Physical environmental designs in residential care to improve quality of life of older people
Information
- DOI:
- https://doi.org/10.1002/14651858.CD012892.pub2Copy DOI
- Database:
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- Cochrane Database of Systematic Reviews
- Version published:
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- 07 March 2022see what's new
- Type:
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- Intervention
- Stage:
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- Review
- Cochrane Editorial Group:
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Cochrane Effective Practice and Organisation of Care Group
- Copyright:
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- Copyright © 2022 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
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Authors
Contributions of authors
All authors contributed to design of the review protocol. SLH independently screened the abstracts and SMD, KEL and RKM screened abstracts in duplicate. SLH screened the full texts retrieved and SMD, KEL and RKM screened full‐text articles in duplicate. SLH, SMD, KEL and RKM independently extracted data and assessed the risk of bias of included studies. SLH completed the GRADE summary tables and duplicate GRADE analysis was completed by SMD and KEL. SLH and SMD drafted the review and all authors reviewed and commented on drafts and approved the final version. All authors made substantial contributions to the conception and design of the work.
Sources of support
Internal sources
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Flinders University, Australia
SLH, SMD, KEL and MC are all staff at Flinders University and Flinders University provided the infrastructure for the project.
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Dementia Training Australia, Australia
RF's funding was covered by Dementia Training Australia, a consortium of five universities and Alzheimer’s Australia funded by the Australian Department of Health to develop, disseminate and implement new knowledge on the care of people with dementia.
External sources
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NHMRC Cognitive Decline Partnership Centre, Australia
The salaries of SLH and SMD, and partly the salary of MC, are supported by funding provided by the National Health and Medical Research Council (NHMRC) Cognitive Decline Partnership Centre (grant no. GNT9100000).
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NHMRC‐ARC Dementia Research Development Fellowship, Australia
KEL is supported by a NHMRC‐ARC Dementia Research Development Fellowship.
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NHMRC and Institute for Safety, Compensation and Recovery Research, Australia
RKM is supported by grants from the NHMRC (grant nos. 1079542 and 1121334) and the Institute for Safety, Compensation and Recovery Research Collaborative Grant.
Declarations of interest
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SLH reports multiple academic publications on the topic of environmental design of aged care facilities. These publications are not included studies in the review.
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SMD reports employment managing a project examining models of residential aged care. The INSPIRED study was supported by funding from the National Health and Medical Research Council (NHMRC) Partnership Centre on Dealing with Cognitive and Related Functional Decline in Older People (CDPC, GNT9100000). Australian aged care service providers were partners in the NHMRC CDPC; they provided information on organisational structures of residential care and access to their facilities. SMD reports multiple academic publications on the topic of environmental design of aged care facilities and multiple unpaid conference presentations (oral and posters) on environmental design in aged care. These publications are not included studies in the review. SMD reports submissions to Australian government inquiries and research reports conducted for the Australian Aged Care Royal Commission that include information on the topic of environmental design in aged care. SMD also reports mainstream and social media dissemination of academic publications on environmental design of aged care facilities.
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KEL reports a fellowship from the Australian Research Council.
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RKM reports grant payments from ECH Inc., Helping Hand, Presbyterian Aged Care, Uniting and Uniting AgeWell. RKM is an author on multiple academic publications on the topic of environmental design of aged care facilities. These publications are not included studies in the review.
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RF reports consultancy payments from Richard Fleming and Associates which involves providing advice on environmental design for people living with dementia. RF is an author on an included study in the review, RF did not contribute to data extraction or assessment of risk of bias of this study.
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MC reports one grant from Amgen and a consultant role for the Royal Commission into Aged Care Quality and Safety. MC reports two academic publications on the topic of environmental design of aged care facilities. These publications are not included studies in the review. MC also works as a health professional (rehabilitation physician at Flinders Medical Centre).
Acknowledgements
We acknowledge the help and support of Cochrane Effective Practice and Organisation of Care (EPOC). The authors would also like to thank the following editors and peer referees who provided comments to improve the protocol: Signe Flottorp (EPOC Editor), Paul Miller (EPOC Information Specialist), Julie Udell (external Peer Referee), and Jemma Hudson (EPOC Statistician); also Elizabeth Royle and Copy Edit Support for copy editing the protocol. We would also like to thank the following editors and peer referees who provided comments to improve the full review: Phillippa Carnemolla (Content expert, external), Nick Seemann (Content expert, external), Brian Duncan (Consumer, external), Harrison Davies (Consumer, external), JC Han (Assistant Managing Editor, EPOC), Denise O’Connor (Contact Editor, EPOC), Cristián Mansilla (Associate Editor, EPOC), Noah Ivers (Associate Editor, EPOC), Paul Miller (Information Specialist, EPOC) and Jennifer Hilgart (Statistical Editor, Public Health and Health Systems’ Network Editorial & Methods Department). We would also like to thank Anne Lethaby for copy‐editing the review.
National Institute for Health Research (NIHR), via Cochrane Infrastructure, gave funding to the Effective Practice and Organisation of Care (EPOC) Group. We also acknowledge Ms Natalie May, Ms Megan Winsall, Dr Wendy Shulver, Dr Justine Irving and Dr Helena Kopunic for assistance in initial abstract and title screening of some citations for full‐text review (in duplicate with study authors) and assistance with grey literature searching. We thank Jenni Suen for research assistance. The views and opinions expressed herein are those of the authors and do not necessarily reflect those of the Systematic Reviews Programme, NIHR, National Health Service (NHS), or the Department of Health.
The Australasian Satellite of the Cochrane EPOC Group is funded by Cochrane.
The contents of the published materials are solely the responsibility of the administering institution — Flinders University and The University of Woollongong — and the individual authors identified, and do not reflect the views of the NHMRC or any other funding bodies or the funding partners.
Version history
| Published | Title | Stage | Authors | Version |
| 2022 Mar 07 | Physical environmental designs in residential care to improve quality of life of older people | Review | Stephanie L Harrison, Suzanne M Dyer, Kate E Laver, Rachel K Milte, Richard Fleming, Maria Crotty | |
| 2017 Dec 07 | Physical environmental designs in residential care to improve quality of life of older people | Protocol | Stephanie L Harrison, Suzanne M Dyer, Kate E Laver, Rachel K Milte, Richard Fleming, Maria Crotty | |
Differences between protocol and review
In the protocol, we reported that secondary outcomes would include "dementia‐specific measures (e.g. global behaviour measures with the Neuropsychiatric Inventory, depression as measured with the Cornell Scale for Depression in Dementia)". However, it is considered that these measures should not be examined separately to behaviour as some measures, including the Neuropsychiatric Inventory, may be used for people not living with dementia and all depression measures should also be considered as one outcome. Therefore, we removed "dementia‐specific measures" as a secondary outcome. We also omitted 'protection against contamination' as one of the EPOC criteria for risk of bias in the protocol, so this was corrected and added in the review.
For the search strategy, we stated we would search Index to Theses, but this was no longer available, and the content was merged into ProQuest dissertations and theses which was searched. We also stated we would search Health Management Information Consortium (HMIC) Ovid, but this was not available at the University of Oxford where the search was conducted.
In the protocol, we stated we would create a Summary of findings table for the main intervention: whole‐facility model compared to usual care or alternative designs. In this review, we also created Summary of findings tables for the lighting and dining room interventions to provide a succinct summary for the smaller interventions which focused on a specific component of design that was analysed quantitatively. In the Summary of findings table, we also grouped the outcomes 'measures of basic function' and 'measures of instrumental function' under one outcome 'function'.
The protocol named "behaviour, mood and depression" as a primary outcome. As this outcome encompasses a large range of possible outcomes and measures, only the two considered most informative were included in the Summary of findings tables. These are: global behaviour measures (as these capture a range of these outcomes) and depression, as this is a common and important negative mood symptom in residents of aged care homes.
The protocol did not specify time points for any of the outcomes. The most important time points for outcomes are considered to be in the range three to six months, as this allows adequate time for an intervention to have an effect, but is not such an extended follow‐up that it will be against a background of large functional or cognitive decline or increased mortality in residents.
Notes
This review is based on standard text and guidance provided by Cochrane Effective Practice and Organisation of Care (EPOC).
Keywords
MeSH
Medical Subject Headings (MeSH) Keywords
Medical Subject Headings Check Words
Aged; Humans;
PICOs
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
| Quality of life | |||||
| Study | Measure | Home‐like | Traditional | Sample size | Reported significance |
|---|---|---|---|---|---|
| Wolf‐Ostermann 2012 | QUALIDEM ‐Feeling at home (adjusted, mean) (higher scores = better) | Baseline: 55.1 6 months: 65.5 12 months: 77.4 | Baseline: 58.7 6 months: 65.5 12 months: 83.2 | 33 | Group differences in trends over time adjusted for gender and stage of dementia: P = 0.674
|
| QUALIDEM ‐Care relationship (adjusted, mean) (higher scores = better) | Baseline: 68.2 6 months: 74.2 12 months: 90.5 | Baseline: 69.5 6 months: 58.0 12 months: 58.9 | 33 | P = 0.065 | |
| QUALIDEM ‐Positive affect (unadjusted mean (SD)) (higher scores = better) | Baseline: 64.3 (24.7) 6 months: 75.0 (23.2) 12 months: 79.2 (20.0) | Baseline: 68.8 (21.7) 6 months: 76.5 (23.3) 12 months: 81.2 (23.5) | 33 | P = 0.683 | |
| QUALIDEM ‐Negative affect (unadjusted mean (SD)) (higher scores = better) | Baseline: 49.4 (28.7) 6 months: 53.6 (25.7) 12 months: 61.7 (23.0) | Baseline: 57.7 (30.6) 6 months: 59.8 (22.2) 12 months: 58.5 (30.0) | 33 | P = 0.373 | |
| QUALIDEM ‐Social isolation (unadjusted, mean (SD)) (higher scores = better) | Baseline: 77.8 (20.7) 6 months: 70.6 (24.3) 12 months: 67.8 (22.2) | Baseline: 61.5 (25.9) 6 months: 63.2 (26.6) 12 months: 59.8 (28.8) | 33 | P = 0.456 | |
| QUALIDEM ‐Social relations (unadjusted, mean (SD)) (higher scores = better) | Baseline: 61.1 (22.1) 6 months: 67.5 (22.9) 12 months: 68.1 (18.8) | Baseline: 47.9 (17.5) 6 months: 66.2 (20.7) 12 months: 59.8 (14.9) | 33 | P = 0.947 | |
| QUALIDEM ‐Positive self‐image (unadjusted, mean (SD)) (higher scores = better) | Baseline: 67.8 (28.9) 6 months: 62.0 (23.5) 12 months: 68.6 (25.5) | Baseline: 69.7 (26.3) 6 months: 65.3 (33.8) 12 months: 68.5 (33.8) | 33 | P = 0.990 | |
| QUALIDEM ‐Restless tense behaviour (unadjusted, mean (SD)) (higher scores = better) | Baseline: 46.7 (34.3) 6 months: 53.9 (32.1) 12 months: 53.9 (36.3) | Baseline: 45.3 (32.9) 6 months: 54.7 (35.0) 12 months: 54.7 (32.9) | 33 | P = 0.226 | |
| QUALIDEM ‐Having something to do (unadjusted, mean (SD)), (higher scores = better) | Baseline: 52.6 (32.5) 6 months: 51.8 (64.6) 12 months: 53.9 (33.1) | Baseline: 29.2 (28.8) 6 months: 62.5 (24.8) 12 months: 55.6 (33.6) | 33 | P = 0.878 | |
Comparison 1: Home‐like vs. traditional environment, Outcome 1: Quality of life
| Behaviour, mood and depression | |||||
| Study | Measure | Home‐like | Traditional | Sample size | Effect estimate or reported significance |
|---|---|---|---|---|---|
| Global behaviour | |||||
| Dettbarn‐Reggentin 2005 | Nurses Observation Scale for Geriatric Patients (NOSGER) (unadjusted mean) (lower scores = better) | Baseline 15.9 6 months 16.0 12 months 15.3 | Baseline 18.0 6 months 18.8 12 months 19.6 | 60 | P < 0.01 at baseline P < 0.001 at 6 months P < 0.0001 at 12 months |
| Te Boekhorst 2009 | Neuropsychiatric Inventory (NPI) (unadjusted mean (95% confidence interval)) (lower scores = better) | Baseline: 12.1 (10.5 to 13.8) 6 months: 7.5 (6.2 to 6.7) | Baseline: 11.7 (10.9 to 12.8) 6 months 8.8 (7.5 to 10.1) | 164 | Adjusted MD for global behaviour change over 6 months: ‐0.04 (95% CI ‐0.13 to 0.04) |
| Wolf‐Ostermann 2012 | Neuropsychiatric Inventory‐Nursing Home version (NPI‐NH) (adjusted mean) (lower scores = better) | Baseline 47.3 6 months 26.7 12 months 17.4 | Baseline 34.1 6 months 36.6 12 months 20.5 | Baseline: 56 12 months: 33 | P > 0.05 |
| Depression | |||||
| Te Boekhorst 2009 | Revised Memory and Behaviour Problems Checklist (RMBPC) (unadjusted mean (95% confidence interval)) (lower scores = better) | Baseline 14.9 (12.8 to 17.0) 6 months 8.9 (7.4 to 10.5) | Baseline 13.1 (12.3 to 13.8) 6 months 8.0 (7.4 to 8.6) | 164 | Adjusted MD (95% confidence interval) for global behaviour change over 6 months: 0.01 (‐0.12 to 0.14) |
| Yoon 2015 | Mood Scale Score (MSS) (lower scores = better) | N/R | N/R | 242 | Adjusted RR (95% confidence interval) for level of social engagement over 18 months: 1.15 (1.02 to 1.29) Adjusted OR (95% confidence interval) for probability of not being socially engaged over 18 months: 0.36 (0.12 to 1.07) |
| Behaviour subdomains | |||||
| Annerstedt 1993 | Organic Brain Syndrome (OBS) scale ‐Dyspraxia (unadjusted mean (SD)) (lower scores = better) | 0‐6 months: 0.95 (0.49) 0‐12 months: 0.57 (0.49) | 0‐6 months: 0.54 (0.54) 0‐12 months: 0.69 (0.69) | 0‐6 months: 53 0‐12 months: 44 | 0‐6 months: P < 0.001 0‐12 months: P > 0.05 |
| OBS scale ‐Hallucinations (unadjusted mean (SD)) (lower scores = better) | 0‐6 months: 0.02 (0.29) 0‐12 months: 0.14 (0.47) | 0‐6 months: 0.03 (0.36) 0‐12 months: 0.14 (0.41) | 0‐6 months: 53 0‐12 months: 44 | 0‐6 months: P > 0.05 0‐12 months: P > 0.05 | |
| OBS scale ‐Lack of vitality (unadjusted mean (SD)) (lower scores = better) | 0‐6 months: 0.05 (0.49) 0‐12 months: 0.63 (0.52) | 0‐6 months: 0.24 (0.47) 0‐12 months: 0.31 (0.55) | 0‐6 months: 53 0‐12 months: 44 | 0‐6 months: P > 0.05 0‐12 months: P < 0.05 | |
| OBS scale ‐Dysphasia (unadjusted mean (SD)) (lower scores = better) | 0‐6 months: 0.04 (0.56) 0‐12 months: 0.63 (0.52) | 0‐6 months: 0.36 (0.48) 0‐12 months: 0.42 (0.70) | 0‐6 months: 53 0‐12 months: 44 | 0‐6 months: P < 0.05 0‐12 months: P > 0.05 | |
| OBS scale ‐Paranoia (unadjusted mean (SD)) (lower scores = better) | 0‐6 months: ‐0.05 (0.32) 0‐12 months: 0.44 (0.40) | 0‐6 months: 0.17 (0.37) 0‐12 months: 0.28 (0.41) | 0‐6 months: 53 0‐12 months: 44 | 0‐6 months: P < 0.05 0‐12 months: P > 0.05 | |
| OBS scale ‐Aggressiveness (unadjusted mean (SD)) (lower scores = better) | 0‐6 months: 0.22 (0.51) 0‐12 months: 0.45 (0.45) | 0‐6 months: 0.09 (0.58) 0‐12 months: 0.07 (0.41) | 0‐6 months: 53 0‐12 months: 44 | 0‐6 months: P > 0.05 0‐12 months: P < 0.01 | |
| OBS scale ‐Depression, anxiousness (unadjusted mean (SD)) (lower scores = better) | 0‐6 months: ‐0.19 (0.23) 0‐12 months: 0.32 (0.50) | 0‐6 months: 0.28 (0.60) 0‐12 months: 0.30 (0.49) | 0‐6 months: 53 0‐12 months: 44 | 0‐6 months: P < 0.01 0‐12 months: P > 0.05 | |
| OBS scale ‐Clinical variations (unadjusted mean (SD)) (lower scores = better) | 0‐6 months: 0.06 (0.54) 0‐12 months: 0.65 (0.65) | 0‐6 months: 0.29 (0.75) 0‐12 months: 0.16 (0.68) | 0‐6 months: 53 0‐12 months: 44 | 0‐6 months: P > 0.05 0‐12 months: P < 0.05 | |
| OBS scale ‐Restlessness (unadjusted mean (SD)) (lower scores = better) | 0‐6 months: ‐0.11 (0.28) 0‐12 months: 0.22 (0.53) | 0‐6 months: 0.09 (0.38) 0‐12 months: 0.26 (0.58) | 0‐6 months: 53 0‐12 months: 44 | 0‐6 months: P < 0.05 0‐12 months: P > 0.05 | |
| Wolf‐Ostermann 2012 | Cohen‐Mansfield Agitation Inventory (CMAI), proportion with physical non‐aggressive behaviour (lower scores = better) | Baseline: 35.0% 6 months: 40.0% 12 months: 30.0% | Baseline: 46.2% 6 months: 46.2% 12 months: 53.8% | 33 | P > 0.05 |
| CMAI, proportion with verbal agitation (lower scores = better) | Baseline: 50.0% 6 months: 50.0% 12 months: 40.0% | Baseline: 30.8% 6 months: 53.8% 12 months: 61.5% | 33 | P > 0.05 | |
| CMAI, proportion with physical aggressive behaviour (lower scores = better) | Baseline: 0% 6 months: 5.0% 12 months: 25.0% | Baseline: 30.8% 6 months: 30.8% 12 months: 30.8% | 33 | P = 0.066 for baseline to 6 months P > 0.05 for baseline to 12 months | |
| Social engagement | |||||
| Te Boekhorst 2009 | Revised Index of Social Engagement (RISE) (unadjusted mean (95% confidence interval)) (higher scores = better)
| Baseline 3.2 (2.7 to 3.7) 6 months 4.5 (4.0 to 5.0) | Baseline 2.9 (2.5 to 3.2) 6 months 3.2 (2.6 t0 3.7) | 164 | Adjusted MD (95% confidence interval) for global behaviour change over 6 months: 0.79 (0.11 to 1.50) |
| Yoon 2015 | Index of Social Engagement (ISE) (higher scores = better) | N/R | N/R | 242 | Adjusted RR (95% confiedence interval) for level of social engagement over 18 months: 0.99 (0.82 to 1.19) Adjusted OR (95% confidence interval) for probability of not being socially engaged over 18 months: 0.76 (0.62 to 0.94) |
Comparison 1: Home‐like vs. traditional environment, Outcome 2: Behaviour, mood and depression
| Function | |||||
| Study | Measure | Home‐like | Traditional | Sample size | Effect estimate or reported significance |
|---|---|---|---|---|---|
| Dettbarn‐Reggentin 2005 | Barthel Index (unadjusted mean) (higher scores = better) | Baseline: 40.9 12 months: 35.9 | Baseline: 35.9 12 months: 23.9 | 60 | P = 0.039 |
| Te Boekhorst 2009 | The Interview for the Deterioration of Daily Living activities in Dementia (IDDD) (unadjusted mean (95% confidence interval)) (lower scores = better) | Baseline 25.9 (22.9 to 28.8) 6 months 28.3 (26.3 to 30.3) | Baseline 33.0 (30.5 to 35.6) 6 months 34.6 (31.9 to 37.2) | 164 | Adjusted MD (95% confidence interval) over six months: ‐4.37 (‐7.06 to ‐1.69) |
| Wolf‐Ostermann 2012 | Barthel Index (adjusted mean) (higher scores = better) | Baseline: 58.6 6 months: 43.7 12 months: 36.2 | Baseline: 64.8 6 months: 46.3 12 months: 49.8 | Baseline: 56 Follow‐up: 33 | Interactions between setting and development over time, P > 0.05 |
| Bathing‐decrease in proportion independent 12 months (%, N) | 10.0% | 7.7% | 33 | ‐ | |
| Toilet use‐decrease in proportion independent 12 months (%, N) | 30.0% | 23.1% | 33 | ‐ | |
| Grooming‐decrease in proportion independent 12 months (%, N) | 15.0% | 15.4% | 33 | ‐ | |
| Bladder‐decrease in proportion independent 12 months (%, N) | 15.0% | 15.4% | 33 | ‐ | |
| Stairs‐decrease in proportion independent 12 months(%, N) | 20.0% | 0% | 33 | ‐ | |
| Feeding‐decrease in proportion independent 12 months (%, N) | 20.0% | 15.4% | 33 | ‐ | |
| Dressing‐decrease in proportion independent 12 months (%, N) | 15.0% | 7.7% | 33 | ‐ | |
| Transferring‐decrease in proportion independent 12 months (%, N) | 15.0% | 7.7% | 33 | ‐ | |
| Yoon 2015 | Activities of daily living (ADL) long‐form scale (unadjusted mean (SD)) (lower scores = better) | Baseline: 14.5 (6.7) 6 months: 15.6 (6.9) 18 months: 18.5 (4.4) | Baseline: 14.5 (7.4) 6 months: 15.1 (7.3) 18 months: 16.9 (7.0) | Baseline n = 242 6 months n = 238 18 months n = 92 | Adjusted MD (95% confidence interval) over 18 months: ‐0.09 (‐0.46 to 0.28)
|
Comparison 1: Home‐like vs. traditional environment, Outcome 3: Function
| Global cognitive function | |||||
| Study | Measure | Home‐like | Traditional | Sample size | Effect estimate or reported significance |
|---|---|---|---|---|---|
| Dettbarn‐Reggentin 2005 | Mini‐Mental State Examination (MMSE) (unadjusted mean) (higher scores = better) | Baseline: 10.3 12 months: 9.9 | Baseline: 9.1 12 months: 7.6 | 60 | P = 0.0082 |
| Te Boekhorst 2009 | Standardised Mini‐Mental State Examination (MMSE) (unadjusted mean (95% confidence interval)) (higher scores = better) | Baseline 15.4 (13.5 to 17.3) 6 months 13.0 (10.4 to 15.6) | Baseline 10.3 (8.3 to 12.3) 6 months 8.9 (6.2 to 11.6) | 164 | Adjusted MD (95% confidence interval) over 6 months: 0.54 (‐1.43 to 2.50) |
| Wolf‐Ostermann 2012 | Mini‐Mental State Examination (MMSE) (unadjusted mean (SD)) (higher scores = better) | Baseline: 15.7 (6.9) 6 months: 13.8 (6.8) 12 months: 10.8 (10.0) | Baseline: 12.4 (6.5) 6 months: 8.4 (7.4) 12 months: 8.7 (7.7) | 33 | P = 0.004 for baseline to 6 months P > 0.05 for baseline to 12 months |
| Yoon 2015 | Cognitive Performance Scale (CPS) (unadjusted mean (SD)) (lower scores = better) | Baseline: 2.5 (1.0) 6 months: 2.6 (1.1) 18 months: 2.9 (1.3) | Baseline: 2.2 (1.2) 6 months: 2.3 (1.3) 18 months: 2.3 (1.5) | Baseline n = 242 6 months n=238 18 months n=92 | N/R |
Comparison 1: Home‐like vs. traditional environment, Outcome 4: Global cognitive function
| Quality of care | |||
| Study | Measure | Sample size | Effect estimate (unclear follow‐up time, reported as up to 5 years) |
|---|---|---|---|
| Afendulis 2016 | Number of bedfast residents | Estimated weighted sample 74,449 | Adjusted MD (95% confidence interval) ‐0.3% (‐0.4% to ‐0.2%) |
| Catheter use | Estimated weighted sample 74,449 | Adjusted MD (95% confidence interval) ‐4.1% (‐6.1% to ‐2.1%) | |
| High‐risk pressure ulcers | Estimated weighted sample 74,449 | Adjusted MD (95% confidence interval) ‐1.2% (‐3.8% to 1.4%) | |
| Low‐risk pressure ulcers | Estimated weighted sample 74,449 | Adjusted MD (95% confidence interval) ‐1.9% (‐2.5% to ‐1.3%) | |
| Hospital readmissions | Estimated weighted sample 74,449 | MD (95% confidence interval) ‐5.5% (‐10.2% to ‐0.8%) | |
| Avoidable hospital readmissions | Estimated weighted sample 74,449 | MD (95% confidence interval) ‐3.9% (‐7.6% to ‐0.2%) | |
Comparison 1: Home‐like vs. traditional environment, Outcome 5: Quality of care
| Serious adverse effects | |||
| Study | Measure | Sample size | Effect estimate (unclear follow‐up, reported as up to 5 years) |
|---|---|---|---|
| Afendulis 2016 | Physical restraints | Estimated weighted sample 74,449 | Adjusted MD (95% confidence interval): ‐0.3% (‐0.5% to ‐0.1%) |
Comparison 1: Home‐like vs. traditional environment, Outcome 6: Serious adverse effects
| Quality of life | |||||
| Study | Measure | Refurbishment | Traditional | Sample size | Effect estimate or reported significance |
|---|---|---|---|---|---|
| Chenoweth 2014 | Dementia quality of life (DEMQOL) Proxy (adjusted mean (95% confidence interval)) (higher scores = better) | Person‐centred environment (PCE) Baseline: 101 (99 to 104) Post‐intervention: 102 (99 to 105) 8 months: 106 (103 to 110) PCE + person‐centred care (PCC) Baseline: 101 (99 to 104) Post‐intervention: 103 (100 to 106) 8 months: 105 (102 to 108) | Baseline: 101 (98 to 104) Post‐intervention: 100 (97 to 104) 8 months: 103 (99 to 106) | Baseline: 601 Post‐intervention: 416 8 months: 296 | Adjusted MD (95% confidence interval) PCE vs. traditional: Post‐intervention: 2.00 (‐2.19 to 6.19) 8 months: 3.00 (‐1.91 to 7.91) PCE + PCC vs traditional: Post‐intervention: 3.00 (‐1.20 to 7.20) 8 months: 2.00 (‐2.91 to 6.91) |
| Diaz‐Veiga 2014 | Fumat for mild cognitive impairment (unadjusted mean (SD)) (higher scores = better) | Baseline: 100.6 (8.0) 6 months: 104.5 (8.0) | Baseline: 107.1 (11.1) 6 months: not reported | Unclear | P = 0.850 |
| Qualid for severe cognitive impairment (unadjusted mean (SD)) (lower scores = better) | Baseline: 27.4 (12.1) 6 months: 23.8 (12.4) | Baseline: not reported 6 months: 30.8 (11.1) | Unclear | P = 0.33 | |
| Wylie 2001 | Life Satisfaction Index (unadjusted mean (SD)) (higher scores = better) | Baseline: 12.0 (4.1) 6 months: 11.2 (3.4) 12 months: 12.1 (3.3) 18 months: 12.6 (3.3) | Baseline: 12.0 (3.9) 6 months: 11.1 (3.6) 12 months: 11.3 (3.3) 18 months: 11.1 (3.4) | Baseline: 100 6 months: 70 12 months: 43 18 months: 33 | 'Not significant' |
Comparison 2: Refurbishment vs. traditional environment, Outcome 1: Quality of life
| Behaviour, mood and depression | |||||
| Study | Measure | Refurbishment | Traditional | Sample size | Effect measure or reported significance |
|---|---|---|---|---|---|
| Depression | |||||
| Galik 2021 | Cornell Scale for Depression in Dementia (CSDD) (unadjusted mean (SD)) (lower scores = better) | Baseline: 4.5 (4.2) 4 months: 4.4 (4.6) 12 months: 3.9 (4.5) | Baseline: 3.9 (3.8) 4 months: 4.2 (4.3) 12 months: 3.2 (3.5) | 336 | Adjusted MD (95% confidence interval) baseline to 4 months: ‐0.73 (‐1.93 to 0.47) Adjusted MD (95% confidence interval) baseline to 12 months: ‐0.04 (‐1.35 to 1.26) |
| Behaviour subdomains | |||||
| Burack 2012 | Cohen Mansfield Agitation Inventory (CMAI) (adjusted mean) Physical agitation (lower scores = better) | Baseline: 1.68 Two years: 1.44 | Baseline: 1.24 Two years: 1.51 | 101 | Adjusted MD (95% confidence interval): ‐0.07 (‐0.14 to ‐0.00) |
| Cohen Mansfield Agitation Inventory (CMAI) (adjusted mean) Forceful behaviours (lower scores = better) | Baseline: 1.50 Two years: 1.35 | Baseline: 1.21 Two years: 1.41 | 101 | Adjusted MD (95% confidence interval): ‐0.06 (‐0.10 to ‐0.02) | |
| Cohen Mansfield Agitation Inventory (CMAI) (adjusted mean) Verbal agitation (lower scores = better) | Baseline: 2.13 Two years: 1.95 | Baseline: 1.48 Two years: 2.06 | 101 | Adjusted MD (95% confidence interval): 0.11 (‐0.00 to 0.22) | |
| Chenoweth 2014 | Cohen Mansfield Agitation Inventory (CMAI) (adjusted mean (95% confidence interval)) (lower scores = better) | Person‐centred environment (PCE) Baseline: 65 (57 to 73) Post‐intervention: 55 (46 to 64) 8 months: 55 (46 to 64) PCE + person‐centred care (PCC) Baseline: 57 (49 to 65) Post‐intervention: 60 (52 to 69) 8 months: 64 (55 to 73) | Baseline: 52 (43 to 61) Post‐intervention: 53 (43 to 63) 8 months: 51 (41 to 62) | Baseline: 601 Post‐intervention: 416 8 months: 296 | Adjusted MD (95% confidence interval) PCE vs. traditional: Post‐intervention: 2.00 (‐11.29 to 15.29) 8 months: 4.00 (‐9.21 to 17.21) PCE + PCC vs traditional: Post‐intervention: 7.00 (‐5.66 to 19.66) 8 months: 13.00 (‐0.22 to 26.22) |
| Galik 2021 | Cohen Mansfield Agitation Inventory (CMAI) (unadjusted mean (SD)) (lower scores = better) | Baseline: 19.8 (6.1) 4 months: 19.2 (5.9) 12 months: 19.2 (7.8) | Baseline: 20.2 (6.6) 4 months: 19.7 (6.8) 12 months: 18.9 (5.6) | 336 | Adjusted MD (95% confidence interval) baseline to 4 months: ‐0.72 (‐2.63 to 1.20) Adjusted MD (95% confidence interval) baseline to 12 months: ‐0.36 (‐2.41 to 1.69) |
| Resistiveness to Care scale (unadjusted mean (SD)) (lower scores = better) | Baseline: 0.83 (2.15) 4 months: 0.10 (0.48) 12 months: 0.81 (2.40) | Baseline: 0.65 (1.62) 4 months: 0.46 (1.34) 12 months: 0.59 (1.85) | 336 | Adjusted MD (95% confidence interval) baseline to 4 months: ‐1.56 (‐2.71 to ‐0.40) Adjusted MD (95% confidence interval) baseline to 12 months: 0.32 (‐0.29 to 0.94) | |
Comparison 2: Refurbishment vs. traditional environment, Outcome 2: Behaviour, mood and depression
| Function | |||||
| Study | Measure | Refurbishment, mean | Traditional, mean | Sample size | Effect size |
|---|---|---|---|---|---|
| Galik 2021 | Barthel Index (unadjusted mean (SD)) (higher scores = better) | Baseline: 45.2 (27.8) 4 months: 44.0 (28.4) 12 months: 42.2 (25.7) | Baseline: 47.6 (27.0) 4 months: 47.9 (28.1) 12 months: 42.2 (25.4) | 336 | Adjusted MD (95% confidence interval) baseline to 4 months: 1.24 (‐3.34 to 5.81) Adjusted MD (95% confidence interval) baseline to 12 months: 1.49 (‐3.53 to 6.50) |
Comparison 2: Refurbishment vs. traditional environment, Outcome 3: Function
| Quality of care | |||||
| Study | Measure | Refurbishment | Traditional | Sample size | Effect estimate |
|---|---|---|---|---|---|
| Chenoweth 2014 | Quality of Interactions Schedule (QUIS) (adjusted mean (95% confidence interval)) (higher scores = better) | Person‐centred environment (PCE) Baseline: 78 (74 to 83) Post‐intervention: 81 (76 to 85) 8 months: 82 (76 to 87) PCE + person‐centred care (PCC) Baseline: 76 (72 to 81) Post‐intervention: 86 (81 to 91) 8 months: 80 (75 to 85) | Baseline: 78 (73 to 83) Post‐intervention: 73 (68 to 79) 8 months: 82 (76 to 88) | Baseline: 601 Post‐intervention: 416 8 months: 296 | Adjusted MD (95% confidence interval) PCE vs. traditional: Post‐intervention: 8.00 (1.03 to 14.97) 8 months: MD 0.00 (‐8.34 to 8.34) PCE + PCC vs traditional: Post‐intervention: 13.00 (6.02 to 19.98) 8 months: ‐2.00 (‐9.67 to 5.67) |
Comparison 2: Refurbishment vs. traditional environment, Outcome 4: Quality of care
| Behaviour, mood and depression | |||||
| Study | Measure | Special care units | Traditional | Sample size | Reported significance |
|---|---|---|---|---|---|
| Global behaviour | |||||
| Frisoni 1998 | Neuropsychiatric Inventory (NPI) (unadjusted mean (SD)) (lower scores = better) | Baseline: 39.2 (18.1) 3 months: 29.0 (15.0) | Baseline: 29.2 (13.8) 3 months: 20.5 (11.1) | 66 | P = 0.007 for intervention |
| Depression | |||||
| Frisoni 1998 | Cornell Depression Scale (unadjusted mean (SD)) (lower scores = better) | Baseline: 10.7 (4.6) 3 months: 8.4 (3.4) | Baseline: 6.5 (3.5) 3 months: 10.5 (5.9) | 66 | P = 0.03 for intervention |
| Behaviour subdomains | |||||
| Frisoni 1998 | Neuropsychiatric Inventory (NPI) ‐delusions (unadjusted mean (SD)) (lower scores = better) | Baseline: 4.4 (4.6) 3 months: 2.8 (3.7) | Baseline: 3.0 (4.1) 3 months: 2.2 (3.4) | 66 | P = 0.06 for intervention |
| NPI ‐hallucinations (unadjusted mean (SD)) (lower scores = better) | Baseline: 2.9 (4.5) 3 months: 1.2 (2.6) | Baseline: 1.3 (2.7) 3 months: 0.8 (1.8) | 66 | p=0.004 for intervention | |
| NPI ‐agitation (unadjusted mean (SD)) (lower scores = better) | Baseline: 5.4 (4.4) 3 months: 3.8 (3.5) | Baseline: 3.5 (4.0) 3 months: 2.5 (2.9) | 66 | p=0.02 for intervention | |
| NPI ‐anxiety (unadjusted mean (SD)) (lower scores = better) | Baseline: 4.8 (4.5) 3 months: 4.0 (4.0) | Baseline: 3.7 (3.9) 3 months: 2.6 (4.1) | 66 | p>0.05 for intervention | |
| NPI ‐euphoria/elation (unadjusted mean (SD)) (lower scores = better) | Baseline: 1.2 (2.6) 3 months: 1.2 (2.7) | Baseline: 1.4 (3.1) 3 months: 0.6 (1.7) | 66 | p>0.05 for intervention | |
| NPI ‐disinhibition (unadjusted mean (SD)) (lower scores = better) | Baseline: 2.0 (3.5) 3 months: 2.0 (3.0) | Baseline: 1.6 (3.5) 3 months: 1.4 (2.5) | 66 | p>0.05 for intervention | |
| NPI ‐irritability/lability (unadjusted mean (SD)) (lower scores = better) | Baseline: 4.7 (4.6) 3 months: 4.7 (3.7) | Baseline: 2.9 (4.0) 3 months: 1.9 (2.8) | 66 | p>0.05 for intervention | |
| NPI ‐abnormal motor behaviour (unadjusted mean (SD)) (lower scores = better) | Baseline: 9.0 (4.3) 3 months: 7.5 (5.0) | Baseline: 8.2 (4.7) 3 months: 6.9 (4.7) | 66 | p>0.05 for intervention | |
| NPI ‐sleep (unadjusted mean (SD)) (lower scores = better) | Baseline: 4.8 (4.9) 3 months: 2.3 (3.1) | Baseline: 3.9 (4.2) 3 months: 1.7 (3.3) | 66 | p=0.01 for intervention | |
| Cohen Mansfield Inventory (CMAI) (unadjusted mean, SD) (lower scores = better) | Baseline: 40.7 (24.6) 3 months: 36.4 (17.8) | Baseline: 31.2 (14.3) 3 months: 26.7 (11.8) | 66 | p>0.05 for intervention | |
Comparison 3: Special‐care units for dementia vs. traditional environment, Outcome 1: Behaviour, mood and depression
| Function | |||||
| Study | Measure | Special care units | Traditional | Sample size | Reported significance |
|---|---|---|---|---|---|
| Frisoni 1998 | Bedford Alzheimer's nursing severity scale (unadjusted mean (SD)) (higher scores = better) | Baseline: 13.5 (3.5) 3 months: 14.0 (4.3) | Baseline: 13.8 (3.9) 3 months: 14.1 (4.7) | 66 | P > 0.05 for intervention |
| Barthel Index (unadjusted mean (SD)) (higher scores = better) | Baseline: 60.7 (23.5) 3 months: 57.5 (26.3) | Baseline: 52.7 (28.1) 3 months: 45.9 (30.2) | 66 | P > 0.05 for intervention | |
Comparison 3: Special‐care units for dementia vs. traditional environment, Outcome 2: Function
| Global cognitive function | |||||
| Study | Measure | Special care units | Traditional | Sample size | Reported significance |
|---|---|---|---|---|---|
| Frisoni 1998 | MMSE (unadjusted mean (SD)) (higher scores = better) | Baseline: 7.0 (5.2)3 months: 7.4 (5.8) | Baseline: 8.3 (5.1)3 months: 8.9 (6.2) | 66 | P > 0.05 for intervention |
| Clinical Dementia Rating (unadjusted mean (SD)) (lower scores = better) | Baseline: 2.8 (0.5) 3 months: 2.9 (0.5) | Baseline: 2.9 (0.5) 3 months: 3.0 (0.5) | 66 | P > 0.05 for intervention | |
Comparison 3: Special‐care units for dementia vs. traditional environment, Outcome 3: Global cognitive function
| Behaviour, mood and depression | |||
| Study | Measure | Sample size | Adjusted OR (95% confidence interval) |
|---|---|---|---|
| Depression | |||
| Elmstahl 1997 | Organic Brain Syndrome (OBS) scale (lower scores = better) | 105 | 8.82 (1.14 to 68.22) |
| Behaviour subdomains | |||
| Elmstahl 1997 | Organic Brain Syndrome (OBS) scale Aggressiveness (lower scores = better) | 105 | 2.02 (0.56 to 7.27) |
| Organic Brain Syndrome (OBS) scale Dyspraxia (lower scores = better) | 105 | 4.57 (0.76 to 27.35) | |
| Organic Brain Syndrome (OBS) scale Hallucinations (lower scores = better) | 105 | 1.06 (0.05 to 22.09) | |
| Organic Brain Syndrome (OBS) scale Lack of vitality (lower scores = better) | 105 | 0.23 (0.04 to 1.47) | |
| Organic Brain Syndrome (OBS) scale Dysphasia (lower scores = better) | 105 | 0.87 (0.08 to 9.73) | |
| Organic Brain Syndrome (OBS) scale Paranoia (lower scores = better) | 105 | 0.12 (0.01 to 1.24) | |
| Organic Brain Syndrome (OBS) scale Restlessness (lower scores = better) | 105 | 0.21 (0.04 to 1.00) | |
| Organic Brain Syndrome (OBS) scale Disorientation, recent memory (lower scores = better) | 105 | 0.87 (0.31 to 2.42) | |
| Organic Brain Syndrome (OBS) scale Disorientation, time (lower scores = better) | 105 | 0.66 (0.22 to 2.01) | |
| Organic Brain Syndrome (OBS) scale Disorientation, identity (lower scores = better) | 105 | 1.23 (0.56 to 2.68) | |
Comparison 4: Group living corridor vs. group living non‐corridor design, Outcome 1: Behaviour, mood and depression
| Behaviour, mood and depression | |||||
| Study | Measure | Lighting intervention | Control lighting | Sample size | Effect estimate |
|---|---|---|---|---|---|
| Global behaviour | |||||
| Riemersma‐vanDerLek 2008 | Questionnaire format of the NPI (NPI‐Q) (mean (SD)) (lower scores = better) | 6 weeks: 4.7 (5.0) 6 months: 5.7 (5.7) 12 months: 5.8 (5.7) 18 months: 4.0 (4.6) 24 months: 4.9 (5.8) | 6 weeks: 6.4 (5.3) 6 months: 5.2 (4.4) 12 months: 6.1 (3.5) 18 months: 6.8 (5.0) 24 months: 8.2 (3.9) | 6 weeks: 87 6 months: 74 12 months: 55 18 months: 41 24 months: 26 | MD (95% confidence interval): 6 weeks: ‐1.70 (‐3.88 to 0.48) 6 months: 0.50 (‐1.80 to 2.80) 12 months: ‐0.30 (‐2.73 to 2.13) 18 months: ‐2.80 (‐5.78 to 0.18) 24 months: ‐3.30 (‐7.27 to 0.67) |
| Depression | |||||
| Riemersma‐vanDerLek 2008 | Cornell Scale for Depression in Dementia (CSDD) , (mean, SD) (lower scores = better) | 6 months: 7.9 (5.6) 12 months: 11.0 (7.7) 18 months: 9.9 (5.9) 24 months: 10.7 (7.3) | 6 months: 9.3 (6.1) 12 months: 11.3 (7.4) 18 months: 12.0 (7.5) 24 months: 15.1 (8.6) | 6 months: 74 12 months: 55 18 months: 41 24 months: 26 | MD (95% confidence interval): 6 months: ‐0.24 (‐0.70 to 0.23) 12 months: ‐0.04 (‐0.58 to 0.50) 18 months: 0.31 (‐0.93 to 0.31) 24 months: ‐0.55 (‐1.35 to 0.26) |
| Behaviour subdomains | |||||
| Hopkins 2017 | Anxiety Anxiety subset of the hospital anxiety and depression (HADA) scale (mean (SD)) (lower scores = better) | 4 weeks: 4.5 (2.5) | 4 weeks: 4.7 (2.7) | 42 | MD (95% confidence interval): ‐0.10 (‐1.67 to 1.47) |
| Riemersma‐vanDerLek 2008 | Distress Questionnaire format of the NPI (NPI‐Q) distress subdomain (mean (SD)) (lower scores = better) | 6 weeks: 5.1 (6.0) 6 months: 6.1 (7.4) 12 months: 6.0 (7.2) 18 months: 4.2 (5.3) 24 months: 5.4 (6.8) | 6 weeks: 6.0 (5.9) 6 months: 3.6 (4.6) 12 months: 3.2 (3.5) 18 months: 4.2 (4.6) 24 months: 7.4 (4.5) | 6 weeks: 87 6 months: 74 12 months: 55 18 months: 41 24 months: 26 | MD (95% confidence interval): 6 weeks: ‐0.90 (‐3.41 to 1.61) 6 months: 2.50 (‐0.24 to 5.24) 12 months: 2.80 (‐0.06 to 5.66) 18 months: ‐0.00 (‐3.03 to 3.03) 24 months: ‐2.00 (‐6.35 to 2.35) |
| Withdrawn behaviour Multi Observational Scale for Elderly Subjects (MOSES) (mean (SD)) (lower scores = better) | 6 weeks: 17.5 (5.9) 6 months: 19.0 (6.1) 12 months: 17.6 (6.2) 18 months: 15.5 (4.7) 24 months: 16.4 (6.2) | 6 weeks: 16.6 (6.1) 6 months: 17.9 (6.0) 12 months: 17.0 (4.1) 18 months: 19.8 (5.4) 24 months: 19.9 (5.0) | 6 weeks: 87 6 months: 74 12 months: 55 18 months: 41 24 months: 26 | MD (95% confidence interval): 6 weeks: 0.90 (‐1.63 to 3.43) 6 months: 1.10 (‐1.69 to 3.89) 12 months: 0.60 (‐2.12 to 3.32) 18 months: ‐4.30 (‐7.45 to ‐1.15) 24 months: ‐3.50 (‐7.84 to 0.84) | |
| Positive mood Philadelphia Geriatric Centre Affect Rating Scale (PGCARS) (mean (SD)) (higher scores = better) | 6 weeks: 10.7 (3.5) 6 months: 10.9 (3.2) 12 months: 11.6 (3.1) 18 months: 11.5 (2.2) 24 months: 11.5 (2.4) | 6 weeks: 11.3 (2.4) 6 months: 10.5 (2.6) 12 months: 11.9 (2.6) 18 months: 10.6 (2.9) 24 months: 11.0 (1.0) | 6 weeks: 87 6 months: 74 12 months: 55 18 months: 41 24 months: 26 | MD (95% confidence interval): 6 weeks: ‐0.60 (‐1.85 to 0.65) 6 months: 0.40 (‐0.92 to 1.72) 12 months: 0.30 (‐1.82 to 1.22) 18 months: 0.90 (‐0.71 to 2.51) 24 months: 0.50 (‐0.83 to 1.83) | |
| Negative mood Philadelphia Geriatric Centre Affect Rating Scale (PGCARS) (mean (SD)) (lower scores = better) | 6 weeks: 5.8 (2.3) 6 months: 6.1 (2.6) 12 months: 7.3 (3.2) 18 months: 6.3 (3.1) 24 months: 6.4 (2.9) | 6 weeks: 7.0 (2.9) 6 months: 6.7 (2.6) 12 months: 6.2 (2.0) 18 months: 6.6 (2.2) 24 months: 9.1 (2.5) | 6 weeks: 87 6 months: 74 12 months: 55 18 months: 41 24 months: 26 | MD (95% confidence interval): 6 weeks: ‐1.20 (‐2.31 to ‐0.09) 6 months: ‐0.60 (‐1.80 to 0.60) 12 months: 1.10 (‐0.27 to 2.47) 18 months: ‐0.30 (‐1.92 to 0.32) 24 months: ‐2.70 (‐4.80 to ‐0.60) | |
| Agitation Cohen‐Mansfield Agitation Inventory (CMAI) (mean (SD)) (lower scores = better) | 6 weeks: 37.1 (11.1) 6 months: 44.0 (18.0) 12 months: 46.0 (18.0) 18 months: 42.0 (14.0) 24 months: 49.0 (15.0) | 6 weeks:37.1 (10.9) 6 months: 47.0 (19.0) 12 months: 48.0 (18.0) 18 months: 47.0 (15.0) 24 months: 58.0 (16.0) | 6 weeks: 87 6 months: 74 12 months: 55 18 months: 41 24 months: 26 | MD (95% confidence interval): 6 weeks: ‐0.16 (‐0.45 to 0.14) 6 months: ‐0.16 (‐0.62 to 0.30) 12 months: ‐0.11 (‐0.65 to 0.43) 18 months:‐0.34 (‐0.96, 0.28) 24 months: ‐0.57 (‐1.37, 0.24) | |
Comparison 5: Lighting intervention vs. control lighting, Outcome 1: Behaviour, mood and depression
Comparison 5: Lighting intervention vs. control lighting, Outcome 2: Behaviour, mood and depression: depression 4‐6 weeks
Comparison 5: Lighting intervention vs. control lighting, Outcome 3: Behaviour, mood and depression: agitation 4‐6 weeks
Comparison 5: Lighting intervention vs. control lighting, Outcome 4: Function 4‐6 weeks
| Function | |||||
| Study | Measure | Lighting intervention | Control | Sample size | Effect estimate |
|---|---|---|---|---|---|
| Riemersma‐vanDerLek 2008 | Nurse‐informant adaptation (NI‐ADL) of the scale by Katz et al (mean (SD)) (lower scores = better) | 6 months: 20.0 (14.0) 12 months: 17.0 (12.0) 18 months: 17.0 (14.0) 24 months: 13.0 (11.0) | 6 months: 22.0 (12.0) 12 months: 22.0 (11.0) 18 months: 27.0 (14.0) 24 months: 29.0 (14.0) | 6 weeks: 87 6 months: 74 12 months: 55 18 months: 41 24 months: 26 | MD (95% confidence interval): 6 months: ‐0.15 (‐0.61 to 0.31) 12 months: ‐0.42 [‐0.97, 0.12] 18 months: ‐0.70 (‐1.34 to ‐0.06) 24 months: ‐1.27 (‐2.14 to ‐0.39) |
Comparison 5: Lighting intervention vs. control lighting, Outcome 5: Function
| Global cognitive function | |||||
| Study | Measure | Lighting intervention | Control | Sample size | Effect estimate |
|---|---|---|---|---|---|
| Riemersma‐vanDerLek 2008 | Mini‐mental state examination (MMSE) (mean (SD)) (higher scores = better) | 6 weeks: 14.5 (6.2) 6 months: 16.6 (5.5) 12 months: 15.6 (5.2) 18 months: 16.2 (4.5) 24 months: 17.4 (3.7) | 6 weeks: 14.3 (7.0) 6 months: 15.4 (7.3) 12 months: 15.6 (6.4) 18 months: 14.5 (5.4) 24 months: 13.7 (7.4) | 6 weeks: 87 6 months: 74 12 months: 55 18 months: 41 24 months: 26 | MD (95% confidence interval): 6 weeks: 0.20 (‐2.48 to 2.88) 6 months: 1.20 (‐1.56 to 3.96) 12 months: 0.00 (‐2.74 to 2.74) 18 months: 1.70 (‐1.03 to 4.43) 24 months: 3.70 (‐0.04 to 7.44) |
Comparison 5: Lighting intervention vs. control lighting, Outcome 6: Global cognitive function
| Quality of life | |||||
| Study | Measure | Dining space redesign | Traditional | Sample size | Effect estimate or reported significance |
|---|---|---|---|---|---|
| Mathey 2001 | Sickness Impact Profile (SIP) (mean percentage change (SD)) (higher scores = better) | ‐2% (11%) | ‐13% (12%) | 16 | P < 0.05 in control group Authors reported values "stayed stable" in intervention group |
| Dutch version of the Philadelphia Geriatric Center Moral Scale (PGCMS) (mean percentage change (SD)) (higher scores = better) | ‐3% (20%) | ‐2% (19%) | 16 | Authors reported values remained "relatively stable", no P values reported | |
| Nijs 2006 | Dutch quality of life of somatic nursing home residents questionnaire (higher scores = better) | N/R | N/R | 178 | MD (95% confidence interval): 6.10 (2.10 to 10.10) |
Comparison 6: Dining space redesign vs. traditional environment, Outcome 1: Quality of life
| Behaviour, mood and depression | |||||
| Study | Measure | Dining space redesign | Traditional | Sample size | Reported significance |
|---|---|---|---|---|---|
| Kenkmann 2010 | Hospital Anxiety and Depression Scale (HADS), (unadjusted mean (SD)) (lower scores = better) | Baseline: 4.07 (3) 12 months: 4.86 (4.61) | Baseline: 6.3 (4.45) 12 months: 6.78 (3.83) | 120 | N/R |
Comparison 6: Dining space redesign vs. traditional environment, Outcome 2: Behaviour, mood and depression
| Function | |||
| Study | Measure | n | Effect estimate |
|---|---|---|---|
| Nijs 2006 | Nursing home physical performance test (higher scores = better) | 178 | MD (95% confidence interval): 3.20 (0.90 to 5.50) |
Comparison 6: Dining space redesign vs. traditional environment, Outcome 3: Function
| Global cognitive function | |||||
| Study | Measure | Dining space redesign | Traditional | Sample size | Reported significance |
|---|---|---|---|---|---|
| Kenkmann 2010 | Mini‐Mental State Examination (MMSE) (unadjusted mean (SD)) (higher scores = better) | Baseline: 19 (5.6) 12 months: 17 (6.2) | Baseline: 17 (6.2) 12 months: 15 (7.9) | 56 | P > 0.05 |
| Kenkmann 2010 | MMSE, cognitive impairment <= 23, % | Baseline: 83.3% 12 months: 81.5% | Baseline: 87.5% 12 months: 79.2% | 54 | P > 0.05 |
Comparison 6: Dining space redesign vs. traditional environment, Outcome 4: Global cognitive function
| Serious adverse effects | |||||
| Study | Measure | Dining space redesign | Traditional | Sample size | Effect estimate or reported significance |
|---|---|---|---|---|---|
| Kenkmann 2010 | Fall within previous year, % | Baseline: 60% 12 months: 60% | Baseline: 56% 12 months: 50% | 105 | P > 0.05 |
| Rate of falls | N/R | N/R | 105 | Rate ratio (95% confidence interval): 0.76 (0.57 to 1.01) | |
Comparison 6: Dining space redesign vs. traditional environment, Outcome 5: Serious adverse effects
| Behaviour, mood and depression | |||||
| Study | Measure | Garden vignette | Traditional | Sample size | Effect estimate |
|---|---|---|---|---|---|
| Marcy‐Edwards 2011 | Neuropsychiatric Inventory‐Nursing Homes (NPI, NH), (mean change (SD)) (lower scores = better) | 12.4 (66.1) | ‐0.4 (19) | 33 | MD (95% confidence interval): 12.8 (‐10.7 to 36.3) |
Comparison 7: Garden vignette vs. traditional environment, Outcome 1: Behaviour, mood and depression
| Whole‐facility changes: Home‐like models compared to traditional environment for older people living in long‐term residential care | ||||||
| Patient or population: older adults living in long‐term residential care including, but not limited to, dementia‐specific care settings | ||||||
| Outcomes
| Illustrative comparative risks (95% CI) | Relative effect Follow‐up time | No of Participants
| Certainty of the evidence | Comments | |
|---|---|---|---|---|---|---|
| Assumed risk Traditional design | Corresponding risk Home‐like model | |||||
| Health‐related quality of life Dementia‐specific quality of life measure (QUALIDEM) (higher scores = better)
| N/a | N/a | Not estimable 6 months and 12 months
| 33 (1 controlled before‐after study) | ⊕⊝⊝⊝ | 2 domains (feeling at home and care relationship) were examined in an analysis adjusted for baseline differences between the groups; 7 other domains were unadjusted. The author stated "No statistically significant differences were observed between the intervention and control groups." |
| Global behaviour Neuropsychiatric Inventory (NPI), Neuropsychiatric Inventory‐Nursing Home version (NPI‐NH) and Nurses Observations Scale for Geriatric Patients (NOSGER) (lower scores = better)
| N/a | N/a | Not estimable 6 months
| 257 | ⊕⊝⊝⊝
| One study found little or no difference in global behaviour change at 6 months using the NPI (N = 164; MD ‐0.04 (95% CI ‐0.13 to 0.04)); two additional studies (N = 93) reported global behaviour endpoint data, but the data were unsuitable for determining a summary effect estimate.
|
| Depression Revised Memory and Behaviour Problems Checklist (RMBPC) and Mood Scale Score (MSS) (lower scores = better)
| N/a | N/a | Not estimable 6 months and 18 months
| 406 (2 controlled before‐after studies) | ⊕⊝⊝⊝ | Depressive symptoms 18‐month change using the MSS (1 study, N = 242; RR 1.15 (95% CI 1.02 to 1.29)) Probability no depressive symptoms 18 months using the MSS (1 study, N = 242; OR 0.36 (95% CI 0.12 to 1.07)) Depressive symptoms 6‐month endpoint using the RMBPC (1 study, N = 164; MD 0.01 (95% CI ‐0.12 to 0.14)) |
| Function Activities of daily living (ADL) long‐form scale (lower scores = better), Interview for the Deterioration of Daily Living activities in Dementia (IDDD) (lower scores = better) Or Barthel Index (higher scores = better)
| N/a | N/a | Not estimable 6 months and 18 months | 499 | ⊕⊝⊝⊝ | Function 18‐month change using the ADL long‐form scale (1 study, N = 242; MD ‐0.09 (95% CI ‐0.46 to 0.28)) Function 6‐month endpoint using the IDDD (1 study, N = 164; MD ‐4.37 (95% CI ‐7.06 to ‐1.69)) Two additional studies: measured function with the Barthel Index but were not included in the quantitative analysis:
|
| Serious adverse effects Physical restraints, reported as percentage points (lower = better)
| 23 per 1000* | 20 per 1000** | MD ‐0.3% (‐0.5% to ‐0.1%) Follow‐up: Unclear
| Unclear (weighted estimate 74,449 participants at enrolment)
| ⊕⊝⊝⊝ |
No further adverse effects were examined. Unclear length of follow‐up (reported as up to 5 years)
|
| CI: Confidence interval; MD: Mean difference;OR: Odds Ratio; RR: Risk ratio | ||||||
| GRADE Working Group grades of evidence | ||||||
| 1 The certainty of evidence was downgraded two levels for risk of bias (high risk of bias on six items including high risk of selection bias, performance bias, detection bias, attrition bias, and other (differences in baseline characteristics and potential residual confounding)) and two levels for imprecision (only 33 participants). 2The certainty of evidence was downgraded two levels for risk of bias (all studies at high risk of bias on at least six items) and one level for imprecision (< 400 participants). 3The certainty of evidence was downgraded two levels for risk of bias (all studies at high risk of bias on six items). 4The certainty of evidence was downgraded two levels for risk of bias (high risk of bias on at least six items) and one level for imprecision (499 participants in total across outcomes but reported across different measures). 5The certainty of evidence was downgraded two levels for risk of bias (high risk of bias on five items including high risk of selection bias, performance bias, detection bias and other (method of selection of facilities unclear, potential residual confounding, significant differences in baseline characteristics and significant differences for many baseline outcome measures)). *Assumed risk for the control group was derived from the study reporting this outcome (2.3%). **Corresponding risk based on a difference of 0.3%. | ||||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1.1 Quality of life Show forest plot | 1 | Other data | No numeric data | |
| 1.2 Behaviour, mood and depression Show forest plot | 5 | Other data | No numeric data | |
| 1.2.1 Global behaviour | 3 | Other data | No numeric data | |
| 1.2.2 Depression | 2 | Other data | No numeric data | |
| 1.2.3 Behaviour subdomains | 2 | Other data | No numeric data | |
| 1.2.4 Social engagement | 2 | Other data | No numeric data | |
| 1.3 Function Show forest plot | 4 | Other data | No numeric data | |
| 1.4 Global cognitive function Show forest plot | 4 | Other data | No numeric data | |
| 1.5 Quality of care Show forest plot | 1 | Other data | No numeric data | |
| 1.6 Serious adverse effects Show forest plot | 1 | Other data | No numeric data | |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 2.1 Quality of life Show forest plot | 3 | Other data | No numeric data | |
| 2.2 Behaviour, mood and depression Show forest plot | 3 | Other data | No numeric data | |
| 2.2.1 Depression | 1 | Other data | No numeric data | |
| 2.2.2 Behaviour subdomains | 3 | Other data | No numeric data | |
| 2.3 Function Show forest plot | 1 | Other data | No numeric data | |
| 2.4 Quality of care Show forest plot | 1 | Other data | No numeric data | |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 3.1 Behaviour, mood and depression Show forest plot | 1 | Other data | No numeric data | |
| 3.1.1 Global behaviour | 1 | Other data | No numeric data | |
| 3.1.2 Depression | 1 | Other data | No numeric data | |
| 3.1.3 Behaviour subdomains | 1 | Other data | No numeric data | |
| 3.2 Function Show forest plot | 1 | Other data | No numeric data | |
| 3.3 Global cognitive function Show forest plot | 1 | Other data | No numeric data | |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 4.1 Behaviour, mood and depression Show forest plot | 1 | Other data | No numeric data | |
| 4.1.1 Depression | 1 | Other data | No numeric data | |
| 4.1.2 Behaviour subdomains | 1 | Other data | No numeric data | |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 5.1 Behaviour, mood and depression Show forest plot | 2 | Other data | No numeric data | |
| 5.1.1 Global behaviour | 1 | Other data | No numeric data | |
| 5.1.2 Depression | 1 | Other data | No numeric data | |
| 5.1.3 Behaviour subdomains | 2 | Other data | No numeric data | |
| 5.2 Behaviour, mood and depression: depression 4‐6 weeks Show forest plot | 3 | 291 | Std. Mean Difference (IV, Fixed, 95% CI) | ‐0.22 [‐0.45, 0.01] |
| 5.3 Behaviour, mood and depression: agitation 4‐6 weeks Show forest plot | 2 | 179 | Std. Mean Difference (IV, Fixed, 95% CI) | ‐0.16 [‐0.45, 0.14] |
| 5.4 Function 4‐6 weeks Show forest plot | 2 | 179 | Std. Mean Difference (IV, Fixed, 95% CI) | ‐0.29 [‐0.59, 0.00] |
| 5.5 Function Show forest plot | 1 | Other data | No numeric data | |
| 5.6 Global cognitive function Show forest plot | 1 | Other data | No numeric data | |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 6.1 Quality of life Show forest plot | 2 | Other data | No numeric data | |
| 6.2 Behaviour, mood and depression Show forest plot | 1 | Other data | No numeric data | |
| 6.3 Function Show forest plot | 1 | Other data | No numeric data | |
| 6.4 Global cognitive function Show forest plot | 1 | Other data | No numeric data | |
| 6.5 Serious adverse effects Show forest plot | 1 | Other data | No numeric data | |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 7.1 Behaviour, mood and depression Show forest plot | 1 | Other data | No numeric data | |
