Paper: Fleming, R., Bennett, K. A., & Zeisel, J. (2023). Values and principles informing designs for people living with dementia—an emerging international consensus. Journal of Aging and Environment, 37(3), 245–254. https://doi.org/10.1080/26892618.2022.2062806
This publication by Fleming, Bennett, and Zeisel (2023) marks a pivotal moment in dementia inclusive environmental design, establishing the first internationally recognized framework for creating environments that truly support people living with dementia. Their systematic development of The Dignity Manifesto represents more than academic achievement, it provides a practical roadmap for transforming how we design, build, and adapt spaces worldwide.
From Regional Practice to Global Consensus
This research demonstrates the remarkable evolution from localized design principles, first developed in Australia during the 1980s, to a comprehensive international framework endorsed by 264 professionals across 35 countries. The systematic approach involved authentic collaboration with people living with dementia, their care partners, architects, researchers, and advocates, ensuring the manifesto reflects real-world needs rather than theoretical assumptions. The thematic analysis of expert feedback from 18 countries revealed striking consensus on fundamental values: holistic wellbeing, authentic co-design, community integration, and respect for individual dignity and choice. This convergence suggests the field has matured sufficiently to support unified global standards.
Transforming Built Environment Practice
The manifesto's ten evidence-based principles provide clear guidance for environmental design. Key principles include creating human-scale environments that feel manageable and comprehensible, optimizing stimulation to support rather than overwhelm, and ensuring easy visual and physical navigation. Significantly, the framework emphasizes connection to nature and community integration, recognizing that dementia inclusive design extends beyond individual buildings to encompass neighbourhoods and social networks. These principles challenge traditional institutional approaches, advocating instead for familiar, homelike environments that maximize intergenerational interactions and maintain cultural connections. The framework explicitly prioritizes enabling people to remain in their communities and families over isolated care settings.
Educational and Training Revolution
The research provides profound implications for professional education and training. By establishing a common vocabulary and shared principles, the manifesto enables more effective communication between architects, planners, care providers, and people living with dementia. This shared language facilitates interdisciplinary collaboration essential for creating truly inclusive environments. Educational programs can now build curricula around internationally recognized standards, ensuring consistent quality in professional preparation. The framework's emphasis on co-design necessitates training that develops skills in meaningful engagement with people living with dementia, moving beyond consultation toward authentic partnership.
Implementation and Action
The manifesto's practical value lies in its immediate applicability. Design teams can use the values and principles as evaluation criteria, ensuring projects reflect best practices. The framework provides structure for design briefs, stakeholder discussions, and retrospective assessments. Crucially, the research identifies implementation pathways. Only 29 of 194 World Health Organization member states currently have national dementia plans, with merely five adequately addressing built environment needs. The manifesto offers ready-made content for policy development, potentially accelerating the inclusion of environmental considerations in national strategies.
Moving Forward Together
This research establishes the foundation for a new era in dementia inclusive design, one characterized by international cooperation, evidence-based practice, and authentic partnership with people living with dementia. The continuing evolution of the manifesto through ongoing stakeholder feedback ensures it remains responsive to emerging needs and evidence. The ultimate measure of success will be environments that genuinely support people living with dementia to maintain dignity, autonomy, and meaningful community connections. This research provides the roadmap; implementation requires collective commitment to translating these principles into spaces that truly enable people to live well with dementia.
References
Fleming, R., Bennett, K. A., & Zeisel, J. (2023). Values and principles informing designs for people living with dementia—an emerging international consensus. Journal of Aging and Environment, 37(3), 245–254. https://doi.org/10.1080/26892618.2022.2062806
Fleming, R., Zeisel, J., & Bennett, K. (2020). Design dignity dementia: Dementia-related design and the built environment (World Alzheimer Report 2020, Vol. 1). Alzheimer's Disease International.
Fleming, R., Zeisel, J., & Bennett, K. (2021). The dignity manifesto of design for people living with dementia. Design Dignity Dementia Organisation. https://designdignitydementia.com/