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Developing best practice guidelines for designing living environments for people with dementia and sight loss


The paper considers a process of developing evidence-based design guidelines to be used in environments where people with dementia and sight loss are living. The research involved a systematically conducted literature review and a series of consultations with people affected by dementia and/or sight loss who lived or worked in care homes or in domestic settings. Findings from the literature and the consultations were used in an iterative process to develop the guidelines. The process is outlined, providing examples from the guidelines about lighting and colour and contrast. In discussing the research findings and the development process, the authors consider implications of the work including the weakness of the evidence base, the challenges of improving this and the need for innovative approaches to understanding the complexities of design for people with dementia and sight loss. They highlight the emphasis in the literature on independence for people with sight loss and the focus on control of people with dementia, arguing that this falls short of a genuinely person-centred approach, which recognises the active participation of people with dementia and sight loss.

Corresponding author
Address for correspondence: Alison Bowes, Faculty of Social Sciences, University of Stirling, Stirling FK9 4LA, UK E-mail:
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Alonso-Coello, P., Irfan, A., Sola, I., Gich, I., Delgado-Noguera, M., Rigau, D., Tort, S., Bonfill, X., Burgers, J. and Schunemann, H. 2010. The quality of clinical practice guidelines over the last two decades: a systematic review of guideline appraisal studies. Quality and Safety in Health Care, 19, 6, e58.
Alzheimer's Society 2013. Sight, perception and hallucinations in dementia. Factsheet 527LP, Alzheimer's Society, London.
Alzheimer' Society 2014. Dementia UK: Update. Second edition, Alzheimer's Society, London.
Ansari, S. and Rashidian, A. 2012. Guidelines for guidelines: are they up to the task? A comparative assessment of clinical practice guideline development handbooks. PLoS ONE, 7, 11, e49864.
Astell, A., Alm, N., Gowans, G., Ellis, M., Dye, R. and Vaughan, P. 2009. Involving older people with dementia and their carers in designing computer based support systems: some methodological considerations. Universal Access in the Information Society, 8, 1, 4959.
Barnes, S. and the Design in Caring Environments Study Group 2002. The design of caring environments and the quality of life of older people. Ageing & Society, 22, 6, 775–89.
Bossen, A. 2010. The importance of getting back to nature for people with dementia. Journal of Gerontological Nursing, 36, 2, 1722.
Bowes, A., Dawson, A., Greasley-Adams, C. and McCabe, L. 2016. Design of residential environments for people with dementia and sight loss: a structured literature review. British Journal of Visual Impairment, 34, 3, 225–37.
Brooker, D. 2003. What is person-centred care in dementia? Reviews in Clinical Gerontology, 13, 3, 215–22.
Brouwers, M. C., Kho, M. E., Browman, G. P., Burgers, J. S., Cluzeau, F., Feder, G., Fervers, B., Graham, I. D., Steven, E., Hanna, S. E. and Makarski, J. 2010. Development of the AGREE II, part 1: performance, usefulness and areas for improvement. Canadian Medical Association Journal, 182, 10, 1045–52.
Brunnström, G., Sörensen, S., Alsterstad, K. and Sjöstrand, J. 2004. Quality of light and quality of life – the effect of lighting adaptation among people with low vision. Ophthalmic and Physiological Optics, 24, 4, 274–80.
Brush, J. A., Meehan, R. A. and Calkins, M. P. 2002. Using the environment to improve intake for people with dementia. Alzheimer's Care Quarterly, 3, 4, 330–8.
Calkins, M. P. 2002. How colour throws light on design in dementia care. Journal of Dementia Care, 10, 4, 20–3.
Calkins, M. P. and Brush, J. A. 2002. Designing for dining: the secret of happier mealtimes. Journal of Dementia Care, 10, 2, 24–6.
Cochrane Effective Practice and Organisation of Care (EPOC) group (2002) ‘Data Extraction Form, part of the EPOC Data Collection Template’ Available online at, [Accessed 12 November 2013]. Now see: Effective Practice and Organisation of Care (EPOC) (2015). EPOC Resources for review authors. Oslo: Norwegian Knowledge Centre for the Health Services. Available online at:, [Accessed 19 December 2016].
Critical Appraisal Skills Programme (CASP) (undated). ‘Critical appraisal checklists’. Now see: Critical Appraisal Skills Programme (CASP) (2013). CASP Checklists. Available online at “” \l ”!casp-tools-checklists/c18f8” , [Accessed 19 December 2016].
den Brinker, B. P. L. M., Burgman, L. J., Hogervorst, S. M. J., Reehorst, S. E., Kromhout, S. and van der Windt, J. 2005. The effect of high-contrast marking of treads on the descent of stairways by low-vision people. International Congress Series, 1282, September, 502–6.
Department of Health 2012. Indicator 4.12: preventable sight loss. In Improving Outcomes and Supporting Transparency. Part 2: Summary Technical Specifications of Public Health Indicators. Department of Health, London, 126–29.
Dewing, J. 2008. Process consent and research with older persons living with dementia. Research Ethics Review, 4, 2, 5964.
Economic and Social Research Council (ESRC) 2015. ESRC Framework for Research Ethics 2010, Updated September 2012. Available online at Accessed 19th December 2016.
Fernler, K. 2015. Informed ignorance and the difficulty of using guidelines in policy processes. Evidence and Policy, 11, 3, 377–96.
Goodman, C. and Watson, L. 2010. Design Guidance for People with Dementia and for People with Sight Loss. Thomas Pocklington Trust Research Findings 35. Available online at Accessed 19 December 2016.
Gould, N. 2010. Integrating qualitative evidence in practice guideline development: meeting the challenge of evidence-based practice for social work. Qualitative Social Work, 9, 1, 93109.
Harding, E., Pettinari, C. J., Brown, D., Hayward, M. and Tayler, C. 2011. Service user involvement in clinical guideline development and implementation: learning from mental health service users in the UK. International Review of Psychiatry, 23, 4, 52–7.
Homes and Communities Agency 2009. HAPPI: Housing Our Ageing Population: Panel for Innovation. Available online at Accessed 19 December 2016.
Kelly, F., Innes, A. and Dincarslan, O. 2011. Improving care home design for people with dementia. Journal of Care Services Management, 5, 3, 147–55.
Kovach, C., Weisman, G., Chaudhury, H. and Calkins, M. P. 1997. Impacts of a therapeutic environment for dementia care. American Journal of Alzheimer's Disease, 12, 3, 99110.
La Grow, S., Robertson, M. C., Campbell, A. J., Clarke, G. A. and Kerse, N. M. 2006. Reducing hazard related falls in people 75 years and older with significant visual impairment: how did a successful program work? Injury Prevention, 12, 5, 296301.
Lawrence, V. and Murray, J. 2009. Promoting independent living among people with dementia and sight loss. Journal of Care Services Management, 3, 3, 261–74.
Lawrence, V., Murray, J., Ffytche, D. and Banerjee, S. 2009. ‘Out of sight, out of mind’: a qualitative study of visual impairment and dementia from three perspectives. International Psychogeriatrics/IPA, 21, 3, 511–8.
Lifetime Homes 2010. The Lifetime Homes Standard (from 5 July 2010). Available online at Accessed 19 December 2016.
Littlefair, P. 2010. Daylighting and Windows in Homes of People with Sight Loss. Thomas Pocklington Trust Research Findings 30. Available online at Accessed 19 December 2016.
Long, R. G. 1995. Housing design and persons with visual impairment: report of focus-group discussions. Journal of Visual Impairment and Blindness, 89, 1, 5969.
Manthorpe, J. 2004. Risk taking. In Innes, A., Archibald, C. and Murphy, C. (eds), Dementia and Social Inclusion. Jessica Kingsley, London, 137–50.
Marquardt, G. 2011. Wayfinding for people with dementia: a review of the role of architectural design. Herd, 4, 2, 7590.
McNair, D., Cunningham, C., Pollock, R. and McGuire, B. 2010. Light and Lighting Design for People with Dementia. Dementia Services Development Centre, University of Stirling, Stirling, UK.
Moreira, T. 2005 Diversity in clinical guidelines: the role of repertoires of evaluation. Social Science and Medicine, 60, 9, 1975–85.
Morse, J. M., Barrett, M., Mayan, M., Olsen, K. and Spiers, J. 2002 Verification strategies for establishing reliability and validity in qualitative research. International Journal of Qualitative Methods, 1, 2, 1322.
NHS Centre for Reviews and Dissemination (NHS CRD) (2001) ‘Undertaking Systematic Reviews of Research on Effectiveness, CRD Report No. 4 (2nd Edition)’. York: NHS Centre for Reviews and Development.
Nutley, S. M., Walter, I. and Davies, H. T. O. 2007 Using Evidence: How Research Can Inform Public Services. Policy Press, Bristol, UK.
Parker, C., Barnes, S., McKee, K., Morgan, K., Torrington, J. and Tregenza, P. 2004 Quality of life and building design in residential and nursing homes for older people. Ageing & Society, 24, 6, 941–62.
Pawson, R. 2006. Evidence-based Policy: A Realist Perspective. Sage, London.
Pawson, R. and Tilley, N. 1997. Realistic Evaluation. Sage, London.
Pollock, R., McNair, D., McGuire, B. and Cunningham, C. 2007. Designing Lighting for People with Dementia. The Dementia Services Development Centre and University of Stirling, Stirling, UK.
Royal National Institute of Blind People 2015. Key Information and Statistics. Available online at [Accessed 19 December 2016].
Sixsmith, A. J., Gibson, G., Orpwood, R. and Torrington, J. M. 2007. Developing a technology ‘wish list’ to enhance the quality of life of people with dementia. International Journal of Gerontechnology, 67, 1, 219.
Thomas, C. 1999. Female Forms: Experiencing and Understanding Disability. Open University Press, Buckingham, UK.
Torrington, J. and Lewis, A. 2011. Extra Care Housing for People with Sight Loss: Lighting and Design Issues. Thomas Pocklington Trust Research Findings 36. Available online at Accessed 19 December 2016.
Unwin, B. K., Andrews, C. M., Andrews, P. M. and Hanson, J. L. 2009. Therapeutic home adaptations for older adults with disabilities. American Family Physician, 80, 9, 963–68.
Utton, D. 2009. The design of housing for people with dementia. Journal of Care Services Management, 3, 4, 380–90.
van Hoof, J., Kort, H., van Waarde, H. and Blom, M. M. 2010. Environmental interventions and the design of homes for older adults with dementia: an overview. American Journal of Alzheimer's Disease and Other Dementias, 25, 3, 202–32.
World Health Organisation 2014. WHO Handbook for Guideline Development. Second edition, World Health Organisation, Geneva.
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Ageing & Society
  • ISSN: 0144-686X
  • EISSN: 1469-1779
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