Dementia Enabling Environments in Singapore

By 9th October 2020Advocacy, Blog, Policy

I have been designing and researching dementia-enabling spaces for almost a decade, and so, it was especially inspiring to see the launch of the World Alzheimer Report. The report focused on salutogenic designs for people living with dementia and is a comprehensive two-volume report with case studies around the globe. Salutogenic architecture is a key aspect in the development of environments that are inclusive and enabling for people living with dementia. A salutogenic design comprises of an environmental design that aligns with socioenvironmental model focussing on the health and wellbeing of the individual. Volume two of the report featured eighty seven case studies from around the world, and this included some examples from Singapore. It also cited the prevailing research in design and environments for people living with dementia spanning across three decades. However, despite the available evidence, we know that there is a gap between the evidence and implementation with countries continuously developing facilities of pathogenic design, which focus on the control of pathogens. These environments, which resemble acute care facilities focuses on a medical model of care. The designs aim to provide treatment to the person living with dementia, reduce risks, and promote infection control. I am writing this article to highlight the built environmental projects in Singapore that can contribute to the growing case studies that serves to support the lives of Singaporeans living with dementia. I am writing this article to promote change.

The crucial role of the built environment in creating an inclusive community in a highly urbanised country

Singapore is a country with a high average life expectancy, high prevalence rate of dementia, ageing population and low birth rate. The population of Singapore is averaging 5.5 million, with more than half a million older adults, 65 years and above. By 2030, this number is projected to reach 900,000. Singapore is a country that is no stranger to dementia. With approximately eight dementia-friendly communities nation-wide, the island state continues to work towards building an inclusive society for Singaporeans living with dementia. Aside from Apex Harmony Lodge and the HortPark therapeutic garden highlighted in the ADI report, there are several key projects which have been carried out to enable people living with dementia to age in place in the community.

Photo of Hort Park in Singapore.
Attributed to https://www.flickr.com/photos/25802865@N08/38316815602

Enabling wayfinding within the neighbourhood 

Problems with wayfinding, the ability to navigate around your environment, are common in dementia, and can lead to people getting lost or confused by their settings. Approximately 80 percent of Singaporeans reside in Housing Development Board  (HDB) flats. More than one million HDB flats are found in Singapore, and they consist of high-rise high-density apartment blocks with built environmental features unique to the culture and climate . Apart from numbers that can be found on each apartment block, the apartments can bear a strong likeness to each other which can be disorientating when a person is trying to find their way around an estate of apartments or flats. A dementia-friendly wayfinding community project in Kebun Baru completed earlier this year worked to ease the complexity of navigation in the neighbourhood with murals of objects that are culturally familiar for older Singaporeans. The project, which included inputs from people living with young onset dementia aims to improve navigation and orientation with distinguishable murals painted strategically in void decks of individuals flats. These murals can help provide visual cues to an individual who may need to find their way home in an urbanised environment. Another project in Nee Soon South and Chong Pang carried out similar interventions taking a leaf from the designs of zones found in parking lots. Apartments or flats are clearly distinguished from each other through the application of colours, large visible numbers and murals to help with wayfinding.

Single-row panorama of Housing and Development Board flats in Bukit Panjang, Singapore. (Taken with a 2008 Sony Cyber-shot point-and-shoot camera.) Retrieved from https://commons.wikimedia.org/wiki/File:Housing_and_Development_Board_flats_in_Bukit_Panjang,_Singapore_-_20130131_(single-row_panorama).jpg

Embracing dementia inclusive therapeutic community gardens

Green spaces are beneficial for people living with dementia. For a person living with dementia, green spaces or environments in the community can contribute to active citizenship, enabling personhood and positive improvements in mood.). In Singapore, where residential living is highly urbanised, green spaces can contribute significantly to the health of individuals living with or without dementia. Well-designed green spaces can encourage intergenerational social engagement or a quiet sensory space to attain a sense of calm or tranquility among nature. A national project by the Singapore National Parks Board aims to develop 30 therapeutic gardens that are inclusive of people living with dementia across the country by 2030. The Singapore National Parks Board is working with the National University of Singapore’s Department of Psychological Medicine and Institute for Health Innovation and Technology to understand the impacts of green spaces on the health and wellbeing of Singaporeans.

Enabling ease of travel with an inclusive transport hub 

For many in Singapore, the public transport system, be it the bus or train or both is the most commonly utilised form of transport in the country by older adults. Singapore is home to an integrated transport hub which is designed to be inclusive to older adults and dementia-friendly.

The transport hub connects a train station and a bus mall, with routes leading to residential apartments and a shopping mall. The transport hub provides a safe barrier-free environment without obtrusive safety features. The barrier-free space also allows staff to have visual access of the environment and for people living with dementia to find key landmarks in the hub. Large, contrasting, visible signage can be found to aid wayfinding. Maps containing both images and text, help visitors orientate and find their way within the hub. The temperature within the environment is controlled via air-conditioning, reducing any negative stimulation brought about by fluctuations caused by heat, wind or rain in the temperate climate. A mix of natural and artificial lighting enables visual access and clarity in the environment. Floor-to-ceiling windows allows light to stream in. At the same time, artificial lighting can help enhance visual access when natural light is lacking. A central reception desk can be found within the hub for people living with dementia. A person trained in dementia awareness is available at the desk to assist both the person living with dementia and their caregivers. For individuals who may find the experience of being in the hub overwhelming, a quiet room is available to help the individual to rest and reduce any feelings of anxiety.

Dementia Friendly Transport Hub from joanna sun on Vimeo.

As you can see, there are a number of significant projects that are currently undertaken in the community to improve the lives of Singaporeans living with dementia. More research and evaluation should be taken to measure to positive impacts of these built environmental projects, such as improved health, wellbeing and independence for people with dementia. With research and evaluation, these projects can be adequately assessed for translation into different countries and cultures. This way, positive projects can be successfully adapted for different countries and cultures to improve the built environment and quality of life for people living with dementia around the globe.

Joanna Sun is a PhD candidate with the University of Wollongong and a social media coordinator at the Wicking Dementia Research and Education Centre. Her research focuses on the development of a built environmental assessment tool for people living with dementia Singapore. Joanna has developed an environmental assessment tool for facilities providing high levels of care for people living with dementia in Singapore. Her research interest lies in the understanding of the influence of the built environment and how technology can reduce isolation and enhance social connectivity, education and engagement for people living with dementia and their families.

Twitter: @Design4agedcare