n empathic architecture scandinavian

8/6/2019 n Empathic Architecture Scandinavian

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Kungliga Tekniska högskolan Design, Arbetsmiljö, Säkerhet & Hälsa, DASH

KTH SYD Campus Haninge Marinens väg 30 136 40 Haninge. Tel: 08-790 48 28. Fax: 08-790 48 00. Mtfn 070-731 72 15E-post: [email protected] www.syd.kth.se

empathic architecture

a Scandinavian approach

about design in elderly homes

for fragile or demented people

Jonas E Andersson

architect SAR/MSA, candidate for the doctorate

DASH, Design, Arbetsmiljö, Säkerhet och Hälsa, KTH, Campus Haninge(Design, Work environment, Security and Health, KTH, Campus Haninge)



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table of contents:

1.0 abstract________________________________________________________ 3

2.0 introduction_____________________________________________________4

3.0 man and environment_____________________________________________ 5

4.0 man and care environment_________________________________________ 7

5.0 man and dementia _______________________________________________ 8

6.0 discussion _____________________________________________________10

7.0 concluding remarks and futher research _____________________________ 11

8.0 bibliography ___________________________________________________ 12

8.1 publications:________________________________________________ 128.2 publications on the Internet: ___________________________________ 14

This paper is written for the conference ”LIVING IN THE NORTH – nor-dic reflections on architecture”, Helsinki le 23 - 25 April 2004.

KTH, Campus Haninge the 16th April 2004© cover, « Eclipse of a thought », the author, reduced

revised 04.04.28/ JEA



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1.0 abstract

The 20th century in Sweden and the other Scandinavian countries has been charac-terized by a social-political ambition to improve the living conditions anywhere inthe society by urban planning and architecture. The Scandinavian architecture de-parted from a an inquiry about man’s basic needs and his corporal dimensions and

arrived at general recommendations that pretended to be an universal guaranteefor the built environment. An integrated notion in the Scandinavian architecture isto compare the physical characteristics of the human body to those of the building;the height, the width, the depth and the mass. Another revealing aspect is theScandinavian way of emphasizing the authenticity of the building material, but alsoto confirm the innate Scandinavian feeling for nature and its materials.

The modern Scandinavian architecture is challenged by the increasing portion of elderly people in the Nordic countries. Infirmities of old age that affect and disturbthe brain will create a cognitive problem for the ageing individual to understand andact in a built environment. In that way, a dementia will challenge any acquired

knowledge about how to plan a home for elderly. Recent findings from brain re-search ought to be integrated in the knowledge for Scandinavian architects. An im-proved competence in this area of human spatial thinking is a condition for under-standing the interaction between man and the built environment. Architecture al-ready functional ought to include the findings on human reactions upon the builtenvironment, colours, lighting effects and the form. In order to ease the daily lifefor elderly people with dementia or sickness, the Scandinavian architecture shouldpromote an empathic architecture, an architecture that combines functionality andimpression.

In the Swedish society, the municipality is responsible for the care of frail and de-

mented people. Gerontologists suggest that the care environment should be warm,filled with a quality so difficult to define, a feeling of home, and stimulate the re-maining capacities of the frail and the demented. This paper indicates that this feel-ing of home must be defined in order to serve as a necessary parameter in the de-sign of homes for elderly people. In Sweden, it is suggested that the best solutionfor elderly people with dementia is a unit for 10 persons. Reality shows that thissolution is no longer possible, the high number of demented people increases al-ready considerably. The conclusion of this paper is that an architectural research isnecessary to understand the relation between the design of a building for elderlypeople and their particular demands on the environment to be a support in theirdaily living.

Key words: special homes for elderly people with special need, dementia, home fordemented people, care environment, architecture, empathic architecture.



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2.0 introduction

The Swedish architecture is distinguished by a great attention to har-mony between building and surrounding nature. [...] The simplicity of the design, the transparency and the close contact with the natural en-vironment are a distinct characteristic of the contemporary Swedish ar-

chitecture and urban planning. 1

A non-verified hypothesis that the most burning information can be found onthe Internet gives the answer above. Similar researches using the other Scandina-vian countries2 demonstrate that Scandinavian architecture is considered to be aunity with individual characteristics. Scandinavian architecture is famous for itssimplicity, its preoccupation of the material, and its close interaction with the sur-rounding environment. In 1900 at the world exposition in Paris, international re-viewers concluded that the Scandinavian pavilion, jointly shared by the countries,bore witness to the importance of nature for their design and architecture3. TheSwedish architecture itself was internationally renowned during the twenties. This

classical expression was replaced by architecture with social-political ambitions, thefunctionalism, introduced at the Stockholm exhibition in 1930. A systematic anddirect approach, based on scientific research, was a strong aspect of this new archi-tecture that integrated economic planning and functional analysis in the designprocess4. The major stock of buildings is of this design, produced from the end of the second world-war until today. The Scandinavian architecture is closely relatedto social development, and things for everyday-use are considered to be a culturalexpression5. Buildings for elderly people dates from the Middle age. The buildingwent from workhouses to large-scale effective care-institutions. Even before func-tionalism, one characteristic of buildings for elderly people was a rational and for-mal look6. Elderly people in need of medical care were sent to hospital. The Swed-

ish reform of the elderly care in 1992, called “the noble reform” 7

reoriented thislook. Experiences had shown that elderly people preferred and felt better in smallerunits with a clear feeling of home and where the care was personalized. The term “special homes for elderly people with a special need” was formulated. The reformconfirmed the principal of small units integrated in an existing social context. Threekey words were adopted to define the new design - a feeling of home, way-finding,and a spatial clarity8.

The 21st century will challenge Sweden. As for the rest of the industrializedworld, the number of elderly people in society is increasing, and they will be veryold. The reform in 1992 focused on the individual and his needs, but elderly peoplein the future won’t have the same infirmities of old age as then. There is a strong

1 « L’architecture suédoise se distingue par la grande attention qu’elle porte à l’harmonie des constructions avec lanature environnante. [...] La simplicité du design, la luminosité et l’étroit contact avec l’environnement naturelconstituent les traits distinctifs de l’architecture suédoise contemporaine et de l’urbanisme suédois. », Yahoo! En-cyclopédie ; Littérature, arts et sciences de la Suède,http://fr.encyclopedia.yahoo.com/articles/jb/jb_597_p0.html

2 search in French, hits only on ”architecture and Danish and Norwegian nationality, Finnish and Icelandic did notproduce any result.3 Glambek, Ingeborg, 1997: Det nordiske i arkitektur och design. Sett utanfra. I Paulsson, Jan; 2003: Art, archi-tecture and design. Notes on the nature and contents of Nordic models during the 20th century; contribution toCPAS, centre for pacific asia studies, symposium What is the Nordic model?, Stockholm University, august 15-17,20034 Andersson, Henrik & Bedoire, Fredric 1986: Svensk Arkitektur, ritningar 1640-1970, Stockholm, Byggförlaget5

Lund, Nils-Ole, 1993: Nordisk Arkitektur, Arkitektens Forlag, Danmark6 Paulsson, Jan, 2002: Det nya äldreboendet, idéer och begrepp, byggnader och rum. Svensk Byggtjänst, p 227 due to the abbreviation of the government-committee8 Larsen, Jörgen, 1989: Anpassade gruppbostäder för åldersdementa, en beskrivning av utvecklingsfronten hösten1989 – om anpassningsbehov samt problem och hinder vid nyetablering. Spri, Stockholms Läns Äldrecentrum



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working place13. Man recognizes and understands these social structures and proc-esses.

Legend 1. man and environment (adaptation after Kagan & Levi, 1975)

The interaction of the individual with the environment depends upon the emo-tional and cognitive way to respond, but it is also influenced by the individual’s per-sonal habits and by its way to react to stress. The process is cybernetic14, and itcan be influenced by inter-acting variables. The variables could be social support,

cognitive therapy, or improvements in the built environment15

. A changed behav-iour implies a change in the number of synapses, and therefore a differentiation inthe brain tissue16. The complexity of a complete identification of the effect from anyvariable is so big, that it is difficult to know which variable causes a certain reactionin the body.

13 Levi, Lennart, 1987; Psychosocial factors and health approaches to person-environment interactions, in Ulrich,Roger S & Hygge, Staffan, 1987; Research on environments and people, Swedish council for building research,Stockholm, Sweden.14 Cybernetic = science of communication and regulation in the living organism and the machine. Le Robert pourtous, dictionnaire de la langue française.15 Levi, Lennart, 1987; Psychosocial factors and health approaches to person-environment interactions, in Ulrich,Roger S & Hygge, Staffan, 1987; Research on environments and people, Swedish council for building research,Stockholm, Sweden, p 45-4916 Kolb, Bryan & Whishaw, Ian, 2002:Cerveau et Comportement, Bruxelles, de Boeck & Larcier SA, p 600.

stimuli(physicalor psycho-social)

profile(psycho-biologicalprogram)

reactions(interactionstimuli andprofile)

signs(disturbed health)

bad healthor sickness

maladie

pre-influ-

ence of theenviron-ment

geneticheritage

inter-acting variables, positive or negative

social con-nections

structureandfunction

environmentman and environment



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4.0 man and care environment

The brain performs several cognitive operations, of which the percep-tion, the execution of actions before perceptual operations, the con-structions of images, planning, spatial cognition and attention. Theseoperations demand a simultaneous activity in the cerebral cortex 17 .

The way the brain deals with the information and creates an interpretation, ina complex system of synapses on different levels of the cerebral cortex. It is impos-sible to find the exact spot where physical or psycho-social stimuli are interpretedor precisely where an appropriate behaviour is decided. A neuro-psychologicalmodel of this process gives a more comprehensible image18: Signals coming fromthe five senses are directed to the rear part of the brain. The central part of thebrain suggests a set of plausible interpretations. The frontal part of the brain decidewhich behaviour to adopt. This model also emphasizes the importance of studyingman in interaction with environment19. Studies from hospitals indicate that patientsfeel stress caused by the psycho-social environment in the hospital or by the rea-

son of being there. A high level of stress hormone in the blood weakens the im-mune defence system20. Neuroscientists suggest that a group of stress hormonescalled glucocorticoid might be considered as a neuro-toxic for the neurons in thebrain21. During long influence of stress, neurons in central parts of the brain degen-erate, which could explain the changed behaviour and the mnemonic problems of heavily stressed people.

Legend 2. man and care environment (after Ulrich, 1991)

A supportive design in a care environment focuses on the patient, the patient’sfamily and the personnel. Its aim is to reduce stress. Studies performed in at hospi-tals prove the need for an architectural design of the environment. The designshould imitate that of a novel – coherence is the most important criterion for un-

17 “Le cerveau réalise de multiples opérations cognitives dont la perception, la mise en oeuvre d’actions devantpermettre la perception, la construction d’images, la planification, la cognition spatiale et l’attention. De tellesopérations nécessitent une activité conjointe de régions corticales“ in Kolb, Bryan & Whishaw, Ian, 2002 : Cerveauet Comportement, Bruxelles, de Boeck & Larcier SA, p 571 18 after the Russian neuro-psychologist Alexander Luria, in Kolb, Bryan/ Whisham, Ian, 2002 : Cerveau et compor-tement. Bryssel, De Boeck & Larcier, s 7219 Luria, Alexander: “There is no hope of finding the sources of free action in the lofty realms of the mind or in thedepths of the brain. (...) To discover the sources of free action it is necessary to go outside the limits of the organ-ism, not into the intimate sphere of the mind, but into the objective forms of social life; it is necessary to seek thesources of human consciousness and freedom in the social history of humanity. (...) “ Luria, Alexander, http://www.marxist.org/archive/luria20 Ulrich, Roger S. 1991: Effects on interior design on wellness: theory and recent scientific research, Journal of healthcare interior design, 3:97-109.21 Kolb, Bryan & Whishaw, Ian, 2002:Cerveau et Comportement, Bruxelles, de Boeck & Larcier SA, p 518.

supportive design in a care environment

a supportive design in care environment must improve health andreduce stress by improving :

1. a feeling of control of the psycho-social environment

2. a social support3. access to distractions in the physical environment



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derstanding a text22, and equally in a built environment23. The design should have aclear visual message of function, long corridors a conscious treatment of walls, ceil-ing and floor, colours and material. The penetration of daylight and the arrange-ment of windows with a view to the adjacent nature are other important criteria.The interior design should appeal to the aesthetic sense of the patient24, thus re-ducing easily appearing stress25. A special home for elderly people with a specialneed is a care environment designed with a strong illusion of home. The majority of

elderly people in Sweden will have a normal ageing, but a group of elderly, ap-proximately 115.500 persons or eight percent26, will experience such a difficult age-ing that a private home is unadvisable. Their capacity to cope with activities of dailyliving, ADL27, is so disturbed that this group needs assistance and a care twenty-four hours a day. Here questions of existential nature are carried to extremes, sincea living this living rather is a hospice where the stay is only some months.

5.0 man and dementia

The cholinergic ascending system contributes to activity [...] in an

awaken person [...] and seems to play a role in the normal awaken be-haviour. Persons touched by Alzheimer’s disease present [...], at an au-topsy, an important loss of these cholinergic neurons28.

In 2003, the number of persons suffering from dementia was estimated to139.000 persons in Sweden. A destruction of the cerebral tissue is concentrated tothe region that according to the mentioned neuro-psychological model decides andputs into execution the chosen behaviour. It is also the center where personality islocated. Among those suffering from dementia 50 to 70 percent have Alzheimer’sdisease. A dementia causes disruptions affecting the personality, the memory, andability to orientate inside or outside. Even before the diagnosis, persons suffering

from dementia are aware of some of the problems. A normal reaction is to denyeverything. In the early phases of a dementia it is possible to go on living at home,in that sense the disease also becomes the family’s problem. Research concentratesupon finding the cause of dementia. For the moment there is no cure for the dis-ease, medicine can only slow down the course. Finally it is no longer possible tostay at home; a complete care around the clock is needed. A special home for eld-erly people with special need of care due to dementia or illness is then the best so-lution for both the individual and his family.

22 Eco, Umberto, 1992; Les limites de l’interprétation i Sörman, Richard, Litteraturvetenskaplig metod, UppsalaUniversitet 2002, s 9823 Evans, Gary W & Mitchell McCoy, Janetta, 1998: When Buildings don’t work: the role of architecture in humanhealth, Journal of environmental psychology 1998:18, s 8624 Ulrich, Roger S. 1991: Effects on interior design on wellness: theory and recent scientific research, Journal of healthcare interior design, 3:97-109.25 Ulrich, Roger S. 1991: Effects on interior design on wellness: theory and recent scientific research, Journal of healthcare interior design, 3:97-109.26 Socialstyrelsen 2003: Äldre – vård och omsorg år 2002, artikel nr 2003-44-0327 ADL = Activities of Daily Living28 “Le système cholinergique ascendant contribue à l’activité [...] chez une personne éveillée [...] et semble donc

jouer un rôle dans le comportement d’éveil normal. Les personnes atteintes de maladie d’Alzheimer [...]présentent, à l’autopsie, une perte importante de ces neurones cholinergiques.” In Kolb, Bryan & Whishaw, Ian,2002:Cerveau et Comportement, Bruxelles, de Boeck & Larcier SA, s 174.



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Legend 3. man and dementia (adaptation from Cars & Zander 1998)

A dementia means that the inner life of the individual is changed into a pre-sent state only. Every dementia has its own manifestation, and the family and thestaff must find the logic in the illogic. A frequently used method in Sweden is to af-firm the self-assessment of the demented, developed by the American psychologistand psychoanalyst Leonard Bellak29. Another form of care for demented people iswater therapy, which strengthens the sensation of the body30. A dementia illness isa cruel experience for the family. The shared family-past is erased. Some stimulilike music can recall the personality that the illness hides31. Demented people areoften anguished or worried, normally at nightfall, the so called Sun Downer’s Syn-drome32. Natural inhibitions disappear and some demented become aggressive oreven sexually offensive. There is often a need to let out the stress and the anguishthrough physical activities.

29 Cars, Jane & Zander, Birgitta, 1998: Samvaro med dementa, Gothia,30 Benito-Garcia, Marc, 1996: Démence, architecture et projet de soins. Université Paris/, Faculté de MédecineLariboisière Saint Louis, Paris.31 Ogay, Suzanne, 1996: Alzheimer – communiquer grâce à la musicothérapie, L’Harmattan, Paris32 Regnier, Victor, 2002; Design for assisted living, guidelines for housing the physically and mentally frail, JohnWiley & Sons, Inc, New York

failing self-functions caused by dementia

1. reflective capacity decreases2. emotional capacity changes3. emotional control falters4. capacity to understand the environment decreases5. capacity to discrimination decreases6. capacity to interact with the environment decreases7. capacity to maintain one’s personality decreases8. independence disappears9. control of defensive mechanism, anguish or worry, falters

10. capacity of self-esteem is threaten11. imaginative capacity disappears12. capacity to understand is lost



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6.0 discussion

empathy – the power of understanding and imaginatively entering intoanother person’s feelings33

A complete documentation with recommendations or practical advice exists for

designing special homes for elderly people with a special need. In our opinion, thetask asks for a deeper knowledge. It is very easy that the architectural work con-centrates on the work environment and its functionality, but avoids the existentialquestions. Probably, the staff spends more time in the built environment than thelodgers, but this is not a good answer to avoid the supportive design issues for eld-erly and moribund people. Due to this fact, a design of a special home ought tohave a conceptual focus on care, man and ageing. It is important that these ques-tions are discussed in the initial phase of the project in order to create an empathic architecture.

Legend 4. empathic architecture – architectural guidelines

The design of a building is a design-process34 where different actors like careorganizers, building coordinators, representatives from union or from relatives or-ganisations and the architect. The architect translates the design discussion into arealistic plan of the building. The philosopher Donald Schön considers “the design-

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explanation from Collins, English Dictionary, 1998 ; HarperCollins Publishers, Glasgow, 4 edition34 design-processen according to Gustaf Rosell: ”the emergence and development of an idea of a product and thetransformation of these ideas to information, will make it possible to produce a product” in Lundequist, Jerker,1992: Projekteringsmetodikens teoretiska bakgrund, Institutionen för Arkitektur, Kungl Tekniska Högskolan,Stockholm

empathic architecture – guidelinesin order to explain the built environment in a special home to elderly people, relatives, andstaff (the users), it is important to design from the following criteria :

1. a knowledge of man and aging2. a knowledge of care, attention, and working environment3. a knowledge of man, environment, environmental psychology,

(a supportive design for the frail and the demented)4. a conceptual approach building – ageing man

(functional and spiritual needs must be respected)5. a knowledge of certain building qualities and of importance for

frail and demented people(daylight, illumination, colours, social meeting)

6. a balance between rationality, aesthetic qualities, and ethics(corridors mean meeting points, activity, work, etc)

7. a clear conception of the use of space in order to explainspatiality (function, details, material on floor, wall, and ceiling)

8. the relation between interior and exterior(penetration of light, panorama, balcony, terrace, patio, garden)

9. location of the building(in an existing social context is to prefer)

10. a clear relation between function, interior design, furniture

(a feeling of home by close interactionarchitect-interior designer-care staff)



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process as a dialogue between the designer and the design situation, where thedesigner should act with his unique competence of different design contexts. Whatis typical for the design practice is the reflection in action and the conversationswith the materials of a situation” 35. When it comes to a special home for elderlypeople, the designer is not a person, but a group of specialists whose intentions foran empathic architecture will characterize the building itself. An empathic architec-ture is not a predefined architectural expression; it aims to an architecture that is

visually comprehensible for the frail or demented individual. It also means ahealthy working environment. A visual clarity is not limited to the organisation of the rooms, arranged to facilitate way-finding and a global view of the building, italso means a clear use of a door or a room. An empathic architecture is a scenarioto explain the contents of the space.

7.0 concluding remarks and further research

Architecture is an ode to space it-self.36 (Paul Valéry)

Several gerontologists have considered the feeling of home as a result of put-ting different objects representing different time-periods that a frail or a dementedperson presumably relates to. A conclusion from this paper indicates that this feel-ing also ought to refer to the interaction between man and environment. Anotherconclusion is that way-finding and spatial clarity make part of this interaction. Forthe best result, a special home for elderly people with special needs should be abuilt environment that promotes a sensation of security and calm, but also a non-stressful framework for the staff working there. The problem is to define each ele-ment in a built environment that contributes to this kind of sensation and of frame-work. Swedish research on special homes has had an inclination towards workingenvironment rather than environmental impression. Further research therefore

should include the impression that elderly frail and demented people have of theenvironment, and also that of their relatives. There are ethical problems to do sucha research, but in the same time there is a great need of this type of investigation.The loss of a dear family member is always a difficult emotional experience thatleaves permanent traces; the goal is to put this emotional event in a warm setting.Consequently, an architectural research means a multidisciplinary approach, col-lecting gerontologists, care professions, psychologists, philosophers on one hand,and architects and interior designers on the other. An approach of this kind couldalso turn into meeting between human beings about age, ageing and the eternalquestions.

35 Lundequist, Jerker, 1992: Projekteringsmetodikens teoretiska bakgrund, Institutionen för Arkitektur, Kungl Tek-niska Högskolan, Stockholm, p 1836 entry architecture; L’architecture est une ode de l’espace à lui-même. Valéry, i Michel Legrain et al, 1994 ; LeRobert pour tous, dictionnaire de la langue française. Dictionnaire Le Robert, Paris.



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versitet



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8.2 publications on the Internet:Andersson, Jonas E, 2003; Hälsofrämjande miljöer för boende och vård på ålderns höst ,vardagsaktivitet eller byggnadsutformninghttp://www.syd.kth.se/forskning/dash/Jonas/pdf/DEF0300414.pdf

Andersson, Jonas E, 2003; Ljus och demens, en inventering av en arkitektonisk utformningav belysning på en demensavdelning och tänkbar påverkan av ljus opå demenssjukahttp://www.syd.kth.se/forskning/dash/Jonas/Ljusochdemens-Haninge.pdf

Bengtsson, Anna, 2003: Utemiljöns betydelse för äldre och funktionshindrade, kunskaps-sammanställning. Statens Folkhälsoinstitut,http://www.fhi.se/shop/material_pdf/utemiljo0401.pdf

Elmer, Eddy M, 2001: Aesthetic considerations in long-term care and psychiatric facilities:Ideas from environmental psychology, Simon Fraser University.www3.telys.net/eddyelmer/artics/facsfu.htm

Luria, Alexander, www.marxist.org/archive/luria

Socialstyrelsen 2003: Äldre – vård och omsorg år 2002, artikelnr 2003-44-03,http://www.sos.se/FULLTEXT/44/2003-44-3/2003-44-3.pdf

Waern, Rasmus, 2001: L’architecture en Suède.

http://www.sweden.se/upload/Sweden_se/french/factsheets/SI/L_architecture_en_Suede_f d109a.pdf

Yahoo ! Encyclopédie ; Littérature, arts et sciences de la Suède,fr.encyclopedia.yahoo.com/articles/jb/jb_597_p0.html

n empathic architecture scandinavian

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