The state of physical environments in Australian residential aged care facilities
Kirsten J. Moore A G , Keith D. Hill A B , Andrew L. Robinson C , Terry P. Haines D E , Betty Haralambous A and Jennifer C. Nitz FA National Ageing Research Institute, 35–54 Poplar Road, Parkville, VIC 3052, Australia. Email: b.haralambous@nari.unimelb.edu.au
B Musculoskeletal Research Centre, La Trobe University and Northern Health, Bundoora, VIC 3086, Australia. Email: keith.hill@latrobe.edu.au
C School Of Nursing and Midwifery, University of Tasmania, Private Bag 121, Hobart, TAS 7001, Australia. Email: andrew.robinson@utas.edu.au
D Allied Health Research Unit, Southern Health, c/o Allied Health Clinical Research Unit, Kingston Centre, Kingston Road, Cheltenham, VIC 3192, Australia. Email: terrence.haines@med.monash.edu.au
E Southern Physiotherapy Clinical School, Monash University, c/o Allied Health Clinical Research Unit, Kingston Centre, Kingston Road, Cheltenham, VIC 3192, Australia.
F School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD 4072, Australia. Email: j.nitz@uq.edu.au
G Corresponding author. Email: k.moore@nari.unimelb.edu.au
Australian Health Review 35(4) 412-417 https://doi.org/10.1071/AH10932
Submitted: 3 June 2010 Accepted: 29 March 2011 Published: 9 November 2011
Abstract
Objective. This paper examines the quality and safety of the physical environment in Australian residential aged care facilities (RACFs).
Design. Cross-sectional study. One assessor completed environmental audits to identify areas of the physical environment that needed to be addressed to improve the wellbeing and safety of residents.
Setting. Nine RACFs participating in a broader falls prevention project were audited. RACFs were located in Queensland, Tasmania or Victoria and were chosen by convenience to represent high level, low level, dementia and psychogeriatric care, regional and metropolitan facilities, small and large facilities and a culturally specific facility.
Main outcome measure. An environmental audit tool was adapted from a tool designed to foster older person friendly hospital environments. The tool consisted of 147 items.
Results. Across all sites 450 items (34%) required action. This ranged from 21 to 44% across sites. The audit domains most commonly requiring action included signage, visual perception and lighting, and outdoor areas.
Conclusions. Although not representative of all residential facilities in Australia, this audit process has identified common environmental problems across a diverse mix of residential care facilities. Results highlight the need for further investigation into the quality of physical environments, and interventions to improve physical environments in Australian RACFs.
What is known about the topic? Despite the importance of the physical environment on the health, wellbeing and safety of older people in residential aged care facilities, few studies have comprehensively evaluated the physical environment in facilities in Australia.
What does this paper add? This paper provides findings from comprehensive audits of nine residential aged care facilities representing a broad range of facility settings in terms of location, level and type of care and target population. Findings indicate that each facility had at least 21% of items requiring action with an average of 34% of items requiring action across all facilities.
What are the implications for practitioners? There is a need to undertake intermittent, thorough assessments of the physical environments in which residents live and, if applicable, implement strategies or modifications to improve the environment. Areas requiring particular consideration may be lighting, colour contrasts, signage and outdoor areas.
References
[1] Satariano WA. The disabilities of aging – looking to the physical environment. Am J Public Health 1997; 87 331–2.| The disabilities of aging – looking to the physical environment.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK2s3ltVyntg%3D%3D&md5=bdb5cd9fefd44ffd17201c4a4f205ea9CAS |
[2] Teresi JA, Holmes D, Ory MG. The therapeutic design of environments for people with dementia: further reflections and recent findings from the National Institute on Aging Collaborative studies of Dementia special care units. Gerontologist 2000; 40 417–21.
| The therapeutic design of environments for people with dementia: further reflections and recent findings from the National Institute on Aging Collaborative studies of Dementia special care units.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3cvjs1CrsA%3D%3D&md5=3c1621b70b4db9a038553ca5a4fcdf6cCAS |
[3] Standards and Guidelines for Residential Aged Care Services Manual. Australian Government Department of Health and Ageing; 2004. Available at http://www.health.gov.au/internet/main/publishing.nsf/Content/ageing-manuals-sgr-sgrindex.htm [verified March 2011].
[4] Cai Q, Salmon JW, Rodgers ME. Factors associated with long-stay nursing home admissions among the US elderly population: comparison of logistic regression and the Cox proportional hazards model with policy implications for social work. Soc Work Health Care 2009; 48 154–68.
| Factors associated with long-stay nursing home admissions among the US elderly population: comparison of logistic regression and the Cox proportional hazards model with policy implications for social work.Crossref | GoogleScholarGoogle Scholar |
[5] Friedman SM, Steinwachs DM, Temkin-Greener H, Mukamel DB. Informal caregivers and the risk of nursing home admission among individuals enrolled in the program of all-inclusive care for the elderly. Gerontologist 2006; 46 456–63.
| Informal caregivers and the risk of nursing home admission among individuals enrolled in the program of all-inclusive care for the elderly.Crossref | GoogleScholarGoogle Scholar |
[6] Jette AM, Tennstedt S, Crawford S. How does formal and informal community care affect nursing-home use? J Gerontol B Psychol Sci Soc Sci 1995; 50B S4–12.
| How does formal and informal community care affect nursing-home use?Crossref | GoogleScholarGoogle Scholar |
[7] Smith M, Gerdner LA, Hall GR, Buckwalter KC. History, development, and future of the progressively lowered stress threshold: a conceptual model for dementia care. J Am Geriatr Soc 2004; 52 1755–60.
| History, development, and future of the progressively lowered stress threshold: a conceptual model for dementia care.Crossref | GoogleScholarGoogle Scholar |
[8] Day K, Carreon D, Stump C. The therapeutic design of environments for people with dementia: a review of the empirical research. Gerontologist 2000; 40 397–416.
| The therapeutic design of environments for people with dementia: a review of the empirical research.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3cvjs1Crsw%3D%3D&md5=21088f1b5a72edf610f81d9d1dc350dfCAS |
[9] Becker C, Kron M, Lindemann U, Sturm E, Eichner B, Walter-Jung B, et al Effectiveness of a multifaceted intervention on falls in nursing home residents. J Am Geriatr Soc 2003; 51 306–13.
| Effectiveness of a multifaceted intervention on falls in nursing home residents.Crossref | GoogleScholarGoogle Scholar |
[10] Cameron ID, Murray GR, Gillespie LD, Robertson MC, Hill KD, Cumming RG, Kerse N. Interventions for preventing falls in older people in nursing care facilities and hospitals. Cochrane Database of Systematic Reviews 2010; CD005465
| Interventions for preventing falls in older people in nursing care facilities and hospitals.Crossref | GoogleScholarGoogle Scholar |
[11] Jensen J, Lundin-Olsson L, Nyberg L, Gustafson Y. Fall and injury prevention in older people living in residential care facilities. A cluster randomized trial. Ann Intern Med 2002; 136 733–41.
[12] De Lepeleire J, Bouwen A, De Coninck L, Buntinx F. Insufficient lighting in nursing homes. J Am Med Dir Assoc 2007; 8 314–7.
| Insufficient lighting in nursing homes.Crossref | GoogleScholarGoogle Scholar |
[13] Haralambous B, Haines TP, Hill K, Moore K, Nitz J, Robinson A. A protocol for an individualised, facilitated and sustainable approach to implementing current evidence in preventing falls in residential aged care facilities. BMC Geriatr 2010; 10 8
| A protocol for an individualised, facilitated and sustainable approach to implementing current evidence in preventing falls in residential aged care facilities.Crossref | GoogleScholarGoogle Scholar |
[14] Improving the environment for older people in Health Services: an audit tool. Melbourne: Victorian Department of Human Services, National Ageing Research Institute; 2006.
[15] National Ageing Research Institute. Improving the environment for older people in Health Services: an audit tool. Melbourne: Victorian Government Department of Human Services; 2006. Available at http://docs.health.vic.gov.au/docs/doc/4A06F2B59C9428F7CA25792B0077B10E/$FILE/audittool.pdf [verified 19 October 2011].
[16] Australia Standard 1428.1 Design for access and mobility: Part 1: General requirements for access – new building work (4th Ed). Sydney: Standards Australia; 2001.
[17] Fleming R. The use of environmental assessment tools for the evaluation of Australian residential facilities for people with dementia. Hammond Care for the Dementia Collaborative Research Centre, UNSW; 2010.
[18] Fleming R, Forbes I, Bennett K. Adapting the ward for people with dementia. Sydney: NSW Department of Health; 2003.
[19] Sloane PD, Mitchell CM, Weisman G, Zimmerman S, Foley KML, Lynn M, 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 2002; 57 S69–78.
| 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.Crossref | GoogleScholarGoogle Scholar |
[20] Conn DK, Madan R. Use of sleep-promoting medications in nursing home residents: risks versus benefits. Drugs Aging 2006; 23 271–87.
| Use of sleep-promoting medications in nursing home residents: risks versus benefits.Crossref | GoogleScholarGoogle Scholar |
[21] Residential aged care in Australia 2007–08: a statistical overview. Canberra: Australian Institute of Health and Welfare; 2009.
