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S46 September-October 2018/HASTINGS CENTER REPORT

Working with elders around the world has

taught me that those living in grass huts

in Africa with children at their feet are of- ten happier than people in assisted-living homes with a

chandelier over their heads. My work in design consul- tancy and in fifteen years of running a nonprofit, Ibasho,

that aims to co-create socially integrated and sustainable

communities that value their elders has allowed me to

learn much about how architects and designers can con- tribute to helping people live a good life in late life.1

People often need supportive services or other adapta- tions as they age, but do they really need—or want—the

luxury environment few are accustomed to? The chal- lenge for architects and designers is not to create a built

environment whose carefully curated facades hide lives

of quiet desperation. It is to help elders access the sup- port they need without upending their lives or severing

virtually all ties to their communities.

Older adults are being marginalized around the world

at the same time that their numbers are growing rap- idly.2

Increasingly, aging is viewed simply as a process of

decline, with the growth that accompanies aging invis- ible to societies that value only those adults who produce

monetized goods or services. As a result, elders are ef- fectively cut off from the flow of daily life, their wisdom

and perspectives lost to the children and younger adults

in their communities.

This applies to both industrialized and developing

nations, but it plays out somewhat differently in the two.

In the industrialized world, housing and community de- signs are often ill-suited to the needs of an aging popula- tion. This is particularly true in the United States, where

urban sprawl and the reliance on the automobile effec- tively strand elders who can no longer drive. Striving to

stay in their homes for as long as possible, elders who

cannot drive often become progressively more isolated

and disengaged from the rest of the community as their

peers become frail or pass away.

No doubt they would be less reluctant to move if the

institutionalized care settings these nations have designed

for frail adults were to afford the lifestyle that they desire

as they age. Traditional elder-care environments in the

industrialized nations are based on the hospital model,

which treats people as patients rather than residents and

focuses on safety, cleanliness, and efficiency. Nursing

homes and assisted-living facilities in these nations are

typically safe and hygienic, but their rigid hierarchies

and strict routines tend to stifle individual choice and

make it difficult to find meaningful engagement or to

accommodate individual preferences and needs.

The developing world has retained a stronger culture

of honoring elders and including them in the daily life

of society. However, those traditions usually depend on

the unpaid caregiving work of daughters and daughters- in-law. That work is becoming harder to count on, as

modernization and urbanization give women more op- portunities to advance their social and economic status

by working outside the home and away from the small

villages where elders tend to live.3

This is creating a need

Co-creating Environments:

Empowering Elders and Strengthening Communities

through Design

BY EMI KIYOTA

Emi Kiyota, “Co-creating Environments: Empowering Elders and

Strengthening Communities through Design,” What Makes a Good Life in

Late Life? Citizenship and Justice in Aging Societies, special report, Hastings

Center Report 48, no. 5 (2018): S46-S49. DOI: 10.1002/hast.913

© 2018 The Hastings Center. Permission is required to reprint.

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SPECIAL REPORT:What Makes a Good Life in Late Life? Citizenship and Justice in Aging Societies S47

for a more formalized elder-care system, including long- term care facilities and trained caregivers.

Some developing nations, unable to finance that care,

are leaving elders to fend for themselves. Others are build- ing institutional care facilities based on the medical model

created by developed countries. Either way, elders are

poorly served. No matter their country of origin, older

adults share the same fears: becoming socially isolated, be- ing treated as useless and unworthy of respect, having no

opportunities to contribute meaningfully to their commu- nity, and having their need for assistance with daily activi- ties go unmet.

Several movements have sprung up in recent years to

offer new ways of addressing elder care. Transformational

nursing homes have begun to dismantle the institutional

model in favor of a relationship-rich approach to care,

giving residents far more control over the rhythms and

routines of their lives. Small houses with small staffs that

provide skilled care offer another alternative to institution- alized life for some frail adults.4

Another model is emerg- ing in neighborhoods that share resources to help older

adults stay in their homes, such as village-to-village net- works and cohousing.5

Providing access to services such as

transportation and property maintenance and recreational

opportunities for socialization, these initiatives tend to en- rich elders’ social lives but often fail to accommodate their

physical needs.

In spite of these hopeful trends, a dichotomy still exists

in the culture at large: we strive to make institutions better

and to keep elders living in their own homes longer, but we

rarely ask what can be done between these two extremes.

In order to create lasting solutions for our global future,

we need to stop thinking in terms of total independence

or near-total dependence. We need to find new ways to

nurture the interdependence that enriches all communities

by ensuring that it extends to the end of life.

It is time to explore ways of investing old age with

greater meaning, enabling elders to provide more input

into where and how they live, remain part of a community,

and remain useful to others. While we must be realistic

about aging and the physical and cognitive changes it of- ten entails, we all want to live our lives to the fullest mea- sure. Architects and designers can facilitate this change by

creating environments in which aging is something not to

fear but to enjoy.

Enabling elders to live in their homes while remaining

engaged in their communities requires design professionals

to answer two critical questions. First, how can services and

built environments be transformed to adjust to people’s

changing needs, rather than forcing people to adjust to dif- ferent places as they age? And second, how can our society

empower elders to participate in transforming their physi- cal and social infrastructures so they can age in place and

remain engaged?

Transforming Services and Built Environments

The current norm in elder-care design is that each type

of place designed for older adults (independent living,

assisted living, or a nursing home) provides a certain level

of care to people with similar physical and cognitive capaci- ties. This approach forces elders to make multiple moves as

their conditions change, from one type of home to another

and also from one unit to another within the same facil- ity. These moves often happen in moments of crisis when

people are at their frailest or most vulnerable and thus most

in need of the comfort and emotional sustenance of a fa- miliar environment. The stress of adjusting to an unfamil- iar place often causes or exacerbates confusion, depression,

and a sense of loss or diminishment. All that trauma could

be avoided if we shifted our approach, designing environ- ments that adapt and evolve as elders’ needs change over

time.

It is important not to try to create “perfect” places that

anticipate and meet elders’ every need. The environmental- press theory holds that places should be designed so as to

maintain a dynamic, balanced interaction between a per- son’s competencies (among which are physical and func- tional health, cognitive and affective functioning, and

quality of life, including a sense of efficacy or mastery) and

environmental press (which includes the person’s home

environment, social environment, and neighborhood).6

As shown in the figure, the fit between competencies and

environmental press determines how well people function

in their surroundings. If environmental press is too high,

it may intensify social isolation because the environment

hinders elders from going out from their own homes. If, on

the contrary, environmental press is too low, it may impair

psychosocial and physical abilities, keeping people from

being engaged in their life in a meaningful manner by fail- ing to be challenging enough.

To maintain a built environment that provides a proper

fit for people of all ages and abilities, societies must recog- nize that no one-size-fits-all approach can work. Even if a

We should design environments that help us to maintain and

develop our capacities, rather than simply facilitating ease of living.