Understanding built into walls and windows

Stirling University's Dementia Services Centre is working from the floor up to improve lives, writes Terry Philpot

On July 16 1989, Mary Marshall was arranging her new desk on her first day as director of Stirling University's Dementia Services Development Centre when the telephone rang. It was the manager of a nursing home for old people who wanted help with the design of a new wing being built.

"I went on a learning curve that was almost diagonal," Marshall says. "And it quickly became obvious that if we were into the business of design, we also had to do it for ourselves."

The design lessons the centre has learnt since those early days are all on display in its recently completed new home, the Iris Murdoch Building, which is named after the philosopher and novelist who died of Alzheimer's disease in 1999. The centre was built on university land, but it had to raise its own building fund.

The centre's innovative design tenets, however, are merely the most visible facets of its work. Under Marshall's leadership - her personal chair came eight months after she took up her post - the centre undertakes many activities. It may give a local authority advice on design one day and publish a guide on how to bathe someone the next, in addition to running conferences and training courses. All its staff teach postgraduates and engage in research. Research projects include communication through arts, sexuality and raising standards in domiciliary care.

Marshall sees the centre, which is part of Stirling's department of applied social science, as "sitting on a bridge between an academic centre and the field".

"Our job," she says, "is disseminating knowledge - but in different ways.

We might write a design guide for Glasgow City Council or advise a care home on tiles in its bathrooms - and we have done both."

The centre, which is funded by the charity the Dementia Services Development Trust, was the first of its kind in the world. There are now several in the UK and Ireland and others elsewhere in the world - some of which the Stirling centre has had a hand in establishing. The comparatively late development of the centres indicates the low priority that dementia receives within universities.

Visiting the Murdoch building is an education. Its aim is "to influence the design of other public buildings", Marshall says. "This is not only about people with dementia but anyone with some cognitive impairment - including people with learning difficulties or people with high levels of stress. We want to influence not just architects and those who work in the health and social services but also those in the travel and leisure industries."

The centre has had an eclectic lot of visitors: during my time there, there were three parties of people with dementia and their carers, social workers, nurses, academics and doctors. The Royal Incorporation of Architects in Scotland brought two groups to visit during its annual conference in Falkirk. People from the Order of St John, the masons and the local church have also visited. The open day held every couple of months attracts about 50 people. And each week, the centre's staff see about 15 people: Marshall herself reckons that she does two or three consultations a week.

The centre takes seriously design blips that are drawn to its attention, especially by people with dementia. Marshall says: "All the time, we are mopping up all kinds of expertise."

To highlight good dementia-design principles, she points out elements in the small conference room in which we sit. It has an open-plan working and library area - the open-plan layout allows a person to see everything and everybody in the vicinity. Marshall says: "It is extremely light and non-reflective so (the room has) no shadows; there are high-quality acoustic tiles on the ceiling so there are no echoes; and you can look through the glass in the door and see what is outside; and if you look through the window you can see what season it is. The purpose of the room is very obvious, with nothing difficult to understand."

One side of the open-plan office is a memory wall - small windows have alcoves to display treasured personal items.

Given the centre's attention to design detail, one might assume that the fixtures, fittings and furniture have been specially designed. Not so.

There is nothing here that could not be bought in the local B&Q or ironmonger's. The glass-fronted refrigerator is the kind used in hotels and restaurants. The reason for them, and the glass-fronted cabinets and drawers, is that a person with dementia can see what is inside and what the equipment is for. All doors have glass panels so people can see through them.

Carpets throughout are solid blue - they have no speckles or patterns that may confuse or disorient a person. Different areas have carpets with different textures to help distinguish locations.

Because people with dementia have problems perceiving three dimensions, each stair has a different coloured nosing, the skirting is stair-shaped, and the banister is pillar-box red. Different colours set apart the seat, pan and back of toilets, whose locations are indicated by door signs that combine symbols, words and pictures. Light switches are in contrasting colours to the plain, light walls.

Another important principle is familiarity - for an old person with dementia, a kettle must look like a kettle. The three study-bedrooms are homely.

The words most often used to describe the building are "friendly" and "accessible", but a woman with dementia who visited told the staff: "You are trying to make a building that is understandable." That word is rarely applied to architecture, but Marshall says that that is the goal - whether it is in the design of a room or the selection of a tap.

ON THE RISE IN AGEING POPULATION

• Dementia is not a consequence of old age, but the longer we live, the more likely we are to succumb to it
• By retirement age, one in 20 people suffers from dementia; one in four at 85
• People with Down's syndrome, Parkinson's disease and Huntington's chorea are particularly vulnerable to the disease, as well as those who drink excessively and those who have suffered brain damage
• The number of people with dementia is rising because of a larger population and greater longevity - particularly among those with Down's syndrome and other vulnerable groups
• The two postwar "baby bulges", in 1946-50 and in 1961-65, will mean an even greater prevalence among that generation in 30 and 40 years
• Famous victims of dementia include Jonathan Swift, Ralph Waldo Emerson, Frederick Law Olmstead, Willem de Kooning, Rita Hayworth and Ronald Reagan.