Built Environment Design Interventions at the Exits of Secured Dementia Care Units: A Review of the Empirical Literature.

PURPOSE: To review evidence around design interventions that influence exiting attempts in dementia care units, informing architectural and clinical practice. BACKGROUND: Built environment design is recognized as important in the care and management of responsive behaviors for those living with Alzheimer's disease and other dementias in secured dementia care units (e.g., exiting attempts, agitation). The repetitious behavior of "walking with purpose" (previously termed wandering) in those with dementia has influenced safety-related architectural design components of dementia care units that decrease exiting attempts. Empirical literature addressing design interventions to prevent exiting for those with dementia is lacking and outdated. METHODS: We sought to describe known design techniques through a topical analysis of experimental studies. A thorough search for empirical studies that assessed interior design interventions at exit doors within dementia care units was undertaken. The review included an extensive search for existing literature and a screening of each study identified for its relevance, quality, and applicability. RESULTS: The experimental studies included in the review collectively assessed five interior design interventions at egress doorways: implementing horizontal and vertical floor grid patterns, mirrors, murals, conditioning responses to color cues, and camouflaging door hardware or vision panels. Why empirical studies have not continued more recently as built environment trends have shifted toward promoting meaningful and purposeful movement through design are considered. Advances in our understanding around the pathophysiology of dementia which might affect future design interventions related to egress are also identified. CONCLUSION: The built environment is an important part of dementia care, and further prospective research is needed on the role of design interventions in the context of exiting attempts within secured units and subsequent behavior outcomes.

Investigating the role of group-based morality in extreme behavioral expressions of prejudice.

Understanding motivations underlying acts of hatred are essential for developing strategies to prevent such extreme behavioral expressions of prejudice (EBEPs) against marginalized groups. In this work, we investigate the motivations underlying EBEPs as a function of moral values. Specifically, we propose EBEPs may often be best understood as morally motivated behaviors grounded in people's moral values and perceptions of moral violations. As evidence, we report five studies that integrate spatial modeling and experimental methods to investigate the relationship between moral values and EBEPs. Our results, from these U.S. based studies, suggest that moral values oriented around group preservation are predictive of the county-level prevalence of hate groups and associated with the belief that extreme behavioral expressions of prejudice against marginalized groups are justified. Additional analyses suggest that the association between group-based moral values and EBEPs against outgroups can be partly explained by the belief that these groups have done something morally wrong.