Design Considerations for Aging Populations

Abstract

This issue of Health Environments Research & Design Journal features several articles that focus on the design of healthcare spaces for populations, both patients and the workforce of healthcare providers. Both of these populations have special needs that must be considered when designing healthcare spaces. According to the Healthcare Cost and Utilization Project (HCUP) (Wier, Pfunter, & Steiner, 2010), the population of people aged 65 years and older in the United States is expected to grow by 79%, as compared with the 20% expected growth in the general population. Furthermore, it is expected that one in five Americans will be over 65 by the year 2030, in contrast to the one in eight Americans who were over 65 in 2010. This significant increase in the population reflects the of the baby boomer generation and has many implications for the healthcare system since the elderly use healthcare at a disproportionate rate as compared to younger populations. Among the elderly who are 65 years and older, there is generally an increase in the number of hospital admissions, a greater proportion of discharges to long-term care facilities, an increase in chronic conditions with co-morbidities, and increased healthcare spending by federal programs such as Medicare. The hospitalization of older patients presents huge challenges to hospitals as patient acuities increase but reimbursement for services decrease. This problem is exacerbated by new rules established by the Accountable Care Act, which penalize hospitals financially for the care of patients who are readmitted within 30 days of a previous hospitalization.The most common causes of hospitalization among the elderly are congestive heart failure, pneumonia, cardiac dysrhythmias, and septicemia-all conditions that may have longer recovery times and an increased risk for readmissions. The mean length of stay for patients 65-74 years is 5.3 days and 5.6 days for patients 75 years and older. While patients are in need of hospitalization for constant observation, medical and surgical treatment, and continuous care, there are also inherent risks associated with hospitalization such as hospital-acquired infections, medical errors, falls, lack of sleep, social isolation, and possible mental or cognitive disorientation. How can the design of hospitals facilitate the healing and recovery of older patients and prevent potential harm while receiving care? What is different about the care of older patients that might influence design decisions? This issue of HERD addresses many issues that must be considered in designing hospital and other healthcare facilities.Environmental GerontologyA new field of environmental gerontology has emerged in the past few decades, founded on theories, research, and practices of older persons in their social spaces and surroundings. This field reflects the multidisciplinary input of occupational and physical therapists, human service professionals, nursing or other medical professionals, and architects and other environmental designers. The intent is to create settings for the elderly that meets the challenges of their changing lifestyles and mental, physical and cognitive abilities.Studies have investigated the cost benefits of aging in place (Oswald, Jopp, Rott, Wahl, 2011; Wiles, Leibing, Guberman, Reeve, & Allen, 2012) as compared to congregate living with various approaches to ensuring total independence or assisted living with supervision for nutrition or medical care. The field also addresses the needs of the elderly when hospitalized to enhance healing, recovery, and the prevention of further deterioration. Many elderly patients have chronic disabilities in addition to the illness that causes their hospitalization, so it is critical to plan accordingly for space to store canes, scooters, wheelchairs, walkers, and other assistive devices in the patient's room or on the patient care unit. These patients often are not only physically disabled, but they may also be sight or hearing impaired, or both, and many patients have more than one sensory loss. …