Designing for older people with cognitive and affective disorders

Arch. Gerontol. 0167-4943/98/$19.00 DESIGNING

P.

Geriatr. suppl. 6 (1998) 515-518 Q 1998 Elsevier Science Ireland FOR

VALLA

OLDER

and

Architecture ontechnology, versity of

T.

PEOPLE

WITH

Ltd. All right

COGNITIVE

reserved

AND

515

AFFECTIVE

DISORDERS

HARRINGTONa

Studio, Centre Eindhoven,

Via Termopili 25, I-20127 Milano, Italy; alnstitute for for Biomedical and Healthcare Technology, Technical Box 513, 5600MB Eindhoven, The Netherlands

CerUni-

SUMMARY Knowledge of the design criteria for specific physical environments for elderly people with dementia, together with medical and pharmacological research studies is a very important scientific target with therapeutical implications for cognitive and affective disorders. Safety, comfort and utility are major concerns for the elderly, especially those who have developed perceptual or other mental deficits. Yet designing environments that are safe and respectful of them is a very complicated task. Here we approach that task simultaneously from two distinctly separate vantage points. The first is from the laboratory, involving the psychophysics of human performance, namely, the parameters of the senses, vision, touch and of cognitive and motor performance which can be used to predict accidents in specific settings. The second one is the accident reconstruction: after accidents occur, they are analyzed to find out which aspects of the person interacted with which aspects of the environment to cause the trip or fall or crash. Data from both of these sources can be used to elevate the standards of safety. Research on visual perception, motor activity, orientation and other relevant human functions often cannot be generalized to the field from the psychophysical laboratory. It is often necessary to perform the relevant experimentation in the field where the research setting is more representative of the lives of the patients and the dangers to them. It is necessary to develop standardized research settings such as the Alzheimer’s garden. Such settings should, first, be mathematically modeled along the dimensions of interest in concert with the collection of data which can be used to test, validate and extend the model and thus the utility of the setting. Separate sub-models can eventually be combined into larger models. Keywords: architectural care facilities, Alzheimer

design, garden.

Alzheimer’s wandering,

disease, visual

therapeutical perception,

environment, simulation

INTRODUCTION In of

Italy,

to

is

the

Italy

that

Geriatric

care

setting

is

teraction refined

in

60 % of

staff

and

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the for typical

falling,

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is

surroundings:

Western

countries,

houses

and

Alzheimer patients’

often

inadequate:

guidelines

wandering,

other

sheltered

between

dementia.

one’s

as

admission

families

and

the suitable more

temporal

relationship for

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lives all

at

agree

that

the

up

for

by

and

disorientation.

spatial

negative

architecture patients

causes

situation by

in

relatives. physical

by

stressed

in-

Designers

thus

need

people

with

elderly

environments

and this

main

institutional

stirred

facilities

the

assisted

environment.

care

of

present

influenced

between Alzheimer

The home

are

physical

behaviors

is one

homes.

problems

designing

escaping,

a close

patients

behavioral

patient

dementia

nursing

the

relationship

are:

perception gradually

of

516 changes.

Vision

Harrington. sensorial

THE

and

assessed

PLAN

OF

homes

long

term

Units

in

suggestions

REGION

on

of

how

for

to design

Quon,

1989:

to make

deficits

Region

units

up

for

scientifically.

Lombardy

for

only

represented

and

and

restructured

these

the

care

Alzheimer”)

Canada

be

LOMBARDY

Plan”

facilities

USA,

(Harrington

can

analyzing

residential

residential the

by

“Alzheimer (“Nuclei

simulation

environment

deficits

extra-hospital

nursing

by

physical

perceptual

so-called

about

be

The

ALZHEIMER The

96

can

1997)

the

demented

first

elders,

Europe.

The

a specific

care

for

15-20 local

unit

to

the

Plan

with

years

public

similar

Alzheimer

the

residents

the

proposal

of

Special

gives

green

1994-

amid

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many

outdoor

useful

spaces

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tegrated. An of

and

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creation

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important

patients

allow

lost.

the

This

the

la,

green

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of

of

Eden”,

Italian

control.

to create

to

his/her Sector

the

move the

District

the

of

quality

medical

of

staff,

facilities any

Milan

for

life

comes

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danger

accepted

people

planned

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Garden”

challenge

dementia.

as

Planning

“Alzheimer

the

with

Antonini

Department the

care

without

a garden

model:

the

the

wander.

Francesco

Therefore,

of the

around to

i.e.,

improves

tasks with

need

geriatrician

a theoretical

which

also

integrated

patients

Services

the

eases

areas

satisfy

“Garden by

freedom

to

contribution and

Alzheimer

Social

initiated

asked

of

helps

The create

therapeutical relatives,

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to

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place

was

allowing

of

Architecture

[AC)

(Mori

was and

Val-

1995). The

wandering

celerate

the

is controlled

process

therapeutical

of

activity

too

functional

often

with

decline,

stimulated

by

sedative

medicines

meanwhile

the

the

environment

which

movement

and

by

may

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acbe

therapeutical

programs. A

specific

affect

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search

environment,

behavior

on

systems,

indoor

daily

living

and offer

and

orientation

memory and

dignity.

utical

goal,

too,

since

abilities,

and

as tors gical

well. on

As

a matter

patients

well-being

The

with of

of may

patients.

and

order

set

programs of

patients,

of

a suitable

have

disease

studies and

physical

(Bonati

and

reassuring

them

for on the

interaction

the

an

Valla,

support

1997). improve

by

The atten-

increasing

au-

is a thcrape-

cognitive

describe

Retechnical

aids

environment

influences

their

positively

declines.

stimulation,

physical

may

furnishings,

up

sensory

implications

positive

many

needs cognitive

colors,

to

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have

fact,

patients’

levels

design

may

the

functional materials,

in

therapeutical

Alzheimer

these

the

spaces,

different

it

of

for

down

exhaustive,

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tonomy

functional

slow outdoor

be

activities

environment tion,

and

, must

etc.

conceived

and

disorders affective

effects

of with

and

disorders sensory the

psycholo-

fac-

a

517 GUIDELINES

FOR

Through dementia

DESIGNING

analysis

(Cohen

1993).

some

guidelines

units.

They

should

tecture”

and

provide

familiar

fic

In

of

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future,

of

cility.

One

settings

with

can

be

for

direct

as

the

In

model

MATHEMATICAL The

in

in

model

model

will

to

it

the

laboratory

is

both

sophisticated

ma-

necessary

to

followed the

every

fa-

standardized

be appropriate

input

reiterate

but

foregoing mental

in from

facilities)

and

universal,

it

can

(computers

are to need ultimate develop

from

the

AC.

dent

causation,

its to

perform

is

by

reach

a multi-

experimentation.

country

music,

These comfort

the

has

to

find

so

and the

perform

its

understand,

us

on

real

the

reshape

the arrow

subtle

the

safety

scene

bench

of

we

we

want

nicely

it

to fit “looks”

warn

AC, may

a specific

data,

someone

things),

the that

experimental

if

friendly

e.g.,

anything

from on

from

vibrantly

interest,

tell

Based

guiding more

to

of

models.

model”,

the

ac-

to:

dim

the

spe-

confused

the

people

who

forth.

need

not

submodels can

actions

mathematical

“mathematical

scene

ranging else.

of

of

chases,

inhabitants,

resize

to

model small

could

designer

blink

beginning and

one

someone

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depict

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it,

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to

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esthetic

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of

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data as

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of

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prototyping

tame

research

and

and

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and

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methods

a setting.

sensory

have

(alcoves),

to

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psychophysical

such

offer

(day

value

who

design

(creation

evaluation

designing

in

archi-

1997).

architectural

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work

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older

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construction

environment;

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to

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in

for

1991;

eliminate

spaces,

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to

models.

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be

to

15 patients),

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special

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operating

own

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reformulated

thematical the

them

(6 -

private

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for

orientation

a wandering

design

Munson,

they

maximize

2 possible

1991:

recommended

a prosthetic

and

environmental

Coon,

size

landmarks,

complicated

such

in

stress,

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been

small

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use

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1991;

corridors,

spaces,

morass

ply

be

of organization, outdoor

literature

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without

specific

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Weisman,

institutional

stimulations plans

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and

then and

even based

be

well-being

be

attempted

on

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combined later.

to

handle

initially.

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data, the

full

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such

possible

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look

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