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2022 Alzheimer's Association Clinician Scientist Fellowship (AACSF)

Health Outcomes of Transitional Space Design for Older Adults with Dementia

How may a community’s built environment impact the brain function and mental health of older adults?

Diana Anderson, M.D., M. Arch
Boston University
Boston, MA - United States


The physical design of an assisted living community has been shown to directly impact the emotional well-being and cognition (memory and other brain functions) in the individuals who live there. One important and positive design feature in these communities is transitional space, or space that gives individuals access to both nature and community activities. These spaces include parks and outdoor benches, as well as spaces in the home, such as porches, yards and windows.

For some older adults, especially those with dementia, access to these spaces may be limited. Research indicates that lack of access to nature and social activities may lower quality of life and increase the speed of cognitive decline. Nevertheless, a majority of this research has focused on the physical design of health care homes. It is important to study how transitional spaces in the larger community — especially those in private residences — impact well-being among older adults over time.

Research Plan

Dr. Anderson and colleagues will study the role of transitional spaces in the larger community for older adults with and without early-stage dementia. They will enroll 100 individuals living in community care settings with either early dementia or mild cognitive impairment (a state of subtle memory loss that may precede dementia) and 100 older adults without cognitive impairment. All study participants will be given a survey that will ask how they use porches, windows and other outside spaces. Specifically, how frequently a space is used, the types of activities done within a given space, and how they used the spaces differently during the COVID-19 pandemic. This survey, along with tests of cognition and mental health, will be given to all individuals multiple times over a three-year period.  The team will then determine how community and home-based transitional spaces impact factors such as loneliness, stress, depression and the brain’s overall activity and function over time in people with and without cognitive impairment.


This study could help clarify the ways an environment can slow or promote dementia risk, especially during periods of greater social isolation, such as the COVID-19 pandemic. It could also lead to novel design approaches that enable older adults to have greater access to community life.

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