Annals of Long Term Care

The physical environment can play a significant role in treatment for and associated outcomes of LTC facility residents with dementia. The purpose of this article is to discuss the needs of this population and highlight research that demonstrates how relatively simple design modifications to the physical environment of existing facilities can have significant benefits for this population. Future research should explore how the physical environment impacts individuals at different stages of dementia, since many studies focus only on individuals with early-stage dementia or ignore the severity of dementia altogether. In addition, any adaptations to the physical environment should take into account factors such as ethic diversity, the needs of visiting families, and the potential to integrate community activities. (Annals of Long-Term Care: Clinical Care and Aging 2010;18[5]:43-45)

Introduction
Within the healthcare profession there is a growing recognition that the physical environment can play a significant role in the treatment of patients and associated outcomes. One area that has received considerable attention over the last two or three decades has been the design of environments for people with dementia, and some extensive reviews of the research in this field have been published.¹ The purpose of this article is to highlight research that demonstrates how “cost-effective” (ie, relatively simple) design modifications to the physical environment of existing long-term care (LTC) settings can have significant benefits for people with dementia.

While we recognize that the majority of people with dementia are cared for within their own home environment, the expected increase in this condition will inevitably result in more individuals being cared for in specialized units. Our hope is that by raising awareness of relatively low-cost environmental changes in healthcare environments such as LTC settings, the impact may be greater than more extensive reviews that highlight the importance of such large-scale changes as building configuration and the provision of garden spaces. This article will discuss three aspects of the physical environment: (1) environmental safety features; (2) manipulation of the physical space to support a variety of activities; and (3) the importance of signage and ensuring optimum levels of stimulation for residents.

Before reviewing research in this area, it is necessary to briefly explain both the rationale for including studies in this review and the theoretical explanations for the importance of the physical environment for dementia. The design of the environment for an individual with dementia can be incredibly important for the well-being and independence of that person. For this purpose it is useful to think of dementia as a disability, one that causes a steady decrease in a person’s cognitive abilities. Lawton’s “environmental docility hypothesis”² states that normal living environments can be increasingly disabling for a person with a disability, especially as the disability worsens. However, the positive side to this theory, according to Lawton, is that even the smallest environmental modification can have a disproportionate effect on the well-being and independence of a person who is disabled by his/her environment.

Another useful perspective to consider is the “behavior-constraint approach.”³ This is commonly used in Environmental Psychology research and is concerned with a person's perceived control over his/her environment.