Cognitive-supportive features in long-term care settings: a cross-sectional observational study

A large proportion of older residents in long‑term care live with cognitive impairment in Finland, making environmental design an important factor in supporting their daily functioning. Physical environments can promote cognitive ability through clear layouts, visual cues, and easily understandable spaces, yet these features are not always adequately implemented. The aim of this study was to investigate the quality of the physical environment in LTC settings for older people by assessing the presence of key cognitive-supportive environmental features. This cross‑sectional observational study assessed the quality of physical environments in long‑term care settings in Finland between June and September 2022 using the structured S‑SCEAM‑Fin assessment tool, with a focus on 18 cognitive‑supportive environmental features. A cluster sampling strategy was applied, resulting in 60 participating units. Trained observers recorded each item as either present or absent, and standardized percentage scores were calculated to represent environmental quality. Data were analyzed using descriptive statistics (mean, standard deviation, and range), and differences between groups were examined with the Wilcoxon rank‑sum test. A total of 60 long‑term care units participated, varying in size, type, operator (public or private for-profit provider), and building completion year. The overall standardized S-SCEAM-Fin score averaged 66.02 out of 100, indicating that approximately two-thirds of cognitive‑supportive features were present across units. Comparisons revealed no statistically significant differences in scores based on unit type, unit size, or operator, and no temporal trends were observed across buildings completed year which varied between 1990 and 2022. Item‑level analysis showed notable variation: contrasting colors were the most commonly implemented feature, whereas circular corridor routes and adequate signage between spaces were among the least frequently present. Cognitive‑supportive design features are only partially implemented in Finnish long‑term care settings, suggesting that the full potential of the physical environment to support residents with cognitive impairment remains underutilized. Suboptimal cognitive-supportive design appears to be a systemic issue in the studied Finnish long-term care settings rather than one limited to particular unit types or operators. Despite the availability of well‑established environmental strategies, their inconsistent application highlights the need for systematic and comprehensive environmental audits. Ensuring cognitive-supportive environments are essential, as residents with cognitive impairment are particularly vulnerable to unsuitable surroundings. More broadly, these findings underscore the importance of interdisciplinary collaboration in ensuring that cognitive-supportive design principles are systematically applied in the planning of care environments. Not applicable.