Design for Geriatrics

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

January 23, 2025 / Dochitect / Design for Geriatrics

In the News

Organization: The Center for Health Design
Title: Design for Healthy Aging: Innovative and Evidence-Based Practices for Every Setting
Date: January 23, 2025

The Workshop
Aging happens everywhere and with ever-greater frequency. The number of Americans aged 65 and older is projected to increase from 58 million in 2022 to 82 million by 2050 – a stunning 47% increase.

Nowhere is this demographic shift being felt more seismically than in the healthcare and living environments serving our aging population. People aged 65 and older are hospitalized twice as frequently as adults aged 45 to 64. The demand for all types of senior living – independent, assisted, skilled nursing and memory care – continues to outweigh supply.

Yes, it’s a challenge, but it’s also a tremendous opportunity – to re-envision, design and build a new generation of “age-friendly” care and living environments that support the goals of patients, residents, caregivers and organizations, and ultimately produce the best outcomes.

The Design for Healthy Aging workshop will provide you with not just a glimpse into that future, but the research, resources, tools and best practices to help get you there.

Whatever types of environments you are creating – from acute care and ambulatory/outpatient, to independent, assisted living, long term and memory care settings – the innovations, ideas and lessons learned presented by our expert faculty of forward-thinking administrators, policy makers, clinicians and designers will have broad and immediate application and impact.

Age-Friendly Health System Initiatives: The 4Ms (and sometimes 5)What is the near and far future of an Age-Friendly Health System (AFHS)? The national AFHS initiative launched by CMS and IHI, uses a well-established clinical framework, the 4Ms – What Matters, Medications, Mentation, Mobility (and increasingly a 5th M: Multi-complexity) – to advance care for older adults. How do the 4Ms create a framework to think about the built environment? Hear from this panel on the policy, regulatory, and practice initiatives that are underway, and learn about the possibilities that exist to address design for aging in all settings.

Panelists
Alice Bonner, Director of Strategic Partnerships, Johns Hopkins School of Nursing CAPABLE Program, Senior Advisor for Aging at the Institute for Healthcare Improvement (IHI)
Diana Anderson, MD, M.Arch, FACHA, Dochitect
Michael McKay, AIA, ACHE, EDAC, LEED AP, NCARB, Planning Design Construction and Corporate Real Estate, UW Health

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.

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

University of Toronto Zeidler-Evans Annual Architecture of Health Lecture: Designing for Older Persons in a Transforming World

October 17, 2024 / Dochitect / Design for Geriatrics

Presentations

Event: Invited Keynote Speaker, University of Toronto Zeidler-Evans Annual Architecture of Health Lecture
Title: Designing for Older Persons in a Transforming World
Date: October 17, 2024

Speaker Bios

Diana Anderson, MD, M.Arch, FACHA

Dr. Diana Anderson is a triple boarded professional – healthcare architect (ACHA-American College of Healthcare Architects), internist, and a geriatrician. She earned her MD from the University of Toronto (OT8). As a “dochitect,”she pioneered a collaborative, evidence-based model for approaching healthcare from the medicine and architecture fields simultaneously. A past Fellow of the Harvard Medical School Center for Bioethics, Diana explores the ethics of built space related to design for aging. She is currently an Assistant Professor of Neurology at Boston University, and a recipient of an Alzheimer’s Association Clinician Scientist Fellowship. She is a healthcare principal at Jacobs, contributing her thought leadership at the intersection of design and health.

Molly Chan

Molly Chan is a principal with the firm of NSDA Architects, a diverse and dynamic architectural practice based in Vancouver, BC. A six-time recipient of the Lieutenant Governor’s award, the firm focuses on a wide range of projects including special needs, social purpose housing, affordable rental, healthcare and multi-family residential. Current projects include YWCA Housing for Women and Children, The Salvation Army Harbour Light facility, and Foxglove Supported Housing and Shelter.

Stephen Verderber, Arch,D., NCARB, ACSA Distinguished Professor

Dr. Stephen Verderber is Professor of Architecture, Director of the Centre for Design + Health Innovation in the John H. Daniels Faculty of Architecture, Landscape and Design, and Adjunct Professor in the Dalla Lana School of Public Health/IHPME at the University of Toronto. A Registered Architect in the U.S. and co-founder of R-2ARCH (Research to Architecture), he is sole author of seven books, co-author of two, and has published over one-hundred peer reviewed scholarly and professional articles. His most recent books are Innovations in Transportable Healthcare Architecture (2016), Innovations in Behavioural Health Architecture (2018) and Innovations in Hospice Architecture (Second Edition, 2020). His first book, Healthcare Architecture in an Era of Radical Transformation (2000), has become a standard reference. Principal investigator of numerous externally sponsored research projects and reports, he holds one of only two North American faculty cross-appointments linking architecture and public health. Dr. Verderber has delivered invited keynotes at numerous international conferences on evidence-based health research and design, educational pedagogy, eco-humanist health-centric design, and has received numerous awards for his interdisciplinary contributions to the advancement of the discipline, profession, and broader community.

Keynote Presentations

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

31st Maine Geriatrics Conference Plenary Speaker: Architecture for Aging: The Built Environment as Healthcare

May 23, 2024 / Dochitect / Design for Geriatrics

Presentations

Event: 31st Annual Maine Geriatrics conference, Bar Harbor, ME
Presenter: Diana Anderson
Date: May 23, 2024

Dr. Anderson presented a plenary session entitled Architecture for Aging: The Built Environment as Healthcare.

Session Description:
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.

Dr. Anderson also hosted a subsequent Fireside Chat to further discuss issues around design and aging.

Session Description:
In this Fireside Chat, attendees will have the opportunity to dive deeper into this topic and Dr. Anderson’s work on design projects within the United States, Canada and Australia. Be part of this open discussion and how her work is not shifting into community living settings.

See more information HERE.

Conference Presentations

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

AIA Florida: Design for the Sameness in Difference: Lessons for Everyone from Working with People Living with Mental Illness and Dementia

July 27, 2023 / Dochitect / Design for Geriatrics

Presentations

Event: AIA Florida Convention & Trade Show 2023
Presentation type: Conference presentation
Presenters: Francis Pitts, FAIA, and Diana Anderson, MD, MArch, ACHA
Date: July 27, 2023

Session E: Design for the Sameness in Difference: Lessons for Everyone from Working with People Living with Mental Illness and Dementia

More than ever, architects and designers are better equipped with research, experience and a common fund of clinical and environmental best practices as a basis for designing more supportive environments for people who are living with the challenges of mental illness or dementia. A mature reflection on that growing body of evidence and experience suggests, however, that a primary focus on the particular needs of people living with these challenges can create its own environmental difficulties for the very people we are trying to care for; that an emphasis on the common basic human needs shared by all people form a more stable platform for designing successful care environments. The presenters, a physician-architect with clinical design experience supporting people living with dementia and a seasoned architect with broad experience designing for special populations, will share what they have learned from practice and research about repositioning the primary drivers for design for special populations – and by extension what we all might learn to create environments supportive for human beings of any level of ability.

Speakers: Francis (Frank) Pitts, FAIA, principal, Architecture+; Dr. Diana Anderson, Dochitect

Conference Presentations

OAA Conference – Designing Dignified Senior Care Environments

June 22, 2023 / Dochitect / Design for Geriatrics, Evidence-Based Design

Presentations

Event: Ontario Association of Architects (OAA) – Annual Conference
Presentation type: Conference presentation and discussion
Presenters: Huda Juma, OAA, M. Arch., MRAIC, PMP, Diploma Health facility planning, LEED, Six Sigma Healthcare, Claudia Salgado, PhD, OAA, MRAIC, LEED AP, Diana Anderson, MD, MArch, ACHA
Date: June 22, 2023

Conference Presentations

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