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Ergonomics and the environment for the elderly

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 CHAPTER XX

Ergonomics and the

Environment for the
Elderly
Vilma Villarouco, Nicole Ferrer, Marie Monique Paiva, Mariana Oliveira
Federal University of Pernambuco
Recife, Brazil
villarouco@hotmail.com

ABSTRACT
Given longer life expectancy rates and declining fertility rates world-wide, the
phenomenon of demographic transition requires the built environment to be adapted
and planned for, particularly for services targeted on the elderly. Among these, it is
the growth of Long-term Stay Institutions for the Elderly that is the fastest in the
world. However, there is a lack of in-depth studies and evaluations of their
structures, which shows the need for Ergonomics to look at these spaces in order to
understand how they affect the quality of life of their residents. Thus, this study
presents a survey of sheltered housing for the elderly in Brazil, an emerging country
in which there is starting to be evidence that its population is living longer. This
study is based on the Ergonomic Methodology of the Built Environment. Use was
made of well-established ergonomic and architectural techniques to make functional
and behavioral assessments in order to identify the level of users’ satisfaction and
the extent to which the spaces are suitable for the activities that are offered.

Keywords: housing for the elderly, ergonomics of the built environment

1 LONG-TERM STAY INSTITUTIONS FOR THE ELDERLY

Worldwide, the proportion of people aged 60 and over can be seen to be
growing faster than any other age group in modern society, as a result of both longer
life expectancy and declining fertility rates. According to the World Health
Organization (WHO), this ageing of the population can be seen as a “success story
for public health policies and for socioeconomic development, but it also challenges
society to adapt, in order to maximize the health and functional capacity of older
people as well as their social participation and security” (WHO, 2011).
Neri (2007) states that this demographic reality should be considered when
planning and adapting several services that cater to this age-group because the new
profile is that of an aging population that has psychosocial and biological
peculiarities that should be considered.
The World Health Organization confirms that the physical environment, as
evidenced by architectural designs, focuses on functionality, which means the
positive interaction between the individual whatever his/her state of health and
personal (age, gender, etc.) and environmental (physical, cultural, etc.) factors.
(WHO, 2003).
In less developed countries, it is expected that the number of older people will
have risen from 400 million in 2000 to 1.7 billion by 2050 (WHO, 2011). Born and
Boechat (2006) and Camarano and Pasinato (2004) claim that of the specialized
services for the elderly, it is Long-term Stay Institutions for the Elderly that are the
fastest growing in Brazil and the world as a whole.
Long-term Stay Institutions for the Elderly (LSIE), according to the Brazilian
National Agency for Safeguarding Health, ANVISA, consist of "governmental or
non-governmental institutions, residential in character, set up as collective
residences for people aged 60 and over, with or without family support, which
provide for their freedom and dignity and citizenship" (2005, p.1).
Given that the ideal home environment is one that provides a sense of
independence, this space needs to be adapted to the reduced capacities of the
elderly. To Perracini and Prado (2007), adapting the environment to the elderly
provides a sense of normalcy or invariance vis-à-vis the personal losses associated
with disorders common to aging.
Thus, institutional spaces should promote the autonomy, independence and
privacy of the elderly, while considering the ambience and identity. It should be
stressed how important the relationship of the elderly with the physical environment
is as the latter contributes directly to determining the quality of aging and what
degree of autonomy the elderly can have.
Ergonomics of the Built Environment, since its focus of study is on human
beings as users of space such as to make this environment more appropriate for
them, seeks to promote their safety and an individual’s quality of life while they
carry out their activities. Therefore, Villarouco (2009) states that the environment is
fundamental if functional needs are to be met, and these besides physical and
cognitive aspects have formal ones, with reference to psychological aspects of the
users.
Therefore, by making use of different social approaches in the way that sheltered
housing for the elderly is conceived, this article aims to analyze three long-term stay
institutions in Recife, a city in the northeast region of Brazil, with a view to
investigating positive and negative aspects of the built environment for the quality
of life of the resident users.
2 METHODS
Taking into account the situation of the aging of Brazilian society and the
prospects for housing for the elderly in Brazil, this research is characterized as an
applied analysis that addresses the issue in a qualitative way, and takes a multiple-
case study approach. Therefore, it works with a purposive sample, selected from the
viability of access in accordance with the research.
The sample comprises three institutions in Recife, Brazil, one of which is private
and profit-making, one a public institution, maintained from government funds and
one managed from mixed funds that come from government maintenance funds and
philanthropic and private contributions.
Thus, with the objective of extending out to the different configurations of
Long-term Stay Institutions for the Elderly by the evaluation of the built
environment as to its suitability and ambience, besides its impact on
functionality, the Ergonomic Methodology of the Built Environment
(VILLAROUCO, 2009) was used, which undertakes an ergonomic approach so
as to understand, evaluate and propose recommendations for environments
which are in continuous interaction with the user.
This methodology consists of an ergonomic evaluation conducted in two
general stages: the first is of a physical order and the second one of perception.
During the physical assessment phase, this methodology is divided into three
distinct steps. Initially, there is the Global Analysis of the Environment, which is the
first contact with the space in which one seeks an understanding of the environment
and the activities carried out in it, besides characterizing the main problems and
demands, which point to the need for intervention.
Later, during the phase of Identifying the Environmental Configuration, all the
physical and environmental conditioning factors are identified. It is to this phase
that gathering all the data from environmental is attributed such as dimensioning,
lighting, ventilation, noise, temperature, layout, displacements, cladding materials
and accessibility conditions, which give rise to the initial hypotheses on the question
of the influences of the space on the conduct of work activities.
In the third and last stage of a physical order – the Evaluation of the
Environment in Use –, care is taken to observe the environment in action, with a
view to identifying its suitability, viewing the extent to which it facilitates or
hinders the conduct of the activities which it hosts.
The phase of a perceptive order should be inserted into studies of environmental
psychology, or environmental perception in which there is the need to adopt tools
that aid identifying variables of a more cognitive and perceptual character. The use
of one of these tools helps the researcher to understand employees’ perceptions in
relation to work spaces. From these data, a check is made on what factors are most
strongly linked to the motivational aspects.
After collecting these data, all the variables should be joined together so
that, after a complete analysis, the Ergonomic Diagnosis can be drawn up.
Having done this, one moves on to the Ergonomic Recommendations, in an
attempt to mitigate and even solve the spatial barriers in the environment
which make it difficult for the elderly to undertake activities in it.
3 RESULTS
Collective dwellings for the elderly in Brazil are subject to national laws, such
as the Resolution of the Collegiate Directorate - ANVISA-RDC No. 283/2005
which lays down norms for operating Long-term Stay Institutions for the Elderly.
Norms of the Brazilian Association for Technical Norms - ABNT-NBR No
9050/2004 for accessibility are also applied, the purpose of which are to see to it
that users can use buildings, urban furniture and equipment autonomously and
safely.
By means of collecting data on Institutions 1, 2 and 3, some instance of non-
compliance were identified. Table 01 below identifies the degree to which their
operation and accessibility to them comply with the laws. This is shown as: full
compliance (represented by OK); partial compliance (represented by P highlighted
in light gray); or non-compliance (highlighted in dark gray.) As to the items in the
Table that do not reflect the representations given above, the legislation does not
apply.
On analysing Table 01, it is seen that the instances of non-compliance in
institutions are mostly issues related to accessibility. In some cases, compliance is
partial and in others there may even be non-compliance which adversely affects the
quality of life of the elderly and their safety.
Another important aspect that stands out is the absence of a fire prevention and
detection system in the institutions investigated. Also the unsuitable floor coverings
assume importance since they are elements that have the potential to cause accidents
because people may slip and fall down.
Incompatible dimensioning of specific facilities for employees in Institutions 1
and 2 was detected, while this area was not covered in the third area. There being no
bathrooms and changing rooms for staff leads them to share the facilities with the
elderly, which the law does not permit.

Table 1 Compliance with legislation for the functioning of sheltered housing in

Brazil for the elderly. The table identifies the degree to which their operation
and accessibility comply with the laws: full compliance (represented by OK);
partial compliance (represented by P highlighted in light gray); or non-
compliance (highlighted in dark gray.)

LSIE 1 LSIE 2 LSIE 3

LEGISLATION RDC NBR RDC NBR RDC NBR
283 9050 283 9050 283 9050

FUNCTIONAL ASPECTS

External access OK - OK - OK -
Ramps P P OK OK P P
Circulation P P OK OK OK P
Hand rail P P OK
 Support bar P P OK OK
Guard rails - OK - P P
Dormitory P - - OK -
Private dormitory bathroom - P - -
Wash-hand basin - P - -
Toilet bowl - P - P - P
Emergency alarm - - - OK
Collective bathroom - OK - P OK P
Activities Room OK - OK - P -
Kitchen OK - OK - OK -
Laundry P - - OK -
Store-room - - OK -
Staff facilities P P
Consultation Room - P - OK -
Cladding/ Flooring - P - P -
Fire detection - - -

3.1 Characterization of LSIE 1

The first institution is an organization with a private source of funding, with
occasional support from volunteers, but is mostly run with private finance.This
Long-term Stay Institutions has thirty six residents, of whom thirty are female and
six male. 40% of them are totally dependent (as per RDC No. 283/2005, degree of
dependence III). According to the management of the institution, the exact number
of residents with a diagnosis of cognitive impairment or behavioral problems is not
known. However, management stated that about 60% of those who are dependent
have Alzheimer's disease at a moderate or advanced stage.
The building that houses the institution was not designed for this purpose. It is
characterized as three houses that are adjacent to each other, adapted from their
original functions of residential use without observing the requirements of Brazilian
norms for collective residential buildings for the elderly.
In general, it is seen that there is a lack of open and green areas set aside for the
well-being of the elderly, and the few existing spaces have poor access. Thus, the
entrance hall, which has one roofed area and another without a roof is widely used
by the independent elderly where they can sit, read newspapers and watch
television, and do physical activities. It is the most frequented area but insufficient
in size to accommodate the total number of residents comfortably. As to the living
rooms of the three houses, they are places where mainly the dependent elderly, who
are monitored by caregivers during the day, stay.
The bedrooms are separated by gender and have dimensions that can hold from
one to four beds. Individual bedrooms with private bathrooms are registered. The
rooms have dimensions that are suitable for the resident´s furniture and objects
(Figure 1). According to the administration, as to accommodating the elderly, the
affinity among residents, the level of their functional capacity and the interest of the
client in the choice of bedroom are all respected.
Under a general context, there are accessibility issues in the home related to
sizing environments, unsuitable handrails, and there only being stairs to access the
residents’ bedrooms. Inadequacies were also observed as to there not being non-slip
floor coverings, the sizing of the leisure and social area of living, and the shortage
of green areas.

Figure 1 Illustration of a bedroom in the Long-term Stay Institution for the Elderly 1 (From the
archive of the authors, 2010).

3.1 Characterization of LSIE 2

The second institution is as an organization funded with public money, the main
source being a government subsidy from the Institute of Social Welfare and
Citizenship – IASC (in Portuguese), an independent agency linked to the
Department of Social Welfare of the City Hall of Recife, and created to consolidate
the social assistance policy of the municipality. It may also receive donations.
Although its maximum occupancy is for 24 residents, during the field research,
twenty-one residents were identified, of whom seventeen were male and four
female. Of the total number of elderly, nine showed dependence with regard to
walking on the march and to undertaking everyday activities (EDAs) like taking a
bath, feeding themselves and getting dressed. However, despite the profile of the
residents of this institution being of independent elderly, it receives on a temporary
basis, the dependent elderly, while they await transfer to an appropriate institution
for the care of the elderly whose profile is that of dependency.
The residents of the Long-term Stay Institution for the Elderly 2 are elderly
people taken from the streets, who have been abandoned by their family or have no
affective ties, and who are taken there by the military police of Recife, sent on to
hospitals or, more commonly, guided by IASC (Institute for Social Assistance and
Citizenship).
 With a built area of approximately 395 m², the organic structure of the LSIE is
distributed in the adaptation of two residential buildings (one for the common and
administrative area and the other for the bedrooms), which were refurbished and
extended in 2003 for the purposes of housing the elderly.
The Institution has four multi-bed rooms, two for males, with no bathroom, for
the elderly with greater independence, and one male and one female, both with en
suite bathrooms. All rooms have more than four beds, which exceeds the standard
recommended by the norm (RDC No. 283/2005). The rooms, which have unsuitable
furniture, allow for neither privacy nor territoriality (Figure 2).
Even though maintenance is barely adequate, the institution is endowed with a
substantial green area. The entrance hall area is in contact with the green area, and
has benches, which gives the environment a homely and welcoming air.

Figure 2 Illustration of a multi-bed room in Long-term Stay Institution for the Elderly 2 (From: the
archives of the authors, 2011).

3.1 Characterization of LSIE 3

The third institution is an organization with a mixed source of funds, which
consist of a government subsidy, ongoing support from volunteers and private
participation. With a maximum capacity of 175 residents, there are currently one
hundred and twenty elderly residents in the Institution, of whom sixty are male and
sixty female. Of the total, between the men and women, the functional capacity of
70% of residents is preserved and 30% are considered dependent. According to the
directorate, there is no record of there having been a bedridden elderly person.
The structure of the building has a pavilion morphology which at one time was a
feature of the social exclusion models for the care of psychiatric patients, those
suffering from infectious diseases and the homeless (VERAS, 1997).
The structure of the institution consists of nine buildings and a church, laid out
on uneven terrain, and they are connected by covered sidewalks, ramps and
passageways.
 The spaces are large with high ceilings, typical of the architectural design, which
gives the environment a gloomy atmosphere. This feeling is exacerbated by the
deficit in natural light despite several openings.
The bedroom pavilions are separated by gender, male and female, and connected
directly to the blocks of common use for dining and leisure, and those for kitchen
and laundry services.
The bedrooms are separated by a plaster wall partition, with a capacity for two,
three or four occupants, which makes the space more private and gives the elderly
their identity back. The infirmary units have a capacity for four or six elderly people
(Figure 3) and are dimensioned to have a large open area between beds.

Figure 3 Illustration of infirmary with six beds in the Long-term Stay Institution for the Elderly 3
(From the archive of the authors, 2011).

4 CONCLUSIONS
Brazil, just like other developing countries, faces a rapidly aging population, and
society is not yet prepared to supply the new demand in their socio-spatial needs. As
they have to accelerate the process of accommodating the elderly in a new area of
the built environment, most institutions in Brazil work in spaces that have long
since been fitted out, and adaptations are not always adequate for the demands of
the new tasks.
However, it is noticeable that for the purposes of financial investment, the
option is made for basic adaptations that allow the institution to operate
immediately. These do not always match the built environment to the real needs of
the elderly, who effectively are the agents of this space, and end up having to put up
with the physical barriers present in the environments. Another important aspect of
the presence of these obstacles is that accidents occur when activities are
undertaken.
It is also seen that the current legislation to guide these adaptations is far from
rigorous and is subject to misinterpretation, which ends up weakening even more
the situation of these institutions. Adequate control or inspection of collective
housing is also difficult.
 Thus, one can understand that recommendations for suitable environments for
the elderly and those that meet the limitations of aging go beyond parameters
established in legislation.
Therefore, the environmental perception that the user has of the environment
because he/she has experienced it justifiably is of fundamental importance,
according to Bins-Ely (2003) and Villarouco (2008), due to the interaction of the
human-environment system, and because the formal (psychological) and functional
(physical and cognitive) needs of elderly users are met.
Therefore, it is concluded that it is essential to make the environments suitable,
since the healthy aging comes about through active engagement with life, being a
function of autonomy that generates improvement in the quality of life.

ACKNOWLEDGMENTS

The authors are grateful to FACEPE for their support by granting a Scientific
Initiation Scholarship for this research study.

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