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) 

Lighting intervention locations

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

II)

Sound intervention locations

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

III)

OneSpace intervention locations

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

IV)

Screen Shot 2017-07-25 at 12.23.13 PM

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)

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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)

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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)

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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)

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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
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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.

Screen Shot 2017-07-03 at 12.49.10 PM
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

 

Hospital Ward of the Future

 

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This rendering institutes the concept of Philips’ Luminous panels within a hospital’s corridors. The diffused lighting, colours, and scenes from nature present a stimulating and dynamic feeling, while also providing wayfinding cues (Abungin Coronel, Halleran, Lang, et al., 2017).
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

Literature Review: Caring for People with Dementia: noise and light; by: Dewing

Assessing and modifying light and noise levels in the environment can contribute to providing dignified care for older people with dementia and for other older people with a range of sensory and cognitive impairments.

In an environment where there is no education, audit or regular evaluation of noise and light levels, sensory stimulation can become unbalanced. There are many situations, in various care setting, where people with dementia exhibit what are often referred to as ‘behavioral problems’, such as anxiety and agitation that are partially a consequence of being in an environment that is not dementia friendly or enabling. At the core of this is often sensory overload or under load from noise and light sources.

Most care settings are noisy places. Older people would not be used to the levels of noise, the continuous noise and noise associated with movement going on around them in their own homes. Background noise from telephones and machines, trolleys and other pieces of equipment, the television and radios all increase auditory stimulation. The motion of people coming and going also adds another layer to auditory stimulation.

Noise levels in hospital can become a form of environmental pollution. Sudden noises, such as when equipment is dropped or when doors arc slammed, cause a startle reflex, which as well as causing various physiological responses in the person with dementia, can also increase their sense of disorientation and insecurity.

Assessment of noise and tight levels in the environment is the first step to providing a more person-centered and dementia-friendly environment.

  • Typical Decibel (dB) Levels:

Threshold of acute hearing – 0 dB

Rustle of Leaves – 10 dB

Sleeping, studying, whispering – 30 dB

Conversation, comfort – 50-60 dB

Safety Threshold – 85 dB

Rock Band – 120 dB

Threshold of Pain – 130 dB

 

Sources:
Dewing, J. (2009). Caring for people with dementia: noise and light. Nursing Older People, 21(5), 34-38. doi:10.7748/nop2009.06.21.5.34.c7102