× You are not currently logged in. To receive all the benefits our site has to offer, we encourage you to log in now.

A multidisciplinary exploratory approach for investigating the experience of older adults attending hospital services

December 2020
The Center For Health Design

Why does this study matter? 
Hospital design tends to be focused on the needs of younger and single-condition patients. For older adults, the inherent complexity and lack of supportive features in hospital and outpatient settings present barriers to accessing medical care. Given the global increase in life expectancy and multiple chronic conditions, older people will increasingly access hospital facilities. Previous studies have described how good hospital design can reduce older patients’ stress, depression, and disorientation, and improve privacy and social support, but most of these studies have been focused on inpatient or emergency care areas. This study contributes insight about the age-friendliness of the ambulatory and public areas of a hospital, including outpatient departments, diagnostic and imaging areas, corridors, surrounding car parks, and entrance areas.

How was the study done?
Sixteen participants were conveniently sampled from a Geriatric Outpatient Clinic at an Australian metropolitan public hospital in the first half of 2017. After attending geriatricians identified possible participants, researchers confirmed willingness to participate as well as other eligibility criteria.
Researchers used scaled maps to document walking observations about participants’ routes inside and outside the hospital, actions, use of assistive devices, and calculate average walking speed.
An environmental audit tool was used to assess conformity with national and international age-friendly guidelines for health facilities. Contextual noise, illuminance, temperature, and humidity were measured during observations.

A customized health survey, comprised of items from validated clinical assessment tools, was used to assess and qualify participants’ degrees of frailty. The survey was distributed at the end of the observation and collected during the interview.

Post-observation semi-structured interviews took place 24 hours after the visit to solicit participants’ insights, perceptions and experiences about the observed period and about the environment more broadly.

The research team used qualitative and qualitative analysis strategies to evaluate the relationship between participants’ capabilities, features in the designed environment, their behavior within this context, and their experience.

What do we learn from this study?
Abilities: People with limited physical capacities (e.g., sensory, mobility, cognition or vitality) were more likely to identify environmental issues and experience episodes of being lost.
Aesthetics: The aesthetics and overall building design were considered to be important and influenced participants’ satisfaction with inpatient and outpatient healthcare provided.

Access:  Even though participants in this study reported being longtime users of the hospital, they were still not comfortable navigating through parking lots, public areas, waiting rooms, and hallways without the aid of staff, volunteers, or family members. This investigation revealed that wayfinding design and systems, such as appropriate floor planning and environmental cues, are of increased importance.

Accordingly, we must first identify and then provide supportive, attractive and intuitive environmental features as well as remove barriers to promote the functional abilities of the elderly and infirm.

Can we say the results definitive? 
For me, methodologically, this study came pretty close to hitting a home run. It was a multidisciplinary collaborative by professionals within environmental design, social sciences, geriatrics and gerontology, and computer sciences to develop a new interdisciplinary methodology to investigate public spaces for older adults. The mixed-method triangulated approach contrasted experiences and perceptions with an independent built environment audit, and individuals’ personal capabilities through validated clinical tools.

It was, however, limited to a small convenience sample of English-speaking patients; selection bias cannot be excluded, nor does it assure a gender, racial, or ethnic representative sample. The study was also conducted prior to the COVID-19 pandemic which would have impacted both access and experience.

Because the research team used multiple strategies to try to ensure rigor and validity of the findings, I think that this study lays the foundation for future research to explore the experience of ambulation from the perspective of older patients in other settings and with a broader range of participants.

What is the takeaway? 
There is growing evidence of the influence of the environment on older adults physical and mental capabilities. Frailty in older adults is a clinical syndrome characterized by a reduced physiological reserve and increase vulnerability to stressors that lead to adverse health outcomes and diminished quality of life. In order to promote healthy aging, hospital design needs to consider strategies to remove barriers and improve experiences for older adults of different capabilities. It’s time to take a page out of Louis Sullivan’s book (literally) and work to understand the needs and the patterns of the people using the space first before we start to design buildings, rather than the other way around. Form should follow function. Giving older adults and others with functional limitations a place to temporarily land while ambulating is the least we can do to promote their functional health in hospitals.

Martins, B. A., Barrie, H., Visvanathan, R., Daniel, L., Martins, L. A., Ranasinghe, D., Wilson, A., & Soebarto, V. (2020). A multidisciplinary exploratory approach for investigating the experience of older adults attending hospital services. HERD: Health Environments Research & Design Journal, in press. https://doi.org/10.1177/1937586720920858



Our slidecasts are an outcome of the popular Research Matters presentations at the annual Healthcare Design Expo & Conference. Our research team picks papers that have some significance to the healthcare design community and distill the study down into a 5-minute summary of how the study was done, what was learned, the limitations and the takeaway. The slidecasts bring research to you in digestible format. Just five minutes, and you’ll know more.