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Universal Design Strategies: Impact of Aging Considerations Checklist

November 2016
The Center For Health Design


This tool is meant to support a universal design approach to environments for aging populations. The following items should be considered as general guidelines (or “thought starters”), and not as comprehensive specifications. The considerations are best reviewed at the very beginning of a project, even before programming, to assess strengths, identify needs, and establish a vision for short- and long-term plans. Upon project completion, this tool can guide a discussion around implementing processes that align with the new design. Understanding the universal design approach can help your organization select the best strategies and design options for your project.

This tool is structured around three sectors of the built environment:
  1. Home and community (residential)
  2. Healthcare
  3. Workplace

For additional considerations, refer to the Impact of Aging Issue Brief:

Piatkowski, M. & Taylor, E. (2016). Universal Design: Designing for Human Needs (Research brief). Concord, CA: The Center for Health Design.


AARP. (2010, November). Home and Community Preferences of the 45+ Population [AARP Research]. Retrieved October 5, 2016, from http://www.aarp.org/research/topics/community/info-2014/home-community-services-10.html

Adams, J. G., & Gerson, L. W. (2003). A New Model for Emergency Care of Geriatric Patients. Academic Emergency Medicine, 10(3), 271–274. https://doi.org/10.1197/aemj.10.3.271

ASID Design for Aging Council. (2016). Design for Aging in Place Toolkit. ASID. Retrieved from https://www.asid.org/sites/default/files/u34215/Aging-In-Place-Toolkit.pdf

Bennett, J., Pitt, M., & Price, S. (2012). Understanding the Impact of Generational Issues in the Workplace. Facilities, 30(7/8), 278–288. https://doi.org/10.1108/02632771211220086

Boltz, M., Parke, B., Shuluk, J., Capezuti, E., & Galvin, J. E. (2013). Care of the Older Adult in the Emergency Department: Nurses' Views of the Pressing Issues. The Gerontologist, 53(3), 441–453. https://doi.org/10.1093/geront/gnt004

Bosch, S. J., & Gharaveis, A. (2017). Flying solo: A review of the literature on wayfinding for older adults experiencing visual or cognitive decline. Applied Ergonomics, 58, 327–333. https://doi.org/10.1016/j.apergo.2016.07.010

Brownell, P., & Kelly, J. J. (Eds.). (2013). Ageism and Mistreatment of Older Workers. Dordrecht: Springer Netherlands. Retrieved from http://link.springer.com/10.1007/978-94-007-5521-5

Cohen, L. W., Zimmerman, S., Reed, D., Brown, P., Bowers, B. J., Nolet, K., … the THRIVE Research Collaborative. (2015). The Green House Model of Nursing Home Care in Design and Implementation. Health Services Research, 51(S1), 352–377. https://doi.org/10.1111/1475-6773.12418

Dill, J., Neal, M., Shandas, V., Luhr, G., Adkins, A., & Lund, D. (2010). Demonstrating the Benefits of Green Streets for Active Aging: Final Report to EPA. Portland, OR: Centre of Urban Studies, Portland State University. Retrieved from http://friendsoftrees.org/images/stories/pdf/psu_green_streets_active_aging_report.pdf

Gray, B., Winblad, U., & Sarnak, D. O. (2016). Sweden’s Esther Model: Improving Care for Elderly Patients with Complex Needs [The Commonwealth Fund Publications - Case Studies]. Retrieved October 3, 2016, from http://www.commonwealthfund.org/publications/case-studies/2016/sep/sweden-esther-case-study

Hablamos Juntas. (2010). Universal symbols in healthcare: Developing a Symbols-Based Wayfinding System: Implementation Guidebook. Robert Wood Johnson Foundation.

Handler, S. (2014). An Alternative Age-Friendly Handbook: For the Socially Engaged Urban Practitioner. The University of Manchester Library. Retrieved from https://www.architecture.com/RIBA/Professionalsupport/Researchandinnovation/Assets/Files/Ageing/Age-friendlyHandbookLARGEPRINTVERSION.pdf

Hedge, A. (2014, September). Sit-Stand Working Programs. Retrieved October 26, 2016, from http://ergo.human.cornell.edu/CUESitStandPrograms.html

Huelat, B. J. (2007). Wayfinding: Design for Understanding | The Center for Health Design. Position Paper for The Center for Health Design’s Environmental Standards Council, Concord, CA. Retrieved from https://www.healthdesign.org/chd/research/wayfinding-design-understanding

Hume, R., & Looney, J. (2016, February 3). Designing for Telemedicine Spaces: Planning for the Next Generation of Health Care Delivery. Retrieved October 26, 2016, from http://www.hfmmagazine.com/articles/1889-designing-for-telemedicine-spaces

Klein, S., Hostetter, M., & McCarthy, D. (2016). The Hospital at Home Model: Bringing Hospital-Level Care to the Patient. Retrieved October 5, 2016, from http://www.commonwealthfund.org/publications/case-studies/2016/aug/hospital-at-home?utm_source=Klein+Hospital+At+Home&utm_medium=Twitter&utm_campaign=Delivery+System+Reform

Lee, K. K., Perry, A. S., Wolf, S. A., Agarwal, R., Rosenblum, R., Fischer, S., … Silver, L. D. (2012). Promoting Routine Stair Use. American Journal of Preventive Medicine, 42(2), 136–141. https://doi.org/10.1016/j.amepre.2011.10.005

Lee, S., & Kline, R. (2011). Wayfinding Study in Virtual Environments: The Elderly vs. the Younger-Aged Groups. ArchNet-IJAR: International Journal of Architectural Research, 5(2), 63–76.

Lund, H. (2003). Testing the Claims of New Urbanism: Local Access, Pedestrian Travel, and Neighboring Behaviors. Journal of the American Planning Association, 60(4), 414–429.

National Association of Home Builders. (2016). Aging-In-Place Remodeling Checklist. Retrieved October 26, 2016, from https://www.nahb.org/en/learn/designations/certified-aging-in-place-specialist/related-resources/aging-in-place-remodeling-checklist.aspx

Pati, D., Harvey, T. E. J., Reyers, E., Evans, J., Waggener, L., Serrano, M., … Nagle, T. (2009). A Multidimensional Framework for Assessing Patient Room Configurations. HERD: Health Environments Research & Design Journal, 2009 Winter(2 (2)), 88–111.

Persson, H., Ahman, H., Yngling, A. A., & Gulliksen, J. (2014). Universal design, inclusive design, accessible design, design for all: different concepts - one goal? On the concept of accessibility - historical, methodological and philosophical aspects. Universal Access in the Information Society, 14(4), 505–526. https://doi.org/10.1007/s10209-014-0358-z

Price, A. D. F., & Lu, J. (2012). Impact of hospital space standardization on patient health and safety. Architectural Engineering and Design Management, 9(1), 49–61. https://doi.org/10.1080/17452007.2012.688522

Shain, M., & Kramer, D. M. (2004). Health Promotion in the Workplace: Framing the Concept; Reviewing the Evidence. Occupational and Environmental Medicine, 61(7), 643–648. https://doi.org/10.1136/oem.2004.013193

Steinfeld, E., & Maisel, J. (2012). Universal Design: Creating Inclusive Environments. Hoboken, N.J.: John Wiley & Sons.

Takano, T., Nakamura, K., & Watanabe, M. (2002). Urban Residential Environments and Senior Citizens’ Longevity in Megacity Areas: The Importance of Walkable Green Spaces. Journal of Epidemiology and Community Health, 56(12), 913–918.

Thomas, M. (2011). Villages Help Older People Age in Place. AARP The Magazine, (May/June), 1–4.

World Health Organization. (2007). Checklist of Essential Features of Age-Friendly Cities. WHO Press. Retrieved from http://www.ageingwellinwales.com/Libraries/Documents/Age-Friendly-Ireland.pdf

Toolbox Topics