Talking Design: Air Quality, Acoustics and Dementia

Colm Cunningham: 0:12

Hello again and thank you for joining the Dementia Podcast. I'm your host, Colm Cunningham. And in this episode, we're joined by not one, but two architects, Annie and Ricky Pollock. And I'm here in their cozy sitting room in Edinburgh, Scotland, to discuss their latest books on the importance of air quality and acoustics in aged care. This episode continues our Talking Design Series, as we build up a compendium of important episodes to help you when you're thinking about design, and people with dementia. The acoustics is such an important issue to manage, as to quote Professor Mary Marshall. "Noise can be to a person with dementia, what stairs are to a wheelchair user", if you don't adapt the environment, it can be incredibly debilitating, and indeed the work of Agnes Houston and others people living with dementia about the sensory challenges have been demonstrated in previous episodes of this podcast. Air quality is another important issue. Never more so, when we know that it supports a reduction in the spread of infection so at a time like this, we want to be paying attention to all the issues of air quality. Ricky and Annie together have decades of experience as architects, and in the design of the internal environment and for Annie in particular, the design of outside Spaces has been a passion and focus. They have been passionate as well about each other because they've been married to each other for decades. I first met them at the University of Sterling's Dementia Centre and in the last decade, their work for HammondCare's Dementia Centre has been so important. Today, we launched their latest books from Ricky, "Acoustics in Aged Care". And from Annie, her book called"A Breath of Fresh Air". The good news is they're both going to be free at the end of this podcast from our Dementia Centre website. In a future episode, we're going to have the opportunity to explore those decades of learning and experience as architects who have chosen to specialize in dementia design. But Annie, can we have a little preview of that by telling me a little bit more about why you became an architect.

Annie Pollock: 2:33

Well, I always loved art, and I liked science. And it was kind of wonder what I can do with these two things and architecture, which I didn't know an awful lot about, although I did have a cousin who was one seemed to fit the bill. So that's where with this leap of faith, I decided to apply to do architecture and got into Edinburgh,

Colm Cunningham: 2:54

And Ricky. architect and a man passionate for research in this area.

Ricky Pollock: 3:00

Yes, well, it came about in the early years of our practice. We did a lot of social housing. And on one particular project, we were presenting to a committee, our designs for social housing project. And it's so happened on that committee, there was a professor Mary Marshall. And at one point in the proceedings, she asked a very significant question. Is there anything in the designs you're presenting that make this project suitable and supportive for people with dementia? And I went blank.

Colm Cunningham: 3:49

And what year was that Ricky?

Ricky Pollock: 3:51

1993 1993, one of our biggest projects that we done at the time in Edinburgh here too. And we took the project forward, we tore up the scheme and started again. And that's when we found there was nothing to tell us. How do we design things for people with dementia? So we had to work it out ourselves.

Colm Cunningham: 4:23

Of course, I first met you at the Iris Murdoch Building at the University of Stirling, which Burnett Pollock Associates designed. It's one of the first public buildings designed specifically with people with dementia in mind, Is that right?

Ricky Pollock: 4:39

Well, ever since that first session with Mary. We introduced the principles behind designing for people with dementia into all our projects. We decided that we were always trying to be the best architects. Designing for disability. And nobody was paying any attention to the needs of people with dementia.

Colm Cunningham: 5:07

Today, one of the things you're influencing on us on is our thinking around air quality, and acoustics two very important issues for people. And Annie, I'm gonna start with you first, I have in my hand here a copy of your book. So why is a book called a breath of fresh air needed? Why is air quality such an issue for aged care and design?

Annie Pollock: 5:33

Well, it's been shown increasingly how poor air quality kills people of all ages, from small children, pregnant women, right up to older people. But older people are more vulnerable for many reasons. Because with age, our lungs become far less able to work properly. And our sense of smell may also be impaired. So even for people without dementia, they may have a poor memory as well. And this means that older people, and especially those with dementia, are often less sensitive to their environment. And air quality is such an important part of this, from very much the smell of cooking to the smells that aren't good to the problems and with heavy traffic, that it's really important. We look at it from the point of view of all of this and how older people are affected and how to mitigate it.

Colm Cunningham: 6:29

And Annie of course, with dementia, there's lots of things that we don't always remember to initiate because our brains aren't working in the same way. So you're quite right, your person might not think, oh, there's a window, I want a bit of fresh air I need to unlock it. So even those things we need to make it easier for people.

Annie Pollock: 6:47

Absolutely, because many old people do feel the cold. And with energy costs rising as they are right now. Keep Windows tightly shut. And staying indoors, they might watch TV quite a lot. And of course, we are absolutely blasted with all sorts of adverts for things to make your air smell better. How to Improve Your living room and remove smells, nothing to do with opening windows. So putting out the message that fresh air is vital is incredibly important. Something my mother knew but something which current generations, I think have forgotten.

Colm Cunningham: 7:20

And could I ask you some of the simple things you might do particularly with this being an international podcast, we're here and a I think it's a plus four at the moment centigrade. So but some of the people listening might be in a plus 30. Yeah, what are some of the simple things we can do to help manage our air quality?

Annie Pollock: 7:40

we need to have doors and windows that are easy to open, where you can see the mechanism for opening them. If your eyesight isn't quite so good. And when shut perhaps these also have trickle ventilation to make sure you're getting air in. In hotter countries, of course, you need ways of stopping the heat getting in. Whereas we in a cold climate have shutters on the insides of our windows to keep the heat in. In other countries, you might need shutters on the outside or screens to stop the heat getting in while still being able to have windows open. Other things that can help is having good access to the outside and something nice to go into so that you're wanting to go outside the fresh air and exercise that. so vital. management and maintenance staff all need to be trained to understand these things. So if for example, an opening mechanism fails, they will replace it with something which is equally easy to see and use. And we must remember that everything has to be maintained regularly because so often faults happen, windows are painted shut, and so on. So that we can't do all the things that are so necessary to keep our air fresh.

Colm Cunningham: 8:53

And of course, you've written a lot on the importance of access to outside spaces, which includes being able to find them and the doors not being locked all of those things that I know in your other books you've you've emphasized as well as the way those spaces are designed. But I guess to not pick on your profession and the healthcare profession, what are some of the things that as they're thinking about designing, they need to be thinking of?

Annie Pollock: 9:16

Thinking about design, that makes things easier, we have to think about the things that cause poor air quality too like, this is where training comes in, like not using loads of things that you spray to keep things clean and infection free. Because all of these go into the air quality and we into the air and we inhale them. Yeah. Which is very bad for our lungs. Having open fires and gas fires are obviously problematic. And this has come up very recently with this with looking at how our climate is changing. So we want to think very carefully about how we heat things, how we keep things cool to be as minimal as possible. And also remembering that all of these things that we have heating systems, ventilation systems, particularly if they're mechanical, do need to be well looked after me to make sure they work properly.

Colm Cunningham: 10:10

No, in writing a book like this, you must have come across some positive examples of prioritizing good air quality. Can you share any of them with us?

Annie Pollock: 10:18

We have some very good examples locally of buildings that work well. There's a care home that Ricky's office and my me in terms of landscape worked on, where we had a green wall. Ironically, the green wall was originated to disguise a large retaining wall, but it works brilliantly at keeping the air clean and looks nice as well. So there are a lot of good design examples. But whether I could say yes, these are ones to go and see right now is hard, because it all depends on how it's looked after. And you can have a beautifully designed building. But if the staff aren't understanding why it's so good, and what they have to do, the benefits can be destroyed. So we have to keep that strongly in mind. But always starting with a really well designed building is a good way forward. But then making sure that those using it really understand why it works well and how to keep it working well.

Colm Cunningham: 11:21

Annie, writing books like these are, I think often labor of love. So why was this issue so important to you?

Annie Pollock: 11:28

Well, I am somebody that suffered from asthma since I was a teenager. And in those days, nobody quite knew what caused it. My suspicion was it was wood burning fires, and also pollens and particulates from the particular vegetation that existed in that part of the country. Later on as an adult, I worked in London, and I was very aware I had extremely poor asthma there I walked to work, which was unusual because we lived near the office. But my asthma was bad. So that probably it was traffic fumes, and also the London plane tree that's known to be an allergen. In later life, I've become very aware of the things that can affect me. Dust Furniture, sprays, smells from so called air fresheners, cigarette smoke, all of these things, and cigarette smoke's a big one, my sister in Los Angeles, died from asthma contributed to by the cigarette smoke, the appalling air quality in Los Angeles, and also the frequent forest fires that happened even before last year when they were particularly prevalent. So yes, that's why it's become a passion for me, because it's something that's affected my family and friends of mine, as long as I can remember.

Colm Cunningham: 12:42

And I know when we did it a design school led by and with people with dementia, this issue came up and a number of people were really shocked to realize that if they were in care that those automated sprays and or would be something that they would lose control over managing and, and as you have highlighted, there's some harmful effects if you're inhaling these all the time. Our second book, again, we've got the double act of yourselves, we also got the double act of these two books being launched"Acoustics in Aged Care", Ricky, it's a passion of mine, obviously, as you know, I'm congenitally deaf on one side. So I know the impact of noise in many ways. Also, in my work in relation to why people are often seen as having behaviors related to dementia, and we often find that the acoustic environment is a disaster for the person with or without dementia. So I certainly start this conversation and the launch your book. With that in mind, but why should we pay attention to noise? What are the impacts?

Ricky Pollock: 13:42

Well, very interestingly, after air pollution, which Annie has just discussed, noise is the second most common cause of death from environmental causes. Worldwide. Wow, that is truly scary. And if nothing else, a very good reason why we should pay more attention to it.

Colm Cunningham: 14:08

So Ricky, what do you mean, in terms of it being a cause of death? How does it put your life at risk?

Ricky Pollock: 14:13

Well, from research carried out mainly in the hospital environment, noise causes cardiac issues. It raises blood pressure, it destroys hearing. It has many, many problems that actually shorten lives. So it's a problem that we really must address. And rather like your issue with hearing, I have an issue with speaking loudly. And if I'm in a noisy room, say a pub with friends. I can't raise my voice to be heard. So in a noisy environment, I cannot communicate.

Colm Cunningham: 15:05

So when writing this book, what role does hearing sound play in the experience of a person living with dementia?

Ricky Pollock: 15:12

Well, hearing and vision are the most important of our senses. And our senses are the only way we communicate with our environment. And the thing with hearing is that it enables us to communicate with one another, to be part of our communities to actually be part of a social circle. And with noise, and hearing loss, we cannot do that. We are isolated from our friends, isolated from those we need to communicate with

Colm Cunningham: 15:55

Now, you've done walk around occasionally with me and taught me how to use a decibel meter. People might be surprised at, for example, in aged care facilities, I think at one point, I remember you telling me this is the level where if this was a building site, we be required to have all those special ear protectors on sometimes the noise can be ridiculous.

Ricky Pollock: 16:19

Yes, there's so many sources of noise that actually are preventable. We get situations where people are dining, trying to be peaceable, and the television left on, blaring away in the corner, we have issues of vacuuming the carpet, in a quiet room, where people are trying to relax. These are all little irritants. But they all add up and Decibels are cumulative. One level of noise adds to another until it becomes a crescendo. And then alarms that aren't attended to external factors, traffic bin collections. I've seen a case where the service area of a care home was right outside residents bedroom windows. So it's six o'clock. On Monday mornings, the bins are collected, which is a racket beyond belief.

Colm Cunningham: 17:36

And you've talked about a few that clearly you can be in control of the TV, the radio, even the staff's conversations are all things we can manage and be aware of.

Ricky Pollock: 17:48

Yes, so it needs management, and staff to understand the importance to control noise at every opportunity.

Colm Cunningham: 17:57

Now, I don't know if you created this word, but it's one that I know was in the book, and one that I certainly picked up from you over the years, which is acoustic intrusion. And I love that term because it puts the responsibility This is intruding. It's such a powerful term. What are you talking about there?

Ricky Pollock: 18:15

It's really, the fact that sound, technically is something we need to hear and like to hear providing is what we're interested in. The problem with noise is we've no ear lids. So when noise is happening, if we have dementia, we don't know the source. Yep. And we can't do anything about it. We can shut her eyes. If there's glare, we can avert our stare, if there's something we don't want to look at, but we can't shut our ears. So noise is a constant problem that people with dementia can often do nothing about.

Colm Cunningham: 19:04

So it's just like what Annie was saying with when we're talking about the windows, you know, we need to make the environment more managed to support the person to be enabled. I've never thought of ear lids. But you're absolutely right. At least you can close your eyes sometimes to things but you don't have that privilege with your ears.

Ricky Pollock: 19:23

No, that's we're always exposed to the sound around us

Colm Cunningham: 19:28

back to the fact that you're an architect, what are the things that we can do to improve the environments from an acoustic point of view?

Ricky Pollock: 19:36

Well, there are probably first and foremost, we've got to get the design of the building. Right. And that means briefing our design teams to get the acoustic environment suitable for its residents. Secondly, we've got to get the interiors Right, plenty of soft furnishings, for example, soft materials, absorbing panels cutting down on reverberation in large rooms. Atria are particularly bad, right for echoey sound that makes speech, totally intelligible. And then the final point is getting the staff and management to understand how to manage a building to control the level of sound in it.

Colm Cunningham: 20:39

Can you give me a wee bit of an example of how the staff can do that? What are some of the things you've seen in practice?

Ricky Pollock: 20:44

Well, there are fun ones, which work very well. One called a Yacker Tracker,

Colm Cunningham: 20:50

A Yacker Tracker?

Ricky Pollock: 20:51

it's like traffic light, red, amber, green. And it's preset to a level of comfort of noise. At which point, the green light comes on. As noise increases, this moves to Amber. and when noise is unbearable, it shows the red light. And everybody is then aware, this is unhealthy.

Colm Cunningham: 21:26

Are there any examples that you came across, in addition to the Yacker Tracker that really thought That's brilliant, this is the way we should be managing acoustics differently.

Ricky Pollock: 21:35

There was one hospital in Sunderland, where they had a slight problem in their dining room, they tend to be quite big spaces. And the staff organized for the design team to come back, check it out, and just said, Please do something. This space is intolerable. And the designers came back with a few builders and put absorbent panels on the ceiling. And the whole tone of the room changed. Suddenly conversations became possible again. And the staff, noticed that people dining are much happier. It made a huge difference to the quality of that space.

Colm Cunningham: 22:31

And for the person managing the budgets, are acoustic panels expensive?

Ricky Pollock: 22:35

No, the issue here is if they'd been put it in the first place, it would have cost virtually nothing more. Having to add things is more expensive. Hence, get it right at the beginning.

Colm Cunningham: 22:53

So for those who are thinking about refitting, or building from scratch, it's got to be in there from the start.

Ricky Pollock: 23:01

It's important that the brief that is given to the architects makes the point that there is an acoustic quality issue for this building. And exactly what that is, it's got to be spelt out. And the book has examples of areas showing extra sound insulation in walls. So somebody having a bad time in one bedroom doesn't waken up people surrounding them in the garden.

Colm Cunningham: 23:38

And you have also clearly called out the fact that if you are designing you should ensure that bedrooms aren't placed next to delivery or supply areas because none of us like it. And as I've said, I've certainly been the one that's complained when I've had that hotel room and thought, Well, what was the point in coming here? I'm getting no rest. So it really shouldn't be like that in a facility either.

Ricky Pollock: 24:00

No, any building can be designed. So that functions that were noises, perhaps part of the buzz, yeah, please, like reception and places where parties are held. They're not too critical. Yeah, but there's a hierarchy of rooms where less and less sound or noise should be excluded must be excluded.

Colm Cunningham: 24:31

Thank you, Ricky and Annie for joining me today. It's been great to have you both with us and to be back in Edinburgh, Scotland, talking about these important books. To you, our listener. As I said at the start, these are free to download and after the podcast just look at our show notes or visit our website to download these and please I encourage you to share this podcast and these free downloads with all your colleagues and friends to get this important knowledge and the passionate work that both Annie and Ricky have put into these books to be shared widely and inform better practice in supporting environments that work for people with dementia. As always, we welcome your feedback on this episode, and any ideas on future ones by emailing us on hello@dementiacentre.com.au. Thank you so much for joining. It's been great to have you on the dementia podcast. Bye for now.