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.  

 
 
 
 

It’s time to rethink how the British railway network works

Nothing doing: commuters await a long-delayed train. Image: Getty.

The recent meltdowns on Northern and Thameslink not only left many passengers besides themselves with frustration about not being able to get to work on time, if at all. It also led to a firestorm of criticism and condemnation from politicians and media alike.

With the immediate shock of that first Monday morning of the meltdown passed, there’s a now a bigger debate about whether the way that rail services are provided for cities needs some far reaching reform. But before coming to that, the first thing to say – and as we set out in our Rail Cities UK report, launched today – is that the fundamentals for urban rail remain very strong.

Here’s why. All cities want to become denser, more dynamic places which attract the best people to the growth sectors of the economy (including the ‘flat white economy’ of media, communications and information). In order to achieve this, as well as to improve air quality, cities are also reducing space for motorised traffic in favour of space for people.

It’s very difficult to see how this can be achieved without expanding rail networks and their capacity. What’s more, if housing need is to be met without creating more sprawl and traffic congestion, then again its rail that will be key – because it opens up former rail-connected brownfield industrial sites, it extends commuting range, plus housing can be built above or around new or existing rail stations and interchanges.

In some ways there’s nothing new here. From Metroland to Docklands, successful cities have always grown with their rail networks. And to be fair, there is significant investment going into urban rail at present. Northern will get a lot better (the pacers are doomed) and both Merseyside and Tyne & Wear are getting a whole new fleet of trains for their urban rail networks.

However, much (but not all) of this investment is incremental, or replacing rolling stock on its last legs. It stops short of the wider vision for the rail cities that we need.


What would that look like in practice? There comes a point when the biggest cities need more cross-city routes, because running trains in and out of edge-of-centre termini can’t cope with the numbers. That explains the push for Crossrail 2 in London, but also the need for more cross-city capacity in cities like Birmingham (on the Snow Hill route) as well as in Manchester (on the Oxford Road to Manchester Piccadilly corridor, as well as a potential new underground route).

Tram-train technology can also help – allowing the lucky commuter that benefits to get on board at their local station and get off right outside their city centre office on main street in the city centre, rather than piling out at a Victorian railway terminal on the edge of that city centre.

Tram-trains aren’t the only tech fix available. Battery packs can extend the range of existing electric trains deeper into the “look ma, no wires” hinterlands, as well as allow trams to glide through city centres without the expensive clutter of overhead wires.

More mundane but equally useful work to increase capacity through signalling, station, track and junction work offers the opportunity to move to turn-up-and-go frequency networks with greater capacity and more reliability – networks that start to emulate the best of what comparable German rail cities already enjoy. Interlocking networks of long distance, regional express, regional, S-bahn, U-bahn, trams and buses, all under common ticketing.

But in talking about Germany and common ticketing I am now getting back to where I started around the debate on whether some fundamental change is needed on how urban rail networks are provided. Obviously there is a bigger national discussion going on about whether the current structure is just too layered, with too many costly interfaces and too fractured a chain of command. And in addition another, on whether the railway should be publicly or privately owned and operated.

But it’s been heartening to see the growing recognition that – regardless of how these debates are resolved – more devolution for urban and regional services should be part of any solution. That’s not only because fully devolved services have been out-performing comparators both operationally and in passenger satisfaction; it’s because local control rather than remote control from Whitehall will mean that the dots can be joined between rail and housing, between rail and the wider re-fashioning of city centres, and between rail and local communities (for example through repurposing stations as wider hubs for local community use, enterprises and housing). It will also allow for rail and the rest of local urban public transport networks to be part of one system, rather than be just on nodding terms as is all too often the case at present.

The crisis on Northern and Thameslink has been a miserable experience for rail users, affected cities and the rail industry. If any good has come out of it, it is that it shows how important rail is to cities, and opens up a space for some bigger thinking about what kind of rail cities we will need for the future – and how best we can make that happen.

Jonathan Bray is the Director of the Urban Transport Group which represents the transport authorities for the largest city regions. You can read the group’s full report here.