Articles and 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

ICU Textbook Chapter: Intensive Care Unit Design: Current Standards and Future Trends

August 30, 2023 / Dochitect / Design for Critical Care

Book Chapter

Book Title: Irwin and Rippe’s Intensive Care Medicine, Ninth Edition
Book Editors: Richard S. Irwin , Craig M. Lilly MD
Publisher: Wolters Kluwer, 2023, ISBN/ISSN: 9781975181444
Chapter Title: Intensive Care Unit Design: Current Standards and Future Trends (Chapter 130)
Chapter Authors: Neil A. Halpern, Lilly A. Bothwell, and Diana C. Anderson

Except: The design of an intensive care unit (ICU) is a complex process and requires a multidisciplinary group of professionals. In 2010, there were approximately 6,100 ICUs with over 104,000 beds in the 3,100 acute care hospitals in the United States. ICU design itself is continuously evolving as new guidelines and regulatory standards are developed, clinical models are changing, and medical technologies are advancing. It is highly probable that hospital-based intensivist leaders will be asked at some point in their careers to participate in efforts to design new ICUs or renovate existing ones. This chapter provides an overview to a wide array of design issues and is divided into three sections: an overview of ICU design, configuring the ICU space, and future trends in ICU design.

Link to Purchase Book:

Intensive Care Unit Design: Current Standards and Future Trends Book Chapter

History of Critical Care Medicine: Four Decades of Intensive Care Unit Design Evolution and Thoughts for the Future

May 26, 2023 / Dochitect / Design for Critical Care

Book Chapter

Book Title: History of Critical Care Medicine (2023 = 70th anniversary), An Issue of Critical Care Clinics, 1st Edition
Book Editor: Hannah Wunsch, MD MSc
Publisher: Elsevier, 2023, ISBN: 9780323940115
Chapter Title: Four Decades of Intensive Care Unit Design Evolution and Thoughts for the Future
Chapter Authors: Neil A. Halpern, Elizabeth Scurth, Michelle Rausen, and Diana C. Anderson

Abstract: Intensive care unit (ICU) design has changed since the mid-1980s. Targeting timing and incorporation of the dynamic and evolutionary processes inherent in ICU design is not possible nationally. ICU design will continue evolving to incorporate new concepts of best design evidence and practice, better understandings of the needs of patients, visitors and staff, unremitting advances in diagnostic and therapeutic approaches, ICU technologies and informatics, and the ongoing search to best fit ICUs within greater hospital complexes. As the ideal ICU remains a moving target; the design process should include the ability for an ICU to evolve into the future.

Keywords: Critical care unit; Design; Evolution; Future-proofing; Informatics; Intensive care unit

Click HERE for more information.

Book Chapter

Residential Environments for Older Persons: A Comprehensive Literature Review (2005-2022)

April 20, 2023 / Dochitect / Design for Geriatrics

Peer-reviewed publication

Publication: Health Environments Research and Design
Publication Reference: 2023;19375867231152611. doi:10.1177/19375867231152611
Authors: Verderber S, Koyabashi U, Cruz CD, Sadat A, Anderson DC.
Date: April 20, 2023. Online ahead of print.

Abstract

Background: Independent noninstitutional and institutional residential long-term care environments for older persons have been the subject of significant empirical and qualitative research in the 2005–2022 period. A comprehensive review of this literature is reported, summarizing recent advancements in this rapidly expanding body of knowledge.

Purpose and Aim: This comprehensive review conceptually structures the recent literature on environment and aging to provide conceptual clarity and identify current and future trends.

Method and Result: Each source reviewed was classified as one of the five types—opinion piece/essay, cross-sectional empirical investigation, nonrandomized comparative investigation, randomized study, and policy review essay—within eight content categories: community-based aging in place; residentialism; nature, landscape, and biophilia; dementia special care units; voluntary/involuntary relocation; infection control/COVID-19, safety/environmental stress; ecological and cost-effective best practices; and recent design trends and prognostications.

Conclusions: Among the findings embodied in the 204 literature sources reviewed, all-private room long-term care residential units are generally safer and provide greater privacy and personal autonomy to residents, the deleterious impacts of involuntary relocation continue, family engagement in policy making and daily routines has increased, multigenerational independent living alternatives are increasing, the therapeutic role of nature and landscape is increasingly well-documented, ecological sustainability has increased in priority, and infection control measures are of high priority in the wake of the coronavirus pandemic. Discussion of the results of this comprehensive review sets the stage for further research and design advancements on this subject in light of the rapid aging of societies around the globe.

To access the full article click HERE.

Peer-Reviewed Publications

Built Environment Design Interventions at the Exits of Secured Dementia Care Units: A Review of the Empirical Literature

October 9, 2022 / Dochitect / Design for Geriatrics, Evidence-Based Design

Peer-reviewed publication

Publication: Health Environments Research and Design
Publication Reference: 2022 Oct 9;19375867221125930. doi: 10.1177/19375867221125930.
Authors: Anderson DC, Kota SS, Yeh L, & Budson AE
Date: October 9, 2022. Online ahead of print.

Abstract

Purpose: To review evidence around design interventions that influence exiting attempts in dementia care units, informing architectural and clinical practice.

Background: Built environment design is recognized as important in the care and management of responsive behaviors for those living with Alzheimer’s disease and other dementias in secured dementia care units (e.g., exiting attempts, agitation). The repetitious behavior of “walking with purpose” (previously termed wandering) in those with dementia has influenced safety-related architectural design components of dementia care units that decrease exiting attempts. Empirical literature addressing design interventions to prevent exiting for those with dementia is lacking and outdated.

Methods: We sought to describe known design techniques through a topical analysis of experimental studies. A thorough search for empirical studies that assessed interior design interventions at exit doors within dementia care units was undertaken. The review included an extensive search for existing literature and a screening of each study identified for its relevance, quality, and applicability.

Results: The experimental studies included in the review collectively assessed five interior design interventions at egress doorways: implementing horizontal and vertical floor grid patterns, mirrors, murals, conditioning responses to color cues, and camouflaging door hardware or vision panels. Why empirical studies have not continued more recently as built environment trends have shifted toward promoting meaningful and purposeful movement through design are considered. Advances in our understanding around the pathophysiology of dementia which might affect future design interventions related to egress are also identified.

Conclusion: The built environment is an important part of dementia care, and further prospective research is needed on the role of design interventions in the context of exiting attempts within secured units and subsequent behavior outcomes.

Keywords: Alzheimer’s disease; Built environment design; architecture; dementia; long-term care; nursing home; visual barriers; wandering.

Find the full article HERE.

Peer-Reviewed Publications

HERD Editorial: Evidence, Bioethics, and Design for Health

May 5, 2022 / Dochitect / Health Design & Ethics

Peer-reviewed publication

Publication: Health Environments Research and Design
Publication Reference: 2022, Vol. 15(2) 13-21
Author: Hamilton, DK

Editorial Excerpt

I like to tell my students that if there is compelling evidence that if design can improve clinical outcomes and patient safety, then healthcare architects have a moral and ethical responsibility to utilize such evidence. This is only a small step beyond every licensed architect’s obligation to protect the health, safety, and welfare of the public. Similarly, I propose that if credible evidence links design and outcomes, institutional boards and their executives have a moral obligation to engage architects, engineers, designers, and consultants who can and will effectively use such evidence

My colleague, Ray Pentecost, recently told me of a set of conversations he was having with friends about bioethics and responsibility as related to design evidence. It is a self-initiated, multidiscipline, and regionally distributed group including architects, physicians, and ethicists. The group’s overall focus adds a bioethics lens to the application of evidence in the health design field. They have been working for more than 2 years at the intersection of healthcare design and bioethics in order that healthcare environments and the way they are experienced can be markedly improved. The group perceives that despite well-intentioned healthcare administrators, architects, physicians, and others, the idea of connecting a strong, common ethos to a data-driven framework and research informed design for health has been slow to develop in comparison to other professions. Their ideas have slowly grown based on dialogue, publications, and presentations.

Pentecost (2022a) has produced an HERD guest editorial about the Union Internationale des Architectes Public Health Group (UIA/PHG) declaration of 2022 as the Year of Design for Health in our last issue. The group has an article published in Health Facilities Management (Hercules et al., 2022) and a piece in the Hastings Center Review (Anderson et al., 2022) and blog (Anderson et al., 2021). Hearing of their conversations led me to want to hear more. We arranged for some conversations on Zoom to further explore their ideas.

Figure 1. January 9, 2022, L to R, top to bottom; Hercules, Hamilton, Deemer, Pentecost, Anderson, Guenther, and Teti.

Read the full editorial HERE.

Peer-Reviewed Publications

The Bioethics of Built Space: Health Care Architecture as a Medical Intervention

May 1, 2022 / Dochitect / Health Design & Ethics

Peer-reviewed publication

Publication: The Hastings Center Report
Publication Reference: March-April 2022, https://doi.org/10.1002/hast.1353
Authors: Diana C. Anderson, Stowe Locke Teti, William J. Hercules, David A. Deemer

Abstract

Decisions made in health care architecture have profound effects on patients, families, and staff. Drawing on research in medicine, neuroscience, and psychology, design is being used increasingly often to alter specific behaviors, mediate interpersonal interactions, and affect patient outcomes. As a result, the built environment in health care should in some instances be considered akin to a medical intervention, subject to ethical scrutiny and involving protections for those affected. Here we present two case studies. The first includes work aimed at manipulating the behavior of persons with neurocognitive impairments, often in long-term care facilities. This is done to ensure safety and minimize conflicts with staff, but it raises questions about freedom, consent, and disclosure. The second concerns design science in service of improved outcomes, which involves research on improving patient outcomes or the performance of health care teams. There is evidence that in some ICU designs, certain rooms correlate to better outcomes, giving rise to questions about equity and fairness. In other cases, a facility’s architecture seems to be putting a finger on the scale of equipoise, raising questions about the intentionality of clinical judgment, freedom of choice, and disclosure. As a result of this innovation occurring outside the boundaries of traditional care delivery and oversight, important ethical questions emerge concerning both the individual patient and patient populations. We discuss, analyze, and make recommendations about each and suggest future directions for these and related issues.

Architecture and Bioethics: A new value proposition for health care facility designers

February 5, 2022 / Dochitect / Health Design & Ethics

Commentaries

Publication: Health Facilities Management Magazine
Publication Date: February 5, 2022
Authors: William J. Hercules, Diana C. Anderson, Stowe Locke Teti, David Deemer
View article

Excerpt:
“Johann Goethe, the 18th Century polymath, once remarked, “Architecture is frozen music,” by which he meant architecture interprets and expresses the values of its time — sometimes in a general epoch and sometimes at a very precise point. Experienced health care architects will appreciate this phenomenon, as current project drivers may have eclipsed those of decades past. It is in precisely this context that designers are studying the decisions and tradeoffs that result from these normative preferences.

In health care architecture, design is being increasingly employed to affect patient outcomes, alter specific behaviors and mediate the interactions of those within health care spaces. The advances in design science have progressed to the point that the built environment in health care can be considered akin to medical interventions. And, as with medical interventions, the nature, risks, benefits and alternatives should be disclosed to patients and caregivers.

The ethics of buildings and construction typically involve environmental impacts and social equity of the built environment. And while these are important, the focus of this article is on the health care setting itself and how it affects patients, families and health care teams. While some of these effects bear on individual patients, such that an informed consent process may be sufficient, others have a population-level impact that will persist for generations, well after the designer’s direct influence.

Focused work in medicine, neuroscience and psychology is being employed to several ends but, to date, there has been little investigation of these practices. This is because the elements affecting control are neither providers nor medications, but the health care facility building itself. Broadly, this raises issues about the nature of the built environment, what constitutes a medical intervention, what architecture is expected to do and, importantly, what obligations emerge from designers’ choices.”

Read the full article HERE.

Commentaries

No Place Like Home: As the pandemic proved, long-term care homes are a health hazard

September 1, 2021 / Dochitect / Design for Geriatrics, Design for Resiliency

Commentaries

Publication: Zoomer Magazine
Date: Published in print and online Aug/Sept 2021
Author: Nora underwood
View Article

As the COVID-19 pandemic proved, long-term care homes are a health hazard. In this Zoomer Article, Nora Underwood investigates how better building design can help.

Excerpt: For Dr. Diana Anderson, design is a parameter of care, as important as other determinants of health, such as where you live and what you eat. “We don’t talk about that a lot, but buildings have a huge impact on us,” says Anderson, a Boston-based doctor and architect who calls herself a “dochitect.” “It’s almost akin to a medical intervention. It has that much of an impact on people.”

Read the full article HERE.

Commentaries

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