Many of the issues that the healthcare design industry grapples with such as safety, infection control, and noise mitigation can acutely affect the elderly. But there are certain building design attributes, as listed below, that more profoundly affect us as we age. What lessons from research on environments for the aging have we learned that could be applied to hospital design?
Several resources, including “Code Plus – Physical Design Components for an Elder Friendly Hospital, second edition” (2015) published by Fraser Health Authority in Canada and Nurses Improving Care for Healthsystem Elders (NICHE), an international nursing education and consultation program focused on geriatric care in healthcare organizations, offer ideas on how to improve healthcare practices and environments to serve seniors. Here are a few ideas to consider:
LIGHTING: As we age, one-fifth to one-third less light reaches the retina, reducing visibility. Consistent ambient lighting with less shadows can help seniors distinguish objects and is a vital design feature especially where older patients ambulate. Minimizing glare, especially on flooring surfaces, is also important in reducing falls. For better sleep, light sources in inpatient rooms should be controlled by the bedded patient, allowing seniors to create a dark, calming environment during rest times, day or night.
INTERIOR DESIGN: Colors can appear more muted to seniors, making pastel colors such as blues and greens appear washed out. A better solution is to use color to create a contrast in relation to the floor, for chair seats, and bathroom fixtures to allow elderly patients to perceive edges more clearly. Higher contrast between walls, floors, and ceilings also helps orient the patient. Floor design should be carefully considered since patterns may be perceived as disorientating movement. Specific color choices matter, too. Studies have shown that colors in the red/orange family, such as peach and apricot, are energizing and more easily perceived than colors in the blue family.
CIRCULATION AND WAYFINDING: Shorter travel distances to hospital destinations are even more important to seniors who may lack the mobility or energy to negotiate long hallways. Handrails and strategically placed seating allow for periodic rest stops and should be provided throughout the facility. Signage needs to feature larger lettering for seniors with declining eyesight or visual impairments and should be mocked up and tested with seniors for clarity and simplicity before final installation.
FAMILY SUPPORT: Many seniors are accompanied at the hospital by concerned family members. Private family seating areas (ideally with windows) located throughout the inpatient unit are more useful than a remote family waiting area and allow meetings with caregivers or phone calls to be done while staying close to the patient’s room. These spaces can also serve as areas of respite when family members need a short break.
More than half of hospitalized patients 65 years or older experience delirium, defined as “mental disturbance characterized by confused thinking and disrupted attention usually accompanied by disordered speech and hallucinations,” according to a study by the American Delirium Society, a community of professionals dedicated to fostering research to minimize the impact of delirium on the health and wellbeing of patients. This equals 7 million patients per year.
Some hospitals have opened specialized geriatric “eldercare” acute care units, which are senior-friendly environments focused on safety and management of geriatric syndromes such as delirium. But it seems to me that all adult inpatient units should be senior friendly, with design features and clinical practices tailored to the elderly and their conditions.
Certainly, the attitudes and preferences of tomorrow’s senior population may be very different than the generation we currently serve. Yet the clinical needs will remain constant. As the U.S. population ages, the design of our inpatient facilities will need to accommodate the needs and desires of the elderly more than any other age group.
