Articles and Publications

Bioethics Peer Review: A Structured Evaluation Framework for Long-Term Care Environments

February 13, 2026 / Dochitect / Design for Geriatrics, Health Design & Ethics

Peer-reviewed publication

Publication: Journal of the American Medical Directors Association (JAMDA)
Title: Bioethics Peer Review: A Structured Evaluation Framework for Long-Term Care Environment
Authors: Anderson DC, Deemer DA, Hercules WJ, Teti SL,
Date: February 13, 2026

Abstract

Health care environments-particularly the built environment-can function like health care interventions, achieving medicine-like effects that shape the lived experience of persons in long-term care (LTC). Despite a growing body of evidence-based design research illustrating the clinical and behavioral influence of environmental conditions, these findings are not consistently incorporated into new LTC construction and renovation. This reflects divergent trajectories of knowledge development across medicine, architecture, and LTC operations. Because shortcomings in environmental design fall outside medical oversight, research protections, and enforceable architectural standards, opportunities to support safety, well-being, and autonomy often remain unrecognized. To address this gap, we developed the Bioethics Peer Review for Long-Term Care Design, a multidisciplinary evaluative process grounded in clinical ethics consultation and aligned with the 5M geriatric framework. We describe the model, its rationale, and lessons learned from pilot applications in 2 LTC facilities.

Book Review of Sick Architecture, by Beatriz Colomina, Nick Axel, and Guillermo S. Arsuaga. The MIT Press, 2025

November 21, 2025 / Dochitect / Evidence-Based Design, The Physician-Architect Model

Book Review

Publication: Sick Architecture, The MIT Press, 2025
Review Publication Date: Nov 21, 2025, Journal of Medical Humanities
Book Author: by Beatriz Colomina, Nick Axel, and Guillermo S. Arsuaga
Book Review Author: Diana C. Anderson, MD, MArch
View article

Excerpt:

Having spent my career at the intersection of architecture and medicine, I often reflected on historical timepoints when these junctures were most impactful to human health and sickness. I have repeatedly hoped for a deeper review and analysis of these inter-professional connections. Sick Architecture by Beatriz Colomina, Nick Axel, and Guillermo S. Arsuaga does just this.

Society of Critical Care Medicine 2024 Guideline on Adult ICU Design

February 21, 2025 / Dochitect / Design for Critical Care

Peer-Reviewed Design Guidelines

Publication: Critical Care Medicine
Publication Reference: February 21, 2025
Authors: Hamilton, D. Kirk PhD, MSOD, BArch, FCCM, Emeritus FAIA & FACHA; Gary, Jodie C. PhD, RN; Scruth, Elizabeth PhD, MPH, RN, CNS, CCRN, CCNS, FCCM, FCNS, CPHQ; Anderson, Harry L. III MD, FACS, FICS, FCCM, FCCP, FAIM; Cadenhead, Charles D. BArch, FCCM, Emeritus FAIA & FACHA; Oczkowski, Simon J. MD, MSc, MHSc; Lau, Vincent I. MD, MSc, FRCPC; Adler, Jason MD, MBA, FCCM, FAAP, FCCP; Bassily-Marcus, Adel MD, FCCM; Bassin, Benjamin S. MD, FACEP, EDAC; Boyd, Joel MBA, BSRT, RCP; Busl, Katharina M. MD, MS; Crabb, James R. PE; Harvey, Clifford BA, BArch, MSc(HQ), OAA, FRAIC; Hecht, Jason P. PharmD, BCPS, BCCCP, FCCM; Herweijer, Milee Dr.Ir.; Gunnerson, Kyle J. MD, FCCM; Ibrahim, Abdullahi S. RN, CCRN, BNSc; Jabaley, Craig S. MD, FCCM; Kaplan, Lewis J. MD, FACS, FCCP, FCCM; Monchar, Sarah MS, PA-C, MBA, FCCM; Moody, Andrew MD; Read, Julie Lindeman DNP, MS, RN, NE-BC; Christian Renne, B. MD; Sarosi, Michael G. MD; Swoboda, Sandra M. DNP, RN, FCCM; Thompson-Brazill, Kelly A. DNP, ACNP-BC, FCCM; Wells, Chris L. PhD, PT, CCS, ATC, FCCM; Anderson, Diana C. MD, MArch, FACHA.

Advances in technology, infection control challenges—as with the COVID-19 pandemic—and evolution in patient- and family-centered care highlight ideal aspects of ICU design and opportunities for enhancement. These guidelines provide evidence-based recommendations for clinicians, administrators, and healthcare architects to optimize design strategies in new or renovation projects.

The guidelines panel issued 17 recommendations based on 15 Population, Intervention, Comparison, and Outcome (PICO) questions relating to ICU architecture and design. The panel strongly recommends high-visibility ICU layouts, with windows and natural lighting in patient rooms to enhance sleep and recovery. The panel suggests integrated staff break/respite spaces, advanced infection prevention features, and flexible surge capacity. Because of insufficient evidence, the panel could not make a recommendation regarding in-room supplies, decentralized charting, and advanced heating, ventilation, and air conditioning systems.

Read the full guideline document HERE and the executive summary version HERE.

Peer-Reviewed Design Guidelines

When Deception Promotes Dignity: The Ethics of Using Illusion to Create Safe Spaces for Persons Living with Dementia

February 14, 2025 / Dochitect / Design for Geriatrics, Health Design & Ethics

Peer-reviewed publication

Publication: The International Journal of Whole Person Care
Publication Title: When Deception Promotes Dignity: The Ethics of Using Illusion to Create Safe Spaces for Persons Living with Dementia
Authors: Teti SL, Deemer DA, Hercules WJ, Anderson DC
Date: February 14, 2025

Abstract

Birds Eye view shot: messy hospital bed, single blooming Epiphyllum oxypetalum flower, sombre black background, minimalist style –profile arb84yc –v 6.1 Job ID: c2d22433-efeb-4ceb-a791-11648fbc9733

Caring for persons living with dementia (PLWD) is challenging. Some of the most challenging aspects include managing behavioral and psychologic symptoms of dementia (BPSD). Many patients and families will consider dementia care facilities to better manage BPSD, which can contain design elements that use the physical environment to decrease BPSD by deceiving residents and controlling their behavior—all for their own benefit and safety. This immersive approach to behavior management represents a more holistic way to manage BPSD. Considering the especially vulnerable status of PLWD, these design elements should be thoughtfully implemented, researched post-implementation, and discussed with patients and their loved ones. The design-based approach to managing BPSD demonstrates the obligation healthcare providers and facility designers have to be more holistic in designing care environments for PLWD, especially for those living in dementia care facilities.

Read the full article HERE.

Peer-Reviewed Publications

Windows in the ICU and Postoperative Delirium: A Retrospective Cohort Study

January 13, 2025 / Dochitect / Design for Critical Care, Design for Geriatrics

Peer-reviewed publication

Publication: Critical Care Medicine Journal
Publication Title: Windows in the ICU and Postoperative Delirium: A Retrospective Cohort Study
Authors: Anderson DC, Warner PE, Smith MR, Albanese ML, Mueller AL, Messervy J, Renne BC, Smith SJ.
Date: January 13, 2025

Abstract

Objectives: The ICU built environment-including the presence of windows-has long been thought to play a role in delirium. This study investigated the association between the presence or absence of windows in patient rooms and ICU delirium.

Design: Retrospective single institution cohort study. Delirium was assessed with the Confusion Assessment Method for the ICU.

Setting and patients: ICU patients between January 1, 2020, and September 1, 2023, were categorized into windowed or nonwindowed groups based on their ICU room design. The primary outcome was the presence or absence of delirium at any time during the patient’s ICU stay. Secondary outcomes included the presence of delirium during the first 7 days of the ICU stay, hospital length of stay, ICU length of stay, in-hospital mortality, pain scores, and Richmond Agitation-Sedation Scale scores.

Interventions: None.

Measurements and main results: A total of 3527 patient encounters were included in the final analysis, of which 1292 distinct patient encounters were admitted to a room without windows (37%). Delirium was observed in 21% of patients (460/2235) in windowed rooms and 16% of patients (206/1292) in nonwindowed rooms. In adjusted analyses, patients in windowed rooms were associated with an increase in the odds of the presence of delirium (odds ratio, 1.29; 95% CI, 1.07-1.56; p = 0.008). Patients in windowed rooms were found to have longer hospital (adjusted hazard ratio [aHR], 0.94; 95% CI, 0.87-1.00) and ICU length of stay (aHR, 0.93; 95% CI, 0.87-1.00) compared with patients in the nonwindowed rooms, although this was not statistically significant in adjusted analyses (p = 0.06 and 0.05, respectively). No statistically significant difference was observed in other secondary outcomes.

Conclusions: The current study provides insightful information regarding associations between a component of the ICU built environment, specifically the presence or absence of windows, and the frequency of delirium.

Who Should Contribute to Decisions About Health Care Space Design?

December 1, 2024 / Dochitect / Health Design & Ethics

Peer-reviewed publication

Publication: AMA Journal of Ethics – American Medical Association
Publication Title: Who Should Contribute to Decisions About Health Care Space Design?
Authors: Anderson DC, Teti, SL
Date: December 1, 2024

Abstract

This commentary on a case considers how and by whom decisions about health care structures and spaces should be made and suggests merits and drawbacks of shared decision-making as one approach to Certificate of Need assessments.

PLoS One: Impact of remote social interaction during the COVID-19 pandemic on the cognitive and psychological status of older adults with and without cognitive impairment: A randomized controlled study

November 12, 2024 / Dochitect / Design for Geriatrics

Peer-reviewed publication

Publication: PLoS One
Publication Title: Impact of remote social interaction during the COVID-19 pandemic on the cognitive and psychological status of older adults with and without cognitive impairment: A randomized controlled study
Authors: Vives-Rodriguez AL, Marin A, Schiloski KA, Hajos GP, Di Crosta A, Ceccato I, La Malva P, Anderson DC, Lahdo N, Donnelly K, Dong J, Kasha S, Rooney C, Dayaw J, Marton G, Wack A, Hanger V, DeCaro R, Di Domenico A, Turk KW, Palumbo R, Budson AE.
Date: 2024;19(11):e0311792. Published 2024 Nov 12.

Click HERE to access the full article.

Peer-Reviewed Publications

Neurology Clinical Practice: An Interprofessional Team for Disease-Modifying Therapy in Alzheimer Disease Implementation

August 16, 2024 / Dochitect / Design for Geriatrics

Peer-reviewed publication

Publication: Neurology Clinical Practice
Publication Title: An Interprofessional Team for Disease-Modifying Therapy in Alzheimer Disease Implementation
Authors: Katherine W. Turk, MD, Mark D. Knobel, MD, PhD, Alexandra Nothern, MD, Garrett Friedman, MD, Hannah Noah, MPH, MD, Brendan Campbell, MD, Diana C. Anderson, MD, MArch, Andreas Charidimou, MD, PhD, Andrew Mills, MD, Vanessa Coronel, MSN, RN, Nacha Pierre, MSN, RN, Beverly V. Reynolds, MPAS, PA-C, Caroline Wagner, PharmD, Leanne M. Varga, PharmD, John Roefaro, PharmD, Laura Triantafylidis, PharmD, and Andrew E. Budson, MD
Date: 2024 Dec;14(6):e200346. doi: 10.1212/CPJ.0000000000200346. Epub 2024 Aug 16.

Read the full article HERE.

Peer-Reviewed Publications

AMA Journal of Ethics: How Should Organizations Be Held Accountable for Promoting Environments That Foster Social Connection?

November 1, 2023 / Dochitect / Health Design & Ethics

Peer-reviewed publication

Publication: AMA Journal of Ethics
Publication Title: How Should Organizations Be Held Accountable for Promoting Environments That Foster Social Connection?
Authors: David A. Deemer, MD, MA, Erin K. Peavey, MArch, Stowe Locke Teti, MA, William J. Hercules, MArch, Jocelyn Wong, MBE, and Diana C. Anderson, MD, MArch
Date: Online Nov 1, 2023

Abstract
Growing familiarity with health risks of loneliness and isolation underscores the importance of social connection in patients’ lived environments and communities. Deficits in social connection are linked to poor cognitive, mental, and physical health and premature death. Design interventions for physical environments—structures, spaces, and soundscapes, for example—can foster social connection, support, and resilience. This article canvasses urban interventions that can support human health investment and development. This article also suggests that designers of community policies, programs, structures, and spaces should be accountable for promoting social connection to help generate measurable health outcomes, such as longevity.

Click HERE to access the full article.

Peer-Reviewed Publications

Characteristics of Home and Neighborhood Built Environments During COVID-19 for Older Adults in the United States and Italy

October 25, 2023 / Dochitect / Design for Geriatrics

Peer-reviewed publication

Publication: Journal of Aging and Environment
Publication Title: Characteristics of Home and Neighborhood Built Environments During COVID-19 for Older Adults in the United States and Italy
Authors: Diana C. Anderson, Renée E. DeCaro, Myna Chadalavada, Anna Marin, Adolfo Di Crosta, Irene Ceccato, Pasquale La Malva, Nicola Mammarella, Alberto Di Domenico, Katherine W. Turk, Rocco Palumbo & Andrew E. Budson
Date: Online Oct 25, 2023 DOI: 10.1080/26892618.2023.2269552

Research Article Abstract

The home and neighborhood environments impact the social and mental health of older adults, yet little research has addressed the various contexts that can affect these relationships, such as community culture, built and natural elements, and demographics. This survey-based study examined community-dwelling older adults’ access and use of transitional outdoor/indoor space (i.e., porches, gardens, windows, etc.), and how that use was related to health variables and changed with the pandemic in two available samples of older adults in the United States and Italy. Use of both outdoor and indoor space was found to be more individualistic in Boston, in the United States, than in Chieti, Italy, where use of these areas with others was more common. Results suggest that window viewing from within the home may be an activity that individuals in Italy engage in when feeling lonely. Changes in the use of home and community space after COVID-19 were minimal; only in the United States did individuals report greater time indoors since the onset of the pandemic. Use of the built environment in and around the home by older adults was found to have multidimensional characteristics between the United States and Italy, with the potential to foster connections and improve well-being.

Click HERE to access the article.

Peer-Reviewed Publications

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