THE IMPORTANCE OF THE AMBIENT IN PATIENTS WITH ALZHEIMER’S DISEASE

The relationships between the influence that physical environments and domestic spaces have on people with Alzheimer’s disease have been studied in the first doctoral thesis that addresses the impact that architecture has on the quality of life of Alzheimer’s patients and their families. The work has the title Influence of the spatial environment on users with Alzheimer’s. Parameters, project criteria, and architectural design guidelines have been carried out for six years at the University of Malaga and culminated in June 2023 with the reading of the thesis by its author, the architect Pablo J. Valero-Flores. Research has shown that an inclusive, adapted, and adaptable architecture is necessary and, above all, healthy for this group of people.

The thesis, directed by Professor Santiago Quesada-García of the University of Seville, is a milestone, an important starting point to be able to design and build, in a sustainable and appropriate manner, facilities, residences, and homes used by the group of people affected by Alzheimer’s disease, both the patients and their family members and/or caregivers. The results show that it is necessary to meet a series of housing needs that those affected by this disease demand, both on a domestic and endowment scale, as well as plan and foresee housing reserves adaptable to the evolution of the disease. The work proposes a series of practical and concrete measures, useful for adapting homes and spaces to the security, accessibility, and personalisation requirements that this disease demands. They are solutions that can be used by family members, carers, therapists, nursing home managers, public administration technicians, socio-health personnel, and architects in the adaptation and design of the environments and buildings inhabited by users with Alzheimer’s.

It should be noted that, in the last forty years, there has been progress in the design and construction of residences and buildings for the population with dementia and, in particular, for users with AD. However, many of these implemented solutions have been focused almost solely on accessibility, with general recommendations that do not differentiate the evolution of the disease or the particular needs of each patient as the disease progresses. This is because they are solutions that do not derive from a characterization of users or from a prior evaluation of the environmental stimuli that impact them. The consequence is that, sometimes, care and/or hospital spaces are not adequately adapted; and in particular, neither are domestic environments, applying solutions that are not very personalised to the specific needs of the patient.

This innovative doctoral thesis on architecture and Alzheimer’s is based on the premise that dementia produces important changes in the way people who suffer from it live and in their family environment. These alterations are caused by disorientation, insecurity, a lack of control, or a limitation of autonomy, among others. The hypothesis proposed is that space and environments have a direct and significant influence on the user with AD in the initial or mild phase. From there, one of the objectives has been to know what this influence is like and determine, quantitatively, what the variables are that affect the sensory stimulation, orientation, or comfort of these people. To achieve this goal, a methodology has been designed that is innovative from an architectural point of view, in which various techniques and tests designed specifically have been used. There have been spatial experiments that have made it possible to know how a sample of the population perceives space, what elements make up their spatial image, or which ones generate a greater repercussion or impact on their sensations and perception of the place. It has been a working method that has combined the empirical process, with which the architectural discipline usually works, with an experimental process used in neuroarchitecture, in which the person is the centre of all research.

In this doctoral thesis, therefore, the empirical architectural experiences of buildings intended for people with AD built in recent decades have been contrasted with an experimental study that has studied how different environments influence these users, obtaining results that have allowed us to determine and verify some of the architectural parameters that have the capacity to influence a specific sample of people. These parameters, useful in the design and construction of spaces intended for this group of patients, are, among others: the dimension of the spaces, the routes, the lighting, the relationship with the environment, climate control, and sensory stimulation. They are parameters that have been verified and contrasted, thus allowing a first characterization of these architectural elements.

With this knowledge, it has been possible to state a series of design criteria and guidelines that make it possible to build a physical environment adapted to the specific needs that these users require in a given place. For example, optimal luminosity ranges per room to generate comfort in the user and mitigate situations of anxiety or fear; propose the recommended temperature according to seasons of the year; schedule routes between rooms so that orientation is encouraged; and provide recommendations on materials, colours, and finishes that enhance the understanding of the use and functionalities, both of the rooms and of everyday objects, among others.

Given the lack of knowledge about how to adapt a house or a care environment and what solutions must be implemented to make an adequate cognitive adaptation of the inhabited environment, the proposed measures head-on address these deficiencies and formulate a set of recommendations in relation to the symptoms that these patients present in their mild phase. The objective is for the affected person to fulfil their desire to stay as long as possible in their home or place of preference, thus not breaking with their environment and social roots.

This work has constituted an enriching experience and an example of a novel multidisciplinary relationship since the thesis has been carried out by an architect within the Doctoral Programme in Biomedicine, Translational Research, and New Technologies in Health, specifically within the line of Basic and Applied Neuroscience Research at the University of Malaga. It is the first time that an architectural theme is developed and investigated in the form of a doctoral thesis in the doctoral programme of a medical school. This circumstance has allowed the research to be transversal and translational, using methods and tools from architecture, medicine, psychology, and other social sciences. All of them are disciplines that work for attention, care, and improvement of the socio-health benefits of the group of people with AD.

Pablo J. Valero-Flores is a PhD architect and researcher at the Healthy Architecture & City Group (TEP-965).
Santiago Quesada-García is a PhD architect and Head of the Healthy Architecture & City Group (TEP-965).

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Institutional repositories and reference links:

• https://dialnet.unirioja.es/servlet/tesis?codigo=317754
• https://grupo.us.es/hac/crece-con-nosotros/tesis-doctorales/