Design for Geriatrics

The Center for Health Design EBD Journal Club: Built Environment Design Interventions at the Exits of Secured Dementia Care Units

December 8, 2022 / Dochitect / Design for Geriatrics, Evidence-Based Design

Webinar

Journal Club Title: Built Environment Design Interventions at the Exits of Secured Dementia Care Units: A Review of the Empirical Literature
Journal Club Date: December 8, 2022
Moderator: Addie M Abushousheh, PhD, EDAC, Assoc AIA
Discussant: Diana Anderson, MD, M.Arch
Organization: The Center for Health Design

The EBD Journal Club

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 Empirical literature addressing design interventions to prevent exiting for those with dementia is lacking and outdated.

To advance our understanding, the presenter sought to describe design interventions in dementia care units through a topical analysis of experimental studies. The studies 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.

Click HERE for more information.

Webinars

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

RAIC 2022 Keynote: Architectural Design as a Determinant of Heath

June 8, 2022 / Dochitect / Design for Geriatrics

Presentations

Event: Invited Keynote Speaker, Royal Architectural Institute of Canada (RAIC) Long Term Care Working Group, RAIC 2022 Virtual Conference on Architecture
Title: Architectural Design as a Determinant of Heath
Date: June 8, 2022

Lecture Overview

A growing body of empirical data and evidence-based design research demonstrates that architecture impacts care delivery as well as health outcomes. This talk explores built space as an important determinant of health and questions whether the built environment itself should be considered alongside other parameters of care, analogous to our medical interventions. A current focus on design equity, ensuring overall accessibility to healthcare built space, is explored. It is imperative that we consider a convergence of the healthcare and design disciplines in order to promote novel solutions to augment built environment resilience and subsequently support equitable, safe and efficient care delivery.

Learning Objectives

Describe how built space is an important determinant of health, to be considered alongside other parameters of care
Identify empirical data linking the built environment with health outcomes
Consider ethical questions raised with long term care design, particularly in the setting of cognitive impairment
Classify design for health within the existing clinical 5M framework

For more information see the conference program HERE.

Keynote Presentations

Wolters Kluwer Health: Advances in Brain Health

October 12, 2021 / Dochitect / Design for Geriatrics, Health Design & Ethics

Presentations

Event: Advances in Brain Health, hosted by Wolters Kluwer Health
Panelists: José Biller MD, Jason Karlawish MD, Diana Anderson MD
Date: October 12, 2021

Panel Discussion: Advances in Brain Health

Please join us for an interactive discussion about new and evolving topics in the treatment of neurological diseases and new ways to consider the long-term health of your patients. Join experts as they discuss current topics in neurology, including:

Next steps in the diagnosis and treatment of Alzheimer’s
Long COVID and its relationship with neurological symptoms
Evidence-based design health impacts of the built environment in dementia and other neurological disorder

Panelists:

José Biller, MD, Professor and Chair, Department of Neurology, Loyola University Stritch School of Medicine, Loyola University Medical Center; Editor, Journal of Stroke and Cerebrovascular Diseases

Jason Karlawish, MD, Professor of Medicine, Medical Ethics and Health Policy, and Neurology, University of Pennsylvania; Co-Director, Penn Memory Center; Author, The Problem of Alzheimer’s: How Science, Culture, and Politics Turned a Rare Disease into a Crisis and What We Can Do About It

Diana Anderson, MD, M.Arch, ACHA, Founder, Dochitect, Fellow in Geriatric Neurology, VA Boston Healthcare System, Instructor of Neurology, Boston University School of Medicine

Moderator: Susan Dentzer, Senior Policy Fellow, Duke-Margolis Center for Health Policy, Duke University

Panel Discussions

Nursing Home Design and COVID-19: Balancing Infection Control, Quality of Life, and Resilience

October 11, 2021 / Dochitect / Design for Geriatrics, Design for Resiliency, Health Design & Ethics

Presentations

Event: American Health Care Association / National Center for Assisted Living (AHCA/NCAL) 2021 Convention and Expo, Washington, DC
Speakers: Diana Anderson MD M.Arch, Thomas Grey Dip.Arch.B.Arch.Sci.MArch., Desmond O’Neill MD
Date: October 11, 2021

Nursing Home Design and COVID-19: Balancing Infection Control, Quality of Life, and Resilience

Many nursing home design models can have a negative impact on older people, and these flaws have been compounded by COVID-19 and related infection-control failures. There is now an urgent need to examine these models and provide alternative and holistic models that balance infection control and quality of life at multiple spatial scales in existing and proposed settings. Moreover, there is an understanding that certain design models and approaches that improve quality of life will also benefit infection control, support greater resilience, and in turn improve overall pandemic preparedness.

3 Learning Outcomes:
Upon completion, participant will be able to:
1) explain the overall impact of the built environment on nursing home residents in terms of quality of life
2) understand the main built environment related infection control issues that have arisen during COVID
3) explain how certain design approaches and models can be use to balance infection control while improving quality of life

Conference Presentations

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

Jewish Hospital Foundation’s 2021 Patient Safety Fellowship: Ethics and Design in the Long-Term Care Setting

July 20, 2021 / Dochitect / Design for Geriatrics, Health Design & Ethics

Presentations

Event: Jewish Hospital Foundation’s 2021 Patient Safety Fellowship
Title: Ethics and Design in the Long-Term Care Setting
Date: July 20, 2021

The Jewish Healthcare Foundation’s 2021 Patient Safety Fellowship will offer a unique curriculum to explore the challenges and opportunities facing senior residential living and senior care. After the disruption of COVID-19, options for seniors must embrace creative solutions that help individuals age well and safely in a range of settings. Fellows, working across disciplines — including health care, public policy, public health, tech, architecture, and beyond — will explore existing and conceptional models for transforming our community and healthcare systems that maximize quality of life for seniors and families. New models of care need to be wired for safety, built for continuous improvement, and efficient for providers, seniors, and families.

As part of the 2021 fellowship program, Dr. Anderson lectured around design ethics in clinical and long-term care settings.

Lectures

2021 European Healthcare Design Congress

June 14, 2021 / Dochitect / Design for Geriatrics, Design for the Future of Health

Presentations

Event: 2021 European Healthcare Design Congress
Dates: June 14-17, 2021

June 14, 2021
Session: Deconstructing the hospital to save itChair: Ganesh Suntharalingam, Intensive Care Society, UK
Panelists: William Hercules, WJH Health, USA; Benjamin Bassin; Cemal Sozener, University of Michigan Health System, USA; Diana Anderson, VA Boston Health System, USA

June 15, 2021
Session: Environments for modern ward rounds for multidisciplinary inpatient review
The Royal College of Physicians and Royal College of Nursing, together with the Royal Pharmaceutical Society, Chartered Society of Physiotherapy and NHS Improvement, have developed updated guidance on ‘Modern ward rounds for multidisciplinary care in hospital wards’. Key elements include: space for multi-professional confidential discussion about and with patients; reducing noise levels to improve cognition; minimising interruptions; interactions with technology to improve information sharing and records; reducing hierarchy to improve communication; and decision-making. This workshop will explore opportunities and challenges in hospital wards to creating the best environment for high-quality multidisciplinary care.

Chair: John Dean, Royal College of Physicians, UK
Panelists: Andrew Rochford, NHS England & NHS Improvement, UK; Nicky Ashby, Royal College of Nursing, UK; Jennifer Flatman, Royal College of Physicians; Clinical pharmacist, UK; Diana Anderson, Jacobs, USA; Cemal B Sozener, University of Michigan Medical School, USA; Bill Hercules, WJH Health, USA Lynne Quinney, Patient representative, UK

June 16, 2021
Session: Nursing home design and Covid-19: balancing infection control, quality of life,
and resilience
Chair: Sylvia Wyatt, Health and care strategic advisor and consultant, UK
Panelists:Thomas Grey, Trinity College Dublin, Ireland; Diana C Anderson, VA Boston Health System, USA

June 17, 2021
Session: How will Covid-19 change healthcare design?
Chair: Paul Bell, Ryder Architecture, UK
Panelists: Matthew Holmes, Jacobs, Australia; Diana C Anderson, VA Boston Healthcare System, USA; Jacobs, USA

Nursing Home Design and COVID-19: Balancing Infection Control,Quality of Life, and Resilience

October 31, 2020 / Dochitect / Design for Geriatrics, Design for Infection Control, Design for Resiliency

Peer-reviewed publication

Publication: JAMDA – The Journal of Post-Acute and Long Term Care Medicine
Publication Reference: COVID-19 Special Article| Volume 21, ISSUE 11, P1519-1524, November 01, 2020
Authors: Anderson DC, Grey T, Kennelly S, O’Neill D

Abstract
Many nursing home design models can have a negative impact on older people and these flaws have been compounded by Coronavirus Disease 2019 and related infection control failures. This article proposes that there is now an urgent need to examine these architectural design models and provide alternative and holistic models that balance infection control and quality of life at multiple spatial scales in existing and proposed settings. Moreover, this article argues that there is a convergence on many fronts between these issues and that certain design models and approaches that improve quality of life, will also benefit infection control, support greater resilience, and in turn improve overall pandemic preparedness.

Access the full article HERE.

Peer-Reviewed Publications

AdvantAge Ontario: Designing the Long-Term Care Home for COVID and Beyond

August 31, 2020 / Dochitect / Design for Geriatrics, Design for Infection Control, Design for Resiliency

Webinar

Webinar Title: Designing the Long-Term Care Home for COVID and Beyond
Webinar Date: August 31, 2020
Organization: AdvantAge Ontario

Monday, August 31, 2020 | 2:00pm – 4:00pm

AdvantAge Ontario is the association of not-for-profit long term care, housing, and services for seniors: “We’ve seen through the pandemic how a long-term care home’s design can acutely influence its ability to prevent and respond to infection outbreaks. But design also affects many other important elements of LTC living. Whether you’re building new, redeveloping, or thinking about adaptations to your existing building, this webinar will equip you with essential knowledge and fresh ideas to consider as you plan. We’ll have a detailed discussion of current design standards and recent changes, what they could mean for your home, and the less understood role of mechanical engineering. Learn about the influence of design on infection control and alternative design approaches that also address other aspects of resident well-being, such as smaller clustered settings. Examples of the impact of design during the pandemic’s spring surge will be reviewed and the implications of provincial funding announcements will be discussed. Bring all your questions for the final part of this timely session.”

Click HERE to access the webinar recording.

Webinars

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