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ASLI QoL 2017
AQoL2017Kuching
http://www.amerabra.org; https://fspu.uitm.edu.my/cebs
3rd ABRA International Conference on Quality of Life
“Quality of Life 3”
Riverside Majestic Hotel, Kuching, Malaysia, 14-16 Oct 2017
eISSN: 2398-4287© 2017. The Authors. Published for AMER ABRA by e-International Publishing House, Ltd., UK. This is an open access article under the CC BYNC-
ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Peer–review under responsibility of AMER (Association of Malaysian Environment-Behaviour
Researchers), ABRA (Association of Behavioural Researchers on Asians) and cE-Bs (Centre for Environment-Behaviour Studies), Faculty of Architecture, Planning &
Surveying, Universiti Teknologi MARA, Malaysia.
https://doi.org/10.21834/e-bpj.v2i6.965
113
Promoting Ageing-in-Place: Design of residential buildings for older people in China
Tulika Gadakari 1, Jingjing Wang 2, Karim Hadjri 2, Junjie Huang 2
1 School of Art and Design, Coventry University, Priory Street, Coventry CV1 5FB, UK
2 School of Architecture, The University of Sheffield, Western Bank, Sheffield S10 2TN, UK
tulika.gadakari@coventry.ac.uk
Tel: +44 (0) 2477658374
Abstract
Ageing-in-place is the most common ageing model in China. Therefore, design of age-friendly residential buildings and neighbourhoods becomes an
important factor leading to improvement in older people’s health and quality of life. This paper presents the current situation of the ageing population
in Chinese cities by qualitatively analysing existing literature, design standards and conducting stakeholder interviews to understand older people’s
housing choices as well as establish physical design factors, challenges and potentials of residential design for older people. The findings will fill the
knowledge gap of age-friendly residential models in China and guide better design to meet older people’s needs.
Keywords: ageing; age-friendly design; residential building; spatial design
eISSN: 2398-4287© 2017. The Authors. Published for AMER ABRA by e-International Publishing House, Ltd., UK. This is an open access article under the CC BYNC-
ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Peer–review under responsibility of AMER (Association of Malaysian Environment-Behaviour
Researchers), ABRA (Association of Behavioural Researchers on Asians) and cE-Bs (Centre for Environment-Behaviour Studies), Faculty of Architecture, Planning &
Surveying, Universiti Teknologi MARA, Malaysia.
https://doi.org/10.21834/e-bpj.v2i6.965
1.0 Introduction
The global population is undergoing a marked demographic shift, where older people will soon outnumber youth populations owing to
increase in life expectancy, falling fertility rates, and lifestyle changes. The number of people aged 65 or older is projected to grow
from an estimated 524 million in 2010 to nearly 1.5 billion in 2050, with most of the increase in developing countries. (World Health
Organisation, 2011) In China, people aged 60 and over are defined as ‘older people’ and this population is rising rapidly due to an
overall increase of life expectancy of 29.8 years since the 1960s to 2010 (OECD, 2014). The number of Chinese people over the age
of 65 are likely to grow from 123 million in 2011, 200 million in 2026, 300 million in 2038, to 330 million by 2050, with around 100
million over the age of 80 (World Health Organisation, 2011; United Nations, 2013; OECD, 2014). According to China’s Ministry of
Civil Affairs, the number of people aged 60 and over is currently 222 million, which comprises of 16.1% of the total population and has
already surpassed the above prediction (CIIC China, 2016).
In tandem with demographic change, China is also undergoing massive social and economic transitions. The country is witnessing
key changes in family structures, urbanisation, educational advancement, technological development and increasing participation of
women in the labour market. These shifts are challenging the traditional family-based care arrangement for older people. In the future,
for every younger couple there will be four or more older family members who require daily care and assistance. (Feng, 2014) This will
have direct consequences in terms of access to social care and financial security, and may even influence the quality of life.
1.1 Ageing-in-Place
According to Davey, de Joux, Nana, & Arcus (2004), ageing-in-place is defined as “remaining living in the community, with some level
of independence, rather than in residential care”. It is a way in which older people can manage their homes and live with greater
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autonomy, choice and control while maintaining their emotional attachments to family and community, without the cost and hassle of
moving (Best & Porteus, 2016).
According to the National Bureau of Statistics of the People's Republic of China (2016), home-based ageing model is the most
common in China. China has a long familistic history and people are keen to uphold the traditional practice of family-based care rooted
in the ideological foundation of filial piety and mutual support, thus preferring to age-in-place (Zhou & Walker, 2016). Although family
support systems are weakening due to the growth of individualism, urbanisation and mass migration, the family and home -based care
models still occupy a large proportion of care models for the older population in China (Zhang & Goza, 2006; Li, 2010). The results
from the National Bureau of Statistics of the People's Republic of China (2016) reiterates the same by listing the reasons as to why
older people chose a home-based care model in the Zhejiang province:
a) 84.2% convenient, free life
b) 51.3% the company of family
c) 35.8% familiar living environment
d) 34.9% saving money
e) 5.1% difficult to find suitable care home
f) 2.1% feel shame to go to care home
In the Chinese context, one must acknowledge that community care is often perceived as an alternative to institutional care and
there is no clear boundary between ‘home care’ and ‘community care’ (Tian, 2010). Home care service is defined as, a government
and social force that is based in the community, which provides a wide range of health and social services such as day care,
housekeeping service, rehabilitation care, canteens, centralised meal delivery and spiritual comfort for older people to age-in-place
(Tian, 2010; Zhou & Walker, 2016).
Pannell & Blood (2012) and Torrington (2014) identify, mobility support, sensory support, support for cognitive failings and health
and safety, as key while adapting homes or local neighbourhoods for older people to age-in-place. There is significant evidence that
making homes more accessible, with better spatial configuration, can reduce the need for care, reduce falls, increase independence
and improve quality of life (Iwarsson & Ståhl, 2003; Burmeister, 2010; Best & Porteus, 2016). Additionally optimising lighting,
maintaining comfortable temperature, providing good outdoor spaces, views and tonal contrasts makes it comfortable, healthier and
safer for older people (Roelofsen, 2014; Hussein, Omar, & Ishak, 2016; Gupta, Barnfield, & Gregg, 2017). Personalisation of space,
use of design prompts, colours to ‘theme’ areas, meaningful artwork, pictorial signage and pictures can help orientate older people with
dementia and other cognitive impairments. An environment that is designed to be intuitive and easy to use can enable older people to
experience a sense of competence, choice and control, thus making a positive difference to a person’s self-esteem (Faith, Hadjri,
Rooney, Craig, & McAllister, 2015; Twyford, 2016; Walker, 2017).
Ageing in familiar surroundings has shown to have a positive correlation with health and well-being and sense of satisfaction and
contentedness (Renaut, Ogg, Petite, & Chamahian, 2015; Hussein, Abidin, & Omar, 2016; Stones & Gullifer, 2016; Dahlan &
SultanIbrahim, 2017; Yousefi, Hosseini, Yazdanfar, & Norouzian-Maleki, 2017). Older people wanting to remain in their homes and
communities for as long as possible helps in the maintenance of social connection and support from family and friends (Lawler, 2001;
Muhammad, 2016; Zakariya, Harun, & Mansor, 2016). Additionally, ageing-in-place is also an option to avoid the expensive choice of
institutional care and is therefore favoured by policy makers, health providers, and by many older people themselves (World Health
Organization, 2007). However, ageing-in-place may not be a perfect option for older people who face various challenges, such as
dementia, visual impairment, acute mental illness or financial issues (Kang, Lyon, & Kramp, 2012).
The use of technology is actively enabling aspects of ageing-in-place by transforming the way health, social care and other
assistive services are designed and delivered (HACT, 2016; Local Government Association & Institute of Public Care, 2016; Agile
Ageing Alliance, 2017). Systematic mapping of current advances in assistive technology revealed that health is the main purpose for
people to use assistive technologies (Labonnote & Høyland, 2015) and the most equipped room in the house is the kitchen (Gibson,
Dickinson, Brittain, & Robinson, 2015). By interviewing older people that currently use assistive technology, Jennings, Hadjri, &
Abdelmonem (2012) discovered that security was a main factor that motivated the use of technology.
1.2 Residential Design: current situation in China
The home environment is a vital consideration and determinant for daily activities and participation for the older generation.
Specifically, the physical settings of housing help support independent living, and is a critical indicator for older people who wish to
continue to live a normal life at home for as long as possible. (Iwarsson & Wilson, 2006) The home environment plays an important
role in later life as it becomes increasingly relevant to older people’s health who spend most of their time at home, far more than any
other setting (Danziger & Chaudhury, 2009). Danziger & Chaudhury (2009) propose that if environmental factors were to match the
individual’s capabilities, frailty can be delayed, more independence can be achieved, and vulnerability and risk of injuries can be
reduced. Zhang, Liu, & Qi (2015) establish, living arrangement (live with children or not); social connection between neighbours;
shopping facilities; health facilities; recreation centre and fitness facilities; sense of community; community activities; level of property
management, as factors that impact the life satisfaction of older people in China.
According to Shu (2006), the homeownership rate of Chinese older people in urban areas is 82.1%, which is the highest rate in the
world. There are a number of housing types currently available in urban China such as, the traditional si he yuan courtyard, new build
commercial housing, unit compound (staff accommodation), affordable housing community, low price housing community and
combination housing community (Gao, 2013). Li (2010) reports, the source of older people’s housing is varied:
a) 40.9% of houses are ancestral (mostly owned by farmers)
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b) 18.8% of houses for older people are allocated by the employer (or previous employer)
c) 14.1% are second-hand buys
d) 11% of older people buy affordable housing
e) 8.2% have commercial housing
According to the China Health and Retirement Longitudinal Study (2013), which is a nationally representative sample of Chinese
residents, ages 45 and older, 45.7% of older people live in multi-storey buildings, while only 22% of buildings have handicapped
facilities such as ramps and 12.9% of buildings have more than 25 steps to access the main entrance.
Family structures and living arrangements greatly influence the area of homes in China. From a sample size of 420 respondents
(Zhang, Liu, & Qi, 2015) a family of two (43.3%) is the most common type for older people, closely followed by the family of five (21%)
and four (18.1%). 49.4% of 60-70 year olds co-reside with their children and the percentage rises to 58% as people age over 80 years.
85.9% of 60-70 year olds live with their partner, while only 38.2% of people over the age of 80 years live with their partner. (China
Health and Retirement Longitudinal Study, 2013) The housing area of older people in Beijing is about 50-100m2, and is proportional to
the number of family members. Older people living alone mainly occupy 50m2 or less; a family of two usually occupies 50-100m2; and
a family of five usually occupies 100-150m2. (Zhang, Liu, & Qi, 2015) 5.2% of older people or couples occupy less than one room;
25.5% have one room; 24.5% have two rooms; 20.6% have three rooms; 14.3% have four rooms and 9.8% have five rooms. Based on
this data (Li, 2010), 24.3% of respondents’ living space is spacious, while 30.8% respondents do not have enough living space.
1.3 Current building design standards for ageing populations
Currently there are a number of building standards for inclusive design all over the world, which align with inclusion requirements and
disability acts. For example, the UK Part M building standards and the UK Lifetime Homes Standards aim to make the home more
accessible and inclusive of disabled and older people. The US ADA Standards for Accessible Design are enforceable accessibility
standards. Some of the other building design standards for older people include, Accessible Design for the Built Environment,
Canada; Recomendaciones de Accesibilidad, Mexico; Design for access and mobility, Australia; Malaysian Code of Practice on the
Accessibility and Mobility of Persons with Disabilities, Malaysia; and Guidelines and Space Standards for Barrier Free Built
Environment for Disabled and Elderly Persons, India. (Hadjri, Afacan, & Gadakari, 2016)
The latest design standard for older people in China titled ‘Code for design of residential building for the aged’ is suitable for new-
builds, extensions and reconstruction of residential buildings. This standard aims to meet older people’s need for safety, accessibility,
health, cost-effectiveness and environmental sustainability by employing 30 criteria under 5 categories (MOHURD & AQSIQ, 2017):
1) Site and planning- considers elements such as adequate sunlight, ventilation, access to public transport, barrier-free walking
paths, wheelchair pathways, handrails, recreational facilities, accessible toilets, wayfinding systems, green coverage, stairs, etc.
2) Public space- considers elements under sub-sections of entrance; public walkway; stairs and lifts; and emergency evacuations.
3) Space within the dwelling unit- introduces adequate dimensions for each living area; minimum living space per person; minimum
wheelchair turning area; window heights for wheelchair eye level; space to meet future needs for adaptations; etc.
4) Physical environment- considers indoor environment under the categories of acoustics; lighting; heating/cooling; and ventilation
5) Building equipment- includes standards for equipment needed for water supply and sewerage system, fire protection and smoke
management, heating and ventilation, alarms and emergency call systems, motion sensors, etc.
1.4 Aims and Objectives
This paper aims to understand older people’s housing choices as well as establish physical design factors, challenges and potentials of residential
design for older people in China. In order to achieve this, the following objectives have been set out:
1) To analyse existing literature and design standards for older people’s environments in China;
2) To conduct stakeholder interviews with Chinese experts in the field of ageing and the built environment; and
3) To develop a set of recommendations, which will fill the knowledge gap of age-friendly residential models in China and guide better design to
meet older people’s needs.
2.0 Methodology
A list of academic researchers and practitioners who are experts in the field of ageing and have been involved in projects for older
people in China was compiled. These experts were contacted by phone and email to gauge their interest in the study and asked
whether they would be willing to be interviewed. Nine experts agreed to be interviewed via telephone, which included: Professor
(Social Science) and Associate Professor (Architecture), Tsinghua University, Beijing; Professor (Social Science), Chinese Academy
of Sciences, Beijing; Professor (Interior Design) and Associate Professor (Environmental design), Beijing Union University, Beijing;
Chief Designer (Interior and Product Design), Beijing; Design Director (Architect), China Construction Design International (CCDI),
Shanghai; Chief Architect, Shanghai; and Architect, Hunan Province.
The interview questions were developed based on findings from the literature review and previous research by the authors and
were concerned with housing choices, physical design factors, challenges and potentials of residential building design for older people.
The interview schedule contained fourteen questions as follows:
Q1) From your experience of designing for older people, what would be the major design factors to consider that can support their
ageing-in-place needs? Can you prioritise these factors according to your opinion?
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Q2) Are you aware of any specific standards, or design guidelines for older people’s living environment? During your design
process, do you refer to them? How important do you think these standards or design guidelines are?
Q3) Are you aware of government policies regarding the ageing industry in China? Do these policies influence or guide your design
project in any way?
Q4) According to research data, many older people are currently living in overcrowded conditions in China. In your opinion, is it
possible to change this situation by designing in a more efficient way (architectural/interior design)? Can you provide any
examples?
Q5) In China, some older people are currently living with their children or even grandchildren. From your point of view, is it possible to
better support multi-generational living by means of architectural design? Can you provide any examples?
Q6) Meanwhile, there are also some older people who choose to live alone or with their partners in order to not put much pressure on
their children. How do you think we can support these older people through design?
Q7) While conducting refurbishment or reconstruction, which elements or conditions of the existing environment could potentially
become design barriers?
Q8) In the housing projects, how could the design better adapt to current residents’ future needs as they get older?
Q9) How do you think financial affordability affects older people’s decision to refurbish, reconstruct and adapt their homes?
Q10) In your opinion, how to reflect human-centred care through housing design? How do you maintain the balance between human-
centred care and the value of design? Can you provide any examples?
Q11) How to maximise the feeling of home through the use of architecture/interior design in care home settings? Can you provide any
examples?
Q12) Are you aware of any assistive technology which can provide or is providing support to older people so as to create a more
independent, healthy, and safe living environment?
Q13) Do you think community care is important for ageing? In what way can the design of community affect older people’s everyday
lives?
Q14) What is your understanding of ageing-in-place? In your opinion, why do you think older people in China prefer to age-in-place?
The purpose and duration of the interviews were explained to the experts at the start of the interviews. The interviews were
designed to be semi-structured and hence the researchers remained as neutral as possible, encouraged responses, did not interrupt
and allowed silences to give participants time to think. The interviews were audio recorded, then transcribed verbatim, translated from
Chinese to English and thematically analysed. The researchers familiarised themselves with the data, which involved reading and
rereading the text to spot similarities, differences, and contrasts. Themes were established, reviewed and refined collaboratively
between four members of the research team at regular meetings to ensure reliability, consistency, and to minimise bias. Differences of
opinions concerning the definition of themes were resolved through group discussions. Ethical approval for the interviews was
obtained from the University of Sheffield’s Research Ethics and Integrity Committee.
The experts were selected due to their unique knowledge and contribution to the field of ageing and the built environment in China.
The research could be limiting due to the small sample size and that the experts are only from Beijing, Shanghai and the Hunan
province.
3.0 Results and Discussion
In addressing the current situation of the existing housing choices available to older people in China and the design issues, challenges
and potentials associated with these, this paper focuses on five particular, but interconnected aspects of the experts’ experiences. The
interviewees gathered upon their knowledge and expertise as academic researchers and design practitioners to address the themes
of design, spatial requirements, emotional factors, community and technology as highly important factors to improve the future of age-
friendly residential models in China to enable older people to age-in-place.
3.1 Design
Health and safety was unanimously prioritised as the most important factor to consider while designing for older people, followed by
accessibility, sensory and then cognitive factors. Most experts added, a familiar environment that was convenient, comfortable and
flexible which catered to social and psychological needs should be considered in parallel to the above factors. The common design
factors highlighted by the experts, which enable ageing-in-place are thematically divided as follows:
Table 1. Design factors that enable ageing-in-place
Accessibility
Sensory
Health & Safety
Cognitive
Social
Spacious rooms
Natural light
Anti-slip flooring
Familiar environment
Community centres
Wide corridors & doors
Motion sensor controlled
lights
Design to prevent falls
Design to create memory
triggers
Activity areas for dancing, art,
calligraphy, music, etc.
Wheelchair ramp
Close to floor lighting at night
Rounded furniture
Photos of children, memories
Religious buildings
Turning area for wheelchairs
Ventilation
Lifts to accommodate
stretchers & hospital beds
Design that encourages
purpose and routine
Public toilets
Lowered furniture height for
kitchen worktops, cabinets,
wardrobes, etc.
Thermal comfort
Community Health Care
facilities (consultation,
rehabilitation, management)
Senior education schemes by
the community
Public seating
Gadakari, T., et. al., / 3rd AQoL2017Kuching, 14-16 Oct 2017 / E-BPJ, 2(6), Nov 2017 (p.113-121)
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Modifications in bathroom,
toilet & kitchen
Soothing colour schemes
Dual opening doors to
prevent locking in
Community library & theatre
Local amenities (shops,
public transport, etc.)
Walk-in showers
Acoustic materials
Extra storage for medicines
Public spaces that feel safe
Walking pathways
Handrails and grab bars
Views
No thresholds
Indoor plants and greenery
Automatic & sliding doors
Outdoor spaces & landscape
Comfortable stair gradients
Structural flexibility for future
adaptation
All the experts responded that the building design standards for older people were important and guided their design process as
well as their research, though they agreed that the current design standards in China were still at an early developmental stage and
need to be more detailed; focus on older people’s health and ergonomics; provide more information on assistive technologies; reflect
more design flexibility; be sensitive to older people’s needs and issues; and cater to the significant differences in the northern and
southern parts of China in terms of climate and lifestyle. Two of the experts who had experience in rural design shared that there were
currently no design standards for older people in rural settings. This resulted in most practitioners relying on the ability and experience
of rural builders which though gave them more freedom in terms of design but also elevated the risks.
The question regarding government policies for the ageing industry in China gathered mixed responses which ranged from very
good to ‘hollow promises with few practical solutions’. Some of the experts believed that the government was implementing a number
of effective policies in areas of foreign investment, pension system, vouchers and gift cards, support to build community centres,
encouragement of public-private partnership models, job placements and postponement of retirement age. Some of the experts added
that the policies needed to be detailed, put into practice and the government needed to provide more community level care services,
train care professionals and improve infrastructure.
Some of the experts noted that though some old 6-7 storey buildings in China were being refurbished by adding lifts externally
there were issues with cost sharing, blockage of views and excessive noise. Limited space was also perceived as a barrier to refurbish
buildings in the old parts of Beijing city especially when surrounding buildings impacted access to adequate natural light and
ventilation. Most experts suggested that flexible design should be encouraged for future adaptability though in their practical
experience they had struggled with the structural framework (mainly loadbearing walls) that limited their design intentions of opening
up interior spaces for better mobility and natural light. Additionally, the wooden structures of rural and traditional buildings posed a
limitation in this aspect. The experts noted that modifications in the bathroom which involved replacing the bathtub with a walk-in
shower and adding grab bars were most needed. Some of the experts identified that traditional home design should be encouraged
with the incorporation of new environmentally friendly technologies for maintaining better standards of thermal comfort, lighting,
acoustics, etc. An expert noted that designers should avoid going overboard with the design features that made a person ‘feel old’ by
blending the clinical/institutional aspects with the rest of the décor.
Several common themes emerged when financial affordability for home refurbishment was discussed and the opinions were
unanimous. Most experts felt that a certain socio-economic section of Chinese older people could not afford refurbishment of their
homes with their meagre pension and savings. At the same time, most experts concurred that there is a rising affluent middle class in
China which can afford to spend money on home improvement but the consumer attitude of this older generation is very different and
they are quite frugal. The older people belonging to this section would avoid spending their money owing to lack of time and effort,
saving money for their family and lack of awareness. It was believed that this situation could be remedied by the government providing
part funding or subsidiaries and raising awareness of modern design and technology.
3.2 Spatial Requirements
The experts were of the opinion that overcrowding was predominantly an urban issue and older people in rural parts of China had
enough space as they were experiencing the ‘empty nest syndrome’ with most young people moving to the cities for better
opportunities. Most experts agreed that better design and innovative solutions would make a huge difference to the living environment
in crowded homes. Three of the experts shared their experience of refurbishing small homes for older people where multifunctional
furniture (such as height adjustable kitchen worktops, cabinets, etc.), well-designed storage, clearing out cluttered paths and improved
natural light, were employed to improve accessibility, safety and the ‘experience of the home’.
One of these experts introduced the concept of ‘time sharing’ where multiple spaces in the home can be used for different
functions at different times of the day, by various family members, so as to promote multigenerational living in tight spaces. Most of the
experts agreed that conscious design which considered both the generations’ varied lifestyle, promoted ‘co-working’ and
communication within families were key to resolving multigenerational family conflicts. Differing sleeping patterns of the generations
sharing a home were considered to be the most disruptive. Providing better acoustics so that different generations could function
without disturbing each other and be mindful of privacy needs was considered key by most experts.
Some experts suggested that if the family could afford to, then they should invest in two apartments within the same community so
that everyone can have their own independent space and reduce family conflicts while staying close to one another for care and
emotional support. Another solution suggested for overcrowded homes was providing community centres so that older people can
have space to enjoy activities that they cannot accommodate in their homes. One of the experts argued that design which considered
privacy needs could be an important tool while designing affordable care homes, which usually have shared rooms occupied by two to
three older people.
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3.3 Emotional factors
All the experts unanimously agreed that architectural design which supported older people’s physical and psychological needs and
enabled them to function independently on a daily basis would be considered as human-centric design.
One of the experts recommended that integration of user-friendly assistive technologies with architectural and interior design was
an effective future strategy that should be explored by China. Additionally, the traditional courtyard housing model of China was
considered a good example of human-centric design as it provides a balance of private-public space. Unfortunately, the experts noted
that current mainstream housing in urban China is mainly mass housing which fails to satisfy the needs of older people. In such cases,
some of the experts indicated that the onus of human-centred care would lie on better community design. Experts suggested
displaying photos of children, memorabilia, having pets and having space to engage in social activities as simple methods to reduce
loneliness. Some experts recommended that instead of focusing on design for older people, designers should concentrate on lifetime
housing which could be adaptable as people aged.
Usually Chinese older people do not want to move to care homes as they do not feel attached to the new surroundings, hence it
was deemed very important by all experts that care homes employ a sensitive design approach to make older people ‘feel at home’.
Additionally, most experts reported that maintaining older people’s dignity and privacy in a care home was key to making them feel
comfortable. Two of the experts noted that the current care homes in China either felt like a ‘hospital’ or a ‘hotel’. In other words, some
of the care homes were too institutional while others were luxuriously built to impress, but either ways they both lacked the personal
homely feeling. Some of the care homes have tall, immaculately decorated entrance lobbies which lack the intimate and pleasant scale
of a home. In some instances, the dining and social areas felt very institutional. The experts recommended that dining areas needed to
be designed more casually with smaller dining tables, sofas and break out spaces, as they were a hub of social activity. Experts also
suggested that older people in care homes should be allowed to bring their own furniture, memorabilia, reposition their décor and have
freedom to personalise their space according to their needs and lifestyle. Also it was very important to provide private social spaces in
care homes which could be used when family and friends visited.
3.4 Community
The experts concurred that designing a better community environment not only includes the physical aspects such as a barrier-free
design, open spaces, walkways, public toilets and outdoor seating but also cultivating a sense of community. Most experts agreed that
the design of community spaces should be conducive to older people’s social life, encourage activities and multigenerational
interaction. It was suggested that well-designed communities should provide services such as health care facilities (consultancy and
emergency), convenience shops, fitness facilities, activity rooms, cafes, day care, night care, food delivery, etc. The consideration of
safety and accessibility were important but it was equally important to ensure that the design did not feel ‘like a hospital’. One of the
experts suggested that traditional teahouses and cafes should be encouraged in the communities which could act as ‘focal points’ for
older people to congregate and share experiences with younger generations. It had recently been observed that some of the current
cafes and teahouses in urban China were a bit ‘upscale and alien’ for older people to use comfortably. The experts recommended the
use of design to create memory triggers by incorporating sensory elements such as colours, sounds, landscape, etc.
The experts shared that some well-organised communities were providing services to older people such as checking up on them
socially, providing free telecare bracelets and large button telephones to contact during an emergency, help buying groceries and
medicines and providing gym equipment in public parks. Additionally, it was reported that small-scale community run care homes were
gaining popularity as older people preferred to live within their familiar community, near their children and friends, while enjoying the
option to have care and health services.
The barrier with regards to community design as noted by most experts was the lack of space, limited resources and funding. One
of the experts narrated that many of the developers in charge of community centres had built them in underground spaces as these
did not generate any profit. Such spaces were undesirable and largely unused by the community. It was felt that such situations could
be remedied through government funding and strict policies and regulations.
3.5 Technology
The one-button emergency call system which contacts hospitals, family and neighbours in times of emergency was one of the most
favoured assistive technology (AT) by most experts. This technology had quite a mixed response, as most experts noted that it
granted older people with some level of safety and independence but reported that this technology was not yet properly supported by
the Chinese care services. They believed that due to the current lack of services, infrastructure, legislation and regulations, there was
a massive disconnect between technology and the Chinese care system. Medical and health related AT such as those used to monitor
and report health statistics (blood pressure, glucose levels, etc.) were also considered important by the experts, followed by telecare
pendants and bracelets. Additionally it was reported that smart home technologies that improved indoor environmental quality such as
voice controlled and motion sensor activated lights, air purifiers, air conditioners and humidifiers were equally necessary. AT which
would help combat loneliness and social isolation, such as video chatting, smartphones and those that assist with failing memory such
as cooking hobs with automatic shut off, medicine reminders were also discussed positively.
A common theme that emerged through all the interviews was that AT was perceived to be expensive and its affordability would be
a major issue hindering their uptake. One of the experts suggested that government funding and sharing of some AT by the
community, could be economical solutions. Most experts observed that older people of the next generation would be more receptive to
and make better use of technology, though there will still be new technologies which the next generation may never know how to use
due to reduction in learning ability and other sensory difficulties faced by older people. Hence it was unanimously agreed that AT
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designed specifically for older people must be ‘easy to use’ and meet all their needs by not being too advanced and complicated to
operate. Raising awareness to educate and encourage older people to use AT was also noted.
3.6 Discussion
The interview results concur that ageing-in-place can be a viable housing choice for people in China if not only the physical needs but
the psychological needs of older people, such as companionship, family values, traditions, are satisfied. The experts had similar views
on what guided Chinese older people’s housing choice and the following reasons were highlighted for ageing-in-place:
1) To save money as good care homes were unaffordable
2) Tradition of familial care and support
3) To live with family
4) Help raise grandchildren
5) Continue to live within their familiar home and community
6) Sense of independence, freedom and belonging
7) Care homes in China are not up to the standard (staff is not well-trained, institutional environment)
8) Societal pressure and embarrassment associated with moving to a care home
9) Children find visiting care homes too inconvenient
Though ageing-in-place is considered the future of ageing in China there were concerns raised about the level of support available
and the limitations due to age and health. It was argued that relatively healthy older people, probably in their 60’s and 70’s, were more
likely to age-in-place. But as people grew older and were afflicted by health conditions that affected their mobility, cognition, etc., they
were more likely to move to care homes or be moved by their children who worried about them. Most experts observed that China was
currently at an early developmental stage with regards to the services and facilities that would enable older people to age
independently in their own homes. This situation could be improved through better building design standards for older people,
government support, infrastructure, legislation and regulations, coordination between technology and the Chinese care system. The
interviews revealed current challenges which inhibited older people from ageing in their own homes and neighbourhoods, which
included:
1) Crowded mass housing
2) External addition of lifts leads to blockage of views, excessive noise and reluctance among residents to share costs
3) Community design is hampered due to the lack of space, limited government funding and inadequate policies and regulations
4) Refurbishment of old residential buildings is difficult due to limited space, inadequate light and ventilation and structural inflexibility
5) Unwillingness of older people to engage in home refurbishment due to meagre pension and savings, conservative consumer
attitude, lack of time and effort, saving money for their family and lack of awareness
6) AT is perceived to be expensive and its affordability is a huge hindrance to its uptake
In terms of financial barriers, it was speculated that the rapidly changing economic scenario and rise of consumerism in China
would contribute to a new generation of older people who are willing to spend money on their future as opposed to the current older
population which belonged to a past that fuelled their frugal lifestyle. The experts also observed that there was some existing potential
which needed to be further explored so as to enable older people to age-in-place better. These positives included the traditional
Chinese courtyard housing model, effective government policies, services provided by the community and community run care homes.
4.0 Conclusion
The interview findings have revealed the challenges, potentials and needs of older people in China as experienced by the experts
through their research as well as designing projects for older people in China. The findings of this research will help fill the knowledge
gap present in the current housing models in China so that they can be significantly age-friendly and establish innovative design
solutions which take into account the cultural, social, economic and political contexts. This research could potentially benefit a range of
stakeholders, i.e. decision makers and local governments; architects, interior designers, product designers; health and social care
professionals; and professionals from the AT industry, to guide better design and to meet older people’s needs in the future.
To conclude, this research proposes some recommendations, which include:
1) Human centric design that promotes health and safety and is supportive of physical and psychological needs of older people
2) Traditional Chinese courtyard housing design with incorporation of new environmentally-friendly technologies for better thermal
comfort, lighting, acoustics, etc.
3) Detailed building design standards for older populations with focus on health and ergonomics; information on AT; design flexibility;
sensitive to needs; and cater to the significant differences in the northern and southern parts of China
4) Encourage refurbishment of homes through government funding, subsidiaries and raising awareness of modern design and
technologies
5) Improve crowded multigenerational homes through multifunctional furniture; multifunctional, co-working spaces; sensitive design
for varied lifestyles and habits; better acoustics; features to improve natural light; well-designed storage; circulation spaces; and
access to local community centres
6) Design to create memory triggers by incorporating sensory elements
7) Blend institutional aspects associated with age-friendly design with the rest of the décor
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8) Create a familiar homely environment in care homes through an intimate and pleasant scale; casual dining areas with sofas and
break out spaces; scope to personalise space with their own furniture, memorabilia, photos; and having pets
9) Improved community design with scope for social activities, multigenerational interaction, professional care, health care facilities,
fitness facilities, cafes and food delivery
10) Integrate user-friendly assistive technologies (AT) with architectural and interior design
11) AT designed specifically for older people that is ‘easy to use’, meets all their needs and is not complicated to operate
12) AT that, assists during emergencies; monitors and reports health conditions; maintains improved indoor environmental quality;
helps combat loneliness and social isolation; and assists with failing memory
13) Government funding for AT and its sharing by the community
14) Raise awareness to educate and encourage older people to use AT
Acknowledgements
This research is co-funded by the Economic and Social Research Council (ESRC), UK; L’Agence Nationale de la Recherche (ANR),
France; and National Science Foundation of China (NSFC), China. We would like to thank all the experts who took the time to
contribute to this research with their valuable insight and knowledge.
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