By Marie Chan, CID, ASID, GREEN AP
As interior designers, we have the responsibility of making the interior environment not only an appropriate reflection of the client’s personal sensibilities but also create a space that protects the health, safety and welfare of the user.
We have a growing population of the cognitively challenged – be it from baby boomers diagnosed with Alzheimer’s disease or the 1.5 million suffering from traumatic brain injuries as a result of war or accidents.
Research shows the cognitively challenged can be more comfortable in their surroundings by engaging their 5 senses – Vision, Hearing, Taste, Smell, Touch, and improving accessibility through universal design. As interior design has the most impact on one’s visual sense, I’ll focus on how interior design affects the quality of life for those living with Alzheimer’s disease or traumatic brain injuries.
Vision & Light
Color is a major part of our vision. As we age, the lenses of the eyes yellow and affect our ability to distinguish between greens and blues, leading to more confusion.
The color shift becomes more acute for people over 50. Ironically, although the aging eye finds clear, highly saturated colors easier to see, medical and assisted living facilities tend to use ‘soothing’ palettes of blue, green and lavender. Since colors in the blue-violet range look the same to the elderly, they have a hard time discerning the different colors.
Glare on walls or floors negatively impact people with cognitive issues, as they can’t see the surfaces clearly due to the excessive reflected light. The pupils of the elderly also dilate and contract at a much slower rate, so looking repeatedly between light and dark surroundings can lead to disorientation.
Contrast is important for safety. Patients need clear demarcations between vertical and horizontal planes (such as stair treads and risers, walls & floors etc) so the perimeters of the space are easily defined. Similarly, it helps to have the toilet fixture stand out – an Alzheimer’s patient who fails to see a white toilet against white walls can result in hygiene issues!
Visual Cliffing is another interior design related hazard. Dark flooring appears to be a step down or cliff to the cognitively challenged and can result in their abruptly stopping in mid-stride. Minimizing this condition will be important to prevent falls.
Though people with cognitive issues are diverse, here are some lighting guidelines for that population:
Raise lighting level
Keep brightness consistent, but if level change is necessary, transition should be gradual
Combination of daylighting with electrical light – daylight exposure promotes Vitamin D, improves sleep quality, prevents depression & reduces agitation
Provide focused task lighting to supplement reading and writing tasks
Control lighting with dimmers or remote controlled window coverings are very helpful to the mobility impaired.
Sundowning is a psychological phenomenon associated with increased confusion and restlessness in patients with some form of dementia. For patients with sundowning syndrome, behavioral problems begin to occur in the evening or while the sun is setting. It is believed the development of plaques and tangles associated with Alzheimer’s disease might cause disruption within an area of the brain that controls the body’s internal clocks and hormonal activities which, in turn, appears to be affected by environmental cues such as daylight.
Sundowning syndrome symptoms may include, but are not limited to:
Increased general confusion as natural light begins to fade and more shadows appear.
Agitation and mood swings. Patients may be aggravated by noise.
Mental and physical fatigue with increased irritability.
Tremors may increase and become uncontrollable.
Experience increased restlessness while trying to sleep.
To prime the body for sleep, keep lower light level, in warm incandescent colors, or use color changing LEDs, from late afternoon
Avoid blue light from any device in the bedroom be they from TVs, alarm clocks or other appliances.