Abstract
This article presents a qualitative synthesis of research findings regarding the effects of environmental interventions on well-being in persons with dementia residing in different settings. It highlights the range of environmental strategies that have been systematically evaluated and the strength of evidence of study results. The primary conclusion is that although 90% of the 63 studies reviewed reported positive outcomes, most studies were methodologically flawed, involved small samples, and were conducted in nursing homes. Future research should focus on rigorous testing of the most promising environmental strategies to enhance quality of care for persons with dementia across different living contexts.
The use of environmental modifications is an important nonpharmacological approach to the management of behavioral manifestations of Alzheimer's disease and related disorders (ADRD). Environmental modifications have been introduced in assisted living and nursing home facilities, as well as in hospital and home health care practices. 1 Nevertheless, the full range of environmental strategies is not widely utilized across the continuum of care for persons with ADRD and clinical guidelines for their implementation have not been systematically developed. This is due chiefly to the lack of clear evidence as to which environmental strategies afford positive outcomes, the range of benefits, and whether strategies used in one living context can be transferred to another.
This article presents a qualitative synthesis of the research evidence on the effects of a wide range of environmental strategies on quality of life in persons with ADRD. Included are studies conducted in different care settings such as private homes, adult day care centers, and nursing homes. Based on this systematic review, future directions for clinically relevant research are delineated.