Senior Living: Aged Care and Evidence Based Design

Evidence based research is a process of basing decisions about the built environment on credible research to achieve the best possible outcome. The following blog will examine evidenced based design in Aged care and Senior living facilities.

Stress in the built environment and how this effects senior living facilities

In 1956, Austrian physician Hans Seyle discovered that stress hormones significantly affect healing in medical and senior living facilities, contributing to diseases like brain hemorrhage, atherosclerosis, coronary thrombosis, certain high blood pressure types, kidney failure, arthritis, peptic ulcers, and cancer.

Stress results from situations needing behavioral adjustment, such as privacy invasions, noise, pain, separation from familiar things, helplessness, and loss of control. It negatively impacts the immune system soon after the event, emphasizing the need for stress-reducing environments. Stress involves the nervous and endocrine systems, connecting mind and body. Music can reduce pain by prompting the brain to release endorphins, the body's natural opiate.

Evidence shows that surroundings significantly affect older people's socialization, mobility, and health, contributing to stress. This highlights the need for innovative design in senior living facilities to improve outcomes. Even small design changes can greatly enhance residents’ quality of life. Here are some strategies for reducing stress.

Connection to Nature

Research shows we humans have a deep need to connect with nature. Even a partial view of a garden or interaction with a water element can immediate psychological benefits in terms of reducing anxiety and stress (Ulrich 1984; Ulrich 1999; Parsons and Hartig 2000). Biophilic design is a concept used within the building industry to increase occupant connectivity to the natural environment through the use of direct nature, indirect nature, and space and place conditions. This concept can be easily implimented into senior living facilities.

Control (choice)

A considerable number of studies have documented that when individuals have options or choices, it reduces stress and enables them to feel more in control (Winkel and Holahan 1986; Evans and Cohen 1987; Steptoe and Appels 1989).

Social support

Being surrounded by family and friends contributes to emotional and psychological well being, especially for those in senior living. According to Kiecolt-Glaser and colleagues (1998), social support is directly related to dimensions of autonomic, endocrine, and immune function, with family ties appearing to be a key source of support relevant to physiological functioning.

Positive distraction

Research in the neurosciences demonstrates that various types of sensory experiences can actually be therapeutic and can boost the immune system (Pope 1995; Taylor 1997). Humans are multisensory beings; this can be done within environments by visuals or music.

Acoustic controls

Our brains are always monitoring sounds for signs of danger, even when asleep. As a result unwanted noises can have a range of mental health effects.

Why Acoustics Matter in senior living

As we age, our hearing deteriorates, making the elderly more sensitive to room acoustics. High-pitched sounds become harder to hear, leading to misunderstandings and social isolation. Those with dementia are also impacted, as they may hear but struggle to interpret sounds accurately.

Controlling Reverberation and Speech Clarity

Research by Michael James Hayne and Richard Fleming from the University of Wollongong highlights the importance of controlling reverberation in dementia care facilities. This ensures speech clarity, reduces intrusive noise, and maintains privacy, especially for residents using hearing aids.

Recommended reverberation times for different spaces for senior living

Recommended design sound levels for different spaces for senior living

Lighting and daylight.

Elizabeth Brawly, author on aging and Alzheimer's design innovations, highlights that residents cannot modify their environments. Reduced visual acuity, impaired depth perception, and poor lighting increase fall risks and daily fear, leading to anxiety, confusion, and anger.

Increased dining area lighting improves food visibility, appetite, calorie intake, sleep habits, and overall quality of life.

Environmental interventions that promote mobility and independence include:

• Even illumination and glare elimination

• Balance of daylight and electric light

• Combination of direct and indirect lighting

• Gradual light level changes upon outdoor entry

• Strong contrast, such as contrasting color grab bars

Homelike environment

Although it may be extremely difficult to provide ‘homelike’ settings, research has shown that the benefits of these ‘homelike’ residences are significant, and its importance should not be underestimated (see Chaudhury & Cooke, 2014).

Green Houses senior living in the US provide innovative residential care for people with dementia. Green Houses were inspired by the ‘Eden Alternative’, a concept that emerged in the early 1990’s, where homelike long-term care facilities are encouraged. This philosophy didn’t create much change initially, which sparked the founder to bring the concept to life with the creation of ‘Green Houses’. Green Houses are small homes for those in need of 24 hour nursing care, with no more than 12 persons per home.

The houses feature resident-selected furniture and décor, ample outdoor space, and abundant sunlight in each room. Residents' preferences and privacy are respected, with nurses ringing the doorbell before entering. Unlike institutional nursing homes, Green Houses lack nurses’ stations, medication carts, and public address systems.

https://thegreenhouseproject.org/solutions/build-a-green-house/

In addition to homelike aesthetics, smaller units appear to have numerous positive benefits, such as higher motor functioning, greater friendship formation, reduced anxiety and depression, and greater mobility.

Reducing resident falls

Resident falls are a major cause of injuries and liability claims in senior living. Research by Xiaobo Quan, PhD, EDAC, and Anjali Joseph, PhD, EDAC, at The Center for Health Design identified key environmental design elements affecting falls:

• High lighting levels and reduced glare lower fall risk.

• Low-height furniture, strategic placement, and ample maneuvering space prevent falls and related injuries.

• Flooring with small motifs and low contrast, plus soft sub-flooring, improves walking and reduces falls.

• Access to wander gardens decreases falls among residents with dementia.

• Properly configured grab bars in bathrooms help reduce falls.

• Restrictive devices like bedrails can cause severe injuries and should be avoided.

Dementia Enabling Environments

Referenced from Fleming, R., Zeisel, J. & Bennett, K. (THE DIGNITY MANIFESTO OF DESIGN FOR PEOPLE LIVING WITH DEMENTIA). There are 10 dementia enabling environment principles based on evidence-based research.

https://www.enablingenvironments.com.au

1. Unobtrusively Reduce Risks

Ensure environments are safe and easy to navigate without obvious safety features that may cause frustration or depression.

2. Provide Human Scale

Design buildings to be comfortable and not overwhelming, promoting a sense of well-being and competence.

3. Allow People to See and Be Seen

Create environments with good visual access to minimize confusion and encourage exploration.

4. Manage Levels of Stimulation - Reduce Unhelpful Stimulation

Minimize unnecessary stimuli to prevent stress, considering all senses.

5. Manage Levels of Stimulation - Optimize Stimulation

Provide meaningful cues to reduce confusion, using text, images, and familiar elements.

6. Support Movement and Engagement

Encourage purposeful movement with clear pathways and opportunities for interaction.

7. Create a Familiar Place

Incorporate familiar designs and objects to maintain competence and comfort.

8. Provide a Variety of Places to Be Alone or with Others - In the Unit

Offer diverse spaces for privacy or social interaction, each with unique characteristics.

9. Provide a Variety of Places to Be Alone or with Others - In the Community

Facilitate community interaction to maintain identity, blending the unit into the community.

10. Design in Response to Vision for Way of Life

Align the building's design with the facility's care philosophy, supporting residents and staff.

11. Colour and Patterns

Avoid bold patterns that can confuse; choose subtle, low-contrast designs.

• Avoid overly bold patterns that can be perceived as moving.

• Choose solid colors over patterns that might be mistaken for objects.

• Avoid high-contrast patterns on floors and walls to prevent misperceptions.

12. Sensory Materials

Incorporate sensory elements to encourage exploration and comfort.

• Use natural materials to add variety and a domestic feel.

• Surround spaces with familiar sensory items to enhance comfort and identity.

• Provide a mix of textures in communal areas for personal engagement.

  
  

In conclusion, the design of senior living environments must prioritize the unique needs and preferences of the residents as the primary focus. This approach is essential not only for enhancing the quality of life for seniors but also for fostering a sense of community and independence among them.

Ultimately, the focus on the residents' needs in senior living design is not merely about aesthetics or functionality; it is about creating a nurturing environment where seniors can thrive. By integrating thoughtful design principles that prioritize accessibility, community, emotional well-being, and technology, we can ensure that senior living spaces are not just places to reside but vibrant communities that enrich the lives of their inhabitants.

Thanks for reading my, blog and if you have any questions, please do not hesitate to contact me.

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