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American Journal of Alzheimer's Disease and Other Dementias logoLink to American Journal of Alzheimer's Disease and Other Dementias
. 2011 Feb;26(1):51–57. doi: 10.1177/1533317510387584

Association of the Spatial Layout of the Home and ADL Abilities Among Older Adults With Dementia

Gesine Marquardt 1, Deirdre Johnston 2, Betty S Black 3, Ann Morrison 4, Adam Rosenblatt 5, Constantine G Lyketsos 6, Quincy M Samus 7
PMCID: PMC3143576  NIHMSID: NIHMS310217  PMID: 21282278

Abstract

We investigated the relationship between architectural space syntax measures describing the spatial layout of a home and activities of daily living (ADL) among people with dementia. We visited the homes of 82 participants in a dementia care comparative effectiveness clinical trial and measured the space syntax variables intelligibility and convexity along with several clinical variables, including ADLs. In regression models, we estimated the cross-sectional association between space syntax measures and ADLs. Higher convexity was associated with worse performance of basic but not instrumental ADLs (adjusted β =19.2, P = .02). Intelligibility was not associated with ADLs. These results imply that enclosed rooms with a clearly legible meaning and function might be better memorized and associated with the spatial layout of the home resulting in better basic ADL performance. These results warrant further research on space syntax measures in the home environment of people with dementia, including longitudinal study, which we are pursuing.

Keywords: dementia, space syntax, home environment, function, activities of daily living

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Contributor Information

Gesine Marquardt, Dresden University of Technology, Dresden, Germany, gesine.marquardt@tu-dresden.de, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Deirdre Johnston, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Betty S. Black, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Ann Morrison, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Adam Rosenblatt, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Constantine G. Lyketsos, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Quincy M. Samus, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

References

  1. Aarp These Four Walls. Americans 45+ Talk About Home and Community. Washington, DC: AARP; 2003. [Google Scholar]
  2. Plassman BL, Langa KM, Fisher GG, et al. Prevalence of dementia in the United States: the aging, demographics, and memory study. Neuroepidemiology. 2007;29(1-2):125-132. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Wimo A., Winblad B., Jönsson L. An estimate of the total worldwide societal costs of dementia in 2005 . Alzheimers Dement. 2007;3(2):81-91. [DOI] [PubMed] [Google Scholar]
  4. Wahl HW, Fänge A., Oswald F., Gitlin LN, Iwarsson S. The home environment and disability-related outcomes in aging individuals: what is the empirical evidence? Gerontologist. 2009;49(3):355-367. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Gitlin L. Conducting research on home environments: lessons learned and new directions . Gerontologist. 2003;43(5):628-637. [DOI] [PubMed] [Google Scholar]
  6. Van Hoof J., Kort HSM, van Waarde H., Blom MM Environmental interventions and the design of homes for older adults with dementia: an overview. Am J Alzheimers Dis. 2010;25(3):202-232. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Moos RH, Lemke S. Evaluating Residential Facilities: The Multi-phasic Environmental Assessment Procedure. Thousand Oaks, CA: SAGE; 1996. [Google Scholar]
  8. Lawton MP, Weisman GD, Sloane P., Norris-Baker C., Calkins M., Zimmerman SI Professional environmental assessment procedure for special care units for elders with dementing illness and its relationship to the therapeutic environment screening schedule. Alzheimers Dis Assoc Dis. 2000;14(1):28-38. [DOI] [PubMed] [Google Scholar]
  9. Parker C., Barnes S., McKee K., Morgan K., Torrington J., Trengenza P. Quality of life and building design in residential and nursing homes for older people. Ageing Soc. 2004;24(6):941-962. [Google Scholar]
  10. Sloane PD, Mitchell CM, Weisman G., et al. The Therapeutic Environment Screening Survey for Nursing Homes (TESS-NH): an observational instrument for assessing the physical environment of institutional settings for persons with dementia. J Gerontol B Psychol Sci Soc Sci. 2004;57(2):S69-S78. [DOI] [PubMed] [Google Scholar]
  11. Gitlin LN, Schinfeld S., Winter L., Corcoran M., Boyce AA, Hauck W. Evaluating home environments of persons with dementia: interrater reliability and validity of the Home Environmental Assessment Protocol (HEAP) . Disabil Rehabil. 2002;4(1-3):59-71. [DOI] [PubMed] [Google Scholar]
  12. Gitlin LN, Corcoran MA Managing dementia at home: the role of home environmental modifications . Top Geriatr Rehabil. 1996;12(2):28-39. [Google Scholar]
  13. Gitlin LN, Corcoran M., Winter L., Boyce A., Hauck W. A randomized, controlled trial of a home environmental intervention: effect on efficacy and upset in caregivers and on daily function of persons with dementia. Gerontologist. 2001;41(1):4-14. [DOI] [PubMed] [Google Scholar]
  14. Mann WC, Hurren MD, Charvat BA, Tomita MR Changes over one year in assistive device use and home modifications by home-based older persons with Alzheimer’s disease. Top Geriatr Rehabil. 1996;12(2):9-16. [Google Scholar]
  15. Van Hoof J. , Kort HSM. Supportive living environments: a first concept of a dwelling designed for older adults with dementia. Dementia. 2009;8(2):293-316. [Google Scholar]
  16. Chafetz P., Namazi K. Structuring environments for persons with cognitive impairment. In: Weiner M, Lipton A, eds. The Dementias. Diagnosis, Treatment, and Research. Washington, DC: American Psychiatric Publishing; 2003:405-432. [Google Scholar]
  17. Namazi K., Johnson B. Pertinent autonomy for residents with dementias. Modification of the physical environment to enhance independence. Am J Alzheimers Dis. 1992;7(1):16-21. [Google Scholar]
  18. Smith R., Mathews RM, Gresham M. Pre-and post-occupancy evaluation of new dementia care cottages. Am J Alzheimers Dis. 25(3):265-275. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Zeisel J., Silverstein NM, Hyde J., Levkoff S., Lawton MP, Holmes W. Environmental correlates to behavioral outcomes in Alzheimer’s special care units. Gerontologist. 2003;43(5):697-711. [DOI] [PubMed] [Google Scholar]
  20. Elmstahl S. , Annerstedt L., Ahlund O. How should a group living unit for demented elderly be designed to decrease psychiatric symptoms? Alz Dis Assoc Dis. 1997. ;11(1):47-52. [DOI] [PubMed] [Google Scholar]
  21. Marquardt G. , Schmieg P. Dementia-friendly architecture: environments that facilitate wayfinding in nursing homes. Am J Alzheimers Dis. 2009;24(4):333-340. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Netten A. The effect of design of residential homes in creating dependency among confused elderly residents. a study of elderly demented residents and their ability to find their way around homes for the elderly. Int J Geriatr Psych. 1989;4(3): 143-153. [Google Scholar]
  23. Passini R., Rainville C., Pigot H., Tétreault M. Wayfinding in a nursing home for advanced dementia of the Alzheimer type. Environ Behav. 2000;32(5):684-710. [Google Scholar]
  24. Lawton MP Environment and other determinants of well-being in older people. Gerontologist. 1983;23(4):349-357. [DOI] [PubMed] [Google Scholar]
  25. Lawton MP, Nahemow L. Ecology and the aging process. In: Eisdorder C, Lawton MP, eds. Psychology of Adult Development and Aging. Washington, DC: American Psychological Association; 1973. [Google Scholar]
  26. Johnston D. , Samus QM, Morrison A., et al. Identification of community-residing individuals with dementia and their unmet needs for care. Int J Geriatr Psych. 2010. IN PRESS. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Hillier B., Hanson J. The Social Logic of Space. Cambridge, UK: Cambridge University Press; 1984. [Google Scholar]
  28. Bafna S. Space syntax: a brief introduction to its logic and analytical techniques . Environ Behav. 2003;35(1):17-29. [Google Scholar]
  29. Lawton MP, Brody EM Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist. 1969;9(3):179-186. [PubMed] [Google Scholar]
  30. Wilkinson IM , Graham-White J. Psychogeriatric dependency rating scales (PGDRS): a method of assessment for use by nurses. Br J Psychiatry . 1980;127:558-565. [DOI] [PubMed] [Google Scholar]
  31. Folstein MF , Folstein SE, McHugh PR "Mini-mental state’’. A practical method for grading the cognitive state of patients for the clinician . J Psychiatr Res. 1975;12(3):189-198. [DOI] [PubMed] [Google Scholar]
  32. Perneczky R. , Wagenpfeil S., Komossa K., Grimmer T., Diehl J., Kurz A. Mapping scores onto stages: mini-mental state exami nation and clinical dementia rating. Am J Geriatr Psych . 2006;14(2):139-144. [DOI] [PubMed] [Google Scholar]
  33. Wackerbarth S., Johnson MMS. Predictors of driving cessation, independent living and power of attorney decisions by dementia patients and caregivers . Am J Alzheimers Dis. 1999;14(5): 283-288. [Google Scholar]
  34. Oswald F., Schilling O., Wahl HW, Fänge A., Sixsmith J., Iwarsson S. Homeward bound: introducing a four-domain model of perceived housing in very old age. J Environ Psychol. 2006;26(3):187-201. [Google Scholar]
  35. Tanner B., Tilse C., de Jonge D. Restoring and sustaining home: the impact of home modifications on the meaning of home for older people. J Housing Elderly. 2008;22(3):195-215. [Google Scholar]

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