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tion and a conscious colour scheme to make the environment
attractive is emphasized. In addition Cooper et al (1999) have
been able to demonstrate that neutral colours and lack of con-
trast minimise attention contrary to strong colour cues, which
seems to attract attention. The former is suggested to prevent
undesirable behaviour such as walking into restricted areas,
the latter is suggested to as means of improving the visual
distinction of environmental objects especially for low-vision
subjects and as a mnemonic device.
It is important to integrate evidence-based results such as
those mentioned above in the health care environment, in order
to prevent differences between the level of adaptation and
demands posed by the surroundings in line with the model of
Lawton (1973).
We propose a more frequent use of contrasting colours in order
to accomplish visual distinction in the environment, to support
depth and spatial perception and to simplify object recognition
(Wijk 2001). Colours similar in lightness could be juxtaposed
when the purpose is to camouflage and minimise attention.
Shades of different lightness within the red and yellow colour
area on the walls of the room could support spatial distinc-
tion. Coding and cueing presuppose a communication between
the carer and resident based upon a common opinion of the
concept. Therefore we recommended a more frequent use of
the elementary colours (blue, red, green, yellow, black and
white) for codes and cues. Due to the often declining vision
following old age, very dark colours should not be situated next
to each other since they seem to be difficult to distinguish, and
the same goes for very light colours. Since colour preferences
remain more or less stable throughout life and since colour and
colour design are highly appreciated among most people it is
indicated that the colour scheme of health care environments
ought to take a greater advantage of this than is common today.
It is also suggested that colour could be used to attract atten-
tion of cues in the environment of the elderly. To support recog-
nition in the long run, the shape of the cue and its associations
seems to be more important. From this follows, that in order to
make the patients be aware of the cues they have to be com-
municated between carers and resident, and they have to be
clearly visible in the environment. Despite the evidence-based
recommendations mentioned above (Wijk 2001) there have not
been all that many systematic attempts to evaluate the advan-
tages of a clear colour design in health care environments.
Illumination of the environment
It is quite common with insufficient illumination in health care
environments which unnecessarily can have a negative effect
on quality of life (Brunnström et al 2004). For patients cared for
in their private homes the most important action is to change
or complement the existing illumination with a better and more
functional quality. This requires knowledge and a conscious-
ness of good products from the dealer. Institutions are often
lacking in variation and flexibility considering the illumination.
In the dining room an illumination that both support activities
and gives a nice atmosphere is needed such as a good lamp
focusing both on the table and food which is crucial for inde-
pendence during the meal (Bowers et al 2001).
Also in the emergency unit illumination is a crucial factor for
safety and quality of care. A high degree of exposure to day-
light has proved to reduce depression and length of stay as well
as to reduce perceived pain and need of analgesics (Golden et
al., 2005, Beauchemin and Hays, 1996; 1998; Benedetti et al.,
2001, Walch et al., 2005). It is also well known that there is a
relation between a higher degree of exposure to daylight and
an increased quality of sleep among the patients (BaHamman,
2006; Wakamura and Tokura, 2001).
The exposure to daylight has also shown to have important
positive effects on staff well-being, job satisfaction and atten-
tion (Rhea, 2004, Mrockzek et al., 2005, Alimoglu and Donmez,
2005) as well as decreasing stress (Verderber and Reuman,
1987). Also during night shift the quality of illumination and
variation in light intense is important with positive effects on
attention, adaption and quality of sleep (Baehr et al., 1999;
Horowitz et al., 2001). When it comes to avoiding adverse
events in health care, illumination can have an impact. A well
adapted illumination has shown to decrease errors in medica-
tion by 37 % during high illumination (1500 lux) compared to
during normal/low illumination (450 to 1000 lux) (Buchanan et
al., 1991).
How to evaluate the impact or usefulness of environmental
factors
An overview of the existing amount of studies of health care
environmental design reveals a lack of as well experimental
as longitudinal studies in this field and the use of a variety of
methods for evaluating the outcome. One of the reasons could
be, as pointed out by Lawton (2001), that many environmental
assessment instruments comprise of descriptive material that
does not easily fit into an evaluative framework that deter-
mines how well a design element performs in meeting user
needs. That is, beside the needs of the residents, of course
also special needs of the staffs’ well-being such as their
general health, anxiety, depression, quality of life, guilt and
grief, job-satisfaction, and attitudes towards care (Skea and
Lindsay 1996). Research strategies for evaluating the effect of
environmental design in health care settings are for example