Degree Name

Doctor of Philosophy


School of Nursing, Midwifery and Indigenous Health



There are more than 84,000 people with dementia in residential care in Australia. This number is increasing by 4% per year. They can benefit from systematic care planning and well-designed environments. The studies presented in this thesis describe and evaluate contributions to these aspects of their care.


Across the six papers presented a mixed methods approach has been adopted.

Chapter 2 describes the quantitative evaluation of the metrics of a care planning tool that assists direct care staff to carry out a comprehensive assessment and prepare for a care planning meeting. Chapter 3 is a review of the literature on environmental design. Chapter 4 describes the quantitative evaluation of the metrics of a tool for assessing the quality of physical environments for people with dementia. Chapter 5 presents the results of a comparison between the theoretical and empirical factors, determined by factor analysis of data from 105 facilities, in the environmental audit tool. Chapter 6 reports the results of a linear regression analysis seeking to determine the relationship between the quality of life of people with dementia and the quality of the environment in which they live. Chapter 7 is a qualitative study using data collected from in-depth interviews to identify the obstacles to the application of the available knowledge on designing for people with dementia.


The studies provide evidence for the availability of a valid and reliable care planning assessment tool, a body of knowledge on good design for people with dementia and the means by which good design can be measured. The quality of physical environments was shown to have a positive relationship with the self-reported quality of life of people with dementia living in them. The lack of awareness by facility managers of the knowledge on good design was found to be the major obstacle to the application of existing knowledge even when that knowledge was known to the architects involved in the design.


Tools can be developed to assist those involved in caring for people with dementia to take a systematic approach to collecting data that informs care planning and the design of the physical environment. There is still much work to be done in bringing the use of these tools, and the available knowledge, into routine use.



Unless otherwise indicated, the views expressed in this thesis are those of the author and do not necessarily represent the views of the University of Wollongong.