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Age and dementia-sensitive architecture

In 2013, one in five Germans already belonged to the 65+ generation. The increasing average age of the population is particularly reflected in inpatient care. In general, the number of patients in acute hospitals increased by 25% between 2003 and 2013, with the percentage of over-65s exceeding 40% in 2013. A further sharp increase is forecast by 2030, when the baby boomers start entering into retirement. Current estimates by the Federal Statistical Office assume that two thirds of all patients in hospitals will then belong to the 65+ generation. In addition, the majority of these patients are already expected to suffer from additional health problems. According to the German Alzheimer Society, there are currently around 1.6 million dementia patients in Germany, and their number will have increased to about 3 million by 2050.

For clinics, this development means that a rethink is necessary: In addition to the acute disease to be treated, an increase in additional cognitive restrictions up to dementia in outpatient and inpatient care will have to be taken into account. In its GHoSt study published in 2016, the Robert Bosch Stiftung points out that 40% of all hospital patients over 65 years of age already suffered from cognitive impairment and one fifth of this age group had dementia. »Old patients and in particular those who suffer from dementia or cognitive impairments quickly serve as a drag on the efficiency-oriented daily hospital routine with its hard-to-understand environment«, says architect Birgit Dietz from the Bavarian Institute for Age- and Dementia-sensitive Architecture (BIfadA) in Bamberg. In addition to the higher burden on nursing staff, patients with dementia in particular stay in hospital longer and incur higher costs in view of the flat-rate costs per case. An age and dementia-appropriate architecture can undoubtedly contribute to the quality of these patients' stay and thus support the healing process.

This is where the Guideline for age- and dementia-sensitive architecture in acute hospitals, published at the end of April 2018, comes in. Consisting of a systematically structured collection that can be accessed online, it contains architectural planning tips for architecture that is sensitive to age and dementia. Accordingly, a kind of planning library has been created in which current research results and regulations, structured according to spaces and topics, are compiled. For example, for corridor design information is provided on dimensions and orientation, room climate, acoustics and light. Checklists and practical cases illustrated with positive and negative examples supplement the online guide. The following six design principles were applied:
•    Ensure safety
•    Provide resource-oriented competencies and thus promote independence
•    A familiar design in order to promote emotional security
•    Offer sensory and mental stimulation within reason
•    Protect privacy
•    Enable social interaction

The project under the direction of the Ingenium Foundation for People with Dementia is currently unique in Germany. Based on the evidence-based literature examination of international, scientific research as well as expert recommendations, the planning tips drawn up by BIfadA have not only been collected but also embedded in a gerontological overall context together with the Ingenium Foundation Ingolstadt. The guide is primarily aimed at hospital planners. In addition, the architectural aspects and their effects in terms of length of stay, recovery and financing also address the level of management and administration of clinics. »Although the new guideline is primarily designed for architects and hospital operators, it is also intended to help nursing staff or, for example, organisations such as the Alzheimer societies«, says Winfried Teschauer of the Ingenium Foundation, talking about the guideline. It can thus make an important contribution to shaping future or existing hospital landscapes in such a way that the environment largely assimilates the patients' diminishing cognitive and physical abilities. Ultimately, whether as patients, carers or relatives, we will all benefit from an environment that breaks down barriers and adapts to our needs.

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