Design for Geriatrics

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

2020 AIASF Design for Aging Symposium

August 13, 2020 / Dochitect / Design for Geriatrics

Webinar

Webinar Title: Designing for Health: COVID-19 + the Future of Senior Living Architecture
Webinar Date: August 13, 2020
Organization: 2020 AIASF Design for Aging Symposium

Day 1: Thursday, August 13 | 9:00 AM – 11:00 AM (PST) (2.0 LUs)
Designing for Health: COVID-19 + the Future of Senior Living Architecture

Keynote
Rodney Harrell, Ph.D., Vice-President, Family, Home + Community, AARP

Moderator
Kris Rebillot, Director of Communications, Buck Institute

Speakers
Diana Anderson, MD, M.Arch, Dochitect/Principal, Jacobs
Deborah Burnett, ASID, IES, AASM, Principal, Benya Burnett Consultancy
Leslie Moldow, FAIA, Principal, Perkins Eastman
John Newman, MD, Ph.D., Assistant Professor, Buck Institute and Division of Geriatrics, UCSF
Leah Witt, M.D., Assistant Professor, UCSF Geriatrics Department of Medicine

Webinars

Ethical Dilemmas in Dementia Care Design

January 31, 2020 / Dochitect / Design for Geriatrics, Health Design & Ethics

Blog Post

Publication: CLOSLER.org, Johns Hopkins Medicine
Title: Ethical Dilemmas in Dementia Care Design
Publication Date: January 31, 2020
Author: Diana Anderson, MD

View Blog Post

The Seven Lamps of Architecture, written in 1849 by the English art critic and theorist John Ruskin, embodies the principles that good architecture must meet. One of the lamps is truth. Do our dementia care designs break this core architectural value?

Closler.org has an email subscription of ~6,000 healthcare providers
and is regularly visited by thousands of individuals from 70 countries.

Blog Post

The Intersection of Architecture/Medicine/Quality and the Clinical Nurse Specialist: Designing for the Prevention of Delirium

December 2, 2019 / Dochitect / Design for Geriatrics, Design for Patient Safety, Evidence-Based Design

Peer-reviewed publication

Publication: Clinical Nurse Specialist (The International Journal for Advanced Nursing Practice)
Publication Reference: 34(1):5-7, January/February 2020
Author: Anderson, Diana C.; Jacoby, Sonya R.; Scruth, Elizabeth Ann

Excerpt:

“We call it the delirium room,” my colleagues would say about a hospital room where, anecdotally, it was noticed that more patients tended to become delirious. I went to visit it—the door squeaked with each swing, there was minimal daylight with the window view being a neighboring wall, and the room faced the constantly noisy nursing station.What insights can architectural design provide toward our understanding of delirium and models of care?

What if “the delirium room” did not incite delirium but instead prevented and even treated it?

Read more about Delirium and Design HERE.

Peer-Reviewed Publications

Geriatric Care at the Intersection of Medicine and Architecture

February 27, 2018 / Dochitect / Design for Geriatrics

Webinar

Webinar Title: Geriatric Care at the Intersection of Medicine and Architecture
Webinar Date: February 27, 2018
Organization: Regional Geriatric Program of Toronto

Overview:

Healthcare design’s recent revolution towards improved patient well-being and care delivery has remained similar for several decades. Can we disrupt our current design thinking by combining medicine and architecture in order to reinvent some best practice design trends for an aging community?

By combining the knowledge of geriatric medicine and physical environmental design, the focus on prevention, rehabilitation, and independent living can allow for the building itself to become the fourth healer in addition to the patient, their family members and the clinical care team.

Webinar Feedback from Geriatricians, Clinical Staff and Administrators:

“Some of the topics presented have been things I’ve wondered about or thought myself. So this webinar has given me more confidence to suggest changes and to share this same info to others.”

“I will consider this information when doing any type of renovation or furniture purchase for our hospital. With limited funding, we can be creative in how we improve our space to meet the needs of our patients.”

“I will look for opportunities to take patients to windows and more nature friendly spaces when in my care and as much as possible.”

“I may consider approaching the patient differently. I will pass on the information to my CEO. We are currently in the process of building a new hospital and I think the information was amazing.”

“I will consider different options in areas where there is no window or natural light.”

“I will try to remember the inherent dangers that hospitals pose for patients (e.g., infections, falls, de-conditioning, pressure sores, etc) and try to always emphasize prevention over treatment.”

Webinars

Disruptive Innovation: Is it time to re-think our healthcare design strategies?

November 14, 2016 / Dochitect / Design for Clinical Staff, Design for Geriatrics

Presentations

Presentation Title: Disruptive Innovation: Is it time to re-think our healthcare design strategies?
Event: Healthcare Design Expo & Conference 2016
Presentation Date: November 14, 2016
Event Location: Houston, Texas

Dr. Anderson co-leads a round table session with Dr. George Taffet, MD, FACP, Chief, Geriatrics, Baylor College of Medicine, Houston Methodist Hospital, to discuss the impact of space design on geriatric patients and clinical staff.

Session Description:

Healthcare design’s recent revolution towards improved patient experience and care delivery has remained similar for several decades. Hospital activist Dr. Leland Kaiser stated that “The hospital is a human invention and as such can be reinvented any time.” Given that there is no therapeutic value to strict bed rest, which can in fact be detrimental and lead to deconditioning- most notably in the elderly population, should the patient bed continue to be the focal point around which we design the room? Hospital corridors are already dynamic spaces of patient physical therapy, multidisciplinary team rounding, family discussions and infection control practices. Can a hospital corridor become more than a long narrow space with equipment spilling over and laundry bins scattered throughout? The notion of separating patient and staff circulation has become best practice in healthcare design over recent years. With healthcare moving in the direction of the patient becoming the advocate of their own healthcare and clinicians providing the expertise to aid patients in their decision-making, should the physical design separate what the clinical model is trying to unify? It may be time to disrupt our current design thinking and reinvent some best practice design trends.

Learning Objectives:

To challenge current healthcare design thinking through the integration of medical knowledge and upcoming clinical trends.
Outline new ways of thinking about the space needs of clinicians by considering staff utilization of space given changing medical practices, including areas for information transfer and multidisciplinary rounding practices.
Understand the geriatric patient needs and how to accommodate complex chronic illness models within the built environment.
Review circulation and flow patterns of clinicians, patients and visitors in order to discuss the on-stage/off-stage model of wayfinding within an acute care space versus the ambulatory care model.

Session Panels:

Conference Presentations

A View From and On the Window

July 1, 2014 / Dochitect / Design for Geriatrics

Letter to the Editors

Publication: Health Environments Research & Design Journal, Letter to the Editors
Publication Reference: 2014 Summer;7(4):135-9.
Authors: Penelope Ann Shaw, PhD, & Diana C. Anderson, MD, MRAIC, LEED AP

View article

Excerpt: One of us, Diana Anderson, is a physician and an architect whose career is aimed at bridging the gap that exists between medicine, research, and architecture in order to improve design and operational efficiency of the clinical environment. She has worked in many hospitals and healthcare environments that are not supportive of staff well-being nor sometimes even patient healing. Dr. Anderson often uses clinical anecdotes in her writing, linking them back to design in order to increase awareness of design’s impact among her clinical colleagues. A recently published piece in the Journal of the American Geriatrics Society entitled Rx: Window Bed recounted her experience with critical care unit delirium and the potential impact of windows on a patient’s physiologic response; a synopsis of this encounter is detailed below.

The other author, Penelope Ann Shaw (Penny), is a nursing home resident who has been living in a facility in a bed by a window for 11 years. She is a survivor of critical care (having spent 4 months in an ICU on life support) from an acute phase of Guillain-Barre syndrome, a rare neuromuscular disorder in which a person’s immune system damages the nerve cells, in her case causing almost total paralysis. That was followed by a year in a respiratory rehabilitation hospital. Of the 11 years in her current facility, she was mostly in bed for 3½ years with a tracheostomy and a feeding tube.

Penny reached out to Diana after reading that piece in the Journal of the American Geriatrics Society in order to relate her story of how a window changed her experience dramatically while in long-term care. They teamed up to write a piece that builds on the topic of windows and exterior views. In the following sections, they provide insight into how these architectural elements can be life changing for patients and of vital importance for staff.

Read the complete letter to the editors including Penny’s patient perspective and Diana’s physician-architect perspective.

Letters to the Editor

Rx: Window Bed

February 1, 2014 / Dochitect / Design for Geriatrics

Peer-Reviewed Publications

Publication: Journal of the American Geriatrics Society, Old Lives Tales
Publication Reference: 2014 Feb;62(2):378-9.
Authors: D. Kirk Hamilton, BArch, MSOD; Diana C. Anderson, MD, MArch

“Interns, any other ideas?” my attending asked the team as we made our daily rounds to the bedside of Ms. T, an octogenarian who had been in our ICU for just over a week. She suffered from dementia and had undergone a tracheotomy, thus limiting her ability to communicate with us. The concern of my attending that morning was due to her sustained tachycardia, the etiology of which we could not explain; she had not responded to our medical interventions.

I was only days into my internship; how could I have any medical suggestions to address this patient’s heart rate? “We could move her to another room with a window,” I said to the group instead, yielding several questionable looks. “There is evidence,” I added, as I knew physicians would consider an intervention seriously if it had been documented in prior studies.

Read the complete story of one patient’s physiologic response to an environmental intervention and the subsequent change in the clinical team’s approach to considering architectural design and the existing evidence (subscription required).

Peer-Reviewed Publications

I’m Still Here: A breakthrough approach to understanding someone living with Alzheimer’s Disease

December 29, 2009 / Dochitect / Design for Geriatrics

Book Review

Publication: Health Environments Research & Design Journal
Publication Date: 2009;3(1):118-120.
Book Author: John Zeisel, Ph.D.
Book Review Author: Diana C. Anderson, MD, MArch
View article

The book I’m Still Here: A breakthrough approach to understanding someone living with Alzheimer’s Disease acknowledges a deeper understanding of this devastating condition, the strength of non-pharmacologic treatments and, most importantly, an offer of hope for continued loving relationships and quality of life.

Click here to read dochitect’s complete book review.

Link to Purchase Book:

I’m Still Here Book Review