HOW SHOULD A GROUP LIVING UNIT FOR DEMENTED ELDERLY BE DESIGNED TO DECREASE PSYCHIATRIC-SYMPTOMS

The main objectives were to study relationships between the design of group living (GL) units and psychiatric symptoms in demented patients before, 6 months after, and 1 year after admission to GL units. The st udy population comprised 105 demented elderly (83 +/- 6 years), 37% wi th dementia of Alzheimer's type and 58% with vascular dementia. The pa tients were relocated by the municipal care planning team after clinic al examination. An observational scale (the Organic Brain Syndrome sca le) was used to assess confusional symptoms and disorientation. The ph ysical environment was assessed by an architect using the Therapeutic Environment Screening Scale, which evaluates general design, space, li ghting, noise, communication area, floor plan, and related factors. Le ss than 15% of the patients had no signs of dyspraxia, hallucinosis, d ysphasia, or depression at admission, whereas 66% or more reported lac k of vitality, aggressiveness, or restlessness. Fourteen out of 18 uni ts had a corridor-like design (group A), one unit an L-shaped design ( group B), and the others a square or H-shaped design (group C). Patien ts living in the B unit had less disorientation than the others at the B-month follow-up. After 1 year, the patients in the A units had more dyspraxia, lack of vitality, and disorientation of identity. The comm unication areas in the units were negatively associated with ''disorie ntation for recent memory'' and ''lack of vitality,'' adjusted for typ e of dementia (r = -0.13 to -0.16). The size of the activity area, ind oor public rooms in square meters, was not correlated to confusional r eactions and disorientation. In conclusion, a GL unit design that faci litates perception without reducing the communication area is to be pr eferred.