This study illustrates the issue of the correlation between built environment and Alzheimer’s disease. In particular, the aim of this paper is to edit a tool in order to evaluate the health environment of dementia. A key part of the process was the analysis of the regulation on the specific issue and the consultation of the existing literature, health tools and case studies. This enabled to provide an overview of the issue in all its aspects. In the first chapter, the topic of Alzheimer’s disease is introduced and what concerns the patient’s medical and psychological point of view is investigated as well. In this section the italian situation is analysed together with the possibilities of residency and the present legislation regarding residential structures in Italy and specifically in Lombardy. A general introduction to the available therapies to contrast this disease is given. An overview on the evidence based design and post occupancy evaluation is also presented: two theories concerning the relationship between design, built environment, patients and stakeholders. The second chapter deals with the process of the research, the drafting of the tool and the application and assessment of the results. In the third chapter the research process is described in detail. Starting from the literature search, the main topics in the relationship between environment and dementia are highlighted, namely Quality, Spaces, Activities and Wayfinding and all the related criteria. At a later time, an investigation on five case studies considered excellent in the European panorama for the care and support of Alzheimer’s disease was carried out. Three cases of Alzheimer villages, a day centre and an RSA unit have been analysed. This study enabled to confirm the macro areas previously identified and to expand the indicators. In conclusion ofthe chapter, the topic of existing evaluation tools is discussed. Examining the major tools in the health field, it is evident that only two of them (EAT and TESS-NH) deal with environments for patients suffering from dementia and that none of them belong to the Italian panorama. In this case the analysis enabled to confirm the correctness of the main topics and the previously identified criteria. In the fourth chapter the evidences emerged from the three analyses are examined and, consequently, a draft of the questionnaire is presented. This was inspected by experts in the medical and healthcare design sectors. The final version of the tool has emerged from their revision. The fifth chapter observes the testing of the revised questionnaire. This was applied to three structures which are all accredited to the national health system and located in Lombardy, but differ in terms of period of construction and type. The first case is a recently built structure as the result of a specific design for Alzheimer’s disease; the second one is a more dated detached core of an RSA while the third one is made by a conversion of an existing department of a nursing home. In the sixth chapter the outcomes of the evaluation are listed and presented by setting out the different evaluations obtained from each case study for each macro area. The critical issues have been assessed overall, highlighting the ones common to the structures. Subsequently, project strategies have been provided and defined in various levels of feasibility in order to eliminate the criticalities found. Ultimately, in the seventh chapter, the final considerations are given. The limits of the research carried out and the research perspectives which can be conducted have been explained.
Nel presente elaborato viene analizzata la problematica del rapporto tra ambiente costruito e malattia di Alzheimer. Nello specifico la tesi si occupa di redigere uno strumento che permetta di valutare gli ambienti sanitari dedicati alla malattia. Questo è stato possibile grazie dall’analisi della normativa sul tema specifico e alla consultazione della letteratura esistente, casi studio e strumenti sanitari esistenti. Nel primo capitolo viene infatti analizzata la tematica della malattia, cosa comporta dal punto di vista medico e psicologico nel paziente. Si analizza inoltre la situazione italiana, con le possibilità di residenza e la normativa presente in merito a strutture residenziali in Italia e nello specifico in Lombardia. Viene data un’introduzione generale in merito alle terapie disponibili di supporto alla malattia. È analizzato inoltre il tema dell’evidence based design e della post occupancy evaluation, due teorie che indagano il rapporto tra progettazione, ambiente costruito, pazienti e utenti. Il secondo capitolo descrive dettagliatemene il processo che viene svolto per la ricerca, la redazione dello strumento e la sua successiva applicazione e valutazione dei risultati. Il terzo capitolo tratta invece tutte le fasci di ricerca. Partendo dall’analisi di letteratura vengono evidenziate le macro aree nel rapporto tra ambiente e demenza, ovvero Qualità, Spazi, Attività e Wayfinding e tutti i criteri ad essi correlati. Successivamente è stata svolta un’indagine su cinque casi studio, considerati eccellenze nel panorama europeo per la cura e supporto ai malati di Alzheimer. Sono stati analizzati tre casi di villaggi Alzheimer, un centro diurno e un nucleo in RSA. Questo studio ha permesso di confermare le macro aree individuate in precedenza e ampliare gli indicatori. In ultimo viene trattato il tema degli strumenti di valutazione esistente. Esaminando i maggiori tool in campo sanitario si evidenzia come solamente due (EAT e TESS-NH) si occupano di ambienti per pazienti affetti da demenza e che entrambi non appartengono al panorama italiano. Anche in questo caso l’analisi ha potuto confermare la correttezza dei main topic e dei criteri precedentemente individuati. Nel quarto capitolo vengono analizzate le evidenze emerse dalle tre analisi e, conseguentemente, viene stilata una bozza del questionario. Questa è stata analizzata da esperti nel settore medico e di progettazione sanitaria. Dalla loro revisione è scaturita la versione definitiva dello strumento. Il quinto capitolo analizza la sperimentazione del questionario revisionato. Il tool è stato applicato a tre strutture, tutte accreditate al sistema sanitario nazionale e localizzate in regione Lombardia, ma diverse in quanto a periodo di realizzazione e tipologia. Il primo caso è una struttura realizzata recentemente e frutto di una progettazione specifica per la malattia di Alzheimer, il secondo è più datato ed è un nucleo distaccato di una RSA mentre il terzo è frutto della conversione di un reparto esistente di una residenza sanitaria assistenziale. Nel sesto capitolo sono stati elencati ed esposti i risultati della valutazione condotta, esponendo le diverse valutazioni ottenute da ogni caso studio per ogni macro area. Sono state valutate nel complesso le criticità, evidenziando quali risultino comuni alle strutture. Successivamente sono state fornite delle strategie progettuali, definite in vari livelli di fattibilità, per eliminare le criticità riscontrate. In ultimo, nel settimo capitolo sono state date le considerazioni conclusive. Sono stati esplicitati i limiti della ricerca eseguita e le pro-spettive di ricerca che possono essere condotte.
Ambiente costruito e Alzheimer. Valutazione della qualità nelle strutture sanitarie per pazienti affetti da demenza
MANGILI, SILVIA;MAINO, ROBERTO
2018/2019
Abstract
This study illustrates the issue of the correlation between built environment and Alzheimer’s disease. In particular, the aim of this paper is to edit a tool in order to evaluate the health environment of dementia. A key part of the process was the analysis of the regulation on the specific issue and the consultation of the existing literature, health tools and case studies. This enabled to provide an overview of the issue in all its aspects. In the first chapter, the topic of Alzheimer’s disease is introduced and what concerns the patient’s medical and psychological point of view is investigated as well. In this section the italian situation is analysed together with the possibilities of residency and the present legislation regarding residential structures in Italy and specifically in Lombardy. A general introduction to the available therapies to contrast this disease is given. An overview on the evidence based design and post occupancy evaluation is also presented: two theories concerning the relationship between design, built environment, patients and stakeholders. The second chapter deals with the process of the research, the drafting of the tool and the application and assessment of the results. In the third chapter the research process is described in detail. Starting from the literature search, the main topics in the relationship between environment and dementia are highlighted, namely Quality, Spaces, Activities and Wayfinding and all the related criteria. At a later time, an investigation on five case studies considered excellent in the European panorama for the care and support of Alzheimer’s disease was carried out. Three cases of Alzheimer villages, a day centre and an RSA unit have been analysed. This study enabled to confirm the macro areas previously identified and to expand the indicators. In conclusion ofthe chapter, the topic of existing evaluation tools is discussed. Examining the major tools in the health field, it is evident that only two of them (EAT and TESS-NH) deal with environments for patients suffering from dementia and that none of them belong to the Italian panorama. In this case the analysis enabled to confirm the correctness of the main topics and the previously identified criteria. In the fourth chapter the evidences emerged from the three analyses are examined and, consequently, a draft of the questionnaire is presented. This was inspected by experts in the medical and healthcare design sectors. The final version of the tool has emerged from their revision. The fifth chapter observes the testing of the revised questionnaire. This was applied to three structures which are all accredited to the national health system and located in Lombardy, but differ in terms of period of construction and type. The first case is a recently built structure as the result of a specific design for Alzheimer’s disease; the second one is a more dated detached core of an RSA while the third one is made by a conversion of an existing department of a nursing home. In the sixth chapter the outcomes of the evaluation are listed and presented by setting out the different evaluations obtained from each case study for each macro area. The critical issues have been assessed overall, highlighting the ones common to the structures. Subsequently, project strategies have been provided and defined in various levels of feasibility in order to eliminate the criticalities found. Ultimately, in the seventh chapter, the final considerations are given. The limits of the research carried out and the research perspectives which can be conducted have been explained.| File | Dimensione | Formato | |
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https://hdl.handle.net/10589/149468