August 26, 2019

Alzheimer’s disease and other types of dementias impact the lives of millions of Americans and their families—including my own. Like many others, my maternal grandmother lived with dementia toward the end of her life and experienced the hardships that often accompany the disease. A Veteran of the Korean War and a fiercely independent member of the Greatest Generation, my grandmother played a pivotal role in our family. Through assisting my mother in her care, I witnessed firsthand the dangers and limitations of medicine. When pursuing my Ph.D., this personal experience, coupled with my professional experience, drove the focus of my dissertation research.

As an interior designer and researcher, I recognized evidence-based design (EBD) elements in my grandmother’s care environment. For instance, her assisted living facility was designed to feel more residential, and there is research that supports the link between a more residential-style facility and improvement outcomes. Nonetheless, there were still gaps. In viewing her care as both a granddaughter and as a designer, I saw my grandmother struggle with aspects of the built environment. She had behavioral needs that clearly weren’t being met.

As I walked the halls of the assisted living facility one afternoon, watching others with similar needs to hers, I asked myself: “As a designer, what can I do to help?” In this post, I share how the answer involved a research-based interior environment designed to calm people with dementia by addressing sensory needs.



Reducing the Need for Rx Interventions
As a volunteer who works with children with special needs, I see how the environment can impact behavior. The application of multi-sensory environments (MSEs) for children as a behavioral health strategy is well established and was particularly interesting to me as an intervention for dementia care. Multi-sensory environments are flexible, purposefully designed environments that help calm people by helping them reach sensory equilibrium. These environments include visual, auditory and olfactory stimuli, such as ergonomic, vibro-acoustic furniture, color-changing LED lights, music, fiber optics, aromatherapy and bubble tubes. I wondered if MSEs could help people with dementia in a similar way to increase positive behaviors and decrease negative behaviors?

Watching someone you love cope with dementia is hard. What’s even harder is seeing how many behavioral issues resulting from dementia, such as bouts of aggression, are treated with medication. Drug-based interventions are not only costly but also dangerous to patients and providers. Ideally, researching the impact of MSEs on behavior for people with dementia would help reduce the need for drug-based interventions—a win-win for patients and healthcare providers.



Coming Full Circle
I pitched the idea to Vital by Design—an AIA-sponsored research consortium at the University of Florida’s (UF) College of Design, Construction and Planning—and my research was green-lighted for funding. As fate would have it, there was a Department of Veteran’s Affairs (VA) physician, who was also a UF professor, in the audience during my pitch. This led to the amazing opportunity to work with the VA at their Community Living Centers—the agency’s equivalent of assisted living facilities.

Some might call me a “military brat.” My father was a rescue helicopter and C-130 pilot, and my mother was an Air Force nurse. Growing up internationally as part of a military family, I developed a passion for service, and it felt like I’d come full circle having the chance to collaborate with the VA on research that was aimed at benefiting the lives of Veterans living with dementia. The VA was already using MSEs in some capacity, but they needed to be systematically evaluated.

That’s where my dissertation comes in. It comprised three interrelated studies. The first was a published systematic literature review, which informed the next two studies. The second was an interview-based qualitative study. This looked at direct feedback from care teams on clinical barriers that would prevent the use of MSEs for Veterans with dementia and sought to help the VA improve implementation. The final study was a registered clinical trial on the effects of MSE intervention on behavior in assisted bathing for Veterans with dementia. On average, the research demonstrated that positive behaviors increased and negative behaviors decreased in the multi-sensory environment.



Implications for Practice

Ultimately, successful research should drive clear next steps, and in the case of the built environment, design applications. I believe that part of what made my research successful is that it relied on a talented, interdisciplinary team—including physicians, nurses, behavioral scientists, researchers and designers—which made the findings more applicable. By including these end users who provide care, the insights gathered were highly relevant and more directly applicable to care. Another benefit to the multidisciplinary approach is that it added credibility to the research by incorporating the diverse expertise of the broader team.

When our research received EDRA’s Certificate of Research Excellence with Merit status for 2019, I couldn’t help but think of my grandmother. Through our experience together, she inspired research that yielded a number of key implications for practice, and has the potential to help many others like her. For example, healthcare designers may be able to help support better behavioral outcomes through incorporating sensory elements within environments in a more effective way in areas where problem behaviors are known to occur, such as common areas and bathing rooms.

My hope is that our team will continue to research multi-sensory environments in other non-VA assisted living facilities and with other behavioral health populations, while inspiring others to do the same.