Dementia-Friendly Acute Care Environments: Approaches for Research and Design

Gesine Marquardt (TU Dresden)

Dementia is present in a significant number of older patients in acute care hospitals. Their enforced passivity during hospitalization may lead to reduced functioning and result in a move to a nursing home. In these settings, dementia sensitive care concepts have been well established. A large body of research supports the relationship between the design of the built environment and outcomes of people with dementia. Building on the evidence-based findings from long-term care, environmental interventions for hospital environments were developed and tested in our studies. Methods included interviews with patients and their care givers, behaviour mappings, and analysis of data from geriatric assessment scales. The environment was operationalized using environmental assessment tools and space syntax. In a series of research and design projects we investigated how to design acute care hospitals to provide supportive environments for patients with dementia and to simultaneously avoid stigmatization of this growing group of patients. We analysed which features of the environment determine the behaviour and the activities performed by people with dementia in acute care hospitals. Building on these findings, we remodelled several functional areas within three acute care hospitals in an inclusive and non-stigmatizing way. Results show, that patients with dementia improved on their independent mobility and variety of activities performed. Staff attitudes towards their work changed. They reported increased work satisfaction, being able to provide better care to the patients with dementia, including improved supervision and validation of behaviour. As a result of our research and design work we argue that a dementia sensitive design can be implemented in such a way that it is supportive for patients with dementia, but also a positive environment for other stakeholders in the hospital context.