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UDC: 362.6:72228.4 Keywords: Activities of daily living; Aging in place;
Collaboration; Elderly resident;.
Architectural Science Review
Volume 41. pp 157--164
Involving the Elderly in the
Design Process
O. DemirbilekA† (Saritabak), H. DemirkanB
Based on the concept of ‘ageing in place’, a prescriptive model is proposed, aiming at the creation of a usable, safe and
attractive built environment where the elderly residents are actively involved in the design process through collaboration
sessions. Quality Function Deployment (QFD) has been adapted to develop an evaluation and translation method for
the collected data of the elderly end-users.
Introduction
Many studies were conducted in attempts to design better houses
and interiors for the elderly (1 to 14). However the opinion of the elderly
themselves related to the design itself is never or rarely considered, as
Cavanagh (3) , who involves older women in the design of house
interiors and equipment in her studies, mentions. The ideas and
comments of old people certainly play an important role in the building
design process. Woudhuysen (15) says that elderly people, besides
responding to questionnaires and attending to focus groups, should
also work in teams with designers, entering early and directly into the
design process. This paper describes a prescriptive model in which the
end users, mainly the elderly residents, can be involved actively in the
design process. Quality Function Deployment (QFD) has been adapted
to develop an evaluation method for the collected data (views and
ideas) of the elderly end- users.
The Ageing Process and the Built
Environment
While getting old, one gradually looses a lot of abilities in daily life
activities. Heikkinen and his colleagues (16) add that aging is associated
AMiddle East Technical University, Faculty of Architecture, Department of
Industrial Design, 06531 Inönü Bulvari, Ankara - Turkey.
e.mail: oyademir@vitruvius.arch.metu.edu.tr
B BIilkent University, Faculty of Art, Design and Architecture, Department of
Interior Architecture and Environmental Design, 06533, Bilkent, Ankara - Turkey.
e.mail: demirkan@bilkent.edu.tr
† Corresponding author
with an increasing prevalence of many chronic diseases and disabilities.
This situation influences how old people deal with their environment.
They may have problems in moving around (mobility deficits), in
manipulating objects (deficits in dexterity), and in receiving proper
information from outside (sensory deficits). Each of the above stated
groups includes a wide range of related problems. The greatest problem
that an older person faces is the loss of independence. This can be
achieved by the assessment of functional status and preventing
disability.
Functional status in ageing includes basic activities of daily living--like
feeding, dressing, ambulating, bathing, transferring from bed to toilet,
grooming, and ability to communicate. Barbaccia (17) claims that
problems occurring frequently are with bathing; problems with
dressing, eating, and grooming are less frequent. Furthermore, he states
that around 80% of the elderly people are mobile and able to get around
in their home and with some limits in the community. Assistance is
most often required with daily activities (18, 19, 20, 21).
Musculoskeletal dimensions, mechanical performance, flexibility of
joints, muscle strength, gait speed, bone density are all important factors
in the physiological system and changes occur in these with ageing.
Arthritis, heart disease, diabetes, difficulty with vision and hearing are
more common in older people. These problems with muscles and joints
as hip fractures really contribute to a decrease in activities of daily living
and instrumental activities of daily living (17). The individuals have the
greatest difficulty related to most functional mobility as heavy
housework; climbing stairs, walking half a mile and gripping with the
upper extremities. The instrumental activities like shopping, doing light
housework, and cooking are less difficult.
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Architectural Science Review Volume 41
A more significant cause of injury and concern are falls,
which account for many hospital admissions and movement
in nursing homes. They are extremely common health
problems for the elderly resulting from neuromuscular and
functional decline. Nevitt (22) claims that there is little
research or data to support the hypothesis that
environmental modifications can prevent falls. Most of the
research has been done on Caucasian population because
falls are a major cause of fractures in this race and people
living in Turkey belongs to a subgroup of Caucasoid.
Stairways without railings, high and irregular steps, clutter
on the floor, a loose rug or a bathroom without grab bars are
the mostly encountered risk factors in a house.
Even if hearing and vision deficits associated with aging
can be corrected with aids, “designers should ensure that
features such as door frames, door handles, steps, stairs and
walkways are well-distinguished by using visual contrast,
achieved either through brightness or colour differences to
make the key features moreconspicuous” (23). Glare from
luminaries, windows and shiny surfaces should be controlled in a
house environment. Local adjustable task lighting can be used to
meet the special needs of elderly people.
Kose (24) accuses architects and designers of not yet being
prepared to accept design requirements for elderly people. He lists
those requirements as follows: Elimination of level differences
(including the elimination of door sills); installation of handrails
(said by architects to interrupt design consistencies in the space);
installation of door level handles; installation of larger switches;
installation of easily operable facilities, etc. (25). There are certainly
many other requirements that can be added to this list, such as the
provision of: adequate lighting avoiding large contrasts (26),
illuminated and well located light switches, visual as well as
auditory alarm systems, differentiation of wall and floor surface
textures, colour coding, induction loops to assist hearing aids,
sound insulation, rounded corners and edges, sliding doors
(particularly for cabinet and cupboard doors), contrasting stripes
on the edges of the treads of any stairs, handrails extended beyond
the top and the bottom of stairs, etc.
The rates of population growth and population aging vary
across countries. The rate of population growth is higher in
developing countries like Turkey, whereas population aging is
higher in developed countries. Even if so, it is predicted that 9.3%
of the population of Turkey will be over the age of 65 in the year of
2025 (27). For this reason the housing policies of Turkey should
supply the housing needs of elderly people and the architects
should be concerned about the quality of life of the residents at all
ages.
Sandhu (28) says that the elderly are potentially the fastest
growing consumer market in the developed countries. He also
advises that designers and manufacturers should make evaluative
research with respective groups of elderly users, at all the stages of
the design process, and particularly before the introduction of new
products. Brink (27) points out that most dwellings are not “senior-
friendly” or barrier free, and that those dwellings are designed
without considering even the basic requirements of elderly
residents, resulting in their exclusion from everyday life.
While modern housing is achieving ever-greater technical
capacity to meet the more specific requirements for
habitability, concern for housing conditions that supports
the psychological and social well-being has not followed
these developments. Many studies of theelderly have
attempted to enumerate and describe the typical activities
performed by
this age group, in the course of their days (8, 17, 18, 19, 20,
29). Unfortunately it has been difficult to translate this
information into design applications.
It is argued by some researchers (30, 31) that when products and
environments are made more accessible to people with limitations,
they have potential benefits, for everybody, such as: lower fatigue,
increase speed in performance, and lower error rates. As space
requirements are more complex for the aged persons, Kose and his
colleagues (2) claim that the elderly should be accepted as the
determining factor in design, and taken as a base and a reference to
the human interaction with the built environment. Thus, if a house is
designed (interior, furniture and equipment) according to the
requirements of elderly people, this same house will also be
adequate for other age groups. This is reinforced by the words of Lee
Fisher: “If the home is designed correctly, many people probably
would be unaware of most of the special features for handicapped
persons” (7).
A Universal Design Base
Researches have shown that psychological well-being is one of the
most intrinsic aspects of successful aging (29, 32, 33). Studies have
identified various factors having impacts on the psychological well-
being of the elderly including housing and neighborhood
environments. Imamoglu and Imamoglu (6, 34) noted that, the
Turkish elderly, on the whole, consider the personal (home-related)
and environmental aspects of their neighborhoods most important;
followed by the functional and natural characteristics; whereas, the
architectural and recreational aspects are considered least important
among the other qualities regarded. They also found that although
the attitudes of the Turkish elderly, in general, are negative towards
institutional living, they become more favorable with urbanization
and age.
The current life situations of the elderly in Turkey show that they
do not live in extended families. However, the Turkish culture is
based on close-knit interpersonal relationships where support and
sacrifice of parents toward their children, and the obedience to and
responsibility of children to care for their parents in old-age are
widely accepted strong values (34, 35). Thus, the housing units for
the elderly should be organized in such a way to satisfy the needs for
such social interdependencies. The universal design concept helps to
integrate aging which is a natural stage of life into the social and
physical aspects of living environments in a meaningful manner (36)
without extra costs nor alterations in terms of aesthetics.
Calmenson (37) states four criteria, named as “the four A’s” of
universal design, as follows: accessibility, adaptability, aesthetics, and
affordability. Accessibility enables a person to fully utilize the entire
space, whether they have failed vision, are pregnant or use a
wheelchair. Adaptability is important especially when the current or
future residents plan to live in a house for many years, thereby ‘aging
in place’. Aesthetics refers not only to making a universally designed
environment beautiful, but also to making it helpful without
appearing different or utilitarian. Affordability promotes an idea that
an adaptable home can be built for the same cost if it is properly
designed at the beginning.
The concept of universal design relates people with their biological
and cultural heritage, and it helps to define a person’s sense of self,
and place in the world, also connecting them to the future. People
need the opportunity to shape situations, places, and activities that
affect their lives. It is desirable to allow more and more aged people
to get old in their present place of residence, and the universal design
concept is a recent development to make this possible.
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Number 4
December 1998
In this concept, children, young people, aged people and disabled
people are all equally considered, and there is no principal user
(people with disabilities, elderly, children, pregnant women, people
carrying packages, etc.) (38). According to Brink (27) universal design is
usually a synonym for good design, because attention is paid to achieving
the best use of space while enhancing usability; and on the other hand, it
reduces costs over the long term. Furthermore, Morini and Pomposini
(39) point out the social and psychological disadvantages of designing
dwellings especially for the elderly, where they feel themselves rejected
from everyday life. Dagostino (40) adds that universal design allows
people to be independent, safe and comfortable. According to Steinfeld
(21) universally designed buildings are accessible and usable by
everyone, including the disabled; and they provide accommodation for
the elderly and the young people, in short, for a majority of persons.
Universal design differs from accessible design, which often has a
medical or institutional look (21). It allows high standards of aesthetics
because it is integrated in the design process from the beginning, and
because it can be incorporated in any style or setting.
Basic Functions of a House
Housing must fulfill the needs for the daily activities of the elderly, and
more precisely it must give them: satisfaction, security, comfort, and
independence, or at least one of them. The basic functions that a house
interior has to fulfill have been stated and grouped in Figure 1.
Functions of a house interior
Usability Attractiveness
Comfort Daily life
activities
Ease in
mobility
and
circulation Independence
Safety
Privacy Security Safety Shelter
A
esthetic Pleasure
in use Quality
The resulting figure depicts the three main groups as usability, safety and
attractiveness; which are emphasised throughout the study.
Comfort, daily life activities, ease of mobility, and independence are
listed under the group of usability. Shelter, security, safety, and privacy are
listed under the group of safety. Aesthetics belongs to the group of
attractiveness. Comfort includes the feeling of thermal comfort
(temperature, humidity, drafts), adequate lighting level and colour
vision comfort, hearing comfort, and physical comfort. Daily life activities
include: cooking and eating; sleeping and resting; grooming; dressing
and undressing; use of shower, bath, toilet, and wash basin; operating
doors and windows; washing clothes - washing dishes; carrying objects -
moving furniture; operating thermostat; walking on carpet; reaching for
high objects; chair comfort (sitting, standing up); counter convenience -
(storage); stair and ramp use - elevator operation; finger and manual
tasks (sewing, writing, playing cards); getting in and out of bed; hearing
and viewing things; using household appliances (vacuum, iron, kitchen
robot); performing hobbies (plants, knitting, needlework...); watching TV,
listening to radio, hi-fi, recorders; wheel chair mobility; operating a
telephone (accessibility, convenience); etc. (19).
Ease in mobility includes all the movements (with their degree of
easiness) that a resident can make while circulating in the house.
Independence includes the feeling of it and the ability to carry out the
daily life activities without assistance. Privacy, security and safety are
interrelated. They deal with available systems and designs preventing
and helping in rescue during any harm from outside the house (burglar,
intrusion, aggression ...) or from any accident (fire, gas infiltration, smoke
...) that may occur. Safety also includes the safe use of any house
equipment without the risk of accident. Privacy is also a condition
reached in a state of independence, in this chart, it belongs to the safety
group. A well-designed house will ensure greater use, safety, security,
and privacy. Shelter is the place where all the functions and activities of a
house are encompassed. Aesthetic includes taste, preferences and value
judgments of the residents.
Researches in literature are mostly oriented toward the construction of
housing for the elderly. These types of housing include: senior housing,
sheltered housing, nursing houses, community dwellings, and so on.
Few studies are interested in letting people aging in place (1, 41, 42, 43),
without having to move. It has been pointed out that daily life activities
can be carried out nearly successfully by elderly residents with
diminished abilities if they are familiar with the surrounding. On the
contrary, these activities can be very hard to carry out, even by less
disabled elderly people, when they are not familiar with the surrounding
(44, 45). In most of the studies on elderly and their house environment,
their opinion and ideas during the stages of the design process were
never asked. Therefore, it will be an important issue to provide a
collaboration between elderly residents and designers.
Figure 1. Basic Functions of a House.
This study proposes a collaboration between experts and end users at the
various stages of the design process. The main focus in the present study
remains oriented towards a design process that will make possible (on a
universal design basis) allowing to ‘age in place’, taking into account the
real world needs of the end user (the elderly in this case) by their
participation in the design process, and combining theirs with the
empirical knowledge of designers. Kose (24) points out the importance of
design modifications, from the view point of usability and safety, to cope
with the decreasing capability of the ageing population.
The results obtained from these collaboration sessions form a base for
designing appropriate house interiors and also serve as guidelines.
Briefly, the creation of a physical interior environment, having in mind
the notion of aging in place, is a complex task. It requires the organization
of appropriate information. The knowledge of designers combined with
the knowledge (opinions, ideas) of the elderly end users should be
involved in the design process because it is not an autonomous business .
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Architectural Science Review
Furthermore, Sheehan (46) adds that the physical design of housing
interiors plays a major role in influencing the quality of life of all elderly
residents.
The Model
The phases of the design process in the Usability, Safety, and
Attractiveness Collaboration (USAC) Model (see Figure 2.) is as follows:
• In the first stage, collaboration sessions are organized with small
groups of elderly people. Small groups consisting of 6 people are said
to successfully produce up to 150 ideas in half an hour at their first
attempt (47). At this stage, they will produce ideas and define their
exact needs and preferences towards the design of house interiors.
This will be a combination of brain storming and unstructured
interviews, where the ideas, comments (written, oral, sketched, or
gestures), and needs are collected. All the data collected in this stage
are classified in the USAC Model.
Construction
Planning
Construction
FURTHER DEVELOPMENT
OF THE CONCEPTUAL
SOLUTION
Knowledge data-base
Ideas and drawings
•
•
Contribution of
designers
Contribution of
elderly end-users
Feasibility study
ACQUISITION OF
END-USER’S NEEDS,
REQUIREMENTS AND
DESIGN REQUIREMENTS
PROPOSITION OF
DIFFERENT CONCEPTUAL
SOLUTIONS FOR HOUSE
DESIGN
TO AGE-IN PLACE
Designers:
Interior architects,
architects,
designers.
End-users:
Elderly
residents
Figure 2. The USAC Model.
• The second stage is the feasibility study where optimal ways to solve
the problem are searched for by the
designers.
• The third stage consists of the
proposition of different solutions to
the problem (designing house
interior allowing ‘aging in place’). In
this stage, elderly users will be
involved for the second time to
make preferences among the
solutions.
• The fourth stage consists of further
developments and refinements of
the chosen solution, detailed design,
comprising all the technical side of
the design process, achieved by the
designers.
• The fifth stage is the construction
planning.
• The sixth stage is the realization of
the construction.
In this model, the end-users, mainly
the elderly residents, are involved
actively in the design process. The
expertise of architects and interior
designers are combined and
compared with that of elderly people
themselves (their own opinions and
ideas on their requirements), and
related to how an interior house
environment should be designed to
allow ‘aging in place’. Eason (48) sees
such an approach as a combination of
design by the user and design for the user.
This combination is important because
human beings are not just task
performers; they have ambitions,
beliefs, emotions, values, satisfactions
and dissatisfactions (48) of their own
that no designer can anticipate or
imagine for them. Furthermore,
Means (41) points out
Volume 41
that constructive dialogue and just task performers; they have ambitions,
beliefs, emotions, values, satisfactions and dissatisfactions (48) of their
own that no designer can anticipate or imagine for them. Furthermore,
Means (41) points out that constructive dialogue and partnership
between users and professionals help in improving the effective use of
existing resources, in order to ensure independent living for the elderly.
Methodology
Figure 3. depicts the simplified process of this involvement and the
steps to be followed.
The collaboration sessions are held with the end-users, a selected
group of elderly people, male and female above 65, from the city of
Ankara. Random sampling is used among a group of volunteers. In
these semi structured interview sessions, a group of 4 to 6 end-users are
asked to ‘design’ the house that they want to age in, considering all their
possible requirements, needs, particular wishes and ideas. These
collaboration sessions are recorded on video for later evaluation (to recall
all the details).
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Number 4
December 1998
In this collaboration, the expertise of designers and the opinions of elderly
are related to the design of a house environment, interior, and/or
equipment to allow aging in place. In these sessions, to take place
naturally, the following general conditions are taken into account for
communication and coordination:
--
Fi
Specific or concrete goals of collaboration are not known to, or cannot be
clearly defined by any participant at the outset.
- Heterogeneous systems of representation and action employed by
individual members are necessarily involved, such as: talking, writing,
sketching, moving hands, mimicking (which makes the use of a video
recorder essential), etc.
- No pre-defined scheduling schemes can be applied for all the sessions.
The results of those collaboration sessions are combined and
compared with the help of the USAC Model.
Use of Quality Function Deployment (QFD)
in the Evaluation Stage
Hudspith (49) points out that in practice, users rarely respond in usable
design terms, and that their responses are difficult to translate into
dimensions. Elderly residents and designers may speak almost a
different language than that of a designer. As an example, a resident
might say “I want a door that is easy to open”. The translation into
technical language might be “door will open with minimum applied
force”. Or a requirement such as “ the soap should leave my skin feeling
soft” must be translated into “pH or hardness specifications for the soap”
(50).
QFD, which originated in Japan (devised by Professor Yoji Akao in 1972)
in the 70’s and was useful in the USA in the 80’s, is widely applied in the
business world. Today, it is one of the most appropriate methods in use
that can enable designers to translate end-user needs into product
requirements, because it focuses on quality as going beyond an “us-
versus-them” mentality (51). In this study, the processes of QFD are
adapted and modified into the USAC Model to develop an evaluation
method for the collected views and ideas of the elderly end-users, on
their design ideas, level of interest, needs and preferences related to the
design of their house interior. In this method, the users (the elderly
residents) are seen as designers or members of the design team, and they
are cooperating in the design process. This method fits the abilities and
circumstances of all the people involved, asking them to help in the
design of the research itself as well as contributing to its results.
Conclusion
To avoid complicating the lives of elderly people by imposing on
them inadequate housing, their contribution in the housing design
process should be encouraged (3). What people’s different needs are;
how they might prefer to use interior house spaces; what their housing
requirements are; and what their opinions and ideas are, should be
questioned before starting the design process and during this process.
According to Eason (48), in such a design process, the end users can
influence the design in a way that agrees with their goals and beliefs
because “only those who will be affected can decide what is in their best
interest” (p. 1668). Furthermore, Mitchell (52) argues that the design
theories of architects such as Le Corbusier and Venturi were essentially
incomplete because they were only dealing with forms, with no
meaningful attention paid on how the users will be affected by these
forms. To be able to design high-quality housing where people will want
to live and age-in-place, professionals should have the direct contribution
of elderly people’s lifestyles and requirements (3). The main goal of such
a collaboration is to improve the quality of life of elderly residents in
particular, preserving their dignity, independence and self-
determination, and to improve the quality of life of all residents in
general. This study can also be extended to areas other than the private
house interior environment, such as public areas, offices, schools, hotels,
hospitals.
g
ure 3. Involvement Process in the
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PROBLEM
z The number of elderly increases constantly;
z Houses are not adequate to AGE-IN-PLACE;
z Designers are reticent to accept some
requirements of the elderly;
z Designers decide for the elderly.
ÖThere is a mismatch between house
interiors and the elderly residents
WHAT TO
DO
Ask the elderly residents (end-users):
z How they prefer to use interior spaces;
z What are their real needs and requirements.
ÖLet the end-users participate and
collaborate to the various phases of
the design process.
HOW TO
DO
z Make surveys with the elderly and the
designers;
z Organize collaboration sessions with the
elderly where they are “designers”;
z Collect every idea and requirement using a
Usability, Safety, and Attractiveness (USAC)
Collaboration Model;
z Deploy the results to the whole design
process.
Ö Collaborate with the elderly through the
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