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.  

 
 
 
 

To boost the high street, cities should invest in offices

Offices in Northampton. Image: Getty.

Access to cheap borrowing has encouraged local authorities to proactively invest in commercial property. These assets can be a valuable tool for cities looking to improve the built environment they offer businesses and residents.

Councils are estimated to have spent £3.8bn on property between 2013 and 2017, funded through the government’s Public Works Loan Board (PWLB) at very low interest rates. Offices accounted for half of this investment, and roughly a third (£1.2bn) has been spent on retail properties. And local authorities were the biggest investor group for UK shopping centres in the first quarter of 2018.

Why are cities investing? There are two major motivations.

First, at a time when cuts are squeezing council revenue budgets, property investments can provide a long-term revenue stream to keep quality public services up and running. Second, ownership of buildings in areas marked for redevelopment allows councils to assemble land more easily and gives them more influence over the changes taking place, allowing them to make sure the space evolves to meet their objectives.

But how exactly can cities turn property ownership into successful place-making? How should they adapt the buildings they invest in to improve the performance of the economies?

Cities need workers

When developing the city’s property offer, the aim should be to get jobs back into the city centre while reducing the dominance of retail space. For councils who have invested in existing retail space and shopping centres, in particular, the temptation may be to try and retain their existing use, with new retail strategies designed to reduce vacancies.

But as the Centre for Cities’ recent Building Blocks report illustrates, the evidence points to this being a dead-end. Instead, cities may need to convert the properties they own so they house a more diverse group of businesses.

Many city centres already have a lot of retail – and this has not offered significant economic benefit. Almost half (43 per cent) of city centre space in the weakest city economies is taken up by shops, while retail only accounts for 18 per cent of space in strong city centre economies. And many of these shops lie empty: in weaker city centres vacancy rates of high-street services (retail, food and leisure) are on average 16 per cent, compared with 9 per cent in stronger city economies. In Newport, nearly a quarter of these premises are empty, as the map below shows.

The big issue in these city centres is the lack of office jobs – which are an important contributor to footfall for retailers. This means that, in order to improve the fortunes of the high street, policy will need to tackle the barriers that deter those businesses from moving to their city centres.

One of these barriers is the quality of office space. In a number of struggling city centres, the quality of office space on offer is poor. But the low returns available for private investors mean that some form of public sector involvement will be required.


Ownership of buildings gives cities the opportunity to reshape the type of commercial space on offer. Some of this will involve improving the existing office stock available, some will involve converting retail to office, and some of will require demolishing part of the space without replacing it, in the short term at least. Without ownership of the land and buildings on it, this task becomes very difficult to do but will be a fundamental part of turning the fortunes of a city centre around.

Cheap borrowing has provided a way not only for local authorities to generate an income stream through property investment. but also opens up the opportunity to have greater control over the development of their city centres. For those choosing to invest, the focus must be on using ownership to make the city centre a more attractive place for all businesses to invest, rather than hoping to revive retail alone.

Rebecca McDonald is an analyst at the Centre for Cities, on whose blog this article first appeared.