Healthy housing, Active aging 健康住宅, 活躍老化 Prof. emerita dr. J.E.M.H. van Bronswijk

WHO definition of Health 聯合國對「健康」的定義 Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity 健康 是指生理, 心里與社會福祉的狀態, 而非只是無疾病或不衰弱 The definition has not been amended since 1948 此定義自1948年起, 就未修訂過 資料來源: Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948 /Built environment 17-11-2018

Meanings 含義 Active aging = Remaining an active member of society during the whole aging process 活躍老化=在整個老化過程, 保留社會中的積極成員 Healthy housing = A living environment to support human health (and to diminish disease) 健康住宅=支援人類健康的生活環境 (並減少疾病)  A. Zaidi: Enabling environments for active and healthy ageing in EU countries. Gerontechnology 2014;12(4):201-208; doi:10.4017/gt.2014.12.4.003.00 /Built environment 17-11-2018

Healthy housing = an enabling environment 健康住宅=一個有利的環境 = Supporting physical, mental and social wellbeing (and preventing or diminishing disease) =支援生理，心理和社會福祉 （並預防或減少疾病） Housing in a broad sense includes the whole man-made built environment 住宅在廣義上包括了整個人為的建築環境 /Built environment 17-11-2018

European Active Ageing Index (AAI) 歐洲活躍老化指數 (AAI) Employment 僱用 (4項) 4 items Participation in society 社會參與 (4項) Independent, healthy and secure living 6 items 獨立、健康、安全的生活 (6項) Capacity and enabling environment 6 items 容量和有利的環境生活 (6項) Newest version: http://www1.unece.org/stat/platform/display/AAI/Active+Ageing+Index+Home /Built environment 17-11-2018

Living (3) and enabling environments (4) 生活（3）和有利環境（4） Source: A. Zaidi. Enabling environments for active and healthy ageing in the EU countries. Gerontechnology 2014;12(4):201-208; doi:10.4017/gt.2014.12.4.003.00 r=0.77 丹麥 斯洛文尼亞 荷蘭 德國 匈牙利 羅馬尼亞 瑞典 捷克 英國 盧森堡 立陶宛 奧地利 愛沙尼亞 比利時 馬爾他 波蘭 塞浦路斯 獨立、健康、安全的生活 斯洛伐克 西班牙 希臘 葡萄牙 保加利亞 拉脫維亞 有利活躍老化的環境生活 /Built environment 17-11-2018

Active Ageing Index (AAI) Section 3 活躍老化指數 Independent, healthy and secure living 獨立、健康、安全的生活 Physical exercise 體能鍛煉 Access to health services 獲得醫療服務 Independent living 獨立生活 Financial security 財務安全 Physical safety 體能安全 Lifelong learning 終身學習 How will housing contribute? 住房如何有助於此項? /Built environment 17-11-2018

Active Ageing Index (AAI) Section 3 活躍老化指數 Independent, healthy and secure living 獨立、健康、安全生活 Physical exercise 體能鍛煉 Access to health services 獲得醫療服務 Independent living 獨立生活 Financial security 財務安全 Physical safety 體能安全 Lifelong learning 終身學習 ↑ Main contribution of housing 住宅的主要貢獻 /Built environment 17-11-2018

Active Ageing Index (AAI) Section 4 活躍老化指數 Enabling environment for active & healthy ageing 有利環境 (活躍老化與健康老化) Remaining life expectancy 剩餘壽命 Share of healthy-life years 分享健康生活年份 Mental wellbeing 精神健康狀況 Use of ICT 使用資訊通訊技術 Social connectedness 社會網絡 Educational attainment 教育程度 How will housing contribute? 住房如何有助於此項? /Built environment 17-11-2018

Active Ageing Index (AAI) Section 4 活躍老化指數 Enabling environment for active & healthy ageing 有利環境 (活躍老化與健康老化) Remaining life expectancy 剩餘壽命 Share of healthy-life years 分享健康生活年份 Mental wellbeing 精神健康狀況 Use of ICT 使用資訊通訊技術 Social connectedness 社會網絡 Educational attainment 教育程度 ↑ Main contribution of housing 住宅的主要貢獻 /Built environment 17-11-2018

‘Global Age Watch Index’ (GAWI) 全球老化觀察指數 Income security 收入保障 (4項) 4 items Health status 健康狀況 (3項) 3 items Employment and education 就業與教育 (2項) 2 items Enabling environment 有利環境 (4項) Newest version: http://www.helpage.org/global-agewatch/ /Built environment 17-11-2018

GAWI rankings 全球老化觀察指數排名 Source: V. Taipale. The Global AgeWatch index, GAWI, 2013. Gerontechnology 2014;13(1):16-20; doi:10.4017/gt.2014.13.1.010.00 指數排名, 以顏色區分 Index rankings 1 10 20 30 40 50 60 70 80 91 Newest version: http://www.helpage.org/global-agewatch/population-ageing-data/global-rankings-map/ /Built environment 17-11-2018

‘Global Age Watch Index’ (GAWI) & Housing 全球老化觀察指數 與 住房 2. Health status 健康狀況 Life expectancy at 60 預期壽命 60歲 Healthy life expectancy at 60 健康期望壽命命 60歲 Psychological well-being 心理健康 4. Enabling environment 有利環境 Social connections 社會網絡 Physical safety 體能安全 Civic freedom 公民自由 Access to public transport 使用大眾交通運輸 How will housing contribute? 住房如何有助於此項? /Built environment 17-11-2018

‘Global Age Watch Index’ (GAWI) & Housing 全球老化觀察指數 與 住房 2. Health status Life expectancy at 60 預期壽命 60歲 Healthy life expectancy at 60 健康期望壽命命 60歲 Psychological well-being 心理健康 4. Enabling environment 有利環境 Social connections 社會網絡 Physical safety 體能安全 Civic freedom 公民自由 Access to public transport 使用大眾交通運輸 ↑ Main contribution of housing 住宅的主要貢獻 /Built environment 17-11-2018

AAI+GAWI: Healthy housing – Active Aging 活躍老化指數＋全球老化觀察指數: 健康住宅-活躍老化 (AAI 3) Independent living 獨立生活 (AAI 3, GAWI 4) Physical safety 體能安全 (GAWI 4) Access to public transport 使用大眾交通運輸 (GAWI 2) Psychological well-being 心理健康 = (AAI 4) Mental wellbeing 精神健康狀況 + (AAI 4) Social connectedness 社會網絡 Situation in the Sinophone world? 全球華人世界的情況? /Built environment 17-11-2018

AAI+GAWI: Healthy housing – Active Aging 活躍老化指數＋全球老化觀察指數: 健康住宅-活躍老化 Adding 1. Xiào (Filial piety) 增加了孝道 2. Independent living 獨立生活 3. Physical safety 體能安全 4. Access to public transport 使用大眾交通運輸 5. Psychological well-being 心理健康 (= Mental wellbeing 精神健康狀況 + Social connectedness 社會網絡) Source: Y-L. Hsu, A Chinese response to the aging society. Gerontechnology 2016;14(4):187-190; doi:10.4017/gt.2016.14.4.011.00 Situation in the Sinophone world 全球華人世界的情況 /Built environment 17-11-2018

Adding Xiào (Filial piety) 增加了孝道 “… findings suggest to young people how to choose their usage pattern of non-Face-to-Face contact with their parents wisely”. 研究結果建議年輕人, 如何明智地選擇與父母非面對面的聯絡時的使用模式 (From: K. Sun, M-Y. Zuo, D. Kong. Communication with children for older adults’ life satisfaction: Non-face-to-face and/or face-to-face? Gerontechnology 2016;14(4):191-203; doi:10.4017/gt.2016.14.4.002.00) This approach should also be taught to daughters and sons in the Western World 這樣盡孝道方式也應該建議西方世界為人子女者使用 /Built environment 17-11-2018

Housing relevance of needs for home care according to home care experts on Taiwan 居家照護需求的住宅相關項目 (根據台灣居家照護專家的意見) Physiological 基本生理   0.296 Extending old age 延展晚年 0.034 Acclimatizing to natural aging 馴化自然老化 0.052 Facing non-natural aging 面對非自然老化 0.045 Food 食物 0.091 Clothing 服裝 0.031 Housing 居家 0.044 Security 安全 0.276 Health and security 健康與安全 0.088 Safety and happiness 安全與快樂 0.026 Economic security 經濟安全 0.055 Household security 家庭安全 0.050 Personal safety 人身安全 0.056 Love and belonging 愛與歸屬 0.153 Psychological adjustment to natural aging 心理調適自然老化 0.048 Overcoming psychological stress of illness克服疾病的心理壓力 0.057 Adjustment to a new life 調整並產生一個新的生活 0.049 Esteem 自尊 0.172 How others view oneself 別人如何看待自己 0.054 Elderly’s view on themselves and life高齡者對自己&人生的看法 0.070 Bidding farewell to life 告別生活 Self-actualization 自我需求 0.103 Learning and creativity 學習與創意 0.051 Societal responsibilities and obligations 社會責任與義務 Source: K.H. Wang, H-C. Chen, G. Chen. Gerontechnology 2016; 14(4):239-243; doi:10.4017/gt.2016.14.4.006.00 /Built environment 17-11-2018

Housing relevance of needs for home care according to home care experts on Taiwan Physiological   0.296 Extending old age 0.034 Acclimatizing to natural aging 0.052 Facing non-natural aging 0.045 Food 0.091 Clothing 0.031 Housing 0.044 Security 0.276 Health and security 0.088 Safety and happiness 0.026 Economic security 0.055 Household security 0.050 Personal safety 0.056 Love and belonging 0.153 Psychological adjustment to natural aging 0.048 Overcoming psychological stress of illness 0.057 Adjustment to a new life 0.049 Esteem 0.172 How others view oneself 0.054 Elderly’s view on themselves and life 0.070 Bidding farewell to life Self-actualization 0.103 Learning and creativity 0.051 Societal responsibilities and obligations GREEN = housing related Source: K.H. Wang, H-C. Chen, G. Chen. Gerontechnology 2016; 14(4):239-243; doi:10.4017/gt.2016.14.4.006.00 /Built environment 17-11-2018

Housing evaluation by 385 Taiwanese older adults 385台灣高齡者認為住宅應改善的地方 A-Entrance入口 A1 No steps A3 Wheelchair can turn around A2 No thresholds A4 Easy to open and lock doors B-Corridor走廊 B1 Wheelchair operates with ease B4 Even surface B2 No thresholds in door entrances B5 Anti-slip B3 No stacking things, no rubble   C-Stairs 樓梯 C1 Step height appropriate C3 Handrail appropriate C2 Step edge anti-slip C4 Lighting appropriate D-Room 房間 D1 Parents' bedroom on first floor D3 Sliding doors D2 Bathroom next to bedroom E-Toilet and bathroom浴廁 E1 Bath and shower separated E4 Anti-slip chair in bathroom E2 No threshold at bathroom entrance E5 Handrails in bathroom E3 Anti-slip floor E6 Wheelchair operates with ease F-Kitchen 廚房 F1 Floor anti-slip F5 Kitchen sink height appropriate F2 Kitchen-table height appropriate F6 Safety switches on gas stove F3 Wheelchair use with table F7 Smoke detector present F4 Cupboard height appropriate Each element evaluated for importance and performance Source: C-S. Lin, H-J. Lee, J.L. Fozard Gerontechnology 2016;14(4):218-223; doi:10.4017/gt.2016.14.4.009.00 /Built environment 17-11-2018

Housing evaluation by 385 Taiwanese older adults 性能 優勢保持區 過度重視區 Green 次要改善區 優先改善區 Orange Red 重要度 Source: C-S. Lin, H-J. Lee, J.L. Fozard Gerontechnology 2016;14(4):218-223; doi:10.4017/gt.2016.14.4.009.00 /Built environment 17-11-2018

Housing evaluation by 385 Taiwanese older adults A-Entrance A1 No steps A3 Wheelchair can turn around A2 No thresholds A4 Easy to open and lock doors 方便開門與關門 B-Corridor B1 Wheelchair operates with ease 方便輪椅操作 B4 Even surface 即使表面 B2 No thresholds in door entrances B5 Anti-slip 止滑 B3 No stacking things, no rubble 無堆積物或碎石   C-Stairs C1 Step height appropriate台階高度 適宜 C3 Handrail appropriate 適當扶手 C2 Step edge anti-slip 台階邊緣防滑 C4 Lighting appropriate 燈光合宜 D-Room D1 Parents‘ bedroom on first floor長者房設在一樓 D3 Sliding doors D2 Bathroom next to bedroom E-Toilet and bathroom E1 Bath and shower separated E4 Anti-slip chair in bathroom E2 No threshold at bathroom entrance E5 Handrails in bathroom E3 Anti-slip floor 防滑地板 E6 Wheelchair operates with ease F-Kitchen F1 Floor anti-slip 防滑地板 F5 Kitchen sink height appropriate F2 Kitchen-table height appropriate 廚房檯面高度適宜 F6 Safety switches on gas stove 燃氣灶安全開關 F3 Wheelchair use with table F7 Smoke detector present F4 Cupboard height appropriate Green: keep-up the good work (high performance, high importance) 綠色代表優勢保持區 Source: C-S. Lin, H-J. Lee, J.L. Fozard Gerontechnology 2016;14(4):218-223; doi:10.4017/gt.2016.14.4.009.00 /Built environment 17-11-2018

Housing evaluation by 385 Taiwanese older adults A-Entrance A1 No steps A3 Wheelchair can turn around A2 No thresholds A4 Easy to open and lock doors B-Corridor B1 Wheelchair operates with ease B4 Even surface B2 No thresholds in door entrances B5 Anti-slip B3 No stacking things, no rubble   C-Stairs C1 Step height appropriate C3 Handrail appropriate C2 Step edge anti-slip C4 Lighting appropriate D-Room D1 Parents' bedroom on first floor D3 Sliding doors D2 Bathroom next to bedroom E-Toilet and bathroom E1 Bath and shower separated E4 Anti-slip chair in bathroom E2 No threshold at bathroom entrance E5 Handrails in bathroom E3 Anti-slip floor E6 Wheelchair operates with ease F-Kitchen F1 Floor anti-slip F5 Kitchen sink height appropriate F2 Kitchen-table height appropriate F6 Safety switches on gas stove F3 Wheelchair use with table F7 Smoke detector present F4 Cupboard height appropriate Green: keep-up the good work (high performance, high importance) Orange: low performance, but low priority Red: Priority measure (low performance, high importance} 優勢保持區 次要改善區 優先改善區 Source: C-S. Lin, H-J. Lee, J.L. Fozard Gerontechnology 2016;14(4):218-223; doi:10.4017/gt.2016.14.4.009.00 /Built environment 17-11-2018

Housing evaluation by 385 Taiwanese older adults A-Entrance A1 No steps A3 Wheelchair can turn around A2 No thresholds A4 Easy to open and lock doors B-Corridor B1 Wheelchair operates with ease B4 Even surface B2 No thresholds in door entrances B5 Anti-slip B3 No stacking things, no rubble   C-Stairs C1 Step height appropriate C3 Handrail appropriate C2 Step edge anti-slip C4 Lighting appropriate D-Room D1 Parents' bedroom on first floor D3 Sliding doors D2 Bathroom next to bedroom E-Toilet and bathroom E1 Bath and shower separated E4 Anti-slip chair in bathroom E2 No threshold at bathroom entrance E5 Handrails in bathroom E3 Anti-slip floor E6 Wheelchair operates with ease F-Kitchen F1 Floor anti-slip F5 Kitchen sink height appropriate F2 Kitchen-table height appropriate F6 Safety switches on gas stove F3 Wheelchair use with table F7 Smoke detector present F4 Cupboard height appropriate 優勢保持區 Green: keep-up the good work (high performance, high importance) Orange: low performance, but low priority Red: concentrate improvement here, high importance, low performance Black: Possible overkill, high performance, low priority 次要改善區 優先改善區 過度重視區 Source: C-S. Lin, H-J. Lee, J.L. Fozard Gerontechnology 2016;14(4):218-223; doi:10.4017/gt.2016.14.4.009.00 /Built environment 17-11-2018

Housing evaluation by 385 Taiwanese older adults A-Entrance A1 No steps A3 Wheelchair can turn around A2 No thresholds A4 Easy to open and lock doors B-Corridor B1 Wheelchair operates with ease B4 Even surface B2 No thresholds in door entrances B5 Anti-slip B3 No stacking things, no rubble   C-Stairs C1 Step height appropriate C3 Handrail appropriate C2 Step edge anti-slip C4 Lighting appropriate D-Room D1 Parents' bedroom on first floor D3 Sliding doors D2 Bathroom next to bedroom E-Toilet and bathroom E1 Bath and shower separated E4 Anti-slip chair in bathroom E2 No threshold at bathroom entrance E5 Handrails in bathroom E3 Anti-slip floor E6 Wheelchair operates with ease F-Kitchen F1 Floor anti-slip F5 Kitchen sink height appropriate F2 Kitchen-table height appropriate F6 Safety switches on gas stove F3 Wheelchair use with table F7 Smoke detector present F4 Cupboard height appropriate To support ‘Active Aging’ by preventing tripping and falling  Take care of RED and ORANGE! (and keep both GREEN and BLACK at good performance) 為了支援活躍老化, 預防高齡者絆倒或跌倒 儘快改善紅色與橘色部分 (但維持綠色和黑色, 以維護照護品質) Source: C-S. Lin, H-J. Lee, J.L. Fozard Gerontechnology 2016;14(4):218-223; doi:10.4017/gt.2016.14.4.009.00 /Built environment 17-11-2018

Healthy housing contributes to Active aging 健康住宅有利於活躍老化 Conclusion 結論 Healthy housing contributes to Active aging 健康住宅有利於活躍老化 by Enabling a happy and active aging-life 擁有快樂與活躍的老年生活 Preventing / compressing morbidities & accidents 預防/壓縮 發病率與意外 e.g. Falling and tripping accidents 意外跌倒與絆倒 House-dust allergy 屋塵過敏 Veteran’s disease 退伍軍人症 Dengue Fever (mosquito vectors) 登革熱 e.t.c. /Built environment 17-11-2018

Thank you for your attention ! 謝謝聆聽 /Built environment 17-11-2018