Recently, I had the opportunity to speak to an audience of architects, owners, researchers and practitioners at the Healthcare Design Conference in San Diego. This year we focused on environments for geriatric, dementia and psychotic patients. This was an interesting mix of ideas and I am going to try to summarize my comments here.
I have been thinking a lot about design for aging populations since a recent conversation with a client who told me that his gero-psychiatric unit was now using 55 years-old as the age threshold. I was shocked by that. After all, people are living longer, working longer. In my mind I don’t even imagine 65 as old anymore (maybe because I am getting older myself). His reason was the increase of dementia in that age group. That got me thinking.
I did some research and learned that Early Onset Dementia has been reported in patients as young as their 30s. Nobody would put a 30 year old in a geriatric unit. Maybe we are looking at this all wrong.
The reality is that elder patients have specific needs, which is why they have a dedicated unit in most psychiatric facilities and why there is a host of healthcare settings focused specifically on aging patients. We know that these patients usually have myriad health issues because the health of the body declines rapidly as we age. In many cases, the spatial and operational methods for treating this population are so similar to the treatment of dementia that they are seen as the same unit.
I asked a clinician recently this question, “Where would you place a 70 year old marathon runner in excellent physical condition, with lots of energy and no chronic illnesses except for bipolar disorder?” The answer without even thinking: “Geriatric unit – over 65.” That guy is going to be a nightmare for the staff in a gero unit and they are going to find it difficult to get him well in that environment.
So what if we designed these spaces for symptoms instead of age?
What do we know about the design of these spaces? We know that older patients generally need community time. They improve with more person to person contact and thrive when given a sense of community. The environment found in a gero unit or in a nursing home or other elder facility can be therapeutic for them if it is successful in connecting them with other humans. Dementia patients also benefit from socialization, but they are much more sensitive to over stimulation and the human contact is better in one on one interactions or very small groups. Does that sound like two populations who have the same programmatic needs?
There is a difference between patients who are suffering from a variety of physical ailments and chronic conditions which affect their quality of life and those that have a cognitive disability which affects their ability to perceive and react to life. If we treat them as the same patient, we do a disservice to both. As designers, we need to ask our clients hard questions and understand who will really be treated in the facility so we can create spaces that will enhance healing and quality of life for all of the patients.