Those working in the health care sector of design and construction have likely encountered issues to do with the growing demographic and specialty of medicine referred to as bariatrics.
Across OECD (Organisation of Economic Co-Operation and Development) countries, one in two adults are currently considered overweight, which is defined as individuals who have a Body Mass Index (BMI) equal to or exceeding 25. BMI is a measure of relative size based on the mass and height of an individual.
One in six adults in OECD countries are considered obese, which means they have a BMI equal to or greater than 30. It’s no secret that this trend is predicted to continue with the OECD projecting a further 15 per cent rise in the number of individuals considered obese over the next 10 years.
Australia is no outlier in this trend; we are in fact leading the way. Over the last 20 years, Australia’s population has been getting heavier at a fast rate than any other OECD country. In 2005, 53.6 per cent of Australian adults were considered overweight, and obesity is now a larger indicator and cause of premature illness and death in Australian than smoking.
The complexities that arise in both caring for people of larger stature and providing suitable accommodation and facilities are multifactorial. People in this cohort often exhibit reduced mobility and use mobility aids, and in some instances may require the assistance of one or more people to ambulate.
Equipment associated with reduced function such as wheelchairs, commodes, shower chairs and the like are significantly wider and may not be accommodated by traditional facilities. Items such as handrails and grabrails are exposed to forces significantly higher to that which their installation was designed for. The size of rooms and facilities may simply not accommodate the circulation or structural integrity necessary for their safe use.
While many organisations have been proactive in the health care sector with creating facilities that will allow larger individuals access, limited information and guidance has been available, and these organisations have largely relied on their experience with this type of patient and the collective knowledge they have accumulated in responding to this patient group.
The environment is only one aspect of what needs to be a more holistic approach. Other elements include staff which are competent and knowledgeable, appropriate policies and procedures being developed, the selection and provision of equipment and assistive technologies which are fit for purpose, and a proactive organisational environment to assist with coordinating all of these complex inputs.
Some organisations have published guidance documents with regard to this issue, and suppliers of specialist health care manual handling equipment such as Arjo have published guidelines for architects and planners which include chapters attributed to bariatrics.
While a detailed account of the considerations and recommendations raised is too detailed to encapsulate, some of the items that arise include the following:
- Wider doorways to allow comfortable movement of bariatric equipment such as wheelchairs and hoists.
- Handrails and grabrails which have been tested to accommodate far greater forces to that normally required by the most relevant Australian Standard AS1428.1:2009, as well as careful consideration of the structure and fixings used in their installation. Anecdotally, it has been suggested that these should be designed to withstand forces in all directions 10 times greater to the weight of the heaviest resident anticipated.
- Selection of fixtures and fittings which can be installed to withstand the necessary loads (e.g. floor mounted pans and basins and no wall mounted alternatives). Fixtures and fittings which have been tested and certified to be able to withstand the higher loads anticipated.
- Corridors and circulation spaces within rooms large enough for bariatric equipment to be moved and navigate the environment comfortably, as well as allow people to transfer safely between equipment.
- Where hoisting equipment is required, consider ceiling mounted hoists in lieu of mobile hoist options, and ensure careful consideration from a structural engineer has been applied in the design of the supporting structure as well as the lift to be installed (e.g. lifts operating on two separate tracks are also available).
- Applying similar consideration to other spaces associated with the facility. That is the entry point, the building’s corridors serving the spaces requiring access as well as other areas such as dining rooms, waiting areas, treatment rooms, and so on, and not just the person’s bedroom and associated bathroom facilities.
- The structure and fabric these spaces needs to be able to withstand point loads reflective of the anticipated occupants (including facilities such as elevators).
- Selection of floor finishes which are more resistant to the increased wear and tear they will be exposed to, as well as robust materials or protective additions to walls, door jambs and the like, to reduce damage caused by impact of equipment such as movable beds or wheelchairs.
To provide some insight with regard to the extent of circulation which may be suitable to bedrooms and bathrooms, here are two figures from a fact sheet readily available from the AusBig website. This was produced to assist with designing safer environments for the bariatric client in aged care.