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Dementia-friendly design How to design the physical indoor environment at home for people with dementia ir. Joost van Hoof Eur Ing dr. Helianthe S.M. Kort Research Centre for Innovation in Health Care Faculty of Health Care Hogeschool Utrecht University of Applied Sciences IFA 10th Global Conference Wednesday 5 May 2010, Melbourne, Australia

Dementia-friendly design - International Federation … · Dementia-friendly design How to design the physical indoor environment at home for people with dementia ir. Joost van Hoof

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Dementia-friendly design How to design the physical indoor environment

at home for people with dementia

ir. Joost van Hoof Eur Ing

dr. Helianthe S.M. Kort Research Centre for Innovation in Health Care

Faculty of Health Care

Hogeschool Utrecht University of Applied Sciences

IFA 10th Global Conference

Wednesday 5 May 2010, Melbourne, Australia

Contents

Introduction

Indoor environment

Thermal comfort

Solutions

Thermostats

Light

Solutions

Attention for colour temperature

Final thoughts

2

Introduction

Dementia: “the loss of cognitive function of sufficient severity to

interfere with social or occupational functioning.”

PWD live at home. NL 65%; USA 70%; UK 63.5%; Italy 80%; Japan

85%; all developed nations 73%

(Rabins, 1998; Valla & Harrington, 1998; Health Council of the Netherlands, 2002;

Wimo et al., 2007, Martin et al., 2007)

NL: 1 / 3 older persons with severe physical limitations (100,000

persons) does not live in a suitable dwelling. Dementia more

challenging.

The home (environment) may hinder PWD in their daily functioning

How to design a dementia-friendly home? 3

4

Indoor environment

The physical indoor environment comprises the

thermal environment, the indoor air quality,

lighting, and the acoustic environment.

It constitutes all that the individual hears, sees,

feels, and smells.

Today focus on thermal comfort and lighting

5

Thermal comfort 1

Thermal comfort is a state of mind, which

expresses satisfaction with the indoor climate or

one of its parameters.

Definition difficult to apply as PWD have

unknown ‘state of mind’

Thermophysiological definition = minimum rate of

nervous signals from heat proprioceptors in skin

and hypothalamus (Mayer, 1993).

Atrophy of brain tissue: other perception of indoor

climate

6

Thermal comfort 2

PWD may lack ability to express themselves reliably other

than by expressing (dis)satisfaction via certain behaviours

Warner (2000): carers’ views of a comfortable room

temperature may not be the same

Steinfeld on his father with dementia (2002): Father’s

“ability to sense thermal comfort seemed to deteriorate.

There were many days when I would arrive to find the

heat well near 32°C or more. In the summer, the opposite

occurred with the air-conditioning.”

7

Thermal comfort 3

Consequence of warm discomfort Undressing

= exhibitionist behaviour / sexual disinhibition

actually just thermal dissatisfaction

Patient files…

Consequence of cold discomfort Put on

additional or inappropriate clothing

even cross-dressing reported in the literature

8

Solutions 1

Warner (2000): when bathroom is too cold, one

knows it is uncomfortable. No link between

temperature and comfort. Frustration, anger,

PWD wanting to flee.

No electrical heaters, but IR heat lamps in

ceiling

Radiators blocked and covered. Pipes

insulated

Floor heating, low-temperature

9

Solutions 2

Do not leave windows/balcony doors open

Risk of escaping. Crawling through windows

(especially in high-rise building)

Position of HVAC-outlets. Moving curtains,

papers. Presence of someone else in room,

even ghosts and thieves. Suspicion

10

Dementia and thermostats

If cognition allows, thermostats give opportunity to

control temperature to a certain extent

Complexity of technology has consequences for using

thermostats and HVAC

Needs and abilities differ per individual: cognition,

apraxia, tremors, muscle strength, vision, language

(English)

Familiar technology may help

11

Dementia and thermostats

Galasko D. European Journal of Neurology

1998;5(suppl 4):S9-S17

12

Dementia and thermostats

If thermostats cause difficulty operating, covers can be

placed over the controls, disguised, or placed out of

sight.

System’s delay problematic when forgetful.

“Malfunctioning or broken”. People forget manipulation of

system’s interface

Overcompensation. Turning button all the way up.

Extreme temperatures indoors.

New secure thermostats with pre-set acceptable range.

14

Light has a positive influence on well-being

and health

visual

non-visual

Of importance for people with dementia

15

Ageing of the eye

Less blue light reaching retina: yellowing of eye

Different perception of colours

Effects on biological clock (SCN)

Retinal ganglion cells

Bluegreen light: melatonin suppression action spectrum

90% problem behaviours. Cause for institutionalisation

Great variation in sleep wake cycle. Even reversed!

Caused by damage to biological clock

16

Ageing of the eye

Lens transmittance

Rela

tive %

tra

nsm

itta

nce

Adapted from Brainard et al, 1994.

0

10

20

30

40

50

60

70

80

90

100

300 350 400 450 500 550 600

New Born

20-29 years

60-69 years

Wavelength (nm)

Values are expressed as a % of the 560 nm point for new born (max transmittance)

17

Light therapy

Table-mounted bright light applications

Requires (scarce!) ‘exposure’ staff

Fixation of subjects

A different solution please!

18

Ceiling-mounted luminaires

19

Ceiling-mounted luminaires

20

Ceiling-mounted luminaires

21

Ceiling-mounted luminaires

Ambient bright light

The Netherlands front-runner in research (van Someren et al., 1997; Riemersma-van der Lek et al., 2008; van Hoof et al., 2009ab)

Short and long-term effects:

1. Decrease of restless behaviour

2. Improved sleep

3. Delay in cognitive decline

4. Decreased feelings of depression

22

Ceiling-mounted luminaires

No harmful effects of light

No concerns for technological

applications in ceiling

Research based on intensity (illuminance

levels, E [lx])

Forbes et al. (2004): not sufficient

evidence, RCT

23

van Hoof et al. 2009

Incorporation of colour temperature

High intensity light (1200 lx) and high

CCT (6500 K) improves circadian

rhythmicity and restless behaviour,

compared to control of 2700 K

Low intensity light (500 lx vert; 2700

and 17,000 K tubes) no positive

effects.

Intensity remains important

Perhaps too much blue. Unnatural

ambiance Culturally-determined

preferences

24

Importance of colour temperature

Final thoughts

Odours, indoor air quality and sounds of importance

Integrated approach needed

Environmental interventions including home

modifications, task simplications, object modifications

and assistive technologies/devices

More research and implementation in practice

25

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Final thoughts

“We must be realistic. Alzheimer’s is a disease

of the mind, not of the home. The environment

is not a treatment, and it offers no cure. But

many problems related to the disease can be

lessened for the person with [Alzheimer’s

disease] and especially for the caregiver by

making changes in the home environment”

(Warner, 2000, pp.2-3).

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Questions and further reading

Contact:

Joost van Hoof / Helianthe Kort

e-mail: [email protected] [email protected]

van Hoof J, Kort HSM, et al. The indoor environment and the integrated building design of homes for older people with dementia. Building and Environment 2010;45(5):1244-1261

van Hoof J, Kort HSM, et al. Thermal comfort and integrated building design for older people with dementia. Building and Environment 2010;45(2):358-370

van Hoof J, et al. High colour temperature lighting for institutionalised older people with dementia. Building and Environment 2009;44(9):1959-1969

van Hoof J, Kort HSM. Supportive living environments: a first concept of a dwelling designed for older adults with dementia. Dementia 2009;8(2):293-316

van Hoof J, et al. Ambient bright light in dementia: Effects on behaviour and circadian rhythmicity. Building and Environment 2009;44(1):146-155

van Hoof J., Kort HSM, et al. Environmental interventions and the design of homes for older adults with dementia: an overview. American Journal of Alzheimer’s Disease and Other Dementias 2010;25 doi: 10.1177/1533317509358885