Ageing in place – design for wellbeing

Judith Davey

6/04/2018

I have written quite a bit about housing in my blogs – using home equity to supplement retirement incomes; calling for a wider range of housing choices and the implications of more older people renting. But I have not delved far into detailed housing design issues.

So I was delighted last year to find three female PhD students in the School of Architecture at Victoria University who were interested in housing for older people. I have been doing my best to help and advise them and have been even more thrilled to see them presenting papers at conferences and publishing their work. With their agreement, I am using some of their findings in my next two blogs (one student has subsequently withdrawn).

One study looks in detail at older people with high care needs living in senior rental housing. This involved detailed documentation of the physical environment, followed by interviews with and observations of the residents and their caregivers. It identified design requirements which could improve quality of life, bearing in mind individual preferences and impairments.

Space for movement

Many older people with mobility problems require walking frames or trolleys to provide support, or hold onto walls and fixtures to keep their balance, when moving around indoors.

Conventional hinged doors, especially with different threshold levels, are difficult for people using these aids to manipulate. Sliding doors, that do not require much strength to open, are better. Doors take up valuable space even though they help to maintain privacy and retain heat. Movement could be eased by removing interior doors between lounges, kitchens, bathrooms and laundries.

Keeping the place tidy

This is important to help people feel that they are in control of their lives. To ensure that they can find things and put them away requires shelves within reach. The kitchens observed in local‐authority housing generally had cupboards/shelves that were impractical for their intended users.

Floor coverings which are easy to keep clean are important for people who are unsteady or whose hands shake.

Visitors

As well as having an environment which is presentable for visitors, older people in the study had a better sense of control when they could see visitors coming. This might require a view of the doorway or driveway from their sitting space, especially for people who found getting up difficult. In this case they could remain seated, call out a greeting and an invitation to ‘come in.’

Privacy

Privacy concerns are particularly important in grouped dwellings where many people pass by. Some residents shut their curtains because ‘people can easily look inside’. Windows need to be positioned to provide residents outside views, but limit views from the outside to the inside.

This is particularly important in cases where there are privacy needs related to incontinence, where toileting needs occur in the lounge as well as in the bedroom through the use of a commode, or other device.

Care

Assistance with showering is the most common personal care requirement and the experience of showering has a high impact on quality of life. Many older people want to do as much as possible themselves during showering to keep their independence and privacy. Many pensioner rentals do not have accessible bathrooms, especially for wheelchair users or those reliant on walker frames. A lack of space, or inflexible design, makes it difficult for caregivers to assist as there is rarely enough space for two people in the bathroom. Keeping wet and dry spaces separate is difficult; wet-area showers can be problematic as water can spread over the floor, increasing the risk of falling. In particular, bathroom design may make this difficult when room for undressing, drying and dressing is inadequate. As one caregiver said:

”She leaves her walker out there [out of the bathroom], because there’s not a lot of space. … And once she’s dry we’ll bring her walker back through with her clothes, and squeeze in where we can and manoeuvre around that. … The clothes that we take off her or that we put back on her, she normally has them all on her walker. … we leave that out there because there just not really enough space, you know, with the water and everything”.

Many respondents wished to be out of sight of their caregivers when they didn’t need assistance. “He never let me in [the bathroom], he’s a bit shy.” Having grab handles, handrails and other fixtures that can be held by the older person with both hands increases their safety and thereby their independence and privacy.

Comfort

Being warm is important when showering and drying. Running the hot water before people entered the shower or turning on a heater well ahead helped warm up an unheated bathroom. A caregiver said:

“I go to one man and he won’t have a shower and what they need is like a wall heater in the bathroom to maybe turn that on, get the room warm first and then they might consider going in the shower.”

I have often said that the greatest challenge for an ageing population in New Zealand is providing housing for older people with high care needs to live at home in the community – to “age in place.” Not to mention provision of the care services to go with the housing. There will be individual differences but the needs of independence and privacy, safety and comfort are basic to the quality of life for older people. Let’s hope that these research findings will resonate with designers and planners for the future.

 

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1. Yukiko Kuboshima, Jacqueline McIntosh and Geoff Thomas. (2017). Implications for the design of rental housing for the elderly that improves their quality of life. In M Schnabel (Ed.), 51st International Conference of the Architectural Science Association (pp. 783–792.). Wellington, New Zealand.
2. Yukiko Kuboshima, Jacqueline McIntosh and Geoff Thomas. Bathroom Design for Assisted Showering that Improves the Quality of Life of the Elderly. (Under review for journal publication)