Dementia Care

Vol 5 No 3 June/July 2016

Australian Journal of Dementia Care

he relationship between the built

environment and dementia care

seems explicit enough to the casual

observer. Architects design new

institutional care facilities (or co-ordinate

the modification of existing ones) in a

process governed by design codes and

yield targets. Architecture’s influence

beyond the institution is scarcely

acknowledged, let alone the prospects of

urban design; indeed, expert designers

seldom attend to the homes of people

with dementia, or to the surrounding

streets. Enablement devices within the

private dwellings of older people remain

limited to the grab rail, and our

neighbourhoods are effectively devoid of

dementia-specific strategies.

The environment and well-being

But this accepted and plainly narrow

concept of the role of architecture and

urban design in dementia care

underestimates the power of our

environment in shaping our health and

well-being, and the potential for

architecture to positively influence this

environment.

In recent times, neuroscientists,

cognitive psychologists and public health

researchers have begun to measure the

effect of our surroundings on our bodies

and minds, confirming something long

known; that a connection to nature and

to community significantly improves our

physical and mental well-being (Ellard

2015; Williams 2016).

Specifically in dementia research,

social interaction and physical activity

has been linked to decreasing rates of

cognitive decline in people with

dementia (Wang

et al

2002; Zunzunegui

2003; Weuve

et al

2004). The public

realm – the world beyond our private

dwelling space – is, for many people, a

primary source of both social interaction

and physical activity.

A growing number of people living

with moderate or severe dementia are,

fortunately, able to live in dementia-

specific care homes that facilitate

residents’ social and physical

stimulation. However, an even

greater number of people with

milder forms of cognitive

difficulty are living in

private dwellings. This

cohort, living with mild

cognitive impairment

(MCI) or prodromal

(mild) dementia, may

experience symptoms

but remain

undiagnosed for an

average of three years

prior to accessing

dementia support

services and/or receiving

a definite medical diagnosis

(Phillips

et al

2011; Speechly

et al

2008).

Overcoming barriers

People with MCI or

prodromal dementia –

particularly those living in

private dwellings – must

confront many physical

and psychological barriers

when venturing out into

the public realm. Whether

based on a real or perceived risk, the

fear of getting lost or having a fall can

be a significant deterrent when

contemplating a journey to the

shop or the local park.

Given the empirical link

between well-being and our

connection to nature and

community, it follows that

overcoming barriers to

engagement with the public

realm is critical to

maintaining the quality of

life for people with dementia

who live in private

dwellings. It was this

realisation that led me to

reconsider the role of

architecture and urban

The adventures of Gladys in

(an augmented) wonderland

Jil Raleigh

’s innovative design project uses a hypothetical scenario, featuring Gladys and her PRO-d

glasses, to explore the potential of wearable ‘smart’ devices and augmented reality to empower and

enable people with dementia to more easily access and navigate public space

This image, created by the author, depicts Gladys’ view of her neighbourhood, as ‘seen’

through the PRO-d glasses, with potential hazards and objects of interest (such as the

flower bed) emphasised

Gladys, PRO-d user, says:

“Since I started using the

glasses, it’s gotten a lot

easier to get out and about.

I’m much less worried about

losing my way now and

things are easier to understand than

before because of all the little

augmentations.”