Received: 11 July 2018 Revised: 11 December 2018 Accepted: 17 January 2019

DOI: 10.1002/col.22358

RESEARCH REVIEW

Chromatic interior environments for the elderly

Anna Delcampo-Carda | Ana Torres-Barchino | Juan Serra-Lluch

Department of Architectural Graphic Expression,

School of Architecture, Universitat Politècnica de Abstract
València, Camino de Vera s/n, Valencia, Spain The impact of the physical environment on individuals has arisen as a growing
Correspondence body of research in population wellbeing. Yet, most of studies in this area do not
A. Delcampo-Carda, Department of Architectural
focus on elderly even though they are particularly susceptible to the characteristics
Graphic Expression, School of Architecture,
Universitat Politècnica de València, Camino de of their interior spaces. It is a well-known fact that to be old is to acquire a toler-
Vera s/n, Valencia 46022, Spain. ance of disabilities based on the gradual degeneration. A common problem is a
Email: andelcar@ega.upv.es dysfunction in visual sensitivity and accordingly, the alteration of their environ-
Funding information mental color perception. That is why these impairments need to be understood in
Secretaría de Estado de Investigación, Desarrollo e
Innovación and European Regional Development
order to minimize the elderly spatial difficulties. To know at what point there is a
Fund, Grant/Award Number: BIA2016-79308-R; loss in the ability to perceive color is necessary to understand how should we take
Generalitat Valenciana, Grant/Award Number: these facts into consideration. A state-of-the-art literature review of current studies
ACIF/2014/228
from the last 20 years is carried out. The aim is to analyze existing practices on
Evidence-Based Research through a multidisciplinary approach in order to create
knowledge about chromatic built environments for the elderly. Data are identified
and considered together with empirical experience about color, perception, built
environment and elderly. Thus, the way in which elderly perceive the space is
explored. The adjustments in the formulation of these impairments throughout any
design strategy to adapt the environment to their physiological changes are deter-
mined. This article aims to determine a design interpretation of the various find-
ings, demonstrating that color, as a parameter of the visual performance, influences
visual comfort and helps performance in architecture for old people.

KEYWORDS

built environment, color perception, elderly, evidence-based, multidisciplinary

approach

1 | BACKGROUND unadapted built environments for older people.6–8 Nonethe-

less, most of the studies in this area do not focus on elderly
It is a well-known fact that physical environment can affect even though older adults are particularly susceptible to the
our welfare and behavior.1,2 Thereby, the impact of the physi- characteristics of interior spaces, especially when they experi-
cal environments on individuals has arisen as a growing body ence limitations in their functional and sensory abilities,9–11
of research in population wellbeing.3 Moreover, global popu- like visual impairments. These limitations do not necessarily
lation is increasing and becoming progressively older.4 This mean a negative change in daily life ability.
trend is expected to continue for the next decades.5 Thus, these The effects of the physical environment may be of particu-
demographic changes should lead significant challenges for lar importance in healthcare settings, such as care homes, where
the elderly. At the same time, research has shown that one of the effect of refurbishment,12 the presence of vegetation,13
the serious problems in elderly care is the complexity and product design,14 among others, has been demonstrated to have

Color Res Appl. 2019;44:381–395. wileyonlinelibrary.com/journal/col © 2019 Wiley Periodicals, Inc. 381
382 DELCAMPO-CARDA ET AL.

big impact on residents and some design guides had been 1.2 | Color and elderly
suggested.8 In these facilities, residents at the latter stages Most older people in care homes are affected by a whole range
of the life course are especially vulnerable and could experi- of impairments, as a result of the progress of biological aging.33
ence a relatively high degree of inability to adapt,15 experi- One of the most common problems affected by elderly is a dys-
ence disorientation,16 and stress17 Thus, it is important to function in visual sensitivity9–11 and therefore, the alteration of
adapt physical environment to the specific conditions of the their environmental color perception. Decline of visual field in
residents by improving their visual comfort, promoting self- older adults also affects daily care.33 In addition, this common
sufficiency, orientation and wellbeing. problem might be exacerbated in an unsuitable design of the
Despite the interest in linking scientific research to the built environments for seniors.6–8 That is why visual perfor-
design of the built environment dates to the late 1960s, mance needs to be understood as well as the way older people
Dr. Edelstein,18 expert in combining design practice with clinical use architecture, to adjust the spaces to their needs throughout a
and research expertise in architecture and anthropology, argues design strategy. Nevertheless, due to complexity of vision, color
that there is a limited rigorously-formulated research in order to perception and built environment, among the elderly, these
be applied in professional practice, leading designers and archi- issues have been assessed on very limited occasions.
tects to work through their intuition and individual practice. Furthermore, it is a well-known fact that literature and
Therefore, a clear theoretical basis is necessary in order to ensure evidence-based research on aging visual system and age-
the application of research findings in practice,3 facilitating to related eye diseases are detailed and well-defined.9,11 Despite
the practitioners the understanding of the research results of this, translations to architecture and environmental design
reported in academic journals. are mostly scarce, specifically to color guidelines for visual
comfort.34 This attention to correlating the physical environ-
1.1 | Effects of color in healthcare facilities ment with residents' visual outcomes may be seen, as men-
tioned above, as a result of review of existing evidence-based
Color, as a feature of the built environment, among others, is
research. Visual perception-based assessment results are nec-
proposed as one of the relevant basis3 on human interaction
essary to explore how one interacts with the built environ-
with the built environment in the current literature. The effects
ment and to determine newly addressed adaptations of it.
of color, applied in the built environment, have proved to be
By offering specifically designed environments35 that can
increasingly relevant for patients wellbeing in healthcare facili-
achieve adequate visual accessibility for older people.
ties.19 Nonetheless, the existing reviews show that the research
There are several summaries of the literature24–27 that, when
regarding the effects of chromatic physical environments, that
are taken together, provide a wide overview of our current
is, the use of color in healthcare settings, are still insuffi-
understanding of color and environment phenomena in health-
cient20,21 in order to establish a specific definition of chromatic
care settings. Rather, the purpose of this article is to provide a
spaces. Color, as well as giving character to space, is useful
comprehensive updated summary that would allow for the iden-
influencing human spatial perception,22 decision making,23
tification of the area of color among elderly, that have been
and behavior.24 For example, a number of studies have found
assessed on very limited occasions, to synthesize and to carry
that white environments, besides the manipulation of wall
out a critical review of the current state of knowledge, and dis-
color, tend to produce stress-inducing effects compared to
cuss the unresolved or new questions emerging from this body
other colors when they are perceived in simulated healthcare
of work from the point of view of color on built environment,
environments20 and, in general, achromatic and monotony
for better understanding and to start out further step of current
environments tend to produce a detrimental affect on recov-
investigation. What special problems result from the visual
ery rates of hospital patients and staff morale because of the
impairments which affect older people and their use of the envi-
lack of stimulation and interest.19
ronment? What are their environmental requirements?
Despite considerable interest and work in the field, pre-
vious critical reviews about color in healthcare environments
noticed some limitations based on the lack of evidence-based 2 | AIMS
studies because of methodological limitations,25 the uncer-
tain experimental control,26 inconclusive findings of the The aim of this study is to set a complete overview of the
experiments review,24 or the concern of being criticized evidence in the literature on older human interaction with
when applying color in architecture.27 Therefore, current the chromatic built environment. Figure 1 shows the hypoth-
and further empirical research is needed. esis that color, applied to the built environment, improves
Moreover, although much fundamental research has been architectural communication and promotes visual accessibil-
conducted on the effects on color and emotions,28 color and ity in healthcare settings, such us care homes, where aged
productivity,29,30 and color and preference,31,32 applied research people with common visual impairments live.
on the influence of color in the built environment is limited, According to this, the following critical elements are
particularly in healthcare settings.28 considered:
DELCAMPO-CARDA ET AL. 383

provide empiric results on color, built environment, and

aging. Therefore, the review of current studies should dis-
criminate rigorous empirical studies from those without a
scientific basis (Figure 2).
The strategy was carried out by using the Web of Sci-
ence and Scopus databases. Web of Science collect the refer-
ences of the main scientific publications of any discipline of
knowledge, both scientific and technological, humanistic
and sociological, since 1945. Scopus is a database of biblio-
graphic references and citations, of peer review literature
and quality web content, with tools for monitoring analysis
FIGURE 1 Analysis of the Elderly-Built Environment relationship from and research visualization. It offers a comprehensive sum-
the perspective of color communication and architectural design. Source:
mary of the results of global research in the fields of science,
developed by the authors
technology, medicine, social sciences and the arts and
• The technical results provided by evidence-based humanities. The search was performed using the keywords
knowledge. elderly, color, vision, perception, architecture, built environ-
• The role of color for visual comfort in aged people. ment, chromatic, interior space, older people, aging, aged
• The impact of color on elderly spatial comprehension. people, design, care home, healthcare. For further and more
specific search, a combination of keywords was used.
To that end, the study requires, on the one hand, to pro- In order to reach the scope of the research, we do not
vide a global view on how research about color and aged peo- directly consider the studies on architecture, which are also
ple is progressing and determine the critical topics that are relevant for healthy age, nor do we provide a multidisciplin-
most researched. On the other hand, it is necessary to evaluate ary approach in order to create knowledge that could be
the multidisciplinary results that have been obtained in order applied in care homes environments and residential institu-
to find its significant impact addressed to built environment. tions for the elderly. That is, “the underlying objective of
Throughout this article, we use the term “environment” to evidence-based practice is the enhancement of outcomes by
refer to inner spaces, the physical context that people experi- augmenting practitioner experience and skills with a valid
ence in interior spaces such as care homes. In addition, treating and reliable data”18 (p. 58). These outcomes will permit to
the term “color” as a function of the environment, we use the determine a design interpretation of the various findings.
term “color” limited to stimulus. An important issue is the lack
of definition of visual comfort in the literature; unfortunately,
visual comfort is still widely debated, and there is no consensus 3.2 | Design and selection criteria
on its definition. We use the term “visual comfort,” defined by The screening process, shown in Figure 3, indicates the dif-
the European standard EN 12665, as “a subjective condition of ferent selection stages. The titles and abstracts were assessed,
visual well-being induced by the visual environment.”36 and full articles for potentially relevant studies were obtained.
Several screenings to identify the studies were carried out:
Initially, controlled studies about color effects in humans
3 | T H E R E VI E W P RO C E DU R E
and/or built environment were selected. Later, among these
studies, those involving older people were identified, that is,
3.1 | Search strategy to identify studies articles were selected that referred to elderly and color in their
As mentioned above, unfortunately and very often, sugges- titles and abstracts. After selection of the articles, full text ver-
tions and directions about design, color, and built environ- sions were obtained and read in total, after which articles
ment are not always adequately scientifically proven. Thus, were either included or excluded.
evidence-based color studies will be analyzed in order to The following inclusion criteria were applied:

FIGURE 2 Research methodology scheme

384 DELCAMPO-CARDA ET AL.

that concerned aspects of medical treatments were

excluded.
• Year of publication: Even though the overall major studies
on color perception in the elderly date back many years,
over the last two decades there have been important scien-
tific and technological advances that have led to relevant
social changes. And together with this advances, research
and its methods have also innovated. Taking these pioneer
studies as a basis, new research on color perception, with
new forms of methodology have been developed. it seems
important to carry out a review of these last 20 years, tak-
ing into consideration the precursor studies that have made
this scientific development possible. Studies that were pub-
lished more than 20 years ago are excluded.

Data were studied as stated in published articles. In total,

221 study abstracts were assessed and 40 full texts were
read. Seventeen studies based on color and elderly related to
various perspectives dated from 1997 to 2017, met the
inclusion area.

3.3 | Analysis
FIGURE 3 Flow diagram of selected studies It is important to note that the studies selected show how
most often they do not match the boundaries of a single dis-
• Study type: published randomized color and elderly stud- cipline. Consequently, different disciplines have to collabo-
ies. Only the empirical research, that is, research using rate in order to obtain complete results about color and
empirical evidence, that present a certain experimental elderly and the built environment. As much of the existing
control and are written in English were included. work is fragmented or related to a specific context or disci-
• Keywords: Only those articles which include in their title pline, consolidation is required. A challenge for consolida-
and/or abstract and/or keywords the words color and tion and also for overcoming the boundaries of current rather
elderly, and variants, were included. As a variant, we unidisciplinary approaches is the comprehension of the results,
considered color/ chromatic/hue and elderly/aging/life the comparison of approaches in different disciplines and the
span/aged observers/aged people/older adults. adjustment into a common field, that is, human interaction
• Study group: In many countries, people are considered with the chromatic built environment.
older when they retire, and this age is generally at 65. The research presented here is based on a comprehensive
On the other hand, there are experiments that research literature study incorporating various research articles from
about the age at which physical changes become more different disciplines, such as optics,37,38 image processing
and neurocomputing,39,40 human and social environment,41
evident, particularly in the vision impairments.9–11 This
psychology,42,43 engineering,44–46 geriatric medicine and health
age limit is very imprecise. However, it is demonstrated
science,21,34,47 environment and information science,48,49 imag-
through empirical evidences that it is at the end of the
ing and printing technology,50 and electronics.51
decade of the 60 years when visual deficiencies such as
Regarding to the participants of the studies analyzed, in
cataracts increases considerably. Therefore, the age of
general, they mix young and aged participants in order to
65 is established as the point at which, both from a social
compare the results obtained in lifespan. For young partici-
and visual point of view, a person is considered older.
pants, it is reported mean ages ranging from 6 to 30 years.
Therefore, the scope of the study is limited to people For adult participants, it is reported mean ages ranging from
over 65 years of age. Individuals with a diagnosis of a 41 to 55. For aged participants, it is reported mean ages
mild type of dementia were accepted. But if the whole ranging from 60 to 95 years. Four studies restricted entry to
set of participants of a same study have some relevant only those with 80 years,21,47 95 years,34 and with over
cognitive illness or diagnosis of severe Alzheimer, that 60 years.46 One study compares specific adult and aged sub-
experiment was excluded. Studies including participants jects.50 Furthermore, if we focus on the participants charac-
with any type of color blindness were also rejected. teristics, it is noteworthy that one study recruited mixed
Cross-sectional studies that have been designed to gain a normal vision subjects with tritanomalous subjects.42 Four
complete situational overview were included. Articles studies who recruited only aged participants allowed
DELCAMPO-CARDA ET AL. 385

participants with not severe aging common visual impair- color samples21,34,41,42,47,50,51 and simulated images in articles,46
ments that had passed some color-perception test.21,34,46,47 or computer programs with color samples or other color
Regarding to aged participants, there is only one study elements.38–40,43–45,48 Nevertheless, few studies have combined
which included participants with severe, moderate, and mild the method assessment with an actual setting context in order to
dementia.21 evaluate the effects of participants in this context.46 The explica-
A summary of the content of the mentioned research tion of that could be that these studies do not focus on built envi-
from the 17 studies recruited is presented below (Table 1). ronment but in characteristics of elderly vision. In this regard,
From these data and their consequent results, the Ikeda et al.50 state that to investigate the visual performance of
research has been guided by the overall research question: older people is necessary, but it results in difficult to perform
How can we implement these results to the field of the build visual experiments by having them participate as subjects at
environment in order to improve elderly visual comfort? laboratory-based experiments. This is very different than the
experience of color on walls in an interior environment27 in order
to evaluate how color affects them. Thus, a real environment is
4 | RE SUL TS important to provide an actual state of the subject for better
understanding. Moreover, in actual setting, subjects probably
Based on literature review, in order to obtain a contextual
behave normally and this will contribute to obtain more accurate
framework of the selected studies, prior to the multidisciplin-
findings.
ary approach by exchanging experiences, the present table
summarizes the 17 research article, focusing on the type of 4.1.3 | Built environment evaluation
context, the context setting, and the assessment method of
Although this review has found few studies focused on
each research (Table 2).
research on build environment for the elderly,46 it is found that
four34,41,46,47 of the seventeen studies take the effect of the
4.1 | Review of color research methodology built environment into consideration or consider that their find-
In the methodology of the analysis of the literature, we see ings could be useful for interior design. Wijk et al. suggest that
several significant factors dominantly featured that should be their results can be used in environmental color design for the
pointed out: elderly “to promote better function and wellbeing”47 (p. 184)
and also to maintain a “balance between demands at the envi-
• Physiology assessment. ronmental levels and the person's ability to respond to those
• Made up or actual context setting and color samples. demands.”47 (p. 184) This recommendation demonstrates that
• Built environment evaluation. architecture and interior spaces are present in many experi-
• Environmental variables. ments. Thus, architectural color environments are considered
as an essential factor in order to obtain reliable results. It is rel-
evant to note how indispensable is this factor but researches
4.1.1 | Physiological assessment focusing on color and architecture for the elderly are scarcely
Interestingly, this review has found that there were less empirical studied.
studies that included psychological evaluation than studies that
included several perspectives of objective vision measurement 4.1.4 | Environmental variables
assessment in their studies. This fact disagreed with the study of As expected, all studies on color perception present the light-
Jalil et al.24 who state that many previous research used psycho- ing factor in a controlled and measured way. It is usual to try
logical evaluation rather than physiological evaluation, probably to maintain controlled and similar conditions for each partic-
due to the studies registered in the present study are more recent ipant. Generally, light source, timeline, no direct sunshine
and accessibility nowadays may face fewer limitations in experi- entrance and glare avoidance are the variables that have been
mentation process. Thus, they are gaining more controlled meth- controlled. However, there are some studies that have been
odology and variables.24 It seems that an increasing number of carried out in subject's homes or institutions.34,46 These stud-
researchers over the past 20 years are using more objective evi- ies tried to reduce extraneous variables as much as possible,
dences in defining color perception in the elderly based on physi- despite of the concomitant environmental factors. The fact
ological evidences and not only in subjective assessments. of working with older people implies greater difficulty in
All the tests and task performances of the studies reviewed moving to a laboratory or research center, due to their vul-
are related to the visual function in order to increase knowledge nerability; what entails having to perform the experiments in
about the physiological changes that occur in aging vision. their habitual space, with environmental variables that are
difficult to control. It is important to highlight the light fac-
4.1.2 | Made up or actual context setting and color samples tor, that is, to study the effects of color under different illu-
It is found that the results of most of the color studies have mination conditions.43,49,50 In these cases, illumination is
been done in laboratory or testing room,37,38,43,49,50 or using introduced as a changeable factor for their experiments. This
 386

TABLE 1 Studies included in the state of art literature review of color, elderly, and architecture (by alphabetic order)

General information Participants

Author Year Country Discipline Keywords Sample Age, years
Artigas et al.37 2012 Spain Ophthalmology, Optics Spectral transmission, human crystalline, elderly, 32 from 41 to 77 years + one 30-year-old
yellowing lens
Beke et al.39 2008 Hungary Image Processing Neurocomputing, Color imaging, aging, color vision, color appearance, 2 exprts 66.6 (n = 5), 25.8 (n = 5), 69.1 (n = 8), 25.8 (n = 5)
Virtual Environment color image preference Total 23
Fu et al.38 2011 United Optics Color constancy, life span, compensatory mechanisms, 185 34.03 years (from 18 to 75 years)
Kingdom unique hue
Ikeda et al.50 2009 Japan Imaging and Printing Technology, Color appearance, size effect, cataract experiencing 3 42, 55, and 74
Design, Photonics goggles, foggy goggles
Ishihara et al.41 2001 Japan Human and Social Environment, Vision in the elderly, decline in vision, simulation, 3 exprts 18 (n = 72), over 60 (n = 1322) years and
Engineering improvements for the elderly, older adults Total 1400 from 80 to 86 years (n = 6)
Kose51 2008 Turkey Industrial Technology, Electronics Color, color perception, artificial neural network Total 320 From 6 to 17 years; 17 to 30 years; 30 to
50 years; + 50 years
Kutas et al.40 2008 Hungary Image Processing, Neurocomputing, Spatial contrast sensitivity, Luminance contrast, 10 25.8 (n = 5), 66.6 (n = 5)
Technology Chromatic contrast, Aging vision
Lillo et al.42 2012 Spain Psychology Color, basic color terms, aged people, tritanomalous 45 21.4 (n = 15), 81.33 (n = 15), 82.5 (n = 15)
Ou et al.44 2012 Taiwan Color Science, Engineering Age effect, color emotion, color preference, color 2 exprts 24.5 (young subjects) 64.8 (older subjects)
harmony, single color, color combination Total 72
Suzuki et al.45 2005 Japan Applied Physics, Imaging Science, Color perception, aging, yellow filter, human lens, 16 22.3 (n = 8), 65.9 (n = 8)
Engineering response speed, simulation, Landolt-C
Suzuki et al.48 2006 Japan Environment and Information Science P300, reaction time, color perception, visibility, aging, 14 21.6 (n = 7), 68.4 (n = 7)
yellow filter, human lens, simulation, Landolt-C
Suzuki et al.49 2012 Japan Environment and Information Science Elderly vision, senile miosis, retinal illuminance, 16 21.8 (n = 8), 67.1 (n = 8)
optical simulation, electrochromic device
Wijk et al.47 1999 Sweden Geriatric Medicine, Gerontology, Color discrimination, color naming, color preference, 189 80
Health Science elderly, environment
Wijk et al.21 2001 Sweden Geriatric Medicine, Gerontology, Cognitive support, color/form memory, dementia, elderly 192 80
Health Science
Wijk et al.34 2002 Sweden Geriatric Medicine, Gerontology, Color discrimination, color naming, color preference, 84 95
Health Science, Ophthalmology color/form recognition, dementia, visual acuity
Wuerger et al.43 2013 United Psychological Sciences Color constancy, life span, compensatory mechanisms, 185 34.03 years (from 18 to 75 years)
Kingdom unique hue
Zamora et al.46 2008 Spain Engineering Elderly, safety perception, falls, conjoint analysis, floors 180 over 60 years 75.21
DELCAMPO-CARDA ET AL.
TABLE 2 Results of studies included in state of art literature review of color and elderly (ordered by alphabetic order)
Context setting Assessment method
Testing
Measurements- performance
Psychology vision age effects Assessment of color Vision aging
Computer- Made up- (preference- (desaturat, illumination discrim.naming- simulation
Author Type of context Actual samples laboratory Environment emotion) haze, glare) differences contrast Performance Observation (goggles)
Artigas et al. Yellowing lens effect x x
DELCAMPO-CARDA ET AL.

(2012)37
Beke et al. Color preference in x x x
(2008)39 image vision
Fu et al. Color sensitivity along the x x x x
(2011)38 protan deutan
and tritan lines
Ikeda et al. Color perception in cataract x x x x x x x
(2009)50 eye. Simulation
Ishihara et al. Problems in daily life x x x x x x x
(2001)41 caused by visual ability
Kose (2008)51 Color preference in x x x
artificial neural network
Kutas et al. Color contrast x x x
(2008)40 sensitivity in lifespan
Lillo et al. Basic color terms x x x
(2012)42 in lifespan
Ou et al. Color emotion x x x
(2012)44 responses in lifespan
Suzuki et al. Color perception. x x x x x
(2005)45 Yellowing lens.
Simulation
Suzuki et al. Color perception. x x x x x
(2006)48 Yellowing lens.
Simulation
Suzuki et al. Vision with senile miosis x x x x x
(2012)49
Wijk et al. Color discrimination, x x x x x
(1999)47 naming, and preference
Wijk et al. Cognitive support x x x
(2001)21
Wijk et al. Color discrimination, x x x x x
(2002)34 naming, preference,
and recognition
Wuerger et al. Color constancy x x x x x
(2013)43 in lifespan
Zamora et al. Safety perception x x x x
(2008)46
Total (17) 1 14 5 4 6 7 3 10 15 0 5
% over 17 research studies 5.8 82.3 29.4 23.5 35.3 41.2 17.6 58.8 88.2 0.0 29.4
387
388 DELCAMPO-CARDA ET AL.

allows their creation of different atmospheres as well as add- Absorption at short wavelengths
ing to understand the changing color circumstances depend- Due to the usual yellowing of the lens and their increase of
ing on illumination conditions. density, older people show symptoms of possible defects in
tritan band,38,42,43,48 in the performance of any discrimina-
tion task. In other words, due to the selective absorption of
4.2 | The effects of aging on vision
the lens for the perception of short wavelengths, the activa-
From the analysis, many of previous studies about elderly tion of all the blue sensitive cones is impeded. Thus, the yel-
focus their experiments in the physiology of vision, that is, lowish lens filter the shortest wavelength of the visible
the effect of aging on vision and, consequently, how old spectrum, producing a lower transmittance of the blue color
people perceive color and why they perceive in that way. As range.
we have seen before, research on this issue has continued Consequently, blue color range is not perceived well
into the present. From the analysis, physiological conditions because of the lower transmittance of the absorption at short
of the aging eye and how vision affects the daily perfor- wavelengths. This fact leads to the color discrimination in
mance of an older person are both the topics of study domi- these ranges being altered.
nantly investigated by previous research studies.
In order to increase knowledge of built environment for Environmental light and the scattering effect
the elderly, research on vision and aging is essential for sev- With aging, the increase of lens density37,50 and opacifica-
eral reasons: the results of these research studies can then be tion49 occurs. As a result, the lens of older people produce
used to develop and evaluate interventions and new designs more luminous dispersion than in young people.37 Studies
for the elderly addressed in interior spaces, thereby, improv- reveal that this luminous dispersion causes deterioration of
ing quality of life. Consequences of visual changes in chro- the visual acuity because of the uncomfortable foggy appear-
matic and spatial perception of the built environment are ance over the visual field.49,50 That is, “the environmental
determined in Section 4.3. We endorse the statement made light coming to the eyes from all directions overlay the reti-
by Owsley10 arguing that a question that arises from this nal image of a color patch and causes to reduce the color
body of work is to determine what types of color vision purity of the image.”50 (p. 351) This fact is mainly suffered
alterations would be troubling to the elderly, and that is what by people with cataracts.
this review has been reported as well as how design could
4.2.2 | Pupil size
resolve them.
It is a well known fact that, under conditions of low levels of
luminance, the pupil area generally tends to increase consid-
4.2.1 | Lens density
erably as the illuminance decreases. However, the dynamic
As many studies have demonstrated over the years, an range of pupil aperture decrease with age, that is, the pupil
increase in lens density occurs with aging,37,50 as well as size becomes smaller with aging and less flexible.42,49
their opacification.49 This fact causes the partial loss of light Therefore, the eye admits less light. Consequently, this fact
that falls on the cornea toward the retina, due to the absorp- poses a risk to elderly people in dark environments. More-
tion, dispersion and reflection of it. Therefore, there is a over, by restricting the passage of light, a smaller pupil
decrease in the total transmission of visible light, especially should deal with greater absorption of short wavelengths;
after the age of 70.37,41 According to the results, this trans- consequently, the effect of color vision will be affected with
mission varies depending on age, that is, from 95% in people increasing age. The accentuation of this phenomenon is
of 30 years, to 75% in people of 53 years, up to 31% in peo- called senile miosis and is very common during the aging
ple of 75 years.37 This fact entails a series of direct conse- process. This fact produces a decrease in retinal illuminance,
quences on vision, such as: especially in dark spaces.49

Yellowing of the lens 4.3 | Consequences of visual changes in chromatic and

As a consequence of this decrease, a more yellowish and sat- spatial perception of the built environment
urated crystalline structure is generated.37–41,43,45,48 At the Visual deficits lead to changes in sensory perception and,
age of 75 this effect increases noticeably, thus by the age of consequently, the alteration of the sense of well-being,
80, approximately 20% of older people may have consider- which often implies a strong feeling of insecurity.2 Despite
able yellowing effect in vision.41 It supposes an increase of numerous studies on color perception, there are few works
absorption of light by the crystalline lens and, consequently, that focus specifically on the elderly population. Color has
a decrease in retinal illuminance. This fact results in less vis- the function of creating contrasts, attracting attention, identi-
ible light being transmitted, not being able to reach 100%. fying, helping objects to be recognized and memorized.
So, color perception is altered due to this yellowing Color transmits messages, informs, focuses attention, and
effect.37,38 stimulates our perception of what surrounds us. It has been
DELCAMPO-CARDA ET AL. 389

FIGURE 4 From the analysis, summary of color combinations that could generate confusion when using them together. Source: prepared by the authors

necessary to study the habitual changes in the visual system That is, contrast sensitivity is related to the ability to dis-
associated to age in order to identify the adjustments in the tinguish differences in chromaticity in a visual percept. This
formulation of these impairments throughout any design contrast sensitivity has an important role in the spatial
strategy to adapt the built environment to their physiological domain, so it is necessary to take it into account. There is
changes. The following analysis is relevant in order to get a growing literature on research about the limits of chromatic
deeper understanding of colors and their implementation in contrasts; however, from the point of view of visual comfort
order to minimize the elderly spatial difficulties. in built environment, it is a subject less studied. We high-
light the most relevant results that, in a more or less direct
4.3.1 | Color discrimination way, can be considered in our field.
Hue sensitivity The various studies analyzed, based on the measurement
The yellowing of the lens supposes a modification of effec- of the threshold contrast and preferred contrast in young
tive luminance, as well as a modification of the color differ- people and elder people, highlight the significant effect
ence between the color itself and the background of the between age and spatial frequency. Older participants need
retina.45 Consequently, it causes a loss of chromatic sensitiv- considerably higher preferred contrast levels for medium
ity, both in the protan line, deutan line, and tritan line,38,42 spatial frequencies and, above all, for low frequencies.40
that is, in the whole spectral transmittance of the visible light. In this way, according to the results of the latest research,
Research confirm this alterations of color perception due it is concluded that older participants need much more con-
to the yellowing of the lenses necessitates avoiding certain trast in the built environment. These results further empha-
color combinations that could generate confusion when size the importance of using differences of contrast between
using them together. For example, color combination of the color of the figure or architectural element and its back-
white and yellow is perceived very similarly,41 and some ground, in order to improve recognition and definition of the
research states that green-blue, dark blue-black, and brown- visual information (Figure 5). That is, to obtain an effective
purple become the most confusing color combinations.41,45 contrast between the architectonical element that should be
It coincides with the findings of other studies stating that the highlighted and its adjacent wall.
aging of the lens produces a decrease in the blue-yellow In order to achieve satisfactory results, the color proper-
function and the discrimination of black-blue-purple color ties of chromaticity47 and lightness34 differences have to be
combinations are more confusing42 (Figure 4). According to taken into account. Considering hue, and keeping in mind
these results, elderly easily perceive small details in red and these criteria for the better visualization of the older person,
yellow colors but less in green, blue, and purple.21 it is recommended to make use of primary colors, easily rec-
Therefore, best color combinations are necessary in order ognizable, that is, for example, the use of primary colors as a
to carry out a better color discrimination in spaces for old code in order to provide orientation, because they are more
people because they may affect the individual when per- recognizable than more complex colors.
forming color-related tasks.
Low saturation colors
Sensitivity to chromatic contrast The white haze, or fog effect, that covers the retinal image of
Another of the consequences that occur with the yellowing the object that is perceived, implies the decrease of its purity,
and opacification of the lens, is the decrease in sensitivity to becoming more desaturated.44,50 Further, research demon-
chromatic contrast. This phenomenon suffers one of the strate that the desaturation of some element increases when
most notable declines.40 Sensitivity to chromatic contrast is the element is smaller.50 The bigger the element is, the more
defined by the “capability to discriminate details in a visual saturation it has.
scene based on the detection of slight variations of the color Furthermore, we usually spend our daily live in interior
stimulus in the perceived scene.”40 (p. 298) spaces with abundant ambient lighting, either from the sun
390 DELCAMPO-CARDA ET AL.

FIGURE 5 Differences of color between the architectural element and its background improve recognition and definition of the visual information. On the
left, image of a habitual toilet present in the residences of the third age of public entity in Spain. On the right, photomontage of color proposal based on the
researches analyzed. Source: photograph taken by the authors, “residence of elderly people in el Pinar,” Castellón, Spain. Source: image edited by the authors

or artificial light. It is demonstrated that, when the illuminance yellowish.38,43 In this way, color combinations that are com-
of the room increases, more desaturation occurs because of posed with blue color must be studied before their application
the increasing of the light coming to the eyes.50 Also, the due to this perceptive alteration in older people; for example,
more pronounced this fog effect is, the more dispersion effect studies confirm the difficulty of discriminating the color combi-
the aged lenses will have. Thus, color desaturation of the nation composed by blue if it is exposed on a gray49 or green
object takes place and chromatic content decrease.37,44 background.41,42,45
Thereby, independently of the hue,37,38 elderly need high According to these results, in order to achieve a better
levels of saturation and lightness differences.47 Regarding to color discrimination in interior architecture for the elderly, it
these notes, in a residence for seniors, it is important to create is advisable to use color details, objects or spatial elements,
distinct zones by color contrasts (Figure 6) (eg, sitting zone, corresponding to medium or/and long wavelenghts21 (Figure 7)
transit point, furniture). by using reasoned color combinations, that is, yellows, oranges,
reds, or considering a big contrast in lightness of the colors
Hue range corresponding to short wavelengths
when using blues and greens. This aspect should be taken into
Numerous scientific studies confirm the gradual deterioration account to improve the visual comfort of the elderly, because it
of the lens because of the aging process. Research indicate that, could affect their visual perception in carrying out daily activi-
particularly, blue color produces the lowest effective luminance ties or tasks in which color is present.
contrast, due to the low transmittance in the short wave-
lengths.49 That is, the decrease in the transmittance of the lens
at short wavelengths significantly influences the visibility of 4.3.2 | Susceptibility to dark environments and glare effect
the color during aging. Consequently, the ability to discrimi- As pointed out previously, color appearance and color discrimi-
nate colors is diminished, especially in blue and green colors.47 nation depend on the illuminance of the surroundings.38,43,49,50
According to the present analysis, with increasing age, blue Thereby, color perception differs with alterations in retinal illu-
color becomes more greenish39 and green becomes more minance. If the aperture of pupil decrease in flexibility, and the

FIGURE 6 Different types of contrasts depending on the color properties. Source: prepared by the authors
DELCAMPO-CARDA ET AL. 391

The use of dark colors are not advisable because they

increase the darkness perception and generate sensation of
confinement. More levels of illuminance are necessary to
determine the proper color scheme in order to provide the
required functions of the ambient.49 Therefore, lighter colors
are more advisable in confined spaces because they increase
the sensation of spaciousness and improve lighting condi-
tions. At the same time, color could be used as a code in
order to provide orientation (Figure 8).
Likewise it is a well-known fact that the eye adapts to
the lighting conditions of the built environment. However,
the effect of light scattering in the ocular environment due to
the opacity of the lenses during the aging process may cause
FIGURE 7 To use color in details, such a door frames, improve color glare from bright light of luminances that are superior to the
discrimination in interior architecture for the elderly. On the left, image of a
level of adaptation of the eye.
habitual bedroom hall, usually present in the residences of the third age of
public entity in Spain. On the right, photomontage of color proposal based
on the researches analyzed. Source: photograph taken by the authors, 4.3.3 | Recognition and reaction time
“residence of elderly people Lledó,” Castellón, Spain. Image edited by the The results show that color is an essential factor for the best
authors recognition. Color becomes a resource to facilitate memory and
recognition of objects and images,34 that is, the information of
retinal illuminance is lower, then, a decline of spatial sensitivity the built environment that is fundamental to recognize in a
will take place.10 more effective way and, consequently, enriching wayfinding in
In addition, from the age of 60 to 70, the rods, that is, the built environment.
the photoreceptors that are responsible for night vision, low Due to the changes in the chromatic discrimination that
illumination and low contrast sensitivity, suffer a drastic are produced by the yellowing and the opacification of the
decrease in density.10 The rods are reduced in number and lenses, research findings establish possible consequences
lose part of their sensitivity in visual function. Therefore, regarding the speed of response and visual processing of the
this fact produces an inefficient visual process in environ- elderly. Generally, older people need more time than young
ments with reduced levels of lighting as well as a process of people to detect, discriminate, recognize or identify objects
adaptation to these environments to be much slower. and signs of the visual scene, due, among other reasons, to

FIGURE 8 As the studies carried out indicate, lighter color are advisable in order to increase the sensation of spaciousness and to improve lighting
conditions. At the same time, the color could be used as a code in order to provide orientation. On the left, image of habitual corridor, usually present in
residencies of the third age of public entity in Spain. On the right, photomontage of color proposal based on the researches analyzed. Source: photograph
taken by the authors, “residence of elderly people in La Canyada,” Valencia, Spain. Image edited by the authors
392 DELCAMPO-CARDA ET AL.

FIGURE 9 The interior space and the various surfaces are defined because of the presence of recognizable colors. Color contrast and chromaticness
influence in the best comprehension of the space. The floor differs from the walls as well as the walls and the handrail due to the color combination. Walnut
Close Care Home in Thatcham. 2013. Source: Oxford Architects. Blurred image prepared by the authors

changes in visual perception. Specifically, the response speed largely responsible for spatial vision sensitivity deficits of the
for gray and blue stimuli is significantly slower for the elderly elderly. Specifically, depth perception fails41 and spatial con-
than for young people in contrast with the stimuli of longer trast sensitivity is reduced.49 Thus, objects without a solid and
wavelengths.45,48 well defined shape are more difficult to distinguish compared
to those objects with a clearly defined shape41 (Figure 9). On
4.3.4 | Visual acuity the other hand, if there is a door, which is not commonly used,
The chromatic vision is configured by signals that are com- it could be concealed by using the same color as the wall.
bined in reactions to provide information about space and It is concluded that, despite the gradual adaptation of the
time. Studies demonstrate that color vision characteristics are person,43 who does not perceive many of these gradual

FIGURE 10 Relation between the effects of aging on vision and their consequences in chromatic and spatial perception. Source: prepared by the authors
DELCAMPO-CARDA ET AL. 393

changes, the ability to discriminate color and to take control to prevent or reduce these visual impairments related to color
of the built environment becomes more challenging with age perception, because the ultimate goal is to preserve a high-
under certain circumstances. level of visual comfort function during the ageing process.
The following Figure 10 provides the relationship Finally, it is important to remark the importance of
between the effects of aging on vision and the consequences increasing knowledge on this topic from the point of view of
of visual changes in chromatic and spatial perception of the different disciplines. That is, as the number of older individ-
built environment. uals is projected to more than triple worldwide over the next
half century,52 built environment of older adults will be
especially considered. Interdisciplinary work that brings
5 | C O N CL U S I O N A N D S U G G E S T IO N FOR together health professionals as well as designers and archi-
FU RT HE R ST EPS O F C UR RE NT R ES E AR CH tects, could get results to minimize the negative conse-
quences of studied impairments, so that they can continue
Seventeen studies on color and elderly were identified and
to maximize their independence, health and wellbeing
met inclusion criteria, providing data about the effect of
within their daily life as they age.
aging on color vision. This article has justified theoretically
the effects of color on elderly people through real experi-
ments of literature analysis from several disciplines that dem- ACKNOWLEDGMENTS
onstrate the high importance of color perception in the elderly, This work is supported by the Generalitat Valenciana under
and how it changes with aging. By incorporating more rigorous Grant VALi+d programm [grant number ACIF/2014/228]
data about aging vision, more precise conclusions can be found and the Research State Agency and the European Regional
and used for generating color guidelines as well as improving Development Fund (AEI/FEDER, UE) with reference to the
professional practice of architects, designers and healthcare research project BIA2016-79308-R, “Modifications of the
designers in architecture for the elderly. Research on color and Visual Comfort in Residential Centres to Improve the Qual-
aging over the last 20 years serve science and society by a theo- ity of Life for the Elderly.”
retical basis that ought to become into a practical experience
applied for the improvement of the elderly daily life. OR CID
Understanding color perception effects in aging is neces- Anna Delcampo-Carda https://orcid.org/0000-0002-6529-
sary because they may all have a profound influence on the 6530
way in which older people perceive their environment. Thus, Juan Serra-Lluch https://orcid.org/0000-0001-6171-1285
the way in which spaces are designed for use by elderly peo-
ple must recognize their impairments, in order to minimize
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buildenv.2016.06.001. ANNA DELCAMPO-CARDA an architect since 2011, holds
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40:62-71.
Master in Training of Secondary Teachers. With the pre-
[32] Yildirim K, Akalin-Baskaya A, Hidayetoglu ML. Effects of indoor color on doctoral grant VALi+d awarded by Generalitat, she is
mood and cognitive performance. Build Environ. 2007;42(9):3233-3240. currently under contract with Polytechnic University of
https://doi.org/10.1016/j.buildenv.2006.07.037.
Valencia (UPV) as researcher, while she is developing
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nursing home: Assessment of environmental illuminances and colour tem- her doctorate within the Architectural Graphical Expres-
perature. Build Environ. 2011;46(10):1917-1927. https://doi.org/10.1016/j. sion Department and the Color Research Group with
buildenv.2011.03.013. which she collaborates. andelcar@ega.upv.es
[34] Wijk H, Berg S, Bergman B, Hanson AB, Sivik L, Steen B. Colour percep-
tion among the very elderly related to visual and cognitive function. Scand
ANA TORRES-BARCHINO has a PhD in Fine Arts from
J Caring Sci. 2002;16(1):91-102.
[35] Demirkan H, Olguntürk N. A priority-based ‘design for all'approach to the Polytechnic University of Valencia (2000) and is a
guide home designers for independent living. Archit Sci Rev. 2014;57: Full Professor since 2005. Her preferred field of research
90-104. is the color and design of architectural spaces. She is a
[36] EN 12665. Light and Lighting-Basic Terms and Criteria for Specifying
Lighting Requirements. Brussels; 2011.
member of the Color Research Group in Architecture
[37] Artigas JM, Felipe A, Navea A, Fandino A, Artigas C. Spectral transmis- and Design. She lectures as part of the Master's in Resto-
sion of the human crystalline lens in adult and elderly persons: color and ration of Architectural Heritage and the Master's in
total transmission of visible lightspectral transmittance of the old human
crystalline lens. Invest Ophthalmol Vis Sci. 2012;53(7):4076-4084.
Design Engineering at the UPV. She is currently leading
DELCAMPO-CARDA ET AL. 395

the MINECO I+D+i Project on Chromatic Modifications architectures with visual impact on the landscape.
in Residential Architecture. atorresb@ega.upv.es juanserra@ega.upv.es

JUAN SERRA-LLUCH received a PhD in Architecture

from the Polytechnic University of Valencia (2010) and
has been a Full Time Lecturer since 2011. He is a mem-
How to cite this article: Delcampo-Carda A, Torres-
ber of the Color Research Group of the Institute of Heri-
Barchino A, Serra-Lluch J. Chromatic interior envi-
tage Restoration at the UPV. His preferred field of
ronments for the elderly: A literature review. Color
research is color in modern and contemporary architec-
Res Appl. 2019;44:381–395. https://doi.org/10.1002/
ture. He is currently the main researcher in a project
col.22358
about color strategies for the visual integration of