Elderly care: Can design cure loneliness as we focus on aging in place?
June 28, 2019
We must confront our aging population’s social-isolation epidemic in today’s technology-driven world
The truth about living and aging in America is that it is rarely about checking off the items on our bucket list. Instead, many aging Americans lead very lonely lives. This social isolation of the elderly translates to poor quality of life, deterioration in health, and increased mortality. ?
Today, as we move toward aging in place, we must recognize that the technology that gives us access to healthcare and services delivered to our doorstep, can’t fix loneliness. Thus, aging at home is potentially more isolating than institutionalization. With our over-65 population expected to double by 2060, it’s important to start talking about loneliness as an epidemic.
As an architect working in healthcare, I’m interested in the ways that design and planning, particularly creating diverse and engaging urban places, can offer solutions to this crisis. As someone who will likely grow old and need care myself, I’m thinking about my future.
“How lonely is our aging population? A UK study indicated that on average an elderly person who lives alone and has limited mobility sees just one person a month."
Do I want to end up here?
We may already have loved ones living in an assisted living or skilled nursing facility. We rarely talk about this stage in life. And our natural tendency may be to focus on the quality of the facility itself. Regardless of the institution’s design, level of care, and expense, when a loved one enters an assisted living or skilled nursing facility, they typically find themselves more isolated from family and friends. But at some point in our lives, we likely will live here, too.
When my mother’s health deteriorated, I was lucky to have the resources to place her in a facility of my choosing in Florida, quit my job, move there, and visit her every day. In that time, I noticed that just one other resident received almost daily visits. Most residents received no visitors the entire time I was there. None.
But what about the quality of life for the other residents at my mother’s home? How about those that need to move into an institution with very few amenities and even fewer caregivers?
Loneliness is killing us. Research shows that chronic loneliness can weaken the immune system, disrupt sleep, promote stress, and cause inflammation.
The toll of loneliness
Loneliness is killing us. Research shows that chronic loneliness can weaken the immune system, disrupt sleep, promote stress, and cause inflammation. Loneliness leads to depression. It has even been linked to cancer.
How lonely is our aging population? A UK study indicated that on average an elderly person who lives alone and has limited mobility sees just one person a month. A 2012 University of California San Francisco study found that 43%of surveyed American older adults felt lonely. Socially isolated seniors are more likely to predict their quality of life will get worse. A study by the University of Chicago showed that elderly people who are affected by “extreme loneliness” are almost 14% more likely to die a premature death.
In general, because of loneliness, the quality of life is especially low in assisted living facilities. They maintain a happy public face, showing off features that exist to soothe our guilt about placing a loved one inside. And the best ones maintain a 360-degree connection for the resident, involving the family and communicating with them about care. But in general, our lives are hectic, family lives far away from these places, and these facilities are frequently out of sight and out of mind.
How can design professionals help fight loneliness in the elderly? Interaction is far more important than?the environment for the well-being of residents. That impacts how we design.
Technology to the rescue?
What about texting or artificial intelligence (AI)? Can they fill the loneliness gap remotely?
Research shows that the benefits of social interaction do not register with the brain’s higher pleasure centers from texting. It’s face-to-face interaction that we crave. AI has a role in health maintenance, but there’s little evidence that it can prevent loneliness.
The way forward
Aging need not mean chronic loneliness and depression. Research shows that recently retired seniors tend to happy and optimistic.
Is countering loneliness simply a matter of creating a facility that engages its residents? Or designing better, cleaner facilities? Previously, I might have homed in on the design details of the facilities themselves as solutions. But seen through the lens of loneliness, it’s clear that interaction is far more important than the environment for the well-being of residents. So, the big question becomes: How can we promote a lifestyle that’s worth living?
Should we focus on moving assisted living from suburbia to cities?
Assisted living facilities shouldn’t be built on farmland out in “Barrington,”? they really should be downtown. Just the ability for residents to see street life and human activity is more stimulating and social in nature than having access to very limited social activity (save a droning television).
And the possibilities for cross-generational interaction are much greater for the seniors in cities. Old people really want to see all generations. They want the new news, not the old news.
Design for interaction
Cities offer opportunities for interaction. So how can we, as designers, capture that in design without building a high-rise for old people or coming up with another warehouse solution?
Architects, urban planners, and public-health officials must come together to provide some answers. In semi-urban situations the concept of the “front porch” may prove useful in creating that social connection. The ability to see the world go by from the front porch is one that we need to tap into. From the urban porch, the elderly can stay in touch and connect with other people and feel a part of life as it goes on. Visibility is also key. These places should be seen so that society can’t deny that they exist.
People crave interaction. Whether in an urban or semi-urban setting, the "front porch" can create opportunities for elderly to be engaged.
What’s the financial cost of loneliness?
The faith-based systems in healthcare tend to have a mission to do right for seniors. They have the resources to connect the elderly to services, programming (from groups that deliver fresh vegetables to live music performances), and even to the people and resources on their own campus who can develop progressive approaches.
If healthcare institutions don’t act on loneliness, they will likely end up footing an even larger bill.
Even not-for-profit healthcare institutions must financially justify the development of a new facility or program. There’s a financial incentive to combat loneliness. AARP calculates that Medicare spends an additional $134 per month for each lonely senior compared with a socially connected older adult—an additional $6.7 billion of spending each year.
Ultimately, our solution for the crisis of isolation must connect with the new population healthcare approach. If we can provide assisted living or community-based care as a part of an urban plan (city or suburban), it will enable the elderly to live engaged lives that boost their overall quality of life. This can keep them out of critical care, which will ultimately reduce overall healthcare dollars spent. Put simply, our society is paying a high price by not providing environments for the aging that are meaningful and productive.
Doing what’s right
There’s a moral argument to be made as well. If we care about our communities, we can’t turn our back on seniors—or any part of our population—and accept isolation. As a designer, I’m fortunate to have the privilege and opportunity to make better, more resilient, and connected communities for all.
The first step we can take is raising consciousness on this issue. Let’s start exploring ways we can build and plan cities for greater interaction. How does designing for a more engaged elderly population dovetail into urban design and land planning? How do we integrate rather than separate diverse populations? What’s housing for the boomers going to look like? There are no easy answers to these questions. ?
We will return to this topic again on the Ideas Hub blog in an investigation of possibilities for making eldercare an integrated part of the community. It will take a lot of work for us to create elderly environments where we can answer yes to the question “do I want to end up here?”