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Design for Aging – Learning from Other Cultures

by Jeffrey P. Rosenfeld, Ph.D., Environmental Gerontologist, and Professor-Parsons School of Design, and Brookdale Center for Healthy Aging

Thinking Cross-Culturally About Aging-in-Place

A different language is a different vision of life.

Federico Fellini, film director & scriptwriter

We are eager to learn from other cultures, but usually not when it comes to making our homes safer or more age-appropriate. Our food preferences are another story. We don’t hesitate to stock our kitchens and cupboards with the ingredients we need for a healthy Chinese stir fry or Turkish couscous.  If only we were as willing to think cross-culturally about aging in place.

We can learn a great deal about home safety from the housing, home-furnishings and design options offered across the world, especially in other nations with rapidly aging populations. Aging in place is a more creative process than it has ever been before.

The beauty of globalization is that it gives us a world of options for designing our homes. To paraphrase Burger King, we can truly “Have it our way,” as we prepare to age in our homes. I learned this lesson well   when Wid Chapman and I were writing Home Design in an Aging World.

Backstory: Home Design in an Aging World

Architect Wid Chapman and I decided to write a book to make cross-cultural comparisons of environments where people age-in-place: everything  from apartments, detached and semi-detached homes, to traditional farmhouses, communes, and high tech dwellings. In 2009, we surveyed homes and home furnishings available to older people in seven of the world’s most rapidly aging nations: Japan, Sweden, China, Brazil, Israel, the United States, and India. By the year 2009, all 7 of these nations were being reshaped by what the Japanese call The Silver Tsunami, and what we describe as The Age Wave.  We decided to do a comparative study of design and architectural responses to global aging.

This led to the publication of  Home Design in an Aging World (NY: Fairchild, 2010).  The book remains one of a handful of cross-cultural comparisons of architecture and design for aging-in-place.

Chapman and I have asked how architecture and design respond to kinship norms. How is aging-in-place shaped by Hindu kinship, which is strongly patriarchal and multigenerational? Or by the sensibilities of Sweden, where fertility is quite low and people typically live in nuclear households?

As environmental gerontologists, we were curious about the impact of age-related norms on aging-in-place. For instance, would aging-in-place be discouraged in Brazil, one of the world’s most youth-oriented societies.  And how about Japan? Unlike Brazil, Japan, is a gerontocracy where elders and old age are honored, and where pride of place in their children’s homes is enjoyed.  What is the impact of the high U.S. divorce rate and small family size on our own architecture and design for aging-in-place?

Chapman and I focused on both Western cultures (USA, Israel, and Brazil); and also on cultures where non-Western architectural norms and traditions are still in play (Japan, China, and India).  What follows are some examples of how constructed environments and local technologies interact with social norms to affect the experience of aging-in-place.

Vernacular Design

Learning from other cultures involves appreciating that there is often a mix of traditional home design – what architects call “vernacular design” – and cutting-edge technologies such as robotics. New technologies, combined with strategic changes in homedesign, are making it easier than ever before to age in place. People on the cusp of retirement can build upon new technologies to create everything from home offices to home care for a variety of chronic illnesses.

What follows is a very brief look at “lessons” drawn from other cultures, ranging from low-tech/high-touch to high-tech/low-touch,  and from ancient to post-modern.

Japan: Living Close To The Floor

There is an old Japanese saying which goes, “May you live and die on tatami.”  This refers to the bamboo mats which cover traditional Japanese homes from wall-to-wall. Home-furnishings in traditional Japanese homes are low-slung or actually on the floor. The futon is perhaps the most familiar example of this approach to home-furnishings. Low, traditional Japanese home furnishings are ofchigaidana-chofu-mori-residence-bigten moved from room to room as needed. This occurs on the tatami mats which cover the floor of a traditional Japanese home.

The floor-based Japanese design aesthetic features low-slung furniture and futons for sleeping that make any home safer. Apart from reducing falls, floor-based lifestyles enhance strength and balance. My sources tell me that even the most contemporary homes in Tokyo or Osaka contain a “Japanese Room” with traditional tatami mats on the floor, and Tokugawa detailing throughout.

Apart from being reverent about its past, Japan is also a world leader in technological innovation.  Japanese homes often contain a mix of products and technologies that hark back centuries, as in the case of traditional tea-sets or futons, and also look ahead to a robotic future. For example, there is a growing number of Japanese households with robotic pets – mostly dogs.

Futurist Timothy Horynak (2006) claims that the interest in robotic house pets reflects Japan’s passion for incorporating the newest of technologies with time-honored canons of Japanese design and home life. Robotics is the product of digital design and innovation. Tatami dates back centuries. That they exist together in some Japanese homes is a reminder that Japanese proudly mix tradition and technology. This may be the new face of aging in place in Japan and elsewhere in the world.

Brazil: Universal Design Begins at the Front Door

Brazilian architect Sandra Perito, from Sao Paulo, has designed Senior Housing that is intended to prevent domestic accidents, especially falls (Rosenfeld and Chapman, 2012). Perito  routinely adds a built-in table on the front porch or entry to a home. Perito makes sure that this Entrée Table is as close to the front door as possible. In apartment buildings for Brazilian Seniors, she does much the same.

The idea behind Perito’s Entrée Table it Seniors a place where they can place packages, bundles, or a purse while searching for their keys. The inspiration came from a elderly woman from Sao Paulo who lost her balance while rummaging through her purse in search of her keys. Perito adds this reminder: her table also functions as a grab-bar for additional balance while locking or unlocking the front door.

Scotland: Why Smaller is Better When it Comes to Refrigerators

On a trip to Scotland many years ago, I visited a number of homes in the Scottish Highlands where people either had very small refrigerators, or no refrigerator at all. Those without refrigerators kept perishable items in their cellars.  The climate in the highlands is such that the home’s basement is always cool enough to put perishables for a day or two.

Philip B. Stafford, author of  Elderburbia: Aging With A Sense of Place in America offers the following advice:  It is best for older people to have small refrigerators.  It has nothing to do with household size, he says.  Very simply, people with small refrigerators must leave home more frequently to do their grocery shopping.  The small refrigerator is an antidote to isolation.

France: Smart Home-Technology 

Beginning in 2013, Paris-based Netatmo has been developing a line of user-friendly Smart Home devices.  By “user-friendl3y,” Netatmo means that their technology provides feedback when and where their user is. For example Netatmo’s home security camera, “…detects and reports in real-time if someone lurks around your home, a car enters your driveway, or your pet is in the yard.”

User-friendly technology provides feedback at home, and also when the user is at work or on vacation.  The user can be far from home and rely on Netatmo’s personal weather station to keep track of  the weather at home. The personal air-quality sensor does the same for levels of air-pollution in and around the house.  The product line also includes a Smart thermostat and a Smart security camera with facial recognition. As more people opt to age-in-place, Netatmo provides the technology for safety and security.

Singapore: Robotic Home-Exercise Coach

In 2015, Singapore company RoboCoach, Inc., introduced  a robotic “exercise coach” at five of Singapore’s Senior Centers. The RoboCoach has a smiling face and appendages  that mimic human movements.  The robot has been developed to teachSeniors  a range of exercises while offering verbal encouragement and support.103266869-robocoach-1910x1000

According to The Guardian, the company predicts that RoboCoach will become a popular fixture in many of Singapore’s Senior Centers and Senior Living Facilities.  The goal is to enable the elderly to lead more independent, fulfilling lives.

“…The android with metal arms and a screen for a face is already leading sessions and will roll out its services to five senior activity centers across the city-state this year.”

Infocomm Development Authority of  Singapore (IDA)

China:  The World’s Earliest Example of Universal Design

BMEHED Elderly Salar man on Kang bed-stove with his granddaughter, Xunhua Salar Autonomous County, Haidong, Qinghai, China

Aging-in-Place, More Global Than Ever

Going forward aging-in-place will mean combining renovation and innovation: changes to the constructed environment of home, and the installation of  technologies which will make living at home safer and easier.  That said, it is as important as ever to respect the role that culture plays in making a home safe to age in place. As technology becomes a more important part of this process we must:

  • Consider how culture shapes the relationship between “private space” and “public space” in and around the home
  • Respect cultural traditions that shape the spaces where people cook, eat, sleep, and toilet. Designers and gerontologists should be mindful of how age, sex, and marital status all shape the form and function of a home
  • Understand the symbolism and social meaning of color in the architecture and design for every culture.

References:

About the Author: For the past 10 years, Dr. Rosenfeld has been researching the interplay of ethnicity, aging, and home design. He is currently looking at home design and community-building by Brooklyn’s “New” ethnic elders from Korean, India, Pakistan, and Guyana. Along with architect Wid Chapman, AIA, he has written Home Design in an Aging World (Bloomsbury, 2010), and UnAssisted Living (Monacelli Press, 2012).

Dr. Rosenfeld is also currently working with the research arm of New York Methodist Hospital in Park Slope, Brooklyn.  He is looking at ethnic differences (incidence and prevalence) of serious geriatric falls in the home.  The goal is to better understand how ethnically-themed design contributes to ethnic disparities in home injury. Dr. Rosenfeld has been on the adjunct  faculty at Brookdale Center since May, 2015. He can be contacted through Parsons School of Design at Rosenfej@NewSchool.Edu; 347-249-4014.

Destination Singapore: Restoring the Joy of Eating

By Ani Grigorian, with Jeff Rosenfeld

In a single century, we have extended human lifespan by 35+ years. At the same time, technology has evolved to the point where we can now communicate instantaneously across oceans, benefit from software which coordinates care and manages health.

We have even created robots which sense emotion and even lead group exercises.   Not only are we living longer.  We are living better!

It’s no wonder that technology and innovations that serve our aging communities are such a hot-topic. The Ageing Asia Innovation Forum, hosted this year in Singapore, brings-together professionals, inventors, and problem solvers from all over the world.  During this meeting, they had the opportunity to sample a new line of food products: Health Food Matters. The founder, Grace Gan, calls it a functional food product because it is intended for people who have feeding issues.

Gregorian was one of the few environmental gerontologists in attendance at these meetings. By and large, the Forum brings designers, inventors, and product-developers together.

On exhibit was a plethora of products and designs meant to make life more comfortable, and nutritious for people with feeding issues.  In other words, people who need help feeding themselves, or who need to be fed.

screen-shot-2016-10-22-at-11-06-07-pmGrace Gan, a native Singaporean, developed this line of functional food products in response to the older people in her own family. The product line is called Health Food Matters, with the subtitle, “Restoring the Joy of Eating.” It is steadily gaining popularity across Singapore, perhaps because it does make eating a more joyous and dignified experience for consumers – and their caregivers.

The original market for Health Food Matters  was older adults, and people living with a disability.  Gan at first marketed exclusively to care centers and retirement residences across Singapore.

Gan, a speech therapist by training, had spent a lot of time working with patients in Singapore’s care-centers.  She was frequently present when meals were served, and she noticed that food-preparation, serving and eating were fraught with stress and tension.

Even more important, Gan noticed that feeding was as stressful for the caregivers and wait staff, as it was for patients who were being fed.

It is familiar that the sense of taste begins to dull as people grow older, affecting the ability to taste, smell and savor food.  This is true even for people aging-in-place at home, where there is more control over what is on the menu, and how it has been prepared.   In care settings, the dulling of taste buds is compounded by loss of control over menu, and dining conditions.

To compound matters, many older adults in institutional care live with neurocognitive disorders that cause dysphagia, a nutritional disorder characterized by difficulty swallowing, malnutrition and dehydration. Malnutrition and dehydration, in turn, contributes to other conditions such as bed sores, infection and hypoglycemia.

When Grace Gan visited Singapore’s care centers, she noticed that it was common practice to thicken food with milk supplements.  The idea was that this would make institutional food more nutritious and more palatable.  But, in fact, Gan believed that the result was neither nutritious, nor palatable.  Milk supplements did not typically enhance appetite, or contribute to better health.

Gan developed Health Food Matters as a way to enhance appetite by making its functional food line taste more like familiar food, and have what professionals call, the “Mouth Feel” of eating familiar food.  In taste and texture, Health Food Matters has the taste and “Mouth Feel” of familiar food, but is much softer, and easier to eat.

Products range from porridges, side dishes, snacks and desserts to condiments and thickeners with a variety of flavors that serve different  functions. As an alternative to thickened fluids, apple ENA-charge fruit jelly for instance, supplement fiber while apricot fruit jelly supplement zinc and iron. Calcium sprinkles can be added to porridges or side dishes providing flavor, color, and extra vitamins which combat low appetite and malnutrition.

In addition to keeping patients in mind when developing functional food products, Health Food Matters has benefits for caregivers. Most important, it relieves them of many meal-related burdens: chopping and cutting food, feeding patients or assisting them when they feed themselves, and the perpetual chore of cleaning-up.

Portions tend to be small, but are densely packed with extra nutrients, proteins and calories. This achieves nutritional goals for patients, and gives caregivers an unexpected bonus. The Health Food Matters philosophy  also harmonizes with Singapore’s efficiency-driven culture:  Mealtime becomes more “Efficient.”  Less food is wasted, and less time is spent coaxing patients to eat. This resonates with local nutritionists and caregivers because Singapore is a culture which strives for efficiency.

One reason for the efficiency, is that this product-line is easily prepared. Caregivers simply submerge prepackaged food bundles in heated water. Nurses and care staff can focus on caring for residents rather than worrying about the viscosity and portion-size.

Products range from porridges, side dishes,  snacks and desserts, to condiments and thickeners with a variety of flavors that serve different functions. As an alternative to thickened fluids, apple ENA-charge fruit jelly for instance,  supplement fiber while apricot fruit jelly supplement zinc and iron.

Calcium Sprinkles, another of Gan’s innovative products, can be sprinkled over porridges or side dishes to enhance flavor, color, and nutritional value.   Caregivers tell Gan that the Calcium Sprinkles also make food look more festive and inviting.

Grace Gan believes that Health Food Matters will eventually be a welcome alternative to forced-feeding.  Thanks to this Singapore-based product, older people all over the world can one day look forward to enjoyable dining, in the company of family or friends.

Even now, local care facilities in Singapore residents report improved health outcomes  when they serve Health Care Matters, Inc. to patients and/or residents.   Caregivers also report minimal food wastage and easier clean up.  Residents enjoy Health Food Matters, Inc. that they often clean their plates.

Above all, Health Food Matters  makes mealtime into dining once again.  Health Food Matters restores dignity to breakfast, lunch, and dinner in long-term care facilities.  Eating can and should be a social experience, something which is true everywhere from Singapore to Seattle.

Singapore is considered to be a leader in applying cutting-edge, sustainable, technology to geriatrics. Technology-based interventions, such as robotics, are already making long-term care facilities more efficient.  Health Food Matters may be doing this for meals and mealtime in long-term care.

Singapore is a world leader in developing and applying technology to geriatrics. Health Food Matters has been proven to make mealtime a more efficient experience.  It may well be that this product-line can also make mealtime a more spiritual and social experience. For older people and people with disabilities. That would be the proverbial icing on the cake!

Contact:  Ani Gregorian:    animgrig@umich.edu

Jeff Rosenfeld:    Rosenfej@newschool.edu

 

 

Destination Tel Aviv: Entrepreneurship in Israel

Paula Adleman, with Jeff Rosenfeld, Ph.D.

Israel is no amateur when it comes to creating new and revolutionary products.  This powerhouse, nicknamed The Start-Up Nation, is now at the forefront of “The Business of Aging.”  VitalGo’s Total Lift Bed, developed by Israel’s Ohad Paz and Ofer Parezky, is one of the examples of this kind of revolutionary product.  VitalGo’s remarkable bed has already made life safer and easier for older people in Israel and many countries around the world.   

Upright Tilting Functionality

degreesThe Total Lift Bed (TLB) has a unique, “…upright tilting functionality” (UHS, 2015:1), which helps patients sit up, stand and start moving away from the safety of the patient’s bed.  This makes it a very therapeutic bed, thus making the TLB more than just a comfortable place to sleep. Click here to see a demonstration of Total Lift Bed.

One hospital in the US tested how the TLB worked for their patients.  They found that patients who were tilted up several times per day improved more in a shorter period of time, and more of them were able to go home than patients who were confined to bed and had traditional therapy (UHS, 2015:1). TLB’s unique functionality minimizes the risk of falling out of bed, and helps contribute to shorter hospital stays.

The Total Lift Bed is FDA registered and is used in Israel, USA, Germany, Austria, U.K, Switzerland, Italy, France, Australia and Norway. Some hospitals in the US include: The Cleveland Clinic, John Hopkins, Stanford University Hospital, Carolinas Specialty Hospital, Florida Memorial and various Veteran Affairs (VA) hospitals.

bed-recline

Seniors, whether in hospital or in their own homes, and regardless of whether they are in good health or not, have a higher risk of falling and becoming less mobile. Immobility then increases the risk of many health conditions and furthers the risk of falling and decline in quality of life.  The use of the bed   decreases this risk.

Many of the patients who have used the TLB have reported that, “This bed undoubtedly saved my life!” The hospital where the study was done found that the TLB “…improved patient-outcomes, the cost-effectiveness of providing care, and the satisfaction of patients and their families.” (UHS, bed-verticle2015:1).

Israel and The Business of Aging

Israel’s demographics make it an ideal marketplace for TLB.   In July of 2016, The Jerusalem Post estimated that 10.6 percent of Israel’s population, or 866,000 people, are now over 65.

According to a recent UN publication: “For most nations, regardless of their geographic location or developmental stage, the 80 or over age group is growing faster than any other segment of the population.”   Global aging has thus created an international marketplace for the TLB in the world’s hospitals, rehab centers, and personal residences for people who wish to “age in place” in their own homes.  VitalGo’s marketing efforts are responsive to the fact that there is already a worldwide need for the TLB, both in hospitals and at home.  

 Aging-in-Place, With Dignity

Many seniors prefer to age-in-place (at home) whenever possible. Safety concerns, aging minds and decreased strength and mobility, along with increased risk of falling (especially getting up out of bed where many falls occur) can make aging in place challenging or unsafe. The chances of falling out of a bed, a chair, or down a flight of stairs increases with age, even for the healthiest of seniors.

One of the key goals in the development of the Total Lift Bed has been to help Seniors age in place with safety and dignity.

At home, or in the hospital, the TLB does most of the lifting that caregivers (whether they be trained professionals or loved ones) would ordinarily give. The TLB does not replace the human touch, but rather, enhances the ability of the caregiver to provide the healing touches needed, without the heavy lifting that leads to caregiver burnout and risk of injury. Additionally, being able to be raised smoothly and effortlessly enhances the quality of the mobility experience, without having to worry about hurting their nurse or loved one who is helping them to get up and move.

With the push of a button, whether at home or in the hospital, TLB contributes to mobility and self-confidence.  Hence, individuals, patients and caregivers (whether professionals or loved ones) are beneficiaries of the Total Lift Bed.

References

“Israel’s Elderly Population To Double By 2035,Statistics Bureau Says”   The Jerusalem Post, July 28, 2016

Carolina’s Specialty Hospital Evaluates The Total Lift Bed In Their Mobility Program”  Universal Hospital Services, 2015:1

For more information about the Total Lift Bed, see the Vital Go site.

Contact:  Paula Adleman:   Paula@Boomersurf.com

Jeff Rosenfeld :   Rosenfej@newschool.edu

Biosketch: Paula Adelman has an eclectic background and divided her time working in sports, raising 2 wonderful sons and helping the aging population. She has a business degree, with an emphasis on entrepreneurship.  She divides her time between the US and Israel. Paula is the founder of BoomerSurf.com, an American/Israeli based tech start-up. Through BoomerSurf, she is helping Boomers and Seniors manage computer, tablet and smartphone tasks online and through It improve their connection to family, friends and community.  For more information visit: BoomerSurf.com.

13th ANNUAL WHAT’S NEXT BOOMER SUMMIT COMES TO THE NATION’S CAPITAL , MARCH 23, 2016

boomerlogo
Nation’s Leading Conference Brings Together Boomer Marketing Experts and Industry Leaders to Focus on “Seizing the Opportunity of the Longevity Economy”

Washington, D.C. plays host to the 2016 What’s Next Boomer Business Summit, the nation’s leading annual conference for the boomer and senior markets. Taking place on Wednesday, March 23rd at the Omni Shoreham Hotel, the upcoming summit shines a spotlight on “Seizing the Opportunity of the Longevity Economy” and includes a prestigious lineup of speakers, sessions, and exhibitors. Learn More →

Q & A with Lori Bitter now live at seniorhousingnet.com


Baby boomers are changing the definition of aging in America. Lori Bitter, a consultant who specializes in engaging with mature consumers at The Business of Aging, delves into the changes in American households and their broader social effect in her new book, “The Grandparent Economy.” She answered some questions for SeniorHousingNet.com on grandparenting, the golden years and deciding where to live. Learn More →

American Marketing Association (AMA) Takes on the Senior Moment

AMA’s Christine Birkner interviewed us about Zillner’s new report on Seniors, All The Wiser, and how we define and market to older consumers. From Lori Bitter: “It’s best to target boomers based on their lifestyles and purchase behaviors—and their core values such as healthy eating or aging well, Bitter says. For example, General Mills’ Cheerios ads focus on heart health, which certainly resonates with boomers, but also could connect with anyone interested in living well, she says. “It’s a way of being ageless. They’re not saying it’s an old person’s cereal or a young person’s cereal. It’s more about the value of healthy eating.”

Read the full article here: https://www.ama.org/publications/MarketingNews/Pages/senior-moment.aspx

Is grandparenting the ultimate “do-over”?

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Lori talked to Huffington Post, on behalf of GRAND Magazine, on the evolution from parenting to grandparenting. Can bad parents make good grandparents? Is there a healing power in these multigenerational relationships. Read more here.

The Internet of Things: Big Thinking for Older Consumers in 2013

Lori’s latest blog post for MediaPost Communications Engage Boomer blog, discusses the Consumer Electronic Show in Las Vegas, and it’s relevancy to the mature consumer market. Many of the presentations focus on technology that monitors consumers, and much is focused on health care, caregiving and health-related reporting. To truly capture the imagination and marketshare of the lucrative boomer consumer market, we need to pull back to the larger concept of the “the Internet of things.” First coined in 1999 by Kevin Ashton, the concept recognized the issue of the computer — and the Internet — being dependent on human action for information. He recognized a more human environment where people have no time and little attention.

Read Lori’s MediaPost Communications Engage Boomer blog post Big Thinking for Older Consumers in 2013: The Internet of Things here.