Memorandum by Professor Peter Lansley
INTRODUCTION
Peter Lansley is Professor of Construction Management
at the University of Reading. He has been closely involved with
the development of the EPSRC EQUAL (Extending Quality Life) Initiative.
He has chaired some of its awards panels and frequently acts as
spokesperson for the Initiative. He is Director of the EQUAL Research
Network which is concerned with promoting the contribution to
improving the independence and quality of life of older people
of design and engineering orientated interdisciplinary research.
The memorandum reviews some the features of
the EQUAL Initiative and the organisation of research at national
level and it offers some proposals for the future. It is informed
by the experiences of the Network and the views of its members
and supporters which include professionals, practitioners and
older and disabled people as well as researchers. However this
not an official account of the EQUAL Initiative. Rather it represents
the perspective of those who have been closely involved with ensuring
that it has had a clear focus on meeting the needs of older people.
THE VALUE
OF DESIGN,
ENGINEERING AND
TECHNOLOGY RESEARCH
Recent research provides valuable support for
the case that better design and application of both conventional
and innovative technology can make a major contribution to improving
the independence and quality of life of older people. The creation
of more comfortable environments and of aids to living and recovery
are valid areas for research.
Such research has been supported by a number
of charities, some of which have a long-term commitment to improving
living conditions for older and disabled people (for example,
the Joseph Rowntree Foundation programme of work centred on Lifetime
Homes, the work of the Thomas Pocklington Trust focused on visual
impairment, and that of the RNIB in many areas including the design
of the home). It has also received significant support from EPSRC,
principally through its EQUAL Inititative. The success of these
programmes gives a clear indication of both the positive outcomes
which can be achieved and useful guidance on how to organise research
to achieve maximum impact.
Given the range and magnitude of the issues
faced by older and disabled people who may benefit from research
there has been insufficient investment. However, since the research
base is small and capacity for research is limited there is a
need to consider how best to develop the research base and more
generally how to organise ageing research, especially in the light
of disappointing progress over the last three years.
THE EPSRC EQUAL INITIATIVE
EPSRC launched its EQUAL Initiative in 1997.
This was focused on enhancing the independence and quality of
life of older and disabled people through a programme of design,
engineering and physical science orientated interdisciplinary
research involving social, medical and health scientists as well
as design, engineering and technology scientists. The programme
required collaboration with intermediate organisations, such as
housing providers, health and social services organisations, transport
companies, and charities, and the direct involvement of older
and disabled people in the individual projects constituting the
programme. EQUAL has supported 39 projects ranging from very small
one year feasibility studies with a value of £30,000, to
large three year consortia projects with an award value of £650,000.
Most projects have considered how the environments
of older and disabled people, and in some cases their carers,
can be designed or modified to enhance well-being, independence
and quality of life, but others have considered the enhancement
of approaches to rehabilitation following illness or accident
so as to enable the rapid return to home and, as far as possible,
to normal daily routines. Although there has been a particular
interest in the home environment including the devices and products
used in the home, there has also been concern for care settings,
public access buildings, urban environments and transport systems.
Some projects have considered general aspects of ageing and disability
whilst others have focused on specific aspects of physical impairment,
sensory impairment (particularly vision and hearing), and cognitive
impairment (especially dementia and stroke).
All projects have entailed the development of
a detailed understanding of the way in which users interact with
their environments, and their priorities and preferences. This
has been a very necessary precursor to the gathering of data and
creation of conceptual and operational models to enhance design
information, improved design methodologies, better assistive technologies
and innovative rehabilitation systems.
THE EQUAL PROJECTS
Those projects concerned with the home fall
into two main categories. Building on the widespread success of
community alarms and related systems, several projects have focused
on the development of the smart home, advanced intelligent sensor
systems, telecare and telemedicine. Other projects have been concerned
with developing design guidance for new homes and yet others with
the challenge of adapting existing homes so that older people
can remain in them despite considerable infirmity. These have
blended the perspectives of sociology, health care, design, technology
and economics to provide important and compelling accounts of
the options for policy makers, housing, health and social services
organisations and for older people themselves. This work is able
to make a sound economic as well as a quality of life case for
the substitution of adaptations and assistive technology for traditional
forms of care services. In some situations the savings could be
considerable. A large proportion of the projects in all fields
have a strong business or economic dimension reflecting their
concern to meet the needs of government, other organisations and
society to identify cost-effective approaches to enhancing independence
and quality of life.
Projects concerned with infrastructure, transport
systems and non-domestic buildings form two groups. Firstly, there
have been those concerned with improving accessibility to buildings,
transport systems and more generally the urban environment through
better design and, secondly, projects concerned with developing
navigation tools for people with specific impairments. Here again
the integration of a range of disciplinary perspectives and exploitation
of new technology have generated new practices, often with the
potential to couple significantly improved independence with major
cost savings.
The projects concerned with sensory and cognitive
impairment have generated unique information about the needs of
specific groups of people which is invaluable to designers, who
previously have had little design guidance, and for health workers
for example, Occupational Therapists, who have to match the needs
of individuals with recommendations about how their homes might
be adapted. Research with dementia patients is leading to systems
which can afford them a greater degree of independence and confidence
for longer whilst also supporting their carers. New technology
has a role to play here but so too do new approaches to the design
of care facilities. The work with stroke patients will contribute
to improved recovery times and will enable some rehabilitation
therapies to be home rather than hospital-based.
Inclusive design projects consider a wide range
of conditions from normal ageing to ageing with multiple impairments.
These are producing design data sets, advice, methodologies and
technologies for design which are immensely attractive in terms
of both innovative design processes and the resulting environments
and products. Here there is much evidence to support the business
and economic case for inclusive design especially when considering
older people as consumers of products and services.
OUTCOMES
Just over half of the projects supported by
the EPSRC EQUAL Initiative have been completed. The reminder will
do so in the next two years. Many of their findings have been
adopted by practitioners and policy makers, often within two years
of project completion, and sometimes before they have been completed.
Because the projects have involved collaboration with service
providers and the involvement of older and disabled people, developments
arising from the projects have been rapidly evaluated and refined.
This has facilitated the further articulation of outcomes, especially
where projects have produced state of the art and best practice
guides, tool kits for professionals, demonstration systems, and
devices and systems ready for application. Some of the outcomes
have been of particular value to those who commission buildings,
infrastructure and products, and to architects and designers who
have to ensure that their designs are more inclusive of the needs
of older and disabled people, and more generally the ageing population.
The research outcomes have also influenced,
for example, the development of British Standards and building
regulations, and the policies, practices and general outlook of
key individuals within government organisations, such as the Housing
Corporation, the Department for Transport, and the Disability
Rights Commission, even where they have called into question current
policies and recommendations in relation to older people. At a
more general level the findings have influenced expectations about
how the built environment and everyday consumer products could
and should be designed to accommodate the needs of older and disabled
people. Similar comments apply to the findings arising from the
rehabilitation projects. In particular these have raised expectations
of what might be achieved through engineering and technology orientated
research.
In addition the EQUAL Initiative has stimulated
an enthusiasm amongst scientists from quite different fields for
working closely together, and has highlighted the need to find
further ways of working across scientific boundaries. For example,
there is a need to understand in much more detail the implications
of the biology of ageing, for instance, the variation in human
biological functions, especially between ethnic groups. This is
required not just to help designers accommodate particular impairments
but also to aid health practitioners in the community to detect
the onset of disabling conditions and to take appropriate action
to arrest the rate of decline.
To summarise, the EQUAL Initiative has been
particularly effective at identifying and supporting projects
which, within a short space of time, have produced significant
outputs for improving the quality of life of older and disabled
people. Some of these outputs have already produced direct benefits.
Others, through informing, for example, official standards and
regulations, design procedures, and professional practice, will
have a long term and systemic effect on the design and management
of the built environment and consumer products, and on approaches
to rehabilitation following illness or accident. Whilst modest,
the approach taken by EPSRC to building research capacity and
facilitating ageing research should be commended.
OTHER INITIATIVES
The EQUAL Initiative has run in parallel with
other similar ageing related research programmes supported by
large and small charities, housing and other organisations. Because
some of these organisations are in a good position to ensure the
application of their work, and many do so very successfully, they
can create important expectations and standards of all research.
A recent example is work carried out by RNIB Cymru and JMU Access
Partnership on the design of housing to meet the needs of people
with sight loss which is being incorporated into the requirements
of grant funded Registered Social Landlords when they are building
or adapting homes.
However, much of this other work is carried
out in isolation and is rather ad hoc. For example, many
organisations are presently involved with the development and
application of home-based technologies in recognition of a major
challenge for the quality of life of older people being that of
supporting people in their own homes, especially people with dementia.
There is a great deal of work needed here in bringing together
these efforts if the aim is to develop cost-effective integrated
services with good distribution networks, skilled installation
personnel, and managers who are aware of the capabilities, cost
effectiveness and limitation of new technologies.
BUILDING A
COMMUNITY
In 1997 although there was a surprising number
of university based research designers and engineers with some
experience of ageing-related research, often gained through small-scale
projects with charities or undertaken out of personal interest,
there were very few experienced researchers in the areas to be
covered by EQUAL. However, the Initiative was successful in attracting
those with experience, as well as many newcomers from a broad
range of disciplines within the physical, social, health and medical
sciences. Probably because so many were new to the area, they
were prepared for and relatively untroubled by many of the challenges
of interdisciplinary user-orientated work. So, they quickly established
new research methodologies which were to contribute to a new style
of applied science. These new approaches deserve greater recognition
for their effectiveness in the skilled business of involving users
as active participants in the research process.
September 2004
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