title: Estimates of crowding in long-term care: comparing two approaches.
abstract: OBJECTIVE
  Because studies of crowding in long-term care settings are lacking, the authors sought to: (1) generate initial estimates of crowding in nursing homes and assisted living facilities; and (2) evaluate two operational approaches to its measurement.
  
  
  BACKGROUND
  Reactions to density and proximity are complex. Greater density intensifies people's reaction to a situation in the direction (positive or negative) that they would react if the situation were to occur under less dense conditions. People with dementia are especially reactive to the environment.
  
  
  METHODS
  Using a cross-sectional correlational design in nursing homes and assisted living facilities involving 185 participants, multiple observations (N = 6,455) of crowding and other environmental variables were made. Crowding, location, and sound were measured three times per observation; ambiance was measured once. Data analyses consisted of descriptive statistics, t-tests, and one-way analysis of variance.
  
  
  RESULTS
  Crowding estimates were higher for nursing homes and in dining and activity rooms. Crowding also varied across settings and locations by time of day. Overall, the interaction of location and time affected crowding significantly (N = 5,559, df [47, 511], F = 105.69, p < .0001); effects were greater within location-by-hour than between location-by-hour, but the effect explained slightly less variance in Long-Term Care Crowding Index (LTC-CI) estimates (47.41%) than location alone. Crowding had small, direct, and highly significant correlations with sound and with the engaging subscale for ambiance; a similar, though inverse, correlation was seen with the soothing subscale for ambiance.
  
  
  CONCLUSIONS
  Crowding fluctuates consistent with routine activities such as meals in long-term care settings. Furthermore, a relationship between crowding and other physical characteristics of the environment was found. The LTC-CI is likely to be more sensitive than simple people counts when seeking to evaluate the effects of crowding on the behavior of elders-particularly those with dementia-in long-term care settings. aging in place.
authors.affiliation: College of Nursing, University of Toledo, Toledo, OH 43614, USA. Donna.Algase@utoledo.edi
authors.forename: Donna L
authors.initials: DL
authors.lastname: Algase
authors.forename: Cathy
authors.initials: C
authors.lastname: Antonakos
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Beattie
authors.forename: Cynthia
authors.initials: C
authors.lastname: Beel-Bates
authors.forename: Jun-Ah
authors.initials: JA
authors.lastname: Song
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D040561:Assisted Living Facilities / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D003441:Crowding / Q000523:psychology*; D003704:Dementia / Q000523:psychology; D004779:Environment Design; D006801:Humans; D008134:Long-Term Care / Q000523:psychology / Q000706:statistics & numerical data*; D009735:Nursing Homes / Q000706:statistics & numerical data*; D019370:Observation; D013018:Sound Spectrography; D013997:Time Factors; D014481:United States