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Involving the Elderly in the Design Process

Article  in  Architectural Science Review · December 1998

DOI: 10.1080/00038628.1988.9696833

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UDC: 362.6:72228.4 Keywords: Activities of daily living; Aging in place; Architectural Science Review
Collaboration; Elderly resident;. Volume 41. pp 157--164

Involving the Elderly in the

Design Process

O. DemirbilekA† (Saritabak), H. DemirkanB

Based on the concept of ‘ageing in place’, a prescriptive model is proposed, aiming at the creation of a usable, safe and
attractive built environment where the elderly residents are actively involved in the design process through collaboration
sessions. Quality Function Deployment (QFD) has been adapted to develop an evaluation and translation method for
the collected data of the elderly end-users.

Introduction with an increasing prevalence of many chronic diseases and disabilities.

This situation influences how old people deal with their environment.
Many studies were conducted in attempts to design better houses
They may have problems in moving around (mobility deficits), in
and interiors for the elderly (1 to 14). However the opinion of the elderly
manipulating objects (deficits in dexterity), and in receiving proper
themselves related to the design itself is never or rarely considered, as
information from outside (sensory deficits). Each of the above stated
Cavanagh (3) , who involves older women in the design of house
groups includes a wide range of related problems. The greatest problem
interiors and equipment in her studies, mentions. The ideas and
that an older person faces is the loss of independence. This can be
comments of old people certainly play an important role in the building
achieved by the assessment of functional status and preventing
design process. Woudhuysen (15) says that elderly people, besides
disability.
responding to questionnaires and attending to focus groups, should
also work in teams with designers, entering early and directly into the Functional status in ageing includes basic activities of daily living--like
design process. This paper describes a prescriptive model in which the feeding, dressing, ambulating, bathing, transferring from bed to toilet,
end users, mainly the elderly residents, can be involved actively in the grooming, and ability to communicate. Barbaccia (17) claims that
design process. Quality Function Deployment (QFD) has been adapted problems occurring frequently are with bathing; problems with
to develop an evaluation method for the collected data (views and dressing, eating, and grooming are less frequent. Furthermore, he states
ideas) of the elderly end- users. that around 80% of the elderly people are mobile and able to get around
in their home and with some limits in the community. Assistance is
The Ageing Process and the Built most often required with daily activities (18, 19, 20, 21).
Environment Musculoskeletal dimensions, mechanical performance, flexibility of
joints, muscle strength, gait speed, bone density are all important factors
While getting old, one gradually looses a lot of abilities in daily life
in the physiological system and changes occur in these with ageing.
activities. Heikkinen and his colleagues (16) add that aging is associated
Arthritis, heart disease, diabetes, difficulty with vision and hearing are
more common in older people. These problems with muscles and joints
AMiddle East Technical University, Faculty of Architecture, Department of
as hip fractures really contribute to a decrease in activities of daily living
Industrial Design, 06531 Inönü Bulvari, Ankara - Turkey. and instrumental activities of daily living (17). The individuals have the
[Link]: oyademir@[Link]
B BIilkent University, Faculty of Art, Design and Architecture, Department of greatest difficulty related to most functional mobility as heavy
Interior Architecture and Environmental Design, 06533, Bilkent, Ankara - Turkey. housework; climbing stairs, walking half a mile and gripping with the
[Link]: demirkan@[Link] upper extremities. The instrumental activities like shopping, doing light
† Corresponding author
housework, and cooking are less difficult.

157
Architectural Science Review Volume 41

A more significant cause of injury and concern are falls, this age group, in the course of their days (8, 17, 18, 19, 20,
which account for many hospital admissions and movement 29). Unfortunately it has been difficult to translate this
in nursing homes. They are extremely common health information into design applications.
problems for the elderly resulting from neuromuscular and
functional decline. Nevitt (22) claims that there is little
research or data to support the hypothesis that It is argued by some researchers (30, 31) that when products and
environmental modifications can prevent falls. Most of the environments are made more accessible to people with limitations,
research has been done on Caucasian population because they have potential benefits, for everybody, such as: lower fatigue,
falls are a major cause of fractures in this race and people
increase speed in performance, and lower error rates. As space
living in Turkey belongs to a subgroup of Caucasoid.
requirements are more complex for the aged persons, Kose and his
Stairways without railings, high and irregular steps, clutter
colleagues (2) claim that the elderly should be accepted as the
on the floor, a loose rug or a bathroom without grab bars are
the mostly encountered risk factors in a house. determining factor in design, and taken as a base and a reference to
the human interaction with the built environment. Thus, if a house is
Even if hearing and vision deficits associated with aging designed (interior, furniture and equipment) according to the
can be corrected with aids, “designers should ensure that requirements of elderly people, this same house will also be
features such as door frames, door handles, steps, stairs and adequate for other age groups. This is reinforced by the words of Lee
walkways are well-distinguished by using visual contrast, Fisher: “If the home is designed correctly, many people probably
achieved either through brightness or colour differences to would be unaware of most of the special features for handicapped
make the key features moreconspicuous” (23). Glare from persons” (7).
luminaries, windows and shiny surfaces should be controlled in a
house environment. Local adjustable task lighting can be used to A Universal Design Base
meet the special needs of elderly people.
Researches have shown that psychological well-being is one of the
Kose (24) accuses architects and designers of not yet being
most intrinsic aspects of successful aging (29, 32, 33). Studies have
prepared to accept design requirements for elderly people. He lists
identified various factors having impacts on the psychological well-
those requirements as follows: Elimination of level differences
being of the elderly including housing and neighborhood
(including the elimination of door sills); installation of handrails
environments. Imamoglu and Imamoglu (6, 34) noted that, the
(said by architects to interrupt design consistencies in the space);
Turkish elderly, on the whole, consider the personal (home-related)
installation of door level handles; installation of larger switches;
and environmental aspects of their neighborhoods most important;
installation of easily operable facilities, etc. (25). There are certainly
followed by the functional and natural characteristics; whereas, the
many other requirements that can be added to this list, such as the
architectural and recreational aspects are considered least important
provision of: adequate lighting avoiding large contrasts (26),
among the other qualities regarded. They also found that although
illuminated and well located light switches, visual as well as
the attitudes of the Turkish elderly, in general, are negative towards
auditory alarm systems, differentiation of wall and floor surface
institutional living, they become more favorable with urbanization
textures, colour coding, induction loops to assist hearing aids,
and age.
sound insulation, rounded corners and edges, sliding doors
(particularly for cabinet and cupboard doors), contrasting stripes The current life situations of the elderly in Turkey show that they
on the edges of the treads of any stairs, handrails extended beyond do not live in extended families. However, the Turkish culture is
the top and the bottom of stairs, etc. based on close-knit interpersonal relationships where support and
sacrifice of parents toward their children, and the obedience to and
The rates of population growth and population aging vary
responsibility of children to care for their parents in old-age are
across countries. The rate of population growth is higher in
widely accepted strong values (34, 35). Thus, the housing units for
developing countries like Turkey, whereas population aging is
the elderly should be organized in such a way to satisfy the needs for
higher in developed countries. Even if so, it is predicted that 9.3%
such social interdependencies. The universal design concept helps to
of the population of Turkey will be over the age of 65 in the year of
integrate aging which is a natural stage of life into the social and
2025 (27). For this reason the housing policies of Turkey should
physical aspects of living environments in a meaningful manner (36)
supply the housing needs of elderly people and the architects
without extra costs nor alterations in terms of aesthetics.
should be concerned about the quality of life of the residents at all
ages. Calmenson (37) states four criteria, named as “the four A’s” of
universal design, as follows: accessibility, adaptability, aesthetics, and
Sandhu (28) says that the elderly are potentially the fastest
affordability. Accessibility enables a person to fully utilize the entire
growing consumer market in the developed countries. He also
space, whether they have failed vision, are pregnant or use a
advises that designers and manufacturers should make evaluative
wheelchair. Adaptability is important especially when the current or
research with respective groups of elderly users, at all the stages of
future residents plan to live in a house for many years, thereby ‘aging
the design process, and particularly before the introduction of new
in place’. Aesthetics refers not only to making a universally designed
products. Brink (27) points out that most dwellings are not “senior-
environment beautiful, but also to making it helpful without
friendly” or barrier free, and that those dwellings are designed
appearing different or utilitarian. Affordability promotes an idea that
without considering even the basic requirements of elderly
an adaptable home can be built for the same cost if it is properly
residents, resulting in their exclusion from everyday life.
designed at the beginning.
While modern housing is achieving ever-greater technical
The concept of universal design relates people with their biological
capacity to meet the more specific requirements for
and cultural heritage, and it helps to define a person’s sense of self,
habitability, concern for housing conditions that supports
and place in the world, also connecting them to the future. People
the psychological and social well-being has not followed
these developments. Many studies of theelderly have need the opportunity to shape situations, places, and activities that
attempted to enumerate and describe the typical activities affect their lives. It is desirable to allow more and more aged people
performed by to get old in their present place of residence, and the universal design
concept is a recent development to make this possible.
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Number 4 December 1998

Ease in mobility includes all the movements (with their degree of

In this concept, children, young people, aged people and disabled easiness) that a resident can make while circulating in the house.
people are all equally considered, and there is no principal user Independence includes the feeling of it and the ability to carry out the
(people with disabilities, elderly, children, pregnant women, people daily life activities without assistance. Privacy, security and safety are
carrying packages, etc.) (38). According to Brink (27) universal design is interrelated. They deal with available systems and designs preventing
usually a synonym for good design, because attention is paid to achieving and helping in rescue during any harm from outside the house (burglar,
the best use of space while enhancing usability; and on the other hand, it intrusion, aggression ...) or from any accident (fire, gas infiltration, smoke
reduces costs over the long term. Furthermore, Morini and Pomposini ...) that may occur. Safety also includes the safe use of any house
(39) point out the social and psychological disadvantages of designing equipment without the risk of accident. Privacy is also a condition
dwellings especially for the elderly, where they feel themselves rejected reached in a state of independence, in this chart, it belongs to the safety
from everyday life. Dagostino (40) adds that universal design allows group. A well-designed house will ensure greater use, safety, security,
people to be independent, safe and comfortable. According to Steinfeld and privacy. Shelter is the place where all the functions and activities of a
(21) universally designed buildings are accessible and usable by house are encompassed. Aesthetic includes taste, preferences and value
everyone, including the disabled; and they provide accommodation for judgments of the residents.
the elderly and the young people, in short, for a majority of persons.
Universal design differs from accessible design, which often has a Researches in literature are mostly oriented toward the construction of
medical or institutional look (21). It allows high standards of aesthetics housing for the elderly. These types of housing include: senior housing,
because it is integrated in the design process from the beginning, and sheltered housing, nursing houses, community dwellings, and so on.
because it can be incorporated in any style or setting. Few studies are interested in letting people aging in place (1, 41, 42, 43),
without having to move. It has been pointed out that daily life activities
Basic Functions of a House can be carried out nearly successfully by elderly residents with
diminished abilities if they are familiar with the surrounding. On the
Housing must fulfill the needs for the daily activities of the elderly, and
contrary, these activities can be very hard to carry out, even by less
more precisely it must give them: satisfaction, security, comfort, and
disabled elderly people, when they are not familiar with the surrounding
independence, or at least one of them. The basic functions that a house
(44, 45). In most of the studies on elderly and their house environment,
interior has to fulfill have been stated and grouped in Figure 1.
their opinion and ideas during the stages of the design process were
never asked. Therefore, it will be an important issue to provide a
collaboration between elderly residents and designers.

Functions of a house interior

Usability Safety Attractiveness

Ease in
mobility
Daily life and Pleasure
Comfort activities circulation Independence Privacy Security Safety Shelter Aesthetic in use Quality

Figure 1. Basic Functions of a House.

The resulting figure depicts the three main groups as usability, safety and
attractiveness; which are emphasised throughout the study. This study proposes a collaboration between experts and end users at the
various stages of the design process. The main focus in the present study
Comfort, daily life activities, ease of mobility, and independence are remains oriented towards a design process that will make possible (on a
listed under the group of usability. Shelter, security, safety, and privacy are universal design basis) allowing to ‘age in place’, taking into account the
listed under the group of safety. Aesthetics belongs to the group of real world needs of the end user (the elderly in this case) by their
attractiveness. Comfort includes the feeling of thermal comfort participation in the design process, and combining theirs with the
(temperature, humidity, drafts), adequate lighting level and colour empirical knowledge of designers. Kose (24) points out the importance of
vision comfort, hearing comfort, and physical comfort. Daily life activities design modifications, from the view point of usability and safety, to cope
include: cooking and eating; sleeping and resting; grooming; dressing with the decreasing capability of the ageing population.
and undressing; use of shower, bath, toilet, and wash basin; operating
doors and windows; washing clothes - washing dishes; carrying objects - The results obtained from these collaboration sessions form a base for
moving furniture; operating thermostat; walking on carpet; reaching for designing appropriate house interiors and also serve as guidelines.
high objects; chair comfort (sitting, standing up); counter convenience - Briefly, the creation of a physical interior environment, having in mind
(storage); stair and ramp use - elevator operation; finger and manual the notion of aging in place, is a complex task. It requires the organization
tasks (sewing, writing, playing cards); getting in and out of bed; hearing of appropriate information. The knowledge of designers combined with
and viewing things; using household appliances (vacuum, iron, kitchen the knowledge (opinions, ideas) of the elderly end users should be
robot); performing hobbies (plants, knitting, needlework...); watching TV, involved in the design process because it is not an autonomous business .
listening to radio, hi-fi, recorders; wheel chair mobility; operating a
telephone (accessibility, convenience); etc. (19).

159
Architectural Science Review Volume 41

Furthermore, Sheehan (46) adds that the physical design of housing that constructive dialogue and just task performers; they have ambitions,
interiors plays a major role in influencing the quality of life of all elderly beliefs, emotions, values, satisfactions and dissatisfactions (48) of their
residents. own that no designer can anticipate or imagine for them. Furthermore,
Means (41) points out that constructive dialogue and partnership
between users and professionals help in improving the effective use of
The Model existing resources, in order to ensure independent living for the elderly.
The phases of the design process in the Usability, Safety, and Methodology
Attractiveness Collaboration (USAC) Model (see Figure 2.) is as follows:
• In the first stage, collaboration sessions are organized with small Figure 3. depicts the simplified process of this involvement and the
groups of elderly people. Small groups consisting of 6 people are said steps to be followed.
to successfully produce up to 150 ideas in half an hour at their first
The collaboration sessions are held with the end-users, a selected
attempt (47). At this stage, they will produce ideas and define their
group of elderly people, male and female above 65, from the city of
exact needs and preferences towards the design of house interiors.
Ankara. Random sampling is used among a group of volunteers. In
This will be a combination of brain storming and unstructured
these semi structured interview sessions, a group of 4 to 6 end-users are
interviews, where the ideas, comments (written, oral, sketched, or
asked to ‘design’ the house that they want to age in, considering all their
gestures), and needs are collected. All the data collected in this stage
possible requirements, needs, particular wishes and ideas. These
are classified in the USAC Model.
collaboration sessions are recorded on video for later evaluation (to recall
• The second stage is the feasibility study where optimal ways to solve all the details).
the problem are searched for by the
designers.
• The third stage consists of the
proposition of different solutions to
the problem (designing house
interior allowing ‘aging in place’). In
this stage, elderly users will be
involved for the second time to
make preferences among the
solutions.
ACQUISITION OF
• The fourth stage consists of further
END-USER’S NEEDS,
developments and refinements of REQUIREMENTS AND
the chosen solution, detailed design, DESIGN REQUIREMENTS
comprising all the technical side of
the design process, achieved by the
designers.
• The fifth stage is the construction
Feasibility study
planning.
• The sixth stage is the realization of
the construction.
PROPOSITION OF
End-users: DIFFERENT CONCEPTUAL Designers:
In this model, the end-users, mainly
Elderly SOLUTIONS FOR HOUSE Interior architects,
the elderly residents, are involved DESIGN
residents architects,
actively in the design process. The TO AGE-IN PLACE
designers.
expertise of architects and interior
designers are combined and
compared with that of elderly people
FURTHER DEVELOPMENT
themselves (their own opinions and OF THE CONCEPTUAL
ideas on their requirements), and SOLUTION
related to how an interior house • Knowledge data-base
• Ideas and drawings
environment should be designed to
allow ‘aging in place’. Eason (48) sees
such an approach as a combination of
design by the user and design for the user. Construction
This combination is important because Planning
human beings are not just task
performers; they have ambitions, Contribution of
designers
beliefs, emotions, values, satisfactions
and dissatisfactions (48) of their own Contribution of Construction
that no designer can anticipate or elderly end-users
imagine for them. Furthermore,
Means (41) points out
Figure 2. The USAC Model.

160
Number 4 December 1998

PROBLEM
dimensions. Elderly residents and designers may speak almost a
different language than that of a designer. As an example, a resident
z The number of elderly increases constantly; might say “I want a door that is easy to open”. The translation into
z Houses are not adequate to AGE-IN-PLACE; technical language might be “door will open with minimum applied
z Designers are reticent to accept some force”. Or a requirement such as “ the soap should leave my skin feeling
requirements of the elderly; soft” must be translated into “pH or hardness specifications for the soap”
z Designers decide for the elderly. (50).
Ö There is a mismatch between house QFD, which originated in Japan (devised by Professor Yoji Akao in 1972)
interiors and the elderly residents in the 70’s and was useful in the USA in the 80’s, is widely applied in the
business world. Today, it is one of the most appropriate methods in use
that can enable designers to translate end-user needs into product
WHAT TO requirements, because it focuses on quality as going beyond an “us-
DO versus-them” mentality (51). In this study, the processes of QFD are
adapted and modified into the USAC Model to develop an evaluation
Ask the elderly residents (end-users): method for the collected views and ideas of the elderly end-users, on
z How they prefer to use interior spaces; their design ideas, level of interest, needs and preferences related to the
z What are their real needs and requirements. design of their house interior. In this method, the users (the elderly
residents) are seen as designers or members of the design team, and they
Ö Let the end-users participate and are cooperating in the design process. This method fits the abilities and
collaborate to the various phases of circumstances of all the people involved, asking them to help in the
the design process. design of the research itself as well as contributing to its results.

Conclusion
HOW TO To avoid complicating the lives of elderly people by imposing on
DO them inadequate housing, their contribution in the housing design
process should be encouraged (3). What people’s different needs are;
z Make surveys with the elderly and the
how they might prefer to use interior house spaces; what their housing
designers;
requirements are; and what their opinions and ideas are, should be
z Organize collaboration sessions with the
questioned before starting the design process and during this process.
elderly where they are “designers”;
According to Eason (48), in such a design process, the end users can
z Collect every idea and requirement using a
influence the design in a way that agrees with their goals and beliefs
Usability, Safety, and Attractiveness (USAC)
because “only those who will be affected can decide what is in their best
Collaboration Model;
interest” (p. 1668). Furthermore, Mitchell (52) argues that the design
z Deploy the results to the whole design
theories of architects such as Le Corbusier and Venturi were essentially
process.
incomplete because they were only dealing with forms, with no
Ö Collaborate with the elderly through the meaningful attention paid on how the users will be affected by these
whole design process. forms. To be able to design high-quality housing where people will want
to live and age-in-place, professionals should have the direct contribution
of elderly people’s lifestyles and requirements (3). The main goal of such
Figure 3. Involvement Process in the a collaboration is to improve the quality of life of elderly residents in
particular, preserving their dignity, independence and self-
In this collaboration, the expertise of designers and the opinions of elderly determination, and to improve the quality of life of all residents in
are related to the design of a house environment, interior, and/or general. This study can also be extended to areas other than the private
equipment to allow aging in place. In these sessions, to take place house interior environment, such as public areas, offices, schools, hotels,
naturally, the following general conditions are taken into account for hospitals.
communication and coordination:
-- Specific or concrete goals of collaboration are not known to, or cannot be
clearly defined by any participant at the outset.
- Heterogeneous systems of representation and action employed by
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