Advancing age is a risk factor of developing dementia. In the World Alzheimer´s Report of 2009, it was estimated that about 35.6 million people worldwide will be living with dementia in 2010. This number is expected to double by the year 2050. Symptoms of dementia affect memory, orientation, language, comprehension, and judgment. As the disease progresses people with dementia are in increased need for assistance with daily tasks. Over the last decades, care concepts, specifically designed for people with dementia, have been well established in many different nursing care settings. The built environment is seen as an important factor in these concepts as a large body of research supports the relationship between the built environment and functionality, well-being and behavior among people with dementia. In this context, a therapeutic environment is characterized by a small group size, homelike appearance, safety and accessibility. These physical features have been empirically linked to more independence and less challenging behavior. Furthermore, the spatial layout is associated with improved wayfinding abilities. However, dementia-friendly care concepts were hardly introduced to acute care hospitals.

Hospitals are also confronted with big challenges caused by the great number of dementia patients. Dementia patients are mostly admitted to hospital because of an acute illness and they display dementia only as a secondary diagnosis. Still, besides medical treatment, they are reliant upon a dementia-friendly caregiving environment. Because of unfamiliar surroundings and the unusual daily structure, the missing of their reference persons and a lack of activities a hospital can become a very stressful and confusing environment for people with dementia. Consequently, a hospital stay can cause further loss of independence and deterioration of their cognitive status. Furthermore, especially those patients with dementia, who display challenging behavior, place a significant strain on staff and other patients.

Therefore, there is a need to develop concepts for dementia-friendly acute care hospital environments. These concepts are supposed to make the hospital stay more pleasant to people with dementia and to promote their independence and functionality. This might contribute to the possibility of discharging them from hospital to their own home instead of a admitting them to a nursing home after the hospital stay. Furthermore, dementia-friendly acute care hospitals might help reduce hospital staffs’ and other patients’ burden.

A systematic literature review of empirical studies on building design for people with dementia was performed to get an overview of the current state of research on this topic. Additionally, a qualitative analysis of the hospital environment was carried out. Together with focus group discussions findings from the literature review were translated into evidence-based design recommendations for dementia-friendly acute care hospitals. They provide information for architects and health- care professionals on how to develop dementia-friendly floor plans as well as patient and common rooms. Furthermore, suggestions on what can be done to communicate information through the hospital environment to support spatial, timely and situational orientation in patients with dementia will be given. Examples from architectural practice will be presented to illustrate the design recommendations.