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.  

 
 
 
 

In many ways, smart cities are really very dumb

Rio de Janeiro’s control centre. Image: Getty.

It’s not news that anything and everything is increasingly being prefaced with “smart”: phones, watches, homes, fridges, and even water (yes, smartwater exists). And it’s not unintentional either. 

Marketeers know that we, the public, are often stupid enough to believe that thanks to their technology, life is better now than it was way back in, say, the primitive Nineties. Imagine having to, like a Neanderthal, remember how to spell words without an autocorrecting algorithm, or open the fridge door to check if you’d run out of milk, or, worse still, interact with actual people.

So it’s hardly surprising that we’re now also witnessing the rise of the so-called “smart cities”; a concept which presupposes that cities that are not technologically  “smart” are dumb, which, as anyone interested in the millennia-old history of cities — from the crypto-currency grain storage algorythms of ancient Mesopotamia to the complex waste infrastructure of ancient Rome, to London’s public transport infrastructure — will know, is not true.

Deployed in these smart cities are cameras and other networked information-gathering devices, load cells and other “sensing devices” detecting passing pedestrians and vehicles, audio surveillance devices listening for gunshots – and even vending machines equipped with biometric sensors to recognise your face. This is not to mention beacon technology — tiny anonymous looking black boxes hidden in trees and on lampposts — which transmits advertising, offers and other information directly to smart phones in the vicinity. 

If that doesn’t seem sinister enough, take, for example, Rio de Janeiro, where, in 2014, the International Business Machines Corporation designed a mammoth “control centre” that integrates data from 30 agencies for the city’s police. 

Described by the Guardian as having “the functionality of a Bond villian’s techno lair”, the then local mayor, Eduardo Paes, claimed the centre was making the city safer while using technology to deploy its “special” police unit to carry out the state’s “pacification programme”. Launched in 2008, the programme, which aims to push out drug gangs from Rio’s favelas, has been criticised by Amnesty International: “in January and February 2017 in Rio de Janeiro alone, at least 182 people were killed during police operations in marginalized neighbourhoods (favelas) – a 78 per cent increase in comparison to the same period in 2016”.

Sinister or not, as smart cities grow, they create new problems. For example, as urbanist Adam Greenfield writes in Radical Technologies: The Design of Everyday Life, neither the algorithms nor their designers are subject to the ordinary processes of democratic accountability – a problem that international academics are currently attempting to tackle.  


“We need to understand that the authorship of an algorithm intended to guide the distribution of civic resources is itself an inherently political act,” writes Greenfield. “The architects of the smart city have utterly failed to reckon with the reality of power.”

The Real Smart Cities project, founded by Dr Gerald Moore, Dr Noel Fitzpatrick and Professor Bernard Stiegler, is investigating the ways in which so-called “smart city” technologies present a threat to democracy and citizenship, and how digital tools might be used create new forms of community participation.

Fitzpatrick is critical of current discourses around smart cities, which he says “tend to be technical fixes, where technology is presented as a means to solve the problems of the city.” The philosophy underpinning the project is “that technologies function as forms of pharmacology”, he adds, meaning that they can be both positive and negative. “The addictive negative effects are being felt at an individual and collective level.” 

An example of this lies in the way that many of these smart cities replace human workers with disembodied voices — “Alexa we need more toilet roll” — like those used to control the Amazon Echo listening device — the high priestess of smart home. These disembodied voices travel at the speed of light to cavernous, so-called “fulfilment centres”, where an invisible workforce are called into action by our buy-it-now, one-click impulse commands; moving robotically down seemingly endless aisles of algorithmically organised products arranged according to purchase preferences the like of which we never knew we had — someone who buys a crime novel might be more likely to go on and buy cat food, a wireless router, a teapot and a screwdriver. 

Oh to be the archeologists of the future who while digging through mounds of silicon dust happen upon these vast repositories of disembodies voices. That the digital is inherently material and the binary of virtual/real does not hold — there is no cyberspace, just space. Space that is being increasingly populated by technologies that want to watch you, listen to you, get to know you and sense your presence.

One project looking to solve some of the problems of smart cities is that of the development of a “clinic of contribution” within Pleine Commune in greater Paris (an area where one in three live in poverty).This attempts to deal with issues of communication between parents and children where the widespread use of smartphones as parental devices from infancy is having effects on the attention of young children and on the communicative abilities between parents and children. 

This in turn forms part of a wider project in the area that Stiegler describes as “installing a true urban intelligence”, which moves beyond what he sees as the bankrupt idea of smart cities. The aim is to create a “contributory income” in the area that responds to the loss of salaried jobs due to automation and the growth and spread of digitisation. 

The idea being that an income could be paid to residents, on the condition that they perform a service to society. This, if you are unemployed, living in poverty and urban deprivation, sounds like quite a simple and smart idea to try and solve some of the dumb effcts of the digital technology that's implemented in cities under the ideology of being “smart”.