Ageing joyfully

Designing bathroom environments that suit the needs and abilities of older people can help reduce barriers to functioning and allow more people to age in place for longer periods.

The importance of the physical environment for ageing is well documented; bathroom design is not just about sanitation. For older people, it also influences a range of social and health measures including quality of life and self-care and is essential to maintaining independence. Inaccessible, difficult and hazardous environments can compromise older people’s ability to carry out activities of daily living.¹

Caring through design

Recent research has shown that design can be a direct substitute for care by up to 42% and can also result in a 40% overall improvement for health-related quality of life.² This effect is even greater for informal care and concerned changes to the bathroom (78.3%.).³

The Livable Bathrooms for Older People Project was a multidisciplinary, multimethod project developed to collect, analyse and synthesise older people’s physical dimensions and abilities in the context of their domestic bathrooms into information that can be used to improve design outcomes. The project was funded as an Australian Research Linkage Grant with GWA Int as the industry partner.

One of the central approaches of the Livable Bathroom for Older People Project was The ‘Livable Bathroom’ survey, which was distributed to a representative cross-section of older Australians from all states and territories over the age of 60, using a database of 16,524 older persons provided by the Australian Electoral Commission; it is believed to be the largest design survey of its kind.

Key findings from the national survey included:

• Over half (51%) of respondents had bathrooms with separate showers with raised perimeters (hobs) making them inaccessible to wheelchairs and a potential trip hazard. A surprisingly large number (62%) said that they rarely or never used their bathroom to take baths.
• Over a third (37%) indicated that they went to the toilet 2–3 times during the night and increased frequency (3–4 times a night) was weakly correlated to medication usage.
• A quarter (25%) rated bathroom size being as poor and just under a half (48%) specifically mentioned insufficient space to dress/undress in the bathroom.
• A fifth (20%) rated winter temperature in bathrooms as poor.
• A fifth (20%) rated the quality of the bathroom floor to prevent slipping as poor.
• Significant safety concerns were expressed, including not being able to call for help in an emergency (18%), not being able to get up after a fall (15%) and slipping in the shower or on wet floors (11%).

Keeping up appearances

Assistive products can have strong associations with disability and loss of independence. Design can be a powerful means of reducing the perceived stigmatising effects of supportive products. Design that promotes or aligns with positive motivations such as independence, forward thinking, improvement in lifestyle and living space is more likely to be accepted by the older people that would benefit from it. Designing bathrooms in anticipation of future need can be a powerful way of choosing long-term independence. Supportive features installed early can ensure many years of safer, more comfortable use.

Better product design helped to reduce the barriers to adopting more supportive features. Some design approaches that were developed through the co-design process were:

• Adaptable — products that could be easily changed as the individual’s needs changed, eg, toilet armrests that could be added when recovering from knee surgery but removed if no longer needed. Added nurse-call functionality can also provide greater confidence for the individual, and improve responsiveness of their carers.
• Multifunctional — when a product has a purpose in addition to the support function, then there is an additional reason to install it other than physical need, eg, an attractive grab rail can function as a sturdy, convenient towel rail.
• Integrated design — where many assistive products look like bolted on afterthoughts, products that include supportive elements that are aesthetically integrated into the whole bathroom design appear more attractive and harmonious.
• Safety for everyone — design that can make the bathroom safer for all people, not just people with reduced mobility, is appealing to everyone. Concern for children, pregnant women and people with injuries helped justify more functional design. Or as one co-designer put it: “What is necessary for us is a luxury for the younger ones.”

What this means for the future of design

For designers, working collaboratively with older people provides rapid feedback on assumptions and design proposals. Older people have at least as varied aesthetic preferences as any other cohort, and they have a powerful connection between home and identity. For decision-makers, data can be analysed, synthesised and translated into multiple forms; however, the topics explored in this research are best understood through open-minded first-hand experience with people.

Ageing is something none of us can escape, and with Australians living longer, wealthier lives, more people are ready to embrace bathroom design extending from the utilitarian into a functional, yet individualised experience offering the luxury they’re accustomed to in other aspects of their life.

This presents many opportunities for designers, architects and decision-makers involved in the design of physical environments for older Australians to design bathroom products and spaces that are safer, more inclusive and contribute to the overall wellbeing of all Australians.

In order to challenge common psychological barriers to the adoption of assistive products, the future of design for older Australians must take a more informed and personalised approach that considers both the functional and aesthetic desires of potential residents.

*Focusing on enabling inclusive design for people with limited mobility, Professor Catherine Bridge is an expert in the Built Environment at the University of New South Wales.

**Industrial design expert at Caroma, Dr Sweatman specialises in developing user-centred bathroom design for older Australians through collaborative workshop programs and laboratory research.

References

1. Mintzes, A., Bridge, C., & Demirbilek, O. (2015). Development of a National Survey on Aging and the Domestic Bathroom: The Livable Bathrooms Survey. In DS 80-1 Proceedings of the 20th International Conference on Engineering Design (ICED 15) Vol 1: Design for Life, Milan, Italy, 27-30.07. 15 (pp. 575-584).
2. Carnemolla, P., & Bridge, C. (2016). Accessible housing and health-related quality of life: measurements of wellbeing outcomes following home modifications. ArchNet-IJAR, 10(2).
3. Carnemolla, P., & Bridge, C. (Accepted for publication). Housing Design and Community Care: How Home Modifications Reduce Care Needs of Older people and People with Disability. Int. J Environ Res Public Health.

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