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EBD Journal Club: Built Environment Design Interventions at the Exits of Secured Dementia Care Units: A Review of the Empirical Literature

When: December 8, 2022
Time: 10:00am Pacific
Price: FREE

Anderson, D.C., Kota, S.S., Yeh, L., and Budson, A.E. (2022). Built Environment Design Interventions at the Exits of Secured Dementia Care Units: A Review of the Empirical Literature. DOI: https://doi.org/10.1177/19375867221125930


Evidence-Based Design Journal Clubs are formatted for 15-minute presentations and 45-minutes of discussion to provide an opportunity for attendees to interact with authors who recently published EBD papers or articles in peer-reviewed journals such as HERD. Learn as they share ways to put their research into practice.

Attendees will receive a link to the article in their registration confirmation along with the Zoom link to the webinar. Please read the article in advance and submit any questions here for the presenters to prepare.



Purpose: To review evidence around design interventions that influence exiting attempts in dementia care units, informing architectural and clinical practice.

Background: Built environment design is recognized as important in the care and management of responsive behaviors for those living with Alzheimer’s disease and other dementias in secured dementia care units (e.g., exiting attempts, agitation). The repetitious behavior of “walking with purpose” (previously termed wandering) in those with dementia has influenced safety-related architectural design components of dementia care units that decrease exiting attempts. Empirical literature addressing design interventions to prevent exiting for those with dementia is lacking and outdated.

Methods: We sought to describe known design techniques through a topical analysis of experimental studies. A thorough search for empirical studies that assessed interior design interventions at exit doors within dementia care units was undertaken. The review included an extensive search for existing literature and a screening of each study identified for its relevance, quality, and applicability. 

Results: The experimental studies included in the review collectively assessed five interior design interventions at egress doorways: implementing horizontal and vertical floor grid patterns, mirrors, murals, conditioning responses to color cues, and camouflaging door hardware or vision panels. Why empirical studies have not continued more recently as built environment trends have shifted toward promoting meaningful and purposeful movement through design are considered. Advances in our understanding around the pathophysiology of dementia which might affect future design interventions related to egress are also identified.

Conclusion: The built environment is an important part of dementia care, and further prospective research is needed on the role of design interventions in the context of exiting attempts within secured units and subsequent behavior outcomes.



Learning Objectives

  • Describe environmental factors which are thought to impact behavior for persons living
    with dementia;
  • Identify visual design interventions which deter exiting attempts from exit doors in secured
    dementia care units;
  • Distinguish which visual design interventions were found to be more successful in
    experimental studies;
  • Understand neurologic explanations for the effectiveness of these interior design techniques in the setting of various dementias.

Presenting Faculty

Diana Anderson, MD, MArch, ACHA, is triple board-certified as a healthcare architect, internal medicine physician, and geriatrician. As a “dochitect,” Diana combines educational and professional experience in both medicine and architecture. She is currently an Instructor of Neurology at Boston University, a clinical Fellow at VA Boston Healthcare System with both research and clinical responsibilities, and a recent recipient of an Alzheimer's Association Clinician Scientist Fellowship. She is a healthcare principal at Jacobs contributing her thought leadership at the intersection of design and health.



Addie Abushousheh, PhD, Assoc. AIA, EDAC, is a gerontologist, researcher, and consultant for organizational and environmental development in long-term care. She explores cultural and bio-psycho-social perspectives, organizational structures and processes, physical environments, workforce models, and regulatory and financial frameworks in relation to decision making, resource management, and quality improvement. With combined expertise in architecture, organizational development, aging and applied research, Dr. Abushousheh advances comprehensive and translational agendas related to quality assessment and performance improvement. Addie is a Research Associate with The Center for Health Design, an Adjunct Faculty member at Kent State University, and a Senior Living Advisor for Abacus Institute.