Center of Design for an Aging Society

Design for Aging

The Environment as Preventive Medicine

As we age, our environment becomes increasingly more important and can seriously impact our ability to perform normal activities of daily living. We lose the ability to adapt to less than optimum conditions. It is estimated that by the year 2030 there will be more people over the age of 65 than under the age of 17. This statistic demonstrates the need for a better understanding of age-related changes and environmental solutions to better serve our older adults. Design for aging goes beyond senior housing complexes and should be applied to the community at large. A survey of AARP members indicates that 84% would prefer to remain in their own homes. Currently only 5% of older adults live in senior housing.  The information provided here applies to senior housing, but the recommendations can also be adapted to nearly any private residence.

In his 1992 keynote address to the American Hospital Association, Dr. C. Everett Koop stated that in order to control health care costs the one thing we cannot have too much of is prevention. A supportive environment must be viewed as preventive medicine and must be included in any personal or national wellness program. For example, hip fractures, deemed the “Silent Epidemic”, are currently estimated to cost $10 billion a year in direct cost, resulting in death for 1/3 of the victims while another 1/3 never regain their prior level of activity. More (white) women between the ages of 50 - 94 will die as a result of a hip fracture, (1 of 6) than breast cancer, (1 of 8). Environmental factors are linked to almost all falling accidents. For the elderly population falls are the leading cause of accidental death. In 1991 there were 300,000 hip fractures due to accidental falls and 94% of those occurred in the over-50-population group. Some hip fractures result not from a fall, but from inappropriate seating. Sensory loss and the changes in the neurological, muscular and skeletal systems are common to the aging process and critically influence our ability to maneuver within the environment. The combination of all these factors demands a clear understanding of the ergonomics of aging.

Chronic conditions affecting older adults, ranked in order, include 1) arthritis, 2) hypertension (high blood pressure), 3) hearing loss, 4) heart disease, 5) cataracts, 6) deformity/orthopedic, 7) chronic sinusitis, 8) diabetes, 9) visual impairment, and 10) varicose veins. (Aging America, Trends and Projections 1991). Since this list was published, new studies indicate that changes in vision due to the loss of contrast sensitivity, negatively impact a person’s independence and is equal to arthritis, which is first on the list.

As we age, the mental processing time slows down and it becomes more difficult to deal with a variety of stimuli simultaneously. Alzheimer’s disease and other dementia begin most frequently in later years. Approximately 6%-8% of all persons older than 65 years have Alzheimer’s disease, and the prevalence of the disease doubles every 5 years after the age of 60, so that nearly 30% of the population older than 85 years has Alzheimer’s disease. (JAMA, October 22-29, 1997, Diagnosis and Treatment of Alzheimer=s Disease and Related Disorders, Small et al.) Planning interior and outdoor environments to serve this population group is of great importance. Since there is not a cure, the best we can do is to lessen the impact of confusion. The starting point begins with maximizing ability by addressing the normal age related changes.

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