Architectural design gives hope for dementia

The places people living with dementia (PLWD) live in, profoundly affect their happiness, behaviour, the course of their illnesses and even the circumstances of their death. Environments that affect PLWD may start out as workplaces, public spaces or their own homes. But as dementia develops, residences often need to change to allow for increased levels of care. For the best part, greater levels of dependence mean greater institutionalization and often that means ‘residential homes’ – institutional substitutes for the real thing. The institutionalization associated with dementia means increased separation from families, communities, loves, passions, hobbies, familiar places and even their material belongings. An undignified last chapter for our parents and grandparents. People who, like the rest of us, have lived full and interesting lives. But what does this attrition of normal living circumstances do to PLWD? Andwhat can architecture do to help? This special issue of Architectural Science Review is dedicated to an exploration of evidence-based and theoretical approaches to designing for PLWD,with the understanding that architecture is not just the setting where care for PLWD will take place, but it is a critical part of the complexity that surrounds a dementia diagnosis. This comes in contrast to the stubbornly extant paradigms of architecture for institutional care settings, where the decoration shifts with fashion and the architects’ ideas, but the core design is driven by the need for the efficient functioning of staff rather than the quality of life that the staff are there to support. Even in permanent residential settings, efficienciesmade to improve the provision of care tend tomake settings institutional, less liveable and possibly worse for dementia outcomes (Charras 2021; Zeisel 2020; Burke and Veliz-Reyes 2021). Dementia is an umbrella term for organic neural deterioration disorders. The most common is Alzheimer’s Disease, which usually manifests as an inability to learn new things and remember new information; there are the Frontal Dementias, which are marked by personality and behavioural change. Other dementias present with other symptoms also. Regardless of the specificity of diagnosis, the dementias typically worsen with time, to impair higher cognitive functions such as abstract thinking, judgement and verbal fluency. As dementia progresses, it frequently causes emotional and behavioural abnormalities also (Dowden et al. 2008) The progression of symptomatology, along