The Effects of Visual Barriers on Exiting Behavior In a Dementia Care Unit

Dickinson, Joan I.; McLain-Kark, Joan; Marshall-Baker, Anna

doi:10.1093/geront/35.1.127

Cited by 51 publications

(11 citation statements)

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“…Camouflage interventions are those that try to hide the exits, whether portraying them as shelves, 7 miniblinds or panels, 9 or as a painted mural. 11 The last two had positive impacts, as they reduced the frequency of exit attempts and door testing.…”

Section: Resultsmentioning

confidence: 99%

Environmental interventions to support orientation and social engagement of people with Alzheimer’s disease

Azevedo¹,

Charchat‐Fichman²,

Damazio³

2021

Dement. neuropsychol.

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The built environment can be a home to compensatory strategies aimed at increasing the independence of elderly people with Alzheimer’s disease, by mitigating the cognitive impairment caused by it. Objective: The aim of this study was to find out which interventions were performed in indoor environments and observe their impacts on the relief of behavioral symptoms related to the disorientation of elderly people with probable Alzheimer’s disease. Methods: A systematic review was carried out using the preferred reporting items for systematic review and meta-analyses criteria in the MEDLINE/PubMed database. Two researchers carried out the selection of the studies, following the same methodology. The third author contributed during the writing process and in the decision-making. Results: Of note, 375 studies were identified and 20 studies were included in this systematic review. The identified interventions were classified into environmental communications and environmental characteristics. Conclusions: Environmental communications had positive results in guiding and reducing agitation. In contrast, while reducing behavioral symptoms related to orientation, environmental characteristics showed improvements mainly in social engagement and functional capacity.

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Section: Resultsmentioning

confidence: 99%

Environmental interventions to support orientation and social engagement of people with Alzheimer’s disease

Azevedo¹,

Charchat‐Fichman²,

Damazio³

2021

Dement. neuropsychol.

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“…A set of six early studies emerged from the literature search which involved disorientating people with dementia by providing distracting cues away from the exit door of residential facilities. These included environmental strategies such as distracting grid patterns of black tape ( Chafetz, 1990 ; Hewawasam, 1996 ; Hussain & Brown, 1987) or covering up the exit door with a blind ( Dickinson, McLain-Kark, & Marshall-Baker, 1995 ), mirrors ( Mayer & Darby, 1991 ) or a wall mural ( Kincaid & Peacock, 2003 ). Whilst all but one ( Chafetz, 1990 ) found significant effects of these barriers on exit-seeking behaviour, this raises an important issue: who is this for?…”

Section: Resultsmentioning

confidence: 99%

Use of the physical environment to support everyday activities for people with dementia: A systematic review

Woodbridge

Sullivan

Harding³

et al. 2016

Dementia

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Difficulty with everyday activities is a key symptom and defining feature of dementia, relating to subjective reports of well-being and overall quality of life. One way to support individuals in their daily activities is by modifying the physical environment to make it easier to interact with during activity performance. This systematic review explores the range of studies available using physical environmental strategies to support performance in everyday activities for people with dementia. Seventy-two relevant studies were identified by the search. Physical environmental strategies included changes to the global environment and to architectural features, use of moveable environmental aids and tailored individual approaches. Strategies supported general everyday activity functioning (N = 19), as well as specific activities, particularly mealtimes (N = 15) and orientation in space (N = 16); however, few studies were found that focused on aspects of personal care such as dressing (N = 1) and showering or the preferred hobbies of individuals (N = 0). Overall, there appeared to be a lack of research within private home environments, and of studies which specify the dementia syndrome or the whole neuropsychological profile of people with dementia. More work is needed to extend theoretical understandings of how people with dementia interact with their environments so that these spaces can be designed to further support activities of daily living performance. Future work in this field could also incorporate the perspectives and preferences of those living with dementia.

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“…Masking the doorknob by painting it the same color as the door to minimize the color contrast and create a camouflage condition and the use of a doorknob cover (allowed the knob to turn only when pressure was applied) were less successful than concealment, but more effective than the use of grid tape patterns. Dickinson et al (1995) found that mini-blinds covering the door windows using the same color to match the door was only marginally significant in reducing exiting attempts (exiting attempts decreased from 115 times to 64 attempts: a reduction of 44%). However, the use of a cloth barrier to cover door hardware, similar to the one used by Namazi et al (1989) to match the door and frame color, was found to be more effective (a reduction of 96% from baseline).…”

Section: Door Hardware and Window Camouflagementioning

confidence: 97%

“…Also for the purposes of this review, exit doors within the institutional setting are considered part of a means of egress, usually leading from the floor area they serve to a separate building, an open public thoroughfare, or an exterior open space. Methods of preventing or limiting PWD from walking with purpose in healthcare and institutional settings have included alarms, locking external doors, physical restraint, or chemical restraint with the use of sedating medications (Dickinson et al, 1995; Namazi et al, 1989). Dickinson and McLain-Kark (1998) note that chemical restraint to prevent exiting behaviors “is only a temporary solution if the exiting is associated with the design of the facility” (p. 24).…”

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confidence: 99%

Built Environment Design Interventions at the Exits of Secured Dementia Care Units: A Review of the Empirical Literature

Anderson

Kota

Yeh³

et al. 2022

HERD

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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.

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The Effects of Visual Barriers on Exiting Behavior In a Dementia Care Unit

Cited by 51 publications

References 0 publications

Environmental interventions to support orientation and social engagement of people with Alzheimer’s disease

Environmental interventions to support orientation and social engagement of people with Alzheimer’s disease

Use of the physical environment to support everyday activities for people with dementia: A systematic review

Built Environment Design Interventions at the Exits of Secured Dementia Care Units: A Review of the Empirical Literature

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