Towards more elder friendly hospitals : final report - studies 3b and 3c

Deconditioning and loss of functional status occurs at high rates among elderly persons admitted to hospitals, independent of their medical condition. Design of the physical environment is one of several explanations as to why this may occur. The two pilot studies described in this report tested selected environmental modifications designed to overcome some of the physical barriers to safe independent transfer, mobility, and toileting identified in Studies 1 and 2 of the Towards More Elder Friendly Acute Hospitals Research Project. One pilot study (Study 3b) took place in two originally identical bedrooms at Burnaby Hospital, a community hospital located in Burnaby, British Columbia. The second (Study 3c) took place in two adjacent bathrooms. In both Studies 3b and 3c, one room remained "as is " and the other was modified; 36 community-dwelling volunteers aged 75+ performed a series of tasks in both the original and the modified bedrooms and the two toilet areas. Order of exposure to the "typical" and modified rooms was counterbalanced. Three types of data were collected: subjective, physiological and video. The environment modifications of interest were rated by participants for ease of use, for helpfulness, and/or for appeal and they were asked to respond to questions such as "what did you like most/least about the rooms and why"? Heart rate was measured as participants rested in each bedroom and postural sway was recorded as they transferred from the bedroom to the bathroom and while they pretended to use the toilet and "freshen up" at the sink. To document gross movement, gestures, coping actions and facial expressions, high resolution webcams were mounted in the bedrooms and bathrooms and a camcorder followed the participants throughout the study. A number of lessons were learned from the study about relatively inexpensive design features that if implemented in new construction and retrofitting, have the potential to increase the elder friendliness of FH hospitals (e.g. movement activated lighting at the entrance to the bathroom). A number of useful lessons were also learned concerning equipment and procedures for remote monitoring of physiological functioning and stress. The report ends with a series of recommendations that include recognizing the diversity of the frail elder population of British Columbia and designing physical space in hospitals to meet the needs of patients with multiple chronic physical and/or cognitive impairments. NOTE: The following thesis constitutes Study 3a of this report series: Love, T. (2007). Modifications to the hospital physical environment: Effect on older adults' retention of post-discharge instructions. M.A. Thesis, Department of Gerontology (Supervisor: G. Gutman).