How Dangerous Design in our cities and homes is killing our olders

The issues of aging and urbanism have preoccupied me for a while; now I can write about them again.

I used to write a lot on the Mother Nature Network about the problems facing aging baby boomers. One issue that preoccupied me was how badly designed our cities and homes were for people who didn’t have perfect sight, hearing or balance, and how this problem was ignored. The subject didn’t fit on Treehugger; I considered doing a book, but didn’t have time to work on it and Carbon Upfront. That suddenly changed last week! I am posting the introduction here to gauge readers’ interest in the subject.

Note the grey granite stairs, the lack of handrail, the lack of light thanks to the hoarding/ photo Lloyd Alter the day after.

On October 12, 2014, a 96-year-old woman put on her best Chanel dress and went for lunch in Toronto at the Arcadian Court, a fancy venue in one of the nicer buildings in the city-at least before its dreadful “upgrade”- designed in 1976 by John B. Parkin, one of the best architects of the era, to the standards of the time. After lunch, a young woman helped her as she left the building, descending a few grey granite stairs under the cover of a construction hoarding blocking the natural light. She couldn’t hold a handrail; the one nearby was useless as it was buried in bicycles. The grey granite stairs had to meet a sloping sidewalk, and the almost invisible bottom stair was about three inches high when the woman missed it, slipped out of the hand of her young helper, and smashed her head on the pavement.

That woman was Debby Alter, my mother. She was sharp, funny, aware, and she didn’t die for another three years, but her life as we knew it effectively ended that day. As soon as I saw those stairs, I knew that she was almost killed by a design problem; these were dangerous. The bottom tread was invisible and of varying height; they were dull grey with no markings; there was no handrail. But they were built in 1976, so they were “grandfathered” in. I complained that there was construction hoarding over them blocking the light and you couldn’t grandfather that, but in the end, every lawyer I talked to said that she was 96; the legal system looks at the years or the income that might have been lost, and when you are 96, there is not a lot of either.

My mother’s life was ruined by dangerous design. It was bad design,  inconsiderate design, assuming that everyone has good eyes and can see a step there. The almost invisible step was made worse by ignorant contractors renovating the building.

What happened to my mother is not a rare event. In fact, the numbers are shocking. In 2019 15,292 Americans were killed by firearms. There were 37,595 motor vehicle traffic deaths, ^⁠both statistics that inspire outrage and demands for action. But there were 39,443 unintentional fall deaths, 34,212 of which were adults over 65 years old. Over 3.1 million were treated in hospitals.

Many of these we caused by inconsiderate, dangerous, or just bad design. Many were caused by poor maintenance. And more are happening every year; the number has increased 58% in the last decade as the baby boomer generation ages and as maintenance declines.

Dangerous design is everywhere, in our homes and our streets. It’s not just about falls; it is about access to the things people need to be part of a community, from decent sidewalks with enough room to move to public washrooms to better design of everything we use. It is not just about olders– the preferred word these days for senior citizens– because if it is safer for them, it is safer for everyone of every age and ability.

Gradually, Then Suddenly

The problem with looking at dangerous design for olders is that they are a moving target. Not that long ago, everyone over 65 was a “senior citizen “or a “pensioner,” and they were often all painted with the same brush. However, over the last few decades, things have changed dramatically.

Many 65-year-olds are hale and healthy these days and certainly wouldn’t describe themselves as old. A few years ago, I wanted to start a website devoted to their interests and every person I wanted to contribute to it said, “why would I want to read that?” Studies have shown that most older adults feel at least 20 years younger than they are. There are also different kinds of old. Camilla Cavendish, in her book Extra Time, writes that In Japan, they are separated into the “young-old” who are different from the “old-old” She talks to an expert:

‘The Young-Old are very active and healthy and productive – totally different from 30 years ago,’ says Professor Takao Suzuki, Professor of Gerontology at Tokyo’s J F Oberlin University. ‘Walking speeds are much faster, for example. The World Health Organization defines “old” as 65, but as gerontologists and geriatricians, our main concern is with the Old-Old, who are very different from a health standpoint.’

In her book This Chair Rocks, Ashton Applewhite notes that the young-old are much healthier than they used to be.

“People aren’t just living longer; they’re healthier and are disabled for fewer years of their lives than older people of decades ago. According to the US Department of Health and Human Services, the share of US healthcare spending going toward nursing and retirement homes has declined since 2000 and been flat since 2006”

Of course, different people age differently. Much depends on social class and wealth more than age; the rich have the resources to care for themselves. They also have better access to health care; that’s one reason Canadians live three years longer than Americans; they have free universal health care. (less access to guns is another) Applewhite notes that according to one long-term study, “The difference in the quality of life as well as its duration correlated with five predictable and modifiable behaviors: not smoking, controlling weight and blood pressure, avoiding diabetes, and regular exercise.” This is all easier when you have money.

But it is not just age or class; genetics matter too. My wife is 64 and has an autoimmune disease that makes it hard for her to function some days. Our bodies do deteriorate with age; I am 70 at the time of writing and am proud of the fact that I still bike everywhere and run or row for half an hour every day, but I rely on cataract surgery and glasses to see, hearing aids to hear, and lots of expensive physiotherapies to learn how to run without hurting my knee. Everyone is different, and loss of ability happens at every age. As Applewhite notes:

Some ailments, like Alzheimer’s, spinal stenosis, and arthritis, are indeed age-related. But many of the changes we attribute to age begin in childhood, and are affected by factors like obesity, poor nutrition, environmental conditions, social adversity, and even personality.

This is a critical point; it is not just about the old. But we cannot avoid the truth that as you age, there is a continuous loss of capacity, stamina, muscle and bone strength, balance, and acuteness of senses. These all contribute to falls; Balance is connected to the inner ear and is affected by hearing loss; poor vision makes it harder to see trip hazards like the one that took out my mom. Brittle bones break more easily. Diet and medication can affect balance.

This is why for many people, aging is much like Hemingway described going bankrupt: gradually, then suddenly.

But just because older people are more likely to fall and suffer more when they do, doesn’t make them responsible. There is a lot of victim-blaming; was it my mom’s fault for not seeing the step or hanging on more tightly to the woman helping her? Or do falls “just happen” with old people?

No, falls don’t just happen. Research shows that 40% to 60% of falls are due to environmental design factors and community hazards due to inadequate building codes, poor design, or inadequate lighting. Then there are maintenance issues, cracks, trip hazards, snow and ice removal.

It might also be said that people don’t care much about old people in general, but this is not just an old people’s problem. But as Applewhite noted, this is a continuum. Our senses start deteriorating at a young age and different people deteriorate at different rates. Some are born with disabilities and others acquire them at a young age. Olders are compromised but they are not necessarily disabled, and many people are disabled but not old.

When Gil Penalosa founded the 8-80 Cities organization in 2007, its vision was:

“We exist to create safe and happy cities that prioritize people’s well-being. We believe that if everything we do in our public spaces is great for an 8 year old and an 80 year old, then it will be great for all people.”

But when you look at the demographics, there are going to be a lot more of those 80 year olds soon, and we’re not ready.

More to come. Read more of my thoughts about aging and urbanism here.