The key design issues are colour, fixtures and fittings, furniture and furnishings, and surfaces. Good design around all these can help people with dementia and make work easier and more satisfying for staff.
Changes you can make now
- Measure lighting levels and look at ways to gain the recommended minimum of 50 footcandles or more.
- Cover shiny table surfaces and reduce glare using tablecloths in contrasting colour to the floor.
- Hide exits by continuing décor such as paint colour, wallpaper or fabric across doorways.
- Change doorknobs to C-shaped handles for easy opening.
- Buy bright cushions to add colour in bedrooms and lounge rooms.
- Repaint walls to contrast with floor colour, furniture and furnishings.
- Buy a home-like sideboard for the dining area.
- Set up a glass cabinet where people can see their favourite teapots and other personal items linked to mealtimes.
- Use home-like pull curtains.
- Hang interactive art along often travelled routes with seating nearby for walkers to stop and rest.
- Reduce noise in living areas by using acoustic ceiling tiles and sound-absorbing carpet and fabrics.
- Put in a system of indirect, non-glare lighting, with a mix of overhead and task lighting, avoiding wall-mounted fluorescent lights over beds.
- Increase natural light using skylights, clerestories and light shelves.
- Put in high performance carpet that helps create a home-like environment, gives warmth and has heavy-use and anti-microbial features.
Colour affects people physically and emotionally. It can promote sociable times, encourage eating and help people find their way around. It contributes enormously to an interesting and inspiring environment. Many dementia-friendly colour schemes are possible. They should reflect people’s religious and spiritual needs and cultural and socio-economic backgrounds. Where there can be personalisation, colour should reflect personal wishes.
Ageing leads to weakened vision, mainly due to changes in the eye lens, and people with dementia often have vision problems linked to dementia. These include impaired depth perception, spatial disorientation, altered colour perception and reduced ability to perceive contrasts.
Like many older people, people with dementia may have cataracts, macular degeneration, diabetes retinopathy, colour-blindness (particularly in men) and glaucoma. Blurred vision and loss of central and peripheral vision are the most serious effects of such impairments.
Tips for colour selection
- Colour awakens emotional responses related to past experiences and cultural background.
- Colour can be used to increase and reduce visibility.
- Colour contrast and good lighting help people’s navigation, orientation, mobility, independence and involvement.
- Too many colours together can be distracting.
- Older people are best able to discriminate strong colours at the warm end of the spectrum.
- Colours with a high degree of brightness, such as yellow, are highly visible.
- Colours such as peach, coral and soft apricot tones flatter skin tones and add warmth to any setting.
- Pastel blues and lavenders are hard for older people to see and often look grey.
- People with colour vision issues are less sensitive to colours on either end of the colour spectrum. Reds and blues will look darker.
- As colour preferences are personal, giving people the chance to personalise private spaces is important.
Effective colour contrasts
Older people need about three times as much contrast as younger people to find objects. Choose colours of major contrast.
Combine light colours from the middle of the spectrum, for example yellow or green, with dark colours from either end of the spectrum, for example red or blue, to produce the most effective contrasts. Do not combine dark green against bright red, yellow against white, blue against green, or lavender against pink.
Camouflaging with colour
Colour can be used to make objects more visible, or it can hide or camouflage them. Choosing background colours similar to the colour of objects in the foreground can make objects invisible to a person with dementia.
Wanting to leave
Colour and lighting
Lighting helps effective colour contrast. The amount of natural daylight should affect choice of colours as colour is visibly changed by different light sources. Carpet, wall colour, fabrics, furniture and accessories look much brighter in direct daylight than under artificial light. Test your colour choices in day and evening light where they are to be used.
Colour rendering means how true colours look under a given light source. How colour looks under daylight is seen as true and accurate. Light sources are compared to daylight through a Colour Rendering Index.
Colour action tool
Colour and wayfinding
Use of colour in wayfinding is most important. Using colour and creating colour contrasts helps people to move about more confidently, reducing confusion and agitation.
Fixtures and fittings
Fixtures and fittings such as grab rails, taps and toilets give valuable wayfinding and informative cues to people with dementia. When choosing fittings and fixtures, focus on what is familiar and easy to use. What is familiar to one person may not be to another: familiarity relates to a person’s life history and to cultural and socioeconomic background.
Choose fixtures and fittings that:
- look familiar
- belong in a domestic setting
- are comfortable to use
- are safe
- are colour-contrasted against background surfaces
- suit people with reduced manual agility.
Fixtures and fittings are sometimes used for unintended purposes. A towel rail can suddenly become a grab rail in an emergency and should be strong enough to take the weight of the person using it.
Handles are easier than doorknobs to use. When choosing handles for doors, cupboards and wardrobes remember C-shaped handles are easier to grasp, mainly for people with poor agility. Fixing handles at a 45-degree angle to the floor is best for people with serious reduced agility.
Oval-shaped handrails with a broad flat surface for arm support let people lean forward on their forearm as they move.
Picture rails make hanging paintings and objects easy, and reduce damage to walls. They are a common design feature in older Australian homes and are likely to be familiar to many people.
Fixtures and fittings are crucial to practical bathrooms. They should be easy to see and use, making bathing more comfortable for the person with dementia and less stressful for staff.
Bathrooms and bathing
Furniture and furnishings
Furniture and furnishings are perhaps what make an environment feel most like home. They should be colour contrasted against walls for easy visibility. Furniture should have rounded edges to reduce bumps and grazes and furnishings should reflect home-like warmth and personal wishes.
Furniture and wayfinding
Familiar furniture in expected places helps people orient themselves and find their way around. What is familiar depends on culture and background. For many people typical items of furniture in certain places are:
Lounge room: comfortable sofa and couch, easy-chairs, television, radio, coffee table, mantelpiece, clock
Dining room: dining table, upright chairs, sideboard for cutlery and crockery
Kitchen: food preparation area, stove, fridge, other white goods, cupboards
Bedroom: domestic-looking bed, bedside table, wardrobe, dressing table, book shelves
Study: desk, chair, bookshelves, computer, telephone
Hallway: chairs, hall table
Patio and sunroom: easy-chairs, table and chairs, plants.
Example - lounge room
The photo is of a lounge area with comfortable couches and chairs. The lounge area is zoned, so it provides a smaller space within a larger room. A large window with drapes provides natural light.
- Home-like furniture is arranged in a home-like way to create a smaller lounge area.
- Contrasting colours assist with recognition of furniture and table.
- The risk of falls is minimised by not having floor mats or small items of furniture.
- The mantel displays a few, easily recognised decorative items.
- Glare from the large window is controlled while still providing light, using the drapes.
- Upright chairs can be provided for people who have trouble getting in and out of lounge chairs unassisted.
Example - a pleasant corner
The photo is of a corner area inside a glass doorway that leads to an outdoor area. The seating provides a rest stop in a well-used thoroughfare. The corner area has a table and two sitting chairs. The area can be seen from outside and from the corridor. The chairs and table are convenient for a rest stop and for private conversations.
- The drapes can be moved to control glare and temperature.
- The furniture is placed to allow a view outside.
- The seating arrangement provides wayfinding cues.
- The small arrangement provides an intimate and restful space.
- Contrasting colours allow the furniture to stand out.
Placement of furniture, above all tables and chairs, can help promote sociability or eating or suggest a quiet and reflective spot. Place chairs and tables to promote the best possible conditions at mealtimes or during activities, or put a chair or two beside a window looking out onto a birdbath to support quiet contemplation.
Chairs must be chosen for comfort and familiarity, not just strength and serviceability. People with dementia may sit for long periods of time, so comfort and a sense of familiarity are crucial. Dining room chairs do not need to be as comfortable as lounge chairs. They need to be light enough to move back and forth, and stable enough not to tip backwards or sideways.
Tables made of wood or wood laminate are likely to be warm and familiar to people with dementia and feel home-like. For dining, square tables are usually best because they give each person a clearly defined eating area. Coffee tables should be made clearly visible by colour contrasting.
Eating, dining areas and kitchens
Although people may need specially designed beds, a domestic bed head creates a more home-like environment. People should be able to sit comfortably on the edge of the bed. The standard seating height of a bed is 600mm.
Always buy top-quality mattresses. They should:
- be firm and supportive
- reflect older people’s needs
- be fire retardant
- have a waterproof cover.
How bedroom wardrobes are arranged and colour contrasted helps with dressing and reducing inappropriate rummaging.
- Good lighting inside a wardrobe increases visibility.
- Partitioning wardrobes into two spaces helps staff and the person with dementia in dressing. Put the day’s outfit on one side to reduce confusion and promote independence.
- Colour contrast the wardrobe door you want the person to use. Paint the other door the same colour as the wall to deter rummaging, damage and loss.
- Use tension drapery rods to place clothing in order of use for dressing.
- Adjust rods to a height each person can easily reach.
Bedrooms: privacy and personalisation
Curtains and cushions
Fabric curtains can create a cosy atmosphere and help reduce noise. Use drapes that can be pulled across by hand rather than curtains using cords and pulleys or venetian blinds.
Cushions can create a home-like feel in bedrooms and living rooms and are an easy way for people to personalise their own spaces. They are a great way of having a splash of colour. Use cushion fabrics that bring out furniture colours and patterns and interior surfaces. Think about colours and fabrics of warmth and comfort.
Furniture and furnishings checklist
Of all design factors, lighting has the greatest impact on care. Everything relating to light has an effect. If people are to be independent for as long as possible they must be able to see properly. Effects of low environmental light levels include:
- worsened sundowning
- poor wayfinding
- more falls
- lower levels of ability to carry out daily activities, mainly for people seriously cognitively impaired
- disrupted circadian rhythm
- poor vitamin D synthesis
- poor calcium absorption.
Vitamin D and sun exposure
Natural light can improve physical wellbeing and should be a key feature in designing healthy buildings. The best lighting method brings natural light inside.
Architects and designers have ways to distribute light. They can:
- use many sources of daylight from different directions
- put large daylight sources out of sight
- use taller ceilings and higher window openings to let light go further into buildings
- use skylights, clerestories and light shelves to reduce glare.
Having more natural light can help reduce energy costs.
Environmentally sustainable design
Getting the right light balance
Suitable and sufficient lighting involves:
- raising light levels
- balancing natural and artificial light for even light levels
- getting rid of glare.
The right quality and quantity of light are needed for good lighting.
Decisions around lighting should include other ceiling features like ceiling fans, smoke detectors, sprinklers, air vents, skylights, heating ducts and cooling ducts.
Quality of lighting
Important factors for quality of lighting include:
- glare control
- flicker-free lighting
- uniform surrounding or general lighting
- directing certain light sources to certain visual tasks
- colour rendition, that is, accuracy of colours under light
- colour temperature or temperature of light source measured in degrees Kelvin
- balanced and filtered daylight.
Quantity of lighting
Designing lighting systems is complicated, for a new building or a renovation. Changing light bulbs and increasing light levels do not automatically improve lighting.
When thinking about the right quantity of light, ask:
- How efficient is the fixture?
- How much light is absorbed by room surfaces?
- What is the size and lay-out of the area?
In existing buildings, make sure lighting fixtures are clean. Covered with dust, they can absorb light and reduce the amount of light reflected.
Light levels: how to measure them
Surface finishes of walls and floors affect the warmth and feel of spaces. Good surfaces and suitable use of pattern and touch can help create a home-like environment.
Flooring materials are usually grouped as resilient (sheet vinyl, vinyl tile and rubber tile), hard surface and carpet. When choosing finishes, think about their long-term benefits and the impact of hard surfaces. Carpet and resilient flooring look better, are quieter, and are more home-like.
Where different flooring materials meet, use surfaces and colours similar in look to encourage movement from one area to another. For safety, make sure edges and steps are clearly defined.
Example - what to avoid
The photo shows an eating area with a timber floor. The floor is light natural timber in colour and has circles of lighter coloured timber inserted as a pattern. The circles of lighter timber are approximately 1.5 metres in diameter.
Circles may appear as piles of sand, pools of water or holes to people with dementia, and they may feel confused and discouraged from moving into an area with this kind of flooring.
Technical advances in infection control and stain-resistant carpet make carpet useful in most areas. High performance carpet is attractive and quiet, and creates a home-like environment. It has good grip for walking, a softer surface if there is a fall, reduced glare, and is wheelchair friendly.
High performance carpet is more cost effective long-term than hard surface floors. Well-made, properly fitted and properly kept carpet gives good performance for light and heavy use, and anti-microbial fibres reduce microbial build-up.
Resilient flooring has non-slip surfaces and non-reflective finishes good for wet areas. It is stain resistant, easily cleaned, and comes in many different thicknesses, colours and surface materials. Resilient flooring is easily used by people with mobility issues and is good for wheelchairs.
Wall and ceiling surfaces
Walls are the edges of a space and ceilings affect intimacy and interest in a room. Movable walls can be used flexibly to create quiet, private spaces with a sense of space and light. Creative use of ceiling surfaces changes the feel of a space and has a large effect on lighting.
Environmentally sustainable design
New residential facilities
Surfaces: strategies for floors, walls and ceilings
Research says ...
- People more easily know home-like furniture and furnishings.
- Fabric type, colour, pattern and style help people work out different areas in a facility.
- Placement of furniture affects how it is used.
- Furniture promoting independence and mobility promotes wellbeing.
- Furniture colour contrasted against walls and floors helps visibility and thus independence.