SENSE- FOR THE

SENSITIVE AGEING
DESIGN

Richard Mazuch (IBI/Nightingale), Sensory sketch

The science community informs us that there are not just five key
senses, but 21 sensory receptors and more by which we engage
with our environments.

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When designing retirement housing and socially
inclusive urban spaces, there is a great deal of
emphasis on mobility and accessibility. Physical
decline is, however, only one important dimension
of old age. Richard Mazuch, Director of Design
Research and Innovation for IBI/ Nightingale, an
architect with specialist expertise in evidence-based
design and healthcare, here describes how architects
and designers need to be mindful of how the senses
wane with age when designing environments for
older people.
Richard Mazuch
As we age, our body, mind and physiology
alter. Our sensory dialogue with the world
we know and experience begins to falter and
erode the quality of our lives. Designing for
the aged therefore requires a fundamental
understanding of the ageing senses to enable
us to create quality and truly supportive
salutogenic environments for tomorrow:
spaces that not only prevent disease, but are
designed to promote activity, good health
and wellbeing.
Substantial evidence-based research
can inform and empower new and elegant
design interventions that can de-stress,
reduce medication, improve physical and
mental health, and help avoid multiple types
of accidents and trauma. An example of this
is the io LED lighting touch-sensitive handrail
designed to help the elderly navigate frequent
visits to the bathroom during the night
without falling.1
Vision: the windows of the mind; Hearing:
the noblest faculty; Touch: the confirmatory
sense; Smell: the inarticulate sense; Taste:
the gustatory sense.
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Vision
Vision, the key ocular receptor, assimilates
approximately 90 per cent of the
environmental data we learn daily. With age,
this ability diminishes, and ocular changes
include reduced visual acuity, depth perception
and sensitivity to colour/contrast, heightened
sensitivity to shadow/glare, and restricted field
of vision. Age-related visual deficits include
macular degeneration, cataracts, glaucoma
and thickening/clouding of the lens.2
Impairment of this primary receptor can
be directly related to sleep issues (such
as sleeping at inappropriate times due to
reduced light penetration through the eye) and
sundowning (a psychological phenomenon
associated with increased confusion and
restlessness in patients with some form of
dementia), as well as falls, burns, difficulty
in metabolising vitamins, and general mental
and physical wellbeing. Innovative design
interventions such as full-spectrum lighting,
surface articulation furniture layout psychology,
biodynamic illumination, period light intensity,
sensor-responsive light-emitting handrails,
colour contrast and articulation can all help to
improve quality of life and avoid life-threatening
events and conditions.
IBI/Nightingale, Sir Michael Sobell House
Hospice, Oxford, 2003
The layers of natural and artificial light, use of
natural materials and generous wandering routes
have proven very popular with both patients
and staff.
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Hearing
The second major receptor affected by age is
hearing, when the ear structure deteriorates
and the eardrum thickens, reducing the ability
to hear high/low frequency pitches. Age-
related hearing impairment includes general
deafness, tinnitus, and loss of conductive
learning. It is said that noise is to people with
dementia what stairs are to wheelchair users.3
Successful design interventions here have
involved white/pink noise, noise-cancellation
speaker induction loops, and new sound-
absorptive fabrics and finishes. In care home
settings, Condiment Junkie Ltd, a sensory
branding and experiential design agency, are
developing soundscapes that relax the elderly
and conjure pleasant memories while not being
too harsh on their hearing receptors.
IBI/Nightingale, Marjory Warren Ward, Health and Ageing
Unit, King’s College Hospital, London, 2011
top: Funded by the King’s Fund, the unit incorporates multi-sensory
rooms and sensory wandering loops providing supportive handrails
delighting in colour, texture and sound.
Touch
This key tactile receptor, known as the
‘confirmatory sense’, validates the important
environmental data received by the other
senses. Touch offers an essential non-verbal
mode of communication and navigation for
those with visual and hearing impairment.
Varied, contrasting and richly articulated
fabrics and finishes are therefore essential
in establishing legible and engaging tactile
environments. Life-threatening issues related to
hyper/hypothermia, due to reduced sensitivity
to temperature, may also be prevented using
audible/visual temperature sensors.
IBI/Nightingale, Kirkwood Hospice, Dalton, Huddersfield,
West Yorkshire, 2013
above: This 16-bed inpatient unit specialises in palliative care,
offering sensory supportive environments with generous views,
with access to sensory-engaging landscaping from all bedrooms.
Smell
Remarkably, the sense of smell, a powerful,
informative and emotionally responsive
chemo-receptor, has no unit of measurement.
A diminished sense of smell is often
accompanied by a loss of appetite and
consequent loss of weight, all of which
ultimately impact on health and wellbeing.
Olfactory sensitivity begins to reduce from
the age of 50. Smart products have been
developed to combat this issue, such as ODE,
a fragrance-release system that emits food
smells three times a day, helping to stimulate
appetite at mealtimes.4 Smart wall and ceiling
finishes can have photo-catalytic effects,
absorbing confounding noxious smells, and
scent emitters can prompt past memories in
cases of dementia.
Taste
Sense of smell and taste collaborate to
identify food flavours and aromas. Two-thirds
of our ability to taste depends on our sense
of smell. Taste buds reduce from the age
of 50, and stimulation from 60 onwards.
Illness, medical treatment and medication
can impact heavily on an ageing gustatory
sense, influencing nutrition and subsequently
leading to weight loss and morbidity. The
newly established Dementia Cafes in Bristol
and Faversham create informal meeting
spaces that engage with these issues, for
example with see-through kitchen/dining-room
cupboards and refrigerator doors, and warm
colours to awaken appetites (rather than
blues, which can suppress).5
21 Other Senses
Beyond the five cardinal receptors, others
such as the sense of pain, time, balance,
space and self are all fundamental to an ageing
community; a sense of time is especially
important to dementia sufferers, and a sense
of balance to those suffering from physical
change and mobility issues such as arthritis
and loss of muscle tissue. Recent scientific
studies have identified 21 sensory receptors
with exotic names such as thermoception,
proprioception and nociception that help to
redefine our sensory responsive environments
for the aged.
Thoughts and Directions
A clear understanding of the ageing process,
the sensory receptors, maturation of the
body’s systems and physiology, related
medical issues and salutogenic needs
should inform our approaches to tomorrow’s
senior-care architecture and interior design.
Designers need to create innovative,
elegant, dignified and exciting environments
for the elderly, moving away from the
mentally/visually debilitating, degraded
and stigmatising institutions of the past with
their usual proliferation of awkward hinged/
swing metal grab bars, handrails, frames,
slow-moving stairlifts and inappropriate,
awkward-looking furniture and fittings. New
emerging design tools such as sensory
plans and spreadsheets, informed by robust
evidence-based research, can help designers
to achieve such pleasant, safe and supportive
environments for the aged. 1

Notes
1. See www.cooperindustries.com/content/public/
en/lighting/brands/io_led/balance_beam.html.
2. A Horowitz and C Stuen, ‘Ageing and Vision
Loss: A Critical Healthcare Issue’, Homecare
Council of New York City Report, 1996.
3. See S Parmet, ‘Adult Hearing Loss’, Journal
of the American Medical Association, Vol 289,
No 15, 16 April 2003, p 2020, and S Bellville, N
Rouleau, M Van der Linden and E Collette, ‘Effect
of Manipulation and Irrelevant Noise on Working
Memory Capacity of Patients with Alzheimer’s
Dementia’, Neuropsychology, 17, 2003, pp 69–81.
4. Design Council and Department of Health,
‘ODE – Appetite Stimulation by Aroma’, Living Well
With Dementia, 2010: http://www.designcouncil.
org.uk/our-work/challenges/health/living-well-with-
dementia1/solutions1/ode/.
5. Elizabeth C Brawley, ‘Smell and Taste’, Designing
for Alzheimer’s Disease: Strategies for Creating
Better Care Environments, John Wiley & Sons (New
York), 1997, p 11.

Richard Mazuch (IBI/Nightingale), Sensory plans Text © 2014 John Wiley & Sons Ltd. Images: pp 108, 111 © Richard Mazuch, IBI/Nightingale; p 109(l)
Sensory plans developed by IBI/Nightingale are unique and centre, then clockwise from left to right: © Shutterstock/Kuttelvaserova Stuchelova; Shutterstock/
innovative design tools that empower the designer to deliver Nejron Photo; Shutterstock/MILA Zed; Shutterstock/Jabiru; Shutterstock/Ollyy; p 110(l) © Charlotte
optimal supportive environments for the ageing community. Wood Photography; p 110(tr) © Lynn Lindley; p 110(br) © Paul White

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