I believe that we engage in a conversation with our environment. We respond to the environment and it responds to us. We change it in all sorts of ways every day, as for example when we open a window, close a curtain or move the furniture. We encourage olfactory experiences as the perfume of flowers or herbs wafts into a room. We allow the sounds of birds or passing traffic to enter, or diminish the impact of noise through our selection of finishes and surfaces.
The shape of this conversation is not random. The environments we design issue invitations to our bodies. They invite people to do certain things and to behave in particular ways: ‘Come here!’ ‘This way please.’ ‘Sit down and relax.’ ‘Please take a seat and pay attention.’ They can offer reassurance: ‘Welcome!’ ‘Yes, you are in the right place.’ They can contribute to a sense of wellbeing, or leave a person feeling uncomfortable: ‘I am so glad I came.’ or ‘What am I supposed to do now?’ ‘Why am I here?’
Our goal should be to design environments that are enabling rather than limiting, to design environments that are salutogenic, rather than pathogenic. Salutogenic design is about creating environments that focus on the health of a person rather than their frailty. It is about designing to make the most of the skills and abilities that a person has, rather than focusing on their disabilities or limitations. It is about designing so that a person can be the best that they can be. We need to design environments that issue invitations to participate, to use our abilities, to engage with life.
Using a restroom is one of our most basic needs, and its design is critical if we are to be able to use it. Restrooms in public buildings, however, are often examples of the way in which invitations can be unclear and unhelpful. These spaces are often filled with reflections, taps that have handles that work in a myriad of ways or have no handles at all, basins that are of many shapes and sizes, soap dispensers and hand driers that are of a variety of designs. The invitation they give can be confusing, as every one functions slightly differently. How often do any of us stand and look at a basin and wonder what to do next? How does it make us feel? I do not for one moment wish to stifle design and innovation. But I do want us to think about the purpose of these rooms: to wash our hands. And so, are we designing these spaces in a way that makes it easy for people to do this?
Creating enabling salutogenic environments is particularly important for people who live with a cognitive impairment, such as dementia. One of the most important ways to do this is to design environments that issue a clear invitation to behave in a certain way. A person living with dementia typically will have difficulty initiating an action and coming up with an idea of what to do. They will not be able to filter out noise and listen to just the most relevant things that are going on around them.
Instead they are bombarded by sound. They may not remember what they started to do. But it is about so much more than memory, it is about cognition, about not recognising the meaning of the objects and spaces. It can be like negotiating a hotel restroom all the time, where little is familiar. Imagine if this was your world!
As designers, if we can create environments that assist people to recognise the invitation that is being given to them, the invitation to behave in a certain way, to sit down and relax, to come and have lunch, to stop and enjoy a moment’s rest, we can make a vital difference to someone’s life and wellbeing.
A number of key design principles have been identified as important when designing for people with dementia. The evidence suggests that well designed environments will reduce agitation, depression, anxiety and improve a person’s wayfinding, eating behaviour, self-help skills, motor functions, mobility and other activities of daily living1. These principles have been described by Fleming and Bennett2 as:
1. Unobtrusively reduce risk
2. Provide a human scale
3. Allow people to see and be seen
4. Reduce unhelpful stimulation
5. Optimise helpful stimulation
6. Support movement and engagement
7. Create a familiar space
8. Provide opportunities to be alone or with others
9. Provide links to the community
10. Provide a vision for way of life
By applying these principles as we design we can enable people to fulfil their potential, allow their stories to shine and use their abilities and enjoy life. Designing for a human scale will influence the size of the room we design and how it is detailed. A large space can be broken down to a human scale through careful detailing which allows a person’s haptic experience to be strong, giving them a sense of place rather than one of being lost. The form the environment can take in response to these principles is endless. It could mean designing spaces for people to sit outside or focusing on a cosy dining room. It could mean designing a billiard room or a shed.
While there has been a focus on issuing a clear invitation by using these key principles in the design of residential aged care for some years now, there is an increasing awareness of the importance of applying these principles in other settings. People with dementia often spend time in hospital and the environment has a key role to play in their recovery. At present a person with dementia is likely to stay almost twice as long in an acute setting3. Imagine if we could design the acute environment to care for a person with dementia rather than disable and distress them as they are faced with noise, lookalike corridors and wards, and hidden toilets?
In the wider community too, there is an increasing awareness of the role the environment has to play in making it easier for a person with dementia to remain the community. How do I find my way to the bank? How easy is it for me to buy milk, to pay a bill? The key design principles have an important role to play in public buildings. We all want to know where we are to go and what we are meant to do when we arrive at a new destination.
Our minds and bodies interact with our buildings. Can we design so that the invitation the environment issues is clear? And can that invitation be one of welcome? Regardless of our ability, regardless of our health, regardless of our frailty, can we be invited to participate? What great environments we would create if we could do this.
1. Fleming, R., & Purandare, N. (2010). “Long-term care for people with dementia: environmental design guidelines”. International Psychogeriatrics, 22(7), 1084-1096.
2. Fleming, R., & Bennett, K. (2013). “Environments that enhance dementia care: issues and challenges”. In R. Nay, S. Garratt & D. Fetherstonhaugh (Eds.), Older People: issues and innovations in care, 411-432. Chatswood: Elsevier Australia.
3. Draper B, Karmel R, Gibson D, Peut A, Anderson P (2011) “The Hospital Dementia Services Project: age differences in hospital stays for older people with and without dementia”. International Psychogeriatrics, 23(10):1649-1658.