As populations continue to age, growing attention is being directed towards the institutional environments where many older adults live, including nursing homes and long-term care facilities. These settings play a significant role in shaping residents’ health and overall quality of life. Increasing evidence shows that the built environment can influence both the physical and cognitive wellbeing of older individuals in complex ways.
Design elements within these spaces can have meaningful consequences. Factors such as layout, lighting, materials and spatial organisation may affect risks related to falls, infection transmission, preventable hospital admissions and even cognitive disorientation. In this way, architecture does not simply provide shelter, but actively shapes health outcomes for ageing populations.
Despite this growing body of research, its application in real-world building projects remains inconsistent. Much of the existing evidence is not systematically integrated into the planning or renovation of long-term care environments. In response, a multidisciplinary team from Boston University Chobanian & Avedisian School of Medicine has introduced a new framework aimed at bridging this gap.
The framework, known as Bioethics Peer Review for Long-Term Care Design (BPR-LTC), is designed to guide the evaluation of architectural plans for long-term care facilities. Its central goal is to ensure that evidence-based design principles are thoughtfully incorporated into the creation of spaces intended for older adults, aligning physical environments with their specific needs.
BPR-LTC brings together several distinct approaches, including evidence-based design research, clinical ethics consultation methods for addressing complex value-driven decisions, and geriatric care frameworks that prioritise the vulnerabilities and requirements of older individuals. While each of these components has contributed independently to long-term care, they have rarely been coordinated during the early stages of architectural design.
Unlike traditional design methodologies or performance metrics, BPR-LTC functions as an ethics-informed, deliberative process that structures how evidence and values are considered in decision-making. By introducing a more systematic and research-driven approach, the framework aims to improve the design of long-term care environments, ultimately enhancing the health and wellbeing of those who live and work within them.
More information: Diana Anderson et al, Bioethics Peer Review: A Structured Evaluation Framework for Long-Term Care Environments, Journal of the American Medical Directors Association. DOI: 10.1016/j.jamda.2025.106088
Journal information: Journal of the American Medical Directors Association Provided by Boston University School of Medicine
