The role of the built environment in dementia: evolution and adaptation of an innovative care model through the SARS-CoV-2 pandemic

Introduction: The first Alzheimers village in Italy rises in Monza named “Il Paese Ritrovato”, an innovative long-term care facility dedicated to individuals with mild-to-moderate Alzheimers disease or other Dementias. The total area is 3, 360 m2 and it hosts up to 64 guests divided into 8 apartments (single rooms and private bathrooms). The village includes buildings with highly recognizable features thanks to the careful selection of colors and finishes with classic, almost stereotypical, but familiar and reassuring lines that limit adequately furnished spaces. Every space is designed to stimulate cognitive functions and provide a good quality of life for residents. Methods: The retrospective cohort study involved 60 subjects. Variables collected from June 2018 to December 2020 included demographic data, cognitive and functional statuses, comorbidities, engagement in activities through the Engagement Social Index, and psychoactive medication use. Follow-up was performed every 6 months from admission until the Tcovid (starting covid Time) period. Outcomes included any significant changes due to isolation compared with the pre-pandemic period. Results: The study population had a mean age of 82.5 years (76.7% female), with a predominant diagnosis of AD (65%). Assessment at Tcovid showed rather different data than those recorded in the first 18 months with accelerated worsening of MMSE and CDR scales, increased prescription of antipsychotics (+5%), antidepressants (+11.7%, p=0.045) and benzodiazepines (+1.7%), and increased number of falls delineating the worsening of functional status accelerated by the pandemic. Limitations of the study include observational design and small sample size. Conclusion: The pandemic resulted in an abrupt reorganization of the care model with an orientation predominantly toward the health needs by disrupting the use of shared spaces and any opportunity for cognitive stimulation. This showed how psychosocial activity and appropriate study of the built environment play an important role in the well-being of people with cognitive impairment.