Impact of dementia care environments: exploring the perceived daily life experiences of people with dementia in their dementia care environments and their immediate outdoor settings

Abstract

“Priorities for action will vary and countries will need to tailor actions to their specific contexts, but improving the fit between older people and their environments is universally achievable.” (World Health Organisation, 2015) The human self is a construct of human interaction as developed through social experience and activity in a given environmental context (Mead, 1934). Human and context are in constant dialogue: social, psychological and physical, generating and preserving the sense of self. This sense of self ought to be preserved also in the face of cognitive decline, when the individual may require adaptations to her surroundings to make up for deficiencies brought on by the effects of the dementia. This thesis explores such adaptations in the immediate environment of the individual, and the impact these may have on her perceived wellbeing and quality of life.

The environment is presented primarily in the theoretical definition of home, and its experience and meaning to the individual with dementia. The thesis then focuses on the care environment, with particular interest on access to outdoor settings in dementia care environments. It responds to traditional care settings that are generally characterized by clinical, enclosed environments, with little to no relation to the outdoors, and heavily reliant on safety and security of the residents, through themes of spatial legibility, cultural appropriateness, fascination, user-centredness and personalization.

Recognition of non-pharmacological approaches such as the built environment in the treatment of dementia (Zeisel, 2012) coupled with the belief that each person is unique can cause the paradigm shift necessary for holistic person-centred care. The parallel literature review juxtaposing the subjectivity of dementia and the architectural microcosm builds the theoretical framework within which the fieldwork subsequently operates. The fieldwork seeks to investigate the architectural character of four dementia-care settings in four different countries, and the effect these have on the quality of life of the residents within. The complex methodology developed particularly for this study proposes a multi-level strategy that is particularly focused on the individual’s experience of her surroundings. Central to the study are dementia-related psychological, sociological and gerontological concepts, re-interpreted in an architectural discourse scenario.

The study is concluded with the proposal of five emergent themes from the results and analysis, that are deemed essential towards the design of dementia care environments that are responsive to the needs of their residents. The ultimate measure of success of such an approach is improved quality of life through custom-designed buildings that are user-specific. Furthermore, the dissemination of person-centred design values can act as catalysts of positive change in care policy and architectural education and practice respectively.

2024-06-29

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