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The Relationship Between Alzheimer's Disease & Design
By Betsy Brawley, ASID, IIDA

Like any other segment of our population, older adults have varying degrees of ability. I know of many 90-year olds who are blessed with vigor and intelligence, but there are more and more 65-year olds who have Parkinson's or Alzheimer's Disease and need daily care. And, as all people age, they become more dependent on the environment to compensate for increased frailty and sensory loss.

Understanding the relationship between Alzheimer's Disease and environmental design means understanding that thoughtfully designed environments are potentially valuable therapeutic resources. How a building looks and functions should be determined by the needs of the residents and the therapeutic activity programs that help to support their remaining abilities. I believe that many of the behaviors attributed to Alzheimer's Disease may be a consequence of counter-therapeutic settings.

Increasing frailty can make it difficult, if not dangerous, for many older individuals to move from one place to another, but most people with Alzheimer's disease remain physically healthy well into the course of the disease. Our image of immobilized, confined, and isolated patients must be replaced in Alzheimer special care settings with one that nurtures physical, social, and creative activity, not merely passive, aesthetic experiences.

It makes sense that the more responsive the environment is to the needs of older residents, the more likely it is that the environment itself will adequately serve people who are cognitively impaired. As Alzheimer's steals their memories, their judgement, and their ability to reason, these individuals need more and more care to perform the most basic activities of daily life and to prevent harm.

This population as a whole tends to be more vulnerable to the weaknesses of poorly designed facilities. By addressing the needs for improved lighting, shortened walking distances, good seating, and access to safe and stimulating outdoor spaces, it is more likely that the environment will also serve those who are cognitively impaired.

Finally, I believe that there is great value in recognizing the residential qualities of environments for people with dementia. The environment conveys many messages and the positive characteristics that remind us of home can prove quite therapeutic.

Those of us who are designing special care settings for people with Alzheimer's disease or dementia should also remember that the cognitively impaired increasingly rely on the sensory environment for their information. Having glare and noise in the environment is aggravating and significantly affects their comfort levels. As our sight fades, there is increased reliance on our other senses to interpret information about the environment.

By designing caring, intimate, and enriching spaces to meet special needs, we may just find that we are designing settings that open doors to family and friends, nurture friendships for the lonely, and encourage opportunities for older people to feel useful. These are therapeutic and healing experiences that encourage activity, companionship, and the enjoyment of life. They are powerful design statements that show that we care.

Betsy Brawley is president of Design Concepts Unlimited in Sausalito, California. She is author of the book, Designing for Alzheimer's Disease: Strategies for Creating Better Care Environments.