Chapter 2: Literature Review
2.3 Design and Elderly Rehabilitation
2.3.1 Design for Elderly
The design community is called upon to address practical challenges to the healthcare of the elderly people. Design methods are extended to rehabilitation research by addressing fundamental and yet practical challenges to the healthcare of older people (Partridge, 2017). Design for the aging population was first introduced in 1991 by the Royal College of Art and followed by the Helen Hamlyn Center in 1999 to develop the theory and practice of inclusive design with a focus on the needs of older people (Gieben-Gamal and Matos, 2017). In old times, rehabilitation was used to recognize the requirements of populations with disabilities. Recently, the focus has been on the needs of older people in the community with or without disabilities (Mincolelli et al., 2019; Kumar, 2009).
The design community has facilitated design research in the context of healthcare to positively change the current practices of rehabilitation (Chamberlain and Partidge, 2017). Codesign research has been acknowledged in the design of healthcare systems for its benefits in reaching deeper understandings on circumstantial user requirements, and improved value and design process (Steen et al., 2011). Co- design is generally applied in marginalized communities (Dearden, 2008; Ssozi-Mugarura et al., 2017). For example, older adults with indigenous knowledge (Winschiers Theophilus et al., 2010), deaf people (Blake et al., 2014; Blake et al., 2011), homeless individuals (Southern et al., 2014; Yoo et al., 2013), and children (Bossavit and Parsons 2016; Sanders, 2000). Evidence-based design (EBD), user-centered design (UCD), and research through design (RTD) approaches have also been considered effective methods in the intervention, exploratory and observation stages of users and
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contexts to increase the potential of healthcare objects by intervening simultaneously in the prototyping phase. RTD approach is regarded as a form of a scientific investigation and a designerly way of knowing that gains useful insights through design practice and offers a better understanding of emerging issues in the design field. The approach was introduced by Frayling (1993) and has majorly utilized in the field of human-computer interaction by Zimmerman et. al (2007), though its application in healthcare and rehabilitation design research is constantly growing. In healthcare design, the integration of EBD, UCD, and RTD methods can be viable in the process of designing products with a shift from a therapeutic situation to a therapeutic product (Giambattista, 2017).
2.3.2 Design for Elderly Rehabilitation
Traditionally, designers have paid attention to acute and chronic treatment through new medical products, prosthetic replacements, hospital, clinic, and home care design (Tsekleves et al., 2019). For example, making the use of design and technology to restore health. This practice contributes largely to existing healthcare, which focuses on treatment rather than prevention (Chamberlain and Partridge, 2017). Moreover, this practice is in line with the existing medical care, which has important limitations for the elderly, such as its complexity, typical use in the hospital context, funding deficits, and care dependency while interacting with the care products (Angela, 2017). Design in rehabilitation for older people focuses on the wellbeing, mental health, social interaction, dietary cautions, and active living of the elderly population. For example, rheumatoid arthritis is a chronic condition that causes disability and mostly affects the small joint of hands and wrist joints causing severe pain.
Goncu-Berk and Topcuoglu (2017) designed a smart glove for patients with rheumatoid arthritis to reduce pain with the use of electrical stimulation therapy. They reported that such a design practice required backgrounds for design research that can cover medical and physiological variables, and electronics technology.
Mincolelli et al. (2019) developed a customizable healthcare service to the elderly at home care using a human-centered design and co-design methods. This practice aimed to support older people in place and to minimize their dependency on families and caregivers. Chamberlain and Partridge (2017) extend that design is generally applied in the context of healthcare with the design of products. They described a health care project that can improve the measured quality of care for frail older patients admitted to hospitals. They further suggested that future design will play a new and progressively significant part in shifting the practice of health to allow hospital improvement teams to implement a co-design practice for quality of care. Tsekleves and Cooper (2017) reviewed design case studies and identified emergent trends in design for health in different dimensions, such as public health, acute, chronic conditions, and elderly care. They concluded that design could contribute significantly to the upcoming healthcare design with a focus on preventive care. Ramírez et al. (2019) followed a human-
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centered design (HCD) approach to understand the stigma for pelvic floor disorder which is a common condition related to women. They designed five concept prototypes of playful types of empowering women and shifting their attention away from the disorder. Pericu (2017) stressed on the design process for healthcare by applying the HCD approach in the design of inclusive products and services that can potentially empower elderly people in their daily life activities and encourage them for healthy practices for independent life.
Design for elderly rehabilitation is understood as a social process of changing behavior. In this regard, design for behavior change attempts to understand people and encourage them to do or not do something (Chamberlain and Partridge, 2017). This kind of design practice includes person-centric healthcare, self-management healthcare, community healthcare, holistic healthcare, and health- promoting care (Tsekleves and Cooper, 2017). They are designed with additional services for example reading materials, and diary follow-up strategies to motivate the elderly for a healthy lifestyle. In this way, the focus to provide practical approaches to prevent specific diseases, such as musculoskeletal disorders, is less understood while these disorders cause disability and chronic illness, which affect the daily life activities of the elderly people. The current body of knowledge on healthcare and rehabilitation in design is presented in Figure 3. This shows the scope of literature on design and design approaches utilized in the context of healthcare and rehabilitation designed for older people.
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Figure 3. Scope of literature in design for elderly rehabilitation