How innovative home design could revolutionise dementia care – and even slow down symptoms

The Alzheimer’s Respite Centre. Image: Nick Kane.

When a clip from Dominic Sivyer’s Grandad, Dementia and Me documentary went viral on Facebook last year, I found it really touched a nerve. Like many who shared the video, I’ve known a dementia sufferer. Like many, I’ve suffered the heartbreak of a blank, unrecognising stare from a family member. 

Today, there are roughly 850,000 people living with dementia in the UK, each surrounded by family and friends also bearing the costs – emotional and otherwise – of the debilitating condition. With an ageing population, that number is expected to reach over a million by 2025, yet cash for research and quality of care is still desperately lacking.

As recently as this year, reports suggested that up to a third of dementia patients in the UK are not receiving full, adequate care. Year on year, more sufferers unnecessarily end up in A&E during the final year of their lives. Frequently, the confusion and distress inherent in these visits proves fatal.

The complacent hope is that we’ll have figured out a cure by the time these numbers reach crisis level. While this is, of course, possible, it’s by no means guaranteed. Without a miracle drug on the horizon, it may be time to get creative. For architects like Niall McLaughlin and Yeoryia Manaloupoulous, this means turning to tailored architecture and home design for a solution.

It sounds deceptively simple, but researchers and architects in this niche area have hit on something that has the potential to revolutionise dementia care. Dementia-friendly design, astoundingly, has the power not only to improve the lives of sufferers and cut costs, but also to decelerate symptoms.

Losing Myself, at the 2016 Venice Biennale. Image: Nick Kane.

Through “Losing Myself”, an interactive piece at the 2016 Venice architecture exhibition Biennale, McLaughlin and Manaloupoulous explored this idea at length. Their exhibit was a reflection upon their dementia-friendly “Alzheimer’s Respite Centre”, built in Dublin back in 2010, and invited gallery-goers to traverse a projection that played scrambled moving images of the building, while speakers blared a cacophony of overlapping voices. The idea was to immerse the audience in the experiential qualities of dementia that make wayfinding, spatial orientation and remembering so difficult.

A poignant experience, yet creating empathy with the sensory world of sufferers was just a starting point for these architects. At the Alzheimer’s Respite Centre, this understanding of a dementia patient’s cognitive and perceptive reality precluded every architectural and design choice in and outside of the building. Swirly patterning can appear in motion to sufferers, so interior design is kept deliberately plain. Dementia patients often get confused about where they are and what time of day it is, which designers hope to combat with large windows throughout the centre to let in natural light.


Were you to visit and walk around the garden, you’d eventually notice that every path loops naturally back to the main building, allowing patients to wander independently without getting lost. Toilets visible from the bed remind patients where they are, so that in the morning – when they’re likely to need it – they can access the bathroom without help.

Such features play a key role in improving sufferers’ quality of life, facilitating independence and avoiding the dreaded “institution” atmosphere. But the really revolutionary aspect of dementia-friendly design, of course, is its potential to actually alleviate common symptoms. Several American studies have backed this theory; recording, amongst other things, less aggressive behaviour and longer sleep duration in patients who are exposed to greater amounts of natural light. One even found that patients living in a facility with long corridors (making wayfinding more difficult) had more advanced psychiatric symptoms after a six-month period than those living in a more easily navigable “L”-shaped space.

McLaughlin and Manaloupoulou aren’t the only ones to see the potential benefits. Just last year, Scottish architect David Burgher developed a virtual reality tool that allows users to experience the visual impairments of a dementia sufferer, hoping that better understanding of the condition will breed better architecture. Liverpool John Moores’ ongoing “design for dementia” research project aims to set new architectural standards for dementia design, speculating that it may eventually become possible to adjust existing homes for sufferers rather than building new ones. With so many patients wishing to remain at home for as long as possible, researching, funding and implementing dementia-friendly design could be a lifeline for thousands as we continue to search for a cure.  

 
 
 
 

What's actually in the UK government’s bailout package for Transport for London?

Wood Green Underground station, north London. Image: Getty.

On 14 May, hours before London’s transport authority ran out of money, the British government agreed to a financial rescue package. Many details of that bailout – its size, the fact it was roughly two-thirds cash and one-third loan, many conditions attached – have been known about for weeks. 

But the information was filtered through spokespeople, because the exact terms of the deal had not been published. This was clearly a source of frustration for London’s mayor Sadiq Khan, who stood to take the political heat for some of the ensuing cuts (to free travel for the old or young, say), but had no way of backing up his contention that the British government made him do it.

That changed Tuesday when Transport for London published this month's board papers, which include a copy of the letter in which transport secretary Grant Shapps sets out the exact terms of the bailout deal. You can read the whole thing here, if you’re so minded, but here are the three big things revealed in the new disclosure.

Firstly, there’s some flexibility in the size of the deal. The bailout was reported to be worth £1.6 billion, significantly less than the £1.9 billion that TfL wanted. In his letter, Shapps spells it out: “To the extent that the actual funding shortfall is greater or lesser than £1.6bn then the amount of Extraordinary Grant and TfL borrowing will increase pro rata, up to a maximum of £1.9bn in aggregate or reduce pro rata accordingly”. 

To put that in English, London’s transport network will not be grinding to a halt because the government didn’t believe TfL about how much money it would need. Up to a point, the money will be available without further negotiations.

The second big takeaway from these board papers is that negotiations will be going on anyway. This bail out is meant to keep TfL rolling until 17 October; but because the agency gets around three-quarters of its revenues from fares, and because the pandemic means fares are likely to be depressed for the foreseeable future, it’s not clear what is meant to happen after that. Social distancing, the board papers note, means that the network will only be able to handle 13 to 20% of normal passenger numbers, even when every service is running.


Shapps’ letter doesn’t answer this question, but it does at least give a sense of when an answer may be forthcoming. It promises “an immediate and broad ranging government-led review of TfL’s future financial position and future financial structure”, which will publish detailed recommendations by the end of August. That will take in fares, operating efficiencies, capital expenditure, “the current fiscal devolution arrangements” – basically, everything. 

The third thing we leaned from that letter is that, to the first approximation, every change to London’s transport policy that is now being rushed through was an explicit condition of this deal. Segregated cycle lanes, pavement extensions and road closures? All in there. So are the suspension of free travel for people under 18, or free peak-hours travel for those over 60. So are increases in the level of the congestion charge.

Many of these changes may be unpopular, but we now know they are not being embraced by London’s mayor entirely on their own merit: They’re being pushed by the Department of Transport as a condition of receiving the bailout. No wonder Khan was miffed that the latter hadn’t been published.

Jonn Elledge was founding editor of CityMetric. He is on Twitter as @jonnelledge and on Facebook as JonnElledgeWrites.