Life-Span Design of Residential Environments for an Aging Population

Design and Problems of Aging

David Levy, Arch.D.
Director

Clark Malcolm, Ph.D.
Senior Associate

Herman Miller Research Corporation

The only place for people to live as they age is where they want to be. Overwhelmingly, older people prefer to live in their own homes. Enlightened design can help make that possible.

People have certainly grown old before, and older people have surely been hampered for years both by their living environments and by the products in their homes. At some point, most older people can no longer meet the demands placed on them by their environment and face this predicament: they must either get help or move to a less demanding place. Too many people are forced to leave for congregate housing or nursing homes. The sheer numbers of older people likely to find themselves in this dilemma are forcing American society to take a new tack. The environment must do some of the adapting. The American home must become more forgiving of the inevitable physiological and mental effects of growing older. It's that simple.

Of course, some people already understand the problems. Others are only beginning to understand that keeping people at home as they age is a complex and multifaceted issue. It involves financial concerns, health care issues, norms of family behavior, and aspects of federal, state, and local policy. Many people are working from these directions. But who is considering the physical environment? The design of the physical environment may even stimulate progress on other fronts. Look at how a single product, the microwave oven, has sparked changes in the way people cook, the things they buy at the grocery store, the way food is packaged, and even the layout in some areas of grocery stores.

Designers and the organizations they work for can be prime agents in an attack on stubborn, inflexible, and dangerous places where older people live. But to set as their goal "universal" design (design for all ages and abilities, sometimes referred to as "transgenerational design") isn't enough. Universal design is a laudable goal. It exceeds our grasp and maybe it ought to. If a design is truly universal and we are hard put to find very many examples of truly universal design -- one of two things will be true: either the problems solved by the product will be small ones, problems that lend themselves to universally acceptable solutions; or the product will be a compromise in the eyes of one of the groups it seeks universally to satisfy. Universal design may remain as an ideal, but researchers and designers also need something more pragmatic to guide their work.

The Case for Industrial Designers

Living environments can contribute directly to a person's life, liberty, and pursuit of happiness or -- since we're waxing revolutionary -- "quality of life," in Patrick Henry's phrase. Unfortunately, millions of living environments all over the United States now contribute directly to debility, institutionalization, and spiritual hopelessness. In a crisis, almost everyone understands clearly the connection between the environment and personal independence. But why should it take a crisis? If an environment and the products within it can contribute directly to personal well-being, can help people even in the pursuit of rights guaranteed in our culture, everyone surely should have a chance at a supportive and appropriate place to live. Toward this end we can make the following assumptions:

Living environments designed with the problems of aging in mind are an absolute and pressing necessity for American society.
Technology, high or low, is only a means often inadequate or irrelevant and never an end. And "low" technology that extends a person's abilities is surely of a higher order than the fanciest gizmo whose buttons bear symbols only the initiated can decipher.
Somewhere along the continuum between complete ability and total disability lies a point where people require extremely specialized products or environments, thus rendering those products useless or undesirable to most other people.
If corporations are to play a large part in a national effort to design and develop and make available enabling environments, they must see a way to contribute while working within the constraints they face in our capitalistic system. In other words, they must be able to make a profit in their work for older and disabled people. Constraints are usually "friendly" facts, something we simply have to deal with. So it is in this case.

People of all ages feather their nests, make a house a home -- there are many evocative ways to translate the academic "adapt one's environment." Many older people have modified their homes themselves to compensate for a loss of strength or sense of balance. These ad hoc modifications, however, are usually inadequate and often unsafe.

Industrial design has a unique and professional point of view from which to modify living environments (including the design of products for those environments) so that they promote longer lives of ability and self-sufficiency. Consider the following points:

Designers are used to defining problems. This is the first step in designing any product. To define the problems entailed in modifying homes for elderly people, they begin by asking the following questions: Just exactly what problems do older people have in their own homes? What demands are most likely to send them packing to another place to live? Our own research shows that problems with home maintenance, mobility, and shopping are among those most likely to cause older people to move out of their homes.
In the manifestation of a problem, designers usually find the seeds of a solution. The best designers never impose a solution upon a problem; rather, they derive a solution from the problem. (Perhaps only the rare genius in invention can engender true solutions outside the context of a given problem.) With designers, of course, the solution is almost always a product. After all, when you call the fire department, you'll probably get hoses, axes, and water.
Designers understand the interactions among people, products, and environments. They are students of living. The first step, an easy one, is to transfer this knowledge to the special case of older people and the places where they live or would like to live. The working out of solutions will not be so straightforward.
Designers understand manufacturing processes. Research just isn't enough. Designing and developing products in our time is an expensive proposition. The process by which a product is manufactured has to be accounted for in its design. Designers can comprehend in a product the findings of research and the prerequisites of manufacturing.
Designers -- at least the good ones -- are familiar with the process of innovation. And in the design of products and environments for older people, we desperately need new ideas.
Designers can bring about change through their products. For instance, the design of products can change a person's behavior or self-image. The Rollator, a Swedish mobility aid cum shopping cart invention, perfectly exemplifies how the functions and appearance of a product can change an older person's image from immobile and dependent to mobile and self sufficient.

What We Don't Need and What We Do

There are a few things we don't need in the search for enabling products and liberating environments for older people. In our experience, we have come across three groups of people who may be trivializing real progress in the field of design and aging: publicity seekers, marketing experts, and trade show organizers.

Our work with older people has shown us, as if we needed reminding, that they are perceptive and shrewd. The older people we know can spot a charlatan at 50 yards. Individuals and organizations who have publicly attached themselves to the problems of older people without offering any real solutions harm the groups who have something of substance to say.

Marketing is a necessary process in our culture; occasionally it is even useful. Many people claim to be experts in marketing to the "mature market." None seems to have much special insight or compassion, however. One of the best things we've seen, by the way, on marketing to older people is AARP's own booklet titled "How to Advertise to Maturity."

Still, people have problems, not markets. Problems and their solutions define markets. Let us not forget that a product and its design lead the selling of that product. The reverse will produce superficial or even false solutions. Given the patience, experience, and shrewdness of most older consumers, a new product had better perform -- that is, solve a problem. People need look no further than at the controversy concerning the Contour chair (manufactured by Craftmatic/Contour Organization, Inc.) to convince themselves of the danger of an enterprise led by marketing.

Trade shows, too, are worthwhile endeavors -- when there is something to show. However, most products on the market today claiming to be for the "senior market" are simply slightly altered products designed years ago for mass consumption. Trade shows or exhibitions focusing on products and services for the elderly have tended to be demeaning collections of objects and services that cater to the fears or dependencies of older people. Why don't the organizers wait until they have enough bona fide improvements in living to offer to older people? When we can have all the trade shows the exhibition halls can handle.

Now to the much more interesting question: What do we need? As might be imagined, other people have already considered this problem. A few books deal with housing and older people, although almost all of those focus on institutional or congregate housing. The American Institute of Architects has published a guidebook, Design for Aging. Sandra Howell's Designing for Aging deals with patterns of use and programming; Vic Regnier and Jon Pynoos have described the issues around congregate housing in Housing the Aged, as has Martin Valins in Housing for Elderly People; and Joseph Koncelik in Aging and the Product Environment has looked more specifically at residential environments.¹ But many of these books simply apply barrier-free guidelines to housing for older people. All start from the perspective of what older people cannot do.

We would rather start with the assumption that many older people suffer only minor disabilities. We want to amplify what they can do. Literature framed under this assumption and specifically treating design of the residential environment and the products in it for older people simply doesn't exist, even though the huge majority of older people reside in single-family homes. James Pirkl and Anna Babic do offer some basic guidelines for "transgenerational" products in their 1988 publication.² The catalog New Design for Old, published in 1986 from an exhibit in London's Victoria and Albert Museum, displays the ideas of many prominent European designers on everyday products for older people; some of these ideas have since made it into production. The catalog to the Museum of Modern Art's 1988 exhibit Designs for Independent Living, written by Cara McCarty, touches tangentially on products for older people. But documents like these are rare since only a few designers are concentrating on this issue.

Designing for problems of aging brings some new and definite difficulties to designers. Of course, designers are used to designing products that ease or solve identified problems, but many find the problems of older people unfamiliar. In designing products for older people, we at Herman Miller Research Corporation ask that the products be bias-free as well as not stigmatize a person as old or disabled. These requirements place new constraints on the design of products. Finding current, reliable, and comprehensive anthropometric data on older people, presents another difficulty.

To research, design, develop, and make available products and living environments for older people, then, we would like to call for the following courses of action. Some of these needs are specific to research and design organizations; some are required of society at large.

1. There must be a closer integration between research around issues of aging and the design of products or environments with those issues in mind. Some organizations are already working toward this goal: the Stein Gerontological Institute in Miami; Advanced Living Systems in Oxford, Mississippi; and the Centre for Studies in Aging in Toronto, for example. If corporate attention is to be gained, focused, and turned to productive use, we must make corporations more aware of the work of places like Stein.

2. Companies such as Marriott, White/Westinghouse, Whirlpool, and Mutations (in France)-no doubt there are other examples-have already begun to grapple with the problems of aging in the research, design, and manufacture of products for residential living environments. We hope that more corporations will join in that effort. Doing so costs money. Only with the resources of the business community will we see broad and quick improvement.

3. Anthropometric data on older people must be maintained on a par with that from other segments of the population. Will the data today be true of future generations of people over age 65?

4. We need to make the population in general more aware that the environment and not the person is the problem. Almost without exception, older people in our studies blame themselves before they find fault with their environments. Such a meekness in the face of difficulty results from an ignorance of the possibilities, an unawareness of the degree to which people can change their environments. People must make the demands. Environments, not people, need to change. A Scottish surgeon in Wellington's army gave the British a big edge over Napoleon by using the environment. Without understanding the reason, but having read of the practice in Alexander the Great's army, he insisted that the British army construct its latrines below the source of water. Thus, a much greater proportion of Wellington's soldiers were healthy and able to fight; Napoleon simply accepted the high incidence of dysentery and disease as a condition of war. It stands to reason, then, that even such a small-scale environment as one's home can be manipulated to human advantage.

5. We need an enlightened group of organizations to examine what we think is a demonstrable connection among the cost of long-term care insurance, a safe environment, and health.

6. We need to understand better the impact the environment can have on care giving in the home.

7. Finally, we call for a set of design by which to judge the work of designers will help bring products and environments into the real world.

Principles for Design

In 1987, early in our work on aging and disability, at The Herman Miller Research Corporation, we developed a set of principles in conjunction with designer Bill Stumpf. These principles, agreed to at the beginning of actual design work, have helped us keep the primary goal for the design in mind: products that respond to genuine needs of older people but do not stigmatize these people as old. To some degree, all the products, environments, or services designed at Herman Miller Research Corporation are true to these principles. We hope that every group trying to develop solutions to problems of aging will devise its own.

1. Bias-free: Not requiring youth or complete ability; helps a broad range of people of different ages and abilities. Environments and products should not presume a user to be young or old or to possess a certain level of physical ability. There is no "normal" age or body. A perspective of normalcy, if forced often enough on public consciousness, preempts an open-minded look at aging and disability. As far as possible, a product should certainly not stigmatize a user as older and should probably not speak loudly to the fact of age. People still prefer to choose how they are distinguished from others, rather than having distinctions imposed upon them, Most of the time, an older person wishes to be considered simply another member of society-a member with certain abilities, not one limited by disabilities.

The Tide laundry detergent bottle, a design provoked by a concern for people with arthritis or little strength, is a good example of bias-free design. The large cap opens easily and holds a cup of detergent. The bottle is easily balanced while being poured, and an inner rim prevents the detergent from spilling down the outside of the bottle.

2. Well-mannered: Takes into account that the way people will live or work changes as people age; readily reveals its purpose. The iconography in the software for the Macintosh computer mimics the way people work at desks, presenting a familiar pattern. Symbols for a trash can, file folders, and so forth reveal to an inexperienced user how the software and operating system work.

Objects should also become familiar, so much so that they disappear in use. People should be able to feel unaware that a product or environment is doing anything at all. A pair of Fiskars scissors, with its specially designed plastic handles and easily manipulated blades, can make one oblivious to all but the cutting. Clumsy shears often call more attention to themselves than to the job.

3. Substantial: Evinces a physical presence -- renewable, durable, not temporary; ages gracefully as people age. Products and environments should employ materials that create a sense of substantiality, a sense that the objects themselves participate in a human activity. A solid, wood-topped table, for example, can be sanded and renewed. Even the temperature of the wood influences our perceptions of its nature: wood is warmer to the touch, its mere presence comforting. Similarly, rails with Braille instructions to signal staircases, ramps, or changes in floor level impose meaning on objects. Such objects don't merely exist in the surrounding environment; they take shape in people's minds and senses.

4. Congruent: Demonstrates the principles behind the design; form follows philosophy. The problems of aging really do demand a comment and ethical point of view behind any physical problem. The forms of Herman Miller Research Corporation's products, environments, and services for- older people will be congruent with our belief that bias toward youth and ability should be eliminated in products, environments, and culture. Just as the Shaker furniture reflects a philosophical and religious position, products, environments, and services for older people should embody the belief that prolonging the independence and autonomy of older people is a pressing and ethical issue.

5. Provocative: Enables activity, discourages passivity; extends people's ability to do things for themselves. Sen. Daniel Inouye tells the story of his recovery after losing an arm in World War II. After asking if he wanted a cigarette, a nurse threw him an unopened pack. She then threw him a book of matches, leaving him to open the pack and light a cigarette one-handed. That is provocative care. It calls for participation on the receiver's part. It calls for exercising the receiver's mind or body or both.

Products and environments for older people should follow this pattern. A good recipe provokes one to experiment; fast-food restaurants require unthinking conformity. While we should not err on the side of dictating or coercing a response, we can, through well-considered designs, furnish the means for maintaining and prolonging independence in the community. Naturally, people should be allowed the choice of exercising their own judgment, of stretching themselves mentally and physically, or not. But we think most people like to extend themselves. Older people especially are interested in expanding their universe. Why should the environment get in their way?

6. Comforting: Expands and strengthens ability and resolve; emphasizes prevention. Everybody is living longer; is everyone living actively longer? Independence and health are directly related to a person's capacity to perform basic activities without assistance. An elevator expands ability and strengthens independence; stairs put them at risk. Products and environments can have health-giving properties that prevent the onset of chronic problems. More and more effort among caregivers will be directed at prevention; our society simply can no longer afford to wait to intervene. Improving the living environments of older people is a clear-cut and economical way to sustain an active and productive life.

A group at Chelsea Community Hospital in Chelsea, Michigan, demonstrated how comforting a well-designed environment directed by competent and dedicated caregivers can be to people with Alzheimer's disease. Bright colors, better signs and identification, music (both by and for the patients), residential qualities, the patients' own furniture, and devoted care heightened the quality of life for the patients and the caregivers. What the patients with Alzheimer's were able to do for themselves expanded markedly. We think that environments can be as therapeutic and comforting as a bath or exercise. People visit spas, after all, for the entire experience, not simply for the hot water.

7. Playful: Allows for delight, surprise, and play. Western culture has tried for a long time to separate play from utility. Hannah Arendt, Johan Huizinga, and, lately, Christopher Lasch have discussed this unnatural division.³ Play and playfulness should be an integral part of life and work. Our products, environments, and services should have something playful about them, something of serendipity in the discovery of their uses and purposes, something of delight and surprise. Play deserves respect. It is not to be dismissed as frivolous or inconsequential. A playful treatment of issues by commentators, artists, or columnists can be both deceptively simple and deadly serious. In the words of Eric Midwinter, a respected British gerontologist, let us ask that "color, fun and vitality irradiate the possessions and domestic tools of elderly people .... For make no mistake about it, the drab and articles that have hitherto been offered older people have been counter-productive."⁴

Conclusion and Questions

We have presented a proposition, our assumptions, seven needs that we see, and seven principles by which to design products for older people.

We would like to close with some questions that we think must be answered in the coming decade if our society is to allow its older citizens to live their long and ever-lengthening lives in dignity, independence, and the pursuit of happiness.

How will architects assume a larger role in the design of the single-family house so that they can address in new construction and remodeling the issue of aging in place? Let to their own devices, owners and builders may prefer expediency to long-term answers.
What potential does new technology hold for the design of products for older people? Will the environments and products in experiments like the National Association of Home Builders' Smart House or General Electric's Living Environments house become a common and affordable reality?
Can we construct or modify residential environments so that they ease the burdens on caregivers of caring for people at home?
Is there federal money available to fund a comprehensive anthropometric study of older people? If not, when will it become available? These data will certainly ease a designer's job.
Will the attitudes of people over age 65 really change as the baby boomers grow older? Or will their attitudes fall into line with the attitudes of older people today? How will the marked differences in attitude between the baby boomers and their parents manifest themselves in the next 20 years?
Will any group be able to demonstrate with sufficient rigor the connection between a safe old age and a safe environment so that the insurance industry will take up the challenge of providing safer residential environments for their policy holders?
Will public policy enable action? The late and indefatigable Wilbur Cohen predicted that Ronald Reagan's successor would be forced to "clean up the mess" from years of avoiding the real issues of our health care system and of long-term health care in particular. Will this happen?
There is, of course, the question of just where will more dependent older people live? Not everybody will be lucky enough to live in enlightened places like the General Mills' experimental Elder Homestead (now called Hilltop) in Minneapolis or the Miami Jewish Home. Nor can humane places like that be built fast enough. Will federal or state governments find ways of encouraging alternatives to nursing homes?

We believe that the only place for people to live as they age is where they chose to be. That is truly our goal. Enlightened design can help make that possible.

ENDNOTES

1. American Institute of Architects (AIA) Foundation, Design for Aging: An Architect's Guide (Washington, D.C.: AIA Press, 1985); Sandra Howell, Designing for Aging: Patterns of Use (Cambridge, Mass.: MIT Press, 1980); Victor Regnier and Jon Pynoos, Housing the Aged: Design Directives and Policy Directives (New York: Elsevier, 1987); Martin Valins, Housing for Elderly People: A Guide for Architects and Clients (New York: Van Nostrand Reinhold, 1988); and Joseph Koncelik, Aging and the Product Environment (Stroudsburg, Pa.: Hutchingson Ross, 1982).

2. James Pirkl and Anna Babic, Guidelines and Strategies for Designing Transgenerational Products (Syracuse, N.Y.: Syracuse University Series in Gerontology Education, 1988).

3. Hanna Arendt, The Human Condition (Chicago: University of Chicago Press, 1958); Johan Huizinga, Homo Ludens: A Study of Play Elements in Culture (Boston: Beacon Press, 1955); and Christopher Lasch, "The Degradation of Work and the Apotheosis of Art," Harper's, February 1984, 40-45.

4. Victoria and Albert Museum, New Design for Old, catalog of exhibit, London, England, May-July 1986, 8.

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