Publication type: "Peer-Reviewed Publications"

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

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

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