The Positive Impact of Design in End-of-Life Environments
The National Institutes for Health in the United States have extensive research underlining the vulnerability of people as they age. Certainly, the end-of life can be a period of acute physical and emotional vulnerability. There is no greater honour for a designer than to be tasked with creating the environment in which people will live out their final days, and in which they will spend final moments with loved ones.
A key consideration is the enhancement of quality of life for everyone involved. While there are many aspects to consider in this work, my focus here is on three key elements: the connection to outdoors, privacy, and managed visual stimulation.
The great outdoors
The benefits of biophilic design have been championed for much of the last decade, based largely on the concept that an interactive relationship with nature supports mental and emotional health, reduces anxiety and cognitive performance…and in short, makes us feel better. An end-of-life bedroom should have large and low windows with views onto the beauty of nature- and these should be able to open. Nature provides a multi-sensory experience with birdsong, natural fragrances, and an expansive outlook.
These natural qualities will also benefit family members and staff, grounding all participants in the beauty of the present moment they share. Opening windows also provide natural ventilation which can minimise the scent of noxious cleaning and infection control substances.
Generous amounts of natural daylight create further benefits. It regulates the body to our circadian rhythms, a natural cycle which repeats roughly every 24 hours and dictates alertness, appetite, and body temperature. This can be especially important in situations where visiting hours may be limited and interaction with family desired. Unless the exterior had been beautifully lit it is best to have a curtain or blind which can be closed at night, so the window does not reflect artificial light back into the room, like a mirror. A dim-out rather than black out window treatment is desirable as it allows for the body’s natural circadian rhythms to properly function.
Privacy
Privacy for end-of-life patients and their families is important. A fascinating example is found in St. Olav’s Hospital in Trondheim, Norway where bedroom have been laid out in a circle with a communal area in the centre, and an external courtyard to outer side of the circle. Patients can decide when they want privacy as the walls in each room can slide back to reveal the communal space by remote control. While few establishments can afford such an innovation, the concept warrants imitation. If an end-of-life resident is alert, with no visitors, they may feel comforted by the presence of others, or may want total privacy. The key component is choice, and to that end a wide door, door curtain, or secured sliding/folding screen may offer similar benefits.
Provision of a separate ‘Family Room’ adjacent to the resident bedroom is also an important offer. This might include a table and chairs for family members to discuss matters, or to enjoy a cup of tea without leaving the floor for an on-site cafe. A toy box to entertain children over long hours, and a television will be much appreciated when the patient is asleep.
One key success of the St. Olav’s model is that there is no visible evidence of clinical equipment, a key attribute in managing visual stimulation.
Managed Visual Stimulation
The environment must be designed to give residents, visitors, and caregivers control of different kinds of stimulation, including audible, olfactory, and indeed visual. While a care environment is not someone’s home, if ‘fixed’ artwork is limited family members can bring pictures which are meaningful to the patient into their space, as well as objects from home.
In other words, the space should be able to be customised to meet the emotional, spiritual, and cultural needs of the patient. Does the bedside table have their familiar clock? Are photos random pictures, or actual family members? Is there a dog bed from home for a visiting pet (if the facility allows).
An often forgotten – but important – surface in this environment is the ceiling. If someone is bedridden, we may expect their view will, on occasion, be straight up. A standard white ceiling is clinical and for people with dementia may even be frightening as it provides no depth perception context. Coming full circle and back to the importance of biophilic design, a ‘natural’ picture or wallcovering above the bed can make this a soothing view. Clouds or treetops (as if viewed from below) are great options.
The parameters available for designs in creating end-of-life environments differ substantially between different sites and operators, but the needs of vulnerable people can be better met through the research and care which designers bring to these essential spaces.
This Blog was originally written for After Cloud. Make sure to listen to Episode S4E5 of the TAD podcast (May 2024), with guest Emeritus Professor Paul Eschelman of Cornell University USA for more on this important topic.
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