How can building design improve dementia care provisions?

This blog will soon be relocated to: blog.nightingaleassociates.com

 

It causes changes in mood, judgement, personality, and makes it difficult to communicate or cope with day to day tasks. And it usually gets worse over time. By 2020, it is estimated over a million of us will suffer from such symptoms – caused by dementia.  

Dementia can start as early as 40. With about one in every 20 people over-65 suffering from it, by the age of 80 about one in five are affected. Yet care provisions and older adult facilities have been identified in the Draft of the Health Building Notes as largely unfit for purpose. Clearly, building design must respond to the demand for quality dementia provisions and care facilities.  

Can Gerry Robinson Fix Dementia Care Homes? - asked BBC One recently.

Care and treatment for sufferers of dementia should be at the heart of the general election campaign, the Alzheimer’s Society charity told the BBC. As the press continues to reveal the flaws in elderly care – specifically in relation to dementia care – how is building design working to improve provisions and facilitate a better healthcare service for older people? 

A report by the Alzheimer’s Research Trust and University of Oxford released yesterday, titled Dementia 2010, reveals dementia as the greatest medical challenge of our age.

In an interview with the Telegraph, Andrew Harrop, head of public policy for Age Concern and Help the Aged, said: “A world class health service should be one that responds to the needs and preferences of those who need it most. 

“Older people are the largest users of healthcare services, yet we are a long way off from seeing their needs at the heart of decision making in the NHS. 

“Our research shows that above all, older people’s definition of quality does not always match the performance regime laid out by politicians.”

Campaigners claim half of all dementia patients treated in hospital end up in a worse state. However, new mental health facilities recognising the need for specially designed environments for older people’s care are being built, which alleviate conditions rather than aggravate them. One of these facilities is Nightingale Associates’ recently opened £7m older people’s unit at St. James Hospital in Portsmouth, which provides a dedicated organic and dementia provision. 

 

The Limes is a 36-bed specially designed mental health unit for older people. The building has been designed to house patients with different needs in separate wards as well as providing separate male and female sleeping accommodation. A 14-bed ward is designed for functional patients while there is a 22-bed ward for organic patients. Further sub-wards allow patients with challenging behavior to be specially monitored. 

To support the wards there is a central therapy area, staff facilities and an entrance area for staff and visitors. Each ward has its own secure garden for patient recreation and a central therapy garden for patients to carry out therapy tasks under the supervision of an occupational therapist. 

The situation of the building  in a tranquil parkland setting with little passing traffic on the existing hospital site will assist patient therapy with the ability for patients to both see and access secluded secure outside spaces is a key requirement of patient care. 

Other features include central shared day space areas and seating areas at intervals to provide rest places for patients along corridors, which also provide amenity spaces for use by patients who need safe wandering spaces. Ultimately, the layout of the building has been designed to meet the clinical need of the patients and to provide a warm, safe and easily accessible unit which affords both views and access to the surrounding landscape. 

  

Currently in the design stages, the £23.75m mental health unit at Aylesbury’s Manor House hospital is another new development proposed to provide 40 beds for older people, split into two 20-bed wards: one for dementia patients, the other for functional illness. The other 40 beds will be for adults of working age and will again be split into two 20-bed wards: one female and one male. 

With some patients potentially staying up to six weeks at a time in the facility, key elements taken into account when producing the layout were: the changes in level, the existing roads and approach to the building across the site – and the views out across the landscape. 

Clinical relationships of each department have been assessed at all stages of the design process and are of paramount importance to allow the hospital to function in an efficient and therapeutic manner. High traffic areas such as the café, PALS, multi-faith and tribunal rooms have been located close to the main entrance to minimise travel distances and also to ensure privacy to the wards that have been located furthest away from the main entrance. 

Due to complete in December 2011, the demand to provide similar dedicated dementia care facilities is almost certain to increase. “As the average age of people in the developed world steadily increases, the numbers of people needing support and treatment for dementia means that this issue is the ‘elephant in the room’ – being studiously avoided by most governments,” says founder of Nightingale Associates, Mike Nightingale. 

The RIBA robot is a Japanese invention aimed at assisting hospital nurses.

“Japan has, perhaps, the most acute manifestation of this growing phenomenon, because of their genetic longevity (highest proportion of people of 100+ in the world) and lack of immigration,” he continues, “One interesting response in Japan is to use technology to help solve the problem.  An example of this, is the development of a very attractive small robot in the shape of a ‘Snoopy dog’ that is programmed to follow patients with dementia with a camera linked to a bank of screens at the ‘Nurses Station’, so that busy nursing staff are able to monitor up to 20 patients simultaneously. 

“With the balance of cost and availability of young carers to rapidly increasing numbers of sick elderly people this sort of lateral thinking has a lot of promise,” Mike concludes. 

Whether or not we can use advances in technology and robotics to bridge the gaps in older people’s care, as the population continues to grow, the need to respond to the demand for elderly care provisions and facilities will be important not only to governments, but to all of us as potential end users. 

Further reading: 

An Interactive Robot in a Nursing Home: Preliminary Remarks provides an interesting read on the use of robotics to aid the elderly population.