Designing For The Generational Shift
From a lack of intuitive wayfinding to poor acoustics to a lack of contrast between walls and floors, many acute care environments are inadequately designed to support seniors.
“You can design an environment that’s beautiful, easy to maintain, and allows for the best care to be provided; however, if it doesn’t have a component that focuses on the empowerment and mental well-being of the patient, then we’re missing the mark,” says Laurie Placinski, interior project designer at Progressive AE (Grand Rapids, Mich.). “Implementing cues that empower a patient to feel capable of walking to the bathroom, walking down the hall, socializing, and managing a component of their care can speed up the healing process and have a potential impact on length of stay, as well as decrease the potential for readmission.”
And it’s time to pay attention. Baby boomers consistently account for the largest percentage of acute care patients, while the Centers for Disease Control and Prevention reports that in 2012, 22.2 percent of patients 65 and older made a trip to the emergency room. At the same time, the senior demographic is projected to more than double by 2030, eventually accounting for close to 20 percent of the U.S. population. As a result, the healthcare industry is bracing for what’s been dubbed the “silver tsunami.”
To help make acute care settings more senior friendly, a number of essential design features are in order.
The patient room
Generally speaking, best practices for patient room design are quite similar for general adult populations and seniors alike. For example, providing surfaces near the bed where patients can store personal items and a family-friendly layout are design approaches that are effective for all.
More specific to seniors, designers advise providing optimal control over the patient room environment, particularly because seniors are often more prone to becoming overwhelmed or disoriented than younger patients. For example, they should be able to easily adjust their room temperature, lighting levels, and television. Likewise, “offering secure places for personal items will decrease worry over missing cell phones or hearing aids when patients are temporarily transported from their room for various tests or surgeries,” says Melissa Davis, director of interior design at BSA LifeStructures (Indianapolis).
However, Chris Korsh, regional healthcare practice leader at HOK (New York), recommends setting up patient rooms to support bedside diagnostics and treatment where possible, to reduce the stress and fear that seniors may experience when transported to another site for testing or exposed to large pieces of equipment.
Another big issue, particularly for the elderly, is mitigating fall hazards. While installing grab bars and handrails between the patient bed and bathroom isn’t a mandated standard, it’s highly recommended.
Additionally, the use of nonslip flooring is promoted across the board, particularly in the patient bathroom. However, Barbara Miszkiel, principal at Stantec Architecture (Toronto), says that some nonslip flooring products are only nonslip when dry and could create a fall hazard in wet areas, so designers should do their research when specifying flooring systems.
A clear path
Good acoustics are essential to help senior patients who are more likely to be hard of hearing. “With poor distinction of pitch, inability to pinpoint sound sources, and the reduced ability to filter background noise, hospitals and other healthcare environments become confusing,” Miszkiel says. “The elderly patient may therefore process information more slowly, respond more slowly to stimuli, and lack a sense of orientation, time, and place.”
By minimizing noise, particularly in unit corridors, this can help reduce anxiety and better promote diagnosis, healing, and recovery.
While carpeting is a great sound-absorbing option, it’s not as easy to clean and maintain as hard flooring. A good compromise might be an “in between” option like rubber flooring. If hard flooring is desired, it’s still possible to balance acoustics with carefully selected wall construction and ceilings carrying higher noise reduction coefficient and articulation class ratings, Davis says.
In terms of supporting older patients as they maneuver through hallways, designers advise avoiding patterns or colors in flooring and ensuring that there’s a clear contrast between where floor and wall surfaces stop and start for better depth perception.
Another recommendation is treating the corridor as a therapeutic and social space by providing views, places to sit, and easy flow into common areas.
“For elderly patients, being bedridden is a cause of significant daily loss in bone density and muscle tone, resulting in poor potential for recovery,” Miszkiel says. “Encouraging patients to take a step beyond their patient room threshold may be a major accomplishment in their goal to recovery. Inclusion of a small sitting/visiting area just outside the patient room within an alcove off the corridor, for example, can be accomplished within the code-dictated minimums for corridor widths.”
Finding the way
Good wayfinding is always an essential hospital design component, but it’s particularly so for older patients whose physical and cognitive abilities may be compromised. This includes signage and directional cues presented in multiple modalities, colors, languages, and symbols, so that seniors can more easily read and process the information, says Dorothy Lloyd, director of the global healthcare practice at HOK (San Francisco).
At the same time, Tim Barnhill, principal at Hord Coplan Macht (Baltimore), cautions against too much signage, which can be over-stimulating and confusing for some older adults. To ensure that signage works optimally, Miszkiel recommends that smaller signs display a font that’s at least three-quarter-inch high, while larger signs intended to be viewed from afar be printed with a font at least one and three-quarter-inch high. “In addition, light letters on dark, matte-ﬁnish backgrounds are most easily visible for the aging eye,” she says.
Furthermore, because older patients tend to look with more of a downward gaze, Miszkiel says to mount signs at an intermediate height above handrails, as opposed to at the top of door frames.
Despite the growing proportion of seniors using EDs, the vast majority of these units in hospitals aren’t designed to support this demographic. According to Nick Slater, principal at MSKTD & Associates (Indianapolis), EDs are primarily focused on efficient throughput and staff functionality, as opposed to the patient experience.
EDs tend to be highly trafficked, noisy areas that can be intimidating, especially for seniors. To begin addressing this, hospitals are considering waiting areas with private clusters, softer lighting and sound-absorbing materials, and fast-track models to move patients into the treatment area quicker, Slater says.
“Several interior elements being discussed throughout the industry include larger clocks and signage to help with visibility, increased natural light for additional comfort, and even soothing music,” says Kathy Clark, senior director for operational healthcare planning at BSA LifeStructures (Indianapol
“Private rooms with simple layouts support privacy and navigation, while ED stretchers can feature surfaces that reduce the risk of bed sores and promote skin safety,” she adds.
Throwing the Affordable Care Act into the mix, a number of ramifications emerge for acute care facilities regarding senior patients. For example, the HCAHPS survey is a metric that captures patient satisfaction levels and is now linked to new reimbursement models, as is a healthcare provider’s ability to support its patients through the full spectrum of care from diagnosis to treatment to recovery.
“Healthcare facilities that are unable to develop and maintain an environment that directly supports seniors will see extended stays and readmissions that will impact their reimbursement and their capacity to maintain quality care,” Lloyd says.
By successfully implementing senior-friendly design and operational strategies, “this can translate into operational efficiencies and improved outcomes with shorter lengths of stay in a recovery-oriented model, where the facility and the community are part of the health and wellness continuum,” Miszkiel says.
Barbara Horwitz-Bennett is a contributing editor for Healthcare Design. She can be reached at firstname.lastname@example.org.