CHAPTER 2 - Review of Related Literature

The Review of Related Literature contains different related topics from various

sources that are used in formulating the proposal. In this section, it includes subjects

about the different Legal basis, main issues existing in the elderly care facilities, what

the predictors of this issue, possible methods to address the problem, new interventions

and the design approach that will support and make the aforementioned possible.

LAWS:

R.A. No. 344 “The Accessibility Law of 1982” provides certain standards and minimum

requirements of building facilities, and utilities accessible to the PWD and older people

seated in a wheelchair, the ones who can hardly walk and climb stairs.

Presidential Proclamation No. 470, Series of 1994, “Declaring the first week of

October of every year as Elderly Filipino Week.” - Presidential Proclamations and

Executive Orders

R.A. No. 7432 “An act to maximize the contribution of senior citizens to nation building,

grant benefits, and special privileges and for other purposes”

R.A. No. 7876 “An act establishing a senior citizen center in all cities and municipalities

of the Philippines and appropriate funds” provides for a facility that caters a social

interaction needs of the older people as well as a venue to conduct meaningful

activities.obligating the DSWD coordinated with NGOs and people’s organization in

producing the technical assistance for the social and recreational services, health and
personal care services, spiritual services, livelihood services, and volunteer resources

services.

Executive order No. 105, series of 2003 “approved and directed the implementation of

the program providing for a group of homes and foster homes for neglected,

abandoned, abused, detached and poor older persons and persons with disabilities.”

Administrative Order No. 4 series of 2010 “Guidelines on the Home Care Support

Services for Senior Citizens” Health and Care – the DSWD have issued - creating

community-based health care services for older persons.

R.A. No. 9994 “provides health care services for poor older persons such as free

medical services on selected medical institutions”

Comprehensive Land Use Plan, Zoning Ordinance (2016-2025) and

Comprehensive Development Plan (2016-2025) of Palafox Association - the senior

citizen center have facilities for recreational, educational, health and social programs

and facilities designed to fully benefit the elderlies.

Administrative Order No. 11 – revised standards on residential care services

R.A. No. 8980 ECCD Act: ECCD Program – Early Child Care and Development refers

to the full range of health, nutrition, early education, and social services programs for

the basic holistic needs of young children from birth to 6 years old.
ISSUE:

Prevalence of Loneliness in Nursing Homes and Assisted living facilities (A.H.

Jansson, 2017)

Loneliness declines the elders’ quality of life. This is due to the differences

between one’s own expectation and one’s actual relationship, hence even being

surrounded with people, an individual may still feel lonely. People in institutional

dwellings tend to be lonelier than those living in their homes, it is associated with poor

psychological well-being and self-rated health, making loneliness common in elderly

care facilities. This may also increase mortality. Nursing homes must also focus on

addressing the resident’s loneliness, this should be taken into consideration in the care

and support of the residents. New strategies and interventions must be done that aims

to develop a meaningful relationship, and communication with their peers, family

members, and nurses.

The empty nest (Mahilum, 2011)

The theory “empty nest” refers to the concerns of the elderly regarding this phase

of their lives. The elderly are the ones that provide for their own families. It saddens

them knowing that their children only cared about them when they are sick. And another

burden they have felt due to the additional expense for regular medication and proper

diet. It is identified that the elderly need financial assistance, a healthy environment,

emotional counseling, physical therapy, and recreation.

Depress elderly residents need social support (Daisy R. Palompomn, 2011)

The elderly population is vulnerable to stress, high chance of having depression

is one of the common stereotypes of growing older. The study was conducted with 37
respondents in the two geriatric facilities in Cebu. The result showed that respondents

had moderate self-esteem, adequate social support and a depression level of moderate

to severe, this is due to the lack of support from caregivers and families. It is concluded

that social support as a predictor of depression, is an essential element for the

prevention of depression among institutionalized elderlies.

SOLUTIONS:

Enhance the living environment for a better quality of life (Nicholson, 2018)

Social, physical, psychological and environmental are the four-aspect related to

the surrounding that contributes to the quality of life of older adults. Social aspects are

the interaction, relation, and support of a person to his co-residence. The physical

health aspect is composed of mobility, daily activities. Functional capacities, energy,

pain, and sleep. Psychological contains self-image, negative thoughts, positive

behavior, self-esteem, and mental status. Environmental has financial resources, safety,

health and social services, living environment, opportunities to acquire new skills and

knowledge, recreation, general environments such as air, noise and pollution and

transportation. These environmental factors were housing, residents, neighborhood,

stench/noise, and traffic. The author recommended that to support the quality of life for

older adults, interventions must focus on these factors.

The Influence of the Physical Environment on Residents with Dementia

(Chaudhury, 2017)

Although physical environment alone can’t establish therapeutic milieu it has an

important role in providing the quality of life and quality for care for people with dementia

who are sensitive individuals to environmental stressor and cues, This study
emphasized the influence of unit size, spatial layout, homelike character, sensory

stimulation and specific spaces such as the dining, bathing and outdoor spaces to the

behavior and welfare of the residents in dementia care facilities. Unit size indicates that

small-size unit 5-15 residents have gained a positive impact on the well-being and

behavior of people with dementia than those living in a traditional larger facility, it

resulted in fewer declines of activities for daily living and less negative impact. One of

the examples is the Green House Residence, it is a structural design to resemble a

home and an assisting living for people with Alzheimer’s and other dimensions each

home have a living room and an open kitchen that encourage participation and a large

communal dining room where the Elder’s won’t feel that they are in an institutional

facility, this may help them reminisced they good past. It scored high on a variety of

quality of life, including Autonomy, privacy, relationship, and meaningful activities.

Group-living residence experienced greater positive effects like an increase of social

engagement, improved ADL, feeling at home and a higher rate of quality of life. Hence it

suggests that a small-scale environment promotes a sense of self and social connection

with others. Although small-scale living shows improvements to the residence, research

also suggests that larger units improve social interaction and lessen social withdrawal.

Spatial layout and orientation cues, the unit layout can play a vital role in the ability of

the resident to navigate independently, in the L, H or square units, spatial disorientation

is minimized where the kitchen, dining, and activity areas are located close together. By

the use of I, layout people with moderate and severe dementia were able to find their

way better than a layout that shifts different directions like the L and H units but people’s

experience in this type of layout resulted to high circumstances of dyspraxia, lack of

vitality, restlessness, and loss of identity. Long hallways may result in a decrease in the

resident’s awareness, safety, security, and orientation. To locate their floor, residents

relied on the furniture and the large floor number painted on the wall. Prosthetic signage

such as a photograph of the residence, memorabilia items, and name tag large font

have found to elevate the resident ability to find their way by 45%-50%. Homelike

environment improved emotional and intellectual functioning that increase social

interaction, autonomy and participation, less tress passing, exit seeking, and agitation. It

also decreases verbal agitation, anxiety and verbal and overall aggression. Environment

ambiance such as warm, welcoming, colorful and novel cause fewer walking/pacing

episodes and longer sitting duration. Thus, a homelike environment with more group-

living characteristics like small-scale common areas with a range of private. Semi-

private and public spaces reduce behavioral disruption and improve resident’s quality of

life. Sensory Stimulation, increase noise levels may result in reduced social interaction,

increased agitation and aggression, disrupt behavior and wandering. Therefore,

reduced noise levels contribute to the quality of life. Exposure to higher light levels also

has a positive outcome on the well-being of the elderly as it improves sleep durations,

decreases restlessness, mood, cognition, and functional decline. Dining area, smaller-

sized dining rooms with homelike ambiance and resident-accessible kitchenette and

high-contrast tableware (blue or red) found to be beneficial as it improves food and fluid

intake, increases social interaction, and reduce anxiety and agitation. Bathing area with

privacy, use of side/end entry bathtubs, presence of windows reduced agitation. The

outdoor area, gardening, going for walks and group activities are physical and social

outdoor activities that are beneficial for people with dementia. Time spent outdoors
reduced stress. Outdoor activities are more beneficial than indoor activities as it could

also reduce the need for medication. Therapeutic goals are defined as the desired

relationship between the physical environment and people with dementia in a care

setting. It composes of maximum awareness and orientation, provides opportunities for

restoration and change, links health with familiar, provides opportunities for social

interaction.

Sense of home in nursing homes (A. Eijkelenbooma, 2017)

Many studies have shown that the design of the nursing home can have a great

impact on the sense of home to its residence, following the psychological and social

factors. The following architectural factors are the private space, quasi-public space,

personal belonging, technology, the nursing home’s look and feel, location and

outdoors. This provides a holistic understanding of what factors contribute to improving

the sense of home in the nursing home. Through evidence-based design, architects will

be able to link the gap between architecture and evidence-based healthcare. Private

space, shared rooms are unacceptable by most of its residents. The wish for having a

private room may have a basis in having the opportunities to be on their property, the

desired privacy and owning personal belonging around them. Spending their time in

their own room and engaging in domestic chores is valued by the residents as they

need to have privacy. They don’t like spontaneous openings of the door by the nurses

as it threatens their autonomy, they want to stay in control of their belongings. It is

necessary to have a private room and private sanitary facilities. Residents like to have

larger space so that they may cater to visitors. Public space is where they engage with

others as they should come out of their private rooms. A well-furnished living room with
carpets, family photos, and table cloths will improve the ambiance to feel the sense of

being in a living room and this shall be done and the waiting room is discouraged. A

small residential with family-style dining improves the sense of belongingness. In most

facilities, having their own place in the table with their own chair helps in making them

feel at home. The design of the building should make it easy for the care professional to

approach the residents. Professional equipment, adequate closet space, storage for

personal items and display space should be provided. An oval space for a walk so that

people would not arrive at a dead-end is also an important aspect of public space. Wide

corridors and wide doorways are vital so that residents can reach all parts of spaces

through their wheelchair. Personal belongings have an emotional value to the resident.

It assists in creating a place’s attachment in terms of nesting and being in control by

bringing beloved items and furniture that has a sentimental value helps in contributing to

the sense of home. And being in charge of arranging their room makes them feel cozy.

Look and Feel, the building should have both an appearance and ambiance of the

home. A homelike environment gives residence ease and contentment connected with

warmth and coziness. Some residence stated that it is necessary to have daylight

access, color and fresh appearance with no smelly odors. A hospital-like environment

should be avoided. Long corridors, narrow space and nook were unsafe while

ventilation, a window nearby and some music may give comfort for the end phase of

their life. Some may also need free of noise and excessive visual stimuli. the building

that allows activities accessible, stimulation and promotes pleasure that supports all

sense with lighting, fresh odor, acoustic and tactile qualities is significant for people with

limited mobility. The resident that shares room considered comfort to be a vital aspect.
Chairs must fit body shape. Types of Furniture such as old-style or wooden are

preferred and a homelike appearance is preferred in shared rooms. Outdoor and

location, these are the outdoor spaces within the site of the facility and the

neighborhood. Nursing homes in large cities are not homey for most of its residents.

The presence of children and loved ones play a role in this. Unfamiliar places give a

negative impact on developing a sense of home. Landscaping with care, fences that do

not block the view and connection to nature can create a feeling of satisfaction. The

green environment is more appreciated. Using outside spaces that promote

engagement with the senses and taking part in meaningful activities is considered to be

important. Direct view to the outside is encouraged whether it is a park, traffic, building,

lively street or playground with children.

Abandoned seniors find life-worth living (Bayanihan, 2013)

Created for already three years in Tanay, Rizal, serving 141 abandoned elderly

aged 60 to 104. It is a “Home away from Home in their twilight years”. It offers home-life

dietary and health, recreational, livelihood, socio-cultural, and spiritual services with

complete staff including resident doctors, nurses, nutritionists, psychologist and house

parents that look after the elderly. It resides on acres of lush garden viewing mountain

surrounded by trees giving a healthy and nurturing environment for the old people. It

encourages a balanced lifestyle by fostering independence and providing social care. In

the facility, residents can sharpen their skills by participation in gardening, poultry

raising, and craftsmanship. The life experience in this facility made its residents feel

grateful and forget their bad past experiences. The facility is continuing its improvement

and accepts any effective strategies and interventions that will fully benefit its residence.
Maintaining the dignity and autonomy of older people (Kate Lothian, 2001)

Health services should maintain the dignity and autonomy of the elderly to

decrease the feeling of distress. Many health care settings undermined the dignity and

autonomy of older people. Some healthcare professionals show negative attitudes

towards elders. Dignity means the self-respect of a person and being valued by other

people. While Autonomy is the self-control of an individual in decision making and

activities. Dignity is threatened due to the negative interaction of the elderly and the

caregiver due to the disrespect in the elderly’s privacy, and general in consideration of

the needs and desires of the aged. Autonomy is threatened when the elderly are not

informed about their choices and health status making them disempowered in the

facility and could make them more frailer. The provision of information and good

interaction between the residents and the staff are the keys to allow old people to gain

back their dignity and autonomy in care settings. The attitude of the staff gives an

impact on the quality of the treatment that the elderly receives regarding preserving the

elderly’s dignity and autonomy. Studies show that staff that cares in the nursing homes

have a more positive attitude towards the elderly than the staff that works in acute care,

seeing people with dementia as “unique human being” than “a homogenous group”.

Training in geriatric resulted in a positive impact on the staff towards the elderly. More

experience with older groups of people is beneficial. In maintaining the autonomy of the

elderly, good communication is the key, provision of the information must be ready

wherein the elderly could understand it clearly, produced in a sensitive and supportive

way and be strengthened by the staff through treatment and care.

Autonomy for the elderly (Das, Autonomy in Long-term Elderly Care, 2017)

There are certain factors affecting the elderly’s autonomy in the long-term elderly

care, namely the freedom to choose, dependency, dignity, paternalism and disability or

frailty. Freedom to choose, As the opportunities to own decision-making decrease, the

person’s ability to act intentionally decreases too. Although the reason why the elderly

came to this institution is due to their inability to depend on their selves, lack of

understanding individual’s moral values increases dependency on long term care

keeping the power of self-determination low, making them even frailer than they used

too. Dependency, the increased dependency is the second factor affecting one’s

autonomy. Dignity, insufficient attention of the care gives to see the elderly as a human

being and improperly addressing the individual’s personality may affect the elderly’s

perception of not being respected and valued. Paternalism, this refers to how care staffs

respect the liberty and address the capacity of an aged. Disability and Frailty, care staffs

neglect the elderly’s wishes and choices due to strict rules and regulations that the

staffs are following, this is where inappropriate constraints exist. These factors may not

only affect the elderly’s autonomy but may also affect their mental well-being. The

author found that opportunities can be provided to practice autonomy in this institution,

specifically the skill of self-management abilities through which increase the expectation

of practicing autonomy in the future, treating elderly as active agents that increase the

positive outlook in old age, digging out the capabilities of the elderly where engaging in

meaningful activities will improve the capacity of autonomy, and changing the view of

caregiver this is the most important opportunity as it increases the engagement and

practice of autonomy by understanding the level of elderly’s disease.

Aging with a “Sense of Place” (Derynck, 2017)

A major theme that describes the elderly residing in one place during their

remaining life and healthy transition. The author questions about “what draws older

adults to choose where to live?”. Keeping connections, many seniors choose to live in

their hometown to be near to their family, friends, and memories, but some choose to

follow their children. While some of them leave their house with the feeling of regret or

guilt, the majority struggles on being independent. Seniors preserve a level of autonomy

through choices offered in a hospital-like setting when freedom is gone. Design for Life,

the author saw aging as a natural growth into a new beginning. Aging in place should

also consider a “sense of place that means discovering many ways we find connections

to the community. A deeper understanding of the places’ value in our lives can change

design for aging. Senior housing projects of DSGW has encouraged social connection

through open kitchens where end-users can cook together. Included fireplaces, inviting

common areas and outdoor spaces. On a larger scale, the following are the ideas worth

considering: Plan for visiting family and friends (lodging for visitors or locating near

hotels), Come back to the Community where the new facilities are close or within

walking distance near public places like parks, farmers market, and shops. Celebrate

the generations, it should be multi-generational providing daycare, elementary school or

college on-site allowing residents to connect with youth. Services that keep personal

freedom and a sense of community allows the residents to “age in place”.

Sense of Belongingness (Guzman, 2007)

The live experience of the Filipino elderly sense of belongingness was defined in

three levels: Plain, Plateau, and Pinnacle. The plain level composes of the feeling of
abandonment and avolition where a social support system is needed for them to cope

up with the feeling of isolation and loneliness, as this is one of the challenges they face

with their daily living. This will be helpful in predicting their capacity for stress

management which may be detrimental that affects their physical and psychological

welfare. The plateau level evokes the feeling of adaptation, association, and assurance.

Adaptation is where there is a social connectedness resulting in the elderly’s solitary

activities focused on the religious aspect. An external relationship is created at the

feeling of association where social interaction is made at a civil level. The development

of a sense of assurance begins when dependence on people for security happens

during events in later life. This is the point where the elderly detach himself from the

plain level phase and connect to the pinnacle level phase. The pinnacle level is the

elderly’s feeling of acceptance, antiphony, assimilation, and attachment and

actualization. Acceptance is achieved when a social relationship exists through active

participation and interaction. Antiphony is where there is selflessness, sharing one’s self

to the community. Recognition of the institution as a second home creates the feeling of

assimilation possible. And lastly, the feeling of attachment and actualization makes an

individual realize deep connection due to a meaningful relationship with someone that

became special to them and maintaining social interaction leads to the achievement of a

sense of belongingness and happiness. Males seek social linkage by creating a

relationship with others and showing their usefulness, making them feel important in the

said group. While women create an intimate relationship with the chosen individuals.

Before admission, after being able to be done with the task that was expected to do,

males feel to belong to their families and friends that is why a stronger connection to
their friends and kin makes them feel the sense of actualization. On the other hand,

women rely more on other’s confirmation for them to feel accepted, giving back the

kindness offered to them.

Risk of loneliness and isolation to elders (Krooks, 2012)

Sense of loneliness and isolation can result to decline in physical health and

even early death. Decrease of social isolation improves the elders' quality of life, though

it is just one of the issues that elders face. In the United States, elderly-rich communities

that live alone suffer from a lack of social interaction. There is still a lack of awareness

that social groups making sense of community can change people’s age. Other studies

also said that isolation and loneliness showed dramatic health risk that contributes to

any physical health risk such as suppressed immune system, high blood pressure and

increased levels of the stress.

Dementia-friendly environments (Sandra Davis, 2009)

Recently, in dementia care the physical and social environment is significant,

supporting the person with dementia. Shifting from condition to consideration of

experience encourages cultural changes that are needed to create an environment that

allows a person with dementia to actively participate in everyday life than a passive

recipient of care where the caregiver or the physician is superior to the patient. Seven

facilities in Australia identified the presentation of self-experience, eating experience,

personal enjoyment experience, end-of-life experience, and staff experience. Each

showed that considering the living experience gives ways of designing the built

environment that supports a person with dementia. The person-experience living with

dementia is described as experiencing themselves, the physical environment, and the

social environment together as each has a relationship with one another. The author

suggests that arrangements for serving food, better access to staffs and increased

comfort of relatives with visiting showed that the physical environment has a great

impact on influencing the social environment. But we need to be mindful that the

provision of dementia care still struggles with the culture change in moving beyond the

‘condition’ of dementia in establishing the built environment implementing the person-

centered care to support the social environment. Considering ‘living experience’ gives

way to focus thinking, to connect the excess information about the built environment to

underpin the person with dementia and to address the whole spectrum of issues in

making dementia friendly physical and social environment.

Design for better dementia residents’ social well-being (Cruz, 2019)

Planning residential facilities for patients with dementia must consider specialized

design features to elevate the quality of life of its residents. Careful design that links the

physical environment and the social interaction of its residents is an effective long-term

care facility in which it improves the well-being of those living with dementia. According

to Farhana Ferdous, Ph.D., a lecturer in the school of architecture at the University of

Kansas “So far there is no established cure for Alzheimer’s diseases, but the

architectural design can offer a lot by changing behaviors and attitudes of the residents

and caregivers.”

Ferdous and her coauthor Keith Diaz Moore, Ph.D. dean of the college of

architecture and planning at the University of Utah, used spatial syntax theory to test

how the spatial configuration of long-term care facilities (LTCFs) could influence the

social interaction of residents with cognitive impairments. Space syntax depends on the
visibility and proximity of the environment is can be applied in any physical setting.

Using these dimensions, Ferdous and Diaz Moore were able to differentiate the specific

features of LTCF environments, identifying environmental elements that encourage

various forms of social interactions.

The key finding was that less accessible and less visible spaces create better

quality social interactions among residents than greater accessibility and visibility

spaces. Specifically, out-of-the-way spaces like nooks in a corridor or areas with just

two or three chairs create lasting deeper conversation, while larger open areas generate

shorter social interactions. Spaces with some degree of privacy tend to engage a

person in a deeper conversation.

Ferdous says, even within larger more open and more accessible spaces,

furniture arrangements such as chairs gathered, set in order that gives some sense of

controlled access and privacy promotes social interactions of greater depth. Social

interaction may still be practice on a larger scale-spaces, abut quality interaction is

engaged in smaller-scale, longer-lasting interactions have been shown to have a

greater therapeutic effect.

According to Margaret Calkins, Ph.D., executive director of the Mayer-Rothchild

Foundation, effective environmental design for people with dementia must consider

various concerns related to privacy, quality of stimulation, wayfinding and orientation,

control, and territoriality. Calkins add some environmental aspect that may influence

social interaction in long term care such as chair arrangement wherein chairs must be

placed in a right angle rather than side by side, in an appropriate distance for

conversation. With such, difficulties of older adults with hearing or vision are addressed
with closer proximity of conversation. On the other hand, she added that designing

spaces that support easy communication such as grouping chairs in front of a window

with a meaningful view where residents can discuss what is happening in their view.

Engagement in social interactions of residents involves works best when an activity is

done together.

Social interaction for seniors (Meyer, 2018)

Being socially isolated may lead to loneliness, depression and less physical

activity which will really put the elder physical health at risk. Social interaction is

significantly important as it improves brain, mental and physical health. The mind is

powerful enough to control our overall well-being, social interaction provides strong

mental health and with that people tend to be more engaging in physical activities that

lead to improvement of physical health and high level of cognitive function. An individual

feels safe knowing that there are people around them and can also assist them with

their personal care. New skill and knowledge can also be perceived by being around

people like elders may learn about new trends and technologist from younger

generations in which it will also increase the growth and learning of an elder. Improved

sense of purpose and belonging, being with people that align with your lifestyle, giving

back and belonging to the right community that conforms with an individual’s

uniqueness provide you with a sense of purpose and belongingness. Being surrounded

by people with healthy habits increases one’s healthy behaviors.

Older people offer resources that children need, Stanford report says (Parker,

2016)

Older people play an important role in the lives of younger ones, especially the

most vulnerable in society. The key is to change the social norms to encourage the

relationships between the generations. According to Stanford research, both children

and older people benefit from each other when they work together. Such a bond is

significant to society, old people can give the kind of attention and mentoring that the

younger ones tend to lack especially the most vulnerable ones, the Stanford scholars

said. This relationship is also beneficial to the older people where they learn about

trends and technology from the younger ones, these children are big contributors to

happiness and excitement to the world from a younger perspective. According to Laura

Carstensen, a Stanford psychology professor who led the report and is the director of

the Stanford Center for Longevity (2016) “there is a growing reason to think that older

people may be just the resource children need.”

Children’s stereotypes of older adults: Evaluating contributions of cognitive

development and social learning (Tara T. Lineweaver, 2017)

Research where conducted base on the perception of children to older people. It

confirms that younger children see older adults in a very positive way while older

children defined old people to be positive in a stereotype way. Thus, older children

shared moreover about their strong bond with their parents and friends capered to

younger ones. Therefore, these results support both cognitive development and social

influences as contributing factors to the formation of children’s stereotypes of older

adults.
The impact of intergenerational programs on children and older adults: a review

(Bert, 2017)

Elderly people are largely at risk of social isolation due to the fact that they tend

to have a lack of social contact and this dilemma may lead to loneliness and also may

affect their health condition. On the other hand, involvement in social interaction can be

advantageous as it can help manipulate their social and mental well-being.

A review of the intergenerational program was conducted between the elderly

and children ranging from preschool to elementary. As a result, it was proven that in

both the short and long term, the program gave a positive impact on the children upon

their perception about the elderly. Furthermore, the effects on the elderly were assorted

considering their well-being, depression, self-reported health, and self-esteem but

despite the different results and variables concluded, the program was still an overall

benefit to the elderly participants even with the ones that have dementia. Moreover,

there is a significant need to give importance to the careful organization and specific

training for the involved staff members.

Intergenerational playgrounds promote common ground for kids ages 1 to 99!

(What'sNew, 2015)

Mentioning the word ‘playground’, possible responses are sand; ladders; monkey

bars; summer; children. It is noticeable that the word children " is involved. Children are

the main component of the playground as historically; playgrounds are made for them.

However, there is a paradigm shift that will change the outdated concept of playgrounds

in which it includes grown-ups as an active participant in the child play. Germany and

China were some of the first countries that established intergenerational (e.g.
multigenerational) playgrounds that are built for all ages. This recent approach is a

differing appreciation of the inclusion of the aging population. Intergenerational

playgrounds offer a series of physical and psychological benefits, the Generation United

organization notes common values that older adults and children needs such as,

appropriate autonomy, sensory stimulation, meaningful experiences, physical exercise,

adults expression of empathy while children learn to express their feelings through it,

social engagement and play of adults whereas children learn through play and adults

can share stories and values that will increase the cultural knowledge of the children.

Adults need this experience to keep their health at its optimum level and children need

them for them to grow into healthy adults. An intergenerational playground serves as an

ideal setting to achieve these shared needs. The United Kingdom’s research published

shows that there is an increase in the creativity, improvement in language and problem-

solving skills of those children who play with adults. Furthermore, observers in the

intergenerational sites concluded that there is a positive change in the adult’s mood.

There is a various current trend in the United States that seems to pave a way for the

Intergenerational playground movement forward. The corresponding current trends are,

the community partnership wherein the health company Humana Incorporation together

with the nonprofit kaboom! built 53 intergenerational playgrounds in the cities of United

States with the aim to link the significance of active play with lifelong health and well-

being, the Grassroots movement often gather the community members if all ages in the

planning and building of the playgrounds, something for everyone through involving its

end-users in the planning process. The design of the Intergenerational playground may

include paths that surround play equipment, painted chess tables, garden pots,
community designed murals and exercise equipment associated with traditional

playground structures.

Combining daycare for children and elderly people benefits all generations

(AEDT, 2017)

We live in a society where there is an increase in segregated care of young and

old, which makes the interaction of the two-age group limited. On the other hand, the

“book end generations” could be a great source for each other, putting them in the same

place is all that is needed. The author took part in an S4C documentary where six

nursery children were introduced to an adult care facility, being part of activities planned

by a team of psychologists at Bangor University. The documentary found that in three

days of company, both care staff and service users commented that the interaction in

the intergenerational project resulted as beneficial. The outcome helps the elders and

the children enjoyed the increase in attention as well, developing their social and

emotional skills. Other than this example, there is plenty of research approving that

bringing generations together is an effective intervention for the care system. The

concept of “non-familial intergenerational interactions” evolves around the idea that

young and old bring new knowledge, energy, and enthusiasm to each other’s lives. In

the past 20 years, this concept has been increasingly used in different care facilities,

particularly in the US. Interaction between generations includes planned interactions

between old and young generations in various settings. Activities encountered in the

said project can be playing games or reading a book together, but the activities in other

states are truly unlimited. In New Jersey, there is an intergenerational orchestra bringing

together musicians aging 60 to 90, in Massachusetts a group of young and old

cooperates in a local environment project. Other places such as Australia and the UK

have studies that showed the potential of activities including children and older adults

increases self-esteem and friendship in a daycare facility. In Japan, shared play

activities resulted in greater smiles and more conversation for elderlies. Another societal

benefit may include fewer expenses in rate and staff cost when shared care is

implemented, this is a huge benefit as some health care facilities depend on public

money.

In valuing older people, it is theorized in 1950 that adults have a great

contributing factor to the next generation, this gives them the feeling of accomplishment,

instead of stagnation, as they age. Intergenerational activities give elders the feeling of

being valued, an individual that still has a lifelong skill rather than just being a passive

care recipient. After the documentary, a lady that attended the care facility commented

that those children brought vibrancy and fun to the center making them change their

focus from watching the time pass to living in the moment. These days, families are

separated through distance, time and lack of understanding between generations, but

intergenerational programs can give aid to change the whole society’s outlook. Children

may be the world’s future, but older generations should not be consigned to the past.

DESIGN APPROACH:

Interactive architectural approach (Mojtaba Parsae, 2015)

This research that used an analytical-interpretative method and is based on

qualitative analyses, seeks to provide a new architectural design approach with a

concept of interaction and multi-relations. Interactive architecture proposes a process

where all factors and parameters of design tend to create a dynamic and mutual
relationship and the final design will consider its effect. Interactive architecture is an

approach in which the architectural design process is analyzed and based on the

mutual relation of the factors, groups, and systems. Thus, the result of the final

architectural design will be a balanced interaction of all factors, groups, and systems.

The purpose of the said approach is to achieve a balanced mutual relation among

different aspects. The balanced pertains to a level in which the resultant of various

factors and force will be equated and neutralized by each other, it is the adaption that is

derived from commonalities and differences interaction of each factor. The multi

relations of each factor are formed with internal and external constraints that serve as a

controller and discouraging factor. Therefore, the different factors’ effectiveness will be

different. Furthermore, interactive architecture analyzes all architectural design aspects

and creates a mutual relation between those aspects. Eventually, the outcome is

achieved through the balanced that is established among all factors and aspects.

Contextual architecture – Contextualism is the adaptation of physical, historical and

social-cultural backgrounds wherein it focuses on the place’s specific features to use

them in design and the human aspect and the physical aspects are considered.

Interactive architecture also creates a multi and mutual connection with the different

design contexts and attains a coexistence and integration with them.

The basic that formed in this model includes a comprehensive and exclusive view to

different aspects of design process, considering the design context, discovering and

understanding relation between the different factors and analyzing them, creating multi

relations (interaction) among all factors, the ability of flexibility and adaptation, creating
a relative balance among all factors (that is involved in design) and also the design

circumstances, modification of design constraints and attending to future development.

In conclusion, the main axis of this architectural approach is comprehensive

interaction with all aspects of design, as most design problems have multi-aspects. It is

believed that using the interactive approach in the design process can eliminate or

decreased most of the challenges and difficulties in design. The ability of flexibility and

adaption is significant and vital in this approach. Hence, it is expected that appropriate

interaction will be achieved in the final design that is accepted by all involving factors in

designing and reach the highest level of adaptation with its context. Thus, the interactive

architectural approach is a practical model to achieve sustainability in architecture and

urban development efficiently. Moreover, with the adaptation of all design context, the

interactive architectural approach can be identified as a context of design. Additionally,

the said approach has great potential to create a sense of belonging in the places.

CONCLUSION:

The adaptation of nursing homes is due to the influences of western culture and

the effect of modernization. However, even elderlies are being catered by these

facilities, there is still a threat to the elderly of having depression because of the

existence of feeling lonely and isolated in this institution. The feeling of emptiness will

not only give a negative impact on the elder’s psychological functioning, but it will also

affect their physical well-being. According to the studies, enhancement of the living

environment conforming to its residents and promoting social interaction between

elderlies and children creates a huge change to the elder’s health as it provides them a

positive impact. Improving the environment of the elders includes a new intervention to
the social, physical, psychological and environmental aspects of the surrounding. On

the physical environment, the influence of the Unit size, spatial layout, homelike

environment, sensory stimulation, areas such as the Dining, Bathroom, and outdoors

plays a key role in achieving the therapeutic goals that is defined as the desired

relationship of the physical environment to the people with dementia in the care

settings. Moreover, in creating a sense of home in nursing homes, establishing private

space apart from public space could improve the sense of belongingness and sense of

purpose, maintaining the dignity and autonomy of elders. Furthermore, studies say that

developing and promoting social interaction in elderly care facilities create a huge

impact on the healing process of the elders. In other countries, they have adapted

intergenerational program in taking care for their elders where pre-school children visit

the nursing home to play and entertain the elderly residents, and other programs and

activities that include social interaction between elders and children. This way, both the

group and the people surrounding them benefit from the said program. It is common

that children and elders have a special bond, it automatically triggers the good in them

and affects them positively whenever such interaction like play occurs. In the final

analysis, the researcher uses the Interactive Architecture as a design approach to make

the mention above possible, with the concept of interaction and multi-relations,

interactive architecture is a design approach based on the mutual relation of the factors,

group, and system. Thus, the result of the design will be a balanced interaction of all

factors, groups, and systems. It also includes contextualism where it focuses on the

place’s specific feature to use them in the design and the human and physical aspect

are considered.
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