Judith Torrington

Quality of life and building design in residential and nursing homes for older people

Older people living in residential and nursing care homes spend a large proportion of their time within the boundaries of the home, and may depend on the environment to compensate for their physical or cognitive frailties. Regulations and guidelines on the design of care buildings have accumulated over time with little knowledge of their impact on the quality of life of building users. The Design in Caring Environments Study (DICE ) collected cross-sectional data on building design and quality of life in 38 care homes in and near Sheffield, Yorkshire. Quality of life was assessed using methods which included all residents regardless of their frailty, and staff morale was also assessed. The physical environment was measured on 11 user-related domains using a new tool, the Sheffield Care Environment Assessment Matrix (SCEAM). Significant positive associations were found between several aspects of the built environment and the residents’ quality of life. There was evidence that a focus on safety and health requirements could be creating risk-averse environments which act against quality of life, particularly for the least frail residents. Staff morale was associated with attributes of a noninstitutional environment for residents rather than with the facilities provided for the staff. The new tool for assessing building design has potential applications in further research and for care providers.

What has architecture got to do with dementia care?: Explorations of the relationship between quality of life and building design in two EQUAL projects

Two projects in the EQUAL programme explore aspects of the influence of building design on the quality of life of people with dementia. Design in Caring Environments (DICE) examined the quality of life of people in residential care homes in relation to building design features. INDEPENDENT (Investigating Enabling Environments for People with Dementia) is a current project with the aim of developing technologies to enhance quality of life by supporting enjoyable activities. One aspect of INDEPENDENT is an exploration of the interaction between spatial settings and meaningful activity, to highlight factors that support and enable activity and to identify barriers. Findings from both projects suggest that a more creative approach to the management of buildings would enhance the well‐being of residents; under‐use of facilities is common. Meaningful space that supports activity is therapeutic but spaces that give confused messages are common in buildings used by older people. Tools to evaluate buildings have a potential role in the long‐term management of facilities to help identify underused spaces, spatial confusion and barriers to activity. Quality of life was shown to be poorer in buildings that prioritise safety and health; buildings that support activity positively by providing good assistive devices, giving people control of their environment and affording good links with the community have a positive association with well‐being.

Designing technology to improve quality of life for people with dementia: user-led approaches

This paper addresses the design of assistive technology that specifically aims to support an improvement in the quality of life of people with dementia. Starting from interviews with users, a grounded theory approach was used to compile a wish list of issues important for maintaining quality of life. A large list of potential technologies that could address these issues was generated, and four were selected for initial development: a music player, a device to reduce social isolation, a conversation prompter, and a device to support sequences of tasks. The music player and social isolation device are described in this paper in detail. A user-led approach to their design was followed, including approaches to finding control interfaces that were intuitive for people with dementia. The paper concludes with a list of recommendations for designers looking to develop equipment of this kind.

Does the design of extra-care housing meet the needs of the residents? A focus group study

ABSTRACT The study objective was to explore the views of residents and relatives concerning the physical design of extra-care housing. Five focus groups were conducted with residents in four extra-care schemes in England. One focus group was carried out with relatives of residents from a fifth scheme. Schemes were purposively sampled to represent size, type, and resident tenure. Data were analysed thematically using NVivo 8. Two over-arching themes emerged from the data: how the building supports the lifestyle and how the building design affects usability. Provision of activities and access to amenities were more restrictive for residents with disabilities. Independent living was compromised by building elements that did not take account of reduced physical ability. Other barriers to independence included poor kitchen design and problems doing laundry. Movement around the schemes was difficult and standards of space and storage provision were inadequate. The buildings were too hot, too brightly lit and poorly ventilated. Accessible external areas enabled residents to connect with the outside world. The study concluded that, while the design of extra-care housing meets the needs of residents who are relatively fit and healthy, those with physical frailties and/or cognitive impairment can find the building restrictive resulting in marginalisation. Design across the dependency spectrum is key in meeting the needs of residents. Inclusive, flexible design is required to benefit residents who are ageing in situ and have varying care needs.

Quality of Life Technologies for People With Dementia

The article presents the results of user research into the quality of life in dementia and outlines priorities for research and development for technologies to enhance the independence and well-being of people with dementia. The article describes prototype music players—1 of 4 technologies currently under development by INDEPENDENT, a government-funded research project in the United Kingdom. The user research indicates that while a persons functional and cognitive deficits are of considerable importance, quality of life encompasses wider contextual issues, such as the physical, social, and technological environment, offering many avenues for technology and design interventions that may facilitate participation in everyday activities.

School design: opportunities through collaboration

This paper explores the process of involving the whole school community, especially teachers and students, in the design of schools. A series of semi-structured interviews were conducted with a range of professionals who have worked with target users in this development process. The interviews were transcribed and then common themes from each of the interviews were developed. Findings suggest that a host of opportunities arise from the special mix of different processes, professions and people involved in school design, but that these are not always being recognised or exploited. The need to acknowledge the opportunities which lie within the process and to not just be fixed on the product – the finished school – appears to be significant. It transpires that the perception of the process from the different perspectives of all involved has an impact on the way in which the process unfolds. The proposed outline model conceptualises the school design process as a collection of opportunities which can arise from collaborative working. Suggestions are made for further research.

User-led design of technology to improve quality of life for people with dementia

There has been quite a flowering of interest in exploring the design of assistive technology to support people with dementia. Just as with any other disability, there is a lot of scope for assistance through items of technology. Areas explored have varied from quite straightforward simple devices up to full-blown autonomous smart home installations (Orpwood, 2006; Bjoerneby, 1997). However, nearly all this work has aimed at improving the safety and security of people with dementia, and its impact on their quality of life has been a by-product (Marshall, 2001). This project reflected the need to address quality of life issues more directly through the design of appropriate technology (Orpwood et al., 2007).

Extra-care housing for people with sight loss: Lighting and design

The study investigated whether United Kingdom-based extra-care housing, which provides older people with individual dwellings, communal facilities and care support, complies with current guidance on design for people with visual impairment and satisfies the needs of residents with sight loss. A total of 41 apartments/bungalows in 11 schemes were surveyed and interviews conducted with the occupants. Participants’ comments suggest the current specialist guidance on design for people with sight loss is sound, although there is scope for additional guidance on aspect and daylight, which were highly valued. Little of this specialist guidance is included in mainstream design guidance, which might explain some deficiencies in extra-care housing, including low lounge and bedroom illuminances, few dimmer switches, and limited use of colour to enhance the legibility of spaces.

The Influence of Building Design on the Quality of Life of Older People

Design in Caring Environments is a study of residential care buildings for older people carried out by architects and psychologists from the Universities of Sheffield and Loughborough. The study is a search for evidence that building design influences the quality of life of residents and the quality of care given by staff. Thirty eight care homes were observed and analysed in terms of their physical and environmental provision in parallel with an assessment of the quality of life of a sample of the residents in each home. The research finds that building design does appear to have an impact on quality of life both positively and negatively. There are indications that a risk-averse culture leads to a diminished lifestyle, and that physically supportive environments are life enhancing. The implications for the design of residential buildings are the subject of this paper.