title: Perceptions of family and staff on the role of the environment in long-term care homes for people with dementia.
abstract: BACKGROUND
  Disruptive behaviors are frequent and often the first predictor of institutionalization. The goal of this multi-center study was to explore the perceptions of family and staff members on the potential contribution of environmental factors that influence disruptive behaviors and quality of life of residents with dementia living in long-term care homes.
  
  
  METHODS
  Data were collected using 15 nominal focus groups with 45 family and 59 staff members from eight care units. Groups discussed and created lists of factors that could either reduce disruptive behaviors and facilitate quality of life or encourage disruptive behaviors and impede the quality of life of residents. Then each participant individually selected the nine most important facilitators and obstacles. Themes were identified from the lists of data and operational categories and definitions were developed for independent coding by four researchers.
  
  
  RESULTS
  Participants from both family and staff nominal focus groups highlighted facility, staffing, and resident factors to consider when creating optimal environments. Human environments were perceived to be more important than physical environments and flexibility was judged to be essential. Noise was identified as one of the most important factors influencing behavior and quality of life of residents.
  
  
  CONCLUSIONS
  Specialized physical design features can be useful for maintaining quality of life and reducing disruptive behaviors, but they are not sufficient. Although they can ease some of the anxieties and set the stage for social interactions, individuals who make up the human environment are just as important in promoting well-being among residents.
authors.affiliation: Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Canada. linda.garcia@uottawa.ca
authors.forename: Linda J
authors.initials: LJ
authors.lastname: Garcia
authors.forename: Michèle
authors.initials: M
authors.lastname: Hébert
authors.forename: Jean
authors.initials: J
authors.lastname: Kozak
authors.forename: Isabelle
authors.initials: I
authors.lastname: Sénécal
authors.forename: Susan E
authors.initials: SE
authors.lastname: Slaughter
authors.forename: Faranak
authors.initials: F
authors.lastname: Aminzadeh
authors.forename: William
authors.initials: W
authors.lastname: Dalziel
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Charles
authors.forename: Misha
authors.initials: M
authors.lastname: Eliasziw
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D003704:Dementia / Q000523:psychology* / Q000628:therapy; D004777:Environment; D005190:Family / Q000523:psychology*; D005260:Female; D017144:Focus Groups; D006282:Health Personnel / Q000523:psychology; D006801:Humans; D008134:Long-Term Care / Q000458:organization & administration / Q000592:standards; D008297:Male; D009735:Nursing Homes / Q000592:standards; D010465:Perception; D011788:Quality of Life; D012931:Social Environment; D000078329:Workforce