Both the culture change and person-centered care movements have led to an increased emphasis on quality of life and other resident-focused outcomes in dementia care. While attention to the delivery of personal and medical care plays an important role in person-centered care, recent research has identified the importance of environmental elements—such as temperature, light, and noise—particularly for residents with severe dementia. A study of eight public long-term care facilities in Spain highlights the importance of environment in the quality of life of residents with dementia.
The researchers randomly selected 20 participants from each community, who were drawn from a larger pool of residents identified as appropriate for the study by nursing staff and residents’ closest relatives. Previously standardized measures of quality of life were used that enabled measurement by proxy, or the report of caregivers based on residents’ behavior. (The authors note that proxy methods have limitations, but are generally viewed as most appropriate for most studies involving participants with severe dementia.) The scales used to assess quality of life included mood, physical comfort, social interaction and difficulties with activities of daily living.
Measurements of brightness, temperature, and atmospheric noise were taken in participants’ bedrooms as well as in the dining and living rooms of each residence. These measurements were taken repeatedly and at different times of the day for precision, over the course of one week. The researchers also collected clinical information about the participants, information about the staff who worked with them, and about the use of physical restraints in each community. This enabled the researchers to factor these relevant variables in their analysis.
When controlling for these related factors, the physical environment of the community had a significant relationship with the quality of life of the participants. In particular, high temperatures were associated with lower overall quality of life, while low lighting was associated with negative mood and high noise levels in shared areas were associated with fewer social interactions. In their discussion of the findings, the authors state that living room noise levels above 50 decibels, which is common for communities in the US, is associated with negative outcomes. The authors also recommend the use of high-intensity light during the day to enhance both mood and sleep patterns for residents, and that high daytime temperatures are associated with higher resident need for care.
While the authors note several limitations to their study—for example, it was conducted during late spring and summer, which may have influenced the effect of light and temperature—this study suggests that modifiable environmental factors may have an important influence for the well-being of individuals with severe dementia in long-term care.
Garre-Olmo J, López-Pousa S, et al. Environmental determinants of quality of life in nursing home residents with severe dementia. Journal of the American Geriatrics Society; (2012). 60(7):1230-1236.