Volume 14, Issue 3 (Autumn 2019)                   Salmand: Iranian Journal of Ageing 2019, 14(3): 342-355 | Back to browse issues page

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Rakhshani Z, Nastiezaie N. Relationship of Design and Architectural Factors of Nursing Homes With the Mental Health of Their Residents. Salmand: Iranian Journal of Ageing. 2019; 14 (3) :342-355
URL: http://salmandj.uswr.ac.ir/article-1-1497-en.html
1- Department of Architecture, Faculty of Architecture and Urban Design, Isfahan Art University, Isfahan, Iran. , zohrerakhshani1479@yahoo.com
2- Department of Educational Management, Faculty of Education and Psychology, University of Sistan and Baluchestan, Zahedan, Iran.
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1. Introduction
The older people are more susceptible to mental health problems because of their age and disability in physical and mental dimensions [1]. The mental disorders in older people living in the nursing homes are more common than those in older people living in the community [2], and a high proportion of them have significant mental disorders [3]. For example, in a study, the prevalence of depression was 23% to 40% in older people living in the community, 25% to 80% for those living in nursing homes, and 51.4% of them had mental disorders [4]. In other words, staying in a nursing home is a significant and independent factor in increasing the prevalence of mental disorders [5]. Disregarding the environmental quality of nursing homes can affect the mental health of older people. In this regard, this study aimed at evaluating the association of design and architecture of nursing homes with the mental health of their residents.
2. Materials and Methods
This research is a descriptive correlational study. The study population consisted of all older people living in nursing homes of Shahriar (n=78) and Qods (n=193) counties in Tehran Province, Iran in December 2017. Using a purposive sampling method, we recruited 158 older people (45 from Shahriar and 113 from Qods). The inclusion criterion included having at least 3 months of residence in the nursing home. After the research was approved by the Isfahan University of Art, the necessary arrangement was made with the authorities of nursing homes. 
The data collection tools were two questionnaires; one was a researcher-made instrument surveying design and architecture of nursing homes, and the other was the General Health Questionnaire-28 (GHQ-28). To determine the validity of the questionnaires, the content validity method was used, and its reliability was examined on 30 samples, who were randomly selected. Then, the Cronbach α coefficient was calculated. The overall Cronbach α was 0.903 for the first questionnaire and 0.833, 0.968, 0.975, 0.797, and 0.863 for its subscales of lighting, public space, personal space, access space, and green space, respectively. The overall Cronbach α was 0.923 for the GHQ-28 and 0.865, 0.883, 0.746, and 0.897 for its subscales of somatic symptoms, anxiety/insomnia, social dysfunction, and severe depression, respectively. The subjects answered the questions individually. In cases where the older people were semi-literate, illiterate, or disabled, the researcher completed the questionnaire by interviewing them. Before the distribution of the questionnaires, the purpose of the research was explained to the participants. We assured them that their information would be completely confidential and would only be used for the study. They voluntarily participated in the research. So they were allowed to leave it if desired. In this study, no sample drop was reported. For analyzing the collected data, the Pearson correlation test and multiple regression analysis were used in SPSS V. 21.
3. Results
The participants were 158 older people (100 men and 58 women) with a Mean±SD age of 68.78±4.82 years and a Mean±SD stay of 27.71±16.97 months in the nursing homes. The results reported a Mean±SD score of 22.93±4.96 for lighting, 27.41±5.01 for public space, 25.15±7.27 for personal space, 28.62±3.69 for access space, 37.48±6.43 for green space, 16.47±2.99 for somatic symptoms, 16.51±3.99 for anxiety/insomnia, 12.13±2.72 for social dysfunction, and 16.39±3.08 for severe depression. As can be seen, the mean scores of lighting, personal space, and green space were higher than the theoretical average. Therefore, samples have higher than average satisfaction with these factors. However, given that the mean scores of public space and access space were lower than the theoretical average, samples had little satisfaction with their public and access spaces (P<0.05). In terms of general health, the mean score of 4 subscales was higher than that of the theoretical average; hence, the samples had lower than average mental health level (P<0.05).
We used the Pearson correlation test to evaluate the relationship of design or architecture of the nursing homes with the mental health of their residents. Table 1 presents the findings. The correlation coefficients of the factors of lighting, public space, personal space, access space, and green space with mental health were -0.662, -0.328, -0.503, -0.404, -0.471, and -0.318, respectively (P<0.001). Then, we used multiple regression analysis to predict the mental health of elderly residents based on design or architectural factors. Based on the regression model, the F-value was significant at the 0.001 level. Therefore, the null hypothesis stating that the regression model is not significant was rejected at 0.99 confidence interval, and it is accepted that the linear regression model has a good fit. The coefficient of determination (R2) is 0.402, which means that the design/architectural factors of the nursing homes explain 40.2% of variations in the mental health of the elderly residents. Among these factors, public space (β=-0.276), personal space (β=-0.216), access space (β=-0.190) and green space (β=-0.145) had the highest prediction powers, respectively. The lighting factor was excluded from the model because it was not significant.

4. Conclusion
There was a negative and significant relationship between older people's satisfaction with the design and architecture of the nursing home and their mental health. This means that with lower satisfaction with the quality of the design and architecture of the nursing home, the mental health of the elderly will be at risk, which leads them to perceive more significant physical problems, anxiety/insomnia, depression, and social dysfunction. Regarding the effect of design and architecture of the nursing homes on the mental health of residents, the authorities should understand the importance of these factors for such places and consider it in their plans to improve the mental health of older people living in these settings. As one of the limitations of the study, we only investigated the older people living in sanatoriums, so the results could not be generalized to all cases.

Ethical Considerations
Compliance with ethical guidelines

All ethical principles were considered in this article. The participants were informed about the purpose of the research and its implementation stages; they were also assured about the confidentiality of their information; Moreover, They were allowed to leave the study whenever they wish, and if desired, the results of the research would be available to them.
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Authors' contributions
All authors contributed in preparing this article.Conflicts of interest
The authors declared no conflict of interest.
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Type of Study: Research | Subject: Psychiatry
Received: 2018/03/06 | Accepted: 2018/06/26 | Published: 2019/11/10

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