Long-term care facilities are currently installing dynamic lighting systems with the aim to improve the well-being and behaviour of residents with dementia. The aim of this study was to investigate the implementation of dynamic lighting systems from the perspective of stakeholders and the performance of the technology. Therefore, a questionnaire survey was conducted with the management and care professionals of six care facilities. Moreover, light measurements were conducted in order to describe the exposure of residents to lighting. The results showed that the main reason for purchasing dynamic lighting systems lied in the assumption that the well-being and day/night rhythmicity of residents could be improved. The majority of care professionals were not aware of the reasons why dynamic lighting systems were installed. Despite positive subjective ratings of the dynamic lighting systems, no data were collected by the organizations to evaluate the effectiveness of the lighting. Although the care professionals stated that they did not see any large positive effects of the dynamic lighting systems on the residents and their own work situation, the majority appreciated the dynamic lighting systems more than the old situation. The light values measured in the care facilities did not exceed the minimum threshold values reported in the literature. Therefore, it seems illogical that the dynamic lighting systems installed in the researched care facilities will have any positive health effects.
The design of healthcare facilities is a complex and dynamic process, which involves many stakeholders each with their own set of needs. In the context of healthcare facilities, this complexity exists at the intersection of technology and society because the very design of these buildings forces us to consider the technology–human interface directly in terms of living-space, ethics and social priorities. In order to grasp this complexity, current healthcare design models need mechanisms to help prioritize the needs of the stakeholders. Assistance in this process can be derived by incorporating elements of technology philosophy into existing design models. In this article, we develop and examine the Inclusive and Integrated Health Facilities Design model (In2Health Design model) and its foundations. This model brings together three existing approaches: (i) the International Classification of Functioning, Disability and Health, (ii) the Model of Integrated Building Design, and (iii) the ontology by Dooyeweerd. The model can be used to analyze the needs of the various stakeholders, in relationship to the required performances of a building as delivered by various building systems. The applicability of the In2Health Design model is illustrated by two case studies concerning (i) the evaluation of the indoor environment for older people with dementia and (ii) the design process of the redevelopment of an existing hospital for psychiatric patients.
Psychogeriatric patients are a very vulnerable group among the elderly. A relative large proportion is institutionalized. In addition, many studies point to the heavy burden on the informal carers of psychogeriatric patients, frequently leading to depression. Geriatric expertise in primary care, however, is limited. To complement this expertise, an experiment was conducted involving a geriatric assessment unit in a nursing home. An evaluation study was carried out including 96 patients, 89 of whom were looked after by informal carers. Data were collected from the unit and two ‘external controls’, both the GP and the informal carer, were interviewed before and 3 months after the intervention. The results show that, in a majority of cases, a new psychiatric or somatic diagnosis could be arrived at. Advice was given on drugs and physiotherapy and the monitoring of behaviour. The impact of the behavioural problems of patients was diminished after the intervention according to the informal carers. Moreover, the sense of competence of the informal carers was enhanced. The health status of the informal carers and the social support they received remained the same. Furthermore,
