Older Adult Strategies for Community Wayfinding

Exploring Healthcare Providers' Difficulties and Strategies when Caring for Community-Dwelling People With Dementia Who are at Risk of Getting Lost

Caring for patients with dementia at risk of getting lost is challenging for community healthcare providers. Through semi-structured interviews with 25 participants, we examined the challenges faced by these providers and the strategies they employed. We identified the following themes of challenging parts: (a) the disturbance caused by behavioral and psychological symptoms in dementia; (b) difficulty in helping older family caregivers to keep the patient from going out; (c) difficulty in changing the attitudes of the family members; families' unawareness of the risk of getting lost. We also identified the following strategies to mitigate these themes: (a) detecting the risk of getting lost through early assessment; (b) encouraging the family to use resources or devices to prevent the patient from getting lost; (c) educating the family to manage behavior and psychological symptoms of dementia; (d) strengthening the patient's crisis awareness.

Elderly users' perceptions of signage systems from tertiary hospitals in Guangzhou

Wayfinding in hospitals today is a significant challenge for urban residents, especially for the elderly. This study investigated the perceptions and attitudes of the elderly toward existing hospital signage systems to identify the wayfinding needs in the healthcare environment. This study collected 762 elderly participants' perceptions and personal preferences regarding 12 features of the existing signage systems in three hospitals in the Yuexiu, Haizhu, and Liwan districts of Guangzhou using a questionnaire methodology. The study further explored the differences in perceptions and preferences for signage based on the gender, age, and educational level of the elderly participants. The findings indicate that most of the elderly participants experienced becoming lost in the hospital; they typically chose to ask others for directions first, followed by using the signage system. Most of the elderly participants had positive attitudes toward the current hospital signage system. Furthermore, they emphasized the importance of the signage system's graphics, texts, colors, and updates, which directly affects the readability and comprehensibility of signs. We found gender differences in perceptions and attitudes toward signage; male participants had more positive attitudes toward the hospital signage systems than female participants. Additionally, consistent with previous findings, the older the age of participants, the less comprehension they had regarding signage graphic symbols. We also found that the more educated elderly participants were, the more understanding of signage they had. At the same time, however, they were less satisfied, which is possibly because the more educated they were, the more aware they were of signage issues.

Improving wayfinding in hospitals for people with diverse needs and abilities: An exploratory approach based on multi-criteria decision making

Hospital wayfinding systems that are based solely on signage do not provide adequate solutions for wayfinding needs, especially for users with impairments. Moreover, the interaction between user characteristics and the inner space of the building also determines wayfinding efficiency. The aims of this study, therefore, were to identify architectural features that affect spatial orientation and wayfinding behaviors; demonstrate the implementation of a multi-criteria decision-making (MCDM) approach for improving wayfinding in a diverse range of users; and produce a set of quantitative values (i.e., weights) for each selected architectural feature, based on the individual's preferences. Doing so could enable the formulating of practical design guidelines for hospital buildings, tailored to the needs and abilities of the users, to minimize disorientation and confusion - as demonstrated in this paper through a case study. The MCDM approach was chosen as it is based on observations whereby wayfinding resembles a continuous decision-making process, throughout which, users continuously select those architectural features that they perceive as having the greatest wayfinding value.

A Scoping Review of Personal, Financial, and Environmental Determinants of Mobility Among Older Adults

OBJECTIVE

To synthesize available evidence of factors comprising the personal, financial, and environmental mobility determinants and their association with older adults' self-reported and performance-based mobility outcomes.

DATA SOURCES

PubMed, EMBASE, PsychINFO, Web of Science, AgeLine, Sociological Abstract, Allied and Complementary Medicine Database, and Cumulative Index to Nursing and Allied Health Literature databases search for articles published from January 2000 to December 2021.

STUDY SECTION

Using predefined inclusion and exclusion criteria, multiple reviewers independently screened 27,293 retrieved citations from databases, of which 422 articles underwent full-text screening, and 300 articles were extracted.

DATA EXTRACTION

The 300 articles' information, including study design, sample characteristics including sample size, mean age and sex, factors within each determinant, and their associations with mobility outcomes, were extracted.

DATA SYNTHESIS

Because of the heterogeneity of the reported associations, we followed Barnett et al's study protocol and reported associations between factors and mobility outcomes by analyses rather than by article to account for multiple associations generated in 1 article. Qualitative data were synthesized using content analysis. A total of 300 articles were included with 269 quantitative, 22 qualitative, and 9 mixed-method articles representing personal (n=80), and financial (n=1), environmental (n=98), more than 1 factor (n=121). The 278 quantitative and mixed-method articles reported 1270 analyses; 596 (46.9%) were positively and 220 (17.3%) were negatively associated with mobility outcomes among older adults. Personal (65.2%), financial (64.6%), and environmental factors (62.9%) were associated with mobility outcomes, mainly in the expected direction with few exceptions in environmental factors.

CONCLUSIONS

Gaps exist in understanding the effect of some environmental factors (eg, number and type of street connections) and the role of gender on older adults' walking outcomes. We have provided a comprehensive list of factors with each determinant, allowing the creation of core outcome set for a specific context, population, or other forms of mobility, for example, driving.

“Everything looks the same”: wayfinding behaviour and experiences of stroke inpatients in rehabilitation clinics

Purpose

To examine stroke inpatients’ real-life wayfinding behaviour and how the built environment of rehabilitation clinics might influence their behaviour and experiences.

Methods

Stroke inpatients in seven rehabilitation clinics were observed (n = 70), each over the course of 12 consecutive hours. Their paths through the clinic and the locations of encountered wayfinding-related events were mapped on the floor plans and described in the written notes. The observations were supplemented by a survey asking patients about their wayfinding experiences.

Results

For a third of observed patients, at least one wayfinding-related event was observed on the observation day, and 50% of patients reported getting lost in their clinic at least once. Most wayfinding-related events occurred between patient rooms and therapy rooms, and patients frequently relied on backtracking or the help of the staff to find their way. Clinics’ layout organization was found to play a role in the wayfinding behaviour of patients.

Conclusions

Wayfinding is a common challenge that stroke inpatients encounter in rehabilitation clinics. Avoiding multiple decision nodes on the paths between patient rooms and therapy rooms and creating distinct identities for corridor segments in the decision nodes and the areas in front of elevators would likely improve wayfinding performance.

A bibliometric analysis of published literature on healthcare facilities' wayfinding research from 1974 to 2020

Objectives

Wayfinding in complex environments is a public issue facing the world and has become a hot research topic in recent years. This article reviews and quantitatively analyzes the literature on wayfinding in healthcare facilities and collates the research trends and hotspots in this area.

Methods

The article used bibliometric analysis to search keywords in the Scopus database in the TITLE-ABS-KEY format. In total, 2359 articles were finally collated between 1974 and 2020 after three screening exercises, and a co-citation analysis was conducted by VOSviewer literature visualization analysis software.

Results

Research in the worldwide literature on wayfinding in healthcare facilities has grown steadily year on year since 2002. Computer science (21.5%) and social science (15.5%) are the most common subject categories, with the United States (N = 767) accounting for the largest proportion of research. “Lecture Notes In Computer Science Including Subseries Lecture Notes In Artificial Intelligence And Lecture Notes In Bioinformatics” is the most active journal in terms of publications (N = 169).

Conclusion

Wayfinding cognition, wayfinding behavior, and individual and group differences are currently the focus of research in the field of healthcare facilities. Future research on wayfinding in healthcare facilities will further investigate intelligent assistive technologies and universal designs such as universal signage systems. In addition, cross-cultural-based wayfinding research is a hot topic for future studies where the boundaries of research are broadened and have practical value.

Wandering Eyes: Using Gaze-Tracking Method to Capture Eye Fixations in Unfamiliar Healthcare Environments

OBJECTIVE

This study aims to investigate the elements of wayfinding in indoor complex healthcare environments.

BACKGROUND

The study replicates Ghamari and Pati's 2018 study to identify the environmental attributes that attract eye fixation during wayfinding by objectively tracking eye movements and fixation as healthy subjects navigate through a complex, unfamiliar indoor healthcare setting. The study addressed what do people look at while navigating in unfamiliar healthcare environments? What are the relative time periods of eye fixations on different visual environmental elements of the healthcare-designed environments? And what role do visual environmental attributes in healthcare facilities, such as configuration, color, art, directories, maps, furniture, and so on, play during the wayfinding process.

METHOD

Twenty-four adults in different genders and various age groups participated in this study and navigated five routes with different degrees of difficulty. The sequence of the destinations in this study was randomized. The data were collected by tracking gaze fixations while human subjects navigated an indoor complex healthcare environment.

RESULTS

The findings show that identifying signs (29.1%), informative signs (20.8%), and architectural features (11.3%) constituted the most frequent elements attracting gaze, substantially more than the other classes of information. Four types of signage (identifying signs, informative signs, directional, and safety/regulatory signs) were accounted for 62.3% of the total gaze fixation time.

CONCLUSIONS

The comparison of the ordered list based on frequencies and time of eye fixations on various elements developed in Ghamari and Pati's study shows a vast degree of similarities.

Study of Effective Corridor Design to Improve Wayfinding in Underground Malls

In retail space, wayfinding difficulties can cause problems, such as loss of time, stress, or discomfort, negatively affecting the shopping experience of consumers and even their patronage intentions. Although studies have reported that space configuration may facilitate navigation, there has been a lack of detailed discussion, particularly in underground malls, where people often encounter wayfinding issues. In this study, a series of exit-finding tasks in virtual malls were simulated to determine if it was practical to encourage turn taking by changing the corridor width, length, height, or angle. The results showed that people have a right-turn preference during exit finding. Moreover, exit-finders mostly prefer taking the upward pathway via stairs followed by corridors with broader widths or curved corners, exhibiting visible and similar navigation effects. Shorter corridors have a visible but relatively small affinity. This study provides some empirical evidence of how the corridor configuration influences the turn taking of people and provides a theoretical reference for adding a guiding function to the spatial arrangement in underground malls.

Representing Route Familiarity Using the Abstraction Hierarchy Framework

Familiarity with a route is influenced by levels of dynamic and static knowledge about the route and the route network such as type of roads, infrastructure, traffic conditions, purpose of travel, weather, departure time, etc. To better understand and develop route choice models that can incorporate more meaningful representations of route familiarity, OBDII devices were installed in the vehicles of 32 drivers, 65 years and older, for a period of three months. Personalized web-based trip diaries were used to provide older drivers with post-trip feedback reports about their risky driving behaviors, and collect feedback about their route familiarity, preferences, and reasons for choosing the route driven vs. an alternate low-risk route. Feedback responses were analyzed and mapped onto an abstraction hierarchy framework, which showed that among older drivers, route familiarity depends not only on higher abstraction levels such as trip goals, purpose, and driving strategies, but also on the lower levels of demand on driving skills, and characteristics of road type. Additionally, gender differences were identified at the lower levels of the familiarity abstraction model, especially for driving challenges and the driving environment. Results from the analyses helped highlight the multi-faceted nature of route familiarity, which can be used to build the necessary levels of granularity for modelling and interpretation of spatial and contextual route choice recommendation systems for specific population groups such as older drivers.

Associations between Physical Activity and Cognitive Functioning among Middle-Aged and Older Adults

OBJECTIVES

To describe aerobic physical activity among middle-aged and older adults by their self-reported cognitive decline and their receipt of informal care for declines in cognitive functioning and most common type of physical activity.

DESIGN

Cross-sectional study using data from the 2011 Behavioral Risk Factor Surveillance System.

SETTING

Landline and cellular telephone survey.

PARTICIPANTS

93,082 respondents aged 45 years and older from 21 US states in 2011.

MEASUREMENTS

Subjective cognitive decline (SCD) was defined as experiencing confusion or memory loss that was happening more often or getting worse during the past 12 months. Regular care was defined as always, usually, or sometimes receiving care from family or friends because of SCD. Using the 2008 Physical Activity Guidelines for Americans, respondents were classified as being inactive, insufficiently active, or sufficiently active based on their reported aerobic exercise. We calculated weighted proportions and used chi-square tests for differences across categories by SCD status and receipt of care. We estimated the prevalence ratio (PR) for being inactive, insufficiently active, and sufficiently active using separate log-binomial regression models, adjusting for covariates.

RESULTS

12.3% of respondents reported SCD and 23.1% of those with SCD received regular care. 29.6% (95%CI: 28.9-30.4) of respondents without SCD were inactive compared to 37.1% (95%CI: 34.7-39.5) of those with SCD who did not receive regular care and 50.2% (95%CI: 45.2-55.1) of those with SCD who received regular care. 52.4% (95%CI: 51.6-53.2) of respondents without SCD were sufficiently active compared to 46.4% (95%CI: 43.8-49.0) of respondents with SCD and received no regular care and 30.6% (95%CI: 26.1-35.6) of respondents with SCD who received regular care. After adjusting for demographic and health status differences, people receiving regular care for SCD had a significantly lower prevalence of meeting aerobic guidelines compared to people without SCD (PR=0.80, 95%CI: 0.69-0.93, p=0.005). The most prevalent physical activity was walking for adults aged ≥ 45 years old (41-52%) regardless of SCD status or receipt of care.

CONCLUSION

Overall, the prevalence of inactivity was high, especially among people with SCD. These findings suggest a need to increase activity among middle-aged and older adults, particularly those with SCD who receive care. Examining ways to increase walking, potentially by involving informal caregivers, could be a promising way for people with SCD to reduce inactivity and gain the health benefits associated with meeting physical activity guidelines.