Aging in Place: Breaking the Barriers - InformeDesign

Implications
VOL. 07 ISSUE 04
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A Newsletter by InformeDesign. A Web site for design and human behavior research.
IN THIS ISSUE
Aging in Place:
Breaking the Barriers
Related Research
Summaries
Aging in Place:
Breaking the Barriers
Katherine S. Ankerson, and
Betsy S. Gabb, EdD
Aging adults have a vast array of living
alternatives from which to choose.
Conventional types of housing include:
independent living, congregate care,
assisted living, skilled nursing, specialized
nursing facilities, and nursing homes.
Although aging adults have a wide variety
of living options, many individuals and
families prefer to “age in place.” Aging in
place is defined by the National Aging in
Place Council as “The ability to continue
to live in one’s home safely, independently,
and comfortably, regardless of age,
income, or ability level. It means living in
a familiar environment, and being able to
participate in family and other community
activities.”
Many adults wish to maintain their
independence, typically in the homes
where they have lived for many years.
Fortunately, social services and senior
home care services are available in most
communities to support mature adults’
aging in place. However, it is often the
familiar home environment that creates
physical barriers for those suffering
from specific age-related ailments. To
overcome these barriers, it may seem to
family members that the only solution is
to move the mature adult into a different
environment; one designed specifically for
the elderly.
Designing environments to support and
enable people as they age to remain in
their homes is the impetus of the approach
presented in this issue of Implications.
When encouraging the elderly to remain in
their homes, the challenge is to re-design
an environment to meet the needs of its
aging inhabitants.
The first step in understanding the needs
of this population is to comprehend the
characteristics associated with each aging
ailment. Each ailment has certain physical
or mental characteristics that can be
attributed to the ailment and significantly
impact the individual. With that
understanding, creating an aestheticallypleasing
and ailment-specific living space
can be accomplished. Well-designed
changes can mean the difference between
staying at home or feeling the need to
move to a new, unfamiliar environment.
The intent of this paper is to bring to
the forefront the most prevalent issues
relative to aging. Medical terminology
can be confusing and overwhelming, yet
it is critical for designers to understand
underlying physical issues associated
with aging. Therefore, in an effort to bring

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2
issues of aging to the design community, medical
research is investigated, and simplified to impactful
elements, while maintaining its integrity. The goal
is to understand how aging impacts the daily life
and activities of the elderly, and to design spaces
accordingly.
In consultation with Julie Masters, University of
Nebraska, Omaha Gerontology Department, research
reveals nine specific, age-related ailments that affect
the built environment in various ways for those who
would prefer to “age in place.” These ailments are
most commonly associated with aging. Sometimes
they occur singly and sometimes they occur in
combination. It is therefore important to understand
not only the characteristics of each, but their impact
on aging individuals in the built environment. The
most common ailments consist of:
Arthritis
Muscular Loss
Cardiovascular Diseases
Neurological Diseases
Diabetes
Osteoporosis
Hearing Impairment
Vision Impairment
Mental Disorders
Prevalent Occurrences
The range of ailments and disorders is broad, and
variable in terms of effects. Here are a few of the most
common ones afflicting our aging population. The
statistics are sobering. Most people age 75+ have at
least one joint affected by arthritis. From 2003-2005,
50% of adults 65 years or older reported an arthritis
diagnosis (MMWR, 2006). Women are impacted 2-3
times more than men by rheumatoid arthritis. Most
hearing loss begins between 40-50 years of age. Over
28% of individuals age 65 and older have a measurable
hearing impairment. By age 85, 50% of individuals
have a hearing impairment. Static acuity (sharpness
of a stationary visual image) declines about age 40;
and by the 70s, it has decreased by 30% compared
to people in their 20s. Depth perception begins to
decline during the 50s and a 60-year-old person may
require 2 to 3 times as much light to see as a 20-yearold;
with the amount of light required doubling for
each 13 years after the age of 20 (Centers for Disease
Control and Prevention, 2009). One in two women
and one in eight men over 50 years of age will have an
osteoporosis-related fracture (National Osteoporosis
Foundation, 2009). The physical limitations of aging
do cause problems in some general areas, potentially
affecting people’s ability to live effectively on their own.
These general limitations are briefly itemized below.
Physical Limitations
In general, aging-related ailments may cause some
degree of problem in the following areas:
• gripping, pinching, twisting and squeezing
(hands)
• bending or reaching for objects
• lifting objects above shoulders or from below
knees
• getting into and out of furniture and fixtures (e.g.,
shower, toilet)
• getting up or down into a squat or floor position
• climbing and descending stairs
• general mobility and flexibility
• the need to rest even while doing stationary tasks
• slippery surfaces (inherent or due to water)
• lifting feet when walking versus shuffling
• requiring more light to see
• requiring more time to adapt to decreases or
increases in light
• losing ability to discern between shadows
• losing ability to see details
Vision and Color
Color plays a major role in visual perception of the
elderly. According to Lighthouse International, the
lens in the eye is a clear, layered structure attached
to eye muscles that contract or relax to focus in
response to light (a loss of focusing ability is the
reason many adults over 40 need reading glasses).
Yellowing of the aging lens decreases color perception,
and is noticeable at age 50. It becomes an increasing
challenge to designers to consider “aging eyes” when
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selecting color palettes. Cool colors become difficult
to discriminate and often appear as “gray,” beginning
at age 60. In other words, a space designed in light
values of blues and greens may appear as gray, and
not as the designer intended. Unsaturated blues
and greens are described as “calming” physiological
colors; however, these are often most difficult for the
maturing eye to discriminate. Blue is one of the first
colors to “gray.” It is typically best if a wide-range
of colors are present. Warm colors and “saturated
bright” colors are easiest to see. Red can be seen by
most aging persons. Color contrast is very important,
especially when differentiating the chair seat from
the floor, finding the toilet or the edge of a counter, or
determinating floor height changes. The best contrast
for the elderly is black and white; however, this can
appear sterile and unwelcoming.
In terms of artificial light, many fluorescent lamps are
deficient in both red and blue-violet areas, allowing
color to loose its warmth and aliveness and giving the
skin a pale, washed-out tone.
• Height on door threshold could be a tripping
hazard:Replace threshold with lower transition
strip
• Inability to distinguish surface edges while
traversing stairs:Include high color contrast
between adjacent surfaces, and at nosings
• Slippery floor surface indoors or out: Use
non-slick, water absorbent surface material
• Unsecured throw rugs: Remove or affix rugs to the
floor surface below
• Eyes unable to focus quickly from dark to
light:Ensure lights have auto adjustment to slowly
raise/lower lighting level
• Porch light creates glare when approaching
the house:Shield lamp from view with a semitransparent
or opaque reflector
• Dark areas and shadows make opening the front
door difficult:Locate porch light on the same side
of the door as the handle/lock
• Navigating dark stairways: Install stair tread
lighting with switching at the top and bottom of
stairs (see Figure 1)
Challenges and Recommendations
While keeping physical limitations in mind, common
activities may be well accommodated in the existing
home environment with relatively straightforward,
achievable solutions. Consider the following
recommendations noted in italics immediatly after
each stated challenge. Also note that many of the
specific challenges/solutions apply across several
situations.
Entering/Exiting Home
• Difficulty grasping and turning circular knobs or
handles:Utilize linear handles or pulls
• Grasping and turning a key: Install a keyless
locking system
• No place to set items while opening the door:
Include small exterior bench to allow a place to
rest and set items
Fig.1: Lighting at stair treads supplements contrasting edge
differentiation.
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Meal Preparation
• Grasping and turning circular knobs or
handles:Utilize linear handles, or push buttons
• Decreased ability to bend and lift: Use storage
between knees and shoulders
• Objects in top or bottom cabinets needed in
preparation:Use roll-out shelves and kitchen
organizers located between shoulders and knees
(see Figure 2)
• No resting area/seat to utilize while preparing
meal:Remove portion of cabinetry to provide counter
with chair
• Inability to see small details/objects in preparing
food:Include a magnifier within easy reach,
increase light levels
• Decreased depth perception: High color contrast
between adjacent objects
• Dark areas under hanging storage: Utilize undercabinet
lighting with lamps properly shielded from
the eye in both sitting and standing positions
• Not enough light to perform most basic
functions:Add task lighting to decrease shadows
and provide consistent lighting levels
• Direct glare from exposed lamps make it difficult
to focus:Ensure all lamps are properly hidden from
view by location, semi-transparent or opaque
reflector
• Reflected glare makes tasks more difficult to see-
Surface materials should have matte finish to
eliminate glare spots
• Slippery floor surface: Use non-slick, water
absorbent flooring
Eating
• Difficulty moving food from preparation to dining
area:Provide wheeled cart to transport items
housed in base cabinet.
• Determining height of eating and sitting areas:Seat
height at or slightly above knee level, lightweight
(yet sturdy) chairs (see Figure 3)
• Diminished muscle capacity in rising and
sitting:Armed chairs with high apron help with
sitting and rising
• If natural light creates uncomfortable glare:Install
adjustable blinds, shades, or drapery over all
natural light sources
Personal Hygiene
• May tire while performing personal hygiene
tasks:Seating at counter
• Grasping and turning circular knobs and
handles:Utilize linear handles, pulls and straight
toilet paper holders (see Figure 4)
• Objects in lower cabinets needed in activities: Place
storage in a height zone between knees and
shoulders
Fig.2: Install kitchen rail organizers for common-use items.
Fig.3: Arm chair with open
apron assists in rising.
Fig.4: Decrease number of specific
actions for common tasks.
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• Stepping into and out of shower: True walk-in with
no threshold, non-slip surface
• Tiring during shower: Seat/bench within shower
stall
• Reflected glare makes tasks more difficult to
see:Surface materials should have matte finish to
eliminate glare spots
• Shadows cast in shower/tub appear as
objects/ obstacles:Direct/indirect lighting source
should be installed over the shower/tub
• Inability to see small details/objects: Provide
magnifier, magnifying mirror, and adequate lighting
levels
• Normal night lighting situation not bright enough
to be useful:Adjustable night light, light entire
pathway to bedroom
• Closet racks and shelving hard to access: Height
adjustable closet racks and shelving (see Figure
5)
• Slippery floor surface made slicker by water: Use
non-slick, water absorbent flooring
• Difficulty distinguishing surface edges due to
decreased depth perception:High color contrast
between adjacent surfaces
Sleeping
• Getting into and out of the bed: Lower bed height
to seating level
• Opening/closing windows for ventilation: Large
handles or knob to open, or automatic adjustment
• Normal night light not bright enough to be useful:
Adjustable night light lighting entire pathway to
and from room
Leisure Activities
• Seat height of chairs, sofas: Seat height slightly
above knee, auxiliary tables at mid-torso height
• On/off switches on light sources: Large button,
rocker panel, or motion detected
• Diminished muscle capacity in rising and
sitting:Armed chairs to help sitting and rising (see
Figure 6)
• Severe change in light intensity from area to
area:Ensure consistent light source and intensity
between areas
• Shadows may appear as actual objects or
obstacles:Consistent light sources throughout
room to decrease dark areas
• Direct glare from exposed lamps make it difficult to
focus:Ensure all lamps
are properly hidden
from view by location,
semi-transparent, or
opaque reflector
• Natural light creates
u n c o m f o r t a b l e
glare:Install adjustable
blinds, shades or
drapery over all natural
light sources
Fig.6: To aid in rising and sitting,
select arm chairs with
height-appropriate arms and
open aprons.
Fig.5: Reorganize clothing storage to reachable zone.
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Cleaning and Laundry
• Placement of appliances require bending: Appliances
placed above floor to decrease bending
• Need for objects on storage shelves above shoulder
height:Locate storage in a height zone between
shoulders and knees (see Figure 7)
• No rest area while folding or ironing clothes: Provide
seating at counter, table, or task area
• Dark areas under hanging storage: Under-cabinet
•
lighting
Grasping and turning circular knobs and
handles:Utilize linear handles or pulls
• Objects in lower cabinets needed in
preparation:Storage placed in a height zone
between knees and shoulders
• Requires more light to perform most basic
functions:Additional task lighting to decrease
shadows and provide consistency
Conclusion
The implications for aging in place discussed in
this article only touch the ‘tip of the iceberg.’ Each
ailment commonly associated with aging has
physical and mental characteristics which can be
significantly impacted (for better or worse) by the
environment. Sometimes the decision to age in
place is not appropriate, necessitated by medical
concerns However, with appropriate environmental
accomodations, aging in place is a possibility for most
individuals.
References
—The National Aging in Place Council. (2009).
Available from http://www.naipc.
org/Default.aspx?tabid=103
—Hootman J., Bolen J., Helmick C., & Langmaid
G. (2006). Prevalence of doctor-diagnosed
arthritis and arthritis-attributable activity
limitation-United States, 2003-2005.
—Centers for Disease Control and Prevention. (2009)
National Center for Health Statistics. Available
from www.cdc.gov/nchs/nhis.htm
—National Osteoporosis Foundation.
(2009). Available from www.nof.org
—Lighthouse International. (2009). Available from
www.lighthouse.org/medical/the-aging-eye
Resources
—www.aarp.org/universalhome
—www.aginginplace.org
—www.homemods.org
—www.abledata.com
—www.seniorresource.com
—www.medem.com/medlib/60
—www.design.ncsu.edu
—www.cornellaging.com
—www.build4boomers.com
—www.nahbrc.com
—www.dynamicliving.com
—www.accesstoday.com
—www.geocel.com
—www.adi/home.htm
—www.aidsforarthritis.com
—www.comforthouse.com
—www.activeforever.com
—www.keybowl.com
—www.lifewithease.com
Fig.7: Place storage within a zone from knee-to shoulder-level
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About the Authors
Katherine S. Ankerson, MS,
NCARB certified, IDEC, is
Associate Dean and Professor
of Interior Design in the College
of Architecture at the University
of Nebraska-Lincoln where she
has taught since 1996. Previous
experience as a Professor at
both Radford University and
Washington State University came following 15 years
as an architecture and interior design practitioner.
Ankerson’s work lies in the areas of translation of
research from medical and other professions as
formative issues in design of the built environment,
principally related to senior living environments. She
has authored multiple books and authored multiple
articles and is a frequent presenter.
Betsy S. Gabb, EdD, FIDEC,
IIDA, is a Professor and
Program Director in the
Interior Design Program in the
College of Architecture at the
University of Nebraska-Lincoln.
Gabb has served on the Board
of Directors for the Council of
Interior Design Accreditation
(CIDA) and is currently serving as Chair of CIDA’s
Standards Committee. In the past, she has served as
the Midwest Regional Chair for the Interior Design
Educators Council (IDEC). Gabb’s research interests
include teaching strategies for design and the design
of senior living environments. Her work has been
published in a variety of publications including the
Journal of Interior Design and IIDA’s Perspective.
Related Research Summaries
InformeDesign has many Research Summaries
about aging in place, and other related topics. This
knowledge will be valuable to you as you consider
your next design solution and is worth sharing with
your clients and collaborators.
“Age and Gender Affect Color Memory”
—Color Research and Application
“Why Older People Move or Wish to Move”
—Housing, Theory and Society
“Clarifying Aging in Place Vocabulary”
—Housing and Society
“Decreasing Risk Falls for Seniors”
—Journal of Safety Research
“How People Interact with Doors”
—Applied Ergonomics
“Effect of Daylight on Cataract Vision”
—Color Research and Application
“Age and Illuminace Affect Color Perception”
—LEUKOS: Journal of the Illuminating Engineering
Society of America
Images Courtesy of
Caren Martin (p.1)
Katherine S. Ankerson (remainder)
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