DOI QR코드

DOI QR Code

Effects of Physical Environment on Quality of Life among Residents with Dementia in Long-Term Care Facilities in Canada and Sweden: A longitudinal study in a large-scale institutional setting versus a small-scale homelike setting

  • Received : 2020.11.30
  • Accepted : 2021.06.25
  • Published : 2021.06.30

Abstract

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 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study demonstrated that the residents with dementia living in a homelike and positive stimulating setting showed less withdrawn behaviors and a higher level of well-being compared to those in a large-scale institutional setting.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.

Keywords

Acknowledgement

This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology, Seoul, South Korea (NRF-2016R1D1A1B03931693).

References

  1. Alzheimer's Disease International.(2018). World Alzheimer Report 2018: The state of the art of dementia research: New frontiers. https://www.alz.co.uk/research/WorldAlzheimerReport2018.pdf?2
  2. Armstrong, P., Banerjee, A., Szebehely, M., Armstrong, H., Daly, T., & Lafrance, S. (2009). They Deserve Better: The Long-Term Care Experience in Canada and Scandinavia. Ottawa: Canadian Centre for Policy Alternatives.
  3. Ausserhofer, D., Deschodt, M., Geest, S.D., van Achterberg, T., Meyer, G., & et al. (2016). "There's no place like home": A scoping review on the impact of homelike residential care models on resident-, family-, and staff-related outcomes. Journal of the American Medical Directors Association, 17(8), 685-693. https://doi.org/10.1016/j.jamda.2016.03.009
  4. Brawley, E.C. (2005). Design Innovations for Aging and Alzheimer's: Creating Caring Environments. Hoboken, NJ: John Wiley & Sons.
  5. Brooker, D., & Surr, C. (2010). Dementia are mapping: Principles and practice. Bradford, UK: University of Bradford.
  6. Calkins, M.P. (2009). Evidence-based long term care design. Neuro Rehabilitation, 25,145-154
  7. Campo, M., & Chaudhur y, H. (2012). Informal social interaction among residents with dementia in special care units: Exploring the role of the physical and social environments. Dementia, 11(3), 401-423. https//doi-org.focus.lib.kth.se/10.1177/ 1471301211421189
  8. Chaudhury, H., Cooke, H., Cowie, H., & Razaghi, L. (2018). The influence of the physical environment on residents with dementia in long-term care settings: review of the empirical literature. The Gerontologist, 58(5), e325-e337. https://doi.org/10.1093/geront/ gnw259
  9. Chenoweth, L., Forbes, I., Fleming, R., & et al. (2014). PerCEN: a cluster randomized controlled trial of person-centered residential care and environment for people with dementia. International Psychogeriatrics, 26(7), 1147-1160. https://doi.org/10.1017/s1041610214000398
  10. Corrada, M.M., Brookmeyer, R., Paganini-Hill, A., Berlau, D., & Kawas, C.H. (2010). Dementia incidence continues to increase with age in the oldest old: the 90+ study. Ann Neurol, 67(1), 114-121. https://doi.org/10.1002/ana.21915
  11. Cutler, L.J. (2007). Physical environments of assisted living: Research needs and challenges. The Gerontologist, 47(3), 68-82. https://doi.org/10.1093/geront/47.Supplement_1.68
  12. Davis, S., Byers, S., Nay, R., & Koch, S. (2009). Guiding design of dementiafriendly environments inresidential care settings: Considering the living experiences. Dementia, 8(2), 185-203. http://www.sagepub.co.uk/journalspermissions.nav https://doi.org/10.1177/1471301209103250
  13. Day, K., Carreon, D., & Stump, C. (2000). The therapeutic design of environments for people with dementia: A review of the empirical research. The Gerontologist, 40(4), 397-416. https://doi.org/10.1093/geront/40.4.397
  14. de Rooij, A.H.P.M., Luijkx, K.G., Schaafsma, J., Declercq, A.G., Emmerink, P.M.J., & Schols, J.M.G.A. (2012). Quality of life of residents with dementia in traditional versus small-scale long-term care settings: A quasi-experimental study. International Journal of Nursing Studies, 49(8), 931-940. https://doi.org/10.1016/j.ijnurstu.2012.02.007
  15. Fleming, R., & Purandare, N. (2010). Long-term care for people with dementia: environmental design guidelines. International Psychogeriatrics, 22(7), 1084-1096. https://doi.org/10.1017/S1041610210000438
  16. Garre-Olme, J., Lopez-Pousa, S., Turon-Estrade, A., Juvinya, D., Ballester, D., & Vilalta-Franch, J. (2012). Environmental determinants of quality of life in nursing home residents with severe dementia. The Ameriacan Geriatrics Society, 60(7), 1230-1236. https://doi.org/10.1111/j.1532-5415.2012.04040.x
  17. Hall, G.R., & Buckwalter, K.C. (1987). Progressively lowered stress threshold: A conceptual model for care of adults with Alzheimer's disease. Archives of Psychiatric Nursing, 1(6), 399-406.
  18. Harrison, S.L., Dyer, S.M,, Laver, K.E., Milte, R.K., Fleming, R., & Crotty, M. (2017). Physical environmental designs in residential care to improve quality of life of older people. Cochrane Database of Systematic Reviews, 12(CD012), 1-14. https://DOI:10.1002/14651858.CD012892
  19. Hung, L., & Chaudhury, H. (2010). Exploring personhood in dining experiences of residents with dementia in long-term care facilities. Journal of Aging Studies, 25(1), 1-12. https://doi.org/10.1016/j.jaging.2010.08.007
  20. Husberg, L., & Ovesen, L. (2007). Gammal och Fri (Old and Free). Angsblomman:Sweden.
  21. Jones, G.M.M., & van der Eerden, W.J. (2008). Designing care environments for persons withAlzheimer's disease: visuoperceptual considerations. Reviews in Clinical Gerontology, 18(1), 13-37. https://doi.org/10.1017/S0959259808002645
  22. Joseph, A., Choi, Y., & Quan, X. (2016). Impact of the physical environment of residential health, care, and support facilities (RHCSF) on staff and residents: A systematic review of the literature. Environment and Behavior. 48(10),1203-1241. https://doi.org/10.1177/0013916515597027
  23. Kane, R.A., Lum, T.Y., Culter, L.J., Degenholtz, H.B., & Yu, T. (2007). Resident outcomes in small-house nursing homes: A longitudinal evaluation of the initial green house program. Journal of the American Geriatrics Society, 55(6), 832-839. https://doi.org/10.1111/j.1532-5415.2007.01169.x
  24. Kok, J.S., Nielen, M.M.A., & Scherder, E.J.A. (2018). Quality of life in small-scaled homelike nursing homes: an 8-month controlled trial. Health and Quality of Life Outcomes, 16(38), 2-8. https://doi.org/10.1186/s12955-017-0832-4
  25. Kovach, C.R., Noonan, P., Schilidt, A.M,, Reynolds, S., & Wells, T. (2006). The serial trial intervention: An innovative approach to meeting needs of individuals with dementia. Journal of Gerontological Nursing, 32(4), 18-25. https://doi.org/10.3928/00989134-20060401-05
  26. Lawton, M.P., & Nahemow, L. (1973). Ecology and the aging process. In The psychology of adult development and aging. Washington, DC: American Psychological Association, 619-674.
  27. Lee, S.Y., Hung, L., Chaudhury, H., & Morelli, A. (2021). Staff perspectives on the role of physical environment in long-term care facilities on dementia care in Canada and Sweden. Dementia, 0(0), 1-15. doi: 10.1177/14713012211003994
  28. Lee, S.Y., Chaudhury, H., & Hung, L. (2016a). Effects of physical environment on health and behaviors of residents with dementia in long-term care facilities: A longitudinal study. Research in Gerontological Nursing, 9(2), 81-91. doi:10.3928/19404921-20150709-01
  29. Lee, S.Y., Chaudhury, H., & Hung, L. (2016b). Exploring staff perceptions on the role of physical environment in dementia care setting. Dementia, 15(4), 743-75. doi:10.1177/1471301214536910
  30. Lee et al. (2007). Health supportive design in elderly care homes: Swedish examples and their implication to Korean counterparts. Architectual Research, 9(1), 9-18.
  31. Marquardt, M., Bueter, K., & Motzek, T. (2014). Impact of the design of the built environment on people with dementia: An evidence-based review. Health Environments Research & Design Journal, 8(1), 127-157. https://doi.org/10.1177/193758671400800111
  32. O'Connor, D., Phinney, A., Smith, A., Small, J., Purves, B., Perry, J., Drance, E., Donnelly, M., Chaudhury, H., & Beattie, L. (2007). Personhood in dementia care: Developing a research agenda for broadening the vision. Dementia:The International Journal of Social Research and Practice, 6(1), 121-142. https://doi.org/10.1177/1471301207075648
  33. OECD. (2018). Care Needed: Improving the Lives of People with Dementia. OECD Health Policy Studies. OECD Publishing: Paris. http://dx.doi.org/10.1787/9789264085107-en
  34. Pollock, A., & Fuggle, L. (2013). Designing for dementia: creating a therapeutic environment. Nursing and Residential Care, 15(6), 438-442. https://doi.org/10.12968/nrec.2013.15.6.438
  35. Rahman, S. (2017). Living well and promoting wellbeing. In Enhancing Health and Wellbeing in Dementia. Jessica Kingsley Publisher, 173-198.
  36. Reimer, M.A., Slaughter, S., Donaldson, C., Currie, G., & Eliasziw, M. (2004). Special care facility compared with traditional environments for dementia care: A longitudinal stuyd of quality of life. Journal of the American Geriatrics Society, 52(7), 1085-1092. https://doi.org/10.1111/j.1532-5415.2004.52304.x
  37. Sloane, P.D., Mitchell, M., Weisman, G., Zimmerman, S., Foley, K., Lynn, M., & et al. (2002). The therapeutic environment screening survey for nursing homes (TESS-NH): An observational instrument for assessing the physical environment of institutional settings for persons with dementia. Journal of Gerontology: Social Sciences, 57B(2), S69-S78.
  38. Smit, D., de Lange, J., Willemse, B., & Pot ,A.M. (2012). The relationship between small-scale care and activity involvement of residents with dementia. International Psychogeriatrics / IPA, 24(5), 722-32. doi:10.1017/S1041610211002377
  39. Soril, L.J.J., Leggett, L.E., Lorenzetti, D.L., Silvius, J., Robertson, D., Mansell, L., Holroyd-Leduc, J., Noseworthy, T.W., & Clement, F.M. (2014). Effective use of the built environment to manage behavioural and psychological symptoms of dementia: A systematic review. PLoS ONE, 9(12), e115425. https://doi.org/10.1371/journal.pone.0115425
  40. United Nations. (2020). World Population Ageing 2019. The United Nations: New York.
  41. University of Bradford. (2010). DCM 8 User's Manual. University of Bradford.
  42. Verbeek, H. (2011). Redesigning dementia care: An Evaluation of Small-Scale Homelike Care Environments. Doctoral Thesis. Universiteit Maastricht.
  43. Verbeek, H., Zwakhalen, S.M.G., van Rossum, E., Ambergen, T., Kempen, G.I.J.M., & Hamers, J.P.H. (2014). Effects of small-scale, home-like facilities in dementia care on residents' behavior, and use of physical restraints and psychotropic drugs: A quasi-experimental study. International Psychogeriatrics, 26(4), 657-68. doi:10.1017/ S1041610213002512
  44. Verbeek, H., Zwakhalen, S.M.G., van Rossum, E., Kempen, G.I.J.M., & Hamers, J.P.H. (2012). Small-scale, homelike facilities in dementia care: a process evaluation into the experiences of family caregivers and nursing staff. International Journal of Nursing Studies, 49(1), 21-29. https://doi.org/10.1016/j.ijnurstu.2011.07.008
  45. Verbeek, H., van Rossum, E., Zwakhalen, S.M.G., Ambergen, T., Kempen, G.I.J.M., & Hamers, J.P.H. (2009). The effects of small-scale, homelike facilities for older people with dementia on residents, family caregivers and staff: design of a longitudinal quasi-experimental study. BMC Geriatrics. 9(1):3. Doi:10.1186/1471-2318-9-3
  46. Verbeek, H., Zwakhalen, S.M., van Rossum, E., Ambergen, T., Kempen, G.I., & Hamers, J.P. (2010). Dementia care redesigned: Effects of small-scale living facilities on residents, their family caregivers, and staff. Journal of the American Medical Directors Association, 11, 662-670. doi:10.1016/j.jamda.2010.08.001
  47. Vermeerbergen, L., van Hootegem, G., & Benders, J. (2017). A comparison of working in small-scale and large-scale nursing homes: A systematic review of quantitative and qualitative evidence. International Journal of Nursing Studies, 67, 59-70. http://doi.org/10.1016/j.ijnurstu.2016.11.006
  48. Zeisel, J., Silverstein, N.M., Hyde, J., Levkoff, S., Lawton, M.P., & Holmes, W. (2003). Environmental correlates to behavioral health outcomes in Alzheimer's special care units. The Gerontologist, 43, 697-711. doi:10.1093/geront/43.5.697
  49. Zimmerman, S., Anderson, W.L., Brode, S., & et al. (2013). Systematic review: Effective characteristics of nursing homes and other residential long-term care settings for people with dementia. Journal of the American Geriatrics Society, 61(8),1399-1409. https://doi.org/10.1111/jgs.12372