Wayfinding Design in Hospitals for the Elderly: Enhancing Navigational Support in Healthcare Space

다국어 초록 (Multilingual Abstract)

Navigating hospital environments poses significant challenges for elderly individuals due to age-related cognitive, visual, and mobility impairments. This study investigates these challenges through two integrated approaches: a systematic literature review (Study A) and an experimental study conducted at a multi-level tertiary hospital in Korea (Study B). Study A synthesizes 23 international studies on wayfinding and highlights recurring issues such as signage clarity, vertical circulation complexity, and cognitive overload. Study B empirically validates these themes by analyzing the navigational behavior of 31 elderly participants using path analysis, heatmaps, think-aloud interviews, and post-task reflections. The findings reveal that vertical transitions, ambiguous signage, and corridor similarity are primary barriers to effective navigation. Comparative discussion across both studies confirms alignment on key themes and emphasizes the importance of inclusive design strategies such as improved environmental zoning, consistent visual cues, and cognitive load reduction to enhance elderly user experience in hospital settings. This research contributes evidence-based recommendations for designing accessible and intuitive healthcare environments for aging populations. Key words Wayfinding, elderly, hospital design, signage, spatial disorientation, vertical navigation, cognitive aging

국문 초록 (Abstract)

병원 환경에서의 길찾기(wayfinding)는 노인들에게 인지적, 시각적, 신체적 약화로 인해 상당한 어려움을 초래할 수 있다. 본 연구는 이러한 문제를 해결하기 위해 두 가지 접근법을 통합하였다: 체계적인 문헌고찰(연구 A) 과 국내 다층 구조의 상급종합병원에서 수행된 실험적 연구(연구 B)이다. 연구 A는 2004년부터 2024년까지 발표된 23편의 국제 연구를 분석하여, 병원 내 길찾기에서 반복적으로 나타나는 주요 문제로 ‘표지판명확성 부족’, ‘수직 동선(계단 및 엘리베이터) 복잡성’, ‘인지적 과부하’를 확인하였다. 연구 B는 총 31명의 노인 참여자를 대상으로 경로 분석, 히트맵, 사고 발화법, 사후 인터뷰를 활용하여 실제 길찾기 행동을 실증적으로 검토하였다.

목차 (Table of Contents)

• Abstract viii
• 1. Introduction 1
• 1.1 Definition and Importance of Wayfinding 1
• 1.2 The Need for Effective Wayfinding in Healthcare 1
• 2. Literature review 2
• 2.1 Purpose of this study 2
• 2.2 Theoretical Foundations of Wayfinding 2
• 2.3 Wayfinding Challenges for Elderly Patients 3
• 2.4 Factors that affect wayfinding. 8
• 2.5 Wayfinding for the elderly in healthcare 9
• 3. Study A- Systematic literature review 10
• 3.1 Methodology. 10
• 3.2 Results 12
• 3.2.1 Design 33
• 3.2.2 Main Outcomes 35
• 3.2.3 The average Sample size 37
• 3.2.4 The Average Age 38
• 3.2.5 Country 39
• 3.2.6 Key Words 41
• 3.3 Discussion 42
• 4. Study B- Experiment 43
• 4.1 Methodology. 43
• 4.2 Hospital 43
• 4.3 Participants 46
• 5. Results 48
• 5.1 Path analysis 48
• 5.1.1 Destination-1 Cardiovascular Center 48
• 5.1.2 Destination-2 Blood Collection Room 50
• 5.1.3 Destination-3 Oriental Medicine Center. 52
• 5.1.4 Destination-4 MRI Room 54
• 5.1.5 Destination-5 Lobby 56
• 5.1.6 Summary 57
• 5.2 Heat maps 58
• 5.2.1 Destination-1 Cardiovascular Center 58
• 5.2.2 Destination-2 Blood Collection Room 59
• 5.2.3 Destination-3 MRI Room 59
• 5.2.4 Destination-4 MRI Room 61
• 5.2.5 Destination-5 Lobby 62
• 5.2.6 Summary 63
• 5.3 Think-aloud interview 66
• 5.3.1 Destination-1 Cardiovascular Center 66
• 5.3.2 Destination-2 Blood Collection Room 67
• 5.3.3 Destination-3 Oriental Medicine Center. 69
• 5.3.4 Destination-4 MRI Room 70
• 5.3.5 Destination-5 Lobby 72
• 5.3.6 Summary 73
• 5.4 Post-interview 74
• 5.4.1 Summary 84
• 5.5 Gender 85
• 5.5.1 Destination-1 Cardiovascular Center 85
• 5.5.2 Destination-2 Blood Collection Room 87
• 5.5.3 Destination-3 Oriental Medicine Center 88
• 5.5.4 Destination-4 MRI Room 90
• 5.5.5 Destination-5 Lobby 92
• 5.5.6 Summary 93
• 5.6 Age 94
• 5.6.1 Destination-1 Cardiovascular Center 95
• 5.6.2 Destination-2 Blood Collection Room 96
• 5.6.3 Destination-3 Oriental Medicine Center 97
• 5.6.4 Destination-4 MRI Room 97
• 5.6.5 Destination-5 Lobby 99
• 5.6.6 Summary 99
• 6. Discussion 100
• 6.1 Signage Clarity and Visual Accessibility 100
• 6.2 Vertical Navigation and Floor Transition Barriers 101
• 6.3 Corridor Complexity and Department Overlap 102
• 6.4 Role of Familiarity and Memory 103
• 6.5 Environmental Features and Cognitive Load 103
• 6.6 Wayfinding Success and Failure Rates 104
• 7. Conclusion 105
• 8. References 107
• <국문 초록> 114
• Table Contents
• Table 1. Summaries of the papers included after the second review round. The table provides all available information about wayfinding 13
• Table 2. Summaries of the papers included after the second review round. The table provides all available information about wayfinding 26
• Table 3. This figure presents the evolution of research focus and methodologies over three
• periods 31
• Table 4. Categorization of Participant Efficient Navigation at Destination-1 (Cardiovascular
• Center) 66
• Table 5. Categorization of Participant Confusion at Destination-1 (Cardiovascular Center) 66
• Table 6. Categorization of Efficient Navigation at Destination-2 the (Blood Collection Room) 67
• Table 7. Categorization of Navigation Confusion at Destination-2 the (Blood Collection Room) 68
• Table 8. Categorization of Efficient Navigation at Oriental Medicine Center (D-3) 69
• Table 9. Categorization of Navigation Confusion at Oriental Medicine Center (D-3) 69
• Table 10. Categorization of Efficient Navigation at MRI Room (D-4) 70
• Table 11. Categorization of Navigation Confusion at MRI Room (D-4) 71
• Table 12. Categorization of Efficient Navigation at Lobby (D-5) 72
• Table 13. Categorization of Navigation Confusion at Lobby (D-5) 72
• Table 14. Elements that supported successful wayfinding with representative quotes 74
• Table 15. Elements that caused confusion during wayfinding 77
• Table 16. Suggestions for improving hospital navigation 80
• Table 17. Gender-Based Comparative Analysis of Wayfinding Performance- Destination-1 85
• Table 18. Gender-Based Comparative Analysis of Wayfinding Performance( D-2) 87
• Table 19. Gender-Based Comparative Analysis of Oriental Medicine Center (D-3) 88
• Table 20. Gender-Based Comparative Analysis of Wayfinding Performance (D-4) 90
• Table 21. Gender-Based Comparative Analysis of Wayfinding Performance (D-5) 92
• Table 22. Participant Age Group Distribution 94
• Table 23. Age-Based Performance Analysis at Cardiovascular Center (D-1) 95
• Table 24. Age-Based Performance Analysis Blood Collection Room (D-2) 96
• Table 25. Age-Based Performance Analysis Oriental Medicine Center (D-3) 97
• Table 26. Age-Based Performance Analysis MRI Room (D-4) 97
• Table 27. Age-Based Performance Analysis Lobby (D-5) 99
• Figure Contents
• Figure 1. The figure represents the systematic literature review (SLR) screening process
• conducted for selecting relevant studies between 2004 and 2024 11
• Figure 2. This graphic represents how research methodologies have evolved over time 33
• Figure 3. Chart showing the changes in research design over time 35
• Figure 4. The chart showing the evolution of wayfinding research focus over time 37
• Figure 5. Average Sample Size 38
• Figure 6. The bar chart showing the average age distribution across the three-year groups 39
• Figure 7. This stacked bar chart shows a shift from research being focused in a few regions to a
• more globally connected scientific community, highlighting the growing worldwide interest in
• improving wayfinding and healthcare design 40
• Figure 8. Key word cloud 41
• Figure 9. This bar chart that shows the frequency of different keywords related to wayfinding
• and healthcare environments across three time periods 41
• Figure 10. Experimental Route. This is an isometric diagram showing the layout of a multi-
• story hospital with different floors labeled as B1층 (Basement 1), 1층 (First Floor), and 2층
• (Second Floor) 45
• Figure 11. The research site location 47
• Figure 11. Destination-1 (Cardiovascular Center) Downward Route First Floor This layout
• illustrates the navigation paths taken by participants using the downward route to reach the
• Cardiovascular Center 48
• Figure 12. Destination-1 (Cardiovascular Center) Upward Route First Floor 49
• This layout shows participant navigation via the upward route to reach the Cardiovascular
• Center 49
• Figure 13. Destination-2.1 (Blood Collection Room) Downward (left) vs. Upward (right)
• Routes (Floor 1) 50
• Figure 14. Destination-2.2 (Blood Collection Room) Downward (left) vs. Upward (right)
• Routes (Floor 2) 51
• Figure 15. Destination-3.1 (Oriental Medicine Center) Downward (left) vs. Upward (right)
• Routes (Floor 1) 52
• Figure 16. Destination D-3.2 (Oriental Medicine Center) Downward (left) vs. Upward (right)
• Routes (Floor1) 52
• Figure 17. Destination-4.1 (MRI Room) Downward (left) vs. Upward (right) Routes (Floor1) 54
• Figure 18. Destination-4.2 (MRI Room) Downward (left) vs. Upward (right) Routes (B1F) 54
• Figure 19. Destination-5.1 (Lobby) Downward (left) vs. Upward (right) Routes (B1F) 56
• Figure 20. Destination-5.2 (Lobby) Downward (left) vs. Upward (right) Routes (Floor 1) 56
• Figure 21. Heat Map of Participant Navigation for Cardiovascular Center (D-1) First Floor 58
• Figure 22. Heat Map of Participant Navigation for Blood Collection Room (D-2). First Floor
• (left) to Second Floor (right) 59
• Figure 23. Heat Map of Participant Navigation for Oriental Medicine Center (D-3). Second
• Floor (left) to First Floor (right) 60
• Figure 24. Heat Map of Participant Navigation for MRI Room (D-4.1). First Floor (left) to
• Basement 1 (right) 61
• Figure 25. Heat Map of Participant Navigation for Lobby (D-5) Basement 1 (left) to First Floor
• (right) 62
• Figure 26. Combined Heat Map of Participant Navigation First Floor (All Destinations) 63
• Figure 27. Combined Heat Map of Participant Navigation - Second Floor (All Destinations) .. 64
• Figure 28. Combined Heat Map of Participant Navigation - Basement Floor (All Destinations)
• 64