Older people living in residential and nursing care homes spend a large proportion of their time within the boundaries of the home, and may depend on the environment to compensate for their physical or cognitive frailties. Regulations and guidelines on the design of care buildings have accumulated over time with little knowledge of their impact on the quality of life of building users. The Design in Caring Environments Study (DICE) collected cross-sectional data on building design and quality of life in 38 care homes in and near Sheffield, Yorkshire. Quality of life was assessed using methods which included all residents regardless of their frailty, and staff morale was also assessed. The physical environment was measured on 11 user-related domains using a new tool, the Sheffield Care Environment Assessment Matrix (SCEAM). Significant positive associations were found between several aspects of the built environment and the residents' quality of life. There was evidence that a focus on safety and health requirements could be creating risk-averse environments which act against quality of life, particularly for the least frail residents. Staff morale was associated with attributes of a non-institutional environment for residents rather than with the facilities provided for the staff. The new tool for assessing building design has potential applications in further research and for care providers.

This paper addresses the design of assistive technology that specifically aims to support an improvement in the quality of life of people with dementia. Starting from interviews with users, a grounded theory approach was used to compile a wish list of issues important for maintaining quality of life. A large list of potential technologies that could address these issues was generated, and four were selected for initial development: a music player, a device to reduce social isolation, a conversation prompter, and a device to support sequences of tasks. The music player and social isolation device are described in this paper in detail. A user-led approach to their design was followed, including approaches to finding control interfaces that were intuitive for people with dementia. The paper concludes with a list of recommendations for designers looking to develop equipment of this kind.

Much assistive technology for people with dementia is primarily designed to support security and safety. This paper describes design work carried out for a project called INDEPENDENT which specifically aimed at designing technology to support quality of life. The project involved academic engineers, social scientists and architects, together with representatives of user groups and a manufacturer. The design work was based on a comprehensive user survey in which people with dementia themselves highlighted the factors which affected their quality of life. This data was analysed through a series of multidisciplinary workshops involving the whole project consortium. The workshops consolidated the data into a wish-list of 11 areas crucial to quality of life that could then be addressed by new designs. Of the total of 69 designs that were considered, 4 were selected for initial design work within the project; a simple music player, a window-on-the-world device for streaming remote images into people's homes and between homes, a conversation prompter, and a device to support sequences of activities. The paper describes progress with these devices, highlighting the iterative and user-led design methodology used.

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Two projects in the EQUAL programme explore aspects of the influence of building design on the quality of life of people with dementia. Design in Caring Environments (DICE) examined the quality of life of people in residential care homes in relation to building design features. INDEPENDENT (Investigating Enabling Environments for People with Dementia) is a current project with the aim of developing technologies to enhance quality of life by supporting enjoyable activities. One aspect of INDEPENDENT is an exploration of the interaction between spatial settings and meaningful activity, to highlight factors that support and enable activity and to identify barriers. Findings from both projects suggest that a more creative approach to the management of buildings would enhance the well‐being of residents; under‐use of facilities is common. Meaningful space that supports activity is therapeutic but spaces that give confused messages are common in buildings used by older people. Tools to evaluate buildings have a potential role in the long‐term management of facilities to help identify underused spaces, spatial confusion and barriers to activity. Quality of life was shown to be poorer in buildings that prioritise safety and health; buildings that support activity positively by providing good assistive devices, giving people control of their environment and affording good links with the community have a positive association with well‐being.