Approximately a week ago, I watched as an elderly woman emerged from a building and tried to come down two flights of stairs, with the aid of her walking stick and a relative. When she finally got to the end of the steps she was observed to be exhausted and in pain. This is an assessment of the outside and inside if a building and a public transportation, which disclosed that they were built without the thought of the elderly population who frequently visit and use these facilities, and it identifies the threat, hazards and problems that can be created from the lack thereof.
The General Hospital has a laboratory that is situated on the second floor of an old building that is separated from the main hospital. When accessing this location, one would either have to climb long flights of stairs, or a hill. It is not the only facility for testing on the island but it is however, the only one that is government operated and is cheaper by cost and for this reason, majority of people frequently use it when they require blood and other investigations.
There are two flights of stairs. One is an enclosed, unpainted stairs that must be navigated before entering the building and the second flight is on a small slop, which to some extent is narrower, leading around a corner.
The area appeared to be bleak, without any signs representing that this building is the laboratory which often makes people question if they are in the right place.
There is a metal; unpainted hand rail located on the right hand side of the building to support individuals, such as the elderly, to ascend the first flight of stairs. In that area the lighting is very poor. Two faulty air conditioning units vents were seen on the outside of the enclosed area, there’s a platform leading to the second flight of stairs that is mostly wet at times. The doors of the laboratory are wooden, brown and vanished on the outside and painted white and blue on the inside, it is seen matching the colors on the wall. On observation, a sign printed on a white sheet of laminated paper on the outside of the left side of the door, at the center, requests that the doors be kept closed owing to the air conditioning unit on the inside, and that persons can come in.
However; one cannot tell if the door is functioned by turning the handle and pushing, or pulling because there are no signs indicating such. On entering the inside directly facing the main entrance, there is a small center table made up of wood, with a small potted plant and some magazines. Away from the centre table is a wooden, metal bench that is not padded, furthermore, it has no support for the back and is secured to the floor. Five-seven persons can be accommodated. Directly above the bench is a big window, which is the only one in the room, adorned by a white curtain and due to their air conditioning, it is kept closed.
Towards the right hand corner along that wall, a red ticket machine is seen, with a small sign above it printed in white letters, disclosing ‘ticket machine’. A fire extinguisher is fastened on the neighboring wall with the sign, “Fire extinguisher” pointing downwards, and next to the fire extinguisher, is a wall mounted hand sanitizer dispenser to the left on a blue background stating, ‘Sample Collection’. The wall to the left of that door holds four small posters and a small aperture towards the end where lab results are assembled. Along that wall is another smaller wooden, metal bench. To the left of the aperture is a door that leads to the interior of the lab. Investigations are performed and samples are collected there.
Facing the aperture on the opposite wall is another wooden, white door. There is an air conditioning unit above, that maintains the cold temperature of the room. Another large wooden and metal bench secured to the floor is also seen on the left side of this door. A ‘No Smoking’ white and blue sign on the wall over the bench is observed, showing two bright posters that highlight the benefits of donating blood. There are two smaller wooden and metal benches to the right side of the white door, facing each other in the corner of the room. On the wall to the right side of the white door is a small mounted white fan that faces the other bench located with its back toward the wall adjoining the main doors.
The waiting room is small and lit brightly by a two florescent bulbs situated in the middle of the roof. The color of the floor is blue and it is tiled. It is smooth, and even all through the room, apart from the front of the aperture, where two small holes are apparent, it seems as though there were wooden benches fastened there at one pointing time. An old mat that is frayed around the edges was seen at the front of the main door.
While ascending the stairs, there’s a handrail that is considered beneficial and supportive because it assists the elderly person in mounting of the stairs. In the elderly vision changes occurs, resulting in diminished visual acuity, macular degeneration, and decreased adaptation to darkness (Jarvis, 2008), the elderly is at risk for falls and accidents and additional lighting would be a good requirement to see. For the elderly people accident prevention is a major concern due to limited vision and owing to that limitation reflexes are slowed, bone density are decreased and loss of muscle mass occurs, therefore, climbing stairs, and even walking requires care(Smeltzer, Bare, Inkle & Cheever, 2010).
Poor lighting in the enclosed area can cause the elderly person to trip and fall, robbed of money or attacked in that area, especially if the vision is poor. There are securities guarding the area frequently, however, bright light is paramount for vision which can prevent mishaps.
The small sign on the door should be enhanced with a large and bolder print which would make it better and easier for the elderly to recognize and read, and what would be helpful are brighter lights in the enclosed area. The magazines on the table and a few of the posters on the wall should have larger prints for the elderly to read if desired, while awaiting investigations. The prints are too small and prove too difficult to read, especially by the elderly with ailing vision. Large prints should be catered for them. The frayed rug on the floor in front of the main doors is a potential hazard for falls and injuries, with impaired vision an elderly can trip over it, leading to a fracture, broken bone or hip, requiring hospitalization. New rugs or mat should be changed or replaced before it frays to avoid hazards.
At the right side of the building hand rails was seen to assist in climbing the first flight of stairs, however; none was seen on the left side, or either seen on the second flight of stairs ( has a slight slope or incline) which would greatly assist with climbing. A big problem could arise here because in the regards to the need of safety and security, an elderly person who suffers from arthritis for example or has a weakness which would require assistance. As a result, handrails should be erected, and it is a good safety measure. Smeltzer, Bare, Inkle & Cheever (2010) stated that with the physical aspect of ageing mobility is affected, there are alterations in bone remodeling, cartilage of joints deteriorates and often times equilibrium cannot be maintained. The body movements can be stiff and restricted; hence, hand rails are a necessity on the stairs.
Water is also a hazard. It was observed on the platform leading to the second flight of stairs. Any elderly with impaired balance can fall and this could result in death. Six years of working on the Male Surgical Unit showed that falls are the main cause of accidental deaths in person over age 65, and those who experience falls suffer from the ensuing mobility. Thus the air conditioning unit should therefore be fixed or replaced.
The door of the laboratory is wooden and has no sign on it, so one cannot tell if it’s functioned by turning the handle to push or pull and what makes it worse is that someone might be making an exit, while another is attempting to enter. Most times individuals have to take a step backwards before facilitating the opening of a door. I can attest to it. As mentioned above, the stairs leading up to the door is on a slight incline and the elderly using a cane or walking a stick to assist in mobility can be a dilemma. Risk of being run into, or falls can occur if one is not too careful. The door handles are gold accent that is faced downwards. Pertaining to safety, there is a possibility that someone’s hand can slip of the door handle, if it is not held firmly, while trying to open the door. This is dangerous and falling can take place. A double handle drop latch should be installed, which would be safer. Also because the door is narrow, a wide door should be placed to accommodate elderly obese people.
The floor is tiled and non skid, a faintly dark blue color, with a smooth, level surface, made up of concrete. An elderly person can slip and fall resulting in a fracture. The two small holes that are seen on the floor in front of the aperture should be covered to prevent injuries from falls because it can be hazardous if an elderly walking stick or cane is caught in them.
The temperature in the waiting room is cool due to the air conditioning unit; this could useful to the elderly person. Jarvis (2008) mentioned decreased response of the sweat glands to thermoregulatory demand also puts the aging person at greater risk for heat stroke. However, for some people this can pose as a problem. Elderly people cannot tolerate cold well because of diminished shivering reflex, and the changes in the integument reduces tolerance to temperatures Smeltzer, Bare, Inkle & Cheever, 2010). For that reason, if subsequent visits are necessary advise and encourage the elderly to dress accordingly.
Five wooden and metal benches were observed in the room for persons to sit on, and it’s a first come first serve basis. Sometimes there are no seats for the elderly. The room is small and is normally filled to capacity on a daily basis, because that section of the laboratory has to serve the Grenada population. An elderly person with arthritis or and injured foot would have to stand for a long while and this may be very exhausting and uncomfortable. The benches too are not padded and would cause discomfort. Jarvis (2008) stated that loss of subcutaneous fat leaves bony prominences more marked. It is an advantage that the benches are not so low, but it would be better if the benches have an arm rest or support, thus it would be easier for the elderly to take up a sitting or standing position, given that some of them experiences joint pain stiffness of the joints, and weakness of the muscles. There were no sharp splinters on the edges of the benches. This is good because for a diabetic person, a cut no matter how small could create a problem.
The large window is located in an area where nice fresh air come in to keep the room cool. I t can be opened for ventilation which is good, in the event that the air conditioning unit is malfunctioned. This would prevent the elderly from fainting spells due to hot air/heat.
Calkins (2010) stated that blue is a restful color with a calming effect. Use of blue in the physical environment can actually lower blood pressure and has also been shown that blue (and green) rooms are perceived as several degrees cooler than rooms painted in warm shades. It is said that blue suggest hygiene and coolness, and that it creates a more relaxing and resting atmosphere. The blue colors on the wall might assist some elderly to be less anxious and become more relaxed when it comes to needles and blood tests. The walls are made of concrete and smooth, creating light wind, and decreasing the level of noise from the outside, preventing noise pollution.
The mat in front of the door is useful in collecting dirt and debris, so it won’t be transferred to the floor before, which is good. However; it poses as a potential threat to the elderly and because it is not non skid and the edges are ragged. An elderly with an unsteady gait with decreased balance or visual impairment who uses a walking stick may fall if it gets entangled in the mat. To be safer a non skid rug without ragged edges should be placed or changed as often as possible before it starts to get frayed.
Situated at the corner of the room is one fan. If the air conditioning unit stops working on a hot day, elderly persons suffering from heart conditions or hypertensions can experience anxiety and stress due to hot air. According to the Center for Disease Control and Prevention, “older adults are more prone to heat stress than younger people. They do not adjust as well as young people to sudden changes in temperature and are more likely to have chronic medical condition that changes normal body responses to heat. Also they are more likely to take prescription medicines that impair the body’s ability to regulate its temperature or that inhibit perspiration”. Ceiling fans should be installed on the other walls to prevent heat exhaustion and what would be beneficial for the elderly, is having an electric water cooler to maintain hydration during hot times.
The hand sanitizer is very useful because the elderly is at risk for changes in their immune system. Increased immune deficiency, although variable, occurs and is due to a reduction in active peripheral T cells with increase in immature T cells ( Bracewell, Gray, & Rai, 2005). Being able to have clean hands is desirous as it breaks the transmission of pathogens. It has its use for the aged person whose immune system is suppressed as a side of the medication taken and would need to have a snack, while waiting. The hand sanitizer on the wall is at a height that would be difficult for short elderly persons who is experiencing stiffness and pain in the joint due to arthritis. He or she may have to stretch, which may be detrimental because an unsteady gait can put him or her at risk for a fall. Someone might have to assist. The color of the hand sanitizer receptacle is off white against a white background, if the elderly is nearsighted or suffers from myopia, it may not be seen. It cause subjects to be out of focus and blurry.
The ticket machine/ dispenser are situated on the wall further away from the main door, with instructions that is difficult to identify by an elderly person with visual impairment. The Machine should be closer to the front with a large and bold sign stating, “Please Take a Ticket”.
The cheapest form of transport on the island of Grenada is the mini bus, and it is used by many people, such as the elderly. The buses are privately owned and are used for serving the general public. For the elderly it can be a challenge with this form of transportation because they have to maneuver themselves to suit which would be very difficult due to how they have to get into the bus. The height, space and seating arrangements space and of course the speed at which the bus is being driven and the loud music played at times, are all challenges the elderly face on a daily basis.
It is always difficult for elderly citizens to get into a bus. Often times someone has to assist them into the bus, which can be a tedious task, due to impaired mobility. This can cause them to lose their balance and they can also experience pain and stiffness in the hands and knees. This can be detrimental; their knees can buckle, resulting in fall. Therefore, someone should always be available to assist them to getting into the bus. Provision of elderly transportation should be implemented.
The height of the bus is dangerous, because an elderly person has to remember to bend forward upon entering and exiting. Elderly sometimes experiences memory loss and might forget to bend on entering which would result in hitting his or her head on the top of the bus leading to a concussion or injury such as a laceration or a bruise, the elderly might even lose balance and fall. A fracture can be sustained due to the brittle bones or he/she may even sustain a hip fracture which can be very dangerous and would require hospitalization. The individual probably would also need knee replacement surgery depending on the damages to his/her knee/s. It would also be detrimental for the individual, if he/she already had one placed in and sustain trauma to the knee/s. It is always a struggle for the elderly to get in and out and for that reason buses with higher roof tops/door way arches are desirable.
The buses are small; there are two passenger seats in the front along with the driver’s seat, with four rows of seats behind and they are close together. Due to the way the bus was built, it can only accommodate about 15 persons. However; an additional three to five persons will be squeezed in by the driver or bus conductor, creating discomfort for an elderly person. Particularly for those who are tall with long legs and suffer from arthritis. There won’t be any room to stretch the legs and depending on the length of the journey, it would also be problematic because he/she may experience pain in the joints, from being squeezed together in that small space for a long while. Not to mention if the elderly has a bag/s, he/she would have to hold the bags on the leg for the entire journey. This can result in back pain, cramps, stiffness and pain in the legs. The advantage for the elderly would be to have more leg room on the interior of the bus. Honor courtesy seating at front seats of the bus for senior citizens should be considered to allow stretching. The back of some buses have handle bars; this would be useful, it would be beneficial to assist the elderly person to support himself/herself as the bus travels around the corners. The seats are soft and comfortable which makes it beneficial since it supports the elderly back.
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