Presentation
HE3 - A Framework for Designing Spatial Orientation Tools to Enhance the Experiences of Persons Living With Dementia
SessionPoster Session 2
DescriptionBackground:
According to the World Health Organization, as of 2023 over 50 million people worldwide are currently affected by dementia, a number expected to rise, making dementia the seventh leading cause of death globally. As dementia progresses, people may experience a range of cognitive and functional impairments, including memory loss, reduced judgment, and deficits in spatial orientation and wayfinding. These challenges play a role in the well being and quality of life (QoL) of those living with dementia.
A primary challenge for people living with dementia is adapting to new environments, such as care homes, due to unfamiliarity and spatial disorientation which can, in turn, affect their QoL. Spatial disorientation involves challenges with perceiving one’s immediate surroundings, awareness of the environment, or being unsure of one's location. This phenomenon can be exacerbated in unfamiliar environments. While wayfinding is an essential aspect of spatial orientation, it refers to an individual’s ability to navigate and solve spatial problems when memory fails to provide solutions.
Wayfinding requires well-functioning skills such as goal selection, route planning, execution, and strategy application, which are often impaired in people living with dementia. Common wayfinding difficulties include remembering routes, focusing on tasks, distinguishing relevant information, processing locational data, and perceiving depth. Both spatial disorientation and difficulties in wayfinding can lead to misinterpreting objects and directions and feeling or getting lost. This state, in turn, diminishes peoples' ability to perform daily activities, and may lead to behaviors such as walking about (wandering), feelings of insecurity, and/or a reduced sense of well-being, identity, and autonomy. Emotional responses to getting lost may include distress, anxiety, confusion, frustration, irritability, fear, and panic, which can further diminish independence and social interaction leading them to avoid certain areas. These negative feelings can reduce wayfinding performance and lead to decreased participation in daily activities and social interactions. Addressing these difficulties is vital for maintaining autonomy and QoL in care environments for individuals with dementia such as long-term care environments, nursing homes, respite homes and retirement homes.
This presentation covers phase one of a case study examining the design of an existing Respite House in Ontario, Canada, where a scoping literature review was conducted to synthesize design considerations relevant to orientation, wayfinding and dementia into a comprehensive framework – Design Considerations in Wayfinding and Orientation Design for Persons Living with Dementia. The development of this framework was intended to guide design teams in assessing ‘orientation and wayfinding design’ in the built environment, to ensure that all significant factors are considered when creating care spaces for people living with dementia. By providing a structured approach, the framework aims to address the wayfinding difficulties and other challenges that impact the autonomy and QoL of individuals living with dementia, and to support the growing demand for innovative design solutions in the built environment (and beyond).
Methods:
This study uses a qualitative approach in the scoping review to better understand the unique context of care homes. The review aims to create a framework as a result to support the design of facilities to support the orientation and wayfinding for people living with dementia. This review included 40 peer-reviewed research papers, 2 books, 7 conference papers and 2 posters, and 22 gray literatures from Canadian governmental and Alzheimer’s Society of Canada’s websites and handouts, dated between 2008 to 2023 that discuss design methods and considerations for designing wayfinding and spatial orientation for individuals living with dementia. The inclusion criteria for these sources required the papers to be in English and to contain at least a combination of two of the following terms in the title, abstract, or keywords: “respite house”; “older adults”; “aged people”; “dementia”; “dementia-friendly”; “design”; “interior design”; “architecture”; “design intervention”; “wayfinding”; “cognitive”; “wandering”, “orientation”; “orientation cues”; “spatial disorientation”; “landmarks”; “behaviors”; “long-term care”; “nursing homes”; “assisted living”; “design elements”; “built environment”; “physical environment”; “nature”; “outdoor”; “environment(al)”; “quality of life”; “ multisensory environment”; “sensory”; “visual barriers”. With these search terms, papers were excluded that were not written in English, irrelevant information, high technology-based research, research focused on individuals with advanced dementia, and medical-related (pharmaceutical) interventions for dementia.
Results and Discussion:
The investigation of various documents revealed that designing care homes for people living with dementia is challenging due to the many factors. These factors can be categorized into four main categories, each with its own subcategories: Proximal Factors, Building Codes, Design Principles and Approaches, and Environmental Factors.
1. Proximal Factors: This category addresses the reasons why people living with dementia may Walk about (wander), such as feeling too hot or too cold, boredom, feeling lonely, hungry, feeling lost or anxious. Designers should study these factors before planning a care home to understand the factors/ changes experienced by residents. It includes two subcategories: the personal needs (physiological and psychological) of individuals with dementia, and the environmental factors (social and physical) that may trigger walking about.
2. Building Codes/ Accessibility Guidelines: This category emphasizes the importance of considering accessibility requirements and guidelines relevant at the municipal, provincial, and national level, depending on the care home's location and objectives for advancing accessibility.
3. Design Principles and Approaches: This category outlines various design approaches, including the Zeisel approach and Fleming and Bennett’s design considerations for care homes with respect to design considerations for dementia. Together, they outline 14 design principles aimed at enhancing the QoL for people living with dementia.
4. Environmental Factors: This category provides a detailed examination of environmental design elements that should be considered in wayfinding and orientation design for individuals with dementia. Due to the breadth, these factors were further subdivided into three subcategories: ambient environment, interior and architectural design, and sensory-enriched design. The ambient environment contains factors, such as light, outdoor access, soundscape, temperature, clutter and crowding. The interior and architectural design factors focus on more intentional design elements, such as signage, colour coding and contrast, flooring, landmarks, visual barriers, building arrangement and floor plan layout. Lastly, the sensory-enriched design category looks at specific sensory details (considering age-related sensory changes), which in some cases combine aspects of both the interior/ architectural design with the ambient environment to create environments that engage the five senses of a people living with dementia.
These categories and subcategories should be viewed as interconnected and considered through a strategic ‘systems lens’ to create an environment that promotes independence and improves the well-being and QoL for people living with dementia.
Conclusion:
Designing appropriate wayfinding and orientation in care homes for people living with dementia can be challenging yet is crucial for their well-being. The scoping review presented resulted in a framework which serves as a guide for design teams to create environments that encourage independence and enhance QoL for people living with dementia. It can be used to inform renovation projects, new builds or post-occupancy assessments as a checklist to select, prioritize, and evaluate design elements to support wayfinding and orientation.
According to the World Health Organization, as of 2023 over 50 million people worldwide are currently affected by dementia, a number expected to rise, making dementia the seventh leading cause of death globally. As dementia progresses, people may experience a range of cognitive and functional impairments, including memory loss, reduced judgment, and deficits in spatial orientation and wayfinding. These challenges play a role in the well being and quality of life (QoL) of those living with dementia.
A primary challenge for people living with dementia is adapting to new environments, such as care homes, due to unfamiliarity and spatial disorientation which can, in turn, affect their QoL. Spatial disorientation involves challenges with perceiving one’s immediate surroundings, awareness of the environment, or being unsure of one's location. This phenomenon can be exacerbated in unfamiliar environments. While wayfinding is an essential aspect of spatial orientation, it refers to an individual’s ability to navigate and solve spatial problems when memory fails to provide solutions.
Wayfinding requires well-functioning skills such as goal selection, route planning, execution, and strategy application, which are often impaired in people living with dementia. Common wayfinding difficulties include remembering routes, focusing on tasks, distinguishing relevant information, processing locational data, and perceiving depth. Both spatial disorientation and difficulties in wayfinding can lead to misinterpreting objects and directions and feeling or getting lost. This state, in turn, diminishes peoples' ability to perform daily activities, and may lead to behaviors such as walking about (wandering), feelings of insecurity, and/or a reduced sense of well-being, identity, and autonomy. Emotional responses to getting lost may include distress, anxiety, confusion, frustration, irritability, fear, and panic, which can further diminish independence and social interaction leading them to avoid certain areas. These negative feelings can reduce wayfinding performance and lead to decreased participation in daily activities and social interactions. Addressing these difficulties is vital for maintaining autonomy and QoL in care environments for individuals with dementia such as long-term care environments, nursing homes, respite homes and retirement homes.
This presentation covers phase one of a case study examining the design of an existing Respite House in Ontario, Canada, where a scoping literature review was conducted to synthesize design considerations relevant to orientation, wayfinding and dementia into a comprehensive framework – Design Considerations in Wayfinding and Orientation Design for Persons Living with Dementia. The development of this framework was intended to guide design teams in assessing ‘orientation and wayfinding design’ in the built environment, to ensure that all significant factors are considered when creating care spaces for people living with dementia. By providing a structured approach, the framework aims to address the wayfinding difficulties and other challenges that impact the autonomy and QoL of individuals living with dementia, and to support the growing demand for innovative design solutions in the built environment (and beyond).
Methods:
This study uses a qualitative approach in the scoping review to better understand the unique context of care homes. The review aims to create a framework as a result to support the design of facilities to support the orientation and wayfinding for people living with dementia. This review included 40 peer-reviewed research papers, 2 books, 7 conference papers and 2 posters, and 22 gray literatures from Canadian governmental and Alzheimer’s Society of Canada’s websites and handouts, dated between 2008 to 2023 that discuss design methods and considerations for designing wayfinding and spatial orientation for individuals living with dementia. The inclusion criteria for these sources required the papers to be in English and to contain at least a combination of two of the following terms in the title, abstract, or keywords: “respite house”; “older adults”; “aged people”; “dementia”; “dementia-friendly”; “design”; “interior design”; “architecture”; “design intervention”; “wayfinding”; “cognitive”; “wandering”, “orientation”; “orientation cues”; “spatial disorientation”; “landmarks”; “behaviors”; “long-term care”; “nursing homes”; “assisted living”; “design elements”; “built environment”; “physical environment”; “nature”; “outdoor”; “environment(al)”; “quality of life”; “ multisensory environment”; “sensory”; “visual barriers”. With these search terms, papers were excluded that were not written in English, irrelevant information, high technology-based research, research focused on individuals with advanced dementia, and medical-related (pharmaceutical) interventions for dementia.
Results and Discussion:
The investigation of various documents revealed that designing care homes for people living with dementia is challenging due to the many factors. These factors can be categorized into four main categories, each with its own subcategories: Proximal Factors, Building Codes, Design Principles and Approaches, and Environmental Factors.
1. Proximal Factors: This category addresses the reasons why people living with dementia may Walk about (wander), such as feeling too hot or too cold, boredom, feeling lonely, hungry, feeling lost or anxious. Designers should study these factors before planning a care home to understand the factors/ changes experienced by residents. It includes two subcategories: the personal needs (physiological and psychological) of individuals with dementia, and the environmental factors (social and physical) that may trigger walking about.
2. Building Codes/ Accessibility Guidelines: This category emphasizes the importance of considering accessibility requirements and guidelines relevant at the municipal, provincial, and national level, depending on the care home's location and objectives for advancing accessibility.
3. Design Principles and Approaches: This category outlines various design approaches, including the Zeisel approach and Fleming and Bennett’s design considerations for care homes with respect to design considerations for dementia. Together, they outline 14 design principles aimed at enhancing the QoL for people living with dementia.
4. Environmental Factors: This category provides a detailed examination of environmental design elements that should be considered in wayfinding and orientation design for individuals with dementia. Due to the breadth, these factors were further subdivided into three subcategories: ambient environment, interior and architectural design, and sensory-enriched design. The ambient environment contains factors, such as light, outdoor access, soundscape, temperature, clutter and crowding. The interior and architectural design factors focus on more intentional design elements, such as signage, colour coding and contrast, flooring, landmarks, visual barriers, building arrangement and floor plan layout. Lastly, the sensory-enriched design category looks at specific sensory details (considering age-related sensory changes), which in some cases combine aspects of both the interior/ architectural design with the ambient environment to create environments that engage the five senses of a people living with dementia.
These categories and subcategories should be viewed as interconnected and considered through a strategic ‘systems lens’ to create an environment that promotes independence and improves the well-being and QoL for people living with dementia.
Conclusion:
Designing appropriate wayfinding and orientation in care homes for people living with dementia can be challenging yet is crucial for their well-being. The scoping review presented resulted in a framework which serves as a guide for design teams to create environments that encourage independence and enhance QoL for people living with dementia. It can be used to inform renovation projects, new builds or post-occupancy assessments as a checklist to select, prioritize, and evaluate design elements to support wayfinding and orientation.
Event Type
Poster Presentation
TimeTuesday, April 14:45pm - 6:15pm EDT
LocationFrontenac Foyer