Design for Dementia

As a complement to the Center for Architecture’s “Booming Boroughs: Redesigning Aging-in-Place in NYC” exhibition, several experts presented ideas about designing for and living with people with dementia. While the exhibition explored fresh ways to design for SMLXL situations in NYC, the Living with Dementia – At Home and in Urban Communities: Opportunities and Challenges program on 01.28.14 focused on the science and the social issues that surround a particularly challenging nuance of “aging-in-place.” (Read a re-cap of the exhibition here.)

Matt Kudish, senior vice president of caregiver services at the Alzheimer’s Association NYC Chapter, gave the audience a solid background of both the medical causes of the disease and its social effects. There are myriad manifestations of the disease, he told us – Alzheimer’s is just one form of dementia. This umbrella condition describes nerve-cell death caused by plaque and tangles. As the disease moves from the hippocampus to other parts of the brain, the organ disintegrates, triggering memory loss, mood swings, and eventually physical impairments. There is no cure, and the disease is actually fatal: the heart and lungs fail when dementia attacks parts of brain that control these organ functions. Though grim, these facts highlighted misconceptions about a process that is all too common; better understanding the disease can lead to better design.

Kudish then offered nuggets of positive ways for caregivers to deal with patients. He emphasized that a person with dementia is exactly that: one person with the disease. This point resonated with an underlying theme of the exhibition: we cannot relegate an aging population to limited care, or isolate that demographic. Designs for aging-in-place can allow for moments of personalization that celebrate an individual. For example, kitchens – notorious danger zones – could be designed more safely so that a person who loves to cook could still participate.

As Kudish pointed out, choice matters: a person with dementia may not be able to tell a caregiver what she wants to eat, but she could pick between two things. This echoed the exhibition’s larger context that how we age must include options. Another pillar of Kudish’s presentation that struck a chord was that aging affects us all: soon, one in five people in NYC will have dementia or care for someone who does.

The presentation shifted to untangling design solutions that could ameliorate living situations for those aging with dementia. Again, in harmony with the exhibition, Dr. Lorraine G. Hiatt from the Planning, Research and Design for Aging, NYC, and her research partner Dr. Richard Olsen, research professor at the New Jersey Institute of Technology, stressed that good design is good for all of us. Safer bathrooms, easier entryways, and smart technology could be put in place for people with dementia now, for those who will age-in-place and perhaps develop the disease, and for future inhabitants. Fittingly, Hiatt framed this discussion by using “we and us.” By placing both herself and the audience within a universal context, the idea that design solutions will benefit everyone came full circle.

Hiatt and Olsen’s ground-breaking research has brought to light the many changes needed to accommodate this necessary design shift. As Hiatt put it, the physical environment doesn’t know its inhabitant has a disease. So, it is up to architects to imagine flexible spaces that are both nourishing and safe as people get older and live longer. This is especially challenging in this city: as we learned from the exhibition, half of residents here live in walk-ups with no elevators; stoops are unforgiving for people whose balance and coordination have eroded; and kitchens and bathrooms are ripe for accidents. Because Alzheimer’s affects abstract reasoning, typical methods of way-finding – color-coding doors, for example – simply aren’t effective. Thus, the presenters argued, it’s imperative to find creative ways that building types can accommodate those who age – as well as those who age with dementia.

Moving beyond the scope of the exhibition, Hiatt pointed out that the home is just a start; libraries and places of worship could be designed not just for sleeker technical appeal, but also as places for the elderly community. She bemoaned the recent action taken by local McDonald’s – an unexpected haven for socializing – where seniors were kicked out after overstaying the draconian 30-minute limit. She pointed to a counterexample in the Netherlands, where a more mixed community could offer lessons: a residence for people with dementia coexists with the next-door neighborhood theater troupe.

Olsen enumerated the ways in which the physical environment is not neutral, and offered design solutions. He explained that the environment is actually intertwined with caregivers. Small apartments, the norm in NYC, are easier to monitor, so way-finding isn’t a design challenge. However, these spaces can be claustrophobic for 24/7 caregivers. Lofts, another typical NYC environment, are unexpectedly fluid: caregivers can monitor their charges with ease, multi-tasking to cut back on patient “shadowing.” I hadn’t considered that the chaotic urban environment outside the home might be positive, but Olsen, while acknowledging that public transportation can be overwhelming, reminded us of the rich opportunities for stimulation and recreation that can help deter the disease. Also, urbanites are more tolerant of erratic behavior that comes through as dementia progresses, he pointed out humorously.

As the three experts mentioned, familiar activities can bring pleasure; this certainly reversed my assumption that we should merely deal with the disease by reacting to negative behaviors that the disease triggers. These exercises don’t have to be framed as “for a person’s memory,” but rather just for enjoyment. The same goes for design: instead of wrangling with it, and over-designing for an isolated demographic, let’s accept that dementia will touch most of us in different ways and design effectively and plan accordingly. Solutions can be implemented for us, not just for them. As both the presentation and the corresponding exhibition emphasized, we all age, and we can do so gracefully.

Claire Webb studied astronomy and philosophy at Vassar College, but an interest in art history and architecture led her to the position of Marketing Director at Edelman Sultan Knox Wood / Architects.

Event: Living with Dementia – At Home and in Urban Communities: Opportunities and Challenges
Location: Center for Architecture, 01.28.14
Speakers: Lorraine G. Hiatt, Ph.D., Environmental Gerontologist, Planning, Research and Design for Aging, NYC; Matt Kudish, LMSW, Sr. Vice President of Caregiver Services, Alzheimer’s Association, NYC Chapter; Richard Olsen, Ph.D., Research Professor, New Jersey Institute of Technology, and author, A Home for Life; and Eric Cohen, AIA, Sr. Associate Principal, Ethelind Coblin Architect; Faculty, New York School of Interior Design (moderator)
Organizers: AIANY Design for Aging Committee and the Center for Architecture