IDEC Report: Adapting the Interior Environment

As our population ages and the needs of this demographic become more complex, we must solve design problems for people who live in institutional spaces by understanding their subjective experience of the space. Although they consider the institution their home, it is also a place that provides a complex range of services within a safe and secure environment—where doctors, nurses, caregivers and volunteers all serve diverse patient needs.

This article is based on a case study involving a situated interior design issue that used design research to solve a real problem in an institutional setting. This case study took place in a long-term care facility for the elderly, where social problems were identified and ultimately solved using light and color as the prime modifiers of the interior space. Residents initially rejected interior space that was designed for hosting daily activities. As a design researcher, I realized early on that this problem would require both inquiry and interior design problem solving. First, an evaluation of needs was done on the site, and secondly, design interventions were proposed with the goal of improving the quality of life for the patients while responding to the functional needs of caregivers. Using direct observation and the input of both patients and caregivers, the researchers suggested modifications to the existing space. Once the physical changes were made, a second evaluation was conducted to study the impact of the changes that were implemented.

Context and Background While our world is essentially built for the average person, it is becoming increasingly hostile for people who are infirm, aged or vulnerable. If we consider that designing interior space is about integrating real, functional human needs with an aesthetically pleasing built environment, then our responsibility as interior designers is to do so by responding to intimate human needs. Unfortunately, when it comes to the aged in institutional settings, too often we design for an "aged" population as a monolithic human "type," rather than as a lived, social human being with complex needs that are quite different from what we have always considered the norm¹.

Several factors affect the capacity of designers to design appropriate institutional settings for the aged. There are not only different stages of aging but also different types of responses to interior environments. First, as we age, our physical and visual responses to the environment become varied. For example, designing for people with dementia and Alzheimer's is not the same as designing for someone with different cognitive abilities at a similar age². Second, while our population is aging rapidly, existing institutions were generally designed for a much younger society. As the aged population grows, the people inhabiting these same institutions are becoming older and frailer—often 85 years old or older³. With this advanced age comes advanced frailty. Third, compounding these issues is how the aged navigate the environment using physiological and psychological responses. If the spaces are improperly designed, the instability caused by feelings of insecurity and panic can be compounded by inappropriate choices of contrast or color⁴. Finally, the social aspect of living in an institution means that people must deal with major changes in lifestyle when moving from the safety, privacy and security of "home" into a publicly social and non-private environment. All of these factors increase costs to the healthcare industry—over-stressing an already high workload on service providers and caregivers.

Why Color and Light? In assessing design problems in the institutional environment, the two salient issues are the use of light and color. Color can be used as a catalyst to promote positive psychological responses. The interior environment must provide both the capacity for the aged to "wayfind" easily as well as prevent disorientation and falling. The spatial organization of color and pattern and the consideration of contrast and placement of color relative to the zoning and pathways of the spaces are important to consider in the overall spatial composition.

A second factor is light. Quite often in existing institutions corridors are long; the linear fluorescent lighting compounds the linear spatial feeling; and floors tend to be glossy to maintain cleanliness. Combined, these three factors create severe contrasts for the aging eye and induce panic for those trying to negotiate corridors. Another issue is the color rendering of the light. Not only are certain colors in the specter of light less visible to the aging eye, but when the Color Rendering Index (CRI) is 80 or less, people look ill in the institutional environment, no matter what the color scheme might be.

The Case Study I was contacted at the University of Montreal following a presentation on falling and the aged in institutions in the fall of 2004⁵. The head nurse of a long-term care facility asked for my help, as she could not understand why her patients were rejecting activity spaces that had been designed for them. They would bring the patients to a room for activities and within 2-3 minutes, they would try to leave. During the research/evaluation, certain issues became apparent:

• The linear ceiling lighting caused glare on the floor, preventing patients from easily finding their way to the activity room;
• The corridor was separated from the activity room by blue doors and frames, creating a physical and psychological barrier;
• The activity space itself was intimidating and unfriendly, and there was no place for the eye to rest.

Once the evaluation was completed, minor changes were implemented including:

• Removal of the blue elements (e.g. doors, frames) near the activity space;
• The addition of new, warmer toned lighting with a CRI of 90+;
• Color change in the corridor/passage area, such as introducing a soft green into the palette;
• Providing spatial cues within the activity space, such as a new bookcase, to create a "living room" feel and to encourage social activities for both patients and visitors.

ConclusionInterior design research can be used as a vehicle to promote well-being in the institutional setting. This case study shows how research and design can work together to improve the quality of life for people— especially when designers understand the actual, lived situations of the end-users of the spaces. For people in institutional settings, spatial cues such as light and color can help to alleviate stress by creating variety, continuity and pleasant spatial experiences, without sacrificing institutional needs.

Tiiu Poldma is an associate professor in interior design at the University of Montreal and a regular researcher with the center for inter-disciplinary research on re-adaptation in the Montreal urban community. She teaches in both the interior and industrial design programs in architecture, urban planning, landscape architecture and design in the faculty of environmental design.

References

1. Mace, R. (1997). Universal Design:
   Housing for the Lifespan of All People.
   New York State University, New York: The Center for Universal Design.
   www.design.nesu.edu:8120/cud/ pubs/center/books/lifespanhous.htm
2. Brawley, E. (1997) Designing for Alzheimer's Disease.
   New York: John Wiley & Sons, Inc.
3. Young, P. (2000) The Age Factor. Azure. Toronto: Azure.
4. Poldma, T. & Wesolkowska, M. (2004).
   The Development of Lighting Products for the Aged and
   Specifically for the Needs of People with Alzheimer's' Disease.
   Rapport final pour la subvention IDM PRM-2002-07. Montreal:
   Institute of design of Montréal & the University of Montréal.
5. Poldma, T. (2004). L'aménagement
   optimal pour prévenir les chutes en institution: Tomber pile.
   Colloque Les chutes en institution:
   Une question d'équilibre?
   Institut de gériatrie de
   Montréal. Montréal, Québec.