The WHO latest guidelines on housing and health have five key areas and accessibility is one of them. The “strong recommendation” is, “Based on current and projected national prevalence of populations with functional impairments and taking into account trends of ageing, an adequate proportion of the housing stock should be accessible to people with functional impairments.” In the remarks it argues that living in an accessible home improves both independence and health outcomes. Although the guidelines argue for a proportion of housing stock it has put the issue on the agenda. It shows it is as important as all other factors. However, the notion of proportion can lead some agencies to think that means specialised and segregated housing. It is worth noting that the lead author of this section is an Australian, Prof Peter Phibbs. The other key areas are crowding, indoor cold, indoor heat, and home safety. For more detail there is an additional document showing method and results of the systematic review that underpinned this section of the Guidelines – Web Annex F. and includes interventions such as home modifications and assistive technology.
Because the majority of our homes are designed as if we are never going to grow old, most of us will need to modify our home as we age. That’s if you want to stay put, which is what most older people say is their preference. An easy to read and nicely presented report from Centre for Ageing Better in the UK gives an excellent overview of how home modification improves quality of life, mental health and overall independence. All good reasons for universally designing our homes from the start for the whole of our lives so modifications aren’t needed or are at least easier to do. Dwellings might be a “product” to property developers but for the rest of us a “home” is the pivot point for living our lives.
A great quote from a study participant to reflect upon, “You don’t get taught, at any point in your life, how to become an older person. It just sort of happens, you know…”. So waiting for consumers to ask for universal design isn’t going to work.
For a more academic take on a related issue of housing quality and health see a longitudinal study from UK.
Hospitals can be distressing places at the best of times. If you have dementia or other cognitive condition it can be a frightening and disorienting place whether a patient or a visitor. Stressed patients stay longer and need more medication.Taking a universal design approach can provide a better experience. Academic research and consumer input underpins this comprehensive guide to designing dementia-friendly hospitals from a universal design approach. In Ireland, where the guide was developed, they estimate almost one third of patients have dementia and as the population ages this will increase. Of course, dementia friendly design using a UD approach is good and inclusive for everyone. The guidelines are available to read online using Issuu software.
Below is a short video that provides an overview of the design factors that need to be considered in creating a dementia friendly hospital.
There is also a media release that provides an overview of the development of the guidelines and the project partners.
Ever wondered what the long term effects of a home modification are? A longitudinal study from the UK shows that household improvements in social housing can reduce risk of hospital stays, particularly in older people. While the study picks up major improvements in chest and heart health, it also found that falls and burns were reduced too. Over the ten years of the study, they found that homes that were modified and upgraded correlated with reduced hospital events. That means savings in the health budget or beds freed up for other patients. Obviously it is better for occupants too. It is not clear how poor the condition of the housing was prior to the upgrade or modification relative to Australian housing. This is an academic paper outlining the methods and comparing to other studies, but the discussion and conclusions give you the take-home message – health and the quality and design of housing quality are related and should be integrated in policy-making and planning.
One key finding was: “Using up to a decade of household improvements linked to individual level data, we found that social housing quality improvements were associated with substantial reductions in emergency hospital admissions for cardiovascular conditions, respiratory conditions, and fall and burn injuries.”
The title of the study is, “Emergency hospital admissions associated with a non-randomised housing intervention meeting national housing quality standards: a longitudinal data linkage study”. Sarah Rodgers et al. Journal of Epidemiology and Community Health.
The Center for Health Design based in California has produced an excellent checklist that focuses on design features specific to older people. Of course, such features will generally benefit others. The checklist is meant to support a universal design approach to environments for ageing populations. It is not meant to be used as a list of comprehensive specifications, but a “thought starter”. It is probably best used to guide the discussion of design teams at the outset of a project. The checklist covers Home and Community including residential, Healthcare and design of clinics and emergency rooms, and Workplace designs and strategies.
The checklist matrix lists the strategy or goal, design considerations for the built environment, and the universal implications (benefits for everyone). For example, the goal of ageing in place in one’s home requires (among others) features that are easy to clean and maintain, and the universal implication is that it increases the suitability of housing for a wider range of users and potential buyers. The checklist has a comprehensive reference list to support the content and for further reading.
Compressed urban footprints might be related to higher rates of depression. Drawing a long bow here? Maybe not. In, Mind over matter: The restorative impact of perceived open space, the authors argue that the loss of natural open space could be having a detrimental affect on mental health: “By 2050 three out of four people will live in urban environments.This premium on open space will reduce vital access to the healing effects of undisturbed nature”. The article by David Navarrete and Bill Witherspoon discusses some of the neuroscience about enclosed spaces, lack of natural light and other factors and how they relate to our perceptions of the world around us. There are references for further reading at the end of the article. The article was posted on the Conscious Cities website.
In the rush to get people walking and being “active travellers” we’ve forgotten a place that most of us walk everyday – our home. This becomes even more important for people who have difficulty getting out and about in the outdoor built environment. So what features should we be looking at in indoor environments to encourage physical activity? Maureen C Ashe is interested in this question. Her book chapter, Indoor Environments and Promoting Physical Activity Among Older People, looks at the issues. You will need institutional access for a free read from SpringerLink.
Abstract: Our house, our homes, ourselves: who we are, and the places that we inhabit are indelibly interwoven. Data are fast accumulating on the significant role of the outdoor built environment and physical activity (and health). For populations such as older adults with (or without) mobility impairments, a poorly structured built environment can significantly restrict community engagement. Despite the fact that we spend most of our lives indoors, there is far less empirical evidence to discern features of the indoor environment that influence physical activity. There is a need to focus on buildings incorporating age-friendly designs to support “ageing in place,” to build homes (and communities) that nurture social interaction, and identify destinations and routines that encourage adoption of activity into daily life habits.