The effects of refurbishment on residents’ quality of life and wellbeing in two Swedish residential care facilities Hanna Falk à , Helle Wijk, Lars-Olof Persson Institute of Health and Care Science, The Sahlgrenska Academy at the University of Gothenburg, Box 457, Goteborg S-405 30, Sweden article info Article history: Received 1 September 2008 Received in revised form 19 November 2008 Accepted 24 November 2008 Keywords: Supportive physical environment Residential care facilities Elderly Quality of life Wellbeing abstract This study was conducted to follow a refurbishment aimed at enhancing the supportiveness of the physical environment in two Swedish residential care facilities. Significant differences between intervention and equivalent reference groups were found for quality of life (p ¼ 0.007) and wellbeing (p ¼ 0.02, 0.01) indicating a deterioration for the intervention group. These results suggest that residential care facilities residents are more frail and sensitive to change than has been assumed. This needs to be considered when facilities accommodating the elderly need refurbishment. It also indicates that interior design features alone have little importance for the care climate in nursing homes. & 2008 Elsevier Ltd. All rights reserved. Introduction The environment is increasingly recognized as important in the care of elderly nursing home residents (Kane et al., 2007; Devlin and Arneill, 2003; Schwarz and Brent, 1999). The concept of healing environments suggests that the physical environment has psychologically supportive attributes, believed to affect the inhabitant’s wellbeing (Dijkstra et al., 2006; Devlin and Arneill, 2003). Research into the effects of the physical environment on elderly people has been conducted for many years, yet the findings are seldom communicated to those responsible for the physical environment of residential care facilities (Devlin and Arneill, 2003). Design is generally regarded as a therapeutic resource for promoting wellbeing and functionality amongst people with dementia (Lawton, 2001; Day et al., 2000; Morgan and Stewart, 1999), and there is evidence that the physical environment can influence the healing process in hospitalized patients (Ulrich, 1991, 1984). A literature review by Dijkstra et al. (2006) revealed that studies altering several environmental stimuli simulta- neously supported the view that the physical environment affects the wellbeing of patients. However, when specific environmental stimuli are studied, conclusive evidence remains limited. This lack of evidence might be partly explained by the problem of performing controlled studies within the field of environmental research (Devlin and Arneill, 2003). Another problem with studying the presumed positive effects of improved physical environments, concerns the practical inconveniences associated with prolonged refurbishment work. Background The majority of the elderly in Sweden live in their own private residences with support from their families, and with access to home help services, healthcare, technical equipment, and home adaptations (The National Board of Health and Welfare, 2007, 2008). Although only 6% of those 65 years or older are institutionalized in Sweden, this increases to 16% among those who reach the age of 80 (The National Board of Health and Welfare, 2008). One effect of the aging-in-place policy (i.e. older people remaining in their own private residences with home health and community services for as long as possible) is that the number of beds in Swedish residential care facilities has decreased by 30% since 2001 (The National Board of Health and Welfare, 2007). A further effect is that those in need of residential care are older, frailer and more disabled, secondary to senescence, disease and trauma. Dementia and cognitive decline are strong predictors for institutionalization (The Swedish Council on Technology Assess- ment in Health Care, 2006), and special dementia care units are designed to meet the unique needs of these people (Schwarz et al., 2004; Day and Calkins, 2002; Zeisel, 1999; Morgan and Stewart, 1999). The prevalence of elderly people with cognitive impair- ment in Swedish residential care facilities has been estimated to ARTICLE IN PRESS Contents lists available at ScienceDirect journal homepage: www.elsevier.com/locate/healthplace Health & Place 1353-8292/$ - see front matter & 2008 Elsevier Ltd. All rights reserved. doi:10.1016/j.healthplace.2008.11.004 à Corresponding author. Tel.:+46 735 42 53 24. E-mail address: gusfalkh@student.gu.se (H. Falk). Health & Place 15 (2009) 717–724