title: Affordances of the care environment for people with dementia-an assessment study.
abstract: BACKGROUND
  Evidence on the importance of the physical environment for the well-being of people with dementia has been growing steadily.
  
  
  OBJECTIVE
  This article aims to (1) introduce an assessment tool for evaluating the physical care environment for people with dementia; (2) describe the method's initial results and the subsequent feedback provided to the 10 care units; and (3) describe the follow-up results 1 year later. The goal has been to provide care workers and managers with information that affects the well-being of people with dementia and to provide this information on the care environment in the context of their own work environment.
  
  
  METHODS
  The assessment was part of a randomized controlled intervention using nonpharmaceutical methods to decrease behavioral and psychological symptoms of people with dementia. During the half-day visits, photographs and field notes were taken, and a final assessment was carried out via the Residential Care Environment Assessment (RCEA) tool developed at the beginning of the study and based on affordance theory. Follow-up data were gathered after 12 months.
  
  
  RESULTS
  There were several possibilities for improvements in the provision of residential care in a person-centered environment. Improvements were needed mostly in comfort and in providing opportunities for engagement, activity, and expression of identity. However, in practice, it was difficult to achieve the improvements even with an intensive intervention study.
  
  
  CONCLUSIONS
  The authors conclude that the physical care environment involves a complex set of issues and stakeholders in which the impetus to fulfill responsibilities to carry out improvements can easily fall away.
authors.affiliation: Corresponding Author: Päivi Topo, National Institute of Health and Welfare, P.O. Box 30, FI-00271 Helsinki, Finland (paivi.topo@thl.fi).
authors.forename: Päivi
authors.initials: P
authors.lastname: Topo
authors.forename: Helinä
authors.initials: H
authors.lastname: Kotilainen
authors.forename: Ulla
authors.initials: U
authors.lastname: Eloniemi-Sulkava
mesh_terms: D003704:Dementia; D004777:Environment; D006282:Health Personnel; D006801:Humans