EVERYDAY HABITS AND ROUTINES: DESIGN STRATEGIES TO

INDIVIDUALIZE HOME MODIFICATIONS

FOR OLDER PEOPLE

By

JANE ELLEN BARRY

A monograph submitted in partial fulfillment of the requirements for the degree of

Master of Arts in Interior Design

WASHINGTON STATE UNIVERSITY

Department of Interior Design

MAY 2008

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To the Faculty of Washington State University:

The members of the Committee appointed to examine the dissertation/thesis of JANE ELLEN BARRY find it satisfactory and recommend that it be accepted.

___________________________________ Chair ___________________________________ ___________________________________

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ACKNOWLEDGMENTS

I wish to thank the Interior Design, Architecture and Landscape Architecture

professors of the Interdisciplinary Design Institute of Washington State University for my

education in interior design. They have inspired and supported me. I thank my committee

members for their enthusiasm and encouragement and my chair, Dr. Janetta McCoy, in

particular, for her patience and continued support. I wish to thank the interviewees for

taking time to share a bit of their lives with me.

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DESIGN THAT RESPONDS TO EVERYDAY HABITS AND ROUTINES:

STRATEGIES TO INDIVIDUALIZE HOME MODIFICATIONS

FOR OLDER PEOPLE

Abstract

by Jane Ellen Barry

Washington State University May 2008

Chair: Janetta McCoy

Can older people’s habitual use of space inform design decisions about home

modifications? By incorporating qualities of continuity and the familiar into plans,

designers can be sensitive to elders’ habits and routines thus encouraging them to make

needed changes in their homes.

Most people want to grow old in their homes, but often they are reluctant to make

changes compensating for age-related functional losses. Reasons for not making changes

such as lack of knowledge, lack of money and distrust of contractors were reported,

according to an American Association for Retired Persons survey (AARP, 2000). Deeper

feelings may underlie these responses, having to do with identity and attachment to place

(Rubenstein, 1989; Rowles & Watkins, 2003).

Habits and routines may reflect an individual’s unique adaptation to a place and

represent a balance between the person’s competence and the demands of the

environment. Habits also include elements of time and meaning, both personal

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(autobiographical) and cultural, and may provide an enriched view of competence (Diehl,

1998; Golant, 2003; Rubenstein & Medeiros, 2004, Wahl & Weisman, 2003).

From gerontology, environmental psychology and occupational therapy literature,

an interview was developed for older homeowners about daily domestic routines and the

immediate home setting. In home visits, four older home-owners discussed their daily

routines and conducted a tour to further describe the interaction between their activities

and environments. Design guidelines were developed using current theory and analysis of

the interview data: 1. since habits preserve order and continuity, the designer should

maintain familiarity when making home modifications, and 2. be especially sensitive to

bodily experience, and focus on the senses to guide design.

Using my father’s home as a model, the outcome of this project is a home

modification plan guided by design strategies which respond to his habits and routines.

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TABLE OF CONTENTS

Page ACKNOWLEDGEMENTS………………………………………………………………iii ABSTRACT……………………………………………………………………………...iv LIST OF TABLES……………………………………………………………………...viii LISTOF FIGURES………………………………………………………………………ix CHAPTER 1. INTRODUCTION………………………………………………………………1 Justification: A Rationale for Using Habit and Routine to Guide Design…..4 Demographics and Statistics………………………………………………...8 The Aging Body……………………………………………………………15

The Role of Home Modifications in Preventing Falls……………………..16

2. MY DAD’S STORY…………………………………………………………...17 3. LITERATURE REVIEW……………………………………………………...31 Habit……………………………………………………………………….32 Routine…………………………………………………………………….35 Lawton’s Ecological Theory of Aging…………………………………….37 Current theory……………………………………………………………..45 4. RESEARCH DESIGN AND METHODOLOGY…………………………….49 Theoretical Analysis of Interviews………………………………………. 51 Discussion…………………………………………………………………53 Development of Design Guidelines……………………………………….59

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5. DESIGN PLAN FOR HOME MODIFICATIONS……………………………62 BIBLIOGRAPHY………………………………………………………………………..74 APPENDIX A. Person-Environment-Activity CHARTS……………………………………….79 B. C.A.S.P.A.R. Home Assessment Tool………………………………………. .82

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LIST OF TABLES

1. Homeownership rates by age of householder……………………………………….. 8

3. Ways in Which It Is Difficult to Get Around Their Home………………………….11

4. Single Modification to Make Home More Livable as Respondent Grows Older......12

5. Reasons for Making Home Modifications………………………………………… 13

6. Reasons for Not Making Home Modifications……………………………………. 14

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LIST OF FIGURES

1. “What I’d really like to do is stay in my current residence as long as possible”…….. 9

2. Preferences if Needed Help Caring for Themselves………………………………. 10

3. 516 G Street, Davis, California……………………………………………………..19

4. Plan and description of the house…………………………………………………..20

5. The Wedgewood Range…………………………………………………………… 22

6. Canadian Model of Occupational Performance…………………………………… 31

7. Habit: A Model of Human Occupation……………………………………………. 32

8. Lawton and Nahemow’s Competence/Press Model………………………………. 38

9. Articulating Environmental Press in Environments for People with Dementia……42

10. Hierarchy of Behavioral Competence……………………………………………...44

11. 516 G Street Plans, current & proposed……………………………………………63

12. Person Chart………………………………………………………………………..79

13. Environment Chart………………………………………………………………….80

14. Activity Chart……………………………………………………………………….81

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Dedication

This monograph is dedicated to my mother and father

who passed away during my years at school. This project is

inspired by my dad’s intense connection to his home.

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CHAPTER ONE

INTRODUCTION

This project is personal. My father’s intense connection to his home raised

questions for me and inspired this study. I saw that his familiarity with the house both

helped and hindered him. He knew just where everything was (by feel as much as

anything), which compensated for his poor vision and increasing weakness. But his usual

trips down the basement stairs to get the canned soup also threatened his safety.

My experience caring for him during his last year at home prompted me to

investigate the theoretical and practical power of habitual behavior; how it may relate to

change in general, and to the design of home modifications in particular. What might I

have done better to help him, had I known what I know now? His story serves as a

touchstone for theory presented here and I use his home as a model for my design

proposals.

First, I briefly discuss background and statistics about the elderly and home

modifications. Then I present a rationale for using the concept of habit and routine as a

framework through which to understand and develop design for the aging individual.

Following that, I tell the story of my father and his home, to exemplify these issues about

the elderly and housing.

Gathering from the fields of gerontology, environmental psychology, sociology,

nursing and occupational therapy, I discuss concepts of habit and routine in depth. I

explain how these concepts fit with M. Powell Lawton’s Ecological Theory of Aging

(Lawton, 1977) which has provided a foundation for gerontology over the past 30 years,

and how they encompass newer thinking in the field.

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Finally, I share my research design and methodology, comprising a home visit

and interviews with four older people, and the analysis of my data which resulted in

design guidelines. Design proposals for home modifications in my father’s home

conclude the project.

Concern for elderly parents is a common thread among baby boomers: sometimes

a situation arises in which a caring daughter or son feels there is no good answer. Worries

about parents’ safety and function at home conflict with fears about moving them to an

assisted living facility. For physical reasons it seems best to take them out of their home

but for emotional reasons, a move may be too a severe loss, robbing them of purpose and

identity. Staying in the home can be the best possible choice. Home modifications are

allowing more people to continue to lead independent lives as they age.

A home modification is an intervention that changes something in the physical

environment of the home for purposes of preventing accidents, promoting independence

and easing care-giving (Pynoos, Nishita & Perleman, 2003).

“Too often, older persons adapt their behaviors to their environments rather than

change their settings to meet their needs” according to Pynoos (2003, p.110). Most

people want to grow old in their homes, but often balk at making the needed changes

compensating for age-related functional losses. Even when elders need home

modifications in order to remain independent, often they do not make these changes due

to reported reasons such as lack of knowledge, lack of money, and distrust of contractors

(AARP, 2000). As I observed in my father, there are deeper-seated reasons as well,

involving personal habits and routines.

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Family members may be baffled by their elders’ resistance and seemingly self-

defeating behavior when it comes to anyone “meddling” in their homes. Over time,

people develop ways of doing and thinking that can be called habitual. Studying an

individual’s habits and routines may provide insight into resistance to change. These

habits and routines are commonly thought of as barriers to change and keepers of the

status quo. But could they offer clues and strategies for the designer of home

modifications that might facilitate change? Might habits and routines also represent an

individual’s on-going, uniquely successful adaptation reflecting personal experience and

meaning as well as physical and mental competence within his/her environment?

By studying the habits and routines of older people, can guidelines be developed

so designers can better respond to an individual in the design of home modifications? An

individual is more likely to react favorably to change when involved in that process from

the start (Steele, 1973). My goal is to develop design guidelines informed by habit and

routine and to model design decisions for my father’s home.

M. Powell Lawton’s argued that “design improvements could enhance…usability

by the competent and make the critical difference between independence and dependence

among the marginally competent” (1973, p.282). The role of the designer in facilitating

the process of change would impact the individual and the entire field of senior housing,

as society moves away from institutionalizing our elders and toward aging-in-place.

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Justification:

A Rationale for Using Habit and Routine to Guide Design

Habits and routines express a complex, holistic transaction with the environment,

blending person, place and performance. A “holistic perspective seeks themes and

taxonomies that envelop a richness of data relationships” (Weisman & Diaz-Moore,

2003, p.24). Might habit be such a theme?

Observable habit is a component of human behavior or performance (Keilhofner,

1995) and thus may be included in M. Powell Lawton’s concept of competence. His

Theory of Ecological Aging (ETA) or Competence/Press model (Lawton, 1977) refers to

the interactive relationship between a person’s abilities and the demands of the

environment (press). Habits and routines may reflect an adaptation level wherein

environmental demands and the individual’s competence are in balance, indicating well-

being.

Throughout the literature behavior is described but not labeled, as habit. Few

studies give a holistic perspective. Behavior setting theory does present a transactional

unit, examining interaction and environment together, but looks primarily at institutional

or community spaces (Norris-Baker, 1998). Other research lists daily activities (Baltes,

Wahl & Schmidt-Furstoss, 1990), tests skills of daily living (Diehl et al, 2005), measures

accessibility and usability of the home (Fange & Iwarsson, 2003) and identifies problems

in home environments (Gitlin et al, 2003). Some studies focus on psychological factors

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of the individual and place attachment (Rubenstein, 1998, 2004, Rowles & Watkins,

2003; Seamon, 2002). Fewer studies directly examine habit and/or routine (Ludwig,

1997; Zisberg, 2007). One study does specifically address the older individual’s routine

within the home (Percival, 2002).

Golant (2003) writes that the ability to explain and predict appropriateness and fit

of environments for the aging would improve by studying time (issues of past, present

and future, and/or changes in environment or person) and behavior (activities, use

patterns and their spatial components.) The holistic quality of habits and routines seem to

respond to Golant’s suggestion here.

Whatever categories are used to conceptualize an older person’s environmental behaviors or activities, the constructs will be most useful if they are further distinguished by both their spatial and temporal properties (2003, p.644). Personal behaviors which exhibit competence and adaptation may be better

understood when seen through that individual’s world of meaning. According to

Rubenstein (2004) Lawton’s concepts of competence and press are incomplete, leaving

out dimensions of personal meaning, embodiment and the aging self.

Works on the meaning of home…..have suggested an idea….that has been virtually unaddressed in the literature, and is certainly missed by competence and press models. That is, that every activity and object that involves a habitual, rather unconscious procedure can be considered part of the self (Bourdieu, in Rubenstein & Medeiros, 2003). Individual competence and perception of environmental demands involve not

only objective and measurable qualities, but cultural and personal standards and

meanings. One asks the questions, “what must I do to be a person in the eyes of society”

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and “what must I be able to do and how should I look, to be myself?” These concerns are

about self-hood as much as they are about environmental press and competence and

reflect the milieu within which an individual’s habits and routines arise.

Familiarity, resulting from the repetitive nature of habit and routine, can be

adaptive for the elder with declining competence, allowing independent living to continue

(Rowles & Ravdal, 2002). Knowing where things are is important, giving a sense of

continuity and bodily orientation. I saw this in my father, who, with his low eyesight,

couldn’t see well into the kitchen cupboards, but knew where everything was by feel.

To study the space and environment in which a person typically lives and dwells.....we must recognize that this space is grounded first of all in the body. Because of body-subject, I know at any moment of my normal experience where I am in relation to familiar objects, places and environments (Seamon, 1979). There is security in being able to perform a variety of household tasks competently with minimal expenditure of energy while reserving one’s attention and personal resources for more demanding aspects of everyday life (Lawton, 1990).

Design for elders: what is known?

Much research and application of theory has been carried out for elderly with

Alzheimer’s disease and other forms of dementia. These studies focus on public and

private care facilities and not domestic residences.

Studies have been done in Alzheimer’s units to test how interior, architectural and

landscape design affects behavior. Zeisel et al (2003) found significant connections

where environmental features impact problematic behavior such as aggression,

depression, social withdrawal and hallucinations. Private rooms reduce agitation and

improve sleep, and common spaces with a home-like character aid in social participation.

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Using Lawton’s competence/ press model, Calkins (2004) has applied theory to

practical purpose for people with dementia. Building on Lawton’s “docility hypothesis”--

the lower the competence, the greater the impact of the environment-- she relates memory

loss and other sensory and cognitive decline to environmental challenges, proposing

guidelines for therapeutic design. I elaborate on this in Chapter Four. As some short term

memory loss is a common age-related phenomenon, might design strategies for the less

competent be generalized to the elderly population?

What this paper adds

This paper adds an in-depth, multi-disciplinary examination of the concepts of

habit and routine. It responds to needs in the gerontological research for categories and

themes that enrich M. Powell Lawton’s Competence/Press Model. This paper suggests

that habit and routine represent a unique adaptation to one’s environment, expressing

competence in a holistic manner, including the elements of time, behavior, personal and

cultural meaning, embodiment and the aging self.

As design of the built environment is the ultimate focus here, this paper suggests

guidelines, informed by theory and research of habits and routines, for designers to use in

evaluating for home modifications, to facilitate an individual fit between the person and

his/her environment.

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Demographics and Statistics

The “elderly” is a demographic group 65 years of age and older; in 2000 there

were 35 million. According to the U.S. Census Bureau, by 2030, 1 in 5 will be elderly, a

total of 80 million comprising approximately one fifth of the total population. The oldest

old (85 and over) are the fastest growing group among the elderly. People today are

living longer and healthier lives. Most of these people would like to remain in their own

homes as they age (AARP, 2000).

Table 1 shows that over 80% of people 65 and older own their homes: in fact,

homeownership rates peak in that age group. With increasing age percentages of

householders decrease, but those 85 and older share a 66% rate with the 35-44 years old

group.

Table 1

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In May, 2000, the AARP released a survey entitled, Fixing to stay: A national

survey of housing and home modification issues. The following figures and tables

illustrate a desire to stay in the home, summarize difficulties in the home and reasons

why respondents did or did not make needed modifications.

The chart in Figure 1 illustrates that the majority of respondents wish to remain in

their home as long as possible.

Figure 1. Agreement with statement, “What I’d really like to do is stay in my current residence as long as possible.” This chart reflects a sample of people age 45 and over: with increasing age, the percentage of those agreeing with the statement increased to 92% in the 65-74 age group and nearly 100% of those over 75 years of age (AARP, 2000).

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Even if they need help caring for themselves, 82% of those would prefer to stay

put.

Figure 2. Preferences if Needed Help Caring for Themselves.

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Eight percent of respondents reported that, due to difficulty with stairs, general

lack of mobility and arthritis or other joint problems, they or other household members

have trouble navigating in their home.

Table 2. Ways in Which it is Difficult to Get Around Their Home

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Table 3 shows a variety of responses to a question about what single modification

respondents would implement. A large percentage of respondents didn’t know, indicating

a need for education.

Table 3. Single Modification to Make Home More Livable as Respondent Grows Older

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Most of those reporting difficulties (86%) have made at least one simple change

such as installing nightlights, non-skid strips in tub or shower, brighter lighting, lever

faucets and/or a large touch pad phone. Seventy percent have made a major change:

installed light switches at the top and bottom of stairwells, made changes allowing one-

level living, installed handrails on stairs and grab bars in bathroom.

Tables 4 and 5 summarize reasons for, and for not, making home modifications.

People reported reasons for implementing changes were to make their homes safer for

themselves and others, to increase independence, to adapt to changing needs and to

modernize. Reasons for not making changes included being unable to do it themselves,

unable to afford it, having a mistrust of contractors, not knowing how, not having anyone

to help, and not knowing how to find appropriate help.

Table 4. Reasons for Making Home Modifications

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Table 5. Reasons for Not Making Home Modifications

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The Aging Body

The population of people aged 75-95 is more greatly diversified in functional

health than any other age group, i.e. greater differences exist between individuals

(Koncelik, 2003). This makes sense when one reflects on how differently people age.

Some stay “young” up into their 80s while others look and feel old at 60. This wide range

of function makes individualizing homes for the older person especially important.

Koncelik, a human factors expert, refers to the Age/Loss Continuum, in which the

normal aging process involves sensory-motor changes that affect performance and have

an impact on how the person functions in his/her environment.

Eyesight and hearing are affected with age. Typical changes in the eye relate to

hardening of the lens which causes decreased color sensitivity, difficulty seeing edges

and heightened sensitivity to glare. Adjusting to light level changes takes longer. In

general, elders need higher levels of lighting. A common hearing change is selective

frequency hearing loss, making it hard to distinguish between conversation and

background noise.

Normal changes in nervous, cardio-pulmonary and musculo-skeletal systems

occur: muscle mass decreases 40% by age 70, especially in arms and legs, contributing to

weakness and fatigue (Koncelik, 2003). Poorer senses of balance and kinesthesia affect

spatial awareness. Gait changes with older age. Walking speed, stride length, upper-lower

extremity synchrony and arm swing amplitude may contribute to a loss of sure-

footedness and an increased risk of falling (Crews, 2005).

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The Role of Home Modifications in Preventing Falls

Prevention of falls is one of three targeted areas for improving older Americans’

health and quality of life. According to the Center for Disease Control’s report entitled

Aging and Health in America (2007), falls are the leading cause of injury deaths and the

most common cause of hospital admissions for trauma in the 65 and older age group.

Fall-related injuries, especially fractures, cause significant mortality, disability and loss

of independence. The home environment is implicated in one third of these falls resulting

in injury: loose throw rugs and general clutter are commonly noted hazards.

Falls can be best prevented by addressing both personal and environmental risk

factors. In a study including assessment, training and home modifications, interventions

reduced reported falls by 31 % in a group of community dwelling frail elders (Nikolaus

& Bach, 2003).

However, it is important to evaluate the strategies of the individual. “Older

persons may adapt to the environmental hazards and indeed may use these purported

hazards to enhance their indoor mobility” (Nikolaus & Bach, 2003, p.304). Maneuvering

by the use of a space “obstructed” with a line of furniture is an example of an individual’s

adaptation.

According to McCullagh (2006) a review of the research has not revealed direct

cost benefits for home modifications alone in preventing falls; however, with an average

individual expenditure of $27,000 per hip fracture1, all prevention strategies should be

encouraged.

1 American Academy of Orthopedic Surgeons, http://orthoinfo.aaos.org/topic.cfm?topic=A00121

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CHAPTER TWO

MY DAD’S STORY

My dad’s life was deeply rooted in his home. For that reason I want to honor him

and focus on that attachment. The meaning of place had a strong influence on his

behavior and the choices he made, and on his resistance to making changes in his

environment. These thoughts resonate with me as I reflect on my dad’s situation:

It is likely that this personal sense of, and attachment to, place extends or shapes personal competence and the perception of press through a variety of techniques including the pure disregard of stressors due to a greater personal sense of attachment to place…(Rubenstein & DeMedeiros, 2004, p.67). In spite of declining strength and balance, and the energy required, he persistently

made trips down into the basement, holding the handrail tightly, to fetch canned goods

even after I had placed them upstairs in a kitchen cupboard where I thought they would

be more convenient for him. His behavior baffled me.

For much of a year I lived with my father and helped him as his health failed. He

lived in his home for over 60 years. Understandably, one of his wishes was to die at

home. Over time, I observed his desire to stay there and his difficulty in almost every

task, and yet he was reluctant to make any changes to the house. It seemed he couldn’t

(or wouldn’t) even imagine what helpful changes might be possible. I labeled my father’s

behavior “stubborn.” But let me set the stage and tell the history that shaped his house at

516 G Street, Davis, California.

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History

My dad was a California boy: third generation. His grandparents came to the

Golden West around the mid 19th century. They settled in the Napa Valley. My father

grew up in and around St. Helena, California, where his father was a ranch hand but

apparently not very good at keeping a job. My dad didn’t talk about his dad very much. I

suspect his dad was a rowdy Irishman, with all its connotations. My father loved his

mother, though, and felt protective of her.

The family moved four times during his youth; they lived on 2 different ranches

in the surrounding lands, the Cole Ranch and the Bourne Ranch, and in one home in

town, his maternal grandfather’s place, at two different times. He left St. Helena after

graduating from high school in 1936, in the middle of the Depression years.

As a young man he moved to Davis, 75 miles to the east, and found work in a

Purity grocery store. He also worked for the Southern Pacific Railroad as a crossing

guard. In the tower at night, he studied for the civil service exam and soon secured a job

at the post office in Davis. He started as a mail carrier, spent time as a clerk and

eventually became Davis’ postmaster. He retired in 1975, at age 59.

When he first moved to Davis in 1937, he lived in a boarding house on the corner

of 4th and F Streets. Two blocks away, two years later at age 22, he contracted to have a

house built for himself and his mother, who was still in St. Helena, now divorced.

I believe that his newly built house embodied all the hopes and dreams of his life

up to that point. It was security in the face of uncertain economic conditions, stability in

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its solidity and permanence, and a safe haven for him and his mother. It also meant that

he was now the head of the family.

The house was a two bedroom “cottage.” The plans came from a pamphlet titled

New Small Homes, (1938) published by L.F. Garlinghouse Company of Topeka, KS. It is

described in the rather flowery language of the time. See Figure 3.

Figure 3. 516 G Street, Davis, California. Photograph in New Small Homes

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Figure 4. Description and Plan of the house

It was a “fine” and “excellent” house and it was all his. He was no longer

dependent on wealthy ranch owners or a family member for shelter, as in St. Helena. It

was complete. There was a basement as well as an attic which was unusual for Davis,

even in 1939. The cost of the 1000 sq. ft. house was $3732.00; (all the original paperwork

is saved in the file.) My dad borrowed the money from his mother’s brother, Uncle

Neely. He made the final payment in 1958 (cancelled check saved in the file!)

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In 1941 my father went into the army. During the World War II years, both of his

parents lived in the home. I believe his father stayed in the attic; perhaps my grandmother

allowed it because he had nowhere else to go. He died in the home in 1950. My father

recalls hearing him upstairs coughing.

When my mother and dad got married in 1951 they moved 10 miles east to

Sacramento while my grandmother stayed in the house alone. She became ill in 1958, so

my dad had another bedroom, bath and laundry area added on and we moved back to

Davis in order to be with her. I spent my school years from first grade through high

school at 516 G Street.

With the back addition, the house was about 1850 sq. ft. My parents and I had the

two front bedrooms and my grandmother had the new space in the back. She passed on in

1960, when I was 8, so we didn’t live together for very long. I moved into her bedroom,

and the front bedroom became an office.

Description of the house: Significant elements of structure and function.

The house at 516 G Street was essentially a backwards “L” shape, with

sleeping/bathroom areas at each end of the structure, living and eating areas at the center.

The kitchen was galley style, long and thin, widening into a dining area at the north end.

It functioned as a food prep/eating area and a passageway, part of a thoroughfare from the

front of the house to the back. In the winter my parents closed doors to the front and back

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and heated the kitchen with the stove. It was a Wedgewood range, installed when the

house was built, with 4 gas burners and a wood burning compartment.

.

Figure 5. The Wedgewood range installed when the house was built in 1939.

There was no central heat: a gas floor heater between the living room and front

hall served the original parts of the house, and in the back, a wall heater between the

laundry room and the bedroom sufficed. My dad never had the heating system upgraded;

turning pilot lights on and off was a complicated affair and one of his seasonal routines.

He kept a record of the dates when he turned on and off the pilot lights.

There were three entries to the house: a front door (west) into the living room, a

side door (north) into the kitchen, and a back door (east) from the backyard into the

laundry/multi-purpose room, each with two steps up, and each had a screen door. In the

back yard, my dad built a concrete paver patio; over the years it settled into a lumpy,

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uneven surface. About five years before he died, my dad put grab handles on the outside

frames of the side and back doors to help my mother get up the steps, but he didn’t place

railings at any of the entries. The screen doors made getting inside somewhat complicated

as my parents aged, because they had to hold them open while unlocking the door.

There were hardwood floors in the living room, bedrooms and hallway, and in the

kitchen, linoleum. A stairway off the kitchen led down into the basement, where along

the top of the basement wall canned goods, potatoes and onions were stored. There was

an open crawl space between the ground and the sub-flooring where you could see soft,

powdery dirt in all directions as you descended the stairs. Originally there was no railing,

but after my dad had a stroke in 1999, he had handrails installed. He had a workshop

down below and underneath the stairs. He kept tools, hardware, old paint and household

cleaners, fishing and camping equipment, and things he might need, like jars. He used

those as containers for nuts and bolts, which he neatly sorted according to size and

purpose. He never disposed of a jar, bottle, can, bag or box. (Infuriating!)

The stairs to the attic were in the front hall off the living room, between the two

bedrooms. There was a single railing. Upstairs were trunks of old clothes, boxes of old

papers, a few pieces of old furniture and lots of dust! Neither the basement nor the attic

were finished; the basement walls were plain concrete, and the attic had no insulation,

just bare studs and rafters…a thin skin.

The front bedrooms had two sets of double hung windows and were filled with

light and fresh air. Opening the windows at night let in the cooling “delta breeze” during

the summer. We shut them early in the day, pulled the shades, and awnings outside

protected against the hot summer sun. The house stayed remarkably cool, unless there

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was a run of 100 degree days and no breeze. There was no insulation whatever in the attic

or in the walls of the house.

A short hall led from the kitchen into the back addition, past a storage closet and

bedroom to the left, bathroom to the right and into the laundry/multipurpose room. Here

was the washer/dryer and washtub. The washer’s rinse cycle emptied into the tub: a hose

was hooked over the side. More than once, my mother left a sock or something in the tub

which clogged the drain, and water overflowed into the room.

Light filled this room also, with north and west windows. We blocked the summer

heat with an outside bamboo shade. It was a large room, containing a conglomeration of

things along with the washer and dryer: a second refrigerator, a bookcase, a big built-in

linen closet and a dining room table where my mother folded clothes and would set up

her sewing machine for mending. When we had guests over, we could put leaves in the

table and extend it to seat 8 or 10. The laundry room transformed into a dining room for

holidays; my dad installed a beam which supported curtains that when pulled, hid the

washer/dryer and refrigerator.

My dad’s routine

A typical day when he was in his prime, during my high school years, went like

this. We would all get up around 6:45 a.m. and my parents would go into the kitchen. My

mother would light the oven and open the oven door to heat the room. My dad started a

fire in the firebox of the stove to burn junk mail, milk cartons, etc. He would be in the

front bathroom getting ready for work while my mother made breakfast. We all sat down

25

at the dinette table for breakfast and then went on our ways to work and school. My dad

walked to work, only about 3 blocks away. My mother and I rode our bikes; she to her

job at the University library and I to the high school.

Daddy came home for lunch, which I fixed for him when I was home during the

summers. After work my mother fed the five cats, balancing 5 plates in her arms from the

kitchen out to the back door, sometimes with cats underfoot. My parents would have their

5 o’clock cocktail hour and if the weather was nice, sit outside in the back yard. Then

they watched the news in the living room, my mother fixed dinner, we ate in the dinette.

My dad often went into the office after dinner to take care of bills and other business. My

mom read on the couch in the living room, and I did homework in my room or at the

dinette table.

His spaces (where my mother never ventured) were the office, the basement and

the detached garage, on the north side of the house. There was frequently something that

needed fixing: window screens replaced, awnings put up or taken down, pilot lights

turned off or on, etc. He did these things himself, using tools and supplies he kept in the

basement or garage.

He also made sure cupboards and drawers were stocked. He kept the kitchen

supplied with staples; he stored sugar, flour, rice, etc. in the basement in large jars and

routinely filled smaller jars with those things for the kitchen cupboards. (This was not my

mother’s job because she avoided the basement. She got rid of things….he kept them.)

This style of separating bulk storage and the daily supplies necessitated my father’s

making numerous trips up and down stairs or from the front of the house to the back. He

also made piles of things to save, like newspapers and magazines, and kept them in the

26

back laundry/multi-purpose room. There wasn’t a direct route from package to use to

storage or wastebasket; there was always an in-between stage, which used multiple

spaces and made for a certain amount of clutter. This was not a difficulty for him when

he was younger, but when he got older and had to struggle just to get up from a chair, it

was exhausting.

Physical and functional changes as he aged

When I left for college in 1970, my parents had retired and were active and

involved people. They spent 30+ years of their lives in retirement. Travel was their

passion, but when at home in Davis, they joined in meals, classes and social gatherings at

the Senior Center and did some other volunteer work in the community and the church.

My mother swam several times a week throughout her life, and they both walked with

friends regularly.

Gradually my bedroom got absorbed into my dad’s territory as he stashed clothes

and various piles throughout the house. The house seemed to become more and more his

and less my mother’s, although I believe she never felt like the place was hers. She

always wanted a dishwasher and an air conditioner, which my dad would never consent

to. She was fed up with all the old-fashioned amenities and she was ready to move to a

retirement village around age 85; they looked, but my dad wouldn’t budge from his

home. My mother died two and a half years before he did. She was 95, eight years his

senior.

27

Not too much changed about the way Daddy used the house after her death. He

left her clothes in her dresser and in the closet and her many family pictures and

swimming ribbons on the walls. He began to use her bed, which was next to his in their

bedroom, to pile clothes and sit while dressing.

He had several chronic health conditions. His vision was always poor, and he

could barely see out of his left eye due to a long-standing optic nerve anomaly. He’d had

a stroke in 1999 when he was 82; he recovered most of his function, but was left with a

shuffling gait, and some weakness and numbness in his left arm and hand. These

worsened over his last 7 years of life. He took medications for high blood pressure and a

heart arrhythmia and was diagnosed finally with Parkinson’s disease, all contributing to

his fatigue, stiffness and slowness of movement.

The ability to grasp is critical. I believe this disability caused him more grief than

his loss of balance, increasing stiffness and declining strength. He had trouble holding

objects with his left hand, so he dropped things constantly. He had trouble opening

containers, using kitchen utensils and tools and manipulating buttons and zippers.

Difficulties in the home: bathroom and kitchen

In the front bathroom, the sink faucets were knobs, operated by twisting which

required a grasp. There was very little space around the sink to set things down. The light

over the mirror/medicine cabinet had an on/off pull chain requiring a reach above

shoulder level. He took a sponge bath rather than a shower. The shower valve in the tub

was broken (for years) so he didn’t use that shower at all. He’d tried to fix it but couldn’t

28

grasp the pliers tightly enough to turn the stem. The toilet paper dispenser was on the left,

(his weaker side) of the toilet, so he kept the roll on the sink which was in front of him in

easy reach for his right hand, but it took up space on the small vanity. Shaving became

hard, so he’d only do it every few days. Getting dressed in jeans and a shirt took him a

couple of hours; physically it was difficult to do things such as pull a t-shirt over his head

and pull up pants with one hand. Mentally, these changes in his physical capabilities

confused and depressed him. He didn’t strategize; he blamed the object or the situation,

“These damn buttons….why are they so small!” “These damn jars….why do they put the

lids on so tight!”

Breakfast

In the kitchen, his habits (and the configuration of the room) required that he

make multiple trips along, between refrigerator and table, and back and forth across the

room between the sink and the stove. Multi-tasking and/or being efficient was never his

style; he did one thing at a time.

My dad always had tea and usually, hot cereal, for breakfast. He kept several

varieties of loose tea in the cupboard to the right of the sink. He had put the teas into

small, labeled, easy-to-handle tins, and kept the original packages in the basement.

He used a Revere Ware tea kettle to boil water, which was lightweight and could

be filled through the spout, eliminating the need to deal with a lid. The teapot was kept in

the cupboard to the left of the sink; it needed to be “scalded,” or heated, before the tea

went in.

Moving between the sink and the stove involved turning around and crossing a 4

ft. space. In addition to the counter top (sink board, he called it), the stove surface was a

29

smooth workspace since iron lids covered the wood burner and the gas burners not in use.

The top of the oven served as a holding/storage area for salt and pepper, honey and

utensils.

So he placed the teapot near the sink, walked across and took the kettle off the

stove, then back to pour in boiling water. Then he poured that pot of water out in the sink,

measured tea into the pot, poured in more boiling water and set the teapot in the open

oven (across from him, at waist level) to steep and to keep warm. He did all these things

essentially one-handed.

Then he started on the oatmeal, grits or cream of wheat which involved more

transferring of water from the sink to the stove, taking containers from the cupboard,

utensils from the drawer and moving back and forth across the room.

Once the cereal was ready, he put it in a bowl and took it to the table. He placed

the teapot and two cups on the table for the tea and the strainer, and went to the

refrigerator to get orange juice, which he poured into a glass to take back to the table. It

was a long walk from the refrigerator to the table, about 12 ft. The refrigerator door

swung right and the work area was across the room, to the right also. And to open the

door with his right hand meant taking items out with his unreliable left hand. He would

then have to pivot left to place the item on the counter about 4 ft. behind him. After

carrying the orange juice to the table, he would make another trip to the refrigerator to get

the milk, and carry the quart carton back.

He chose to sit facing west, a vantage point to the street, which necessitated going

around to the far side of the table. If he forgot something, he got up again to get it. After

30

he ate, he left the dishes and milk out and went to sit in the living room in his chair, with

the heating pad on his shoulders.

It sounds complicated and exhausting. Being a younger, healthy person, it is hard

to relate to the weakness that older people can experience in their limbs. The simplest

activities become difficult, tiring, and overwhelming. My dad would hold onto the chair

as he went around the end of the table, and keep a hand on the counter for support as he

traveled along the length of the kitchen. Suffering numbness along with weakness, he lost

his grip and dropped utensils, pots and pans frequently during his last months. He

knocked things over. He cleaned up after himself less and less because it was just too

tiring.

Mental inflexibility added to the physical problems. I observed an inability to

change his habits, to adapt his usual way of behaving in order to take his disabilities into

account. He wanted the house to stay as it always was, even when that made it hard for

him. He was angry when I moved the canned goods from the basement to a lazy susan in

a kitchen cupboard. He would hang onto the basement stair railing for dear life rather

than look in the cupboard.

There were a few ways he made things easier for himself: he kept pliers,

magnifying glasses and flashlights strategically placed throughout the house, front,

middle and back. I bought a large button phone for him. He kept a portable phone by his

bed at night, although the cradle remained in the office because there wasn’t a phone jack

in the bedroom. He called a handyman from the senior center to change light bulbs for

him. As time went on, he asked a family friend, Nyla, to go grocery shopping for him and

to the bank. (Nyla finally arranged for Meals on Wheels when she discovered things he’d

asked her to buy at the market spoiling in the refrigerator.)

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CHAPTER THREE

LITERATURE REVIEW

In this chapter I discuss the concepts of habit and routine, Lawton’s Ecological

Theory of Aging and current issues in gerontology that respond to his model. Throughout

this section I intersperse stories about my father, where his experience is an example of a

particular idea.

A basic assumption here is that habit is an aspect of human performance. From an

occupational therapy perspective, performance is a holistic concept arising from an

individual’s interaction with the environment (Iwarsson, 2003). See Figure 6.

Figure 6. Canadian Model of Occupational Performance. (Law et. al., 1996)

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Habit

Figure 7. from Kielhofner, (1995) A Model of Human Occupation. Habits sustain themselves in repeated actions through time.

What can we find out about how people use their homes by studying habit? What

do habits and routines tell us about person-environment-activity (P-E-A) fit? Can we use

habit/routine as a means to describe and diagnose P-E-A fit? These questions drove this

study.

But first, what are habits? Who studies them? Biologists, neurobiologists,

psychologists, sociologists, occupational therapists and even marketers investigate habits.

Neurologically, habits are a form of learning that develops slowly and not

necessarily consciously. The brain bundles together information bits connecting a

sequence of actions and a contextual trigger, thus creating units, or “chunks of behavior”

(Graybiel, 1998).

Psychology says that though habits are cued by contexts, they are more than mere

stimulus-response reactions, and ultimately serve goal-directed behavior (Wood & Neal,

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2007). Repeated behaviors that become habitual are often aimed at a specific outcome;

for example, putting down one’s fork after each bite, when trying to lose weight.

Contexts refer to place, time and culture, i.e., the physical setting where the habit is

performed, completing an action that typically precedes it, or encountering a person who

is typically present. These environmental cues play an important role in setting the habit

in motion.

Swartz (2002), reviewing the French philosopher Bourdieu, offers a sociological

viewpoint. Considering habit too limiting a word, Bourdieu prefers habitus, a broader

idea that encompasses the individual’s set of circumstances and influences growing up

with a set of particular family tastes, values and rules. By acquiring a tacit awareness of

familiar opportunities and constraints, one identifies a sense of place in the greater social

order. One internalizes the possibilities and impossibilities within a given situation.

(Environmental affordances and press?) The most defining and powerful feature of habit

is not that it provides regularity or predictability, but reliability. It can be counted on to

work. Thus, habitus sustains and reproduces the social order and the individual’s place in

that order.

Swartz gives the following recommendations, based on Bourdieu’s principles, to

occupational therapists working with clients: search out cultural patterns and consistent

style in behavior, emphasize habit rather than rational choice in therapeutic interventions

(focus on action and experience rather than talk), and change environment and behavior

for the best chance of solving a problem. The suggestions are useful for designers as well.

The field of occupational therapy provides an appropriate and complete definition

of habit, considering the focus here on fit between the older person, environment and

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activity. Occupational therapy studies human activity: human occupation is defined as

“doing culturally meaningful work, play or daily living tasks in the stream of time and in

the contexts of one’s social and physical world” (Kielhofner, 1995, p.3). Kielhofner’s

definition of habit follows, with a look at each italicized component:

“Habits are latent tendencies acquired from previous repetitions mainly operating at a preconscious level and influencing a wide range of behavioral patterns that correspond to familiar habitats” (p.65).

• Latent tendencies: Habits reflect an individual style; they are highly personal or

idiosyncratic. They have to do with one’s character, disposition and temperament,

or the consistent manner in which one behaves across a range of activities (i.e. are

you big picture or detail-oriented)?

• Previous repetitions: Habits can only be generated by doing, and are acquired

through repeated actions within a stable environment, over time. See figure 7.

• Preconscious level: Habitual behavior is rooted in the body and its repeated

movements. Merleau-Ponty (in Seamon, 2002, p.43s) describes the person as

“body-subject,” 2 who intelligently and efficiently transforms needs into activities,

with an innate understanding of what to do and how to do it. This automatic

nature is characteristic of habit; accordingly, one’s mind is free for other thoughts

and concerns.

• Behavioral patterns: Habits are a set of integrated behaviors which sustain a

particular task or aim (Seamon, 2002). They are made up of smaller actions,

organized into a larger unit and operating as a whole. Habits are conservative,

(Seamon, 2002) as they help connect past with present (“I’ve always done it this 2 We experience the world through a body. As we move through our daily lives we are the subject, not the object; we do not see ourselves, we see and feel where we are and what we are doing. “The body is not perceived visually, but experienced in contact” (Ziada, 2007, p. 12).

35

way!”): by definition their “basic function is to preserve patterns of behavior”

(Kielhofner, 1995, p. 263).

• Correspond to familiar habitats: Habitual actions result in a mental map

constructed by repeated, selected mental images related to experience in a

particular setting.

Experience in the environment generates a set of rules for how we can effectively traverse a period of time, a particular occupation (activity) or a physical environment. What is internalized is a set of rules that serve as a map giving us a way to appreciate the topography of the external world (Kielhofner, 1995, p. 66).

That my dad had mental pictures of where things were was obvious to me. His intimacy

with the geography of his home--where things were--was tremendously important. He had a

mental picture of where everything was, down to the minutiae in drawers, in the basement and the

attic. He could tell me where every rubber band was, which pile Tuesday’s newspaper was in or

where the chili powder was in the spice cabinet (which was NOT alphabetically arranged!).

Knowing exactly where things were compensated for his poor vision and physical fatigue: if he

only had to get up from his chair once and go directly to what he wanted, that was a good thing.

But he would endanger himself in going to those familiar places, like down the basement steps to

get the canned soup.

“The habitual force (italics added) of body-subject…supports a time-space

continuity grounded on bodily patterns of the past” (Seamon, 2002, p. 44S).

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Routine

Routines organize our behavior, and can be understood as a habitual use of time.

An important function of routine is to create and maintain personal identity through

everyday choices and activities (Ludwig, 1997). Foundations for routines are laid in

childhood as parents pass on values and particular ways of doing things (Swartz, 2002).

We are what we do (or what we can’t do). In Ludwig’s study, the purposes of routine for

her subjects were to:

• meet obligations

• maintain activity levels

• maintain health

• anticipate or look forward to things

• maintain control

• balance work, rest and play

• accomplish and achieve

• feel good about self

• provide continuity

In a concept analysis of routine, Zisberg et al (2007) distilled several common

elements from a literature survey. Routine is contextual, repetitive, patterned behavior

that organizes our activities. It is more automatic than deliberate, therefore conserving

mental and physical energy. Although it is linked to inflexibility, boredom and burnout,

it also serves to provide self-esteem, meaning and well-being. Zisberg summarizes

routine as

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an adaptation mechanism serving individuals by allowing a more efficient allocation of resources, automation of activities and organization of the environment into units that can be handled efficiently (2007, p.448). This description seems nearly identical to that of habit and suggests that the

difference between habit and routine lies in scale only.

The role of the immediate environment--the products we use, the “stuff” in

people’s everyday lives—is important in consumer research. Tapping into the centrality

and power of people’s everyday habits and routines, marketers have studied daily rituals

worldwide (Brady, 2007). Five common daily rituals were identified: “preparing for

battle” (the morning routine), “feasting” (connecting with others over a meal), “sexing

up” (primping), “returning to camp” (returning home after work) and “protecting yourself

for the future” (closing down the home before bed). While the purpose here was to

pinpoint opportunities for embedding products in people’s lives, it illustrates the

timeliness and importance of focusing on daily activity patterns and their environmental

components.

One important daily routine my father had was checking the outside temperature. The

thermometer was by the back door, so he walked all the way through the house to see it. Then,

going back through the house, he recorded the temperature on a calendar hanging in the kitchen,

by the phone. This is one of the things he gave up as he became weaker.

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Lawton’s Ecological Theory of Aging

M. Powell Lawton’s Ecological Theory of Aging (ETA) has provided a

theoretical and practical foundation for the field of gerontology since the 1970s. I discuss

Lawton’s docility hypothesis, proactivity hypothesis, and the concepts of environmental

press, competence and adaptation level. This paper suggests that people’s habits and

routines describe their adaptation level in a holistic way and can be useful in studying this

component of Lawton’s model.

The ETA presents a transactional perspective, meaning that person and

environment comprise an inseparable unit, with all the parts participating and affecting

the other’s identity (Schwarz, 2003). Adaptive behavior comes from the balance between

one’s abilities (competence) and forces in the environment that make demands (press)

upon the person.

The adaptation level is a point at which an individual’s competence and

environmental press have neither a positive or negative effect on behavior and emotion.

At this “indifference point” there is an effortless relationship between the person and

his/her environment (Rubenstein & De Medeiros, 2004). Surroundings are taken for

granted and the body performs without thinking. In Lawton’s words,

the adaptation level represents a normal balance that most people attain in terms of being able to engage in everyday activities without a great deal of environmental awareness (1977, p.8).

On either side of the adaptation level there is a range of successful behavior. However,

with either a too highly demanding environment or an environment with too few

38

demands, behavior disintegrates. This balance varies according to the individual’s level

of competence. See Figure 8.

Figure 8. Lawton and Nahemow’s Competence-Press Model (1973)

39

Lawton states in his Environmental Docility Hypothesis that as a person’s ability

declines, environmental support becomes increasingly important. This is where home

modifications enter the picture, as they reduce the demands of the environment. The need

for home modifications is triggered by an imbalance, or mismatch, between competence

and press. To address the mismatch one must improve the person’s ability to function

and/or reduce the demand of the environment.

“Too often, older persons adapt their behaviors to their environments rather than

change their settings to meet their needs” (Pynoos, Nishita & Perleman, 2003, p.110).

According to the docility hypothesis, a person of low competence is “docile,” or passive,

in terms of acting upon the environment. As a person’s competence declines,

environment takes on heavier weight, that is, plays a growing role in shaping successful

behavior. Small changes can make big differences. Lawton states, “design improvements

could enhance…usability by the competent and make the critical difference between

independence and dependence among the marginally competent” (1973, p.282).

In the Environmental Proactivity Hypothesis, the individual is an active problem

solver who seeks, chooses or creates an environment that meets needs and preferences.

“As personal competence increases, the variety of environmental resources that can be

used in satisfaction of the person’s needs increases” (Lawton, 1990, p.639). For example,

the expansive strategy of a new retiree or other “young-old” person who is in good

health, financially secure, well-educated and open to new experiences may be seen in

energetic endeavors such as travel, political activity or new hobbies.

Environmental proactivity requires mental competence: Lawton suggests that

even in the instance of an elder’s world contracting due to physical decline, such

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strategies as the “control center” can be seen as a proactive response to constricted social

space. When a person is no longer able to shop, run errands or drive, a chair centrally

located in the home, typically in the living room, with a view to the front porch can

provide stimulation, interaction and a sense of control (Lawton, 1990).

My father had his control center in the living room. He could see the busy sidewalk and

the mailman approaching the front door. My parents spent a lot of time noticing who went by (it

was a busy street, a transition between the downtown and residential areas) and they named some

of the more colorful characters; (my aunt) “Phyllis’ Boyfriend” was one of them.

The TV was directly across the room, the phone was nearby on the kitchen wall (a rotary

dial until I bought him a large touchpad phone) but the bathroom was not too convenient,

requiring a trip into the front hallway and around the corner. He had a floor lamp with adjustable

height light and a small coffee table beside his chair, which was cluttered with pens, a pocket

knife for opening mail, papers and magazines, a magnifying glass, a flashlight and the TV remote

control. There was another, identical chair in the living room from which I took the back pillow

and added it to his chair to help him sit more forward and get up a little easier. He expressed

surprise and gratitude for that…..I got the feeling he would have never thought of it himself,

being so accustomed to things as they were (exhibiting environmental docility rather than

proactivity.)

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Environmental Press is defined as aspects/qualities of the environment that

demand or activate behavior (Lawton, 1977): proximity, noise, stairs are examples of

press in the physical environment. Lawton also identifies press in the socio-cultural

environment, such as the presence of family members, friends and larger social groups or

institutions. Calkins (2004) has categorized press into more specific dimensions in order

to develop environmental strategies that help people with dementia to cope. See Figure 9.

These categories are:

• quantity: There can be more or less press in an environment.

• quality: Press has different qualities that affect the person in positive or negative

ways, for example, a setting can be “nourishing, coercive, amusing, belittling,

chilling, befriending or restraining” (Calkins, p.166).

• structure: Size, configuration, adjacencies, circulation, complexity, legibility etc.,

suggesting action suited to a particular space, i.e. church, kitchen, etc.

• mobility: Mobility refers to whether one can escape the particular demand, or is

captive to it, for example, noise, (mobile press). An individual acts upon

immobile press by looking at it, touching or moving it.

• predictability: The stimulus may be predictable, such as a regular or scheduled

activity. Unpredictability creates an adverse effect, while a person’s sense of

• having control in the setting increases chances of positive behavior or affect.

• salience: Salience is the importance or meaningfulness of a particular

environment; personal interpretation and cultural symbolism are powerful forces.

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Dimensions of Press by Strategy of Interventions Dimensions of stimulation that can be expressed in the organizational, social and physical environments

Quantity

Quality

Structure

Predictability

Control

Salience

Mobility

Reduce size Simplify Provide options

Increase familiarity

Redundant cueing

Enhance salient press

Provide options

Figure 9. from Calkins, M. P. (2004). Articulating Environmental Press in Environments for People with Dementia. Alzheimer’s Care Quarterly. 5 (2) p. 171.

Calkins describes two current theories about mental functioning of the elderly:

information processing theory and neural network theory, and she then links these mental

processes to corresponding environmental aids.

It is harder for the elderly to use memory and problem solving skills

simultaneously, according to information processing theory. Too much environmental

stimulation with competing demands is difficult to cope with. Reducing conflicting

patterns, clarifying ambiguous spaces, reducing noise and glare are examples of design

strategies that decrease stimuli and simplify the surroundings.

Neural network theory argues that as information travels along certain nerve

pathways, these routes grow and diversify with repeated activity, generating many

different connections to the same information in the brain. The more times one does

something the more pathways are created. This means that the familiar is more readily

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recalled and understood than the unfamiliar. Adhering to routine and familiar

topography, or structure, is an appropriate strategy here. People’s past experiences inform

their perception of the present setting.

Another strategy focuses on the quantity of environmental press. Redundant

cueing presents the same information in several different modes and to multiple senses,

thus addressing multiple nerve pathways. Simultaneous visual and olfactory signals, such

as looking at the clock and smelling the morning coffee send a stronger message than

either alone.

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To see the equation (P-E fit) from the angle of competence: “Competent behaviors

occur when capabilities of the individual match environmental demands and resources”

(Golant, 2003, p. 643).

Lawton’s definition of competence is “the theoretical upper limit of capacity of

the individual to function in the areas of biological health, sensation-perception, motor

skills and cognition” (1977, p.8). A person is defined as a measureable set of

competencies, a behavioral organism. See Figure 10.

Figure 10. (Lawton, 1970). These are categories that Lawton felt could be measured.

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CURRENT THEORY

What is missing from Lawton’s model is the dimension of meaning in daily

experience. Theories of P-E fit have mostly to do with measurable function (competence)

and measurable environmental forces (press).

“Competence” needs redefining as actual everyday behavior rather than as a

potential or capability to perform certain tasks, according to Diehl (1998). Its dynamic

and adaptive qualities have not been explored. Everyday competence involves physical,

psychological (cognitive and emotional) and social functioning. Diehl states that the

antecedents and consequences (physical and mental health) of everyday competence are

well understood, but that its components and mechanisms are not. He notes that too few

studies observe actual everyday activities, while less reliable self-report studies abound.

He suggests dimensions of competence that need further research: 1) deficit awareness

and compensatory efforts, i.e. what makes people become aware of their changing

capabilities and how do they compensate? and 2) motivation as a moderating influence. It

is important to know more about how goals and values drive elders’ daily behavior.

Can habits/routines be the focus of a study to identify such adaptive and compensatory

behaviors as well as to reflect an individual’s goals?

Speaking about the individual’s competence and referencing the French

sociologist and philosopher Bourdieu, Rubenstein (2004) writes

An ability to do certain tasks in the morning, or at a certain time of the year, that is, to micromanage competence or press on the basis of personal identity and personal meaning, has not been accounted for in environmental theory, even though it is a primary means through which elders adapt, especially those with diminishing functional abilities. Moreover, these activities and routines are at the core of the self and are symbolically significant to the person; they are what the

46

person does and who she is. Routines and activities are embodied within the person through their unconscious nature and the habitus (p. 72). One of my father’s seasonal routines was turning on and off the pilot lights on the two

gas heaters in the house. This, along with putting up and taking down the awnings over the south

and west windows, was important enough to him that he recorded the dates on a single piece of

paper he kept in the dresser in the back bedroom. The heater in the newer part of the house was

simple enough. But, the 1939 living room furnace was another story.

He instructed Nyla and me how to turn on that pilot light one afternoon. It did indeed take

two of us. 1). Remove the floor grate, located between the living room and hall. 2). Go to the

basement and get the match holder, a two foot long thin, metal rod with a little notch at the end,

which hangs on the wall by the workbench. 3). Kneel on the floor and stick your head down into

the space under the grate, with a lighted match stuck on the end of the holder and reach it down

into the bottom while the other person turns the pilot light key to “on.” If you’re lucky, it lights!

He had been doing this twice a year, for over 70 years, but couldn’t manage this year, as he was

in a wheelchair.

Rubenstein (1989, 2004) discusses three domains of meaning that are not included

in Lawton’s model of competence. First, the aging self should be considered, going

beyond psychological dimensions such as perception, cognition and personality and into

a person’s lived experience. Personal history and life course guide daily activities: “what

things do I need to do, to be myself?” The statement “I’ve always done it this way!” is a

powerful determinant of behavior. (Don’t we really love the way we do things?! Aren’t

we really attached to our own little quirky habits and routines?)

Secondly, cultural meanings (ethnicity, norms, standards, values) filter through

the individual and impact behavior: “what does it mean to be a person who belongs in

society?”

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Thirdly, we experience and interpret life through the body, i.e. we are embodied.

Embodiment involves the meanings and physical realities associated with the body.

Physical, kinesthetic and emotional sensations such as height, weight, health, mobility,

comfort, pain and attractiveness are examples. An elder might ask, “What does it mean to

be a body in decline?” What am I able to do? Being able or unable to open containers,

dress oneself, etc., carry a strong message about personal worth and identity. It was

acceptable to my dad to use a cane, but not a walker or a wheelchair.

Also, bodily experience is part of place attachment in that we become identified,

in varying degrees, with our possessions and surroundings through movement and

positioning in daily routines, according to Rubenstein (2004). Our belongings serve to

orient us.

To study the space and environment in which a person typically lives and dwells.....we must recognize that this space is grounded first of all in the body. Because of body-subject, I know at any moment of my normal experience where I am in relation to familiar objects, places and environments (Seamon, 1979, p. 60).

So, in light of the theories described here, what is the nature of this interface

between habit and home which might be instructive to the home modifications designer?

Do habits represent successful adaptation, reflecting an “indifference point” or a balance

between the environmental press of a person’s home and that person’s competence? If we

see competence through the lens of habit, how do we identify press in a home: in terms of

its quantity, quality, structure, predictability, salience and mobility?

On the simplest level, the habit/home interface is a physical relationship generated

from the interaction of a person’s activities with shape, size, and organization, etc, of the

48

environment. This physical factor is especially important in older people, for whom

issues such as decreasing mobility and sensory acuities demand attention.

Experientially, this basic physical level has an intelligence of its own expressed

through body-subject. Through the body’s repeated action and over time, a person

becomes rooted in his/her environment (Seamon, 1979).

Eventually, space is no longer a set of objective areas, things and points in terms of which behaviours must be figured out cognitively. It becomes a field of pre- reflective action grounded in the body (p.80). And, as we see in the work of Rubenstein, Rowles and others, flowing through the

physical dimension (through embodiment) are layers of psycho-social, cultural and

philosophical/spiritual meaning.

.In the following chapter I explain how I conducted and analyzed my research and

how I developed design guidelines that respond to habit. I explain the use of the model

illustrated in Figure 6 (p.31) as a structure upon which to build the analysis of my

research data. I elaborate on the theoretical concepts from this literature review which

provided categories for that analysis.

49

CHAPTER FOUR

RESEARCH DESIGN AND METHODOLOGY

What can we find out about how people use their homes by studying habit? What

do habits and routines tell us about person-environment-activity (P-E-A) fit? Can we use

habit/routine as a means to describe and assess P-E-A fit? These questions drove this

study.

To delve into the qualities of habit and routine, I took a phenomenological

perspective. Phenomenology is an approach to knowledge in which the individual’s

experience of everyday life is primary, genuine and at the same time reflects the truth of

the human condition in general. Being-in-the-world is a central tenet of phenomenology,

and means that it is impossible to separate the human being from where one is. We are

always somewhere; we are bodies in a physical world. Looking at a person without a

place, or a place without people, renders an incomplete portrait (Seamon, 2002). This

holistic viewpoint appears to fit with Lawton’s (and others’) ecological theories of aging

(ETA), which present a transactional perspective, meaning that person and environment

comprise an inseparable unit, with all the parts participating and affecting the other’s

identity (Schwarz, 2003).

One must examine people’s actual experience by observation and/or through

interview. I interviewed 4 older people and they showed me through their homes. All

were women, ages 75, 80, 83 and 87. Two I know well and two were acquaintances. I

spent from an hour and a half to an overnight in their homes, recording our interviews

and taking pictures, with their permission. Fictional names are presented here.

50

The interviews were basic and open-ended. I asked, “what is your daily routine

and how is your house working for you?” I wondered if I might discover something about

the relationship between habits and home through what things people might describe as

little irritations or inconveniences. What thwarts goals? What would they change? What

would they keep the same? We walked and talked through rooms according to people’s

usual sequence of activities.

First, I transcribed the conversations and interpreted them by viewing each

component-- person, environment, and activity--from ecological theories of aging,

through the lens of categories presented in current phenomenological studies. I used these

categories to organize a preliminary assessment tool and to see what information could be

gathered. See Person, Environment and Activity Charts, Figures 12, 13 and 14, beginning

on page 63.

Then, I combed through the interviews to see what categories naturally arose as

people discussed their daily activities. Finally, I compared and contrasted the

interviewees’ experiences with my father’s experience. What similarities and differences

were there in others’ daily habits and routines in relation to my father?

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Theoretical Analysis of Interviews

From David Seamon (1979), I used the themes of movement, rest and encounter

to understand the activity (or the habit/routine.) These themes arose from his doctoral

work with Environmental Experience Groups, composed of people who observed and

discussed their relationships with place and environment over a year’s time. Movement

includes the role of the body, habit and routine, rest is about rootedness, or attachment to

place and encounter involves awareness of one’s surroundings.

I used Rubenstein’s (1998) three psychological processes linking person to place

to categorize information about the person. Rubenstein carried out in-depth interviews

with 7 elders over a 4 month period, making note of categories which came up naturally

in the course of their conversations about life experiences and associated meanings.

These processes are

• Socio-cultural meaning

o Ordering: a person’s set of ideas derived from cultural norms about the

appropriate use of rooms, how to arrange space and where things should

go, etc.

• Personal meaning: a continuum of connectedness with environmental items and

features

o Accounting or awareness of one’s belongings

o Personalization, or display of things reflecting life events, aesthetic taste

o Extension, a deeper personalization such as paintings made by oneself--

direct representations of some aspect of self-identity

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o Embodiment (different than below), an intense identification with

items/environment, blurring of boundaries between thing and person.

• Embodiment, the third process linking person to place involves entexturing, or a

body’s awareness of itself within the sensory environment. With what sensory

modalities does the person surround him/herself? Heat, sound, light, color, etc.

To examine environment I used visibility (or views, what is seen in the field of

vision close by and at a distance,) permeability (referring to connections between spaces,

i.e., doorways and hallways) and enclosure (boundaries). These are principles of space

syntax theory (Hanson, 1998) to which Seamon (2002) refers as a good description of

how space organizes behavior.

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Discussion

The routines we discussed most often focused on getting up in the morning and

preparing breakfast. This I recorded as “activity” and described the qualities of

movement, rest and encounter associated with each interviewee’s getting up routine.

Dimensions of movement reflected body-subject and how it felt to go from the

bedroom to the bathroom; what was their experience of the pathway? Alice went from a

cool bedroom with windows open into a windowless, warmer bathroom. Delia kept her

bedroom door open a crack so she could see whether or not her daughter was in the

bathroom. Normally during the day she used a walker, but at nighttime she dispensed

with it and supported herself along the furniture and walls. I noted distances, direction

and views, both interior and exterior, along the way.

The qualities of rest include rootedness, appropriation, regeneration, at-easeness

and warmth (Seamon, 1979). For example, in Alice’s routine, she and her husband sleep

in an adjustable bed with individual controls. Her husband has Alzheimer’s disease and

sometimes thrashes at night, pulling off the covers. The bed provides a separate, yet

together, experience giving Alice a better chance to rest and still maintain the bond with

her husband. Before arising, she does her exercises in bed without disturbing him. (This

bed encompasses several categories, moving into cultural and personal meaning and

embodiment; it maintains the marriage bond, allows closeness and serves Alice’s need

for sleep. The headboard, which is unattached, is from their original bed, expressing their

history together.)

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While Alice’s, Sara’s and Jenny’s bedrooms are primarily a place to sleep, Delia’s

is also her main living territory in the house that she shares with her daughter. She has her

books and puzzles, snacks, vitamins, TV and radio in her bedroom. Among the four, she

is the only one who must use a walker and her bedroom could be considered an example

of Lawton’s “control center.”

An important aspect of rest is appropriation: I made note of what items were at

hand in each room. Jenny keeps a glass of water on her nightstand, and a box of tissues in

the bed. She also has books, crosswords and other activities handy in her bedside table, in

case she awakens and can’t go back to sleep. In a corner of Sara’s bedroom are a pile of

stuffed animals for her grandchildren to play with when they visit.

Encounter can be described as a range of awareness from obliviousness, or basic

contact, in which “the perceptual field is automatically known in places of rootedness”

(Seamon, 1979, p. 117), to noticing any external cue such as a calendar or clock, to

watching a squirrel outside which has grabbed one’s attention, to an intense spiritual

experience of nature or the transcendent.

Alice, Jenny and Sara have morning meditation/prayer times. Light plays an

important role. In Alice’s home, she and her husband have devotions at their dining room

table after breakfast. This is a fitting place, I thought, because the room is cathedral-like,

with high ceilings and light streaming in from windows on three sides. Jenny crosses the

hall from her bedroom into her studio, where she has a comfortable chair facing the

window in which to meditate. This room has “the nicest light in the house” she says, and

she enjoys watching the sky and the seasonal changes of the tree just outside. Sara’s

meditation room has a large bay window and a solar tube in the ceiling above her chaise.

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Information about the environment I placed in the categories, visibility,

permeability and enclosure. Items at hand, what one sees when looking around the room,

what one keeps on the counter, etc. are part of the view, constituting visibility. These are

accessible things, important to one’s function and comfort. Sara’s house--the kitchen

cupboards, the walls--are covered with paintings, cards, notes, signs she has put up for

herself, “to keep me going.” In the hallway outside her bedroom door are scarves hanging

on hooks and shoes on the floor. In her study, she has a chaise where she sits with books,

journals, papers, pens and art supplies surrounding her within reach on the shelves, so she

can paint, write and meditate in the mornings.

Spatial patterns create patterns of movement (Hanson, 1998). Permeability has to

do with where one can go; adjacencies and openings ease movement or impede it, around

the house. There are two basic possibilities for movement in an enclosure: with one

threshold, entering and exiting happen at the same place and the room constitutes a dead

end. With two or more thresholds, one can pass through.

Permeability determines public and private spaces. If a room has only one

threshold, whoever occupies the room may control who enters. Spaces with multiple

openings tend to be central and public, with less individual control.

Distance and direction are significant: is there a direct, straight route between

locations or are there many turns? I sketched the floor plans of each home and recorded

people’s typical circulation patterns involved in the routines.

Enclosure signifies control. In Alice’s’ home, the kitchen is small with one

entrance from a hallway. However, it has a large greenhouse window on one side and an

interior window (a pass-through) on another. Waist-high counter space flanks the

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entrance. Immediately adjacent are the dining and living areas, where the volume

increases dramatically with a double-height ceiling. Within the kitchen, one feels

enclosed, like a pilot in a cockpit, yet has a view to the outside and the interior, where

family gathers; Alice can prepare food and visit with her family at the same time.

At night time, Alice and her husband sleep with their bedroom door closed, blinds

drawn and a window open. They like it very dark and cool. My father never closed his

bedroom door, slept with open windows and partially closed curtains, preferring a lighter,

less enclosed space.

Compare and Contrast with my Dad: Similarities and Differences

Sequence of activities, ordering of spaces, territoriality, personal standards, the

importance of interior and exterior views, preferences of ambient conditions, the use of

tactile support along pathways were factors mentioned by interviewees that related with

my dad’s experience in some way.

Ordering of spaces and territoriality

Not surprisingly, most people proceeded from bedroom to bathroom to kitchen in

the morning. Most used their bedrooms exclusively for sleep, except for Delia, who

“stayed out of her daughter’s way” as much as possible and had set up her bedroom to be

her personal, multi-use space. Three interviewees had separate rooms for their own

meditation and/or work. All rooms had discrete functions, except for the multi-purpose

hallways in Alice’s house where storage closets lined the halls.

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Personal standards

Delia stated she never felt dressed until she had her earrings on, even at home.

Two of four interviewees mentioned an overwhelm dealing with papers and clutter.

“Disorder drives me crazy,” said Jenny. Ann stated, “This is my chaos,” indicating her

desk. My dad, with his papers spread out everywhere, his piles, had a certain chaotic

order to things and took comfort in his system.

Tactile support

Delia, the most physically limited of the interviewees, talked about feeling her

way along the walls for support and gripping the door frame during the night when she

got up to use the bathroom. Jenny relied heavily on the stair railings due to her bad knees.

Alice used grab bars by the toilet to lower herself during the night when it was dark and

always used the grab bar to step into her tub/shower, just for support. My dad also used

the structure of the house and the furniture to support him; he traveled along the kitchen

counter top and used the chair backs going around the table to his spot.

Views: Exterior

The importance of exterior views was mentioned by everyone. Delia appreciated

seeing the moon out of her east-facing window, a situation she hadn’t experienced in any

of her homes before. Jenny counted on seeing the daily and seasonal changes in the front

yard tree and sky from her studio window, where she meditated and reflected. Alice

looked out her kitchen window to the bird-feeder, saying the squirrels provided “daily

entertainment” for her and her husband. They had designed their home in its forest

location to let in as much of the outside view as possible. My dad’s most important view

was to the main street out front, which provided entertainment and security.

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Views: Interior

What could be seen from certain vantage points such as the bathroom from the

bedroom, the living room from the bedroom and the living room from the kitchen, was

important. This seemed to be a control issue in my dad’s case, as he kept tabs on inside

activities, and a strategy to prevent isolation and stay connected with others for Alice and

Jenny.

Ambient conditions.

Interviewees commonly remarked on light conditions, temperature (warmth) and

sound. Two had a radio playing during our interviews and Delia stated she turned hers on

first thing each day. It was the opposite for my dad who listened or watched TV only at

certain hours.

Major differences were apparent in peoples’ awareness levels, Seamon’s

“encounter.”

Sara said, “I use every inch of this house and I LOVE it!” She had sought out

certain features and found them in this house. She has deliberately planned so everything

is handy. She displayed many things. Her personal journey was reflected on the walls

which were covered with her paintings, cards, etc. Her home was a good example of the

degrees of difference in how much visual stimulation people prefer.

Jenny was aware of views from kitchen to dining and living rooms, and expressed

the desire to be included in activities happening in the other room. She also displayed her

favorite dishes in an open cupboard, because of their aesthetic value. She was very aware

of some needed changes, i.e. the many exterior and interior steps in her home.

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Delia was much less concerned with how things looked. When I asked what she

would change about her home, she said she’d like to get a cat. She said, “Home is

wherever we happen to be.” She lived many places in her life, and often moved to be

close to family.

My dad’s house reflected time and self. His situation exemplified Seamon’s

“basic contact” where the “perceptual field is automatically known in places of

rootedness” (1979, p.117).

Development of Design Guidelines

The design guidelines developed from the literature review, my

observations of my dad, and the interview/home visit data. The two major guidelines for

responding to habit and personalizing home modifications are Retain the familiar and

Design for the senses.

These are not new strategies per se. Their creation from an investigation into the

qualities of habit/routine provides a new approach to evaluating the person-environment-

activity fit. Using habit as a touchstone for understanding the balance between

competence and press may give the evaluator—therapist, designer, researcher—a holistic

picture of the individual’s daily behavior. And the elder person has a new (and yet

familiar) way to respond to an interviewer’s questions about everyday activities.

To retain the familiar, consider the structural features and associated functions in

the home. What elements create the person’s experience of the home’s circulation paths?

Dimensions, direction, volume, and intersections are examples. What qualities do the

60

enclosures or rooms have? How many openings are there? Does the room have a discrete

function or is it transitional and multi-purpose? Is it an open or closed plan?

Where are rooms located and what functions are adjacent? What items are kept in

sight? What is stored where?

Design for the senses does not just mean the usual five senses. It includes the

somatic senses and really means design for experience. It involves evaluating tactile

sensations such as texture of walls, floors and other surfaces, and level changes in floor

or ceiling. With what does the person surround or “entexture” him/herself, such as degree

of visual and/or auditory stimulation? Is the atmosphere warm or cool?

Color and light are significant not only as visual elements of what one sees, but

play a role in the kinesthetic experience of moving around in and throughout the home.

From what direction does light fall upon the body? This is part of physical orientation

and proprioception, or the sense of position of the body and its relationship to

surrounding objects. Haptic perception involves the cutaneous sense of touch, especially

in the hands, and especially in response to the topology of the surroundings (Desmet &

Hekkert, 2007).

An outline of the guidelines follows, and then in Chapter Four specific home

modifications are suggested for my father’s home.

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Design Guidelines.

1. Retain the familiar a. Note qualities of pathways/circulation

i. Dimensions

ii. Volume (ex: space expands or contracts)

iii. Direction

iv. Intersections

b. Note qualities of enclosures/boundaries

i. Hard vs. soft, i.e. closed vs. open plan

ii. Transition areas

iii. Multiple use areas

c. Note order of spaces

i. Adjacencies

ii. Public/Private

d. Note function of spaces

e. Storage: what is kept where?

2. Design for the senses a. Tactile experience

i. Support along pathways, ex: walls, furniture, railings

ii. Level changes in floor or ceiling

iii. Texture

b. Illumination

i. Natural

ii. Artificial

iii. Source and direction

iv. Color

c. Temperature

d. Sound

e. Kinesthesia

i. Note bodily orientation, gesture, posture, gait

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CHAPTER FOUR

DESIGN PLAN FOR HOME MODIFICATIONS

AT 516 G STREET

My father’s physical limitations and safety needs dictated the urgency and

prioritization of changes. Mobility needs came first; getting in and out of the house,

moving around inside the house, using the bathroom and bedroom. These kinds of

problems would be identified using an assessment tool such as the C.A.S.P.A.R. See

sample pages in Appendix B.

The design strategies responding to habit then guided decisions about which ideas

were discarded and which prevailed. I maintained important locations which included

interior views such as from his bedroom into the living room, his vantage point from the

kitchen table to the front windows and his chair in the living room, or his “control

center,” where he could see in several directions. I maintained floor colors, and used

them to set up visual contrast with cabinetry. I retained the kinesthetic experience of

moving through/in the home by reducing distances, but maintaining direction.

The focus here is conceptual, illustrating a design decision-making process

framed through awareness of my dad’s everyday habits and routines. Load-bearing walls

were not identified, and thus placement as suggested may require beams to support the

span. The structural engineering of these changes is outside the scope of this project. Nor

were cost issues addressed at this time, and thus movement of interior walls and

plumbing revisions may be prohibitively expensive. Future refinement, for practical

purposes, is necessary.

63

Figure 11. (Rotate page 90 degrees counterclockwise.) 516 G Street plans, current (left) and proposed (right).

64

Solutions

Remodel back as helper’s apartment

Decrease length of kitchen

Enlarge bathroom to meet ADA standards

Widen halls to 42”

Widen doorways to 34”

Add ramp & railing to front entry

Straighten circulation path

Maintains direction (kinesthetic experience), Responds to sequence of morning activities

Problem

Simplify path

Widen doors & hallsCongested hallway

Complicated path

Solution

Design for habit:

65

Add ramp and railing to front entry

KeyLightChair to rest and put down itemswhile opening the door

66

Kitchen

Current Proposed

Task Lighting under cabinets

Maintain floor color, Maintain view to front (table remains in same position), Retain hutch (build in), Hot water dispenser for tea

Refrigerator drawerseasy access, space saver

Visual Contrastat cabinet edges, floor and cabinet, countertops

Rolling cartto carry items

Shelf by doorto place keys, mail, etc.

Built-in Storage

Design for habit:

67

Design for habit: Preserve view to front

Perspective from seat at kitchen table

Shelving by door Easy access to washer/dryer

68

Rolling cart, Refrigerator drawers, Lowered countertopResting place at sink, H ot water tap for tea

Basement stairs, current

Proposed: Two rails, Visual contrast, railing & each step

Design for habit:Maintains experience of descending stairsMaintains family/cultural customs: cellar storage

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Bathroom

Increase size

Problem(Environment)

Small Counter Space

(Person)

Low Vision

Weakness/Poor balance

Weak grasp

Solutions

Non-slip Flooring

Increase Visual Contrast

H ooks for towels/clothing

Tub SeatGrab Bars

Open Shelving

noraplan® eco

Increased visual contrast: grab bars, vanity, toilet, tub seat, open shelves

Design for habit: Maintain window in bathroom Retain Predominant Color (Pink)

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Problem

Tight spaceScattered rugs

Solution

Increase space to maneuver with walker

Replace multiple rugswith single large carpet

Sits to dress, Doesn’t like feet on cold floor

(environment)

Weakness, lower extremities

Weakness & numbness, hands

Poor grasp

(person)

Bedroom

Remove one bed, Add chair

Change closet location

H ooks to hang clothes

Reduce distance from bedroom to bathroom

Design for habit:

Design for habit: Maintain view to living room

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Roll-out storage cabinet for TV, magazines, newspapers, to reduce clutter

Table by front door to keep mail, keys, etc. as reminder on way out

Living RoomDesign for habit:Maintain chair in same spot: “surveillance zone.”View to front door, street, kitchen, hall, office.

Storage cabinets in hall to reduce clutter

Add closet by front door to hang coats, keep umbrellas, etc.

Surveillance zone

Easier access to bathroom

Living Room

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Back bedroom and multipurpose roombecome helper’s apartment

Easy access maintained to bathroomImproved access to washer/dryer

Bathroom enlarged for easier maneuvering

73

CONCLUSION

My father’s struggle with declining health, his intense attachment to his home and

his reluctance to make changes inspired me to investigate the power of habit and to

explore possibilities for its use in planning home modifications.

Habits are rooted in the body. Subjective experience of moving through and being

in the home may suggest strategies to individualize design and thus encourage people to

make the changes allowing them to age at home. These changes would not only promote

safety and independence; design guided by the individual’s experience of his/her familiar

surroundings may reduce stress and increase satisfaction. Evaluation of stress and

satisfaction levels before and after implementation of these design guidelines for home

modifications would make a valuable contribution to knowledge in the fields of aging,

public health and design.

74

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APPENDIX

79

Appendix A Figure 12. Person

3 psychological processes linking person to place Rubenstein (1989)

Habit/Routine

1. Public/private ordering of space? 2. Room

functions? Supports roles and identity M

aintains standards

• “W

hat must one do to be a

person in society?” •

Ability to maintain care &

appearance of the hom

e. •

Reflection of cultural identity

Socio-Cultural M

eaning

Values

Roles

Standards O

rdering of space Territoriality

1. Provide display, work

and storage space for hobbies, personal artifacts, etc. 2. Personal routines? W

ays of doing are learned in families

“I/we have alw

ays done it that way!”

Personal Meaning

C

ontinuity A

uto-Biography

1. Personal standards “W

hat must I do to be m

yself?” 2.D

egree of investment in

household belongings, identification w

ith objects 3.U

se multi-sensory cues,

i.e. visual, tactile, to signal position and place. N

ote sensory milieu:

entexturing. With w

hat does the person surround them

selves?

Embodied Self

C

ultural Physical Standards Place A

ttachment

Kinesthesia

80

Figure 13. Environment

How space organizes behavior (space syntax)

Habit/Routine

1. What is seen?

At hand? Distant?

2. Is entire pathway

visible? Are intersections visible? 3. C

onnections to exterior?

Visibility

A

ccessibility C

onnectivity V

iews

1. Maintain direction

Minim

ize distance 2. Preserve adjacencies. 3. D

oorways:

ease passage by widening, and flattening

threshold

4. Multiple-use hallw

ays

Permeability

C

onnectivity D

istance D

irection Pathw

ays

1. Abrupt transitions and hard boundaries offer m

ore control and surveillance. Form

al. 2. N

umber of entries per

room determ

ines centrality. Soft boundaries allow

for m

ultiple use and transition areas. Inform

al. Enclosure (B

oundaries)

Containm

ent C

entrality C

ontrol

81

Figure 14. Activity

Performance = Habit/Routine, Motivation, Cognition

(Kielhofner)

Habit/Routine

1.Note orientation, gesture,

posture, gait. 2.N

ote qualities of pathway:

Dim

ension Volum

e D

irection Tactile experience (w

hat’s under- foot, w

hat’s on walls? furniture support?)

Illumination (natural &

artificial; dir- ection of source) W

hat’s visible? (at hand & distant?

3. Create fam

iliar or logical flow

of activities, supported by environm

ent. Ex: locate dresser and closet along pathw

ay from bed to bathroom

Movem

ent B

ody-Subject (mind understands the

world through the body)

Kinesthesia (sense that detects bodily

position, weight and/or m

ovement )

Path V

iew

1. Note quality of enclosures

/boundaries. hard vs soft. Ex:closed vs open plan; Ex: bedroom

door closed, room

darkened, at night vs. open door, open blinds) 2. N

ote ordering of public/ private spaces 3. N

ote storage spaces (what

is kept where?)

4. Com

fort Light Tem

p Ergonom

ic fit Personalization R

est R

ootedness(Center for departure

and return) A

ppropriation ( Possession &

control) R

egeneration A

t-easeness (Freedom to be)

Warm

th (Signs of com

fort & care)

1. Note topology responding

to routine: C

irculation pattern Intersections Enclosures a. view

s (interior/exterior) 2. O

rdering of public/private space. a. centrality vs isolation (dining room

table, meditation corner)

Encounter awareness of

surroundings. B

asic Contact ( perceptual

field is automatically know

n in places of rootedness) O

bliviousness---Noticing---

Watching---H

eightened contact ( spiritual, unity, peace)

82

Appendix B

83

84

85