How Design Can Enhance the Brain Health of a Rapidly Aging Population

By 2050, an estimated 2.1 billion people worldwide will be over 60 — a staggering number more than double the current population of older adults. In a rapidly aging society, we face major challenges of rising senior care and housing costs, not to mention the effects of physical and mental illness that increase as we get older.

Mitigating the tolls aging takes on the body and mind is increasingly a collective responsibility.

Cognitive decline — often evidenced by confusion, memory loss, or difficulty concentrating and learning new things — is among the most widely feared aspects of aging, according to Dr. Upali Nanda, HKS Principal and Director of Research.

“When we think of the aging brain, our first connotations are negative. At some point, aging stops being a positive thing,” Nanda said. “We become worried about what’s going to happen to our brain as we get older.”

To better understand the science behind cognitive decline and learn how designers can attempt to counteract it, HKS recently conducted research in partnership with Hume, a UK-based design practice that relies on behavioral neuroscience to inform its work.

“Science-informed design helps us understand the deep influence our environments have on our day-to-day cognitive experience,” said Hume’s director, Itai Palti, who noted that our physical surroundings have numerous effects on our brains — effects that accumulate over time to shape both development and decline.

Science-informed design helps us understand the deep influence our environments have on our day-to-day cognitive experience.

The HKS and Hume research illuminates biological and cultural inhibitors to healthy brain development over the course of a person’s life. For example, physiological conditions like sensitivity to stress can impede the brain’s ability to age healthfully. But cognitive decline is not just a physical concern, it’s a social concern as well. It exacerbates negative stereotypes of ageism and counteracts positive associations of growing old such as wisdom and intelligence. When elders are perceived as unwell or incoherent, their opinions are more likely to be dismissed, their voices less likely to be heard. Often, even with good intentions regarding their safety, caretakers and family members grant elders less influence over where and how they can live their lives.

Contradicting common perceptions of what aging does to the mind and body, research shows that the brain itself is capable of growing and changing at all stages of life. The prospects of neurogenesis (the brain’s process of creating new neurons) and neuroplasticity (the brain’s ability to reorganize and develop neural networks) do not completely diminish as we age.

“If our brain has the capacity to grow and generate new connections, then we have to shift our thinking from preventing cognitive decline to promoting brain health,” said Nanda, who encourages designers to create spaces that may be used by seniors to start from a perspective of positivity and development instead of deterioration.

If our brain has the capacity to grow and generate new connections, then we have to shift our thinking from preventing cognitive decline to promoting brain health.

Enriched Environments Support Brain Health

But how exactly can the built environment promote brain health and enhance the lives of older adults?

According to our research, environmental enrichment — the stimulation of the brain by its physical and social surroundings — can stem the tide of cognitive decline and increase the likelihood of neurogenesis. When people encounter complex environments that offer a variety of activities for various personality types, cognitive abilities, and ages, brain function and neuroplasticity flourish.

“We tend to think that we need to make things really simple for older adults. But this isn’t always true. Environments that have a certain level of complexity – not too much or too little— actually help cognitive function,” Nanda said. “When your brain engages with stimuli, it stays healthier. One great way of engaging the brain is through art and creative activities.”

An architect of senior living communities, HKS Principal and Senior Designer Grant Warner, has seen first-hand that elders suffering from the most detrimental form of cognitive impairment — dementia — have much to gain from enriched environments. He’s noticed that one of the hurdles preventing wide adoption of enriched environments for seniors is a lack of understanding about what actually happens to their brains as they age.

“One of the misnomers in memory support is that people behave like children. That’s not accurate. Their ability to perceive the world changes to be like the abilities of children but regressively,” Warner said, noting that dementia patients’ behavior is often still logical and adult-like even though their ability to perceive the world and their memory may be impaired.

At The Vista at CC Young, a high-rise senior living community in Dallas, a stationary automobile provides rehabilitation support, triggers sense memory to boost cognitive activity and encourages positive interactions and educational moments among residents.

Warner said that when he designs senior environments, he incorporates as many sensory experiences as he can — including visual, auditory, olfactory, and tactile elements— all in an attempt to support cognitive abilities and corresponding behaviors.

By digging into the science of the aging brain, we discovered new insights that have major implications for the future of design. We learned that as the brain ages, some parts degenerate faster than others. Verbal abilities and comprehension decline slower than abilities related to speed of processing, memory, spatial ability and reasoning.

“These nuanced insights remind us that spaces we design need to have spatial coherence — an ability for elderly persons to understand how different elements go together in a space,” Nanda said.

From Neuroscientific Evidence to Design Solutions: A New Approach

A crucial part of a science-informed design approach is when creative minds engage directly with research to generate new ideas. HKS developed a research-based workbook with exercises meant to serve as catalysts for designers and collaborators to create environments capable of supporting brain health in a workshop setting.

Putting this process to test, HKS invited ten young designers to explore how enriched environments can be designed and incorporated in the public realm during our 2021 Mid-Atlantic Design Fellowship (MADF). Now in its 10th year, MADF unites students and recent graduates with HKS designers from the Washington D.C., Richmond and New York City offices in an intensive weekend-long design charrette.

The 2021 MADF took place in a virtual think tank environment where Nanda and MADF coordinators Rebecca Soja and Divya Nautiyal facilitated an immersive workshop focused on the combined lenses of science and empathy. Following informed brainstorming, they tasked fellows to develop hypothetical design solutions that foster brain health among aging people and increase quality of life for all members of a community. The HKS and HUME research findings and projects from HKS’ Senior Living practice served as a foundation for the fellows’ work.

In three teams, formed to address small, medium, and large-scale solutions, MADF participants designed theoretical public parks that, if built, could support brain health and create positive connections across generations.

“The fellows explored everyday design strategies and analyzed their effectiveness to contribute to an enriched environment,” Soja said. “They addressed design prompts not only from physical and spatial points of view, but also from an experiential or emotional perspective.”

The fellows explored everyday design strategies and analyzed their effectiveness to contribute to an enriched environment. They addressed design prompts not only from physical and spatial points of view, but also from an experiential or emotional perspective.

Working on an individualized scale, “Team Small” considered user interactions, landscape integration and materiality in their design. Comprised of two overlapping circles for passive and active engagement, their park provides visually compelling sculptural seating areas and low-impact exercise equipment along a circular path made of soft blue paving-like material.

Speaking of the senior-friendly exercise equipment her team selected for the park, MADF fellow Denise Lee, said, “We made a decision to sprinkle it along the circulation path rather than have it in a cluster to promote exercise throughout and make it more easily accessible.”

“This park isn’t elder-exclusive, it’s meant to be intergenerational,” said Lee’s teammate, Austin Rivers, adding that just like the entire park itself, the exercise equipment can be used by people of all ages due to it’s low-impact nature.

“Team Small’s” innovative circular layout aligns with best practices for designing for elders who suffer from cognitive decline, according to Warner.

“Dead ends are bad for residents especially if they don’t realize they can turn around. Some could get scared or even panic. So, we try to make sure that memory support environments are contiguous loops,” he said.

Warner believes circular designs also promote exercise and that soft ground coverings (such as the blue material “Team Small” selected) are particularly good in the event of falls, indicating that environments designed for both physical and mental health in conjunction, are ideal.

MADF Team Small’s circular park design caters to active and passive adults with low-impact exercise equipment and visually interesting seating options.

Rising to the challenge of a slightly broader scale that needed to consider site layout and adjacencies, “Team Medium” designed an environment that could support individual choices and collective experiences at the same time.

“We came to the conclusion that, within a medium size scale, the collective experience of the elderly at a park included elements of overlook, path and shade,” said MADF fellow Gloria Kim.

Inspired to create spaces for reflection as well as energy and activity, the team’s design solutions included an overlook offering visual connections and shading as well as a marketplace or pavilion, which Kim called a “vessel for opportunity.” Other mid-scale community areas — a pond, a garden and a skate park — connect to one another via diverse pathways.

“Team Medium’s” idea to feature a skate park in an environment that caters to the elderly may seem unexpected, but it was an intentional choice to promote joy and positive associations — two key contributors to brain health.

“A skate park isn’t necessarily active for our target group, but it can be very engaging for them,” said MADF fellow Ryan Griffin.

Warner said that he’s often put playrooms and playgrounds in the senior communities he designs, as they spark creativity and excitement among residents who enjoy watching children play and laugh. Both he and Nanda agreed that incorporating elements of play into environments for people of all ages undoubtedly enhances quality of life.

“Play is so essential,” Nanda said. “It’s why intergenerational environments really work— you can do the same thing for grandkids and grandparents and they both benefit but in completely different ways.”

MADF “Team Large’s” streetscape design encourages way-learning and sensory exploration so people can navigate safely to a park and have fun along the way.

Expanding beyond the boundaries of a single park, “Team Large” set out to design an arrival journey, considering entry points and the network of streets and green spaces people encounter along the way.

“One of our main goals was to enrich that journey from your house to the park,” said MADF fellow Sharanya Reddy.

The team’s design mapped a section of a hypothetical city activated with a series of porches and sensory kiosks that could play music or show pictures. Streetscapes along the journey engage people of all ages while sidewalk cafés and interstitial spaces cater to older adults who may need water breaks or shade as they make their way to the park.

“We tried to incorporate many sensory experiences that could trigger memory and help with cognitive activities. These experiences were developed keeping in mind accessibility and way-learning,” said MADF fellow Ishita Parmar.

In this instance, way-learning took shape in “Team Large’s” design with colored curbs to visually validate that pedestrians are moving in the right direction and color-matched park entrances to signify arrival.

The concept of way-learning improves upon traditional wayfinding in design, according to Nanda. When those experiencing cognitive decline are provided with visual cues in the form of repeating colors or objects rather than just words or numbers, they are more likely to remember the journey to their destination, whether it be their bedroom or a public space.

“With aging populations, you need to give anchors to help learn their way, not just find it,” Nanda said, noting that developing new memories and retaining old ones are crucial signifiers of a healthy brain and can be aided by design interventions.

With aging populations, you need to give anchors to help learn their way, not just find it.

An Urgent Social and Health Concern

In 2020, the global pandemic noticeably hit seniors hardest, compounding issues of isolation, declining health and ageism. For the first time in recent memory, elders’ health and housing needs were front and center.

“During COVID, our seniors have been disproportionately affected and there’s a risk that we address only physical, rather than equally important social and cognitive needs,” Soja said.

As the pandemic demonstrated, seniors are often overlooked. In order to provide dignified environments and care for the steadily rising population of elders, we must pay more attention. By embracing science-informed design and introducing enriching, intergenerational environments in our communities, we can combat cognitive decline and improve quality of life for everyone, especially older adults.

“That’s the best thing about being a designer,” Nanda said to the MADF fellows. “Every problem is your opportunity to come up with ways of addressing it and making it better.”

Learn more

Interested in learning more about how design can support brain health or conducting a science-informed design workshop with your team? Reach out to Upali Nanda.