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Introduction
The elderly population in Sweden has increased and now over
17% of the population is 65 years of age or older, and the
proportion of elderly is estimated to be 23% in 2030. The fact
that older persons are living longer requires a well function-
ing health care system and social services, a need that in the
future will increase even further. A majority of older persons
spend the last time of their life within a caring environment
(Socialstyrelsen, 2010). Research on evidence-based design
and supportive environments focuses on a range of measurable
variables that could have an influence on the users such as
light, sound, form and colour (Dijkstra, Pieterse & Pruyn, 2006)
with outcomes including the use of space, health, functionality
and usability (Ulrich, 2006).
Nursing home facilities
Approximately 90 000 persons who are 65 years or older are liv-
ing in nursing homes in Sweden. These persons are predomi-
nantly a highly frail group often suffering from a large degree
of functional and cognitive impairment, and a majority of these
persons have dementia. With increasing levels of frailty they
spend most of their time within the home and therefore need
special attention to ensure safety and quality of life (Social-
styrelsen, 2011). This creates challenges for designing nurs-
ing home facilities that enhances the living conditions for all
residents (Parker et al, 2004). The number of care environ-
ments for elderly are limited and there is a high demand on the
existing ones. According to the Swedish law (SoL 2001:453) the
municipalities are responsible for offering residential facilities
for persons with specific care needs (Socialstyrelsen, 2009).
Visual impairments due to age
The ageing process is connected to decreasing levels of visual
functioning. The amount of sensory cells in the eye reduces
and the ability to refract the light is distorting. It becomes
more difficult to define contrasts and the size of the visual field
is reduced (Kristensson & Jakobsson, 2010; Socialstyrelsen,
2009; Rundgren, 2001). This affects the ability to communicate
with the surroundings and also the ability to orientate (Social-
styrelsen, 2009).
Dementia
Dementia is the main reason for functional impairment for old-
er persons and there are approximately 150 000 persons living
with dementia in Sweden. The most common type is Alzheim-
er’s disease followed by Lewy body dementia (Ekman, Jönha-
gen, Fratioglioni, Graff, Jansson & Robinson, 2007; Marcusson,
Blennow, Skoog & Wallin, 2003). Dementia is a term for several
different symptoms caused by brain damages. The symptoms
vary according to which part of the brain that is damaged. Com-
mon symptoms are loss of memory and increased difficulties
to perform daily chores. In addition, other cognitive functions
are often reduced such as language, perception of time and the
ability to orientate. Dementia is also affecting the personality
and emotional functions of the person (Marcusson et al., 2003).
Dementia can be described in three different stages: mild, av-
erage and severe. Initially the person has a lot of capacity and
might not need support from health care or social services. In
the next stage the person will need daily help and support, and
the last stage means that the person is dependent on health
care to a great extent (Socialstyrelsen, 2010).
Light and colour
The visual senses of human beings work with three dimensions
in order to perceive space. The knowledge of light and colour
interaction is the base for the understanding of a room, and
the person’s innate or learned experiences are important when
trying to interpret the surroundings and its spatial properties
(Klarén, 2006; Liljefors, 2006). Patterns on a flat surface can
also be perceived as spatial due to its lightness contrasts. The
visual sense strives at interpreting the pattern as behind or in
front of, and as lightened or shadowed (Klarén, 2006). Details
with deviant colours will be in focus, especially when the light-
ness contrasts are high and this knowledge can be used to
highlight or conceal aspects within a room in order to facilitate
way finding and understanding (Wijk, 2006). Light and colour
have impact upon human beings. Strong, contrasting and warm
colours stimulate the brain more compared to colours not that
strong or contrasting. But this is a complex phenomenon and
it is not known in what way the colours impact the wellbeing of
human beings, and colours can have different impact on dif-
ferent individuals due to personality, the current mood and the
purpose of the room (Janssen, 2006; Küller, 2006). According
to a study by Brunnström, Sörensen, Alsterstad and Sjöstrand
(2004) lighting improvement could increase the quality of life
for persons with visual impairments.
Colours and way finding
Wijk (2001) found in a Swedish study that a majority of persons
who were 80 years old, 95 years old and elderly with Alzheim-
er’s disease could recognize and identify by name over 20
different colours. The elementary colours white, black, yellow,
red, blue and green were easiest to identify by name by all of
these three groups of older persons. Colour shades belonging
to the red and yellow field were easier discriminated compar-
ing to colours within the blue and green area. Another find-
ing was that persons with dementia could, almost as well as
persons without dementia, discriminate colours in spite of their
cognitive impairment. As a conclusion, colours should be used
in residential settings in order to support older persons (Wijk,