To manage the care of increasing numbers of residents with dementia, many long-term care facilities have created special care units (SCUs) designed to meet the unique needs of this group. This article describes results of the qualitative component of a larger research project examining environment-behavior relationships in dementia care settings. Eighteen in-depth interviews were conducted with 9 staff and 9 family members of SCU residents. Thematic analysis was conducted using grounded theory techniques. Participants described residents’ needs in relation to both the physical and social environments. This article focuses on the five areas of need identified by participants in relation to the physical environment: safety, homelike setting, optimal stimulation, cues, and options for privacy and social interaction.
Get full access to this article
View all access options for this article.
References
1.
Algase, D. , Beck, C., Kolanowski, A., Whall, A., Berent, S., Richards, K., & Beattie, E. (1996). Need-driven dementia-compromised behavior: An alternative view of disruptive behavior. American Journal of Alzheimer’s Disease, 11(6), 10-19.
2.
Alzheimer Society of Canada . (1993). Guidebook for care. Toronto: Author.
3.
Aronson, M. (1994). Reshaping dementia care: Practice and policy in long-term care. Thousand Oaks, CA: Sage.
4.
Breitmayer, B. , Ayres, L., & Knafl, K. (1993). Triangulation in qualitative research: Evaluation of completeness and confirmation purposes. IMAGE: Journal of Nursing Scholarship, 25, 238-243.
5.
Calkins, M. (1988). Planning environments for the elderly and confused. Owings Mills, MD: National Health Publishing.
6.
Canadian Study of Health and Aging Working Group . (1994a). Canadian Study of Health and Aging: Study methods and prevalence of dementia. Canadian Medical Association Journal, 150, 899-913.
7.
Canadian Study of Health and Aging Working Group . (1994b). Patterns of caring for people with dementia in Canada. Canadian Journal on Aging, 13, 470-487.
8.
Cleary, T. , Clamon, C., Price, M., & Shullaw, G. (1988). A reduced stimulation unit: Effects on patients with Alzheimer’s disease and related disorders. The Gerontologist, 28, 511-514.
9.
Cohen, U. , & Weisman, G. (1990). Experimental design to maximize autonomy for older adults with cognitive impairments. Generations, 14(Suppl.), 75-78.
10.
Coons, D. (1990). Residential care for persons with dementia. In N. Mace (Ed.), Dementia care (pp. 337-373). Baltimore: Johns Hopkins University Press.
11.
Denzin, N. (1989). The research act: A theoretical introduction to sociological methods (3rd ed.). Chicago: Aldine.
12.
Glaser, B. , & Strauss, A. (1967). The discovery of grounded theory: Strategies for qualitative research. Chicago: Aldine.
13.
Guba, E. (1981). Criteria for assessing the trustworthiness of naturalistic inquires. Educational Communication and Technology Journal, 29(2), 75-91.
14.
Hall, G. , & Buckwalter, K. (1987). Progressively lowered stress threshold: A conceptual model for care of adults with Alzheimer’s disease. Archives of Psychiatric Nursing, 1(6), 399-406.
15.
Hamel, M. , Pushkar, D., Andres, D., Reis, M., Dastoor, D., Grauer, H., & Bergman, H. (1990). Predictors and consequences of aggressive behavior by community-based dementia patients. The Gerontologist, 30, 206-211.
16.
Health & Welfare Canada . (1991). Designing facilities for people with dementia. Ottawa, Canada: Health Facilities Design Unit, Department of National Health and Welfare.
17.
Jackson, M. , Drugovich, M., Fretwell, M., Spector, W., Sternberg, W., & Rosenstein, R. (1989). Prevalence and correlates of disruptive behavior in the nursing home. Journal of Aging and Health, 1, 349-369.
18.
Knafl, K. , & Howard, M. (1984). Interpreting and reporting qualitative research. Research in Nursing and Health, 7, 17-24.
19.
Lawton, M. (1981). Sensory deprivation and the effect of the environment on management of the patient with senile dementia. In N. Miller & G. Cohen (Eds.), Clinical aspects of Alzheimer’s disease and senile dementia (Aging, Vol. 15, pp. 227-251). New York: Raven.
20.
Lawton, M. , & Nahemow, L. (1973). Ecology and the aging process. In C. Eisdorfer & M. Lawton (Eds.), Psychology of adult development and aging (pp. 619-674). Washington, DC: American Psychological Association.
21.
Lui, L. , Gauthier, L., & Gauthier, S. (1991). Spatial disorientation in persons with early senile dementia of the Alzheimer type. American Journal of Occupational Therapy, 45, 67-74.
22.
Maas, M. , & Buckwalter, K. (1993). Catastrophic reactions and other behaviors of Alzheimer’s residents: Special unit compared with traditional units. Archives of Psychiatric Nursing, 7(5), 292-299.
23.
McEwan, K. , Maxwell, D., & Gutman, G. (1992). Basic facts and figures about dementia patients in institutions. In G. Gutman (Ed.), Shelter and care of persons with dementia (pp. 3-17). Vancouver, Canada: Gerontology Research Centre, Simon Fraser University.
24.
Moos, R. (1987). Person-environment congruence in work, school, and health care settings. Journal of Vocational Behavior, 31, 231-247.
25.
Morgan, D. (1996). Impact of high versus low density special care units on the behavior of elderly residents with dementia. Unpublished doctoral dissertation, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
26.
Morgan, D. , & Stewart, N. (1997). The importance of the social environment in dementia care. Western Journal of Nursing Research, 19, 736-758.
27.
Morgan, D. , & Stewart. N. (1998). High versus low density special care units: Impact on the behavior of elderly residents with dementia. Canadian Journal on Aging, 17(2), 143-165.
28.
Morse, J. (1991). Approaches to qualitative and quantitative triangulation. Nursing Research, 40, 120-123.
29.
Namazi, K. , Whitehouse, P., Rechlin, L., Calkins, M., Johnson, B., Brabender, B., & Hevener, S. (1991). Environmental modifications in a specially designed unit for the care of patients with Alzheimer’s disease: An overview and introduction. The American Journal of Alzheimer’s Disease, 6, 3-9.
30.
Nasman, B. , Bucht, G., & Eriksson, S. (1993). Behavioral symptoms in the institutionalized elderly: Relationship to dementia. International Journal of Geriatric Psychiatry, 8, 843-849.
31.
Nelson, J. (1995). The influence of environmental factors in incidents of disruptive behavior. Journal of Gerontological Nursing, 21(5), 19-24.
32.
Rockwood, K. , Stolee, P., & Robertson, D. (1989). The prevalence of problem behavior in elderly residents of long term care institutions. Canadian Journal of Public Health, 80, 302-303.
33.
Royall, D. (1994). Precis of executive dyscontrol as a cause of problem behavior in dementia. Experimental Aging Research, 20, 73-94.
34.
Seidel, J. , Kjolseth, R., & Seymour, E. (1988). The Ethnograph (Version 3.0) [Computer software]. Littleton, CO: Qualis Research Associates.
35.
Strauss, A. (1987). Qualitative analysis for social scientists. Cambridge, UK: Cambridge University Press.
36.
Strauss, A. , & Corbin, J. (1990). Basics of qualitative research: Grounded theory procedures and techniques. London: Sage Ltd.
37.
Taft, L. , Delaney, K., Seman, D., & Stansell, J. (1993). Creating a therapeutic milieu in dementia care. Journal of Gerontological Nursing, 19(10), 30-39.
38.
Weisman, G. , Cohen, U., Day, K., & Meyer, G. (1990). Programming and design for dementia: Development of a 50-person residential environment. Milwaukee, WI: Center for Architecture and Urban Planning Research.
39.
Zuckerman, J. (1969). Theoretical formulations: Part 1. In J. Zubek (Ed.), Sensory deprivation: Fifteen years of research (pp. 407-432). Norwalk, CT: Appleton-Century-Crofts.
