Greetings from Virginia
It’s Not Just Alzheimer’s: Design for the Cognitively
Impaired and Stealthy
Aging , a two-part series.
With this series, I want to explore areas of design that
most of us rarely talk or think about until confronted by stark reality -
design for the physically or mentally imapired. Noting statistics that
the 1st boomers turned 65 in 2011, many of whom are caring for aging
parents, 100 million people are looking for homes that don’t exist – i.e.
that do not meet their needs considering the physical, mental and
financial challenges that they are facing today. By 2050, 80 million or
roughly 1-5 will be over 65. Of those, 89% who are now over 45 will want
to remain in their homes, 80% will require special housing needs, and
where you live at 65 will be where 70% live for the rest of their lives.
In October of 2011, the Washington Metro Chapter of ASID
presented two Continuing Education courses at the Washington Design
Center related to ongoing health issues. It was my priviledge to help
organize these courses which were presented by Drue Ellen Lawlor, FASID,
of education-works, inc., Dallas, Texas, who spoke to approximately 40
designers and architects with the purpose of providing functional and
compassionate design for those who have special challenges due to aging,
disease or traumatic injury.
Universal Design is defined
as "the design of products and environments to be used by all people,
to the greatest extent possible, without the need or adaptation of
With that in mind....
Part I of this series: It's Not Just Alzheimer's: Designing for the
Cognitively Impaired focuses on Mental and Physical
Dysfunction, which can be the result of aging (dementia), blunt trauma,
Parkinson’s disease, and a myriad of other diseases, accidents or genetic
defects. To mitigate these, the American Disabilities Act was passed in
1993 and has made significant strides forward since that time, most
notably with the creation of Universal Design which must be intuitive
while providing equitable use and flexibility. With Wounded Warriers
returning from Iraq and Afganistan even greater strides are being made in
this arena as evidenced by the partnering of the military with noted
architect Michael Graves, who is wheel-chair confined, to provide user
friendly housing for veterans.
Because those with Mental and Physical Impairments have
different sensory perception from "normal" functioning beings,
we must focus on Involvement
of the Senses which include Smell, Sight/Vision &
Light, Hearing and Touch.
Smell is the 1st sense
and as such it is necessary to provide comforting scents such as cookies
rather than detrimental scents such as perfumes.
Sight -Vision & Light:
Lighting is a major issue for not only those with cognitive disabilities
but for the general aged population. It is imperative to provide
adjustable, natural and artificial light without glare. This is true for
vertical surfaces as well as horizontal surfaces in order to eliminate
confusion or disorientation.
With the aged, the perception of color changes as the eye
lens yellows which makes it easier to see primary and clear colors. To produce
the healing power of full spectrum colors (those found in nature) it is
best to balance or blend the 7 basic colors: red, blue, yellow, green,
violet, orange, and white.
In addition, Evidence Based Research indicates that
"mood" lighting can be frightening when objects and art can
lack visual acuity, with features that can be misinterpreted causing
confusion. Dementia patients often misinterpret floor or ground patterns
to create a syndrome called "Visual Cliffing" in which they
"stall" while walking and suddenly stop. There is an excellent
example, in a chapter of the novel, "Still Alice," about a
Harvard professor who suffers early onset Alzheimer's, where the central
character perceives a rug in her foyer as a "hole" that she
fears she will fall into.
While much of the following is meant for institutional
settings, some of the following points can be applied to home use.
In terms of lighting criteria, "Homelike
Settings" as opposed to "Institutional Settings" should be
incorporated into the patients environment. To diminish confusion, levels
of illumination should be raised. There should be gradual changes of
light level during a transition period to avoid "sundowning"
syndrome or agitation. To avoid "sundowning" syndrome, research
indicates that it is best to turn lights on before it gets dark outside.
Additional points of interest demonstrate that gradual changes in light
evels should be made from public to private spaces.
Adjustable window treatments: staff or home health care
providers may be required to do this with remote control. Do not allow
loose cords as patients can tangle or pull the treatment down.
We all know elderly individuas who have had traumatic
falls. To help avoid these mishaps it is necessary to provide contrasting colors for
visual acuity in the following areas: Toilets, Furniture,
Floors/Walls, Countertops and Stair treads (using different tones for
treads and risers).
Pattern is interesting in that certain fabric or wallpaper
patterns can be problematic for those working with mentally impaired
patients. Flame stitch patterns provide too much "movement,"
while stripes are symbolic of the illusion of prison or jail cells.
Challenging for upholstery is a process called "picking," during
which patients try to "pick" fruit, flowers, or textures
because they think they are real.
Touch, as with all
humans, is important. It is therefore compassionate to provide soft
throws or accessory pillows – something to hold. The low cost provides
something which makes a big difference.
Hearing and Auditory senses include noise from music, TV, phones, HVAC, and
the like. To mitigate these disruptive factors it is wise to provide soft
surfaces that can diminish noise and avoid hard surfaces that reflect
noise, combine aesthetics with function, and in institutional settings
stagger corridor doors across from each other in hallways.
Sensory Deprivation is learning dysfunction
where no new learning takes place and should be avoided by
providing variety without confusion.