Autonomy-supportive environments for people with dementia: an evidence-based review

Abstract Objective: As one of the core principles of person-centered care, supporting the autonomy of residents with dementia has received increasing attention worldwide. Supportive physical environments play an important role in promoting autonomy in the everyday life of residents in care facilities. However, there is no universal definition for autonomy in everyday life nor focused research on autonomy-supportive environments. Thus, this study aims to systematically review the existing evidence of autonomy-supportive design features based on a synthesized concept analysis of autonomy in everyday life. Methods: A synthesized concept analysis on autonomy was conducted based on related definitions of autonomy in design guidelines and environmental assessment tools of elderly care facilities. Using keywords from the concept analysis, multiple databases including PubMed, Web of Science, CINAHL, PsycINFO, and Dementia Design Info were used to carry out a systematic review of autonomy-supportive environmental design features for people with dementia. Additional guidelines and standards were manually searched. The design features supported by empirical studies and studies based on experts’ experience were extracted from the literature. The evidence intensity of each feature was assessed according to the quality and quantity of related studies. Results: Four domains of autonomy, freedom, independence, control, and choice emerged based on the concept analysis. Seventy-eight autonomy-supportive design features were extracted from the literature. Features are summarized into 8 categories: building layout, circulation space, living room, dining space, bathroom, bedroom, outdoor space, and details. Of design features, 60% in the category of building layout have been cross-validated by empirical studies, whereas only 25% of the overall design features have. Conclusions: The results of this review show that numerous design features of the physical environment can support the autonomy of people with dementia in the 4 domains. Features of building layout are well researched and the evidence intensity for the rest of design features still needs to be improved through future empirical studies.