empathic architecture

a Scandinavian approach
about design in elderly homes for fragile or demented people
Jonas E Andersson
architect SAR/MSA, candidate for the doctorate DASH, Design, Arbetsmilj, Skerhet och Hlsa, KTH, Campus Haninge (Design, Work environment, Security and Health, KTH, Campus Haninge)
Kungliga Tekniska hgskolan Design, Arbetsmilj, Skerhet & Hlsa, DASH

KTH SYD Campus Haninge Marinens vg 30 136 40 Haninge. Tel: 08-790 48 28. Fax: 08-790 48 00. Mtfn 070-731 72 15

E-post: jonas.andersson@syd.kth.se www.syd.kth.se

table of contents: 1.0 abstract________________________________________________________ 3 2.0 introduction_____________________________________________________ 4 3.0 man and environment_____________________________________________ 5 4.0 man and care environment_________________________________________ 7 5.0 man and dementia _______________________________________________ 8 6.0 discussion _____________________________________________________ 10 7.0 concluding remarks and futher research _____________________________ 11 8.0 bibliography ___________________________________________________ 12 8.1 publications: ________________________________________________ 12 8.2 publications on the Internet: ___________________________________ 14

This paper is written for the conference LIVING IN THE NORTH nordic reflections on architecture, Helsinki le 23 - 25 April 2004.

KTH, Campus Haninge the 16th April 2004

cover, Eclipse of a thought , the author, reduced revised 04.04.28/ JEA

1.0 abstract The 20th century in Sweden and the other Scandinavian countries has been characterized by a social-political ambition to improve the living conditions anywhere in the society by urban planning and architecture. The Scandinavian architecture departed from a an inquiry about mans basic needs and his corporal dimensions and arrived at general recommendations that pretended to be an universal guarantee for the built environment. An integrated notion in the Scandinavian architecture is to compare the physical characteristics of the human body to those of the building; the height, the width, the depth and the mass. Another revealing aspect is the Scandinavian way of emphasizing the authenticity of the building material, but also to confirm the innate Scandinavian feeling for nature and its materials. The modern Scandinavian architecture is challenged by the increasing portion of elderly people in the Nordic countries. Infirmities of old age that affect and disturb the brain will create a cognitive problem for the ageing individual to understand and act in a built environment. In that way, a dementia will challenge any acquired knowledge about how to plan a home for elderly. Recent findings from brain research ought to be integrated in the knowledge for Scandinavian architects. An improved competence in this area of human spatial thinking is a condition for understanding the interaction between man and the built environment. Architecture already functional ought to include the findings on human reactions upon the built environment, colours, lighting effects and the form. In order to ease the daily life for elderly people with dementia or sickness, the Scandinavian architecture should promote an empathic architecture, an architecture that combines functionality and impression. In the Swedish society, the municipality is responsible for the care of frail and demented people. Gerontologists suggest that the care environment should be warm, filled with a quality so difficult to define, a feeling of home, and stimulate the remaining capacities of the frail and the demented. This paper indicates that this feeling of home must be defined in order to serve as a necessary parameter in the design of homes for elderly people. In Sweden, it is suggested that the best solution for elderly people with dementia is a unit for 10 persons. Reality shows that this solution is no longer possible, the high number of demented people increases already considerably. The conclusion of this paper is that an architectural research is necessary to understand the relation between the design of a building for elderly people and their particular demands on the environment to be a support in their daily living. Key words: special homes for elderly people with special need, dementia, home for demented people, care environment, architecture, empathic architecture.

2.0 introduction The Swedish architecture is distinguished by a great attention to harmony between building and surrounding nature. [...] The simplicity of the design, the transparency and the close contact with the natural environment are a distinct characteristic of the contemporary Swedish architecture and urban planning. 1 A non-verified hypothesis that the most burning information can be found on the Internet gives the answer above. Similar researches using the other Scandinavian countries2 demonstrate that Scandinavian architecture is considered to be a unity with individual characteristics. Scandinavian architecture is famous for its simplicity, its preoccupation of the material, and its close interaction with the surrounding environment. In 1900 at the world exposition in Paris, international reviewers concluded that the Scandinavian pavilion, jointly shared by the countries, bore witness to the importance of nature for their design and architecture3. The Swedish architecture itself was internationally renowned during the twenties. This classical expression was replaced by architecture with social-political ambitions, the functionalism, introduced at the Stockholm exhibition in 1930. A systematic and direct approach, based on scientific research, was a strong aspect of this new architecture that integrated economic planning and functional analysis in the design process4. The major stock of buildings is of this design, produced from the end of the second world-war until today. The Scandinavian architecture is closely related to social development, and things for everyday-use are considered to be a cultural expression5. Buildings for elderly people dates from the Middle age. The building went from workhouses to large-scale effective care-institutions. Even before functionalism, one characteristic of buildings for elderly people was a rational and formal look6. Elderly people in need of medical care were sent to hospital. The Swedish reform of the elderly care in 1992, called the noble reform7 reoriented this look. Experiences had shown that elderly people preferred and felt better in smaller units with a clear feeling of home and where the care was personalized. The term special homes for elderly people with a special need was formulated. The reform confirmed the principal of small units integrated in an existing social context. Three key words were adopted to define the new design - a feeling of home, way-finding, and a spatial clarity8. The 21st century will challenge Sweden. As for the rest of the industrialized world, the number of elderly people in society is increasing, and they will be very old. The reform in 1992 focused on the individual and his needs, but elderly people in the future wont have the same infirmities of old age as then. There is a strong

1 Larchitecture sudoise se distingue par la grande attention quelle porte lharmonie des constructions avec la nature environnante. [...] La simplicit du design, la luminosit et ltroit contact avec lenvironnement naturel constituent les traits distinctifs de larchitecture sudoise contemporaine et de lurbanisme sudois. , Yahoo! Encyclopdie ; Littrature, arts et sciences de la Sude, http://fr.encyclopedia.yahoo.com/articles/jb/jb_597_p0.html 2 search in French, hits only on architecture and Danish and Norwegian nationality, Finnish and Icelandic did not produce any result.

Glambek, Ingeborg, 1997: Det nordiske i arkitektur och design. Sett utanfra. I Paulsson, Jan; 2003: Art, architecture and design. Notes on the nature and contents of Nordic models during the 20th century; contribution to CPAS, centre for pacific asia studies, symposium What is the Nordic model?, Stockholm University, august 15-17, 2003 4 Andersson, Henrik & Bedoire, Fredric 1986: Svensk Arkitektur, ritningar 1640-1970, Stockholm, Byggfrlaget 5 Lund, Nils-Ole, 1993: Nordisk Arkitektur, Arkitektens Forlag, Danmark 6 Paulsson, Jan, 2002: Det nya ldreboendet, ider och begrepp, byggnader och rum. Svensk Byggtjnst, p 22 7 due to the abbreviation of the government-committee 8 Larsen, Jrgen, 1989: Anpassade gruppbostder fr ldersdementa, en beskrivning av utvecklingsfronten hsten 1989 om anpassningsbehov samt problem och hinder vid nyetablering. Spri, Stockholms Lns ldrecentrum

correlation between an old age and a risk for dementia9. The strategy for solving this problem is to adapt the private dwellings to the specific needs of the individual, but also to expand the social service at home in order to permit a longer stay at home. A place in a special home for elderly people with special need is offered only to those who have such a deficiency in their activities of daily life, ADL10, that a private home no longer is advisable. This paper is about the environment in a special home for elderly with special need. In the first chapter a model presents the relation between man and environment. The following chapter describes the interaction between the individual and the built environment in a care context. A third chapter is about dementia and its consequences. Finally, the paper discusses the demands to formulate when it comes to designing an environment for elderly people with special need. An idea for an empathic architecture is formulated, aiming for a design that conceptualizes the specific needs of an ageing individual. A model for empathic architecture is described. The paper ends with some concluding remarks about the home feeling and future research. 3.0 man and environment There is a huge difference between brain and behaviour, but the two are connected. The brain is a physical object, a living tissue, an organ in the body. The behaviour corresponds to an action that is observable for a moment, but evanescent. Although, one is responsible for the emergence of the other, the second will affect the first one, which will act upon the other, and so on11. The brain tissue is made up of cells called neurons, whose outgrowths, the axons; create a representation of the body at the brain level, a homunculus12. The nervous system in the body is divided in three subsystems; the brain system in the scull (brain and cranial nerves), the medulla system (spinal cord and neural extensions) and the autonomic nervous system (the sympathetic system and the parasympathetic system), who control the organs in the body. The communicative signals are the synapses who convey messages by releasing small quantities of chemical substances. The synapses affect apprenticeship and behaviour. The number of synapses is important for the ramification of each neuron and for the interconnection between neurons. Brain research has identified a small fraction of the chemical substances involved in the neural information transfer. Physiologically, the two nervous systems, sympathetic and parasympathetic, act as opponents, stimulating and inhibiting. The systems are always alert to respond to events. The sympathetic system activates the organism to combat or flight, and the parasympathetic system appeases and controls the metabolism of the organism. Man is a part of his environment and his social context. A way to describe the relation is the following illustration. The social structures can be a building or a neighbourhood, a family or a

9 Etenneur, Luc & Dartigues, Jean-Franois, 1994: Maladie dAlzheimer, bilan des donnes pidmiologiques. LAnne Grontologique. Volume 8, 1994, p 227-233 10 ADL = Activities of Daily Living, p svenska Aktiviteter i Dagligt Liv

Il y a une diffrence norme entre cerveau et comportement, mais les deux sont lis. Le cerveau est un objet physique, un tissu vivant, un organe du corps. Le comportement correspond une action, observable momentanment, mais evanescente. Pourtant, lun est responsable de la survenue de lautre, qui son tour agit en retour sur le premier, qui va agir sur lautre, et ainsi de suite. In Kolb, Bryan & Whishaw, Ian, 2002 : Cerveau et comportement, Bruxelles, de Boeck & Larcier SA, p 3. 12 homunculus, a descriptive picture of the human body in mobility and sensory parts of the brain, and therefore a topographical picture from the neural extension in the body. Kolb, Bryan & Whishaw, Ian, 2002: Cerveau et Comportement, Bruxelles, de Boeck & Larcier SA, p 366.

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working place13. Man recognizes and understands these social structures and processes.

man and environment environment

social connections structure and function

stimuli
(physical or psychosocial)

profile
(psychobiological program)

reactions
(interaction stimuli and profile)

signs
(disturbe d health)

bad health or sickness

maladie

pre-influence of the environment

genetic heritage

inter-acting variables, positive or negative

Legend 1. man and environment (adaptation after Kagan & Levi, 1975) The interaction of the individual with the environment depends upon the emotional and cognitive way to respond, but it is also influenced by the individuals personal habits and by its way to react to stress. The process is cybernetic14, and it can be influenced by inter-acting variables. The variables could be social support, cognitive therapy, or improvements in the built environment 15. A changed behaviour implies a change in the number of synapses, and therefore a differentiation in the brain tissue16. The complexity of a complete identification of the effect from any variable is so big, that it is difficult to know which variable causes a certain reaction in the body.

Levi, Lennart, 1987; Psychosocial factors and health approaches to person-environment interactions, in Ulrich, Roger S & Hygge, Staffan, 1987; Research on environments and people, Swedish council for building research, Stockholm, Sweden. 14 Cybernetic = science of communication and regulation in the living organism and the machine. Le Robert pour tous, dictionnaire de la langue franaise. 15 Levi, Lennart, 1987; Psychosocial factors and health approaches to person-environment interactions, in Ulrich, Roger S & Hygge, Staffan, 1987; Research on environments and people, Swedish council for building research, Stockholm, Sweden, p 45-49 16 Kolb, Bryan & Whishaw, Ian, 2002:Cerveau et Comportement, Bruxelles, de Boeck & Larcier SA, p 600.

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4.0 man and care environment The brain performs several cognitive operations, of which the perception, the execution of actions before perceptual operations, the constructions of images, planning, spatial cognition and attention. These operations demand a simultaneous activity in the cerebral cortex17. The way the brain deals with the information and creates an interpretation, in a complex system of synapses on different levels of the cerebral cortex. It is impossible to find the exact spot where physical or psycho-social stimuli are interpreted or precisely where an appropriate behaviour is decided. A neuro-psychological model of this process gives a more comprehensible image18: Signals coming from the five senses are directed to the rear part of the brain. The central part of the brain suggests a set of plausible interpretations. The frontal part of the brain decide which behaviour to adopt. This model also emphasizes the importance of studying man in interaction with environment19. Studies from hospitals indicate that patients feel stress caused by the psycho-social environment in the hospital or by the reason of being there. A high level of stress hormone in the blood weakens the immune defence system20. Neuroscientists suggest that a group of stress hormones called glucocorticoid might be considered as a neuro-toxic for the neurons in the brain21. During long influence of stress, neurons in central parts of the brain degenerate, which could explain the changed behaviour and the mnemonic problems of heavily stressed people.

supportive design in a care environment

a supportive design in care environment must improve health and reduce stress by improving : 1. 2.
3.

a feeling of control of the psycho-social environment a social support

access to distractions in the physical environment

Legend 2. man and care environment (after Ulrich, 1991)

A supportive design in a care environment focuses on the patient, the patients family and the personnel. Its aim is to reduce stress. Studies performed in at hospitals prove the need for an architectural design of the environment. The design should imitate that of a novel coherence is the most important criterion for unLe cerveau ralise de multiples oprations cognitives dont la perception, la mise en oeuvre dactions devant permettre la perception, la construction dimages, la planification, la cognition spatiale et lattention. De telles oprations ncessitent une activit conjointe de rgions corticales in Kolb, Bryan & Whishaw, Ian, 2002 : Cerveau et Comportement, Bruxelles, de Boeck & Larcier SA, p 571 18 after the Russian neuro-psychologist Alexander Luria, in Kolb, Bryan/ Whisham, Ian, 2002 : Cerveau et comportement. Bryssel, De Boeck & Larcier, s 72 19 Luria, Alexander: There is no hope of finding the sources of free action in the lofty realms of the mind or in the depths of the brain. (...) To discover the sources of free action it is necessary to go outside the limits of the organism, not into the intimate sphere of the mind, but into the objective forms of social life; it is necessary to seek the sources of human consciousness and freedom in the social history of humanity. (...) Luria, Alexander, http:// www.marxist.org/archive/luria 20 Ulrich, Roger S. 1991: Effects on interior design on wellness: theory and recent scientific research, Journal of healthcare interior design, 3:97-109. 21 Kolb, Bryan & Whishaw, Ian, 2002:Cerveau et Comportement, Bruxelles, de Boeck & Larcier SA, p 518.
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derstanding a text22, and equally in a built environment23. The design should have a clear visual message of function, long corridors a conscious treatment of walls, ceiling and floor, colours and material. The penetration of daylight and the arrangement of windows with a view to the adjacent nature are other important criteria. The interior design should appeal to the aesthetic sense of the patient24, thus reducing easily appearing stress25. A special home for elderly people with a special need is a care environment designed with a strong illusion of home. The majority of elderly people in Sweden will have a normal ageing, but a group of elderly, approximately 115.500 persons or eight percent26, will experience such a difficult ageing that a private home is unadvisable. Their capacity to cope with activities of daily living, ADL27, is so disturbed that this group needs assistance and a care twentyfour hours a day. Here questions of existential nature are carried to extremes, since a living this living rather is a hospice where the stay is only some months. 5.0 man and dementia The cholinergic ascending system contributes to activity [...] in an awaken person [...] and seems to play a role in the normal awaken behaviour. Persons touched by Alzheimers disease present [...], at an autopsy, an important loss of these cholinergic neurons28. In 2003, the number of persons suffering from dementia was estimated to 139.000 persons in Sweden. A destruction of the cerebral tissue is concentrated to the region that according to the mentioned neuro-psychological model decides and puts into execution the chosen behaviour. It is also the center where personality is located. Among those suffering from dementia 50 to 70 percent have Alzheimers disease. A dementia causes disruptions affecting the personality, the memory, and ability to orientate inside or outside. Even before the diagnosis, persons suffering from dementia are aware of some of the problems. A normal reaction is to deny everything. In the early phases of a dementia it is possible to go on living at home, in that sense the disease also becomes the familys problem. Research concentrates upon finding the cause of dementia. For the moment there is no cure for the disease, medicine can only slow down the course. Finally it is no longer possible to stay at home; a complete care around the clock is needed. A special home for elderly people with special need of care due to dementia or illness is then the best solution for both the individual and his family.

Eco, Umberto, 1992; Les limites de linterprtation i Srman, Richard, Litteraturvetenskaplig metod, Uppsala Universitet 2002, s 98 23 Evans, Gary W & Mitchell McCoy, Janetta, 1998: When Buildings dont work: the role of architecture in human health, Journal of environmental psychology 1998:18, s 86 24 Ulrich, Roger S. 1991: Effects on interior design on wellness: theory and recent scientific research, Journal of healthcare interior design, 3:97-109. 25 Ulrich, Roger S. 1991: Effects on interior design on wellness: theory and recent scientific research, Journal of healthcare interior design, 3:97-109. 26 Socialstyrelsen 2003: ldre vrd och omsorg r 2002, artikel nr 2003-44-03 27 ADL = Activities of Daily Living 28 Le systme cholinergique ascendant contribue lactivit [...] chez une personne veille [...] et semble donc jouer un rle dans le comportement dveil normal. Les personnes atteintes de maladie dAlzheimer [...] prsentent, lautopsie, une perte importante de ces neurones cholinergiques. In Kolb, Bryan & Whishaw, Ian, 2002:Cerveau et Comportement, Bruxelles, de Boeck & Larcier SA, s 174.

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failing self-functions caused by dementia

1. reflective capacity decreases 2. emotional capacity changes 3. emotional control falters 4. capacity to understand the environment decreases 5. capacity to discrimination decreases 6. capacity to interact with the environment decreases 7. capacity to maintain ones personality decreases 8. independence disappears 9. control of defensive mechanism, anguish or worry, falters 10. capacity of self-esteem is threaten 11. imaginative capacity disappears
12. capacity to understand is lost

Legend 3. man and dementia (adaptation from Cars & Zander 1998)

A dementia means that the inner life of the individual is changed into a present state only. Every dementia has its own manifestation, and the family and the staff must find the logic in the illogic. A frequently used method in Sweden is to affirm the self-assessment of the demented, developed by the American psychologist and psychoanalyst Leonard Bellak29. Another form of care for demented people is water therapy, which strengthens the sensation of the body30. A dementia illness is a cruel experience for the family. The shared family-past is erased. Some stimuli like music can recall the personality that the illness hides31. Demented people are often anguished or worried, normally at nightfall, the so called Sun Downers Syndrome32. Natural inhibitions disappear and some demented become aggressive or even sexually offensive. There is often a need to let out the stress and the anguish through physical activities.

Cars, Jane & Zander, Birgitta, 1998: Samvaro med dementa, Gothia, Benito-Garcia, Marc, 1996: Dmence, architecture et projet de soins. Universit Paris/, Facult de Mdecine Lariboisire Saint Louis, Paris. 31 Ogay, Suzanne, 1996: Alzheimer communiquer grce la musicothrapie, LHarmattan, Paris 32 Regnier, Victor, 2002; Design for assisted living, guidelines for housing the physically and mentally frail, John Wiley & Sons, Inc, New York
30

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6.0 discussion empathy the power of understanding and imaginatively entering into another persons feelings33 A complete documentation with recommendations or practical advice exists for designing special homes for elderly people with a special need. In our opinion, the task asks for a deeper knowledge. It is very easy that the architectural work concentrates on the work environment and its functionality, but avoids the existential questions. Probably, the staff spends more time in the built environment than the lodgers, but this is not a good answer to avoid the supportive design issues for elderly and moribund people. Due to this fact, a design of a special home ought to have a conceptual focus on care, man and ageing. It is important that these questions are discussed in the initial phase of the project in order to create an empathic architecture.

empathic architecture guidelines

in order to explain the built environment in a special home to elderly people, relatives, and staff (the users), it is important to design from the following criteria : 1. a knowledge of man and aging 2. a knowledge of care, attention, and working environment 3. a knowledge of man, environment, environmental psychology, (a supportive design for the frail and the demented) 4. a conceptual approach building ageing man (functional and spiritual needs must be respected) 5. a knowledge of certain building qualities and of importance for frail and demented people (daylight, illumination, colours, social meeting) 6. a balance between rationality, aesthetic qualities, and ethics (corridors mean meeting points, activity, work, etc) 7. a clear conception of the use of space in order to explain spatiality (function, details, material on floor, wall, and ceiling) 8. the relation between interior and exterior (penetration of light, panorama, balcony, terrace, patio, garden) 9. location of the building (in an existing social context is to prefer) 10. a clear relation between function, interior design, furniture (a feeling of home by close interaction architect-interior designer-care staff)

Legend 4. empathic architecture architectural guidelines

The design of a building is a design-process34 where different actors like care organizers, building coordinators, representatives from union or from relatives organisations and the architect. The architect translates the design discussion into a realistic plan of the building. The philosopher Donald Schn considers the design33

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explanation from Collins, English Dictionary, 1998 ; HarperCollins Publishers, Glasgow, 4 edition design-processen according to Gustaf Rosell: the emergence and development of an idea of a product and the transformation of these ideas to information, will make it possible to produce a product in Lundequist, Jerker, 1992: Projekteringsmetodikens teoretiska bakgrund, Institutionen fr Arkitektur, Kungl Tekniska Hgskolan, Stockholm

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process as a dialogue between the designer and the design situation, where the designer should act with his unique competence of different design contexts. What is typical for the design practice is the reflection in action and the conversations with the materials of a situation35. When it comes to a special home for elderly people, the designer is not a person, but a group of specialists whose intentions for an empathic architecture will characterize the building itself. An empathic architecture is not a predefined architectural expression; it aims to an architecture that is visually comprehensible for the frail or demented individual. It also means a healthy working environment. A visual clarity is not limited to the organisation of the rooms, arranged to facilitate way-finding and a global view of the building, it also means a clear use of a door or a room. An empathic architecture is a scenario to explain the contents of the space. 7.0 concluding remarks and further research Architecture is an ode to space it-self.36 (Paul Valry) Several gerontologists have considered the feeling of home as a result of putting different objects representing different time-periods that a frail or a demented person presumably relates to. A conclusion from this paper indicates that this feeling also ought to refer to the interaction between man and environment. Another conclusion is that way-finding and spatial clarity make part of this interaction. For the best result, a special home for elderly people with special needs should be a built environment that promotes a sensation of security and calm, but also a nonstressful framework for the staff working there. The problem is to define each element in a built environment that contributes to this kind of sensation and of framework. Swedish research on special homes has had an inclination towards working environment rather than environmental impression. Further research therefore should include the impression that elderly frail and demented people have of the environment, and also that of their relatives. There are ethical problems to do such a research, but in the same time there is a great need of this type of investigation. The loss of a dear family member is always a difficult emotional experience that leaves permanent traces; the goal is to put this emotional event in a warm setting. Consequently, an architectural research means a multidisciplinary approach, collecting gerontologists, care professions, psychologists, philosophers on one hand, and architects and interior designers on the other. An approach of this kind could also turn into meeting between human beings about age, ageing and the eternal questions.

Lundequist, Jerker, 1992: Projekteringsmetodikens teoretiska bakgrund, Institutionen fr Arkitektur, Kungl Tekniska Hgskolan, Stockholm, p 18 36 entry architecture; Larchitecture est une ode de lespace lui-mme. Valry, i Michel Legrain et al, 1994 ; Le Robert pour tous, dictionnaire de la langue franaise. Dictionnaire Le Robert, Paris.

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8.0 bibliography 8.1 publications:

Alfredsson, Betty, 1989: Age, competence, and environment, elderly dementia patients in three different environments. Gerontologiskt centrum Lund, 1989, Andersson, Henrik & Bedoire, Fredric 1986: Svensk Arkitektur, ritningar 1640-1970, Stockholm, Byggfrlaget Benito-Garcia, Marc, 1996: Dmence, architecture et projet de soins. Universit Paris/, Facult de Mdecine Lariboisire Saint Louis, Paris. Berthoz, Alain, 2003: La Dcision, Odile Jacobe Sciences, Paris Cars, Jane & Zander, Birgitta, 1998: Samvaro med dementa, Gothia, Cars, Jane & Zander, Birgitta, 2003: Tyst kunskap anvndbar nr jaget sviker. Tidskriften ldre i Centrum, nr 4/2003, s24-25 Dahl, Agneta, 2003 : Smnbrist kan ge demensliknande symptom. Tidskriften ldre i Centrum, Stockholm, n44/2003, s26 Demensfrbundet, Riktlinjer gllande gruppboende fr mnniskor med demens Eco, Umberto, 1992; Les limites de linterprtation i Srman, Richard, Litteraturvetenskaplig metod, Uppsala Universitet 2002, s 98 Etenneur, Luc & Dartigues, Jean-Franois, 1994: Maladie dAlzheimer, bilan des donnes pidemiologiques. LAnne Grontologique. Volume 8, 1994, 227-233 Evans, G W, & Mitchell McCoy, J, 1998: When building dont work: the role of architecture in human health. Journal of Environmental Psychology, 1998:18, s 85-94 Glambek, Ingeborg, 1997: Det nordiske i arkitektur och design. Sett utanfra. I Paulsson, Jan; 2003: Art, architecture and design. Notes on the nature and contents of Nordic models during the 20th century; bidrag till CPAS, centre for pacific asia studies, symposium What is the Nordic model?, Stockholm University, augusti 15-17, 2003 Collins, English Dictionnary, 1998 ; HarperCollins Publishers, Glasgow, 4 edition Ingvad, Bengt, 1989: Senildementa i ett bostadsomrde, attityder till en dagsjukvrdsenhet Gerontologiskt centrum, Lund Knez, Igor, 2001: Effects of colour of light on nonvisual psychological processes. Journal of environmental psychology, 2001:21, s 201-208 Kolb, Bryan & Whisham, Ian, 2002 : Cerveau et comportement. Bryssel, De Boeck & Larcier, s 72 Lanesj, Ethel, 2003: Sjukdomar som pverkar hjrnan, Tidskriften ldre i Centrum, nr 4/2003, s7-8 Larsen, Jrgen, 1989: Anpassade gruppbostder fr ldersdementa, en beskrivning av utvecklingsfronten hsten 1989 om anpassningsbehov samt problem och hinder vid nyetablering. Spri, Stockholms Lns ldrecentrum Leroux, Robert, 1983: Que faire des dements sniles? Psychologie Mdicale, 1983, 15, 8:1237-1238. Paris Levi, Lennart, 1987; Psychosocial factors and health approaches to person-environment interactions, i Ulrich, Roger S & Hygge, Staffan, 1987; Research on environments and people, Swedish council for building research, Stockholm. Liljefors, Anders, Briedits, Mona, Fridell, Solveig, 19XX: Ljus och frg i lokala sjukhem. Spri rapport 192 Lundequist, Jerker, 1985: Arkitekturen som modell och system, Inst Arkitektur, avd projekteringsmetodik, KTH 1985

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Lundequist, Jerker, 1992: Design av byggprojekt, om design, kommunikation och kunskapsintegration i komplexa organisationer, speciellt byggprojekt, MDA mnniskor, datateknik, arbetsliv. Arbetsmiljfonden, Nutek Lundequist, Jerker, 1992: Projekteringsmetodikens teoretiska bakgrund, Institutionen fr Arkitektur, Kungl Tekniska Hgskolan, Stockholm Lundequist, Jerker, 1995: Design och produktutveckling, metoder och begrepp, Studentlitteratur, Lundkomplettera Marcusson, Jan, 2003: Ur den sjukes perspektiv. Tidskriften ldre i Centrum, nr 4/2003, s 18-20 Morton, B Gulak, 1991: Architectural guidelines for State Psychiatric Hospitals. Hospital and Community Psychiatry, 1991:7, volyme 42, s 705-707 Ogay, Suzanne, 1996: Alzheimer communiquer grce la musicothrapie, LHarmattan, Paris Paulsson, Jan; 2003: Art, architecture and design. Notes on the nature and contents of Nordic models during the 20th century; bidrag till CPAS, centre for pacific asia studies, symposium What is the Nordic model?, Stockholm University, augusti 15-17, 2003 Paulsson, Jan, 2002: Det nya ldreboendet, ider och begrepp, byggnader och rum. Svensk Byggtjnst, Stockholm Raune, Inger, 2003: Hjrnan sviktar nr kroppen r sjuk. Tidskriften ldre i Centrum, nr 4/2003, s 6-7 Regnier, Victor, 2002; Design for assisted living, guidelines for housing the physically and mentally frail, John Wiley & Sons, Inc, New York Saillon, Alfred, 1992: Le dment en institution. Psychiatrie Franaise, nr 3, 1992 september, s 56-59 Socialstyrelsen, 1993: De ldres vrdbehov r 2000, forskare om framtiden, Underlagsrapport till Srskilda boendeformer fr ldre och funktionshindrade, Socialstyrelsen fljer upp och utvrderar 1993:12, Artikelnr 1993-15-12 Spri, 1979: Lokala sjukhem, underlag fr planering och projektering, rapport 12, Vellas, Patrick et al, 1991: Chronique darchitecture et vieillissement. LAnne Grontologique 1990, s273-295 Vetel, JM et al, 1994: Architecture et services griatriques, lAnne Grontologique, 1994:8, s 539-551 Vetel, JM, & Denis, B, 1993 : Conception architecturale des structures institutionnelles daccueil de patients atteints de la maladie dAlzheimer. Psychologie Mdicale, 1993, 25, 8. s 808-810 Vilalta, MS et al, 1993: Architecture et psychiatrie. Psychiatrie, No 575-576 aotseptembre, 1993, s 39-42 Wertheimer, Jean, 1994: Le Sens du non-sens dans la dmences propos de la communication. Revue Mdicale de la Suisse Romande, 114, 1994. s 281-285 Wijk, Helle, 2001: Colour perception in old age; colour discrimination, colour naming, colour preferences and colour/ shape recognition. Dept of Geriatric Medicine, Gteborgs Universitet, Gteborg, Sweden Ulrich, Roger, S, 1991: Effects of interior desing on wellness: theory and recent scientific research. Journal of health care interior design, 1991:3, s 97-109 hlund O, Annerstedt L, Elmesthl S, Samuelsson SM, 1995: Gruppboende fr demenssjuka ldre en analys av miljutformningen. Institutionen fr klinisk samhllsmedicin, avd fr geriatrik, Malm, Institutionen fr Byggnadsfunktionslra, LTH, Socialt arbete, Lunds Universitet

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8.2 publications on the Internet:

Andersson, Jonas E, 2003; Hlsofrmjande miljer fr boende och vrd p lderns hst , vardagsaktivitet eller byggnadsutformning http://www.syd.kth.se/forskning/dash/Jonas/pdf/DEF0300414.pdf Andersson, Jonas E, 2003; Ljus och demens, en inventering av en arkitektonisk utformning av belysning p en demensavdelning och tnkbar pverkan av ljus op demenssjuka http://www.syd.kth.se/forskning/dash/Jonas/Ljusochdemens-Haninge.pdf Bengtsson, Anna, 2003: Utemiljns betydelse fr ldre och funktionshindrade, kunskapssammanstllning. Statens Folkhlsoinstitut, http://www.fhi.se/shop/material_pdf/utemiljo0401.pdf Elmer, Eddy M, 2001: Aesthetic considerations in long-term care and psychiatric facilities: Ideas from environmental psychology, Simon Fraser University. www3.telys.net/eddyelmer/artics/facsfu.htm Luria, Alexander, www.marxist.org/archive/luria Socialstyrelsen 2003: ldre vrd och omsorg r 2002, artikelnr 2003-44-03, http://www.sos.se/FULLTEXT/44/2003-44-3/2003-44-3.pdf Waern, Rasmus, 2001: Larchitecture en Sude. http://www.sweden.se/upload/Sweden_se/french/factsheets/SI/L_architecture_en_Suede_f d109a.pdf Yahoo ! Encyclopdie ; Littrature, arts et sciences de la Sude, fr.encyclopedia.yahoo.com/articles/jb/jb_597_p0.html

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