This week, I attended a superb symposium on design principles in dementia care. Whilst I may have been in the land of the Trustefarians (those borne into trust funds), actually I was in a comfortable room in a community centre in Ladbroke Grove.
My doctoral thesis at Cambridge was in a minute area of neuroscience and academic neurology, relating to dementia. I would never have thought that 11 years later that I would end up interested in something seemingly rather different, the design of environments in dementia.
There are a number of reasons why I believe tackling the environment in dementia is important, but I think ultimately I believe in the best quality-of-life possible for patients with dementia. In a society driven by targets, it has become very untrendy to measure quality-of-life and happiness, yet it is clear to me that well-being and happiness can impact on physical health, in ways that are not yet fully understood. This may be due to discoveries which have not happened yet in neuroimmunology, but just because we may not understand the phenomenon, it doesn’t mean that the phenomenon does not exist. Anecdotes provide that transplanting an advanced patient with dementia to a totally unfamiliar surrounding can be very distressing and detrimental to their physical health; one might wonder why on earth you would do this, but unfortunately thousands of people make this journey everyday from their home to a nursing or care home everyday.
This course, run by senior people at the University of Stirling, such as Prof. Mary Marshall, did not get unreasonably bogged down in the scientific evidence. This put me much at ease, as well as making the designers, architects and artists comfortable that their creativity and common-sense were not jeopardised. We discussed everything from corridors to balconies, but the discussions were open-minded. We considered how patients with dementia perceived their outside environment. For example, I learnt that colour constancy was relatively intact in most stages of Alzheimer’s disease, despite there being many potential ‘lower-level’ visual problems. This phenomenon relates simply to how the human brain perceives the colour of something relative to the background colour. This colour constancy is well known to have been utilised to great effect in the art work of Pier Monde.
The course, and my discussions with several Professors and Readers in the UK, make me convinced that we can see a paradigm shift in the design of better environments for patients with dementia, including better use of assistive technology and planning of houses and built environments. It would be even better, if we could bridge this drive with the cognitive, behavioural and activities-of-daily-living challenges posed by patients in their day-to-day life, but I remain confident that this can happen one day.
Dr Shibley Rahman
QS, BA (1st), MA, MB, BChir, PhD, MRCP(UK), FRSA, LLB(Hons)
