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Long-term care for people with dementia: environmental design guidelines

Published online by Cambridge University Press:  18 May 2010

Richard Fleming  and
Nitin Purandare
Richard Fleming*
Affiliation:
Dementia Services Development Centre, HammondCare, Hammondville, NSW, and Faculty of Health and Behavioral Sciences, University of Wollongong, Wollongong, NSW, Australia
Nitin Purandare
Affiliation:
Manchester Academic Health Science Centre, Psychiatry Research Group, School of Community Based Medicine, The University of Manchester, Manchester, U.K.
*
Correspondence should be addressed to: Richard Fleming, Director, Dementia Services Development Centre, HammondCare, Judd Avenue, Hammondville, NSW 2170, Australia. Phone: +61 2 8295 0380; Fax: +61 2 9825 1044. Email: [email protected].
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Abstract

Background: A large and growing number of people with dementia are being cared for in long-term care. The empirical literature on the design of environments for people with dementia contains findings that can be helpful in the design of these environments. A schema developed by Marshall in 2001 provides a means of reviewing the literature against a set of recommendations. The aims of this paper are to assess the strength of the evidence for these recommendations and to identify those recommendations that could be used as the basis for guidelines to assist in the design of long term care facilities for people with dementia.

Methods: The literature was searched for articles published after 1980, evaluating an intervention utilizing the physical environment, focused on the care of people with dementia and incorporating a control group, pre-test-post-test, cross sectional or survey design. A total of 156 articles were identified as relevant and subjected to an evaluation of their methodological strength. Of these, 57 articles were identified as being sufficiently strong to be reviewed.

Results: Designers may confidently use unobtrusive safety measures; vary ambience, size and shape of spaces; provide single rooms; maximize visual access; and control levels of stimulation. There is less agreement on the usefulness of signage, homelikeness, provision for engagement in ordinary activities, small size and the provision of outside space.

Conclusions: There is sufficient evidence available to come to a consensus on guiding principles for the design of long term environments for people with dementia.

Keywords

literature reviewelderlyphysical environmentdementiaresidential care
Type
Focus on mental health issues in long-term-care homes
Information
International Psychogeriatrics , Volume 22 , Special Issue 7: Focus on mental health issues in long-term-care homes , November 2010 , pp. 1084 - 1096
Copyright
Copyright © International Psychogeriatric Association 2010

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References

Access Economics (2009). Making Choices. Future Dementia Care: Projections, Problems and Preferences. Canberra: Access Economics.Google Scholar
AIHW (2007). Older Australia at a Glance. 4th edn. Canberra: Australian Institute of Health and Welfare.Google Scholar
Alessi, C. A. (2005). Randomized, controlled trial of a nonpharmacological intervention to improve abnormal sleep/wake patterns in nursing home residents. Journal of the American Geriatrics Society, 53, 803–810.Google Scholar
Alessi, C. A. et al. (1999). A randomized trial of a combined physical activity and environmental intervention in nursing home residents: do sleep and agitation improve?. Journal of the American Geriatrics Society, 47, 784–791.CrossRefGoogle ScholarPubMed
Ancoli-Israel, S. et al. (2003). Increased light exposure consolidates sleep and strengthens circadian rhythms in severe Alzheimer's disease patients. Behavioral Sleep Medicine, 1, 22–36.Google Scholar
Annerstedt, L. (1993). Development and consequences of group living in Sweden: a new mode of care for the demented elderly. Social Science and Medicine, 37, 1529–1538.Google Scholar
Baker, R. et al. (2001). A randomized controlled trial of the effects of multi-sensory stimulation (MSS) for people with dementia. British Journal of Clinical Psychology, 40, 81–96.Google Scholar
Barnes, S. (2006). Space, choice and control, and quality of life in care settings for older people. Environment and Behavior, 38, 589–604.Google Scholar
Bellelli, G. et al. (1998). Special care units for demented patients: a multicenter study. Gerontologist, 38, 456–462.CrossRefGoogle ScholarPubMed
Bharathan, T. (2007). What do patterns of noise in a teaching hospital and nursing home suggest? Noise and Health, 9, 31.Google Scholar
Bianchetti, A., Benvenuti, P., Ghisla, K. M., Frisoni, G. B. and Trabucchi, M. (1997). An Italian model of a dementia special care unit: results of a pilot study. Alzheimer Disease and Associated Disorders, 11, 53–56.CrossRefGoogle ScholarPubMed
Bowie, P. and Mountain, G. (1997). The relationship between patient behaviour and environmental quality for the dementing. International Journal of Geriatric Psychiatry, 12, 718–723.3.0.CO;2-3>CrossRefGoogle ScholarPubMed
Brawley, E. C. (1997). Designing for Alzheimer's Disease: Strategies for Creating Better Care Environments. New York: Wiley.Google Scholar
Chappel, N. L. and Reid, C. R. (2000). Dimensions of care of dementia sufferers in long-term care institutions: are they related to outcomes? Journals of Gerontology, 55B, S234–244.Google Scholar
Cleary, T. A., Clamon, C., Price, M. and Shullaw, G. (1988). A reduced stimulation unit: effects on patients with Alzheimer's disease and related disorders. The Gerontologist, 28, 511–514.Google Scholar
Cohen-Mansfield, J. and Werner, P. (1995). Environmental influences on agitation: an integrative summary of an observational study. American Journal of Alzheimer's Disease and Other Dementias, 10, 32–39.Google Scholar
Cohen-Mansfield, J. and Werner, P. (1998). The effects of an enhanced environment on nursing home residents who pace. Gerontologist, 38, 199–208.CrossRefGoogle ScholarPubMed
Cohen, U. and Weisman, G. D. (1991). Holding on to Home: Designing Environments for People with Dementia. Baltimore: Johns Hopkins University Press.Google Scholar
Cox, H., Burns, I. and Savage, S. (2004). Multisensory environments for leisure: promoting well-being in nursing home residents with dementia. Journal of Gerontological Nursing, 30, 37–45.CrossRefGoogle ScholarPubMed
Day, K., Carreon, D. and Stump, C. (2000). The therapeutic design of environments for people with dementia: a review of the empirical research. Gerontologist, 40, 397–416.CrossRefGoogle ScholarPubMed
Dickinson, J. I. and McLain-Kark, J. (1998). Wandering behavior and attempted exits among residents diagnosed with dementia-related illnesses: a qualitative approach. Journal of Women and Aging, 10, 23–34.CrossRefGoogle ScholarPubMed
Dickinson, J. I., McLain-Kark, J. and Marshall-Baker, A. (1995). The effects of visual barriers on exiting behavior in a dementia care unit. Gerontologist, 35, 127–130.Google Scholar
Elmstahl, S., Annerstedt, L. and Ahlund, O. (1997). How should a group living unit for demented elderly be designed to decrease psychiatric symptoms? Alzheimer Disease and Associated Disorders, 11, 47–52.CrossRefGoogle ScholarPubMed
Evans, B. (1989). Managing from Day to Day: Creating a Safe and Workable Environment. Minneapoolis: Department of Veterans Affairs Medical Centre.Google Scholar
Ferri, C. P. et al. (2005). Global prevalence of dementia: a Delphi consensus study. Lancet, 366, 2112–2117.CrossRefGoogle ScholarPubMed
Fleming, R. and Bowles, J. (1987). Units for the confused and disturbed elderly: development, design, programming and evaluation. Australian Journal on Ageing, 6, 25–28.Google Scholar
Fleming, R., Crookes, P. and Sum, S. (2008). A Review of the Empirical Literature on the Design of Physical Environments for People with Dementia. Sydney: Primary Dementia Collaborative Research Centre, UNSW.Google Scholar
Forbes, D. A. (1998). Strategies for managing behavioural symptomatology associated with dementia of the Alzheimer type: a systematic overview. Canadian Journal of Nursing Research, 30, 67–86.Google ScholarPubMed
Forbes, D., Morgan, D., Bangma, J., Peacock, S. and Adamson, J. (2004). Light therapy for managing sleep, behaviour, and mood disturbances in dementia. Cochrane Databases of Systematic Review, 2, CD003946.Google Scholar
Grant, L. A., Kane, R. A. and Stark, A. J. (1995). Beyond labels: nursing home care for Alzheimer's disease in and out of special care units. Journal of the American Geriatrics Society, 43, 569–576.CrossRefGoogle ScholarPubMed
Hall, G., Kirschling, M. V. and Todd, S. (1986). Sheltered freedom: an Alzheimer's unit in an ICF. Geriatric Nursing, 7, 132–137.CrossRefGoogle Scholar
Hanley, I. G. (1981). The use of signposts and active training to modify ward disorientation in elderly patients. Journal of Behavior Therapy and Experimental Psychiatry, 12, 241–247.Google Scholar
Hewawasam, L. C. (1996). The use of two-dimensional grid patterns to limit hazardous ambulation in elderly patients with Alzheimer's disease. Nursing Times Research, 1, 217–227.Google Scholar
Leon, J. and Ory, M. G. (1999). Effectiveness of Special Care Unit (SCU) placements in reducing physically aggressive behaviors in recently admitted dementia nursing home residents. American Journal of Alzheimer's Disease and Other Dementias, 14, 270–277.CrossRefGoogle Scholar
Low, L. F., Draper, B. and Brodaty, H. (2004). The relationship between self-destructive behaviour and nursing home environment. Aging and Mental Health, 8, 29–33.CrossRefGoogle ScholarPubMed
Marshall, M. (2001). Environment: how it helps to see dementia as a disability. Care Homes and Dementia: Journal of Dementia Care, 6, 15–17.Google Scholar
Mayer, R. and Darby, S. J. (1991). Does a mirror deter wandering in demented older people? International Journal of Geriatric Psychiatry, 6, 607–609.Google Scholar
Melin, L. and Gotestam, K. G. (1981). The effects of rearranging ward routines on communication and eating behaviours of psychogeriatric patients. Journal of Applied Behaviour Analysis, 14, 47–51.Google Scholar
Morgan, D. G. and Stewart, N. J. (1998). Multiple occupancy versus private rooms on dementia care units. Environment and Behavior, 30, 487–503.Google Scholar
Morgan, D. G., Stewart, N. J., D'Arcy, K. C. and Werezak, L. J. (2004). Evaluating rural nursing home environments: dementia special care units versus integrated facilities. Aging and Mental Health, 8, 256–265.CrossRefGoogle ScholarPubMed
Namazi, K. H. and Johnson, B. D. (1991a). Environmental effects on incontinence problems in Alzheimer's disease patients. American Journal of Alzheimer's Disease and Other Dementias, 6, 16–21.Google Scholar
Namazi, K. H. and Johnson, B. D. (1991b). Physical environmental cues to reduce the problems of incontinence in Alzheimer's disease units. American Journal of Alzheimer's Disease and Other Dementias, 6, 22–28.Google Scholar
Namazi, K. H. and Johnson, B. D. (1992a). Pertinent autonomy for residents with dementias: modification of the physical environment to enhance independence. American Journal of Alzheimer's Disease and Other Dementias, 7, 16–21.Google Scholar
Namazi, K. H. and Johnson, B. D. (1992b). Dressing independently: a closet modification model for Alzheimer's disease patients. American Journal of Alzheimer's Disease and Other Dementias, 7, 22–28.Google Scholar
Namazi, K. H. and Johnson, B. D. (1992c). How familiar tasks can enhance concentration in Alzheimer's disease patients. American Journal of Alzheimer's Disease and Other Dementias, 7, 35–40.Google Scholar
Namazi, K. H. and Johnson, B. D. (1992d). The effects of environmental barriers on the attention span of Alzheimer's disease patients. American Journal of Alzheimer's Disease and Other Dementias, 7, 9–15.Google Scholar
Namazi, K. H. and Johnson, B. D. (1992e). Environmental issues related to visibility and consumption of food in an Alzheimer's disease unit. American Journal of Alzheimer's Disease and Other Dementias, 7, 30–34.Google Scholar
Namazi, K. H. et al. (1989). Psychological well-being of elderly board and care home residents. Gerontologist, 29, 511–516.CrossRefGoogle ScholarPubMed
Namazi, K. H., Rosner, T. T. and Rechlin, L. (1991). Long-term memory cuing to reduce visuo-spatial disorientation in Alzheimer's disease patients in a special care unit. American Journal of Alzheimer's Disease and Other Dementias, 6, 10–15.Google Scholar
Nelson, J. (1995). The influence of environmental factors in incidents of disruptive behaviour. Journal of Gerontological Nursing, 21, 19–24.CrossRefGoogle Scholar
O'Connor, D. (2007). A Review of the Literature on Psycho-social Interventions for Behavioral and Psychological Symptoms of Dementia. Sydney: Primary Dementia Collaborative Research Centre.Google Scholar
Opie, J., Rosewarne, R. and O'Connor, D. W. (1999). The efficacy of psychosocial approaches to behaviour disorders in dementia: a systematic literature review. Australian and New Zealand Journal of Psychiatry, 33, 789–799.CrossRefGoogle ScholarPubMed
Ouslander, J. G. (2006). A nonpharmacological intervention to improve sleep in nursing home patients: results of a controlled clinical trial. Journal of the American Geriatrics Society, 54, 38–47.Google Scholar
Passini, R., Pigot, H., Rainville, C. and Tetreault, M. H. (2000). Wayfinding in a nursing home for advanced dementia of the Alzheimer's type. Environment and Behavior, 32, 684–710.CrossRefGoogle Scholar
Phillips, C. D., Sloan, P. D., Howes, C. and Koch, G. (1997). Effects of residence in Alzheimer disease special care units on functional outcomes. JAMA, 278, 1340–1344.CrossRefGoogle ScholarPubMed
Ragneskog, H. (1998). Probable reasons for expressed agitation in persons with dementia. Clinical Nursing Research, 7, 189–205.CrossRefGoogle ScholarPubMed
Reimer, M. A., Slaughter, S., Donaldson, C., Currie, G. and Eliaszew, M. (2004). Special care facility compared with traditional environments for dementia care: a longitudinal study of quality of life. Journal of the American Geriatrics Society, 52, 1085–1092.Google Scholar
Rosewarne, R., Opie, J., Bruce, A., Ward, S. and Doyle, C. (1997). Care Needs of People with Dementia and Challenging Behaviour Living in Residential Facilities. Canberra: Australian Government Publishing Service.Google Scholar
Satlin, A., Volicer, L., Ross, V., Herz, L. and Campbell, S. (1992). Bright light treatment of behavioural and sleep disturbances in patients with Alzheimer's disease. American Journal of Psychiatry, 149, 1028–1032.Google ScholarPubMed
Sloane, P. D., Mitchell, C. M., Preisser, J. S., Phillips, C., Commander, C. and Burker, E. (1998). Environmental correlates of resident agitation in Alzheimer's disease special care units. Journal of the American Geriatrics Society, 46, 862–869.CrossRefGoogle ScholarPubMed
Sloane, P. D., Christianna, P., Williams, S. and al., E. (2007). High-intensity environmental light in dementia: effect on sleep and activity. Journal of the American Geriatrics Society, 55, 1524–1533.Google Scholar
te Boekhorst, S., Depla, M., de Lange, J., Pot, A. M. and Eefsting, J. A. (2009). The effects of group living homes on older people with dementia: a comparison with traditional nursing home care. International Journal of Geriatric Psychiatry, 24, 970–978.CrossRefGoogle ScholarPubMed
Thorpe, L., Middleton, J., Russell, G. and Stewart, N. (2000). Bright light therapy for demented nursing home patients with behavioral disturbance. American Journal of Alzheimer's Disease and Other Dementias, 15, 18–26.Google Scholar
Torrington, J. (2006). What has architecture got to do with dementia care? Explorations of the relationship between quality of life and building design in two EQUAL projects. Quality in Ageing, 7, 34–49.CrossRefGoogle Scholar
Verbeek, H., van Rossum, E., Zwakhalen, S. M. G., Kempen, G. I. J. M. and Hamers, J. P. H. (2009). Small, homelike care environments for older people with dementia: a literature review. International Psychogeriatrics, 21, 252–264.Google Scholar
Wells, Y. and Jorm, A. F. (1987). Evaluation of a special nursing home unit for dementia sufferers: a randomised controlled comparison with community care. Australian and New Zealand Journal of Psychiatry, 21, 524–531.Google Scholar
Zeisel, J. et al. (2003). Environmental correlates to behavioral health outcomes in Alzheimer's special care units. The Gerontologist, 43, 697–711.Google Scholar
Zuidema, S. U., de Jonghe, J. F. M., Verhey, F. R. J. and Koopmans, R. T. C. M. (2009). Environmental correlates of neuropsychiatric symptoms in nursing home patients with dementia. International Journal of Geriatric Psychiatry. Epublished ahead of print, doi: 10.1002/gps.2292.CrossRefGoogle Scholar