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Review

Strategies to Improve Environmental Comfort of Institutionalized Older Adults: A Scoping Review

by
Catarina Lobão
1,*,
Adriana Coelho
1,2,
Rocío Gil Gutiérrez
3,4,*,
Inês Marçal
5,
Madalena Antunes
5 and
Vítor Parola
1,2
1
Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000 Coimbra, Portugal
2
Portugal Centre for Evidence-Based Practice: A Joanna Briggs Institute Centre of Excellence (PCEBP), 3000 Coimbra, Portugal
3
Department of Nursing, University of Granada, 18016 Granada, Spain
4
Instituto de Investigación Biosanitaria (ibs.GRANADA), 18012 Granada, Spain
5
Nursing School of Coimbra (ESEnfC), 3000 Coimbra, Portugal
*
Authors to whom correspondence should be addressed.
J. Ageing Longev. 2024, 4(4), 328-342; https://doi.org/10.3390/jal4040024
Submission received: 3 September 2024 / Revised: 24 October 2024 / Accepted: 29 October 2024 / Published: 5 November 2024
Browse Figure
Review Reports Versions Notes

Abstract

:
The demographic trends of an aging global population present significant challenges and opportunities for healthcare, particularly in providing optimal care environments for older adults living in long-term care facilities, with it being imperative to ensure these environments provide basic care and promote overall well-being through enhanced environmental comfort. This scoping review intends to show evidence-based practices enhancing the environmental comfort of institutionalized older people. Following the Joanna Briggs Institute’s methodology, this scoping review’s inclusion criteria included studies in English, Portuguese, or Spanish between 2013 and 2023, focused on institutionalized people over the age of 65 years residing in long-term care settings where nurses implemented strategies or interventions designed to enhance environmental comfort in which older residents themselves directly evaluated, indexed in Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, Psychology and Behavioral Sciences Collection, DART-Europe, or Repositório Científico de Acesso Aberto de Portugal (RCAAP). Out of 497 initially retrieved studies, none of them met the established criteria, leading this study to be an empty review. The absence of studies meeting the inclusion criteria indicates a significant gap in the existing literature, highlighting the need for specialized training programs that equip nurses with the skills and knowledge to implement effective comfort-enhancing interventions, ensuring that the unique and challenging needs of older people are covered.

1. Introduction

The demographic trends of the aging global population present significant challenges and opportunities for healthcare, particularly in providing optimal care environments for older adults. As the number of older people living in long-term care facilities continues to rise, is imperative to ensure that these environments meet the standards of basic care and promote overall well-being through enhanced environmental comfort. The World Health Organization (WHO) has also established this concern as one of the main priorities in aging, promoting research on healthy aging strategies with the main goal of aligning health systems to the needs of older people for long-term integrated care, enhancing the global network for age-friendly cities and communities [1].
As referred to in Kolcaba’s Theory of Comfort, comfort can be interpreted as the experience of being supported [2]. Thus, environmental comfort in long-term care settings encompasses a broad range of factors, from the tangible aspects of their living spaces, such as lighting, temperature, and noise levels, to more intangible ones, like the adoption of person-centered care patients and the innovative use of technology to improve their day-to-day comfort and well-being [3,4]. The use of this theory gives structure to professional care, strengthens nurse–patient–family relationships, and favors the development of health-seeking behaviors, understanding comfort as a main objective and desirable outcome of nursing care [5].
Although it has been previously demonstrated that nursing professionals have a pivotal role in enhancing patients’ comfort [6], several scientific studies have pointed out that nursing professionals have difficulty assessing patients to ensure their comfort needs are met, calling for practical yet valid and reliable comfort assessment tools [7] and interventions, as evidence-based knowledge of the effect of physical environment on health outcomes and safety of older people in caring environments is still scarce [8]. This scoping review is motivated by the critical need to consolidate and appraise the array of strategies and interventions implemented across long-term care institutions worldwide to enhance environmental comfort for older individuals. The significance of this endeavor cannot be overstated, as environmental comfort directly impacts the well-being, dignity, and quality of life of older people, among the most vulnerable populations in society [9]; therefore, the promotion of what can be named as age-friendly environments is mandatory [10]. As Florence Nightingale stated in the 19th century, environmental determinants of health and disease are pervasive and integral to the assessment, diagnosis, intervention, planning, and evaluation components of nursing practice [11], and, even knowing this, environmental factors affecting health and, subsequently, comfort and perceived quality of life, are often overlooked in routine assessments. Improving environmental comfort aligns not only with the ethical imperatives of care but also with practical considerations of healthcare outcomes, potentially reducing the incidence of stress-related conditions and improving overall satisfaction with care among older adults [12].
This investigation seeks to explore the literature on the subject systematically. It aims to identify, map, and synthesize existing evidence-based practices, focusing on interventions designed and implemented by nurses to improve environmental comfort for institutionalized older people. Through a comprehensive search across electronic databases and grey literature, this review intends to compile the actual existent evidence on physical modifications of the environment, user-centered care practices, and the employment of assistive technologies aimed at enhancing the quality of life for older adults in long-term care settings, with the overarching goal of informing and guiding healthcare providers, facility managers, and policymakers in adopting proven practices enhancing environmental comfort and quality of care provided to this frail population.
An initial search, including MEDLINE (PubMed), the Cochrane Database of Systematic Reviews, the International Prospective Register of Ongoing Systematic Review (PROSPERO), and the Open Science Framework (OSF) [13,14], revealed a noticeable absence of scoping or systematic reviews explicitly addressing the improvement of environmental comfort for the institutionalized older population, underscoring the significance of this review in contributing valuable insights of older adults in long-term care facilities [15]. This exploration is intended to pave the way for future research and innovation in elder care, ensuring that our aging population is afforded the comfort, dignity, respect, and quality of life they deserve.

2. Materials and Methods

This scoping review was conducted following the Joanna Briggs Institute’s (JBI) methodology for conducting scoping reviews [16], ensuring a comprehensive and systematic exploration of published and unpublished literature [13,14]. This approach is aligned with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) [17] guidelines, underscoring our commitment to transparency and the reproducibility of the research process. The scoping review protocol was previously registered with the OSF, emphasizing our dedication to open and accessible research practices (DOI 10.17605/OSF.IO/EMBV).

2.1. Review Questions

By examining strategies ranging from physical environmental modifications to the implementation of person-centered practices and innovative technological solutions, the scoping review procedure, including the search strategy and screening and selection criteria procedures, was guided by the following review questions:
-
What strategies and interventions have been adopted in long-term care institutions to improve environmental comfort for institutionalized older adults, and how have these been evaluated by older people themselves?
-
What impact do these strategies have on the environmental comfort of older adults, as perceived and reported by them?
-
What challenges and barriers have been encountered in implementing these interventions, and what best practices can be identified from the older adults’ evaluations?

2.2. Search Strategy

The search strategy for this scoping review was meticulously designed to capture a comprehensive spectrum of published and unpublished studies relevant to enhancing environmental comfort for institutionalized older people. This strategy was established through a collaborative effort among two primary reviewers, with additional oversight and peer review provided by a third expert to ensure adherence to the Peer Review of Electronic Search Strategies (PRESS) checklist [13,18].
An initial exploratory search was conducted within MEDLINE (via PubMed) and Cumulative Index to Nursing and Allied Health Literature (CINAHL) Complete (EBSCOhost) databases. This preliminary step gauged the scope of existing literature and refined the search terms for a more targeted approach in subsequent searches. A robust search strategy was developed based on the insights gained, emphasizing keywords and MeSH terms specifically chosen for their relevance to the review’s focus. These terms included “environmental comfort”, “aged”, and “nursing homes”, among others.
To ensure the inclusivity and breadth of our search, the exploration was extended beyond the initial databases to encompass additional resources known for their rich healthcare and gerontological literature repositories. This included databases such as Scopus and the Psychology and Behavioral Sciences Collection, each offering unique contributions to older adults’ care and comfort.
In addition to these published sources, our search strategy prioritized identifying grey literature to uncover studies and analyses that might not be available through conventional academic channels. Key platforms for this aspect of our search included DART-Europe for access to European research theses and Repositório Científico de Acesso Aberto de Portugal (RCAAP) for a broader scope of grey literature.
To complement our database and grey literature searches, hand searches of the reference lists of all selected articles were conducted. This meticulous approach ensured no significant study was missed, allowing for the inclusion of potentially relevant literature that may not have been indexed in the searched databases.
Our search was adapted as necessary for each information source, considering each database’s specific indexing terms and search functionalities. This adaptability ensured that our search strategy remained comprehensive and focused, aligning to map out the most relevant and current evidence on strategies for enhancing environmental comfort for people over the age of 65 years in long-term care settings. Table 1 displays the search strategy.

2.3. Screening

The inclusion criteria for this scoping review were meticulously defined by the Population, Concept, and Context (PCC) mnemonic, as recommended by JBI:
-
Population: records focused on studies involving institutionalized individuals aged 65 and older residing in long-term care settings.
-
Concept: This review was centered on exploring implemented strategies and interventions provided by nursing professionals designed to enhance environmental comfort, which older adults themselves directly evaluated. This encompassed a wide array of interventions, including but not limited to adjustments to the physical environment (lighting, noise, temperature, equipment, and the inclusion of color and natural or artificial elements within their living spaces), adopting person-centered care practices, and using technology to elevate the comfort level. These modifications are essential for creating an environment conducive to the well-being and comfort of older residents. It was imperative that the interventions explored were not only implemented within long-term care settings but also were subjectively evaluated by the residents themselves. This ensured that the strategies identified had a genuine impact from the perspective of those directly experiencing them rather than being solely based on external assessments or theoretical benefits.
-
For clarity, the International Council of Nurses (ICN) defines nursing as encompassing both autonomous and collaborative care for individuals of all ages, families, groups, and communities. This definition includes health promotion, illness prevention, and the care of persons who are ill, disabled, or dying. Additionally, nursing roles encompass advocacy, the promotion of a safe environment, research, involvement in health policy development, and management and education within health systems [19]. Our study specifically targeted interventions conducted by professional nursing staff, emphasizing the competencies and responsibilities of trained nursing professionals, rather than non-professional care staff. This focus ensured that our findings are directly relevant to the professional scope of nursing practice. Context: The review has included studies from various long-term care environments, such as nursing homes, assisted living facilities, and continuous care institutions, across different geographical areas. This wide-ranging context allowed for an inclusive examination of environmental comfort interventions and their perceived impact on older adults across diverse care settings.
-
Types of sources: this review has included quantitative, qualitative, and mixed-methods research designs alongside systematic reviews to ensure a holistic overview of available evidence.
-
Publication period: reflecting on the rapid advancements in care practices and technology, this review was focused on studies published within the last ten years, capturing the most contemporary and relevant insights into strategies for enhancing environmental comfort for older people [20].
-
Language of publication: to ensure a thorough and quality-assured analysis, the review included studies published in English, Portuguese, and Spanish, acknowledging the linguistic capabilities of the review team and ensuring the integrity of the research findings.

2.4. Study Selection

All identified records from our database search were meticulously collated and managed using Mendeley Reference Manager (Mendeley Ltd., Elsevier, Amsterdam, The Netherlands) to ensure a comprehensive and systematic review process. This step removed duplicates to streamline the selection process and focused solely on unique studies relevant to the review’s objectives.
The selection of studies for inclusion in this scoping review has followed a structured, two-tiered approach. Initially, two independent reviewers began preliminarily screening titles and abstracts of all retrieved records. To ensure the reliability and consistency of the screening process, a pilot test designed to achieve a minimum of 80% agreement between reviewers, refine screening data, and ensure a standardized application of these criteria across all records was performed.
After initial screening, potentially eligible studies’ full-text versions were closely examined to ensure their compliance with the fixed inclusion criteria and the clarity of their relevance to our research questions. Reasons for exclusion at this point were properly documented. Discrepancies between reviewers at any stage of the selection process were resolved through collaborative discussion or, if necessary, by consulting a third reviewer. Concerted efforts were made to contact the authors directly if there were challenges accessing the full text of potentially relevant studies, as well as where data were missing or required further clarification to ensure the accuracy of the analysis performed.
The culmination of the selection process can be seen in Figure 1, in which a flow diagram adhering to PRISMA-ScR guidelines [17] is presented.

3. Results

The initial search across the selected databases yielded 497 potential studies. During the initial phase, 67 studies were identified as duplicates and subsequently removed. The remaining 430 studies underwent a rigorous title and abstract screening process. This screening aimed to filter out studies that did not align with the specific research questions focused on nursing interventions designed to improve environmental comfort for institutionalized older adults.
The title and abstract screening process resulted in the exclusion of 377 studies. These studies were excluded for various reasons, such as not focusing on people over 65 years in long-term care settings, not involving nursing interventions, or not addressing environmental comfort as a primary outcome. This left us with 53 studies that appeared to meet the initial inclusion criteria and were selected for full-text review.
During the full-text review phase, each of the 53 studies were meticulously examined to assess their eligibility based on the predefined inclusion criteria. Of them, 1 was not available as full text, 52 did not include nursing interventions, 47 did not perform any environmental comfort management intervention, 37 were focused on populations aged <65, and 3 studies were carried out in places different from long-care term settings. A detailed description of the met criteria of by each study can be seen in Table 1. Therefore, despite this comprehensive review process, none of the 53 studies fully met all the inclusion criteria.
Table 2 provides a description of met inclusion criteria by each screened study [21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73].

4. Discussion

Our primary aim was to discover nurses’ strategies that may contribute to the well-being and comfort of older adults, focusing on interventions that are effective and adaptable to different care environments. However, no results were found on this matter.
Reviews such as this one, yielding no eligible studies, commonly known as “empty reviews” [74], although they may be especially problematic for the decision-making process, can serve several purposes and are still important to scientific knowledge advances. Reasons explaining this result could be that a highly specific question has been proposed, or because the review was restricted to environmental interventions only provided by nursing professionals and evaluated by residents itself. Additionally, stringent methodological inclusion criteria were fixed looking for the highest possible quality evidence and documental sources, criteria which may not have been considered in the existing primary studies concerning this issue.
Despite this fact, the results obtained demonstrate the lack of evidence on this subject and highlight the critical need to further investigate practices enhancing person-centered care, which involves nurses and patients working together to ensure their needs and preferences are the main points of their healthcare, considering the biographical and social factors [75] directly affecting people’s health status continuum.
Although holistic person-centered nursing care should be promoted and assured by all practitioners, as it is an approach considering physical, social, spiritual, and psychological needs, which are effective in preventing illness and death, as well as improving the quality of healthcare provided [76], the provision of nursing care is nowadays limited to meeting the human basic needs due to various institutional, organizational, and governmental limitations. Inadequate time, experience, and a lack of resources, among others, make it difficult to provide holistic care [77]. Additionally, while nursing staff may not always have control over fundamental aspects of environmental comfort, such as the pre-established design, infrastructure, or interiors often created by professionals without a healthcare background, they are nonetheless well-positioned to adapt and optimize the existing environment to enhance patient comfort. Simple actions, such as adjusting clothing or managing small environmental changes, can make a significant difference. Moreover, their involvement in the planning and design phases of new builds and refurbishments is essential, as their hands-on experience and daily care interactions provide valuable insights into creating environments that better support resident comfort and overall well-being [78]. Therefore, we consider this work beneficial as a starting point for the inclusion of healthcare staff in the critical phases of designing new constructions and renovations, based on a prior body of documentation on which factors or interventions yield the greatest health improvements in their target populations.
The reality is that comfort should be recognized as just as important as the other needs, being a key component when providing nursing care to older people [79]. To achieve this, the multidimensionality of this concept must be considered, as providing comfort is a complex function going beyond pain relief, bathing, or feeding [80]. From the patients’ perspective, comfort is multidimensional, and different factors are relevant to different individuals, with up to four interrelated levels identified in perceived comfort: patient’s use of self-comfort strategies, family, professionals’ actions and behaviors, and environmental factors [81]. If one of them is not properly provided, the main objective of care is missing [82].
The creation of welcoming healthcare settings is essential for improving patient well-being and encouraging healing. Factors such as air quality and flow, ventilation, humidity, lighting, and temperature significantly impact the physical environment of care settings, thereby affecting the comfort of patients, staff, and even families [6]. In line with this, the work of Chaudhry et al. [83] demonstrated how renovations in dining spaces improved not only the comfort and social interaction of residents, but also the teamwork and personal support provided by nursing staff and caregivers.
Meanwhile, the study conducted by Aase and colleagues [84] addressed how healthcare professionals conceptualize “quality” in care settings outside hospitals, such as nursing homes and homecare services, a particularly relevant approach to environmental comfort. The core elements of quality in these contexts include dignity, continuity of care, and professional competence, which also influence users’ perceptions of comfort and well-being. A friendly physical environment helps patients feel at ease, reducing stress and anxiety, preventing adverse physiological reactions, and meeting the needs and expectations of patients and families [85]. This is particularly relevant for institutionalized older residents, whose quality of life is directly impacted by the progressive loss of autonomy and the perception of being in an institution, where they may feel with people but alone [86]. Thus, environmental comfort should be considered a defining element for achieving an optimal and integral state of comfort, as it supports and enhances other levels of comfort, including physical, social, spiritual, and psychological dimensions.
Unfortunately, environmental comfort often goes unnoticed, devaluing the impact of the environment on the person, when the reality is that solid scientific evidence has pointed out that, on the one hand, the environment is a determining factor in the health status and well-being of institutionalized older adults [87], and, on the other hand, older persons are particularly vulnerable and susceptible to changes in the physical environment [42]. Therefore, it is critically important to create adaptative, responsive environments that cater to the unique needs and preferences of older adults in long-term care settings, promoting their comfort and well-being. To help achieve this task with the greatest precision, specific comfort assessment tools considering each target population through a person-centered and resident-focused approach and emphasizing resident comfort should be created, an example of this is the Environmental Assessment Tool (EAT) by Fleming and Bennet [88] or the Dementia Design Rating Tool [89] for individuals with dementia, both specifically designed to assess and guide the design of environments for individuals with this condition through the identification and consideration of their particular disabilities, support needs, and physical and social aspects, as well as promoting changes in detected key environmental factors and collaboration between healthcare providers and stakeholders involved in environmental design and modification for enhancing comfort, accessibility, and safety, thereby improving the quality of life for residents or patients.
In this context, the guidelines provided by the Australian Government arose just a few months ago as a comprehensive framework for designing care environments supporting the comfort and well-being of older residents, emphasizing the need for environments that are not only functional but also sensitive to all needs of older adults (physical, emotional, and social spheres), ensuring a design enhancing high-quality, person-centered care [90].
In exploring various studies that have been mapped in this scoping review, it is evident that while there are insights into factors like temperature, wall colors, and other environmental aspects, these studies often do not specifically address these elements as standalone nursing interventions focused on comfort. For instance, Shintani et al. [57] studied the effects of wall colors on the comfort of older residents, finding that traditional Japanese colors promoted higher degrees of relaxation, but this was not in the context of nursing interventions. Similarly, Hasbollah et al. [40] explored the implementation of green and sustainable building designs in older adults care homes, which included aspects like ventilation, bright colors, and energy-efficient systems to enhance comfort. However, these environmental modifications were not framed as nursing interventions specifically aimed at enhancing comfort.
Additionally, Wicaksono et al. [64] investigated the use of autonomous robots and integrated systems for older people monitoring, which included elements like smart home technologies and wearable devices to enhance safety and comfort. While these technologies show promise in improving the overall living conditions for older adults, they do not specifically focus on nursing interventions for comfort.
These findings suggest a need for nursing-focused research on how such environmental adjustments can be effectively integrated into holistic care strategies aimed explicitly at enhancing comfort. There is a critical gap in the literature regarding nursing interventions specifically designed to address environmental comfort in long-term care settings, highlighting the need for targeted research in this area.
While this review focused exclusively on nursing interventions, it is important to acknowledge that patient comfort in clinical settings is often the result of a combination of multidisciplinary interventions. Nursing interventions, though crucial, do not operate in isolation but rather in synergy with other therapeutic approaches. Future research should explore the integration of nursing interventions within the broader context of multidisciplinary care, aiming to understand how these interventions can complement and enhance the effectiveness of other treatments. This perspective is essential for developing comprehensive strategies that maximize patient comfort and well-being across diverse healthcare settings.
As this empty review shows the absence of evidence in the current literature, further research on the subject to produce more evidence-based, person-centered care practices, with the main goal of improving the quality of care provided by nursing professionals, as part of a multidisciplinary team, should be a priority.
Given the absence of studies meeting our inclusion criteria, the present discussion focuses on a reflective and informed analysis based on our research questions and the relevant literature identified. This approach enabled us to critically explore the implications of the gaps in the literature and to propose directions for future research that can address these critical needs.
One of the key considerations during the development of our search strategy was achieving a balance between sensitivity and specificity. While a more specific search could have enhanced precision in identifying studies explicitly related to ‘person-centered care’ and ‘assisted living’ settings, it also risked excluding relevant studies that did not explicitly use these terms. To mitigate this risk, we opted for a broader, more inclusive search strategy, followed by a thorough manual review to ensure that no relevant studies were overlooked. This approach allowed us to capture a wide range of evidence across different settings, ensuring that the review remained comprehensive and representative. However, we acknowledge that this strategy may have introduced some limitations in specificity, and future research could benefit from exploring more targeted search terms to refine the scope further.
The findings obtained should be considered in light of three important limitations. Namely, our searches only included studies in English, Portuguese, or Spanish, as well as studies published in 2013 and later, which may have excluded relevant publications not meeting these criteria. Although we are aware that the chosen publication period may be very limited, it should be noted that the presented work has aimed to provide a reference frame based on current healthcare settings, where technologies and practices are rapidly undergoing significant transformation and facing new challenges, such as home automation, which are changing the way care is delivered, especially in the aftermath of the COVID-19 pandemic. Lastly, retrieving studies from recognized academic channels, despite leading to a greater potential number of results, implies that the method, data analysis techniques, and results obtained may not have been peer-reviewed. An additional detail to consider that could also explain the lack of results obtained is the COVID-19 pandemic, during which, long-term residential centers for older people, especially affected by it, drastically reduced their care and research activities.
However, some strengths should be noted. Firstly, this scoping review was conducted under the JBI methodology for scoping reviews and PRISMA-ScR guidelines, ensuring a comprehensive and systematic exploration of published and unpublished literature. Secondly, databases known for their rich healthcare and gerontological literature repositories were specifically selected, to gather as much information as possible specific to the question posed. Likewise, in addition to the use of these published sources, our search strategy prioritized identifying grey literature to uncover studies and analyses that might not be available through conventional academic channels. In addition, hand searches of the reference lists of all selected articles were conducted, ensuring no significant study was missed. Lastly, our search was adapted as necessary for each information source, considering each database’s specific indexing terms and functionalities, ensuring a comprehensive and focused search strategy focused on mapping out the most relevant and current evidence on strategies for enhancing environmental comfort for older adults in long-term care settings.

5. Conclusions

The absence of studies meeting the inclusion criteria highlights a significant gap in the existing literature regarding evidence-based nursing interventions designed to enhance environmental comfort for institutionalized older adults. This empty review underscores the critical need for further research in this area. It is imperative to conduct and publish studies that rigorously evaluate the impact of nursing interventions on the environmental comfort and overall well-being of older adults in long-term care settings.
Environmental comfort is a multifaceted concept that encompasses various physical, psychological, and social aspects of the living environment. Effective nursing interventions can significantly improve these dimensions, leading to enhanced quality of life for older adult residents. Future research should focus on developing and testing specific strategies that nurses can implement to create more adaptive and responsive care environments. These strategies may include investigating the effects of modifications in lighting, temperature control, noise reduction, and ergonomic furniture to create a more comfortable living space for older residents.
Emphasizing the importance of individualized care that considers the unique preferences, needs, and backgrounds of each old resident can foster a sense of dignity and respect, which is vital for their comfort and well-being. Furthermore, highlighting the need for specialized training programs that equip nurses with the skills and knowledge to implement effective comfort-enhancing interventions is necessary. Continuous professional development in this area can ensure that nurses are well-prepared to meet the evolving needs of older people.
By concentrating on these areas, future research can provide valuable insights into the best practices for enhancing environmental comfort in long-term care settings. Such research is essential for informing healthcare providers, facility managers, and policymakers, ultimately leading to improved care standards and better quality of life for institutionalized older adults.
Addressing the current gaps in the literature through targeted research will not only contribute to the academic knowledge base but also have practical implications for the care of one of the most vulnerable populations in society. It is through these concerted efforts that we can hope to create care environments that are truly supportive, comfortable, and conducive to the well-being of older residents.

Author Contributions

Conceptualization, V.P., C.L. and A.C.; methodology, V.P., C.L. and A.C.; validation, M.A., C.L., A.C., V.P. and I.M.; investigation, V.P., M.A., C.L., I.M., R.G.G. and A.C.; resources, M.A., C.L., A.C., V.P., R.G.G. and I.M.; writing—original draft preparation, M.A., C.L., A.C., V.P., R.G.G. and I.M.; writing—review and editing, M.A., C.L., A.C., V.P. and I.M.; visualization, M.A., C.L., A.C., V.P., R.G.G. and I.M.; supervision, V.P., C.L. and A.C. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Not applicable.

Data Availability Statement

Not applicable.

Acknowledgments

Authors wish to acknowledge the Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Portugal, and the Portugal Centre for Evidence-based Practice: a Joanna Briggs Institute Centre of Excellence, Portugal.

Conflicts of Interest

The authors declare no conflicts of interest.

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Figure 1. Review flowchart. Abbreviations: CINAHL: Cumulative Index to Nursing and Allied Health Literature; RCAPP: Repositório Científico de Acesso Aberto de Portugal.
Figure 1. Review flowchart. Abbreviations: CINAHL: Cumulative Index to Nursing and Allied Health Literature; RCAPP: Repositório Científico de Acesso Aberto de Portugal.
Jal 04 00024 g001
Table 1. Database search strategy and results.
Table 1. Database search strategy and results.
Medline (via PubMed)—searched on 4 January 2024: 230 results
((((((((((((((elderly [MeSH Terms]) OR (oldest old [MeSH Terms])) OR (older person [Title/Abstract])) OR (older adult [Title/Abstract])) OR (older people [Title/Abstract])) OR (older patient [Title/Abstract])) OR (geriatric [Title/Abstract])) OR (aged [Title/Abstract])) OR(aging [Title/Abstract])) OR (older [Title/Abstract])) OR (elder [Title/Abstract])) OR(elderly [Title/Abstract]))) AND (((Patient Comfort[MeSH Terms]) OR (Environmental comfort[Title/Abstract])) OR (Comfort[Title/Abstract]))) AND (((((((((((((residential facilities[MeSH Terms]) OR (nursing homes[MeSH Terms])) OR (institutionalization[MeSH Terms])) OR (Homes for the Aged[MeSH Terms])) OR (nursing home[Title/Abstract])) OR (residential care facility[Title/Abstract])) OR (residential facility[Title/Abstract])) OR (aged care facility[Title/Abstract])) OR (elderly care facility[Title/Abstract])) OR (long-term care facility[Title/Abstract])) OR (institution[Title/Abstract])) OR (institutionalized[Title/Abstract]))) Filters: in the last 10 years, English, Portuguese, Spanish, MEDLINE
CINAHL Complete—searched on 4 January 2024: 111 results
TI (older person OR older adult OR older people OR older patient OR geriatric OR aged OR aging OR older OR elder OR elderly) OR AB (older person OR older adult OR older pe ople OR older patient OR geriatric OR aged OR aging OR older OR elder OR elderly) OR MH (aged OR frail elderly) AND TI (comfort OR environmental comfort) OR AB (comfort OR environmental comfort) OR MH comfort AND TI (nursing home OR residential care facility OR residential facility OR aged care facility OR elderly care facility OR long-term care facility OR institution OR institutionalized) OR AB (nursing home OR residential care facility OR residential facility OR aged care facility OR elderly care facility OR long-term care facility OR institution OR institutionalized) OR MH (residential facilities OR nursing homes OR institutionalization) Limiters—20130101–20231231; Exclude MEDLINE records; Language: English, Portuguese, Spanish
Scopus—searched on 4 January 2024: 135 results
(TITLE-ABS (“older person” OR “older adult” OR “older people” OR “older patient” OR “geriatric” OR “aged” OR “aging” OR “older” OR “elder” OR “elderly”)) AND (TITLE-ABS (“Environmental comfort” OR “Comfort”)) AND (TITLE-ABS (“nursing home” OR “residential care facility” OR “residential facility” OR “aged care facility” OR “elderly care facility” OR “long-term care facility” OR “institution” OR “institutionalized”)) AND NOT ((((PMID (1*) OR PMID (2*) OR PMID (3*) OR PMID (4*) OR PMID (5*) OR PMID (6*) OR PMID (7*) OR PMID (8*) OR PMID (9*))))) AND (LIMIT-TO (LANGUAGE, “English”) OR LIMIT-TO (LANGUAGE, “Portuguese”) OR LIMIT-TO (LANGUAGE, “Spanish”)))
RCAAP—searched on 4 January 2024: 13 result
(Idoso (assunto) AND conforto (assunto)) Limiters—20130101–20231231
Psychology and Behavioral Sciences Collection—searched on 4 January 2024: 8 results
TI (older person OR older adult OR older people OR older patient OR geriatric OR aged OR aging OR older OR elder OR elderly) OR AB (older person OR older adult OR older people OR older patient OR geriatric OR aged OR aging OR older OR elder OR elderly) AND TI (comfort OR environmental comfort) OR AB (comfort OR environmental comfort) AND TI (nursing home OR residential care facility OR residential facility OR aged care facility OR elderly care facility OR long-term care facility OR institution OR institutionalized) OR AB (nursing home OR residential care facility OR residential facility OR aged care facility OR elderly care facility OR long-term care facility OR institution OR institutionalized) Limiters—20130101–20231231;
DART-Europe—searched on 4 January 2024: 0 results
(older OR elderly) AND comfort Filters: English; Portuguese; Spanish; in the last 10 years
Abbreviations: CINAHL: Cumulative Index to Nursing and Allied Health Literature; RCAPP: Repositório Científico de Acesso Aberto de Portugal.
Table 2. Entailed description of met inclusion criteria by each screened study.
Table 2. Entailed description of met inclusion criteria by each screened study.
Reference-YearFull-Text AvailableLanguageNursing
Intervention		Environmental
Comfort
Intervention		Population Age ≥ 65Long-Term Care SettingsDecision
Abbott et al., 2019. [22]YesEnglishNoNoNoYesExclude
Akan et al., 2017. [23]YesEnglishNoNoNoYesExclude
Baquero et al., 2023. [24]YesEnglishNoNoYesYesExclude
Baquero et al., 2022. [25]YesEnglishNoNoNoYesExclude
Baquero Larriva et al., 2022. [26]YesEnglishNoNoNoYesExclude
Beime et al., 2018. [27]YesEnglishNoYesNoYesExclude
Bentayeb et al., 2015. [28]YesEnglishNoNoYesYesExclude
Blackler et al., 2018. [29]YesEnglishNoNoNoYesExclude
Cleary et al., 2019. [30]YesEnglishNoNoYesYesExclude
Cui et al., 2021. [31]YesEnglishNoNoNoYesExclude
Daniel et al., 2019. [32]YesPortugueseNoNoYesYesExclude
Devos et al., 2020. [33]YesEnglishNoNoNoYesExclude
Douma et al., 2017. [34]YesEnglishNoNoYesYesExclude
Ergin et al., 2019. [35]YesEnglishNoYesNoYesExclude
Forcada et al., 2020. [36]YesEnglishNoNoNoYesExclude
Forcada et al., 2021. [37]YesEnglishNoNoNoYesExclude
Fu et al., 2022. [38]YesEnglishNoYesNoYesExclude
Hannah. 2018. [39]YesEnglishNoNoNoYesExclude
Hasbollah et al., 2019. [40]YesEnglishNoNoNoYesExclude
Ho et al., 2021. [41]YesEnglishNoNoYesYesExclude
Jingyi et al., 2022. [42]YesEnglishNoNoNoYesExclude
Johansson et al., 2020. [43]YesEnglishNoNoNoYesExclude
Kainaga et al., 2022. [44]YesEnglishNoNoYesYesExclude
Karnik et al., 2014. [45]YesEnglishNoNoNoNoExclude
Khaliq et al., 2022. [46]YesEnglishNoNoNoYesExclude
Kunduraci et al., 2022. [47]No-----Exclude
Magnussen et al., 2021. [48]YesEnglishNoNoYesYesExclude
Mendes et al., 2017. [49]YesEnglishNoNoYesYesExclude
Mu et al., 20121. [50]YesEnglishNoNoNoYesExclude
Mu et al., 2023. [51]YesEnglishNoNoNoYesExclude
Zambrano et al., 2023. [52]YesEnglishNoNoNoYesExclude
Noguchi et al., 2019. [53]YesEnglishNoNoNoYesExclude
Pinto et al., 2019. [54]YesEnglishNoNoNoYesExclude
Flores et al., 2020. [55]YesEnglishNoNoNoNoExclude
Rosenfelder et al., 2015. [56]YesEnglishNoYesNoYesExclude
Shintani et al., 2018. [57]YesEnglishNoYesYesYesExclude
Soest- Poortvliet et al., 2014. [58]YesEnglishNoNoNoYesExclude
Tappen et al., 2023. [59]YesEnglishNoNoNoYesExclude
Tartarini et al., 2017. [60]YesEnglishNoNoYesYesExclude
Tartarini et al., 2017. [61]YesEnglishNoNoYesYesExclude
Tartarini et al., 2018. [62]YesEnglishNoNoYesYesExclude
Tejedor et al., 2020. [63]YesEnglishNoNoYesYesExclude
Wicaksono et al., 2022. [64]YesEnglishNoNoNoNoExclude
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Zarghami et al., 2019. [21]YesEnglishNoNoNoYesExclude
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MDPI and ACS Style

Lobão, C.; Coelho, A.; Gil Gutiérrez, R.; Marçal, I.; Antunes, M.; Parola, V. Strategies to Improve Environmental Comfort of Institutionalized Older Adults: A Scoping Review. J. Ageing Longev. 2024, 4, 328-342. https://doi.org/10.3390/jal4040024

AMA Style

Lobão C, Coelho A, Gil Gutiérrez R, Marçal I, Antunes M, Parola V. Strategies to Improve Environmental Comfort of Institutionalized Older Adults: A Scoping Review. Journal of Ageing and Longevity. 2024; 4(4):328-342. https://doi.org/10.3390/jal4040024

Chicago/Turabian Style

Lobão, Catarina, Adriana Coelho, Rocío Gil Gutiérrez, Inês Marçal, Madalena Antunes, and Vítor Parola. 2024. "Strategies to Improve Environmental Comfort of Institutionalized Older Adults: A Scoping Review" Journal of Ageing and Longevity 4, no. 4: 328-342. https://doi.org/10.3390/jal4040024

APA Style

Lobão, C., Coelho, A., Gil Gutiérrez, R., Marçal, I., Antunes, M., & Parola, V. (2024). Strategies to Improve Environmental Comfort of Institutionalized Older Adults: A Scoping Review. Journal of Ageing and Longevity, 4(4), 328-342. https://doi.org/10.3390/jal4040024

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