Elderdesign: Home Modifications for Enhanced Safety and Self-Care

Abstract

Many people blame the aging process for problems they encounter with daily activities, when instead quite often it is the design of the home itself that creates unnecessary disabilities. Even though there are more people over the age of 65 than there are under 25 years of age, the design of today's homes, including the products contained in them, is still based on the anthropometry of young healthy adults (Pirkl, 1994). Builders and manufacturers do not take into account age-related conditions such as limited range of reach or reduced mobility when creating a home or a household product. Consequently, most dwellings are hostile to the physical and sensory changes that older adults encounter as they live well into their 8th, or 9th or 10th decade. For instance, 51% of adults 85 years of age and older receiving home care need help with bathing (King, 1994). This is easy to understand as many seniors undergoing the normal process of aging find it difficult to enter and exit safely from the bathtub. Even seemingly insignificant home features can have powerful and disabling effects: for a person recovering from surgery, taking multiple medications and in a weakened state, negotiating a walker over a doorsill can be tantamount to climbing Mt. Everest (Bakker, 1997). Due to cost containment, miniaturization of hospital equipment, and personal preference, the home is now the preferred place both to recover from illness and receive long-term-care services (King, 1994). But until we have new housing stock and products that take into account the needs of a person throughout a lifetime, retrofitting a home for safe aging should be a routine part of an older person's life, like tuning a car or visiting a doctor. As health care professionals, we need a basic understanding of how the design of the environment can both prevent injuries and maximize a patient's functioning. In addition, we need to keep abreast of the rapidly changing technological developments in home care equipment. UNDERSTANDING AESTHETICS Many people resist home modifications and assistive technology products that are designed for easier use by people with disabilities because these products have an industrial appearance: people do not want their homes are dangerous stand-ins for grab bars, umbrellas, not made to support a person's weight, are used as canes; and household shopping carts without brakes replace walkers. Fortunately, due to consumer demand and computer technology, institutional products are slowly being redesigned to blend in with the home environment: grab bars and hand rails in decorator colors, low air-loss bed overlays with chintz coverlets, hospital beds with wooden headboards and footboards, walkers in bright hues with quilted carry-alls, and slip-retardant flooring in an array of colors. Increased attention is being paid to elder ergonomics: products that are easier for arthritic hands to twist, hold and grasp, color contrasts for on/off buttons, larger print for aging eyes; chairs designed for elder anatomy that are easy to get into and out of; and doorbells and telephones with enhanced high- and lowfrequency tones for older ears. Many of these products are not readily available in neighborhood stores, and tracking down distributors can be a timely chore for both consumers and health care professionals. In addition, because limited production means high costs, many attractive and innovative products may be beyond the financial reach of the majority of older adults. Research suggests, however, that offering consumers a choice and including them in the decision- making process helps them more readily accept change (Miller, 1997). SAFETY AND SELF-CARE The National Center for Injury Prevention and Control states that falls are the number one cause of home injury, and studies suggest that a significant proportion of all falls are due to environmental factors (Connell, 1996). The second most common home injury is burns, primarily from fires, and older adults are killed in home fires at twice the rate of society as a whole (National Association of Home Builders (NAHB), 1990). …