The care home is the typology most commonly associated with Alzheimer’s disease, and with dementia more generally. With approximately 80% of resident in the UK care homes living with some form of dementia, this association is not without current statistical foundation. Additionally, the archetypal association of retirement with a withdrawal from public life to the Arcadian idyll of the countryside, also seems to bear some statistical validity, with London’s over 65’s being the only age demographic to decrease in size, due to migration, from 2014-2016. The care maps were, created using data from the Care Quality Commission and the Office for National Statistics, shows the distribution of the 15,765 care homes in England. Synthesised using the parametric software grasshopper, the radius of each circle additionally indicates the number of beds available in each care home, and its colour indicates the number of beds in comparison to the areas human and economic resources. As indicated on the map, the borough of Hastings, has the largest discrepancy between number of care home beds (1612) to available resource. In contrast, the borough of Camden has the highest value for access to resources compared to number of care home beds (344). These values reflect the average age of their respective populations, with Camden having a far smaller senior population than that of Hastings, drawing parallels with Pliny the younger’s description of the rural, as a ‘land of grandfather and great grandfathers.
As AD prevalence increases however, the sustainability of the rural or segregated care home becomes increasingly untenable. The second map (blue) anticipates the situation of care in 2050, plotting the location of care homes and beds against the projected AD population size and access to resources (again using ONS figures). If we are to assume that 1/3 of the projected AD population will require a care home bed – as they currently do – between now and 2050, England will have to collectively provide an additional 200,000 care home beds on top of the existing 450,000. As the map illustrates, the southern coastal towns are likely to be the most severely affected by this population increase. The urban communities, however, fare relatively well, mostly due to their human and economic resource rich context – the concentration of volunteers in city centres as part of the Alzheimer’s Society’s, ‘Dementia Friend Scheme’ is a particularly substantial factor in this calculation. Though a positive depiction, the number of care home beds is still critically low in the urban context, which is likely to be compounded by the continued shift in recent years, of over +65’s remaining, or indeed, moving to, England’s city centres, with London seeing its lowest ever decrease (-0.8%) of the +65 demographic in 2016.
This data, though limited in its scope, does seem to suggest that the picturesque Arcadian idyll of retirement is perhaps losing popularity among the baby boomers. This trend is similarly mirrored across Europe, with a recent ARUP study finding that by 2020 over 50% of the over 60 population will live in urban centres. As indicated on the map, cities offer substantial advantages over an isolated rural context, particularly in the context of AD prevalence. However, the typical architectural program of the urban care home differs little in from, and indeed actively invokes, its secluded rural counterpart.