Cue Color and Familiarity in Place Learning for Older Adults

Improving wayfinding in hospitals for people with diverse needs and abilities: An exploratory approach based on multi-criteria decision making

Hospital wayfinding systems that are based solely on signage do not provide adequate solutions for wayfinding needs, especially for users with impairments. Moreover, the interaction between user characteristics and the inner space of the building also determines wayfinding efficiency. The aims of this study, therefore, were to identify architectural features that affect spatial orientation and wayfinding behaviors; demonstrate the implementation of a multi-criteria decision-making (MCDM) approach for improving wayfinding in a diverse range of users; and produce a set of quantitative values (i.e., weights) for each selected architectural feature, based on the individual's preferences. Doing so could enable the formulating of practical design guidelines for hospital buildings, tailored to the needs and abilities of the users, to minimize disorientation and confusion - as demonstrated in this paper through a case study. The MCDM approach was chosen as it is based on observations whereby wayfinding resembles a continuous decision-making process, throughout which, users continuously select those architectural features that they perceive as having the greatest wayfinding value.

The Assessment of Long-Term Care Environments for Wayfinding Design

OBJECTIVES

The purpose of this article is to compare three different methods to assess the complexity of a long-term care (LTC) environment for wayfinding before and after an environmental design intervention. The methods include space syntax (SS), the Wayfinding Checklist (WC), and the Tool to Assess Wayfinding Complexity (TAWC).

BACKGROUND

Wayfinding is important to maintain older adults' independent functioning. The design of environments can impact wayfinding ability by providing support; this can be via building structure or by environmental design features such as signage and landmarks. Few methods or tools have been scientifically validated to assess environments for wayfinding complexity. In order to compare environments in terms of complexity and to measure the impact of interventions, valid and reliable tools are necessary.

METHODS

This article discusses the results of the use of three wayfinding design assessment tools using three routes in one LTC environment. The results of the three tools are discussed.

RESULTS

SS analysis could quantitatively measure the complexity of routes using integration values, which indicates connectedness. The TAWC and the WC were able to measure differences in visual field scores pre- and postenvironmental intervention. There were limitations to each tool: the lack of psychometric properties for the TAWC and the WC, and the lack of ability to measure changes in design features within visual fields with SS.

CONCLUSIONS

Multiple tools to assess environments for wayfinding design may be needed in studies that test environmental interventions. Future research is needed to provide psychometric testing for the tools.

Adults' Visual Cue Preferences and Wayfinding Abilities in Healthcare Centers

OBJECTIVES

Physical and visual elements that help people find their way around an environment are called visual cues (VCs). The current study aims to evaluate adults' wayfinding abilities (navigation, orientation, spatial anxiety, and distance estimation) and VC (navigational color coding) preferences in terms of color and position; additionally, investigates their differences in adults' life span phases (young adults, early middle-aged adults, and late middle-aged adults).

BACKGROUND

Wayfinding in complex environments such as healthcare centers has been challenging for most people. Although VCs are being used increasingly to facilitate wayfinding, considering people's preferences regarding VCs, especially navigational color coding, are neglected.

METHODS

Obtained data from a survey of 375 healthcare center visitors with textual and photo questionnaires were analyzed by descriptive statics and one-way analysis of variance.

RESULTS

Young adults preferred VCs with "mixed colors and positioned in the middle of the floor," early middle-aged adults preferred "warm color VCs in the middle of the wall," and late middle-aged adults preferred "warm color VCs at the bottom of the wall." Additionally, the results demonstrated that with aging, navigation and distance estimation abilities deteriorate, and spatial anxiety increases.

CONCLUSIONS

The outcomes of the present study increase our knowledge regarding the impact of adults' life span phases on their wayfinding abilities and VC preferences and offer suggestions for architects and healthcare center stakeholders to provide environments that improve adults' wayfinding.

Nostalgia enhances route learning in a virtual environment

Salient landmarks enhance route learning. We hypothesised that semantically salient nostalgic landmarks would improve route learning compared to non-nostalgic landmarks. In two experiments, participants learned a route through a computer-generated maze using directional arrows and wall-mounted pictures. On the test trial, the arrows were removed, and participants completed the maze using only the pictures. In the nostalgia condition, pictures were of popular music artists and TV characters from 5 to 10 years ago. In the control condition, they were recent pictures of these same artists and characters. In Experiment 1, in the test trial, participants in the nostalgia condition completed the maze faster than controls. Experiment 2 conceptually replicated these findings and extended them by exploring boundary conditions. Participants had to learn two mazes sequentially. In Maze 1, we placed nostalgic/control landmarks only at non-decision points (whereas we placed them at decision points in Experiment 1). In Maze 2, we placed nostalgic/control landmarks at decision points during acquisition but removed them in the test trial (whereas they were present in the test trial in Experiment 1). In both mazes, participants in the nostalgia (compared to control) condition completed the test trial faster.

A Systematic Review of Navigation Assistance Systems for People With Dementia

Technological developments provide solutions to alleviate the tremendous impact on the health and autonomy due to the impact of dementia on navigation abilities. We systematically reviewed the literature on devices tested to provide assistance to people with dementia during indoor, outdoor and virtual navigation (PROSPERO ID number: 215585). Medline and Scopus databases were searched from inception. Our aim was to summarize the results from the literature to guide future developments. Twenty-three articles were included in our study. Three types of information were extracted from these studies. First, the types of navigation advice the devices provided were assessed through: (i) the sensorial modality of presentation, e.g., visual and tactile stimuli, (ii) the navigation content, e.g., landmarks, and (iii) the timing of presentation, e.g., systematically at intersections. Second, we analyzed the technology that the devices were based on, e.g., smartphone. Third, the experimental methodology used to assess the devices and the navigation outcome was evaluated. We report and discuss the results from the literature based on these three main characteristics. Finally, based on these considerations, recommendations are drawn, challenges are identified and potential solutions are suggested. Augmented reality-based devices, intelligent tutoring systems and social support should particularly further be explored.

The Effect of Landmarks With Their Color on Learning Basketball Lay-Up in Beginners

The purpose of this study was to determine the effect of landmarks on learning basketball lay-up in beginners. Twenty-seven females (age = 20.30 ± 0.24 years, height = 164.37 ± 0.53 cm) participated in this study. They were assigned to three groups: no landmark group, colored landmark group, and black and white landmark group. All participants performed basketball lay-up for six sessions. The colored group and black and white group trained with the landmarks on the ground while the no landmark group trained without any landmarks based on a trainer instruction. Posttest was performed at the end of the last session of training and also in the retention test following 72 hr. All trials were assessed through 5-point Likert scales, ranging from 1 (very poor) to 5 (very good). The results showed that using landmarks significantly changed the lay-up pattern; however, these changes were not significant for color and lay-up shot accuracy.

Color Coding the "Labyrinth": How Staff Perceived a Two-Part Intervention to Improve Wayfinding in an Adult Emergency Department

OBJECTIVES, PURPOSE, OR AIM

We report a two-part wayfinding intervention, considering four quality criteria (visibility, usability, efficiency and overall effectiveness) from staff perspectives.

BACKGROUND

Few studies to date have explored wayfinding in the Emergency Department (ED). Yet, as ED usage continues to grow, effective wayfinding in these high-stress, fast-paced environments is likely to become increasingly important. At an adult ED located in the U.S. Southeast, wayfinding has been a persistent problem. We subsequently developed a two-part wayfinding intervention: colored routes to key destinations in the ED and corresponding visitor badges.

METHODS

Quality criteria were formulated using the Donabedian model: visibility (structure), usability (process), efficiency (process), and overall effectiveness (outcome). Assessments consisted of staff surveys, which were distributed from March to early April 2019.

RESULTS

The strong ratings across quality criteria, added to affirmative comments from staff, provide evidence that the color coding system made a positive impact on wayfinding.

CONCLUSIONS

While the results should be generalized with caution, the two-part intervention may be highly portable to other contexts. Future studies might examine the effect of colored routes alone. They might illuminate relations between structure, process, and outcomes as they relate to the assessment of wayfinding. They might also expand wayfinding quality criteria. Ultimately, such studies should improve not only the productivity but also the accessibility and user experience of the ED.

Eye Tracking Analysis of Visual Cues during Wayfinding in Early Stage Alzheimer's Disease

INTRODUCTION

Persons with Alzheimer's disease (AD) have profound impairment in wayfinding, potentially related to a deficit in visual attention and selection of relevant environmental information. This study sought to determine differences in visual attention to salient visual cues and nonsalient cues (building features) in older adults with and without AD during active wayfinding in a large-scale, virtual reality spatial task.

METHODS

Fifteen subjects (7 with AD and 8 controls without AD) were asked to find their way repeatedly during 10 trials in a virtual simulation of a senior retirement community. Subjects wore eye tracking glasses to capture visual fixations while wayfinding. The least square means (LSMs) and their standard errors (SEs) for percentage of fixations and duration of fixations on salient and nonsalient cues were estimated from the linear mixed effects models and compared by group (AD or control) and cue type.

RESULTS

The group by cue type interaction was significant for both percentage of fixations (F(1, 13) = 6.79, p = 0.02) and duration of fixations (F(1, 13) = 4.87, p = 0.04). The AD group had significantly lower percentages of fixations on salient cues, LSM = 57.91 (SE = 2.44), compared to controls, LSM = 66.40 (SE = 2.19); p = 0.03. Persons with AD had a higher percentage of fixations on building features, LSM = 31.65 (SE = 2.18), than controls, LSM = 24.54 (SE = 1.95); p = 0.02. Shorter durations of fixations on salient cues were experienced by the AD group, LSM = 38.89 (SE = 1.69), than the control group, LSM = 44.69 (SE = 1.55); p = 0.02.

DISCUSSION/CONCLUSION

Individuals with AD may have difficulty selecting relevant information for wayfinding as compared to normally aging individuals and attend more frequently than controls to irrelevant information. This may help explain the wayfinding difficulties seen in AD.

Wayfinding Strategies and Spatial Anxiety in Older Adults With and Without Alzheimer's Disease

Persons with Alzheimer's disease (AD) often experience problems finding their way (i.e., wayfinding) even in familiar locations. One possible explanation for wayfinding impairments in persons with AD is that they use different wayfinding strategies than persons without AD; and these strategies may be ineffective. The current study examined differences in wayfinding strategies and spatial anxiety in older adults with and without early-stage AD, as well as the effect gender has on both variables. Older adults with normal cognition (n = 50) and adults with early stage AD (n = 38) completed a demographic survey, cognitive tests, the Wayfinding Strategies Scale, and the Spatial Anxiety Scale. Results indicated that adults with normal cognition used significantly more orientation strategies (t [85] = 2.54, p = 0.013) than adults with AD, and men (n = 37) used significantly more orientation strategies than women (n = 51; t [85] = 2.41, p = 0.018). Participants with AD rated their spatial anxiety significantly higher than adults with normal cognition (n = 51; t [84] = -3.89, p < 0.001). Orientation strategy use was inversely related to spatial anxiety (r = -0.434, p < 0.001). These findings suggest that persons with early-stage AD may use fewer wayfinding strategies and have higher wayfinding-related anxiety compared to adults without AD. [Research in Gerontological Nursing, 13(2), 91-101.].

How age relates to spatial navigation performance: Functional and methodological considerations

Aging effects have often been reported for spatial navigation performance. Moreover, navigation performance is thought to be an early marker of pathological aging. Yet, the cognitive complexity of navigation and large individual variation in healthy population make it difficult to pinpoint the precise aging mechanisms involved. We performed a systematic literature review with specific attention to functional dissociation between the tasks used and methodological characteristics. The literature search resulted in 39 articles in which age comparisons were made for large-scale navigation measures. Outcomes were categorized into the domains of landmark, location (egocentric and allocentric), and path knowledge (route and survey). Results indicate that clear functional dissociation exists between these navigation knowledge domains. Aging effects are found for path knowledge most convincingly, while landmark and egocentric location knowledge are frequently omitted in assessment. The participant samples reported often neglect adult, middle aged participants, while this group could be highly informative to the aging process as well. Moreover, having a clear image of age-related performance across the lifespan could be a valuable addition towards the early detection of pathological aging through navigation performance.

Salient Cues and Wayfinding in Alzheimer's Disease within a Virtual Senior Residence

Wayfinding is a problem for persons with Alzheimer's disease (AD), especially in complex environments such as senior residential communities. In this study, persons with AD or mild cognitive impairment (MCI) and a control group of older adults were asked to navigate a virtual reality simulation of a senior residential community. Subjects had to find their way repeatedly over multiple trials for two consecutive days in standard (no extra cues) and salient (colorful, memorable cues placed at key decision points) cue conditions. The results showed that all subjects found their way faster and more effectively in the salient cue condition than in the standard cue condition. Those in the AD/MCI group were significantly more impaired in wayfinding ability compared with those in the control group. Persons with impaired wayfinding ability due to AD and MCI can find their way more effectively in virtual environments enhanced with salient environmental cues.

Flying solo: A review of the literature on wayfinding for older adults experiencing visual or cognitive decline

Accessible tourism is a growing market within the travel industry, but little research has focused on travel barriers for older adults who may be experiencing visual and cognitive decline as part of the normal aging process, illness, or other disabling conditions. Travel barriers, such as difficulty finding one's way throughout an airport, may adversely affect older adults' travel experience, thereby reducing their desire to travel. This review of the literature investigates wayfinding strategies to ensure that older passengers who have planned to travel independently can do so with dignity. These include facility planning and design strategies (e.g., layout, signage) and technological solutions. Although technological approaches, such as smart phone apps, appear to offer the most promising new solutions for enhancing airport navigation, more traditional approaches, such as designing facilities with an intuitive building layout, are still heavily relied upon in the aviation industry. While there are many design guidelines for enhancing wayfinding for older adults, many are not based on scientific investigation.

Search Strategies Used by Older Adults in a Virtual Reality Place Learning Task

PURPOSE OF THE STUDY

Older adults often have problems finding their way in novel environments such as senior living residences and hospitals. The purpose of this study was to examine the types of self-reported search strategies and cues that older adults use to find their way in a virtual maze.

DESIGN AND METHODS

Healthy, independently living older adults (n = 129) aged 55-96 were tested in a virtual maze task over a period of 3 days in which they had to repeatedly find their way to a specified goal. They were interviewed about their strategies on days 1 and 3. Content analysis was used to identify the strategies and cues described by the participants in order to find their way. Strategies and cues used were compared among groups.

RESULTS

The participants reported the use of multiple spatial and non-spatial strategies, and some of the strategies differed among age groups and over time. The oldest age group was less likely to use strategies such as triangulation and distance strategies. All participants used visual landmarks to find their way, but the use of geometric cues (corners) was used less by the older participants.

IMPLICATIONS

These findings add to the theoretical understanding of how older adults find their way in complex environments. The understanding of how wayfinding changes with age is essential in order to design more supportive environments.

Creating a Supportive Environment Using Cues for Wayfinding in Dementia

The ability to find one's way in the world, known as wayfinding, is impaired in individuals with Alzheimer's disease (AD). Older adult residential environments (e.g., independent living, assisted living, nursing home residences) are often especially difficult for wayfinding, with long, non-distinctive hallways and poorly differentiated routes. Wayfinding problems can cause anxiety, distress, and decreased interaction in individuals with dementia. Visual cues are one promising intervention to help this population find their way more easily. The current article reviews research studies that examine the influence of visual cues on wayfinding. The literature shows evidence that individuals with AD have difficulty wayfinding, yet can still learn their way if the environment is supportive of wayfinding. There is beginning evidence that colorful, familiar (easily identified), and personally meaningful cues placed at key decision points and residents' rooms can help individuals with AD find their way.

Wayfinding in ageing and Alzheimer's disease within a virtual senior residence: study protocol

AIM

To report a study protocol that examines the impact of adding salient cues in a virtual reality simulation of a senior residential building on wayfinding for older adults with and without Alzheimer's disease.

BACKGROUND

An early symptom of Alzheimer's disease is the inability to find one's way (wayfinding). Senior residential environments are especially difficult for wayfinding. Salient cues may be able to help persons with Alzheimer's disease find their way more effectively so they can maintain independence.

DESIGN

A repeated measures, within and between subjects design.

METHODS

This study was funded by the National Institutes of Health (August 2012). Older adults (N = 40) with normal cognition and older adults with early stage Alzheimer's disease/mild cognitive impairment (N = 40) will try to find their way to a location repeatedly in a virtual reality simulation of senior residence. There are two environments: standard (no cues) and salient (multiple cues). Outcome measures include how often and how quickly participants find the target location in each cue condition.

CONCLUSION

The results of this study have the potential to provide evidence for ways to make the environment more supportive for wayfinding for older adults with Alzheimer's disease. This study is registered at Trialmatch.alz.org (Identifier 260425-5).