Jun 1, 2001

It doesn't take much imagination to see that preventing falls, brightening dark and depressing spaces, and generally making environments habitable can be among the most important elements for improving the health of the elderly. So perhaps the only thing surprising about Project GEM (Gerontologic Environmental Modification) in the Division of Geriatrics and Gerontology at New York Weill Cornell Medical Center is its uniqueness. It is the only Hospital-based program of its kind around.

GEM has a dedicated leader, a research associate named Rosemary Bakker, who was an interior designer until her mother's experience with a hip fracture awakened her to a pressing need. Ms. Bakker got a graduate degree in gerontology; wrote a book, Elderdesign: Designing and Furnishing a Home for Your Later Years (1997); and connected with Dr. Mark Lachs, Co-Chief of Weill Cornell's Division of Geriatrics and Gerontology and a nationally renowned authority in geriatric medicine. Now, with Weill Cornell as her base, Ms. Bakker conducts research, gives talks, and organizes forums and task forces—all with the aim of identifying what elders need in their environment and how it can be supplied.

"Most things that we use every day are designed for younger people," she says. "The pressure needed to turn a door knob or faucet, the width of a doorway, the height of a doorsill, even the controls on air conditioners are not made with the elderly in mind. So GEM is concerned with how to modify homes and environments so that people can spend their retirement years safely and happily in their own homes."

Once Ms. Bakker identifies the problems, she looks for resources available to address them. "For example, did you know that there are low-cost or no-cost services available for income-eligible adults?" she says. "There are agencies, particularly one called MetroPair, sponsored by the Metropolitan New York Coordinating Council on Jewish Poverty, that will install grab bars for free in your bathroom. MetroPair will do minor repairs, install deadbolt locks, and put up window gates, where possible. It's funded in part by the Department of the Aging of the City of New York."

GEM also identifies legal and practical problems faced by the elderly. Under the law, a landlord cannot deny a renter the right to make reasonable changes to accommodate a disability. "A renter can widen doorways, install grab bars. Many people don't know this, or they're afraid to challenge their landlord. In some cases, the renter has to put money in escrow so that the apartment can be put back in its original condition once the renter vacates. A widened doorway does not come under that definition, because anyone can use a wider doorway. But if you want to remove a bathtub and put in an accessible shower, that's something the next tenant may not want."

One research project that Ms. Bakker is just finishing up concerns the less than optimal light levels in Manhattan apartments for the elderly. "If you can't read your medicine bottles, perhaps there is a need for a program with funding for this issue," she says.

In general, she says that New York is a wonderful place to be old, because there are so many resources available. "But some apartments do not have much access to daylight, and the elderly can be reluctant to use artificial light in the daytime. Especially with people with dementia, the natural circadian rhythms can be disturbed because of light levels that are too low." Another problem with New York is that the sidewalks and crosswalks can be uneven, and that can make mobility a problem for those who are impaired.

GEM is involved with many other research and education projects. Ms. Bakker is currently putting the finishing touches on an informative Web site, http://www.environmentalgeriatrics.org/, which details GEM's missions and many of its findings, and provides links to innumerable resources.