COME TO YOUR SENSES hospital architecture for people with cognitive risks

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1 Bamberg This World Heritage Town is located in southern Germany in the north of Bavaria. It is a good example of a central European town with an early medieval plan and many surviving ecclesiastical and secular buildings from the medieval period.

2 I am an architect and Director of the Bavarian Institute of Architecture for the elderly and cognitively impaired located in Bamberg. We work in this old building and enjoy that very much.

3 Dr. Ing. Birgit Dietz Received PhD (Dr. Ing.) from the TU Munich Subject: The Heidelberg University Hospital Teach Hospital and health care architecture at the TU Munich, School of Medicine and Department of Architecture Member of the German DIN standards committee (DIN 13080) Member of the EDK (committee of experts in DIN hospital construction standards) Member of the AKG (Architects for Hospitals)

4 More than 50 % of the patients in German hospital populations are over 65 years old Dementia patients are over represented compared to the general population, because they are older and stay longer 40% of patients > 65 in hospitals have dementia or cognitive impairments Dementia had been recognized and recorded as a formal diagnosis in the patient's records in less than 40% of the affected patients, i.e. approximately two-thirds of all dementia cases are not recognized as such at the time of their admission to hospital. Schäufele, Martina; Bickel, Horst (2016): General Hospital Study - GHoST. Zusammenfassung einer repräsentativen Studie zu kognitiven Störungen und Demenz in den Allgemeinkrankenhäusern von Baden-Württemberg und Bayern. Hg. v. Robert Bosch Stiftung.

5 Financial considerations Treating cognitively impaired patients costs more: their length of stay is, on average, 3-4 days longer they require more time with more nurses or carers Many people recognise the need for change, but do not know what to do.

6 the common thread 1. Impairments with age (with a focus on seeing) 2. Surroundings for people with dementia 3. Working modules

7 Body changes with age physical ability changes mobility strength dexterity sensory changes sight hearing touch smell/taste mental ability changes memory processing of information reactions coordination Minister of health, Nila Moeloek, at ALZI 17: Indonesian dementia plan

8 1. physical ability changes DIN, the German Institute for Standardization, is the independent platform for standardization in Germany and worldwide.

9 2. sensory changes The five traditionally recognized methods of perception are sound, sight, touch, smell and taste

10 3. Memory performance Mental performance is decreased and so is information processing speed. In Indonesia the population is still relatively young, but the number of people afflicted with demetia is rising. Support from family members in Indonesia 13:1 in 2010 to 6:1 in 2035

11 Perception of environment is about 85% visual, symptoms with old age could be e.g. reduced visual resolution increased glaring effects reduced colour vision reduced sensivity to contrasts loss of peripheral vision central visual loss

12 The size of the pupil reduces with age the surroundings seem darker, the need for light increases

13 Need for light The transmission properties of the lens are reduced more slowly for long waved red light than for the short waved blue light. Appropriate lighting therefore means intensifying the blue-white end of the spectrum.

14 Lighting with biological function The influence of daylight on the circadian rhythms Figure: licht.de

15 colour vision green, blue, violet fade Yellow, orange, red remain easy to distinguish

16 For the people with dementia the world is falling into pieces, especially patterns in seeing and hearing could no longer be identified Shards of glass I won t walk through this graveyard

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19 If the senses can no longer read the environment and the memory can no longer retain previously known patterns ("Last in first out ), the result is fear.

20 the common thread 1. Impairments with age (with a focus on seeing and hearing) 2. Surroundings for people with dementia 3. Working modules

21 In 15 Bavarian hospitals we asked Nurses and Carers: Malnourishment & malnutrition Problems with orientation Night unrest Falls and injuries Emotional outbursts Anxiety Aggression and physical intimidation Incontinence Complaints from other patients Attempts to run away Most problems occur at night when staffing levels are low Doctors: Perceived few problems except for the fact that communication is difficult so diagnosis and treatment takes longer.

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23 the common thread 1. Impairments with age (with a focus on seeing and hearing) 2. Surroundings for people with dementia 3. Working modules

24 Lighting Light with visual function Light with emotional function Light with biological function

25 Colour Colour as a barrier Colour for orientation Colour for well-being

26 Acoustics Communication Noise limitation Orientation

27 Design Familiarity Functionality Hygiene

28 Safety avoid falls deter wandering prevent injuries

29 Open-Air Areas Vitamin D-production Relaxation, stress reduction Muscle activation, exercise Sleep-wake cycle

30 Signage Familiarity Use of images or symbols High contrast design Visibility at eye level

31 It is easy!

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33 We marked things to support the independent use of the bathroom.

34 EXAMPLE bathroom Let us assume: 800-bed hospital with 420 bathrooms 70 % occupation 560 patients with use 6 times daily Estimation: 560 patients x 330 days = 185,000 days x 6 uses = 1,110,000 uses yearly, of which 20% will need assistance. Result: 220,000 uses with 16 minutes caretime means 58,700 hours a year 33 fulltime equivalents. Study Grey Performance T. Guthknecht, Lausanne Health and Hospitality Group, 2012

35 Results of research at Bamberg Hospital: marked reduction in the rate of falls reduced length of stay greater levels of satisfaction amongst staff, patients and relatives

36 As peoples cognitive abilities decline, their surroundings must serve as a prosthesis to offset this decline as far as possible If the patient is no longer able to adjust to life in the hospital, the hospital must adapt to the needs of the patient Then existing resources can be used for other tasks

37 We are working on innovations to support the elderly and cognitively impaired providing consultation in healthcare facility construction/design Together we could be drivers for change! Thank you! Huadong Hospital, Shanghai