A bright light for dementia care

With dementia rapidly on the rise, Kingston Hospital is pioneering a new style of ward for elderly care. Samantha Laurie explores a world of movement and light

Arriving at Kingston Hospital’s new dementia-friendly ward, Derwent, the first striking difference from the norm is the corridor. It seems wider – much wider – than those in adjoining wards.

“Everyone says that, but it’s a trick of the eye,” explains  Dr Louise Hogh, Consultant and Clinical Director for Elderly Care. “We’ve taken all the equipment you’d normally find in the corridors, all the hoists and various bits of machinery, and put them in storage cupboards. We want the passage to be free of obstacles so that patients can walk freely. It really helps at those times when patients are agitated.”

Walk freely? On a hospital ward? This is the first indication that the hospital’s dementia-friendly redesign is more than skin deep. Dementia, as we all know, is a huge challenge – one in four of us will suffer from it, a figure set to rise to one in three – but for Kingston Hospital it’s an especially pressing concern: it has twice as many patients with the condition as the national average. 

The clue is in the elegant Georgian homes of Kingston Hill and the surrounding affluent suburbs. Kingston has one of the highest life expectancies in the country: 89. But longevity comes at a price: almost half of the hospital’s elderly patients have dementia.

Four years ago, the hospital began talking to patients, staff and relatives about designing a better ward environment for the elderly. The result? A major refurbishment project to create three wards that would not only look different, but function in a style far more in keeping with the care sector. In Derwent, the first of these, patients are encouraged to get dressed, walk around, eat together and take part in activities.

“Our motto is active days, calm nights,” says Dr Hogh. “If we get patients up and moving, they’ll sleep better at night and it’s much better for them physically – by lying in bed for a week you lose 15% of your muscle mass.

“It’s easy to become institutionalised. Many of our patients were happily getting dressed and washing themselves before they came into hospital, but then it stops and they lose those skills. We need to encourage them to keep on doing things for themselves.”

I meet Dr Hogh in a comfy, retro-themed day room, one of several new ‘social spaces’ throughout the ward where patients can sit away from their beds, and where nurses and health care assistants can bring those that may be getting agitated or upset. 

Gone is the nurses station, replaced with a hotel-style reception. The aim is to create a calmer space devoid of visual clutter: all the computers, whiteboards and notes – along with the nurses and doctors – have been moved into a side room. Down the corridor is the activity room, where a small group of patients are doing arts and crafts with an enthusiastic leader. This room doubles up as a lunch club – an idea imported from the stroke unit, where staff find that patients eat more and develop better coordination by eating together.

Staff areas are discreetly designed to tone with the surroundings, while bed bays, conversely, are brightly painted in different colours to guide patients back. On the walls are giant canvases of local scenes, rotated to match the season. And the traditional polished floors that can appear slippery and wet to someone with dementia have been replaced with matt, wood-effect flooring. 

Lighting is bright – dementia sufferers need higher lux levels to see clearly, says Dr Hogh – and one of the bays has human-centric lighting that changes through the day, thereby helping to maintain circadian rhythms. At the exit to the ward, a black mat easily mistaken for a hole deters patients from attempting to leave.

Clearly there is more activity here – several patients are up and wandering the corridors. So what happens when it comes to ward rounds? 

“We have to be more flexible. We’ll go and find people in the activity room, or we’ll come back later,” explains Dr Hogh.

Olivia Frimpong, who as Dementia and Delirium Lead has overseen the project, is delighted with results so far.  

“It definitely feels a lot calmer in the ward,” she reflects. “The nurses say how helpful it is to be able to take patients who are getting agitated to the social area or activity room.”

Since the changes were implemented, Derwent has seen a four-day reduction in average length of stay, fewer pressure ulcers and, thanks to the clearer corridors and better lighting, fewer falls.

Soon the designers move on to Blyth Ward: money permitting, a third ward will be refurbished next year. Kingston Hospital Charity, which is funding the dementia-friendly elements such as signage, lighting, flooring, artwork, decor and the social spaces, is now actively fundraising for the next stage.

Yet perhaps the most uplifting – and long overdue – effect of the change is that it has raised the profile of dementia across the hospital.

“Elderly care is very much a Cinderella speciality, lacking glamour,” says Dr Hogh. “Yet this has engaged the whole hospital – lots of other departments have seen the design features and taken aspects of them back to their own areas. 

“It’s also got us all talking about how precious time is when you reach that late stage of life; how important it is to make those days meaningful.”

For more information on Kingston Hospital Charity’s Dementia Care Programme see kingstonhospital.nhs.uk or call (020) 8973 5041

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