With an aging global population, more and more people will need palliative care in the coming decades. This population of older adults will not only need community and hospital facilities to cope with their end-of-life issues, but also spaces that keep them from harm, such as falls. Some current architectural features and other factors erode older adults’ independence and confidence, thereby impairing their quality of life, privacy, and dignity.
The objective of this review was to identify key elements of the physical hospital environment for end-of-life care of older adults and their families as reported by patients, relatives, staff, and policymakers.
The researchers conducted a literature review, using 13 databases from 1966 to 2010. They searched ASSIA, BNI, Cochrane Library, CINAHL, EMBASE, MEDLINE, PsycINFO, Social Science Citation Index, the Science Citation Index, HMIC, and the National Research Register. They performed reference and citation tracking on included publications. Two reviewers independently screened titles and abstracts for inclusion and completed data extraction. They did not report study quality, noted the researchers, because it poses methodological difficulties in integrative reviews.
The literature review team manually completed descriptive thematic analysis (Miles & Huberman, 1994), because the volume of qualitative data they extracted did not warrant using software to identify themes. The quantitative data were also limited, so the team used relevant findings from quantitative studies to inform the narrative within the themes that they identified.
The researchers included 10 articles in the analysis and identified four themes: privacy as needed; proximity (physically and emotionally) to loved ones, home, and nature; satisfaction with the physical environment; and deficiencies in the physical environment.
Further, the literature review team also identified the following key elements of the physical environment for older adults at the end of their lives: cleanliness, homeliness, accessibility, size, familiarity, and atmosphere of the hospital, along with available internal and external spaces. The authors point out, however, that individual preferences play a key role in what aspects of the physical environment patients, carers, and staff find satisfactory or deficient.
The authors conclude that there is little evidence about the physical hospital environments for end-of-life care of older adults and their families and recommend more research in this area.
The authors note that this integrative review addresses a gap in the evidence by identifying key elements of the physical hospital environment for end-of-life care of older adults and their families as reported by patients, relatives, staff, and policymakers. They used comprehensive electronic search, retrieval, and review strategies that addressed some limitations of previous reviews. However, the searches were limited as the researchers only used English language databases. Further, they did not do hand searches of journals or contact experts in the field were directly. Finally, the authors note, grey policy literature searches could have been further developed, so, they might have missed some studies.