Building for Dementia

Building
for
Dementia
Christoph Metzger

Foreword 7
Rethinking Architecture 10
Phenomena 11
Movement in the Room 16
Windows as a Promise 18
Sleep and Memory 20
Roads and Paths through Life 22
Roads 23
Material 25
Images 25
Home 26
Childhood 27
Walking 29
Bodies in Motion—Stimulations 32
Swimming 32
Bodies 33
Motion 34
Age and Orientation 38
Recognition 38
Memory Work 39
Magic Mountain 40
Orientation 41
Room Planning 43
Research into Aging 44
Cognitive Skills 46
Degrees of Similarity 46
Complexity—Reduction 48
Compensation as a Process 50
Gestalt and Abstraction 50
Cognition in a State of Flux 51
Communality of the Senses 51
Dementia and Perception 53
Spatial Awareness 54
Gestalt Theory and Spatial Perception 55
Perspective and Color 56
Multisensory Rooms 56
Localization of Acoustic Events in Space 58
Sound Direction 60
Life without Acoustic Orientation 60
Rooms Provide Orientation 62
Orientation in the Room 64
Structure and Pattern of Hearing in the Room 65
Hearing Loss 67
Signal Recognition in the Field of Sound 67
Cognitive Training 68
Memory—Remembering—Action 71
Memory 72
Remembering 72
Action 73

Types of Housing for the Elderly 74
Development of Care Facilities 75
Bases 77
Precursors and First Generation 77
Second Generation 78
Third Generation 79
Fourth Generation 79
Fifth Generation 79
Future-Oriented Local Authority Policies and Sixth Generation 80
Multisensory Architecture 82
Situation 82
Forms of Housing—Infrastructure—Types of Building 84
Intuitive Legibility 84
Home Comfort 85
Quality of Structures and Materials 85
Age-Related Changes in Perception 85
Assistive Systems and Smart Homes 92
Systems 94
Building Technology 95
Services 97
Safety in Old Age 98
Emergency Systems 100
Private and Public Spheres 102
House and Room 102
The Building as an Urban Center 106
Tables, Beds, and Chairs 109
Windows and Doors 111
Changing Environments 112
The House as a Home 115
Inclusion or Exclusion 120
Visual Axes and Opportunities 120
Location and Planning 122
Center and Circle 125
Periphery as an Opportunity 126
Political Understanding 126
Prospect of an Architecture of the Future 128
Lifelines 132
Topoanalysis 138
Navigation 139
Movement and Neuroplasticity 140
Physical Experience of Acoustic Events 142
Acknowledgments 149
Bibliography 150
Notes 152
Captions/Picture credits 157
Imprint 159

Foreword
Building for Dementia came about as a sequel to the treatise Architektur
und Resonanz (Architecture and Resonance), written at the Technical
University of Cottbus. Since then, many new ideas have continually changed
my views on architectural phenomena and the perception of their sensory
qualities. I have learned to interpret the bodies of buildings as an ensemble,
to which people react with their own physical sensorium. I was already acquainted
with animated bodies that vibrate in response to stimuli, but not
so much from architecture as from the practice of music and sound art.
Since 2004 this artistic genre, which is still relatively new, has been taught
an advanced international level by Ulrich Eller at the Braunschweig University
of Art. We have been researching the field together, both in theory and in
practice, since 2006. The sound art projects that have developed from this
are concerned with architectural spaces and landscapes. We have carried
out many projects in historical places, such as churches, monasteries, old
factories, and museums, as well as in a boatyard on the Baltic Sea island of
Usedom, where they still work mainly with wood. Regular trips to the Venice
Architecture Biennale have suggested concepts of sound in space that
have ultimately led to experiences of the multisensory properties of rooms.
With these sensual experiences we are going beyond a practice that just
resembles hearing, seeing, or tasting in the tradition of monosensory culture.
Today we know more about the spaces that surround us, leave their
mark on us, and influence our senses. To state that, coming from a common
background in the guitar, we both found new ways into architecture
FOREWORD
7

Rethinking
Architecture
This book is the result of a search for a new way of thinking about
architecture. It is about buildings and the spaces for movement that they
create, and not exclusively for an aging society. Research on this topic has
drastically altered my thinking about life in old age and the physical activity
and movement that becomes increasingly necessary at this stage of life. In
architectural terms, thinking means an ability to adapt to an environment with
sheltering spaces, in order to feel physically at home. 1 Significant parts of the
metaphor coming into play here originate from a phenomenology of the body
and are transferred to architecture. Movement is introduced as a key motif as
an extension of existing ideas. However, security and living are at first considered
as a single unit. In the course of the book, it will be pointed out that
age-adapted forms of living require only marginally higher financial expenditure
at the start, and that such expenditure is justified. Good architecture not
only helps maintain health in old age, but pays for itself in all areas, always
assuming that movement through the interior and exterior spaces of the
building is assisted and motivation is maintained over long periods. When
10

looking for a house in the sheltered housing project in Vals, in the Swiss
canton of Graubünden/Grisons (the town that is famous among architects
for the Thermal Baths by Peter Zumthor), I asked for the old people’s home
and was met only with shakes of the head. The local inhabitants remain in
their houses with their vegetable gardens to the end of their lives. A home for
the elderly built in the 1990s remains almost empty. There is no need for it.
The image of the elderly in Vals remains with me. It points to fundamentals
of healthy living, which can also be realized, in part and with modifications,
in urban areas.
Phenomena
My argument concerns a radical change, a fundamentally new understanding
of housing for the elderly, which is currently still designed to
hinder movement within the home and its surroundings instead of encouraging
it.
RETHINKING ARCHITECTURE
11

Roads and Paths
through Life
I am starting to write long after I learned to walk. If my gait becomes
unsteady in old age, according to relatively recent scientific discoveries this
can be diagnosed as a warning sign of dementia. It is essential to act immediately
to counteract declining abilities. Walking means being and remaining
independent. It is essential to maintain and encourage walking. For two
years now, walking has become the most important ritual of the day; I feel
very well physically. My joints are more flexible than before and my gait is
firmer. Most of the thoughts that will accompany me during the day come to
me in the early morning, shortly after sunrise, when I take the first of my three
daily walks with our pug Riva around the Lietzensee in Berlin-Charlottenburg.
There is no such thing as bad weather. Not in the city and not really in
the countryside. I have the right shoes. In the open air, I have become familiar
with all kinds of weather and the welcome signs of the seasons. Walking
makes me happy, and when I come home I am greeted by the smell of fresh
coffee and rolls. A healthy and wonderful life. It is thanks to my family that I
became aware of all this along the way. If the brain is provided with the vital
functions, intellectual and motor processes are almost certainly secured.
When I think about it, I seem to be unconsciously and naturally continuing
the experiences I have gathered over the course of my life.
22

Roads
I know the roads and paths of my life. They lead me to the fundamental
motifs of the theme of Building for Dementia. Good architecture is
simple. However, in our times simple things have been forgotten and it is
essential to recover them. Good, simple architecture is not committed to the
principles of movement and appealing to all the senses for the elderly alone.
Good architecture today integrates technical support systems that make life
easier for the elderly right from the start. The automotive industry leads the
way in this with its networking systems. What is currently standard there
leads us into what will be the norm in the future, when we will make use of a
large number of services. A smart home may still be a luxury today, but we
should be treating ourselves to it now.
In Building for Dementia, I am concerned with combinations of multisensory,
stimulating rooms and successions of rooms that promote orientation,
while at the same time discreetly offering security. In the contemporary
version of its parameters, architecture creates the conditions that are now
vital for a long and independent life for the elderly and those with the first
signs of dementia. Security and safety are therefore the leitmotivs of my
ROADS AND PATHS THROUGH LIFE
23

Bodies in Motion
—Stimulations
I connect walking and swimming with the experience of getting to
know the central point of one’s own body. I am often delighted by the beaming
faces of children when they master the art of walking upright and begin
to run unsteadily, fall, and immediately stand up again.
Swimming
Swimming with my favorite girlfriend, who has remained true to me
until today. Although it is no longer there today, in the 1980s in Frankfurt in
the Eschenheimer Anlage, immediately behind the old opera house was an
indoor swimming pool that was getting on in years but flooded with light.
While swimming, you could look out at the trees of the neighboring park in
the middle of the city. It was here that I taught my girlfriend to do the crawl. I
was allowed to guide her slim, elegant body. I could keep her balanced with
my right hand. It was like launching a yacht. She swam the crawl for the first
time in her life and made me the gift of that abiding image. Lying in the water
seems to make the body weightless, and this unspoiled, natural floating, as
in a mother’s womb, makes us all as light in the water as the birds of the air at
every stage of our lives. It is hard to imagine that there are people who have
never learned to swim; they are missing a great deal. Reading and swimming
should be declared to be basic human rights.
32

Bodies
I have recently been discovering more and more objects and structures
that have an empathy with human bodies. Nowadays, model yachts
seem to me like young, athletic people diving in freefall from the swimming
pool springboard. Similarly, the hull of a wonderful wooden boat like the
1930s yacht being renovated in the boatyard in Freest, Kröslin, on the Peene
estuary, reminds me of a person lying on his back on an operating table.
The opened body seems to be waiting for its next life. The individual rails,
ribs, and planks resemble a human skeleton. I see ribs and vertebrae, and
the image frightens me. The central point of the hull, which is also its center
of gravity, is where the mast foot is positioned. Like connecting a plug, the
mast is inserted into the ship. This is where the strongest forces will be in
play and particular stability is required. Parallels with Peter Zumthor’s Chapel
of St. Benedict in Grisons/Graubünden come to mind. There, tonal forms
of stringed instruments are translated into architecture, with stable vibra-
BODIES IN MOTION—STIMULATIONS
33

Age and
Orientation
Recognition
The memory and presence of images are important elements for
orientation in the world. At all stages of life, we are referred back to courses
of events that we have learned. We recognize patterns and structures, and
the properties associated with them allow us to act to some extent intuitively.
Recognition concerns the whole range of events that can be perceived with
the senses. These could be the sound of a familiar voice, footsteps on a
flight of stairs, the taste of a meal, or the smell of a dwelling that has become
our home. Familiar things invite us in, whereas we meet new things
with a critical distance—approaching or walking away, listening in or turning
aside. Every interest leads automatically to a change in the attitude of the
body that is part of our behavior toward things and thus of orientation and
preparation for action. The special feature of actions lies in their growing importance
as purposeful movements in the context of rooms. Body and mind
always work together, not separately, in order to act. Motor processes and
mental presence combine, as is clearly visible, particularly in small children,
and they determine movements and actions in a complex system that lasts
well into old age. Sequences of movements that function well enable us to
draw conclusions about a person’s healthy development and general state
of mind. Movement is also to be understood as coping safely with actions
and covering specific stretches in a given time. The time we need for carry-
38

ing out anything from simple actions to complex movements therefore also
reflects a part of our personal conditioning. We enjoy regularly remembering
the physical movements we experienced as children and adolescents, jumping,
running, or swimming, as being perfectly natural.
Memory Work
Memory work and biographical self-affirmation secure the knowledge
of every aspect of personal identification. As we grow older, what distinguishes
us from children is our dwindling carefreeness and self-assurance.
Our bodies change throughout our lives and so do our worries about them,
which are expressed in the measures we take—or are taken by others—to
retain our health. Older people, especially, demonstrate to us how closely
their movement and certainty about the passing of time are bound together.
Motor skills and cognition, which have been thoroughly researched in the
field of child development, are now only slowly gaining importance in the
area of research into old age. Ritualized daily actions that are associated with
movement are attracting particular attention. Human functional processes
change with age. It is crucially important that the planning of specific ranges
of spaces and their sensory requirements should be geared to the cognitive
abilities of residents. Interdisciplinary initiatives are required.
AGE AND ORIENTATION
39

These subareas, which lead to a range of spaces optimized for old
age and a safe world to live in, lie somewhere in between philosophy, cognitive
science, psychology, and medicine, and also extend into the arts. During
our entire lives, we learn and remember this in our images. These images acquire
increasing importance in old age. We store and remember images that
will ultimately be described and communicated in speech. Art and literature
have a special part to play when rooms and paths appear as places in an
artistic production that will be linked to their own experiences.
Magic Mountain
To give an example: if I read a passage from Thomas Mann’s novel
The Magic Mountain, especially the pages devoted to the detail of the arrival,
development, and abating of the snowstorm, 57 as a reader, I plunge
into the world of images and associate a snowy mountain landscape I know
well with the description of the details that will leave their mark on my images,
according to the space the author gives to them and the detail of his
descriptions. “But if they had no sun, they had snow. Such masses of snow
as Hans Castorp had never till now in all his life beheld. The previous winter
had done fairly well in that respect, but it had been as nothing compared to
this one. The snow-fall was monstrous and immeasurable, it made one realize
the extravagant, outlandish nature of the place. It snowed day in, day out
and all through the night. The few roads kept open were like tunnels, with
towering walls of snow on either side, crystal and alabaster surfaces that
40

were pleasant to look at, and on which the guests scribbled all sorts of messages,
jokes and personalities.” 58 At the center—as if to implement the laws
of Gestalt theory—is the dissolution of the contours of a landscape, which is
represented as a world of ice and fog in motion. As the reader, I project images
that will become a part of my personal world of images that is triggered
by literature. The appearance and disappearance of shapes and contours
gives this scene a meaning that can be understood as a general search for
patterns that must be recognized—the point being that the engraving of
these patterns begins when structures are no longer available.
Orientation
Our orientation and movement in real and artistically created spaces
are so significant that, from the point of view of a philosophy of cognition,
even the essence of our consciousness of our bodies develops from it. The
consequence of this is that movements in space and our intuitive, mostly
familiar, experience of them are inseparably linked to our self-awareness.
Movement promotes certainty and security. Rooms can help to ensure orientation
and security. Easy-to-read rooms and clear designs are also to
be seen as guidelines for sensible planning. The intellectual association of
body and experience is seen as an aging process in people. Experiences are
AGE AND ORIENTATION
41

Cognitive Skills
The receiving and processing of sensory stimuli and the cognitive
process of converting them into actions mark all areas of our daily life. The
more stimuli we are simultaneously subjected to, the greater the demands
on cognitive performance and compensation. The more easily situations can
be recognized, the less energy is needed in order to respond to them with
appropriate actions. Rudolf Arnheim’s analysis of visual regularities (1954)
emphasizes the importance of morphogenetic skills and links them to the
concept of levels of abstraction. This theoretical approach is appropriate for
gaining a better understanding of the general laws of cognitive impairment
that can provide a basis for relevant planning guidelines.
Degrees of Similarity
The transfer of approaches from Gestalt theory to architectural
planning is illustrated by a procedure in fine art. Similarities can be seen in
the processes of abstraction, which appear to be comparable to production
and perception from two perspectives. The creation and understanding of
art are discussed. There are obvious parallels between the path to understanding
the abstract image captured on canvas and the everyday recognition
of objects at greater distance. The farther away an object appears,
the greater the degree of compensation the viewer has to employ in order
to identify the object. The image only ever comes into existence through
46

the viewer and the way he looks at things. Here there is a suggestion of a
kind of functional logic hinting at a logical relationship between the awareness
of something and its image. Transferring this concept to architecture
seems to be the obvious thing to do. If a situation is identified, actions can
be derived from it. This explains the comment that “more plausibly, we
might observe that when by some circumstance the mind is freed from its
usual allegiance to the complexities of nature, it will organize shapes in accordance
with the tendencies that govern its own functioning. Many experiments
suggest that the predominant tendency at work here is a tendency
toward the simplest structure, the most regular, symmetrical, geometric
shape that can be achieved in the given circumstances.” 71 According to
Arnheim, in terms of cultural history this is reflected in symmetrical shapes,
especially in sacred architecture and works of art. “The symmetry of the
composition represented the stability of the hierarchic order created by the
Church. By eliminating everything accidental and ephemeral, elementary
posture and gesture emphasized lasting validity.” 72 As a result, natural laws
of cognition are accepted and given excessive importance as dogmatic
truths in the world of art and architecture and their importance is exaggerated.
Symmetry, in the form of quasi-natural location, can be found in all
forms of art; even the structure of the human body is largely symmetrical.
COGNITIVE SKILLS
47

Localization
of Acoustic
Events in Space
“One day when the windows were open, Christian Wolff was playing
one of his pieces on the piano. Traffic noise and ships’ sirens were not only
heard during the pauses but, because they were louder, heard better than
the piano. Later someone asked Christian Wolff to repeat the piece with the
windows closed. Christian Wolff said he would gladly do so, but it was not
actually necessary, as the sounds of the surroundings did not in any way
interrupt those of the music.” 102
This account of an event in New York City in the early 1970s in the
field of contemporary composition, which refers to the relationship between
organized and random happenings, goes to the heart of the problem discussed
in connection with acoustic focusing. Where the description of phenomena
of awareness is concerned, the listener determines the extent of the
detail of his understanding of the event. The acoustic environment is far more
complex than the way it is portrayed in the description and designation of
sound phenomena. As we are usually required to select what we must and
want to hear from many superimposed layers, memory, hearing, and expectation
must once again be brought simultaneously into play in the act of
listening. Not only is describing this attitude to the acoustic event a complex
process, the way the actual sounds spread out in the room depends on their
frequencies and dynamics and this must also be described as a process.
58

Basically, as well as visual location, Gestalt theory classifies movements
in the room as acoustic events and processes, which are identified in
the literature as stimulus and response of differing interest. What the discussions
have in common is that processes of acoustic localization are recognized
as physical procedures and cognitive processes, both of which are
dependent on architectural conditions as well as the reception and perception
of the sound. A chain of interacting factors can be established, extending
from the reception and assessment of a sensory event to its function and
identification. The recognition and designation of a sound source are dependent
on the number of acoustic signals and their interplay and superimposition.
Events and the density and properties of impulses require different
conditioning. The perception and understanding of events and objects can
also be described as a process spanning a broad time period, with a specification
that is subject to many variables during a lifetime. Thus, the supposedly
simple identification of sensory events—like the identification of acoustic
events in a room—is based on knowledge that was acquired early in life and
can then be remembered for a long time, so that acoustic situations can be
LOCALIZATION OF ACOUSTIC EVENTS IN SPACE
59

Types of Housing
for the Elderly
Changes in types of housing for elderly people largely correspond
to the changes in lifestyles that have become apparent since the 1950s.
Various phases of adapting accommodation for the elderly to structural requirements
for modern housing mean that up until now we can distinguish
five generations of housing for the elderly that can be found and identified
in plans, equipment, and building techniques as well as the range of care
and services on offer. Considered chronologically, this development ranges
from dormitory accommodation via individual types of sheltered housing to
private-sector housing with a wide range of integrated services. Although it
is still primarily a matter of equipment that has been produced exclusively
for older age groups and mainly applied to accommodation in urban areas,
the furnishings and fittings of housing for the elderly around the periphery
are gradually catching up with urban standards. While, statistically speaking,
housing for older people in rural areas is still mainly organized within the
family circle, in urban areas the rising number of single-person households
demands a rethink. Due to increasing densification and rising land prices,
cities are often left with no other option than to settle more and more of their
elderly citizens in less attractive locations, with the attendant risk of pushing
them aside and forcing them out of public life. Economic criteria usually
dominate the planning and administration of housing for the elderly. Alternatives
that would make it possible for older people to have a well-earned life in
the community have to be demanded by the citizens themselves. However,
74

these processes can only be put together piece by piece. Although it is quite
possible to trace a change in the adaptation of types of housing and urban
development for older people that is associated with a change of awareness
in society, studies reveal that different types of accommodation still exist side
by side today. There is a lack of visible dynamics or political will to change in
this area. In our society, the elderly are still neglected and forced out to the
fringes of social and public life. What can be seen in the types of housing
also applies to the way people are treated. Without daily conversation, people
of all age groups grow lonely, resulting in depression and loss of vitality,
irrespective of the architectural quality and location of the housing. In a world
in which the speed of data streams increases daily and rapidly overtaxes
the associated cognitive activity—not only in older people—it is worthwhile
rediscovering conversation and caring as qualities of life. When we get older,
the metaphor of conversation as spiritual nourishment becomes more meaningful
in all senses of the word. 151
Development of Care Facilities
There are complex changes reflecting processes of social transformation
underlying the requirements for suitable care facilities for the elderly.
It has taken seventy years, from 1946 to 2016, to develop the features of
TYPES OF HOUSING FOR THE ELDERLY
75

Multisensory
Architecture
Situation
For the year 2010, the World Health Organization recorded 36.6 million
people suffering from dementia, and their number is predicted to rise by
7.7 million per year to reach 154 million by 2030. LMIC countries, that is,
countries with populations on low and middle incomes, are disproportionately
affected. In Germany, 260,000 people (23.9 percent) in the 85–89 age
group are affected and 177,000 (35.6 percent) in the 90-plus age group. 161
About a quarter of the population of over-65s are currently suffering from
a mental or psychological disorder, sometimes resulting from degenerating
perception and the consequent decline of experiential skills and social contacts.
Some 6–10 percent of this is due to severe dementia and severe functional
psychoses. As the prevalence of the disease increases rapidly with
age, demographic changes mean that the condition becomes the focus of
social interest. A new study by the Rostocker Zentrum zur Erforschung des
demografischen Wandels (Rostock Center for Demographic Change) and
the Deutsche Zentrum für neurodegenerative Erkrankungen (German Center
for Neurodegenerative Diseases) investigates the speed with which the
number of dementia patients will rise. In Germany, there are currently some
1.2 million people living with moderate to severe dementia. In future, as the
number of older people in Germany rises, the number of dementia patients
will also rise. But how rapid will this rise be? For Germany, the estimated
82

MULTISENSORY ARCHITECTURE
83

Assistive Systems
and Smart Homes
At various stages of our lives the demands of functional requirements
change, not just in terms of architectural environment. Our homes
should offer more for older people than has hitherto seemed possible. As
in our youth, in old age we should also ideally live in continuous exchange
with our surroundings. We are a part of a changing community, which we
hope will be able to adjust to its members’ altered cognitive performance
and the increasing impairment of their sensory skills. Emotional balance can
also become destabilized in old age, when contacts become fewer. Older
people are definitely in need of protection. They are part of a society that
is generally aging. Every day we are confronted with the decline in speed
of reception, processing, and planning of cognitive and motor actions in
all areas of life. Growing old also means having to get slower. What may
seem fast to us is slow for other people. And vice versa. Older people are
increasingly dependent on rules, which are often enshrined in daily rituals,
92

just as children learn through constant repetition of apparently the same
thing. Processes become ingrained and regularity helps older people to
make their way more easily in organized daily routines—especially when
they have to settle into new surroundings. Rituals convey security. Similar
returning images are also linked to the seasons; the color of the light, the climate,
and the associated aromas appeal directly to the sensory center that
is responsible for our wellbeing. Transitions from the home to public life that
we find natural and manage without effort help us to remain independent. It
is important to retain these thresholds and make all barriers associated with
them as low as possible.
ASSISTIVE SYSTEMS AND SMART HOMES
93

Private and Public
Spheres
House and Room
People’s relationship to their surroundings can be determined by
specific typologies of movement in rooms. Circles of different diameters are
associated with age. They grow larger in early childhood, mature in adulthood,
and then become considerably smaller in old age. Spatial worlds,
communicative activities, and much more can be read from the size of circles
of action. The circles themselves show patterns of movement that reflect
daily routines. Many buildings, like the Alvar-Aalto-Kulturhaus in Wolfsburg,
Lower Saxony, even reflect these circular shapes in their interior and use
them to define different zones. In this context, particular attention should be
paid to rooms and the movements to be performed in them, which should
be taken as examples when giving closer consideration to the parametrization
of planning, realization, and final analysis. Viewed from this angle, in
future it will be indispensable for the evaluation of high-quality plans to have
an accurate idea of the distances covered in apartments, houses, and their
surroundings, and consideration must also be given to the proportion of
independently completed actions that remain essential for the fulfillment of
individual everyday wants. Rooms are always experienced positively when
their architecture stimulates people to engage in plenty of movement. This
allows us to draw conclusions about the relationship between structural
102

equirements and vital functions. Good rooms always stimulate the senses.
By contrast, poor surroundings affect us negatively, preventing or impeding
sensory experience, cramping us and keeping us firmly fixed in the room
for most of the time. In much functionalist architecture—identified at the
preliminary planning stage as supposedly providing comfort—movement is
even reduced to the few remaining mechanical actions people still have to
perform, while all free movement is systematically prevented. If the human
body then becomes a stationary object and subject to a large number of
coercive measures for avoiding movement, it is harmful to body and mind
in the long term and vital functions degenerate. By contrast, if movement is
stimulated and promoted by architectural structures, the frequency of communicative
contacts increases and there is a distinct improvement and even
regeneration of vital functions. Movement of every imaginable kind keeps
people healthy and can be experienced in various ways or as a combination
of motor and mental activities. It is a complex system of equivalences but it
follows clear rules.
PRIVATE AND PUBLIC SPHERES
103

110

Windows and Doors
People with cognitive impairment, and dementia sufferers in particular,
no longer have the ability to cope easily with complex changes of place
and direction. This means that they are dependent on reference points in the
room. The ideal is therefore to have pathway systems and visual axes within
their own rooms, in the building, and in sheltered outdoor areas, to provide
visual orientation and guidance. Windows are positioned in a way that extends
the space in the building by means of visual axes and allows light to
flow in. At the 2014 Venice Architecture Biennale, a small selection from the
Brooking National Collection was on show, containing a total of 500,000
windows of all periods. 209 While in the work of Alberti the window openings
of the temple “must be moderate and open at the top, so that one sees
nothing but the sky through them … in order to intensify the thrill aroused
by the darkness,” 210 the windows of the secular building are designed to be
openings to the outside for communication. Size and measurements are to
depend on the building and lead to a decision on how much light should
penetrate into the room.
For people with cognitive impairment, the routes of covered walkways
and corridors should run in straight lines. Changes of direction, branches,
and even circular paths can be managed in later stages only if there are
clear reference points with sensory attractions that can be remembered. 211
Until now most of the references in the literature have been to visual aspects;
there is rarely any consideration of the proportion of haptic and acoustic
orientation that is made possible by a variety of distinctive floor coverings,
handrails that indicate direction, and clear fields of resonance. “The fact that
the handrail guides the movement of residents can be used to create barriers.
For example, a tactile and visual barrier is created when the handrail
is diverted via neighboring rooms or exit doors.” 212 These measures build a
haptic bridge, creating security for residents, but without conveying the image
of an enforcement measure.
In the same way that looking through a window or an open door
gives the view a frame and a target, recognizable acoustic events can guide
people along the safe route to the kitchen, bathroom, or communal area.
The audible signs have a positive emotional charge and encourage people
to move in the direction of the sound source where familiar routines await
them. Dining rooms and lounges become the center of old people’s lives.
Only those who are still able to participate in meals and events, which have
often become something of a ritual, receive animating stimuli and responses
that always help to confirm identity and maintain life for dementia sufferers.
Rooms where these meetings occur prove to be functioning places when
“the place for eating and relaxing is clearly developed as an area that leaves
a good impression in the mind through the use of suitable materials and
PRIVATE AND PUBLIC SPHERES
111

Inclusion or
Exclusion
Visual Axes and Opportunities
The buildings of the retirement homes and care homes I have visited
so far are as varied in their detail as the types of housing and the people
themselves. As in earlier life, housing for the elderly should ideally reflect
their personalities. 231 However, theory and practice rarely coincide. Typical
ideal approaches are rare, though they are still being formulated today. 232
Many people suffer from the system in old age. A good many suffer in silence,
some sedated by drugs or even strapped and bound to beds, tables,
and chairs. 233 Restraining measures that were used to prevent falling are
no longer acceptable for legal reasons, 234 which leads us to conclude, that,
many years before they resorted to such measures for restricting movement,
there must have been even more focus on movement in proper accommodation
for the elderly, in order to maintain coordination and ensure mobility
for as long as possible. If physical movement is impaired, the senses must
be stimulated—even if it is by looking out of the window. This kind of visual
axis over busy streets is essential and particularly meaningful when residents
are bedridden for relatively long periods. According to what I learned from
the staff when I visited the Haus der Vita e.V. on the Heerstrasse in Berlin,
with its geriatric daycare, therapeutic residential community, and outpatient
daycare, the rhythm of the traffic breaks up the daily routine of the building.
The open glass façades allow people visual participation in public life.
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In the field of housing for the elderly, there is also the success story
of people who have clearly made their own decision to structure their old
age in a positive and active way. “More than 70 per cent of over 85-year-olds
manage their everyday life independently. However, somehow the very old
are actually invisible.” 235 These are usually not people who retire voluntarily;
it is the challenges of a system of architecture and care that become impossible
to cope with independently and then, as a logical result, exclude people
from public life. 236
Fortunately, there is already a developing political lobby that is now
publicly questioning the entire health system as a profit-oriented organization.
237 In the eyes of their critics, care homes have become a source of profit
and the widespread talk of dignity in old age is seen as a cliché, an official
catchphrase promulgated by an administration that is no longer interested in
people but claims to be filling the gaps in modern society. People are not the
problem; it is the system of Western societies that have produced the chains
of hospices listed on the stock market. 238 But what is happening with the
welfare system in the United States can only be a warning to us. In my view,
we have an opportunity to develop a new concept of housing for the elderly
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Prospect of an
Architecture
of the Future
The relationship between people and rooms in housing for the elderly
is seldom the subject of critical discussion. Until now, the discourse
in architectural theory has also rarely been concerned with demonstrating
and planning for the vital needs of old people and implementing them in
practice. 253 If we look at the beginnings of housing for the elderly in the
twentieth century and its background in the field of hospitals, asylums, and
types of housing with systematic selection of people and the associated
exclusions, we can see that valuable alternatives, originating in the monastic
lifestyle and surviving to a certain extent in anthroposophical concepts of
life 254 , have been forgotten. Nor can the almost utopian model of a house
containing several generations offer alternatives that reflect the structure of
families in cities. In professional discussion, the requirements of housing
for the elderly must be reconsidered from the residents’ point of view. Are
daily routines functioning? Do people still feel secure? What images do old
people convey to us and what do they want us to think of them? Do meetings
that were meaningful in the past still take place? Do old acquaintances
and friends come to visit them in an old people’s home? Is the housing inte-
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grated into public life? Can the old person still find the inner balance that is
considered to be the center of the person, which is declared to be the aim
of the anthroposophical movement? 255
An anti-institutional view of housing for the elderly may help to sharpen
the focus. Do the buildings still allow space for movement and freedom,
or are they in many ways more like parts of an open prison (Foucault) that
could be described as corporal punishment of the elderly by modern forms
of torture? 256 Is that not precisely why old people avoid visiting these buildings,
in order to banish the possible scenario of their own future from their
minds? A brief glance at the outlines of a history of housing for the elderly
should make clear people’s experiences of the medical care system, with
a final home waiting for them at the end. It is important to understand the
development of housing for the elderly alongside the beginnings of medical
care for the population in the eighteenth century. Associated with this are
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Bodies reflect rooms and in turn affect them. If sensory appeals are lacking,
bodies 275 and souls are deprived of vital stimuli and the result is illness.
Until now, this concern about a range of stimulating features has rarely been
associated with volumes, materials, surfaces, and sequences of rooms. 276
Pharmaceutical products treat the symptoms, not the causes, which can be
described as sensory deprivation. 277
Topoanalysis
To give himself a practical image of the requirements for safe living,
Bachelard invented a method of description, which he calls topoanalysis,
and which, as the word suggests, involves sensual experiences marked out
by places of childhood. “Was the room large? Was the loft crammed full?
Was the spot hot? And where did the light come from? How did the human
being keep quiet in this room? How did he savour these different, very
special forms of quietness in the various hiding places of lonely daydreaming?”
278 Bachelard places the human body in the context of architecture as
a room of experiences and sets a course that can show us a way out of
the constraints of functionalist building. Bollnow also ties in here, requiring
people to devote themselves to living as a lifetime process. He also refers
to a poetics of living, which simply polarizes the contrast between feelings
of security and alienation, repose and flight. Home is therefore the place
that occurs in rooms that are concerned with images of childhood and
usually with maternal love. Following a tradition stretching from Steiner via
Heidegger, Lévinas, Merleau-Ponty, and Bachelard to Bollnow, we can now
also understand the observations of architect-philosophers like Philippe
Rahm and Peter Zumthor, who put materials and their sensory qualities
at the center of their creative activities and explain the effects of architecture
with references to music. Rooms are like instruments. Rooms make
sounds, absorb aromas, and produce an atmosphere. Qualities of rooms in
the form of sensory properties of abundance and volume are very similar to
the cosmological dimensions contained in the anthroposophical metaphor
of “music in all things.” 279
Room experiences are genuine physical experiences that have the
ability to stimulate cognitive processes, which in turn are engraved in the
memory as patterns of movement. If the body is called upon to perform
many motor actions, architecture has fulfilled its purpose of connecting the
childlike urge to move about with security and sensory experiences. Features
that encourage movement, such as stairs, steps, handrails, and handles,
should therefore be understood as essential elements that have been
shown to require the use of different areas of the brain, and managing them
is remembered as a positive experience. Moving around inside the building
is remembered as success.
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Navigation
In his composition Navigation for Strings, the neuro-musician Alvin
Lucier investigated the process of seeking and finding as the basis of musical
experience. As in art, so also in life it is important to find paths and
cover distances. Safe navigation in a new environment not only confronts
people with cognitive impairment with similar challenges to finding one’s way
in unfamiliar towns and streets, it must always be possible to associate it
with positive memories. “For the prevention of dementia, the most successful
effects are achieved by appealing mental, social and physical activities.
… Autosuggestion is more effective than external stimuli.” 280 You probably
know about the extremely demanding test that prospective London taxidrivers
have to pass. The network of streets they have to memorize and be
able to recall at any time is so extensive that this can actually been seen in
the neuroplasticity of the corresponding areas of the brain by means of imaging
procedures. The taxi-drivers learn this demanding map system not as
children but as adults, and not only the layout of the streets; they must also
be able to recall prominent points very quickly in order to be able to take the
best route at any given time. This ability is engraved in the memory by the
orientation training. The hippocampus—the part of the brain responsible for
orientation—actually grows bigger with the years in the profession. 281 Neural
activities and motor skills—whether they are carried out with the feet or the
hands—are linked together as cognitive processes and can be presented
at different levels, as each brain shows different forms reflecting traces of its
life story. 282 Activities determine patterns of approximation that even suggest
parallel processes in imaging procedures. The widespread public image of
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insect through the wooden bodies of the stringed instruments, you would
be rewarded with a multisensory experience. The story of the growth of
many different native and tropical woods and the traces of how they were
worked could be perceived though the sense of smell in the same way that
the calm, softly lingering sound that turns the instruments inside them into a
resting, living being can be heard with the ears. All stringed instruments are
descended from the model of the tortoise shell with strings, the body and
house of a land-dwelling animal, one of the most ancient living creatures we
know. Roofs that have adopted this tortoise-shell form, invoke this image
and promise protection imbued with the special calm of this armor-plated
animal, whose sleep no one may disturb because it always seems to have
its house, and therefore its home, with it.
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