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Designing for Dementia - A Subconscious Approach

During my graduate and post-graduate study of dementia as applied to design, I was delighted to learn that not all memory function is affected by dementia. Generally speaking, it is the explicit memory, also known as the conscious memory, that is most affected. Implicit memory, also known as the subconscious memory, isn't lost and that provides a reasonable starting point for the design of dementia care environments.  The survival option referred to as "fight or flight" is associated with instincts stored in the implicit memory system and triggered by visual and other sensory perceptions such as smell.

The implicit memory system includes innate responses to what Grant Hildebrand refers to as the aesthetics of survival. Hildebrand defined the aesthetics of survival as refuge, prospect, complexity, order, hazard and enticement. These aesthetics are embedded in our subconscious self as a result of our evolutionary quest for survival as individuals and as a species. Hildebrand also concluded that they are the source of and, "origin of all architectural pleasure."

It is significant that the aesthetics of survival respond instinctively to stimulus from not only our sense of sight, but from all of our senses.  The information perceived by our various senses respond instinctively and are processed differently in the brain than conscious thoughts. These instinctive responses that are associated with the implicit memory system are processed intuitively rather than the rational and slower explicit system for processing information.  Processing information stored with the explicit memory system also relies on brain speed to link various pieces of information quickly while holding the basic thought or action being considered. Various forms of dementia, including the vascular dementia associated with aging, generally slows brain speed and conscious processing of thoughts necessary for decision.

Our preliminary dissertation research within a dementia care facility indicates some support for a design approach including the intuitive memory processes.  It is possible that as explicit memory processes decline in the determination of behavior for an individual. The intuitive processes might become the dominant influence.  Additional research is certainly needed before any definitive conclusions can be reached, but it is difficult due to privacy laws and minimum interest to fund such research. Fortunately, architecture has historically progressed at times on instinct where the science is unsettled. The results create a basis for case studies that can lead to advance the science.

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