Over the past years, design of environments for individuals living with dementia has evolved tremendously. Though each of these evolving models of care provided overlapping design-related concepts and recommendations, the lack of a consolidated therapeutic framework focusing on person-centered values for designing dementia-friendly communities was felt. This literature review focused on the shared areas in care facilities for dementia residents, and the impact on person-centered care (PCC).
To explore research on built environment factors and characteristics of shared residential settings to conceptualize a framework and propose a set of design recommendations to create supportive environments for individuals with dementia.
1- A systemic and comparative evaluation was made across the therapeutic goals of six versions of frameworks presented from 1986 to 2004 for individuals living with dementia to come up with five overreaching PCC themes. 2- Based on an extensive literature review of home and shared residential settings, a number of examples and design strategies to enhance quality of life and support functional abilities were discussed for each of the five PCC values.
The literature review resulted in defining the following themes for consideration:
1- Create a sense of community within the care environment.
2- Enhance comfort and dignity for everyone in the care community.
3- Support courtesy, concern, and safety within the care community.
4- Provide opportunities for choice for all persons in the care community.
5- Offer opportunities for meaningful engagement to members of the care community.
The study was limited to a literature review with no actual case studies or data collection. The research results were limited in the number of dementia patients studied.
Design Implications
Within the care community:
1. To create a sense of community:
- Plan accessible public spaces for residents to engage with the community, such as restaurants, shopping, and local art exhibit spaces.
- Design the interiors and ambient features to avoid over-stimulation (reduce glare and control acoustics).
2. To enhance comfort and dignity:
- Provide self-contained homelike environments for around 10-20 residents (termed as household) comprised of a mixed configuration of shared or private rooms, and common spaces like dining rooms, kitchen, living area.
- Provide easily visible and meaningful visual cues (e.g., opportunity for displaying personal mementos and props to increase awareness and orientation).
3. To support courtesy, concern, and safety:
- Design spaces to support the resident’s basic functional independence (e.g., dressing, going to the bathroom). Choices and location of clothes or personal care items, access to secured outdoor space are examples of characteristics that can support daily activities.
- Balance safety with independence and privacy by designing to minimize risks -- adding slip-resistant flooring material in wet areas, eliminating changes in floor levels, using sufficient light, incorporating technology like motion sensor lighting, including easy-to-reach to grab bars, and limiting access to potentially hazardous items (especially in the kitchen).
4. To provide opportunities for choice:
- Design indoor and outdoor spaces of meaningfully varied sizes and scales and ambiance to accommodate different activities, providing choice and control to the residents.
5. To offer opportunities for meaningful engagement:
- Enable social engagement in communal areas like kitchens during meal preparation and dining spaces of limited size with flexible furniture configurations.