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139

Original scientific article           UDC: 365-053.88:645.4(497.4Ljubljana)
received: 2017-02-17

HEALTHY AGEING AT HOME: 
ERGONOMIC ADAPTATIONS OF INTERIOR DESIGN AND 

SELF-ASSESSED QUALITY OF LIFE OF OLDER ADULTS OF 
THE MUNICIPALITY OF LJUBLJANA 

Jasna HROVATIN1, Saša PIŠOT2, Matej PLEVNIK3

1 Faculty of Design, Associated Member of University of Primorska, Trzin, Slovenia
2 Science and Research Centre of Koper, Institute for Kinesiology Research, Koper, Slovenia 

3 University of Primorska, Faculty of Health Sciences, Applied Kinesiology, Izola, Slovenia

Corresponding Author:
Jasna HROVATIN

Faculty of Design, Associated Member of University of Primorska, Prevale 10, 1236 Trzin, 
Slovenia 

Tel.: +386 59 23 5008
e-mail: jasna.hrovatin@fd.si 

ABSTRACT 

Population is ageing and many nations already respond by developing and promot-
ing special strategies of healthy ageing. Living environment is one of the factors that 
can contribute to healthy and safe ageing at home, providing that it is well adapted to 
the needs of older adults. On the contrary, it can cause stress, discomfort and lead to 
injuries, resulting in the loss of independence and autonomy. With the use of a ques-
tionnaire, conducting a survey and an analysis regarding the adaptability of living 
environment to the needs of older adults, we obtained an insight into the quality of 
living environment of the elderly. In the Quality of Life Survey as a part of the A-Qu-A 
questionnaire, the participants were 198 older adults with an average age of 71.5 ± 
5.2 years of age. Further on, 83 of them participated in the study of the “Adaptation of 
the Living Environment to the Needs of Older People,” carried out in the homes of the 
participants, (with an average of 76 ± 1.2 years of age). The results showed that there 
is a significant difference between the subjective evaluation of the participants and 
the evaluation by the professionals regarding the estimation of appropriate lighting. 
The participants who estimated their quality of life as better are more likely to have 
sufficient or adequate lighting and more adaptations in the kitchen, which makes daily 
kitchen work easy and safe. Further investigation dealt with the ergonomic adaptation 
of the bathrooms, where we found out that less than 15 % of the participants installed 

mailto:jasna.hrovatin@fd.si


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the handrails in the shower or bath tub, which can significantly contribute to safety. 
Additionally, physical capability as part of quality of life negatively correlates with the 
number of adaptations made in bathroom (r = -0.149; p = 0.039), which refers to the 
fact that the adaptation of accessories (handrails) were only installed when the need 
for them appeared. With minor changes in the living environment and taking care for 
maintaining psycho-physical capabilities, older adults can easily and safely perform 
everyday tasks, which prolongs an individual’s autonomy and independence − the fact 
we are still not sufficiently aware of.

Keywords: older adults, ergonomic furniture adaptation, self-assessed quality of 
life. 

ZDRAVO STARANJE NA DOMU: ERGONOMSKA PRILAGODITEV 
NOTRANJE OPREME IN SAMOZAZNANA OCENA KAKOVOSTI 

ŽIVLJENJA NA PRIMERU STAREJŠIH ODRASLIH V MESTNI 
OBČINI LJUBLJANA

IZVLEČEK 

Človeštvo se stara in mnoge države so se na to dejstvo že odzvale z razvijanjem in 
promocijo ukrepov za zdravo staranje. Bivalno okolje je eden od dejavnikov, ki lahko 
prispevajo k zdravemu, predvsem pa k varnemu staranju na domu, če je le to urejeno 
in prilagojeno potrebam, ki jih imajo starejši odrasli. V nasprotnem primeru lahko 
neprilagojeno bivalno okolje povzroča stres, slabo počutje in izgubo samostojnosti, 
poleg tega pa je lahko tudi vzrok za poškodbe. V raziskavi o kvaliteti življenja je 
sodelovalo 198 starejših odraslih s povprečno starostjo 71 ± 5,2 let. Nadalje se je 83 
izmed vseh udeležilo tudi raziskave “Prilagojenost bivalnega okolja potrebam starej-
ših oseb”, ki se je izvajala na domovih uporabnikov (povprečna starost 76 ± 1,2 leti). 
Študijo smo izvedli z uporabo dveh prilagojenih vprašalnikov ter osebnim vpogledom 
v bivanjski prostor udeležencev. Ugotavljamo, da glede na priporočila obstajajo po-
membne razlike med oceno primerne osvetlitve po mnenju starostnikov v primerjavi s 
strokovno oceno izmerjeno na domu. Starostniki, ki so imeli primerno urejeno osvetlje-
nost prostorov, so kvaliteto svojega življenja ocenjevali višje in so poročali tudi v več 
primerih prilagoditev v kuhinji, ki olajša dnevno delo v kuhinji. Nadalje smo raziskali 
stanje ergonomske prilagojenosti kopalnic udeležencev, kjer smo ugotovili, da je manj 
kot 15 % sodelujočih v raziskavi že uredilo ustrezne ročke za oporo v kopalnici pod tu-
šem ali v kopalni kadi. Telesna zmogljivost teh posameznikov, kot komponenta kvalitete 
življenja, statistično značilno negativno korelira s številom prilagoditev v kopalnici (r 
= -0,149; p = 0,039). Ti svojo telesno zmogljivost kot del kvalitete življenja ocenjujejo 



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nižje. To vodi do ugotovitve, da prilagoditve bivalnega prostora starostniki uredijo šele, 
ko jih potrebujejo. Z manjšimi prilagoditvami v bivalnem okolju ter z ohranjanjem psi-
ho-fizične zmogljivosti bi starejši odrasli lahko vsakdanja opravila izvajali lažje, z manj 
napora in bolj varno. To bi pomenilo daljše samostojno in neodvisno bivanje starejših 
odraslih v domačem okolju - dejstvo, ki se ga ne zavedamo dovolj.

Ključne besede: starejši odrasli, ergonomija, prilagoditev pohištva in opreme, sa-
moocena kakovosti življenja.

INTRODUCTION

Being aware of the fact that population is ageing, the main focus and challenge 
for nations are how to increase or at least maintain the quality and years of healthy 
life (Drewnowski et al., 2003; WHO, 2002). Many nations have already responded by 
developing and implementing the policies to promote healthy ageing. According to the 
last data from 2011, in Slovenia the older adults (65 +) represented 16.6 % of popu-
lation (women 19.8 %, men 13.3 %). EROPOP2010 Eurostat projection expects that 
lifespan will be prolonged, so older adults (65 +) will represent 27.5 % of population 
in 2040, yet in the year 2050, 30.6 % of population and in the year 2060 every third 
Slovenian will be older than 65 years of age (Statistic Office RS, 2012).

A lot of older citizens live in homes that are not properly adapted to the needs of 
older adults (Colombo, Vitali, Molla, Gioia, & Milani, 1998), which can cause stress, 
discomfort and loss of independence. In the last decade, there has been a trend in deve-
loped countries to provide independent living conditions for older people, in a familiar 
home environment and for as long as possible (Grdiša, 2010). In Slovenia, only 7.85 
% of people aged 65 and over live in the old people’s homes, therefore, it is very im-
portant that housing and equipment for older adults and disabled persons is facilitated 
and adapted to the safety and comfort of their use (Hvalič Touzery, 2009). The research 
performed by the School of Architecture, University of Sheffield, UK (2004), regarding 
the impact of architecture on the quality of life, with the emphasis on environmental 
suitability of housing for the elderly, found out that the design of buildings have both 
positive and negative effects on the quality of residents’ life. That is particularly impor-
tant since older people spend most of their time in the building in which they reside. 
Due to the increased susceptibility of older adults to infections and diseases, they found 
that the compliance with hygiene standards is of extreme importance, particularly in 
the parts of buildings where food preparation and dining take place (Torrington, Bar-
nes, McKee, Morgan, & Tregenza, 2004). In the research by Colombo et al. (1998), 
the most frequent problems faced by older adults were identified. Among other things, 
older adults reported a safety problem in the kitchen (as many as 33 % of the dwellers) 
and of inadequate lighting (25 % of the dwellers). Very few older adults can afford a 
thorough home adaptation because of financial reasons. It was found that 60 % of older 



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people live in homes that have not been renovated or ergonomically adopted or newly 
equipped more than 20 years, which affects lower comfort and safety of the residents. 
More than 14 % of older people in England live in inadequate housing condition at 
home that urgently needs adaptation (Boyo, 2001). 

In addition, only 10 % of older adults decide to modify the existing equipment 
and adjust them to new needs (Gilderbloom & Markham, 1996). The studies mainly 
focused on furniture design for seniors, which is extremely important as most products 
include the elements designed for young people, so that older adults often have difficul-
ties in using them (Fabisiak & Jankowska, 2016; Klos, Fabisiak, & Kaczmarek, 2014). 
It should be emphasized that the designers and furniture manufacturers who wish to 
create products tailored to the needs of elderly people should first identify and focus 
on the needs arising from the old-age-related changes occurring in the human body 
(Fabisiak & Klos, 2016). However, there is also evidence that older adults have poor 
knowledge of the possible psycho-physical changes in the old age and about positive 
effect on performance of daily routines and, thereby, the possibilities to prolong the 
period of independence in home environment (Batič et al., 2016).

Beside the adaptation of living environment to age-related changes in functiona-
lity of older adults, we were focused also on the potentially dangerous places in the 
apartment. Evidence showed that most accidents in the home environment happened 
in the kitchen and bathroom (Stevens, 2005), so we need to pay more attention to the 
ergonomics of the furniture to maintain the performance of daily habits easy and, most 
of all, safe.

In addition, the lighting proves to be a common problem with the kitchen 
equipment. The kitchen is a workspace where we use sharp knives, home appliance 
and hot dishes, so it is necessary that the entire kitchen, especially the working area 
has proper lighting. A particular attention should be paid to the main working surface, 
sink and cooker hob area. When installing the lighting and choosing a single lamp, 
we must pay attention to disturbing shadows, glare and adequate power. For lighting 
which is directed towards the workplace, it is necessary to be installed from the front 
or from the left side and not from behind. This prevents the appearance of throwing 
shadows on the worktop.

Another potentially dangerous place in the living environment is the bathroom 
(Carter, Campbell, Sanson-Fisher, & Redman, 1997). The handrails intended for gre-
ater security should be placed at the appropriate level and at appropriate places. Our 
next analyses were directed to the research of handrails and other accessories (shelves, 
anti-slip mats) and their connection with the self-assessed quality of life, as well as the 
falls that occurred in a one year period. 

Within the definition of healthy ageing (Pell, McClure, & Bartlett, 2005) as “a 
lifelong process optimizing opportunities for improving and preserving health and 
physical, social and mental wellness; independence; quality of life and enhancing 
successful life-course transitions” we were focused on the situation of living old 
people’s environment. Having in mind the self-assessed quality of life according to 
the status of ergonomics adapted in living environment and furniture, we wanted to 



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examine the effect on independence and diminishing the potential injuries. That is 
why we examined the current status of adapted living environment when prolonging 
autonomy and ensuring the independence of older adults, their safety and comfort 
when living at home.

According to the presented facts, the research questions we considered in this part 
of the project were the following: i.) what is the present state of ergonomic interior 
design of old people’s home environment in the studied sample of older population 
in the Municipality of Ljubljana and ii.) does the self-assessed quality of life of older 
adults correlate with the level of adapted living environment (considering the number 
of adaptations).

METHODS

The study was a part of the project titled A-Qu-A: Active and Quality Ageing, (Pro-
ject no. 4300-472/2014), supported by Norway Grants. The leading partner of the pro-
ject was the Ljubljana Home Care Institution, Department of Home Care Ljubljana 
(Slovenia), while the research partners of the project were the Institute for Kinesiology 
Research, Science and Research Centre, University of Primorska and the Faculty of 
Design that collected all the data of the mass measurements and carried out the inter-
vention. Through a complex questionnaire and with an interview we tried to determine 
the status of interior adaptations to the needs of older adults living in dwellings within 
the Municipality of Ljubljana. The research protocol was conducted according to the 
Declaration of Helsinki, all the participants also signed a written consent to participate 
in the measurements. 

Participants

In the Quality of Life Survey, there were 198 older adult participants (151 female, 
70.35 ± 5.8 years of age and 47 male, 71.54 ± 5.3 years of age). 83 of them (58 female 
and 25 male), with their average age of 76 ±1.2 years, have additionally decided to 
participate also in the second Survey – “Adaptation of the Living Space to the Needs 
of the Elderly.” All the participants of the study are the residents of the Municipality 
of Ljubljana.

Measurements

In the Quality of Life Survey, 198 older adults filled out a complex A-Qu-A questio-
nnaire regarding the demographic and socio-economic data, healthy lifestyle, nutrition 
habits and ergonomic adaptation of interior design and furniture. They were all initial-
ly tested for physical characteristics, functional capabilities and general health status. 



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AQuA questionnaire was a combination of different parts of standardized questionnai-
res (GPAQ, QOL), where part of QOL was used also in the survey of Quality of Life 
of National Institute for public health. It consisted of 78 questions and was sent to each 
participant who agreed with a signed consent to participate in the mass measurement. 
The participant brought their own questionnaire, filled out on the first day of measure-
ment. After the measurement, the researchers checked the understanding and the mis-
sing answers together with the participants, to obtain more relevant data. In the second 
survey titled “Adapt the Living Space to the Needs of the Elderly,” the questionnaire 
was filled out by a group of interior design experts during their visit at the participant's 
home. The questionnaire was divided into 7 groups according to individual residential 
premises and comprised a total of 121 questions. Most of the questions were related 
to individual elements that affect the increased security and functionality processes in 
homes for the elderly. The adequacy of light exposure was measured using the LUX-
-meter (CEM, model DT-1301). 

Statistical Analysis

All data were organized in Microsoft Excel and analyzed in IBM SPSS Statistical 
Package, Version 20.0. Descriptive statistics, independent samples of T-test for gender 
difference, the number of adaptations and Spearman test for correlation between the 
number of living environment adaptations and quality of life (general health, physical 
capability, psychical condition and general quality of life) were used. P values < .05 
were considered significant.

RESULTS 

During the visit at the participant's home, we found out that only 22 % of the total 
of 83 respondents have appropriate task lighting. The measurements for determining 
the suitability was performed using the LUX meter. There is a high level of those who 
assessed their kitchen lighting inadequate (Figure 1). 



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Figure 1: Comparison of adequate or inadequate lighting of working area by profes-
sional assessment criteria and self-assessed criteria.

Additionally, we have analyzed the bathroom’s equipment for safety when entering 
into a bath tub (a step) and the shower equipment (a chair) and additional accessories 
such as handrails, shelves for shampoo and anti-slip mats. The results showed that 59 
% of the participants have a shower and only 33 % participants reported a bath with at 
least one of the listed accessories (Figure 2 and Figure 3 respectively). The other 8 % 
did not report any ergonomic accessories. The results from the questionnaire showed 
that only less than 15 % of the respondents installed the handrails in the shower or 
either in the bath tub, which significantly increases safety when using the bathroom. 
From the interviews, it was evident that persons who have handrails installed were 
already receiving benefits by physiotherapists or occupational therapists who advised 
them to set up such holders. Similar results were found also with the presence of a seat 
/ a chair in the shower.



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Figure 2: Number of the participants who have equipment in the shower (n = 117).

Figure 3: Number of the participants who have specially adapted equipment in the bath 
tub (n = 66).

Within the study, we additionally analyzed the self-assessed adequate living enviro-
nment (no. of adaptations) and its correlation according to the self-assessed “Quality of 
Life”: general health, physical capability, psychological conditions and general quality 
of life. The participants assessed the quality of life on the qualitative scale, in the range 



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from 1 − ”very bad,” 2 − “bad,” 3 − “fair,” 4 − “good,” and 5 − ”very good.” In the 
correlation analysis also the variables such as “education level” and “number of falls in 
the previous year” were included. Since bathroom is marked as a place with the highest 
rate of accidents, we have gathered the data of the number of participants’ adaptations 
of useful accessories such as handrails, shelves and seats in the shower or steps, shelves 
and anti-slip mats in the bath tubs, which could prevent potential falls and slips. 

The number of adaptations showed us logical results in negative correlation (ρ = 
-.149) between the number of adaptations in the bathroom and the self-assessed physi-
cal capability, which could be argued that older adults who assessed their physical 
capability lower have more adaptations than those with better physical capability. Ad-
ditionally, we found no correlation between the number of the adaptations with the pre-
sented variables (Table 1) and other life quality determinants. Also, there is no gender 
difference referring to the number of adaptations among men and women who partici-
pated in project. 

Table 1: Spearman correlation of adaptations in the bathroom and Quality of Life.

Spearman's rho General health 
status

Physical 
capability

General Quality 
of Life

No. of
Adaptations in
in the bathroom

Cor re l a t i on 
Coefficient -.036 -.149* -.089

Sig. (2-tailed) .620 .039 .213

N 197 192 198

Spearman's rho Psychological 
status

Level of 
education

No. of falls last 
year

No. of
Adaptations in
in the bathroom

Cor re l a t i on 
Coefficient -.084 -.078 -.021

Sig. (2-tailed) .241 .272 .767

N 198 198 197

Correlations were found between the characteristics of QOL, especially physical 
status, which were estimated better by those participants who assessed general health 
(ρ=.490), physical capability (ρ=.339) and general quality of life (ρ=.731), which is 
reasonable, and also we can confirm that those with higher education level more likely 
estimate psychological status (ρ=.282) and general quality of life (ρ=.246) better than 
those with lower. On the other hand, the variable “number of falls last year” showed 
us significant negative correlations regarding general health (ρ= -.260), physical capa-



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bility (ρ=-.213) and education (ρ=-.148), which can be argued that older adults who 
are less healthy have lower physical capabilities and lower educational level are more 
likely to fall in the previous year.

Additionally, we can find a larger share of those with the self-assessed quality of 
life as “very good” and “good” and reported more adaptations in the kitchen which 
simplify their daily kitchen work and provide safety (automatic shutdown of the oven; 
lower edge of the oven at the height of the kitchen countertop and easy cleaning of the 
kitchen hob), which could suggest possible correlation between QOL and adaptation of 
furniture (Figure 4).

Figure 4: Self assessed General Quality of Life in relation to the characteristics of 
kitchen adaptation.

Still, a significant number of participants do not pay enough attention to the safety 
in the bathroom, whereas only 18 % possess the handrails, 31 % have a seat in their 
shower and 22 % have an anti-slip mat. For this reason, the warnings of possible acci-
dents in the bathroom (falls, slips) should be much more highlighted. Living in una-
dapted apartments does not allow an independent life and could even present a danger 
for health. 



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DISCUSSION

Within the detailed analysis of ergonomic characteristics of participant’s homes, 
we focus on two main characteristics: adequate lighting in the kitchen work area and 
the safety of equipment and accessories in the bathrooms. For adequate lighting, 1400 
lux or more for work surface and 600 lux or more for general lighting are advised. 
However, a general recommendation is that the lighting of between 1400 and 2000 lux 
is advisable for the working surface and from 600 to 900 lux for the general lighting of 
kitchens for people over 65 years of age (Podlesnik, 2011). Most of the participants had 
too weak lighting. Our findings varied from the data in the questionnaire, where the re-
spondents self-reported having adequate worktop lighting in their kitchen with a rather 
higher percentage (46 %). The results indicate that older people generally think they 
have sufficient lighting of their work surface, but in reality the lighting in most cases is 
too weak, which hinders older adults at their work and may also be a cause of accidents.

Due to the fact that older adults find it difficult to stand up for a long time, in par-
ticular while they wash their hair with their arms raised, it is recommended that a seat 
is placed in their shower. There are special self-supporting chairs which could even be 
attached to the wall. Thus, older adults can sit while showering and washing their hair 
without any danger to slide on the slippery floor or to fall as they might get dizzy as 
well. The above presented results show that only 15 % of the participants have a seat 
placed in their shower despite the fact that many older people have problems with bal-
ance because of poorer movement skills. To enhance the security in the shower, shelves 
for storing soaps and shampoos also help as deposing and bending can cause a loss of 
balance and lead to a fall. Here we found more promising results because almost 60 % 
of the participants reported having a shelf for storing cosmetics in the shower. Installing 
the storage shelves in the shower is simple, as they can also be fixed with the help of a 
vacuum; that is why a majority of the respondents have shelves in the shower, however, 
43 % of showers are still without shelves. Tinetti (2003) and Tomšič & Gunčar, (2012) 
found out that the falls of older adults grow constantly and linearly with the increas-
ing number of risk factors among which we also rank unadjusted living environment. 
That could be argued that adaptation and installing the accessories (handrails) only take 
place after the first fall. 

Older adults are not aware enough of the potential problems encountered in their 
own homes, and of the existing possibilities in order to create living environment with 
minimal interventions that could significantly ease their living at home (Hrovatin, 
2015). Older adults are often afraid of any kind of adaptation, on one hand due to 
the fear of high costs and on the other hand due to the fear of the organization. The 
fact is that even a minor adaptation, which is neither financial nor organizational pro-
blem, brings significant changes that ensure greater safety and consequently prolong an 
individual’s independence. 

With this research, we found that most of older adults from our sample do not have 
ergonomically adopted interior design of their home, i.e. that they live in the apartments 
which do not suit their actual needs. Despite the fact that there are negative correlations 



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between self-assessed physical capability as one characteristic of quality of life and 
the adaptations of equipment or accessories in the bathrooms, such as holders, shelves, 
steps and seats, we found that higher-assessed quality of life is more common for peo-
ple with higher education. That corresponds also to higher economic status and, thus, 
higher standards of living conditions.

CONCLUSION

According to the research, we found that the majority of older adults in our sample 
live in the apartments which could prove a threat to their health and prevent successful 
ageing. Older adults are mostly not aware enough that they could achieve a signifi-
cant level of safety and independence in their living environment with only minimal 
interventions or adaptations. The best time to make adjustments to achieve ergonomic 
interior design is immediately after the retirement, when the problems are not yet pres-
ent, to avoid the fact that maladjusted interior design leads to the early loss of indepen-
dence. For the safe, high-quality and independent living in particular homes, it is also 
very important to maintain the physical and mental fitness of older adults. The need for 
safe, high-quality and independent living is evident so the awareness of possible small 
adaptations needs to be highlighted. Being aware that inadequate living environment 
remains a problem among older population, we need to investigate and identify the 
proper strategies to ensure healthy ageing with prolonged living at home. Conscious 
of the potential barriers to achieve adaptation in the old people’s living environment 
should present a further challenge in creating national strategies of health promotion 
for the older population. As mentioned, older adults should be aware that even minor 
changes in their living environment could allow them to perform everyday tasks faster, 
with less effort and more security, but above all, that this can prolong their autonomy 
and independence and contribute to the sufficient quality of life even in their »golden 
age.«

Acknowledgements

The presented parts of study were funded by Norway Grants, Project no. 4300-
472/2014 and the Government Office for Development and Cohesion Policy. We are 
grateful to all project partners, researchers and co-workers for their contribution and 
especially to the participants for their willingness to take part in this study. 



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