The physical environment influences neuropsychiatric symptoms and other outcomes in assisted living residents

Mark C. Bicket, Quincy M. Samus, Mathew McNabney, Chiadi U. Onyike, Lawrence S. Mayer, Jason Brandt, Peter Rabins, Constantine Lyketsos, Adam Rosenblatt

Research output: Contribution to journalArticlepeer-review

47 Scopus citations


Objective Although the number of elderly residents living in assisted living (AL) facilities is rising, few studies have examined the AL physical environment and its impact on resident well-being. We sought to quantify the relationship of AL physical environment with resident outcomes including neuropsychiatric symptoms (NPS), quality of life (QOL), and fall risk, and to compare the effects for demented and non-demented residents. Methods Prospective cohort study of a stratified random sample of 326 AL residents living in 21 AL facilities. Measures included the Therapeutic Environmental Screening Scale for Nursing Homes and Residential Care (TESS-NH/RC) to rate facilities and in-person assessment of residents for diagnosis (and assessment of treatment) of dementia, ratings on standardized clinical, cognitive, and QOL measures. Regression models compared environmental measures with outcomes. TESS-NH/RC is modified into a scale for rating the AL physical environment AL-EQS. Results The AL Environmental Quality Score (AL-EQS) was strongly negatively associated with Neuropsychiatric Inventory (NPI) total score (p < 0.001), positively associated with Alzheimer Disease Related Quality of Life (ADRQL) score (p = 0.010), and negatively correlated with fall risk (p = 0.042). Factor analysis revealed an excellent two-factor solution, Dignity and Sensory. Both were strongly associated with NPI and associated with ADRQL. Conclusion The physical environment of AL facilities likely affects NPS and QOL in AL residents, and the effect may be stronger for residents without dementia than for residents with dementia. Environmental manipulations that increase resident privacy, as well as implementing call buttons and telephones, may improve resident well-being.

Original languageEnglish (US)
Pages (from-to)1044-1054
Number of pages11
JournalInternational Journal of Geriatric Psychiatry
Issue number10
StatePublished - Oct 2010
Externally publishedYes


  • assisted living
  • behavior
  • dementia
  • neuropsychiatric symptoms
  • physical environment

ASJC Scopus subject areas

  • Geriatrics and Gerontology
  • Psychiatry and Mental health


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