PLACEMAKING WITH DEMENTIA IN MIND
LINDA CARROLI | CONSULTANT WITH HARBINGER CONSULTANTS, MEMBER OF ALZHEIMER’S AUSTRALIA’S DEMENTIA FRIENDLY COMMUNITIES ADVISORY COMMITTEE, PHD CANDIDATE AT QUT.
The experience of place and built environment for people living with dementia can be confusing and frightening - even deadly. In January this year, the media reported the death of a 71 year old man with dementia who became disoriented and trapped in a shopping centre stairwell: His decomposing body was found three weeks after he was reported missing leaving the wider public shocked and angered.
Shopping centres were originally designed to disorient and overwhelm shoppers, conferring an experience of ‘non-place’ and often negatively impacting on more legible traditional shopping strips in suburban areas. This design and planning legacy continues in many newer and refurbished shopping centres and suburbs, presenting severe constraints and risks for people living with dementia who hope to maintain their independence. For many people living with dementia in the community, everyday tasks, like banking, shopping, paying a bill and posting letters, can become more difficult with additional risks such as getting lost or communication failures.
Alzheimer’s Australia describes dementia as a broad term for the symptoms of a large group of illnesses which cause a progressive decline in a person’s cognitive and physical functioning. In Australia, there are presently 413,106 people living with dementia, with the incidence expected to markedly rise, including early onset dementia, in the near future. Dementia friendly design is a consideration for the care setting, the independent living environment and the broader community context.
Globally, design thinkers, researchers and practitioners are developing approaches to designing that enables people living with dementia to live independently and well. Earlier this year, the UK’s Royal Town Planning Institute released a report, Dementia and Town Planning, to demonstrate the role of good planning in creating better environments for people living with dementia. The report stresses the importance of the built environment in supporting social inclusion while also advocating for change in professional practice. The report proposes that a dementia-aware approach to places and planning that promotes legibility and safety, from city vision to local wayfinding to green space, will ultimately benefit everyone in the community.
Perhaps the best known innovation in dementia-friendly residential care is De Hogeweyk, located in Weesp, The Netherlands, which provides residential care in a uniquely designed environment. The award winning De Hogeweyk, developed by the non-profit care provider Vivium Care Group, has a neighbourhood look and feel and features a range of services and facilities that support lifestyle choice and independence in a safe environment. The aim is to provide a sense of normalcy and familiarity for people living with severe dementia. De Hogeweyk is designed at human scale and includes streets, squares, gardens, a park and a range of shops and restaurants which are open to residents and the surrounding community.
Developments like De Hogeweyk herald new thinking about places for people living with dementia, offering evidence-based learnings that can enhance the lives of people with dementia in the community. In Australia, many researchers and practitioners are addressing the needs of people living with dementia, both those living independently and those living in care. Notably, the Dementia Enabling Environments Project, led by Alzheimer’s Australia and University of Wollongong academic Professor Richard Fleming, is an Australian first. The project aims to facilitate the development of supportive environments focusing on architecture, interior design and gardens in public buildings, homes, care environments and other urban spaces: “The places occupied by people with dementia are not designed with them in mind,” Professor Fleming said. “They are designed to appeal to the economic buyer, which is often the daughter or son of the person with dementia.”
Professor Fleming also noted that dementia care environments tended to resemble an amalgam of hospitals and hotels, which often failed to provide the full range of experiences needed to live fulfilling lives. He describes the resulting residential facilities as “a superficially attractive but ultimately stultifying environment that may be good for the efficient delivery of ‘services’ to a passive client”.
Entrenched assumptions and practices mean that change will not come from dementia care providers or architects, and Professor Fleming proposes that change will come from better informed consumers who demand places and care environments that are genuinely grounded in human wellbeing and health giving (salutogenesis): “We need informed consumers who will seek out examples of salutogenic design and demand more of them [...] Consumers who understand that a well-designed environment (in conjunction with staff who understand salutogenesis) can enable people with dementia to lead full lives. When there are enough informed consumers the market will change.”
Though the Dementia Friendly Communities program, Alzheimer’s Australia aims to improve the place-based experiences of people living with dementia. A dementia-friendly community is a place where people living with dementia are supported to live a high quality of life with meaning, purpose and value. The physical environment is an essential and defining element of both place and quality of life.
Under the umbrella of Dementia Friendly Communities, several local authorities have introduced dementia-inclusive planning and policy work. Indigo Shire incorporated dementia-friendly design principles into the refurbishment of a local library and other facility upgrades. Kiama Municipal Council is assessing the design of public spaces so that the physical environment can provide better experiences for people with dementia.
According to the Dementia Friendly Communities Program Manager, Carol Vickers, ‘sense of place’ is very important for a person with dementia:
“It can be a familiar and physical space that can help orientate a person with dementia, or it could be any space within a community where they feel supported. One where a person with dementia is safe and connected,” she said.
“It is important to not only understand and incorporate dementia-friendly design principles, but to also think about the person or group of people you are designing for.”
Ms Vickers said the best advice she could give to urban designers and placemakers is to focus on the needs of the person or group and “ask the person with dementia what they need from a space and how navigational cues, for example, might assist [...] It is also important to be flexible, what works for a person with dementia in one setting may not necessarily work for another in a different setting”.
Several guides for designing for dementia are now available for professionals, such as Dementia Friendly Communities guidelines and Dementia Enabling Environment principles. While such design guides contribute to changing practice, other changes are needed according to Professor Fleming, who is also Executive Director of Dementia Training Australia. He observes significant inertia in design for people living with dementia, particularly residential aged care, due to care models which address ageing and dementia as problems to be managed.
Ms Vickers stressed that guidelines that are developed in conjunction with stakeholders will “produce places and spaces that people with dementia and their carers feels comfortable in, a sense of ownership over and will use frequently.”
Such engagement challenges placemakers to refine their approaches to human-centred design and participation to respect the person living with dementia and their changing needs, cognition and capabilities. Dementia Training Australia, Dementia Enabling Environments and Dementia Friendly Communities have published practice notes, guides, resources and toolkits that can facilitate dementia aware environmental design.
If people living with dementia come to harm in places like shopping centres or public facilities then those places are clearly not safe for or inclusive of everyone. Broader understanding and application of these guidelines in places will mitigate the risks that people with dementia face while supporting independence, social inclusion and choice in their everyday lives.
Dementia Training Australia (http://www.dementiatraining.com.au)
Linda Carroli is a writer, planner and researcher based in Brisbane. She is a consultant with Harbinger Consultants and a member of Alzheimer’s Australia’s Dementia Friendly Communities Advisory Committee. She is currently completing a PhD at QUT.
issue 03. autumn 2017