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Revision as of 20:03, 31 October 2011

Group #10

• 1.Colin Meincke
• 2.Maygan Bosma
• 3.Kate Dionne

Designs in Assisted Living Facilities

Introduction

A concept that is growing more popular as the average life expectancy increases, the residents of elderly living facilities could over populate the fast food restaurants that are located on every major street corner. Even though this idea sounds exaggerated, the continuous need for more elderly assisted living homes is real (Huang & Shanklin, 2008)^[1]. With a population of elderlies closely matching that of the young, and a group of Baby Boomers on the horizon of retirement, architecture and designing in assisted-living facilities will become a booming business (Huang & Shanklin, 2008)^[1].

Location and Overall Design

In the Post World War II era, living in the outer city neighbourhoods, owning a small piece of land surrounded by ever-green lawns and tree-lined streets with newly paved sidewalks became the North American Dream way of living. What the North American population of this time did not realize was the benefits of the new suburban community would turn into negatives for newly developed elderly assisted living facilities and their residences. Since the layout of most cities is already chaotic and cramped, construction of new large facilities/buildings need to take place on the city line, which is a problem, because that is where the suburban community is located (Hatfield, 2003)^[2].

The Royal Henley, one of the top assisted living facilites in Saint Catharines is located on the perimater of the city

It is common for assisted living facilities to be built on the outside borders of the suburbs, away from the city's and suburb’s facilities (i.e., grocery stores, malls, parks, and leisure centres) (Hatfield, 2003)^[2]. This is a problem, because much of the elderly cannot drive a vehicle, making the city facilities inaccessible. Assisted living facilities then need a dining area that offers different types of meals to its residences, or to have an on foot accessible shopping centre, containing grocery store, drug store, and small mall on location. This layout is less common, even though such a facility design promotes more physical activity in residences (Hatfield, 2003)^[2]. Another rare assistant living structural design has one/two floor homes set up side by side with a small yard in the front. Since residences have to go outside in order to go anywhere, they are more likely to interact socially with others in the facility. Past research has found that this facility layout promotes better well-being in residences because it has larger living space and increases social activity, which is the most important determinant of well-being in the elderly (Street, Burge, Quadagno, & Barrett, 2007)^[3]. Most assisted living facilities are multiple floor buildings, with several rooms on each floor, very similar to an apartment or hotel [1]. These facilities have smaller properties and limit outside activities, such as walking, unless residences want to venture off the property, which some facilities restrict (Hatfield, 2003)^[2].

The Interior

With the interior of assisted living facilities, as with most services, you get what you paid for. Residences pay top dollar for private, individual homes which are more personalized and have more room, or they pay significantly less for rooms that are smaller and shared with non-kin. Residences that stay in the larger private, individual homes are twice as likely to state their place has a more “home-like lifestyle”, whereas, residences who share a room with non-kin have a significant reduction in life satisfaction (Street et al., 2007)^[3].

Basic Bedroom Layout: Top Image-Bedroom with Kitchen & Bottom Image-Bedroom with Living area

With regards to the layout of the room, there are basically two different styles. The first is one bedroom with living area, bathroom, and small kitchen. The increase in room size and an addition of a kitchen is often meant for residences that are still quite independent and who also live with their partner. The second style is a one bedroom with sitting area and bathroom. The decrease in size and lack of kitchen often means the individual/couple at their current age lack the physical/cognitive tools to be independent. This layout of room is also used if the assisted living facility has a large dining room where all residences gather to eat prepared meals, which makes a kitchen unnecessary. Aside from these two types of rooms, several architects/designers have taken it upon themselves to create new designs, taking into consideration the booming market that waits in the future.

Hoof & Kort (2009)^[4] created a room for assisted living facilities that is specifically meant for residences that have dementia. The design mimics the more expensive individual home with a front lawn and porch. The layout has an open concept feel to it, which allows an individual or a partner to see almost everything that is happening from any room. Therefore, this home is easier for a spouse who has to monitor their partner with dementia, or an individual residence with dementia, because less goes unnoticed in each room (Hoof & Kort, 2009)^[4]. One of the drawbacks to this design is that it is very expensive, because it is an individual outside unit. However, the practicality of the inside design could very easily be applied to an apartment structure, which would still allow for the benefits of the open concept. Past research has also looked at other design changes that could benefit residences in assisted living facilities.

Bird's Eye View

Angled Birds Eye View

View from Kitchen

Sleep cycle research has discovered that intensified lighting in the dining area has shown to improve circadian rhythm disturbances in residences that have moderate to severe dementia (Someren, Kessler, Mirmiran & Swaab, 1997)^[5]. Increased lighting in assisted living facilities has also shown to reduce cognitive deficits by 5% and decrease depressive symptoms by 19% in residences with dementia (Remersma-van der lek et al., 2008)^[6].

Conclusion

In conclusion, assisted living facilities are frequently located on the borders of cities, away from shopping centres and grocery stores. In attempts to maximize land use, assisted living facilities mimic apartment or hotel designs instead of smaller individual housing which has a more “home feel” to it. Overall, assisted living facilities focus more on the assisted aspect and focus less on the living. Residences at assisted living facilities are often governed by many rules and are less likely to be allowed to live freely as they please. However, as the need for assisted living increases, more qualitative and quantitative research on these facilities will be completed. Unfortunately as it stands now, the facilities and research are not there yet. --Cm08yo 12:13, 31 October 2011 (EDT)

References

1. ↑ ^{1.0 1.1} Huang, H. & Shanklin, C. (2008). An integrated model to measure service management and physical constraints’ effect on food consumption in assisted living facilities. American Dietetic Association, 108, 785-792.
2. ↑ ^{2.0 2.1 2.2 2.3} Hatfield, J. (2003). A community for the elderly and assisted living. New Urbanistic Architecture, 1-43.
3. ↑ ^{3.0 3.1} Street, D., Burge, S., Quadagno, J., & Barrett, A. (2007). The salience of social relationships for resident well-being in assisted living. Social Sciences, 62, 129-134.
4. ↑ ^{4.0 4.1} Hoof, J. & Kort, H. (2009). Supportive living environments: A first concept of a dwelling designed for older adults with dementia. Sage, 8, 293-316.
5. ↑ Someren, V., Kessler, A., Mirmiran, M., & Swaab, D.F. (1997). Indirect bright light improves circadian rest-activity rhythm disturbances in demented patients. Biological Psychiatry, 41, 955-963.
6. ↑ Remersma-van der lek, R., Swaab, D., Twisk, J., Holg, E., Hoogendijk, W., & Van Someren, E. (2008). Effect of bright light and melatonin on cognitive and noncognitive function in elderly residents of group care facilities: A randomized controlled trial. Jama, 299, 2642-2655.

Activities in Assisted Living Facilities

Introduction

Exercise

Older adults can maintain or improve physiological changes through consistent exercise. According to Cafiero and Maritz (2003) participation in exercises specific to health conditions can decrease risk of injury as a result of balance, flexibility and mobility. Although their findings do show links to improvements it is important to tailor exercise regimens to suit outstanding health conditions. Cafiero & Maritz explain that those suffering with the chronic disease of osteoarthritis can experience decreased range of motion resulting from joint and muscle degeneration. This causes pain in joints such as knees and fingers and can make simple tasks such as getting out of bed and brushing ones teeth very difficult. Improvements in flexibility, mobility and balance can be achieved through low impact activities such as swimming, walking or weight training (Cafiero & Martiz, 2003). Older adults suffering from osteoporosis also experience chronic pain as the result of decreased bone mass which may be partially recovered through exercises that include resistance and weight training (Cafiero & Martiz, 2003). Resistance exercises include swimming and biking in which there is force acting against your muscles producing tension. Lastly, exercising can have indirect effects on ones psychological health. Cafiero and Maritz (2003) point out that there are effects that take place during exercise that can alter ones well-being, for example when chemicals such as serotonin are released and have the ability decrease depressive symptoms. Prior to participation in exercise, older adults should receive doctor’s clearance and seek information on which types of exercise are best for their condition. Taking these proactive steps can decrease the risk of injury before initiating the exercise routine.

Exercise not only benefits older adults physically but it has the potential to improve their cognitive abilities as well. Colcombe et al. (2006) found that older adults who participated in an exercise routine for 6 months showed increased white and grey matter in areas responsible for memory, higher order control, motor skills. Therefore older adults may experience better memory and better physical functioning, which can facilitate increased participation in exercise and can promote injury reduction. It can also provide an opportunity for gaining some independence back as their reliance on others can be decreased.

Gardening

Gibson et al. (2007) state that older adults living at home have more opportunity to enjoy the outdoors and gardening than those living in a facility. Thus, increasing the opportunity to get outdoors in the garden at a living facility may promote a feeling of comfortability. People in assisted living facilities are often confined indoors by their physical and mental impairments however, with proper design and tools this limitation can be overcome. Accessibility to gardening activities for normally and abnormally aging adults can be made possible through adjustments to gardening tools used prior to the onset of disabilities. Kwack et al. (2004) have suggested customizing gardening tools by increasing grip size by using foam padding or using PVC pipe to lengthen the handle and to create better mobility. People may be unable to grip the small handles successfully do to complications of diseases such as osteoarthritis and increasing the grip size and adding padding will make holding the tool less painful. Lengthening the handle provides an opportunity for those in a wheelchair to reach the ground. Presenting these older adults with the opportunity to do something they thought impossible will foster feelings of independence and accomplishment.

Pet Assisted Therapy

Providing elders with access to animals in assisted living facilities is a great way to increase social interaction. Animals in shelters can get much needed exercise and socialization they are lacking at the shelter by introducing them to patients at the assisted living facilities who are lacking in the same areas. Firstly, Kathy Saylor (1998) pointed out that those in assisted living facilities experience loneliness and the animals not only provide intrapersonal social benefits but also acts as a liaison for interpersonal socialization by introducing a common topic among residents and nurses. Residents can pet and talk to the animals alone or with others and the animals can provide for introductions and facilitate conversation between staff and other residents. Additionally, animals can encourage exercise in the older adults through playing, walking or grooming that has been found to improve physiological and cognitive functioning (Minman & Heyl, 2002; Cafiero & Maritz, 2006; Colcombe et al., 2006). Lastly, animals have the ability to evoke calmness and relaxation by regulating physiological functions such as heart rate (Stasi et al., 2004).

Psychological Well-being in Assisted Living Facilities

Introduction

The aging population is increasing at a steady rate, thus requiring more assisted living facilities to be developed. However, this is not the only primary concern in regards to the aging baby boomers. Psychological well-being/ mental health [2] of elderly residents is an important area of research that questions what possible predictors are. Thus it is important to implement both home-like and cost-effective programs/tools that influence residents’ psychological well-being. Because depression [3] is particularly prevalent among those who move into assisted living facilities, either because of loss of a spouse or illness, it is important to consider the areas that promote psychological well-being (Cummings, 2003) ^[7]. Current research on psychological well-being of the elderly within assisted living facilities has focused on a number of predictors:

• Social relations
• Group therapy
• Coping methods

Social Relations

Having social relationships is an inevitable and important aspect of life, one that may actually increase with age in terms of importance and psychological well-being (Barrett, Burge, Street & Quadango, 2007) ^[8]. Social support in itself provides better psychological well-being; it provides a buffer against negative health outcomes

such as depression or lower functioning impairment (Nicassio & Schanowitz, 2006). Therefore having social relationships while living in an assisted living facility should be regarded as just as important as having relationships when living alone. Recent research on assisted living facilities questions which relationships are most salient and influential on the elderly, and how they may enhance the well-being its residents (Barrett et al., 2007) ^[8]. Living in an assisted living facility may be difficult to empathize with because it is likely that the number of individuals one interacts with is confined to a select few, being other residents’ and staff members; consequently, it may be difficult to adjust and find meaning within these relationships. Recent research validates this, in that the most important relationships while living in an assisted living facility are with staff members and other residents’ (Barrett et al., 2007) ^[8]. Those who were socially integrated within the facility, demonstrating internal social relationships and positive feelings towards staff members served as predictors of psychological well-being (Barrett et al., 2007) ^[8]. Specifically, these residents reported better quality of life, higher life satisfaction, and reports of feeling at home (Barrett et al., 2007) ^[8]. Other findings suggest that enjoyment during mealtime predicts greater psychological well-being than does social support, reciprocal relationships, and activities (Park, 2009)^[9]. These findings suggest that those who adjusted well to life in assisted living facilities display better psychological well-being. However, further research should focus on whether this is applicable only to those who can alter their social resources easily. Another form of social relationships that provides support and predicts psychological well-being appears to be participation in group therapy.

Group Therapy

Group therapy is another form of social relations which seems to predicts psychological well-being because it aims to combat isolation, loneliness, and allows residents to normalize their feelings about age-related issues (Cummings, 2003)^[7]. Group therapy may be an important method of intervention to employ within assisted living facilities because it encourages meaningful interaction and communication with residents; rather than having individuals be passive during activities, or simply being entertained (Cummings, 2003)^[7]. Group therapy is designed to engage and attract residents (Cummings, 2003)^[7]. It attracts participates through an activity such as gardening, and engages them via group discussion (Cummings, 2003)^[7]. Therefore this form of regime may be extremely beneficially for psychological well-being because it allows participants to intellectually engage in discussion but also in activities that require a degree of skill; thus they are utilizing their brain and skills with the added benefit of seeking out relationships. Research demonstrates that it is not the amount of programs one attends, but the perception residents have of the programs attended, and the level of social support they receive from them (Cummings, 2002)^[10]. Therefore as group therapy and other researchers suggest, it is not about implementing programs for residents to do in assisted living facilities, but it is the quality and activity of programs that involve utilization of skill and support seeking that enhance psychological well-being (Cummings, 2002)^[10]. A final area that may enhance well-being involves coping mechanisms, and what types of strategies promote wellbeing.

Coping Mechanisms

Various coping mechanisms produce different results in terms of well-being (Nicassio & Schanowitz, 2006)^[11]. Meaning-based coping methods, which involve positive re-appraisal, religious beliefs, and revision of goals in response to life stressors such as moving into an assisted living facility, is associated with better psychological well-being (Nicassio & Shanowitz, 2006)^[11]. More specifically, positive reappraisal is associated to better social relationships, better self-acceptance, and higher positive affect in regards to a better sense of overall well-being (Nicassio & Shanowitz, 2006)^[11]. Therefore meaning-based coping methods may be a good explanation of positive emotional adjustment, and thus should be implemented in some form in assisted living facilities so that residents may have the right tools to adjust to a new life within an assisted living facility.

Conclusion

In conclusion, it is clear that there is an increasing need for assisted living facilities to develop interventions that promote, and possibly enhance the psychological well-being of its residents. Recent research discusses several ways to do so; being social support, which may include development of social relationships with other residents and staff members, group therapy, or meaning-based coping strategies. As of now, more research needs to be done in order to determine which aspects can truly influence psychological well-being, or if it is a combination of factors previously suggests, or whether it is individually based.

Notes and References

1. ↑ ^{1.0 1.1} Huang, H. & Shanklin, C. (2008). An integrated model to measure service management and physical constraints’ effect on food consumption in assisted living facilities. American Dietetic Association, 108, 785-792.
2. ↑ ^{2.0 2.1 2.2 2.3} Hatfield, J. (2003). A community for the elderly and assisted living. New Urbanistic Architecture, 1-43.
3. ↑ ^{3.0 3.1} Street, D., Burge, S., Quadagno, J., & Barrett, A. (2007). The salience of social relationships for resident well-being in assisted living. Social Sciences, 62, 129-134.
4. ↑ ^{4.0 4.1} Hoof, J. & Kort, H. (2009). Supportive living environments: A first concept of a dwelling designed for older adults with dementia. Sage, 8, 293-316.
5. ↑ Someren, V., Kessler, A., Mirmiran, M., & Swaab, D.F. (1997). Indirect bright light improves circadian rest-activity rhythm disturbances in demented patients. Biological Psychiatry, 41, 955-963.
6. ↑ Remersma-van der lek, R., Swaab, D., Twisk, J., Holg, E., Hoogendijk, W., & Van Someren, E. (2008). Effect of bright light and melatonin on cognitive and noncognitive function in elderly residents of group care facilities: A randomized controlled trial. Jama, 299, 2642-2655.
7. ↑ ^{7.0 7.1 7.2 7.3 7.4} Cummings, S., M. (2003). The efficacy of an integrated group treatment program for depressed assisted living residents. Research on Social Work Practice, 13, 608-621.
8. ↑ ^{8.0 8.1 8.2 8.3 8.4} Barrett, A., Burge, S., Street, D., Quadango, J. (2007). The salience of social relationships for resident well-being in assisted living. Journal of Gerontology: Social Sciences, 62B, 129-134.
9. ↑ Park, N., S. (2009). The relationship of social engagement to psychological well-being of older adults in assisted living facilities. Journal of Applied Gerontology, 28, 461-481.
10. ↑ ^{10.0 10.1} Cummings, S., M. (2002). Predictors of psychological well-being among assisted-living residents. Health & Social Work, 27, 293-302.
11. ↑ ^{11.0 11.1 11.2} Nicassio, P. M., Schanowitz, J. Y. (2006). Predictors of positive psychosocial functioning of older adults in residential care facilities. Journal of Behavioral Medicine, 29, 191-201.