Scroll Down Scroll Up

Dementia and environmental design

Evidence-based design principles to improve the built environment to assist in delivering safe, respectful and dignified support.
By Meredith Gresham PhD, Occupational Therapist


The environment around us has a profound effect on how we function and our quality of life. This magnifies as we age. Think of how well-maintained footpaths or escalators can make the difference to getting around if mobility is an issue.

For people with dementia, the environment has even more influence over function and well-being. It can make or break daily activities from finding your way around to using the toilet. Living in a hotel environment is fine for a holiday, but when the ability to make a cup of tea when you want one or tinker in the shed is taken away, much joy in life disappears.

The Australian Government is acting upon a recommendation of the Royal Commission into Safety and Quality in Aged Care to improve the design of residential caged care. The Government is using evidence-based principles to improve the built environment to assist in delivering safe, respectful and dignified support.

There are four key principles.

1. The environment should enable people who live and work in aged care to experience well-being, maintain a sense of identity and promote health. Some of the design guidelines include:

    • making the environment simpler by decluttering (but not taking away items of personal value that help keep a person’s identity)
    • improving light levels as the older eye does not get as much light as younger people’s eyes
    • providing seating that enables people to sit and stand more easily and with safety; and
    • highlighting objects that need to be seen, such as contrasting colours for taps and toilet seats.

2. Create a home, not an ‘institution’. Traditionally nursing homes were designed like hospitals, focussing on delivery of care and not on the experience of living. This principle emphasises home-like designs that enable normal daily activity to occur. Guidelines include small house design of 15 residents or fewer with domestic kitchens, private bedrooms with ensuite bathrooms and usual domestic style of furnishing. Staff rooms and clinical equipment are kept discreetly out of sight.

3. Ensure people who live in aged care have access to the outdoors. Research showspeople in nursing homes, especially when not independently mobile spend almost all of their time indoors. This principle ensures a dedicated and inviting outdoor space that is easy to access, move about in and has a range of activities that invite participation – such as a BBQ area, suitable outdoor seating, a clothesline, raised garden beds and a potting shed.

4. Design spaces to give opportunities for residents to socially interact with one another as well as welcoming in or getting out into the local community. Many people in aged care have no or highly infrequent visitors. Isolation and loneliness are huge risks. Some aged care homes run child-care centres or have intergenerational programs with local primary schools. Some homes have windows over-looking the street while others have an on-site café that invites the public and residents alike to enjoy. Design is important to enable these or other activities that integrate the home into the community.

The report demonstrates how design plays an important role in health and well-being. Access the Final Report on Draft National Aged Care Design Principles and Guidelines


Dementia enabling design at home

Design is also important in your own home to help people with dementia to function at their best. Alzheimer’s WA has an interactive website that allows you to click through rooms of a house or apartment to see what changes you can make to create a more dementia-friendly space. Visit Enabling Environments for more information