Structural Model for the Relationships between Indoor Built Environment and Behaviors of Residents with Dementia in Care and Attention Homes

Behavioral symptoms such as distress, sleep disturbance and aberrant mobility are common in all types of dementia. Indoor built environment (IBE) of care and attention (C&A) homes should be optimized for the abilities, health and morale of their elderly residents with dementia, to reduce the likelihood of it inducing in residents problematic behaviors with burdensome symptoms. Therefore, it is necessary to investigate the interactions between the IBE and the behavior of the elderly with dementia. This study aims to establish an integrated IBE-Behavior model to uncover these complicated relationships. The daily activities and engagement of 40 residents with dementia were observed and recorded using dementia care mapping. A questionnaire survey of a total of 96 respondents with mild and moderate dementia was conducted in C&A homes. Multiple research methods were applied to develop the integrated IBE-Behavior model, including factor analysis, reliability test, Pearson correlation, multiple regression analysis and structural equation modeling. The model confirmed the following: 1) surprisingly, both factors of the space management component (i.e., distances and privacy) are found to have no impact on the behavioral symptoms of residents with dementia in C&A homes; 2) three IBE factors belonging to building services components – lighting (E4), lifts (E6) and water supply (E7) – influence demented residents’ negative emotion, positive emotion, sleeping disturbance and limited mobility; 3) loneliness is affected by the supporting facilities factor of furniture (E8). Practical recommendations are made, including: automatic adjustment of lighting, anti-scald devices, seats around small tables or in a sociopetal position, etc.