ARCHITECTURAL PLANNING STRATEGIES FOR THERAPUTIC ENVIRONMENTS

elderly 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.

C) Various departments in Geriatric Healthcare facilities

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.)

Figure 34: Effects of effects on body in a therapeutic environment Source: https://issuu.com/manushisheth/docs/thesis_volume

A) Architectural elements to create Therapeutic environments

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.

i) Understanding the psychological impacts of architectural elements

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.

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

Analyzing an experiment carried out by the University of British Columbia, 2009 :

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 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.

LOFTY CEILING RESULTS: Subjects engaged in more abstract styles of thinking HIGH CEILING RESULTS: 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.

1) Wayfinding - An uncertainty of any manner can set off negative emotions for a person undergoing trauma. Inability to locate things or places can lead to anxiety.

Healthcare facilities are inherently complex environments. The built environment should provide clear visual cues to orient and guide people to their destination. An effective wayfinding program includes physical elements, communications, and human interaction. Landscaping, building elements, color, texture, and pattern should all give cues, in addition to artwork and signage. (Sheth, n.d.)

2) Acoustics - Noise in healthcare environments can lead to negative impacts including elevated psychological and physiological stress levels that can worsen other outcomes and contribute to poor sleep quality. At the same time, natural sounds such as birds and trees create a calming atmosphere thus, contributing to the healing process. The planning of a building should involve consideration of acoustical impacts to achieve a productive environment.

Acoustical separation of activity zones from zones requiring peace and quiet should be considered. (Sheth, n.d.) 3) Colour - Colors can provoke and elevate positive or negative emotions. These emotions are triggered through our mental perceptions of colors in relation to the association of these colors with certain past personal events or cultural beliefs.

Society's emotional response to color is based on shared

Figure 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.) 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 memory attached 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 performance." This is proven 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. (Sheth, n.d.)

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 41: Ability of the brain to associate smell to a place Source: https://scentfie.com/scent-control-mood/

Figure 42 : A view from the window - Thong house by Nishizawa Architects Source : https://www.archdaily.com/785311/thong-L.S Raheja School of Architecturehouse-nishizawa-architects

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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 room that is not easily achievable with an electric illuminant. (Sheth, n.d.)

The warmth of sunlight cannot be replaced by artificial lighting. Along with delivering vitamin D to the body, natural light also leads to higher productivity; greater natural light during the day can help stabilize circadian rhythms and improve the mood.

The design of openings can control the quality and quantity of light in a space. Depending on the functionality of the space, openings can be designed to control the mood of the space. (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/