You are stuck in a busy, noisy, unfamiliar building. You are unsure of where you are or even what time of year it is. All the corridors look the same. You find it hard to judge how far away the floor is. You can't remember where the toilets are. You can't remember why you're here. You feel a rising sense of panic as you search for clues to where you are, and even who you are.
On the 2nd December the UK Cabinet became Dementia Friends as part of a nationwide initiative run by Alzheimer's Society to raise awareness of dementia. As the world's population expands and the proportion of older people grows, the needs of elderly patients are increasingly relevant to healthcare design. It is estimated that one in four people in UK hospital beds have dementia, and the number of people with dementia is expected to double over the next 30 years.
The King's Fund, an independent charity working to improve health and healthcare in England, was funded by the Department of Health to carry out a special project looking at how the design of hospitals, outpatient services and care homes could be improved to make life better for people with dementia. This Enhancing the Healing Environment programme was the first systematic look at this topic in the UK, and has resulted in materials and resources which are now being used globally. As well as guidelines for what makes a service dementia-friendly, there is a tool for assessing how dementia-friendly a service is.
The guidelines outline five key principles: meaningful activity, familiarity, legibility, orientation and wayfaring.
What do places that use these principles look like in real life? Age-related changes to vision mean that older people often find it harder to see contrasts and to perceive depth. If flooring changes colour between rooms this can seem like a step and be confusing. If carpets have bold, swirling patterns these can seem like obstacles or holes, which makes moving slow and difficult and can lead to falls. Dementia-friendly wards have matt, even-coloured flooring and clear sightlines through corridors.
The most helpful designs use clear contrasts in colour to mark spaces that have different uses, particularly to flag where toilets are. The toilets themselves have contrasting toilet seats and rails so the person can see where to sit.
Sarah Waller of the King's Fund notes how innovations that might make some people's lives easier can actually make things more confusing for people with dementia: "Odd-looking taps are difficult to understand. Sensor taps are almost impossible."
Features similar to those seen in evidence-based hospital design are also important, including increased light, less noise and use of natural scenes. Increased opportunities for social space, and memorabilia and artworks that prompt memory, can also help. Increased access to staff, for example by using a cluster model of nursing rather than enclosed nursing stations, helps to reassure patients.
The results have shown how crucial good design can be. Changes like these have led to "fewer falls, less violence and aggressive behaviour, and less staff sickness," says Waller. "Actually we're making the environment friendly for everybody," she adds. "Good dementia design is good for everybody."