For many patients, a hospital is challenging due to its stressful, busy, and unfamiliar nature. But for a person with dementia, the experience can be exacerbated by cognitive impairment and behavioral or psychological symptoms, making it a frightening, distressing, and disorientating place. For this vulnerable population, unintended consequences of unsupportive design include longer hospital stays, more emergency department visits, and more frequent hospital admissions, according to speakers at the HCD Expo in Cleveland, who discussed how designing waiting areas to alleviate stress and accommodate both patients and their families is an important part of hospital design.

“Hospital and outpatient settings are generally designed to support single-condition patients who are capable of maintaining both physical and cognitive independence,” said speaker Addie Abushousheh, gerontological research associate at The Center for Health Design (Concord, Calif.), during the session “Forget Me Not: Dementia and Aging in Acute and Ambulatory Waiting Rooms.”

“The harmful side effects of hospitalization come as a surprise to many older adults who are expecting to be discharged in better, not worse, condition—this has come to be known as ‘hospital-associated disability’,” she continued. “People who have Alzheimer’s disease and other dementias demonstrate patterns of use that tend to have more intense implications than other adults and they are disproportionately negatively affected. For older adults, especially those with dementia, waiting room design can unintentionally present barriers to accessing medical care and result in maladaptive behaviors and symptoms. This further contributes to the individual’s confusion, difficulty in negotiating spaces, and an increased dependence upon companions.”

To deliver a dementia-supportive waiting room, Abushousheh and speakers Jen Worley, director of design research at BSA LifeStructures (Indianapolis, Ind.), and Chase Miller, director of planning at BSA LifeStructures, discussed how to translate person-centered design strategies (e.g., promoting autonomy and self-sufficiency through visible destinations, manageable walking distances, and adaptable furnishings and arrangements) drawn from dementia-focused design interventions in residential care settings. This approach can support equitable access for the broadest range of patients in a healthcare setting.

The presenters outlined design strategies relevant to waiting rooms that support aging and those with dementia:

  • Understand the needs of the client. In order to design supportive spaces, teams need to understand the unique challenges faced by aging individuals, and especially those living with Alzheimer’s disease and other dementias. “There are changes that are commonly associated with growing older and there are other changes that are more frequently experienced by those with Alzheimer’s disease and related dementias,” Abushousheh “It is important to think through these things to provide inclusive design for occupants of all age, ability, origin, and orientation.” ”The symptoms associated with different dementias can be really confusing, especially when people can have more than one type of dementia at a time; that’s why it’s really important to think holistically and inclusively to accommodate the most vulnerable.”
  • Consider how a space is seen and perceived. “Older adults may lose the ability to see objects up close or small print, have obscured or clouded vision, or experience vision loss and blindness. The lens of the eye also begins to turn yellow which changes the perception of color,” Abushousheh said. “The finishes, and color selections need to be very intentional because they are critical to the perceived safety or peril of the space. Aging and elderly adults may have one or more visual impairments, in addition to cognitive deficiencies that change the way they experience and navigate the built environment.”
  • Provide intimate seating zones within a large space. “As designers, we need to make the space as easily understood as possible,” Worley said. “ Seating zones within an environment need to be more defined so that the use of each is apparent and provides cues on how to behave. In addition, moveable furniture should be used to allow for future flexibility. There also needs to be enough space between seating areas , to allow for the use of mobility devices, and for the companions to attend appointments.”
  • Include visual cues and lighting strategies that aid interactions within a space. Echoing the guidance provided by the NIBS Design Guidelines, Worley said, “Treatment of low vision and other visual disorders is a medical issue; assuring optimal access to the built environment for persons with visual impairments is a design issue.” She went on to say, “The lack of clarity in visual cues or any defect in our interpretation or comprehension of the environment can reduce our ability to understand or to safely navigate the environment.” Layered lighting strategies should be used to reinforce spatial zones and to light pathways to aid in the navigation of space.
  • Regulate acoustic sources and improve acoustic controls. Noise contributes to physical and psychological disability and mitigation strategies, such as insulating drywall, acoustic ceiling tiles, carpeted floors, private bedrooms, and clinical offices instead of stations—just to mention a few—improve the acoustics of spaces which improves sleep, focus, mood, strength, stamina, diet, and work performance, according to Abushousheh.

“With such a large percentage of the population in this demographic, inclusive design for the aging population is critical to improve and enhance the quality of life,” Miller said. “These individuals are not only experiencing the waiting room spaces common to nearly every care environment, but also in the context of larger commercial settings and public spaces. As designers, we must think holistically such that the built environment is enabling and supporting all individuals, rather disabling them. After all, we are all aging, so it’s not ‘them,’ it enables and supports all of us.”