Elder Patient Needs Begin with the Brain

Posted on August 19, 2014


For some time, I have been struggling with hospital wayfinding: how to make it better for our clients, and thus for hospital visitors.

What I have found is wayfinding, like other big design problems in healthcare, traces its roots to understanding cognitive functions and how people process information, universally.  Wayfinding will be solved when we can meld a better understanding of cognitive function with an appropriate tool on-site at the facility level (at the hospital).

I was reading about how the Baby Boomers (65+ years old) are 12% of the patient population now, but comprise nearly 35% of all hospital stays; their numbers are expected to double by 2030.  If hospitals truly become primarily buildings to treat only the very ill, as many industry experts believe, it is likely the primary users of hospitals will be elder patients—possibly to the tune of 70% of all patients in as soon as 16 years.

Some time ago, I examined the concept of universal design, or design to accommodate all people regardless of need.  Since then, there has been a niche uptick in the growth of ‘Senior EDs‘, or Emergency Departments that are senior-friendly, i.e. designed around unique needs of the elder patient.  I continue to collect information that definitively proves how elder patients differ from those under the age of 65.  And I wonder how the hospital of the future would look if we applied design to the special needs of the elder patient?

According to a seminar I attended at last year’s HCD.13 Conference, older patients seek  to fulfill several key needs from their healthcare environment:

  • Confidence
  • Autonomy
  • Problem Solving
  • Facilitate Safe Mobility
  • Reduce Stress & Anxiety
  • Support Cognitive Ability
  • Enable Restful Sleep
  • Family Contact & Giving
  • Knowledge Acquisition for Self-Care

To me, this list has only two items that are elder-specific, the items italicized.  The others are relevant for all patients that are not children, which makes this list is, in effect, a primitive recipe for a universal healthcare environment for all non-pediatric patients.

Understanding the two elder-specific concerns—facilitating safe mobility and supporting cognitive ability—the latter being especially difficult to translate into design because it involves more in-depth understanding of the aforementioned cognitive functions of the brain, are key focus areas for the future.  These two are not mutually exclusive of the others, and if an architect can master safe mobility and help support elder cognitive ability while also providing the others on the list, the healing environment will be ideally suited to handle possibly 95% of the patient population.  That would be impressive.

At that same  HCD. 13 Conference, another session examined perhaps a more difficult question:  ‘How do we give people information they can act on?’

Research shows the trail from input to outcome looks like this:

  • Data   —>  Information  —>   Comprehension  —>   Knowledge  —>   Action   —>   Outcome

What happens at the “arrows” is where the mystery lies.  We may not yet know if this trail happens differently between young adults and elderly patients.  If so, that would add yet another wrinkle to our necessary understanding prior to design.  Yet, this equation is a key to “support cognitive ability” in the elder patient, as well as achieve many other bullets on the above list.

It is exciting to see how healthcare evolves as we learn more about our brains, and what it takes for our brains to help us heal.  Architectural design by-way-of biopsychology and cognitive theory:  a road map to the next wave of healthcare design breakthroughs of the future.