Building for Dementia

ISBN 978-3-86859-478-2 https://www.jovis.de/de/buecher/product/building-for-dementia.html

ISBN 978-3-86859-478-2


You also want an ePaper? Increase the reach of your titles

YUMPU automatically turns print PDFs into web optimized ePapers that Google loves.

<strong>Building</strong><br />

<strong>for</strong><br />

<strong>Dementia</strong><br />

Christoph Metzger

Foreword 7<br />

Rethinking Architecture 10<br />

Phenomena 11<br />

Movement in the Room 16<br />

Windows as a Promise 18<br />

Sleep and Memory 20<br />

Roads and Paths through Life 22<br />

Roads 23<br />

Material 25<br />

Images 25<br />

Home 26<br />

Childhood 27<br />

Walking 29<br />

Bodies in Motion—Stimulations 32<br />

Swimming 32<br />

Bodies 33<br />

Motion 34<br />

Age and Orientation 38<br />

Recognition 38<br />

Memory Work 39<br />

Magic Mountain 40<br />

Orientation 41<br />

Room Planning 43<br />

Research into Aging 44<br />

Cognitive Skills 46<br />

Degrees of Similarity 46<br />

Complexity—Reduction 48<br />

Compensation as a Process 50<br />

Gestalt and Abstraction 50<br />

Cognition in a State of Flux 51<br />

Communality of the Senses 51<br />

<strong>Dementia</strong> and Perception 53<br />

Spatial Awareness 54<br />

Gestalt Theory and Spatial Perception 55<br />

Perspective and Color 56<br />

Multisensory Rooms 56<br />

Localization of Acoustic Events in Space 58<br />

Sound Direction 60<br />

Life without Acoustic Orientation 60<br />

Rooms Provide Orientation 62<br />

Orientation in the Room 64<br />

Structure and Pattern of Hearing in the Room 65<br />

Hearing Loss 67<br />

Signal Recognition in the Field of Sound 67<br />

Cognitive Training 68<br />

Memory—Remembering—Action 71<br />

Memory 72<br />

Remembering 72<br />

Action 73

Types of Housing <strong>for</strong> the Elderly 74<br />

Development of Care Facilities 75<br />

Bases 77<br />

Precursors and First Generation 77<br />

Second Generation 78<br />

Third Generation 79<br />

Fourth Generation 79<br />

Fifth Generation 79<br />

Future-Oriented Local Authority Policies and Sixth Generation 80<br />

Multisensory Architecture 82<br />

Situation 82<br />

Forms of Housing—Infrastructure—Types of <strong>Building</strong> 84<br />

Intuitive Legibility 84<br />

Home Com<strong>for</strong>t 85<br />

Quality of Structures and Materials 85<br />

Age-Related Changes in Perception 85<br />

Assistive Systems and Smart Homes 92<br />

Systems 94<br />

<strong>Building</strong> Technology 95<br />

Services 97<br />

Safety in Old Age 98<br />

Emergency Systems 100<br />

Private and Public Spheres 102<br />

House and Room 102<br />

The <strong>Building</strong> as an Urban Center 106<br />

Tables, Beds, and Chairs 109<br />

Windows and Doors 111<br />

Changing Environments 112<br />

The House as a Home 115<br />

Inclusion or Exclusion 120<br />

Visual Axes and Opportunities 120<br />

Location and Planning 122<br />

Center and Circle 125<br />

Periphery as an Opportunity 126<br />

Political Understanding 126<br />

Prospect of an Architecture of the Future 128<br />

Lifelines 132<br />

Topoanalysis 138<br />

Navigation 139<br />

Movement and Neuroplasticity 140<br />

Physical Experience of Acoustic Events 142<br />

Acknowledgments 149<br />

Bibliography 150<br />

Notes 152<br />

Captions/Picture credits 157<br />

Imprint 159

Foreword<br />

<strong>Building</strong> <strong>for</strong> <strong>Dementia</strong> came about as a sequel to the treatise Architektur<br />

und Resonanz (Architecture and Resonance), written at the Technical<br />

University of Cottbus. Since then, many new ideas have continually changed<br />

my views on architectural phenomena and the perception of their sensory<br />

qualities. I have learned to interpret the bodies of buildings as an ensemble,<br />

to which people react with their own physical sensorium. I was already acquainted<br />

with animated bodies that vibrate in response to stimuli, but not<br />

so much from architecture as from the practice of music and sound art.<br />

Since 2004 this artistic genre, which is still relatively new, has been taught<br />

an advanced international level by Ulrich Eller at the Braunschweig University<br />

of Art. We have been researching the field together, both in theory and in<br />

practice, since 2006. The sound art projects that have developed from this<br />

are concerned with architectural spaces and landscapes. We have carried<br />

out many projects in historical places, such as churches, monasteries, old<br />

factories, and museums, as well as in a boatyard on the Baltic Sea island of<br />

Usedom, where they still work mainly with wood. Regular trips to the Venice<br />

Architecture Biennale have suggested concepts of sound in space that<br />

have ultimately led to experiences of the multisensory properties of rooms.<br />

With these sensual experiences we are going beyond a practice that just<br />

resembles hearing, seeing, or tasting in the tradition of monosensory culture.<br />

Today we know more about the spaces that surround us, leave their<br />

mark on us, and influence our senses. To state that, coming from a common<br />

background in the guitar, we both found new ways into architecture<br />



Rethinking<br />

Architecture<br />

This book is the result of a search <strong>for</strong> a new way of thinking about<br />

architecture. It is about buildings and the spaces <strong>for</strong> movement that they<br />

create, and not exclusively <strong>for</strong> an aging society. Research on this topic has<br />

drastically altered my thinking about life in old age and the physical activity<br />

and movement that becomes increasingly necessary at this stage of life. In<br />

architectural terms, thinking means an ability to adapt to an environment with<br />

sheltering spaces, in order to feel physically at home. 1 Significant parts of the<br />

metaphor coming into play here originate from a phenomenology of the body<br />

and are transferred to architecture. Movement is introduced as a key motif as<br />

an extension of existing ideas. However, security and living are at first considered<br />

as a single unit. In the course of the book, it will be pointed out that<br />

age-adapted <strong>for</strong>ms of living require only marginally higher financial expenditure<br />

at the start, and that such expenditure is justified. Good architecture not<br />

only helps maintain health in old age, but pays <strong>for</strong> itself in all areas, always<br />

assuming that movement through the interior and exterior spaces of the<br />

building is assisted and motivation is maintained over long periods. When<br />


looking <strong>for</strong> a house in the sheltered housing project in Vals, in the Swiss<br />

canton of Graubünden/Grisons (the town that is famous among architects<br />

<strong>for</strong> the Thermal Baths by Peter Zumthor), I asked <strong>for</strong> the old people’s home<br />

and was met only with shakes of the head. The local inhabitants remain in<br />

their houses with their vegetable gardens to the end of their lives. A home <strong>for</strong><br />

the elderly built in the 1990s remains almost empty. There is no need <strong>for</strong> it.<br />

The image of the elderly in Vals remains with me. It points to fundamentals<br />

of healthy living, which can also be realized, in part and with modifications,<br />

in urban areas.<br />

Phenomena<br />

My argument concerns a radical change, a fundamentally new understanding<br />

of housing <strong>for</strong> the elderly, which is currently still designed to<br />

hinder movement within the home and its surroundings instead of encouraging<br />

it.<br />



Roads and Paths<br />

through Life<br />

I am starting to write long after I learned to walk. If my gait becomes<br />

unsteady in old age, according to relatively recent scientific discoveries this<br />

can be diagnosed as a warning sign of dementia. It is essential to act immediately<br />

to counteract declining abilities. Walking means being and remaining<br />

independent. It is essential to maintain and encourage walking. For two<br />

years now, walking has become the most important ritual of the day; I feel<br />

very well physically. My joints are more flexible than be<strong>for</strong>e and my gait is<br />

firmer. Most of the thoughts that will accompany me during the day come to<br />

me in the early morning, shortly after sunrise, when I take the first of my three<br />

daily walks with our pug Riva around the Lietzensee in Berlin-Charlottenburg.<br />

There is no such thing as bad weather. Not in the city and not really in<br />

the countryside. I have the right shoes. In the open air, I have become familiar<br />

with all kinds of weather and the welcome signs of the seasons. Walking<br />

makes me happy, and when I come home I am greeted by the smell of fresh<br />

coffee and rolls. A healthy and wonderful life. It is thanks to my family that I<br />

became aware of all this along the way. If the brain is provided with the vital<br />

functions, intellectual and motor processes are almost certainly secured.<br />

When I think about it, I seem to be unconsciously and naturally continuing<br />

the experiences I have gathered over the course of my life.<br />


Roads<br />

I know the roads and paths of my life. They lead me to the fundamental<br />

motifs of the theme of <strong>Building</strong> <strong>for</strong> <strong>Dementia</strong>. Good architecture is<br />

simple. However, in our times simple things have been <strong>for</strong>gotten and it is<br />

essential to recover them. Good, simple architecture is not committed to the<br />

principles of movement and appealing to all the senses <strong>for</strong> the elderly alone.<br />

Good architecture today integrates technical support systems that make life<br />

easier <strong>for</strong> the elderly right from the start. The automotive industry leads the<br />

way in this with its networking systems. What is currently standard there<br />

leads us into what will be the norm in the future, when we will make use of a<br />

large number of services. A smart home may still be a luxury today, but we<br />

should be treating ourselves to it now.<br />

In <strong>Building</strong> <strong>for</strong> <strong>Dementia</strong>, I am concerned with combinations of multisensory,<br />

stimulating rooms and successions of rooms that promote orientation,<br />

while at the same time discreetly offering security. In the contemporary<br />

version of its parameters, architecture creates the conditions that are now<br />

vital <strong>for</strong> a long and independent life <strong>for</strong> the elderly and those with the first<br />

signs of dementia. Security and safety are there<strong>for</strong>e the leitmotivs of my<br />



Bodies in Motion<br />

—Stimulations<br />

I connect walking and swimming with the experience of getting to<br />

know the central point of one’s own body. I am often delighted by the beaming<br />

faces of children when they master the art of walking upright and begin<br />

to run unsteadily, fall, and immediately stand up again.<br />

Swimming<br />

Swimming with my favorite girlfriend, who has remained true to me<br />

until today. Although it is no longer there today, in the 1980s in Frankfurt in<br />

the Eschenheimer Anlage, immediately behind the old opera house was an<br />

indoor swimming pool that was getting on in years but flooded with light.<br />

While swimming, you could look out at the trees of the neighboring park in<br />

the middle of the city. It was here that I taught my girlfriend to do the crawl. I<br />

was allowed to guide her slim, elegant body. I could keep her balanced with<br />

my right hand. It was like launching a yacht. She swam the crawl <strong>for</strong> the first<br />

time in her life and made me the gift of that abiding image. Lying in the water<br />

seems to make the body weightless, and this unspoiled, natural floating, as<br />

in a mother’s womb, makes us all as light in the water as the birds of the air at<br />

every stage of our lives. It is hard to imagine that there are people who have<br />

never learned to swim; they are missing a great deal. Reading and swimming<br />

should be declared to be basic human rights.<br />


Bodies<br />

I have recently been discovering more and more objects and structures<br />

that have an empathy with human bodies. Nowadays, model yachts<br />

seem to me like young, athletic people diving in freefall from the swimming<br />

pool springboard. Similarly, the hull of a wonderful wooden boat like the<br />

1930s yacht being renovated in the boatyard in Freest, Kröslin, on the Peene<br />

estuary, reminds me of a person lying on his back on an operating table.<br />

The opened body seems to be waiting <strong>for</strong> its next life. The individual rails,<br />

ribs, and planks resemble a human skeleton. I see ribs and vertebrae, and<br />

the image frightens me. The central point of the hull, which is also its center<br />

of gravity, is where the mast foot is positioned. Like connecting a plug, the<br />

mast is inserted into the ship. This is where the strongest <strong>for</strong>ces will be in<br />

play and particular stability is required. Parallels with Peter Zumthor’s Chapel<br />

of St. Benedict in Grisons/Graubünden come to mind. There, tonal <strong>for</strong>ms<br />

of stringed instruments are translated into architecture, with stable vibra-<br />



Age and<br />

Orientation<br />

Recognition<br />

The memory and presence of images are important elements <strong>for</strong><br />

orientation in the world. At all stages of life, we are referred back to courses<br />

of events that we have learned. We recognize patterns and structures, and<br />

the properties associated with them allow us to act to some extent intuitively.<br />

Recognition concerns the whole range of events that can be perceived with<br />

the senses. These could be the sound of a familiar voice, footsteps on a<br />

flight of stairs, the taste of a meal, or the smell of a dwelling that has become<br />

our home. Familiar things invite us in, whereas we meet new things<br />

with a critical distance—approaching or walking away, listening in or turning<br />

aside. Every interest leads automatically to a change in the attitude of the<br />

body that is part of our behavior toward things and thus of orientation and<br />

preparation <strong>for</strong> action. The special feature of actions lies in their growing importance<br />

as purposeful movements in the context of rooms. Body and mind<br />

always work together, not separately, in order to act. Motor processes and<br />

mental presence combine, as is clearly visible, particularly in small children,<br />

and they determine movements and actions in a complex system that lasts<br />

well into old age. Sequences of movements that function well enable us to<br />

draw conclusions about a person’s healthy development and general state<br />

of mind. Movement is also to be understood as coping safely with actions<br />

and covering specific stretches in a given time. The time we need <strong>for</strong> carry-<br />


ing out anything from simple actions to complex movements there<strong>for</strong>e also<br />

reflects a part of our personal conditioning. We enjoy regularly remembering<br />

the physical movements we experienced as children and adolescents, jumping,<br />

running, or swimming, as being perfectly natural.<br />

Memory Work<br />

Memory work and biographical self-affirmation secure the knowledge<br />

of every aspect of personal identification. As we grow older, what distinguishes<br />

us from children is our dwindling carefreeness and self-assurance.<br />

Our bodies change throughout our lives and so do our worries about them,<br />

which are expressed in the measures we take—or are taken by others—to<br />

retain our health. Older people, especially, demonstrate to us how closely<br />

their movement and certainty about the passing of time are bound together.<br />

Motor skills and cognition, which have been thoroughly researched in the<br />

field of child development, are now only slowly gaining importance in the<br />

area of research into old age. Ritualized daily actions that are associated with<br />

movement are attracting particular attention. Human functional processes<br />

change with age. It is crucially important that the planning of specific ranges<br />

of spaces and their sensory requirements should be geared to the cognitive<br />

abilities of residents. Interdisciplinary initiatives are required.<br />



These subareas, which lead to a range of spaces optimized <strong>for</strong> old<br />

age and a safe world to live in, lie somewhere in between philosophy, cognitive<br />

science, psychology, and medicine, and also extend into the arts. During<br />

our entire lives, we learn and remember this in our images. These images acquire<br />

increasing importance in old age. We store and remember images that<br />

will ultimately be described and communicated in speech. Art and literature<br />

have a special part to play when rooms and paths appear as places in an<br />

artistic production that will be linked to their own experiences.<br />

Magic Mountain<br />

To give an example: if I read a passage from Thomas Mann’s novel<br />

The Magic Mountain, especially the pages devoted to the detail of the arrival,<br />

development, and abating of the snowstorm, 57 as a reader, I plunge<br />

into the world of images and associate a snowy mountain landscape I know<br />

well with the description of the details that will leave their mark on my images,<br />

according to the space the author gives to them and the detail of his<br />

descriptions. “But if they had no sun, they had snow. Such masses of snow<br />

as Hans Castorp had never till now in all his life beheld. The previous winter<br />

had done fairly well in that respect, but it had been as nothing compared to<br />

this one. The snow-fall was monstrous and immeasurable, it made one realize<br />

the extravagant, outlandish nature of the place. It snowed day in, day out<br />

and all through the night. The few roads kept open were like tunnels, with<br />

towering walls of snow on either side, crystal and alabaster surfaces that<br />


were pleasant to look at, and on which the guests scribbled all sorts of messages,<br />

jokes and personalities.” 58 At the center—as if to implement the laws<br />

of Gestalt theory—is the dissolution of the contours of a landscape, which is<br />

represented as a world of ice and fog in motion. As the reader, I project images<br />

that will become a part of my personal world of images that is triggered<br />

by literature. The appearance and disappearance of shapes and contours<br />

gives this scene a meaning that can be understood as a general search <strong>for</strong><br />

patterns that must be recognized—the point being that the engraving of<br />

these patterns begins when structures are no longer available.<br />

Orientation<br />

Our orientation and movement in real and artistically created spaces<br />

are so significant that, from the point of view of a philosophy of cognition,<br />

even the essence of our consciousness of our bodies develops from it. The<br />

consequence of this is that movements in space and our intuitive, mostly<br />

familiar, experience of them are inseparably linked to our self-awareness.<br />

Movement promotes certainty and security. Rooms can help to ensure orientation<br />

and security. Easy-to-read rooms and clear designs are also to<br />

be seen as guidelines <strong>for</strong> sensible planning. The intellectual association of<br />

body and experience is seen as an aging process in people. Experiences are<br />



Cognitive Skills<br />

The receiving and processing of sensory stimuli and the cognitive<br />

process of converting them into actions mark all areas of our daily life. The<br />

more stimuli we are simultaneously subjected to, the greater the demands<br />

on cognitive per<strong>for</strong>mance and compensation. The more easily situations can<br />

be recognized, the less energy is needed in order to respond to them with<br />

appropriate actions. Rudolf Arnheim’s analysis of visual regularities (1954)<br />

emphasizes the importance of morphogenetic skills and links them to the<br />

concept of levels of abstraction. This theoretical approach is appropriate <strong>for</strong><br />

gaining a better understanding of the general laws of cognitive impairment<br />

that can provide a basis <strong>for</strong> relevant planning guidelines.<br />

Degrees of Similarity<br />

The transfer of approaches from Gestalt theory to architectural<br />

planning is illustrated by a procedure in fine art. Similarities can be seen in<br />

the processes of abstraction, which appear to be comparable to production<br />

and perception from two perspectives. The creation and understanding of<br />

art are discussed. There are obvious parallels between the path to understanding<br />

the abstract image captured on canvas and the everyday recognition<br />

of objects at greater distance. The farther away an object appears,<br />

the greater the degree of compensation the viewer has to employ in order<br />

to identify the object. The image only ever comes into existence through<br />


the viewer and the way he looks at things. Here there is a suggestion of a<br />

kind of functional logic hinting at a logical relationship between the awareness<br />

of something and its image. Transferring this concept to architecture<br />

seems to be the obvious thing to do. If a situation is identified, actions can<br />

be derived from it. This explains the comment that “more plausibly, we<br />

might observe that when by some circumstance the mind is freed from its<br />

usual allegiance to the complexities of nature, it will organize shapes in accordance<br />

with the tendencies that govern its own functioning. Many experiments<br />

suggest that the predominant tendency at work here is a tendency<br />

toward the simplest structure, the most regular, symmetrical, geometric<br />

shape that can be achieved in the given circumstances.” 71 According to<br />

Arnheim, in terms of cultural history this is reflected in symmetrical shapes,<br />

especially in sacred architecture and works of art. “The symmetry of the<br />

composition represented the stability of the hierarchic order created by the<br />

Church. By eliminating everything accidental and ephemeral, elementary<br />

posture and gesture emphasized lasting validity.” 72 As a result, natural laws<br />

of cognition are accepted and given excessive importance as dogmatic<br />

truths in the world of art and architecture and their importance is exaggerated.<br />

Symmetry, in the <strong>for</strong>m of quasi-natural location, can be found in all<br />

<strong>for</strong>ms of art; even the structure of the human body is largely symmetrical.<br />



Localization<br />

of Acoustic<br />

Events in Space<br />

“One day when the windows were open, Christian Wolff was playing<br />

one of his pieces on the piano. Traffic noise and ships’ sirens were not only<br />

heard during the pauses but, because they were louder, heard better than<br />

the piano. Later someone asked Christian Wolff to repeat the piece with the<br />

windows closed. Christian Wolff said he would gladly do so, but it was not<br />

actually necessary, as the sounds of the surroundings did not in any way<br />

interrupt those of the music.” 102<br />

This account of an event in New York City in the early 1970s in the<br />

field of contemporary composition, which refers to the relationship between<br />

organized and random happenings, goes to the heart of the problem discussed<br />

in connection with acoustic focusing. Where the description of phenomena<br />

of awareness is concerned, the listener determines the extent of the<br />

detail of his understanding of the event. The acoustic environment is far more<br />

complex than the way it is portrayed in the description and designation of<br />

sound phenomena. As we are usually required to select what we must and<br />

want to hear from many superimposed layers, memory, hearing, and expectation<br />

must once again be brought simultaneously into play in the act of<br />

listening. Not only is describing this attitude to the acoustic event a complex<br />

process, the way the actual sounds spread out in the room depends on their<br />

frequencies and dynamics and this must also be described as a process.<br />


Basically, as well as visual location, Gestalt theory classifies movements<br />

in the room as acoustic events and processes, which are identified in<br />

the literature as stimulus and response of differing interest. What the discussions<br />

have in common is that processes of acoustic localization are recognized<br />

as physical procedures and cognitive processes, both of which are<br />

dependent on architectural conditions as well as the reception and perception<br />

of the sound. A chain of interacting factors can be established, extending<br />

from the reception and assessment of a sensory event to its function and<br />

identification. The recognition and designation of a sound source are dependent<br />

on the number of acoustic signals and their interplay and superimposition.<br />

Events and the density and properties of impulses require different<br />

conditioning. The perception and understanding of events and objects can<br />

also be described as a process spanning a broad time period, with a specification<br />

that is subject to many variables during a lifetime. Thus, the supposedly<br />

simple identification of sensory events—like the identification of acoustic<br />

events in a room—is based on knowledge that was acquired early in life and<br />

can then be remembered <strong>for</strong> a long time, so that acoustic situations can be<br />



Types of Housing<br />

<strong>for</strong> the Elderly<br />

Changes in types of housing <strong>for</strong> elderly people largely correspond<br />

to the changes in lifestyles that have become apparent since the 1950s.<br />

Various phases of adapting accommodation <strong>for</strong> the elderly to structural requirements<br />

<strong>for</strong> modern housing mean that up until now we can distinguish<br />

five generations of housing <strong>for</strong> the elderly that can be found and identified<br />

in plans, equipment, and building techniques as well as the range of care<br />

and services on offer. Considered chronologically, this development ranges<br />

from dormitory accommodation via individual types of sheltered housing to<br />

private-sector housing with a wide range of integrated services. Although it<br />

is still primarily a matter of equipment that has been produced exclusively<br />

<strong>for</strong> older age groups and mainly applied to accommodation in urban areas,<br />

the furnishings and fittings of housing <strong>for</strong> the elderly around the periphery<br />

are gradually catching up with urban standards. While, statistically speaking,<br />

housing <strong>for</strong> older people in rural areas is still mainly organized within the<br />

family circle, in urban areas the rising number of single-person households<br />

demands a rethink. Due to increasing densification and rising land prices,<br />

cities are often left with no other option than to settle more and more of their<br />

elderly citizens in less attractive locations, with the attendant risk of pushing<br />

them aside and <strong>for</strong>cing them out of public life. Economic criteria usually<br />

dominate the planning and administration of housing <strong>for</strong> the elderly. Alternatives<br />

that would make it possible <strong>for</strong> older people to have a well-earned life in<br />

the community have to be demanded by the citizens themselves. However,<br />


these processes can only be put together piece by piece. Although it is quite<br />

possible to trace a change in the adaptation of types of housing and urban<br />

development <strong>for</strong> older people that is associated with a change of awareness<br />

in society, studies reveal that different types of accommodation still exist side<br />

by side today. There is a lack of visible dynamics or political will to change in<br />

this area. In our society, the elderly are still neglected and <strong>for</strong>ced out to the<br />

fringes of social and public life. What can be seen in the types of housing<br />

also applies to the way people are treated. Without daily conversation, people<br />

of all age groups grow lonely, resulting in depression and loss of vitality,<br />

irrespective of the architectural quality and location of the housing. In a world<br />

in which the speed of data streams increases daily and rapidly overtaxes<br />

the associated cognitive activity—not only in older people—it is worthwhile<br />

rediscovering conversation and caring as qualities of life. When we get older,<br />

the metaphor of conversation as spiritual nourishment becomes more meaningful<br />

in all senses of the word. 151<br />

Development of Care Facilities<br />

There are complex changes reflecting processes of social trans<strong>for</strong>mation<br />

underlying the requirements <strong>for</strong> suitable care facilities <strong>for</strong> the elderly.<br />

It has taken seventy years, from 1946 to 2016, to develop the features of<br />



Multisensory<br />

Architecture<br />

Situation<br />

For the year 2010, the World Health Organization recorded 36.6 million<br />

people suffering from dementia, and their number is predicted to rise by<br />

7.7 million per year to reach 154 million by 2030. LMIC countries, that is,<br />

countries with populations on low and middle incomes, are disproportionately<br />

affected. In Germany, 260,000 people (23.9 percent) in the 85–89 age<br />

group are affected and 177,000 (35.6 percent) in the 90-plus age group. 161<br />

About a quarter of the population of over-65s are currently suffering from<br />

a mental or psychological disorder, sometimes resulting from degenerating<br />

perception and the consequent decline of experiential skills and social contacts.<br />

Some 6–10 percent of this is due to severe dementia and severe functional<br />

psychoses. As the prevalence of the disease increases rapidly with<br />

age, demographic changes mean that the condition becomes the focus of<br />

social interest. A new study by the Rostocker Zentrum zur Er<strong>for</strong>schung des<br />

demografischen Wandels (Rostock Center <strong>for</strong> Demographic Change) and<br />

the Deutsche Zentrum für neurodegenerative Erkrankungen (German Center<br />

<strong>for</strong> Neurodegenerative Diseases) investigates the speed with which the<br />

number of dementia patients will rise. In Germany, there are currently some<br />

1.2 million people living with moderate to severe dementia. In future, as the<br />

number of older people in Germany rises, the number of dementia patients<br />

will also rise. But how rapid will this rise be? For Germany, the estimated<br />




Assistive Systems<br />

and Smart Homes<br />

At various stages of our lives the demands of functional requirements<br />

change, not just in terms of architectural environment. Our homes<br />

should offer more <strong>for</strong> older people than has hitherto seemed possible. As<br />

in our youth, in old age we should also ideally live in continuous exchange<br />

with our surroundings. We are a part of a changing community, which we<br />

hope will be able to adjust to its members’ altered cognitive per<strong>for</strong>mance<br />

and the increasing impairment of their sensory skills. Emotional balance can<br />

also become destabilized in old age, when contacts become fewer. Older<br />

people are definitely in need of protection. They are part of a society that<br />

is generally aging. Every day we are confronted with the decline in speed<br />

of reception, processing, and planning of cognitive and motor actions in<br />

all areas of life. Growing old also means having to get slower. What may<br />

seem fast to us is slow <strong>for</strong> other people. And vice versa. Older people are<br />

increasingly dependent on rules, which are often enshrined in daily rituals,<br />


just as children learn through constant repetition of apparently the same<br />

thing. Processes become ingrained and regularity helps older people to<br />

make their way more easily in organized daily routines—especially when<br />

they have to settle into new surroundings. Rituals convey security. Similar<br />

returning images are also linked to the seasons; the color of the light, the climate,<br />

and the associated aromas appeal directly to the sensory center that<br />

is responsible <strong>for</strong> our wellbeing. Transitions from the home to public life that<br />

we find natural and manage without ef<strong>for</strong>t help us to remain independent. It<br />

is important to retain these thresholds and make all barriers associated with<br />

them as low as possible.<br />



Private and Public<br />

Spheres<br />

House and Room<br />

People’s relationship to their surroundings can be determined by<br />

specific typologies of movement in rooms. Circles of different diameters are<br />

associated with age. They grow larger in early childhood, mature in adulthood,<br />

and then become considerably smaller in old age. Spatial worlds,<br />

communicative activities, and much more can be read from the size of circles<br />

of action. The circles themselves show patterns of movement that reflect<br />

daily routines. Many buildings, like the Alvar-Aalto-Kulturhaus in Wolfsburg,<br />

Lower Saxony, even reflect these circular shapes in their interior and use<br />

them to define different zones. In this context, particular attention should be<br />

paid to rooms and the movements to be per<strong>for</strong>med in them, which should<br />

be taken as examples when giving closer consideration to the parametrization<br />

of planning, realization, and final analysis. Viewed from this angle, in<br />

future it will be indispensable <strong>for</strong> the evaluation of high-quality plans to have<br />

an accurate idea of the distances covered in apartments, houses, and their<br />

surroundings, and consideration must also be given to the proportion of<br />

independently completed actions that remain essential <strong>for</strong> the fulfillment of<br />

individual everyday wants. Rooms are always experienced positively when<br />

their architecture stimulates people to engage in plenty of movement. This<br />

allows us to draw conclusions about the relationship between structural<br />


equirements and vital functions. Good rooms always stimulate the senses.<br />

By contrast, poor surroundings affect us negatively, preventing or impeding<br />

sensory experience, cramping us and keeping us firmly fixed in the room<br />

<strong>for</strong> most of the time. In much functionalist architecture—identified at the<br />

preliminary planning stage as supposedly providing com<strong>for</strong>t—movement is<br />

even reduced to the few remaining mechanical actions people still have to<br />

per<strong>for</strong>m, while all free movement is systematically prevented. If the human<br />

body then becomes a stationary object and subject to a large number of<br />

coercive measures <strong>for</strong> avoiding movement, it is harmful to body and mind<br />

in the long term and vital functions degenerate. By contrast, if movement is<br />

stimulated and promoted by architectural structures, the frequency of communicative<br />

contacts increases and there is a distinct improvement and even<br />

regeneration of vital functions. Movement of every imaginable kind keeps<br />

people healthy and can be experienced in various ways or as a combination<br />

of motor and mental activities. It is a complex system of equivalences but it<br />

follows clear rules.<br />




Windows and Doors<br />

People with cognitive impairment, and dementia sufferers in particular,<br />

no longer have the ability to cope easily with complex changes of place<br />

and direction. This means that they are dependent on reference points in the<br />

room. The ideal is there<strong>for</strong>e to have pathway systems and visual axes within<br />

their own rooms, in the building, and in sheltered outdoor areas, to provide<br />

visual orientation and guidance. Windows are positioned in a way that extends<br />

the space in the building by means of visual axes and allows light to<br />

flow in. At the 2014 Venice Architecture Biennale, a small selection from the<br />

Brooking National Collection was on show, containing a total of 500,000<br />

windows of all periods. 209 While in the work of Alberti the window openings<br />

of the temple “must be moderate and open at the top, so that one sees<br />

nothing but the sky through them … in order to intensify the thrill aroused<br />

by the darkness,” 210 the windows of the secular building are designed to be<br />

openings to the outside <strong>for</strong> communication. Size and measurements are to<br />

depend on the building and lead to a decision on how much light should<br />

penetrate into the room.<br />

For people with cognitive impairment, the routes of covered walkways<br />

and corridors should run in straight lines. Changes of direction, branches,<br />

and even circular paths can be managed in later stages only if there are<br />

clear reference points with sensory attractions that can be remembered. 211<br />

Until now most of the references in the literature have been to visual aspects;<br />

there is rarely any consideration of the proportion of haptic and acoustic<br />

orientation that is made possible by a variety of distinctive floor coverings,<br />

handrails that indicate direction, and clear fields of resonance. “The fact that<br />

the handrail guides the movement of residents can be used to create barriers.<br />

For example, a tactile and visual barrier is created when the handrail<br />

is diverted via neighboring rooms or exit doors.” 212 These measures build a<br />

haptic bridge, creating security <strong>for</strong> residents, but without conveying the image<br />

of an en<strong>for</strong>cement measure.<br />

In the same way that looking through a window or an open door<br />

gives the view a frame and a target, recognizable acoustic events can guide<br />

people along the safe route to the kitchen, bathroom, or communal area.<br />

The audible signs have a positive emotional charge and encourage people<br />

to move in the direction of the sound source where familiar routines await<br />

them. Dining rooms and lounges become the center of old people’s lives.<br />

Only those who are still able to participate in meals and events, which have<br />

often become something of a ritual, receive animating stimuli and responses<br />

that always help to confirm identity and maintain life <strong>for</strong> dementia sufferers.<br />

Rooms where these meetings occur prove to be functioning places when<br />

“the place <strong>for</strong> eating and relaxing is clearly developed as an area that leaves<br />

a good impression in the mind through the use of suitable materials and<br />



Inclusion or<br />

Exclusion<br />

Visual Axes and Opportunities<br />

The buildings of the retirement homes and care homes I have visited<br />

so far are as varied in their detail as the types of housing and the people<br />

themselves. As in earlier life, housing <strong>for</strong> the elderly should ideally reflect<br />

their personalities. 231 However, theory and practice rarely coincide. Typical<br />

ideal approaches are rare, though they are still being <strong>for</strong>mulated today. 232<br />

Many people suffer from the system in old age. A good many suffer in silence,<br />

some sedated by drugs or even strapped and bound to beds, tables,<br />

and chairs. 233 Restraining measures that were used to prevent falling are<br />

no longer acceptable <strong>for</strong> legal reasons, 234 which leads us to conclude, that,<br />

many years be<strong>for</strong>e they resorted to such measures <strong>for</strong> restricting movement,<br />

there must have been even more focus on movement in proper accommodation<br />

<strong>for</strong> the elderly, in order to maintain coordination and ensure mobility<br />

<strong>for</strong> as long as possible. If physical movement is impaired, the senses must<br />

be stimulated—even if it is by looking out of the window. This kind of visual<br />

axis over busy streets is essential and particularly meaningful when residents<br />

are bedridden <strong>for</strong> relatively long periods. According to what I learned from<br />

the staff when I visited the Haus der Vita e.V. on the Heerstrasse in Berlin,<br />

with its geriatric daycare, therapeutic residential community, and outpatient<br />

daycare, the rhythm of the traffic breaks up the daily routine of the building.<br />

The open glass façades allow people visual participation in public life.<br />


In the field of housing <strong>for</strong> the elderly, there is also the success story<br />

of people who have clearly made their own decision to structure their old<br />

age in a positive and active way. “More than 70 per cent of over 85-year-olds<br />

manage their everyday life independently. However, somehow the very old<br />

are actually invisible.” 235 These are usually not people who retire voluntarily;<br />

it is the challenges of a system of architecture and care that become impossible<br />

to cope with independently and then, as a logical result, exclude people<br />

from public life. 236<br />

Fortunately, there is already a developing political lobby that is now<br />

publicly questioning the entire health system as a profit-oriented organization.<br />

237 In the eyes of their critics, care homes have become a source of profit<br />

and the widespread talk of dignity in old age is seen as a cliché, an official<br />

catchphrase promulgated by an administration that is no longer interested in<br />

people but claims to be filling the gaps in modern society. People are not the<br />

problem; it is the system of Western societies that have produced the chains<br />

of hospices listed on the stock market. 238 But what is happening with the<br />

welfare system in the United States can only be a warning to us. In my view,<br />

we have an opportunity to develop a new concept of housing <strong>for</strong> the elderly<br />



Prospect of an<br />

Architecture<br />

of the Future<br />

The relationship between people and rooms in housing <strong>for</strong> the elderly<br />

is seldom the subject of critical discussion. Until now, the discourse<br />

in architectural theory has also rarely been concerned with demonstrating<br />

and planning <strong>for</strong> the vital needs of old people and implementing them in<br />

practice. 253 If we look at the beginnings of housing <strong>for</strong> the elderly in the<br />

twentieth century and its background in the field of hospitals, asylums, and<br />

types of housing with systematic selection of people and the associated<br />

exclusions, we can see that valuable alternatives, originating in the monastic<br />

lifestyle and surviving to a certain extent in anthroposophical concepts of<br />

life 254 , have been <strong>for</strong>gotten. Nor can the almost utopian model of a house<br />

containing several generations offer alternatives that reflect the structure of<br />

families in cities. In professional discussion, the requirements of housing<br />

<strong>for</strong> the elderly must be reconsidered from the residents’ point of view. Are<br />

daily routines functioning? Do people still feel secure? What images do old<br />

people convey to us and what do they want us to think of them? Do meetings<br />

that were meaningful in the past still take place? Do old acquaintances<br />

and friends come to visit them in an old people’s home? Is the housing inte-<br />


grated into public life? Can the old person still find the inner balance that is<br />

considered to be the center of the person, which is declared to be the aim<br />

of the anthroposophical movement? 255<br />

An anti-institutional view of housing <strong>for</strong> the elderly may help to sharpen<br />

the focus. Do the buildings still allow space <strong>for</strong> movement and freedom,<br />

or are they in many ways more like parts of an open prison (Foucault) that<br />

could be described as corporal punishment of the elderly by modern <strong>for</strong>ms<br />

of torture? 256 Is that not precisely why old people avoid visiting these buildings,<br />

in order to banish the possible scenario of their own future from their<br />

minds? A brief glance at the outlines of a history of housing <strong>for</strong> the elderly<br />

should make clear people’s experiences of the medical care system, with<br />

a final home waiting <strong>for</strong> them at the end. It is important to understand the<br />

development of housing <strong>for</strong> the elderly alongside the beginnings of medical<br />

care <strong>for</strong> the population in the eighteenth century. Associated with this are<br />



Bodies reflect rooms and in turn affect them. If sensory appeals are lacking,<br />

bodies 275 and souls are deprived of vital stimuli and the result is illness.<br />

Until now, this concern about a range of stimulating features has rarely been<br />

associated with volumes, materials, surfaces, and sequences of rooms. 276<br />

Pharmaceutical products treat the symptoms, not the causes, which can be<br />

described as sensory deprivation. 277<br />

Topoanalysis<br />

To give himself a practical image of the requirements <strong>for</strong> safe living,<br />

Bachelard invented a method of description, which he calls topoanalysis,<br />

and which, as the word suggests, involves sensual experiences marked out<br />

by places of childhood. “Was the room large? Was the loft crammed full?<br />

Was the spot hot? And where did the light come from? How did the human<br />

being keep quiet in this room? How did he savour these different, very<br />

special <strong>for</strong>ms of quietness in the various hiding places of lonely daydreaming?”<br />

278 Bachelard places the human body in the context of architecture as<br />

a room of experiences and sets a course that can show us a way out of<br />

the constraints of functionalist building. Bollnow also ties in here, requiring<br />

people to devote themselves to living as a lifetime process. He also refers<br />

to a poetics of living, which simply polarizes the contrast between feelings<br />

of security and alienation, repose and flight. Home is there<strong>for</strong>e the place<br />

that occurs in rooms that are concerned with images of childhood and<br />

usually with maternal love. Following a tradition stretching from Steiner via<br />

Heidegger, Lévinas, Merleau-Ponty, and Bachelard to Bollnow, we can now<br />

also understand the observations of architect-philosophers like Philippe<br />

Rahm and Peter Zumthor, who put materials and their sensory qualities<br />

at the center of their creative activities and explain the effects of architecture<br />

with references to music. Rooms are like instruments. Rooms make<br />

sounds, absorb aromas, and produce an atmosphere. Qualities of rooms in<br />

the <strong>for</strong>m of sensory properties of abundance and volume are very similar to<br />

the cosmological dimensions contained in the anthroposophical metaphor<br />

of “music in all things.” 279<br />

Room experiences are genuine physical experiences that have the<br />

ability to stimulate cognitive processes, which in turn are engraved in the<br />

memory as patterns of movement. If the body is called upon to per<strong>for</strong>m<br />

many motor actions, architecture has fulfilled its purpose of connecting the<br />

childlike urge to move about with security and sensory experiences. Features<br />

that encourage movement, such as stairs, steps, handrails, and handles,<br />

should there<strong>for</strong>e be understood as essential elements that have been<br />

shown to require the use of different areas of the brain, and managing them<br />

is remembered as a positive experience. Moving around inside the building<br />

is remembered as success.<br />


Navigation<br />

In his composition Navigation <strong>for</strong> Strings, the neuro-musician Alvin<br />

Lucier investigated the process of seeking and finding as the basis of musical<br />

experience. As in art, so also in life it is important to find paths and<br />

cover distances. Safe navigation in a new environment not only confronts<br />

people with cognitive impairment with similar challenges to finding one’s way<br />

in unfamiliar towns and streets, it must always be possible to associate it<br />

with positive memories. “For the prevention of dementia, the most successful<br />

effects are achieved by appealing mental, social and physical activities.<br />

… Autosuggestion is more effective than external stimuli.” 280 You probably<br />

know about the extremely demanding test that prospective London taxidrivers<br />

have to pass. The network of streets they have to memorize and be<br />

able to recall at any time is so extensive that this can actually been seen in<br />

the neuroplasticity of the corresponding areas of the brain by means of imaging<br />

procedures. The taxi-drivers learn this demanding map system not as<br />

children but as adults, and not only the layout of the streets; they must also<br />

be able to recall prominent points very quickly in order to be able to take the<br />

best route at any given time. This ability is engraved in the memory by the<br />

orientation training. The hippocampus—the part of the brain responsible <strong>for</strong><br />

orientation—actually grows bigger with the years in the profession. 281 Neural<br />

activities and motor skills—whether they are carried out with the feet or the<br />

hands—are linked together as cognitive processes and can be presented<br />

at different levels, as each brain shows different <strong>for</strong>ms reflecting traces of its<br />

life story. 282 Activities determine patterns of approximation that even suggest<br />

parallel processes in imaging procedures. The widespread public image of<br />



insect through the wooden bodies of the stringed instruments, you would<br />

be rewarded with a multisensory experience. The story of the growth of<br />

many different native and tropical woods and the traces of how they were<br />

worked could be perceived though the sense of smell in the same way that<br />

the calm, softly lingering sound that turns the instruments inside them into a<br />

resting, living being can be heard with the ears. All stringed instruments are<br />

descended from the model of the tortoise shell with strings, the body and<br />

house of a land-dwelling animal, one of the most ancient living creatures we<br />

know. Roofs that have adopted this tortoise-shell <strong>for</strong>m, invoke this image<br />

and promise protection imbued with the special calm of this armor-plated<br />

animal, whose sleep no one may disturb because it always seems to have<br />

its house, and there<strong>for</strong>e its home, with it.<br />




Hooray! Your file is uploaded and ready to be published.

Saved successfully!

Ooh no, something went wrong!