The History and Future of Design for Dementia in Long-term Care Environments: An Application of Theory and Evidence-Based Design Strategies.

Presented by: Migette Kaup

Interior design has the power to dramatically impact the quality of the experiential nature of any place-type. This impact can be exponentially increased for individuals who rely on good design to assist them with basic functional capacities that maintain their dignity and quality of life. One such place-type is long-term care. These environments provide housing and supportive health-care for the frailest of residents. For a majority of these institutionalized elders cognitive loss is a significant factors of daily life (US Census Bureau, American Community Survey, 2008). These cognitive declines can often result in maladaptive behaviors that must be managed. In the late 1980’s and early 1990’s (circa) health-care providers (in America) moved aggressively to reduce or eliminate restraint-based procedures to control unwanted or undesirable behaviors. These efforts spurred the recognition of the role of the built environment and specifically the design of the interior as an effective agent in reducing the negative aspects of cognitive decline. There is now a strong body of research and assessment on environments specifically for persons with dementia that includes several well-known instruments such as the Therapeutic Environment Screening for Nursing Homes (TESS+, TESS-NH) (Sloane & Mathew, 1990; Sloane et al., 2002) the Professional Environmental Assessment Protocol (PEAP) (Lawton, et al., 2000) the Environmental Audit Tool (EAT) (Fleming, 2010), and most recently, the Residential Care Environmental Assessment (RCEA) (Topo, Kotilainen & Eloniemi-Sulkava, 2012). These instruments have contributed to evidence that specific design features are beneficial to supporting care for individuals with dementias (Marquardt, Bueter, Morzek, 2014). For examples, research has measured the implications of the physical and social environment and have consistently demonstrated a strong correlation between reduced agitation and the design of the interior environment that supports continuity of self through meaningful artifacts and opportunities for personalized spaces (e.g. Sloane et al, 1998; van Hoof, et al., 2010). A review of seminal literature (e.g. Cohen & Weisman, 1991) and current research findings ( e.g. Lee, Chaudhury, & Hung, 2014) on design for dementia care provides theoretical foundations and current research paradigms for understanding the therapeutic role of the built environment in segregated applications. There is, however, a continued debate about segregation versus integration (e.g. Calkins, 2008; Weyerer, Schaufele, & Hendlmeir, 2010) and, to date, there is little to no evidence that with appropriate attention to therapeutic (interior) design that elders with dementia cannot be equally served within integrated settings. This will be an increasing important question to explore as individuals and their families will press for the right to age in place even within planned care institutions. This poster presentation will provide a reflective history of the research in environmental gerontology that has contributed to the current understanding of the therapeutic role the physical environment plays in supporting the care of those with cognitive challenges in long-term care settings. Pictorial, diagrammatic, and narrative case studies of purpose-built special care units (e.g. the Philadelphia Geriatric Center, The Corrine Dolan Center, and Woodside Place) will demonstrate the history of dementia care and design intervention that has fostered evidence-based design thinking to facilitate a more person-centered approach to caring for someone with cognitive loss. Seminal literature (e.g. Cohen & Weisman, 1991) and current research findings (e.g. Lee, Chaudhury, & Hung, 2014) on design for dementia care will be summarized to provide theoretical foundations and current research paradigms for advancing the understanding the therapeutic role interior environment on dementia care. Areas for future research will be posited for discussion.


  • Calkins, M. P. (2008). Contemporary issues for environmental research in long-term care settings. HERD 1(2). 60-64.
  • Cohen, U. & Weisman, G. D. (1991) Holding onto home: Designing environments for people with dementia. Baltimore: MD. The John Hopkins University Press.
  • Fleming, R. (2011). An environmental audit tool suitable for use in homelike facilities for people with dementia. Australasian Journal on Ageing, 30(3), 108-112.
  • Marquardt, G., Bueter, K., & Motzek, T. (2014). Impact of the design of the built environment on people with dementia: An evidence-based review. HERD: Health Environments Research & Design Journal, 8(1), 127-157.
  • van Hoof, J., Kort, H.S.M., van Waarde, H., and Blom, M. M. (2010). Environmental interventions and the Design of homes for older adults with dementia: An overview. American Journal of Alzheimer’s Disease & Other Dementias 25(3). 202-232.