Make public toilets dementia-friendly: experts call for better design and signage

Public toilets in shops and other buildings need better design and signage so that people with dementia can use them more easily, a group of experts in the condition has said, as they called on retailers and public bodies to take simple steps that can make a big difference.

The sixteen experts make the call in a letter published in medical journal The Lancet.  They include academics, clinicians and design experts, led by Swansea University dementia researcher Professor Andrea Tales and colleagues.

In their letter, the experts argue that public toilets need to be properly accessible to people with dementia.   Otherwise, people with the condition, even in its early stages, are likely to be less willing to leave the house.  This restricts their opportunities and quality of life, and can make social isolation and loneliness worse.  It also means shops and attractions are missing out on potential customers.

Read the letter in The Lancet

600 x 343

Taking action now is particularly important because the number of people living with dementia is rising fast, as people live longer. 

  • Wales has the highest percentage of people with dementia in the UK.
  • Over 850,000 people live with dementia in the UK and this is predicted to rise to over 2 million by 2051 as the population is ageing.
  • It is estimated that there is a new case of dementia somewhere in the world every 4 seconds.

Professor Andrea Tales of Swansea University explained why design and signage are so crucial:

“Research evidence shows that dementia can damage the attention system, not just the memory.  This means people with the condition are less able to process the information around them, and to filter out things which are irrelevant.   

This is why the design of public toilets and signage are especially important in making them more accessible to people with dementia.

There are good design guidelines already available.   As for signage, simple steps can make a big difference.  Take a look around.  Try out how easy it is to find your way out of the toilet facilities.  Ask someone who doesn't work there.  If necessary put up a simple “Way Out” sign”.

Design guidelines for making public toilets more dementia-friendly include: using familiar or automatic flush systems, non-reflective surfaces, good lighting, contrast between doors and surroundings and between the toilet and toilet seat, sinks that do not resemble urinals, well labelled taps and soap dispensers, and the careful placing of mirrors.

Good practice in design for dementia

400 x 600The team explain in their letter why signage needs to be clear and uncluttered: 

“A fire exit sign showing someone running with a directional arrow is also easily misunderstood as an exit sign, which can result in misdirection with people ending up outside the building and, in some cases, wandering on to a road.

Similarly, doors that are both a fire exit and the route back to a public area can cause confusion, and might elicit a reluctance to open them, primarily because of the fear of setting off a fire alarm.”

Dr Judy Haworth, a specialist in dementia at North Bristol NHS Trust, and one of the signatories to the letter to The Lancet, cited a comment made about the toilets in her hospital’s own emergency department by someone caring for a person with dementia:

“Not sure where exactly to go; couldn’t see a sign and when you get there the signs for male and female were too high and the doors were plain.  It looked like any door - no clue it was to a toilet. It just added to an already stressful occasion.  You need to be close to see the sign.”

Dr Haworth said that the hospital has now introduced new larger signs for the toilets, and positioned them lower.  It also now has pictures and words displayed on the door.

Dr Tony Bayer from the School of Medicine at Cardiff University, another of the experts signing the letter, said:

“People with Alzheimer's disease are easily disorientated when there's a need to work things out on their own.  Clear direction signs and colour contrasts make a trip to the toilet less stressful for everyone - and cost nothing.” 

Other Swansea University researchers signing the letter are Professor Vanessa Burholt and Dr Paul Nash of the Centre for Innovative Ageing, and Dr Amy Jenkins, an expert in Alzheimer’s.

Swansea University also hosts a pan-Wales Centre for Ageing and Dementia Research, which combines research policy and practice in the field.  Led by Professor Vanessa Burholt, the Centre carries out work on the environments of ageing and how to make these more dementia-friendly.

Swansea also has a dementia research group in the Department of Psychology, directed by Prof Andrea Tales.

Concluding their letter, the dementia experts underline that the problem is pressing, but the solutions are relatively simple:

“People living with dementia, with arguably some of the greatest need to quickly find, use, and safely exit a public toilet, have some of the greatest difficulties in doing so.  Sometimes there are distressing consequences that can have a detrimental impact on confidence, levels of anxiety, and quality of life.

Effective intervention, such as putting up clear exit signs, should be simple and will benefit everyone and not just those with dementia. The key is for the public and professionals to raise awareness and to pressure retail and public bodies to take prompt corrective action.”

Dementia – the facts, courtesy of BRACE-Alzheimer’s Research