Evaluation of environmental assessment tools for settings for individuals living with dementia

Abstract

Introduction The overarching goal of research on physical settings for individuals living with dementia is to identify associations between designed features within the built environment and outcomes of interest. Over the past three decades numerous environmental assessment tools have been developed in several countries, responding to a changing set of care industry values that increasingly prioritize a holistic, quality‐of‐life–driven person‐centered care (PCC) model over a biomedical approach to long‐term care (LTC) provision. This article reviews the diversity, constructs, strengths, and limitations of existing environmental assessment tools and identifies gaps for future tool development. Methods A systematic literature search was conducted using four databases (Medline, CINAHL, PsycInfo, and Avery Index) and terms related to health‐care environments and assessment tools. Results A total of 13 environmental assessment tools for people living with dementia within shared residential settings were identified. Evaluation of the environmental assessment tools includes a synthesis of published data for each tool's reliability, validity, ease of use, interpretability, strengths and weaknesses, as well as a comparison of various tool characteristics including date of development, country of origin, applicable care setting(s), number and variety of measures and underlying constructs, format, and descriptive versus evaluative content. Discussion While the shift to person‐centered values encompasses all aspects of care and care settings, the majority of person‐centered definitions exclude the important role of the designed, physical environment. However, this review of environmental assessment tools clearly demonstrates that newer tools are embracing the full array of PCC values. In the United States, this is shown in the shift from tools designed to assess segregated dementia care settings to tools that integrate the needs and preferences both of individuals living with and without dementia. Next‐generation tools need to specifically address the household model of design. Highlights The overarching goal of research on physical settings for individuals living with dementia is to identify associations between designed features within the built environment and outcomes of interest. A systematic literature search identified a total of 13 environmental assessment tools for people living with dementia within shared residential settings; these tools were then described and evaluated based on reliability, validity, ease of use, interpretability, strengths, and weaknesses. This review of environmental assessment tools clearly demonstrates that newer tools are embracing the full array of person‐centered care values.

The Environmental Audit Screening Evaluation: Establishing Reliability and Validity of an Evidence-Based Design Tool

“…The first step was to identify the tools against which the EASE would be validated. A detailed analysis of 13 long-term care environmental assessment instruments was conducted ( Calkins et al, 2022 ) and used to determine which tools to compare the EASE to. The TESS and PEAP were selected as comparison tools because they were both developed in the United States to assess special care units and were based on values that were ultimately adopted by the PCC movement.…”

“…Thus, the decision was made to include the EAT-HC as the third comparison tool. A brief description of each tool is provided later, and a more complete description which includes more detailed psychometric properties can be found in Calkins et al (2022) .…”

“…A few of the more prominent tools include The Preferences for Everyday Living Inventory which assesses the extent to which residents’ preferences are assessed and honored ( van Haitsma et al, 2013 ); Artifacts of Culture Change which assesses organizational changes that reflect PCC practices ( Bowman, 2006 ); Culture Change Indicators Survey which also assesses progress toward organizational adoption of PCC values ( Institute for Caregiver Education, 2003 ); and the Eden Warmth Surveys for elders, staff, and families which assess residents, families, and employees’ satisfaction with the organization adopting PCC practices ( Eden Alternative, 2007 ). It is worth noting that although these tools assess the core values of PCC, and some of these instruments include some items about the designed environment, none is comprehensive ( Calkins et al, 2022 ). In examining tools specifically focused on the designed environment, the two U.S.-based tools (TESS and PEAP) were developed prior to the evolution of HH models.…”

Measurement to improve care and outcomes for persons with Alzheimer's disease and dementia

“…Already, the special collection includes papers on reconsidering frameworks for dementia care, 10 measures for dementia care planning, 11 and person‐centered assessment; 12 a paper on environmental assessment tools is currently in press. 13 Upcoming papers will overview and evaluate measures related to detection and diagnosis and activities of daily living; discuss goal attainment scaling as a person‐centered measurement tool useful across individuals and the course of the disease; address recruitment and engagement in dementia research; and explore the operationalization of person‐centered care in practice. As an additional effort to promote new measurement development, the Alzheimer's Association is issuing a series of request for research applications on Advancing Research on Care and Outcome Measurement (ARCOM).…”

Implementing the model-based systems engineering (MBSE) approach to develop an assessment framework for healthcare facility design

“…Also, when an HCO is affected, it can also affect another HCO. The examination of the existing assessment tools reveals that they are inadequate in providing a systematic and comprehensive EBD-based evaluation for addressing the challenges mentioned above (Calkins et al, 2022;Elf et al, 2017). That is mainly due to three key shortcomings.…”