Toward an Integrated Context-Based Design Approach for Dementia Residential Care Homes: A Review of Key Operational Design Problems.

OBJECTIVES, PURPOSE, OR AIM: This article seeks to develop a context-based management system focusing on assessing key operational and design problems and affecting wayfinding in dementia residential care homes. BACKGROUND: Dementia is multifaceted neurocognitive impairments largely attributed to cognitive deterioration manifested in memory loss and visuospatial deficit which have wider practical implications to both environmental safety and wayfinding and navigation of dementia user. Two key questions were addressed in this context: (1) How can cognitively facilitating assistive technology (AT) be made more user-focused to mitigate the impacts of cognitive impairments on environmental safety and wayfinding? (2) How can design intervention and changes in design topology, colors and texture, and internal finishing aid wayfinding, navigation, and orientation in dementia residential care homes? METHOD: A systematic literature review and analysis was undertaken to assess the efficacy of key cognitively-related AT to support activities of daily living and environmental safety of dementia sufferers in a care home and aid wayfinding, navigation, and orientation. RESULTS: Several key design variables to facilitate wayfinding and spatial orientation were identified which include design topology, floor finishing, signposting, and use of color and texture strengthened by meaning, emotional connection to places and cognitively focused intervention via memory cueing and objects-centered recognition. CONCLUSIONS: Key operational and design guidelines were proposed to assist built environment, care home developers, clinicians and healthcare professionals, and care services providers. There is a need to move toward a dementia-centered design to address the challenges facing people living with dementia in care homes. This should be based on the interrelated behavioral, cognitive, and communication factors.

A growing role for 'smart' sensors.

Dr. Ghasson Shabha, senior lecturer at the integrated Design and Construction Centre at the School of Engineering and the Built Environment at Birmingham City University (BCU), and associate professor, Chris Conway, associate professor and the Centre's acting head, explain their recent work to investigate 'the latest development' of incorporating smart sensor technology (SST) to monitor and detect airborne infection in British hospitals. Here they set out why they believe effective incorporation of such technology in healthcare facilities in this digital age is the sine qua non for an effective infection control strategy to mitigate against this 'endemic problem', and ask whether such smart sensors can indeed be the 'panacea for hospitals' ills'.

Identifying infection hotspots early on.

According to many published studies, 'ducting in ventilation and air-conditioning are largely overlooked and ignored, as they are out of sight and out of mind', despite mounting evidence indicating a higher risk in spreading airborne infections'. So says Ghasson Shabha BSc (Arch) MSc, PhD (Arch), MBIFM, Associate CIBSE, PG Cert Ed, of the Faculty of Technology, Engineering and the Environment (TEE), at the Birmingham School of the Built Environment (BSBE) at Birmingham City University, who adds that CIBSE estimates that fewer than 5% of buildings with air-conditioning systems above 12 kW have been inspected so far. Here he argues that incorporating 3D building information modelling software into existing computer-aided facilities management software systems will enable hospitals' 'infection hotspots' to be far more quickly identified, and subsequently monitored, to prevent future problems.

Better systems for combating MRSA.

Ghasson Shabha, Facilities Management MSc course leader at the School of Property, Construction and Planning at Birmingham City University, examines the effectiveness of current design and management intervention systems in combating MRSA and other hospital-acquired infections in British hospitals.