Designing for Neurodivergence: Principles for Supporting Dementia in the Built Environment
As the general demographic in the United Kingdom ages, there is a growing demand to approach the fundamental design of spaces with the needs of the elderly in mind. This is particularly important for those living with dementia and Alzheimer’s, as they require additional support to ensure a comfortable and safe living environment.
Currently, approximately 900,000 people in the UK are living with dementia, predominantly affecting individuals over 65. This statistic translates to 1 in 14 people aged over 65 and rises to 1 in 6 for those aged over 80. These figures underscore a substantial proportion of the population, emphasising the need for architecture to focus on inclusive design principles tailored for individuals with cognitive impairments.
The environment in which these individuals reside can significantly impact their quality of life. Design changes may start as minimal adjustments in early stages of the project lifecycle, but they can yield positive and direct benefits for the end-users, enhancing their well-being and comfort.
In this article, we will explore the available design guidance and key principles that can be utilised to create dementia-friendly environments. Before diving into these principles, let’s take a moment to understand what Alzheimer’s and dementia are and how they affect individuals.
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What is Dementia?
Dementia is a progressive group of symptoms caused by various diseases that damage the brain. These symptoms often start mild but worsen over time, categorising dementia as a neurodegenerative condition. Common symptoms include memory loss, confusion, difficulties with daily tasks, language issues, and changes in behaviour.
Importantly, dementia is not a natural part of ageing. It occurs when a disease damages nerve cells in the brain. Approximately 19 out of 20 people living with dementia have one of the four main types.
Alzheimer’s Disease
Alzheimer’s disease is the most prevalent form of dementia. The causes are complex, but one key factor involves the build-up of two substances in the brain known as amyloid and tau. When the brain’s conditions are disrupted, these substances clump together to form plaques and tangles, hindering proper brain function.
Over time, Alzheimer’s disease causes certain areas of the brain to shrink, reducing the levels of essential chemicals needed for effective communication between nerve cells. Eventually, this leads to significant issues with memory and cognitive functions.
Vascular Dementia
Vascular dementia is the second most common type of dementia and is characterised by symptoms such as difficulties with planning or organising, making decisions, solving problems, and following a series of steps (e.g., when cooking a meal). Individuals may experience slower thinking speeds, concentration issues, and sudden episodes of confusion. Early-stage symptoms can also include memory and language difficulties.
Various types of vascular dementia arise from problems with blood supply to the brain, leading to damage. The primary risk factor for vascular dementia is age, with the risk increasing after age 65.
Dementia with Lewy Bodies (DLB)
In dementia with Lewy bodies, tiny clumps of proteins known as Lewy bodies develop within nerve cells. This accumulation disrupts the levels of critical neurotransmitters, impairing communication between cells and eventually causing them to cease functioning. DLB typically develops over several years, often appearing as individuals approach old age.
DLB is commonly misdiagnosed, as it shares similarities with both Alzheimer’s and Parkinson’s diseases. Approximately 1 in 10 people with dementia have DLB.
Frontotemporal Dementia (FTD)
Frontotemporal dementia, sometimes referred to as Pick’s disease, is a less common form of dementia. It specifically damages the frontal and temporal lobes of the brain. FTD can be divided into two types:
- Behavioural Variant: This type causes behavioural and personality changes due to damage in the frontal lobes, which regulate emotions.
- Primary Progressive Aphasia (PPA): This variant affects areas responsible for word meaning and language storage, leading to significant language difficulties.
Symptoms of FTD can vary widely from those of Alzheimer’s disease. Common signs of the behavioural variant include loss of motivation, difficulty focusing, impaired decision-making, and reduced empathy towards others. In contrast, individuals with PPA may experience vocabulary loss, difficulty using familiar objects, altered speech patterns, and the use of shorter, fragmented sentences.
As we see above, dementia isn’t a simple and narrow cognitive disease, its impacts on behaviour and personality vary from person to person just as its severity does. If we collate some overarching symptoms of all 4 varieties we can start to piece together the design principles and how to action them in the built environment;
- Memory loss
- Problems with communication
- Misunderstanding what’s being seen
- Difficulty planning and organising
Dementia is a complex neurodegenerative condition that affects individuals uniquely, with symptoms ranging from memory loss and communication challenges to difficulties with planning and orientation. As the disease progresses, these symptoms can intensify, leading to behavioural changes, such as aggression, wandering, and sleep disturbances. Recognising the varied impact of dementia on cognitive, sensory, and physical abilities is essential in shaping environments that cater to these needs. The following design principles and guidelines aim to create spaces that provide safety, familiarity, and ease of use, ultimately enhancing quality of life for those living with dementia.
Guidance & Legislation
We can look to multiple sources of guidance and legislation to promote and support designing positive environments that prioritise safety, accessibility and well-being of those with dementia related diseases.
1. HBN 08-02: Dementia-Friendly Health and Social Care Environments (NHS)
Healthy Building Notes (HBN) draw together the best current knowledge for healthcare needs, regarded as best practice guidance and providing essential information on statutory and policy compliance it provides specific guidance for designing healthcare and care home environments that accommodate dementia patients.
The HBN 08-02 document outlines 12 core design principles categorised into Overarching, Sensory, Cognitive, and Physical principles. Below is a summary of these key areas:
Overarching Principles
Principle 1 – Provide a Safe Environment:
Safety is prioritised to minimise risks without using intrusive features that could cause frustration or agitation in dementia patients. Key safety elements include:
- Slip-resistant flooring with matte finishes to avoid glare and reduce falls.
- Contrasting handrails to aid visibility and offer support.
- Safe storage for hazardous materials, with low-contrast door finishes to reduce inappropriate access.
- Clear wayfinding cues to prevent disorientation and getting lost.
Sensory Principles
For those in later stages of dementia, sensory stimulation becomes essential as verbal communication decreases. Environments should be designed to support appropriate levels of sensory input:
Principle 2 – Provide Optimum Levels of Stimulation:
- Limit exposure to overwhelming stimuli such as busy, cluttered spaces or patterned floors and walls.
- Include multi-sensory environments like sensory rooms with tailored lighting, textures, and sounds to engage the senses.
- Design quiet zones and small lounges to prevent overstimulation and offer spaces for respite.
- Consider sensory gardens for safe outdoor sensory engagement.
Cognitive Principles
Dementia can impair memory, spatial awareness, and communication, making wayfinding and navigation challenging. Simplifying navigation is key for cognitive support:
Principle 6 – Support Wayfinding and Navigation:
- Use small-scale, straightforward layouts that reduce the need for memory-based decisions.
- Ensure proximity of related areas, such as kitchen, dining, and activity spaces.
- Avoid long, monotonous corridors and provide clear circulation routes without sudden direction changes.
- Use dementia-friendly signage that avoids abbreviations, places arrows close to relevant text, and incorporates personal items on doors to help residents identify personal spaces.
Physical Principles
As dementia progresses, physical functions like walking, standing, and eating become challenging, and individuals may struggle with nutrition and hydration.
Principle 12 – Support Diet, Nutrition, and Hydration:
- Maintain suitable lighting levels in dining areas.
- Create dining rooms with a family-style layout to encourage social interaction.
- Design areas for comfortable socialising that allow for easy mobility and access to support.
Core Design Features
HBN 08-02 specifies architectural features essential for dementia-supportive environments.
These recommendations cover:
- Construction elements: Ceilings, doors, flooring, walls, and windows should be designed with visual contrast and functionality to support mobility and accessibility.
- Enrichment elements: Thoughtful use of decoration, furniture, and signage can improve comfort and orientation.
- Technical aspects: Lighting, acoustics, and colour choices are essential. Natural light should be maximised with non-glare artificial lighting to reduce shadows, while acoustic treatments help manage noise levels.
This document emphasises creating familiar, homelike spaces with simple, clear signage to support navigation and non-slip flooring, accessible bathrooms, and support rails to enhance safety. By following these recommendations, designers can foster environments that support well-being, comfort, and safety for those living with dementia.
2. University of Stirling: Dementia Services Development Centre (DSDC) Environments for Ageing and Dementia Design Assessment Tool (EADDAT)
The Environments for Ageing and Dementia Design Assessment Tool (EADDAT), developed by the University of Stirling’s Dementia Services Development Centre (DSDC), is a three-tiered assessment tool designed to empower individuals and professionals in creating inclusive, dementia-friendly environments.
- Tier 1: This entry level is ideal for small-scale improvements in homes or small businesses, providing practical guidance on small changes, such as using contrasting colours, non-slip surfaces, and simplified wayfinding.
- Tier 2: Offering more detailed design features, this toolkit applies to a wide variety of building types and environments, including homes, businesses, healthcare facilities, and community spaces. It provides guidance on implementing dementia-friendly design features across various settings.
- Tier 3: The advanced level, still under development, will cater to healthcare providers, construction professionals, developers, and urban planners, aiming to incorporate dementia-friendly principles into large-scale projects.
Case Study: Kirklees Council Pilot
Kirklees Council piloted Tiers 1 and 2 of EADDAT in various redevelopment projects. Working with limited budgets, they prioritised wayfinding improvements within facilities. An assessment revealed that existing glossy, reflective signage was difficult to read in daylight. To enhance orientation, Kirklees implemented signage with a muted colour palette, such as charcoal grey with white symbols and numbers in close alignment, making navigation easier. Large, personalised room numbers and distinct colours were added to door entrances to help residents more easily locate their rooms, encouraging independence.
Case Study: Almondbury Library
At Almondbury Library, the council focused on creating a dementia-friendly environment by reducing stark lighting, which previously cast confusing shadows from bookshelves. Flooring was updated to support safe navigation, and large, simple-font signage with a matte finish was installed above bookshelves to reduce glare and improve readability.
03. University of Stirling: Good practice in the design of homes and living spaces for people with dementia and sight loss
These guidelines are based on findings from a study which aimed to assess the research evidence around what works well for visually impaired people with dementia in terms of the design of their homes and the things in them. The guidelines are intended to be used to make people’s ‘living spaces’ more supportive and accessible, whether those spaces are individual and family residences or the bedrooms, bathrooms and shared areas of care homes.
Using a simple tick system, this is a visual and descriptive document providing a useful and easy to follow instructive design guide.
04. BRE Dementia Friendly Home Project
The BRE Dementia Friendly Home Project is a demonstration home based on a refurbished 100-square-metre Victorian two-up, two-down house—one of the most common housing types in the UK. Adapted to cater to various types and stages of dementia, the house serves as a test bed for ongoing research on how buildings and technologies impact the health, comfort, safety, and dignity of individuals with dementia. According to BRE, it provides a platform for knowledge sharing between the healthcare and construction industries, focusing on improvements in health, wellness, and mental health.
Design Overview:
- Ground Floor: Designed for individuals with mild dementia, the open-plan space includes a living room, kitchen, dining area, dayroom, shower room, and storage.
- Upper Floor: Adapted for advanced stages of dementia, the upper floor features a main bedroom with a connected kitchenette and shower room, as well as a secondary bedroom for a carer or loved one.
Key features of the dementia friendly design
- Walkability throughout the house – including wheelchair access in all rooms with charging points located upstairs and downstairs. Space for a future lift installation has also been included. The lift would be able to carry an individual in a wheelchair plus one other person.
- Dementia friendly bathroom facilities – including a wet room downstairs and upstairs. There are also sight lines to the bathroom facilities across the house to make sure they are always easy to find.
- Stable furniture with rounded corners – used throughout the house to reduce risk of injury. The main bedroom upstairs and the ground floor dayroom also have hoist provisions.
- Improved artificial lighting – to improve visibility in the house.
- Line of sight to vegetation – so residents can always see greenery and nature outside of the property.
- Noise reduction features – including an isolated washing machine, to lower the chances of stress.
- Simple switches and heating controls – easy-to-use switches and safety sensors in high risks areas such as the kitchen.
Globally, there is a plethora of guidance and initiatives undertaken by many stakeholders. The initiative ‘HACK’ led by the Lien Foundation has gathered ideas in a catalogue format similar IKEA. Providing users a guide on improving, improvising and expanding care for persons with dementia.
Conclusion
The rising prevalence of dementia in the UK highlights the urgent need for inclusive, dementia-friendly design in both private and public spaces. Dementia costs society an estimated £19 billion annually, according to HBN 08-02, the number of people experiencing dementia will double in the next 30 years and the cost is expected to rise to over £50 billion in this time period. The scale of the problem today and its future impact means that the effects of dementia on society cannot be underestimated.
The design principles and guidance explored—from the BRE Dementia Friendly Home Project to the University of Stirling’s EADDAT tool—demonstrate that thoughtful architectural choices can profoundly improve the quality of life for those with dementia. By focusing on elements like safety, accessibility, sensory stimulation, and wayfinding, architects and designers can create environments that enhance autonomy, reduce stress, and promote well-being. As more stakeholders in healthcare and construction recognise the importance of these principles, dementia-friendly design will hopefully become an integral part of building standards, shaping spaces where all individuals can thrive with dignity and comfort.
If you haven’t yet caught up on the first part of this series, check out Part 1, Designing for Neurodivergence: Principles for Supporting ADHD and Autism in the Built Environment.
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References and Further Reading
HBN 08-02: Dementia-Friendly Health and Social Care Environments (NHS)
dementia.stir.ac.uk
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Author
Liam is a Chartered Senior Architectural Technologist at a leading architectural practice in Manchester. He serves as the CIAT Aspiration Chair for the Northwest region and tutors at the University of Salford. Liam regularly contributes to the Architectural Technology Journal.
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