Interboro Partners

As architects and planners, weíre interested in talking about the physical environment, and the extent to which it works—or doesn’t work—for aging bodies. As an expert on healthy aging, what do you think designers can do to help enable seniors to function independently? Should we concentrate on adapting the built landscape—lighting, curb cuts, etc.—or on creating the right social conditions?

Linda Fried

All of the above. The challenge is to think differently about design and aging, and to set different kinds of goals. We need to work on straightforward improvements like enhanced mobility, ease of access, and greater safety and stability as people become frail and unsteady on their feet. But more broadly, we must design the things that help prevent frailty in the first place and enable people of all ages to thrive and grow.

We live in an amazing moment in history; over the past 100 years, weíve added 30 years to human life expectancy in the developed world. Thatís an unprecedented public health accomplishment. And it means we’ve added one or even two new stages to the lifecycle. So, we need to redesign our communities to facilitate aging in place, and to help older adults stay engaged and connected.

IP

As a geriatrician and epidemiologist based in New York City, what does the urban landscape look like, or feel like, through the lens of health and aging?

LF

When Iím on the subway, I rarely see people older than their 50s and 60s. Our transportation system sorts people by age.

IP

And the bus is the reverse; most riders appear to be over 50.

LF

Exactly. And thatís a stimulating thought for me: What do we have to build to make subways accessible to all people? Or, if subways are too challenging and buses are the major source of transportation for older people, are they adequate?

IP

That’s a reminder that making the built environment better for seniors would make it better for everyone. People with baby carriages or people with disabilities would benefit from a more accessible subway system.

LF

Absolutely. Designing for older adults is designing for the canary in the coal mine. They experience the stresses of the environment more acutely than many other groups experience them.

IP

You worked on New York City’s pioneering “Age-Friendly NYC” initiative, which recommended creating “Aging Improvement Districts.” Could you tell us about that initiative?

LF

The goal of Age-Friendly NYC is to adapt the city so that older adults can age in place. We developed 59 interventions citywide and for targeted communities, addressing issues that older adults identified. The solutions we introduced were not high cost, and turned out to benefit everybody.

For example, then mayor Michael Bloomberg asked every department in New York City to reassess its operations through the lens of aging. The Department of Transportation subsequently noticed that there were intersections in the city with high rates of traffic accidents and older people were the ones getting hit. So the department began targeting those cornersóredesigning the crosswalks to make them safer for older people. As a result, there was a huge decline in traffic accidents and fatalities.

Similarly, the city added more benches to target areas, offering people who are frail or have difficulty walking more opportunities to sit down. Itís not a huge capital expense, but it makes a big difference.

IP

As a dense, mixed-use environment with a range of housing and transit options, New York is already in some ways a comfortable place in which to age. But most American seniors are aging in suburban environments. Have you thought about the unique challenges that aging in the suburbs presents? Can we imagine an Age-Friendly Long Island?

LF

My work has focused primarily on cities, so while I recognize that there are huge problems for older adults in suburban communities, I donít have a fast answer. As a geriatrician, I know that when people can no longer drive, it can be a catastrophe—particularly if they live in suburban or rural areas. They are trapped in their homes, without access to public transportation. That’s a major problem.

IP

And it’s not only about transportation; it’s about having housing options, too. Long Island has a high percentage of single-family, owner-occupied homes with very high property taxes; this presents problems to people on a fixed income.

LF

Older adults are often homeowners, whether they live in urban, suburban, or rural areas. Their ability to stay in their homes matters to them, and also affects the stability of their communities. So what happens when the majority of homeowners can’t maintain their homes because they are getting frail, or don’t have disposable income to make repairs? How do we prevent these homes from being abandoned?

IP

Ironically, a lot of suburban seniors donít want to change the built environment, despite their dissatisfaction. We have heard suburban seniors complain about second-floor bathrooms; about mowing grass and raking leaves; about how they canít drive anymore. But in response to adding new housing or more walkable, mixed-use communities, they’ll say: “If you want urban, move to Queens.” We can romanticize the “wisdom of the elders,” but in fact seniors can be a big impediment to change—their own worst enemies.

LF

Well, somewhere in there is a challenge for design, right? To offer visions of what change might look like, so it doesn’t look like the worst alternative.

IP

Yes, absolutely. This is an important role for design: to visualize the opportunities. One of the first steps in tweaking or adjusting the physical environment in American suburbs is to help people understand the issues, and then to work with them to imagine the future.

LF

Right, and I think that people struggle to see what a better alternative could actually look like. Thereís a great need for people like yourselves to say: Well, we want to preserve the character of this suburban community because people love it, but we also want the people who have lived there for their whole lives to stay part of the community. So, what are the design elements that could accomplish both of those goals?

IP

We have thought a lot about how to increase density in communities with single-family homes. Many communities in Nassau County won’t allow an accessory dwelling unit, which would enable, say, a younger person to live in an apartment attached to a garage, and to periodically check in on an elderly person.

LF

That would be amazing.

IP

This is an opportunity to create the kind of meaningful engagement that you’ve written about: the pairing of different groups to create a win-win situation. The accessory dwelling unit is one of those physical design elements that does not completely change the community; it simply opens up the community to people who want to live in smaller units, and who can also provide support for the elderly.

LF

Yes, and we should be exploring different kinds of housing that enable people to live together in suburban areas, such as complexes, or homes that friends can share.

IP

Killing two birds with one stone. This is more or less what you are trying to do with Experience Corps, right?

LF

Experience Corps matches “a critical need with a vital resource.” Rather than killing two birds, it is designed to help both thrive. Many children in low-income communities need help to succeed in school, and require more adult attention. Older adults have time on their hands, a desire to give back, and skills to share. We designed Experience Corps to have a large impact—through older volunteers—on kids and schools, while improving the health of the volunteers. It’s a powerful combination that works wonders for all involved. What do you think about something like Experience Corps as a design challenge?

IP

We think it’s a fantastic design challenge, and we wonder how that kind of thinking could yield other
models of meaningful engagement. Our first question would be: what other groups could you pair with the elderly to benefit society?

LF

It amazes me that we, as a society, have added this whole new stage to life and weíre assuming itís a disaster. We have the healthiest and best-educated group of older people in the history of the world. One characteristic of getting older is that you want to create something of value that endures. Meanwhile, we have so many unmet needs: for saving our environment, for improving the public’s health, and for community-based programs that support the development of children. We could design new roles for older adults to address these issues.

IP

There are probably groups that have a harder time than others participating in programs like Experience Corps. Is it easier for women, for instance, to volunteer? For whites? Are seniors with disposable income more likely to participate?

LF

We quickly learned that many older adults in New York live on very limited fixed incomes, without even the resources to take the bus to see a friend. So itís hard for them to volunteer unless their out-of-pocket costs are defrayed. Reimbursement for transportation therefore became an important design element of Experience Corps; it encouraged people to volunteer who otherwise couldn’t afford to. And there was an added benefit: their bus passes not only enabled them to get to the school, but also allowed them to visit friends and family, attend concerts and museums, and to be in the world in a way that they previously could not.

IP

That’s an example of great design: you solve one problem, and in doing so, you create many more
opportunities.

We want to talk about another item in the age-friendly toolbox: NORCs—or naturally occurring retirement communities. What you think about them?

LF

NORCs are fantastic. The idea of evolving the housing environment to accommodate residents who want to age in place makes perfect sense. In New York, many people stay in the same apartment building forever. So a large proportion of the building grows older together. These residents begin to need a certain set of services. If the building can provide them, or if the residents can team up to develop them, itís fabulous.

IP

In New York, to officially be considered a NORC, more than 50 percent of the heads of households in the community have to be over 60 years old. That 50 percent is a sweet spot: it means there are enough seniors to justify the NORCís age-friendly programs, yet not so many that it turns into a segregated, purpose-built retirement community.

LF

Yes, and that offers opportunities to create cohesion across age groups within a community, as well as within age groups.

IP

We want to end by talking about young peopleóabout education. We’re all educators. In the past, you’ve described how hard it is to get undergrads excited for classes about aging, and we’ve have had this experience too. So how are we going to get students interested in this topic?

LF

I often tell students that this whole question of aging is really about them, not about me. It’s about designing a world that today’s young people want to live in when they’re in their 60s and 70s and 80s and 90s. And it’s a design opportunity that is unprecedented—the chance to proactively design for these new stages of the life cycle, for what amounts to a new world. When have we ever had that opportunity before?

IP

That sounds very persuasive!

LF

If I do a survey in an undergraduate class, I say, “How many of you expect to live to 60?” Everybody raises their hands. “70?” Everybody raises their hands. “80?” Most people raise their hands. And even if I say “90,” half the room still raises their hands. And then, if I ask: “Are you doing things now that you wouldn’t do if you expected to live only to 47?"—which was our life expectancy 100 years ago—I usually hear a collective gasp, as they think through how they would live their lives differently if they only had 23 more years.

We have changed our life course without thinking about it. People expect to live longer, but we havenít yet tackled what the next stages need to be about.

IP

We wonder if the next generations will be more adaptable as they enter old age. Our students seem to be anticipating longer lives, as well as a lot more change in their lives—they might go on to have multiple careers, live in different cities, etc. Maybe we can capitalize on this; maybe they will be willing to look at each stage of life with fresh eyes.

LF

So, we’re about to have an interesting run, huh?

Harvard Design Magazine Issue No. 1
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