The building has only 2 lifts which are not sufficient for the daily movement of elderly on first floor, which might effect there chances of social interaction and connections

No direct access to garden from individual rooms

Cons

Each residential unit has many doors which creates confusion and problem for the elderly to find their rooms.

50 Fig

10. De Klinkenberg nursing home

De Klinkenberg nursing home Location: Amsterdamseweg 56, 6712 GZ Ede, Netherlands

promoting a sense of community. Every living room consists of a wide private balcony overlooking the other building and the public square

Category: Nursing home

in the middle. The building’s interiors consist of memory enriched environment with colorful wallpapers, patterns, memory boxes in front

Residents: Senior with dementia

of the door, and the layout of the room, allowing residents to use their original furniture. All the efforts aim to preserve the residents’ previous

Project time: 2015 – 2018

trajectory and life experience as much as possible. The whole building is connected to the neighbourhood without any fenced boundaries but

Number of residents: 120 apartments, 10 residents as a group

with pathways that can be used by the people in the neighbourhood. The exterior of the building blends in the neighbourhood with similar materials and roof systems.

De Klinkenberg is a nursing home in Ede designed by Wiegerinck Architecten, a three-storey residential care home for seniors with

Few activity spaces like multi-purpose rooms, an outdoor park with

dementia. The whole building consists of two main blocks, and

exercise furniture, and animal farms were provided. The animal farm

each block has two wings connected through glass bridges. These

is one of the very fond activities in the building where pets are raised

bridges are not just connection passages but have wide corridors with

and taken care of by their residents, providing multi-sensory stimulation

communal spaces and hangout spots with glass windows offering a

to the elderly. Apart from the animal farm, the building does not have

broad view of the neighborhood to the residents. The whole building is

many activity spaces that the elderly or the neighbourhood people can

designed in the form of an enclosed triangle with a central courtyard

use.

acting as a public square. The building architecture caters to the residents’ needs with wide and bright corridors, private cozy rooms for each resident, and a spacious common living room on each floor for every block to socialize, 51

Activities Residences

Green spaces and built area

Proportion of residential and activity spaces in the building

Restaurant Reception Winkel

Multi purpose

Kapsalon Clothes shop

Communal living area

Physiotherapy

Service space

Multi purpose

Bathroom

Carpentry

Residences

Lift & stairs Residences

Multiple activity spaces in the building

Multiple activities in the residential unit

Route to activities Route to private space Route to shared space

Primary routing system of the building

Routing scheme of the building

Primary routing system in the residential units

Routing scheme in the residential units

Technology

Safety

Technology was well integrated into design of the nursing home to ensure safety and fun for elderly. Many technological features were used in the building for well being of the residents. Some of these features include - Smart lift - Motion detective sensors and alarms - Smart devices like Tovertafel, Gaming pc’s and more

Way finding

Lot of doors were present in the corridors which can cause confusion while finding the door of the required room. Every residential room has a memory box where the resident can display their personal belongings. This memory box can be a clue to them to recognise the space effortlessly. 54

The shape of the building is in the form of a triangle to form a safe enclosed habitat with enough opening on sides for easy movement around the building

Pros

1. Normal residential care home settings with centeral square and green spaces all around

2. Every corridor ends at a communal areas which are open and filled with lighting and furniture to rest and interact with others

3. The care centre has a pet farm with animals and birds which are raised by the residents. These space promotes well being of elders.

4. Different colours, textures and landscape features were displayed in the building creating an interesting scenarios and refreshment for residents

5. Technology is used for the well being of residents in the form of smart bracelet, tovertafel, brain trainer and smart screens projections.

3. No social interactive spaces like central gardens, cafe or shops were there which might reduce the change of interactions and active life

4. The building has 3 to 4 floors height. This restricts the elderly to move freely from one floor to other without the help of the lifts.

5. No direct access to garden from individual rooms was provided

Cons

Priva t

lic

Pub

Pri v

ate

1. The care centre has long double stacked corridors with no windows to have natural light and ventilation

2. No transition space or semi public space is provided from inside the building to public outdoor spaces

56 Fig

11. De Koekoek nursing home

De Koekoek nursing home Location: Nieuweweg 30, 3901 BE Veenendaal, Netherlands

which ends up in a communal living area with kitchen and dining.

Category: Nursing home

Apart from essential residential spaces, the building has only very few activity spaces like physiotherapy and multipurpose hall are present,

Residents: Senior with dementia on 1st and 2nd floor

which reduces the chance of movement and social interaction. The major setback of these nursing home is the absence of gardens or any

Project time: 2012- 2014

kind of outdoor spaces which silences the elderly’s chances to spend some time in nature within the safe premises of the building. Although

Number of residents: 24 residents

the interiors of the residences are well planned, due to lack of outdoor spaces or activity zones and problems with mobility from floor to floor

De is a nursing home in Veenendal designed by studio id+, a multi-

by lift or stairs, the overall building has many restrictions for the daily

storey building with residences for seniors with dementia on 1st

activities and free movement of the residents which can affect their

and 2nd floor. The building has four floors with ground floor for

quality of life.

administration, staff and few activity spaces and above three floors are for senior residences. Topics like wayfinding and safety are given special interest, which can be seen in the building’s interiors. Every resident can easily find their room with the help of a personalized memory box at the entrance of their room. The corridor have non-institutional looks with long wooden panels that act as grab rails and smart lighting all along with the corners of the corridor for the safety of residents. The residential floorplans are simple and clear, consisting of individual rooms with personal bathrooms that are open to a long wide corridor, 57

Activities Residences

Green spaces and built area

Proportion of residential and activity spaces in the building

Restaurant Reception Winkel Kapsalon Clothes shop Physiotherapy Multi purpose Carpentry Lift & stairs Residences

Multiple activity spaces in the building

Route to activities Route to private space Route to shared space

Primary routing system of the building

Fig 54. Routing scheme of the building

Technology

Safety Main road

Main road

Smart lighting system in the corridor that produces light at dark nights. This helps the elderly to wander in well lit corridors

Grab rails are present in main corridor which helps elderly for fall proof and safe walking.

Technological equipment that detects and alarms about accidents and falls is present in every room

Safe atmosphere is created in the insides of the building but the location of the building is next to busy vehicular road which might create some noise pollution

Way finding

Lot of doors were present in the corridors which can cause confusion while finding the door of the required room Every residential room has a memory box where the resident can display their personal belongings. This memory box can be a clue to them to recognise the space effortlessly 60

Pros

Corridors have intelligent lighting systems at skirting level that glows in dark which helps elderly to wander safely at night

Grab rails are made in an innovative way that does not look like typical institutional hand bars. Memory box in-front of every room helps with wayfinding

The interiors of the building were taken special care to fit the taste of elderly. And stable furniture provides safety incase of fall

There are no outdoor spaces for residents to go out and enjoy the nature which is not so good for their well being

PWD live on 1st and 2nd floors of building which are connected by lift & stairs. This restricts the elderly to move freely from one floor to other.

Cons

The care centre has long double stacked corridors with no windows to have natural light and ventilation

They are no special spaces or social activity zones or green spaces in the building. This is a huge problem for the social life of dementia elders

The overall environment of the nursing home is kind of institutional with only residential units and small communal areas.

4.2 Comparative analysis 4.2.1 Green spaces Hof van naussau

De Klinkenberg care home + Central courtyard with rooms

+ The building is surrounded by

surrounding the internal garden.

outside green spaces and inside square.

+ Large courtyard was divided into

small gardens to make elderly feel comfortable.

_ No internal gardens or patio

between the buildings

Boswijk nursing home

+ Building is present in between a

De Koekoek nursing home

lush landscaped settings.

_ Green space present on the

frontside of the building but not used.

+ Every residence is surrounded by

the greenery of the outside.

_ No gardens or green spaces for

the recreation of elderly.

Conclusion

De hogeweyk nursing home +

The design has a main boulevard(street), squares and clusters of small gardens.

+ Different kind of gardens to help

elderly with wayfinding and to indulge comfort. 62

Building surrounded by green spaces inside or outside provides recreation and positive impact on elderly. The presence of different kind of gardens and patios in Hof van naussau, boswijk and De hogewyk made the residents to wander around and interact with nature, wheras the residents of de kinkerberg and De koekoek were less likely to come outside the buildings due lack of green spaces. To conclude outdoor spaces are as vital as indoor facilities for elderly for their health and well being.

4.2.2 Activity spaces in the building Hof van naussau

De Klinkenberg nursing home + The nursing home has a restaurant

+ The buildings are connected

which is open to residents and public.

by bridges which opens to communal areas where elderly meet each other.

+ Various activities were well distribut-

ed all along the building.

The outdoor space has a pets farm which attracts many seniors. Not many activities were present

Boswijk nursing home

_ in the building. + The core of the building was filled

with multiple activity spaces and

De Koekoek nursing home _ Not many activities or outdoor

patios which invites the elders from

spaces were present in the

their residential clusters which are

building.

present around the core.

Conclusion

De hogeweyk nursing home

Research shows that activities nurture the health and prosperity of the elders.

+ The building has a restaurant

which is open to residents and public which leads to interaction for elders.

+ Different activities were present

which were well distributed all along the building.

De hogeweyk and Hof van naussau not only have multiple activities for residents but also have few spaces cafe and restaurants which are open to the public, this way, the people from the neighbourhood can use the space in the building and interact with the residents on a daily basis. This implies having few public spaces in the design can benefit the decrease of social isolation for the elders.

4.2.3 Layout of residential units Hof van naussau

De Klinkenberg nursing home + Clear separation of living room

+ Clear separation of living room

and private rooms through internal corridor.

_ Double stacked corridors might

cause confusion for wayfinding.

Double stacked corridor with long hallway.

Boswijk nursing home

+ Every residential unit is

De Koekoek nursing home

and visitors.

connected to the main corridor of _

+ Separate corridor for residents

the building.

Double stacked corridor with long hallway.

Double stacked corridors with zig zag hallway.

Conclusion

De hogeweyk nursing home +

Single stacked corridors which helps elderly to find their door easily.

Living room has internal corridors on both sides which might cause confusion.

Every residential unit has a communal living room and a hallway that consists of private rooms. This kind of arrangement allows the elderly to come from their private rooms to the communal area within a few steps and have social exchanges on regular basis. This hierarchy of spaces help elderly to travel from place to place at ease.

4.2.4 Routing in the building Hof van naussau

De Klinkenberg nursing home

_ The corridor opens directly to the individual private rooms, lacking in privacy control.

+ The entrance opens to a public

cafe which leads to semi public gardens which then opens to

_ No smooth transition from public to private areas.

private residential clusters. This results in nice transition from the public spaces to the private

Boswijk nursing home

+ The central semi public corridor

directly opens to the private

De Koekoek nursing home _

residential clusters. Nice transition from public activities

No smooth transition from public to private areas.

space to private rooms.

Conclusion

De hogeweyk nursing home + The entrance opens to a public

cafe which leads to semi public

Tr a n s i t i o n a l zo n e s h e l p t h e e l d e r l y t o a d j u s t a n d r e a c t t o t h e sudden changes the environment offers. H aving a natural flow of

gardens which then opens to

p riva te, sem i - p riva te sp a c es c a n b en efi t sen iors i n u n d ersta n d i n g

private residencial clusters. This

w h a t s p a c e i s a n d h o w t o m o v e f u r t h e r t h e i r j o u r n e y. S o s m o o t h

results in nice transition from

transition of the spaces is necessar y for the bet ter wayfinding of

the public spaces to the private

t h e e l d e r l y.

Comparitive analysis of case studies 66

4.3 Timeline analysis

When visited the case studies, along with looking around the building and observing the elderly, a day of the resident was also noted with the help of care manager and staff people in a few of the visited buildings. General questions like what is the daily routine of the resident and what activities does a resident do on a typical day were asked to the staff members of every case study. While some of the responses were general for a few case studies, the staff of De klinkenberg, Boswijk, and De koekoek gave an overview of their residents’ daily routine from morning to evening. These findings were

Activities of a resident in a day - Boswijk nursing home In boswijk nursing home, with the help of the care manager of the organization an analysis about the day of a resident was noted, and the findings were mapped in a timeline. The residents’ daily activities revolve around the living room of residential units, central activity units, and green spaces all around the building. A typical day of a resident starts with waking up, getting ready, and

mapped in the form of timelines, which will be discussed further.

having breakfast with others in the living room. Later, most people

The study of these timelines helped to develop a hypothetical timeline,

to walk and reach activity rooms like restaurant, fitness centre,

which explains the various activities of an elderly in a day from morning to evening. The timeline was one of the conclusions of the research and a start towards design development. This timeline can be found in the research results chapter and will be discussed further.

like to wander, so the central corridor is mainly used as a promenade hairdresser, and more. At lunchtime, the residents would return to their respective homes with the help of caretakers to have meals together. Many residents would help the carer of the residential unit with peeling vegetables and cooking. After lunch, many residents would take a nap in their private rooms or the living room. Each resident has his/her outdoor space and a small garden in which they spend quality time with nature at different times of the day. In the evenings, many social activities like singing, bingo, arts, and crafts were planned for different days of the week, which encourages the residents to interact.

Fond activity spaces: Cafe, Gardens, a small chapel, and arts-crafts room. 68

Various activities done by the residents in a day and the spaces used for them

Afternoon

Morning

Evening

Nap

Singing

Cafe

Wake up

Wandering Outdoor time

Breakfast Lunch

Dinner Gardening

Back to bed

Wandering

Re siden tial un it

Co m m u na l a rea

G a rden & pets

Corri d or

R esi d ent i a l uni t

Illustration about activities and spaces used in Boswijk nursing home 69

Activities of a resident in a day - De Klinkenberg nursing home One of the caretaker of the Klinkenberg had provided some insights about the day of an elder in their care centre. It typically starts with the residents meeting in the main living room of the floor for breakfast. Later most of the residents will wander in the corridors, chit chat in communal spaces of the bridges, and many of them visit the animal shed to take care of the pets. In the afternoon, the residents would meet up in the main living room of the floor to have lunch together, and some preferred to cook at their own homes. The living room was equipped with furniture and couches for the elderly to rest and computer screens and technical gadgets like brain teaser to stimulate their cognitive activity. Alongside with the technology, interactive physical activities like group singing, arts, story reading were also planned mostly in the evenings. In the evening few residents go to walk around the building and look at the animals in the park as apart of their evening routine. At night people gather together in the communal living area of their respective floor and have dinner together or in their private apartments.

Fond activity spaces: Pets park, meeting spaces in the bridges and pathways around the building.

Various activities done by the residents in a day and the spaces used for them

Morning

Afternoon

Pets

Evening

Television

Nap

Breakfast Wake up

Wandering Singing

Meeting space

Dinner Wandering

Re side n ti al un i t

Com m u na l a rea

Lunch

G a rden & pets

Brain games

Corri d or

Back to bed

R esi d ent i a l uni t

Illustration about activities and spaces used in De Klinkenberg nursing home 71

Activities of a resident in a day - De koekoek nursing home In De koekoek nursing home, the daily activities of residents happen entirely inside the building. Lack of outdoor spaces and green areas was unfortunate. With the help of the building manager(Fenja Huizinga), residents’ activities were noted and made into the above timeline. In the morning, the residents will meet in the communal area of their respective wing block to have breakfast. Later many residents hit the gym or physiotherapy room for some exercise. Other residents would wander inside the building in the corridor or stay in the communal living room and watch television. Most of the residents will help with meal preparation and have a meal together in the living area. Only the ground floor has activity spaces like gym, meeting rooms, and multi-purpose hall used by residents who can travel from floor to floor. In the evening, caretakers will organize social gatherings with singing and bingo as a stimulation activity. Lack of outdoor spaces and pathways around the building leads to only indoor life for the residents.

Fond activity spaces: Communal kitchen and living area 72

Various activities done by the residents in a day and the spaces used for them

Morning

Afternoon

Evening

Gym Television

Nap

Breakfast Wake up

Wandering Singing

Meeting space

Dinner Wandering

R e si de n t i a l un i t

Lunch

Com m u n al area

Back to bed

Co rrid o r

Illustration about activities and spaces used in De koekoek nursing home 73

4.4 Case study conclusion

From the case studies, speaking with care staff, analytical drawings,

Sequence of spaces:

and observing seniors’ activities, it is understood that few factors

Often times, seniors who want to step out of their room to do some

enhance the experience of space and help the seniors positively carry

activities are confronted by the routing of the surroundings to reach

their daily actions. Below are the main findings.

their destination. Creating a sequence of spaces with transitions and levels of privacy gives people the time to settle and adjust to

Green spaces:

the change. Clueful environments with proper spatial order and

One can never have enough of nature. For every human being and

arrangement can help seniors to find their destination areas easily.

people with dementia, nature provides a unique source of relaxation, stimulation, and time-space orientation. Access to nature relieves and freshens up; it provides opportunities for walks, gardening, and meditation, and contemplation. Well-structured and designed outdoor space, which leaves space for all of these activities, can enhance the quality of life to a great extent. Equally important is bringing nature inside the design in the form of courtyards and small patios with some plantations and water elements.

Activity zones: Creating spaces only to live no activity zones degrades the overall quality of the space, the experience it provides, and the well-being of seniors. Daily activities provide physical movement, sounds, smells, and various tactile stimulation, which keeps the brain active and fulfilling the day without boredom. Additionally, these activities act as a source of natural therapy and are a way of normal life. Spaces that encourage personal, group, or public activities engage seniors with multiple incentives and different levels of interactions. 74

Green spaces , Activity zones and Sequence of spaces

Fig 12. Illustration by Gérard DuBois

5. Research Results 76

5.1 Defining Housing Typologies 5.2 Spatial Design Guidelines 5.3 A day of a senior

The research question was divided into three elements: Ageing in place, Daily activities, and Social interaction, and these elements were analysed with the help of literature research and case studies.

Aging in Place Research states that aging in home can be associated with the feeling of growing old in the place where the elderly would experience emotions of comfort, care, sense of home, independence, and daily interactions. This raises the question of what housing typology would be suitable for qualifying the above characters. Some literature

Aging in Place + Daily Activities + Social Activities = Well Being

mentions that having multigenerational homes with different age groups can increase the daily interactions for seniors and can receive care and comfort from them. Having proper spaces for daily and social activities can help seniors with dementia to carry their hobbies or tasks

Aging in Place

Daily Activities

Social Activities

independently. Providing nurturing spaces with nature and surroundings can benefit the overall mental and physical health of seniors and brings care and comfort to their everyday life. All these factors can contribute to the emotion of aging in place and the sense of home. Keeping all these factors in mind, a new typology of residential homes with care and activities was considered for the design.

Housing

Spacial

Day of an

typology

guidelines

elderly

Breakdown of research question

Daily activities

Social interaction

How a person derives meaning from their everyday activities and

Observing the residents’ daily routine and inputs from the care staff of

environment is central to their well-being (Hui-Xin Wang, 2002).

the visited nursing homes, it is understood that daily activities are an

Everyday activities(daily and social) are not only vital for the health

essential source for social interaction and bonding. Having a balanced

of a person but also provide a sense of motivation to do tasks and

blend of personal activities(ADL) and common ones in a day will give

a positive stimulation when the task is accomplished. Many times

the seniors a chance to experience independence and social bonding

when an elderly with dementia needs to do something, the spatial

with others resulting in their cognitive stimulations and wellbeing. With

environment around him/her matters so much as a guiding factor to

intergenerational housings and availability for multi-activity spaces

accomplish the task. Due to their declined cognitive state, the elderly

provide changes for less social isolation, which decreases the risk

look for clues in the environment around them to guide them further.

of loneliness elderly experience. Keeping these in mind a timeline

So a well-designed space should have qualities to intuitively lead the

explaining the day of a senior with the activities and spaces they visit

person towards it and help them to do activities. In the search for the

in a day period was drawn as starting point towards the design.

factors that make a space more intuitive and clueful for the elderly literature and case studies helped to understand and formulate some guidelines. The guidelines were taken on topics of ADLs(activities of daily living) and outdoor spaces and will be explained further in the spatial guidelines topic.

5.1 Defining Housing Typologies

Based on literature research and case studies, information was drawn about the housing situation for the elderly in the Netherlands. Previously care homes and other housing facilities for people with dementia use to have medical care as the core rather than the feeling of normal life with everyday activities. The buildings use to have institutional settings with no liveliness or freedom for the senior resident. With the development in socio-economic conditions and awareness in society, the notion of looking older adults as a burden is no longe and seniors are looked an asset to society. Empowering this norm, the housing typologies for seniors are changing towards less hospitalized, institutional buildings to healing environments with the emphasis on the mental wellbeing of senior residents. Research also showed that new typologies are emerging in the form of dependent, independent living, communal living, senior apartments, co housing and more which caters to the personal needs of seniors. Keeping all this research in mind, the typology for the design was developed in a way it provides to the needs of seniors with dementia. The design consists of three different types of living homes for the seniors and their families, activity spaces-public zones accessible to residents and people of the neighbourhood, care facilities for seniors with different stages of dementia and service spaces. The following figure explains in detail the types of housing and service unit the design consists of.

Ty p o l o g y R e s i d e nt i a l - Act i vi t i e s - C a r e - S m a l l s ca l e l i vi ng Ot

r f ac

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ut Individual a c d o o homes r ti vit

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A home for independent elders. ts

Ty p ol o g y

These are homes for people who want to live independently, having

als their own private spaces like bedroom, bathroom, and a living room.

Residential - Activities - Care - Small scale living

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This are self-contained houses are located in a residential apartment O

the where independent r f and couple apartments are situated on the ground a cil

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Ind

spaces with care, and services. Although these homes are independent,

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two individual houses share a common S hcommunal space where the R people can meet and greet their

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Shared/ couple homes

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for senior couples who share and care for each other.

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shared spaces of individual homes. The couple can sit in front of their apartment while having the opportunity for simple social contact with people passing by.

82 La

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Ty p ol o g y Residential - Activities - Ca - Small scale living Ot

r f ac ilit i

Family homes A home for families with children. This homes consists of kids who can act as a

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dementia. A bigger courtyard is created in In front of family homes

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excellent interaction point for

me r nts children,

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as a transition between the main road and centre of theOplot where u dementia blocks are located. Zoning of family homes

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fac

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Care facilities

Care, clinic, and fitness to promote health for elders. Care and services are available at reach all the time in the residential apartments and in various parts of the design. The design consists of every resident in the campus.

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Created Olena Panasovska from the by Noun Project

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Sit me

tin

up wi le h th o vis m ito r 83

Shops, café and others(Activity block)

A place to do day to day activities.

This place consists of various activities coming together like café,

r f ac ilit ies

restaurant, shops, hairdresser, gym, physiotherapy, and more. This space is not only for the people of the inclusive design but also open to

the entire neighbourhood. That is why it is situated at the entrance of the site.

Sh stu ops , ra nt Caf e an d , oth e

rs Ca

W ele ate me r nts

Homely design without provisions of service and storage spaces is of no value. So the design will have ample service spaces in residential and non-residential blocks of the whole site.

Created Olena Panasovska from the by Noun Project

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Ou t ac doo tiv r itie

O f a cWu t d i lai tl ko o r i eisn g

5.2 Spatial Design Guidelines

Guideline’s for ADL’s It is a known fact people with dementia can no longer adapt to the environment around them, but the environment should adapt according to their needs(Van Hoof & Kort, 2009). Many times when an elderly with dementia needs to do something the spatial environment around him/her matters so much as a guiding factor. So architectural spaces should provide hints and clues for the seniors to carry their daily activities easily. There is a broad range of environmental interventions available to support individuals with dementia for doing a range of daily activities

Way ﬁnding

Safety

and functions. Activities included in this chapter are basic ADLS’s which are toileting, bathing, dressing, cooking and sleeping. Each of these activities requires a specific space, and the guidelines to make these spaces dementia-friendly were studied and translated. For the elderly to do an activity successfully and feel positive about it, few elements should be addressed well. For an activity to be done effectively topics like wayfinding and safety are important. To resolve

Layout

Differentation

Lighting

Furniture

Elements to be considered while the planning of spaces

the problems in these topics, few sub-topics like layout, differentiation, lighting and furniture were taken into consideration.

Bathing

Bathroom

Feeding

Kitchen

Grooming

Bedroom

Walking

Corridors

Resting

Bedroom

Architectural spaces used to carry daily activities(ADL’S) To carry an activity, space is vital, and different activities have different problems, so as different spatial solutions. The architectural spaces used for ADLS, which are bedroom, bathroom, living area, kitchen, and corridors, are studied with the help of literature and visits to case studies. The following pages consist of guidelines to resolve some of the relevant problems, and solutions were translated in the form of small drawing. These guidelines for specific space are then validated with the help of existing examples from the case studies.

Bathroom

Activity

Space

Bathing

Bathroom

Living room

e Toil

Bathroom

Bedroom

It is evident that toilets are easier found (and thus used)

Highlighting the toilet door or its frame from its adjacent wall

when clearly marked or visible from the different rooms in a

can help with elderly to locate the toilet easily (1,2,3&4).

house(1).

Problem : Way finding

Solution : Layout

Solution : Differentiation(Door)

Clearly defining each section of the bathroom by colours or

Coloured toilet seat can create contrast between surrounding

texture can help the elderly to differentiate between shower

fixtures so that it could be clearly found from other equipment

and toilet areas without any effort(5).

in the toilet(6).

Problem : Way finding

Problem : Wayfinding

Solution : Differentiation(Walls)

Solution : Differentiation 89

Bathroom can be dangerous place for elderly as its a wet floor

Grab rails and hand bars can be very useful for elderly with

space. Non-slip flooring in shower is preferred to reduce the

motor impairments to get a grip and support which prevents

fall risks(7).

accidental falling(1,5,8,9&10).

Problem : Wayfinding

Problem : Safety

Solution : Differentiation(Floor)

Solution : Furniture

Examples from case studies

Fig 13: Bathroom in De koekoek nursing home

Fig 15: Bathrooms located in corridor of De Boswijk Different areas of toilet were distinguished by colour and contrast. The doors of toilets were made clearly visible Fig 14: Bathroom in De koekoek nursing home

from adjacent walls with readable signages.

References 1. van Hoof, J., Blom, M., Post, H., & Bastein, W. (2013). Designing a “Think-Along Dwelling” for People With Dementia: A Co-Creation Project Between Health Care and the Building Services Sector. Journal Of Housing For The Elderly, 27(3), 299-332. doi: 10.1080/02763893.2013.813424 2. Wilkinson, T., Henschke, P., & Handscombe, K. (1995). How Should Toilets be Labelled for People With Dementia?. Australian Journal On Ageing, 14(4), 163-165. doi: 10.1111/j.1741-6612.1995.tb00727.x 3. van Hoof, J., Kort, H., van Waarde, H., & Blom, M. (2010). Environmental Interventions and the Design of Homes for Older Adults With Dementia: An Overview. American Journal Of Alzheimer’s Disease & Other Dementiasr, 25(3), 202-232. doi: 10.1177/1533317509358885 4. Calkins, M., & Namazi, K. (1991). Caregivers’ perceptions of the effectiveness of home modifications for community living adults with dementia. American Journal Of Alzheimer’s Care And Related Disorders & Research, 6(1), 25-29. doi: 10.1177/153331759100600106 5. Day, K., Carreon, D., & Stump, C. (2000). The Therapeutic Design of Environments for People With Dementia. The Gerontologist, 40(4), 397-416. doi: 10.1093/ geront/40.4.397 6. Petersen R, editor-in-chief (2002) Mayo Clinic on Alzheimer’s disease. Practical answers on memory loss, aging, research, treatment and caregiving. Mayo Clinic Health Information, Rochester, MN, USA 7. Blom M, Tjadens F, Withagen P (2000) Weten van vergeten. NIZW, Utrecht, The Netherlands 8. Warner ML (2000) The complete guide to Alzheimer’s proofing your home. Revised and updated edition. Purdue University Press, West Lafayette, IN, USA 92

9. Fleming R, Forbes I, Bennett K (2003) Adapting the ward - for people with dementia. Sydney, Australia: NSW Department of Health 10. Gitlin L. Guidelines for environmental adaptations and safety at home. Alzheimer’s Care Today 2007;8(3):278-281

Kitchen

Activity

Space

Feeding

Kitchen

Kitchen Bedroom

Livin

Be dr oo

Open kitchen next to main spaces can be benefit PWD to

Contrast between floor of kitchen to adjacent room can help

have an easy access. It also stimulates the olfactory sense

PWD to identify the space effortlessly(2).

resulting in remembering to eat on time(1).

om g ro

Living room

Problem : Way finding

Solution : Layout

Solution : Differentiation(Floor)

It can be helpful to make use of contrast in the kitchen. For

Keeping the basic utensils in reach and visible can provide an

example, contrasting handles or knobs on cupboard doors and

opportunity for domestic activities like making a cup of tea. Labelling

kitchen drawers are more easily identifiable(3).

the cabinets can help the user to distinguish items with ease(4).

Problem : Way finding

Problem : Safety

Solution : Differentiation(Surfaces)

Solution : Furniture 95

Provide place for person with dementia to sit and carry out

Natural lighting in kitchen can help people to see things better.

activities or observe others. A work island or table can serve as

Windows can help in offering reality reassurance by providing

a centre for unobtrusive observation of the household (5,6&7).

outdoors views that help with orientation to the season and time of day(6).

Problem : Safety

Problem : Way finding

Solution : Furniture

Solution : Lighting

Examples from case studies

Fig 16: Kitchen in De koekoek nursing home

Fig 17: Corridor in De hogeweyk nursing home

Fig 18: Kitchen in De koekoek nursing home

References 1.van Hoof, J., Kort, H., van Waarde, H., & Blom, M. (2010). Environmental Interventions and the Design of Homes for Older Adults With Dementia: An Overview. American Journal Of Alzheimer’s Disease & Other Dementiasr, 25(3), 202-232. doi: 10.1177/1533317509358885 2. Kelly, F., Innes, A., & Dincarslan, O. (2011). Improving care home design for people with dementia. Journal Of Care Services Management, 5(3), 147-155. doi: 10.1179/17 5016811x13020827976726 3. Goodman, C. and Watson, L. (2010) ‘Design guidance for people with dementia and for people with sight loss’, December 2010 4. Unwin BK, Andrews CM, Andrews PM, Hanson JL. Therapeutic home adaptations for older adults with disabilities. Am Fam Physician. 2009;80(9):963-970. 5. Warner ML (2000) The complete guide to Alzheimer’s proofing your home. Revised and updated edition. Purdue University Press, West Lafayette, IN, USA 6. Mace NL, Rabins PV (2006) The 36-hour day. Fourth edition. The Johns Hopkins University Press, Baltimore, MD, USA 7. Bowlby Sifton C. Setting up surroundings for success and safety. Alzheimer’s Care Today 2007;8(3):286

Bedroom

Activity

Space

Gromming

Bedroom

Living room

Bedroom

Bathroom

The layout of the bedroom should be in a way that it can be found

Contrast between floor of bedroom to adajecent room can

easily and connected to multiple rooms especially to bathroom to

help PWD to identify the space effortlessly(2).

simplify the purpose of toileting, bathing and dressing(1).

100

Problem : Way finding

Solution : Layout

Solution : Differentation(Floor)

B l an

ke t s

It can be helpful to make use of contrast in the Bedroom. For

Keeping the basic utensils in reach and visible can provide an

example, contrasting handles or knobs of wardrobe, cupboards

opportunity for domestic activities like making a cup of tea. Labelling

and drawers so that they are more easily identifiable(3).

the cabinets can help the user to distinguish items with ease(4).

Problem : Way finding

Problem : Safety

Solution : Differentiation(Surface)

Solution : Furniture 101

om ro th

Stable and strong furniture can prevent accidents of falling and

Natural lighting in the bedroom can benefit elderly in many health

helps elderly to get a grip of balance in case of fall downs(1).

aspects like vitamin D and cardiac rhythm which helps to promote quality sleep at night(5&6).

102

Problem : Safety

Problem : Way finding

Solution : Furniture

Solution : Lighting

Examples from case studies

Fig 19: Bedroom in De klinkenberg care centre

Fig 20: Bedroom in De koekoek nursing home

Every bedroom has ample lighting with furniture(bed and chairs)which are vintage, strong and stable that helps to provide support to reduce accidents.

103

References 1. Hoof, van, J. (2010). Ageing-in-place : the integrated design of housing facilities for people with dementia Eindhoven: Technische Universiteit Eindhoven DOI: 10.6100/IR685914 2. Kelly, F., Innes, A. and Dincarslan, O. (2011) ‘Improving care home design for people with dementia’, Journal of Care Services Management, 5(3), 147- 155. 3. Goodman, C. and Watson, L. (2010) ‘Design guidance for people with dementia and for people with sight loss’ December 2010 3. Unwin, B.K., Andrews, C.M., Andrews, P.M., & Hanson, J.L. (2009) ‘Therapeutic home adaptations for older adults with disabilities’, American Family Physician, 80(9), 963. 4. Fleming R, Forbes I, Bennett K (2003) Adapting the ward - for people with dementia. Sydney, Australia: NSW Department of Health 5. Warner ML (2000) The complete guide to Alzheimer’s proofing your home. Revised and updated edition. Purdue University Press, West Lafayette, IN, USA 6. Bowlby Sifton C. Setting up surroundings for success and safety. Alzheimer’s Care Today 2007;8(3):286

104

Corridors

Activity

Space

Walking

Corridors

105

Corridors should be wide enough for atleast two people to

Doors recessed abit inside the wall of a long corridor can give

stand side by side. Consider length of corridors, try to aviod

the illusion of short span corridors(2).

long narrow hallways to increase mobility(1).

106

Problem : Way finding

Solution : Layout

Strong contrast between walls and floor helps to distinction

Widen doorways to make rooms easier to enter. Highlighting the door

between wall and floor. Colours with considerable are easier

frame can help elderly to distingush entrance to room easily(6&7).

to see than pastel or colours of similar intensity(3,4&5).

Problem : Way finding

Solution : Differentation(Floor)

Solution : Differentiation(Door) 107

108

Show case or photo corner, in front of main door for

Avoid dead ends in corridors. If unavoidable, place furniture

reminiscing or comfort. Name and photo of person on room

or chairs at the end of long corridors to provide rest from

/ front door(8&9).

wandering and indicating its dead end(4&9).

Problem : Way finding

Problem : Safety

Solution : Differentiation(Floor)

Solution : Furniture

Pantry

Install secure handrails or grab bars in stairway and corridors.

Adequate lighting shall be provided in corridors which can

For doors that should remain closed, camouflaging / hiding

help elderly to find the spaces easily and to prevent the risk of

them by adding pictures, curtains or painting doors same

accidents(12&13).

colour as wall(6,10&11).

Problem : Safety

Problem : Way finding

Solution : Furniture (Grab bars)

Solution : Lighting 109

Fig 21: Corridor in De klinkenberg care centre

Fig 22: Corridor in De Koekoek nursing home

Fig 23: Corridor in De klinkenberg care centre

Clear contrast between walls and floors.

Grab bars were designed in a special way

Every corridor is ending at a open communal

The door frame of the residential rooms were

from sill height to ground which does not

place with lot of lighting and furniture to

highlighted from its wall which helps people

look like typical institutional grab rails. These

rest on. This can help elderly to rest a bit

to recognise it and doors that should remain

element reduce the feel of an institution.

and interact with others after long walks in

closed were camouflaged into wall. Every room of elderly has a memory box before the door to identify their room easily. Rooms were recessed abit from corridor which helps to break the longness of the corridor.

110

corridor.

References 1. Rodriguez JG, Baughman AL, Sattin RW, deVito CA, Ragland DL, Bacchelli S, Stevens JA. Astandardized instrument to assess hazards for falls in the home of older persons. Accident Analysis & Prevention 1995;27(5):625-631 2. Gitlin L. Guidelines for environmental adaptations and safety at home. Alzheimer’s Care Today 2007;8(3):278-281 3. Gitlin LN, Corcoran M. Making homes safer: Environmental adaptations for people with dementia. Alzheimer’s Care Quarterly 2000;1(1):50-58 4. Mace NL, Rabins PV (2006) The 36-hour day. Fourth edition. The Johns Hopkins University Press, Baltimore, MD, USA

1989;4(6):4-8 11. Silverstein NM, Hyde J, Ohta R. Home adaptation for Alzheimer’s households. Technology and Disability 1993;2(4):58-68 12. Zgola J. Alzheimer’s disease and the home: Issues in environmental design. The American Journal of Alzheimer’s Care and Related Disorders & Research 1990;5(3):1522 13. Day K, Carreon D, Stump C. The therapeutic design of environments for people with dementia. A review of the empirical research. The Gerontologist 2000;40(4):397-416

5. Cohen U, Day K (1993) Contemporary environments for people with dementia. The Johns Hopkins University Press, Baltimore, MD, USA 6. Bowlby Sifton C. Setting up surroundings for success and safety. Alzheimer’s Care Today 2007;8(3):286 7. Ponzetto M, Scarafiotti C, Ferrario E, Fabris F. Health promotion for family caregivers of people with Alzheimer’s disease and related disorders. 1998. 8. Brawley E. Alzheimer’s disease: Designing the physical environment. The American Journal of Alzheimer’s Care and Related Disorders & Research 1992;7(1):3-8 9. Marshall M (1995) Design for dementia. In: Tanner B, editor. Proceedings of RSAS one day symposium “Coping with the problems of dementia in old age”. 22 May 1995. Held at the Royal College of Physicians. Royal Surgical and Society, London, United Kingdom. pp 43-54 10. Pynoos J, Cohen E, Lucas C. Environmental coping strategies for Alzheimer’s caregivers. The American Journal of Alzheimer’s Care and Related Disorders & Research 111

Guideline’s to carry activities in outdoor spaces For every human being as well as for people with dementia, nature provides a unique source of relaxation and stimulation and helps a person to orient themselves with time and space. Nature provides opportunities for walks, gardening as well as for meditation and contemplation. Well-structured and designed outdoor space, which leaves space for many refreshing activities, can enhance the quality of life to a tremendous extent(Uriel Cohen & Gerald D. Weisman., 1991). Many factors contribute to the proper access and usability of the outdoor spaces for the seniors. The following pages consist of some main factors and guidelines that provide easy access for the outdoor spaces.

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Outdoor spaces

Accessibility

Recognition

Safety and openness

Layout

Visual clues

Boundaries

Pathways

Distinctive environment

Comfort

Barrier free

Familiar features

Ambience

Transition spaces

Social Interaction

Lighting

113

Accessibility

Layout

114

Pathways

Barrier free

Lighting

Hogewyk nursing home, Weesp, Netherlands

Care and nursing home, Nijmegen, Netherlands

Nursing home, Orbec, France

Hogewyk nursing home, Weesp, Netherlands

Elderly prefer walking in the neighbourhoods consisting of well-connected street network, high residential density and low rates of vehicular traffic (Michael et al, 2006)

Paths should avoid dead ends, it should lead to somewhere for instance, a tree, a sculpture, pergola or to another space; and back it should be a journey to accomplish (Pollock, 2012).

The environment should be flat and even. If height differences are unavoidable, then the difference should be bridged by gentle slopes (Mitchell et al.,2006).

Lighting can be guide for seniors to travel from one a place to another(Eloy van Hall, De Hogewyk)

Hof van naussau, Steenbergen, Netherlands

Care homes on Kellersvej, Denmark, Nord architects

Piligrim garden care home, London

De Koekoek nursing Veenendaal, Netherlands

Places to shop and rest while walking may be important for seniors (Mitchell et al.,2006).

Well-defined paths helps people to find their way around outdoor spaces. Evidence suggests that free-flowing looped designs are preferred (Mitchell et al.,2006).

High raised planters gives an opportunity to people in wheelchairs to garden (Pollock, 2012).

Sufficient light must be provided in the places of movement to enhance the vision and walkability of elderly (Fenja Huizinga, De Koekoek)

home,

Recognition

Visual clues

Distinctive environment

Familiar features

Transition spaces

Hogewyk nursing home, Weesp

Nursing home, Oslo, Norway, Nord architects

Elderly home, Harleem

Hogewyk nursing home, Weesp

Clues like water elements, sounds, smells and change of landscpae can act as a tool for recognition.(Eloy van Hall, De Hogewyk).

Changes in shape, material, colour and contrast can help to distinguish (Mitchell et al., 2006)

Familiar things that are present in their early life like traditional signages, doors, windows and other objects can be the anchor points for recognition (Eloy van Hall, De Hogewyk).

Canopies and porches can aid in way finding by emphasising the entrance of a building (Pollock, 2012).

Nursing home, Hof van naussau, Netherlands

Boswijk nursing home, Vught, Netherlands

Nursing home, Oslo, Norway, Nord architects

Care home Meerkamp, Havelte

Landmarks and environmental cues such as churches, towers, squares or unusual buildings can help to continue or retrace their steps and find they war back (Pollock, 2012).

Differentiation between flooring can indicate seniors that they are entering different space.

Having elements like traditional street lamps, furniture, brick walls and pedestrian flooring can make residents feel like walking in a typical street(Pollock, 2012)

A sheltered place in front of the house, a ‘threshold’, a perfect place to engage with neighbours (Hertzberger, 1991). 115

Safety and relaxation

Boundaries

116

Comfort

Ambience

Interaction

Residential care home, Erika horn, Austria

Hogewyk nursing home, Weesp

Elderly home, Harleem

Hogewyk nursing home, Weesp

Acoustic buffers like grass, bushes and trees will reduce noise and provide natural boundaries (Pollock, 2012).

Sheltered outdoor spaces make it possible for residents to also be outside during bad weather (Pollock, 2012).

Familiar enviornment with greenery, recognisable materials, furniture and objects can help elderly to use the space more

Outdoor spaces with paticular or mixed activities gives an opportunity to interact with others while doing them(Hertzberger, 1991)

Nursing home, Oslo, Norway, Nord architects

Hogewyk nursing home, Weesp

De klinkenberg nursing home, Ede, Netherlands

Buildings and semi open spaces can acts as natural boundaries from outside traffic (Mitchell et al.,2006)

Private areas within a public space provides quiet spaces to rest for the elderly (Mitchell et al.,2006).

Places for pets or children to play and for elders to watch and make conversation could be an to engaging activity (Hertzberger, 1991).

Integration of home environment and outdoor spaces guidelines

From articulating set of guidelines from the literature research and from observations of the case studies, it was understood that an elderly with dementia looks around for clues in their environment from many factors which are mentioned above. So a well-designed space should provide different levels of clues for its user to easily access spaces and do their regular activities without any hindrance to their movement. Visual clues are very important to pursue the space and to further the journey.

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5.3 A day of a senior

Observing the daily routine of the residents in the visited nursing homes and inputs from the care stuff, it is understood that daily activities are an essential source for social interaction and bonding. They benefit the seniors with active aging, finding purpose, and memorable moments in their day to day living. From the visited case studies it is observed that some of the favourite things to do for elderly are going out to restaurant or café, doing groceries in the evenings, raising flora-fauna, sitting in nature and its surroundings. Having a daily routine can help the elderly remember the tasks easily and help caregivers with the process of guidance (fenja Huizinga, 2019). A balanced blend of personal and social activities in a day can benefit the seniors with increasing stimulations of self-care, communal participation, and social exchanges. The activities can range from getting ready, communal cooking, having meals together, raising flora and fauna, going out to different places, walks in nature, and many more. Furthermore, every activity needs a suitable and accessible space with design elements providing clues and hints to the residents. Based on these factors and research outcomes from case studies, an ‘ideal’ day for a senior is created in the form of a timeline. It consists of basic survival activities(ADL’S) to the activities that seniors enjoy and like to do at their leisure time. The timeline shows the homogeneous mixture of activities ranging from individual to group or social carried by an elderly at different times of a day.

118

Ti m e l i n e of a m i l d sta g e PW D

Wake up

Get ti n g ready

Breakfast

‘its a go o d day’

‘ h ere I com e’

‘y um’

7: 00

7: 30

8 : 00

News

Walk i n gard en

Gym

‘g o o d s m el l & soun d s’

‘ I a m get t i n g st ron g’

9 : 00

8 : 30

9 : 30

10:00

10:30

Ca fe b rea k 11:00

11:30

Chi l l out ‘ I won i n t h e c a rd s’

Parlour/Salon

Talki n g to kids

‘I look g ood :)’

‘ i ts my son’ s pic’

1 6: 00

1 5 : 00

1 5 : 30

Wan deri n g i n bui ldi n g/garden 1 4 : 30

Nap

Lunch

zzz

‘y ummy i n t ummy’

1 4 : 00

1 3: 30

1 3: 00

12:30

12:00

Prep a ri ng mea l

G ardening

‘ G o o d jo b’

1 6: 3 0

Tak i ng care of pet s ‘bru no c om e here’

1 7: 00

Shopping

H elping dinn er

Di n n er

Fami ly & frien ds vi s i t

Bi n go

Walki n g

‘p la tes a ll set’

‘tast y’

‘ I l ove my fam i ly’

‘ I won’

‘wh at a day’

1 7: 3 0

1 8 : 00

1 8 : 30

1 9 : 00

1 9 : 30

20: 00

20: 30

Return to hom e

S l eep ‘d rea mi n g’

21:00

Wa nd eri ng Mid d l e of the nig ht

‘where a re p ota toes’

Different activities involved in a day of a senior at different moments of day

119

Tim e l in e of a ct ivit ies m il d sta g e PW D

Wake up

Get ti ng ready

‘i t s a g o o d d ay’

‘ h ere I c om e’

7:0 0

7:3 0

News

Breakfast

8:0 0

Walk i n ga rden

Gym

‘g o o d s m el l & sou n d s’

‘ I a m get t i n g st ron g’

9 :0 0

8:3 0

9 :3 0

10:00

10:30

Cafe break 11:00

11:30

Chi l l out ‘ I won i n c a rd s’

Parlou r / Salon

Talki ng to kids

‘I l o ok g o o d : ) ’

‘ i ts my son’ s pic ’

16: 00

1 5:0 0

1 5:3 0

Wanderi ng i n bui ldi ng/garden

Nap

‘y u m my i n t u m my’

1 4 :0 0

1 4 :3 0

Lu nch

zzz

1 3 :3 0

1 3 :0 0

1 2: 0 0

1 2: 3 0

P repari ng meal

G ardening

‘ G o o d jo b’

16: 3 0

Takin g c are of p et s ‘ bruno c om e h ere’

17: 00

Shopping

H elping dinner

Di nner

Fami ly & friends vi si t

Bi ngo

Walki ng

‘p l a tes a l l set’

‘ tast y’

‘ I l ove my fa m i ly’

‘ I won’

‘wh a t a d ay’

17: 3 0

1 8:0 0

1 8:3 0

1 9 :0 0

1 9 :3 0

20 :0 0

20 :3 0

Ret u rn to hom e

Sl eep ‘d re a m i n g’

21 : 0 0

‘wh ere a re p ota to es’

Personal activi ties < 4 hours

Social activi ties 9-10 hours

Mixed act ivi t ies < 2 hou rs

Timeline showing different levels of activities of a senior from personal to social and in-between.

120

Wanderi ng Middl e of t he night

B ed ro om

Ba t hro om

Di nni ng ro om

Livi ng ro om

O utd o or spaces

Gym, physiot herapy

Wa ke up

G et t i n g re a dy

B re a kfast

‘its a g o o d day’

‘ h ere I c om e’

‘y u m’

7:00

7:30

8 :00

News

Wa l k i n g a rd en

Gym

‘g o o d sm el l & sou n d s’

‘ I a m g et t i n g st ron g’

9 :00

8 :30

10:00

9 :30

Cafe, Rest urant

10:30

Ca fe b re a k Chi l d ren d ay c a re

Corrid ors / G a rd en

Be d ro om

D i nni ng space

11:00

M ul t i purpose space

H a ir d resser 11:30

Ch i l l out ‘ I won i n t h e c a rd s’

O utdo or spac es

Pa rl ou r / Sa l on

Ta l ki n g to kid s

‘I look good :) ’

‘ i t s my son’ s pic ’

16:00

Wa n d eri n g i n b u i l d i n g / g a rd en

15:00

15:30

N ap

‘y u mmy i n t u m my’

14 :00

14 :30

Lu n ch

zzz

13 :30

13 :00

1 2: 0 0

1 2: 3 0

P re p a ri n g m e a l

G a rd en i n g

H ome / communal ki tchen

‘ G ood job’

16:30

Home / com mu na l kitch en & d i nni ng

Vi s i t i ng sp a ces

M u l t i p u rp ose

Corrid ors

B ed room

Taki n g c are of p et s ‘bruno com e here’

1 7: 0 0

H el pi n g d i n n er

D i n n er

Fa m i ly & frien d s vi s i t

Bingo

Wa l ki n g

‘plates all set’

‘ tast y’

‘ I l ove my fam i ly’

‘ I won’

‘wh at a day’

Ret u rn to hom e

Sleep ‘d rea mi n g’

Wa n d eri n g

Sm all store 1 7: 3 0

S ho p pi n g

18 :00

18 :30

19 :00

19 :3 0

20:00

20:3 0

21 : 0 0

Mid d l e of t h e n ig ht

‘where are potatoes’

Pub l ic sp a c es

Sp a c es t h a t a re m e a nt for ever yon e

Sp a c es t h a t a re m e a nt for ot h er p e o p l e

Sp a c es t h a t a re m e a nt for on ly t h em selves

Res id ent s + N eigh b ou rho o d

Al l res id ent s + sta f f

O n ly res id ent or sta f f

Sem i p ub l ic

P riva te

Timeline showing different spaces used by seniors to do activities and the multiple levels of privacy the spaces offer.

121

Personal activities

Semi-public

Public activities

Personal, semi public and private activities of elderly in a day

Desired movement through spaces

From the analysis of the timeline it is understood if a senior wants to do some group or social activities, he/she has to move from their most private space to most public space at various periods of the day. For example, after reading their news in their private room, if the senior wants to go to the public gym, the environment has to lead him with sequences of spaces and clues to guide him from his/her personal space to the public space. Creating transitions between different spaces and privacy levels gives the elderly time to settle and adjust to the change. So providing architectural spaces with a smooth transition can benefit the elderly to understand the different levels of privacy from most private space to open and public space.

122

5.4 Research results conclusion

With the synthesis of research results, it can be concluded that having a mixed housing typology with residential facilities for seniors with dementia and multi-generational homes for families and younger stars can benefit the seniors with dementia to socialize more and thus less affected by loneliness and isolation. This kind of typology also provides a chance for the elderly to live with their families and thus providing

Aging in Place

Daily Activities

Social Activities

the opportunity to age in place. Additionally, creating smooth transitional zones and a sequence of spaces guides the seniors from place to place without any agitation or feeling of lost in space. Having a smooth transition between spaces can link places with different functions and activities. It acts as a hint for the elderly to remember the routes and continue their journey. At

Housing

Spacial

Day of an

typology

guidelines

elderly

the same time, having clues and hints in the spaces with architectural elements along with smooth transition can reinforce their ability to find areas easily, thus helping them to carry their daily activities independently.

Mixed typology

Transition

Clues

Design Guidelines

Research results as design guidelines

123

Fig. 24 Illustration by Brian Cornin

6. Design 124

6.1 Site Analysis 6.2 Concept 6.3 Individual blocks - architectural drawings 6.4 Construction detail 6.5 Design guideline implementation 6.6 Experience of spaces 6.7 Conclusion

125

6.1 Site Analysis

The site is located across the Malvalaan street in Voldijn, in the south

the neighbourhood. The site consists of lush greenery on the south

of Eindhoven. It is currently occupied by three “Wooninc” Housing

side, protecting the buildings from noise pollution from the main road.

association apartments consisting of independent living seniors and the

The volumetric analysis of the neighbourhood is mostly low rise with

fourth building owned by Oktober, specialized for Dementia care. The

buildings, not more than 2 to 3 floors height. The urban fabric of the

total site area is 1.7 hectares, situated next to the main road in a quiet

site is a mostly residential neighbourhood with only a few facilities like

neighborhood with its main entrance located on the northside towards

supermarkets and office spaces situated on the main roadside.

Existing site

126

6 storey building Site line

5 storey building

Greenery

2 storey building

Greenery around the site

Volumetric analysis of the site

Residential

Road network analysis of the site

Main road

Commercial shops

Internal streets

Offices

Site pathway

Activity area

Typology analysis of the neighbourhood

127

128

Fig. 25 Site neighbourhood

Fig. 26 Topology of the site - Flat ground

Fig. 27 Prominent materials of the surroundings

Fig. 28 Existing buildings

Site analysis conclusion From the site analysis and location visit, it is observed that there is a lack of activity spaces and functions in the neighbourhood that the elderly can use. Additionally, the existing buildings seem enclosed and disconnected from their surroundings due to a lack of amenities. So designing a mixed housing typology for seniors with public and activity spaces can integrate the site with the neighbourhood.

129

6.2 Concept

With the design guidelines from the synthesis of research, a design has been developed which would merge the guidelines together in a harmonious environment. Mixed housing topology, Transition, Clues, the three primary design directives are the starting points for concept generation. The spatial guidelines from the research implied the importance of clues and transition. These aspects helped to implement subtle transition clues to design the spaces inside out.

Concept approach

130

The resulting design is a conjunction of desired qualities, relations, and

Thinking about everyday routines and challenges, I slowly developed

atmospheres. Starting with the requirements and the experience of a

the plan from a small scale of private rooms to shared and outside

person with dementia, the building naturally started developing itself

spaces. The resulting design is a cluster of buildings and a variety of

from the innermost place. The conventional approach of starting from

outside spaces their articulation creates.

a bigger scale seems to be inappropriate, and the only natural way to think about the building is from the perspective of a person inside.

To reconcile To share and care

To oneself

To connect

To interact To reconnect To live actively The Journey

131

Private rooms are the smallest, yet one of the most potent parts of the building. It is a space for one’s identity and constant reminder of who they are. It’s a space to retreat when everything becomes difficult, and it is a space to remember. The proportion of the room is quite enough to accommodate the personal furniture and yet small enough to feel cozy and safe. Direct access to the balcony and outdoors enables the elderly to go outside and enjoy nature, which enhances the quality of personal space. The private room opens to a small living room, consisting of furniture and space to relax and enjoy the view towards the outside and shared corridor. In case studies it is observed that residents feel at home when they can carry their personal items from their previous place or home.

To oneself

Individual home I 1:100

These items act as reminders of their past and produce a positive effect on their overall wellbeing. The bedroom and living room have the flexibility to accommodate the personal belongings and this items act as reminders of their past and produce a positive effect on their overall wellbeing.

To oneself

Clue - Flat roof 132

Individual Bedroom I Scale 1:100

133

In between every two private rooms, there is a space that makes residents bump into each other. This is shared hallway is the place where neighbours help, laugh, and share stories together. Through this shared hallway, neighbours can interact more with each other while having their own personal spaces at reach. It consists of furniture to sit, plants to water, storage to preserve. The shared hallway also offers visitors an area to talk to residents and room for social interaction with fellow people.

To share and care

Shared hallway I 1:100

Clue - Vaulted roof 134

135

The individual residents are arranged in a semi-circular way that the whole private residential areas form an enclosed part of the building. As we know, demented seniors have a tendency to wander a lot, so having an enclosed space to walk around increases the factor of safety and familiarity to the resident. The atmosphere of this space is vivid with wide corridors and vaulted brick roofs, giving a subtle clue to the residents that they are in a public space. People sitting in their private hallways can observe what’s going on in the corridor without disturbance to their privacy.

To connect

Central corridor I 1: 250 136

137

The rooms are entwined around the central courtyard, which not only helps with the daylight and ventilation of the building but also acts as a reference of time and seasons. It gives a hint of the day-night and seasonal changes that helps to enhance the circadian rhythm of the residents. The nature inside the building, which is accessible at any moment, adds stimulation to elders and value to building design. With its everlasting presence, the courtyard helps residents to initiate their way from private spaces to open shared spaces and guides their way out. Also, the courtyard acts as a small preview of the exterior outdoor spaces and provides a hint of nature before the elderly go out to the larger outdoor spaces.

Clue - Vaulted roof with courtyard 138

To connect

Central corridor with courtyard I 1:250

139

Stepping from the corridor and courtyard leads the elderly to a public space of the building, which offers chances to interact with others and engage in different activities. This is a space for doing familiar activities liking cooking, sharing the meals, watching tv together and chatting with others. This space encourages the everyday activities of the elderly with the view of the entire building. With a well-clued sequence of spaces, the whole building adds a familiar atmosphere and relaxation to the elderly without burdening them with wayfinding and sudden changes of spaces.

Clue: Wall with semi circular arches 140

To interact

Communal living area 1: 250

141

Two residential units are connected by a communal hallway, which leads to the main entrance. This common hallway consists of lift and stairs to reach the first floor and few hangout spaces to rest and interact. Not only useful for circulation, but this area offers interactive space for elders from different residential buildings to meet and visitors a place to wait.

To reconcile

Shared hallway with main entrance I 1:300

142

143

The main entrance opens to a lively outdoor space with gardens, sheltered seating areas, and pathways with destination points. This outdoor space provides a panoramic view of the entire residential units and the connecting bridge to the activity block. It is a safe space for elders to enjoy walking outside the buildings or sit and relax in a village kind of atmosphere relishing in the nature.

144

To reconnect

Internal garden | 1: 500

145

Spaces without activities are just dead spaces. Following the pathway leads to the activity building with many social spaces offering multiple functions and activities to the entire site and the neighbourhood. A series of semi-circular archways were provided in the corridor, which acts as guiding elements for the user to continue the journey. This entire atmosphere also opens to a large courtyard with outdoor garden connecting different typologies of the site.

Clue - Series of semi circular arches 146

To live actively

Activity space I 1: 750

147

Every circle represents a specific place for a particular activity starting from personal to public. The journey from one’s private room to the open public garden consists of subtle architectural transitions which help the elderly to move easily from place to place for their daily and social activities.

To reconcile To share and care

To oneself

To connect

To interact To reconnect To live actively

148

Demonstration of activities on design

149

150

Site plan | 1: 2000

151

152

Site Section | Scale 1:1500

153

Assistive Residential Block Activity block Family block

154

Typology of blocks in the design

6.3 Individual blocks

Assitive Residential Block It is observed from case studies that people who are like-minded, suffering with the same problems, and similar diagnostics likely to have more compassion and compatibility towards each other. The assistive residential block is designated for people with dementia who require care but are independent to live individually or with others. Each block consists of twelve private homes on the ground floor and six shared/ couple units on the first floor. These private/shared homes are open to a central communal living room where social activities like communal cooking, sharing meals, and watching TV with others happen. Spaces for visitors, other facilities were provided, and care is offered when it’s needed. Each assistive residential block consists of inner courtyards, a wide shared corridor with a loop pattern helping seniors to walk around with ease and green spaces all around the block. To bring people more together and increase the interactions between them, the three residential units were clustered together with shared entrances and hallway with hangout spaces. This residential cluster has a central garden where people from different residential units can meet and spend time together in nature. Assistive Residential Block

155

A’

B’

4m 4m

B’

A 4m

Ground floor plan

156

A 4m

First floor plan

To give the building order and structure, there is an underlying grid

The grid helps to co-relate one space to another in proportions by

that helps the building to present itself to the user subtly.

providing clarity to residents and coherence to the whole floorplan.

Vaulted roof producing the feeling of spaciousness

Transition point between

Windows that provide visual

shared corridor and

connection to the corridor

private homes

Semi-circular windows that are more relate-able to elderly

Corridor that overlooks the activity happening in the ground floor

Patio for that brings natural light, ventilation Living room that has a view toward

and acts a clue for

the entire building on one side and

outdoors

landscape area on the outside

Communal kitchen shared by the whole building

Axonometry of the residential block 157

158

Section

n AA’

The variety of activities the spaces provide are enhanced by the modulations in roof and wall surfaces. The roof heights change according to the level of privacy, and its shapes enhance the experience of the space. Strong visual connection is present in different parts of the building, with the first floor overlooking the ground floor’s activities and communal living area having views to the entire building.

159

160

Sectio

n BB’

161

162

Evidence based research shows that having a familiar environment with distinctive features can help elderly with way finding.

East elevation showing the main entrance to the residential units

163

164

West elevation towards the neighbourhood

165

Assistive Residential Block Activity block Family block

166

Family Block Aging in home can be associated with the feeling of growing old where the elderly experience emotions of comfort, care, and daily interactions. There could be no better form of comfort, care, and daily interactions provided by the family members to the seniors with dementia. Keeping this in mind, the design encourages seniors who want to live with their families by providing family residential blocks. This block consists of multi-generational housing facilities with residences not only for seniors but also for their children and

Family block

their grandchildren. This typology not only promotes more daily interactions to the elderly with family but also benefits the seniors living independently by the presence of different age groups and the opportunity of social interaction they bring. Additionally, these homes act as a transition between the main road to the plot center where dementia blocks are located. Zoning of family homes is done in such a way that they are located near to the activity block of the design and also close to the shops, restaurants, and bars of the surrounding neighborhood.

167

4 4

1 3

4 4 2

168

1. Family gardens with play areas

3. Bicycle parking

2. Communal space

4. Family residential blocks

Ground floor cluster plan 1: 1000

All the family units are designed together to form a semi-circular cluster

to shops, commercial spaces and activity areas of the neighbourhood.

with necessary facilities and hangout spaces. The cluster has a back

Other facilities like playground, roof terraces, communal living spaces,

entrance to the main roadside, providing easy access to residents to go

and cycle parking were also provided for multi-generational users.

7 7

6 7 7 5

5. Shared corridor

First floor cluster plan 1: 1000

6. Hangout spaces 7. Family residential blocks

169

A’

B’

170

3. Elderly bedroom

2. Double height living room

4. Kitchen

B’

Ground floor plan I 1: 100

1. Main entrance

5. Corridor over-looking the living room

First floor plan I 1: 100

6. Bedroom 7. Children bedroom

The floorplan for the family blocks is created with the same

in the kitchen, eat meals together in the living room, and do some

principles used for assistive residential units. The ground floor plan

activities in the balcony, all situated on the ground floor. The first floor

consists of a living room, kitchen, and bedroom for seniors with

consists of bedrooms for family members with storage and balcony

a balcony looking at nature. The elderly with his family can cook

spaces.

Axonometry of family block

171

Section AA’ I 1: 100

The main entrance on the ground and the first floor opens to a shared corridor with seating spaces where the people can meet their neighbours.

172

Section BB’ I 1: 100

The elderly on the ground floor can view their family members from the double-height living room without climbing the stairs.

173

174

Front elevation of the cluster

175

Assistive Residential Block Activity block Family block

176

Activity Block A homely environment without activities is such a waste. A properly designed care home not only caters to the requirements of residential facilities but also accommodate extracurricular activity spaces which encourages the seniors to participate in different things which stimulates positive effects. These spaces provide changes to kill boredom and also encourages the seniors to get out of their private room and move around the site. The block is designed in the form of a traditional building with vaulted

Activity block

roof, semi-circular arch projections, and wide corridor with a series of arches walls leading to multiple activity spaces. This kind of traditional architecture reminds seniors there past memories and make them at easy while walking through the building.

177

Entrance to roof garden

Internal pathway having view towards the landscape and family units

Main corriodor open to lush landscape

Pathway leading Main corriodor leading to the staircase

178

Bridge connecting to the family blocks

to entrance

o the

Wooden pergolas for sheltered walking

The ground floorplan consists of multiple activity spaces, including restaurant/café, small wrinkles, multipurpose halls, daycare, arts and crafts space, and many more. The restaurant and winkles are not only for seniors or residents of the site but also for the entire neighbourhood. In this way, the residents of the site can interact with Roof garden with

the neighbourhood people, which promotes social conversations and

an view towards the

interactions between them.

residential blocks Vaulted roofed corridor

The first floor consists of other activity spaces like carpentry workshop,

for walking

arts/crafts room, physiotherapy, a small clinic, and some office spaces for the staff. It also contains a roof garden with greenery, pathways, and hang out spots, which provides a panoramic view of the entire site and the neighbourhood.

179

3 4

6 1

10 1

Ground floor plan 1: 1000

180

1. Corridor leading to activity spaces

4. Hall with foldable doors

7. Hairdresser

2. Main entrance

5. Multi-purpose hall

8. Shops

3. Restaurant/ cafe

6. Staircase

9. Daycare

10. Courtyard with seating areas

18 15

11 19

First floor plan 1: 1000 11. Corridor

14. Meeting room

17. Terrace

12. Office spaces

15. Physiotherapy

18. Other facilities

13. Workshop spaces

16. Clinic

19. Roof garden

181

182

ctivity block section 1:1000

183

300mm concrete slab 100mm insulation Damp proof membrane 40mm cement coating Smart sensor floor system

10mm Wooden finish flooring

6.4 Construction detail

Aggregate course 300mm concrete slab 100mm insulation Damp proof membrane

40mm cement coating Smart sensor floor system 10mm Wooden finish flooring

B Rubble masonry Earth Foundation footing

Detail A

Wall section 1:50 184

Scale 1:15

500mm reinforced concrete beam 10mm plaster finish 100mm brickwork Damp proof membrane 100mm insulation Vapor resistance sheet 20mm air cavity 100mm external brick

Steel lintel Plywood Wooden window frame Fixed glass window

15mm tile finish 110mm concrete slab 5mm plaster finish 300mm concrete slab 100mm insulation Damp proof membrane

500mm reinforced concrete beam

40mm cement coating Smart sensor floor system 10mm Wooden finish flooring

10mm plaster finish 100mm brickwork Damp proof membrane 100mm insulation Vapor resistance sheet 20mm air cavity 100mm external brick

Steel lintel Plywood Wooden window frame Fixed glass window

Detail B

Scale 1:15

Detail C

Scale 1:15

Aggregate course 300mm concrete slab 100mm insulation Damp proof membrane

40mm cement coating Smart sensor floor system 10mm Wooden finish flooring

5mm plaster finish 300mm concrete slab 100mm insulation Damp proof membrane

40mm cement coating Smart sensor floor system

185

6.5 Design guidelines implementation For any senior to live independently and be able to do activities

research results chapter were implemented in the final design of

effectively without hurdles, spaces have to be appropriate and

residential and family blocks. Especially in core spaces like Bathroom,

understandable. This section talks about how the guidelines from

bedroom, kitchen and shared corridor.

Bathroom

Layout

Differentiation

Furniture

Design guidelines for bathroom

186

Bathroom design

Bedroom

Layout

Lighting,

Differentiation

Furniture

Design guidelines for bedroom

Bedroom design

187

Kitchen

Layout

Differentiation

Lighting

Furniture

Design guidelines for kitchen

188

Kitchen design

Corridor

Layout

Lighting

Differentiation

Furniture

Design guidelines for corridor

Corridor design

189

6.6 Experience of spaces

Timeline Having implemented all the design aspects, this section talks about how the design and spatial experience is perceived by the seniors at different moments of a day. These experiences are collated as per the timeline that was used in the design development phase. These series of impressions shows how elderly move through sequence of the spaces from waking up in the morning to enjoying the night walks in the safe enviornment of the proposed design.

190

Demonstration of timeline on design

191

192

Bedroom | 7:00 AM

Wandering in courtyard | 9:30 AM

193

194

Communal living room with kitchen | 11:00 AM

Wandering in courtyard | 2:30 PM

195

196

Enjoying the walk in the roof garden | 04:30 PM

Interactions in Activity block | 5:30 PM

197

198

Heading back to their home | 6:30 PM

Having night walks in the residencial units | 10:00 PM

199

6.7 Research validation through the design

Mixed topology active living

Assistive Residential Block

Family block

Activity block

Different types of blocks of the design

200

The mixed typology consists of family homes for the elderly who wants

also consists of various spaces for public and private activities, thus

to live with their family, which supports aging in place. The design also

increasing the quality of space. All of these facilities creates a typology

consists of independent & shared homes for seniors who need care in

that is less institutional and a more home-like environment where the

the form of assistive residential units. Apart from residences, the design

elderly have lots of freedom and interactions.

Transition of spaces

Private

Semi-Public

Public

Transition of spaces

The design consists of structured spatial planning which gradually flows

block) where people from inclusive site and neighbourhood meet and

from private space(residence) to semi-private space (communal areas

participate in activities together.

of residences) which opens to a semi-public space( shared garden of residential units) and finally unfolds at a public space (activity 201

Fig.29 Illustration by Roberta Coni

7. Conclusion 202

How a person derives meaning from their everyday activities and

spaces which intuitively guides the elderly to find the right spots

environment is central to their well-being (Kaufmann & Engel, 2014).

to do individual and social activities. With these outputs from the

Daily activities not only act as a natural remedy to improve the

research the design was developed from a perspective of a senior. The

cognitive health of elderly but provide a chance for social interactions

result was an inside-out design with transition of spaces and subtle

and space is the link the person and activity. So, safe environments

environmental clues as a main concept.

which consists of rational spaces that encourage elderly to do their everyday activities are necessary for improving the health and

The design starts from most private living space of the senior and

happiness of the demented person. These environments not only helps

gradually opens to a semi-public space with areas for general

to feel independent, self-supportive and unburdened but also provides

interactions, elements of nature, and later unfolds to a public activity

opportunity to lead a normal life with access to multiple actions.

space which is open to residents of the plot and to the neighbourhood. This spatial planning not only helps residents to forward their journey

Designing this kind of spaces for seniors with dementia requires

with subtle levels of transition but also provides architecture clues with

extensive knowledge on spatial influence on the elderly and how well

shapes, colour, materials and scale/proportions of the areas to help

architectural planning can guide them to pursue their normal life. This

them find the required spaces to live, cherish and do activities.

lead to the research question “How spatial planning of the design can help seniors with dementia ageing in place to carry their daily and

Additionally, the general layout of the design consists of spaces which

social activities independently resulting in their well-being?”.

supports aging in place, daily activities and social interaction in the form of a mixed housing typology consisting of multi-generational

Based on research it was observed ageing in home like environments

residential spaces and activity zones which are open to residents

and surroundings plays a vital role for elderly to lead a normal life

and people of the neighbourhood. These spaces act as a interaction

filled with activities and social interactions. Additionally these home

hub promoting social exchanges and communications between the

like environments should have visual clues, hints and sequence of

residences of the site and the neighbourhood.

203

All together with transition of spaces and architectural clues in the design the elderly can move easily from place to place to carry their daily and social activities. And with aging in a multi-generational home environment with spaces for different activities the elderly has more opportunity for meaningful social interaction and bonding. Thus deriving a meaning from the day-to-day activities and the environment leads to the wellbeing of elderly with dementia. In conclusion coming back to the basics through design of environments which are safe, readable and nature integrated are beneficial to all of us, no matter what stage of life or the type of diagnosis people have.

204

Daily activities + Transition of spaces + Mixed typology = WELL-BEING

205

Fig 30. Illustration by Elisabet Ericson

8. Reflection 206

Apart from struggling with time management, I must say that I really

Translating this essence and implementing the design guidelines

enjoyed working on my graduation project and acquired a great

obtained from research into a uniformed design was a struggle at

appreciation for the whole process. Thanks to my mentors, who helped

first, but later with proper reasoning backed from literature and case

me with the process of organizing research which helped me to find my

studies, the design choices were made to produce a coherent design.

personal way out to design.

Finally, with its up and downs the design process was a non-linear but vivid experience and I tried my best to create logical and safe

The whole journey of graduation consists of challenging and

environments through design for the users. In the future, I want to use

memorable moments where I learned the importance of design through

the knowledge, insights, and experiences I learned from my graduation

research, the process of organizing the work, and the power of

and masters as a whole to shape me into a better architect.

storytelling. This studio helped me to reinforce my abilities to conduct resourceful research by asking questions, understanding the user needs, and finding the right problems to design for. Additionally, learning to design for dementia and the elderly provided me a great chance to take a step back and reflect on the influence of architecture as a whole. Getting to know the disease and its consequences on elderly, gave me an opportunity to shift my focus back towards the basic sensory experience of architecture, which is to provide shelter and enrich lives.

207

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