Eur Rev Aging Phys Act (2007) 4:33–38
DOI 10.1007/s11556-007-0016-z
ACADEMIC LITERATURE REVIEW
Housing for the aging population
Halime Demirkan
Received: 16 August 2006 / Accepted: 22 January 2007 / Published online: 15 February 2007
# EGREPA 2007
Abstract Based on the concept of ‘aging in place,’ design
of houses in the past years are explored. Design features in
the built environment become barriers for aging people
with functional limitations. Initially, houses were designed
according to the required needs of the user with the
physical limitations. Later, adaptable house design was
introduced that allows the house to meet the specific needs
of the user, while maintaining the appearance of the house
until more obvious accessibility features are needed. Today,
‘design for all’ is recognised as a tool for ensuring physical
accessibility for aging people. The holistic perspective
embedded in the universal design theory should be
systematically and consistently developed during the design
process.
Keywords Aging . Functional limitations .
Physical accessibility . Universal design
Introduction
The increase in life expectancy, the resulting growth of the
elderly population and the preference to age in familiar
environments are the driving forces for architects to
consider aging population in the design process. It is
estimated that Europe will have 173 million people aged 65
and above by 2050 [34]. According to UN projections,
almost one third of the population (32.5%) will be aged 65
or older in 2050 [68]. Aging is most serious in Southern
H. Demirkan (*)
Department of Interior Architecture and Environmental Design,
Faculty of Art, Design and Architecture, Bilkent University,
Ankara 06800, Turkey
e-mail: demirkan@bilkent.edu.tr
Europe. In Northern Europe, by contrast, ‘only 25%’ of the
population will be aged or older in 2050. These estimates
show that there will be a demand of housing for a number
of aging people, and the supply will not be sufficient. If a
house is inadequate for the needs of people living in it, it
never becomes a home. For the aging population, a house
must be fully accessible to become a home.
Treffers [65] stated that “designing places and spaces for
all means designing society, including aging people” (p. 3).
Older people become disabled as they experience a decline
in hearing and sight as well as their mobility. Physical
design issues become barriers for aging people. There are
some studies that examined relationship between life in the
home and the well-being of the elderly [15–20, 26, 56, 57].
Because there is a limitation in outside physical activities,
aging people focus more on the activities in their
residences. Their homes become the only places that they
can maintain social bonds with individuals and their
community. Researches have shown that psychological
well-being is one of the most intrinsic aspects of successful
aging [10, 41, 58]. Housing must fulfil the needs for the
daily activities of the elderly and give the feeling of
satisfaction, security, comfort and independence [16].
Previous studies for the elderly housing were mostly
focused on senior housing, sheltered housing, nursing
houses and community dwellings rather than private
housing. The global aging phenomenon highlights the
disparity between traditional housing and the actual
standard of housing required to enable people to live in
their homes as their needs change. Studies have identified
various factors having impacts on the psychological wellbeing of the elderly including housing and neighbourhood
environments. Environmental psychologists were showing
positive links between perceived well-being in the home
and the quality of the residential environment [11, 40, 49,
34
69]. It is reported that elderly residents with diminished
abilities, if they are familiar with the surroundings, can
carry out daily life activities nearly successfully. On the
contrary, these activities can be very hard to carry out, even
by less disabled elderly, when they are not familiar with the
surroundings [40, 49].
Although research from other disciplines shows effects of
the built environment on human happiness and welfare, the
design professional is required to reach beyond the known
application of design knowledge and previously conceived
solutions [53]. An understanding of the requirements of
aging people must be considered from the preliminary
phase of design. It is critical that the needs of the elderly be
addressed in the initial phase; not only does this avoid
costly design changes later, but more importantly, addressing these needs as an afterthought depicts segregation.
Accessible housing design
Many studies were conducted in attempts to design better
houses and interiors for the elderly. However, the opinion
of the elderly themselves related to the design itself is rarely
considered. Women’s Design Service was set up in London
in the 1980s to provide advice and information on the
requirements of elderly women [9]. This was a collaboration medium for architects and users to improve standards
and choices in housing design. The findings of these
collaboration sessions were published as a publication titled
‘Designing Housing for Older People’ [8]. Then, many
designers started to participate or collaborate with the
elderly people during the design process of houses [16–19]
or house renovation [57].
Accessible generally means that the dwelling meets
prescribed requirements for accessible housing [21, 29].
Accessible features in dwellings include items such as wide
doors, sufficient clear space for wheelchairs, loop-type
handles on hardware, grab bars in the bathroom and knee
spaces under the sink. These features are permanently fixed
in place and very apparent [29]. There is a broad body of
written documents that refer to the accessibility of elderly
and disabled people. These include the standards [7, 21],
references [32] and norms that guide the design process.
These European documents were similar to American
National Standards (ANSI A117.1) [2] and Fair Housing
Act Design Manual Guidelines [30] in the USA. In the past
years, there has been a development towards considering
groups with special needs in the design process within the
context of given information in the standards and reference
documents. This was mostly achieved by a specialised
solution in addition to the regular one [22]. Comparison of
housing policies for the aged persons in different countries
can be found in Brink [6]. Thus, the provided solutions in
Eur Rev Aging Phys Act (2007) 4:33–38
the design process should include all users in a holistic
perspective.
In December 1993, the United Nations [67] invited its
member states to find solutions to the increasing number of
elderly people and those with functional limitations
amongst populations in many regions of the world. ‘United
Nations Standard Rules on the Equalization of Opportunities for Persons with Disabilities’ specified 22 concise rules
stipulating how designers in the member states could
prepare designs for integration and provide equal opportunities for people with functional limitations. As a result,
standard organisations started to develop standards and
issue guidelines addressing the people with physical
limitations.
In many design guides, the requirements for people with
changing needs are stated with special emphasis given to
the needs of people who are extremely mobility-impaired
like wheelchair users [57]. The needs of aging people are
mentioned in a general context or within a few sentences.
Therefore, many of the recommendations are not specifically useful for all people with minor limitations. For a
designer, it is hard to make a decision for an actual solution.
Sagdic and Demirkan [57] proposed a design decision
support system to support designers during design process.
Further studies were conducted for integration of reasoning
systems in architectural modelling activities [23–25].
Findings of Sagdic and Demirkan’s [57] study on habitual
activities and daily living of the Turkish elderly supported
Imamoglu and Imamoglu’s [35] study on housing of the
Turkish elderly. They also found that there were gender
differences in preferences while using interiors that were
not considered in the standards.
Adaptable housing design
Research on housing highlights a growing discordance
between the users’ requirements and housing standards
even in western societies [36, 46, 52, 64]. The major cause
of this discordance is the neglect of the individual differences in dwelling habits by the designers and planners [31].
The researches conducted in this field are mostly restricted
to the evaluation of housing satisfaction as opposed to
residential satisfaction [54], although they are closely
interrelated [37]. Although, a few are interested in the
analysis of house plans and found out that interior spatial
layouts had changed significantly over the years [33].
Many non-disabled people prefer not to live in accessible dwellings because of its clinical outlooks, and the
clearances for the able bodies were considered as lost
spaces such as clearance under the counter instead of base
cabinet storage space in the kitchen. Many people did not
use the houses with accessible features. To overcome these
Eur Rev Aging Phys Act (2007) 4:33–38
problems, adaptable features were introduced. “Adaptable
features are either adjustable or capable of being easily and
immediately added or removed to ‘adapt’ the unit to
individual needs or preferences” ([29], p. 2).
For some, adaptation may be as simple as adding grab
bars and a seat to the bathtub. For wheelchair users, it may
require ramping entrances, widening doorways, lowering
counter surfaces, lever-type handle to doors and drawers
and modifying storage areas. Individuals with sensory
disabilities may require visual adaptations for such items
as the telephone ringer, the doorbell and smoke alarms.
People who are visually impaired may require tactile
marking of changes in floor level and stair edges and
Braille markings on appliances and controls [22].
With adaptation, in addition, some terms like ‘enabling
environments’ and ‘home modifications’ were started to be
popular. Developing enabling environments through removal of barriers includes the utilisation of architectural
and interior design modifications and building technologies
[42, 50, 60]. The level of disability of the elderly plays a
role in the extent of modifications. Pynoos et al. [51]
recommended that data on individual differences, acceptance and priorities were valuable for the implementation of
home modifications. These data could help improve design
of assistive technology, consumer products and building
technology.
Morini and Pomposini [47] analysed a number of
countries in Europe such as Italy, The Netherlands, Great
Britain and France for their tendencies to the housing
demand from the aging population perspective in 1996.
They stated that accessibility and adaptability were specified in the Ministerial Decree of 1989 [14] that linked these
terms to the law on the architectural barriers free of the
same year in Italy. In The Netherlands, the Senior Citizen
organisation with the Steering Committee for Experiments
in Housing constituted The Senior Citizen Label which is a
consumer quality certificate for new housing [47] that states
four types of requirements, namely, safety, ease of use,
accessibility and adaptability. Morini and Pomposini [47]
also reported that in 1996, UK had not extended building
regulations concerning access and facilities for disabled to
domestic buildings yet. In France, they [47] reported that
accessibility was an already accepted concept and defined
in the building codes for having the elderly in their familiar
environments. They also added that in 1995, Ewart [28] has
proposed adaptable housing as better and safer for
everyone, although it is more cost effective in the long
term.
Lansley [39] thought that in UK, national building
research did not have common initiatives focused towards
achieving an inclusive society with the other developed
countries. Although there were building regulations, since
1995, “little emphasis was given to the needs of older
35
people and disabled people” ([39], p. 63). In 1995, a report
about the implications of the changing age structure of the
population was published [63]. The term EQUAL (Extend
Quality Life) was the focus on the needs of older people
(http://equal.ac.uk). EQUAL is a national research initiative
designed to encourage university-based academics and
researchers to become involved with quality-of-life research
for the benefit of older people and disabled people and,
more generally, to meet the challenges of the aging
population in the UK. In 1998, the Engineering and
Physical Sciences Research Council launched a special
initiative to enable research engineers, designers and
physical scientists and social, medical and health scientists
to collaborate and to work directly with older people,
disabled people and their representatives on issues that
were of fundamental importance to improving the quality of
life. The theme ‘design for all’ was added to EQUAL in
1998 [39]. The concepts of barrier-free and lifetime homes
are considered in the UK community.
Design for all (universal design)
Although codes and standards for the benefit of people with
mobility limitations specify accessible or adaptable design
requirements, the universal design approach targets all
people of all ages. Universal design is defined in the USA
as “an approach to creating environments and products that
are usable by all people to the greatest extent possible”
([45], p.156). There are seven principles of the universal
design as seen in Table 1. Story et al. [61] stated that its
root is deep and strong throughout the twentieth century
because of the demographic, legislative, economic and
social changes among older adults and people with
disabilities. A universal design feature is any component
of a house that can be used by everyone regardless of
ability or disability. The definition also started many
discussions on the issue on what is a design that is ‘usable
by all people.’ Consequently, many international standards
on usability are published to support this issue [5].
Although the universal design is not a recently coined
term, it has not called attention to architects and engineers
over the past years in Europe. The term ‘design for all’ is
used instead of the universal design in Europe. The
European Institute for Design and Disability played a
decisive role and chose the term ‘design for all’ [27] in
2005. Trost [66] stated the difference between these two
terms, as the universal design suggests a comprehensive
philosophy, whereas the ‘design for all’ relates to practical
applications. This comprehensive philosophy is explained
as the holistic approach for all users that do not include
disabled people as a specialised group.
36
Eur Rev Aging Phys Act (2007) 4:33–38
Table 1 The principles of the universal design [12]
Principles
Description
1. Equitable use
2. Flexibility in use
3. Simple and intuitive use
The design is useful and marketable to people with diverse abilities
The design accommodates a wide range of individual preferences and abilities
Use of the design is easy to understand, regardless of the user’s experience, knowledge,
language skills or current concentration level
The design communicates necessary information effectively to the user, regardless of ambient
conditions or the user’s sensory abilities
The design minimises hazards and the adverse consequences of accidental or unintended actions
The design can be used efficiently and comfortably and with a minimum of fatigue
Appropriate size and space is provided for approach, reach, manipulation and use, regardless
of the user’s body size, posture, or mobility
4. Perceptible information
5. Tolerance for error
6. Low physical effort
7. Size and space for approach and use
In 1997, Aslaksen et al. [3] from The Norwegian State
Council on Disability claimed that although there is an
improvement in the usability of both buildings and outdoor
areas in the last 20–30 years, there are still poor design
solutions because of the lack of knowledge and competence
of architects and planners. Besides, they pointed that more
effort should be given to understand various needs and
wishes of the population for better solutions. Although they
recommended the universal design for having better design
solutions, they pointed out that there was a gap between the
best possible solution for the individual and the actual one.
They added that consideration must be given to a whole
series of conditions such as social considerations as
economy, aesthetic design, sustainable development and
cultural qualities in the process of planning and development. Therefore, the principles of the universal design
should be seen as a quality assurance process in the whole
architectural design process. In applying the principles,
there may be conflicts between issues, and the designer
should decide upon the priorities of these issues. They
concluded that the imperfection in theory and methodology
should not be interpreted as an obstacle in implementing
the universal design in practice.
For Norwegian architects and planners, an interactive
medium was presented for integrating accessibility and the
universal design into architecture [13]. It provides a
communication media through sketches and text as well
as pictures of built examples and checklists. According to
Christopherson [13], the dominant detached, single-family
housing in Norway is capable of accommodating universal
design principles.
Designers are now aware of the changing role of
designers and the function of universal design education.
On the 15th of February, 2000, the Council of Europe
adopted a resolution to introduce the principles of the
universal design to school programs for professions
involved in the built environment [55]. Despite this
European legislation in favour of design for all, the
architects and designers were not educated to apply it in
the design process. Therefore, the AAOutlis [38] project
co-funded by the European Union LEONARDO Program
started to build innovative teaching tools for the universal
design for architects and architectural students in Europe.
With Belgium being the coordinator, Denmark, France and
Poland were the other partners of the project.
Research related to the universal design flourished more
in the product field [4, 19, 20, 59, 62] than architecture
[44]. The architecture literature sources mostly provide the
requirements of elderly users for a safe and functional
environment [16, 18, 57]. In addition, some sources have
developed a list of characteristic features of universal
houses as checklists [43]. Recently, a building survey [48]
is developed as a tool for evaluating the existing buildings
from a human-centred perspective. Examining the checklists or building surveys, it is found that there are many
universal design principles to cover, as well as one principle
may comprise the others. Besides, for a novice designer, it
is hard to rank these principles. The holistic perspective
embedded in the universal design theory should be
systematically and consistently developed during the design
process. A survey should guide the design process and
provide criteria for new usable environments. A building
survey may encourage alternative universal design solutions rather than one accessible solution.
Future research
Accessibility to the built environment was recognised
internationally in 1993 by the United Nations Standard
Rules on the Equalization of Opportunities for Persons with
Disabilities [67]. Almost every country in the world signed
the standard rules, and rule 5 defined all the issues of
accessibility including the accessibility to the built environment. For many years, standard organisations have been
developing standards and issuing guidelines addressing the
needs of people with disabilities in the built environment.
However, these developments were segregating diversified
Eur Rev Aging Phys Act (2007) 4:33–38
groups instead of dealing with the whole population. The
Expert Group of the European Commission on Full
Accessibility published a report entitled ‘2010, a Europe
Accessible to All’ [1]. This report indicated the lack of
awareness of designers as one of the obstacles in achieving
accessibility to the built environment. In this report,
“accessibility means providing buildings and places which
are designed and managed to be safe, healthy, convenient
and enjoyable to use by all members of society. It implies
that buildings should be accessible, that they should be
really usable from ground floor to the top, and that
adequate means of autonomous exit should be provided”
([1], p.6). Accessibility for all is therefore no longer limited
to a minority with special needs. Designers, architects,
urban designers and others should be designing buildings
and objects to accommodate a diversity of people
concerned by accessibility issues. Accessibility should be
addressed in the wider perspective of spatial planning. An
accessible environment is safer and healthier, thus avoiding
accidents while allowing aging people to enter. An
accessible environment is more comfortable, as it is more
livable. Furthermore, it is more adaptable, as it accommodates later changes. The Expert Group of the European
Commission concluded that “all legislation, standards,
guidelines, etc should be designed and implemented with
an aim to make the built environment accessible and usable
by all those who could be expected to use it” (p. 13). In
addition, it is stated that the construction works, products of
information and communication technologies should be
amended considering the essential requirements to include
accessibility for all.
Design for all is recognised as a tool for ensuring
physical accessibility for aging people, but there are many
other types of accessibility, which depend on mental and
physical factors. If the built environment has been designed
to take into account the physical dimensions of the human
being, also perceptual, motor and cognitive abilities support
human activities. Therefore, the design for all is the design
for human diversity, social inclusion and equality.
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