Long-term care Facilities and Dementia. Development of a framework to assess design quality in healthcare structures for people with dementia

BackgroundLife expectancy has experienced rapid growth (from 77.6 to 81.3 years), resulting in an increase in Non-Communicable Diseases (NCDs) and years lived with disability. One of those is dementia, with about 7 million people affected in Europe and the number is set to double by 2050. Those patients are complex due to the serious changes in the cognitive sphere, altering perceptions of the space. They are the most frequent users of healthcare facilities, but these structures often are not suitable to them. To this end, a rethinking is now urgent, and the use of Evidence-Based Design (EBD) could be the way to create safe and suitable environments. This study aims to develop an evaluation framework of the main aspect in the design of a built environment for people with dementia.MethodThree analyses were conducted: systematic literature review, analysis of existing tools, and case study analysis. The first was conducted on scientific databases using meaningful keywords. In the second the assessment tools in the field of healthcare facilities used worldwide were analyzed. The third explored best practices of dementia architecture. The three analyses were compared to outline the main characteristics that the environment dedicated to the dementia patient must possess to be inclusive and prosthetic.ResultThe final union of results obtained from the analysis has allowed defining a set of requirements that the space must have to be prosthetic for the patient. Those findings have been identified by comparing the two analyses were then divided into three main macro-areas (physical, cognitive, and social aspects) and 31 criteria. The results were also validated through the involvement of stakeholders and experts in the topic, both from architectural and medical field to establish the relationship between physical factors and patient outcomes.ConclusionThe framework is a starting point for the development of inclusive projects for people with dementia and cognitive disabilities because it is urgent to investigate which are the main aspects to be considered in the design and renovations of facilities to make them as much as possible therapeutic and prosthetic, creating places where the wellbeing of patients is the priority.