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Ageing-in-place and integrated care: Findings from the ODESSA project.

Professor Karim HadjriHead of School of ArchitectureThe University of Sheffield

1 March 2019London

Content

1. ODESSA Project introduction.2. Age-friendly environments.

• Case studies.• Exploratory focus groups.• Final focus groups.

3. Design alternatives and guidelines.

An international research venture investigating current long-term care delivery models for older people to allow them to live

independently for longer (3/2015-2/2018)

ODESSA: Optimising care delivery models to support ageing-in-place

EU-China: Understanding Population Change.

ODESSA: Optimising care delivery models to support ageing-in-place

EU-China: Understanding Population Change.

Key issues

1. Overcoming isolation, keeping up social networks and accessing public services for older people within the community.

2. The physical environment is often a barrier to accessibility, mobility and independence.

3. The challenges of retrofitting existing homes and their affordability.

ODESSA Project Aims

A better understanding of ageing-in-place in the three countries and identify common features of an effective system of integrated care under different policy and society circumstances.

Project Objectives

1. housing choices, needs, and preferences of older people.

2. the potential for engaging communities in effective and inclusive models of social care delivery to support healthy ageing.

3. design alternatives for age-friendly housing environments.

Work Packages

1. WP1: Older people’s housing conditions and living arrangements.

2. WP2: Older people’s housing and care expenses and residential mobility.

3. WP3: Care delivery and community support/ connected communities.

4. WP4: Age-friendly housing environments. 5. WP5: Innovative financial channels to provide

serviced-homes and promote ageing-in-place.6. WP6: Comparative study and future scenario

building.

ODESSA Project Framework

Automony

Affordability

Ageing in Place

StrategyStrategy

Financial innovationFinancial innovation

WP2

WP1

Comparison and Scenario Building

IdentificationIdentification

Vulnerable groups Vulnerable groups

PlanningPlanning

health and social care modelhealth and social care model

Global Challenge of Ageing Society

Demographic TrendAgeing Equality

Financial ModelCost-effectiveness

AnalysisRisk Analysis

Ageing-friendly HousingInclusive design

Fall prevention Monitoring and care delivery

Social Network SupportDignity

IndependenceCommunication

WP5

Sustainability

WP4

WP3

Theo

reti

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Theo

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Empi

rica

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Polic

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arni

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lear

ning

WP6

Housing Condition

Living Environment

WP4: Age-friendly housing environments.

Karim Hadjri; Tulika Gadakari; JunjieHuang; Jingjing Wang.

WP4 Age-friendly environment

Age-friendly design of the physical environment is increasingly being encouraged by many governments and organisations given its role in the promotion of better health, wellbeing and overall quality of life of older people, which would facilitate ageing-in-place.Age-friendly housing can facilitate wayfinding, improve quality of life, maintain and empower social networks and increase autonomy. Inclusive Design standards such as Lifetime Homes should form the basis to support the production of age-friendly environments.

WP4 Objectives

1. Review best practice age-friendly and smart homes in EU (UK, France, NL) and China.

2. Establish whether there are practical replications, similarities or differences between the countries.

3. Propose design alternatives and guidelines for age-friendly housing environments that support ageing-in-place.

WP4 Methodology

Literature Review

Assistive Technology Universal Design & MobilitySocial &

Community

Dementia Care

International Good Practice

Focus Groups

UK

France

China

Case Studies in

China

Case Studies in

UK

Case Studies in

France

Retrofitting Recommendations

ExploratoryFocus

Groups in China

Recommendations for Work Package

5 and 6

Literature Review

Findings

Case Studies in

NL

WP4 Case studies

Age-friendly environments equipped with assistive technology.

Selection criteria:1. Inclusive design2. Assistive technology3. Provision for care4. Recent development

WP4 Case studies

The user requirements and the domains were established as key issues affecting older people following a comprehensive literature review.

Five User Requirements:1. Mobility2. Sensory3. Cognitive4. Health and Safety5. Social Inclusion

WP4 Methodology

Case studies

WP4 Exploratory Focus Groups, Beijing

1. 12 retired university employees, Tsinghua University.2. 14 participants representing three generations.3. 15 people from the Chaoyang Minjin Committee.


Domains and themes for the focus groups:

Domain Accessibility Sensory Cognitive TechnologyThemes principles of

Lifetime Home Standards; age-friendly design

effects of home comforts, environment, colours and contrasts, lighting, temperature, sound, sensory health and wellbeing

the connection between the sense of identity, autonomy, control, independence and a familiar home environment; self-identity, independence and control, wayfinding

familiarity; current or previous use of assistive technology; assistive technology that supports daily activities, safety, access health care; social inclusion


Discussion Questions1.Have you made any modifications/adaptations to your

current home due to accessibility and mobility issues?2.What concerns do you have in relation to sensory

health and wellbeing? 3.If your independence is affected by your current

home, what are the main underlying reasons?4.Which Assistive Technologies do you use?5.What Assistive Technologies can enhance your health

and wellbeing?6.What Assistive Technologies will support your daily

activities?


Results: Themes and sub-themes?

Theme Sub themes1 Ageing-

in-placedesign, spatial sufficiency, architectural design, wanting to stay home, age well, quality of life, flexible housing, and multi-functional spaces

2 Cultural multigenerational living, background, death, rural, urban, society, and ethics.

3 Safety falls, emergencies and accidents4 Economic money, affordability and savings5 Political government and policy


Results: What is ageing-in-place?1. being able to live with children and grandchildren.2. stay in familiar community and surroundings.3. the sentimental value of the home.4. fear of abandonment.5. fear of loneliness.6. economic reasons.7. care home facilities in China were at an early stage

and not yet of good quality.


Results: Barriers to ageing-in-place:1. unable to modify homes or install devices

especially when living with children.2. inadequate medical and professional care service

at home.3. accessibility issues such as – no lifts, poor

staircase design, narrow corridors, slippery floors.4. affordability issues.5. Some technology was not yet supported by the

Chinese health and care system.


A sketch made by one of the participants


“I think, the technology can’t replace emotion.” “Emotion in caring is more important than these products and technologies”.

“We do not have enough living space, I have a two-bedroom apartment, but I need to look after my grand-children. So three generations are living together, the space is not enough!”.

“I feel really uncomfortable when I hear the term ‘dementia’”.

WP4 Findings

User Requirements Design Framework domains for Mainstream HousingRetrofit Technology

MobilityTotal features: 33

Universal - Bedroom - Bathroom -Kitchen

Universal

SensoryTotal features: 28

Light - Indoor Air Quality -Visual/Hearing - Materials and Colours - Outdoor Spaces

Universal - Light - Indoor Air Quality - Visual/Hearing

CognitiveTotal Features: 15

Normalness - Kitchen - Memory -Mental Health

Normalness - Easy to use -Memory - Mental Health -Personalisation

Health and SafetyTotal Features: 32

Universal - Bathroom - Kitchen Telemedicine - Telecare - Fire Safety - Surveillance - Access -Intelligent Systems

Social InclusionTotal Features: 11

Physical - Virtual Maintaining contact

WP4 UK & France Focus Groups

WP4 Focus Groups

Findings:Mobility• Wheelchair accessibility; ramp; lift/stairlift; wide

doors; walk-in shower.• Accessible emergency call systems.• Less importance to features that were perceived

to be of high assistance such as reclining shower seats, ceiling hoists, bath hoists.


Findings:Sensory• Access to adequate natural light or daylight in the

home. • Access to good outdoor views and outdoor spaces.• Better lighting, convenient light and temperature

control. • Technologies for health & safety.• Home automation.


Findings:Cognitive• Both design and technology that helped with

memory and orientation was highly significant. • Displaying identifiable pictures or memorabilia

at the entrance door to help with wayfinding was deemed ‘Important’ by all groups in UK and ‘Very Important’ in France.


Findings:Group discussion The concept of ‘homes for life’ or adaptable housing that evolves as people age was well received.• Some older people would not like to move in a

home which was completely ‘fitted for old age’ as they would feel overwhelmed.

• The issue of managing people’s perceptions and ensuring a normal environment that was attractive was discussed at length.


Findings:Group discussion• There is a danger that if everything is important

then this will make the future home very complex, hence it is important to prioritise and be more strategic to provide a future-proof solution.

• Participants also discussed what aspects of inclusive design and technology that can make older people feel stigmatised.

An accessible apartment.

Symposium publicationhttps://www.sheffield.ac.uk/polopoly_fs/1.832699!/file/Odessa-Symposium-publication-2019.pdf

Conference publicationhttps://www.sheffield.ac.uk/architecture/latest/odessa-conference-1.747080

Symposium in Chongqing, China

3 December 2018. Sino-British Ageing Innovation Forum.

Symposium in Chongqing, China

Next steps - impact creation

The results of the projects need now to be taken further as policy and practice guidelines and standards in UK and China. 1. The setup of an Anglo-Chinese ageing-in-place

Knowledge and Development Exchange (KDE) Network.

ODESSA Impact Project team

JunjieHuang

JingjingWang Yiru Pan Isaiah

DurosaiyeDavidMorris

Thank you.

[email protected]

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