Dementia

Is this the world we created….?

I’ve been asked to talk at a Masterclass on Design for Dementia and Ageing at Stirling University this week.  The brief is 10mins on the environment, dementia and acute care. The focus is on the real world aspect rather than reams of data.

So what do we mean by the environment? Type that into Google and you get this:

’the surroundings or conditions in which a person, animal, plant lives or operates’

They often like to provide an example of how to use the word and given the subject matter this one really struck a cord:

‘survival in an often hostile environment’

That is exactly what coming into hospital is like for the person with dementia.

Now before I get into this some more I want to be clear from the start that the people working in hospitals do not deliberately create this nor do we go out our way to make it as horrible an experience as possible.  That said you will frequently hear colleagues talk about how hospitals ‘break people’.  Even in my recent visits to care homes staff would tell me about how residents would seem both cognitively and physically worse after an admission to hospital.

We know that people admitted to hospital are not there because of their dementia but due to conditions associated with it e.g. falls, hip fractures, chest infections, delirium etc.  With that in mind hospitals are perfectly designed to deal with this array of illness. What it was never designed to do was be a place that met the needs of a cognitively impaired person.

Years ago I heard a talk that somewhat poured scorn on the notion of ‘artificial’ dementia friendly environments.  At the time I could understand the frustration – how does a mock 1950s kitchen or living room help?  If they’re well enough to be in a sensory garden should they not be at home recuperating/rehabbing….?

However people with dementia get sick just like everyone else.  So when you need admitted with pneumonia or a fracture then I do think hospitals should do more.  It is not the person’s responsibility to adapt to our broken systems and processes.

There is evidence that if we invest in the environment we can reduce length of stay, falls and violent/aggressive behaviours.  Not to mention the positive effect it can have on staff caring for these people.

The evidence points towards simple, inexpensive measures having a big impact.  Clear signage, quiet, well lit clinical areas.  Ironically the move toward single rooms in new build hospitals has prompted discussion about resurrecting the Day Room as a place for social interaction.

Perhaps one of the biggest challenges is in creating an environment where families/carers are welcomed.  If we are striving to have the person with dementia feel safe and secure then we need them.  They very often point out things that we have become blind to ourselves.

So I would like to see the hostile environment of acute care become a place where the person with dementia thrives and not merely survives….

For more info:

https://www.kingsfund.org.uk/projects/enhancing-healing-environment/ehe-design-dementia

http://www.knowledge.scot.nhs.uk/media/CLT/ResourceUploads/4075017/19870707-ace6-4c5c-b3df-0556816f61fe.pdf

http://futurehospital.rcpjournal.org/content/2/1/63.full.pdf

http://dementia.stir.ac.uk/design/virtual-environments/virtual-hospital

Thanks to Janice McAllister (@janicemcalister) for providing some of the refernecesIMG_4304

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