Stumbling Across Evidence Based Design (EBD)
The Veterans Administration (VA) sometimes pops up in the news where it takes some heat for mis-administration. Dad is a veteran, but his silent health issues never extended into the VA system’s quagmire. He started out safe and comfortable in the comfort of his own home with his caregiver; Mom. While we were fortunate to have Mom provide that care, it was now two, not one life, that was being denied environmental joys each of us takes for granted on a daily basis. A walk in the park could be jarring for an Alzheimer’s patient. But what if it wasn’t? What if even a walk in the park was designed specifically to assist someone to start and finish that walk visually.
If a life doesn’t personally touch you with a dementia-related disease, then you probably don’t know about Dementia Friendly Cities (DFC).
“A DFC survey found that many people with dementia feel constrained by the condition and are not confident to get out and engage in their areas. Overwhelmingly, 63% of people with dementia did not want to try new things and the underlying issues of confidence, worry and fear must be overcome in a dementia-friendly community.”
One week at work, I was introduced to a community hospital in Virginia. Naturally, I did my homework to get an overall idea of what/where/how. I don’t even have cable television, and yet I still see the many social media and news site’s reports of VA sins-a-grievous. Fort Belvoir Community Hospital (FBCH) introduced me to Evidence-Based Design (EBD), and it goes well with understanding what environmental comforts people with dementia-related issues might find less stressful to navigate.
“As a result of the Base Realignment and Closure recommendations released May 13, 2005, the decision was made to close DeWitt Army Community Hospital and Walter Reed Army Medical Center” and realign staff and resources from DeWitt and Walter Reed National and to Fort Belvoir. FBCH began serving patients in 2011. “FBCH is part of National Capital Region Medical, a Department of Defense joint-service medical command based in Bethesda, Md. FBCH is a $1.03 billion, 1.3 million-square-foot facility [Wikipedia]. The hospital is part of an integrated health care system under the Joint Task Force National Capital Region Medical (JTF CapMed) providing health care to members of the United States Armed Forces and their families.” Lucky Armed Forces and their families.
FBCH is “the first integrated healthcare facility serving all branches of the U.S. military’s active-duty service members, retired veterans, and their families using evidence-based design (EBD), sustainable design principles, and structured cultural change criteria.” It makes you wonder how on the one hand, we have such ugly reports of grievous errors against our patriotic warriors, and yet on the other, we talk sustainable design principles and cultural change criteria!
“The original directive for the art program, according to the dictates of biophilic design and current evidence-based standards, called for realistic and representative imagery with subjects that were recognizable.” This is key for someone with Alzheimer’s. Finding a recognizable form with which to grasp is integral to survival. The shape of my face has meaning. It does not mean that Dad can say, “Connie.” It means that in his mind the curve of my smile or the crease of my brow has meaning. It means comfort of knowing.
“Research shows that meaningful engagement with the arts improves quality of life for those with dementia-Non-pharmacological interventions use a wide range of approaches, characterized as behavior-, emotion-, stimulation- or cognition-oriented, that aim to improve quality of life and maximize function in the context of existing deficit.” http://bjp.rcpsych.org/content/201/5/344.full Alzheimer’s caregivers are usually spouses. The profound sense of loss is rarely shared because an Alzheimer patient finds the outside world very stressful, so caregivers maintain the same distance.
“At Fort Belvoir Community Hospital, the art program rests on a solid foundation of nature-based imagery, a central tenant in EBD, based primarily upon the findings from Roger Ulrich’s groundbreaking 1984 study of patients with and without access to views of the outside.” I read these words and quietly hoped that some veteran and their spouse would be able to appreciate such dedication to design.
Alzheimer’s patients tend to wander. “Wandering is often seen as a “symptom” of Alzheimer’s, but it is more realistically seen as a natural tendency to look for something, to explore, but in a setting that has no self-evident layout” “Cues can be photos in the hallway of seascapes and urban streets that remind people of the places they spent their lives”.
Like stumbling in a half-lit room, sleepily, as you make your way to and from the safety of a bed. Your hands reach out, grasping for a sure hold, and the shapes in the room become your compasses. Forms that are familiar and certain, but sleep-blurred. Sounds of a fan comfort space or the slow rhythmic breathing of a pet. If you squint your eyes sometimes at everyday objects; you might see those shapes that bring some clarity. The curve of smile and crease of a brow. Details are for the faint-hearted.
Dementia-related diseases seem to be growing, and when you are the child of family history, you tend to take stock in data related research. “An estimated 5.2 million Americans of all ages have Alzheimer’s disease in 2013. This includes an estimated 5 million people age 65 and older, and approximately 200,000 individuals under age 65 who have younger-onset Alzheimer’s. By mid-century, someone in the United States will develop the disease every 33 seconds. By 2025, the number of people age 65 and older with Alzheimer’s disease is estimated to reach 7.1 million.”
Ultimately, we all must bear the weight of an aging nation. I like the idea and implementation of Evidence-Based Design, and I hope that when I’m stumbling in the dark one day that someone has taken it upon themselves to look into my eyes and know that I recognize the curve of their smile and the crease of their brow.