Designing for Alzheimer’s using the Goals of Universal Design

elderly woman walking using a walker with younger man walking along side her

Designing meaningful environments that help people thrive is a primary objective of Universal Design.  There is a growing body of evidence-based design research that demonstrates the many benefits resulting from a well-designed environment.  Particularly for individuals with Alzheimer’s disease, the built environment can act as a therapeutic tool.  Research shows there is a strong link between the environment and their behavior, in addition to the environment’s effect on quality of life issues.

As part of my graduate thesis work, I became specifically interested in the design features that support health and wellness for those with Alzheimer’s.  I researched memory care environments and how the design impacts resident behaviors and quality of life outcomes.  As part of the research, I was able to evaluate current design recommendations in a specific memory care facility to determine how these guidelines are working in practice.  I had the opportunity to spend time with and study the population of people I would be designing for, as a way to better understand their needs.  What I found through my research was that many of the design guidelines for memory care environments directly relate to the Goals of Universal Design.

According to Steinfeld and Maisel, “Universal design is a process that enables and empowers a diverse population by improving human performance, health and wellness, and social participation” (Steinfeld & Maisel, 2012).  The Goals of Universal Design© “define the outcomes of UD practice in ways that can be measured and applied to all design domains within the constraints of existing resources. In addition, they encompass functional, social, and emotional dimensions.”

The following is a list of the 8 Goals of Universal Design©, and what aspects of the memory care environment were found to pertain to them through the thesis research:

  1. Body Fit- Accommodating a wide range of body sizes and abilities:

The progression of Alzheimer’s disease varies greatly from individual to individual, and impacts everybody differently.  Some residents are ambulatory, while others, especially those at the later stages of the disease progression, may rely on walking aids.  The design of the facility takes these ranges into account by limiting the length of corridors and providing handrails throughout corridors for those who are unsteady.

  1. Comfort- Keeping demands within desirable limits of body function and perception:

Environmental features on site were evaluated based on desirable limits of both body function and cognitive function, recognizing the varying degrees of physical ability and cognition in the residents.  One example is the design of seating along the corridor, accounting for limits in body function by providing an opportunity for rest while walking if needed.  The provision of multi-sensory cues to increase understanding of the purpose of space supports cognitive function.  For example, multiple visual cues in the dining area include design elements that would typically be found in a residential kitchen to enhance familiarity.

  1. Awareness- Ensuring that critical information for use is easily perceived:

Supportive features and design considerations help counteract changes in cognition and perception caused by the disease progression.  Design features that allow environmental information to be received by the residents were evaluated.  These can include the provision of good wayfinding strategies and multi-sensory cues as part of the design.

  1. Understanding- Making methods and operation of use intuitive, clear, and unambiguous:

Ensuring the environment makes sense and is easy for the residents to use were important aspects of the design evaluation.  Specifically, design elements that are clear in operation and use have the potential to support independence and autonomy in residents were identified and evaluated.   Multi-sensory cues, such as residential characteristics, support understanding in addition to the goal of awareness.  These characteristics include a fireplace in the living room or dishes hung on the walls in the dining area.  Within the enclosed courtyard, the entrance back into the building has a portico that resembles a residential doorway, which has been shown to increase understanding of the door function.

  1. Wellness- Promote positive health outcomes for the residents through design:

This research acknowledged and emphasized the relationship between the environment and positive health outcomes for those with Alzheimer’s.  Design features that promote positive health were the basis for the evaluation, including large windows maximizing daylighting and access to the outdoors in the courtyard.  6. Social Integration- Treating all groups with dignity and respect:

Treating the residents with respect through appropriate design and opportunities for social interaction are essential to their wellbeing.  The importance of resident identity and dignity, and their relationship to care delivery and the design of the environment were addressed in the research.  One example, the memory boxes placed adjacent to the doorway of each resident room, allow residents to express who they are visually, through photos and images.  Another example are the multiple activity areas and outdoor courtyard, which provide different types of seating for both formal and informal  social interaction.

  1. Personalization- Incorporating opportunities for choice and the expression of individual preferences:

Residents with Alzheimer’s benefit from personalization in the environment as a way to help draw on their long term memory and maintain identity.  Design features that support individual preferences were identified on site.  For example, residents are able to personalize their rooms with their own furniture and decorations.  The memory boxes not only help residents personalize their space, they also aid in locating the room from the corridor.

  1. Cultural Appropriateness – Respecting and reinforcing cultural values and the social and environmental context of any design project:

The social and environmental context associated with residing in a locked unit plays a critical role in how the space can be designed to improve quality of life.  The research suggests that residents within memory care environments can be seen as a sub-culture; therefore it is important to understand their unique needs and values.

Although some may consider designing for individuals with Alzheimer’s as being specialized and unique, I found through my research that there were many similarities with universal design. I observed that the design recommendations directly relate to the Goals of UD, and therefore  are likely to positively impact a wider range of individuals.

For example, good wayfinding is one characteristic of the built environment that has been shown to reduce stress and help counteract cognitive decline in those with memory impairments.  Forming a mental map or an overall mental image of a space becomes increasingly difficult as the disease progresses.  However, if the design is straightforward and understandable, those with Alzheimer’s disease can more easily find their way.  Good wayfinding offers benefits to the staff and visitors as well, helping with orientation and navigation within the environment.  Memory care environments can be high stress and visits can sometimes be emotional for family members, so reducing confusion and disorientation has great benefits to all users.

Another example, physical and visual access to the outdoors, is critical to resident wellbeing. A connection to nature can alleviate feelings of confinement and break up the monotony of the indoor environment.  A secured courtyard provides residents in a locked unit with some level of independence if they are able to get outdoors when they want to. Outdoor access encourages movement, which in turn supports health.  However, these positive benefits also impact staff and visitors.  For staff members, the outdoor area can be an ideal location to relax or take a break, especially when the demands of working in memory care are stressful.  And for visitors, a courtyard is an ideal location to spend time with and participate in activities with loved ones.

While the design of these facilities should primarily benefit the residents, supportive and well-designed environments benefit all users.  Ensuring that we are including the needs of those with Alzheimer’s along with the wider population in the design process ensures that the environment is successful and usable by all.  And while designing for those who often times cannot communicate or express their needs is challenging, finding design solutions that provide positive outcomes is very rewarding.  In the case of my research, the time I spent on site with both residents and staff was invaluable, and has helped define the direction I wish to take as I enter professional practice.  Universal design acknowledges the power and positive impact our designs can have on all people, especially when those benefits improve the quality of life for populations who are often excluded from the design process.