Older people experience sensory, cognitive, and social deficits that adversely affect their interaction with the environment. Design of institutions for the elderly resident should be prosthetic to ensure that environments optimally accommodate the functioning of the residents.
The sensory and cognitive state of the residents should be considered in everyfacility. This review
discusses how sensory and cognitive changes in aging affect orientation and wayfinding as well
as how the physical aspects of the environment can accommodate these changes to reduce
confusion and disorientation. Environmental features that promote social interaction are reviewed Because the environmental needs and unique characteristics of the cognitively impaired
resident differs from that of the nonimpaired resident, special issues in the design of facilities
for demented residents are reviewed Conclusions are offered with regard to research needs and
applied problems.
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References
1.
Abend, A., & Chen, A. (1985). Developing residential design statements for the hearing-impaired elderly. Enviromnent and Behavior , 17, 475-500.
2.
Ablowitz, M. (1983). Letter to the editor. Journal of the American Geriatrics Society, 31, 627.
3.
Andreasen, M.E.K. (1985). Make a safe environment by design. Journal of Gerontological Nursing , 11, 18-22.
4.
Bakos, M., Bozic, R., Chapin, D., & Neuman, S. (1980). Effects of environmental changes on elderly residents' behavior. Hospital and Community Psychiatry , 34, 677-682.
5.
Baltes, P. B., & Brim, O. G., Jr. (Eds.). (1984). Life-span development and behavior. New York: Academic Press.
6.
Bartol, M. A. (1979). Nonverbal communication in patients with Alzheimer's disease. Journal of Gerontological Nursing, 5, 21-31.
7.
Benson, D. M., Cameron, D. , Humbach, E., Servino, L., & Gambert, S. R. (1987). Establishment and impact of a dementia unit within the nursing home. Journal of the American Geriatrics Society , 35, 319-323.
8.
Brody, E. M., Lawton, M. P., & Liebowitz, B. ( 1984). Senile dementia: Public policy and adequate institutional care. American Journal of Public Health, 74, 1381-1383.
9.
Calkins, M. P. (1987). Designing special care units: A systematic approach. American Journal of Alzheimer's Care and Research, 2, 30-34.
10.
Chapman, J. R., Grant, M. A., & Simmons, D. A. ( 1986). Design that cares. Owings Mills, MD : National Health Publishing.
11.
Cheek, F. W., Maxwell, R. , & Weisman, R. ( 1971). Carpeting the ward: An exploratory study in environmental psychiatry. Mental Hygiene, 55, 109-118.
12.
Cornbleth, T. (1977). Effects of a protected hospital ward area on wandering and nonwandering geriatric patients. Journal of Gerontology, 32, 573-577.
13.
Droubay, E. H. (1964). Blue is for bathrooms. Colors guide geriatric patients. Mental Hospitals , 15, 386-390.
14.
Fozard, J. L., Wolf, E., Bell, B., McFarland, R. A. , & Podolsky, S. ( 1977). Visual perception and communication. In J. E. Birren & K. W. Schaie (Eds.), Handbook of the psychology of aging (pp. 497-534). New York: Van Nostrand Reinhold.
15.
Friedman, E. P. (1966). Spatial proximity and social interaction in a home for the aged. Journal of Gerontology, 21, 566-570.
16.
Gang, R., & Ackerman, J. O. (1983). Letter to the editor. Journal of the American Geriatrics Society, 31, 627-628.
17.
Gottesman, L. E., & Bourestom, N. C. (1974). Why nursing homes do what they do. The Gerontologist, 14, 501-506.
18.
Gutman, G. M. (1989). Dementia patients in institutions: A review of recommendations and research concerning their design, staffing and programming needs (Report prepared for the Pacific Health Care Society, the Gerontology Research Centre. Burnaby, BC: Simon Fraser University Press.
19.
Hanley, I. G. (1981). The use of signposts and active training to modify ward disorientation in elderly patients. Journal of Behavioral Therapy and Experimental Psychiatry , 12, 241-247.
20.
Harris, H., Lipman, A., & Slater, R. (1977). Architectural design: The spatial location and interactions of old people . Gerontology, 23, 390-400.
21.
Haugen, P. K. (1985). Behavior of patients with dementia. Danish Medical Bulletin, 32, 62-65.
22.
Herman, J. F., & Bruce, P. R. (1981). Spatial knowledge of ambulatory and wheelchair-confined nursing home residents. Experimental Aging Research, 9, 83-85.
23.
Hiatt, L. G. (1980). Disorientation is more than just a state of mind. Nursing Homes, 29(4), 30-36.
24.
Hiatt, L. G. (1981). The color and use of color in environments for older people. Nursing Homes, 30, 18-22.
25.
Hoffman, S. B., Platt, C. A., Barry, K. E., & Hamill, L. A. (1985). When language fails: Nonverbal communication abilities of the demented. In J. T. Hutton & A. D. Kenny (Eds.), Senile dementia of the Alzheimer type (pp. 49-64). New York: Liss.
26.
Horowitz, M. J., & Wilner, N. (1980). Life events, stress, and coping . In L. W. Poon (Ed.), Aging in the 1980s (pp. 363-374). Washington, DC: American Psychological Association.
27.
Howell, S. C. (1982). Built space, the mystery variable in health and aging. In A. Baum & J. E. Singer (Eds.), Advances in environmental psychology (pp. 31-47). Hillsdale, NJ: Lawrence Erlbaum.
28.
Hunt, M. E., & Roll, M. K. (1987). Simulation in familiarizing older people with an unknown building. The Gerontologist, 27, 169-175.
29.
Ittelson, W. H., Proshansky, H. M., & Rivlin, L. G. ( 1970). Bedroom size and social interaction of the psychiatric ward. Environment and Behavior, 2, 255-270.
30.
Jarvik, L. (1982). Research on dementia: The philothermal response. Psychiatric Clinics of North America, 5, 87-88.
31.
Kayser-Jones, J. S. (1986). Open-ward accommodations in a long-term care facility: The elderly's point of view. The Gerontologist, 26, 63-69.
32.
Kirasic, K. C., & Allen, G. L. (1985) Aging, spatial performance and spatial competence. In N. Chamess (Ed), Aging and human performance (pp. 191-223). Chichester , England: Wiley.
33.
Lawton, M. P. (1970a). Planner's notebook: Planning environments for older people. Journal of the American Institute of Planners, 36, 124-129.
34.
Lawton, M. P. (1970b). Public behavior of older people in congregate housing. In J. Archea & C. Eastman (Eds.), EDRA Two: Proceedings of the second annual Environmental Design Research Association conference, October, 1970, Pittsburgh, Pennsylvania (pp. 372-380). Stroudsburg, PA: Dowden, Hutchinson, & Ross.
35.
Lawton, M. P. (1980). Environment and aging. Monterey, CA: Brooks/Cole .
36.
Lawton, M. P. (1981). Sensory deprivation and the effect of the environment on management of the patient with senile dementia. In N. E. Miller & G. D. Cohen (Eds.), Clinical aspects of Alzheimer's disease and senile dementia (Aging) (Vol. 15, pp. 227-251). New York: Raven .
37.
Lawton, M. P., Fulcomer, M., & Kleban, M. H. ( 1984). Architecture for the mentally impaired elderly. Environment and Behavior, 16, 730-757.
38.
Lawton, M. P., Liebowitz, M.S.W., & Charon, H. ( 1970). Physical structure and the behavior of senile patients following ward remodeling. Aging and Human Development, 1, 231-239.
39.
Liebowitz, B., Lawton, M. P., & Waldman, A. ( 1979). Evaluation: Designing for confused elderly people. American Institute of Anchitects Journal, 68, 59-61.
40.
Lindsley, O. R. (1964). Geriatric behavioral prosthetics. In R. Kastenbaum (Ed.), New thoughts on old age (pp. 41-60). New York: Springer.
41.
Lipman, A. (1968). Some problems of direct observation in architectural social research. Architects' Journal Information Library, 147, 1349-1356.
42.
Lipman, A., & Slater, R. (1977). Status and spatial appropriation in eight homes for old people. The Gerontologist, 17, 250-255.
43.
Lipman, A., & Slater, R. (1979). Homes for old people: Towards a positive environment. In D. V. Canter & S. Canter (Eds.), Designing for therapeutic environments (pp. 277-308). Chichester, England: Wiley.
44.
MacKay, D. B. (1976). The effect of spatial stimuli on the estimation of cognitive maps. Geographical Analysis, 8, 439-451.
45.
McClannahan, L. E., & Risley, T. R. (1975). Design of living environments for nursing-home residents: Increasing participation in recreation activities . Journal of Applied Behavior Analysis, 8, 261-268.
46.
Meacher, M. (1972). Taken for a ride. London: Longman.
47.
Milke, D. L., Dobbs, A. R. , Rule, B. G., & Milke, A. L. (1987). The use of space by Alzheimer disease patients in a nursing home. Canadian Psychology, 28(2A), 415. [abstract]
48.
Moos, R. H. (1976). The human context: Environmental determinants of behavior. New York : Wiley.
49.
Moos, R. H., & Lemke, S. (1984). Supportive residential settings for older people. In I. Altman, M. P. Lawton, & J. F. Wohlwell (Eds.), Human behavior and environment: Advances in theory and research: Vol. 7, Elderly people and the environment (pp. 159-190). New York: Plenum.
50.
Nelson, M. N., & Paluck, R.J. (1980). Territorial markings, self-concept and mental status of institutionalized elderly. The Gerontologist , 20, 96-98.
51.
Ohta, R. J., & Kirasic, K. C. (1983). The investigation of environmental learning in the elderly. In G. D. Rowles & R. J. Ohta (Eds.), Aging and milieu: Environmental perspectives on growing old (pp. 83-95). New York: Academic Press.
52.
Ohta, R. J., & Ohta, B. M. (1988). Special units for Alzheimer's disease patients: A critical look. The Gerontologist, 28, 803-808.
53.
Osmond, H. (1957). Function as the basis of psychiatric ward design. Mental Hospitals, 8, 23-32.
54.
Pastalan, L. A. (1979). Negotiating the environment. In T. O. Byarts, S. C. Howell, & L. A. Pastalan (Eds.), Environmental context of aging: Lifestyles, environmental quality and living arrangements (pp. 103-126). New York: Garland.
55.
Pastalan, L. A. (1982). Research in environment and aging: An alternative to theory. In M. P. Lawton, P. G. Windley, & T. O. Byerts (Eds.), Aging and the environment (pp. 122-177). New York: Springer.
56.
Pastalan, L. A., Mautz, R. K., II, & Merrill, J. ( 1973). The simulation of age related sensory losses: A new approach to the study of environmental barriers. In W.F.E. Preiser (Ed.), Environmental design research (Vol. 1, pp. 383-391). Stroudsberg,PA: Dowden, Hutchinson, & Ross.
57.
Peppard, N. R. (1986, May). Effective design of special care units. Provider, pp. 14-17.
58.
Peterson, R. F., Knapp, T. J., Rosen, J. C., & Pither, B. F. (1977). The effects of furniture arrangements on the behavior of geriatric patients. Behavior Therapy, 8, 464-467.
59.
Prinsley, D. M. (1973). Psychogeriatric ward for mentally disturbed elderly patients. British Medical Journal, 15, 574-577.
60.
Pynoos, J., & Stacey, C. A. (1986). Specialized facilities for senile dementia patients. In M.L.M. Gilhooly, S. H. Zarit, & J. E. Birren (Eds.), The dementias: Policy and management (pp. 111-130). Englewood Cliffs, NJ:Prentice-Hall.
61.
Quayhagen, M. P., & Quayhagen, M. (1988). Alzheimer's stress: Coping with the caregiving role. The Gerontologist, 28, 391-396.
62.
Rabins, P. (1986). Establishing Alzheimer's disease units in nursing homes: Pros and cons. Hospital and Community Psychiatry, 37, 120-121.
63.
Reizenstein, J. E. (1981). Hospital design and human behavior. A review of the recent literature. In A. Baum & J. E. Singer (Eds.), Advances in environmental psychology: Vol. 4, Environmental health (pp. 137-169). Hillsdale NJ: Lawrence Erlbaum.
64.
Rovner, B. U., & Rabins, P. V (1985). Mental illness among nursing home patients. Hospital and Community Psychiatry, 36, 119-128.
65.
Schiff, M. R. (1982). Environmental design. Helping residents find their way. Ontario Association of Homes for the Aged, 18, 7-8.
66.
Schwartz, A. N. (1975). Planning micro-environments for the aged. In D. S. Woodruff & J. E. Birren (Eds.), Aging: Scientific perspectives and social issues (pp. 279-294). New York: Van Nostrand.
67.
Sivadon, P. (1970). Space as experienced: Therapeutic implications. In H. M. Proshansky, W. H. Ittelson, & L. G. Rivlin (Eds.), Environmental psychology: Man and his physical setting (pp. 409-419). New York: Holt , Rinehart & Winston.
68.
Snyder, L. H. (1980) An exploratory study of patterns of social interaction, organization, and facility design in three nursing homes. In J. Hendricks (Ed.), Institutionalization and alternative futures (pp. 66-80). Farmingdale, NY: Baywood.
69.
Sommer, R., & Ross, H. (1958). Social interaction on a geriatrics ward. International Journal of Social Psychiatry, 4, 128-133.
70.
Spivack, M. (1967). Sensory distortions in tunnels and corridors. Hospital & Community Psychiatry , 18, 21-30.
71.
Standford, T., & Pollack, R. H. (1984). Configuration color vision tests: The interaction between aging and the complexity of figure-ground segregation . Journal of Gerontology, 39, 568-571.
72.
Stephens, M. P., & Willems, E. P. (1979). Everyday behavior of older persons in institutional housing: Some implications for design. In A. D. Seidal & S. Danford (Eds.), Environmental design: Research theory and application (pp. 344-348). Washington, DC: Environmental Design Research Association .
73.
Walsh, D. A., Krauss, I. K., & Regnier, V A. ( 1981). Spatial ability, environmental knowledge, and environmental use: The elderly. In L. Liben, A. Patterson, & N. Newcombe (Eds.), Spatial representation and behavior across the life span (pp. 321-357). New York: Academic Press.
74.
Weber, R. J., Brown, L. T. , & Weldon, J. K. ( 1978). Cognitive maps of environmental knowledge and preference in nursing home patients. Experimental Aging Research, 4, 157-174.
75.
Willmott, M. (1986). The effect of a vinyl floor surface and a carpeted floor surface upon walking in elderly hospital in-patients. Age and Aging, 15, 119-120.
76.
Wiltzius, F., Gambert, S. R., & Duthie, E. H. ( 1981). Importance of resident placement within a skilled nursing facility. Journal of the American Geriatrics Society, 29, 418-421.
77.
Zimring, C. (1981). Stress and the designed environment. Journal of Social Issues, 27,145-171.
