Built environment impact on people with dementia (PwD) health and well-being outcomes: a systematic review of the literature

Main Article Content

Silvia Mangili
Andrea Brambilla
Marco Trabucchi
Stefano Capolongo


Dementia, Built environment, well-being, health, evidence-based design, healthcare design, outcomes


Background and aim: The number of People with Dementia (PwD) is rising worldwide and represents a complex figure because of the changes in the cognitive sphere, altering perceptions of the Built Environment (BE). Even though the role of the built environment in the health and well-being of people it’s nowadays well known, few studies analyze and evaluate the impact of specific Architectural Features. To this end, this contribution provides a systematic review that will underline the impacts of BE on the Health and Well-being of PwD and set a matrix of the relationship with measurable outcomes.

Methods: A literature review has been conducted on scientific databases. 40 studies that relate health outcomes and aspects of the built environment have been identified and organized on a comparison matrix that clearly shows the relationships between Architectural Features of BE and Health and Wellbeing Outcome. This matrix allows to identify which are the aspects that can impact on PwD as well as possible lacks.

Results: Many aspects appear to be widely explored, such as BPSD or wandering. In addition, significant gaps in the relationship between recognized aspects of the built environment recognized as relevant to the well-being of people with dementia and the real impacts on health outcomes such as the location and personalization of spaces.

Conclusions: This study collected the most recent studies to underline the relationship between BE and dementia, providing a set of outcomes and architectural features that can be analyzed to assess the quality of BE for PwD.


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1. Eurostat. Mortality and life expectancy statistics. 2021; Available from: https://ec.europa.eu/eurostat/statistics-explained/index.php?title=Mortality_and_life_expectancy_statistics.
2. Alzheimer’s association. 2020 Alzheimer’s disease facts and figures. Alzheimers Dement. 2020 Mar;16(3):391–460. doi: 10.1002/alz.12068.
3. Chaudhury H, Cooke HA, Cowie H, Razaghi L. The Influence of the Physical Environment on Residents With Dementia in Long-Term Care Settings: A Review of the Empirical Literature. The Gerontologist. 2018 Sep 14;58(5):e325–37. doi: 10.1093/geront/gnw259.
4. Mangili S, Brambilla A, Capolongo S. Long‐term care Facilities and Dementia. Development of a framework to assess design quality in healthcare structures for people with dementia. Alzheimers Dement [Internet]. 2022 Dec [cited 2023 Feb 3];18(S8). doi: 10.1002/alz.065844.
5. Brambilla A, Maino R, Mangili S, Capolongo S. Built Environment and Alzheimer. Quality Evaluation of Territorial Structures for Patients with Dementia. In: Bevilacqua C, Calabrò F, Della Spina L, editors. New Metropolitan Perspectives Cham: Springer International Publishing; 2020 [cited 2020 Jul 28]. p. 178–86. (Smart Innovation, Systems and Technologies; vol. 177). doi: 10.1007/978-3-030-52869-0_15.
6. World Health Organization. Global status report on the public health response to dementia [Internet]. Geneva: World Health Organization; 2021 [cited 2021 Sep 20]. Available from: https://apps.who.int/iris/handle/10665/344701
7. Capolongo S. Preface Social aspects and well‑being for improving healing processes’ effectiveness. Ann Ist Super Sanita. 2016;52(1):11-4. doi: 10.4415/ANN_16_01_05.
8. Chrysikou E, Tziraki C, Buhalis D. Architectural hybrids for living across the lifespan: lessons from dementia. Serv Ind J. 2018 Jan 25;38(1–2):4–26. doi: 10.1080/02642069.2017.1365138
9. Fleming R, Goodenough B, Low LF, Chenoweth L, Brodaty H. The relationship between the quality of the built environment and the quality of life of people with dementia in residential care. Dementia 2016 Jul;15(4):663-80. doi: 10.1177/1471301214532460.
10. Ulrich R, Quan X. The Role of the Physical Environment in the Hospital of the 21st Century: A Once-in-a-Lifetime Opportunity. 2004;69.
11. Buffoli M, Bellini E, Bellagarda A. Listening to people to cure people The LpCp – tool, an instrument to evaluate hospital humanization. Ann Ig. 2014 Sep-Oct;26(5):447-55. doi: 10.7416/ai.2014.2004.
12. Harrison SL, Dyer SM, Laver KE, Milte RK, Fleming R, Crotty M. Physical environmental designs in residential care to improve quality of life of older people. Cochrane Database Syst Rev 2022 Mar 7;3(3):CD012892. doi: 10.1002/14651858.CD012892.pub2.
13. Istat. Invecchiamento attivo e condizioni di vita degli anziani in Italia. 2020. [Internet]. Rome: Istituto nazionale di statistica; 2020 [cited 2023 Aug 2]. Available from: http://avvisi.istat.it”
14. Capolongo S, Bellini E, Nachiero D. Soft qualities in healthcare Method and tools for soft qualities design in hospitals’ built environments. Ann Ig. 2014 Jul-Aug;26(4):391-9. doi: 10.7416/ai.2014.1998.
15. Capolongo S, Mauri M, Peretti G, Pollo R, Tognolo C. Facilities for Territorial Medicine: the experiences of Piedmont and Lombardy Regions. TECHNE - J Technol Archit Environ. 2015; 24:230-236.
16. Izzicupo, F. Alzheimer. Conoscere la malattia per saperla affrontare. [Internet]. Rome: Istituto Superiore di Sanità; 2009 [cited 2023 Aug 2]. Available from: https://www.epicentro.iss.it/demenza/AlcoveAdCareVideo.
17. Marquardt G, Bueter K, Motzek T. Impact of the Design of the Built Environment on People with Dementia: An Evidence-Based Review. HERD 2014 Oct;8(1):127–57. doi: 10.1177/193758671400800111”
18. Gola M, Botta M, D’Aniello AL, Capolongo S. Influence of Nature at the Time of the Pandemic: An Experience-Based Survey at the Time of SARS-CoV-2 to Demonstrate How Even a Short Break in Nature Can Reduce Stress for Healthcare Staff. HERD 2021 Apr;14(2):49–65. doi: 10.1177/1937586721991113
19. Brambilla A, Buffoli M, Capolongo S. Measuring hospital qualities. A preliminary investigation on Health Impact Assessment possibilities for evaluating complex buildings. Acta Biom 2019 Sep 13;90(9-S):54–63. doi: 10.23750/abm.v90i9-S.8713
20. Faroldi E, Fabi V, Vettori MP, Gola M, Brambilla A, Capolongo S. Health Tourism and Thermal Heritage: Assessing Italian Spas with Innovative Multidisciplinary Tools. Tour Anal. 2019 Jul 1;24(3):405–19. doi: 10.3727/108354219X15511865533121
21. Higgins JP, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions: Cochrane Book Series 1st ed. Wiley; 2008 [cited 2023 Apr 3]. doi: 10.1002/9780470712184
22. Pati D, Lorusso LN. How to Write a Systematic Review of the Literature. HERD Health Environ Res Des J. 2018 Jan;11(1):15–30. doi: 10.1177/193758671774738
23. Mangili S, Capolongo S. Healthcare Facilities and Dementia Development of a Framework to Assess Design Quality. Stud Health Technol Inform. 2022 Sep 2;297:323-330. doi: 10.3233/SHTI220856.
24. Liberati A. The PRISMA Statement for Reporting Systematic Reviews and Meta-Analyses of Studies That Evaluate Health Care Interventions: Explanation and Elaboration. Ann Intern Med. 2009 Aug 18;151(4):W. doi: “10.1016/j.jclinepi.2009.06.006
25. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021 Mar 29; 71. doi: 10.1136/bmj.n71
26. Kok JS, van Heuvelen MJG, Berg IJ, Scherder EJA. Small scale homelike special care units and traditional special care units: effects on cognition in dementia; a longitudinal controlled intervention study. BMC Geriatr. 2016 Dec;16(1):47. doi: 10.1186/s12877-016-0222-5
27. Lee SY, Chaudhury H, Hung L. Effects of Physical Environment on Health and Behaviors of Residents With Dementia in Long-Term Care Facilities: A Longitudinal Study. Res Gerontol Nurs. 2016 Mar;9(2):81–91. doi: 10.3928/19404921-20150709-01.
28. te Boekhorst S, Depla MFIA, de Lange J, Pot AM, Eefsting JA. The effects of group living homes on older people with dementia: a comparison with traditional nursing home care. Int J Geriatr Psychiatry. 2009 Sep;24(9):970–8. doi: 10.1002/gps.2205
29. Calkins MP. Evidence-based long term care design. Zasler N, editor. NeuroRehabilitation. 2009 Oct 28;25(3):145–54.
30. Kane RA, Lum TY, Cutler LJ, Degenholtz HB, Yu TC. Resident Outcomes in Small-House Nursing Homes: A Longitudinal Evaluation of the Initial Green House Program: GREEN HOUSE RESIDENT OUTCOMES. J Am Geriatr Soc. 2007 Jun;55(6):832–9.
31. Mu J, Zhang S, Kang J. Estimation of the quality of life in housing for the elderly based on a structural equation model. J Hous Built Environ 2021; 37:1255–1281. Doi:10.1007/s10901-021-09887-0
32. Graf A, Wallner C, Schubert V, Willeit M, Wlk W, Fischer P, et al. The effects of light therapy on mini-mental state examination scores in demented patients. Biol Psychiatry. 2001 Nov;50(9):725–7. doi: 10.1016/s0006-3223(01)01178-7
33. Leung M yung, Wang C, Chan IYS. A qualitative and quantitative investigation of effects of indoor built environment for people with dementia in care and attention homes. Build Environ. 2019;157:89–100. doi: 10.1016/j.buildenv.2019.04.019
34. Origgi L, Buffoli M, Capolongo S, Signorelli C. Light wellbeing in hospital: research, development and indications. Annali di Igiene 2011;23(1):55-62. PMID: 21736007
35. Riemersma-van der Lek RF. Effect of Bright Light and Melatonin on Cognitive and Noncognitive Function in Elderly Residents of Group Care Facilities: A Randomized Controlled Trial. JAMA. 2008;299(22):2642. doi: 10.1001/jama.299.22.2642
36. van Hoof J, Aarts MPJ, Rense CG, Schoutens AMC. Ambient bright light in dementia: Effects on behaviour and circadian rhythmicity. Build Environ. 2009 Jan;44(1):146–55. doi: 10.1016/j.buildenv.2008.02.005
37. Aarts M, Aries M, Straathof J, van Hoof J. Dynamic lighting systems in psychogeriatric care facilities in the Netherlands: A quantitative and qualitative analysis of stakeholders’ responses and applied technology. Indoor Built Environ. 2015;24(5):617–30. doi: 10.1177/1420326X14532387.
38. van Hoof J, Schoutens AMC, Aarts MPJ. High colour temperature lighting for institutionalised older people with dementia. Build Environ. 2009 Sep;44(9):1959–69. doi: 10.1016/j.buildenv.2009.01.009.
39. Johansson K, Borell L, Rosenberg L. Qualities of the environment that support a sense of home and belonging in nursing homes for older people. Ageing Soc. 2022 Jan;42(1):157–78. doi: 10.1017/S0144686X20000896.
40. Verbeek H, Zwakhalen SM, van Rossum E, Ambergen T, Kempen GI, Hamers JP. Small-scale, homelike facilities versus regular psychogeriatric nursing home wards: a cross-sectional study into residents’ characteristics. BMC Health Serv Res. 2010 Dec;10(1):30. doi: 10.1186/1472-6963-10-30.
41. Wilkes L, Fleming A, Wilkes BL, Cioffi JM, Le Miere J. Environmental approach to reducing agitation in older persons with dementia in a nursing home. Australas J Ageing. 2005 Sep;24(3):141–5. doi: 10.1111/j.1741-6612.2005.00105.x.
42. Mazzei F, Gillan R, Cloutier D. Exploring the Influence of Environment on the Spatial Behavior of Older Adults in a Purpose-Built Acute Care Dementia Unit. Am J Alzheimers Dis Other Demen. 2014 Jun;29(4):311-9. doi: 10.1177/1533317513517033
43. Davis S, Byers S, Nay R, Koch S. Guiding design of dementia friendly environments in residential care settings: Considering the living experiences. Dementia. 2009 May;8(2):185–203. doi: 10.1177/1471301209103250
44. Gascon M, Sanchez-Benavides G, Dadvand P, et al. Long-term exposure to residential green and blue spaces and anxiety and depression in adults: A cross-sectional study. Environ Res. 2018;162:231–9. doi: 10.1016/j.envres.2018.01.012
45. Lee KH, Boltz M, Lee H, Algase DL. Is an Engaging or Soothing Environment Associated With the Psychological Well-Being of People With Dementia in Long-Term Care?: Environment and Psychological Well-Being. J Nurs Scholarsh. 2017 Mar;49(2):135–42. doi: 10.1111/jnu.12263
46. Leung M yung, Wang C, Wei X. Structural model for the relationships between indoor built environment and behaviors of residents with dementia in care and attention homes. Build Environ. 2020 Feb;169:106532. doi: 10.1016/j.buildenv.2019.106532
47. Olson NL, Albensi BC. Dementia-Friendly “Design”: Impact on COVID-19 Death Rates in Long-Term Care Facilities Around the World. :24.
48. Lee SY, Hung L, Chaudhury H, Morelli A. Staff perspectives on the role of physical environment in long-term care facilities on dementia care in Canada and Sweden. Dementia. 2021 Oct;20(7):2558–72. doi: 10.1177/14713012211003994.
49. Brambilla A, Morganti A, Lindahl G, Riva A, Capolongo S. Complex Projects Assessment. The Impact of Built Environment on Healthcare Staff Wellbeing. In: Gervasi O, Murgante B, Misra S, et al, editors. Computational Science and Its Applications – ICCSA 2020. Cham: Springer International Publishing; 2020: 345–54. doi: 10.1007/978-3-030-58814-4_24.
50. Chau H wah, Newton C, Woo C, Ma N, Wang J, Aye L. Design Lessons from Three Australian Dementia Support Facilities. Buildings. 2018 May 7;8(5):67. doi: 10.3390/buildings8050067
51. Calkins MP. From Research to Application: Supportive and Therapeutic Environments for People Living With Dementia. The Gerontologist. 2018 Jan 18;58(suppl_1):S114–28. doi: 10.1093/geront/gnx146

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