How to avoid flooring dementia patients

Putting the right texture, pattern and colour underfoot can make a critical difference to the health and comfort of people living with dementia

A seating bay in one of the wards at Croydon University Hospital, whose wood-effect vinyl flooring was not only matt and non-slip, but contrasted well with wall surfaces to help those with sight problems or dementia.
A seating bay in one of the wards at Croydon University Hospital, whose wood-effect vinyl flooring was not only matt and non-slip, but contrasted well with wall surfaces to help those with sight problems or dementia.

Choosing dementia-friendly flooring requires a completely different approach to specification. As well as the usual balancing of practicality, budgets and aesthetics, specifiers need to prioritise the changes to perception and sight of those with dementia. Get it wrong with an ill-judged texture, pattern or use of colour, and the result can raise stress and increase the risk of falls among an already vulnerable user group.

With the number of people living with dementia rising as the demographic ages, it’s an issue of growing importance. According to the Alzheimer’s Society, 850,000 people have dementia in the UK, a figure set to reach two million by 2051. 

Considerable strides have recently been made in promoting dementia-friendly design, including a £50 million fund launched in 2012 by the Department of Health to create pioneering health environments for those with the condition. A new Health Building Note is being prepared to promote best practice for the design of environments for people with dementia.

‘There’s still a long way to go, but there’s definitely an increase in awareness,’ says Professor June Andrews, director of the University of Stirling‘s Dementia Services Development Centre (DSDC), which provides advice, training and resources for how to achieve dementia-friendly environments and services.

‘The real challenge is to make it aesthetically appealing without resorting to things that will cause difficulties,’ she says.

In dementia-friendly refurbishment projects, changing the flooring is often the first priority according to IBI Group interior designer Lynn Lindley, who points out that traditional polished hospital floors are completely unsuitable for those with dementia.

‘When we assess a refurbishment and look at the budget, flooring is the first move. That’s the uppermost priority,’ she says.

As sensory faculties weaken with age, the right choice of flooring is particularly important for dementia patients, who may like to wander through the ward or residence, but are often also frail and susceptible to falls. 

The Alzheimer’s Society reports that people with dementia can experience visuo-perceptual difficulties, leading to misperceptions and distortions of reality – a dark patch on a floor can be mistaken for a hole for example, and a glossy surface might be perceived as being wet. Changes in surface can be mistaken for changes in levels. Older people in general may also find certain colours harder to differentiate due to a thickening of the lens of the eye.

Taking this into account, dementia-friendly flooring needs to avoid anything that causes anxiety and deters patients from being able to walk safely across the floor without getting distracted or thrown off balance. This means avoiding flecks or sparkly specks, which patients may try to pick up, as well as shine, dark colours, and pattern, which can be seen as a physical obstruction. Spongy, noisy floors are not advised. But strong colours can work well. 

‘A large or busy pattern can confuse the eye, and cause hesitation if it looks like an obstacle or a hole. Shiny finishes can look unsafe, so a matt flooring is preferable and people can walk more quickly and safely,’ says the DSDC.

Natural-looking effects such as wood are useful in creating a familiar, homely ambience. Colour and surface contrasts in particular need careful handling according to John Mellor, market manager at vinyl flooring specialist Polyflor. As a member of the International Dementia Design Network at the University of Salford, Polyflor has a particular interest in this area, which Mellor says is increasingly being raised by specifiers.

‘In adjacent areas, the use of tones with similar light reflectance values (LRVs) are recommended instead of a sharp contrast which may confuse and be perceived as a step by dementia patients… However, appropriate contrast is required between surfaces such as floors and walls as well as between the floor and wall junction to reduce confusion for the visually impaired and those that experience gradual changes to colour vision,’ he says, adding that it can also be used as a visual barrier to deter patients from entering places that are out of bounds, such as staff areas. 

‘A floor that is dementia friendly can help reduce anxiety and stress in a dementia patient who may be experiencing changes to their sense of sight, including loss of peripheral vision and changes to vision of colour,’ he says.

Architects working in this sector are finding it easier to specify appropriate flooring. 

‘There’s a good range of stuff available now. You don’t have to struggle as much as you used to,’ says Georgia Burt of GBS Architects, (see case study 2), who has found flooring manufacturers receptive to suggestions on more appropriate products.

It’s still quite a task, however, to make a dementia-friendly environment that also feels and looks fantastic for everyone else. 

Niall McLaughlin strived to avoid institutional connotations and create a convivial and bright atmosphere in his design of the Alzheimer’s Respite Centre in Dublin. In the flooring, particular attention was paid to appropriate colour contrasts and acoustics. In such contexts, risk-averse management can be an issue in trying to create a rich environment.

‘Some of these places can be managed to death in terms of specification,’ he says. 

‘I like a challenge,’ says IBI’s Lindley, who has worked in this sector for the last four years. 

‘Polyflor, Altro and a few other manufacturers have made a huge effort to add products and that’s been a great help. We now have a wider range to choose from,’ she adds. 

According to DSDC’s June Andrews, selling the idea of dementia-friendly design to independent care homes and dementia-specific wards is relatively easy as part of a refurbishment or new build, since it brings staff and cost benefits as a result of calmer patients who are less stressed about their environment. As a result, they may be more able to reach, for example, the toilet in time, without being distracted or confused along the way by inappropriate flooring. The bigger challenge is introducing dementia-friendly principles throughout hospitals – which treat people with dementia in all sorts of other wards – and other health centre settings, and importantly in private homes, where the vast majority of people with dementia live. ‘I can’t think of anywhere it isn’t useful,’ she says. 

· Credit: David Oates

Case study 1
Belong Warrington
Client: CLS Care Services
Architect: Pozzoni

Familiar and homely flooring was specified at Belong Warrington, a home to 72 people with dementia. 

The development is designed by Pozzoni, which specialises in older-care accommodation and is working on 12 dementia-specific projects. Residents live in six groups of 12, each with a lounge, dining area and kitchenette, to create a ‘family’ setting on a domestic rather than institutional scale. A downstairs café is open to the public.

Pozzoni created open plan accommodation to assist in orientation, with bedroom and toilet doors, and has made the kitchen clearly visible. A similarly toned carpet – Danfloor Equinox Tones – was specified for bedrooms and lounge areas.

‘Everything is a uniformly flat colour, with any junctions between the carpet, edge slips and non-slip flooring in the same tone so that it’s all perceived as a continuous surface,’ explains Pozzoni partner Damian Utton.

Timber-effect Polyflor Expona flooring with a contrasting skirting is used in both the residents’ kitchens and the downstairs café, which is open to the public. This was chosen because of its familiarity: ‘everyone knows what wood looks like,’ says Utton, adding that standards have risen a lot in care home design in the UK over the last decade. 

Since it opened last year, Belong Warrington has been visited by care home owners and designers from all over Europe, including Oslo City Council.  


Case study 2
Beaconsfield East Ward, Hillingdon Hospital
Client: Hillingdon Hospitals NHS
Foundation Trust
Design: GBS Architects

Beaconsfield East Ward has been transformed into a dementia-friendly environment following a £550,000 refurbishment by Oxford-based GBS Architects. 

The project reworked a 20-bed rehabilitation ward catering for many patients with dementia to create a friendly and attractive environment for patients and their carers. Central to the transformation was the bold use of art, colour, and crucially, new flooring to replace the shiny linoleum, which can be confusing to people with dementia.

GBS specified 590m2 of Forbo Flooring Systems’ Surestep Wood Decibel throughout the ward and corridors. This oak-effect floor replaces strident blue and yellow lino and helps create a ‘comforting and domestic environment’, according to GBS architect Georgia Burt.

‘Making things look like you’d want it at home makes a huge difference,’ she says, adding that fear and uncertainty caused by an inappropriately designed environment can be very counterproductive to patient wellbeing.

She chose the Forbo floor after testing a large sample in-situ. As well as its oak design, the product was chosen for its matt appearance and acoustic backing. By using it throughout the main spaces without threshold strips, the architect avoided the problem of patients with dementia becoming confused by changes of flooring at entrances. The floor also provides sufficient contrast with the walls, and colourful floral artwork in the bed bays, day-room and corridors.

In the assisted bathrooms, GBS specified Altro Suprema II Dew SU2036, a soft grey that has no confusing flecks. 

The 2,473 m2 project, which includes a sensory room and sensory garden, won the Best Internal Environment Award at the Building Better Healthcare Awards 2014.

Case study 3
Dementia Friendly Care Zone, Croydon University Hospital
Client: Croydon Health Services NHS Trust
Design: IBI Group

IBI reconfigured two older peoples’ wards at Croydon University Hospital, introducing a new dementia hub/café and incorporating safe wander loops with integrated seating, as well as activity zones, a quiet room and a sensory zone. The main change was the dementia hub/café, which replaces the nurse station and encourages staff to engage more directly with patients. 

Another key innovation was removal of the vinyl floor which, with dark patches, shiny surface and low lighting, was everything you shouldn’t have for dementia patients, according to interior designer Lynn Lindley.

This was replaced with Polyflor’s fx PUR product, a homely, easy-to-clean wood-effect flooring with added slip-resistance, chosen in a ‘not too dark, not too light’ shade that contrasted well with the walls. Joints are welded with no transition strips, which can be hugely problematic by causing anxiety and deterring patients from crossing thresholds. Patients were immediately less anxious about the replacement floor, according to Lindley.

Skirtings are coved for ease of cleaning. IBI chose an independent Gradus Sit-in vinyl product, welded to the floor. 

In the washrooms, the firm used vinyl flooring with the same LRU value as the timber-effect flooring – a warm grey hue of Altro’s Aquarius, which is matt and non-slip when wet or dry, shod or barefoot.

Construction costs were £985,000. Dementia-friendly work to a third ward is also proposed.