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EBD

Evidence
Based
Design

Journal 1:
Aged Care
evidence-based strategies
for the design of aged care
environments

Image: iStock/Getty

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Design Strategy
Back to Contents1F:
Priming
Design Strategy 1F:
Priming

Strong supporting evidence


resulting from an accumulation
of reliable research undertaken
in an architectural context.
Design strategies have moved
beyond the hypothetical
and have been shown to be
effective.

Reliable theory from a relevant


discipline that has a potentially
high impact but has not
been adequately tested in an
architectural context. Design
strategies therefore remain
hypothetical.

Use of colour unique to


a particular route can
differentiate one path
from another and aid
non-cognitive priming.

Potentially useful information


with conflicting evidence
from complex context. Worth
considering, but pre-design
research under local conditions
is essential to determine
View through to external
relevance.
garden or street, but can
be any attractor/niche
that differentiates

B.

Destination

y travelled routes,
lies on cognitive
nd explicit

idual
have a
on noise
to main
ide free
ive 'niche'
nts to
of sensory

Effective Orientation
Scenario

Residents with Alzheimers


disease, with medial-temporal
lobe damage, can retain their
implicit memory17 for object
information relevant for
navigation.18

Quiet/Semi Public

However those residents with


dementia with Lewy bodies
continue to perform poorly in
orientation tests.19

Quiet environments have also


been associated with diminished
Light
Dark
levels of agitation.20 In Nettens
1993 study of 79 dementia
residents at 13 long-term care
facilities, higher levels of
orientation were associated with
quiet environments. Researchers
theorised that disorientation
followed residents attempts to
shut out noisy environments.21

Loud/Public

The scale of individual


social spaces can have a
significant impact on noise
levels. In addition to main
social areas, provide free
access to alternative 'niche'
spaces, for residents to
'self-select' levels of sensory
stimulation.

Provide adjustable lighting zones


to allow flexibility in lighting
levels based on the needs.
(Refer to principle 4D for more
detailed information) Reduce
reverberation time through the
use of absorptive materials.

Quiet/Semi Public

Smaller niche
creates very quiet
social spaces

Design Strategy 1G:


Light and Sound
Legend

Bedrooms

Loud Social Spaces

Light

Adjustable Zone

Adjustable Zone

Adjustable Zone

Wayfinding among residents can


be less successful in facilities
with low lighting levels in public
areas.21

Click on dot to enlarge


image/diagram/photo,16
use to close.

Design Principle 01:

Facilitate Orientation

EBD Journal: 1

be any attractor/niche
that differentiates

Use of colour unique to


a particular route can
differentiate one path
from another and aid
non-cognitive priming.

Use of colour unique to


a particular route can
differentiate one path
from another and aid
non-cognitive priming.

Roll over on colour code


B.
to reveal
Destinationcategory of research
(quality). Assisting the reader
to understand the limitations
of each piece of research.
B.
Destination

However those residents with


Residents with Alzheimers
Quiet environments
have also
dementia with Lewy bodies
disease,
with medial-temporal
been associated with diminished
Loud/Public
continue to perform poorly in
lobe
retain their
levels damage,
of agitation.20can
In Nettens
1993 studymemory17
of 79 dementia for object
orientation tests.19
implicit
residents at 13 long-term care
information
relevant
for
facilities, higher levels
of
orientation were associated with
navigation.18
quiet environments. Researchers
However those residents wit
Residents with Alzheimers
For frequently travelled
routes,
theorised that disorientation
Close
followed residents attempts
to
dementia with Lewy bodies
disease,
with medial-temporal
wayfinding relies on cognitive
shut out noisy environments.21
continue to perform poorly i
lobe damage, can retain their
abilities beyond explicit
[19]
orientation tests.19
implicit memory17 for object
memory.16
Mondon, K., Gochard, A., Marque, A.,
information relevant for
Armand, A., Beauchamp, D., Prunier, Quiet en
Sound
navigation.18
C., Jacobi, D., de Toffol, B., Autret, A., been as
Quiet/Semi Public
The scale of individual
Camus, V., Hommet,Loud/Public
C. (2007) Visual
Closelevels o
social spaces can have a
recognition memory differentiates
significant impact on noise
1993 stu
dementia with Lewy
levels. In addition to main
[19] bodies and
resident

social areas, provide free


Parkinsons disease
dementia.
J Neurol A., Mar
Wayfinding among residents can
Mondon,
K., Gochard,
facilities
access to alternative 'niche'
be less successful in facilities
Neurosurg Psychiatry
78:738741.
doi:
Light
Dark
Armand,
A., Beauchamp,
D., Pr
spaces, for residentsSound
to
orientat
with low lighting levels in public
10.1136/jnnp.2006.104257
C., Jacobi, D., de Toffol,
B., Au
areas.21
'self-select' levels of sensory
quiet
en
Quiet/Semi Public
Zone
The scaleAdjustable
of individual
http://jnnp.bmj.com/content/78/7/738
Adjustable Zone
stimulation.
Camus, V., Hommet,Loud/Public
C. (2007)
theorise
social spaces can have a
Click on superscript
number
1
recognition memory differentia
significant impact on noise
followed
with Lewy bodies an
to reveal notesdementia
and literature
levels. In addition to main
shut ouJ
social areas, provide free
Parkinsons
disease
dementia.
Smaller niche
references. References
creates very quietaccess to alternative 'niche'
Neurosurg Psychiatry 78:7387
spaces, for residents to
social spaces
include links to
original
10.1136/jnnp.2006.104257
'self-select' levels of sensory
http://jnnp.bmj.com/content/7
publication
websites
where
stimulation.

Provide adjustable lighting zones


to allow flexibility in lighting
levels based on the needs.
(Refer to principle 4D for more
detailed information) Reduce
Provide
adjustable
Smaller niche
reverberation
time through
the lighting zones
creates very quiet
to
allow
flexibility
in
lighting
social spaces
Legend
use of absorptive materials.
levels based on the needs. Bedrooms
Quiet Social Spaces
(Refer to principle 4D for more
Design Principle 01: Facilitate Orientation
Loud Social Spaces
detailed information) Reduce
reverberation time through
the
Light
Legend
use of absorptive materials.

G
EBD Journal

In larger social areas,


residents can choose
between areas of
differing light qualities.
In smaller social areas
and bedrooms, residents
have the ability to adjust
the amount of direct or
indirect light present
within certain spaces
(Adjustable Zones).

Adjustable Zone

eas,
ose

Dark

Strong supporting evidence


Reliable theory from a relevant
Pote
resulting from an accumulation
discipline that has a potentially
with
of reliable research undertaken
high impact but has not
from
in an architectural context.
been adequately tested in an
cons
Design strategies have moved
architectural context. Design
resea
beyond the hypothetical
strategies therefore remain
is es
and have been shown to be
hypothetical.
relev
Strong supporting evidence
Reliable theory from a
effective.
resulting from an accumulation
discipline that has a po
Use of
colour unique
to
of reliable
research
undertaken
high impact but has no
a particular route
can
in an architectural
context.
been adequately teste
path
Designdifferentiate
strategies one
have
moved
architectural context.
from another and aid
beyond the hypothetical
strategies therefore re
non-cognitive priming.
and have been shown to be
hypothetical.
View through to external
garden or street, but can
effective.

Design Strategy 1G:


Light and Sound

paces

Light

Standard PDF Features:


Ability to click on contents
to go to page.
Ability to search for specific
terms in the document
Ability to bookmark and
copy text.

Destination

Quiet Social Spaces

paces

Effective Orientation
Scenario

It is hypothesized that orientation


strategies based on implicit not
A.
Path from the
explicit memory, can potentially
It is hypothesized that orientation
dinning area through
enable
residents A.to move
strategies based on
implicit not
to bedroom B.
explicit memory, can potentially
between
destinations,
without
enable residents to move
It isabout
hypothesized
having
to think
how to that orientation
between destinations,
without
strategies
based on implicit not
having to think about how to
A.
get from one place to another.
get from one place to another.
Path from the
explicit
memory,
can potentially
Priming is definedPriming
as the use is defined as the use
dinning area through
of repetitive stimuli to produce
to move
to bedroom
of repetitiveenable
stimuliresidents
to produce
a non-cognitive response.
between
destinations,
without
Strategies could include
the
a non-cognitive response.
use of short, looping circulation
having
to think
Strategies
could
include
theabout how to
paths, a unique sequence
of
get
from
one
place to another.
unobtrusive routeuse
identifiers
and
of short,
looping circulation
nodes with clear lines of sight to
Priming
is defined
paths, a unique
sequence
of as the use
the next destination.
of
repetitive
stimuli
unobtrusive route identifiers andto produce
a non-cognitive
response.
nodes with clear
lines of sight
to
Strategies
could
include
the
However those residents with
Residents
with Alzheimers
For
frequently
travelled
routes,
the next destination.
dementia with Lewy bodies
disease, with medial-temporal
wayfinding relies on cognitive
use
of
short,
looping
circulation
continue to perform poorly in
lobe damage, can retain their
abilities beyond explicit
orientation tests.19
implicit memory17 for object
memory.16
paths, a unique sequence
of
information relevant for
unobtrusive route navigation.18
identifiers and
nodes with clear lines of sight to
For frequently travelled routes,
the next destination.
Sound
wayfinding relies on cognitive
Design Strategy 1G:
abilities beyond explicit
Light and Sound
memory.16

uiet

paces

Design Strategy 1F:


Priming

Path from the


dinning area through
to bedroom

the
hrough
m

paces

Effective Orientation
Scenario

Back to Contents

entation

lities.
reas
sidents
adjust
ect or
ent
ces
s).

Limitations:
EBD Journal cannot guarantee
full interactivity when the PDF
is viewed on tablet and mobile
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available, saving the reader


valuable time.

Legend

Bedrooms

Staff Facilities

Indirect Light
Direct Light

In larger social areas, Bedrooms


residents can choose
Quiet Social Spaces
between areas of
differing light qualities. Loud Social Spaces
In smaller social areas

16

Light

PDF Capabilities

Adjustable Zone

Adjustable Zone

Dark

Wayfind
be less s
with low
areas.21

Contents

Article 1:
Designing for Dementia

vanHoof, J. and OBrien, D.

Design Principles

Case Study 1:
Home and the Familiar:
Lessons from Montemurlo

5
36

OBrien, D.

46
53

Case Study 2:
The Dementia Competence
Centre in Nuremberg
A Review of the Spatial Design
Marquardt, G.

Article 2:
Smart Homes:
Digitally Augmented
Residential Settings to
Support Aging.
Demiris, G.

Back to Contents

Design
Principle 01:

Facilitate
Orientation

The importance of appropriate


wayfinding strategies, designed to
suit the needs of residents, cannot be
overstated.1

1
EBD Journal: 1

Image: iStock/Getty

For mobile people with dementia, wayfinding


decisions are based on environmental information
that is readily accessible, moment-by-moment, as
they move along a path. Plan configuration can
therefore support or impede orientation, having
a significant impact, not only on quality of life for
residents but also staff workload and operational
costs. Disorientation can create stress leading to
agitated and aggressive behavioural responses.
Residents who cannot identify paths to desired
locations have exhibited anxiety, confusion,
mutism and even panic. It is apparent that unique
environments are preferable to repetitive ones,
however, excessive complexity can also lead to
disorientation.2

Design Principle 01:

Facilitate Orientation

Back to Contents

Clustered Layouts:

Design Strategy A:
Layout

Create a simple network of


differentiated but visually
connected spaces. Smaller, open
plan, cluster layouts are best
suited to dementia care units.
They provide mobile residents
with a direct line of sight from
their bedroom door to adjoining
destinations such as dining, living
and outdoor spaces. The shared
social space may not have to
be fully contained and can be
integrated with access to walking
paths, private nodes and outdoor
areas.

Corrine Dolan Center, Ohio 1991

Virranranta, Finland 1992

Nuremberg, Germany 2006

Legend

Line-of-sight

Bedrooms
Social Spaces
Staff Facilities

Direct line of sight


between private
and social areas

Outdoor/Garden

Controlled Exits

The tendency to
become lost is
shared by almost
all patients with
Alzheimers Disease
(93%), however this
is not just related to
memory impairment,
it reflects an inability
to consciously link
recognized scenes
with locations in the
environment.3
Smaller, open plan,
cluster layouts can
produce higher levels
of orientation and
reduced behavioural
disturbances than
larger Communal
facilities.4

Corrine Dolan Center, Ohio 1991

Prototype Plan:
Dementia Care Unit
Neighbourhood model: 1215 beds arranged around
social and staff areas. Suited to mobile residents
with dementia. A sheltered, large, external deck is
recommended for upper levels that are more suited
to less mobile residents, who require supervised
access to social areas and garden spaces.

To promote a sense of openness


and autonomy, primary social
areas have direct view, and access,
to a secure garden space

Legend
Bedrooms
Social Spaces
Staff Facilities
Outdoor/Garden

Short corridors with direct


line-of-sight to activity
areas, with no dead-ends
to be negotiated

Controlled Exits
Managed Open Access
Resident

EBD Journal: 1

Design Principle 01:

Facilitate Orientation

Back to Contents

Home and the


Familiar: Lessons
from Montemurlo.

C1

Case Study One

Dr Darragh OBrien

Image: Pietro Savorelli

Montemurlo
Aged Care Facility
Overview

In the dry hills of Montemurlo, above the


medieval town of Prato, Italy, Ipostudios
Residential Aged Care Facility grows
comfortably from an historic, agricultural
landscape, characterized by the traditional
dry stone terraces of the region.

Credits

Consultants

Architects:
ipostudio architetti

Structural Engineer:
Niccol De Robertis
aei progetti srl

Client:
Azienda Sanitaria Locale
4 Prato
Program:
Health Centre and
houses for elderly people
Photography:
Pietro Savorelli,
Jacopo Carli,
Ipostudio Archieve

Environmental systems:
Paolo Pietro Bresci e
Leopoldo DInzeo
Consilium srl
Contractor:
Restructura soc coop arl
S. Arsenio (SA) Staccone
spa Costruzioni Generali
Roma
Construction supervisor:
Nicola Freddi - STS spa
edificio al grezzo
assisted by Elisabetta
Zanasi Gabrielli
ipostudio architetti.

EBD Journal

Case Study 1:

Montemurlo Aged Care Facility

36

Back to Contents

A protected group of ancient trees, existing rural


buildings and a unique landscape became the
conceptual generators for this project. For the
architects, the site is intrinsically connected to
the history of place, a survivor of new farming
techniques that, elsewhere, have reshaped the
soil profile.

This difference between an


open and closed environment is
perhaps nowhere more critical
than in residential aged care.

The architecture is reminiscent of the farmyards


and walled villages we associate with the Tuscan
landscape. Appearing to support an elevated yard
populated by independent structures, a single,
punctuated stone wall presents itself to the valley
and the city beyond, its curved profile resonating
with the contours of the land.

The idea of context is crucial here, not only to the


quality of the architecture but also to the purpose
for which it exists. Montemurlo is offered as case
study for two significant issues that are critical
to the design of any residential aged care facility,
anywhere in the world: The first being the concept
of Care Facility as Home and second, the manner in
which residents are connected with each other and
the world beyond. This difference between an open
and closed environment is perhaps nowhere more
critical than in residential aged care.
Montemurlo is home to forty elderly residents
who share the facility with approximately 10 day
care visitors. Equal numbers of high and low care
residents are accommodated separately across two
levelsbelow the entry yard with its free-standing
pavilionsin the volume formed between the wall
and the slope of the hill. The whole complex is
arranged in a radial grid overlooking the valley.
Image:Jacopo Carli

IPO Studio drew their inspiration from a


combination of archetypes: the Convent and
the Farmyard, both being relevant, not only in
the context of the Tuscan hills, but also because
they contain highly specific communities that
are, by necessity Heterotopian1places that are
simultaneously open and closedand therefore
highly relevant to the unique circumstances of
a residential aged care facility. The merging of
these references became critical, not only to the
architectural aesthetic, but also to the organisation
of functional areas. The farmyard (aia),
characteristic of Tuscan farmhouses, inspired the
idea for a sort of rural piazza that provides access
to the facilities that are open to external guests:
the day care centre, places of collective life
(offices, kitchens and the place for worship)
and the main entrance.

From The Architects


For the Design of Residential Care Facilities, the
monastic analogy becomes extremely interesting
and useful. The convent... is constituted as a city
block, identified as an articulated and complex
structure of spaces where the placement of
private space is inversely proportional to the
degree of accessibility. In the monastic structure
it is also possible to identify three spatial systems
that are useful when considering the organisation
of a Residenza Sanitaria Assistenziale (RSA):
public space represented by the Church and the
cloister of catechumens; collective but private
space constituted by the refectory, the aula
magna and General Services structures; the
private space of the cells.

Villa Medici di Belcanto


Image: Ipostudio

Rural House in Tuscany.


Image: Ipostudio

However, there is another fascinating aspect of


monastic typologies that might be interesting
for the purposes of analogy: the wealth and
the articulation of the outdoor spaces that are
distinguished depending on their location in the
structure and their relationship with the interior
spaces. All this can be a valid interpretation of
a clearly expressed general concept which says
that taken together, the solutions must configure
a living organism of residence-scale where, in
addition to domestic spaces, there are areas
dedicated to social relations.
Extract From:
Arbizzani, E and Di Giulio, R. (eds.), Health
Assistance Residences-design and realization,
Maggioli editore, Rimini

EBD Journal: 1

Case Study 1:

Montemurlo Aged Care Facility

37