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Environmental Modification

Key Messages

  • In relation to the delivery of palliative care for older Australians in a residential care facility (RACF) or in the community, little high-quality evidence exists to describe suitable environmental characteristics or modifications. [1]
  • Environmental audits considering safety, comfort, personalisation of space, and privacy can highlight what is needed and useful; these can be done from the perspective of the person and of the family, relatives and carers. [1-4]
  • Built structures should be considered but also lighting, noise, privacy, equipment for mobility, comfort and quality of life, and equipment for medication support and compliance. [1-5]
  • There may be tensions between the principles of risk and occupational health and safety, and those of patient-centred care and personal comfort. [1-4]

 

 

No Evidence Synthesis

due to the sparcity of the published evidence

Background

The physical environment of an older person’s home or living space in residential care affects his or her quality of life. Age-related disabilities may require modifications to be made to the living environment to optimise autonomy and social connectedness, maintain a safe environment for the older person or to enable care to be provided in the home.


In relation to the delivery of palliative care, the physical environment will have a bearing on the person receiving palliative care as well as on his/her family, friends and carers. As quality of life is important in the delivery of palliative care, certain aspects of the physical environment merit consideration and perhaps modification. [1]


This summary discusses the role of environmental modification in palliative care.


Evidence Summary

A review by Brereton [1] focused on the key elements of the hospital environment in the delivery of palliative care for older people. The authors surmised that there is a need to balance privacy and the loneliness or isolation a person may feel. Proximity to home, visitors and nature were important as were homeliness and cleanliness of the hospital environment. Screening of noise and the ability to have a personalised and private space were important in the feelings of dignity and comfort of the person and visitors. No systematic reviews assessing environmental modifications to enable the provision of palliative care for older persons have been identified.


The effectiveness of environmental modifications to reduce the risk of falls is assessed in two systematic reviews. [2, 3] The specific environmental needs of people living with dementia in aged care facilities has also been studied. [4] The environment in which people with dementia live may have a positive or negative effect on their behaviour, social engagement or cognitive ability.


It is likely that some adaptation of the home environment will be required to meet the palliative care needs of older persons. [5] Home modifications may include structural alterations such as installation of hand rails or ramps or the provision of exterior lighting to allow care providers safe access at all hours. Simple assistive technology like wheelchairs, shower chairs, hospital-style beds, lifting aids or portable threshold ramps may also be useful.

Physiotherapists can advise on patient mobility aids and occupational therapists can advise on equipment and home modifications to make activities of daily living safer and more manageable for patients and carers. Both can advise on safe manual handling for carers. [5]


Modifications may be implemented pragmatically in response to assessed individual needs, or may have been implemented earlier in the disease process and not specifically to meet palliative care needs.


Quality Statement

Only four systematic reviews were identified in relation to the hospital environment, prevention of falls and assistance for people living at home with dementia. The lack of evidence for environmental modification to facilitate palliative care provision may reflect the difficulty of undertaking research in palliative care. It would be difficult to undertake randomised controlled trials as withholding home modifications or non-provision of needed equipment would be unethical.

 

Gaps in the Evidence

Gaps in the evidence could focus on 

  • the effectiveness of home modifications in assisting older persons to remain in their own homes.
  • the effect large pieces of equipment have on the home environment and how this may affect others living in the home.
  • the degree to which older people receiving palliative care and their families are satisfied with home modifications to facilitate the provision of palliative care, and what modifications are most useful.

 

Page updated 23 May 2017

 

  • References

  • About PubMed Search

  1. Brereton L, Gardiner C, Gott M, Ingleton C, Barnes S, Carroll C. The hospital environment for end of life care of older adults and their families: an integrative review. J Adv Nurs. 2012 May;68(5):981-93. Epub 2011 Dec 29.
  2. Chase CA, Mann K, Wasek S, Arbesman M. Systematic review of the effect of home modification and fall prevention programs on falls and the performance of community-dwelling older adults. Am J Occup Ther. 2012 May-Jun;66(3):284-91.
  3. Gillespie LD, Robertson MC, Gillespie WJ, Sherrington C, Gates S, Clemson LM, et al. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2012 Sep 12;(9):CD007146.
  4. Marquardt G, Bueter K, Motzek T. Impact of the design of the built environment on people with dementia: an evidence-based review. HERD. 2014 fall;8(1):127-57.
  5. Therapeutic Guidelines Limited. Therapeutic Guidelines: Palliative Care. Version 4. Melbourne: Therapeutic Guidelines Ltd, 2016.
 

Definition

Environmental modification can be viewed as a psychosocial intervention, because features such as appropriate lighting and us of space can improve psychosocial wellbeing for older adults. For example, lighting can improve wellbeing (eg by minimising falls and increasing mobility) if it is appropriate for the ageing eye, reduces glare and areas of darkness, increases light and contrast within the main area of focus, and uses the red-yellow spectrum (Compac 7.3.8)
 

Search

 ("Environment Design"[mesh] OR "Accidents, Home/prevention and control"[Mesh] OR ((home[ti] OR environment*[ti]) AND (modification*[ti] OR design[ti] OR control[ti] OR equipment[ti] OR lighting[ti] OR automation[ti])) OR ((Assistive[ti] AND (equipment[ti] OR device*[ti]))) OR (bariatric[ti] AND (handling[ti] OR care[ti])))