Remove Barriers to Improve Quality of Life

By Christine MacDonell, member of the ASID Aging in Place Council

As interior designers with a passion for assisting those who are aging, it is important that you are aware of barriers and the need to remove them. Barriers can take many forms—attitudinal, communicative, environmental, architectural, etc. A major concern for designers creating spaces used by older persons is any barrier that relates to falls.

Dr.Ernst Wunder, president of the American Health Foundation, said in 1975, “It should be the function of medicine to help people die young as late in life as possible.” Medical science has begun to do this, but a fall injury can undermine even the best medicine. Falls are the leading cause of injury, institutionalization and loss of independence among older adults. Falls are also the leading cause of death from injury in the U.S.

According to the Center for Disease Control, in the United States, one of every three persons age 65 and older falls each year. “Fallers” are two to three times more likely to fall again within six months. The impact on quality of life is dramatic. Elders develop a fear of falling, which for many reduces activity, limits independence and increases social isolation. Removal of barriers is thus an excellent way to have elders age in place without impeding their function or quality of life, whether in a private home, care facility or public space.

The economic impact of injury from falls is substantial. One study determined that the average total cost of a single fall injury in 1998 was nearly $20,000. The U.S. total direct cost of fall injury in 2000 was slightly more than $19 billion, and it is expected to reach $32.4 billion (in current dollars) by 2020. The Medicare cost for hip fractures in 1991 was $3 billion. By 2040, Medicare costs for hip fractures are projected to reach $240 billion dollars.

One third of falls are related to environmental barriers. Designers should review the entire environment to make sure all obstacles are removed and that physical needs are addressed. The removal of barriers means that the environment is converted or adapted to support ongoing independent living by making the performance of daily activities easier and accidents less likely to occur.

As designers you stress the importance of an overarching quality of life, health and wellness for all individuals you work with. This holistic approach is reflected in four key areas that have been shown to reduce the number of falls:

  1. Having a regular exercise program
  2. Making the home safer
  3. Having a health care provider review medicines
  4. Having vision checked regularly

Exercise is a critical component of the equation. Strength, balance, coordination and overall quality of life all improve with regular exercise. Many individuals need adequate space to establish exercise programs. Talk with your client to find out where they are in relationship to exercise and how much they do or will want to do. When you are designing a care facility or other public space, it is critical to include accommodations so that those at risk for falling and those who have already fallen also have opportunities for regular exercise.

Safety in an elder’s own home as well as congregate living situations is critical. There are many excellent Checks for Safety forms and systems. These checks could also be used to demonstrate conformance to some of the accessibility standards. A great source is the National Center for Injury Prevention and Control. Staff also can be enlisted to review safety in units of congregate living and other facilities. For example, housekeeping and maintenance workers in units could be tasked with checking the following:

  1. Does the resident have to walk around furniture to navigate through a room?
  2. Are there throw rugs on the floor?
  3. Does the resident have to walk over extension cords or telephone cords?
  4. Are items that are used frequently on high shelves?
  5. Is the path from the bed to the bathroom lit?
  6. Is the light near the bed hard to reach?

 Any of these obstacles can become a hazard and result in a fall.

The wrong mix of medications can lead to poor balance, lapsed attention and increased sleepiness—any of which can result in a fall. The barrier in this case is usually communication about medications. On the care provider side, there needs to be a good knowledge base of what medications are being used, both prescribed and over the counter. On the elder patient’s side, having inadequate or unclear information about their medications and their indications, contra-indications and dosages can lead to deadly the results. In addition to talking to clients to find out what medications they may be taking, be sure to provide adequate space and storage to help them organize and regulate their medication regimen.

Poor vision or changing vision is a frequent cause of falls. Annual check ups should be part of the individual’s general health and wellness philosophy. Proper lighting that takes into account the need for additional light as the eye ages, particularly in task areas and where there are steps or stairs, is essential to prevent falls and other injuries.

Many falls and resulting injuries are preventable. A designer’s focus on removing barriers and responding to the changing needs of their customers can make the difference in quality of life for elders. This means reviewing, analyzing and looking at trends of incidents, falls and complaints. The development of action plans and quality improvement plans in the design of the person’s living space will benefit the individuals you are engaged with. Designers make a difference!

Christine MacDonnel is Managing Director, Medical Rehabilitation and International Aging Services/Medical Rehabilitation, Commission on Accreditation of Rehabilitation Facilities (CARF).