Supportive Environment for Aging Population: Three Approaches to Utilizing the Indoor Environmental Features to Create Psychologically Supportive Environment for Older Adults With Dementia

Abstract

The physical environment is a critical determinant of psychological and physiological well-being in long-term care facilities. However, most memory care facilities are characterized by unfamiliarity, sensory deprivation, and inadequate lighting, which may exacerbate agitation, depression, and sleep disturbances among older adults with dementia. Thus, this dissertation investigates three non-pharmacological environmental approaches, namely biodynamic lighting, a bi-sensory “Arosound” environment (aroma + sound), and affordable multisensory environments, to enhance the quality of life for older adults with dementia living in memory care settings. Three studies were conducted in memory care facilities. Study one evaluated the feasibility and effects of biodynamic lighting, a circadian lighting system that varies in intensity and spectrum throughout the day, using a 7-week counterbalanced crossover design with ten participants (mean age = 75.6). Biodynamic lighting improved total sleep time by 82 minutes compared to Baseline and 57 minutes compared to constant moderate lighting, with trends toward reduced depressive symptoms and lower aggressive behaviors. Study two examined a bi-sensory “Arosound” environment combining aroma and sound, compared to single-sensory aroma and sound exposures. Fifteen residents participated over twelve weeks, with two-week washouts. All interventions reduced evening depressive symptoms, with the strongest effects during aroma exposure. Sound exposure significantly reduced agitation, while Arosound showed balanced improvements across both mood and behavior. Study three tested two affordable, passive multisensory environments, a morning stimulating environment (MSSE) and an evening relaxing environment (MSRE) as well as their combined effect, in eleven participants. The combined MSSE+MSRE condition significantly improved sleep efficiency and reduced depressive symptoms and heart rate compared to Baseline, while MSSE reduced morning non-aggressive behaviors. Collectively, the findings demonstrate that ambient features of the indoor built environment, when strategically designed, can serve as scalable, supportive interventions to improve behavioral and physiological well-being among individuals with dementia. The results provide evidence-based design guidance for architects, designers, and care providers aiming to create supportive, human-centered environments in memory care settings.