Gaze Behaviour during Space Perception and Spatial Decision Making

A series of four experiments investigating gaze behavior and decision making in the context of wayfinding is reported. Participants were presented with screen-shots of choice points taken in large virtual environments. Each screen-shot depicted alternative path options. In Experiment 1, participants had to decide between them in order to find an object hidden in the environment. In Experiment 2, participants were first informed about which path option to take as if following a guided route. Subsequently they were presented with the same images in random order and had to indicate which path option they chose during initial exposure. In Experiment 1, we demonstrate (1) that participants have a tendency to choose the path option that featured the longer line of sight, and (2) a robust gaze bias towards the eventually chosen path option. In Experiment 2, systematic differences in gaze behavior towards the alternative path options between encoding and decoding were observed. Based on data from Experiments 1 & 2 and two control experiments ensuring that fixation patterns were specific to the spatial tasks, we develop a tentative model of gaze behavior during wayfinding decision making suggesting that particular attention was paid to image areas depicting changes in the local geometry of the environments such as corners, openings, and occlusions. Together, the results suggest that gaze during a wayfinding tasks is directed toward, and can be predicted by, a subset of environmental features and that gaze bias effects are a general phenomenon of visual decision making

Remember me: how we can modify the home for people with dementia

More than 50 million people live with dementia worldwide. For reasons of familiarity, affordability, and psychological comfort, the home is uniquely preferred by people with dementia (PwD) and their caregivers for aging in place. Ample studies show that built environmental features (e.g., furnishing, lighting, layout) influence the daily lives of PwD. These features can be modified easily and with fewer disruptions to daily life at home. However, most PwD and their caregivers usually have little knowledge of what can be achieved through simple interventions to environmental features. There is a great need for an exhibition to explain the dementia-friendly home environment to the general public. Therefore, a series of annual exhibitions, distributed around the world and adapted to the characteristics of the local home environment, is introduced. These regularly-held and updatable exhibitions can meet the constant new cases and build long-term relationships with people for multiple study visits. This laboratory immersion exhibition will break through the traditional format of communicating information. During the continuous exploration and interactive activities in the experiment areas, visitors can learn about dementia-friendly home environments to facilitate and customize evidence-based home modifications by themselves. Meanwhile, the simulation of the real home environment brings visitors through a more immersive experience. The exhibition will also help promote further research in this field through bringing together PwD, caregivers, researchers, and designers to communicate the best practice. In the end, the exhibition should provide support for creating dementia-friendly environments and help improve PwD’s quality of life

The influence of hospitable design and service on patient responses

A study of 216 respondents examined a medical center environment’s influence on patient responses. A stimulus–organism–response (S-O-R) model was adapted to the theory that more hospitable healthcare servicescape elements will affect patients’ overall satisfaction with healthcare experience, loyalty intentions, and willingness to pay out-of-pocket expenses for healthcare services. Servicescape elements included atmospherics of the healthcare environment, service delivery by healthcare staff, physical design of the healthcare environment, and wayfinding. Results of structural equation modeling confirmed that the four servicescape elements – had a significant impact on patients’ overall satisfaction with the healthcare experience. Furthermore, overall satisfaction with the healthcare experience predicted patients’ loyalty intentions and willingness to pay out-of-pocket expenses for healthcare services. The study makes a significant contribution to the empirical modeling of patients’ behavioral responses to hospitable healthcare environments

Patterns of behavior in Alzheimer units: examining the role of the physical environment interface

Includes bibliographical references.2015 Summer.The purpose of this study was to examine the relationship among the physical environment and behaviors within individuals with Alzheimer’s in a Special Care Unit (SCU). The SCU was located in a skilled nursing facility in Fort Collins, CO providing care for individuals with mid to late stage dementia, including individuals with Alzheimer’s. Of interest in this research study was the impact of this relationship to influence positive, and negative, behaviors contributing to positive quality of life, or positive behaviors supported by one’s physical surroundings creating a living environment directed at acknowledging the person’s life experiences, opportunities for choice and decision, and activities replicating prior home/work activities for residents with Alzheimer’s or dementia. This study sought to enhance the existing body of knowledge about environmental impacts on behavior in care for individuals with Alzheimer’s. Day, Carreon, and Stump (2000) suggested design of the physical environment should be therapeutic, promoting well-being and functionality for individuals with Alzheimer’s or dementia. The research design was an instrumental case study investigating issues surrounding a specific phenomenon (i.e., the relationship of environment and behavior in the SCU) and collected both qualitative and quantitative data. Data collection began with a physical inventory documenting the environment through photographs noting furniture locations, lighting, colors, contrast, materials and finishes, and wear within the space. Observational data were collected over a 10 week consecutive period, during non-randomized times to accommodate the facility (three times a week) for 30 minutes each. Finally, the e-Survey with qualitative and quantifiable data obtained from staff (ns = 6) perceptions of the physical environment and residents’ (nr = 9) behaviors. Findings suggested staff behavior reinforcing a medical model of care in contrast to contemporary approaches providing person-centered care; staff perceptions of communications differed from observed instances of communication; resident wandering and communication were the two most frequently occurring behaviors recorded during observations. Instances where the physical environment impacted resident behaviors considered: a flooring transition strip instigated frustration by a resident in a wheelchair unable to move over the height difference; areas with greater levels of lighting, whether natural or artificial, appeared to promote greater socialization; and furniture placement and corridor planning in the unit shaped the pathways for movement through the unit. Two specific behaviors, not identified in the empirical literature, were found in the study to potentially contribute to a positive quality of life for residents with Alzheimer’s: physical touch and cleaning. Observed body language and facial expressions, of residents, during these behaviors suggest possible connection supporting in individual’s positive quality of life. The study revealed positive quality of life and person-centered care to be interlaced and not separate entities due to their concentration on personalization of care and establishing a connection to the individual’s past experiences

Optimising Refurbishment in Australian Residential Aged Care Facilities Using a Mixed Methods Approach

The growth in ageing populations in addition to an increase in rates of chronic diseases such as dementia, has led to projections that this upsurge will be matched by increased demand for residential aged care placements for the foreseeable future. Currently, significant proportions of aged care government funding both locally and internationally are directed towards the residential sector. Australia has recently released Aged Care Quality Standards whereby the outcomes to residents need to be verified specifically across a range of domains (including the living and built environment) in order to maintain this government funding. Building new facilities is not always a financially viable option for aged care organisations, so refurbishment of existing stock needs to be considered. However, it is often not clear how residential organisations are to identify, prioritise and undertake minor refurbishment initiatives in ways which both addresses the needs of the residents and also fulfils rising consumer expectations. The purpose of this research was to determine how minor refurbishment of residential aged care facilities (RACFs) could be undertaken in a prioritised, consistent and sustainable manner to ensure the outcomes enhance the abilities and wellbeing of the people who live within them. This work sought to contribute to the future development of a resource for providers who are planning minor refurbishments at RACFs. A sequential mixed methods research design using a pragmatic approach was undertaken to identify the elements of minor refurbishments; examine the ways in which they can be objectively assessed; determine the most suitable assessment approach and tool to be used in the assessment; and pilot the tool at a RACF. Data were gathered from diverse sources including narrative review of minor refurbishment elements, systematic review of environment assessment tools, e-Delphi survey, nominal stakeholder focus groups and the pilot tool findings including content validity index (CVI) and rater concordance measures. The research encompassed three phases. Phase 1 identified the elements of minor refurbishment and the existing environment assessment tools which could assess these elements. Phase 2 examined these tools at international, national and local levels and piloted and evaluated the identified assessment tool at a RACF. Phase 3 synthesised all the data to formulate recommendations when undertaking minor refurbishments. Seven minor refurbishment elements were identified and were represented in four environment assessment tools. International and national experts examined and ranked the tools for the local stakeholder groups to consider in their review of the tools. Evaluation of Older People’s Living Environments (EVOLVE) was selected as the tool to pilot at a RACF. Although initially developed for assisted or retirement living, the tool was found to be transferrable to RACF, including demonstrating good concordance and good correlation between the four raters. The tool results reiterated the value and importance of the minor refurbishment elements with a particular focus on lighting. The minor refurbishment elements of colour/contrast, flooring, furniture, lighting, noise, signage and wayfinding are complex and often interwoven. Differing levels of expertise are also required to translate the assessment findings into outcomes that can provide the appropriate support to residents living in residential aged care. This research ideally positions RACF managers to undertake minor refurbishment initiatives in an informed and systematic way. This can facilitate appropriate prioritisation and allocation of often tightly contested funds. Future research that evaluates measuring and undertaking minor refurbishments is recommended

Wayfinding in People with Alzheimer’s Disease: Perspective Taking and Architectural Cognition—A Vision Paper on Future Dementia Care Research Opportunities

Based on a targeted literature review, this vision paper emphasizes the importance of dementia-sensitive built space. The article specifically focuses on supporting spatial orientation and wayfinding for people living with dementia. First, we discuss types of wayfinding challenges, underlying processes, and consequences of spatial disorientation in the context of dementia of the Alzheimer’s type. Second, we focus on current efforts aimed at planning and evaluating dementia-sensitive built space, i.e., environmental design principles, interventions, evaluation tools, strategies, and planning processes. Third, we use our findings as a starting point for developing an interdisciplinary research vision aimed at encouraging further debates and research about: (1) the perspective of a person with dementia, specifically in the context of wayfinding and spatial orientation, and (2) how this perspective supplements planning and design processes of dementia-sensitive built space. We conclude that more closely considering the perspective of people with dementia supports the development of demographically sustainable future cities and care institutions

Third place: a qualitative examination of socialization and community building in CCRCs

2020 Summer.Includes bibliographical references.Continuing Care Retirement Communities (CCRCs) continue to be a popular option for senior living. Social activity is invariably tied to improved health trajectories and decreased loneliness but is often challenging for persons who may not have transportation available pointing at designers and architects to create quality social spaces within the CCRC itself. The concept of Oldenburg's third place and the breadth of literature tied to it provides a link between the built environment and network sociology informing this study. This case study utilized a spatial inventory, resident interviews and direct observations to investigate 1) whether CCRCs are utilizing Evidence-based design (EBD), 2) if there are naturally occurring or purpose-build third places internal to the community, and 3) whether these spaces were supporting socialization for the residents. While findings indicated limited use of EBD principals, the use of administrative policy lead to unique social leveling in the CCRC's purpose-built third place

Dementia-friendly wards: a review of the literature and pilot study of patient interaction and daily activity engagement

Purpose: The purpose of this paper, practice-based mixed methods small-scale study, is to explore the design features of a “dementia friendly” acute ward environment and, staff views on the implications of daily activity engagement for patients with dementia. Design/methodology/approach: Eight staff members of the multidisciplinary team who work full time on an acute “dementia friendly” ward completed semi-structured questionnaires. Thematic analysis explored responses to the open-ended questions, and a further environmental assessment tool rated features of the “dementia friendly” ward design, on promoting aspects of well-being in patients with dementia. Findings: Six overarching themes were found. These included: contrasting ward colours; clear ward signage; positive staff interaction; memorabilia, and activity rooms and items, had a positive influence on patient interaction, well-being and engagement in daily activities. The audit scores were rated highly for various aspects of the ward design. These included: the ward design promoting patient interaction, well-being, mobility, orientation, continence, eating and drinking and calm and security. Research limitations/implications: This practice-based small-scale study highlights the importance that a “dementia friendly” ward environment may have on patient engagement and well-being, from a daily activity perspective. Further research into the key aspects of design that enable meaningful daily activity engagement is required. Practical implications: This study supports staff perceived views of the positive influence that “dementia friendly” design may have for patients with dementia. Both the physical design modifications of the ward and staff interaction were highlighted as positively influencing patient well-being, and daily activity engagement. Staff members also felt that they needed to balance the clinical ward priorities, with the contextual requirements of patients with dementia, to establish an effective “dementia friendly” ward. Originality/value: The value of this research is the combined consideration of an environmental assessment tool and qualitative interviews with members of the multidisciplinary team

Exploring Possibilities: Virtual Reality in Nursing Research

This paper describes the use of virtual reality (VR) as a method of measurement in nursing research. VR refers to the use of computerized displays to display a life-like environment in which the user interacts. Although many disciplines are beginning to use VR environments in research, nursing has yet to embrace this technology. Nursing, as a profession which values the interaction between the environment, individual, and health, can benefit from the use of VR in research. Establishing reliability and validity of the VR tool selected for research is important and requires special consideration. VR testing can produce side effects, such as vertigo and discomfort, which must be anticipated in the research protocol

Optimising hospital designs and processes to improve efficiency and enhance the user experience

The health sector is facing increasing pressure to provide effective, efficient, and affordable care to the population it serves. The National Health Service (NHS) of the United Kingdom (UK) has regularly faced scrutiny with NHS England being issued a number of challenges in recent years to improve operational efficiency, reduce wasted space, and cut expenditure. The most recent challenge issued to NHS England has seen a requirement to save £5bn per annum by 2020, while reducing wasted space from 4.4% to 2.5% across the NHS estate. Similarly, satisfaction in the health service is also under scrutiny as staff retention and patient experiences are used in determining the performance of facilities. [Continues.