Potter, Rachel (2012) Does the physical environment predict depressive symptoms in older people living in care homes? PhD thesis, University of Warwick.

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Abstract

40 % of residents living in care homes in the United Kingdom have significant depressive symptoms, compared with 9% living in the community. Care homes can appear to be depressing places, but whether the physical environment of homes directly affects depression in care home residents is unknown.
The overall aim of the thesis was to establish whether the physical environment or specific features of the physical environment predict depressive symptoms in older people living in care homes. A mixed methods approach was used:
1. A systematic review was conducted to identify and evaluate instruments designed to measure the physical environment of healthcare settings and informed the choice of instrument used to measure the physical environment of care homes in an observational study.
2. Semi-structured interviews with 15 participants living in four care homes identified features of care home design that were considered important to investigate in the observational study and assisted with interpretation of the results.
3. An observational study explored the longitudinal relationship between the physical environment and depressive symptoms using data from an interventional trial among older people living in care homes. The physical environments of 50 care homes were assessed using The Sheffield Care Environment Assessment Matrix (SCEAM). Depressive symptoms were measured using the Geriatric Depression Scale (GDS-15) for 510 residents living in the care homes at baseline, six and twelve months. Multi-level modelling was used to analyse the data.
Interviews revealed residents valued environments that increased opportunity for social interaction, maximised physical function, and allowed access to outdoor space. In the observational study the overall physical environment of care homes (overall SCEAM score) did not predict depressive symptoms. Care homes that scored highly on the SCEAM domain community weakly predicted lower depressive symptoms. Controlling for dependency (Barthel Index), social engagement (Index of Social Engagement) and home type (nursing/residential) ‘access to outdoor space’ predicted greater depressive symptoms. This finding initially appeared counterintuitive; however evidence from the interview study suggested access to outdoor space was restricted for residents in many different ways: locked doors, lack of paths, inadequate seating, steep steps, and needing permission or assistance of staff to go outside. Residents may have ‘free access to outdoor space’ but are prevented from using the outdoors for reasons that negatively affect their decisional autonomy and consequently their mood.
The research provides evidence to support care home design that encourages social interaction and allows unrestricted access to outdoor spaces in order to positively influence mood in care home residents.

Item Type:	Thesis (PhD)
Subjects:	H Social Sciences > HV Social pathology. Social and public welfare R Medicine > RA Public aspects of medicine
Library of Congress Subject Headings (LCSH):	Older people -- Institutional care, Older people -- Mental health, Nursing home patients -- Mental health, Depression in old age, Nursing homes -- Planning
Official Date:	June 2012
Dates:	Date Event June 2012 Submitted
Institution:	University of Warwick
Theses Department:	Warwick Manufacturing Group ; Warwick Medical School
Thesis Type:	PhD
Publication Status:	Unpublished
Supervisor(s)/Advisor:	Sheehan, Bart; Jennings, Paul; Cain, Rebecca
Extent:	xi, 248 leaves : illustrations, charts.
Language:	eng

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