Design concepts in Alzheimer’s care facilities

People with Alzheimer’s disease live in a world of anxiety and confusion where the commonplace and familiar become unknown and threatening. Sensitive and intelligent design using flooring adapted to sufferers’ specific problems can help provide a safe and welcoming environment that combines quality of life with functionality.
This article is based on the long-term and ongoing expertise Tarkett has built from working with medical professionals on aged care and Alzheimer facilities.

The symptoms of Alzheimer’s
For most people memory loss is the most recognizable symptom of Alzheimer’s disease, but it is only one of a whole range of specific problems that afflict sufferers.

To memory loss can be added anxiety and depression and, as the disease progresses, mood and behavioural problems, the inability to recognise people, places or objects, spatial problems, confusion, motor problems, and incontinence, leading ultimately to debility and complete dependence.

A suitable environment
Today, healthcare professionals recognise that the successful and humane management of Alzheimer’s requires a holistic approach that combines diet, exercise, mental stimulation and medication and, just as important, a suitable environment. That is a framework for residents to use all their remaining abilities (eating, washing, walking….) in safety, comfort, and dignity, while also meeting the needs of carers and possible medical treatments.

Most of the ideas suggested here are relatively simple, but they are all carefully developed solutions based on Alzheimer’s research and the specific problems caused by this disease.

Any population of elderly or frail residents can benefit from:

USE

  • Non-slip, matt surfaces and freedom from clutter.
  • Recessed plugs and concealed cables.
  • Furnishings with rounded edges.
  • Space for mobility aids.
  • Easy clean surfaces for hygiene and maintenance.
  • Air conditioning, easy clean surfaces and regular cleaning
    to control odours.
  • Outside space and connection to local communities to
    prevent isolation.
  • Noise and lighting controlled for comfort.
  • Lockable doors and windows and electric blinds for safety
    and security.

AVOID

  • Rugs and long curtains
  • Clutter
  • Sharp edges
  • Shiny surfaces
  • Fluorescent lighting

Lifestyle quality, comfort and security
Because Alzheimer’s disease produces anxiety and confusion and behavioural problems, it is important for sufferers to have their own personal space. This will not only provide somewhere they can feel safe and comfortable, but it also offers the privacy needed to handle the sometimes distressing affect of Alzheimer’s, such as incontinence, as well as medical treatments should they become necessary.

In the bedroom carefully selected personal items and even fake fur (which offers some of the psychological benefits of a pet) can provide comfort and familiarity. In some countries, floorings that suggest a particular region can also be beneficial (terracotta impression for South of France for example).

Colour and appropriate flooring can be used to create distinct functional divisions between the bedroom and bathroom. This will help the resident with orientation and encourage independent use of the toilet. In the bathroom the emphasis should be on ease of use for both residents and carers. Both rooms require functional surfaces and floorings with an emphasis on easy cleaning and maintenance.

Colour and Pattern
As we age our eyes change – contrasts are no longer so sharp and it can be difficult to distinguish some colours and shapes. When, as in Alzheimer’s there are also psychological problems, particular colours and colour ranges can make the condition worse leading to confusion, anxiety, distress and depression. Pronounced patterns can have similar effects and cause disorientation and confusion.

In designing for Alzheimer’s the choice of colour should emphasise a natural palate (animal, vegetable, mineral) in light, solid colours with a matt finish or tints. Where pattern is used it should be confined to abstracts or subtle spots, or imitation wood, tiles or stone. Stripes can be used in front of entries and emergency exits to deter residents from leaving the building. In general borders should be avoided but they can be used in a limited fashion on the floors to provide residents with a guideline.

USE
Colour

  • Natural
  • Light
  • Matt
  • Tints
  • Solid
  • Mid-range shades (not dark)

Pattern

  • Imitation wood (without grain)
  • Imitation stone/mineral
  • Blends
  • Solids
  • Subtle spot
  • Abstract
  • Borders

AVOID
Colour

  • Acid and vibrant
  • Dark
  • Very light
  • Bright red
  • Colours with particular meanings

Pattern

  • Stripes (except exits and entries)
  • Repetitive shapes
  • Dark stippling
  • Typographical
  • Digital
  • Imitation grass, leaves, straw etc.

Colour Contrast for Safety and Independence
People with Alzheimer’s frequently go through a stage of restless wandering.
But being able to move freely is an opportunity for mental stimulation, for relieving boredom and for residents to feel independent, while the physical movement also improves general health and muscle tone.

Colour coding and highlighting can provide some visual distinctiveness and prompts that people need to orient themselves and identify particular areas or functions, while containing the risks. Using different colours to separate the walls from floors also helps to combat disorientation so that residents can locate themselves in space. Doors could be painted in different colours according to function – bedrooms, activity rooms, catering, television, and most important toilet facilities - providing an opportunity for people to learn to recognise and find what they need. Similarly, using different colours for door handles and handrails will prevent confusion and frustration.

Staircases are potentially very dangerous, so every element should be clearly marked, with coloured strips to highlight the leading edge of each stair tread and different colours for the first and last tread of each section. Using different colours for each landing will make it easier for residents to identify where they are.

USE

  • Different colours for floors, walls, and doors
  • Different colours for doors for different functions
  • Different colours for door handles and handrails
  • Colour to highlight stair treads
  • Different colours for first and last tread
  • Different colours for different levels
  • Stripes to mark exits

Light and open
Good natural and interior lighting are particularly important for people with Alzheimer’s who frequently experience sleep disturbance in addition to the usual problems of ageing eyes. Increasing light levels (+70% lux) at dusk and during winter helps to regulate the body’s internal clock, improving sleep/wake patterns and general mood and behaviour. Large windows and rooms can also relieve the sense of confinement and isolation by bridging the gap between the interior and exterior spaces.

A positive plus for carers
Everything that improves life for residents will make the task of carers easier. Encouraging independence and movement, and using the environment to manage difficult behaviour reduces the necessity for physical or chemical intervention. Suitably equipped rooms with appropriate floor coverings will reduce the strain of maintaining hygiene and providing medical care when necessary, while keeping areas free from clutter will ensure enough space to move residents or equipment without unnecessary strain. And when care-staff go off-duty they need to be able to leave their work behind by having a place to relax that is stylistically separate from the rest of the building.

Conclusion
With ageing populations and every growing numbers of Alzheimer’s sufferers, intelligent design has an increasingly important role to pay in handling their ongoing care. As this article shows some simple measures combined with the use of materials such as suitably designed flooring, can transform an environment from somewhere that is just a place to live into an environment that might positively foster quality of life.