Research has demonstrated that enabling societal and physical infrastructure and personal accommodations enhance healthy and active aging throughout the lifespan. Yet, there is a paucity of research on how to bring together the various disciplines involved in a multidomain synergistic collaboration to create new living environments for aging. This paper aims to explore the key domains of skills and knowledge that need to be considered for a conceptual prototype of an enabling educational process and environments where healthcare professionals, architects, planners, and entrepreneurs may establish a shared theoretical and experiential knowledge base, vocabulary, and implementation strategies, for the creation of the next generation of living communities of active healthy adults, for persons with disabilities and chronic disease conditions. We focus on synergistic, paradigmatic, simple, and practical issues that can be easily upscaled through market mechanisms. This practical and physically concrete approach may also become linked with more elaborate neuroscientific and technologically sophisticated interventions. We examine the domains of knowledge to be included in establishing a learning model that focuses on the still-understudied impact of the benefits toward active and healthy aging, where architects, urban planners, clinicians, and healthcare facility managers are educated toward a synergistic approach at the operational level.
According to the World Health Organization (WHO), physical and social environments are key determinants in maintaining an autonomous, meaningful life along the aging process [
Epidemiological studies have identified a strong link between health status and societal domains [
The work of Zeisel on Alzheimer’s [
Visual interpretation of Zeisel’s three key elements in the treatment and care of people with dementia—the medication, the human interaction, and the physical environment.
Zeisel advocates that although there are three key elements in the treatment and care of people with Alzheimer’s, that is, the medication, the human interaction, and the physical environment, funding and research concentrate on the first, reducing considerably the resources allocated to the other two. This disproportionate allocation of resources happens despite the fact that space and human care may have significant, sustained, and immediate impact on health status of dementia person, when compared to pharmaceuticals where progress still needs to be made [
In this paper, we aim to highlight the need for synergy between healthcare systems, the built environment, as well as their social context including public and private domains and urban setting as well as the smallest scale of domestic objects and artefacts that can enhance life during the life span.
Despite the evidence suggesting that space is a key component of any healthcare plan, the design of individual dwellings for encouraging active and healthy aging is a truly underdeveloped area of research, compared, for example, to assistive technologies. Yet, the living space and its impact on quality of life are indeed a very ancient concept [
“More of the Same Is Not Enough” [
The diversity of noncommunicable chronic diseases (NCDs), which hamper healthy and active aging, also shares key modifiable life style factors: sedentary lifestyles with lack of physical activity, poor nutritional habits, high stress levels, and lack of social connectivity [
A crucial component of this ecosystem is the enabling of movement. This is primarily viewed through the concept of universal design. It is the main concept that has provided solutions for the mobility of the general population, yet so far it presents limitations when neurological or mental disorders are concerned [
The built environment is commonly used in connection with technology supported aging [
In addition to the homelike age-friendly environment, there is an emerging literature of the important connection to nature and its restorative and therapeutic value, along with space for physical and recreative activities in mental health and healthy aging. We discuss these topics next.
Research has long established the beneficial elements of nature to mental and physical wellbeing [
As far as physical activity space is concerned, ergonomic design of healthcare facilities, mainly concentrating on nurses’ movement, ignored the complications of confined space for patients without access to the outdoors. Single-loaded corridors for instance could increase the opportunity for walks indoors as well as allow better orientation [
In healthcare environments creativity could be enhanced through a variety of spaces designed for different uses, such as dancing or exercise and space for horticulture, to give to examples out of the numerous possibilities, rather than the one-type-of-common-room-fits-all approach. Research on long-term care connected architecture and the implementation of therapeutic regime through the availability/lack of such areas [
In residential settings suitable comfortable sitting, presenting a variety of types in accordance with individual preferences and functional elements such as task lighting, worktops, and variety of storage could provide opportunity that a variation of the “student bedsit” that is often applied in care environments, that is, one desk, one bed with a side table, and a wardrobe, or hopefully if it is like a 4- or a 5-star hotel room an additional armchair and a coffee table, could not possibly cover.
External views, art, and positive or negative distraction methods [
Control is a factor that tends to appear lower in the pyramid of needs, when compared to more basic needs of sustaining life. However, it is linked with improved health [
Day Centre for children and adolescents with autism in Paleo Faliro, Greece. Designed by SynThesis Architects.
Maggie’s West London, located at Charing Cross Hospital. Designed by Rogers Stirk Harbour + Partners.
Lighting, carefully designed circulation spaces, especially in turning points, comfortable and strong grab-rails, preferably cleverly integrated in the decoration rather than the sad and possibly dangerous accessibility devices, opportunities for mind and body exercise for the brain through salutogenic design, and solid and strong furniture at an adequate height for people lifting themselves comfortably are only some of the possibilities that architects can consider as their tools in their aim to design an environment that allows older people to use their body in a safer manner. Yet, the lack of research and the lack of a communication channel between the disciplines have not provided the data that would allow these solutions to be approached systematically and eventually enter the design guidelines documentation allowing their broader implementation.
Based on the theoretical models and research utilizing these models as cited above, we suggest that the creation of an experiential curriculum for all relevant players in designing and building facilities to meet the needs of an aging society is a goal we should be aspiring to. The planning of this type of curriculum should involve all sectors of the economy, that is, governmental, private, and the third sector, as well as cross-industry from the very beginning. This would utilize the experience of the stakeholders, from policy to user level, and enable the burning issues that are well known to those that deal with the subject on an everyday basis to be addressed in a more systematic way. We are aware, for example, of participatory design initiatives such as the Collectively Commissioned Housing in Casteren, Netherlands, where the architects worked mainly as facilitators and residents were the main decision-makers, which proved a cost-effective solution [
Medical sciences have a clear knowledge that the perception and the physiology of an older frail person differs from a normative one. Yet, that message has not entered the conscious design process of the built environment professionals, as the perception and visual distraction in architectural literature [
It would be important, among others, for practitioners, designers, and stakeholders, to understand to what extent the built environment is adequate for its residents. It would be important, for instance, to research the safety of universal design features in an older person’s bathroom and ways for improvement. Through learning we could encourage designers to broaden their perspective of what constitutes innovative architecture, in a way more human-focused than the glass and steel iconic landmarks. It would be important to help them understand user needs across the lifespan when designing public outdoor areas. That would be the way to create a series of public space improvements that might encourage people to be confident enough and go out of their home in a not so cold day and engage in social activities. A module should provide students the know-how of facility planning in order to create facilities that could act as a magnet for older and frail people and how these could be intergraded in the urban grid. Through case study learning and fieldtrips they could familiarise themselves with existing examples of good practice that need to be explored and lessons to be learned. They should be able to understand the limitations of the existing definition of accessibility in covering the needs of the largest ever generation approaching old age. It would be also important for all stakeholders to build the skills to comprehend the value of more elaborate and neuroscientific and technologically sophisticated interventions that could generate significant health benefits with relatively low costs. The list is indicative and the authors could by no means cover the whole spectrum of research possibilities and the learning potential in a single paragraph.
Part of the gap between human science and architecture relates to the educational process of architects, the lack of evidence-based guidelines or best practices that architects could refer to, and the lack of translational research across fields. The article presented a theoretical framework for incorporating into architecture the vision of design for active and healthy living; features medical research suggest would add value toward active and healthy aging.
The challenges aging presents to individuals and society as a whole are complex and multilevel. For example, aging person functionality is impacted by not only one’s intrinsic personality but also by ecopsychosocial elements. These multilevel and complex societal domains can be modified through the creation of multidisciplinary knowledge and educational opportunities along with design for wellbeing research to explore the benefits of interlinking space, architecture of living environments, and their impact on physical and cognitive functionality. It is important for medical practitioners to be aware of the developments and opportunities in the built environment and vice versa and at the same time to see the social impact and the extent in terms of social scale of the problem. Creating a multidisciplinary program for the various professionals (architects, doctors, and planners) and aging persons can be accomplished through blended learning curriculum (see, e.g.,
The authors declare that there is no conflict of interests regarding the publication of this paper.
Dr. Evangelia Chrysikou is Chief Investigator of the Planning and Evaluation Methodologies for Mental Healthcare Buildings (PEMETH) project. Dr. Chrysikou’s research is funded by the European Union’s Horizon 2020 Research and Innovation Programme under the Marie Skłodowska-Curie Grant Agreement no. 658244.