Architectural design for Dementia: Exploring alternate contemporary cultures of residential care design

Abstract

Architectural Design for Dementia: exploring alternate contemporary cultures of residential care design. The Alzheimer's Association (2018) projected the number of people living with a dementia diagnosis to surpass 2 million, reaching 1 in 37.5 of the population of the United Kingdom by 2051: up from 1 in 79 in 2015. This growth in rate and number coincides with an ageing population and a decline in the relative number of people able to care for the needs of people suffering difficulties associated with the symptoms of their diagnosis. The move to a residential care home is not only a viable but necessary step for many, and recent years have seen the growth in demand for and construction of residential care homes to provide residents with the specialist care and supervision that they need. The built environment has come to be recognised for its therapeutic and supportive role in the lives of people living with a dementia diagnosis, and a great wealth of recent knowledge showcases environmental factors that support cognition, mitigate perceptual difficulties, or assist with wayfinding in the home has amassed. Much of the architectural knowledge on the relationship between residents and their environment takes a medical stance, and a naturalised typology of residential care homes has arisen, as a result. This has led to concerns from some scholars that residents’ views and experiences in the home are underrepresented, as medical concerns take priority over their lived experiences or social opportunities. Notwithstanding the importance of the need for the environment to support residents’ safety and personal care, contemporary literature from the fields of social care and occupational health emphasises a person-centred approach in which the quality of residents’ experiences and personhood are prioritised alongside the treatment of their symptoms. There has been, however, little research into the influence of the built environment on the experiential quality of life in residential care, as well as in codesign processes that appropriately capture the views of residents on the delivery of residential care environments. This thesis describes the design and application of a research inquiry that seeks to address the question; how does the physical environment in residential care homes for people living with dementia diagnoses influence residents’ personal and social fulfilment? The inquiry is both critical and active and uses a Constructivist Grounded Theory approach to scaffold ethnographic and designerly methods. As a result, insights are constructed into both lived reflections and shared aspirational projections for supportive residential care environments. Transdisciplinary fieldwork was grounded in the lives of the occupants in two residential care homes in the West of England and uses a compliment of traditional qualitative methods, such as interview and observation, alongside disciplinary apparatus including, drawing and the construction of virtual environments, to the explore reflective environmental qualities, in which participants were instrumental in the construction of data and theoretical concepts. The thesis proposes theoretical and methodological outputs that contribute to new knowledge to emergent insights into the supportive role of the built environment in the lives of people living with a dementia diagnosis. Findings are framed in a theory model comprised of two core categories and five conceptual categories. Embodied characteristics frame experiential qualities of the built environment, and consist of liminalities, affordances, and enablement. Processual discrepancies frame perceived tensions between residents’ aspirations and perceptions of the environment and discuss ideological conceptions of space-time and veridictions. The theoretical outputs offer a model through which to explore other residential care settings, while the methodological outputs offer approaches for both researchers and designers looking to understand and develop supportive configurations of the built environment for vulnerable people.