creating environments that support care and independence pam turpin senior health care consultant...
TRANSCRIPT
Creating environments that support care and independence
Pam Turpin
Senior Health Care Consultant
Arup
1st December 2010
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Overview of Presentation
Day to day challenges Where people with dementia live Approaches to dementia design Design for dementia versus Design for sight loss Specific challenges
Lighting Acoustics
Staying put – creating a supportive environment Gaps in research
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Day to day challenges for people with dementia
Memory problems Difficulty with thinking and in understanding or
following a sequence Impaired ability to learn new information, or to
recall learnt information Age related changes and reduced ability to adapt to
them. High levels of stress
Wherever a person lives, they should be able to live well, and as independently as possible, in a safe environment (AD Society: 2010)
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Where do people with dementia live?
There are currently 750,000 people living with dementia in the UK and this number is predicted to double in the next 30 years (DH: 2009).
People with dementia live in many different care settings.
The majority of people with dementia live in their own homes within the community (DH: 2009).
Around 59,000 people with dementia received domiciliary care (NAO: 2010).
Around 208,000 people live in care homes of which 91,000 in dedicated dementia beds (NAO:2010).
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People with dementia and sight loss
Most people with dementia live in their own homes. Most people with sight loss live in their own homes. People may live alone or with a carer . Most people want to remain living in their own
homes. Dual diagnosis may trigger a move to a care home. To assist individuals to remain within the
community, caregivers need to possess the skills, knowledge, motivation and resources to support self-care.
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What is ‘home’?
Safe Cosy My stuff My castle All my things I can do what I want, when I want Happiness
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Approaches to Dementia Design How design problems are addressed will depend on
how dementia is conceptualised:
Medical model
Disability (social) model
Citizenship model
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Environmental press
M Powell Lawton – environmental gerontologist. The significance of the environment gains in
importance as you become more disabled. As we age, activities which we once undertook
unconsciously now need some application of effort. When the pressure of this starts to impact on the
person, it is described as ‘environmental press’ A person’s own home is often the last place where an
individual can strengthen their self identify as the pressures in external environments increase.
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Therapeutic design for dementia
Therapeutic design is one of the key factor in maximising the functioning and quality of life of people with dementia.
The environment has the greatest impact on those with the least physical and/or mental capacity.
Good design may compensate for disability or impairment.
Two vital areas that good dementia-friendly design must take account of are: Light and lighting Hearing, sound and the acoustic environment.
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Characteristics of a dementia-friendly environment
Small size Familiar, domestic and homely in style Plenty of scope for ordinary activities Unobtrusive concern for safety Different rooms for different functions Age-appropriate furniture and fittings Safe outside space Good signage and multiple cues where possible – sight,
sound, smell Use of objects rather than colour for orientation Controlled stimuli, especially noise.
(Marshall: 1998)
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Design for Dementia versus Design for Sight Loss
Design guidance for dementia has tended to focus on care home design.
Design guidance for sight loss tends to focus on enabling or maximising a person’s ability to remain independent.
Common ground BUT also potential for conflict. University of Stirling have been looking at designing
friendly homes. New publication Dementia Design School
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Light and lighting
Increase light levels Use ‘domestic style’ fittings to help promote a
recognition of place Daylight is important Avoid glare Avoid sudden changes in light level Think – vision – can the person see clearly – if not,
what can I do to help? Regular eye checks Spectacles!
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Hearing, sound and the acoustic environment
Meaningless noise can be disabling. Turning it off can help the person with dementia
think more clearly. Regular hearing tests Hearing aids Soft furnishing can help to absorb noise Windows Take time to listen from the point of view of a
person living with dementia
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Interior design Two scenarios:
Person who has been living in the same place for a long time. Person who is moving to a new place.
Walking safely Smooth matte colour throughout Ban shiny and reflective floors Colour contrast helps orientation Patterns can be problematic Watch out for obstacles
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Kitchens and Dining Rooms De-clutter the kitchen
Consider open shelving
Traditional taps clearly marked hot and cold
Use of light is important
Colour contrast – plate, food, tablecloth, place mats.
Use crockery that the person with dementia can recognise.
Putting cup in someone’s hand may stimulate a memory to drink.
Make full use of kitchen devices that help people with reduced mobility or strength.
Consider Assistive Technology devices (e.g. Alarms, cooker)
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Bedrooms Avoid unnecessary changes
If there is an ensuite toilet, position the bed so the person can see the toilet when in bed, if possible.
If no ensuite toilet, consider installing assistive technology devices that put the light on if the person gets up in the night.
Traditional wardrobe – don’t use new design features.
Discuss with the person with dementia what would help them remember what is in drawers, wardrobe – pictures, signs?
A large number clock may be helpful
Patterns on wall paper can cause difficulties
Consider noises at night
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Bathrooms and Toilets
Incontinence can be an issue for people with
dementia.
Use traditional features – taps, plug and chain, soap
Toilet seat and lid should be a contrasting colour to
the pan and other surroundings
Floor finish needs to be non-slip and not shiny.
Problem areas: Mirrors Toilet and bath mats Consider installing a flood prevention plug and/or assistive
technology devices for baths and basins.
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Halls and Stairs
Lighting is crucial Worn or loose footwear is dangerous Consider movement sensors Beware of stairs:
Install banisters and railings on both sides of the stair. Good lighting Replace worn or loose carpets.
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Staying Put – making life easier at home
Put yourself in their shoes!
Everyone is different.
Make it easy for the person with dementia to work things out.
Try not to introduce new things for the person to learn.
Think about spectacles and hearing aids
Reduce stress
Keep a sense of humour!
Take advantage of assistive technologies
Two success stories
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Walter Mixed Dementia + Heart Disease + Cancer Own home – bungalow Control Centre:
Located in the living room Favourite chair Telephone and television remote within easy reach View of front door and window Side tables
Large number clock -Big button phone Adaptations in toilet and bathroom Supportive family and community
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Betty Dementia + Sight loss + hearing loss + heart disease Moved to extra care housing flat Own possessions – armchair, display cabinet, bed Main problems:
Staff unaware of vision problems Staff forgetting to make sure she wore her hearing aid Family concerned about dropping medication.
Solutions: Low vision assessment New glasses Staff awareness training around sight loss and dementia Increased lighting levels Individualised sensory needs passport.
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Gaps in environmental research
The environmental challenges for people with advanced dementia
Need for a sensory model of dementia incorporating the enriched model of dementia and the Nightingale-approach to dementia care (Bartlett & McKeefry: 2009)
Arup (through UCL) is supporting a PhD study over the next three years into this area of research.
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Conclusion We are all affected by our surroundings. The quality of the
environment has been recognised as a fundamental factor in determining the well being and health outcomes of older people (Calkins: 1997; Wahl: 2001; Schaie et al: 2005) and it can be adapted to reduce day to day difficulties faced by many older individuals such as sensory and cognitive impairments and increasing frailty (Lawton: 2001; Brawley: 2001; Bartlett & McKeefry: 2009).
If you live to be 90 years you will have: 50% chance of experiencing dementia. 1 in 3 chance of experiencing significant visual impairment
Consider your own home, consider the future
Consider the benefits of a dementia friendly designed home.
Thank You
Pam TurpinArup
Admiral House, Rose Wharf, 78 East Street,
Leeds LS9 8EE
Tel: 07825095332
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References Bartlett, R., & McKeefry, D. (2009). People with dementia and sight loss: a scoping study of models of
care. London: Thomas Pocklington Trust. Birren, J. E., & Warner Schaie, K. (Eds.). (2001). Handbook of the Psychology of Aging (5th ed.). San
Diego: Academic Press. Brawley, E. C. (2001). Environmental design for Alzheimer's disease: a quality of life issue. Aging and
Mental Health , 5 (Suppplement 1), S79-S83. Calkin, M. P. (1997). A Supportive Environment for People with Late-Stage Dementia. In C. R. Kovach
(Ed.), Late Stage Dementia Care: A Basic Guide (pp. 1001-111). Washington DC: Taylor and Francis. Department of Health;. (2009). Living with Dementia: A National Dementia Strategy. London: Crown
Copyright. Judd, S., Marshall, M., & Phippen, P. (1998). Design for Dementia. London: Hawker Publications. Lawton, M. P. (2001). The physical environment of the person with Alzheimer's disease. Aging and
Mental Health , 5 (2), 56-64. Lawton, M. P., & Nahemow, L. (1973). Ecology and the aging process. In C. Eisdorfer, & M. P. Lawton
(Eds.), The Psychology of adult development and aging (pp. 132-160). Washington DC: American Psychology Association.
National Audit Office. (2010). Improving Dementia Services in England - an Interim Report. London: The Stationery Office.
Pool, K. (2010). Alzheimer's Society guide to the dementia care environment. London: Alzheimer's Society.
Wahl, H. W. (2001). Environmental Influences on Aging and Behavior. In J. E. Birren, & K. W. Schaie (Eds.), Handbook of the Psychology of Aging (Vol. 5, pp. 215-237). London: Academic Press.
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Useful publications
Utton D (2007) Designing Homes for People with Dementia, London, The Journal
of Dementia Care
McManus M (2010) Hearing, sound and the acoustic environment for people with
dementia, Stirling, Dementia Services Development Centre
McNair D, Cunningham C, Pollock R, McGuire B (2010) Light and Lighting
Design for people with Dementia, Stirling, Dementia Services Development
Centre.
DSDC (2010) 10 Helpful hints for dementia design at home, Stirling, Dementia
Services Development Centre
Habinteg (2010), Design guidance for people with dementia and for people with
sight loss, Research Findings 35, Thomas Pocklington Trust