practical living
specific stresses are and tries to root them
out, and once the major ones are gone,
they become very fuzzy and difficult to
identify because they become so nebulous.
If somebody is suffering from disease X,
yeah, sure, you treat disease X. But once
that’s been cured, then what? How do we
bring up the overall health of somebody?
That’s where salutogenics comes in
because it doesn’t look at those specific
stresses. It just understands that we have
a generalised stress as a background, and
what we need to do is not address those so
much as turn the other way and give us the
resources that we need to overcome.
Building health
Architecture can have
profound impacts on the
physical and mental health
of patients in healthcare.
Jan Golembiewski interviewed
by Conor Burke
S
alutogenic design is a buzzword in
the aged care space, but do we really
know what it is?
More commonly known as dementia-
friendly design, it is a catch-all term easily
described as design that makes life better
for those with dementia.
The science behind the idea that
architecture can affect a person’s health is
relatively new, as is the theory of dementia
design. The first papers discussing the
links can be placed close to the turn of
this century.
In recent years we have heard the theory
that light can influence hormones through
serotonin, and this can affect sleep and
overall happiness.
Academics also believe that a number
of neurotransmitters react to our
environment and these can affect balance,
muscular tone, body warmth and hunger,
among other things.
28 agedcareinsite.com.au
A study of patients experiencing mental
health issues found 30 per cent faster
recovery and 38 per cent lower mortality
when given sunlit rooms.
One academic interested in salutogenic
design in health architecture is Dr Jan
Golembiewski, director at Psychological
Design. He believes that architecture can
have profound impacts on the physical and
mental health of patients in healthcare.
He also argues that salutogenics can
make residents of aged care happier, assist
in treatment, and promote and maintain
social independence.
Aged Care Insite spoke with Golembiewski
to delve into the role psychology plays in
dementia design.
ACI: Salutogenics is a word that many
people in aged care will have heard, but
what does it mean as you see it?
Salutogenics is a theory for health
promotion. In fact, out of all the theories
for health promotion, it is the most pure
theory. Health promotion doesn’t mean
advertising health. It means creating health,
building health and making health happen.
The health that we have isn’t just a product
of our endocrine system and what’s going
on inside our bodies, it’s also a reaction to
the environment around us. So I’ve been
using salutogenics as a way of bringing
those two things into alignment: aligning
the physical environment in order to get
better health outcomes generally.
The difference between the pathogenic
approach, the typical medical approach,
and the salutogenic approach is that the
pathogenic approach looks at where the
What is the psychological theory
behind the notion that design affects
mental illness or behaviour?
The theory behind it is that mental illness
at its root is not caused by any known
dysfunction, or usually it isn’t. What is
primary in mental illness is the diagnosis,
and the diagnosis is based on people’s
behaviour and people’s experience, and
both of those things have a lot to do with
the environment. The environment that
we’re in affects people’s behaviour in a
huge way, and not just in superficial ways
like whether you can turn left or turn
right. It affects the way people feel, what
people will do.
You think of the differences between
giving somebody a glass of wine in a
mug and a glass of wine in a crystal wine
glass. Just that simple design difference
is enough to change our behaviour
around that glass of wine and change the
experience, and so that’s what we’re doing,
but at a much larger scale architecturally.
What are the big problems you see
with design that doesn’t incorporate
salutogenics?
The main difference is whether it’s client or
resident-centred, or whether it is centred
around staff. The tradition of centring
things around the staff comes from
budgets and not having enough money
after World War II, and it’s sort of rooted
down there right into health practice and
practice around dementia care.
What are some examples of that?
Convenience of the staff. The whole
environment is frequently set up to make
the staffing more convenient. You’ll often
have, in really old-fashioned places, seating
around the walls with seats facing in
because it’s easier to vacuum, but it’s really
bad socially, and so salutogenics says,