1 The experience of disorientation
The cognitive impairment that accompanies dementia can seriously affect people’s sense of where they are in time and place; this is called spatial disorientation. Of course, this experience is not confined to people with dementia; it is possible for anyone to experience disorientation in time and space under certain situations. For example, after a long-haul flight recently, I stayed in a 24-hour hotel, where it could have been any time of the day or night. This was ideal for a stopover, because I wanted to have something to eat and drink, and be able to sleep – services that are normally constrained by time. The lighting meant that it was impossible to distinguish night from day – it was in fact 3 a.m. The hotel was designed to make use of temporal and spatial disorientation to enhance the service by overcoming the rigid way in which time is constructed and the way in which space is traditionally arranged.
There are plenty of public spaces where the intention is not to disorientate people because it is important that they reach their destination. Yet walk into most large hospitals and you find a maze of corridors and many signs to help people to find their way. The following account from a nurse reminiscing about the start of her training in a large teaching hospital illustrates this point:
On my first day of training I was terrified that left to my own devices I would never find my way around. The main corridor was so long that the end was almost out of sight. When I went on to do further training in an old Victorian psychiatric hospital, the endless corridors were equally daunting. I wondered how it must feel not only to be lost but also to be incarcerated in a locked ward and sleeping in a dormitory with up to as many as 50 other people. If this made me feel distressed and disorientated – what must it be doing to the patients?
In the images below you can see how disorientating the interiors of some health and social care buildings are:
The next focus is the idea that the design of space is one way in which access and everyday living can be facilitated or constraining or can even prevent activity.