Design

There are many ways in which sensory challenges may have implications on design. This section mainly focuses on the design of places and spaces. With thoughtful consideration of the senses, the environments in which people with dementia live or spend time in can be made more inclusive and 'sensorially-friendly'.

When, designing, creating or adapting living spaces for people with dementia, it is important to take into account personal preferences and needs. The individual should always be the centre of any choices made.

Colour and Contrast

With age the way colours appear often changes. Due to the thickening of the lens, colours can appear less vivid or washed-out and it can be more difficult to distinguish one colour from another. Certain colours such as blues, greens and purples can be more difficult to differentiate. Colour contrast is particularly important to consider in homes and spaces outside the home. Without thinking about it, everyone uses colour cues in their day-to-day lives. A yellow sign may suggest a warning or a green light may tell you to go. For people with dementia, these colour associations may become less easier to establish and can be confusing. Therefore, it becomes more important to use imagery, text and colour together to put across messages. To help with distinguishing one room from another, coloured doors with signage can be used. The colours should be vivid, the text should be large and accompanying imagery should be used. This could be a toilet, for the bathroom, or a knife and fork for the kitchen.

Contrasting colour tones can make furniture and objects easier to identify. Here, the term contrasting tone does not mean the hue of the colour (e.g. blue, red, green), it refers to the light or dark value of the colour. This is measured in LRV (light reflectance value). This scale runs from black (0 LRV) to white (100 LRV) depending on how much light the colour or surface reflects. It is important to remember that, as we age, our perception of colour diminishes. Therefore, a contrast of 30 LRV or more between one colour and another can make it easier to see. This may be a cup on a tablecloth, text on a page, or a chair against a wall.

Tone

Hue

1

2

Activity:

You can use your smart phone or tablet camera to assess levels of LRV.
Turn your camera to 'greyscale' and use it to view your surroundings.
Notice how colours that contrast in hue can appear the same.
Now try comparing the two images below. Feel free to vote which image appears best in contrast using the poll below.

Lighting and Shadow

Carefully considered lighting is particularly important for people who have dementia and visual challenges. Some people with dementia may experience an increased sensitivity to light and might need extra time to adjust to a change in light levels (e.g. inside to outside). Others may have poorer vision in lower light levels. Large windows can provide natural light and are particularly important for people who are not able to get outside often. They can also help with the recognition of time, from daylight to night. Large windows can also allow seasonal changes such as budding flowers or falling leaves to be seen, which may help with knowing the time of year.

24-hour exposure to light and dark can also help with sleep patterns. Circadian rhythms, also known as the 'body-clock', are synchronised by light and dark, which controls sleep, digestion, body temperature, hormonal cycles and sometimes behavioural patterns. Disruption to the circadian rhythms can cause irregular sleeping patterns and an increase in confusion. A higher level of light in the morning can be particularly beneficial, as it been found to improve sleep efficiency, a longer night's sleep and reduced wake-times. Some people with dementia may experience changes to their behaviour in the evening, such as increased agitation, confusion or aggression; this is known as sundowning. You can find out more about sundowning, including tips for carers by following this link.

'Good lighting for vision is a key element of dementia-inclusive design. It gives people the best change of making sense of their environment and retaining as much independence as possible for as long as is practicable.'

- D. McNair, R. Pollock, C. Cunningham

Natural lighting can provide higher levels of light than domestic lighting. It can also cover larger spaces and be more diffused, minimising shadows. Multiple sources of light can also help to create uniformity of lighting and minimise dark corners. For people who experience visual hallucinations, shadows can cause visual disturbances. Dark, shadowed areas can also increase the risk of falls.

Blinds can be difficult to use

Natural lighting is obscured

Inconsistent lighting and heavy shadows

Patterned wallpaper can cause illusions

Familiar curtain design

No patterns

Contrasting colours

Lots of natural lighting

Patterns, Materials and Surfaces

Patterned surfaces, floors or fabrics can cause visual disruption or illusions for people with certain types of dementia, such as Lewy body dementia. Floors or carpets with elaborate patterns can appear to be moving which can be distressing. Complicated patterns, swirls or vertical strips should be avoided as they can be misinterpreted. The busy patterns of seats used in transportation (e.g. buses and trains) can also cause visual misperceptions which could increase the risk of falls or cause people with dementia to avoid travelling on public transport.

Patterned and vertical blinds

could create visual misperceptions

Inconsistent

patterning on worktops can appear unclean or hide dirt

Modern appliances, such as this built in oven may be unfamiliar and difficult to identify

The mirrored surface may cause alarm

Unfamiliar materials can contribute to confusion or misidentification. Often people with dementia can find memories from childhood or younger life much clearer. Depending on preference, often traditional materials and design can be easier to recognise. A chrome sink or toilet may look stylish, but more traditional materials such as porcelain may be easier to identify. The sense of touch is important for navigating spaces and identifying objects, particularly for people with visual challenges and dementia. Certain materials also can provide a more pleasant feel, for example, a wooden hand rail may feel nicer than a metal one. A carpeted floor may feel more comforting than a wooden or laminate one. Some kitchen worktop materials can also create illusions for people with dementia. Worktop surfaces made of materials that are inconsistent in colour or pattern, such as quartz, can appear to be unclean or can hide dirty spots. Matt, rather than reflective, surfaces can also minimise glare. Glass table tops should also be avoided.

Reflective surfaces can also create issues for people with visual challenges. Visual misperceptions can cause reflective or shiny surfaces, such as a floor, to appear as a pool of water. This can be alarming and may cause someone with dementia to avoid rooms with these surfaces. Mirrored surfaces can also cause issues if a person does not recognise themselves or do not expect to see a reflection. Consistent colour contrast between floors is important, as a change in colour tone may be perceived as a step.

Outdoor Spaces

Getting outside is a great way to get exercise, relieve stress, improve mood and help regulate sleeping patterns. Outside the home, it is more difficult to control over-stimulation to the senses. It is important that society learns more about how sensory challenges can affect people, so they can be understanding and patient. People with visual impairment can carry a white pointer stick to help them navigate and also alert other people to their visual difficulties. To help minimise unhelpful amounts of sound protective auditory barriers, such as ear plugs can be worn or digital hearing aids can be readjusted.

Outdoor spaces or home gardens can be designed to be sensorially-friendly and minimise hazards. Well defined and even paths can help people to get around outdoor spaces with minimal trip hazards. Lighting can also be used in gardens along paths or to provide ample light in the evening. Appropriate contrast should be used on hazards, such as steps and key features, such as railings. Patterned flooring such as intricate brickwork should be avoided to minimise the risk of visual illusions. High fences or bushes can help create an appropriate perimeter, as well as block out noise and wind. Warmer coloured plants should be used, such as orange, red and yellow, as cooler colours are more difficult to distinguish. In home gardens plants can be personalised depending on preference. People that have difficulty with smell may prefer unscented plants. Whereas, certain scented plants can draw on memories and experiences.

Sensory gardens can be created in home gardens or public spaces. Sensory gardens can engage the senses in a way that is not overwhelming. Certain smells, sounds and areas may aid in memory and provide talking points. Groups of flowers of the same colour, scented plants, tactile materials and gentle sounds can all create an interesting sensory experience in outdoor spaces. Sitting on a bench and hearing the gentle sound of running water can be relaxing. Plants that make subtle sounds such as bamboo or high grass can provide an interesting soundscape. Raised beds can provide opportunities to smell and touch plants. It is important not to include any plants that may be poisonous or harmful.

It is important to remember that everyone is different and some people may find sensory gardens unpleasant. The Sensory Trust provides more guidance about designing sensory gardens.

Sound and Noise

Soft surfaces such as cushions, carpets, and fabric on furniture can absorb sound to help minimise reverberation that can cause problems for people with auditory impairments. If possible, living rooms and bedrooms should not be next to busy roads or railway lines. Double glazing can also minimise sound and noise from outside.

Apps to detect sound can be used to measure the decibel levels of a space.

You can find recommendations for such apps below.

Measure Sound

Further resources

What is inclusive design? - Sensory Trust

Good practice in design of homes and living spaces for people with dementia and sight-loss - C. Greasley-Adams, A. Bowes, A. Dawson and L. McCabe

Enlighten: Lighting for Older People and People with Dementia - David McNair, Richard Pollock, Colm Cunningham

Sundowning and Dementia - Alzheimer's Society

Dementia and the outdoors - Path's for All

Sensory garden advice - Sensory Trust