Offering architects insights into experiences of living with dementia: A case study on orientation in space, time, and identity.

Due to memory loss, people with dementia are increasingly disorientated in space, time, and identity, which causes profound experiences of insecurity, anxiety, and homesickness. In the case study presented in this article, we explored how architecture can support people in coping with this challenge. We took a novel approach to offer architects insights into experiences of living with dementia. Starting from a critical realist and constructionist approach, we combined ethnographic techniques with an architectural analysis. This case study offers insights into the experiences and activities of a woman living with dementia within the architectural context of her home. We describe how the physical and social environment provided her guidance through sequences of day-to-day activities. This study highlights how architecture can support people with dementia in orientating by accommodating places for (1) everyday activities and (2) privacy and togetherness.

How Enclosure and Spatial Organization Affect Residents' Use and Experience of a Dementia Special Care Unit: A Case Study.

AIM:: We aim to gain insight into how a dementia special care unit is used and experienced by its residents and what design aspects are important therein. BACKGROUND:: In Flanders, housing for people with dementia evolves toward small-scale, homelike environments. As population aging challenges the affordability of this evolution, architects and other designers are asked to design dementia special care units that offer the advantages of small scaleness within the context of large-scale residential care facilities. How these units are used and experienced is not systematically evaluated. METHOD:: A case study was conducted in a recently built residential care facility where a dementia special care unit was foreseen on the ground floor, yet after a few months was moved to the top floor. The case study combined architectural analysis, participant observation, and qualitative interviews with residents and care staff. RESULTS:: Comparing the original situation on the ground floor with the new situation on the top floor highlights how enclosure (physical and visual access to outside and the rest of the facility) and spatial organization affect how residents use and experience a dementia special care unit. CONCLUSIONS:: Depending on the type and stage of dementia, residents may have different needs for space to move, sensory stimuli, and social contact. In order to meet these different needs, confining residents to a dementia special care unit to the top floor should be avoided unless it is carefully designed, providing sufficient freedom of movement and connection with the outside world.

How architectural design affords experiences of freedom in residential care for older people.

Human values and social issues shape visions on dwelling and care for older people, a growing number of whom live in residential care facilities. These facilities' architectural design is considered to play an important role in realizing care visions. This role, however, has received little attention in research. This article presents a case study of a residential care facility for which the architects made considerable effort to match the design with the care vision. The study offers insights into residents' and caregivers' experiences of, respectively, living and working in this facility, and the role of architectural features therein. A single qualitative case study design was used to provide in-depth, contextual insights. The methods include semi-structured interviews with residents and caregivers, and participant observation. Data concerning design intentions, assumptions and strategies were obtained from design documents, through a semi-structured interview with the architects, and observations on site. Our analysis underlines the importance of freedom (and especially freedom of movement), and the balance between experiencing freedom and being bound to a social and physical framework. It shows the architecture features that can have a role therein: small-scaleness in terms of number of residents per dwelling unit, size and compactness; spatial generosity in terms of surface area, room to maneuver and variety of places; and physical accessibility. Our study challenges the idea of family-like group living. Since we found limited sense of group belonging amongst residents, our findings suggest to rethink residential care facilities in terms of private or collective living in order to address residents' social freedom of movement. Caregivers associated 'hominess' with freedom of movement, action and choice, with favorable social dynamics and with the building's residential character. Being perceived as homey, the facility's architectural design matches caregivers' care vision and, thus, helped them realizing this vision.

Mary's Little Worlds: Changing Person-Space Relationships When Living With Dementia.

With the case study presented in this article we explore how people with dementia experience and use their environment to expand our understanding of how architectural environments can improve their well-being. We focus on how relationships between people and spaces change for people with dementia. Using a qualitative analysis of three in-depth interviews with a woman living with dementia, we obtained an insider's perspective and a rich account of the changes in her life, including her lived experiences and interventions in her home environment. We contend that looking at people with dementia in relation to and interaction with their environment, combined with an explorative research approach, might reveal multiple and innovative possibilities in designing for people with dementia. To that end, and to build on existing architectural expertise, we suggest focusing on architectural ordering principles across different cases.