Environment critical for Alzheimer’s care

By Dennis Boggio
The Denver Business Journal
Health-care Design
May 10, 1997

 Winston Churchill once remarked, “We shape our buildings and our buildings shape our lives.”  As the nation’s elderly population continues its dramatic rise, how we “shape” environments for the increasing number of frail seniors will greatly influence the quality of life we provide for these older Americans.

The U.S. Census Bureau anticipates a doubling of the 85-plus year old population between 1990 and 2010. In numbers, this represents an increase from 3 million individuals in 1990 to more than 6 million in 2010.  This population again will double during the next 30 years to more than 12 million people. It is estimated that more than half of this population group suffers from Alzheimer’s disease or some form of cognitive impairment.

Until a cure for Alzheimer's is found, one of the most effective interventions to improve the quality or life for those with the disease begins with a well-designed environment that utilizes architecture as a tool to compensate for cognitive losses that accompany this disease. Studies have shown responsive design of the physical environment can help Alzheimer's residents function more normally, which fosters independence and a higher quality of life. 

The architecture, however, is just one component in the total response system.  No amount of architectural talent or knowledge can compensate for a poor service plan. an inappropriate or hostile neighborhood or an inept use of the building.  Designing special-care environments for Alzheimer’s residents is both a physical and social undertaking that has to begin with an understanding of the social and psychological needs of the resident.  Only through this understanding can we provide design solutions and support systems that enhance the quality of life for residents.

 The dementia resident 

Those with Alzheimer’s have a reduced ability to reason and make judgements, which puts these individuals at risk.  They can become confused and disoriented very easily.  Design solutions should therefore incorporate simple and direct circulation patterns that are easily understood and comprehended.  Distinctive, memorable, architectural features that provide cues and clues of location, along with the use of familiar building elements that allow for the incorporation of personal furnishings and objects, help promote orientation in time and space.

 A residential environment

Those with dementia are constantly dealing with changes in themselves and their world, and it is important to help them maintain links to the past and to “things” that are familiar.  Creating a home-like environment with rooms and furnishings modeled after the single-family home is an important design objective for a therapeutic environment.  The design should reflect the premise that the special-care living environment is a home, not an institution.  All aspects of the development should be residential in orientation.

Some basic ideas for planning and design are:

Brick, wood siding, sloped roofs, covered porches, shutters, fireplaces, staircases, lamp posts, and circle driveways are home-like materials and details.  Choose materials and design standards from the single-family home industry for the impression of the building.

Establish the size and volume of interior spaces based on single-family homes and other residential building types.  Avoid atriums and large open spaces that are more commercial than home-like.

Incorporate residential building systems and elements that are likely to be familiar to residents.  For example, doors and windows should look and operate much like those most commonly used in homes.

Use residential interior furnishings, materials and color schemes that are familiar and consistent with the vocabulary of single-family homes.

Provide electrical, mechanical and hardware items used in the housing industry for all interior devices, including light fixtures, sprinkler systems, thermostats, door hardware, bath accessories and kitchen appliances. 

 Safety and security 

Safety and security are primary objectives in the environment.  Those with Alzheimer’s and the cognitive impairments that accompany this demeaning illness are physically vulnerable.  Providing safe and secure walking areas, eliminating  places where residents are likely to fall are important goals.  The physical environment should allow observation of residents.  The use of hardware such as visual monitors and lock-outs prevent residents from entering unsafe places.

Family participation 

Family involvement and intervention in the daily lives of the Alzheimer’s resident is a major objective in creating a normal lifestyle.  Regular visits and participation can be encouraged by a physical environment that makes family and friends feel welcome.  This gives the setting a residential, non-institutional persona and enables family members to feel more comfortable.  Private dwelling units and small private niches in the public areas, for example, can provide opportunities for visitation and create feelings of home.

There is no one specific design that works for all residents or for all projects.  The challenge for meeting the needs of the burgeoning senior population afflicted with this disease will be to carefully understand the needs of the individuals and provide innovative new approaches to how we “shape” their environments. 

Dennis Boggio is the president of Lantz-Boggio Architects in Englewood.