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Physical environmental designs in residential care to improve quality of life of older people

Physical environmental designs in residential care to improve quality of life of older people

What is the aim of the review?

There is an increasing older population worldwide and an increase in the numbers of people living with dementia. It has been suggested that improving lived area designs may improve quality of life, mood, and ability to perform daily living activities of aged care residents. The aim of this Cochrane review was to examine the effects of different physical environmental design changes in residential aged care to determine the effect on quality of life for the residents. The review authors collected and analysed all relevant studies to answer this question and found 20 studies.

Key messages

We are uncertain of the effects of design changes in residential aged care to improve quality of life for residents because more high‐quality studies are needed.

What was studied in the review?

The review studied changes to physical environmental design in residential aged care, referring to any changes to the environment in which residents live, in an aim to improve their quality of life. These may be large‐scale or small‐scale changes. Large‐scale changes can be changes to the design of residential care such as changing from the currently used lived‐area designs to home‐like designs with smaller numbers of residents living together. Small‐scale changes may involve refurbishing the lived area or changing a single part of the lived area such as lighting. We included studies which compared different large‐scale or small design changes in residential aged care, or compared design changes to currently used lived‐area designs and examined the effect of design changes on quality of life, behaviour and daily living activities for the residents. There is no one definition of quality of life agreed upon, but most definitions include multiple aspects of a person’s expectations for their life, such as physical, mental, and emotional health, social activity and life situation.

What are the main results of the review?

The review authors found 20 relevant studies that took place in nine different countries (Australia, Canada, Germany, Italy, the Netherlands, Spain, Sweden, the UK and the USA). The main design change which was investigated was the effect of creating a 'home‐like' model of care which usually involved creating small‐scale living units for residents and changes to care practices such as changes to staffing or choices residents had on daily routines.  

Six studies examined changes to the size of the building to limit the number of residents per living unit ranging between six and fifteen residents per living unit, in addition to changing care practices, for example, changes to staffing, or changes to the choices residents had for their daily routines. One study examined quality of life, but there was insufficient information presented to draw conclusions. Three studies examined behaviour; one study found little or no difference in behaviour and two studies provided insufficient information to draw conclusions. Two studies examined depression and reported little or no difference in depressive symptoms or the effect was uncertain. Four studies examined daily living activities; one study reported improvement in daily living activities, one study reported little or no difference in daily living activities, and two studies provided insufficient information to draw conclusions. One study reported a reduction in serious adverse effects (the use of physical restraints).  We are uncertain of the effects of home‐like models of care on quality of life, behaviour, depression, daily living activities or serious adverse effects because the certainty (confidence) of the studies was determined to be very low due to issues with study design.

The other fourteen studies examined smaller design interventions such as refurbishment without changes to the scale of the building, special care units for people with dementia, different corridor designs, bright lighting, redesign of the dining room and an indoor garden. 

How up‐to‐date is this review?

The review authors searched for studies up to February 2021.