Impact of hospital design on the psychological well-being of geriatric patients

Why does this study matter?
Our global aging demographic is increasing. As we live into old age and increased vulnerability, the more points of contact we are likely to have with healthcare settings of all kinds. Normal age-related changes, common types of cognitive decline, and other neurologic issues impacting sensory processing result in disproportionately negative consequences. Understanding how our most vulnerable patient populations perceive healthcare design can improve the mental, emotional, and health outcomes for all.

How was the study done?
This mixed method case study was carried out at 3 different types of healthcare facilities in Delhi. A 200-bed public government hospital, a 300-bed nonprofit medical college hospital, and a 300-bed super specialty private hospital. Ward occupancy ranged from 17 to 11 to 6 patients respectively. Each ward had shared gender-neutral toilets. Subject recruitment resulted in 100 geriatric acute care in-patients. The average age was 67 and approximately 1/3 were female. Participation remained at 100% throughout the study. Half of the sample was drawn from the super specialty private hospital. The remaining half was evenly split between the public hospital and the nonprofit medical college hospital. Data were collected using multiple methods in 3 phases. Environmental factors influencing the experience of geriatric patients in hospitals were identified through a review of the literature. An observation checklist and structured interview were then used to investigate and analyze each of the hospital wards. Geriatric patients’ perceived stress, comfort, and interaction with indoor features were then evaluated through interviews using an adapted version of the Spielberger State-Trait Anxiety Inventory tool.          

What do we learn from the study?
Thirty environmental features that were identified in the literature were used to inventory built features in each of the 3 hospitals. Secondary in-patient interviews resulted in categorizing the features into 6 environmental parameters: spatial comfort, sensory comfort, social comfort, self-autonomy, privacy, and safety and security. The three hospital environments were retroactively evaluated in relation to each of the parameters as well as in-patent stress levels. Even though the super specialty private hospital performed better on the three comfort dimensions, permitted autonomy, self-control, safety and privacy, geriatric patients still experienced more measured stress than those from the non-profit medical college hospital and public hospital. In the end, analysis revealed subtle preferences and significant insights into the architectural features enhancing comfort and reducing stress for geriatric patients during their hospital stays. Those achieving the level of statistical significance include:

• The quantity of furnishings
• Furnishings to accommodate visitors (day & night)
• Bedside windows
• Distance from a nursing station (farther was better for sensory comfort, but closer was better for response time)
• Distance from the bed to the toilet
• Distance from the bed to lighting and thermal control switchboard
• The food table achieved the highest level of significance where perceived safety was concerned
• Fewer patients per ward
• The presence of privacy curtains

Can we say the results are definitive?
While this study offers many insights, it was conducted in Delhi which can complicate translating findings to other regions with different cultural, economic, and healthcare infrastructures exist. And, while a validated Anxiety Inventory tool was used, neither the measures nor the adaptations to those measures were detailed by the research team. The authors acknowledge that factors beyond the physical environment must have contributed to stress levels. Accordingly, the study would have benefited from collecting the cause and duration of admission, physical and cognitive capabilities, socioeconomic, and other relevant demographic data for participants.   

What’s the takeaway?
Older adults are disproportionately likely to be hospitalized. I think that the findings of this study can inform healthcare facility design by providing insight into the design features that promote the well-being of the elderly and other vulnerable patients. Designing to support our most vulnerable patient populations is just good design.
 

Summary of:

Arafat, M. Y., & Atreya, S. (2024). Impact of hospital design on the psychological well-being of geriatric patients. Frontiers in Engineering and Built Environment, 4(2), 101–115.

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