Article

The Influence of the Physical Environment on Residents With Dementia in Long-Term Care Settings: A Review of the Empirical Literature

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Abstract

Background and objectives: The physical environment in long-term care facilities has an important role in the care of residents with dementia. This paper presents a literature review focusing on recent empirical research in this area and situates the research with therapeutic goals related to the physical environment. Research design and methods: A comprehensive literature search was conducted in Ageline, PsychINFO, CINAHL, Medline and Google Scholar databases to identify relevant articles. A narrative approach was used to review the literature. Results: A total of 103 full-text items were reviewed, including 94 empirical studies and 9 reviews. There is substantial evidence on the influence of unit size, spatial layout, homelike character, sensory stimulation, and environmental characteristics of social spaces on residents' behaviors and well-being in care facilities. However, research in this area is primarily cross-sectional and based on relatively small and homogenous samples. Discussion and implications: Given the increasing body of empirical evidence, greater recognition is warranted for creating physical environments appropriate and responsive to residents' cognitive abilities and functioning. Future research needs to place greater emphasis on environmental intervention-based studies, diverse sample populations, inclusion of residents in different stages and with multiple types of dementia, and on longitudinal study design.

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... A 2013 systematic review assessing the impact of nursing home characteristics on overall resident quality of life found 11 studies with mixed results and an inadequate evidence base. 11 Subsequent reviews focused on quality of life have highlighted the influence of physical environments 12 and design 13 for residents with dementia. The impact of community characteristics on resident social connection and quality of life more broadly, is even less clear. ...
... We also scanned reference lists from relevant reviews. [11][12][13][20][21][22] 2.4 | Step 4: Charting the data Two reviewers independently extracted data from the included studies. We summarized studies according to study characteristics and reported a narrative synthesis of the results. ...
... Overall, findings were mixed, however potentially promising results were found in studies examining the impact of small-scale home-like settings. Our scoping review highlights knowledge gaps and points to the need for research that will inform policy, care planning, and evaluation.This study builds on previous reviews[11][12][13][20][21][22] by focusing on literature that quantifies distinct aspects of social connection and includes community-level characteristics as well as summarizing approaches to measuring social connection in nursing homes. We found the number of studies in this area has increased substantially since Xu et al's review. ...
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Background and aims: Social connection is associated with better physical and mental health and is an important aspect of the quality of care for nursing home residents. The primary objective of this scoping review was to answer the question: what nursing home and community characteristics have been tested as predictors of social connection in nursing home residents? The secondary objective was to describe the measures of social connection used in these studies. Methods: We searched MEDLINE(R) ALL (Ovid), CINAHL (EBSCO), APA PsycINFO (Ovid), Scopus, Sociological Abstracts (ProQuest), Embase and Embase Classic (Ovid), Emcare Nursing (Ovid), and AgeLine (EBSCO) for research that quantified associations between nursing home and/or community characteristics and resident social connection. Searches were limited to English-language articles published from database inception to search date (July 2019) and update (January 2021). Results: We found 45 studies that examined small-scale home-like settings (17 studies), facility characteristics (14 studies), staffing characteristics (11 studies), care philosophy (nine studies), and community characteristics (five studies). Eight studies assessed multiple home or community-level exposures. The most frequent measures of social connection were study-specific assessments of social engagement (11 studies), the Index of Social Engagement (eight studies) and Qualidem social relations (six studies), and/or social isolation (five studies) subscales. Ten studies assessed multiple social connection outcomes. Conclusion: Research has assessed small-scale home-like settings, facility characteristics, staffing characteristics, care philosophy, and community characteristics as predictors of social connection in nursing home residents. In these studies, there was no broad consensus on best approach(es) to the measurement of social connection. Further research is needed to build an evidence-base on how modifiable built environment, staffing and care philosophy characteristics-and the interactions between these factors-impact residents' social connection.
... The physical design of the buildings and surroundings of innovative residential care facilities aims to follow the most recent design principles focusing on optimizing helpful stimulation, supporting movement and engagement, creating a familiar place and designing according to a clear model on the way of life at the facility [14]. An effective design of the physical environment enables people with dementia to better find their way, reduces challenging behavior such as agitation and improves independence in activities of daily living [15][16][17][18]. Furthermore, the physical environment and architectural design help to support care and activities, as well as the approach through which staff are able to maintain and reinforce the capabilities of people with dementia. ...
... Behavior and everyday functioning are the result of an interaction between the individual and her/his environment, although exact working mechanisms for people with dementia are unknown. Theories from various scientific backgrounds (i.e., psychology, nursing, gerontology, geriatrics) stress that a match is needed between the person's needs, his/her abilities and environmental demands to elicit adequate behavior in people with dementia, also referred to as person-environment fit [3,15,17,38,39]. If environmental demands exceed a persons' ability to cope, they will have more difficulty maintaining adequate behavior. ...
... Various studies show the importance of environmental aspects for people with dementia (e.g., sunlight, sounds, view, spatial layout, nature, orientation, music, privacy, auton- Behavior and everyday functioning are the result of an interaction between the individual and her/his environment, although exact working mechanisms for people with dementia are unknown. Theories from various scientific backgrounds (i.e., psychology, nursing, gerontology, geriatrics) stress that a match is needed between the person's needs, his/her abilities and environmental demands to elicit adequate behavior in people with dementia, also referred to as person-environment fit [3,15,17,38,39]. If environmental demands exceed a persons' ability to cope, they will have more difficulty maintaining adequate behavior. ...
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Alternative care environments for regular nursing homes are highly warranted to promote health and well-being of residents with dementia that are part of an age-friendly and dementia-friendly city and society. Insight is lacking on how to translate evidence-based knowledge from theory into a congruent conceptual model for innovation in current practice. This study reports on the co-creation of an alternative nursing home model in the Netherlands. A participatory research approach was used to co-create a conceptual framework with researchers, practitioners and older people following an iterative process. Results indicate that achieving positive outcomes for people with dementia, (in)formal caregivers, and the community is dependent on how well the physical, social and organizational environment are congruently designed. The theoretical underpinnings of the conceptual model have been translated into “the homestead,” which is conceptualized around three main pillars: activation, freedom and relationships. The Homestead Care Model is an illustrative example of how residential care facilities can support the development of age-friendly communities that take into consideration the needs and requirements of older citizens. However, challenges remain to implement radical changes within residential care. More research is needed into the actual implementation of the Homestead Care Model.
... My current research expands that knowledge to a noncare setting, where the staff do not have prior knowledge that the person is living with dementia. Second, the physical/sensory environment of the open house deserves study, because it has been shown that the design of care home settings can influence a PLWD's wellbeing and influence how well people wayfind (Chaudhury & Cooke, 2014;Chaudhury et al., 2018;Hung et al., 2017;O'Malley et al., 2017). For instance, PLWD can be sensitive to noise and light, which, if mismanaged, can cause over-or understimulation (Dewing, 2009). ...
... For instance, PLWD can be sensitive to noise and light, which, if mismanaged, can cause over-or understimulation (Dewing, 2009). Further, a systematic review of the interior design of congregate living facilities discusses the need to prevent sensory overload (Chaudhury et al., 2018). Although not previously researched, these studies point to the potential importance of the environment for supporting engagement of PLWD. ...
... A high level of noise (or threat of it) was considered a barrier and can make concentrating difficult for PLWD, as George remarked during the interview: Noise was influenced by the physical aspects of the room (i.e., linoleum flooring/sound-reflective paneling versus carpet and other noise-controlling features) and number of people present. Participants described most open houses as providing bright, consistent lighting, which is supported by literature as important in terms of engagement for PLWD (Chaudhury et al., 2018). ...
Article
Problem, research strategy and findings The number of people living with dementia (PLWD) is set to increase to 132 million by 2050, with most expected to reside in their own homes, not congregate living settings. Limited research on the impact of the built environment on PLWD has focused on planning outcomes, with no research on access to the planning process that shapes the places they live in. In this study I ask: what are the barriers and facilitators to participation for PLWD at open houses? I accompanied seven PLWD (individually or in pairs) to open houses, a commonly used public engagement tool, in Waterloo (Canada). To capture the experiences, I used audio recordings, field notes and sketches, photographs, and a postexperience interview with participants. Accessibility of public engagement tools for PLWD can be improved by ensuring respectful and patient communication (not rushing attendees, using plain language); providing clear, concise presentation materials (less is more, offering in-the-moment feedback opportunities); and using a familiar, comfortable physical location (sensitive to sensory overstimulation through acoustics and lighting). The sense of inclusion participants felt in attending the open houses was unexpected. Takeaway for practice The open house is already well suited to the accessibility needs of PLWD, with peripheral, circular layouts allowing participants to learn at their own pace and interact one on one with practitioners. However, the recommendations that would make public engagement tools more accessible to PLWD are easily implementable, and by educating planners in these techniques there could be an opportunity for the profession to help dismantle the stigma associated with dementia. The commonly used public engagement tools used during the planning process need to be universally accessible so PLWD and other people with disabilities can attend any meeting they choose and have an impact on decision making in their communities.
... Feeling at home is thus not solely connected to the "home" dwelling, but rather to people, occupations, and an atmosphere of comfort that is often attributed to the physical and social design of the home, by considering its characteristics (Lim et al., 2019). Home-likeness would thus qualify places that confer this identical feeling of being at home, also referred to as being-in-place (Chaudhury et al., 2018;Rowles & Chaudhury, 2005). Feeling at home is often taken for granted, and usually goes unnoticed situations of being-in-place (feeling comfortable and familiar with one's everyday world), and creates a sense-of-home experienced as a sense of belonging and comfort (Johansson et al., 2020). ...
... The transcripts and field notes were read several times to immerse us in the participants' experiences and to get a grasp of important aspects and feelings they generated (Boeije, 2002;Bryman & Burgess, 1994). A constant comparison method was used to highlight words and sentences as focal points of the experience of familiarity (Charmaz, 2014). Codes were used to describe contents, then compared with each other, matched, and opposed, and themes started to take shape. ...
... Transcripts and field notes were read several times to immerse oneself in the participants' experiences and get a grasp of important aspects and feelings generated (Boeije, 2002;Bryman & Burgess, 1994). Initially, the first, second and last authors used a constant comparison method to highlight words and sentences as focal points of the experience of familiarity (Charmaz, 2014). Codes were used to describe contents, for example, the feelings associated with familiarity or how familiarity was characterised. ...
Thesis
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Participation in occupations and places outside the home has been related to health and social benefits as well as offering challenging and risks for older adults living with and without dementia, yet little is known about how this participation is experienced, also considering the places visited and the occupations performed. Places are central in a transactional and occupational perspective to understand how visiting, maintaining and abandoning them affects their participation outside the home. Acknowledging the complexity and interrelatedness properties of participation, with the embodiment of places by the occupation while it is embedded in the place, provides a new way of examining participation. Thus, the overarching aim of the fours studies was to explore and provide new knowledge on participation in places outside the home for older adults with mild-to-moderate dementia as compared with older adults without dementia, as well as developing an understanding of the transactions between the persons and the places, and how places outside home are associated with perceived participation. To attain this aim, the Participation in Activities and Places Outside Home (ACT-OUT) questionnaire was developed in Study I, as no tool existed that combined occupations and places. ACT-OUT was revised and aligned using cognitive interviews with 26 older adults living without dementia and five older adults living with dementia. ACT-OUT was then used in Study II, together with the occupational gap questionnaire OGQ, to evaluate stability and change in places visited outside home, and associations between number of places currently visited and perceived occupational gaps, and in Study III to consider factors, e.g. perceived risks, that potentially affected perceived participation outside the home with 35 older adults living with dementia, in comparison with 35 older adults living without dementia. Study IV used qualitative, mobile interviews to explore familiarity outside home as experienced by nine older adults living with dementia. Findings (Study II) showed that participants living with dementia visited places to a lesser extent than the comparison group. Social and cultural places as well as places for recreation and physical activity tended to be abandoned, in contrast to places for medical care. Overall, they maintained less places and abandoned more places than the group of comparison, and participation in places was associated with occupational gaps for those living without dementia. In Study III, number of places visited, were associated with the perception of participation outside home, but only for the group of persons living without dementia, while risks of falling and for getting lost were associated for those living with dementia. Findings in Study IV showed that familiarity was experienced in a continuous way, as a whole and in repeated occurrences in personal territories that encompassed diverse places and occupations. This thesis contributed new knowledge about how visiting places contributed to our understanding of the conception of participation outside the home of older adults living with and without dementia, including how perceived risks would influence participation. Familiarity was seen as an overarching concept that links place with participation outside the home, as personal territories including places support participation outside the home for older adults living with dementia.
... Additionally, the place of residency seems to affect the manifestation of symptoms, with individuals residing in long-term care facilities presenting more symptoms from the hyperactivity spectrum (irritability, aberrant motor behavior, euphoria) and appetite disorders than those that are community dwelling [10]. The psychosocial/physical environment characteristics of long-term care facilities, such as interior design, lighting levels, and daily activities, seem to contribute to an increased risk of BPSD [11]. However, to our knowledge, studies conducted in long-term care facilities did not make a distinction between different types of dementia. ...
... However, to our knowledge our study is the first to show the high frequency of these symptoms regardless of dementia type. Certain aspects of long-term care facilities' envi-ronments appear to contribute to an increased risk of BPSD [11]. Dementia-related processes affect the perception of the environment and coping abilities [22,23]. ...
... There are several non-pharmacological strategies targeting physical environment that have been proven to be effective in alleviating hyperactivity symptoms in long-term care settings. These strategies involve designing homelike environments, configuration of spatial layout and orientation cues, optimizing the level of lightning and noise [11]. Additionally, outdoor activities, music therapy and interventions improving communication with individuals with dementia have shown positive effects in reducing hyperactivity [11,54]. ...
Article
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Background: The majority of individuals with dementia will suffer from behavioral and psychological symptoms of dementia (BPSD). These symptoms contribute to functional impairment and caregiver burden. Objective: To characterize BPSD in Alzheimer's disease (AD), vascular dementia (VaD), mixed (Mixed) dementia, Parkinson's disease dementia (PDD), dementia with Lewy bodies (DLB), frontotemporal dementia (FTD), and unspecified dementia in individuals residing in long-term care facilities. Methods: We included 10,405 individuals with dementia living in long-term care facilities from the Swedish registry for cognitive/dementia disorders (SveDem) and the Swedish BPSD registry. BPSD was assessed with the Neuropsychiatric Inventory - Nursing Home Version (NPI-NH). Multivariate logistic regression models were used to evaluate the associations between dementia diagnoses and different BPSDs. Results: The most common symptoms were aberrant motor behavior, agitation, and irritability. Compared to AD, we found a lower risk of delusions (in FTD, unspecified dementia), hallucinations (FTD), agitation (VaD, PDD, unspecified dementia), elation/euphoria (DLB), anxiety (Mixed, VaD, unspecified dementia), disinhibition (in PDD), irritability (in DLB, FTD, unspecified dementia), aberrant motor behavior (Mixed, VaD, unspecified dementia), and sleep and night-time behavior changes (unspecified dementia). Higher risk of delusions (DLB), hallucinations (DLB, PDD), apathy (VaD, FTD), disinhibition (FTD), and appetite and eating abnormalities (FTD) were also found in comparison to AD. Conclusion: Although individuals in our sample were diagnosed with different dementia disorders, they all exhibited aberrant motor behavior, agitation, and irritability. This suggests common underlying psychosocial or biological mechanisms. We recommend prioritizing these symptoms while planning interventions in long-term care facilities.
... Environmental characteristics such as physical environment (e.g., lighting, maintenance, cleanliness); architectural features (e.g., layout and size of rooms, and common spaces); and schedules and care routines (e.g., staff availability, mealtimes) may influence LS [26]. The role of environmental characteristics in NHs has emerged as an important care component associated with better quality of life, improved activities of daily life, and reduction in NPS [27]. ...
... Environmental characteristics are accessible and potentially modifiable features that influence mobility within NHs, and higher-quality physical environments have been associated with improved activities of daily life and reduction in NPS [25,27]. However, we did not detect an association between physical environment and LS in our study. ...
... However, we did not detect an association between physical environment and LS in our study. LS in NHs is strongly related to daily routines [26], and mealtimes provided in dining areas represent a key focal activity in residents' lives [27]. Stable daily routines and mealtimes provided within the unit, could explain why most residents maintained a stable LS and why daily life unfolded within their unit (Group 2). ...
Article
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Background Traditional performance-based measurements of mobility fail to recognize the interaction between the individual and their environment. Life-space (LS) forms a central element in the broader context of mobility and has received growing attention in gerontology. Still, knowledge on LS in the nursing home (NH) remains sparse. The aim of this study was to identify LS trajectories in people with dementia from time of NH admission, and explore characteristics associated with LS over time. Methods In total, 583 people with dementia were included at NH admission and assessed biannually for 3 years. LS was assessed using the Nursing Home Life-Space Diameter. Association with individual (age, sex, general medical health, number of medications, pain, physical performance, dementia severity, and neuropsychiatric symptoms) and environmental (staff-to-resident ratio, unit size, and quality of the physical environment) characterises was assessed. We used a growth mixture model to identify LS trajectories and linear mixed model was used to explore characteristics associated with LS over time. Results We identified four groups of residents with distinct LS trajectories, labelled Group 1 (n = 19, 3.5%), Group 2 (n = 390, 72.1%), Group 3 (n = 56, 10.4%), Group 4 (n = 76, 14.0%). Being younger, having good compared to poor general medical health, less severe dementia, more agitation, less apathy, better physical performance and living in a smaller unit were associated with a wider LS throughout the study period. Conclusion From NH admission most NH residents’ LS trajectory remained stable (Group 2), and their daily lives unfolded within their unit. Better physical performance and less apathy emerged as potentially modifiable characteristics associated with wider LS over time. Future studies are encouraged to determine whether LS trajectories in NH residents are modifiable, and we suggest that future research further explore the impact of environmental characteristics.
... In terms of the chronological trend, the applied research of TD in the field of environment, architecture, and space occurred between 2010 and 2014. In terms of research method, the application research of TD in the fields of environment, architecture, and space mainly adopts literature review [23,63,64] and case study [65][66][67]. In terms of the research subject, the TD mainly focuses on the design of the nursing environment for patients with dementia to improve their quality of life [64,68,69], followed by the elderly [54,70,71] and children [57,58,72]. ...
... In terms of research method, the application research of TD in the fields of environment, architecture, and space mainly adopts literature review [23,63,64] and case study [65][66][67]. In terms of the research subject, the TD mainly focuses on the design of the nursing environment for patients with dementia to improve their quality of life [64,68,69], followed by the elderly [54,70,71] and children [57,58,72]. In terms of the research topic of TD, the research contents of environment, architecture, and space are interrelated. ...
... In addition, the TD oriented the environment, architecture, and space is mainly used in hospital places [23,55,65]. Further, in a therapeutic environment, it is mainly implemented for the physical environment [64,68,69] and the nursing environment [53,73,74]. The following section analyzes and describes the research content of TD in the fields of environment, architecture, and space. ...
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At present, a smart city from the perspective of the United Nations Sustainable Development Goals (SDGs) emphasizes the importance of providing citizens with promising health and well-being. However, with the continuous impact of coronavirus disease 2019 (COVID-19) and the increase of city population, the health of citizens is facing new challenges. Therefore, this paper aims to assess the relationship between building, environment, landscape design, art therapy (AT), and therapeutic design (TD) in promoting health within the context of sustainable development. It also summarizes the existing applied research areas and potential value of TD that informs future research. This paper adopts the macro-quantitative and micro-qualitative research methods of bibliometric analysis. The results show that: the built environment and AT are related to sustainable development, and closely associated with health and well-being; the application of TD in the environment, architecture, space, and landscape fields promotes the realization of SDGs and lays the foundation for integrating digital technologies such as Building Information Modeling (BIM) into the design process to potentially solve the challenges of TD; and the principle of TD can consider design elements and characteristics from based on people’s health needs to better promote human health and well-being.
... Physical environments may contribute to this. (16,(18)(19)(20) B. Personal relationships between staff and residents facilitate care that is unique and resident-specific. ...
... Small-scale, home-like settings and décor, in contrast to an institutional design, are appreciated and promote social interaction, (18,21) positively impacting residents with dementia. (19,20) E. Dining experiences offer multi-faceted opportunities for improved well-being. As above, homelike décor is also comforting in the dining area. ...
... (18) When bathing, privacy also reduces agitation. (19) Residents should also be given privacy when toileting and only be assisted when necessary. (14) ...
Article
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Background: Long-term care (LTC) facilities require urgent, evidence-based care renewal. During 2020 three medical student-driven research projects aiming to study care satisfaction, patient care team dynamics, and advance care directive effectiveness in a local LTC facility required a marked shift in approach due to COVID-19 regulations. Methods: All three projects were re-invented as rapid reviews from their initial designs intended to provide a baseline for quality improvement projects. English-limited PubMed searches for publications within the past 10 years were undertaken. Review articles were prioritized and supplemented by individual studies. Students reviewed the initial abstracts, reviewed them with a supervisor/mentor, assessed the articles for quality, and synthesized major themes. Results: A total of 52 publications were evaluated for the final synthesis of all three projects. Relevant information was retrieved for all three areas, suitable for local evaluation/intervention at micro, meso, and macro policy levels. Conclusions: Rapid reviews of issue-specific, long-term care literature are low resource avenues towards coordinated care improvement. They may also serve as rapid means for regular policy updates while providing next-generation care providers with improved LTC perspectives.
... However, beyond such high-profile examples, little is known about the standards of dementia supportive design in typical residential aged care settings across the country. Furthermore, although significant volumes of research evidence (Fleming, Crookes, and Sum, 2008;Verbeek et al., 2008;Fleming and Purandare, 2010;Marquardt, Bueter and Motzek, 2014;Chaudhury et al., 2017) have been distilled into clear dementia design principles (Marshall, 2001;Fleming, 2011;Waller, Masterson, and Evans, 2017) some researchers have questioned whether this knowledge has effectively translated into design practice (Fleming, Fay, and Robinson, 2012;Fleming and Kelly, 2015). For example, much of the available dementia design evaluation literature focuses on post-occupancy evaluation (Fleming, 2011;Cunningham et al., 2011;Sloane et al., 2002), but offers little by way of formal design evaluation of design proposals, most commonly articulated in floor-plan drawings. ...
... Past evidence tends to conclude that smaller residential aged care environments lead to improved behaviour and wellbeing amongst residents living with dementia (Annerstedt, 1993;Reimer et al., 2004;Verbeek et al., 2009), whilst there have also been neutral (Verbeek et al., 2010) and also somewhat contradictory evidence in support of larger units (Zeisel et al., 2003). There are also questions from some researchers about the extent to which the recorded positive effects of smaller environments are due in part to other design and social characteristics rather than size alone (Fleming, Crookes, and Sum, 2008;Chaudhury et al., 2017) and suggesting that the number of residents living together is a more significant factor. With this approach comes the argument that physical size is a dependent, if loosely tied, natural result of designing to provide accommodation for a smaller number of people. ...
... Physical settings that encourage meaningful (ordinary) activities, support autonomous wayfinding, and promote casual social interactions tend to lead to increased levels of independent ability and increased participation in activities of daily living (Reimer et al., 2004;Verbeek et al., 2008). There is also evidence that appropriately designed environments can lead to reductions in agitated behaviour, the use of pharmacological and physical restraint, the frequency of falls, incidence of incontinence and overall reductions in resident dependency on care staff (Fleming and Bowles, 1987;Lawton and Zarit, 2001;Price, Hermans and Grimley Evans, 2001;Fleming and Purandare, 2010;Chaudhury et al., 2017). ...
Thesis
International literature consistently reports that more than half of people living in residential aged care have a diagnosis of dementia. Research findings in this field concur that well- designed physical environments can increase independence, enhance quality of life, and provide a drug-free means of improving the behavioural and psychological symptoms experienced by people living with dementia. Despite this, there has been limited research into how well the broad stock of existing residential aged care settings supports the needs of residents with dementia. This dissertation investigates the design quality of existing residential aged care units, with a focus on the impact of architectural planning layouts on overall dementia design quality. Specifically, the dissertation develops new knowledge in terms of three interconnected research aims. The first research aim is to evaluate and compare dementia design quality in the layout planning of NSW-based and international best-practice examples of residential aged care units. To fulfil this aim, the dissertation uses floor-plan layouts to evaluate the dementia design characteristics of ninety residential aged care units from New South Wales (NSW), Australia, and compares these against the characteristics of ninety-four published international best-practice examples. The second research aim is to determine whether the dementia-enabling characteristics of floor-plan layouts for residential aged care units in NSW have improved over the last four decades. This aim is addressed by correlating the dementia design evaluation scores, from the analyses undertaken as part of the first research aim, against the year of construction for each unit. The third aim of the research is to investigate the impact of five spatial planning factors on the dementia design properties of Australian and international residential aged care settings. The five factors are: the unit floor area, number of bed-spaces provided, floor area per resident, storey location, and whether purpose-built for dementia or not. The research undertaken for this aim builds on the results of the first two aims by undertaking correlation analyses between the identified attributes and the dementia design evaluation scores for each residential aged care unit. In order to fulfil the three aims of the research, a new evidence-supported dementia design evaluation methodology is developed. This method, derived from Fleming’s (2011)Environmental Audit Tool, forms the basis of evaluations undertaken of the layout planning of the ninety NSW-recruited residential aged care units, and ninety-four international units, considered to be exemplars of dementia design. This new design evaluation approach produces formal scored measures of dementia design quality across nine established dementia design principles. These evaluations help to identify strengths and weaknesses in the layout planning of individual units and allow comparisons of design quality between sets of units. The results developed in response to the first aim show that the international exemplars tend to provide higher quality building layouts, with NSW evaluation scores falling behind by a significant margin. The results include the findings that both the NSW and international sets perform well under three of nine established dementia design principles, whilst showing that the most significant differences between the sets occur under four of these principles. There is room for improvement across both sets, but especially so for the NSW unit layouts, having achieved, on average, less than half of the available dementia design quality scores for five of nine dementia design principles. Results from research undertaken to address the second aim show clear improvements in dementia design quality for NSW units over the evaluated period (1970-2016). The most recently constructed NSW units tend to achieve a significantly higher dementia design quality score than those built at earlier dates. International units, assessed for comparison, started at a much higher level of design quality, but also improved significantly over four decades. Analysis of the rate of design improvements between both NSW and international sets show that the dementia design quality of the broad stock of NSW residential aged care units has typically trailed behind the design quality standards of the international exemplars by about twenty years. Findings developed in response to the third research aim include evidence that higher quality residential aged care units have fewer resident bed-spaces and, possibly because of this, tend to be physically smaller. A more contradictory finding is that high scoring residential aged units tend to provide more overall floor area per resident. Results also show that higher quality dementia design tends to occur in units that are located at ground floor and be amongst those purpose-built for accommodating people living with dementia. While the three sets of findings in this dissertation provide valuable information for the aged care sector, the methods and approaches developed to investigate the aims of the research have the potential to be useful for both larger scale evaluations of existing residential care settings, and to inform the design process of future residential aged care settings. This research was undertaken in accordance with the University of Newcastle’s Human Research Ethics Committee Approval No. H-2014-0044.
... The built environment has been known for several years to be a key element of dementia-specific care [5]. If nursing homes are designed with people with dementia in mind, this may help residents maintain their independence in daily activities and improve their quality of life [5]. ...
... The built environment has been known for several years to be a key element of dementia-specific care [5]. If nursing homes are designed with people with dementia in mind, this may help residents maintain their independence in daily activities and improve their quality of life [5]. Specifically, the advantages of such an adapted environment have and between 0.38 and 1.0 in terms of comprehensiveness. ...
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Dementia-specific environmental design has the potential to positively influence capabilities for daily living and quality of life in people with dementia living in nursing homes. To date, no reliable instrument exists for systematically assessing the adequacy of these built environments in Germany. This study aimed to test the adapted version of the Environmental Audit Tool—High Care (EAT-HC)—the German Environmental Audit Tool (G-EAT)—with regard to its feasibility, interrater reliability and internal consistency. The G-EAT was applied as a paper-pencil version in the German setting; intraclass correlation coefficients at the subscale level ranged from 0.662 (III) to 0.869 (IV), and 42% of the items showed at least substantial agreement (Cohen’s kappa ≥ 0.60). The results indicate the need to develop supplementary material in a manual that illustrates the meaning of the items and practical implications regarding dementia-specific environmental design. Furthermore, the intersectionality of built and physical environments must be considered when interpreting G-EAT results in future research and applications to residential long-term care practice.
... Person-centered care in a long-term care facility is a philosophy that recognizes that each person has an equal right to dignity, respect, and to participate fully in her/his environment and that emphasizes the importance of relationships (Alzheimer Society of Canada, 2011;Brooker & Surr, 2005). With the adoption of the person-centered care approaches, the physical environment of a care home has been acknowledged as an essential component of care model because of their restricted functions and staff care practices to be associated with the physical surroundings (Bicket et al., 2010;Chaudhury et al., 2018;Chenoweth et al., 2014;Cioffi et al., 2007;Harrison et al., 2017;Kane et al., 2007;Lee et al., 2016aLee et al., , 2014Reimer et al., 2004). ...
... Based on this theory, several studies have been conducted on the impact of the environment on older adults living with dementia: design interventions beneficial to the behavior (Marquardt et al., 2014;Pollock & Fuggle, 2013), effective design improving the person-centered care (Chenoweth et al., 2014;Lee et al., 2016b;Zeisel, 2013), the role of the environment on reducing behavioral dysfunctions (Cohen-Mansfield & Werner, 1995;Figueiro & Rea, 2019;Lee & Morelli, 2010;Soril et al., 2014), and on resident's quality of life/health (Joseph et al., 2016;Zeisel et al., 2003), small-scale, and homelike environments for the residents with dementia (Nakanishi et al., 2012;Regnier & Scott, 2001;Van Amerongen-Heijer, 2013;Verbeek et al., 2010). Although the existing evidence (see review in Chaudhury et al., 2018) supports the impact of the physical environment on people living with dementia, there is still much to be learned about the processes and contexts of the influence of the environment in providing care. ...
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Objectives This study aimed to explore staff perspectives of the physical environment in supporting their care practices for residents living with dementia in Canadian and Swedish long-term care facilities. Design An exploratory, descriptive, qualitative research design based on focus groups was used. Participants A total of 24 staff members who worked closely with the residents such as nurses or care aides participated in the focus group interviews from four facilities, two in Sweden and two in Canada. Measurements Focus group interview was held at each selected care facility once and a total of four times were conducted. Broad questions were asked about the effect of physical environment on care practice, job satisfaction, and interaction with residents. Data were analyzed by thematic analysis. Findings This study identified three environmental themes that have substantial effect on the social interaction and care practice: (i) design ambience enables and limits social and care interaction, (ii) space arrangements facilitate and hinder the effectiveness of care delivery, and (iii) sensory stimuli have direct impact on residents. The findings demonstrate that well-designed environment qualities such as homelike ambience, an open layout, and stimulating courtyard positively stimulate the emotion of staff as well as residents, which also leads to build trust and relationship and to increase job satisfaction. The study found that the appropriate level of sound or familiar music for residents with dementia is a positive stimulus. When the staff felt comfortable and supported by good care unit’s ambience, they can be motivated to care for their residents, leading to better care practices. The study also found that the closed floor plan in an institutional setting could increase staff fatigue by obstructing the view of residents’ behaviors and movement and by increasing walking loads. Conclusions This study highlights the complexities of how care was organized and influenced by the physical environment of the setting. The variations in the physical environmental characteristics and quality of care suggest the value of comparative research in identifying and exploring the possible causes and consequences. Future development in long-term care facilities requires a better understanding of staff experiences and staff involvement in the physical design of care settings.
... Such research generates knowledge to inform the design of healthcare buildings (Ulrich et al., 2010;Hamilton, 2016). However, healthcare building design research has focused mainly on acute environments such as surgery and intensive care (Joseph et al., 2018) and with significant attention paid to residential aged care (Chaudhury et al., 2018) and mental health facilities (Connellan et al., 2013). Fewer studies focused on design perspectives for health promotion. ...
... Attention to health equity and the needs and abilities of vulnerable populations, the design can be culturally sensitive, universal and inclusive. For example, improving wayfinding for people with visual disabilities (Rousek and Hallbeck, 2011) or support the specific need for people with dementia or children (Chaudhury et al., 2018). Lastly, the need for empowerment has been related to both to the ability to be involved in the design process of new environments (Eriksson et al., 2012;Elf et al., 2015), access to health information (Miedema et al., 2019a), as well as being able to control your surroundings (Golembiewski, 2010;Ulrich et al., 2010), such as the temperature or lighting. ...
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The Health Promoting Hospitals (HPH) networks, founded by the World Health Organisation, support the introduction of health promotion in healthcare. This development involves the creation of a health promoting built environment. However, few studies have explored the HPH in relation to the built environments, and it is unclear how HPH-networks incorporate the built environment in their work. The study therefore examined the Swedish HPH-Network in relation to the built environment. The mixed-method study included data from (i) key online material from the Swedish network, (ii) a survey with open-ended questions of representatives of the networks' workgroups and (iii) semi-structured interviews with the built environment workgroup. The study showed that the built environment is unevenly and incoherently incorporated in the network. Moreover, there is more attention for healing and healthy rather than health-promotive strategies, indicating a knowledge gap. Descriptions of the health promoting built environment are diverse, and address design features, design strategies or indicate places for health promotion interventions. The descriptions of the built environment are combined with various HPH goals and population groups. To utilize the built environment as a resource for HPHs, the networks should consider incorporating the built environment in documents and action plans at all organizational levels.
... 16 Focus has also been on the structural elements of the environment, such as size, homelikeness, spatial layout, noise level and temperature. [17][18][19] However, other aspects of the environment may be important to consider. Namely, engaging environments that promote both cognitive and physical activity are associated with positive emotional responses from people with dementia. ...
... This is consistent with existing research. For example, Chaudhury et al, 17 reported that having a more homelike environment reduces responsive behaviours such as wandering. Higher basic environment quality scores (hallways free from clutter, well lit, etc) were associated with more responsive behaviours. ...
Article
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Objective: Responsive behaviours (eg, wandering, resisting care and verbal abuse) are a continuing issue for staff and individuals living in long-term care (LTC) homes. The LTC environment can influence responsive behaviours and is a factor in determining the quality of life for those living there. The ways in which the quality of the environment might influence responsive behaviours has not been investigated yet. We hypothesised that better quality environments would be associated with reduced rates of responsive behaviours. We used a tool that simultaneously encompasses human and structural elements of the environment, a novel approach in this field of research. Design: Cross-sectional study, using data collected from September 2014 to May 2015 as part of the Translating Research in Elder Care research programme. Setting: A representative, stratified (size, owner-operator model and health region) random sample of 76 LTC homes in British Columbia, Alberta, Manitoba. Participants: 13 224 individuals (67.3% females) living in participating LTC homes. Outcome measures: Quality of care unit work environment was assessed using the observable indicators of quality (OIQ) tool. Responsive behaviours were assessed using routinely collected Resident Assessment Instrument-Minimum Data Set V.2.0 data. Results: Adjusted regression coefficients of overall Aggressive Behaviour Scale score and interpersonal communication were 0.02 (95% CI -0.011 to 0.045), grooming 0.06 (95% CI -0.032 to 0.157), environment-basics 0.067 (95% CI 0.024 to 0.110), odour -0.066 (95% CI -0.137 to -0.004), care delivery -0.007 (95% CI -0.033 to 0.019), environment-access -0.027 (95% CI -0.062 to 0.007), environment-homelike -0.034 (95% CI -0.065 to -0.002) and total OIQ score 0.003 (95% CI -0.004 to 0.010). Conclusions: We found small associations between the environmental quality and responsive behaviours in Western Canadian LTC homes. Higher scores on homelikeness were associated with decreased responsive behaviours. Higher scores on basic environmental quality were associated with increased responsive behaviours.
... The influence of the physical environment has been identified as a key element in dementiaspecific residential long-term care over the previous decade (Chaudhury et al., 2018). Depending on the scientific discipline scholars take, dementia care environments have been described as (1) being therapeutic or rehabilitative, focusing on compensating for existing deficits (mainly geriatrics and health sciences origin) (Chaudhury & Cooke, 2014;Zeisel et al., 1994), (2) needsbased, focusing on how the environment can meet the needs of people with dementia (rooted in nursing science and psychology) (Algase et al., 1996;Morgan & Stewart, 1999), or (3) experience-based, focusing on how people pose meaning to a place through interaction with their environment (i.e., gerontology and social ecology) (Charras et al., 2016;Molony et al., 2011). ...
... From our perspective of nursing and healthcare science-in this context-a well-designed environment may help people with dementia to maintain and enhance their remaining abilities (Fleming & Purandare, 2010), whereas environmental features and layouts that are not adapted to the specific needs of residents with dementia can trigger responsive behavior or lead to disorientation and frustration (Chaudhury et al., 2018;Fleming & Purandare, 2010;Marquardt & Schmieg, 2009;Woodbridge et al., 2018). ...
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Background In dementia-specific care, the design of the environment is regarded as an influential element in the support and maintenance of skills and can improve the quality of life of residents. To date, there is no valid instrument in the German-speaking countries with which the quality of the physical environment in residential long-term care facilities can be systematically assessed. Objective To report the translation, linguistic validation, cultural adaptation, and content validity evaluation of the Australian Environmental Audit Tool—High Care in preparation for use in German nursing homes. Method The procedure was guided by an adapted multistep process of the World Health Organization (1998) and included focus groups involving potential users of the new tool such as scientific experts and healthcare professionals ( n = 40). Content validity indices were calculated following a two-step expert survey. Results The final draft versions of the German Environmental Audit Tool (G-EAT) included 74 and 77 items, for non-secured units and secure units, respectively, divided into 10 key design principles according to the Australian original. The evaluation of content validity showed that cultural differences existed in several items. Conclusions The G-EAT provides the means for conducting a valid assessment of the environmental quality of people with dementia in German nursing homes. However, its usability in healthcare research must be preceded by testing its interrater reliability.
... We also defined clusters of outcome variables related to health, behavior, and quality of life. This clustering was based on the aggregation of synonyms and integration of matrices found in the reviews (Calkins, 2018;Chaudhury et al., 2018;Joseph et al., 2016;Marquardt et al., 2014), supplemented with topics from other reviews and studies. Finally, the widest possible list was maintained, with as little overlap as possible between the clusters. ...
... As stated above, we did not assess the quality of enrolled studies; however, it strikes us that the studies are often carried out with a small sample size, little use of control groups, and variables that are neither precisely defined nor described in detail. Many authors of reviews concerning individuals with psychogeriatric disorders or disabilities conclude exactly the same deficit of the research quality (Calkins, 2018;Chaudhury et al., 2018;Woodbridge et al., 2018). They also often notice that many studies rely on subjective measures, such as the perception of family and staff. ...
Article
Objectives To identify available literature on the impact of built environments on health, behavior, and quality of life of individuals with intellectual disabilities in long-term care. Additionally, we aimed to map the available literature, (re)frame the overall research situation in this area, and formulate recommendations. Background Long-term care facilities in the Netherlands are planned without using knowledge from research regarding evidence-based design because it is unclear what evidence is available about the impact of long-term care built environments on individuals with intellectual disabilities receiving 24/7 care. Methods Twelve scientific databases were searched for keyword combinations. After systematically screening 3,095 documents, 276 were included in the analysis. Results There is an underrepresentation of research and publications in intellectual disabilities, compared to other user groups living in long-term care facilities. A total of 26 design components were found in all groups; as for intellectual disabilities, research was available on only seven of them. Community care, home-likeness, and variety seem to have a positive effect on health, behavior, and quality of life. There are conflicting results regarding the effects of house size. Conclusions Although individuals with intellectual disabilities live in long-term care facilities, sometimes for life, little research has been conducted on the impact of the built environment on them. In the future, more empirical research should be conducted, addressing all aspects of quality of life and specific design components, with hypotheses based on needs assessments and the use of good research designs. This requires an investment of time and funding.
... In an effort to critique the Euro-American centrism embedded in these studies, historical and cultural research revealed an absence of the common connotation of homes as private havens for the nuclear family prior to the 18th century (Hareven, 1991) or outside Northern Atlantic regions (Shin, 2014). Recent gerontological literature has added to this criticism by calling for contextually sensitive and process-focused inquiry when studying home environments (Chaudhury, Cooke, Cowie, & Razaghi, 2017). ...
Article
Northern China has experienced unprecedented urbanization over the past several decades, with younger Chinese moving to cities while leaving the lion's share of the older population in rural areas. This study explores how this structural change creates unique opportunities and challenges for older adults living in rural houses, which informs their everyday practices, the meanings of homes, and their subsequent housing choices. We examined the housing experiences of rural older adults through a field study conducted in Heilongjiang province. The study employed qualitative in-depth interviews with thirty-two older adults who live or have lived in rural housing, along with systematic documentation of their houses through photography and hand drawings captured from the field. We analyzed the interview narratives and images using the Glaserian grounded theory method to allow a high level of flexibility and conceptualization. The study identified five core categories of residential experiences: (1) houses as sites of production; (2) the earth/dwelling relationship; (3) social life in interstitial spaces; (4) the house as a means to preserve agency in old age and; (5) the burdensome house. These features were directly linked to the older adults' senses of home and their subsequent housing choices. The rural houses offered a strong sense of agency and belonging to rural older adults, but the city's expansion, the changing household registration system, and their aging bodies forced rural older adults to engage in constant reevaluation of their houses, informing their residential choices. We discuss the study's theoretical contributions and offer insights into policies and future planning for residential areas in both rural and urban areas by comparing the spatial configurations of rural dwellings with their urban apartment counterparts.
... Allerdings legen aktuelle Forschungsergebnisse nahe, dass die Umwelt von Pflegebedürftigen so wohnlich und familienähnlich wie möglich sein sollte, um Verhaltensauffälligkeiten und Wohlbefinden positiv zu beeinflussen (Chaudhury, Cooke, Cowie & Razaghi, 2018). In den letzten Jahren haben sich deshalb weltweit verschiedene alternative Wohnform-Konzepte etabliert -"small scale living arrangements" in den Niederlanden und in Belgien, "green houses" in den USA, "group homes" in Japan, oder "ambulant betreute Wohngemeinschaften (abWGs)" (engl. ...
Thesis
Full-text link: https://nbn-resolving.org/urn:nbn:de:bvb:29-opus4-163969 --- Hintergrund und Ziele: Demenz ist eine lebenslimitierende Erkrankung. Gleichwohl fehlen derzeit evidenzbasierte Leitlinien für eine angemessene Palliativversorgung von Menschen mit Demenz. Ein Grund hierfür ist der Mangel an belastbaren empirischen Daten zu Menschen mit Demenz in der letzten Lebensphase. Ziel der vorliegenden Dissertation ist daher unter anderem, Symptombelastung, Inanspruchnahme des Gesundheitssystems sowie Todesumstände in dieser Zielgruppe mit Daten aus dem Bayerischen Demenz Survey (BayDem) zu untersuchen. Darüber hinaus haben Menschen mit Demenz ein signifikant höheres Risiko für Krankenhauseinweisungen, welche wiederum starke negative Auswirkungen auf diese vulnerable Gruppe haben. Nichtsdestotrotz gibt es bis dato keine wirksame nicht-pharmakologische Intervention zur Reduktion von Krankenhauseinweisungen. Um diese Forschungslücke zu schließen und einen Beitrag zur Optimierung der Demenzversorgung zu leisten, soll außerdem das Studienprotokoll der Studie DemWG sowie die auf evidenzbasierten Komponenten aufbauende komplexe psychosoziale Intervention dieser Studie detailliert erläutert werden. Methodik: BayDem, eine multizentrische Längsschnittstudie in drei bayerischen Regionen (Erlangen, Dachau, Kronach), untersuchte die Versorgungssituation von Menschen mit Demenz. Daten wurden in standardisierten, persönlichen Interviews zu Studienbeginn sowie 6, 12, 18 und 36 Monate darauf erhoben. Für die vorliegende Fragestellung erfolgte ein 1:1-Propensity Score Matching zwischen verstorbenen und nicht-verstorbenen Menschen mit Demenz, um vergleichbare Gruppen zu erhalten. Die Studie DemWG ist eine prospektive, multizentrische, mixed-methods, cluster-randomisierte Interventionsstudie in ambulant betreuten Wohngemeinschaften (abWGs), die primäre und sekundäre Daten sowie quantitative und qualitative Forschungsansätze umfasst. Die Cluster-Randomisierung erfolgt stratifiziert nach Bundesland und Region (Stadt vs. Land). Die komplexe, psychosoziale Intervention beinhaltet drei Bausteine: A) Fortbildung des Pflege- und Betreuungspersonals; B) Fortbildung der Hausärzt*innen; C) Multimodale, nicht-pharmakologische, psychosoziale Gruppenintervention MAKS-mk+, bestehend aus motorischen („m“) und kognitiven („k“) Übungen der evidenzbasierten MAKS-Therapie sowie Übungen zur Sturzprävention („+“) aus dem evidenzbasierten OTAGO Exercise Program. Die Datenerhebung erfolgt zu Studienbeginn, sowie 6, 12 und 18 Monate darauf mit standardisierten Instrumenten. Ergebnisse: In der Studie BayDem sind Menschen mit Demenz am häufigsten zuhause (36.2 %), im Krankenhaus (25.9 %) oder im Alten-/Pflegeheim (19.0 %) verstorben, jedoch nie im Rahmen einer Palliativversorgung. In den meisten Fällen starben Menschen mit Demenz an Komplikationen des respiratorischen Systems (13.8 %), an kardiovaskulären Komplikationen (12.1 %) oder einem Schlaganfall (12.1 %). Menschen mit Demenz in der letzten Lebensphase hatten zum letzten Befragungszeitpunkt im Vergleich zu nicht-verstorbenen Menschen mit Demenz signifikant stärker ausgeprägte körperliche Komorbiditäten (Charlson-Index: M = 2.75 vs. M = 1.80, p = .030) und wurden dementsprechend signifikant häufiger in einem Krankenhaus (46.6 % vs. 12.1 %, p < .001) oder in einer Notaufnahme (22.4 % vs. 3.4 %, p = .007) behandelt. Die Symptombelastung in Form von psychischen und Verhaltens-auffälligkeiten (BSPD) war bei Menschen in der letzten Lebensphase ebenfalls stark ausgeprägt (NPI: M = 31.67 vs. M = 24.78, p = .118). Ambulante Angebote wurden insgesamt eher selten genutzt. Da sich die Studie DemWG gegenwärtig noch am Beginn befindet, liegen noch keine empirischen Ergebnisse vor. Diskussion: Für eine adäquate, bedürfnisorientierte Palliativversorgung für Menschen mit Demenz müssen zwingend evidenzbasierte Leitlinien entwickelt werden. Dabei sollten die in der Studie BayDem beobachteten stark ausgeprägten psychischen und Verhaltensauffälligkeiten (BPSD) ebenso wie körperliche Komorbiditäten berücksichtigt werden. Ein besonderer Fokus sollte zudem auf die Entwicklung evidenzbasierter fachlicher Empfehlungen für den stationären Bereich gelegt werden. Ergänzend hierzu wird angenommen, dass die in der Studie DemWG untersuchte innovative, psychosoziale Intervention einen Beitrag dazu leistet, Krankenhauseinweisungen zu reduzieren und dazu beiträgt, BPSD bereits frühzeitig positiv zu beeinflussen. Ergebnisse hierzu stehen zum aktuellen Zeitpunkt noch aus. Nichtsdestotrotz ist die interne Validität der Studie DemWG durch die stratifizierte cluster-randomisierte Zuordnung zu Interventions- und Warte-Kontrollgruppe sowie die Verwendung einer standardisierten und manualisierten Intervention als hoch einzuschätzen. Die externe Validität sollte zudem aufgrund des „naturalistischen“ Versorgungssettings, der Rekrutierung in städtischen sowie ländlichen Regionen in fast allen deutschen Bundesländern ebenfalls stark ausgeprägt sein. Durch die komplexe Intervention, die gleichzeitig mehrere Akteur*innen adressiert, sind allerdings weder die geschulten Wohngemeinschafts-Mitarbeiter*innen noch die Teilnehmenden verblindet.
... The results of this study reinforce other studies that show a positive effect of dementia-sensitive design on people with dementia (Chaudhury et al. 2018); however, this study breaks new ground by demonstrating the effectiveness of the criteria in the hospital setting. Guidelines for dementia-sensitive design criteria are not absolute, and design goals can sometimes be reached in more than one way. ...
Article
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Hospitals are efficiency-oriented and often fail to adequately accommodate anything more than the most basic needs of their patients. This applies especially to patients with dementia because of their particular vulnerability to further functional decline during a hospital stay, as normal day-to-day activities atrophy very quickly when they are paused. In acknowledging this problem, Special Care Units (SCUs) have been developed especially to treat patients with dementia while in hospitals. SCUs are intended to work on several levels, including the model of care, comprehensive integration with the hospital at large etc. but our interest is in dementia-friendly design, because whether these measures affect outcomes has hitherto not been quantified. Using multilevel regression analysis, looking at the spatial data from 25 German SCUs alongside retrospective routine data from geriatric patients (N = 2735), it was revealed that most dementia-friendly design measures are associated with significant improvement in patients’ self-care abilities. The design measures proved to be effective, feasible and attractive. This paper outlines the potential of dementia-friendly design to shift from speciality design towards human-centred design for the entire general hospital.
... The physical environment of the RCFs is also important for stimulating residents' autonomy and informal care provision. Unit size, spatial layout and homelike character improve resident autonomy and also influence the provision of informal care (Chaudhury et al., 2018;Day et al., 2000). An important element of the physical environment is the use of technology. ...
Article
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Background and objectives Residential care facilities (RCFs) strive to enhance autonomy for people with dementia and to enhance informal care provision, although this is difficult. This study explored how RCF staff can enhance autonomy and improve informal care by looking at the influence of interactions (contact and approachability between residents, staff members and informal caregivers) and the physical environment, including the use of technologies. Research design and methods A realist evaluation multiple-case study was conducted using document analyses, eight semi-structured interviews with staff members and relatives and 56 hours of observations of residents across two RCFs aiming to provide person-centred care. Realist logic of analysis was performed, involving Context-Mechanism-Outcome configurations. Findings The behaviour, attitudes and interactions of staff members with residents and informal caregivers appeared to contribute to the autonomy of people with dementia and enhance informal care provision. The physical environment of the RCFs and the use of technologies were less relevant to enhancing autonomy and informal care provision, although they can support staff members in providing person-centred care in daily practice. Discussion and implications The findings add to those of other studies regarding the importance of interaction between residents, staff members and informal caregivers. The findings provide insight for other RCFs on how successfully to enhance autonomy for their residents and to improve informal care provision, as well as, more broadly, how to implement person-centred care.
... This was evident throughout data collection that an added variable in resident safety was how residents interacted with staff and with other residents. Like Chaudhury, Cooke et al. (2018), the vignettes suggest that unpredictability of residents' behaviour did not solely depend upon cognitive ability, which may fluctuate throughout the day, but was also influenced by environmental factors. This was also evident in the data, by the suggested change in dynamics when a new resident moved to the care home. ...
Article
Background The care home sector provides 24-hour residential care or nursing care to more than 450,000 vulnerable older people in the UK with complex needs and high levels of dependency. These services face many challenges in relation to funding, increasing demand, staff shortages and relying on an unregistered workforce with almost 40% possessing no qualifications. Care homes present a unique setting that provides care to individuals at significant risk of harm but has received little attention or research. Care homes provide a particularly rich context in which to study safety, as they are inherently complex organisations that have historically suffered many catastrophic failures and scandals and continue to struggle to achieve safety goals. It was widely accepted that organisational culture was important for patient safety. Both the organisational culture and patient safety literature have been dominated by the positivist assumption that organisations are part of an external reality that can be both measured and manipulated. Many scholars now argue that positivist approaches do not reflect the complexity of contemporary organisations as they only capture the very surface of organisational cultures. The deeper levels of organisational culture and its impact upon safety have received little exploration in the patient safety literature and have not before been explored in the context of care homes. Aim The thesis aimed to empirically explore organisational culture and how this related to safety in care homes. The thesis focused on how residents, relatives and staff in this context made sense of their reality by investigating the basic underlying assumptions that underpin human perception and behaviour, specifically in relation to quality and safety. Through this exploration the thesis also captured how different groups contributed to and negotiated quality and safety. Research Question The thesis addressed the central research question: • How do employees, residents and relatives give meaning to and value issues of safety in care homes? Methodology The thesis aligned with the interpretive paradigm and adopted an ethnographic case study approach within the care home sector. Over 200 hours of observations and interviews with 50 participants took place across two care homes between January – December 2018. Inductive thematic analysis was used to analyse both interview and observational data. Research Gaps and Intended Contribution This study adds to the limited evidence base through its interpretive, ethnographic approach, accepted as a method suited to achieving a deeper level of cultural analysis. The approach taken has not previously been used to address safety in the care home sector, which presented a setting that was theoretically and empirically distinguished from mainstream care settings. Due to the under-researched nature of this care setting the study also enabled theoretical contribution to the patient safety literature. The findings from this study make a contribution to current debates around care home policy and practice, which was of particular relevance given the recent impact of the COVID-19 pandemic upon the care home sector. The thesis makes a new contribution to the literature around patient safety by presenting a conceptual understanding of how culture relates to safety in care homes that comprises of Uncertainty, Identity and Role, Responsibility and Relationships. My study argues that within care homes there was a disconnect between the formal culture and approaches, and the informal culture within the care home. The study has highlighted that traditional patient safety orthodox approaches being used within care homes may be inappropriate due to the unpredictability and the assumptions that underpin how people give meaning to and value safety in care homes. Moreover, my study has shown that safety in care homes was achieved through attempts to get to know residents, focusing on their identity, building relationships and the importance of promoting resident autonomy and responsibility for their own safety.
... Using a participatory approach, CHOICE+ accounts for the characteristics of those who eat, visit, and work in a specific dining room, including residents, family members, dining room volunteers, direct care workers (e.g., Personal Support Workers, Care Aides), as these factors are known to influence program adoption and sustainment (MacEachern et al., 2020;Wu et al., 2018). Changes to organizational culture, as well as physical and social dining environments are considered necessary in order to support RCC mealtimes (Berta & Laporte, 2010;Chaudhury et al., 2018;Wu et al., 2018). For example, leadership ensuring that staff have the appropriate equipment to play calming music during meals, staff actively including residents in social conversations, or ...
Article
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Context: Mealtimes in residential care homes are important for social engagement and can encourage resident relationships. Yet, training programs to improve mealtime care practices in residential care set- tings remain limited in learning approaches and scope. Objectives: To determine whether a one-day Champion Training session would improve participants’ knowledge, skills, and confidence to implement a relationship-centred mealtime program (CHOICE+) in their homes. Methods: The study employed a pre-/post-test design to evaluate a train-the-trainer model using paper- based questionnaires. Thirty-four participants attended the training session; 25 participants completed pre/post training questionnaires based on Kirkpatrick’s evaluation model. Training included: 1) program implementation manual, 2) best-practices document, 3) educational resources and evaluation tools, 4) presentation on theory-based implementation strategies and behaviour change techniques, and 5) group discussion on applying strategies and techniques, problem-solving for implementation facilitators and barriers. Findings: More than half of attendees worked as Food Service Managers or Registered Dietitians. Par- ticipants identified several organizational factors that could impact their home’s readiness to implement CHOICE+, though they felt training to be acceptable and feasible for their homes. Participants reported increase in knowledge (8.4 ± 1.1), confidence (8.3 ± 1.4), and commitment (8.8 ± 1.4) to implement the relationship-centred mealtime program. There was no association with pre-training readiness, leadership, or home characteristics.
... She has looked at wayfinding, sensory experience, privacy and autonomy, and how those are affected by the built environment. Chaudhury et al. (2018) and Garcia et al. (2012) all provide valuable perspectives on the interrelationship between the built environment and dementia. Heward et al. (2020) demonstrate the importance of a 'homely feel' for residents with dementia, while O' Malley et al. (2015) examine how dementia-friendly design can improve quality of life. ...
Article
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This study undertakes a spatial analysis of an Australian aged care setting where residents receive person-centred support in a specially-designed home-like environment. Focus groups were conducted with staff to explore the impact of the built environment in a new residential aged care setting that has implemented a Household Model of care for people living with mental health conditions. Drawing on Actor-Network Theory and proxemics, we mapped how the built environment supports improved behaviours and care practices in four areas: food preparation and dining, sleep and self-care, site layout, and relationships.
... It is increasingly recognized that the environment, both interpersonal and physical, plays an important role in fostering or impeding how well persons with dementia retain existing capabilities and functioning (O'Connor et al., 2007). There is substantial evidence that supportive physical environment can serve as an effective therapeutic resource to improve quality of life among residents with dementia in long-term care settings (Campo & Chaudhury, 2012;Chaudhury et al., 2018;Chenoweth et al., 2014;Fleming & Purandare, 2010;Harrison et al., 2017;Lee et al., 2016a, b;Marquardt et al., 2014;Pollock & Fuggle, 2013;Rahman, 2017;Soril et al., 2014;Verbeek et al., 2014;Zimmerman & Anderson, 2013). Small-scale living is a form of physical environmental context for older adults with dementia, intended to provide a more responsive and person-centred environmental support in long-term care settings (Ausserhofer et al., 2016;Day et al., 2000;Husberg, 2007;Joseph et al., 2016;Kane et al., 2007;Kok et al., 2018;Verbeek, 2012;Vermeerbergen, 2017). ...
Article
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The aim of the longitudinal study was to examine whether residents with dementia in long-term facilities with variability in physical environmental characteristics in Vancouver (N= 11), Canada and Stockholm (N=13), Sweden had a difference in their quality of life (QoL). QoL was assessed using Dementia Care Mapping tool three times over one year for the reliability of data. The results of the study demonstrated that the residents with dementia living in a homelike and positive stimulating setting showed less withdrawn behaviors and a higher level of well-being compared to those in a large-scale institutional setting. This study also found that the residents living in a large-scale institutional environment spent more monotonous times than the other groups, which may be to provision of fewer structured activity programs or less social interaction with neighbors or staff members. Residents living in a large-scale institutional setting in Canada showed so far as five times more agitated/ distressed behaviors and twice more withdrawal compared to the ones living in a small-scale homelike setting in Sweden. The study supports that the large-scale institutional environment was considerably associated with levels of lower quality of life among the residents with dementia.
... Rather than helping, complex geographical features may cause cognitive overload in aging brains once these individuals start to have cognitive function issues (Cassarino & Setti, 2015). The majority of research on the built environment and cognition of older adults living with dementia has focused on the therapeutic nature of building designs (Chaudhury et al., 2018;Weisman, 2003), homes (Regnier & Pynoos, 1992) and outdoor features related to orientation, wayfinding, sensory stimulation, and aesthetic appreciation in institutional settings (Marquardt, Bueter, & Motzek, 2014;Mitchell et al., 2006;Regnier & Pynoos., 1992). Very few studies have examined the role of neighborhood residential environments on the cognitive functioning of those with dementia, except a qualitative study in ...
Thesis
The number of older adults using home and community-based services funded by federal and state governments has increased over the last two decades. This has occurred largely due to a growth in beneficiary preferences for home and community-based services (HCBS) over institution-based care, and U.S. Supreme Court's 1999 landmark decision in Olmstead v. L.C. (Olmstead), which found unjustified segregation of people with disabilities in institutions is a form of unlawful discrimination under the Americans with Disabilities Act (ADA). Previous research on HCBS users, or the community-dwelling long-term care population, have tended to focus on their service utilization and its consequences, rather than whether and how social and built environmental conditions influence their health and health care outcomes. Limited research on this topic stems in part from an underappreciation of the heterogeneity across places, difficulty of gaining access to data on both social and built environmental contexts and residents, and methodological challenges such as spatial correlation in the outcome variable of interest or attrition bias. My dissertation aims to address these gaps, using the case of the U.S. state of Michigan. First, I document the geographic distribution of aging and health-related resources, with a specific focus on social service organizations for older adults and persons with disability. Second, I examine the association between living in a neighborhood with dense social service organizations and two of the most prominent indicators of independent living for community-dwelling older adults: cognitive health and hospitalization. I leverage a US census and administrative data to provide new evidence on the association between aging and health-related resources and health and health care outcomes among urban community-dwelling older adults, who are using home and community-based services and are physically and/or cognitively impaired. Analyses offer several key findings. First, net of key predictors of formal care demands, socio-economically disadvantaged neighborhoods tend to have a high density of social service organizations. This counters previous findings suggesting that living in socioeconomically disadvantaged neighborhoods was associated with a lack of formal resources supporting aging in place. Second, residing in an urban area with more restaurants, recreation centers, or social services for older adults and persons with disability, was associated with slower cognitive decline among older adults who were initially cognitively intact. This protective effect was not found in already cognitively impaired older adults, and this study is one of few that has uncovered such variation by initial cognitive status group. Finally, dense social service organizations in a neighborhood were associated with better health care management outcomes in this community-dwelling long-term care sample. Results from multinomial logistic regression models predicting hospitalization trajectories over a 15-month period show that living in a neighborhood with a higher number of social service organizations lowered the expected risk of being in a group whose hospitalization risk was consistently high over time, as compared to being in a group whose hospitalization risk significantly decreased over the same period. This study highlights the potential role social service infrastructure plays in post-hospitalization care management. My dissertation provides new evidence on neighborhood resources that could accommodate the needs of a growing population of community-dwelling older adults in the United States public long-term care system.
... 1 2 Healthcare design research generates evidence to inform the design of healthcare facilities. Recent healthcare design research has focused on acute environments such as surgery and intensive care, 3 with significant attention paid to residential aged care 4 and mental health facilities. 5 Between these disparate sectors lies an important and expensive sector of healthcare: hospital-based inpatient rehabilitation. ...
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Objectives To identify, appraise and synthesise existing design evidence for inpatient stroke rehabilitation facilities; to identify impacts of these built environments on the outcomes and experiences of people recovering from stroke, their family/caregivers and staff. Design A convergent segregated review design was used to conduct a systematic review. Data sources Ovid MEDLINE, Scopus, Web of Science and Cumulative Index to Nursing and Allied Health Literature were searched for articles published between January 2000 and November 2020. Eligibility criteria for selecting studies Qualitative, quantitative and mixed-methods studies investigating the impact of the built environment of inpatient rehabilitation facilities on stroke survivors, their family/caregivers and/or staff. Data extraction and synthesis Two authors separately completed the title, abstract, full-text screening, data extraction and quality assessment. Extracted data were categorised according to the aspect of the built environment explored and the outcomes reported. These categories were used to structure a narrative synthesis of the results from all included studies. Results Twenty-four articles were included, most qualitative and exploratory. Half of the included articles investigated a particular aspect of the built environment, including environmental enrichment and communal areas (n=8), bedroom design (n=3) and therapy spaces (n=1), while the other half considered the environment in general. Findings related to one or more of the following outcome categories: (1) clinical outcomes, (2) patient activity, (3) patient well-being, (4) patient and/or staff safety and (5) clinical practice. Heterogeneous designs and variables of interest meant results could not be compared, but some repeated findings suggest that attractive and accessible communal areas are important for patient activity and well-being. Conclusions Stroke rehabilitation is a unique healthcare context where patient activity, practice and motivation are paramount. We found many evidence gaps that with more targeted research could better inform the design of rehabilitation spaces to optimise care. PROSPERO registration number CRD42020158006.
... The physical environment can have a significant influence on these experiences (Chaudhury, Cooke, Cowie, & Razaghi, 2018;Soilemezi, Drahota, Crossland, & Stores, 2019). In their review of the literature on the relationship between physical environments and dementia, Fleming et al. (2008) found strong support for the effects of environmental modifications on wellbeing in dementia; for example, enhancing visual access, providing a variety of living spaces and single rooms, and balancing levels of stimulation improved quality of life for people living with dementia. ...
Article
Modifications to the environment can have a positive impact on the person living with dementia. The purpose of this study was to examine the effects of a virtual reality (VR) educational workshop on improving understanding of the impact of environments for people living with dementia for carers in residential aged care facilities in Australia. Participants were nonrandomly allocated to one of two conditions: a VR condition which enabled them to take the perspective of a person living with dementia as they navigate a home environment (n = 40), or to a non-VR condition, in which participants received equivalent information in a classroom without the use of VR (n = 56). Participants completed a purpose-built pictorial measure of their understanding of environmental factors that could impact on people with dementia before and after the workshop. Following education, an analysis of covariance revealed that compared to non-VR education, those who received VR education identified a significantly greater number of appropriate environmental modifications, after adjusting for practice test scores. The results from this study demonstrate the utility of VR as a promising tool to improve carers’ understanding of the ways in which the environment can be modified to assist people living with dementia.
... The HTD studies are mainly associated with the healing and therapeutic architecture [31,68,69], spaces [70][71][72], environment [36,73,74], and healing and therapeutic landscape design based on gardens [33,75,76]. In addition, HTD studies are focused on dementia patients to improve their environments and their quality of life [77,78]. Based on the application field of HTD, the healing and therapeutic architectural design is largely associated with BIM; and the healing and therapeutic landscape design corresponds to LIM. ...
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In the face of the health challenges caused by the COVID-19 pandemic, healing and therapeutic design (HTD) as interventions can help with improving people’s health. It is considered to have great potential to promote health in the forms of art, architecture, landscape, space, and environment. However, there are insufficient design approaches to address the challenges during the HTD process. An increased number of studies have shown that emerging information modeling (IM) such as building information modeling (BIM), landscape information modeling (LIM), and city information modeling (CIM) coupled with blockchain (BC) functionalities have the potential to enhance designers’ HTD by considering important design elements, namely design variables, design knowledge, and design decision. It can also address challenges during the design process, such as design changes, conflicts in design requirements, the lack of design evaluation tools and frameworks, and incomplete design information. Therefore, this paper aims to develop a conceptual BC enhanced IM for HTD (BC-HTD) framework that addresses the challenges in the HTD and promotes health and well-being. The structure of BC-HTD framework is twofold: (1) a conceptual high-level framework comprising three levels: user; system; and information, (2) a conceptual low-level framework of detailed content at the system level, which has been constructed using a mixed quantitative and qualitative method of literature analysis, and validated via a pre-interview questionnaire survey and follow-up interviews with industry experts and academics. This paper analyzes the process of BC enhanced HTD and the knowledge management of HTD to aid design decisions in managing design information. This paper is the first attempt to apply the advantages of BC enabled IM to enhance the HTD process. The results of this study can foster and propel new research pathways and knowledge on the value of design in the form of non-fungible token (NFT) based on the extended advantages of BC in the field of design, which can fully mobilize the healing and therapeutic behaviors of designers and the advantage potential of HTD to promote health, and realize the vision of Health Metaverse in the context of sustainable development.
... It is increasingly recognized that the environment, both interpersonal and physical, plays an important role in fostering or impeding how well persons with dementia retain existing capabilities and functioning (O'Connor et al., 2007). There is substantial evidence that supportive physical environment can serve as an effective therapeutic resource to improve quality of life among residents with dementia in long-term care settings (Campo & Chaudhury, 2012;Chaudhury et al., 2018;Chenoweth et al., 2014;Fleming & Purandare, 2010;Harrison et al., 2017;Lee et al., 2016a, b;Marquardt et al., 2014;Pollock & Fuggle, 2013;Rahman, 2017;Soril et al., 2014;Verbeek et al., 2014;Zimmerman & Anderson, 2013). Small-scale living is a form of physical environmental context for older adults with dementia, intended to provide a more responsive and person-centred environmental support in long-term care settings (Ausserhofer et al., 2016;Day et al., 2000;Husberg, 2007;Joseph et al., 2016;Kane et al., 2007;Kok et al., 2018;Verbeek, 2012;Vermeerbergen, 2017). ...
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Reduction in competence makes older adults with dementia more sensitive to the influence of the physical environment. The aim of the longitudinal study was to examine whether residents with dementia in long-term facilities with variability in physical environmental characteristics in Vancouver (N=11), Canada and Stockholm (N=13), Sweden had a difference in their quality of life (QoL). QoL was assessed using Dementia Care Mapping (DCM) tool three times over one year for the reliability of data. DCM is a technique and observational framework devised to systematically investigate QoL from the perspective of the older adults with dementia. The results of the study demonstrated that the residents with dementia living in a homelike and positive stimulating setting showed a higher level of potential positive engagement, and less agitated and withdrawn behaviors compared to those in the large-scale institutional setting. Residents living in a large-scale institutional setting in Canada showed so far as five times more agitated/distressed behaviors and twice more withdrawal compared to the ones living in a small-scale homelike setting in Sweden. The study supports that the large-scale institutional environment was considerably associated with levels of lower quality of life among the residents with dementia.
... 14 Thus, the provision of independent access to the outdoors within modern NHs is increasingly acknowledged as important in maximizing resident quality of life (QoL) and function. 1,3,[15][16][17] However, the degree to which providing independent access to outdoor areas within NHs translates to practical increases in use of outdoor areas, or is associated with improvements in resident QoL, has received relatively little attention. 3,18 The aim of this analysis is to examine the association between provision of independent access to outdoor areas at the NH level and actual use of outdoor areas by the residents with health-related QoL (HR-QoL) in a population of residents of Australian NHs with a high prevalence of dementia. ...
Article
Associations between provision of independent access to outdoor areas and frequency of Australian nursing home (NH) residents going outdoors with health-related quality of life (HR-QoL, EQ-5D-5L) are examined in a cross-sectional study (541 participants, 17 homes, 84% with cognitive impairment) using multilevel models. After adjustments for potential confounders (including comorbidities and home location), independent access to outdoor areas was not associated with HR-QoL (β=-0.01, 95% CI, -0.09–0.07). Going outdoors daily (β=0.13, 95% CI 0.06–0.21), but not multiple times a week (β=0.03; 95% CI, -0.03–0.09), was associated with better HR-QoL. Residents living in small-scale, clustered, homelike facilities had greater odds of going outdoors daily (odds ratio 15.1; 95% CI, 6.3–36.2). Provision of independent access to outdoor areas alone may be insufficient to achieve HR-QoL benefits of NH residents venturing outdoors, in a pre-COVID era. Staffing structures, organizational attitudes, environmental design, and activities to support residents of NHs venturing outdoors frequently, despite any COVID-19-related restrictions, are needed.
... When renovations or a new clinical facility are being planned, hearing health professionals should capitalize on the opportunity to make their clinic dementia-friendly. Training for Staff • A positive, accessible, and enabling physical environment is important but cannot alone create a positive therapeutic milieu (Chaudhury et al. 2018;Hebert & Scales 2019). In addition to a supportive physical environment, the VIPS model highlights the need for a supportive social environment. ...
Article
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Hearing impairment commonly co-occurs with dementia. Audiologists, therefore, need to be prepared to address the specific needs of people living with dementia (PwD). PwD have needs in terms of dementia-friendly clinical settings, assessments, and rehabilitation strategies tailored to support individual requirements that depend on social context, personality, background, and health-related factors, as well as audiometric HL and experience with hearing assistance. Audiologists typically receive limited specialist training in assisting PwD and professional guidance for audiologists is scarce. The aim of this review was to outline best practice recommendations for the assessment and rehabilitation of hearing impairment for PwD with reference to the current evidence base. These recommendations, written by audiology, psychology, speech-language, and dementia nursing professionals, also highlight areas of research need. The review is aimed at hearing care professionals and includes practical recommendations for adapting audiological procedures and processes for the needs of PwD.
... zp < corrected a ¼ a per test of family satisfaction domains ¼ 0.0127. renovations such as redesigning or building some sections of the facility into small-homes or households, those financially manageable actions of eliminating institutional features of the NHs (e.g., removing nurse station and overhead paging, building accessible indoor/outdoor play areas, displaying personal items in common areas, home-like decoration) has shown beneficial effects on resident QOL (Chaudhury et al., 2018;Day et al., 2000). These environmental transformations are generally thought to enhance residents' experience with the physical aspect of the living environment such as comfort, convenience, safety, and privacy. ...
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Transforming nursing homes (NHs) from restrictive institutions to person-centered homes, referred to as NH culture change, is complex and multifaceted. This study, based on a survey of administrators in Minnesota NHs ( n = 102), tested the domain-specific relationships of culture change practices with resident quality of life (QOL) and family satisfaction, and examined the moderating effect of small-home or household models on these relationships. The findings revealed that culture change operationalized through physical environment transformation, staff empowerment, staff leadership, and end-of-life care was positively associated with at least one domain of resident QOL and family satisfaction, while staff empowerment had the most extensive effects. Implementing small-home and household models had a buffering effect on the positive relationships between staff empowerment and the outcomes. The findings provide meaningful implications for designing and implementing NH culture change practices that best benefit residents’ QOL and improve family satisfaction.
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ABSTRACT Introduction: Although the home environment is most familiar to the person with dementia, due to the difficulties that dementia brings, it is not able to performing daily activities. Purpose: To identify adjustments to the home environment, who advised the adjustments, and the impact of adjustments on the person with dementia. Methods: A qualitative case study based on a sample of 10 relatives interviews was used. Results: Qualitative analysis (open coding) creates the categories: adaptation of the living environment and the surroundings, the source of information on adjustments and safety measures. The most commonly adapted spaces are the bathroom, bedroom and kitchen, and the adjustments were: sensor light, hospital bed, fence by the shower, non-slip floor in the shower, handles on the toilet, commonly used items in sight, and locking sharp and hazardous objects. Discussion and conclusion: we found that the home environment supports the person with dementia. By fulfilling the conditions of carrying out the activities, safety and autonomy, we influence the well-being and satisfaction and thus achieve a higher quality of life of the demented person. Discussion and Conclusion: A modified home environment is supportive of a person with dementia. Adjustments, changes and adaptations enabled the implementation of activities, increased safety and independence, which affected the well-being and satisfaction of the person with dementia. Keywords: adaptation, living environment, relatives, activity
Article
Aims and objectives This study explored nursing home staff’s barriers and needs in implementing person‐centered care for people with dementia. Background Person‐centered care is an imperative international policy and the best‐practice standard for dementia care. However, a gap exists between policy and practice. Moreover, there is a lack of qualitative studies that explored nursing home staff’s barriers and needs in implementing person‐centered care for people living with dementia. Design A qualitative descriptive approach was adopted. Methods Using convenience sampling method, a total of 24 staff members (nurses, nurse’s aides, or care workers) were recruited from six nursing homes in Korea. Two in‐depth, face‐to face, one‐to‐one interviews were conducted with all participants (a total of 48 interviews). A semi‐structured interview guide was used and field notes were written after each interview. Data were collected until data saturation was reached. Qualitative content analysis was used. This study followed the COREQ guidelines. Results Four themes emerged from data analysis: insufficient resources, lack of education, negative mindset, and poor relationships. This study showed that nursing home staff experienced many barriers and unmet needs in implementing person‐centered care for people with dementia. Conclusion The findings indicated that nursing home staff faced many barriers and needs in implementing person‐centered care for people with dementia. Nursing home staff need more legitimate, financial, educational, and emotional support. Relevance to clinical practice The study indicates more national and organizational support are needed for nursing home staff to successfully implement person‐centered care for people living with dementia. Nursing home leaders need to recognize the importance of their role in overcoming the barriers and provide effective support for staff in implementing person‐centered dementia care.
Article
Persons with dementia (PWD) make up a large portion of the long-term care (LTC) population the world over. Before a global pandemic swept the world, governments and healthcare providers struggled with how to best care for this unique population. One of the greatest challenges is a PWD’s tendency to “walk with purpose” and exhibit unsafe wayfinding and elopement, which places them at risk of falls and injury. Past solutions included increased use of restraints and pharmacological interventions, but these have fallen out of favor over the years and are not optimal. These challenges put enormous strain on staff and caregivers, who are often poorly trained in dementia care, underpaid, overworked, and overstressed. PWD are impacted by these stresses, and unmet needs in LTC places an even greater stress on them and increases their risks of morbidity and mortality. The physical design of their environments contributes to the problem. Old, institutionalized buildings have poor lighting, poor ventilation, long dead-end hallways, poor visual cues, lack of home-like décor, shared bedrooms and bathrooms, and are often dense and overcrowded. These design elements contribute to the four ‘A’s’ of dementia: apathy, anxiety, agitation, and aggression, and they also contributed to the rapid spread of COVID-19 in these facilities the world over. In this review, we present current “dementia friendly” design models in the home, community, and LTC, and argue how they could have saved lives during the pandemic and reduced the stresses on both the dementia resident and the caregiver/staff.
Article
Objective The purpose of this study was to translate the Environmental Assessment Tool–Higher Care (EAT-HC) into Japanese and validate its use in small-scale group living facilities in Japan. Background Environment of a facility is shown to improve its residents’ quality of life (QOL). Japan’s “welfare-based nursing homes for the elderly” are gradually shifting to a small-scale group living concept called group care units (GCUs). However, there is no appropriate environmental tool available for evaluating GCUs. The application of valid environmental assessment tools brings about a better understanding of the nature of good environments and the relationship between environments and outcomes for residents living with dementia. Methods The study had a mixed method design conducted in several steps, covering translation and adaptation. The translation phase involved (1) forward translation and (2) backward translation. The adaptation phase involved (3) content validity and homogeneity reliability and (4) concurrent validity and interrater reliability. Results 71 Items (92%) met the acceptable level of content validity (item-content validity index [CVI] > .79) and had good scale-CVI of .88. Concurrent validity was confirmed between .65 and .78 ( p < .001). For reliability test, the internal consistency of six subscales was between .88 and .98. Overall interobserver agreement was 90.3%. Intraclass correlation coefficients were .80–.98 ( p < .001), and homogeneity reliability coefficient for all items was >.76 ( p < .01). Conclusions Validation of the EAT-HC-Japanese Version (EAT-HC-JV) was confirmed as an appropriate tool for environmental assessment to enhance the QOL in Japan’s GCUs. For future study, we plan to modify the EAT-HC-JV to adapt to Japanese cultural aspects in order to increase its usability in Japan.
Article
When planning long-term care facilities (LTCFs), architects strive to design buildings that support high well-being (WB) levels for those who live and work in them. To achieve this goal, architects must understand what defines WB in old age and how these qualities can be achieved through the designed physical layout. This task must be achieved while tackling additional challenges, such as considering the official planning guidelines, codes, and additional requests given by the client. During the planning process, architects use their subjective impressions by visiting similar institutions, their personal experience as architects, and their subjective assumptions on what residents and caregivers may consider desirable. Once built, there are a lack of methodological ways to evaluate an existing LTCF unit’s plan as a supportive tool for higher levels of WB. The current study aims to create a methodological tool to analyze LTCF units’ layout, giving scores to each plan based on five aspects of WB that they support. In our article, we demonstrate this methodology’s application on 40 plans of LTCFs, demonstrating its effectiveness. We believe that the approach presented in this article will contribute to furthering the quality of planning of LTCFs benefiting residents and caregivers alike.
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Although older persons wish to age at home, many older persons with mental health conditions and psychosocial disability (MHC-PSD) spend the last few years of their life in residential facilities. This paper will examine the impact of ageism and human rights violations manifested in environmental design, specifically regarding social isolation, loneliness, inadequate psychosocial, environmental, recreational and spiritual support. This is compounded by failure to meet basic care needs-nutrition, hydration, pain and medication support. This paper highlights two innovative initiatives from the Netherlands, which show that older persons’ rights can be maintained in innovative, collective living arrangements. It is concluded that the creation of inclusive and safe environments for older persons with MHC-PSD can facilitate the enjoyment of Human Rights.
Article
Background: Workplace violence is frequent, especially in long term care, but often unreported. Aims: To identify workers experiences and coping strategies when they face physical aggression from residents and assess the value of incident reports for violence follow-up. Methods: This mixed method study is based on incident reports collected over 3 years from two different long term care geriatric facilities in France, and thematic analysis of 20 semi-structured interviews of nurses and nursing assistants. Results: The reported frequencies of physical aggression among respondents range from none to daily aggression. Only seventy-six incident reports were submitted. Aggressions were under-reported by caregivers who often felt guilty for not having avoided them. Coping strategies included banalization and seeking support from colleagues. Incident reports can constitute a warning signal for the management team, but are not a reliable tool for workplace violence follow-up. Conclusions: Our study emphasizes the complexity of workplace violence prevention in long lerm care settings. Proposals can be formulated to train and support caregivers, but a shift from a task-oriented organization to a patient-centered approach seems necessary to reduce violence. Implications for nursing management: Situations to be reported should be better defined, aggression reporting encouraged and judgmental attitudes toward reports discouraged.
Chapter
The field has increasingly used developmental science to systematically inform clinical psychological science, and recent years have witnessed rapid advances in the developmentally informed study and treatment of youth and older adults. The present chapter outlines the basic principles that underlie developmentally informed clinical psychology, and provides an overview of developmental considerations as they relate to the understanding and treatment of mental health problems in youth and in older adults. Throughout, we pay particular attention to the ways in which advances in intervention science have worked to optimize the developmental compatibility of treatments for individuals across the lifespan.
Article
Objectives This evidence-based design clinical trial assessed the feasibility of a multisensory environment (MSE) using aromatherapy, color-changing lights, and music as a behavioral intervention to calm Veterans with dementia during assisted bathing to improve the patient experience. Background The number of Veterans with dementia is growing rapidly, along with the associated debilitating behavior challenges. The severity of these distressed behaviors that predominantly occur at bath time often necessitates costly, dangerous sedatives. Feasibility studies of nonpharmacological behavioral interventions during bathing for people with dementia are urgently needed, and research supports MSE as a viable solution. Method Using an A–B, multiple baselines across participants design, this study tracked operational behaviors of four Veterans with dementia during bathing without and with an MSE intervention. Sessions were provided and recorded by a dedicated team of five nurses, so the study team could analyze the Veterans’ operational behaviors to understand the impact of individualized MSE during both baseline and intervention phases. Results The results support the feasibility of MSE as a helpful, nonpharmacological behavioral intervention for Veterans with dementia during bathing. All participants experienced an overall increase in duration of positive operational behaviors and an overall decrease in duration of negative operational behaviors. Conclusions Healthcare environments are integral components in dementia care and the use of MSE within the bathing setting appears to improve not only operational behaviors but the overall bathing experience.
Article
Aim This study was designed to examine how residents in long-term care (LTC) units perceive their living environment based on the theory of supportive design. Background Healthcare environments may cause a significant level of stress mainly due to patients’ lack of familiarity with such environments and patients’ poor health conditions. According to the theory, the healthcare environments providing a sense of control, social support, and positive distraction can promote wellness. This study was designed to learn how LTC residents perceive their current living environments. Method This study collected data through qualitative interviews. A total of 48 residents living in two LTC units were asked the three interior environments they liked and they wanted to improve. Only the residents who lived in the current space for 1 month and communicate without any cognitive disabilities were able to participate. Most residents were female and lived in a private room. Results The participants’ responses indicated the importance of perceived control, social support, and positive distraction in the environment. The most frequently mentioned interior environment that the residents liked was “window and view,” followed by “pictures and photos” and “TV,” while they wanted “bigger room and space,” followed by “improved privacy” and “more options for food.” In addition to the three elements, the participants considered other elements as important for them which can benefit the participants. Conclusion More studies must be carried out to expand the theory, so that it can be applied to future studies with inclusive perspectives.
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Im Rahmen des Engagements der privaten Kranken- und Pflegeversicherungen in der Gesundheitsförderung und Prävention hat der Verband der Privaten Krankenversicherung e. V. (PKV-Verband) das IGES Institut beauftragt, eine Expertise über Angebote zur Förderung kognitiver Ressourcen und der psychosozialen Gesundheit von Bewohnerinnen und Bewohnern stationärer Pflegeeinrichtungen zu erstellen. Das vorliegende Dokument stellt die identifizierten Angebote vor. Ausgehend von den Ergebnissen wird diskutiert, wie Leistungen gemäß § 5 SGB XI in die derzeitige „Pflegelandschaft“ eingeordnet werden können. Die Förderung kognitiver Ressourcen und psychosozialer Gesundheit sind Ziele, mit denen sich verschiedene Fachdisziplinen beschäftigen und zu deren Erreichung bereits eine Vielzahl von Angeboten bzw. Ansätzen existiert. Die vorliegende Expertise stellt bestehende Angebote zur Prävention in stationären Pflegeeinrichtungen gemäß § 5 SGB XI, Ansätze der Pflege, der medizinischen und der rehabilitativen Versorgung sowie der Eingliederungshilfe vor. Weiterhin werden Beispiele berichtet für die Nutzung von Organisationsentwicklung in stationären Pflegeeinrichtungen. Basierend auf der wissenschaftlichen Literatur lassen sich mögliche Interventionen zur Förderung kognitiver Ressourcen und psychosozialer Gesundheit mehreren Gruppen zuordnen: besondere Pflegekonzepte, kognitive und sensorische Verfahren, Angebote sinngebender Aktivitäten, Verfahren zur Förderung sozialer Interaktionen, Interventionen zur Gestaltung des Wohnumfelds sowie Verfahren mit mehreren Komponenten. Die Ergebnisse der Expertise zeigen, dass sich Leistungen gemäß § 5 SGB XI gut in die derzeitige „Pflegelandschaft“ einfügen: Die gesetzlichen Rahmenbedingungen der Pflegeversicherung betonen seit der Einführung des neuen Pflegebedürftigkeitsbegriffs im Jahr 2017 vermehrt Erhalt und Förderung von Selbständigkeit und Fähigkeiten pflegebedürftiger Menschen. Die sich für die Pflegepraxis ergebenden Konsequenzen werden derzeit von den Pflegeeinrichtungen nachvollzogen und in Veränderungen ihrer Strukturen und Prozesse überführt. Weitere Veränderungen ergeben sich aus der Konzertierten Aktion Pflege, welche zum Ziel hat, Pflege als Beruf attraktiver zu gestalten. Diese Entwicklungen im Pflegesektor bieten einen guten Anknüpfungspunkt für Gesundheitsförderung. Denn die Ziele für die Bewohnerinnen und Bewohner (Erhalt und Förderung von Selbstständigkeit und Fähigkeiten) und die Beschäftigten (attraktive Arbeitsverhältnisse) lassen sich letztlich nicht trennen von dem Ziel der Gesundheitsförderung, nämlich „personale, soziale und materielle Ressourcen für die Gesunderhaltung zu stärken“ (RKI, 2015).
Article
Background This article describes the development of the Singapore Environmental Assessment Tool (SEAT), a culturally appropriate, usable, reliable, and valid assessment tool designed to evaluate the extent to which the built environment in Singaporean aged care facilities is able to support the provision of high levels of care to people living with dementia. Methods A multistage sequential mixed methods approach was carried out involving 16 raters in Stage 1 and six raters in Stage 2 using a culturally adapted English version of the Environmental Audit Tool–High Care (EAT-HC) in eight nursing homes. The first stage captured qualitative data on cultural sensitivities and usability of the tool. The SEAT was improved based on the findings, and in the second stage, the usability and psychometric properties of the modified tool were again assessed. Usability was determined by data collected via the System Usability Scale and the Questions to Assess Barriers and Facilitators survey. Psychometric properties were examined by the calculation of percentage agreement, item-level interrater agreement was measured using Fleiss’s κ, and Cronbach’s α was used to measure the internal consistency of the subscale scores. Results The culturally adapted SEAT was found to have an acceptable level of usability and moderate level of reliability among subscales. Conclusion The study indicated that the tool is reliable and valid when completed by users with knowledge of dementia-enabling environments. For the tool to be used with confidence education in the application of principles of design to the design of environments for people living with dementia is recommended prior to its use.
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Evidence shows that living in small scale homelike Special Care Units (SCU) has positive effects on behavioural and psychological symptoms of patients with dementia. Effects on cognitive functioning in relation to care facilities, however, are scarcely investigated. The purpose of this study is to gain more insight into the effects of living in small scale homelike Special Care Units, compared to regular SCU’s, on the course of cognitive functioning in dementia. A group of 67 patients with dementia who moved from a regular SCU to a small scale homelike SCU and a group of 48 patients with dementia who stayed in a regular SCU participated in the study. Cognitive and behavioural functioning was assessed by means of a neuropsychological test battery and observation scales one month before (baseline), as well as 3 (post) and 6 months (follow-up) after relocation. Comparing the post and follow-up measurement with the baseline measurement, no significant differences on separate measures of cognitive functioning between both groups were found. Additional analyses, however, on ‘domain clusters’ revealed that global cognitive functioning of the small scale homelike SCU group showed significantly less cognitive decline three months after the transfer (p < 0.05). Effect sizes (95 % CI) show a tendency for better aspects of cognition in favour of the homelike small scaled SCU group, i.e., visual memory, picture recognition, cognitive decline as observed by representatives and the clustered domains episodic memory and global cognitive functioning. While there is no significant longitudinal effect on the progression of cognitive decline comparing small scaled homelike SCU’s with regular SCU’s for patients with dementia, analyses on the domain clusters and effect sizes cautiously suggest differences in favour of the small scaled homelike SCU for different aspects of cognition.
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OBJECTIVE: In this review the impact of the design of the built environment on people with dementia in long-term care settings is systematically analyzed and summarized. Architects and designers will be provided with credible evidence on which they can confidently base their design decisions. Researchers will be able to determine which environmental aspects have been well investigated and where there are gaps in the current state of the research. BACKGROUND: A great number of studies have established a relationship between the design of the physical environment of long-term care settings and outcomes of people with dementia. However, the methods employed are heterogeneous and the results are often conflicting. Consequently, the process of integrating the best evidence available into architectural designs may be hindered. METHODS: A systematic literature search was conducted reviewing studies that meet certain inclusion criteria. Using an evidence-based approach, the methodical quality of the studies was rated. RESULTS: One hundred sixty-nine studies were found. They were thematically summarized into four main categories: basic design decisions, environmental attributes, ambience, and environmental information. The effectiveness of the interventions on the behavior, cognition, function, well being, social abilities, orientation, and care outcomes on people with dementia was illustrated by matrices. CONCLUSIONS: Results of this review indicate that, with the exception of cognition, specific design interventions are beneficial to the outcomes of people with dementia. Overall, the field of environmental design for people with dementia is well researched in many aspects and only few gaps in knowledge were identified.
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By the end of this chapter the reader will: • understand the importance of the physical environment in creating a supportive care setting to enhance the quality of life in people with dementia • know about the conceptual issues and therapeutic goals that should inform planning and design of a dementia care environment • appreciate the major findings of empirical studies on the effect of environmental design features of a long-term care facility on behaviour and affect in people with dementia • be aware of the strategies in which the physical environment can be modified to reduce challenging behaviours and to foster meaningful engagement for people with dementia
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The social environments of people with dementia are complex and still not fully understood. Investigating how residents in a dementia care setting navigate and participate within social groups is critical as the therapeutic benefits of social engagement are unequivocal. An ethnographic study of social environments within a dementia care residence revealed that there is active socialization and even strong and lasting friendships formed between people with dementia. Many of these relationships were observed to be a part of groups, ‘nested’ within the larger social environment. These ‘nested social groups’ had unique dynamics and their structuring was often influenced by outside factors (e.g. physical environment and staff preferences). The existence of these groups has implications for the experiences and quality of life of the residents in long-term care. Nested social groups will be defined and their function within the social environment will be discussed.
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Purpose: Drawing on therapeutic physical environmental design principles and Kitwood's theoretical view of person-centered care, this study examined the impact of environmental renovations in dining spaces of a long-term care facility on residents' mealtime experience and staff practice in two care units. Method: The research design involved pre-and post-renovation ethnographic observations in the dining spaces of the care units and a post-renovation staff survey. The objective physical environmental features pre-and post-renovations were assessed with a newly developed tool titled Dining Environment Audit Protocol. We collected observational data from 10 residents and survey responses from 17 care aides and nurses. Findings: Based on a systematic analysis of observational data and staff survey responses, five themes were identified: (a) autonomy and personal control, (b) comfort of homelike environment, (c) conducive to social interaction, (d) increased personal support, and (e) effective teamwork. Implications: Although the physical environment can play an influential role in enhancing the dining experience of residents, the variability in staff practices reveals the complexity of mealtime environment and points to the necessity of a systemic approach to foster meaningful culture change.
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Purpose: Drawing on therapeutic physical environmental design principles and Kitwood's theoretical view of person-centered care, this study examined the impact of environmental renovations in dining spaces of a long-term care facility on residents' mealtime experience and staff practice in two care units. Method: The research design involved pre- and post-renovation ethnographic observations in the dining spaces of the care units and a post-renovation staff survey. The objective physical environmental features pre- and post-renovations were assessed with a newly developed tool titled Dining Environment Audit Protocol. We collected observational data from 10 residents and survey responses from 17 care aides and nurses. Findings: Based on a systematic analysis of observational data and staff survey responses, five themes were identified: (a) autonomy and personal control, (b) comfort of homelike environment, (c) conducive to social interaction, (d) increased personal support, and (e) effective teamwork. Implications: Although the physical environment can play an influential role in enhancing the dining experience of residents, the variability in staff practices reveals the complexity of mealtime environment and points to the necessity of a systemic approach to foster meaningful culture change.
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This study examined the effects of particular design interventions in a long-term care facility on residents with dementia and staff perceptions of care delivery. Major renovations were carried out in a care facility in the Midwestern United States. Renovations included a new addition of a dementia care unit designed as a cluster of resident rooms around living and dining areas, and two renovated wings with decentralized dining areas. The research methods used in the study included environmental assessment with the Professional Environmental Assessment Protocol (PEAP), behavioral mapping, and focus-group interviews with staff members. The renovated environment scored higher in PEAP and was perceived by the staff members as a more homelike setting. Although behavioral observations indicate that there was more involvement in programmed activities by the residents, the decentralized neighborhood design did not meet all the behavioral expectations due to a lack of appropriate activities, high staff turnover, and family members' resistance to the relocation of their loved ones. Organizational commitment, advanced planning for appropriate staffing levels, and dementia-related training is crucial for fuller realization of the potential of a household design.
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This study aimed to characterize the features of outdoor areas for persons with dementia, and to clarify the relationship between design features, use, and satisfaction with these areas. A national survey of long-term care facilities with outdoor areas investigated the characteristics and features of these areas, and how those related to their perceived impact on their users. Most respondents rated outdoor spaces as very useful, and as having a great benefit for users. The perceived benefit was related to the presence of more design features, such as the presence of gazebos and to the number of activities offered in the area. Despite these positive findings, respondents stated the areas were not used as much as possible and indicated several problems, mostly related to the safety of the residents. The results of this survey can assist facilities in better designing or improving their outdoor areas to increase use and satisfaction.
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Objective: This paper reports the effects on challenging (agitated) behaviours, such as aggression, noisiness and wandering, when persons with dementia were relocated to a special unit. Methods: The study was a simple interrupted time series quasi-experimental design. The dependent variable was agitated behaviour and the independent variables were residing in an old unit and in a Special Care Unit (SCU). Twenty-two persons with dementia from a nursing home were involved in this study. Subjects were assessed weekly for 1 month prior to the move to the SCU and weekly for 1 month at 3 and 6 months after the move. Data were entered into SPSS software and analysed. Results: The most significant results from the study were that the verbally agitated behaviour of the subjects was reduced and sustained throughout the 6 months of the study after their move into a SCU. Conclusions: This study has shown that environmental design does impact positively in the care of persons with dementia.
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The concerning phenomena of spatial disorientation and wayfinding difficulties among elders with Alzheimer's disease or a related dementia in assisted living residences are understudied. This qualitative study aimed to identify the types of wayfinding difficulties as experienced by residents with memory-loss in two special care units of an assisted living residence. The data collection period included participant observation complemented by semi-structured interviews with care staff and managers and review of clinical records. A wide spectrum of wayfinding difficulties was identified as experienced by six residents. The residents experienced difficulties reaching several destinations on the units. The implications of the findings to practice, architectural design, and policy are discussed.
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Purpose of the Study: Older Chinese immigrants are one of the largest and fastest growing groups in Western societies. This article used the solidarity-conflict model to synthesize current research examining parent-child relationships in this group.Methods: A comprehensive literature search was conducted in the CINAHL, Medline, and PubMed databases to identify relevant articles. A narrative approach was used to review the literature. Thirty-six articles were identified. Compared with Caucasians, older Chinese immigrants are more likely to live with children and have higher filial expectations. However, considerable numbers live independently. Of these, most live in public housing and rely on the community rather than their children for instrumental help. Many older Chinese immigrants have adjusted their filial expectations and valued being independent. They also provide extensive household help to their children. There are indications of intergenerational conflict, probably due to generational differences in attitudes toward life and limited intergenerational contact. This review suggests that although filial piety continues to influence older parent-child relationship in Chinese immigrant families, many changes have occurred. These findings have important implications for service planning and delivery for this cultural group. This review also provides evidence for the utility of the solidarity-conflict model.
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Background: Occupation remains an unmet need in long-term dementia care. To increase residents' occupation, knowledge of types of occupation related to wellbeing, and organizational and environmental characteristics encouraging involvement in these types of occupation, is indispensable. Methods: In this explorative study, Dementia Care Mapping was used to study involvement in different types of occupation and wellbeing among 57 residents of 10 dementia care facilities. For each type of occupation, mean experienced wellbeing was studied. Occupation types with high mean wellbeing scores were classified as "wellbeing-enhancing occupation." Care facilities were ranked according to the mean time residents spent in types of wellbeing-enhancing occupation. Using information on staff-to-resident ratio, individual space, and items of the Physical Environment Evaluation Component of Dementia Care Mapping, organizational and environmental characteristics of the facilities were compared to study their relationship with wellbeing-enhancing occupation. Results: Reminiscence, leisure, expression, and vocational occupation had greatest potential to enhance wellbeing, but these types were seldom offered. Much variation existed in the extent to which wellbeing-enhancing occupation was provided. Long-term care facilities that did so more frequently generally had a more homelike atmosphere, supported social interaction through the environment, and had no central activity program. Conclusions: This study suggests that it is possible to engage residents in wellbeing-enhancing occupation, within current means of budget and staff. The physical environment and care organization might play a role, but the key factor seems to equip staff with skills to integrate wellbeing-enhancing occupation into care practice.