HEALING THROUGH DESIGN: THE PSYCHOLOGICAL EFFECTS OF DESIGN ON THE ELDERLY A DARCH PROJECT SUBMITTED TO THE GRADUATE DIVISION OF THE UNIVERSITY OF HAWAI‘I AT MĀNOA IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF ARCHITECTURE DECEMBER 2016 By Kellene Kehau DeMello DArch Committee: Sara Carr, Chairperson Andy Kaufman Beverly Hoversland Keywords: Environmental Psychology, Elderly, Biophilic ABSTRACT The purpose of this dissertation is to document and explore how the built environment impacts elderly individuals dealing with various forms of dementia. The human population within the United States is not only increasing, but the number of those over the age of 65 is also increasing. As U.S. citizens age, the number of individuals with dementia will increase accordingly, which will increase the demand for senior care facilities that focus on treating individuals with dementia-related diseases. When continuing to live at home or with loved ones is no longer an option, family members will look for an appropriate senior care facility where their loved one can live and receive healthcare. Given the medical realities involved in the aging process, design elements must be created in a way that allow residents to physically, psychologically, and emotionally flourish. However, creating such a senior care facility that addresses all of these needs for residents on an individual basis can be challenging when the range and ability of each individual can vary greatly. This dissertation proposes to investigate current senior care facilities from three different locations around the world and three locations on the island of O’ahu to determine the ideal senior care residential design for a modern facility in Hawai’i. This dissertation will also be drawing from growing research on environmental psychology, nature’s effect on health, and contemporary advances in senior care for residents with dementia. Native Hawaiians have a strong connection to and respect for the land along with their ancestral lineage as this element, too, connects each individual to past generations and the places upon which Hawaiians lived and thrived for centuries. These cultural elements are deeply embedded in an understanding of nature’s healing powers and the importance of family and one’s larger familial community. This dissertation will show how modern conceptualizations of the therapeutic qualities of nature, specifically connected to traditional Hawaiian cultural practice, and the need for human connections within the growing aging population can be interwoven to create a unique architectural design solution for a senior care facility focused on care for individuals dealing with dementia. i TABLE OF CONTENTS ABSTRACT ........................................................................................................ i LIST OF FIGURES ............................................................................................ iv LIST OF TABLES ............................................................................................. vii INTRODUCTION ............................................................................................... 1 1.0 RESEARCH IMPERATIVE ........................................................................... 3 1.1 The Aging Population in the Nation ......................................................... 4 1.2 The Aging Population in Hawaii .............................................................. 5 1.3 Needs for the Elderly in Hawaii .............................................................. 6 1.4 Aging in Place ...................................................................................... 8 2.0 HOW THE BUILT ENVRIONMENT IMPACTS THE ELDERLY ............................ 12 2.1 The Human-Environment Relationship and Its Impacts ........................... 14 2.2 Importance of Environmental Psychology .............................................. 16 2.3 The Benefits of Nature on the Elderly.................................................... 17 2.4 How Planning Plays a Role ................................................................... 22 3.0 ALIMENTS PARTICULAR TO THE ELDERLY ................................................ 27 3.1 Physical Aliments ............................................................................... 27 3.2 Psychological Aliments ........................................................................ 31 4.0 DESIGN ELEMENTS ............................................................................... 33 4.1 Spatial Organization ........................................................................... 33 4.2 Sensory Experience ............................................................................ 38 4.3 Natural Environment and Landscape ..................................................... 45 4.4 Sense of Place ................................................................................... 55 5.0 CASE STUDIES ..................................................................................... 59 5.1 Introduction ...................................................................................... 59 5.2 Dementia Village Advisers (DVA) - De Hogeweyk, Amsterdam Location .... 60 5.3 Cohen Rosen House ........................................................................... 69 5.4 Custead Care Center–Haven Hospice .................................................... 76 5.5 Case Study Conclusions ...................................................................... 82 6.0 SITE VISITS TO EXISTING SENIOR CARE FACILITES ................................. 84 6.1 Site 1 ............................................................................................... 85 6.1.1 Location of Site ............................................................................... 85 6.1.2 General Interior Layout and Design .................................................... 86 6.1.3 Exterior Configuration and Features ................................................... 90 6.1.4 Interview ........................................................................................ 90 6.2 Site 2 – The Plaza Mililani.................................................................... 91 6.2.1 Location of Site ............................................................................... 91 ii 6.2.2 General Interior Layout and Design .................................................... 92 6.2.3 Exterior Configuration and Features ................................................... 95 6.2.4 Interview ........................................................................................ 95 6.3 Site 3 – Ka’amilo Hale ........................................................................ 96 6.3.1 Location of Site ............................................................................... 96 6.3.2 General Interior Layout and Design .................................................... 97 6.3.3 Exterior Configuration and Features ................................................... 98 6.3.4 Interview ........................................................................................ 99 6.4 Site Visits Conclusion.......................................................................... 99 7.0 DESIGN: Site Selection and Analysis ..................................................... 103 7.1 Senior Population Distribution on Oahu ............................................... 104 7.2 Senior Care Facility Distribution on Oahu ............................................ 105 7.3 Hawaiian Population Distribution on Oahu ........................................... 106 7.4 Hawaiian Homestead Lands on Oahu .................................................. 107 7.5 Climatic .......................................................................................... 108 7.6 Geographical ................................................................................... 109 8.0 Design Implementation ........................................................................ 111 8.1 Spatial Organization ......................................................................... 111 8.2 Sensory Experience .......................................................................... 120 8.3 Natural Environment and Landscape ................................................... 122 8.4 Sense of Place ................................................................................. 135 9.0 CONCLUSION ......................................................................................... 141 Bibliography ................................................................................................ 143 iii LIST OF FIGURES Figure 1.1 Image of apartment at The Karmel, Deerfield, Illinois. ........................... 8 Figure 1.2 Floor plan of The House for Betty, Asbury Methodist Village, Gaithersburg, Maryland ....................................................................................................... 10 Figure 4.1 Floor Plan of Woodside Place, Oakmont, Pennsylvania ......................... 34 Figure 4.2 Living area in Warroad Senior Living Center in Warroad, Minnesota ....... 42 Figure 4.3 Enclosed patio in Warroad Senior Living Center in Warroad, Minnesota .. 42 Figure 4.4 Public space in Massachusetts General Hospital .................................. 46 Figure 4.5 Patient room at Massachusetts General Hospital ................................. 47 Figure 4.6 Horticulture Therapy........................................................................ 49 Figure 4.7