Ambulation behaviors of people with Alzheimer's disease: Case studies of residents on three facilities along the homelike continuum.

Abstract

An embedded multiple case study design was used to examine the impact of physical environment on ambulation behavior for six cases with Alzheimer's disease within a real-life context. The descriptive observational approach aimed to identify and describe associations between ambulation behaviors and characteristics of the physical and social environment. Three settings (institutional, hotel-like, & home-like) were selected to demonstrate unique philosophical and environmental design issues across the continuum between institutional and homelike settings. Each case's level of impairment was described regarding: gait and balance testing, functional performance of activities of daily living, observed ambulation behaviors, and cognitive function. Ambulation behaviors (number of episodes, travel patterns, self-initiated activities, social contacts and negative consequences) were recorded on a palm held video camera over a 48 hour period. Ambulation episodes, time spent in each location, ambulation travel patterns, negative consequences of ambulation, and social contacts were recorded over a 48 hour period. Data were summarized using descriptive techniques. Home-Like Facility had the following positive outcomes: high number of episodes, more time spent ambulating, efficient travel, environmental ownership activities, and high number of social contacts. This was attributable to its: social model, small scale, visual access to multiple locations, familiar and engaging physical attributes, and individualized policies and procedures. The Hotel-Like Facility produced strikingly different outcomes than the other two facilities (i.e. low number of episodes, least time ambulating, inefficient travel, public activities, low number of social contacts). This was likely due to the large scale size, crowding and service style policies and procedures.