Lifetime Housing, Urban Design and Health

O. Monaghan1, D. O’Neill1,2

1. Centre for Ageing, Neuroscience and the Humanities, Tallaght University Hospital, Dublin D24 NR0A, Ireland
2. Trinity Haus, Trinity College Dublin, Dublin, Ireland

Keywords (MeSH): Housing; Architecture; Aging; Disabled Persons


Housing has long been recognized as an important factor in wellbeing and health 1, and in particular a focus of research has developed in housing and its relationship to optimal ageing 2.

This has been a relatively neglected focus of research in Ireland, other than recent work on universal design and dementia-friendly design through UD for domestic houses 3,4. It is therefore very welcome that the Royal Institute of Architects of Ireland has published a report in 2018 focusing attention on housing for older people 5.

Drawing on data from a report published by the Housing Agency in 2016, the RIAI has drawn attention to the new demographics, the unsuitability of existing homes for supporting living with disability, and the likelihood that many older people live in houses with rooms that are not currently permanently used 6.

There is a mismatch between current home features and what is actually needed. Important features requested included: widened doorways, ramps, chairlift, ground floor bedrooms, storage for walking aids, surveillance and intercom system.

Much of the RIAI focus is on the potential for building in such a fashion as to support downsizing, and this report makes substantial reference to the Nursing Home Support Scheme (also known as the ‘Fair Deal’) as a potential driver to promote tax incentives to create opportunities for downsizing. In this, the authors point to a gap between current housing models with community support and nursing home care: one of their key response is the creation of a broader spectrum of options such as programs for building homes and apartments suitable for downsizing.

However, the report missed an opportunity to include some more fundamental options for shaping our housing sector for ageing, and in particular the concepts of Lifetime Homes and Universal Design.

The public and professionals often think that gerontology is focused solely on older people but in fact its focus is on ageing across the lifespan, and in the words of a pioneering geriatrician and gerontologist, Bernard Isaacs, “if you design for the old, you include the young, if you design for the young, you exclude the old”. This points to the broader societal benefit of age-attuned design – those with a range of disabilities throughout the lifespan, as well as those with small children, will also benefit.

Universal Design (UD) is a movement which has developed over six decades to promote design which accommodates all people, regardless of age, disability or other factors. The original principles have expanded to include health and well-being 7. There is a significant opportunity to engage with UD in Ireland, as our Centre for Excellence in Universal Design (CEUD) is the only one in the world established by legislation. Through its work, consideration is being given to incorporate UD into the continuous professional development of Irish architects 8

Could UD retrofitting and incorporation into new build be the solution for the many, relegating downsizing to an option for the few? The UD  home recognizes the fact that, our abilities and needs may change over time 3. The guidelines were created to help guide design and inform future developments with the aim of supporting people to continue living in their homes as they get older or if they become disabled. The ability of a person to remain as independent as possible can be influenced by accessibility and usability of products, services and environments. The detail in CEUD guidelines is comprehensive and optimizes the build environment to best cater for all ages and abilities.

A key focus of UD is to avoid creating “architectural disability” in its design. These include layout hazards and barriers that produce a built environment which is inconvenient and unsafe to use. This architectural disability is mainly created from insufficient and inflexible space or changes of floor level. The current Irish home for the older person is mostly conventional in design and does not cater for their eventual age-related disabilities.

The UD approach has been mirrored by the movement of Lifetime Design, a lifespan approach for architecture which also encompasses our expanding ageing population. This is encapsulated by the concept that we are all potential or actual victims of architectural discrimination as a result of conventional building design 9. Some jurisdictions and many designers have adopted the Lifetime Design Principles 10. They provide technical and design adaptions to houses to render them suitable in UD Terms. This may be a pragmatic solution for current houses before the future waves of UD development become incorporated into practice.

Although housing and urban design are clearly key factors in promoting health and wellbeing across the lifespan, physicians may wonder where to turn to develop articulacy and skills in this arena. A helpful and emerging concept is that of “Clinicians for Design” an international group made up of architects and doctor (www.cliniciansfordesign.org). It was set up with an aim to accelerate the design of environments and systems in order to enhance the healthcare interface 11. While the initial focus of this group is mainly on hospital healthcare design, it represents an opportunity for physicians and other healthcare workers to engage with the principals of UD and Lifetime Design.

Promoting a fuller dialogue between medicine, architecture and urban design has the potential to bring positive influence to bear on the impact of housing on health and wellbeing across the lifespan, and in particular into later life.

Corresponding Author
Prof. Desmond O’Neill
Consultant physician in geriatric and stroke medicine and Professor in Medical Gerontology,
Tallaght University Hospital and Trinity College Dublin
doneill@tcd.ie

References

1. Stafford M, McCarthy M. Neighbourhoods, housing and health. In: Marmot M, Wilkinson R, editors. Social Determinants of Health, Second Edition. Oxford: Oxford University Press 2005, 297-317.
2. Tinker AM. Housing for frail elderly people. Public Health 1992; 106(4):301-305.
3. Centre for Excellence in Universal Design. Universal Design Guidelines for Homes in Ireland. Dublin: Centre for Excellence in Universal Design; 2015.
4. Grey T, Pierce M, Cahill S, Dyer M. Universal Design Guidelines: Dementia Friendly Dwellings for People with Dementia, their Families and Carers. Dublin: Centre for Excellence in Universal Design; 2015.
5. Royal Institute of Architects in Ireland. Designing homes for an ageing population. Dublin: RIAI, 2018.
6. Amárach Research, Lyons R, Sirr L, Innovation Delivery. Housing for older people – thinking ahead. Dublin: Housing Agency, 2016.
7. Steinfeld E, Maisel J. Universal Design: Creating Inclusive Environments. Hoboken, New Jersey: Wiley; 2012.
8. Shea EC, Basnak M, Bucholz M, Steinfeld E. Universal Design and Continuing Professional Development for Architects: An Irish Case Study. Studies in health technology and informatics 2016;229:189-98.
9. Schindler SB. Architectural exclusion: discrimination and segregation through physical design of the built environment. Yale Law Journal 2014; 124: 1934-2024.
10. Goodman C. Lifetime Homes. Lifetime Homes Design Guide. Watford: BRE Publishing; 2012.
11. Anderson D, Pang S, O’Neill D, Edelstein E. The Convergence of Architectural Design and Health: Clinicians for Design. Lancet 2018;392:2432-2433.


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