Nursing homes supporting health and quality of life

The importance of Architectural Design as an alternative to Medicalization.

These days we all have experienced what it is like to live indoors, unable to go out or adjusting to a particular time schedule due to circumstances beyond our control. We have had to adapt to living conditions that do not meet our needs for work, leisure, socialization, ... In some cases, without outdoor access or sunlight. Living in reduced spaces. Suffering from the lack of privacy... In short, it has been a radical and stark way of verifying the importance of the environment in our quality of life.

This relationship between person and environment is basic in various disciplines: architecture, environmental gerontology, etc. but it was not until the 1970s when, from various perspectives1 , the impact of this interaction on the ageing process began to be analyzed. Since then, research has been conducted generating evidence on the role of design in promoting capabilities and improving people's well-being and quality of life. In this sense, we now have data on the importance of taking into account aspects related to: integration in the urban environment, dimensions and characteristics of common spaces, contact with the outside, nature, private space and the importance of the home, materials, lighting...

In the light of this, one might ask whether the actual solution we provide for the elderly is good enough, and whether the future lies in creating an even more hospitable environment.

In an attempt to find answers to these questions, this entry opens a series dedicated to the importance of architectural design in improving the quality of life of older people, and how this approach has developed in recent years through different models of accommodation and housing.

Environmental design and quality of life

In construction, design is based on the most demanding conditions of normal use and also some safety coefficients are applied. This approach is used to design and size the structures, installations, etc...

However, designing environments where people live considering the Covid as the most adverse condition is not the appropriate approach. Neither from the architectural point of view, nor from the point of view of care and attention. We cannot forget that health in residences is an integral "good" that, in addition to health care, must include architectural and organizational aspects, as well as relational and treatment skills.

When the current trends in the hospitals themselves are aimed at favouring a higher quality of life through the humanisation of spaces, it seems pointless for us in the residential sphere to consider going in the opposite direction, this means towards more hospitable environments.

On the other hand, where is the voice of the elderly? Are we going to ignore their opinion on something as fundamental as being able to decide where and how they want to age? For years, these people have been demanding alternative accommodation options to the classic residential home model. In Spain, only 4% of older people choose this model, compared to 90% who would prefer to continue living in their own home2.

As an architect I am concerned about how to avoid more deaths, but above all how to improve the quality of LIVES. Thus with capital letters, as they deserve to be treated.  That is the key, where we should put the focus. To generate spaces that facilitate life, encounter, relationship, meaning and well-being. It is a question of improving the quality of life of the elderly, which is ours.

I share all the pain and concern that arise from the present situation, especially when we see the conditions in which many people are leaving... when a death that is accompanied and dignified is so badly missed. But all this only serves to reaffirm my position. I truly believe in the importance of an appropriate design of the environment for improving the quality of life.

This is not only an opportunity to protect older people, but also to improve their well-being. It is time to opt for a change in the housing model, a change that protects older people, yes, but also improves their quality of life. If the quality of life is high, the end of life is dignified.

^[1] Ecological Theory of the Environment (Lawton and Nahemow, 1973); Theory of Successful Aging (Rowe and Kahn, 1987); Model of Selection, Optimization and Compensation (Baltes and Baltes, 1990).^[2] IMSERSO. White Paper on Active Ageing, 2011.