Abstract
The challenges in investigating the effects of the physical environment on residents with dementia include having a sample of comparable study groups and a lack of long-term follow-up evaluation. This study attempted to address these two challenges by carefully matching residents between groups in sample selection and including three points of time of evaluation in the study design. The main aim of the study is to examine whether residents with dementia living in different physical environment, focusing on large-scale institutional design and small-scale homelike environment exhibit a difference in health and behavioral outcomes. Physical environmental assessment of the two care facilities was conducted using the Therapeutic Environment Screening Survey for Nursing Homes. Behavior assessments of residents were performed using three tools at three assessments over a period of 1 year: (a) Multidimensional Observation Scale for Elderly Subjects, (b) Minimum Data Set, and (c) Dementia Care Mapping. The longitudinal results suggest that older adults with early to moderate stage dementia can be supported to become socially active and engaged with others in an optimal environment. It is possible that a small-scale, home-like unit makes it easier to socially relate with others, as fewer people in the setting are not as overwhelming or over-stimulating. A smaller home-like environment may also offer a sense of comfort, security, and belonging.