Visual Impairment: Art, Design and the Patient Environment. Copyright Hufton and Crow. The London Eye Clinic

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1 The London Eye Clinic Copyright Hufton and Crow Visual Impairment: Art, Design and the Patient Environment

2 Contents 1.0 Understanding the needs of the patient Interior Design Recommendations Use of Artwork Recommendations Selecting and hanging artworks Further information 8 2

3 1.0 Understanding the needs of the patient Clear clutter and check that furniture stands out against the flooring It s important to understand the needs of your patients in relation to the environment in which they will receive care. Patients perception of colour in general may be faded or heightened, as may their sensitivity to glare 1. While patients coming for laser refractive surgery may be in their early 20s or 30s, many visual impairments or other issues are most common among older adults. Older adults comprise the largest group worldwide who experience age-related vision loss 2. Age-related problems include macular degeneration (which destroys the central field of vision), cataract, diabetic eye disease, glaucoma, low vision and dry eye 3. Irritation from glare and changes in colour perception are common and represent normal changes in vision that accompany aging 4. In addition, the likelihood that older patients may also be suffering mild to moderate dementia must also be considered. There is a high prevalence of dementia in older adults. A recent report by Dementia UK reported that 12.2% of year olds have dementia with this figure rising to 28.6% in adults aged years of age 5. Therefore, the specific needs of patients with dementia need to be considered when designing the environment and selecting artworks for patients who are undergoing cataract surgery. People with dementia face particular visual deficits, including difficulty with colour discrimination, depth perception, and sensitivity to contrast 6. People with dementia also have difficulty with orientation and wayfinding, particular in unfamiliar environments 7. Carefully selected artworks and placement at key wayfinding points could contribute significantly to these patients ability to navigate the environment successfully. Selection of artworks that show familiar scenes may also help to reassure patients with dementia. Identify where art can be used to welcome, reassure and distract. Carefully selected artworks will help with way finding Brawley, E.C. (2001). Environmental design for Alzheimer s disease: a quality of life issue. Aging and Mental Health. 5(Supplement 1): S79-S Day, K., Carreon, D., & Stump, C. (2000). The Therapeutic Design of Environments for People with Dementia: A Review of the Empirical Research. The Gerontologist. 40(4): Day, K., Carreon, D., & Stump, C. (2000). The Therapeutic Design of Environments for People with Dementia: A Review of the Empirical Research. The Gerontologist. 40(4): Day, K., Carreon, D., & Stump, C. (2000). The Therapeutic Design of Environments for People with Dementia: A Review of the Empirical Research. The Gerontologist. 40(4):

2.0 Interior Design Recommendations The use of colour and interior design in a healthcare environment should do much more than just make the building look attractive.

Tonal colour contrast (light against dark colour or vice versa) should be used to distinguish critical surfaces such as floors, walls, ceilings and doors.

4 2.0 Interior Design Recommendations The use of colour and interior design in a healthcare environment should do much more than just make the building look attractive. Well chosen colour and thoughtful interior design can contribute positively to the creation of an environment in which patients feel safe, comfortable and at ease. Tonal colour contrast (light against dark colour or vice versa) should be used to distinguish critical surfaces such as floors, walls, ceilings and doors. Tonal colour contrast used to distinguish surfaces Skirting boards should be the same colour and tone as walls (unless a distinguishing colour is used to mark out a physical obstacle such as a pillar), so that there is a clear junction between the walls and floor. Use colour to highlight the area behind the reception desk in order to identify it to visitors. The overall environment should be clear and free from clutter. Place drinking fountains, fire extinguishers and other objects of furniture along one wall only throughout corridors and hallways to enable people to trail the other wall without encountering obstacles. Tonal colour contrast distingusihes between floors, walls and doors. Furniture, seating and sanitary-ware should be of a different and contrasting colour to the floor or wall surface against which it sits so that it can be easily seen. Strong tonal contrast should be used to distinguish small identifying objects, for example - Door handles on doors - Light switches on walls - Handrails on stairs or along corridors - Stair nosing. Areas should be well lit, but avoid glare and strong reflection. Avoid strong, bold and geometric patterns on furniture, walls and floors. Floor covering with strong stripes or patterns create disorientation and confusion, and dark floor mats can cause the impression of a hole in the ground. Areas should be well lit, but avoid glare and strong reflection. 4

3.0 Use of Artwork Recommendations The introduction of art into the patient environment can play an important and effective role in supporting the patient journey, ensuring a good first impression, a

5 3.0 Use of Artwork Recommendations The introduction of art into the patient environment can play an important and effective role in supporting the patient journey, ensuring a good first impression, a welcoming arrival and a stress-free wait. However, careful consideration needs to be paid to selecting and presenting the art appropriately, especially for people with visual impairments. All images should have contrasting colours. Artworks should be framed using anti-reflective glass, as sensitivity to glare is common in older people and patients with eye conditions. All images should have contrasting colours, rather than shades of similar colours, as colour perception is impaired in older adults. Brighter or darker shades of colours may work better for patients with cataracts as they perceive colours to be faded. Images should not be too detailed and should have a clear focal point. As age-related macular degeneration destroys central vision, images that provide background cues to the subject matter of the image may be helpful (for example, the horizon line of a landscape or the shoreline in an image of the beach). Images that provide background cues such as the horizon line may be helpful for identification. Plaques with the name of the work and artist should be separated from the artwork and a large font (14pt minimum) used to allow for easy reading. Framing the artworks using a different colour frame from the background wall colour may make it easier for patients to perceive the boundaries of images. Artworks placed at key wayfinding points may help to orient patients with dementia. Subject matter should be uplifting and reassuring. Artworks that serve as reminders of familiar landmarks or events or happy memories may be particularly appropriate for older adults (e.g. summer holidays, local landmarks). There is a wealth of evidence to support the use of images of nature in order to calm and reassure patients. Evidence supports that images of nature calm and reassure patients. 5

4.0 Recommendations for selecting and hanging artworks Define your art Your art can be one of many things. It can be one over-sized painting or a considerably small piece.

6 4.0 Recommendations for selecting and hanging artworks Define your art Your art can be one of many things. It can be one over-sized painting or a considerably small piece. You can group a couple of average sized paintings or a collection of multiple frames. If you have a large group of frames, use the floor to lay them out into many different arrangements and judge which you like best before you hang them. Try to choose frames that are similar in colour, shape or material for the best composition. Define your hanging area If you are hanging a painting in an art gallery, your painting may be the only thing on the wall. If you are decorating a room, you may have an assortment of walls to choose from. Large paintings look the best on large walls and small paintings look the best on smaller walls. Using a vertical wall to hang a vertical painting will flatter the artwork and complement the architecture. If you have an oddly-shaped wall, try an oddly-shaped collection of smaller paintings. Use the same or similar style frame throughout Choosing the same framing mould and mount can unify a collection of assorted pictures. Be aware of your audience Define your hanging area If you are hanging an exhibition in a children s department you might want to consider hanging the pictures at different levels, some lower than others, to appeal to all ages. Similarly if you are hanging work in an elderly unit, you might consider hanging the pictures with a lower sight line than normal. Security fixings will keep pictures levelact as a deterrent to theft. Consider your lighting when hanging a picture Good lighting will help to illuminate a picture, however too much strong light might create strong reflections or too much glare. Security Fixings Security fixings will keep pictures level (people can t knock them out of place) and are great theft deterrents! Try mirror fixings (but make sure you paint over them to give a clean look) or T-screw security fixings. 6

Determine gallery level Hanging art properly is a must if you want to take full advantage of your investment.

Measure the distance between the wire at full tension (B) and the top of the frame (A). See image below. 2. Measure the height of your frame (C) and divide the result in half. 3.

Use tape to measure the gap between hooks or screws 5. From this mark, measure downward the distance recorded in step 1 (D). 6. Place nail and hanger here.

7 Determine gallery level Hanging art properly is a must if you want to take full advantage of your investment. In this step-by-step guide we will teach you how to properly place and hang art using a hook and picture wire. Hanging picture rail example 1. Measure the distance between the wire at full tension (B) and the top of the frame (A). See image below. 2. Measure the height of your frame (C) and divide the result in half. 3. From the floor, measure up the wall to 58 (average eye-level) and make a pencil mark. 4. From the mark, measure upward the distance recorded in step 2 and make a second light pencil mark (E). Use tape to measure the gap between hooks or screws 5. From this mark, measure downward the distance recorded in step 1 (D). 6. Place nail and hanger here. Make sure that the bottom of your hanger is resting on the line when you hammer your nail in, rather than the nail point. This is where your wire will rest (on the crook of the hanger). Trust your eye If you have levelled your picture but it still looks wonky use your instinct and alter it. However make sure you repeat this method with the rest of the pictures you are hanging on that wall so there is consistency. Use a post it note to catch dust when drilling Uniformity is key; you can zig-zag paintings across a room provided they are uniform, and it should still look fantastic. Determine the gallery level 7

8 5.0 For further information For further information please contact: Jane Willis 20 Portland Square BS2 8SJ Telephone: Case studies of our projects and other resources and information are available to download on our website: 8

MCB/DDS Partnership Orientation & Mobility/Low Vision Services

MCB/DDS Partnership Orientation & Mobility/Low Vision Services www.mass.gov/dds/visionloss Creating Safe Environments For People with Vision Loss: the Basics! Color and High Contrast Use of highly contrasting