Sensory for Dementia at TRI

At Toronto Rehab Institute’s (TRI) 5 South, patients who suffer with severe forms of dementia are admitted in hopes of helping them with their ailments, before sending them back to their long-term care centres.

The graduate students of OCAD U’s Design for Health program joined together with TRI to help redesign 5 South with a more effective and healing design. The aspect of “Sensory” was integrated throughout the floor, integrating lighting and sound to help relieve stress, depression, agitation and an overall sense of wellness.

Here are some renderings from the project:

 

I) 

The yellow blocking in this image represents the spaces that will be addressed with the lighting interventions.

II)

This image represents the locations where the sound interventions will be located, including both public and private spaces.

III)

The yellow rectangles marked on this image represent the locations where Philips’ OneSpace product can be instituted.

IV)

This rendering demonstrates what the hallways of 5 South could look like with the integration of Philips’ Luminous Textile panels on the walls, providing an element of interest while helping to create a calm and stimulating environment.

V)

This rendering demonstrates what the ceilings on the hallways of 5 South could look like with the integration of Philips’ OneSpace, providing the sense of space and air, while providing a calming defuse light throughout the space.

VI)

Philips’ OneSpace on the ceiling of the dining room brightens up the space in a calm manner, creating a more inviting place for eating meals, which can sometimes be a difficult task for those with dementia.

VII)

The patient bedrooms have been outfitted with bigger windows to allow more outside light to come in, intigrating the circadian rhythm into the space, as well as the integration of the OneSpace, to further allow for calm and defuse light within the space.

VIII)

The physical therapy room was once a dark room located within the interior of the building, not permitting for any natural light and outfitted with fluorescent lighting. This rendering demonstrates the relocation of this room to an exterior room outfitted with a window. this room also has windows into the hallway and Philips’ OneSpace on the ceiling.

 

Sources:

Abungin Coronel, A., Halleran, L., Lang, A., Abreu Ligabue, F., Mulvale, A., Saby, A., Tagari, S.,  Talebzadeh, A. (2017). Designing for the Dementia Environment. Unpublished. OCAD University

Sensory for Dementia

People with Dementia are particularly affected by Environment.

Designers, Architects, and Health Care planning staff have a great responsibility in designing a dementia friendly environment.

This is a short video to help you start thinking about multisensory environment when designing for people with dementia.

Noise and light are the two most obvious sources of sensory stimulation in the environment, and when ignored or mismanaged, they can become important sources of under or over stimulation for the person with dementia.

Hamilton Rating Scale for Depression (HRSD)

The Hamilton Rating Scale for Depression (HRSD) was originally designed by Max Hamilton in 1960 but has gone through many revisions over the years. This scale is based on a set of  questions which can be used to provide an indication of depression and thus, to guide the recovery.

The questions provided relate to mood, feelings of guilt, suicide ideation, insomnia, agitation, anxiety, weight loss and somatic symptoms.

Each question relates to a 3 or 5 point scale which are then tallied up to a final score number. This assessment takes about 20 minutes.

Click on link below for a PDF of the HRSD –

Hamilton Rating Scale for Depression (HRSD)

Sources:

Hamilton, M. (1960). Rating Scale for Depression . Retrieved July 3, 2017, from http://jnnp.bmj.com/content/23/1/56

The Hamilton Rating Scale for Depression. (1997). [PDF] Triangle Park: Glaxo Wellcome. Available at: http://healthnet.umassmed.edu/mhealth/HAMD.pdf [Accessed 3 Jul. 2017].

Agitated Behaviour Scale (ABS)

The Agitated Behavior Scale (ABS) was initially developed to assess the nature and extent of agitation during the acute phase of recovery from a brain injury.

The ABS is a serial assessment, allowing professionals to obtain objective feedback about the patient’s agitation.

Click link below for a PDF copy of the ABS-

Agitated Behaviour Scale

 

Source:

Bogner, J. (2000). Introduction to the Agitated Behavior Scale. Retrieved July 03, 2017, from https://www.tbims.org/combi/abs/

Beddit Sleep Tracker

A sleep tracker, such as Beddit, can be used to measure the quality and quantity of sleep and the patient’s heart rate (indicator of stress), breathing (number of breaths per minute), snoring (indicator of poor sleep quality), while also monitoring the environment.

 

Source:

Beddit. (2016). Retrieved April 15, 2017, from http://www.beddit. com/?gclid=Cj0KEQjwicfHBRCh6KaMp4-asKgBEiQA8GH2x-iQOp_Y- aHPPdm08amP31wFzoHXXZTiSMp_Z5-ZpUUaAgyt8P8HAQ

 

Pittsburgh Sleep Quality Index (PSQI)

The Pittsburgh Sleep Quality Index (PSQI) can be used to help the dementia health care team evaluate the sensory interventions by assessing the patient’s quality of sleep.

The PSQI is a questionnaire used to assess one’s quality of sleep over a one-month period. A score is generated based on the 19 questions provided which can then be used to diagnose sleeping disorders.

Pittsburgh Sleep Quality Index

Click on link below to access a PDF copy of the PSQI –

Pittsburgh Sleep Quality Index

Source:

Pittsburgh Sleep Quality Index (PSQI). (n.d.). Retrieved July 03, 2017, from http://www.sleep.pitt.edu/research/instruments.html

Evaluating the New Design

A list of measures should be referred to for testing the new design implications. The purpose for this is to know if these sensory applications are in fact working and at what rate.

This can be a crucial first step to take so that the financial burden can be evaluated and the hospital team as well as the designers and architects can determine whether these sensory aspects are necessary or not, within their particular environment.

(Lang & Talebzadeh 2017)

Source:

Lang, A., & Talebzadeh, A. (2017). Meta- Ethnography/ Scoping Review. Unpublished. OCAD University

Sound Transmission Class (STC)

Considering the control of sound transmission between certain areas such as patient rooms and mechanical or high traffic spaces, will improve patient sleep patterns. This can happen with improving the Sound Transmission Class (STC) ratings of dividing walls.

An STC of 45 is recommended between rooms and corridor and 65 STC between rooms and mechanical spaces (Design and Dementia, 2011).

Adding sound masking devices to rooms with staff control function, can allow staff to lower the noise level in the rooms during the night time and control the intensity of sound in the dining room and lounge during activities.

Source:

Design and dementia. (2011, July). Retrieved March 12, 2017, from http:// brainxchange.ca/Public/Resource-Centre-Topics-A-to-Z/Design-and-dementia. aspx

Woodford, C. (2016, December 18). Soundproofing a room | Science of noise reduction. Retrieved July 03, 2017, from http://www.explainthatstuff.com/soundproofing.html

Noise Design Strategies (reviewed from Design & dementia)

Addressing noise sensitivity does not mean eliminating all noise (this can lead to under-stimulation), but rather providing the right kinds of noise at the right level at the right time.

• Layout

Strategies:

· Consider the control of sound transmission between certain areas of the building.

· Situate bedrooms away from, and not adjacent to, high-noise areas such as dietary, utility, programming and/or administration.

· If resident rooms are adjacent to noisy areas, design dividing walls with Sound Transmission Class rating of 45-65 depending on noise source levels (45 for owing water, 65 for mechanical). Consider soundproofing dividing walls between bedrooms as well.

· Ensure quieter lounge areas are available for those who do not want to be immersed in noisy activity

• Reduce Noise Echo

Strategies:

· Reduce hard surfaces and increase sound absorbing textiles/drapes/carpet (e.g., sound absorbing ceiling and wall tiles, carpet or cork flooring). Likewise, acoustical wall treatments may be used.

· Consider how the architectural features of the space might affect the acoustics, for example domed ceilings might reflect sound.

· A large room will be louder, therefore consider breaking down rooms into smaller areas

· Apply sound absorbing materials to walls and ensure that the surface material is damage resistant and below shoulder height.

• Noise Production Equipment

Strategies:

· Lubricate squeaky doors, windows and wheels, leaky toilets or faucets routinely.

· Ensure upkeep of mechanical lifts to reduce noise.

· Use cleaning equipment (i.e. wax oor machines, vacuums) at appropriate times for the resident such as cleaning halls when residents are in the dining room.

· When possible, purchase equipment and machinery that is low noise.

· HVAC equipment and ductwork should provide resulting sound levels that do not exceed noise criterion NC 25 in bedrooms, NC 35 in dining areas, NC 40 in toilet/ shower rooms, and NC 35 in all other occupied spaces.

· Soundproof HVAC equipment by utilizing sound attenuation measures.

 

Source:

Design and dementia. (2011, July). Retrieved March 12, 2017, from http:// brainxchange.ca/Public/Resource-Centre-Topics-A-to-Z/Design-and-dementia. aspx

 

Literature Review: Lighting for People with Dementia; by: Torrington & Tregenza

Research has shown that guidance for lighting design for people with dementia, should not be limited to the consideration of visual tasks or compensation for deteriorating eyesight. The well-being of those who are physically and cognitively weak is affected by their overall exposure to the circadian cycle. Their freedom from anxiety and the extent to which they can continue the activities they enjoy depend on their perception of the whole place, as well as on the physical support that the building provides. The importance of lighting as an element in design for older people has been observed in architectural practice while there is increasing evidence that lighting is a significant component of a therapeutic environment.

Dementia is primarily a disease of later life, so recommendations for those with dementia must be set within the context of the lighting requirements of the older person. Sources within residents’ elds of view should be of low luminance or indirect rather than small and bright. They should also be positioned away from users’ directions of sight. Windows should have means of excluding low-elevation sunlight; windows at the ends of corridors and on lines of sight should also be avoided. However, windows providing natural or interesting views is almost universally welcomed, and the presence of a view may have beneficial effects on the health of dementia sufferers and people confined within a building. Window positions and sill heights should be related to the probable activities of people, in particular, whether they are walking, standing or sitting.

Other recommendations listed in this article: The lighting of rooms should not create dark areas where contrast with the brighter parts of the room inhibits vision. As well, reflections in shiny materials can cause both disability and discomfort glare. They hinder perception of the actual surface and mask the surface’s underlying colour; matt surfaces are preferable.

Increase the visibility of tasks; this enhances the ability to see differences of brightness and colour. Integrate diurnal daylight cycle; this ensures that residents have sufficient daylight exposure to minimize the risk of SAD and to ensure that they experience a 24-hour cycle of light and dark.

Provide potentially therapeutic views to enhance opportunities for social interaction. Preferred views are of natural scenes rather than the built environment; people confined within a building often enjoy seeing the activities of people outside. Window positions and sill heights should be related to the probable activities of people, in particular whether they are walking, standing or sitting. Seating and areas for social interaction should be provided beside view windows.

Lighting should support activities, enabling residents to continue activities they enjoyed through their lifetime and enhance opportunities for social interaction.

There should be recognition of ‘place’; interior spaces should be recognizable by dementia sufferers with no memory of recent experience. The information given by all the senses must be consistent. The clues to the nature of the room must be consistent with a common sense understanding of the building.

Source:

Torrington, J. M., & P. R. Tregenza. (2016). Lighting for People with Dementia. Retrieved from http://journal.sagepub.com/doi/pdf/10.1177/1365782806074484