Using the “user-centered” design perspective and the construct of design “humanization” as theoretical underpinnings, this field study verified the role of “objective” design quality of residential facilities for the elderly in the prediction of “subjective” users’ psychological responses. A sample of over-65-year-old adults (N = 114) was recruited in eleven residential facilities, which differed for the degree of “objective” design humanization (rated on the basis of a design expert assessment). Participants had to fill in a questionnaire including measures of both specific perceived environmental qualities (spatial-physical and social-relational) and more general psychological responses (such as residential satisfaction and psychological well-being). Outcomes revealed that older residents living in high-humanization structures show higher scores of residential satisfaction, psychological well-being and perceived environmental qualities than those living in low-humanization structures. Moreover, significant correlations emerged between specific perceived environmental qualities of the facility and general psychological outcomes. These results confirm the importance of design features for supporting elders’ needs and fostering their quality of life.
The rapid aging of the global population, represented by the number of about 901 million over-60 year olds worldwide (
Doubtless, relocation may provoke a complex and stressful experience having both cognitive and affective implications, especially for older people and particularly if the relocation concerns a residential healthcare facility. In spite of the general older adult preference for remaining in the familiar context of their own home (
Residential facilities for older people may differ in various aspects, such as the level of care, social and caregiving support, physical features, and accessibility (
Specific tools were developed for measuring perceived quality of urban neighbourhoods (e.g., the PREQIs, Perceived Residential Environment Quality Indicators:
Regarding the physical attributes of buildings, they seem to be relevant in determining residential satisfaction (
A relocation aimed at improving health (or a general enhancement of well-being) is likely to be ineffective if the residential structure’s design features fail to support the users' requirements. This assumption is mirrored by an increasing attention, in the field of healthcare design, toward the evaluation of those environmental features supporting the particular needs of the users. In this regard, following a “user-centered” design perspective (
The promotion of a friendly atmosphere - similar to the home environment - in healthcare and residential structures, taking into account both sensory limitations and the fear of getting lost often found in older adults, may produce positive consequences and improve those skills that help to carry out the normal tasks of everyday life (
Following these premises, interventions that have proven to be useful are “de-institutionalization” of the environment (e.g., removal of barriers or other visual impediments, introduction of carpets in corridors, the possibility to personalize room spaces in order to increase the sense of continuity in their life, allocation of areas for carrying out activities such as cooking or art), an increase in perceptive clues that make orientation easier, continuity of paths, access to external spaces such as gardens and other green areas, and the design of areas for socialization and recreational activities (
The main aim of this field study was to verify if a higher design humanization of elders’ facilities was positively associated with higher perceived design qualities, residential satisfaction and general well-being. This objective was pursued through the comparison of psychological responses of older users living in residential facilities at different degrees of design humanization. In particular, it was hypothesized that:
H1. Older adults living in high-humanized residential facilities show more positive psychological responses than older adults living in low-humanized residential facilities; in other words, it was expected that there would be a pattern of congruence between “objective” design quality and “subjective” individual responses.
H2. Perceived environmental qualities of the facilities are positively associated with residential satisfaction (H2a) and psychological well-being (H2b).
Participants were over-65 year old individuals (
The sample was characterized as follows. Marital status: 62.2% of the participants were widowed, 28.1% had never been married, 5.3% were separated or divorced, and 4.4% were married. Length of permanence in the facility: 44.7% had been living in the facility for more than two years, 33.3% for more than six months but less than two years, 21.1% for less than six months, and 0.9% for less than two weeks.
An expert in the design field (i.e., an architect) visited all the residential facilities and filled in an “expert” grid in order to quantify the environmental quality of the eleven structures, thus rating their degree of “objective” design humanization.
The grid was composed of 24 items including various design attributes of the residential facilities, regarding both external spaces (11 items) and internal spaces (13 items) Examples of items are: “Accessibility of the structure’s entrance”, “Signposting for orientation”, “Quality of green areas”, “Upkeep of furnishing”, and “Presence of decorative elements”.
Depending on their total mean score (i.e., below or above the mean score of the response scale), seven structures were labeled as low-humanized, while the remaining four were labeled as high-humanized.
To be eligible for the study, participants had to be: i) at least sixty-five years of age, ii) without any particular impairment in cognitive faculties, iii) able to verbalize their thoughts, and iv) willing to participate in the study. Upon approval from the manager of each facility, four trained interviewers approached the residents to explain the purpose of the study, and to recruit potential participants.
All participants gave their informed consent. Information about the purpose, procedure and anonymity of the research was provided. Participants were also made aware that they had the right to decline and to withdraw even when the study had begun, including the withdrawal of their data up to the publication of the results. Older adults who agreed to participate in the study were administered a questionnaire by one of the four interviewers. Each questionnaire compilation was carried out in agreement with the staff (in order to not disturb the other residents’ activities), and lasted about one hour.
The questionnaire included the following measures:
For the perceived environmental qualities of the facility, three measures of physical-spatial features and a measure of social-relational features (adapted from PHEQIs by
The three measures of physical-spatial features were:
The measure of social-relational features was:
The following data analyses were performed.
Preliminary analyses were run in order to evaluate the impact of socio-demographic features and users’ experience in the facility on psychological responses.
In order to test H1, one-way ANOVAs were performed, considering the elderly facility’s degree of design humanization (high vs. low) as the IV, and perceived environmental qualities and molar psychological responses (i.e., Satisfaction toward the residential facility and Psychological Well-being) as DVs.
In order to test H2, bivariate correlations between perceived environmental qualities and the molar psychological responses were performed. Two different regression analyses were also carried out with perceived environmental qualities (i.e., physical-spatial features and social-relational features) as predictors and, respectively, a) residential satisfaction and b) well-being as criteria, controlling for length of stay in the facility.
Findings of preliminary analyses showed no significant influence of socio-demographic and users’ experience in the facility on Residential Satisfaction and Psychological Well-being, except for Gender and one’s own vs. others’ choice. Specifically, women appear more satisfied than men,
Regarding H1, significant differences between high- vs. low-humanized facilities emerged for all the dependent variables, except for the Views and Lighting factor (see
Variable | Degree of objective humanization |
|
η2 | ||||
---|---|---|---|---|---|---|---|
High |
Low |
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|
|
|
|
||||
Well-being | 3.52 | .76 | 3.08 | .80 | 7.58 | .007 | .07 |
Residential Satisfaction | 4.33 | .77 | 3.92 | .83 | 5.53 | .021 | .05 |
Orientation | 4.72 | .44 | 3.98 | .55 | 57.48 | < .001 | .34 |
Comfort | 4.64 | .52 | 3.99 | .60 | 34.74 | < .001 | .24 |
Views and Lighting | 4.49 | .63 | 4.47 | .58 | 0.04 |
|
.00 |
Socio-relational Features | 4.61 | .46 | 4.33 | .45 | 5.53 | .021 | .05 |
More specifically, older residents of high-humanized facilities showed a significantly higher perceived quality in Orientation,
For other psychological responses, older residents in high-humanization structures expressed both a higher Psychological Well-being,
Regarding H2, that is, the relationships between perceived environmental qualities and the molar psychological responses, the results are shown in
Variable | 1 | 2 | 3 | 4 | 5 |
---|---|---|---|---|---|
1. Well-being | - | ||||
2. Residential Satisfaction | .53*** | - | |||
3. Socio-relational Features | .35*** | .56*** | - | ||
4. Views and Lighting | .06 | .07 | .17 | - | |
5. Orientation | .43*** | .47*** | .47*** | .05 | - |
6. Comfort | .26** | .38*** | .57*** | .22* | .57*** |
*
The correlation matrix showed a general picture where perceived environmental qualities were significantly related to the other psychological responses. More specifically, Orientation and Comfort were positively related to both Psychological Well-being (respectively,
Moreover, Socio-relational Features were positively related to both Comfort (
Regarding the results of the two multiple regression analyses, the first, with Residential Satisfaction as a criterion and perceived environmental qualities as predictors (
The purpose of the current study was to analyze the relationship between residential facilities showing different levels of design quality and psychological responses of older users who have experienced them. Specifically, assessments of older people living in low-humanization vs. high-humanization residential facilities were compared. Such assessments concerned both specific environmental qualities (i.e., comfort, orientation, views and lighting, and socio-relational features) and more general patterns, such as satisfaction toward the residential experience and psychological well-being.
On the whole, the research findings confirmed the hypotheses of the study.
Firstly, the outcomes highlighted a substantial congruence between ‘‘expert’’ (or “technical”, or “objective”) evaluation, based either on objective physical measures or on expert judgments, and “lay” (or “observational”, or “subjective”) evaluation, based on either users’ observations or on users’ perceptions (see
Furthermore, as hypothesized, specific perceived environmental qualities were related to the molar psychological responses of older users (H2). In fact, in line with results of other studies (
A further interesting result is the positive relationship between the quality of comfort and orientation and social-relational aspects, that is, the higher the degree of design humanization, the better the perceived quality of social and relational dimensions. This association could be due to a mutual bi-directional influence (
The present study provided evidence about the association between design humanization of residential facilities and older users’ satisfaction and well-being. In particular, in line with findings of previous studies (see
A limit of this study concerns the reliance on only one design expert for the evaluation of objective environmental quality, so that the consequent labeling of the degree of design humanization was based on a single respondent’s ratings. Nevertheless, in the instructions for the expert’s task it was clearly suggested to assess the quality of each parameter on the basis of the expert’s professional background (and not on the basis of an individual preference). However, more sophisticated methods should be developed in order to strengthen the validity of classification of the structures’ degree of humanization. In this regard, future research on this issue should both increase the internal validity of the studies and verify multifaceted models that reflect the complexity of the unit of analysis, for example, by comparing different age groups with different needs.
The authors have no funding to report.
The authors have no support to report.
The authors have declared that no competing interests exist.
The theoretical introduction of this paper is based on a previous manuscript, which was included in the Proceedings of the ARCH12 Conference, held in the Chalmers University of Technology of Gothenburg (Sweden) from 12th to 14th November 2012: Cerina, V., & Fornara, F. (2012). Promoting design quality in the community residences for the elderly: A comparison between high- vs. low-humanization structures in Sardinia (Italy). In