Designing For Patients With Mild Cognitive Impairment

Designers and researchers have made significant advances in designing environments that meet the needs of the general aging population as well as people living with dementia. Nevertheless, 12 to 18 percent of people aged 60 or older develop mild cognitive impairment (MCI), falling between these two populations.

People living with MCI often have difficulties making plans, focusing attention, remembering instructions, interacting with others, and operating independently at home and in their communities due to their decline in cognitive functioning.

Such challenges are more prominent than those that cognitively healthy older adults face, but they’re not as incapacitating as those experienced by people living with dementia. Thus, the design of healthcare facilities for people living with MCI should not simply follow the recipe learned from those undergoing normal aging or dementia.

Addressing mild cognitive impairment

For many decades, MCI has not been understood as a specific condition with its own challenges. It was only recently recognized as such and as a precursor to severe forms of dementia, thus attracting the attention of healthcare professionals, architects, and the population at large.

Driven by a lack of local options for people living in Atlanta who are experiencing MCI, Georgia Institute of Technology, Emory University, Nelson Worldwide, the James M. Cox Foundation, and Cox Enterprises partnered to develop the Cognitive Empowerment Program.

The program includes activities for both individuals living with MCI as well as their care partners, such as cognitive and functional independence training, nutritional education, and support groups, among others.

It’s envisioned to enable participants to take control of their treatment by engaging them not only in therapy but also in activities that foster functional independence and shared decision-making with health providers and care partners. For these reasons, the program’s participants are defined as members—not patients—to reflect the active engagement expected from them as empowered individuals.

Because there wasn’t an existing suitable space to implement the program as envisioned, the stakeholders also designed a one-of-a-kind center to support the program’s activities as well as provide a space to experiment with the built environment over time to identify ways it might be improved to stimulate people living with MCI. A 20,000-square-foot space at Emory Brain Health Center in Atlanta was identified for the program and, in April 2018, design on the Cognitive Empowerment Center (CEC) began.

 

Building the Cognitive Empowerment Center

As first steps, researchers from the SimTigrate Design Lab, an interdisciplinary research and design lab at Georgia Institute of Technology, conducted an in-depth literature review on assisted living facilities for people living with dementia and case studies on adult daycare facilities and similar environments. Then, researchers, designers, people living with MCI, and their care partners co-created concepts for the CEC during design charrettes.

The process resulted in a series of design goals, including:

• providing spaces to learn how to autonomously perform everyday tasks at home (e.g., cooking)
• fostering social interaction among members and care partners, as well as engagement with the community
• maximizing safety and spatial flexibility
• supporting environmental exploration
• and promoting well-being through contact with nature, physical activity, and cognitive stimulation, while avoiding information overload.

 

Design strategies for MCI

These design goals were translated into different spaces at the center to support the CEC’s activities. Specifically, the center’s program is made up of four cores, which are interdisciplinary teams responsible for planning and implementing research and interventions with members and care partners.

The teams include the Built Environment Core, the Therapeutic Core, the Technology Core, and the Innovation Accelerator. Some spaces are specifically designed to meet the needs of one core, while other areas address the demands of all four cores.

• The Built Environment Core is responsible for planning and designing the CEC in a flexible, safe, and engaging way. To support the CEC’s research and innovation processes, most spaces at the CEC are adaptable and outfitted with technologies. These include tunable lighting, controllable zone-based sound system, video cameras, and wearable tags, which can be used to allow testing of changes made in the built environment. For example, tunable lighting can be used to study the effect of distinct light conditions on the alertness of people living with MCI and the potential of sound masking to reduce cognitive load.
• The Therapeutic Core is focused on enhancing the physical, cognitive, and emotional well-being of the program members and their care partners. The CEC has several spaces dedicated to therapeutic activities, including conversation rooms with acoustic insulation to preserve privacy and semitransparent walls to facilitate orientation; a library with semi-private areas with computer stations and space for cognitive training; group rooms with rearrangeable furniture and partitions to host different activities such as large group lectures or smaller programs; and a studio for physical activity. Finally, the kitchen has an open-plan area with safe appliances to host cooking classes, stimulating functional independence and facilitating social interaction.
• The Technology Core supports nonintrusive interventions that can take place anywhere in the CEC. For example, a mobile app increases engagement and adherence to the program and smart sensor technology is used to collect information while maintaining privacy. The center also includes spaces dedicated to technology, such as a tech bar near the reception area where staff can help members with their technology needs and an innovation theater that provides a controlled environment for testing new technologies with members.
• Interacting with all the other cores, the Innovation Accelerator team is focused on creating opportunities for all stakeholders to engage in co-design and research to generate insights on improving the lives of those living with MCI. This includes an accelerator area designed with transparent glass walls and an adaptable furniture layout where people can participate in different group activities, such as data collection for research, presentations and discussions on prototypes of built environments and technological solutions, and think tanks. The transparent space ensures that research teams and members have continual exposure to each other, enhancing shared understanding and increasing engagement.

 

Creating a welcoming research setting

Overall, the 20,000-square-foot center is designed to create a welcoming environment with natural elements, including a water feature behind the check-in desk, floor-to-ceiling glass windows that provide visual access to nature and natural light, various plants, a color palette of greens, and flooring with natural wood grain patterns.

The building is functionally divided into two main areas: the north side of the building is dominated by the open studio, which is visible to the reception area and flows into the open dining area while the south side of the building houses enclosed offices for staff, consult rooms, the innovation theater, and a large reconfigurable group room. An outside garden is visible from one corner of the building, and a balcony on all four sides provides seating areas.

 

Gathering lessons on designing for MCI

In January 2020, the CEC opened its doors to people living with MCI and their care partners. As a genuine living laboratory, the effects of the design continue to be evaluated with valuable lessons gathered on designing healthcare facilities for people living with MCI.

For example, observations of members within the CEC have shown that some design features such as semi-open space layouts with conversational furniture arrangement, natural lighting, visual access to nature, and multifunctional and adjustable settings are critical for them to take ownership of the space and navigate it comfortably.

The team plans to complete a post-occupancy evaluation to add to the evidence base for this population, and lessons learned from this project will be shared in a guide that will be available from the SimTigrate Design Lab by the end of the year.

 

Leandro Miletto Tonetto is a research affiliate at SimTigrate Design Lab, Georgia Institute of Technology (Atlanta), and a professor of design at the Federal University of Health Sciences of Porto Alegre, Brazil. He can be reached at ltonetto@gmail.com. Jennifer DuBose is the executive director of SimTigrate Design Lab and the head of the Innovation Accelerator of the Cognitive Empowerment Program (Atlanta). She can be reached at jennifer.dubose@gatech.edu. Joshua Crews is the regional healthcare practice leader at Nelson Worldwide (Atlanta). He can be reached at jcrews@nelsonww.com. Craig Zimring is Emeritus Faculty at Georgia Institute of Technology and head of the Built Environment Core of the Cognitive Empowerment Program. He can be reached at craig.zimring@design.gatech.edu.

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