Planning for Aging In Place

Posted on March 30, 2011

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Design for the aging is a subject not often discussed or written about in mainstream architecture magazines, which is why its presence in January’s Architect magazine made it all the more refreshing.

Architect Matthias Hollwich’s views on growing old and design for the aging were the focus of the article.  I found his views hopeful; two in particular are worth echoing here. 

One, “Hollwich believes we ought to call ourselves old earlier”.  How true.  In ancient societies and other non-Western cultures, the aged have almost a hallowed distinction.  They are revered as being enlightened and a source of wisdom.  The elderly in most cultures demand instant respect, if for nothing else than they have staying power.  Watching Blockbuster video stores close in my neighborhood reminded me of how transient, especially commercial things, can be:  Blockbuster was born, grew, dominated, withered and died—all during the first half of my life. We should be so lucky as to be identified as “old” to garner the societal respect that comes with age—and not necessarily to be a card-carrying AARP member for the crass discounts afforded to the “old”.

Hollwich says the aging process should be integrated into daily life to prepare for the inevitable changes that occur at the end of life. At the Virginia Rural Health Association conference last December, this topic was discussed at length.  Aging in place is a crucial concern, especially for rural communities.  It was consensus thinking that healthcare and home design must allow for dignity, pleasant experiences and self-respect. In advanced age, some of the simple things we take for granted—safety, freedom, access—are not so easily accomplished.

On some level, the “old” have specific needs; but in general, they only want to maintain what they have experienced throughout their lives—independence, comfort, dignity— until they truly become incapacitated. What is perplexing is how we plan our lives in many ways, but we deny that we will get old.  This is Hollwich’s second main point:  “denial is the worst thing we can do”.  As a society we are preoccupied with extending life, even living forever, or at least rejecting the notion that death will come for us.  Perhaps we feel in a very delusional way that some other alternative to death will present itself by the time we ‘get to that age’.  Since the beginning of time, no one has managed to cheat death.

Part and parcel with the denial is the belief that the environment for death is something other than our house. We struggle with staying in our homes as long as possible, until the inevitable move to a more “hospital-like” environment where care is more available. Arguments still abound that say if our homes were more aged-friendly, we might postpone what is seen as an inevitable move to a nursing or continual care facility. Or, at least if we modify our physical environments through design we could severly reduce the home accidents that create hospital visits and begin the gradual decline of health toward death.

The reality is we all age differently and have different ideas of what is important to us as we age, and what a satisfactory home environment looks like for us. Then again, there are some legitimate consistencies among the “old”, which should be researched further and designed around.  For instance, loss of mobility creates a very real sense of loss, vulnerability and loss of independence. Also, aging is really a series of major steps / declines around milestone events, like a fall that generates a broken hip (and loss of mobility), not smoothly floating down a river of gradual decline toward our demise.  We do not wake up one day and realize we are old; we achieve it by passing through significant thresholds.

Hollwich’s “New Aging” concept proves that, with proper planning, aging can be adequately dealt with in the physical environment. Some important  solutions we should expect to provide for ourselves as we age:  walkable communities, close amenities like grocery stores, public transit and healthcare, and residential environments with activities to encourage and maintain physical vigor.

The key is adequate planning.  We plan by creating wills and trusts, and purchasing products like long-term care insurance, but give our own homes and neighborhoods much less thought. Only by being honest with ourselves can we acknowledge our true wellness and physical environment needs—what will keep us self-sufficient and happiest longest—and keep the unpleasantries of continous healthcare in our advanced age at an arm’s length as long as possible.

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