Dr Evangelia Chrysikou on designing for dementia
Dr Evangelia Chrysikou investigates the field of architecture and dementia, and how we can design for dementia.
What attracted you to investigate the field of architecture and dementia and why is it important?
I am a researcher of medical architecture, which is a transdisciplinary area studying the built environment for people suffering from illness and disease – mostly healthcare facilities and the spaces in which care takes place.
Long-term care environments, such as those for people with dementia, have significant implications for people’s lives. If we consider that the healthcare ecosystem involves three main components – the clinical-pharmacological interventions, the staff and the environment – then in dementia the clinical-pharmacological component has a limited success and so we need to rely significantly on the other two in order to best support those suffering from the condition.
Can you tell us about the project focused on people living with dementia that has been awarded funding from UCL Grand Challenges and Knowledge Exchange, and how it came about?
One of the main findings of my research regarding long-term care is that successful healthcare infrastructure requires extensive end user involvement.
My research in inpatient psychiatric wards was the first to challenge the lack of involvement of end users in the design of the premises in which they received care. This was considered challenging for several reasons at that time. It was also the first to actively involve psychiatric patients in aspects regarding the built environment of care. It helped establish a culture in which psychiatric patient consultation is now an established stage of the design.
The approach to people with dementia has to be very different from other patient groups and in line with the physiological and perceptual limitations of dementia.
The UCL Grand Challenges project aimed to address exactly this. What should be the protocol of engagement with people with dementia in order to involve them in meaningful consultation for their built environment?
We are starting from a commitment to incorporating the views and perception of needs of people with dementia and this does pose significant challenges. We had to investigate those challenges, explore the potential and limitations of proxies and create practical rules that support people with dementia in their interactions with the research and design teams.
How does this project aim to improve care for people living with dementia?
Care has to be inclusive and reduce the chances of facilities becoming small institutions, which is a difficult task even for small community-led projects. End user involvement is critical for psychosocially supportive care.
Providing the template for enabling end user involvement was our main deliverable. This involved psychosocial elements: for example, how to approach people, how to introduce them to the project, how much time to allow for the engagement, how to determine who should be present. It also involved environment elements: for example, where this should take place, where should people sit, what amenities would be required.
What are some of the challenges of designing for dementia?
As for all projects of medical architecture we need to start from understanding three main questions regarding:
- The physiology of the people, i.e. what are the limitations, side effects, physical symptoms and multimorbidities that dementia poses and how do these need to be addressed or mitigated by design?
- The perception of people with dementia and how design can best support people with the condition.
- The system in which the care takes place: what resources are available, how well staffed is a facility (so that its architecture is compatible with its operation), its connections with other services, the catchment area, the clinical requirements and the sustainability of the provision.
In a systemic approach we need to allow for all these factors and include all people involved – including patients and staff – in a fruitful consultation process as to what the space and place should look like.
Finally, we need to consider the needs of those who live and care for people with dementia and especially older carers, who might neglect themselves. For that purpose, not only the design but the location of the dementia care facilities needs to be considered, as we understood from our case study of the Dementia Village in the Netherlands.
From my research, the consideration of these parameters together with people’s active involvement can have a significant impact towards a successful project.
What insights from other disciplines can help architects design for people living with dementia?
Architecture as a study has not focused on the critical aspect that people who are ill have a different perception and physiology from the same people when they are well. This is why medical architecture as a discipline is important.
Without the understanding of this principle there will be significant translational issues from architecture to healthcare architecture, and especially architecture for dementia. This is the first principle and most important principle that students learn when they come to study on the MSc Healthcare Facilities, and it is paramount for the practice of healthcare planning.
Collaboration with staff and clinicians is essential but the gap between architecture and healthcare sciences should not be underestimated. The inclusion of a medical architect/ healthcare planner in the team is essential to enable this translation.
Do you have plans for future work in this area?
We are currently undergoing a systematic literature review on the topic, and are collaborating with Politecnico di Milano on the validation of a protocol for the planning of facilities for dementia in the UK. We’re also planning to explore further the role of advanced technologies in the design for dementia.
Currently, I am leading a project on old people and frailty and their cohabitation with needy robots. We have started expanding on the idea of how robots and patients cohabitate in physical, real environments in broader studies of ageing, including environments for dementia.
Artwork serving as visual clues in the dementia village in the Netherlands. Copyright: Dr Chrysikou