Dementia Inclusive Design
Dementia is one of the most pressing public health challenges of our time. According to the World Health Organization (2025), more than 57 million people worldwide were living with dementia in 2021, with nearly 10 million new cases diagnosed every year with nearly 10 million new cases diagnosed every year, a number set to more than double by 2050. This staggering growth makes the design of our physical environments not a matter of luxury, but of urgent human necessity.
Dementia inclusive design refers to the intentional, evidence-based approach of shaping built environments including homes, care facilities, hospitals, and public spaces, so that they actively support the independence, safety, dignity, and wellbeing of people living with dementia. The importance of this approach cannot be overstated. Research has consistently demonstrated that poorly designed spaces can cause confusion, anxiety, agitation, and spatial disorientation in people living with dementia, whereas well-designed environments can reduce these distressing outcomes and enable individuals to live fuller, more autonomous lives. Professor Richard Fleming, one of the world's foremost authorities on dementia enabling environments, laid critical groundwork for this field when he established, in collaboration with colleagues, a set of evidence-based principles for long-term care facility design including unobtrusively reducing risks, providing human-scale spaces, optimising helpful sensory stimulation, creating familiar environments, and supporting movement and community engagement (Fleming & Purandare, 2010). These principles, built from a review of 156 empirical studies published after 1980, gave designers and policymakers a confident, research-backed foundation on which to act. Fleming, in collaboration with Zeisel and Bennett, extended this work globally through the landmark World Alzheimer Report 2020: Design, Dignity, Dementia, which surveyed international best practice across 84 case studies from around the world and demonstrated that dementia inclusive design was not only possible in every cultural context, but was a moral imperative rooted in human rights (Fleming et al., 2020). Building on this global foundation, Fleming and colleagues identified an emerging international consensus , drawn from expert feedback in 18 countries, on the core values that should underpin dementia design, including holistic wellbeing, authentic co-design with people living with dementia, community integration, and respect for individual dignity and choice (Fleming et al., 2023).
Crucially, this consensus recognised that dementia inclusive design extends far beyond institutional walls to encompass neighbourhoods, public transport, shops, parks, and the everyday environments where people live their lives. Complementing this internationally influential work, researcher Dr. Joanna Sun has made vital contributions to both the science and the cultural sensitivity of dementia enabling environments. In her landmark scoping review of built environments for people with dementia across East and Southeast Asian nursing homes, Sun and Fleming (2018) found that the eight evidence-based principles of design could be applied with cultural sensitivity across nine countries to identify gaps and guide improvements in care environments. Recognising that no validated, culturally appropriate tool existed for assessing these environments in the Singaporean context, Sun and Fleming (2021) developed and validated the Singapore Environmental Assessment Tool (SEAT) , a reliable, person-centred instrument designed to evaluate the extent to which built environments in aged care facilities support high-quality dementia care. The importance of this work lies in its practical reach: assessment tools like the SEAT give facility managers, architects, and policymakers a structured, evidence-based means of identifying where their environments fall short and how to improve them. Most recently, Sun et al. (2025) extended the evidence base further through a scoping review that examined the concept of familiarity , one of the most widely cited yet inconsistently defined principles in dementia inclusive design,. Their review of 46 studies from 19 countries uncovered three core themes including three core themes of homelike environments, wellbeing, and multisensory integration, and concluded that creating a strong sense of familiarity in built environments is directly linked to enhanced quality of life for people living with dementia.
Taken together, the body of work by Fleming and Sun forms a clear, urgent, and evidence-based case: the way we design the spaces in which people with dementia live, move, and connect is not a background detail ; it is a direct determinant of their dignity, their safety, and their quality of life. As the global dementia population continues to grow, dementia inclusive design is not optional. It is one of the most powerful, cost-effective, and humane tools available to support millions of people to live well with dementia for as long as possible.
References
Fleming, R., & Purandare, N. (2010). Long-term care for people with dementia: Environmental design guidelines. International Psychogeriatrics, 22(7), 1084–1096. https://doi.org/10.1017/S1041610210000438
Fleming, R., Zeisel, J., & Bennett, K. (2020). World Alzheimer Report 2020: Design, dignity, dementia: Dementia-related design and the built environment (Vol. 1). Alzheimer's Disease International.
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
Sun, J., & Fleming, R. (2018). Characteristics of the built environment for people with dementia in East and Southeast Asian nursing homes: A scoping review. International Psychogeriatrics, 30(4), 469–480. https://doi.org/10.1017/S1041610217002241
Sun, J., & Fleming, R. (2021). The development and reliability of the Singaporean Environmental Assessment Tool (SEAT) for facilities providing high levels of care for people living with dementia. HERD: Health Environments Research & Design Journal, 14(2), 57–75. https://doi.org/10.1177/1937586720980175
Sun, J., Brennan, S., & Doan, T. (2025). Defining familiarity in nursing homes providing care for residents with dementia: A scoping review. Frontiers in Dementia, 4, Article 1470066. https://doi.org/10.3389/frdem.2025.1470066
World Health Organization. (2025, March 30). Dementia. https://www.who.int/news-room/fact-sheets/detail/dementia
Alzheimer's Disease International. (2024). World Alzheimer Report 2024. https://www.alzint.org/u/World-Alzheimer-Report-2024.pdf