Debra D. Harris, Ph.D., IIDA, EDRA
Texas A&M University

Purpose

Methodology

This research study used an interdisciplinary multi-methodology to build a protocol for evaluating interior finish materials. The objectives were: (a) to measure physical criteria of the flooring finish materials for the development of an Indoor Environmental Quality (IEQ) index; and (b) examine the IEQ index as it relates to patient and staff perceptions, preferences, comfort and biological responses to their environment. Criteria of the flooring materials included durability ratings, maintenance procedures, cost analysis, and material composition. Measures for IEQ focused on indoor air quality, light reflectance and acoustics.
The study was conducted in two phases. The first phase was the development of the IEQ index, a profile of the physical environment for each patient room. Thermal comfort ratings were assessed in accordance to ASHRAE standards (ASHRAE, 1997). Ratings for light levels and reflectance were measured to address issues related to lighting design and materials choices (IES, 1993). Acoustic levels were measured in accordance with ASHRAE standards (ASHRAE, 1997) and M. David Egan's Architectural Acoustics (Egan, 1988). Measures of airborne contaminants and volatile organic compounds were compared with flooring samples to determine differences in respiratory exposure and levels of flooring material contamination.
Phase two of the study focused on patient and staff responses to their physical environment. Data collection included: documentation of the telemetry unit including average length of stay, number of recorded falls, and staffing; surveys for the patients and medical staff; and behavior mapping that focused on length of time medical staff and visitors spent in the patient rooms.

Summary of Results

The results found that healthcare staff preferred vinyl composition tile (VCT) over carpet for the flooring choice in patient rooms, citing ease of maintenance as their reason. Patients preferred carpet in their patient rooms citing comfort, slip-resistance, and less noise as the reasons for their choice.
Healthcare staff perceived patient rooms with VCT to be more clean and attractive, have better odor, ventilation, air movement, and fresher air. Staff perceived rooms with carpet to be more comfortable and have less noise and glare, fewer temperature shifts, and better temperatures. Patients perceived patient rooms with VCT to be more clean, have better ventilation and fresher air, but rooms with carpet to have better temperatures.
The measurement and analysis of the indoor environmental conditions indicated that VCT had a higher level of glare and a higher level of bacteria in the air samples. No significant differences were found in the levels of noise, temperature, carbon dioxide, and total volatile organic compounds.
One of the most important findings was the significant difference in the amount of time visitors spent in rooms with carpet compared to the time spent in rooms with VCT. This would indicate that the environmental quality influences behaviors that may prove beneficial to patients.
The study determined whether the indoor environmental conditions of the patient rooms were consistent with patient and staff preferences, physical comfort, biological response, and satisfaction. The specification of appropriate flooring materials in patient room environments depends on the composition of the material, its impact on the environmental conditions of the room, and the comfort and satisfaction of the patients.
Additional research should focus on the properties of flooring products, the effect of carpet on the indoor relative humidity, and exposure to volatile organic compounds and micro-organisms.

References

ASHREA. (1997). ASHREA Handbook: Fundamentals. Atlanta, GA: American Society of Heating, Refrigerating and Air-Conditioning Engineers, Inc.
Egan, M. D. (1988). Architectural Acoustics. New York, NY: McGraw-Hill, Inc.
IES. (1993). Lighting Handbook (8th ed.). New York, NY: Illuminating Engineering Society of North American.

BRIGHT LIGHT TREATMENT OF BEHAVIORAL AND SLEEP DISTURBANCES IN PATIENTS WITH ALZHEIMER’S DISEASE

Andrew Satlin, M.D., Ladislav Volicer, M.D., Ph.D., Virginia Ross, Ph.D., Lawrence Herz, M.D., and Scott Campbell, Ph.D.

Purpose
The authors tested the hypothesis that evening bright light pulses would improve sleep-wake patterns and reduce agitation in patients with Alzheimer’s disease who have severe sundowning and sleep disorders.

Methodology
Ten inpatients with Alzheimer’s disease on a research ward of a veterans’ hospital were studied in an open clinical trial. All patients had sundowning behavior and sleep disturbances. After a week of baseline measurements, patients received two hours per day of exposure to bright light between 7pm and 9pm for one week. During the baseline week, the treatment week, and a post-treatment week, patients were rated by nurses for agitation, sleep-wake patterns, use of restraints, and use of prescribed-as-needed medication. On the last two days of each week, patients wore activity monitors. Activity counts were analyzed for circadian rhythmicity.

Summary of Results
Clinical ratings of sleep-wakefulness on the evening nursing shift improved with light treatment in eight of the ten patients. The proportion of total daily activity occurring during the nighttime decreased during the light-treatment week. The relative amplitude of the circadian locomotor activity rhythm, a measure of its stability, increased during the light-treatment week. More severe sundowning at baseline predicted greater clinical improvement.

Conclusions

Evening bright light pulses may ameliorate sleep-wake cycle disturbances in some patients with Alzheimer’s disease. This effect may be mediated through a chronobiological mechanism.

References

Andrew S, Volicer L, Ross V, Herz L, Campbell S: Bright Light Treatment of Behavioral and Sleep Disturbances in Patients with Alzheimer’s Disease. American Journal of Psychiatry 1992; 149: 1028-1032.

References
Travis Thompson, Julia Robinson, Myles Graff and Rita Ingenmey, “Home-like architectural features of residential environments.” American Journal on Mental Retardation. 95 (3), (1990):328-341.

A COMPARISON OF THE EFFECTS OF FLOOR MATS AND SHOE IN-SOLES ON STANDING FATIGUE

Phyllis M. King
Department of Occupational Therapy, University of Wisconsin, Milwaukee

Purpose

The purpose of this study was to compare floor mats and shoe in-soles to workers' feelings of tiredness and discomfort after an 8-hour shift of standing continuously. Joint pain, a slower circulatory system, and lower back pain are associated with standing for long periods of time. Floor mats and in-soles are two typical remedies used to relieve standing fatigue, but little scientific evidence has shown the benefits of these elements.

Methodology

Twenty-two assembly workers (five men with a mean age of 56 years and 17 women with a mean age of 51 years) participated in a 4-week study at a large manufacturing plant. The workers stood continuously through 8-hour shifts. Four different standing conditions were tested separately for one week each: 1) hard floor without in-soles, 2) hard floor with in-soles, 3) a mat without in-soles, and 4) a mat with in-soles. Subjects rated the perceived firmness of the floor surface, their general fatigue, leg fatigue, and also discomfort levels associated with various parts of their bodies. Questionnaires that used a Likert Scale were filled out at the end of each shift. Pearson’s correlation coefficients were used to determine relationships among height, weight, age, and job tenure in response to discomfort and fatigue ratings. T-tests were completed to analyze differences in ratings and gender for the various standing conditions. Repeated ANOVA determined the significance of the responses.

Summary of Results

Floor mats were better than in-soles at alleviating foot and lower leg pain; anti-fatigue mats helped control tiredness by making the body sway imperceptibly keeping muscles moving and blood from pooling in the veins. Age and height likely play a role in the amount of fatigue perceived by workers. Although this study cannot be generalized due to the small sample size, additional research may show that carpet offers similar health benefits to standing users.

References

King, Phyllis M.: A Comparison of the Effects of Floor Mats and Shoe In-Soles on Standing Fatigue. Applied Ergonomics: 33, 5: 477-484.

Kyung Sook June
Andong National University, Andong, South Korea

Purpose

This study focused on older people and the effects of both the built environment and personal assistance to improve functional ability and reduce the likelihood of institutionalization. The purpose of the study was to test three hypotheses:

1. Functional disability increases the likelihood of relocation of older people
2. Older people who receive personal assistance are less likely to relocate than those who do not.
3. Older people with supportive built environments are less likely to relocate than those who do not.

Methodology

Data for this study came from a longitudinal survey which began in 1993 (AHEAD, 1998). Data was collected from 7,501 respondents in 1993 with a follow-up to 6,225 respondents in 1995. Two exclusive relocation behaviors were identified: a residential move and entrance into an institutional setting. Using logistic regression analysis, the probability of a residential move was compared with non-relocation and the probability of an institutional move was compare to non-relocation. The change in functional ability from 1993 to 1995 was also measured as well as the change in need of assistance for activities of daily living. Finally, five changes in the built environment were measured: ramps at street level, special railings, modification for access by a wheelchair user, bathroom modifications (like grab bars an shower seats), and a call system. Age of respondents, gender, income, race, home ownership, and duration of residency were also measured.

Summary of Results

Findings indicated that disability increased the likelihood of entrance into an institutional setting. However, respondents were less likely to enter an institution when their homes were equipped with built environmental features such as ramps, railings or grab bars. Personal assistance did not significantly reduce the likelihood of a residential move or institutionalization.

References

Asset and Health Dynamics among the Oldest Old (AHEAD)(Version 2.10)[Data File]. (1998). AnnArbor, MI: Institute for Social Research, University of Michigan. (Available from https://ssl.isr.umich.edu/hrs/files.php)

June, Kyung Sook. Effects of Functional Disability, Personal Assistance, and Built Environment Features on the Relocation of Older Persons. Housing and Society: Journal of the Housing Education and Research Association: 30, 2 (2003): 139-160.

Joan I. Dickinson, PhD,IIDA
JoAnn L. Shroyer, PhD
Jeffrey W. Elias, PhDc

Purpose

The purpose of this research study was to examine the effect of a selected commercial-grade carpet on the static balance of healthy, older adults who had not fallen more than twice in the last 6 months.

Methodology

A total of 45 participants we tested. Each participant stood on a computerized balance machine and was subjected to a carpeted versus a non-carpeted condition while exposed to various sensory limitations. We measured both postural sway and balance strategy.

Summary of Results

The selected commercial-grade carpet did not affect postural sway. The participants were able to adapt to the sensory limitations regardless of whether they were standing on the carpet. Although balance strategy scores were significantly lower during the carpeted conditions, the clinical significance was questionable as the difference between the means was small for practical purposes.

Reference

Dickinson, J., Shroyer, J., and Elias, J. The Influence of Commercial-Grade Carpet on Postural Sway and Balance Strategy Among Older Adults. The Gerontologist 42:552-559.

VIEW THROUGH A WINDOW MAY INFLUENCE RECOVERY FROM SURGERY

Roger S. Urlich Ph.D.
Texas A&M University

Purpose

This study was conducted to determine if siting decisions should address patient views in hospital rooms. Previous studies showed that patients prefer natural scenes of vegetation and water to urban views. It was hypothesized that window view could influence a patient's emotional state and accordingly affect recovery.

Methodology

Surgical patient records from a suburban Pennsylvania hospital were examined to determine the influence of view on patients. Variables of age, sex, smoking habits, obesity, previous hospitalization, type of illness, location, type of patient room, and color of patient room were controlled. Patients facing a brick wall were compared to patients facing trees with foliage using Wilcoxson matched-pairs signed-ranks analysis and the multivariate two-sample Hotelling test.

Summary of Results

The patients with a view of foliage had shorter postoperative stays, fewer negative evaluations from nurses, slightly fewer complications, and took fewer doses of analgesic than those facing a brick wall.

References

Ulrich, Roger. 1984. View through a widow may influence recovery from surgery. Science 224: 420-421.