The Gerontologist
 QUICK SEARCH:   [advanced]


This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Zeisel, J.
Right arrow Articles by Holmes, W.
Right arrow Search for Related Content
Right arrow PubMed Citation
Right arrow Articles by Zeisel, J.
Right arrow Articles by Holmes, W.
The Gerontologist 43:697-711 (2003)
© 2003 The Gerontological Society of America

Environmental Correlates to Behavioral Health Outcomes in Alzheimer's Special Care Units

John Zeisel, PhD1,, Nina M. Silverstein, PhD2, Joan Hyde, PhD1, Sue Levkoff, ScD3, M. Powell Lawton, PhD4 and William Holmes, PhD5

Correspondence: Address correspondence and requests for reprints to John Zeisel, PhD, Hearthstone Alzheimer Care, 271 Lincoln Street, Lexington, MA 02421. E-mail: zeisel{at}

Purpose: We systematically measured the associations between environmental design features of nursing home special care units and the incidence of aggression, agitation, social withdrawal, depression, and psychotic problems among persons living there who have Alzheimer's disease or a related disorder. Design and Methods: We developed and tested a model of critical health-related environmental design features in settings for people with Alzheimer's disease. We used hierarchical linear modeling statistical techniques to assess associations between seven environmental design features and behavioral health measures for 427 residents in 15 special care units. Behavioral health measures included the Cohen-Mansfield physical agitation, verbal agitation, and aggressive behavior scales, the Multidimensional Observation Scale for Elderly Subjects depression and social withdrawal scales, and BEHAVE-AD (psychotic symptom list) misidentification and paranoid delusions scales. Statistical controls were included for the influence of, among others, cognitive status, need for assistance with activities of daily living, prescription drug use, amount of Alzheimer's staff training, and staff-to-resident ratio. Although hierarchical linear modeling minimizes the risk of Type II—false positive—error, this exploratory study also pays special attention to avoiding Type I error—the failure to recognize possible relationships between behavioral health characteristics and independent variables. Results: We found associations between each behavioral health measure and particular environmental design features, as well as between behavioral health measures and both resident and nonenvironmental facility variables. Implications: This research demonstrates the potential that environment has for contributing to the improvement of Alzheimer's symptoms. A balanced combination of pharmacologic, behavioral, and environmental approaches is likely to be most effective in improving the health, behavior, and quality of life of people with Alzheimer's disease.

Key Words: Special care units • Environment • Alzheimer's disease • Nonpharmacologic treatment

This article has been cited by other articles:

Home page
GerontologistHome page
J. Hyde, R. Perez, and B. Forester
Dementia and Assisted Living
Gerontologist, December 1, 2007; 47(suppl_1): 51 - 67.
[Abstract] [Full Text] [PDF]

Home page
DementiaHome page
J. M . Cioffi, A. Fleming, L. Wilkes, M. Sinfield, and J. Le Miere
The effect of environmental change on residents with dementia: The perceptions of relatives and staff
Dementia, May 1, 2007; 6(2): 215 - 231.
[Abstract] [PDF]

Home page
Arch Intern MedHome page
R. Leonard, M. E. Tinetti, H. G. Allore, and M. A. Drickamer
Potentially modifiable resident characteristics that are associated with physical or verbal aggression among nursing home residents with dementia.
Arch Intern Med, June 26, 2006; 166(12): 1295 - 1300.
[Abstract] [Full Text] [PDF]

Home page
W. Wood, S. Harris, M. Snider, and S. A. Patchel
Activity situations on an Alzheimer's disease special care unit and resident environmental interaction, time use, and affect
American Journal of Alzheimer's Disease and Other Dementias, March 1, 2005; 20(2): 105 - 118.
[Abstract] [PDF]

All GSA journals Journals of Gerontology Series A: Biological Sciences and Medical Sciences Journals of Gerontology Series B: Psychological Sciences and Social Sciences
Copyright © 2003 by The Gerontological Society of America.