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Novel Framework Addresses the Importance of Buildings As A Physical Determinant of Health

Systematically incorporating scientific research into the architectural process for long-term care can impact the health of those who live and work in these environments.

As the population ages, renewed attention is being given to the institutional buildings where many older adults reside, such as nursing homes and long-term care settings, which affect the health and quality of life of those living in them. Research suggests that built spaces exert strong and subtle influences on the brains and bodies of aging persons. For example, the way space is designed can play a role in the risk of falling, infection control, avoidable hospitalization and confusion.

Developing methods to systematically incorporate scientific research into the architectural process for long-term care can impact the health of those who live and work in these environments.

Diana Anderson, MD, M.Arch, assistant professor of neurology

Unfortunately, this research is not currently incorporated in a systematic way into new construction or renovation projects. A multidisciplinary team led by Boston University Chobanian & Avedisian School of Medicine has developed a framework for evaluating long-term care architectural drawings and designs. Entitled “Bioethics Peer Review for Long-Term Care Design (BPR-LTC),” the framework’s intent is for evidence-based design principles to be incorporated into the development of spaces for older adults.

BPR-LTC integrates evidence-based design research, the methods of clinical ethics consultation for navigating value-laden decisions, and geriatric frameworks that center on the needs and vulnerabilities of older adults. Although each of these elements has independently contributed to aspects of long-term care, they rarely have been coordinated during the formative stages of architectural planning. “BPR-LTC is not a design methodology or quality metric, but an ethics-informed, deliberative process that structures how empirical evidence and values are integrated during design decision-making,” explains corresponding author Diana Anderson, MD, M.Arch, assistant professor of neurology.

While other professions such as medicine, nursing and law have incorporated an empirical approach to their practice based on data and evidence, architectural design has been slow to incorporate this methodology. The team of experts in bioethics, healthcare architecture and geriatric medicine created the BPR-LTC framework to inform design decision-making that has enduring implications and provides a unique structured evaluative mechanism to designing long-term care spaces.

“Developing methods to systematically incorporate scientific research into the architectural process for long-term care can impact the health of those who live and work in these environments.  As many regions embark upon long-term care projects to create more available beds, our aim is to ensure this process is done with care and consideration for the health and well-being of those inhabiting these spaces,” adds Anderson.

These findings appear online in the Journal of the American Medical Directors Association.