Dementia-friendly architecture: Reducing Spatial Disorientation in Dementia Care Homes

Lead Research Organisation: Bournemouth University
Department Name: Faculty of Science and Technology

Abstract

Knowing where we are and how to get to places are fundamental features of successful everyday living. Although most of us rely automatically and unquestioningly on our wayfinding abilities, they are markedly impaired in people with Alzheimer's disease (AD), the most prevalent form of dementia. This project will identify the features of buildings that make them relatively harder or easier for people with AD to navigate. The knowledge gained will allow us to create dementia-friendly architectural guidelines for use in the design of residences for people with AD.

Many people with AD eventually move from their familiar home environments into unfamiliar care homes. Unfortunately, the dramatic reduction in wayfinding skills commonly seen at the onset of AD is particularly marked when it comes to learning unfamiliar environments. Thus, people with AD would have an easier transition to new residences if these larger - and often more institutional - environments were designed to be dementia-friendly in terms of wayfinding. A psychological understanding of orientation and navigation could play a major role here but, unfortunately, current design-guidelines are mainly based on custom and practice, not theory and research. This project aims to improve matters through a series of experiments on navigation in people with AD.

Our research is innovative in several ways: We will use Virtual Reality (VR) technology to simulate unfamiliar care home environments. VR lets us change environmental features and structures systematically, to monitor how these changes impact on learning to way-find over a period of several weeks. This would be impractical in real world settings. Additionally, by using state-of-the-art eye tracking technology to record gaze direction, we can pinpoint the types of cues people use to find their way through unfamiliar environments (www.spatial-cognition.org). Finally, our experiments will allow us not only to measure the way in which navigation abilities decline in people with AD, but also to identify the mechanisms underlying these declines.

Successful navigation depends on learning to recognise places by identifying and remembering landmarks, environmental cues that are unique to each location. We will investigate this process in more detail. Our experiments will examine how AD impacts on landmark selection by comparing the performance of people with AD and healthy adults of a similar age (age-matched controls). Our participants will learn routes through virtual residences that include multiple intersections. We will systematically vary the features present at the intersections to determine whether people with AD have particular difficulties when the same distractor cues are present at more than one intersection, and/or when uninformative cues are nevertheless particularly noticeable (salient).

Next, we will use VR to simulate what happens when people move into unfamiliar residences. Over several weeks, we will (a) teach people with AD and age-matched controls to navigate a number of different routes through the same environment, and (b) compare their ability to discover new routes through the same environment, based on knowledge of the routes they have just learned. VR allows for systematic comparisons of different floor plans, so we will be able to establish the kinds of architectural structure that either help or hinder wayfinding in people with AD.

A key output of the research will be a set of empirically validated design guidelines that support effective wayfinding in people with AD. Because these principles will be widely applicable, we will work with architects, building standards agencies and care commissioning bodies to ensure that they are used to develop national standards for residential care home design. Our research will thus help to increase or preserve the independence and well-being of people with AD, avoiding a further loss of autonomy, dignity and control that is, in theory, preventable.

Planned Impact

Who will benefit from this research?
-
The primary beneficiaries of this research are people with Alzheimer's Disease (AD) and other forms of dementia, and their families and carers. Currently 800,000 people in the UK, including 80% of care home residents, live with dementia. This figure, which is expected to double within 30 years as longevity is extended through improved medical care, is reflected throughout much of the developed world. In 2012, the Prime Minister launched a dementia challenge to improve dementia awareness, care quality, and research by 2015 (https://www.gov.uk/government/publications/prime-ministers-challenge-on-dementia/).

One of the earliest signs of AD is spatial disorientation. This has a devastating effect on independence, wellbeing, and quality of life. It is therefore crucial that the design of care homes is sensitive to the problems experienced by residents and, whenever possible, capitalises on their residual navigational abilities. Current guidelines for dementia-friendly design reflect awareness of these issues, but they rely on architectural custom and practice, or intuition, to guide construction and furnishing (e.g., http://dementia.stir.ac.uk/design/design-guides). Not surprisingly, the resulting solutions are not well integrated with the neuropsychological wayfinding theory on which our research builds, nor with empirical evidence of the kind that we will gather.

A central goal of our impact strategy is therefore to ensure that our research findings be disseminated effectively to potential users of research. Foremost amongst these are policy-makers at international, national and local levels and care commissioning bodies, who are in a position to influence dementia care through legislation or regulation. Likewise, the architects who design care homes, the care organisation managers who commission them (working either for companies and their shareholders, or public services), and the residential care providers who manage the staff teams that service them are important potential consumers of our research. Access to these groups will be facilitated through existing contacts of the Bournemouth University Dementia Institute (BUDI).

How will they benefit from this research?
-
The research can bring about improvements in the health and quality of life of people with dementia by informing design-principles for environments that promote independence, access to outside spaces thus reducing agitation and frustration through difficulties in navigating the physical spaces where they live. The families of people with dementia will benefit from the reassurance that their loved ones live in environments designed to meet their needs, ensure their safety, and protect their independence as far as possible. These benefits will come about because we will work with policy-makers, architects, and representatives of the care provision industry to ensure our guidelines are adopted in future design of care homes and, wherever possible, incorporated into the refurbishment of existing facilities.

BUDI (Bournemouth University Dementia Institute) has many contacts with stakeholder to whom our research will be of immediate interest. We would expect the successful completion of the project to coincide with further applied or translational research to evaluate the impact of our dementia-friendly guidelines to the design of residential facilities. For example, we would seek KTP funding with a major care provider and/or architectural studio to ensure that this work proceeds seamlessly. Wider adoption of our design principles would then follow, supported by further research and dissemination. The likely timescale for such implementation in the UK would be around 5 years from the start of the project. We would expect to then see widespread major changes in practice with corresponding benefits to people with AD living in care homes and their families within 5-10 years of the design implementation process.

Publications

10 25 50
 
Description Since the project is still ongoing, we haven't met all of our objectives yet.
So far, we have run a series of experiments exploring the role of attention in general, and visual attention in particular, on participants ability to learn novel routes. We have now also started experiments investigating the role of landmark placement and architectural structure on people's ability to learn novel environments.
Preliminary interesting findings highlight the importance of landmark objects for route learning. In particular, objects need to be salient and unique to make good landmarks. In both experiments we found that healthy ageing older participants performed worse than younger participants (i.e., they made more errors and needed more repetitions to learn the routes). However, preliminary analysis of attentional engagement and gaze behaviour during while learning the route did not reveal significant differences between young and old participants, suggesting that the control of attentional resources and visual attention do not contribute to age-related differences in spatial learning.
The next planned steps are: 1) finalise data collection for the last experiments; 2) publish results from the experiments in a series of papers.
Exploitation Route Key findings will be published in scientific journals. Based on our findings and under guidance of an advisory board with relevant stakeholders, we currently will develop improved design guidelines for dementia-friendly environments. A first draft of these has now been made available at: https://microsites.bournemouth.ac.uk/wayfinding/consultancy/ . Once the design guidelines have been finalised they will be widely disseminated using different media (online website, app for devices like phones or tablet PC's, printed as a handbook). The design guidelines are meant to be accessed by architects, interior designers, care home developers among others who are involved in planning and developing environments for older people and people with memory complaints.
Sectors Communities and Social Services/Policy,Construction,Environment,Healthcare

 
Description We set up a "Research to Impact Advisory Board" to guide the process of translating research findings into design guidelines that are applicable in real residential environments. The board first met in January 2017 and further meetings will be held every 6-9 months to learn about the progress of our research and, in collaboration with the researchers, advice on future work. Members will also be asked to advise on dissemination strategies. The Advisory Board brings together relevant key stakeholders (carers, care home managers and developers, architects and designers with a special interest in dementia, representatives of UK dementia charities and academics ) which will facilitate the process developing improved guidelines and their dissemination. The aim of the advisory board is to assist with the development of improved evidence based ageing- and dementia-friendly design guidelines for environments that minimise spatial disorientation. After several meetings with the advisory board, we have now made a first draft of our improved dementia friendly design guidelines to minimise spatial disorientation available at: https://microsites.bournemouth.ac.uk/wayfinding/consultancy/
First Year Of Impact 2017
Sector Communities and Social Services/Policy,Construction,Environment,Healthcare
Impact Types Societal

 
Description ARUK South Coast Network pump priming grants - Summer Studentship
Amount £2,177 (GBP)
Organisation Arthritis Research UK 
Sector Charity/Non Profit
Country United Kingdom
Start 06/2018 
End 09/2018
 
Description Internal funding for PhD project to work closely with ESRC project and top support dissemination of results
Amount £56,000 (GBP)
Organisation Bournemouth University 
Sector Academic/University
Country United Kingdom
Start 01/2016 
End 12/2020
 
Description Research Assistant to support dissemination of findings, development of ageing and dementia friendly design guidelines based on our work, organising of advisory board
Amount £2,000 (GBP)
Organisation Bournemouth University 
Sector Academic/University
Country United Kingdom
Start 03/2017 
End 07/2017
 
Title Development of new Research Tool 
Description During the project, we have developed new Virtual Environments (VE) and new experimental paradigms using these VEs that are now used in other projects (e.g., undergraduate as well as postgraduate research projects) to study cognitive mechanisms and strategies involved in route learning. 
Type Of Material Improvements to research infrastructure 
Year Produced 2017 
Provided To Others? No  
Impact The tool and the VEs are now widely used in our research group for a number of other projects. We plan to make these tools freely available once we have published first data. 
 
Title Open Access Database Hartmeyer et al 
Description Data of own research made available to access openly on UK DataService ReShare . Database title: Effects of cognitive aging on attentional engagement during route learning 
Type Of Material Database/Collection of data 
Year Produced 2016 
Provided To Others? Yes  
Impact Data has been submitted for publication in December 2016 (awaiting further status) to "Frontiers in Psychology". 
URL http://reshare.ukdataservice.ac.uk/852534/
 
Description ADRC's Annual Open Public Meeting 2016 
Form Of Engagement Activity Participation in an open day or visit at my research institution
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Public/other audiences
Results and Impact It was the most successful event of the Ageing and Dementia Research Centre (ADRC) yet with close to 100 people attending including academics, local practitioners, business, charity and care managers as well as people with dementia and their care partners. The event consisted of five presentations delivered by ADRC staff and PhD researchers. The post-presentation activities included a networking and poster session, and a Dementia Friends Awareness Session as part of ADRC's wider aim to ensure Bournemouth becomes a Dementia-Friendly University.
Year(s) Of Engagement Activity 2013,2014,2015,2016
URL http://blogs.bournemouth.ac.uk/dementia-institute/past-events/
 
Description ARUK Southcoast Network Public Meeting 2018 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Public/other audiences
Results and Impact In January 2018 Prof Jan Wiener presented his current ESRC project at the ARUK (Alzheimer's Research UK) Southcoast Network Public Meeting to the public.
Year(s) Of Engagement Activity 2018
 
Description ARUK meeting Southampton 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Supporters
Results and Impact On the 1st February 2017 Southampton University hosted an annual Alzheimer's Research UK (ARUK) public awareness event. The Ageing and Dementia Research Centre (ADRC) was invited to set up a display and provide information about ADRC's services and research. Jan Wiener from ADRC, along with scientists and clinicians from the local ARUK network demonstrated and provided information about Alzheimer's disease and other dementias, current treatments and the latest research. The event was attended by many members of the public, carers and students. ADRC was able to provide information about the services it can provide and insight from ongoing research. The day was very well received by the public and was said to be an 'excellent event".
Year(s) Of Engagement Activity 2017
URL http://www.alzheimersresearchuk.org/dementia-researchers-share-findings-public-southampton/
 
Description Bournemouth University Festival of Learning 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Public/other audiences
Results and Impact As part of the Festival of Learning the Ageing and Dementia Research Centre presented their work on Dementia Friendly Architecture to the public.
Year(s) Of Engagement Activity 2017
 
Description Dorset Wide Memory Advisers Group Meeting 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact We presented our work on Dementia Friendly Architecture at the meeting of the Dorset Wide Memory Advisers Group.
Year(s) Of Engagement Activity 2017
 
Description Invited talk at Lincoln University 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Postgraduate students
Results and Impact Jan Wiener gave a talk about "The effects of typical and atypical ageing on orientation and spatial navigation" at the weekly Research Seminars at the School of Psychology, Lincoln.
Year(s) Of Engagement Activity 2016
 
Description Mind body soul - Alzheimer's society event 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Patients, carers and/or patient groups
Results and Impact This was a 4 day event in which we presented our work on Dementia Friendly Architecture to patients and carers.
Year(s) Of Engagement Activity 2017
URL http://www.mindbodysoul.gallery/alzheimer-s-society.html
 
Description Residential Provider Forum 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Policymakers/politicians
Results and Impact We presented our work on Dementia Friendly Architecture to the Residential Provider Forum organised by Bournemouth Council.
Year(s) Of Engagement Activity 2017
 
Description Residential Provider Forum March 2017 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Policymakers/politicians
Results and Impact Ramona Grzeschik will attend this forum on 30 March 2017. The forum is meant to discuss the Bournemouth Council's Commissioning priorities and their current view of the Care Home Market (Supply and Demand, Quality and Sustainability). There will be information sharing on a range of subjects, and an opportunity to network with other Care Home Proprietors and Managers. Also in attendance on the day: NHS Dorset, Skills For Care, Partners In Care, Bournemouth's Workforce Development Team, "Alive", Equipped For Living, and others.
Year(s) Of Engagement Activity 2017