Environmental Factors, Spatial Behavior, and Unit-Based Design in Dementia Care: A Case Study of Three Long-Term Care Facilities in Xi’an, China

Older adults with dementia in long-term care facilities often become lost, enter unintended rooms, and develop greater dependence on care staff as a result of visuospatial impairment. However, existing dementia-friendly design studies have rarely distinguished among residents with different cognitive impairment characteristics. This exploratory cross-sectional study investigated 76 older adults with dementia and visuospatial impairment in three long-term care facilities in Xi’an, China. Neuropsychological assessment, behavior mapping, BIM-based modeling, space syntax analysis, and statistical analysis were integrated to examine the associations between environmental factors and the spatial behaviors of older adults with different research-based visuospatial impairment profiles. The results showed that the sample could be classified into three profiles: visual construction impairment, spatial disorientation, and global spatial cognitive impairment. The three groups showed different sensitivities to visual cues, path structure, and environmental stability, and exhibited distinct patterns of getting lost and spatial use. Based on these exploratory findings, this study formulates three hypothesis-generating unit-based design concepts: feature-enhanced units, path-simplified units, and stable low-load units. These concepts provide a provisional framework for examining how dementia care environments might be adapted to cognitive abilities and require validation in larger, longitudinal, and intervention-based studies.