In recent years, there has been a growing pool of dementia-inclusive design guiding principles developed by subject matter experts, intended for laypersons, caregivers, and care professionals to address and enhance the multiple aspects of the physical environments that persons with dementia live in.
Design Principles & Audit Tools
To be in line with the delivery of person-centred dementia care, the design process should take into account the voices of persons living with dementia and their families, and the voices of the communities they are from, in a collaborative and consultative manner. Persons living with dementia and their communities can draw on their unique resources and identities to shape their environments. By including the ideas and opinions of persons living with dementia and those who live in the same environment, the design process may be more beneficial and personalized for them.
Across the various design guiding principles developed by experts all over the world, here are some common features that these guidelines have highlighted what a well-designed, supportive dementia-inclusive environment should comprise:3-6
Homely & Familiar Environment
“Home” symbolizes comfort, safety, and security for many individuals. A homely environment that is familiar to persons living with dementia can provide them with the feelings of security, comfort and warmth. A familiar environment can also help them to know where they are and find where they want to go, further promoting independence and supporting wayfinding. An environment should therefore be familiar to the person living with dementia and reflect the characteristics of a typical Singaporean home setting.
Dementia brings about changes to the brain that may impair risk assessment abilities and affect judgments. It is important to create a safe environment for persons living with dementia to move around, such as increasing visibility, reducing clutter, preventing falls and avoiding access to high-risk areas.
Supporting Cognitive & Functional Abilities
A well-designed supportive environment can compensate for the cognitive impairments and functional limitations that dementia causes. Some ways to support the remaining abilities of persons living with dementia include:
• Appropriate and adequate lighting help to reduce eyestrain and improve depth perception
• Strong colour contrasts between table tops and dinnerware help to improve differentiation
• Not too much patterns in walls and flooring help to prevent distraction
Appropriate Environmental/ Sensory Stimulation
Too many stimuli in the surroundings can overstimulate persons living with dementia, leading to negative behavioural changes (e.g., confusion, disorientation, agitation, anxiety, etc.). A calm and serene environment can alleviate distress and minimize behavioural changes.
Thus, to support persons living with dementia to interact positively with their surroundings, there should be a balance in the amount of stimuli that they are exposed to. Negative stimuli should be reduced and positive stimuli should be encouraged.
Avoid exposure to:
• Loud noises and continuous sound
• Drastic swings in temperatures
• Inadequate lighting
• Bright and confusing prints
Empowerment & Autonomy
A well-designed supportive environment should empower persons with dementia to live as independently and as autonomously as possible, such as moving around by themselves and managing their own choices. This can maximize their well-being and confidence levels.
Personal Space & Privacy
Physical spaces of different functions can be created for persons living with dementia. There should be a space for them to get some privacy and enjoy quiet moments by themselves.
In centre-based services and care facilities, physical spaces for operational functions, such as delivery of goods or rubbish collection, should be designed in a manner that they do not come into the view of persons living with dementia, to reduce interference and disturbance to them.
Activity Space & Meaningful Participation
There should be physical spaces and opportunities for persons living with dementia to engage in individual and group activities which are meaningful and purposeful to them, as activities can help to maintain their cognitive and functional abilities. Activities offered to persons living with dementia should be tailored to their preferences and interests during that period of time, and be culturally and age appropriate as well.
Opportunities for Social Interactions
In centre-based services and care facilities, furniture and seating can be arranged in a manner where groups of persons living with dementia can socialize and interact, promoting their well-being.
A dementia-inclusive community would offer persons living with dementia easy accessibility to essential services and amenities in the neighbourhood (e.g., post office, markets/supermarkets, banks, hospitals and clinics, etc.).
Checklists and audit tools are typically included along with dementia-inclusive design guiding principles, for laypersons, caregivers, and/or care professionals to assess and identify key areas for improvement in the physical environments to better support persons living with dementia. Most of these checklists and assessment/audit tools can be self-administered.
Some of these improvements can be as small as creating signages or changing the lightings at a low cost, while others may involve larger-scale renovations which will require a higher budget. No matter what these changes are, they can have a major impact in creating dementia-inclusive environments for persons living with dementia.
In the following sections, design guiding principles developed by subject matter experts all over the world, have been consolidated and classified according to the different settings they can be applied to. Resources which contain the abovementioned checklists and assessment/audit tools will be indicated in the tables below.
Please note that the following lists of resources of design guiding principles, and checklists and assessment/audit tools are not exhaustive. Additionally, there is no one perfect checklist or assessment/audit tool, users may select one or a combination of several tools that suit their needs.
Most importantly, one should understand and be thoroughly familiar with the guiding principles to design and create a dementia-inclusive and person-centred environment, before putting them into practice.
The section below lists resources on dementia-inclusive design for:
• Physical Environments of Various Settings
• Long-term Care Facilities
• Outdoor Environments Only
“Looking to the Future” (2nd Edition) and Singaporean Environment Assessment Tool (SEAT)
The second edition of “Looking to the Future” serves as a guidebook to build dementia-friendly design in community care facilities in Singapore.
On top of detailing the six principles in designing dementia-friendly facilities and spaces, it provides recommendations and examples of how users may put these principles into practice in various physical spaces, including:
• Common Areas (lobby, lift lobbies, entrances and exits)
• Toilets and Showers
• Therapeutic Activity Spaces
• Sensory and Reminiscence Areas
• Quiet Spaces
• Dining Areas and Dry Pantries
• Therapeutic Gardens and Outdoor Spaces
The second part of the guidebook introduces the Singaporean Environment Assessment Tool (SEAT), which provides a systematic framework for reviewing environments for people living with dementia and identifying areas for improvement. The SEAT is designed to be used by a non-design professional and can be completed by a member of staff or a person visiting the facility with minimal knowledge of dementia care.
Elderly- and Dementia-Friendly Environment
This booklet by Nanyang Polytechnic, Dementia Singapore, and Agency for Integrated Care serves as a guidance and starting point for individuals who intend to build an inclusive, supportive, and sustainable environmental design in Housing and Development Board (HDB) flats/apartments where most Singaporeans reside, and in which most elderly and persons living with dementia are living with their families.
It offers recommendations on the therapeutic design of the physical environment, including both environments inside and outside (Residential Estate) of a HDB flat/ apartment.
The booklet also offers a 79-item checklist that reminds and recommends individuals the aspects to focus on when considering designing and building an elderly- and dementia-inclusive environment. This checklist focuses on the following areas:
• Spatial Environment
• Accessibility and Safety
• Lighting and Nature
• Colour Contrast
• Tranquil Environment
• Barriers or Challenges
Dementia Enabling Environment Virtual Information Centre
Alzheimer’s Western Australia’s Dementia Enabling Environment Virtual Information Centre provides design guiding principles, practical tips, and resources to make some physical environments more dementia enabling. These environments include:
• The home
• Care environments
• Public buildings
This Virtual Information Centre also provides a pool of Environmental Assessment Tools and Design Audit Tools for use to assess dementia care environments.
The King’s Fund/University of Worcester Environmental Assessment Tools
Since 2014, The King’s Fund and the Association for Dementia Studies, University of Worcester, in the United Kingdom have developed and updated, respectively, a suite of Workflow dementia friendly environmental assessment tools for use across healthcare and community care settings.
There are five versions of the environmental assessment tools available developed according to the following settings:
• Care home assessment tool
• Housing assessment tool
• Health centre assessment tool
• Hospital assessment tool
• Ward assessment tool
The tools offer rationales for effecting change in dementia care environments, which are established through support from research evidence, best practices and over 300 survey responses from those who have used the tools in practice.
Dementia Services Development Centre (DSDC) of the University of Stirling
DSDC is among the leaders on the design of environments for persons living with dementia. This resource offers a pool of evidence-based design guiding principles and resources on enhancements which can be made to layouts and features, in order to make a difference to the lives of persons living with dementia in various settings, including home, acute hospital setting, and long-term care home.
Resources from the National Disability Authority in Ireland
The National Disability Authority in Ireland has published resources which provide useful pointers and discussion points on designing dementia-inclusive environments.
Research for “Dementia and Home Design in Ireland Looking at New Build and Retro-Fit Homes From a Universal Design Approach: Key Findings and Recommendations Report 2015
This 2015 report was written as part of a collaborative research study that was developed to underpin the development of Ireland’s national Guidelines used to inform future design of dwelling for persons living with dementia, and to retrofit existing dwellings using a Universal Design approach.
Universal Design Guidelines Dementia Friendly Dwellings for People With Dementia, Their Families and Carers Centre for Excellence in Universal Design
These guidelines were developed in response to the collaborative research study detailed in the 2015 report above.
Person-Directed Dementia Care Assessment Tool
The Person-Directed Dementia Care Assessment Tool serves as a guide for care professionals to identify strengths and areas for improvement in various aspects of a dementia care facility. One of the important aspects this tool has recommended to consider is the environment of the facility.
This tool also allows care professionals to establish initial baseline on the environment of their care facilities, and re-assess and measure its changes over time, in order to identify new areas for improvement.
For good person-centred dementia care practices, the tool has recommended the following aspects to consider when designing the environment:
• Space configuration
• Colours and patterns
• Visual cues
• Personalization of individual space
Design Guide for Long Term Care Homes
Robert Wrublowsky, principal architect of MMP Architects, a Canadian architectural firm, has created an evidence-based design guide for long-term care settings. This guide is intended as a guiding framework for designers and stakeholder groups involved in long-term care to connect their respective research-based best practices with the existing research, and to establish relationships between the two groups.
Guidelines on Dementia-Friendly Environments
These resources by the Social Care Institute for Excellence (SCIE) in the United Kingdom, contain information on how the physical environments of various aspects in a care home can be designed to be more dementia-inclusive, such as:
• Kitchen and dining areas
• Toilets and bathrooms
• Assistive technology
• Noise levels
Six Principles of Dementia-Friendly Neighbourhood
The Agency for Integrated Care and Singapore University of Technology and Design have authored a document which outlines six guiding principles and features which are useful for designing dementia-friendly outdoor spaces and environments in Singapore. Good practices of dementia-friendly interventions are offered in this document for consideration as well.
Neighbourhoods for Life
Mitchell, Burton & Raman (2004) have created a checklist of recommendations to help housing associations/boards improve and design dementia-friendly outdoor environments. These recommendations are supported by findings of a three-year research project.
- Rapoport, A. (1990). The meaning of the built environment: A nonverbal communication approach. University of Arizona Press
- Chaudhury, H., & Cooke, H. (2014). Design matters in dementia care: The role of the physical environment in dementia care settings. In M. Downs & B. Bowers (Eds.), Excellence in dementia care: Research into practice (pp. 144-158). Open University Press.
- Agency for Integrated Care. (2021). Looking into the future (second edition): Inclusive design for people living with dementia. https://www.aic.sg/resources/Documents/Brochures/Mental%20Health/Looking%20to%20the%20Future.pdf
- Nanyang Polytechnic, & Alzheimer’s Disease Association. (2019). Elderly- and dementia-inclusive environment. https://www.aic.sg/resources/Documents/Brochures/Mental%20Health/AIC%20NYP%20Guidebook%20Eng.pdf
- Yuen, B., Bhuyan, M. R., Močnik, Š., & Yap, W. (2020). Six principles of dementia-friendly neighbourhood. https://www.aic.sg/resources/Documents/Brochures/Mental%20Health/SUTL%20Dementia%20Friendly%20Guidelines.pdf
- Chaudhury, H., Hung, L., & Badger, M. (2013). The Role of Physical Environment in Supporting Person-centered Dining in Long-Term Care. American Journal of Alzheimer’s Disease & Other Dementias, 28(5), 491–500. doi: 10.1177/1533317513488923