Submitted in Partial fulfillment of the requirements for the Degree of Bachelor in Architecture
Patil – Pallavi Semester IX (Part 1)
Guided by Ar. Krishnan Venkateshwaran
L.S. Raheja School of architecture, Mumbai Affiliated to Mumbai University October, 2021
L.S Raheja School of ArchitectureThis is to certify that PALLAVI PATIL has successfully completed her design dissertation (part 1) on the topic ‘ Humanization of healthcare through Architecture ’ under the guidance of Ar. Krishnan Venkateshwaran.
This dissertation is undertaken as a part pf the academic study based on the curriculum for Bachelors of Architecture program conducted by the University of Mumbai, through L.S. Raheja School of Architecture, Mumbai.
SEAT NUMBER : __________
Ar. Krishnan Venkateshwaran (Thesis Guide)
Ar. Mandar Parab (Principal)
L. S. Raheja School of Architecture, Mumbai
External Juror 1 :
External Juror 2 :
L.S Raheja School of Architecture
L.S Raheja School of Architecture
I hereby declare that this written submission entitled “Humanization of Healthcare through Architecture - A Holistic Approach for Geriatric Care” represents my ideas in my own words and has not been taken from the work of others (as from books, articles, essays, dissertations, other media and online); and where others’ ideas or words have been included, I have adequately cited and referenced the original sources. Direct quotations from books, journal articles, internet sources, other texts, or any other source whatsoever are acknowledged and the source cited are identified in the dissertation references.
No material other than that cited and listed has been used.
I have read and know the meaning of plagiarism and I understand that plagiarism, collusion, and copying are grave and serious offences in the university and accept the consequences should I engage in plagiarism, collusion or copying.
I also declare that I have adhered to all principles of academic honesty and integrity and have not misrepresented or fabricated or falsified any idea/data/fact source in my submission.
This work, or any part of it, has not been previously submitted by me or any other person for assessment on this or any other course of study.
Name of the Student: Pallavi Ankush Patil Exam Roll No:
Date: Place:
*The following defines plagiarism: “Plagiarism” occurs when a student misrepresents, as his/her own work, the work, written or otherwise, of any other person (including another student) or of any institution. Examples of forms of plagiarism include: the verbatim (word for word) copying of another’s work without appropriate and correctly presented acknowledgement; the close paraphrasing of another’s work by simply changing a few words or altering the order of presentation, without appropriate and correctly presented acknowledgement; unacknowledged quotation of phrases from another’s work; the deliberate and detailed presentation of another’s concept as one’s own.
“Another’s work” covers all material, including, for example, written work, diagrams, designs, charts, photographs, musical compositions and pictures, from all sources, including, for example, journals, books, dissertations and essays and online resources.
The journey to completion of this research took the efforts, guidance and blessings of multiple individuals.
Firstly, I would like to thank my parents Ankush Patil and Neena Patil for never losing faith in me and supporting me at every step on my way to achieving my dreams, no words can suffice how thankful I am to them both for everything they’ve done for me. My elder brother, Choshal Patil for being my constant motivator and entertainer to help me get through stressful days. My grandparents and friends for always wishing the best for me and encouraging me to do my best.
I would like to express my sincere gratitude to my thesis guide Ar. Krishnan Venkateshwaran for his continuous support, guidance, advice and encouragement throughout my research process.
Apart from my guide, I would like to thank my class incharges Ar. Swanand Mahashabde, Ar. Sachin Vedak, Ar. Arun Firardo and Ar. Uttara Nalawde for sharing their immense knowledge with me.
My 3 musketeers, Srishti Sawe for being the best dost I could ask for and being my go to source for services and building construction and my constant partner through thick and thin, Samta Yadav for being my rock and shoulder to cry on during the internship and AD and thank you for being such a great and helpful friend and lastly, Yash Yelne for always picking up my calls at the same time bearing with my cribbing and being my companion in sharing life problems and having long phone calls. Thank you for making each day in college feel like a fun day full of entertainment and being the lifelines of all the outings, trips and parties. Apart from that I’d also like to thank Shubham Sawant, Nidhee Mene, Nikita Patil, Nimit Patni and Urvi Patil for being so supportive and helpful for 4 years.
Special thanks to my closest friends Siddhi Rane and Bhoomi Udani for understanding my worked up schedule and adjusting to it through all the years.
“Mental health…is not a destination, but a process. It’s about how you drive, not where you’re going.” – Noam Shpancer, PhD
L.S Raheja School of Architecture
Figure 3:Congested wards with medical odor...................................................................................18 Figure 1: Plain light coloured walls......................................................................................................18 Figure 2:Enclosed waiting lobbies......................................................................................................18
Figure 4: Ayurveda during the Vedic period Source: https://www.kottamparaayurveda.com/about_us............................................................................22
Figure 5: Holistic Health complete health Source: https://www.healthyhildegard.com/holistic-healing/........................................................................24
Figure 6: Holistic health - Whole health of the body Source: https://www.healthyhildegard.com/holistic-healing/........................................................................25
Figure 7: Mind, Body, Soul, Emotional health Source: https://www.healthyhildegard.com/holistic-healing/ 25
Figure 8: 5 senses of the body Source : https://www.dreamstime.com/fivesenses-icon-set-vector-isolated-illustration-human-perception-taste-touch-hearing-smell-visionsensory-organs-brain-image186680798 26
Figure 9 : Mental health in elderly Source: https://preventionlane.org/mental-healtholder-adults 26
Figure 10: The sanctuary of asklepios at epidaurus Source: https://www.gutenberg.org/files/61612/61612-h/61612-h.htm 27
Figure 11: The church and spiritual healing Source: https://upload.wikimedia.org/wikipedia/commons/5/58/Rahn_Kloster_Sanct_Gallen_nach_Lasius.j
pg 28
Figure 12: Pavilion system and nightingale ward plan Source: https://issuu.com/manushisheth/docs/thesis_volume 28
Figure 13: Schematic site plan, King Edward Memorial Hospital, Mumbai -Town within a hospital Source: https://issuu.com/manushisheth/docs/thesis_volume.........................................................29
Figure 14: Three doshas in Ayurveda Source: https://www.healthbenefitstimes.com/the-three-doshas -in-ayurveda-vata-pitta-kapha/..............30
Figure 15: Evolution of healthcare architecture Source:https://issuu.com/manushisheth/docs/thesis_volume..........................................................31
Figure 16: Design theory to reduce stress in healthcare facilities Source: https://www.semanticscholar.org/paper/Towards-a-design-theory-for-reducing-aggression-inUlrich-Bogren/9c07b5972f8704b7d6e21a7a79f2852ada4490b7.......................................................32
Figure 17: Holistic care - Physical, social, psychological, spiritual Source: https://www.practicalnursing.org/importance-holistic-nursing-care-how-completely-care-patients: .............................................................................................................................................................33
Figure 18: Open spacial quality of a space Source: https://www.timescolonist.com/real-estate/multi-building-proposal-pitched-for-capital-iron-areacould-include-a-new-art-gallery-1.24353975.......................................................................................34
Figure 19 Explanatory theoretical model of the humanization construct in the Healthcare Professional Humanization Scale Model. Source: https://www.mdpi.com/16604601/16/20/3999/htm..........................................................................................................................35
Figure 20: Humanization of Care: Key Elements Identified Healthcare Providers. Source: https://link.springer.com/article/10.1007/s40271-019-00370-1...........................................................36
Figure 21: Patience centric healthcare Source: www.therapeutic-environments-devising-space-designs-that-provide-measurable-positive-effecton-patients-clinical-outcomes-part1-38-638.com...............................................................................37
Figure 22: Well-being of a patient
Source:https://www.researchgate.net/profile/UlrikaHultgren/publication/341342778/figure/fig3/ AS:905103317946369@1592804855654/Definition-of-Well-being.png............................................37
Figure 23: Piedmont Newnan Hospital Newnan, Georgia Source: https://contractdesign.com/practice/healthcare/ designing-for-health-thoughts-on-the-spiritual-inhealthcare/..........................................................................................................................................38
Figure 24: Children's hospital of Pittsburgh of UPMC Source: https://dlaplus.com/pages/children-s-hospital-of-pittsburgh-of-upmc-and-rangos-research..........38
Figure 25: Healing through architecture Source:http://waterlooarchitecture.com/bridge/blog/2015/07/30/thesis-healing-througharchitecture/ 39
Figure 26: Figure 20: Lucina Women and Children’s Hospital
Source:https://awards.rethinkingthefuture.com/rtf-awards-2020-winners/lucina-women-andchildrens-hospital-bh-architects/ 39
Figure 27: Types of healthcare facilities Source: by Author 40
Figure 28: Categories of specialization in healthcare Source: by Author 41
Figure 29: Types of specialty hospitals Source: by Author 42
Figure 30: Types of users and areas in a healthcare facility Source: by Author 43
Figure 31: Burden of illness type among Indians. Source : https://www.nap.edu/read/13361/chapter/20#373 45
Figure 32: Percentage distribution of population by age group to the total population by sex and residence, India 2012 Source: https://www.academia.edu/28726381/GERIATRIC_HOSPITAL.........46
Figure 33: Number of disabled per 100,000 elderly persons for different types of disability Source: https://www.academia.edu/28726381/GERIATRIC_HOSPITAL.........................................................47
Figure 34: Effects of effects on body in a therapeutic environment Source:
https://issuu.com/manushisheth/docs/thesis_volume 51
Figure 35: Factors affecting human body Source: Author Omar Youssef 52
Figure 36 : Experiment on 'How the color of interior walls influences the imagination' by the psychologists at the University of British Columbia, 2009 Source: Author Manushi Sheth........................................................................................................................53
Figure 37: Experiment on 'The relationship between ceiling height and thinking style' by psychologist Joan Meyers-Levy at the Cadson school of management Source: Author Manushi Sheth...................................................................................................................................................53
Figure 38: Design features for wayfinding in architecture Source: Author Manushi Sheth............54
Figure 39 : Design features for considerations of acoustics in architecture Source: Author Manushi Sheth..........................................................................................................54
Figure 40: The phycology of colors Source : Author Manushi Sheth................................................54
Figure 41: Ability of the brain to associate smell to a place Source: https://scentfie.com/scentcontrol-mood/.....................................................................................................................................55
Figure 42 : A view from the window - Thong house by Nishizawa Architects Source : https://www.archdaily.com/785311/thong-house-nishizawa-architects.............................55
Figure 43: Natural Sunlight entering the room Source : https://people.bath.ac.uk/zw305/ROOM/sunlighttab.php...............................................................56
Figure 44: Five senses of the body contributing to physchological effects Source : https://www.rethinkingthefuture.com/rtf-fresh-perspectives/a597-therapeutic-architecture-role-of-architecturein-healing-process/..............................................................................................................................56
Figure 45: Guilin Medical School Affiliated Hospital..........................................................................57
Figure 46 : Four storey building inspired by local culture and nature Source: Guilin Medical School Affiliated Hospital...........................................................................................58
Figure 47: Design concept Source : Guilin Medical School Affiliated Hospital.................................59
Figures 48 : Images and views of the structure Source: Guilin Medical School Affiliated Hospital.60
Figure 49: Karunashraya hospice
Source:https://static.wixstatic.com/media/bfc9d9_4b00dce50866459f99f28dcb5e31b40d~mv2.jp g/v1/fill/w_560,h_374,al_c,q_80,usm_0.66_1.00_0.01/Karunashraya_JPG.webp............................61
Figure 50: Karunashraya landscape - open spaces
Source:https://archnet.org/sites/5185/media_contents/44827.........................................................62
Figure 51: Water body surrounding at one side of all the wards Source: https://karunashraya.org/about-us/...................................................................................................63
Figure 52: Site plan Source : https://archnet.org/sites/5185/media_contents/44824.......................63
Figure 53: View towards the fountain in the water body Source: Google maps.............................64
Figure 54: Open ground for activities Source: https://archnet.org/sites/5185/media_contents/44827 64
Figure 55: View from the ward Source: Google maps 64
Figure 56: Maggie's London west center Source: https://www.archdaily.com/38246/richard-rogers-wins-stirling-prize-for-maggies-centre 65
Figure 57: Maggie's Manchester center Source:: https://www.archdaily.com/786370/maggies-cancer-centre-manchester-foster-plus-partners/ 5720b90de58ece0c35000005-maggies-cancer-centre-manchester-foster-plus-partners-photo 65
Figure 58: Design features in maggie's centers Source: Author Manushi Sheth 66
Figure 59: Maggie's Fife center kitchen table Source: https://www.zaha-hadid.com/2016/12/05/maggies-fife-10-years/ 66
Figure 60: Maggie's Lanarkshire center counselling room Source: https://www.dezeen.com/2014/10/20/reiach-and-hall-architects-maggies-centre-lanarkshirewalled-gardens/..................................................................................................................................66
Figure 61: Maggie's Manchester center floor plans Source: https://www.archdaily.com/786370/maggies-cancer-centre-manchester-foster-plus-partners.....67
Figure 62: Site option one Source: https://www.google.com/maps 70
Figure 63: Site distance from the city of Pune Source: https://www.google.com/maps 70
Figure 64: Site images Source: https://www.google.com/maps 70
Figure 65: Distance of site from the city of Mumbai Source:https://www.google.com/maps 71
Figure 66: Site option one Source: https://www.google.com/maps.................................................71
Figure 67: Road leading to the site Source: https://www.google.com/maps 71
Figure 68: Humanized spaces for elderly Source: https://nastroy.net/post/ikea-i-koroleva-shveciiadaptiruyut-modulnye-kvartiry-boklok-dlya-pozhilyh-lyudej-10-foto................................................71
Hospitals or healthcare facilities have always been a large part of my life while growing up as I come from a family with a medicine background. Since I spent a lot of time in these facilities, on the basis of my personal observations various questions started arising in my mind such as,
Why do we always experience anxiety while we are awaited in the hospital lobby? Why do all hospitals seem similar with the pain walls, medical odor and suffocating atmosphere almost creating a negative or uncomfortable ambience?
While researching about this I came across an approach defying the odds in the healthcare sector with an approach termed as “Holistic Healthcare”. The word “holistic” means relating to the idea that things should be studied as a whole and not just as a sum of their parts. “Health is a state of complete harmony of the body, mind and spirit. When one is free from physical disabilities and mental distractions, the gates of the soul open.” – B.K.S. Iyengar.
Whenever we experience the ambience of a new place, it has some influence over us consciously or sub-consciously. This is where the 4 senses of sight, touch, smell and sound of our body play a part in determining the aura of the place. If the image created by our mind is pleasant we get a serene feeling of comfort whereas on the other hand if the vision of the place is bleak we associate it with insecurity or uneasiness. Such places with negative mental impacts can cause distress and fear which can be mind-draining.
In holistic healthcare, the focus is on a patient’s overall health with consideration of the surrounding, rather than just the treatment of a specific disease. This holistic approach has been implemented in our Indian culture since decades through Ayurveda. But somehow with modernization we have failed to preserve some of the necessary or beneficial aspects of mental health in the new healthcare facilities. The physical environment contributes immense help in self-healing process of an individual. With time, patients started being seen as objects and not the main focus of the design. The environmental qualities that could be considered as psychosocially supported have not been explored.
If the spaces in the healthcare facilities are designed in order to humanize the areas for the patients, the psychological impact caused on the patients will give them a sense of relief and ease and make the ambience around a lot more peaceful. By using architectural elements or strategies the human senses can be stimulated in the created environment. Proper special planning methods, use of natural materials, and proper lighting methods - natural and artificial, planting certain plants in the landscape are few of the strategies that can be used to convert a stressful space into a calming and soothing place.
The holistic needs of patients in the healthcare sector is in every field of medicine but some of the user groups or patients suffering from specific chronic diseases have tremendous psychological needs which also affect their treatment process. As the healthcare sector is very vast it was important for the purpose of this thesis to narrow down to a specific specialized facility or user group which has large holistic needs but seem to be ignored in India specifically.
Asking the question, The treatment of which set of patients gets affected due to lack of psychological, emotional and spiritual needs in the Indian context? The answer to the question led to the identification of the Geriatric group on the basis of the L.S Raheja
analysis of the healthcare situation of various user groups in India.
Why is the perception of hospitals negative or intimidating even though it is the place we seek for treatment?
Can architecture contribute in improvising the mental health of patients by aiding in the healing process to make the injury easier to endure?
We always have a stereotypical image of a healthcare facility created in our minds which focuses mainly on the functional and practical aspect because of what we see in our surroundings. But in an ideal scenario, a user’s experience would also be a priority in the design making process, as the aesthetic and environmental factors play a large role in the recovery process of a patient. The ambience of the facility is not just essential for the recovery process of patients but also for the state of mind the doctors, nurses and family members of the patient during intricate times. Even though it is not a compulsory requirement for healthcare facilities in India, this concept is certainly very essential and if it had already been executed the circumstances of the healthcare sector today would’ve been uncomplicated. The question is why is there so much negligence towards such an efficient approach? The main reason is the lack of familiarity with the concept. The more the people see this idea being executed in the environs, the more it will start becoming a crucial part in the forthcoming programs.
The main aim is to study how a holistic approach in a healthcare setting can overlap with
L.S Raheja School of Architecturemodern-day western medicine, and go beyond the regular treatment of symptoms in order to support more than just the body.
1) To study how senses can be revitalized through architecture.
2) To understand the psychological effects of humanized architecture and the relation of the mind with the chemical process in the body responding to its surrounding.
3) To study various typologies of healthcare facilities.
4) To identify a category of users/patients in healthcare that has immense holistic needs and to research their specific requirements which can be fulfilled architecturally.
5) To analyze healthcare situation and requirements in India.
6) To identify special needs of the geriatric group of patients.
7) To investigate various issues faced by various user groups like patients, doctors, family members and staff.
To achieve the objectives of the study the following research methodology will be fulfilled:
Detailed literature review related to holistic approach in architecture and healing environments.
The need and requirement of physical aspects and architectural features in healthcare centers will be studied.
Analyzing the different types of healthcare centers in India and abroad.
Studying several categories of patients and their requirements.
Studying various newspaper articles written on issues faced by geriatric groups in India
Detailed case studies of successful holistic healthcare facilities or other facilities incorporating mental health.
Exploration of design considerations and interventions.
As proven, a patient’s mind-set contributes in speeding up the healing process of their body. In this case, it becomes vital to induce a holistic approach in the healthcare facilities. The immense stress caused on the patients, doctors, and family members can be reduced by understanding and implementing the study done in reality.
Due to such a vast topic for the purpose of this thesis it was important to identify the user group with immense holistic needs. Looking at the Indian context since there is need for specialized healthcare for geriatric groups there is immense scope in research.
Holistic approach will be a vital mandatory part of healthcare facilities in the future.
All healthcare facilities, hospitals, clinics have to encounter a multitude of patients that are struggling with problems and diseases on a day to day basis, with the hope to be treated at the earliest. Which simplifies that the main task of these facilities is to focus on the physical health with the help of the latest diagnosis and number of treatments available.
But the question that arises is that, “Are the physical diagnosis and treatments the only functions that can be embodied in a healthcare facility?” Can physical treatment be enough to completely get rid of the pain and illness caused to a patient? If the answer is yes, then what is the cause of the psychological aspects observed in the patient during and after recovery?
The environment plays a significant role to influence either positively or negatively on a patients healing process. According the World Health Organization (WHO), the health state of an individual is defined not only as being free from illness but also a complete physical, mental and social well-being. Hence, it can be derived that the function of a healthcare facility goes beyond body treatments.
Dated back more than 5000 years ago, the perfect balance of mind, body andsoul was considered as complete health in Ayurveda.
This concept in ancient India had been since pre-Vedic period where it was highly important to keep in mind the mental state of a patient for boosting the self-healing process of the body. Yet has somehow lost its essence in the medical field today.
As most of the hospitals and clinics Built in the 20th century were not designed for the healing of patients, reducing stress levels and considering comfort of family members of the patients.
Source: https://www.kottamparaayurveda.com/about_us
Consider, for example, how the focus of most hospitals is on the latest medical equipment’s using the latest technology, which slightly frightens the patients while the halls throughout are plain, practical and noisy. It is often a dehumanizing environment that runs counter to healing of the body but on the contrary cause immense stress on a patient and their family who endure it for a long period in the facility.
However, this is beginning to change as healthcare moves towards a more patientcentered and holistic model. With this increase in the awareness of mental health in healthcare it should become a general characteristic to be seen in these facilities.
These characteristics of an environment can create hope and positivity. They can either accelerate or vice versa, decelerate the healing process. It is clearly comprehensible that there is an active interaction between the environment and occupants. Thus, the quality level of this interaction eventually will be the determinative factor. To achieve this quality or increasing it in the hospital spaces, the environment not only should meet the medical needs of the patients but also should cover wide aspects of needs to provide different types of comfort, or in another word setting up the environment based on the human needs to make a place more pleasant or more suitable. Hence, it is imperative to have a clear concept of humanized spaces in healthcare centers that can be defined as holistic approach in healthcare.
Source: https://www.healthyhildegard.com/holistic-healing/
Holistic healthcare is a form of healing that considers the whole person - body, mind, spirit, and emotions - in the quest for optimal health and wellness.
It is an on going process and it is not a remedy to turn to in times of sickness but a principle to abide by through life. The role of architecture in this concept is limited to the psychological impact it leaves on the human mind.
Healthcare buildings should be designed with the idea of holistic treatment in mind, in addition to treatment through technological and scientific advances.
Figure 6: Holistic health - Whole health of the body Source: https://www.healthyhildegard.com/holistic-healing/
“Calling holistic medicine alternative medicine is no is no longer appropriate. The best approach now is ‘integrated medicine’ in which we take the best of both worlds." - Candess M. Campbell, Ph.D. in Clinical Hypnotherapy.
In order to achieve this, various architectural methods should be incorporated in the design making process beforehand. These strategies help in stimulating the senses of the human body. The physiological effect that are caused through architecture helps reducing the amount of stress that creates this uneasy, unpleasant atmosphere in the hospital. Including scenic views, open spaces, natural elements like trees gardens, landscape and use of natural materials like stone cladding to the walls etc. are a few of the ways a space can be converted from having a negative to a positive impact.
Analyzing the current scenario of healthcare industry in India, it was noticed that the holistic needs of patients was generally not being fulfilled in the healthcare facilities but the most prominent part was that even the patients that are at a very vulnerable situation do not receive the mental and emotional help they require the most.
The geriatric patients are one of the most venerable user groups today in healthcare. The most saddening part about this situation is that geriatric medicine is not a separately recognized part of healthcare study or degree in India. Hence the normal physicians treat the elderly population when in actuality there should be designated doctors with a geriatric degree practicing in a geriatric hospital treating the senior citizens physically mentally and emotionally.
Along with the drawback in the healthcare system the old people are most commonly observed to have immense mental issues hence it becomes all the more important to introduce geriatric facilities that provide mental, social, emotional and physical needs to the elderly patients which can be provided architecturally.
Figure 8: 5 senses of the body
Source : https://www.dreamstime.com/five-sensesicon-set-vector-isolated-illustration-humanperception-taste-touch-hearing-smell-visionsensory-organs-brain-image186680798
Figure 9 : Mental health in elderly
Source: https://preventionlane.org/mental-healtholder-adults
A study of the evolution of healthcare is required to comprehend when and how healthcare, in terms of holistic treatment, began to fail and to attain a better understanding of the current healthcare practices and requirements.
In ancient Greece and Rome, an Asklepion was a healing temple, sacred to the Greek God of medicine Asklepios. The Sanctuary at Epidaurus hospital facilities is an eminent example of a Hellenic architectural ensemble of the 4th century BCE. It is the earliest organized sanatorium.
Archaeological evidence provides proof that Asklepieia offered in antiquity what we nowadays call holistic health care. Each activity that took place at Epidaurus was designed to harmonize the mind, body, and soul.
The theatre of Epidaurus was where visitors could attend performances and escape from their debilitating problems. After having attained a calm and mentally relaxed state, they were led to the main therapeutic space, the Abaton; further was followed by the main healing phase, known as enkoi-mesis.
During sleep in the Enkoimeterion, the patient allowed himself to dream of the God, who would visit him and offer the healing treatment that was needed. The sanctuary with its peaceful natural surroundings invited people to explore the forces of nature and those within themselves. Thus, it is the ultimate example of holistic care.
Figure 10: The sanctuary of asklepios at epidaurus
Source: https://www.gutenberg.org/files/61612/61612-h/61612-h.htm
L.S Raheja School of Architecture
Early in history, the sick were cared for in their homes. As the Roman Empire turned to Christianity, the Church's role in looking after the infirm within their churches. After 400 AD, the Catholic Church became the most powerful provider of health care, and monastic orders were the caretakers for the sick. The monarchs of the 6th century reinforced this role with emperors that a hospital should be attached to every cathedral that was built in the empire.
Religious institutions continued to provide most of the healthcare to the poor in large, open wards housing multiple patients which continued to expand and became the standard for the public hospitals for hundreds of years. Often the wards were configured so the sick could see the altar to assist with their recovery.
The cross-shaped plan achieved this goal with the altar in the middle and multiple wards radiating from it. The plan is similar to many hospitals today, with the nurse's station instead of the altar at the center. The Church emphasized in the healing power of prayer and encouraged spiritual interventions as treatment procedures.
Figure 11: The church and spiritual healing
Source: https://upload.wikimedia.org/wikipedia/commons/5/58/Rahn_Kloster_Sanct_Gallen_nach_Lasius.jpg
iii) The Pavilion system and nightingale wards L.S Raheja School of Architecture
In the late 1700's a re-evaluation of the hospital form was prompted by the new recognition of clean air and hygienic conditions as agents of health, especially in hospital environments.
Florence Nightingale was a very influential figure in nursing following the Crimean war in 1854. Her approach towards a healing environment for patients not only looked at the physical surroundings but also at the social welfare of her patients. She focused on providing patients with access to natural light, air, landscape, attention to diet, as well as a clean, sanitary environment.
The pavilion plan allowed light and fresh air to penetrate and created garden views between the building crenellations. This design emphasized function over form.
Due to its large horizontal spread and the imminent crunch of space in cities, the typology died out. It was one of the best conceived ideas of healthcare architecture.
Figure 12: Pavilion system and nightingale ward plan
Source: https://issuu.com/manushisheth/docs/thesis_volume
In the hospital boom following World War II, Florence Nightingale's Original concept of hospitals was replaced by hospitals that prioritized efficiency over human comfort and healing.
A typical hospital configuration became a deep span, multi- floor block. Building technology aided in this transformation with a new ability to create long-span structures, mechanically ventilated interior spaces, and movement of people vertically with elevators. Through time, with the progression of diagnostic and treatment facilities, this platform has gotten bigger and taller, limiting access to the aspects of natural air, light, and view. Designers and builders maximized the machine-like efficiency of hospitals without evaluating how these changes in form related to human health, stress, and comfort.
The hospitals no longer functioned as "healing centers”. They were taken over by equipment and machinery. With everything from ventilation to circulation mechanized, the only scope for architectural intervention remained in the design of smooth functionality to support the mechanics and the aesthetics. Thus, the huge chunks of mass or rather the platform and podium transformed into decorated blocks of buildings from the outside as well as inside.
Although this concept has started coming back to the lime light in the recent years, it actually dates back to a thousands of years ago, having its roots deep into the Indian culture that seemed to have been faded with time.
The history of healthcare in India can be traced to the Vedic times (5000 BCE), Atharvaveda, one of the four Vedas, is considered to have developed into Ayurveda, a traditional Indian form of holistic medicine Ayurveda worked on the principal of, the combination of certain characteristics that comprise one’s constitution (doshas) is derived from a person’s physical, mental and emotional composition.
Ayurveda applies the Thridhosha theory of disease. Thridhosha describes three dhoshas, or biological elements, which are linked to a patient’s health: Vata (wind), Pitta (gall) Kapha (mucus). Disease is explained as a disturbance in the equilibrium of the three dhoshas, a concept similar to the theory put forward by Greek medicine.
Figure 14: Three doshas in Ayurveda Source: https://www.healthbenefitstimes.com/the-threedoshas -in-ayurveda-vata-pitta-kapha/
Historical records show that efficient hospitals were constructed in India by 600 BC. During the splendid reign of King Asoka (273-232 BC), Indian hospitals started to look like modern hospitals.
During the Mughal rule in King Akbar's period the Unani medicine system spread all the way through the greater part of India. During his period, there were a good number of government hospitals, as well as private clinics run by many physicians.
In the 17th century, the modern system of medicine in India was introduced by the British emperors and the Christian missionaries in South India.
The architecture of healthcare facilities has undergone drastic changes along the way. During this evolution, the healing ability of architecture is lost in the transition from healing spaces to functionalist buildings. Healthcare today focuses on the ease of functionality and has side-lined the well-being of the patients and caregivers in architectural design and spatial planning. Aesthetics of the building are given precedence over the quality of space. With the space crunch and high real estate rates, healthcare buildings have expanded vertically without consideration of therapeutic spaces.
Hospitals in the current times are home to machinery and designers attempts to conceal this machinery. Healing is prioritized from the medical and techno- logical point of view. The psychological effects on the patients waiting in long corridors or family awaiting results of their loved ones in the emotionless waiting rooms are not considered relevant as opposed to the efficiency and smooth functioning of the hospital.
Source:https://issuu.com/manushisheth/docs/thesis_volume
"During the modern era, the hospitals became more machine than monument, a stripped- down, functional series of boxes accommodating the increasingly complex technical apparatus for prolonging life. Architecture flatlined." - Edwin Heathcote, Architect.
What will we define good architecture as? It is not about something which looks good, it is about something which makes us feel good. It is not the beauty or aesthetics of a building which makes us stay longer, but it is the feel we get there. "We build the buildings that end up shaping us"Winston Churchill.
Hospitals often instill so much fear and anxiety in patients which promotes a stress response and the body becomes weak and unable to handle medications and treatments received in hospitals. Everyone seeks healing for their mental and emotional wounds. Healing has an ability to make us feel better. Any space, view, colour, person or anything can make us feel better. In order to create a healing environment, it is necessary to study and understand about the human psychology, feelings, attitude and behavior and also the physical aspects (i.e. Day lighting, window design, thermal conditions), which can positively influence the human psychology. The well designed architectural spaces and surroundings is physically healthy and have positive impact on the human psychology.
Architecture takes a holographic approach at the effectiveness of art to promote healing therapy of connecting with the inner-self to bring about change in a person's lived experience. Healing involves a process where recipient receives a physically external antidote to help them heal "Architecture has its own realm. It has a special physical relationship with life. I do not think of it primarily as either a message or a symbol, but as an envelope and background for life, which goes on, in and around it, a sensitive container for the rhythm of footsteps on the floor, for the concentration of work for the silence of sleep."-Zumthor, Peter.
The term “holistic health” is used many times in literature with a variety of different connotations. Holism also has its origin in the Greek word holos, which means “whole.” Holism is not about any cult or religion, rather, it is an approach that looks at things in a total perspective. Holistic health or holistic healing is often defined as a form of healing that looks at the whole person: body, mind, and spirit. This kind of holistic healing often involves multiple complimentary medicines and alternative healthcare practices that can overlap with modern-day western medicine, but will go beyond the singular treatment of symptoms to support more than just the body.
According to the holistic medicine philosophy, one can achieve optimal health by gaining a proper balance in life. A holistic approach to healing goes beyond simply eliminating symptoms. In holistic medicine, a symptom is considered a message that something needs attention. The symptom is then used as a guide to look beyond the surface for the root cause. After which, what really needs attention can be addressed.
Holistic medicine is also based on the belief that unconditional love and support is the most powerful healer and a person is ultimately responsible for their own health and well-being. Other principles of holistic medicine include the following:
All people have innate healing powers. The patient is a person, not a disease. Healing takes a team approach involving the patient and doctor, and addresses all aspects of a person's life using a variety of health care practices.
Treatment involves fixing the cause of the condition, not just alleviating the symptoms.
Figure 17: Holistic care - Physical, social, psychological, spiritual Source: https://www.practicalnursing.org/importance-holisticnursing-care-how-completely-care-patients:
The goal is to engage patients in the process of healing and recovery. As a result, spaces should be designed to reduce patient and family stress. Healing through architecture aims to:
Eliminate environmental stresses, such as noise, lack of privacy, poor air quality and glare.
Connect patients to nature.
Enhance the patient's feeling by offering options and choices e.g. - privacy versus socialization type of music etc.
Encourage opportunities for social support.
Inspire feelings of peace, hope, reflection and spiritual connection.
Figure
Source: https://www.timescolonist.com/real-estate/multi-building-proposalpitched-for-capital-iron-area-could-include-a-new-art-gallery-1.24353975
Creating holistic environments helps in developing calming and peaceful spaces that reduce the stress levels in the environment while also increasing its comfort levels and the use of natural materials will build the sense of familiarity and pleasant atmosphere.
What does it mean to be human? According to the dictionary it means belonging to mankind. We often hear or read a lot of times about humanizing things but we often ignore what it really means and the value it holds. Just like the term ‘Humanization’ simply means to give a human nature or character to a space, object or thing. But why does a creation made by humans needs to be humanized? For example, the concept of humanization of hospitals came into existence after it became a common practice in healthcare facilities to direct their central focus towards the treatment of a patient’s disease. It is a misconception that suffering is only exclusive to patients or their relatives, however it is also equally stressful to the health professionals, who feel to be at the center of the depersonalization process. Over-technification and the fact that the disease process is sometimes the only priority of healthcare activities, together with the ever-increasing influence of institutional power seen in recent times, all cause the health professionals to be the first in demanding a change in health institution dynamics.
Figure 19 Explanatory theoretical model of the humanization construct in the Healthcare Professional Humanization Scale Model.
Source: https://www.mdpi.com/16604601/16/20/3999/htm
Human centrality is an approach which focuses on human beings and their survival, attention to human health and its promotion is one of its basis. Hospitals are designed to use medical healing incorporated with the latest modern techniques as much as possible. While well-documented, stress, depression, and anxiety have detrimental effects on health, it has become increasingly important today with the advent of the new approach. The origin of any architectural work is based on some foundations; Form, performance, technology, and content can be considered as the architectural basis, each one plays a role in the genesis of an indelible work; Forms in the form and geometry of building and beauty, performance in the use of space and efficiency, content in the identity and theoretical foundations of the work and technology as usual including tools, machinery, and construction techniques considered as a phenomenon derived from human thought and created for human comfort and tranquility in accordance with the way of thinking and his intellectual foundations. Human transforms the environment according to his needs, values, and goals and is interactively influenced by the transformed environment, especially advanced technology makes a human
L.S Raheja School of Architectureimpact on the environment intensify and accelerate. Some consider these rapid changes in the environment as a destructive factor and believe it will lead to the dissolution of the "humanenvironment" system, emphasizing that any fundamental and profound change in the natural environment must be executed according to its long-term impact on humans to predict its positive and negative results. - Nazer Ilkhani & Rahaei, 2015. What distinguishes environmental psychology from other branches of psychology is the study of the relationship between behaviors based on the human psyche and the physical environment. Therefore, the designers' attention to the psychological study of designed spaces has created an inseparable link between environmental psychology and design; as far as the architects realized the need to create a common language between them and psychologists, and sought to build and create new knowledge to create an environment that could be better known to the public.
Figure 20: Humanization of Care: Key Elements Identified Healthcare Providers. Source: https://link.springer.com/article/10.1007/s40271-019-00370-1
Modern psychology, assuming the indirect effect of the physical environment on human behavior, which ultimately required itself to examine architectural and urban environments, on the one hand, and on the other hand, paying attention to environmental designers to meet the needs of customers and users of designed spaces, led to the familiarity of psychology with the design profession, and vice versa and as a result, the seed of new knowledge or a new paradigm called "environmental psychology". -Nazer Ilkhani & Rahaei, 2015. One of the facilities that have a high-level sensitivity for design is medical centers, due to the special conditions of patients in terms of their physical, mental, and emotional. Research has shown that employees of medical centers and hospitals are more exposed to diseases and occupational injuries than employees of other departments. Therefore, the architecture of medical centers can play an important role in improving and promoting the safety and health of the work environment for the employees of these centers. -Hasanpour, baqeri, & Almasi, 2012.
L.S Raheja School of ArchitectureFigure 21: Patience centric healthcare
Source: www.therapeutic-environments-devising-space-designs-that-provide-measurablepositive-effect-on-patients-clinical-outcomes-part1-38-638.com
Now, if we consider illness and the need for medical services as a real and integral part of life, it is inevitable that the need for standard centers that are appropriate to the diseases and needs of the human is an essential part of life. That is why the need to plan, equip, and transform these centers based on new science is felt. It should be noted that an advanced hospital, clinic, or medical center includes a very complex and diverse set of needs, contradictions, equipment, and facilities. By fairly looking at this issue, we find that the purpose of creating architecture is not only to meet its physical and material needs but also to pursue a much higher goal, which is to communicate with the deepest human feelings and emotions. If we consider the attention to psychological issues in the architectural design along with the factors of efficiency, stability, and economy as one of the duties of the process of creating architectural works, the position of this important, especially in designing health and medical spaces, requires a more important rank.
Figure 22: Well-being of a patient
Source:https://www.researchgate.net/profile/UlrikaHultgren/publication/341342778/figure/fig3/ AS:905103317946369@1592804855654/Definition-of-Well-being.png
In order to bridge the gap between humans and the environment, the concept of humanization should be applied in such a way that human traits are applied not only from the object's point of view but also from other human perspectives in the environment. -Martos, et al., 2018. The concept of humanization has been considered during the last decades as an essential step for perceiving its implication in hospital design practice, therefore, paying attention to the right meaning of humanistic design approach and to interrogate the language of humanization, in order to better understand it as a design goal is crucial, which has been neglected since ages. The term humanization in a wide range of contexts is often referenced as a trend idea about the hospitals, tapped into social, political, intellectual and economic trends around the world instead of its right meaning and implications. So that these ideas restricted the ability to implement humanistic design for the patient, visitor, and staff.
At the beginning of the new era methods that architects implied in modern hospitals were putting the patient experience at the center of their design strategy which mostly the main purpose of the complex architecture in these buildings was to "normalize" the healthcare environment and making them look normal, rather than being a place for sick people. While putting the patient at the center of the target design strategy was right, but good hospital design should inspire wellness and healthcare architecture progresses as inspiration when the architects consider medical technology and landscape rather than as restriction or things to be hidden. (Adams, 2017) Therefore, the concept of humanization of a healthcare service can be evaluated as an essential factor related to the comfort level and user need satisfaction and by evaluating the user's point of view, upgrading and enhancing the space is more possible aimed at imposing positive Intervention and changes toward more humanization and comfort level by the relative authorities. -A. Bellagarda, et al., 2014.
Figure 23: Children's hospital of Pittsburgh of UPMC
Source: https://dlaplus.com/pages/children-s-hospital-ofpittsburgh-of-upmc-and-rangos-research
Figure 24: Piedmont Newnan Hospital Newnan, Georgia
Source: https://contractdesign.com/practice/healthcare/ designing-for-health-thoughts-on-the-spiritual-inhealthcare/
The humanization of spaces focuses on physical and mental needs of the patient thus it is derived from architectural psychology in which studying the interactive processes between man and environment, is an important factor to determine the quality of hospital as the functional and technological center of medicine simultaneously is the connector of human and environment.
The quality that is closely related to health, can be achieved by focusing the human needs to understand their interaction with the environment, a matter which always was neglected.Pellitteri & Belvedere, Humanization and Architecture in Contemporary Hospital Building, 2011.
Figure 25: Healing through architecture
Source:http://waterlooarchitecture.com/bridge/blog/2015/07/30/the sis-healing-through-architecture/
Figure 26: Figure 20: Lucina Women and Children’s Hospital
Source:https://awards.rethinkingthefuture.com/rtfawards-2020-winners/lucina-women-and-childrenshospital-bh-architects/
quality of design so they are more affected by the humanization of those dedicated space than staff. So perceived hospital environment quality will be improved when a degree of humanization increases in space. -Fornara, Bonaiuto, & Bonnes, 2006. Hospitals are places in which solidarity, equity, and participation must be found as the conditions of effective enjoyment of right in the space.
Hence, a good architecture can promote effective enjoyment of social rights by emphasizing the right to health in the hospital space. Humanization of hospital spaces is not only called to reduce and remove the disease but on one hand, they have to be the provider of health rights services for community in order to answer the new social needs for citizens. It is clear that simply designing a functional and therapeutic set is not enough, and other factors are involved in achieving the goals set.
Elements that may be seemingly intangible but directly affect the quality of spaces and the patient's mood; Items such as harmony, variety, sense of control over space, etc., which are often less considered in the design of hospitals.
A health facility is, in general, any location where healthcare is provided. Health facilities range from small clinics and doctor's offices to urgent care centers and large hospitals with
L.S Raheja School of Architectureelaborate emergency rooms and trauma centers. The number and quality of health facilities in a country or region is one common measure of that area's prosperity and quality of life Healthcare facilities are not only limited to a hospital or a clinic, a brief look at the healthcare industry shows a lot of different types of facilities which help in easing the burden on large hospitals.
Healthcare facilities can be differentiated based on a variety of factors that includes functionality, size, location, ownership and specialization.
Functionality refers to whether the hospitals are general-purpose, teaching hospitals, acute care facilities, long-term hospitals, community hospitals, research hospitals or if they provide trauma care for patients. It refers to how the hospitals themselves function within the communities they serve.
There are three primary classifications when it comes to size:
Small hospitals: Fewer than 100 beds
Medium hospitals: 100 to 499 beds
Large hospitals: 500 or more beds Typically, these sizes are classified by the number of beds they have although there can be some variation within these groups of hospitals and medical centers.
They can also be classified by their locations. Rural hospitals aid smaller communities and often have limited access to advanced equipment also face competition, urban hospitals serve larger metropolitan areas and must often offer a wide degree of versatility when it comes to treatment options and patient experience.
Ownership of the hospital also tells a lot about how the hospital will operate.
Some hospitals are a part of larger networks that offer a streamlined approach to management. While some physicians feel this improves efficiency and patient experience, some feel it removes the emphasis from the patient and makes treatment less personal.
Private hospitals often offer access to the latest technologies and equipment, but may underserve community members who need healthcare the most.
Government-supported facilities operate via grants and other public funds. They have greater restrictions but also reach out to members of the community who may not otherwise receive healthcare and medical treatment.
Specialized hospitals appeal to physicians who entered the medical field with plans to treat people with a specific condition. Most physicians choose specializations due to personal reasons, an area of intense interest or a desire to provide a comfortable life for themselves and their families.
Figure 28: Categories of specialization in healthcare
Source: by Author
In an ideal scenario all patients suffering from all kinds of illnesses whether severe, long term, minor or temporary require a holistic approach in their treatment. But since it is not a very common practice it is important to understand that chronic diseases affect a patients wellbeing in various ways patients experience low self-esteem, social isolation, body image issues and even severe depression as a result of their conditions. It’s important that patients and their caretakers don’t ignore these issues or view them as unimportant next to the physical disease process. Many of these emotional needs are beyond the reach of modern medicine and doctors, but holistic care
can help to fill that gap.
Types of specialty hospitals that treat chronic diseases with a requirement of holistic needs are:
1) Multi- specialty hospitals
2) Cardiac hospitals
3) Pediatric hospitals
4) Geriatric hospitals
5) Cancer treatment hospitals
6) Trauma center
7) Neurology hospitals (brain)
8) Bariatric hospital (obesity)
9) Oncology hospitals (tumor)
10) Psychiatric hospitals
Out of these specialty hospitals or healthcare centers cancer treatment hospitals, oncology hospitals and trauma centers are comparatively most likely to have holistic approach incorporated at least in the working system of the facility if not the design.
Most probably Psychiatric hospitals also have mental health programs included in the working systems.
Cardiac, Pediatric, Geriatric, Neurology and Bariatric hospitals have an essential need for humanized designs and holistic working systems but are more commonly ignored.
When it comes to the healthcare industry, it includes a lot of spaces or rooms that are designed in a certain way so as to fulfill the required function which cannot be changed or to be precise should not be redesigned for aesthetic purposes. For example, departments like:
L.S Raheja School of Architecture1. ICU, ICCU, NICU
2. Operation theatres
3. Special wards
4. Recovery room
5. Radiology/ECG or 2D echo
6. Pathology
7. Areas that don’t give access to patients like sterilization, server, storage rooms and HR office. Such rooms or spaces cannot incorporate a holistic approach architecturally hence they shall not be considered for this particular aspect.
On the other hand, spaces where patients spend most time recovering and getting treated should incorporate a holistic environment. For example:
1. General wards – Male and female
2. Physiotherapy and stress test rooms
3. Rehabilitation wards
4. Isolation wards
5. Consultation rooms
6. Common rooms or spaces like; Registration/ billing, waiting room, canteens, auditoriums, doctor/staff rooms, etc.
In order to create a holistic environment, it is not only necessary to create calm areas for patients but also for other users like doctors, nurses and family members to keep a less stressful environment for all.
Figure 30: Types of users and areas in a healthcare facility
Source: by Author
Architecture
The comparison is not to indicate which is better than the other. It only shows what are the pros and cons in each to get better clarification.
The need of today’s healthcare industry is dependent on the latest technology, equipment and modern medicine development but at the same time it also has a requirement to fulfil psychological needs.
An ideal healthcare facility would be a facility that is very well equipped and provides all services with the latest technology and machinery while also inducing a holistic approach in the working as well as the design of the facility.
The healthcare industry is indispensable to the holistic needs of every patient in any sector. For example, Cancer and trauma patients require a lot of emotional support for recovery. However, besides these facilities there is a particular sector which is often bypassed in the healthcare industry which is the Geriatric healthcare sector. It is not an unknown fact that very few geriatric care facilities exist in India. “The concept of geriatric care has drawn a black in our country.”- Consultant physician, Dr. Rohit Barman at Breach Candy Hospital. It is unfortunate that Indian Medical Science does not even offer geriatrics as a branch of study. There is only one university in India that offers the degree. How aware and sensitive are we about geriatric care in our country and are there enough geriatricians to cater to the ageing population?
India has about 112 million elderly population that deal with multiple physical, social psychological, and economic problems with unmet needs in all domains of health. Over the years, as the average longevity of humans increased, so has the need for specialized care in older age.
Makes use of latest technology and equipment Encourages natural methods and remedies
In the west, it is a specialized field and they have doctors who specialize in tending to older people. In our country, however, the physicians cater to the older people along with all the other age groups.
Figure 31: Burden of illness type among Indians.
Source : https://www.nap.edu/read/13361/chapter/20#373
One in five elderly persons in India has mental health issues. Around 75 per cent of them suffer from a chronic disease. And 40 per cent have some or other disability. These are the findings of the Longitudinal Ageing Study of India (LASI) released by the health ministry of India. The survey found that more than one in 10 people aged 60 and above have “probable major depression”.
“We find that senior citizens are the most vulnerable group after their transition from being confident to self-doubting. They need special attention and emotional care,’ said Kartik Rajagopal, regional director, south, Fortis Healthcare.
In addition, Indian elderly face several social issues such as loneliness, elder abuse, neglect, lack of income security, and poor access to health care. Health Care for elderly people cannot be fully achieved unless we consider complete health of the individual, i.e., physical, social, economic, psychological, and spiritual aspects. Unless we address all these issues, geriatric health cannot be ensured. The biggest aspiration of the elderly in India is to live independently with dignity.
Geriatrics differs from standard adult medicine because it focuses on the unique needs of the elderly person. The aged body is different physiologically from the younger adult body, and during old age, the decline of various organ systems becomes manifest. Previous health issues
L.S Raheja School of Architectureand lifestyle choices produce a different constellation of diseases and symptoms in different people. The appearance of symptoms depends on the remaining healthy reserves in the organs. Smokers, for example, consume their respiratory system reserve early and rapidly India is undergoing an epidemiologic and demographic health transition, the average life expectancy of Indians has increased over the years on account of advancement in medical technologies, penetration of better healthcare facilities, better education & living conditions, increased per capita income and better affordability for services. Consequently, the percentage of elderly people (above 60 years) has increased from 5.3% of the total population during 1971 to 6.9% in 2001. As per the 2010 census projection the old aged population was 7.5% of India's population. India has thus acquired the label of "an ageing nation" as per the classification of United Nations.
Source: https://www.academia.edu/28726381/GERIATRIC_HOSPITAL
The increasing number of elderly persons has a direct impact on the demand for health services due to the consequent rise in degenerative diseases of aging and changing life style. Elderly people suffer from both communicable as well as non-communicable diseases; further, this is compounded by impairment of sensory functions like vision, hearing, and stability management. Poor life style, decline in immunity as well as age-related physiologic changes lead to an increased burden of communicable diseases in the elderly. In the population over 70 years of age, more than 50% suffer from one or more chronic conditions. The rapid urbanization and Societal modernization has also brought in its wake a breakdown in family values and the Frame work of family support, resulting in economic insecurity, social isolation, and elderly abuse leading to a host of psychological illnesses. This demands a timely initiative in this direction by the policy makers to arrange and mobilize additional resources for the geriatric population. At the same time, it emerges as a challenge and major responsibility of health care providers in India. However, there is an acute dearth of specialized geriatric care units in hospitals or as standalone centers in the state.
Age considerationThere is no set age at which patients may be under the care of a geriatrician or geriatric Physician but in general people over 60 years of age are considered under geriatric care. (Agarwal G. , n.d.)
L.S Raheja School of Architecture
A) Need for specialized care for elderly geriatric illnessFigure 32: Percentage distribution of population by age group to the total population by sex and residence, India 2012
The old age people are more susceptible to chronic diseases, physical inability and mental inabilities which depend on the social values as well. Due to deteriorating physical conditions their body is more prone to illness which is multiple and chronic in nature. People have wrong perception that ailments are part of old age and they accept the sufferings and the physical trouble even though they are curable, so this results in neglecting the health conditions.
Figure 33: Number of disabled per 100,000 elderly persons for different types of disability Source: https://www.academia.edu/28726381/GERIATRIC_HOSPITAL
Most of the elderly patients, among the population over 60 years age, 10% suffer from impaired physical mobility and 10% are hospitalized at any given time, both proportions rising with increasing age. In the population over 70 years of age, more than 50% suffer from one or more chronic conditions. The chronic illnesses usually include hypertension, coronary heart disease, and cancer.
3.7 million suffer dementia 40 million suffer from poor vision
1.6 million annual stroke cases
1 in 3 suffer from arthritis 1 in 3 has hypertension
1 in 5 has diabetes
1 in 5 has auditory problems
1 in 4 suffer from depression
1 in 10 falls and sustains a fracture
I in 3 bowel disorder
Cancer is 10 times more common.
According to Government of India statistics, cardiovascular disorders account for one-third of elderly mortality, respiratory disorders account for 10% mortality while infections including tuberculosis account for another 10%. Neoplasm accounts for 6% and accidents, poisoning, and violence constitutes less than 4% of elderly mortality with more or less similar rates for nutritional, metabolic, gastrointestinal and genito-urinary infections.
An Indian Council of Medical Research (ICMR) report on the chronic morbidity profile in the elderly, states that hearing impairment is the most common morbidity followed by visual impairment. However, different studies show varied results in the morbidity pattern. A study reported decreased visual acuity due to cataract and refractive errors in 57% of the elderly
L.S Raheja School of Architecturefollowed by pain in the joints and joint stiffness in 43.4%, dental and chewing complaints in 42%, Limited supply of medical and para medical personnel trained in Geriatric medicineMadras Medical College in Chennai is the only college in India offering an M.D course in Geriatrics and the number of MD Geriatrics seats is limited to three per year. There are no other formal training centers for geriatric care and hence there is a dearth of availability of medical and paramedical geriatric specialists. The Government hence under the NPHCE, had issued orders to extend the reach of medical care for the elderly in all the levels of the healthcare - tertiary, secondary and also primary. Government also has planned the Inclusion of geriatric course in the syllabus of medical courses and also courses for nurse. (Agarwal G. , n.d.)
Another important area is the mental condition of the old aged people. People of all ages feel sad or depressed but it is observed that the degree of depression increases with increase in age. In India, the suffering of elderly by metal disorders is under-reported because the elderly don't go for a regular check-up to a hospital and the common mental disorder observed is dementia. Dementia is defined as the global deterioration of individual's intellectual, emotional and cognitive faculties in a state of impaired consciousness.
Social and cultural impacts on healthThe elder people after retirement restrict their activities resulting in limited usage of their mental ability, and slowly confine themselves to the house and even reduce their physical activity. It is deeply rooted in the Indian mind that old age is the age of ailments and the elderly consider many of the health issues that can be cured as natural and inevitable. There is a perception in the society that aged people should their living habits especially their diet by eating less, sleeping more and developing religious interest. However, due the lack of physical activity, absence of work and irregular sleeping habits health issues arise.
In the past traditional families were the key institutions that provided psychological, social, and economic help to the family members. The elders in the family were respected and approached for advice and were taken care of. However, with urbanization and modernization nuclear families are not able to support the aged family members; this has put a great social strain on the healthcare of the elderly. The rapid urbanization and societal modernization has brought in its wake a breakdown in family values and the framework of family support resulting in, economic insecurity, social isolation, and
L.S Raheja School of Architectureelderly abuse leading to a host of psychological illnesses. (Agarwal G. , n.d.)
Other issues in geriatric care-
The other key issues in geriatric care is as follows,
Non availability of hospital care
Financially dependent on children and relative
Failing health
Isolation
Lack of preparedness
Transportation Issues
Absence of social security
Difficult to get continuum care
Proper referral mechanism is not available
Disabilities in the old age cause difficulty in doing their day to day activities.
Geriatric department – Medical
Cardio geriatrics (focus on cardiac diseases of elderly)
Geriatric dentistry (focus on dental disorders of elderly)
Geriatric dermatology (focus on skin disorders in elderly)
Geriatric diagnostic imaging
Geriatric emergency medicine
Geriatric nephrology (focus on kidney diseases of elderly)
Geriatric neurology (focus on neurologic disorders in elderly)
Geriatric oncology (focus on tumors in elderly)
Geriatric pharmacotherapy
Geriatric psychiatry or psychogeriatric (focus on dementia, delirium, depression and other
psychiatric disorders)
Geriatric rehabilitation (focus on physical therapy in elderly)
Geriatric rheumatology (focus on joints and soft tissue disorders in elderly)
geriatric subspecialty medical clinics (such as geriatric anticoagulation clinic, geriatric assessment clinic, falls and balance clinic, continence clinic, palliative care clinic, elderly pain clinic, cognition and memory disorders clinic) (Agarwal G. , n.d.)
Geriatric departments - Surgical
Orth geriatrics (close cooperation with orthopedic surgery and a focus on osteoporosis and rehabilitation).
Geriatric Cardiothoracic Surgery
Geriatric urology
Geriatric otolaryngology
Geriatric General Surgery
Geriatric trauma
Geriatric gynecology
Geriatric ophthalmology
Other geriatrics subspecialties
Geriatric anesthesia (focuses on anesthesia & perioperative care of elderly)
Geriatric intensive care unit: (a special type of intensive care unit dedicated to critically ill elderly)
Geriatric nursing (focuses on nursing of elderly patients and the aged).
Geriatric nutrition
Geriatric Occupational Therapy (part of Geriatric Rehabilitation)
Geriatric Physical Therapy
Geriatric podiatry
Geriatric psychology (Agarwal G. , n.d.)
“The greatest revolution in our generation is the discovery that human beings, by changing the inner attitudes of their minds, can change the outer aspects of their lives.” (Levitt, Andrew. 2015). Hence adopting such a spatial design that caters to physiological and psychological needs does not only help people interact better but also add more meaning to therapeutic architecture. Designing exquisite spaces closely associated with the natural environment certainly lead to human healing and well-being.
The concept of designing Architectural spaces by considering natural factors like sound, light, color, smell and pleasant views connect to human senses and proves to show more ability in the physical and psychological healing of patients. Architectural spaces directly affect human emotions in a way that pleasant Architectural space helps in the natural process of healing of their body. (Zohby, n.d.)
The concept of therapeutic architecture is a term derived from opposition to the austerity of modern healthcare facilities, implied to an environment that aims at providing a situation, able to promote a healing environment factors through considering natural factors such as sound, light, color, privacy, views, and even smell to affect both positively on physical and psychological patient healing. Despite setting up the functional requirements, medical practices and technologies involved with, patient safety and care quality, the architecture of a healthcare facility should be designed to be characterized as a psycho-socially supportive therapeutic environment, whereby it embraces also the families and personnel. (Grinde & Patil, 2009)
Flavio Albanese stated the mind-body-spirit balance as the meaning of wellness. It is very important to study the architecture of healthcare facilities which not only plays an important role to create healing spaces but also plays a great role in the community and ever progressing technology. (Zohby, n.d.)
Raheja School of ArchitectureFigure 34: Effects of effects on body in a therapeutic environment Source: https://issuu.com/manushisheth/docs/thesis_volume
In order to improve the patient outcome, four important factors must be considered and implemented when the healthcare environment is being designed:
1. Reducing or eliminating environmental stressors such as noise, crowding, odors, pollution, etc.
2. Providing positive distractions for example, view of nature from patient rooms, lobby, waiting and other "high stress” areas; access to nature by means of healing gardens, chapel or meditation room; artwork, music, pets and other activities or elements that allow for a sense of stimulation which can help nurture a patient's sense of positive well-being.
3. Providing spatial social support where the users can interact with others without difficulty, for example, non-fixed seating, round tables, etc.
4. Offering a feeling of autonomy and self-control, of choosing or adjusting how patients spend hospitalization time, of doing their own work in their own way in the environment such as controlling the light quantity, the level of the noise, visual content, ability to move and locate, etc.
Experiencing architecture has less to do with the aesthetics than its engagement with all our senses. People experience a space with their entire body, through movement, memory, and imagination. There exists a sub-conscious dialogue between a person and architecture. In architecture and spatial design, atmosphere refers to the sensorial quality that space limits. It is the impact of this atmosphere that affects the human mind and body. (Sheth, n.d.)
“We don't notice the noise, the bad air, the harsh conflict of hard-edged shapes and forms. We become immune to the negative forces in our environment and that is when they do us most harm! These factors subconsciously reflect on our emotions and mindset.” – Christopher Day.
RESULTS: Subjects were better at skills requiring accuracy and attention to detail such as catching spelling mistakes or keeping random numbers in short-term memory.
REASON: People automatically associate red with danger, which makes them more alert and aware.
RESULTS: Subjects engaged in more abstract styles of thinking
HIGH
RESULTS: Subjects performed badly in short-term memory tasks. They scored on tasks requiring imagination such as listing creative uses of a brick or designing a child's toy out of geometric shapes. They generated double 'creative outputs than subjects in the red condition.
REASON: The blue color doubled their imaginative power.
Subjects excelled at puzzles in which the answer touches on the theme of freedom such as liberated and unlimited.
REASON: Airy spaces prime us to feel free (Sheth, n.d.)
LOW CEILING RESULTS: Subjects were quicker at solving anagrams involving confinement such as bound, restrained, and restricted.
Figure 35: Factors affecting human body Source: Author Omar Youssef Figure 36 : Experiment on 'How the color of interior walls influences the imagination' by the psychologists at the University of British Columbia, 2009 Source: Author Manushi Sheth Figure 37: Experiment on 'The relationship between ceiling height and thinking style' by psychologist Joan Meyers-Levy at the Cadson school of management Source: Author Manushi ShethFigure 38: Design features for wayfinding in architecture
Source: Author Manushi Sheth
Figure 39 : Design features for considerations of acoustics in architecture Source: Author Manushi Sheth
Figure 40: The phycology of colors
Source : Author Manushi Sheth
psychological associations of certain emotions to certain colors, For example, the color blue automatically triggers associations with the sky and ocean.
One tends to think about expansive horizons and diffuse light, sandy beaches and lazy summer days. This sort of mental relaxation makes it easier for one to daydream and think in terms of tangential associations thus, focusing less on what's right in front of him and being more aware of the possibilities simmering in his imagination, 1991. A careful selection of colors used in the interiors, on walls and ceilings, as well as on the external facades of healthcare facilities can affect patient outcomes. (Sheth, n.d.)
Figure 41: Ability of the brain to associate smell to a place
Source: https://scentfie.com/scent-control-mood/
4) Odor - The expression 'it is a hospital smell is familiar to most people because of the smell associated with hospitals. Majority scents have a certain emotion or to it. Though it may be subjective sometimes, typically a human reaction to different smells is programmed. The presence of these odors in a space sets off emotional reactions associated with the idea of that smell. The executive director of the Smell of Sense Institute says, "Scents can have positive effects on mood, stress reduction, sleep enhancement, self-confidence, and physical and cognitive by the use of different incenses in spas to generate a calming atmosphere. The smell of lavender has been proven as a successful pain relieving agent. It also has a powerful ability to treat insomnia. The smell of a freshly mowed lawn can induce joyousness and relaxation. Citrus can boost energy and awareness; vanilla can lift ones' mood: peppermint boost concentration whereas jasmine helps with depression.
5) Views - Patients in hospitals recovered faster when their rooms had a direct view of the external natural environment rather than a blank wall. A window is not seen merely as a functional necessity that provides light and ventilation, but also a gateway that has the ability to transport a patient from a harsh reality to a place of contemplation, serving as a temporary escape. In urban hospitals, sometimes the only view available for a patient is an artistic depiction of nature which comes without a breath of fresh air and natures sounds and smells Windows allow sunlight
Figure 42 : A view from the window - Thong house by Nishizawa Architects
Source : https://www.archdaily.com/785311/thonghouse-nishizawa-architects
and warmth inside a room while providing views to the outside, thereby adding a sense of openness, spaciousness, and orientation. (Sheth, n.d.)
6) Natural Light - The balance or imbalance of a space can easily be altered through the play of light and in combination with forms, colors, and natural elements. The quality of light can be manipulated and adapted to ultimately create the ability to transcend individuals into an alternate state of consciousness that could essentially be recollected in memory, after its lived experience. Patients exposed to an amplified concentration of natural sunlight perceive less stress, require less medication and even experience less pain. - Fabrizio Benedetti. A dark or dingy atmosphere generates a feeling of imprisonment, whereas an artificially lit space has no impact on the mood. The changing character of daylight adds a dynamic qualitative dimension to the ambiance of the electric illuminant. (Sheth, n.d.)
Figure 43: Natural Sunlight entering the room Source : https://people.bath.ac.uk/zw305/ROOM/sunlighttab.php
Figure 44: Four senses of the body contributing to physchological effects Source : https://www.rethinkingthefuture.com/rtf-fresh-perspectives/a597-therapeuticarchitecture-role-of-architecture-in-healing-process/
Guilin, Guangxi Zhuangzuzizhiqu, China
FACT PROFILE
Location : Size : Capacity : 1 Zhiyuan Rd, 2,769,554 sf 1400 beds Lingui District, (257,300 m²) Guilin, Guangxi, China
Status : No. of storeys : Built up area: Under construction 4 185,800 sqm L.S Raheja School of Architecture
The Guilin Medical School Affiliated Hospital is located in one of the most spectacular destinations in China. A beautiful city on the west bank of Li River, Guilin is famous for its beautiful landscape, limestone karst mountains, and the fragrant sweet Osmanthus trees. The new 1,700-bed, two-million-square-foot hospital will accommodate clinical care, teaching and research programs, which are currently provided in the co-located medical school and hospital campus. The new hospital is designed as a new futuristic model that promotes medical and wellness tourism in harmony with nature. Here, a holistic health journey blends eastern and western medicine to define a new path toward total health (HDR, n.d.)
The Hospital Design was inspired by the Local Culture and Nature of the area. The design concept of the project, “Garden in Garden,” is inspired by the natural landscape and culture of Guilin. Both the form and exterior design of the building are inspired by Guilin’s flowering Osmanthus. Osmanthus patterns throughout the facility create an aesthetically and physically healing environment. Several courtyards with therapeutic landscapes, roof gardens and light wells will improve the patient and staff experience. (HDR, n.d.)
On the new campus, each petal of the Osmanthus is a center of excellence and provides clear wayfinding to both patients and staff. This efficient design greatly improves workflow and medical circulation within each center of excellence, while making sure that the medical resources are evenly distributed.
The goal was to create a modern, garden-style hospital full of sunshine and greenery. The series of inpatient towers placed throughout the site are also unique, providing plenty of views and natural sunlight for the patient rooms and centrally located family zones.
The symbolism of the local Osmanthus flower is dispersed throughout the building and gives its visitors a sense of local culture and belonging. The integration of nature into the hospital not only provides visually appealing imagery, but also helps patients and visitors remain connected to the unique and iconic natural surroundings of Guilin. (HDR, n.d.)
Multiple towers:
Each department was segregated in multiple independent centers.
A segregated theme of water, fire, wood, metal and earth was given to each tower by providing different colours, sizes, landscape design and art sculptures to identify easily on the site.
These become focal points for wayfinding and carry the patient through their journey while connecting them to the natural environment.
Glass podiums:
Additional glass podiums create transparency throughout the campus to enhance the human experience with views, light, and connection to nature.
Low height:
The building is low heighted buildings were placed while maintaining maximum distance from the roads to prevent noise from the vehicles.
It also elevates the ambience on the campus and establishes privacy from the surrounding community so the new medical campus is a beneficial landscape rather than a towering building that obstructs views.
The building evolved into the series of low- rise buildings not only to follow the city guideline but also to maximize a common sight line throughout the city and its surroundings.
Floor wise planning:
On top of each center of excellence is a roof garden.
Recessed medical floors enhance the building's flower-like shape. Patients and staff coming up or down from the inpatient tower to these transitional floors have access to the roof gardens, sunken gardens, and courtyards to move throughout the campus and experience its garden-natured design, both between and within the buildings. (HDR, n.d.)
The circulation organization and zoning division are based on different users' needs and behaviors, avoiding unnecessary crossovers and keeping the circulation as efficient as possible. It will also help in handling crowded situations systematically.
Integrating and classifying specific disciplines/departments that have similar functions or are closely related to each other was important, and it improves staff work efficiency and minimizes the patient travel distance. This method will tremendously help the senior patients to locate certain areas without any guidance, due to commonly seen eye sight issues.
Large-scale shared medical technology has been centralized so that each specialty can easily get access to diagnostics and treatment, which makes treatment more efficient.
The location chosen has beautiful view and smell of flowers which will help enormously in reducing the commonly experienced medical odor. The good view and ventilation will help to reduce the stressful atmosphere and suffocating ambience.
Using colour and size or scale to signify a specific department in the structure is made to give individual identities to all areas, which is also an environmental characteristic feature of the research.
Marathahalli, Bangalore, India
Location : Size : Capacity :
40, Varthur Rd, 2,769,554 sf 55 beds Kundalahalli, (257,300 m²) Marathahalli, Bangalore, India
Status : No. of storeys : Built up area : Built in 2004 Ground floor structure 3400 sq
Karunashraya meaning 'Abode of Compassion' is a huge establishment. It is a hospice for terminally ill cancer patients. It is covered in lush greenery, bird song and peace, in the middle of a busy city that houses the hospice that caters to palliative care. The hospice has been offering in-patient care since 1999 and home care since 1995, tending to over 17,500 patients and touching the lives of their families by providing a supportive environment.
It was inspected as a registered charitable trust by the Indian Cancer Society (Karnataka Chapter) and Rotary Bangalore Indiranagar to provide free professional palliative care for advanced stage cancer patients who are beyond cure. (Karunashraya, n.d.)
A hospice with a soul, designed to create a calm nurturing environment for the elderly. A place in the midst of the busy city which feels like it’s in an isolated area away from the day to day chaos. The facility provides various activities and has numerous architectural elements to encourage a peaceful and spiritual environment to the patients. (Karunashraya, n.d.)
The building is situated in 8200 sq. Are a plot and the total build up area is 3400 sq. The hospice is focused around a large expanse of water that generates a sense of peace and calm. The front of the complex houses an administrative area, conference facilities and a day-care composite masonry- cladded with locally available granite. The building is designed in a way that all
rooms of the patients receive natural lighting and ventilation. The patients can relax with a view of greenery on one side and water on other of their ward. The building has five to house in-patients wards. Recreational activities include indoor games, watching TV, newspaper etc.
A 100 seat auditorium is provided which is fully equipped with modern communication facilities for conferences and training. Solar energy is used to serve power to the Lighting in the wards and also exterior. (Karunashraya, n.d.)
The structure is a great example of for the research, as most of the design elements contribute to stimulating the mental health of the patients while making the space a comforting and peaceful environment. The water body, stone facades and green spaces and landscapes used in the design has calming and soothing properties which help in reducing stress in the surrounding. The use of local stone for façade also gives a sense of familiarity. The large number of trees and water fountains reduce the noise from the roads to an extent where it isn’t unpleasant or disturbing. The amphitheater and courtyards create spaces where the patients can socialize and get rid of their loneliness and fear. The activities carried out in these spaces further helps them psychologically.
L.S Raheja School of Architecture
Maggie's Centers are a unique typology, an idea envisioned by Margaret Keswick Jencks, a terminally ill woman who Believed that cancer treatment environments needed good design. Combining spaces to rest and reflect, these unique buildings include gardens, private rooms and gathering areas.
Maggie's is a cancer caring organization that aims at providing comfort to patients. It is not a palliative care center nor a hospice. Neither do they indulge in medical treatment. Maggie's Centers provide emotional, social, and psychological support. They aim at positive outcomes through the domesticity of spaces in their centers by creating an informal environment for patients to respond positively to the work of caregivers.
With more than 20 Maggie's Centers spread throughout the United Kingdoms, most of them designed by world-renowned architects, all centers are designed by a set of design features laid out by the organization. These features are observed in almost all the centers.
The therapies offered at a Maggie's Contra are: Nutritional advice with specialist support for managing hair loss and skin care. Emotional support/counseling with stress reduction and relaxation workshops. Support groups to focus on the emotional impact of cancer. Gardening groups to participate in horticultural activities.
Figure 56: Maggie's Manchester center
Source:: https://www.archdaily.com/786370/maggiescancer-centre-manchester-foster-plus-partners/ 5720b90de58ece0c35000005-maggies-cancer-centremanchester-foster-plus-partners-photo
Courses and talks on exercise, healthy eating, emotional wellbeing, managing post-treatment challenges, partnering with the medical team, and keeping up momentum. Different methods of relaxation such as controlling anxious thoughts, meditation, creative writing, bereavement support, expressive art, and exercise.
The red striking red wall of Maggie's London West Centre by Rogers Stirk Harbour + Partners acts as an optimistic, energized, restorative feature that psychologically communicates the influence that the centers intends to envelop a patient into. It creates its own little world in the midst of the busy city life. Though small, Maggie's Centers comprise an intriguing architectural complexity. The interior spaces are subdivided in a way as to allow for private as well as communal spaces at the same time allowing users to feel part of the whole building.
Frank Gehry's homely center in Dundee looks as if a child made its roof out of folded foil while Zaha Hadid's in Fife, with its shark-like exterior made of sparkling silicon carbide grit, allows its visitors to move, in a bold metaphorical way, from darkness to light.
Maggie's Centers aim to build spaces that inspire people to explore the things they can do to help themselves to live with, through and beyond cancer in their lives.
Source: https://www.dezeen.com/2014/10/20/reiach-and-hallarchitects-maggies-centre-lanarkshire-walled-gardens/
The ceiling heights and room sizes are kept similar to those in a typical house. The partition walls fall short of the ceiling as this allows, according to Jencks, 'spaces to flow into each other while allowing a datum of visual privacy.'
Figure
Source: https://www.zaha-hadid.com/2016/12/05/maggiesfife-10-years/
The kitchens in all the centers are perceived as the heart of a home where the table is a place to sit and read, talk to other people, and find support from professional experts.
Figure 60: Maggie's Manchester center floor plans Source: https://www.archdaily.com/786370/maggies-cancer-centremanchester-foster-plus-partners
The programme and design of the center are carefully tailored as to provide the most appropriate as well as desirable atmosphere to patients battling cancer. Every aspect and detail of the design and space within the center is controlled and designed with the idea of providing a home-like, comforting place for the patients.
The success of these centers speaks for the accomplishment of the design and programs offered.
A center like Maggie's Centre is required in or around every hospital offering cancer treatment.
Providing a cancer caring center, with a similar programme and design features, in Mumbai can be the start of a series of caring centers.
Healthcare centers as one of the most important environments for human survival have undergone extensive changes with time, changing in every era throughout history. The facilities we see today are a result of the requirements during each time period that demanded for these changes to occur. With these changes the users have had different views on these spaces with different approaches. The advances in the healthcare industry is tremendous, the development in science, economy, and technology have provided ample facilities for improving the treatment of patients and greatly assisted physicians and medical staff.
However, with these advancements the negligence towards physiological needs of the patients increased as the clock was clicking, hence these emotional or mental needs and support were merely met. In addition to this, the spatial complexity, stressors, and the priority of medical and therapeutic aspects over the other factors formed an unfavorable environment not only for patients but also for staff and visitors. As the demand for healthcare increased and with the development overall in all fields the introduction of compressed and compacted spaces came into being which with time resulted in damage
caused by stress and nervous crises.
Knowing that stress, depression, and anxiety derived from the treatment and hospitalization period which have detrimental effects on an individual’s health, humanizing healthcare spaces as an approach has become increasingly important today. The involvement of architecture as a decisive part of this subject is inevitable. Architecture has the ability to fulfill and contribute immensely to the psychological needs with a holistic approach in the design making process.
As holistic approach allows to create patient-centered spaces in order to increase the level of interaction with nature which also plays an important role in the humanization of hospital environments because nature acts as a useful resource for humans and architecture can work as an effective mediator to achieve positive results. By doing so, we can introduce natural materials which can be experienced by the patients, that will give them a sense of comfort and familiarity reducing to the stress levels and anxiety. The use of various strategies to induce a humanized design in a project is not only psychologically helpful but is also cost friendly as use of local materials takes place.
Therefore, it is a practice which can easily be incorporated into the design making process of healthcare facilities and on the other hand can also contribute extremely to the people and in return also fortunately but unintentionally spread awareness about mental health which is a big issue seen in India, as it will be seen in and around the surroundings often. But in order for this to take place it is essential to at least become a common practice in the treatment of certain patients of a specific disease or age as they are at the most vulnerable stage with the lack of mental, social, spiritual or emotional support.
On analyzing the statistics of patients in India it was very easy to point out one of the most evidently observed user groups with holistic needs in India, the Geriatric patients. This group of patients have high emotional and mental needs as they are at a very vulnerable stage of their life and often being admitted in hospices brings down their self confidence level due to loneliness and poor health.
Highest number of diseases documented are in the geriatric category, chronic diseases like cancer, tumor, etc. are observed. Along with this it is also noticed that these patients have very high numbers of mental health issues and diseases.
To add to the already existing issues, the situation specifically in India is extreme as Geriatric degrees are not recognized in our country because of which there is no proper medically trained professionals specifically to geriatric treatments. Whereas, the needs of the elderly are completely different and sensitive in comparison to patients of other age groups. It is essential for this issue to come into the limelight but at the same time it is also important to have healthcare places and professionals catering to this particular age group.
When it comes to architecture, it also includes various strategies in designing specifically for the elderly. Architecture can play a very important role in mending or bettering their mental health in a healthcare setting. A program that is specially designed for the needs and requirements of the elderly people can
contribute to a large extent. A holistic approach in the design making stage to create areas, ambiences and environments in a healthcare facility will help in providing a sense of belonging and comfort to its users. Achieving all the holistic as well as physical needs of the elderly will be the ultimate goal of the design brief.
Depiction of the mind with colours
L.S Raheja School of ArchitectureAs positive mental health is still in dearth in our nation which is immensely developing day by day, physiological issues are overlooked and also considered as a stigma.
Even in a healthcare setting, where holistic healing plays a crucial role and helps in achieving vast progress in treatment.
The aim is to create a space which creates opportunity for therapy through architecturally designed areas within a structure.
Engaging individuals into a journey which allows them to re-connect to their senses and emote positively, leading to rejuvenation of the mind and body.
Instilling this idea within a healthcare setting considering all the medical aspects will challenge the pre-existing stereotype catering to mental health and medical facilities and encourage in creating a positive difference in society.
The selection of the site is based on three factors:
A) On the basis of Location :
1. The site location should be near and well connected to the city. 2. But also should be disconnected from the city to prevent noise or chaos. 3. Accessibility - Availability of all transportation facilities and good road connectivity to the site.
B) On the basis of User population : Since the project caters to the senior citizens, the site context must have some old age facilities or centers. For example, 1. Old age homes, 2. Retirement townships 3. Senior citizen residencies 4. Old age orphanages 5. Other senior citizen facilities.
C) On the basis of Natural connect :
1. The programme would either be an extension or a separate facility in the midst of an existing senior citizen/ retirement township.
2. It will cater to all the medical as well as psychological needs of the elderly.
3. The focus of the programme will be to create a humanized design in a hospital that will fulfill all the holistic needs of all the users.
4. The design will be inclusive of all the technical areas in a hospital like ICU, operation theatres, etc, but the main design intent will be towards designing healing environments in a hospital setting.
5. The aim of the design programme is to create a structure that fulfills all the essential needs of the senior citizens but at the same time also prioritizes the holistic needs by creating a patient centric design.
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