Exterior space for patients with Alzheimer's disease and related disorders

Abstract

This paper examines program considerations for the design of exterior space for Alzheimer's disease patients. It is directed to planners and administrators, architects and landscape architects involved in the initial planning stages of an Alzheimer's disease facility (or nursing home) building project. The focus of the study is the Alzheimer's disease patient who is no longer able to attend to the activities of daily living (middle dementia), and therefore resides in a day care facility, a special unit, or a nursing home.

This paper outlines design schemes based on cognitive and behavioral symptoms of the disease. For example, sundowning (patient agitation and hallucination in late afternoon) is a common Alzheimer's diseases symptom. In order to ameliorate sundowning, the designer needs to provide not only familiarity and comfort, but also a way to minimize shadows that could be misinterpreted as frightening spectres. The exterior space should be located on the southeast side of the building in order to ensure only a monolithic building shadow cast into the garden by the afternoon sun. For this purpose, and a number of others discussed in the paper, siting is an important consideration in this design program. Considerations of agitation, frailty, loss of short-term memory, and reduced sensory perception suggest and control all elements of the design.

The study presents concepts and suggestions for creating outdoor activity and garden space for Alzheimer's disease patients. The outlined concepts may also be usefully employed in an already established facility. Creating exterior space that is safe and pleasant for Alzheimer's disease patients, as well as acceptable to adninistrators and visitors, is both a challenge and an attainable goal.

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References

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2. Calkns MP : Conversation with P Randall, 1990:4-4

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6. Kalicki: 134

7. Calldns (note 3:111) suggests the use of a plow and an old pump. We wonder if some of these items might be seen as fearful, a pump as a vulture, for example. For this sam reason, vines on walls may be seen as snakes. We are particularly cautious about these matters as the delusions have been describe by D Randall as occasionally extremely intense and extremely disturbing to the patient, to other residents and staff

8. Knoefel (note 5): We have noticed during our research, that doctors seem more willing to risk falls for the benefits of exercise, but that nursing staffs are hesitant to allow paients to walk unaccompanied. This emphasizes the need for careful selection of flooring and the, creation of a walking path.

9. Wooden handrails might be used because wood is warmer than metal. A square cross section might discourage gripping. Patients who grip a rail tend to stop and need to be brought back by the nursing staff.

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10. Funkenstein H : Brigham and Women's Hospital, Corespondence, 1989;12-12 wrote that plant ingestion is a symptom of the later stages of the disease, not of middle dementia.

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11. This description of the symptoms of Alzheimer's disease is based on The Office of Technology Assessment: Losing a million minds: Confronting the tragedy of Alzhimer's disease and other dementia Watington, U.S. Government Printing Office, 1987;passim

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12. Kimball P: Evanswood Facility for the Elderly, Kingston, Massachusetts, encouraged the use of bird feeders and bird baths as focal points. She was not coerned with possible fear of birds or the hazards of eating bird seed. Also, she did not see the use of water as a problem, either from a safety or a personal care standpoint. Other reviewers were cncemed with fear of birds, so our designs have evolved to include plants and seed to which only small song birds will be attracted.

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13. Burkhardt SSJ: Indian Summer, Unpublished, 1988

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