“Aging gracefully means being flexible, being open, allowing change, enjoying change and loving yourself.” – Wendy Whelan.
In order to provide the aging population with the most dignified care and the best life expectancy possible we must continuously ask ourselves if we are doing all we can to give them the care environment that they need. Similar to the point made by Wendy Whelan, caregiving professionals also need to be open to allowing change for the better.
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With this population increase in mind and the subsequent increased levels of supervision required, we've put together some examples of design interventions and adaptations for care facilities that can affect fall incidence rates and the overall health of your residents. Working out ways to create the right environmental conditions that are free of common hazards as a passive element of your fall prevention program is vital for the future of long-term care communities.
The irony is hard to miss in terms of designing for senior care. Those who determine the need for, and design, assistive equipment for our aging population are those who have not experienced the challenges of senescence themselves. In light of this, it's important for us to note and periodically remind ourselves, of the very real effects of aging on a person's quality of life such as:
It's vital that the environments in which we care for the elderly are designed with real understanding and sympathy for these challenges, especially given that we may all experience these things in our time.
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One of the fundamentals of age-friendly design is to consider color theory and contrast as they appear to the elderly. This is perhaps easier said than done, but it's important to consider as it's thought that many common colors and color combinations are not easy for the aging eye to process and to distinguish between. Reds start to look pinker and the yellowing of the lens can severely distort color contrast to make them much less extreme than they are to you. Add on top of that, cataracts which make the vision appear blurry or milky and you have a recipe for a lot of avoidable injuries from slips, trips and falls.
Shades of blue are also notoriously hard for our aging eyes to distinguish between, but this does not necessarily mean you cannot use blue in your color scheme. If in doubt, consulting an experienced interior designer will certainly help you settle on a color scheme that is both appealing and functional in terms of inclusive design.
It's one of the key concepts in any good design approach, but even more crucial in accessible design because of the way senior residents' eyes will interpret light. We've heard it said that "a good design badly lit is no longer a good design," and this is certainly true of age-competent interior design. But what is considered 'poor lighting' or 'proper lighting' according to age-friendly design guidelines?
Well, sufficient lighting is certainly important and one helpful rule of thumb is to think whether you would be able to write your notes in the lighting in any given room. The temptation is often to put more atmospheric lighting in bedrooms and leisure areas used for relaxation to help create a pleasant ambiance. However, this can create potentially unsafe conditions. To reduce the chances of falls you may want to resist dim lighting as a part of your design as inadequate lighting can cause increased disorientation and make potential hazards harder to see.
Also, from an safe work practices point of view, reporting and replacing broken lighting in a timely manner is one of the most important things staff can do to prevent falls. All the fluorescent strip lights in the world aren't worth anything if they aren't working so staff safety training should include routine reporting to maintenance of broken or damaged safety equipment, including lights.
This refers to additional lighting (often wall lights) which should be placed strategically to assist in specific tasks. Either side of the mirror in the bathroom or bedroom is one good place for task lighting, to help with common daily activities such as tooth brushing, washing or hair care. All these activities require the use of at least one hand, meaning that the person may be less able to reach for and hold onto grab bars to steady themselves so as a minimum we want to ensure their activity is at least well lit. Focused task lighting is one way we can enable residents' independence for these activities and mitigate potential risks associated with them.
If you're not familiar with the term, then LRV stands for Light Reflectance Value and refers to how certain colors and surfaces either reflect or absorb light. As we've previously mentioned, ensuring adequate color contrast between the floor, walls, and ceilings for better orientation is important but it's also best design practice to consider the LRV of finishes too, if we are truly to walk a mile in the hypothetical flat, proper footwear of our elderly residents.
Not to get too technical, but the accepted rule is to ensure that there is at least a 30% difference in the LRV rating for the color of the floor and the color of the walls and the same percentage of contrast between the walls and the ceiling. An interior designer experienced in senior living design will be able to advise best practices for LRV contrast but simply put, using juxtaposing light and darker shades between the various angles of the room will assist the aging eye in understanding the environment better and to easily differentiate between the walls and the floor, as an example.
Thinking about the light reflectance values of the surfaces in your facility, it's important to note that furniture and fittings also have an LRV which needs to be considered carefully. While adequate lighting is vital for resident safety and well-being, glare is not your friend as a design intervention for accidents. So steering clear of gloss or silk paints and finishes which reflect a lot of light and opting out of shiny, glossy surfaces such as tables and cabinets is best for age-inclusive design. Different types of flooring have differing reflectance values too, so high-shine flooring might make the room look modern and bright to you but can make it look like a slippery, wet surface to residents.
You don't need to be a licensed interior designer to carry out an audit of pathways and walking surfaces in your care facility, hospital, or other care environment. If you're used to seeing the same hallways and stairs every day, it can be easy to become accustomed to clutter, obstacles and uneven surfaces in plain sight. With fresh eyes, really look at the walkways around the building. Is there clutter on the stairwells that could be an obstruction or wires trailing that need to be secured or moved? Are there unmarked steps that could derail your elderly fall prevention strategy?
Amid the pandemic, the nursing shortage and the hassle of changing regulations in recent years, nursing staff have sure had their hands full, so sometimes things get put in places that they shouldn't be. That's life. The important thing is to make identifying potential obstructions in pathways and eliminating them where possible a regular priority for safe work practices.
It sounds like an obvious one, but you'd be surprised how often implementing smooth, even planes are forgotten about. Smooth ramps are usually safer than steps and where planes do change, it's vital that the flooring has an adequate color contrast so the two planes are clearly identifiable to the aging eye. Where there is no change of plane, it's also important to keep the floor coloring the same, so no obstacle is perceived where there isn't one. If you wish to change the flooring from the hallway to the dining room, for example, but there is no change of plane, then consider changing it further into the room, rather than sharply at the door threshold. A sharp change of flooring should indicate a change of some sort that the resident needs to be cautious of such as an uneven surface or safety hazard.
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Taking the bathroom as an example, color contrasts need to be carefully considered for the safety of the users. Just as in other rooms, the contrast between different planes and surfaces helps the aging eye to distinguish between parts of the room. Assuming there is an even plane shower area in the room, not unsafe elevated surfaces, this should be distinguishable from the rest of the room so that it's easily navigable and residents know to be cautious of a potentially wet or slippery surface.
You'll also need to think about the contrast between the floor and the walls and the assistive equipment such as grab bars, so they are instantly identifiable. Considering this design challenge, some suggest using dark finish grab bars with paler wall decor or vice versa, always remembering that bathrooms don't have to be functional OR beautiful. They can absolutely be both.
When choosing finishes, it's a good choice to visualize how different elements will work together. Using the bathroom as an example once more, matching the shower fitting with the finish of the bathroom grab bars will make the whole room look more intentionally designed and less accidental. Ponte Guilio is one manufacturer that has some excellent pieces of bathroom assistive equipment. They are stunning in design but safety-focused too. Their products are featured on the popular "Toilet Talk" YouTube series by Maria Lindburgh for successfully balancing aesthetics with safety. So, if you're not sure where to start with inclusive bathroom design then their website is a great starting point.
Thinking about what colors and reflective surfaces to use is one key element of senior-inclusive design, but another aspect to consider is the use of soft furnishings. The use of soft furnishings in senior care communities can be extremely beneficial because of the way fabrics can dampen noise traffic. Hearing aids are commonplace among the golden generation, and they don't decipher between background noise and what the person is actually listening for well. Imagine being in a dining room with fifty other residents where all conversation and noise throughout the whole room is at an equal level to your ear while trying to hold a conversation with the person next to you. Ensuring adequate placement of soft furnishings can considerably help reduce noise traffic and help the hearing impaired to live more peacefully.
There is little doubt that the long-term care industry will face further strain due to the increasing aging population in the next few years. Not only because of the bumper generation who are entering senility but also because of the domino effect of steady medical breakthroughs resulting in a longer life expectancy and a fundamental demographic shift. Of course, we're all grateful for the chance to live longer, but we must also recognize and prepare for the challenges this will create.
According to Pat Conroy, "Every industry is going to be affected [by the aging population]. This creates tremendous opportunities and tremendous challenges."
With caregiver strain and burnout a frequent companion for nurses today, we must modify and alter what we can to take the pressure from them where possible. Letting design support the well-being and continued health of seniors is one way to release a portion of that pressure while hopefully decreasing the average rate of falls.
We hope this article has given you a few ideas for some design adaptations for safer senior care environments such as adequate lighting, an emphasis on safety training for staff, interior color contrasts, and safety measures in bathroom design, but for a more comprehensive guide to design for fall prevention, you can access our free whitepaper, Falls Prevention by Design here.
It contains insights from design masters, room-by-room advice, and practical safety tips on how to minimize the risk of falls and injury events through environmental modification. Alternatively, for a thorough insight into how you can prevent bedroom falls, you might find our article, How to Prevent Bed Falls in Long-Term Care Communities valuable.
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