Designing health care spaces for dementia

Patients with dementia and related diseases often are cared for in hospital settings, and the physical environment can serve to ease the patient experience, mitigate agitation and promote orientation to the environment. The following highlights three recent research studies that outline design considerations that not only serve to create therapeutic environments for dementia patients but may also support the general patient population.

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Center for Health Design Knowledge Repository

First, a team supervised by Leung studied dementia care facilities in Hong Kong to understand relationships between indoor visual environments and emotional and behavioral patterns in residents. Researchers invited residents with mild-to-moderate dementia symptoms to complete a survey. The team then interviewed staff to corroborate the survey findings. One hundred patients and 12 staff members participated across four sites.

Researchers found that although residents were often not satisfied with the size of their accommodations, their orientation and mobility were better in smaller spaces. They also noted that window views of nature and activity were welcome but could cause problems if street lights and noise disrupted sleep. The team also identified the benefits of recognizable doors and furnishings to help orient residents while creating a familiar, homelike environment. Finally, researchers reinforced the importance of lighting to aid vision, but in soft temperatures so as not to overstimulate.

Next, Talebzadeh and colleagues conducted an exploratory study to determine the feasibility of a sound-based intervention with dementia patients on a geriatric unit in Canada. The research team recorded baseline measures before randomizing eligible patients to either the intervention or treatment-as-usual condition. For the intervention group, intentionally selected therapeutic sounds were initiated remotely in the evening and early morning hours.

The team noted a reduction in the resisting-care subscale of the Pittsburgh agitation scale in the intervention group. While a small number of participants and COVID-19 challenges were study limitations, the team learned that soothing sounds had the potential to reduce patient agitation, and replicating the study on a larger scale would be feasible. They also identified the need for more direct measures of behavioral outcomes for future projects.

Finally, Ng and colleagues evaluated a newly renovated outdoor garden space at a psychogeriatric unit in Australia. The team used facility-level metrics, a staff survey and interviews with family members to assess the impact of the garden renovation. Survey responses revealed staff-perceived challenges to using the garden included lack of time and patient safety concerns, including the risk of falls, sunburn or other injuries, but hospital metrics demonstrated no new falls or behavioral disruptions within the renovated garden space during the six months after it opened.

Staff felt the garden provided beneficial activity and expanded sensory options, helping patients connect with nature, fresh air and sunlight. During interviews, family members commented that being outside helped link patients to their identities outside of the hospital, provided a sense of purpose and supplied both physical and cognitive stimulation. The authors recognized the need to balance garden features that support activity with safety.

Customizing care environments for dementia care can benefit all stakeholders. If you are interested in more research on designing for dementia, you can find articles on this and other health care design topics in The Center for Health Design’s Knowledge Repository. 

Research used for this column

The following research citations from The Center for Health Design’s Knowledge Repository of health care design resources were used by the author when writing this column:

• M. Leung, C. Wang and L. Li, “Impact of Indoor Visual Environment on Emotional and Behavioral Symptoms of Older People with Dementia,” Building and Environment, vol. 265, Nov. 1 (2024).
• A. Talebzadeh et al., “Effect of Soundscape Augmentation on Behavioural Symptoms in People with Dementia: A Pilot Randomized Controlled Trial,” Innovation in Aging, vol. 8, no. 9 (2024).
• L. Ng et al., “Impact of an Improved Outdoor Space on People with Dementia in a Hospital Unit,” Frontiers in Dementia, vol. 3, June 5 (2024).

About this column

“Design Discoveries” highlights research from The Center for Health Design’s Knowledge Repository, a user-friendly library of health care design resources. This research effort is supported by the American Society for Health Care Engineering, the American Institute of Architects, the Academy of Architecture for Health Foundation and the Facility Guidelines Institute. It can be accessed at healthdesign.org/knowledge-repository.

Yolanda Keys, Ph.D., R.N., EDAC, research associate, The Center for Health Design.