Background: With the increasing global population of older adults, there is a need for environmental interventions that directly affect their physical, psychological, and emotional well-being to help them maintain or regain their independence and autonomy – all of which promote longevity. Methods: To better understand potential opportunities and challenges associated with interior design and “future homes” that may promote well-being, aging in place, and independent living in older adults, the authors reviewed relevant literature and included their own expert opinions from a multidisciplinary point of view including interior design, wellness, and engineering. Results: After summarizing existing environmental interventions for the aging population and their effectiveness, this review reveals knowledge gaps in interior design for the well-being and longevity of older adults followed by a discussion of opportunities for future research that may fill these gaps. Some of these opportunities include finding habilitative design strategies that identify and address unique situational needs of each user, advancing multidisciplinary fields such as environmental gerontology that recreate security and independence for older adults even outside of their homes, implementing technically advanced design strategies, which are flexible and adaptive to individual needs; and integrating the Internet of things (IoT) into living environments, including voice-activated command technologies to improve seniors’ central role in enabling an optimized healthcare ecosystem. Conclusions: Knowledge of current evidence regarding the impact of different environmental factors may hasten adaptation of well-designed innovations that can provide optimal healing and living environments for the aging population. By effectively addressing older adults’ unique and specialized needs, design practitioners can become an indispensable part of their medical, social, and environmental team. One of the rapidly developing infrastructures promising to revolutionize the design of “future homes” is the IoT. While it is at an early stage of development, ultimately we envisage a connected home using voice-controlled technology and Bluetooth-radio-connected add-ons, to augment much of what home health does today. Bringing these approaches together into an effective strategy for a model of effective geriatric care is important and needs to become an integral part of both design education and practice.

Global aging statistics indicate that by 2050, 65 nations are expected to have a population where people aged over 60 constitute 30 percent of their population. Indeed, -Japan at present is already in this category [1]. This phenomenon, though not surprising in developed countries which have resources for adequate nutrition, healthcare, and safety, is extraordinary for developing countries. Developing countries constituted 7 of the 50 countries with a population of more than 10 million aged 60 and over in the year 2012 [1].

In the United States, the population of older adults – defined by the U.S Census as the number of people 65 years and over – grew at a faster rate between the years 2000 and 2010 (15.1%) than the total U.S. population as per the U.S. Census of 2010. The 2010 U.S. census reported more people 65 years and over than any previous U.S. Census [2]. In fact, the number of older adults is expected to more than double over the next 25 years, creating a demographic status that is unprecedented in the history of the United States [3].

One of the outcomes of this changing global demographic is the implication for the design of living environments for older adults. With a new set of needs and living standards, interior designers and architects are finding new opportunities and meeting exciting challenges to create ingenious solutions for seniors to promote their well-being and longevity. While a number of design philosophies such as accessible design, universal design, and habilitative design exist to address the needs of older adults, design practitioners need to determine how effective each approach is for each user. They, along with caregivers, should provide means to help the elderly compensate for declines in their physical and mental health [4].

While older adults are increasingly adding smart items to their homes piecemeal, such as smart LED light bulbs, smart thermostats, home security systems, and door locks, there is rising interest in integrally incorporating such devices into remodels and designing “smart homes” to address the challenge of aging, eldercare, and aging in place. To better understand potential opportunities and challenges associated with implementing new technologies for remodeling homes and promoting aging in place and life independency, the authors reviewed recent relevant literature and included their own expert opinions from a multidisciplinary point of view including architecture design, engineering, and integrative medicine. More specifically, this article discusses the latest knowledge and advances in environmental factors impacting healthy aging, aging in place, smart home devices, and their potential uses for promoting independent living and aging in place.

Environmental Implications of Aging in Place

The older adult population most often chooses to age in place [5]. This is because the ability to stay at home not only saves money, with the high cost of other living options, which include assisted care facilities, but it is also considered to be good for mental well-being. Aging adults experience increased freedom, safety, and comfort by living independently in familiar environments. Most importantly, a safe and supportive living environment is conducive to independence and increases the likelihood of older adults continuing to live in their homes [6, 7].

The United Nations Population Fund reported in 2012, globally, 2 individuals celebrate their sixtieth birthday every second – a total of almost 58 million sixtieth birthdays per year [1]. The European Foundation’s 2006 study reported that in the European Union, only 18% of the population had moved outside their region, and only 4% ever moved to another Member State and fewer than 3% ever moved to a country outside the EU [8]. This data supports the increasing trend of aging in place in Europe. In 1994, for the first time, the Organization for Economic Co-operation and Development ministers made the significance of this issue clear when they stated that the older, aged population in the EU should be able to continue living in their own homes and where this was no longer possible, in a supportive and sheltered environment, and both socially and geographically as close to their community as possible [9].

Aging adults also benefit financially from remaining at home [10]. The U.S. Department of Housing and Urban Development notes that many aging Americans choose to continue living in their homes because it is an affordable option. The cost of living in an assisted care facility is high – 3 times more than noninstitutional or at home care. In the U.S., over 94 percent of seniors pay for this cost out of pocket [10]. A study conducted in the U.S. compared long-term aging in place programs in Medicare and Medicaid for older adults in home and community-based health care services to those living in nursing homes. It found the former groups have potential monthly savings of USD 1,591.61 [11].

Promoting aging in place may also create systemic cost savings for the U.S. Medicare and Medicaid programs. Of the USD 203 billion spent in 2009 for nursing homes, home healthcare, and other long-term services and supports, 62% was paid through Medicaid, 4% was paid through Medicare, and 23% was paid by individuals out of pocket [12]. The remainder was paid by private insurance [12]. Longer-term home and community-based services care are covered by Medicaid for those who meet the program’s eligibility requirements. Because of rising -demand and seniors’ desire to age in place, Medicaid home and community-based services spending in 2007 rose to USD 41.8 billion, a 95 percent increase from 1999 levels [13].

The phenomenon of aging in place means that the design of new homes and remodels of existing homes must not only be safe and functional but also be conducive to health and longevity. Every interior environment designed for an older adult requires a unique, sensitive design approach to create environments that are safe, flexible, and conducive to the occupant’s overall health and well-being.

This review takes a broad look at what has been done so far in the design of interiors for older adults and then discusses new approaches and possibilities for creating interior environments that promote their well-being and longevity. It focuses on the existing evidence on the influence of environmental variables on ageing actively at home. In addition, it seeks to identify knowledge gaps and future directions for interior design and research in the field of gerontology.

Different geographical, social, and cultural environments influence the ability of older adults to maintain various activities, social interactions, and personal identities [14]. Place attachment involves individuals or groups forming affective, cognitive, and behavioral bonds to particular socio-physical settings. The need for each individual to find a balance between basic needs (a secure, safe and stable base) and higher-order needs toward exploration, stimulation, and environmental mastery links place attachment to individual outcomes of autonomy and well-being [14].

The meanings of aging in place for older individuals, however, go beyond the home [15]. They are highly influenced by the geographic location of where an individual chooses to age [16]. Geographic locations with higher social capital are likely to be more beneficial to one’s health and well-being [17]. Rural configurations of place compared with urban configurations provide different experiences for those who live there [18]. Growing old in a rural area has been found to create a double jeopardy, combining the challenges of later life with living in a geographically remote, sparsely populated area where healthy amenities and access to healthcare may not be available [19].

Communal space in close proximity to the home and an urban, animated context has been found to be highly important to the elderly [20]. These public spaces should also be accessible in order to be conducive to the well-being of the elderly population [21]. Jane Jacobs in her seminal book, The Death and Life of Great American Cities, provides insights into the relationship between the built environment of cities and the social capital of its residents. She argues that vibrant, safe neighborhoods are ones that allow for and encourage social interactions and mutual support through the mix of uses and the provision of sidewalks. Neighborhood amenities are also crucial for older adults, since they provide opportunities for chance encounters [17]. In Madrid, Spain, for example, most elderly individuals live within 10 min of accessible amenities. As a result, 94% of these individuals were found to be satisfied with their neighborhoods in a survey [16].

Different climate conditions and weather patterns create additional challenges for the elderly. A study in the city of Edmonton, Alberta, Canada, found that gathering in outdoor places is difficult most of the year due to cold weather, reducing opportunities for spontaneous encounters and creating a sense of community. Seniors in these regions were forced to seek out indoor public as well as pseudo-public and private spaces. This study indicates the need for more supportive built environments for healthy aging in cold climates such as more indoor communal spaces that are in close proximity to private residences as well as to each other [22].

Elements and features in interior environments that support independence, autonomy, and health need to be carefully considered when designing for the elderly. According to research by Boyden and others [23], well-being features in building design need to include opportunities to engage in spontaneous social encounters, provide relaxation, and psychological restoration, provide the ability to maintain and control personal comfort, allow one to make connections to the natural environment, and have meaningful change and sensory variability [23]. Some of the key interior design elements that have been employed to directly address these needs in designing spaces for older adults are discussed in this section.

Spatial Organization and Safety to Mitigate Perceptual, Motor, Balance, and Memory Issues Related to Aging

Since hippocampal memory loss – spatial memory – is among the earliest memory deficits in dementias such as Alzheimer’s [24]. Spatial familiarity and predictability are key to the safety and autonomy of seniors in home or healthcare environments. For example, hospital rooms for elderly patients need to be designed such that the patient can easily find the location of the entry point to the room and process how to move across the open space to get to a desired point such as the bathroom. Similarly, group activity areas must have clearly marked and visible public toilet facilities [4]. The level of familiarity and predictability should preferably increase with the level of disability.

Loss of balance and motor function contribute to one of the greatest fears in older adults: the fear of falling and losing their independence. An important safety requirement in hospitals, therefore, is the provision of handrails, grab bars, and lean bars in any place where the elderly patient is required to stand and wait, such as elevators, registration desks, and waiting lobbies. In addition, the handrail should preferably be a contrasting color to the wall, and designed with rounded edges and smooth finishes so that the skin does not bruise easily [25]. Special consideration must also be paid to flooring for seniors, since fall prevention is a significant safety issue. Flooring must be slip-free. Materials such as rubber flooring can provide increased friction to reduce falls without making the space look institutional and going over-budget [5].

Researchers also advocate using spatial cues, that is, objects or elements that are intentionally and strategically placed in environments for older adults to help them maintain balance. It is important to note that such cues can become compromised when a person is moving (e.g., walking) or when the environment itself moves (such as an escalator) – since an individual’s balance becomes unstable at these times [4, 26]. Furthermore, storage should be accessible (upper wall cabinets and low shelves in base cabinets in kitchens may not be usable) and display areas for personal objects and memorabilia must be incorporated into the design to bring about feeling of place attachment and self-identity for the elderly [27].

Living spaces for those with dementia need modifications to compensate for degenerative processes. For example, dementia sufferers often try to escape and are lost or injured as a result; it is, therefore, important to control all exits in terms of their operation as well as location [28]. Selection of materials and finishes that may reduce potential injuries in older adults such as rounded wall corners, tempered safety glass in windows, and furnishings that are durable yet comfortable can also help to prevent injury [4]. While the literature on public and institutional settings for the elderly was found to be more extensive and conclusive than that for residential environments, the concerns for interior layout, wayfinding, materials, and finishes are similar, and can also be applied to new and modified residential designs.

Ambient Qualities of the Environment: Light, Color, Sound Design to Mitigate Visual, Mood, and Auditory Issues Related to Aging

Daylighting: Effects on Mood, Sleep, and Circadian Rhythm

A study by Heerwagen [29] found that good visual access to daylight via interior glazing increased satisfaction in office workers even if they did not have daylight in their immediate space. In fact, merely seeing daylight somewhere in the environment also had positive effects [29]. Another study by Rubin et al. [30] compared the length of stays of 174 patients with depression randomly assigned to sunny or dull hospital rooms found that those in sunny rooms stayed an average of 16.9 days compared to 19.5 days for those in dull rooms that is, rooms without sun [30]. Indoor sunlight is also associated with perceived cheerfulness of the environment and higher levels of positive affect for occupants. Moreover, sunlight is beneficial to building occupants who experience Seasonal Affective Disorder, which leads to lowered energy and moods during winter months [29]. Older adults are also more likely to experience circadian disorders in the form of sleep disturbances possibly due to a combination of many factors, which include among others, a less sensitive circadian clock and age-dependent reduced retinal light exposure [31]. In this respect, Figueiro found that light sources delivering higher circadian simulation during daytime hours had the potential to improve sleep in older adults and Alzheimer’s disease patients [31]. Daylighting the interior environment, therefore, may be highly beneficial to the well-being of this population group.

Light Quality, Intensity, Glare: Effects on Visual Acuity and Perceptual Changes

Daylighting and electrical lighting must be integrated into the interiors of different spaces keeping in mind that seniors are more perceptive to glare, and their eyes transition more slowly to changes in light. Figures 1 and 2 show how local Tucson, Arizona, architect Judith Chafee introduced careful architectural daylighting strategies (overhangs and clerestory windows with light shelves) for visual comfort in the house she designed for her elderly mother. In addition to individual rooms, pathways, hallways, and staircases need to be well-lit without producing glare. Light-dimming controls may address this issue by allowing individuals to control their levels of light stimulation, facilitating their relaxation [4]. Lighting strategies such as wall washers instead of recessed down lights, adjustable task lighting to light a work surface or under cabinets, and lighting the stair treads themselves work better than simply increasing the general lighting. Manufacturers are also working to make light fixtures that not only meet medical and accessibility requirements but also look residential and aesthetically pleasing [5].

Fig. 1.

Window overhangs for minimizing glare and increasing visual acuity at the Viewpoint Residence designed by architect -Judith Chafee for her mother, Christina Affeld Johnson, in Tucson AZ. Source: Altaf Engineer.

Fig. 1.

Window overhangs for minimizing glare and increasing visual acuity at the Viewpoint Residence designed by architect -Judith Chafee for her mother, Christina Affeld Johnson, in Tucson AZ. Source: Altaf Engineer.

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Fig. 2.

Clerestory windows with light shelves for minimizing glare and even daylight distribution at the Viewpoint Residence designed by architect Judith Chafee for her mother, Christina Affeld Johnson, in Tucson AZ. Source: Altaf Engineer.

Fig. 2.

Clerestory windows with light shelves for minimizing glare and even daylight distribution at the Viewpoint Residence designed by architect Judith Chafee for her mother, Christina Affeld Johnson, in Tucson AZ. Source: Altaf Engineer.

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Color and Contrast for Visual Acuity and Perceptual Changes

Many older people require a higher degree of contrast to notice differences between colors, since the ability to differentiate between colors decreases with age. One study found that by age 75, an individual requires twice as much contrast as a younger person, and by age 90, that same person requires 3 times as much [32]. Pastel colors from the cooler end of the spectrum such as blues, greens, and purples, therefore are very hard for an older adult to delineate and for many of them, these colors all appear gray. This is important information for designers, particularly when they plan changes in elevations where there is a possibility of a fall. While providing some contrast is good, too much such as combinations of black and white, or black and yellow, may create an optical illusion for seniors, and should be avoided [4]. Older adults also often look down as they walk to adjust the placement of their feet. A darker color or pattern in the midst of light patterns may appear to be a step of a change in grade. Reducing color contrasts in the flooring, is therefore, advisable [25]. Researchers also found that contrast impairments are problematic when detecting curbs or stairs. Low-light, low-contrast, and glare conditions in interiors in combination with this impairment, reduces older adults’ reaction and response times and must therefore be avoided along with sudden changes in lighting levels [32].

Sound and Noise Mitigation for Hearing Loss and Cognitive Disorders

For individuals with cognitive disorders – whether attention deficit disorder or dementia – noise and extraneous sound reduction are significant aspects to be considered while developing a supportive environment. This may be accomplished by design strategies such as using thicker walls with multiple air cavities, using acoustical materials and finishes, or a combination of both. Since this type of construction may add considerable expense, an effective, long-term and cost-effective strategy needs to be implemented by designers and developers to measure return on investment of incorporating such design features [4].

Combined Effects and Implications for Future Design

Ambient environmental features such as lighting quality, and meaningful sounds and aromas are found to be conducive to active living among residents with dementia. To build on the knowledge base of this field and its design applications for improving residential spaces, future research should focus on measuring built environment factors in detail with increasing use of digital technologies and facilitating active living. This work should preferably be undertaken by multidisciplinary research teams that can conduct policy-driven research for housing the growing population of older adults in a healthy manner [33].

Indoor Temperature and Physical Performance

Indoor temperature has been found to influence mortality and self-perceived health problems related to heat [34]. One study found an association between indoor temperature and physical performance in older adults. It compared results of physical performance in older adults in absentia of a heat wave and during a heat wave. It found chair-rise performance and habitual gait speed to be negatively affected by heat in older adults. The study recommends better exercise interventions for older adults, since increased physical fitness may provide them with the physical capacity and resources to adapt adequately in times of heat stress [35].

Guidelines for optimum temperature and humidity ranges in living environments for older adults may also need to be revisited keeping specific needs of the elderly in mind. An effective approach may be to make thermostats and other environmental controls easily accessible, user-friendly, easily distinguishable, and readable for seniors. Nurses in healthcare facilities, for example, very often notice elderly patients simply holding remote controls with call buttons with their finger on the correct button for fear that they might lose its location. Contrasting shapes and colors on the remote control could potentially minimize that fear and is also helpful for elderly patients who are visually impaired, cognitively challenged, or medicated and have difficulty remembering which buttons call the nurse or control the television [25]. Arguably, designers and engineers could adopt the same approach in the design of environmental control devices for older adults. An example of a smart temperature thermostat and phone application that adopts some of these user-friendly features is shown in Figure 3 below.

Fig. 3.

Smart temperature control thermostat and phone app. Source: Altaf Engineer.

Fig. 3.

Smart temperature control thermostat and phone app. Source: Altaf Engineer.

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Biophilic Spaces

Biophilia is the human affinity to seek connections with nature and other forms of life [35]. Outdoor urban and interior environments tend to be dominated by manmade objects. An increasing number of studies in the last few decades have shown the positive influence of nature on human health and well-being [36, 39].

Viewing natural landscapes has proven psychological and health benefits, including stress reduction [37]. Ulrich found that having a hospital window with a view improves healing, as reflected in patients’ reduced level of pain medication and increased speed of recovery after surgery [38]. The idea that nature can positively influence health and well-being, that is, the biophilia hypothesis is well substantiated, including views of nature (actual or even as pictures), the therapeutic use of nature, addition of plants to indoor environments, and outdoor studies [38, 39]. An important direct physical health benefit of nature in the surrounding environment is increased longevity [36] and self-reported health and well-being [40, 41]. Spaces such as healing gardens provide the elderly at home or elderly patients in hospitals and their families with sanctuary and relief from confinement – whether they choose to sit quietly amid greenery or pursue gardening activities [28]. Such environments may include gardens along primary pathways, plants or natural elements in a facilities interior, and sensory stimuli such as water features and colorful surfaces [42]. Incorporating biophilic design into the interiors of homes, healthcare, or assisted living environments of older adults is therefore, vital to their health, well-being, and quality of life.

Accessible Design and Universal Design

Accessibility is an important consideration for interior environments used by people whose abilities are impaired by age, illness, or genetics. Disabled or handicapped people include not only those in wheelchairs, as many believe, but also developmentally or physically challenged people including many in the geriatric population who have a range of impairments such as Alzheimer’s or Parkinson’s disease. Designers must, therefore, pay careful attention to specific accessible design needs for the elderly [43].

The Americans with Disabilities Act (ADA) in 1990 was the first piece of national legislation in any country to insure equal rights for the people with disabilities. One of the most comprehensive pieces of civil rights legislation in the United States, it guarantees that people with disabilities will have the same opportunities to participate in the mainstream of American life [44]. Even though the guidelines apply only to public facilities, ADA standards are typically used as the basis for accessible design in home environments. Accessible design compensates for deficiencies in everyday design via the reduction or elimination of barriers for individuals with limitations for specific abilities. Since these specialized designs were originally developed for institutional settings, they are medical in appearance and as a result, accessible design is sometimes an object of stigma [45].

To counter the stigma and create more aesthetically pleasing and functional products for all users, not just the disabled, in 1991, architect Ron Mace described the concept of “universal design” in a publication that is still the most widely accepted definition of the term today [46, 47]. It is an approach to design that accounts for the widest possible range of body shapes, dimensions, and movements [45]. These characteristics not only give it a built-in accessibility, but also make the accessibility undetectable and avoid the stigma of specialized design [47]. As a result, a universal design approach has proven to be useful in designing residential, institutional, and public environments for older adults. Universal design has obvious benefits; however, it can only be a baseline for usability. There is still a need for customized designs that cater to the unique individual needs of the elderly [45].

According to the American Association of Retired Persons, nearly 90% of seniors prefer to stay in their own homes as they age. Fortunately, we live in a world where technology is increasingly being integrated into every aspect of our lives, representing an opportunity for creative solutions to promote independency and aging in place. In particular, thanks to new “smart” sensors and communication technologies available today, new opportunities have opened for designing “smart homes” to support older adults and people with disabilities to remain living independently in their own homes and to reduce the considerable care burden on family or professional caregivers [48-50]. Fueled by the recent adaptation of a variety of enabling wireless technologies, such as RFID tags and wearable sensors and actuator nodes, and the “internet of things (IoT),” the smart home concept has stepped out of its infancy and is the next revolutionary stage, transforming residential homes into a fully integrated “Future IoT or connected homes.” The cross-sectionality of smart home devices and portable diagnostic sensors has paved the way for an IoT byproduct called the Internet of Medical Things (IoMT). IoMT may be defined as medical device connectivity to a health care system through an online network, such as a cloud, often involving machine-to-machine communication [51]. Currently, IoMT is frequently used for activities such as remote patient monitoring for chronic illnesses, tracking medication orders, and wearable mobile health devices [49]. Significant business decisions have been made recently by major information and communication technology players such as Google, Apple, Cisco, and Amazon to position themselves in the IoT landscape. For example, in 2014, Novartis began working with Google on sensor-technologies, including the smart lens, and a wearable device to measure blood glucose levels [50]. In 2017, Amazon teamed up with Merck and Luminary Labs in an effort called the Alexa Diabetes Challenge, with the goal of finding the ultimate way to monitor diabetes using voice-enabled solutions [50]. As the IoT continues to develop, there is increased potential for facilitating management of chronic conditions at home as well as to facilitate the delivery of care for acute and chronic illness. In addition, most medical devices that connect to analytics dashboards can be developed into IoMT technology. As sensors that can detect falls, monitor physical activities, sleep quality, or measure early signs of complication (e.g., diabetic foot ulcers, frailty, dementia) are being developed, there is a need to explore how these new devices can be integrated into an IoMT model for promoting healthy aging and living independency.

IoT is a concept reflecting a connected set of anyone, anything, anytime, anyplace, any service, and any network [50]. This enables making the environment around us smart, potentially giving rise to many medical applications such as remote health monitoring to engage in intervention/prevention programs and improvement of adherence with treatment and medication at home and by health care providers.

Thanks to recent advances in voice-driven technologies, voice-activated commands are evolving into an integral component of the IoT [50]. Voice-controlled IoT is already ubiquitous and is becoming more so, ranging from intelligent personal assistance such as Apple’s Siri, Amazon Alexa, Google’s Google Now, and Microsoft’s Cortana to the devices that learn each individual person’s unique voice and create an interface where that voice can reliably interact with a variety of applications from ordering grocery to managing temperature inside of home. It is estimated that 40–60% of American adults already use voice search in their everyday lives, and that 50% of all queries will be voice searches by 2020 [50]. This figure will only grow as voice-enabled assistant devices like the Amazon Echo and Google Home become more commonplace and interactions more normal.

Recent improvements in voice-enabled assistant devices have not only reduced their cost but also include many interactive features allowing users to connect to the world and facilitate self-care. For instance, these voice-enabled devices can help users order pizza, call an on-demand transportation service, control home appliances (e.g., lights), control a TV, request media playback, check the weather, order groceries, and much more [50]. These features also create opportunities for self-care solutions as it pertains to the goals of seeking timely health care information, ordering medications, encouraging adherence to care management plan, easing communication between doctors and patients, and many more [50].

Healthcare data privacy and security concerns are however major challenges for implementation of these consumer-grade technologies, in particular among older adults and vulnerable population such as those with dementia or cognitive impairment [50]. While patient privacy is certainly regulated within traditional medical systems, the advent of personal consumer electronics (such as home assistants) used in health care contexts creates novel challenges. For instance, consumer electronics purchased by patients for personal use (rather than being prescribed and delivered as a health care solution) fall outside the bounds of conventional regulatory umbrellas such as Health Insurance Portability and Accountability Act. Therefore, innovative solutions are needed to protect patient privacy and risk associated with connected devices in particular for life-critical connected devices such as wirelessly connected insulin pumps and pens [50]. It should be also noted that elders’ perception of privacy concerns vis-à-vis home-based technologies are highly individualized and influenced by perceived usefulness, culture, geographic locations, collected data granularity [51], and their living and health situations. For instance, older adults are increasingly willing to trade privacy for prolonging their ability to remain safe and independent in their home [51].

Each person ages differently and has varying degrees and kinds of abilities or disabilities. Universal design and accessibility standards have made spaces and places for older adults safer and more functional, but design that caters to the unique, everyday needs of people may enable them to function at their highest capacity. One study, for example, found that the most effective intervention to improve the well-being of people with dementia and their caregivers was customizing and adapting private homes to specific user needs, in a balanced combination with pharmacologic, behavioral, and occupational approaches [52].

Habilitative design is one such emerging model of individualized design catering to an individual’s unique needs. Its concept comes from the fields of rehabilitation and disability in healthcare where most therapies enable an individual to keep or regain their independence. Habilitative design strategies distinguish themselves from universal ones, by not being replicable for all users and identifying and addressing their unique situational needs instead [47]. Environmental Gerontology is another multidisciplinary field that has emerged in the past few decades, combining the input of environmental design practitioners, medical professionals, human service professionals, and occupational and physical therapists in healthcare settings. While aging in place gives a sense of security to the elderly in their own homes, environmental gerontology re-creates the same security and independence for them outside their home [25].

Architects and interior designers are uniquely positioned to address habilitative design needs and participate in environmental gerontology [25, 45]. Technically advanced design strategies, which are flexible and adaptive to individual needs, are also beginning to define the future of interior design for older adults. For example, adjustable lights that are blue during the day and amber at night so that they do not interfere with seniors’ melatonin levels, have been found to be effective in maintaining normal circadian rhythms and sleep, and are being increasingly used to light senior living environments [5].

As described earlier, the IoT has opened new avenues for designing “smart” and “connected” homes, which may provide cost effective and highly convenient solutions to promote healthy aging and aging in place in health care. This new generation of “Smart Homes” may empower patients to take care of their own health, thus promoting patients’ central role and responsibility in enabling an optimized health care ecosystem. This rapidly developing infrastructure has the potential to not only keep patients safe and healthy but also improve how physicians deliver personalized and timely care. The benefits of the IoT will likely extend beyond the realm of consumer health care, benefitting researchers with its ability to continuously and remotely monitor patients. While IoT is being celebrated as the future of medicine, there are still some concerns that need to be addressed on patient compliance, battery life issues, and security and privacy. Nonetheless, we find ourselves in the early stages of a dramatic change in health care: where the merging of consumer electronics and medical devices has made the home the clinic of the future [50].

Researchers have also found that although older adults experience difficulty with new technologies, they are eager to learn how to use them to enrich their lives and to be independent [53]. Designers therefore, should not be afraid to consider technologies that will help older adults retain mastery over their environments. More research, however, is needed to understand patterns that reveal elements of design that make a significant impact on well-being and longevity. This research data need to become an integral part of design education and practice [47].

Buildings affect us psychologically and physically. It is not by chance that they sometimes undermine the designer’s best intentions and are unsupportive of a person’s daily activities. Living with impairments can be even more psychologically debilitating when the environment hinders a person’s ability to function. Positive, psychologically healthy spaces are therefore, crucial to the well-being of the elderly, and have a number of features that distinguish them from others [10].

Interior design for older adults provides many opportunities for future research and is translating both existing and new evidence into design to create optimal healing and living environments. Designers’ understanding of space, and human perceptions and experiences of that space along with its characteristics make them uniquely qualified to understand and apply design strategies that address the needs of older adults and their specific conditions. New approaches in interior design not only enhance the life of seniors but also promote their well-being and longevity. To achieve these goals, design practitioners need to adopt an integrated approach to human physical, psychological, and social health with relation to built environments. They must work together with health professionals and aging adults. With this knowledge and skill set, design professionals can play a significant role in an older adult’s medical, social, and environmental team [25, 45].

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