UNIVERSAL DESIGN IN HOUSING FOR PEOPLE WITH DEMENTIA

Universal Design is a method of design of our environment that integrates with it without causing vast or major
changes in the build. And which can be used by all the people without depicting any potential barrier.
Most often universal design is interpreted as Accessible (barrier-free) Design. But both are distinct in their area of
emphasis and the way they are implemented. An accessible design relies on a set of rules to make sure that the
majority of the population can access a space. It proposes a design focused on a particular group of people. Ex-
providing ramps for people who use wheelchair (Quinn, 2003).
On the other hand, Universal Design is a broader concept. It provides an accessible environment for everyone without
concerning about whether the person is disable or not (Quinn, 2003).

Abstract:
This paper introduces the key role placed by Universal Design in Housing for people with dementia and age related
difficulties. It raises the issue related to dementia specific design and provides solutions for the same. There are certain
guidelines to be kept in mind to create a dementia friendly environment so that the people suffering from it continue
living in their respective homes, without bringing about adverse changes in their normal lifestyle. These Guidelines
not only help the people with dementia but also their family members and carers.
The inclusion of cost-effective and real solutions is needed to promote independence and affordability.

BENEFITS OF UNIVERSAL DESIGN IN HOMES

We all have different lifestyles and it majorly depends upon our age, our family, finances or health. Universal Design
allows people to adapt themselves and enhance their quality of life at home. It provides a flexible approach but at the
same time improves comfort and supports independent living.
A Universally designed home proves to be cost-effective and energy-efficient by tackling and overcoming unfortunate
circumstances in a later stage of life. It reduces the need for re-fitting and other installations afterwards.
UNDERSTANDING THE ISSUES:
According to World Health Organization (2019), “Dementia is a syndrome – usually of a chronic or progressive nature
– in which there is a decrease in cognitive function (i.e. the ability to process thought) beyond what might be expected
from normal ageing” (World Health Organization, 2019). Dementia generally results from other diseases like
Alzheimer’s and is marked by a loss of memory, thinking, language and the ability to carry out regular activities. It
mostly affects people of older age groups. Some common symptoms include-
 Increased sensitivity to the environment
 Difficulty in learning new things
 Short term memory loses
 Reduced problem thinking ability
In the initial stages, these symptoms go unnoticed but progressively become unavoidable.
Ex - daily activities like eating, dressing, medication, washing become a real challenge. People with dementia might
also start showing other problems like mobility, visual and hearing. Most of which are age-related. Specific changes in
the built and social environment could prove to be useful to meet the necessities of people with dementia, their
families and carers. Before facilitating these changes, the Universal Design principles should be considered as the
environment has the ability to influence the symptoms related to dementia.

This approach should try to:

1. Increase self-confidence
2. Encourage social engagement
3. Identify and assign responsibility to family members
4. Promote assistive technology
Design issues in carrying out the task:
1. A sound and uninterrupted environment is not present everywhere
2. A sequential arrangement of different spaces in a house so that these spaces are easy to memorize
3. Provide a safe outdoor environment which is easily accessible and encourages usage of space. Each
environment should have visual connectivity from the indoors
4. Provide assistive technology for a safe and smoother workspace
5. Provide a good visibility to key areas of the house
6. Universal Design dementia-friendly features:
7. Dealing with the environment - provide acoustic barriers and conditions like orienting key spaces away
from the noise sources. Using natural environment to achieve the same or by placing plants and trees
near the source.
8. Mark the entrance through directional sense achieved by placing shrubs or by the use of distinct colors
at the entrance area. Ex - a bright colored front door
9. Use of a curtain as a disguise element at the door interior to restrict the person with dementia from
leaving the house at unsuitable times.
10. Ensure that natural light comes in without any obstruction and full view is maintained to the outside
11. Avoid shiny surface finishes like on floors and in the kitchen. Instead keep the floor surface plain and
matte colored.
12. Use glazed kitchen cabinets to provide visual access inside. Similarly provide visual access inside
wardrobe and cupboards
13. Maintain proper artificial lighting at key spaces like entrance and stairs (Tom Grey, 2015, pp. 8-9).

UNIVERSAL DESIGN APPROACH

The most important design consideration is the participatory design approach. It involves interaction with the people
associated with the person. This includes the occupants of the house, the person providing care, health experts,
neighbors and friends.

Approach during Construction phase:

Installing additional fixtures or bringing about changes in the existing one might result in anxiety and confusion in a
person with dementia. They might not remember the space as their own. So before carrying out this phase, make sure
that the person is living at some other convenient place that is noise-free.
DESIGN INTERVENTION AND ADAPTATION
1. Setting up signages, labels, planting. This doesn’t affect the existing house [minimum impact]
2. Assistive technology and telehealth is also a low-impact modification [low impact]
3. Replacing existing furniture’s either indoors or outdoors [medium impact]
4. Replacing existing windows for better acoustics, lighting and visibility [high impact]
5. Changing spatial layout of the rooms. This approach is large scale [highest impact] (Tom Grey, 2015, p. 19).

QUALITY FEATURES CONCERNING DEMENTIA-FRIENDLY HOUSING:

 LOCATION OF HOME
A house located closer to public services allows a person with dementia to carry out their daily activities with ease
using personalized elements like colored doors.
Consider these issues -
1. Orientation and navigation corresponding to public spaces
2. Protection from excessive disturbance
 1. The housing should be easily accessible and easily front the community.
Some people with dementia might have a feeling of getting lost and insecure at certain places. Eliminate these spaces
that make them feel insecure and vulnerable. Consider setting up centrally located housing for easier access and
security. The location should minimize travel distances to public amenities.
 PUBLIC FEATURES
1. Clear signage’s enhance way-finding, use of landmarks and grid-like street system
2. Minimize cluttered spaces
3. Low vehicular speeds, noise and volume
4. Improved lighting features that reduce glare and creates even illumination and keep the lighting at higher levels
5. Plantation of certain type triggers sensory connection through characteristic smell
6. Provision of ramps, handrails and steps at convenient locations. Handrails that are steel covered are cold and,
uncomfortable to touch. Instead, use wood or plastic coated rail to avoid it. The provision of low-heightened
rails at 600-750mm benefits other people too (Tom Grey, 2015, pp. 28-49).
 HOMES
While entering a house, make sure the door is located at a predictable or obvious place and is clearly visible and
distinguishable.
Brighter lighting at the entrance, placement of sun-shades to reduce shaded area results in a safe transition. It's been
proved that people restricted to or confined in a restricted environment like locked doors, are more expected to show
behavioral problems like frustration, anxiety, wandering. So it's best to set up an environment that gives them
independence and freedom.
But this approach is not always advisable. Try integrating assistive technology like door alarms, signaling the
occupants.
 INSIDE HOMES
Circulation within home must be unhindered with good visual access to the outside, ultimately encouraging the
person to go outside. Use large south facing windows with provision for controlled lighting for people sensitive to
bright lights.
Spaces can be differentiated by the use of colored walls, wall partition and screens.
Internally steps may pose a problem for people with dementia with mobility difficulties. Variation in steps, the wall
and the handrail in terms of material and color provides visual comfort and advantage
LIVING SPACE
Large open space providing unrestricted views to the outside
Avoid glare surface finishes
Avoid floor rugs as the person might tip over
Ensure that acoustic insulation is achieved through walls, ceilings, floors and windows. If possible provide direct
access from the living room to the outdoor space.
DINING ROOM
It should be in close proximity to the kitchen.
Overhead lighting helps in emphasizing the dining table and provides good lighting
Avoid glossy surfaces especially the utensils/cutlery and maintain visual contrast.
KITCHEN
Include an eating table within the kitchen area if possible.
Color contrast between countertops and flooring makes the space more organized and legible.
Use glazed kitchen cabinets, familiar kitchen fittings, non-glossy finishes.
Conceal hazardous appliances that can be used accidentally.5
BEDROOMS
Ensure full door swing and use a distinct color to make it more visible.
Proximity to the bathroom, wardrobes, and corridors should be kept in mind.
Different fixtures like switches, plug furniture should be more legible.
Replace light bulbs with LED’s to act as spotlights and highlight key areas.
Direct views to the WC from the bedroom give easier visual and physical access to it.
BATHROOMS
Create color contrast between walls and floor tiles.
Provide grab-bars at comfortable heights for people with mobility difficulties.
Wall mounted WC gives a more spacious feeling.
Avoid visual clutter by eliminating unnecessary fittings.
Use mechanical ventilation to remove bath steam.
Assistive technology like emergency pull-cords can help in case of a fall.
When natural elements like sound of nature- water, birds, animals and their painting and pictures, were provided along
with favorite foods and distracting conversation, it showed decreased agitation among people with late-stage dementia
(Whall A. L., 1997).
OUTDOOR SPACES
Easier access to provide opportunities to the person with dementia to do physical activities, get sunlight and
interaction with other people helps in improving their condition.
Covered spaces like overhangs, pergolas between outdoor and indoor provide smoother transition by reducing the
need for visual adaptation difficulties. Also it gives shelter from varying atmospheric conditions.
Familiar furniture placement, plantation and material presence helps in triggering long-term memory of the person.
Also the opportunity to grow plants acts as therapy for the person with dementia.
(Marshall, 1998)Has explored the issue of outside spaces in her paper stating that spaces like balconies and terraces
are a good way to access fresh air, daylight and views, especially when the person with dementia is living in a high-
rise building and it is inconvenient for him to access outdoor spaces.
COMMON SPACES
These spaces not only support the person with dementia but also their family members and carers. It acts as a retreat
space. A space should be provided that allows the person to have some privacy but at the same time has visual access
to key areas like the front door and stairs.
“If buildings and their carers relate to people living with dementia as individuals, support them and provide
opportunities for them to practice their remaining skills, then it most likely allows people living with dementia to work
at their greatest potential” (Innes, 2011).
FLEXIBILITY IN BUILDING CONSTRUCTION
It allows less radical disruptions in the built environment when modifications are carried out.
Material finishes are important in terms of safety, comfort and visual equality. Color, tone, texture, reflectance and
surface patterns are important for counteracting the effects of cognitive, memory and visual difficulties.
It is highly recommended to use plain colored walls to prevent fear, anxiety, delusions among people with dementia.
Include physical layout of the space at the entrance of the house to tackle short-term memory loss by pictorial or
graphic means.
ASSISTIVE TECHNOLOGY
Technology has laid roots in many housing units and it can be very helpful in assisting people with dementia. These
can be adjusted according to users’ needs. Ex - a day clock allows us to keep track of the time of day and orients the
person with dementia.
Panic buttons, door alarms, automatic taps and heat sensors are other examples. Installation of door alarms that
triggers on the opening of the front door at certain unexpected times.
Safety concerns -
Conceal exit points to prevent frustration
Alarm or sound system might not be suitable for some persons with dementia. So first make sure that person is
familiar with that system.
Hazardous areas like storage units could be concealed to restrict entry into that space.

“People with disabilities need to be educated to develop their knowledge and skills for individual-help, decision-
making, management and concern” (Shahrom, 2015).
Consult the family members before implementing these design features to get a better idea on how to approach people
with dementia and create a suitable targeted environment for the same.

Bibliography
Innes, A. (2011). Dementia care environments: Physical design, direct care delivery, and the wider
context of care. Journal of Care Services Management , 5 (3), 125-127, DOI:
10.1179/175016811X13020827976591.

Marshall, M. (1998). Therapeutic buildings for people with dementia. London: Journal of Dementia Care;
1998 .

Quinn, J. &. (2003). Universal Design in Housing: is it the answer for home design for the ageing
population?. ResearchGate.

Shahrom, S. &. (2015). Universal design in housing for people with disabilities: A review. Journal of
Design and the Built Environment , 15 (1), 33-42.10.22452/jdbe.

Tom Grey, M. P. (2015). Universal Design Guidelines: Dementia Friendly Dwellings for People with
Dementia, their families and carers. Retrieved from www.universaldesign.ie:
http://universaldesign.ie/Web-Content-/UD-DFD-Guidelines-Full-Document-non-acc-June-15.pdf

Whall A. L., B. M. (1997). The effect of natural environments upon agitation and aggression in late stage
dementia patients. American Journal of Alzheimer's Disease , 12 (5), 216-
220.https://psycnet.apa.org/doi/10.1177/153331759701200506.

World Health Organization. (2019, septemeber). Dementia - World Health Organization. Retrieved from
www.who.int: https://www.who.int/news-room/fact-
sheets/detail/dementia#:~:text=Dementia%20is%20a%20syndrome%20in,ability%20to%20perform%20
everyday%20activities.