Susan Rodiek

Influences of Physical Environment on Corridor Walking Among Assisted Living Residents Findings From Focus Group Discussions

Walking has multiple physical and psychological benefits for older people. This study explores corridor walking behaviors and perceptions of corridor walkability in assisted living residents. Focus groups were conducted with 50 residents in six assisted living facilities in Texas. The data were analyzed by the constant comparative method. The findings revealed three types of corridor walking: walking to destination, walking for exercise, and walking for interaction. Residents’ perception of corridor walkability was related to the themes of safety, comfort/convenience, and aesthetics. Qualities of design elements that residents used to judge corridor walkability included continuity and graspability of handrails, coverage of carpeted floor, availability of seating, appropriate size of the corridor (i.e., width and length) and the elevator, appropriate locations of activity spaces and restrooms, and presence of artwork, window views, and plants. The findings provide insights to environmental interventions that may promote walking among sedentary residents.

You Can't Get There From Here: Reaching the Outdoors in Senior Housing

By providing access to outdoor environments, exterior doors can enhance the sense of freedom in residential environments for aging. However, doorways may also present barriers to outdoor access. Using environmental audits, this study examined doorway problems at 68 assisted living facilities in three geographic regions. Results were compared with resident surveys (n = 1,128), staff surveys (n = 432), and resident focus groups (n = 76). Specific doorway issues were found to be associated with residents’ weekly minutes of walking, outdoor usage, and perceived ease of reaching outdoor areas. The main problems were door opening/closing, thresholds and landings, and self-locking doors. The findings indicate that exterior doorways often present barriers to assisted living residents, resulting in lower levels of walking and outdoor use. By discouraging these health-related behaviors, doorway problems may negatively affect residents’ health and well-being. Practice implications suggest that many existing doorway problems, such as high thresholds or excessive opening force, are easily remedied.

Restorative Design Features for Hospital Staff Break Areas: A Multi-Method Study

Objectives: The study investigated the main restorative components of staff break areas in healthcare facilities, by assessing usage patterns, verbal/visual preferences, and perceived restorative qualities of specific design features found in break areas for hospital staff. Background: Nurses are extremely important to the healthcare industry, and maintaining the quality of nursing care is a central concern for healthcare administrators. While healthcare leaders are concerned about improving nurses’ satisfaction, performance, and job retention, they may overlook the importance of respite for nurses and underestimate the value of designing staff break areas to maximize their restorative potential. Methods: A multi-method approach combined qualitative explorations (focused interviews and narrative survey questions) with quantitative measurements (discrete survey questions and a visual ranking of break-room spaces), and the results were compared and triangulated. Results: It was found that staff break areas are more likely to be used if they are in close proximity to nurses’ work areas, if they have complete privacy from patients and families, and if they provide opportunities for individual privacy as well as socialization with coworkers. Having physical access to private outdoor spaces (e.g., balconies or porches) was shown to have significantly greater perceived restorative potential, in comparison with window views, artwork, or indoor plants. Conclusions: The results of this empirical study support the conclusion that improvements in the restorative quality of break areas may significantly improve nurses’ satisfaction and stress reduction, potentially leading to improved care for the patients they serve.

A Review of Design and Policy Interventions to Promote Nurses’ Restorative Breaks in Health Care Workplaces:

The nursing profession in the United States is on the precipice of a crisis. Nurses are essential to the health care industry, and maintaining quality nursing care is a primary concern of today’s health care managers. Health care facilities report high rates of staff burnout and turnover, and interest in the nursing profession among younger students is declining. Health care leaders must improve nurses’ job satisfaction, performance, and retention. However, they often overlook the need for nurses’ respite and underestimate the value of well-designed staff break areas. An exhaustive and systematic literature search was conducted in the summer of 2014, and all studies found on the topic were reviewed for their relevance and quality of evidence. The existing literature about the main causes of nurses’ fatigue, barriers that prevent nurses from taking restorative breaks, and consequences of nurses’ fatigue for staff, patient, and facility outcomes demonstrates the pressing need for interventions that improve nurses’ working conditions. Additional literature on the restorative effects of breaks and the value of well-designed break areas indicates that efforts to improve breakroom design can play an important role in improving nurses’ job satisfaction and performance.

Aging in Place at Home Through Environmental Support of Physical Activity: An Interdisciplinary Conceptual Framework and Analysis

This article presents a conceptual framework to link issues of health, services, physical activity, and environment to help older adults age in place in their own homes, which may reduce the demands on society to provide institutional long-term care. Using environments to promote physical activity has received attention by researchers, but its impact on aging-in-place at home has been largely ignored. This article interprets and synthesizes existing studies on aging-in-place in relation to health and services, contributions of physical activity to health and service accessibility, and environmental support of physical activity. The conceptual framework can serve as the core construct to address gaps in previous research and as a tool to refine practical targets for policies and interventions aimed at promoting healthy aging.

Neighborhood Factors and Fall-Related Injuries among Older Adults Seen by Emergency Medical Service Providers

Falls are serious health problems among older adults, and are the leading cause of fatal and nonfatal injuries treated by emergency medical services (EMS). Although considerable research has examined the risk factors of falls at the individual level, relatively few studies have addressed the risk factors at the neighborhood level. This study examines the characteristics of neighborhood environments associated with fall injuries reported to EMS providers. A total of 13,163 EMS records from 2011 to 2014 involving adults aged 65 and older in the city of San Antonio (TX, USA) were analyzed at the census tract level (n = 264). Negative binomial regression was used to identify significant census tract-based neighborhood environmental variables associated with the count of fall injuries in each census tract. Adjusting for exposure variable and the size of the census tract, neighborhoods with higher residential stability, captured as the percent of those who lived in the same house as the previous year were associated with decreased count of fall injuries. Neighborhoods with higher residential density and having a higher vacancy rate were associated with increased count of fall injuries. The study highlights the importance of stable and safe neighborhoods in reducing fall risks among older adults, which should be considered a prerequisite for promoting age-friendly environments.

Can Better Outdoor Environments Lead to Cost Benefits in Assisted Living Facilities through Increased Word-of-Mouth Referrals?

Objective: This study explores how better outdoor environments may produce cost benefits for assisted living providers by raising occupancy levels through increased resident satisfaction and word-of-mouth referrals. Background: Older adults who spend even minimal time outdoors may reap substantial health benefits. However, many existing outdoor areas in assisted living facilities are reportedly underutilized, in part because of design issues. Providers may be more willing to improve outdoor areas if they produce cost benefits for provider organizations. Methods: This study used data from a recent assisted living survey to assess the relationship between satisfaction with outdoor spaces, time spent outdoors, and resulting improvements in mood. A financial analysis was developed to estimate potential benefits from improved outdoor areas attributable to increased occupancy and decreased marketing costs associated with increased word-of-mouth referrals. Results: Increasing resident satisfaction with outdoor areas (from approximately 29% to 96%) results in residents spending more time outdoors (increase of 1 1/2 hours per week per resident) and improved psychological well-being (12% increase in feeling better). This greater overall satisfaction leads to 8% more residents willing to refer potential residents to their community. Because word-of-mouth referrals by current residents are a major factor in resident recruitment, improving outdoors areas leads to an estimated 4% increase in new residents, resulting in over

Can a Virtual Nature Experience Reduce Anxiety and Agitation in People With Dementia

170,000 of increased revenue per year for a community of 100 residents. Conclusions: Improved outdoor space can provide substantial cost benefits for assisted living providers. Increasing resident well-being and satisfaction, and thereby generating additional word-of-mouth referrals, can result in higher occupancy levels.

Affordance-Based Evaluations that Focus on Supporting the Needs of Users.

ABSTRACT Research has found that viewing nature reduces stress and improves mood, but few studies have focused on the potential of viewing nature to reduce negative emotions associated with dementia. Using a counterbalanced design, 14 memory care residents were alternately exposed to a virtual nature experience (treatment) and a generational movie (control). Before and after each exposure, heart rate was measured, and emotions were assessed with the Observed Emotion Rating Scale and the Agitated Behavior Scale. Results are that heart rate declined significantly compared with the generational movie, and anxiety and pleasure showed greater improvements during the nature intervention, although the difference was not significant.

The Seniors’ Outdoor Survey (SOS Tool): comparing ratings and reliability between Italy and the USA

The Concept and Use of AffordancesOverviewThis article discusses using an affordance-based approach to evaluating therapeutic and restorative spaces in healthcare settings. Affordances can be described as the functional potential of environmental features that carry meanings and values in how they support human usage ([Gibson, 1979]). Viewing physical environments through the lens of affordances makes it possible for individuals to make decisions quickly and comprehensively regarding the supportive characteristics of an environment, for the purpose of influencing or facilitating behavior ([Chemero, 2003]). When care providers and designers are required to plan or evaluate therapeutic spaces, they need to be able to understand whether these spaces will meet the requirements of the user groups they are intended to serve. The use of affordance-based evaluations offers a way to incorporate the critically important interrelationships of features in an environment, from the perspective of specific user groups.Affordances can be described as the functional potential of environmental features that carry meanings and values in how they support human usage This can be more revealing than simply recording the presence or absence of the separate environmental features, and counting/measuring them, as might be done with a simple design inventory of a space that may be informed by professional best practices. This is also a subtle shift beyond the use of postoccupancy evaluations (POEs), many of which have a basis in research for specific user groups. The difference is in the added dimension of proactively observing and recording the support, value, and usefulness of features within a space. This is done for a specifically identified user niche whose needs are clearly drawn from research.Links Between the Design and Features of Physical Spaces and Health/LongevityAmple research has shown clear linkages between patient and resident quality of life and the design and arrangement of spaces within the clinics, hospitals, and residential care facilities that support these users (e.g. [Cooper Marcus & Sachs, 2014]; [Miller & Swensson, 2002]; [Rodiek, Lee, & Nejati, 2014]; [Ulrich, Berry, Quan, & Parish, 2010]). Connections to nature, both active and passive, and social interaction can all be supported through targeted features within an interior space or landscape, whether at the scale of a large clinic waiting room or a small outdoor therapeutic garden (e.g. [Coles & Millman, 2013]; [Souter-Brown, 2015]). Research and design experience (a primary focus of the Health Environments Research & Design journal) has identified many specific environmental features and qualities that have been found to provide these benefits. Some of these environmental characteristics include indoor sunlight in hospital rooms ([Beauchemin & Hays, 1996], [1998]), views of nature that promote healing ([Kaplan & Kaplan, 1989]; [Ulrich, 1991]; [Ulrich et al., 2008]), clear wayfinding within complex hospital settings that help reduce stress ([Devlin, 2014]; [Ulrich, 2001]), comfortable chairs that have backs and arms to support seniors and those with balance challenges ([Malone & Dellinger, 2011]), gardens that stimulate multiple senses to support cognitive function ([Barnicle & Midden, 2003]; [Whitehouse et al., 2001]), and activity elements that can help to achieve therapeutic goals in the care of children while also enhancing play ([McMahon, 2012]).Utilize the Interrelationships of ElementsIn real-world settings, there is typically a complex interplay among environmental features, which is an essential aspect of their restorative potential for the intended users. Relationships such as comfortable seating coupled with shade plantings or structures will enhance the support for frail seniors who may be sensitive to bright sunlight or heat ([Rodiek & Schwarz, 2005]). …