Abstract:Recently there has been an increasing interest in the acoustic environment and its perceptual counterpart (i.e., the soundscape) of care facilities and their potential to affect the experience of residents with dementia. There is evidence that too loud sounds or poor soundscape quality more generally can affect negatively the quality of life of people with dementia and increase agitation. The AcustiCare project aims to use the soundscape approach to enhance the Quality of Life (QoL) of residents and to reduce Behavioral and Psychological Symptoms of Dementia (BPSD), as well as improving the everyday experience of nursing homes for both residents and staff members. In order to gain further insights into the sound environments of such facilities, sound level monitoring and soundscape data collection campaigns were conducted in the living rooms of five nursing homes in Flanders. Results showed that sound levels (dB) and loudness levels (sone) did not vary significantly between days of the week, but they did so between moments of the day and between living rooms. From the perceptual point of view, several soundscape attributes and the perceived prominence of different sound source types varied significantly between the living rooms investigated, and a positive correlation was found between sound levels and the number of persons present in the living rooms. These findings claim for further attention on the potential role of the sound domain in nursing homes, which should promote (and not only permit) better living and working conditions for residents and staff members of nursing homes.

As noise is a basic contributor to the evaluation of an environment, the indoor environment of a nursing home (where residents are provided with 24-hour functional support and care) is studied with this focus. General research results, as indicated from a literature review, are limited up till now. Using quantitative and qualitative methods five nursing homes in Flanders were studied before and after acoustic interventions. Sound levels were measured in individual bedrooms, living rooms and corridors to obtain the typical levels during a day. Acoustic intra-room performance parameters (reverberation time) and inter-room performance parameters (airborne noise insulation level and impact noise insulation level) were measured and compared with Belgian target values. The post operam measurements indicated the potential of the acoustic interventions (use of acoustic curtains, wall and ceiling panels, ventilations grills, floating floors) to improve the building performance and the acoustic climate. From a qualitative viewpoint, the thematic analysis of staff response to the acoustic interventions indicated direct positive outcomes (e.g., more pleasant, quieter indoor soundscapes) with both positive and negative outcomes from perceived indirect effects (i.e., non-acoustic factors).

Sound and its resulting soundscape is a major appraisal component of the living environment. Where environmental sounds (e.g., outdoor traffic sounds) are often perceived as negative, a soundscape (e.g., containing natural sounds) can also have a positive effect on health and well-being. This supportive effect of a soundscape is getting increasing attention for use in practice. This paper addresses the design of a supportive sonic environment for persons with dementia in nursing homes. Starting from a review of key mechanisms related to sonic perception, cognitive deficits and related behavior, a framework is derived for the composition of a sonic environment for persons with dementia. The proposed framework is centered around using acoustic stimuli for influencing mood, stimulating the feeling of safety and triggering a response in a person. These stimuli are intended to be deployed as added sounds in a nursing home to improve the well-being and behavior of the residents.

There are relatively few studies on the acoustic environment of care facilities. However, sound is an important component of the users' experience and quality of life in these spaces, and particularly in nursing homes, where both staff and residents have medium-to long-term perspectives, contrarily to hospital settings. This study included an online large-scale survey for nursing homes in Flanders and it targeted the group of professionals. It aimed at providing an overview about noise sensitivity and sound perception of the staff members in their work environment, as well as investigating the potential effects on sound perception of staff role and context. Results showed that limited differences emerged for staff roles, while more differences were found when exploring the context factor. Overall, the results of this study claim for further attention on the management and design of the sound environment in these facilities.

Acoustic comfort is becoming an increasingly important dimension for practitioners in the context of design of care facilities for older adults, namely nursing homes. Defining the quality of these spaces based on room acoustics criteria alone might be challenging if aspects related to their functioning (e.g., speech-based activities) are not taken into account. The acoustical capacity concept has been previously proposed for eating establishments as a way to provide a quality assessment based on both physical characteristics of the space and the perceived quality of verbal communication. In this study, a revised version of a prediction model for ambient noise levels based on occupancy and an estimation of acoustical capacity are proposed for nursing homes hosting people with dementia, and the corresponding parameters of slope, group size and absorption per person are optimized for the specific application, using a Nursing Home in Flanders (Belgium) participating to the AcustiCare project as case study. Results show that, compared to normal eating establishments, lower absorption per person values and higher group size values should be used in nursing homes to reduce errors in ambient noise levels prediction. Furthermore, using a retrofit intervention carried out in the living room of the Nursing Home, the enhanced acoustical capacity of the space was analysed. Results, in this case, show that, prior to the retrofit intervention, the acoustical capacity was already exceeded with average occupancy (i.e., saturated in normal functioning conditions), while the reduction in reverberation time achieved with the retrofit increased considerably the acoustical capacity of the space, shifting the quality of verbal communication in the living room from insufficient to satisfactory.