VISUAL CUES: Design Strategies to Support People with Dementia

Memory-Dementia Care Cover GraphicAs the incidence of Alzheimer’s disease and other types of dementia have been steadily increasing, the demand for specialized settings is likewise on the rise. There is also a growing movement to empower our towns and cities to better support those with dementia, so they can choose to remain in their personal homes and fully engage with others (not just others with dementia) for as long as possible. In either scenario, we believe careful and respectful design strategies can function as a silent “enabler” to support dignity, personal expression and independence to the greatest extent possible.

Several of our interior designers, including me, experienced firsthand what mental decline feels like through the Virtual Dementia Tour®.  This tour involved us trying to complete common everyday tasks while outfitted with patented devices that made it harder to hear and see, difficult to pick things up, painful to walk and so forth so that we could experience the physical and mental challenges people with dementia typically face. It was a real “eye opener.” Drawing on lessons learned through these types of experiences, industry research, post occupancy reviews and especially input from caregivers and people with dementia, our team has developed a checklist of design details to help empower individuals to function comfortably and independently for as long as possible. While some of these details are specific to senior care residences, many are applicable for private homes as well.

Improving Wayfinding

Providing views to the outdoors helps with orientation and wayfinding. Providence Point; Pittsburgh, PA

Providing views to the outdoors helps with orientation and wayfinding. Providence Point; Pittsburgh, PA

While uniform quality is often visually appealing, it tends to feel institutional and often makes wayfinding more challenging. Navigating a corridor where all rooms look alike can be daunting even without dementia, something like locating your hotel room in a long corridor with doorways that all look the same. One way to help differentiate rooms is varying the carpet pattern at the entrance to each person’s room; for instance it could be a diamond outside the first room, a circle at the next and so forth.  It may also be helpful to vary the trim or color in each entryway or even change the door style for each bedroom. Another simple technique is placing personal furniture and/or decorative items just inside the door. If using memory boxes or curio cabinets, they should extend into the corridor to be easily seen, but also need to be close enough to each individual room so there’s no confusion as to which room they “belong to.”

The Power of PicturesLongwood Resident Room

Artwork is another way to individualize spaces and help with wayfinding, sometimes more effectively than traditional signage.  At The Osborn in Rye, NY, we used large, distinctive artwork outside the entry to each room.  Studies have shown that artwork depicting nature scenes has a positive, calming effect which is why it’s become increasingly prevalent in healthcare environments. Abstract artwork should be avoided based on a number of studies  illustrating negative emotional responses and the potential for added confusion and frustration. Natural objects, shapes and forms tend to be familiar and appealing  It’s worth noting that a studies have indicated the value of art therapy for people with dementia so another consideration is prominently displaying a person’s own artwork.

A Room of One’s Own

The bedroom should provide opportunities to surround individuals with their personal items so in a care environment it feels like their home rather than a hotel or hospital room.  At a minimum, space should be provided for the person’s own recliner chair (no matter how ugly we may think it is), and optimally, the entire room should be furnished with personal items. A uniform set of furniture already included in each room is certainly simpler than managing the logistics of moving potentially oversized personal furniture in with each resident.  However the positive qualities of having a “room of one’s own” with items unique to each person’s heritage and life history should not be undervalued.

Lights

Consider a lighted switch for both the bedroom and bathroom which will not only be easier to find, but also can serve as a visual reminder to turn on the lights.  Motion sensors are another option, but lights should come on and turn off gradually.  Using tunable LED lighting that adjusts levels during the day based on natural light and biorhythmic patterns can also help with sleep patterns.

Bathroom Improvements

Providing contrast—between grab bars and walls, the toilet seat and floors—makes individual elements easily discernable and can help ease confusion and tension.  Similarly, placing sink faucets off-center (at 1:30 instead of 12:00) improves visibility by making them less likely to blend with the counter backsplash.  Double handled faucets with red for hot and blue for cold can further prevent confusion.

The typical mirror over the sink should be carefully considered.  With the progression of dementia, some people will think they are looking at someone else when observing their own reflection.  One possible solution is placing sinks and mirrors to the side so at least the reflection is not visible when entering the room or standing at the sink.  Other options are to install a shutter or piece of artwork to go over the mirror or relocating the mirror to the inside of the cabinet door.

Color Considerations

Living spaces in the H.O.P.E. Center at The Osborn in Rye, NY are deliberately varied allowing residents to choose where they feel most comfortable at any given time.

Living spaces in the H.O.P.E. Center at The Osborn in Rye, NY are deliberately varied allowing residents to choose where they feel most comfortable at any given time.

Our general rule is to vary the hue by at least two “steps” on the gray scale so that most people will be able to easily differentiate between the two.

Our general rule is to vary the hue by at least two “steps” on the gray scale so that most people will be able to easily differentiate between the two.

When it comes to color, the design principles for those with dementia are basically the same as for any aging person. Common vision challenges such as yellowing of the lens, reduced pupil size and general loss of clarity  should be considered when choosing colors.  Colors that are a mix of hues from opposite sides of the color wheel (such as yellow and blue) will appear muddy to most aging eyes. Likewise, pastels can be harder for seniors to discern.

Once again, contrast for flooring transitions, chair seats and floors, plates and tablecloths, is the key to helping people safely navigate their residence. Conversely using color to de-emphasize certain elements can be helpful as well. For example, painting a service door the same color as the corridor wall helps to avoid drawing the attention of those walking by.  Despite the challenges of finding the right mix, we do feel color is an important component to make spaces appealing and individually distinctive.

Like any of our own homes, there’s no one size fits all solution. The best solution may be in simply providing a variety of spaces with varying design themes, a mix of intimate and grand spaces and different color schemes to allow individuals to go where they feel most comfortable on any given day.

Charlotte Stoudt, NCIDQ, LEED AP, has 17 years of experience as a commercial interior designer, including senior living residences for people with dementia such as The Osborn’s H.O.P.E. Center pictured above. Her goal is to provide interior design solutions that create appealing living spaces for every level of care. 

Additional Information:

Using Color as a Therapeutic Tool:  This article provides practical insights and ideas.

Finding the Balance Between Risk & Quality of Life. Not related specifically to design, but great “food for thought” when caring for someone with dementia.

RLPS Interiors Blog Editor –  Jodi Kreider, LEED AP