SEARCHNARRATIVE_REVIEWgeriatrics, gerontology

narrative_review·geriatrics, gerontology, architecture, public_health, neurology, cognitive_neurology·PMC10218107

Active and Assisted Living, a Practice for the Ageing Population and People with Cognitive Disabilities: An Architectural Perspective

International Journal of Environmental Research and Public Health · 3 authors, 2 centres

AI SUMMARY

FIDELITY 100%

This summary was generated by AI from a single paper. It has not been reviewed by a clinician and is not clinical advice. Verify against the source before acting on it.

AGENT 01 · STRUCTURED SUMMARY

TRACE TO SOURCE

“

TL;DR

This narrative review examines Active Assisted Living (AAL) from an architectural perspective, arguing that AAL must evolve beyond a technology-focused EU funding programme into a holistic design paradigm for buildings and cities. The authors find that only 19 of 155 funded AAL-1 projects (roughly 1 in 10) reached the market, and that current implementations neglect people with cognitive disabilities and lack integration with physical space design. The paper concludes that architecture must combine ambient intelligence with meaningful, culturally resonant spaces to create environments that function as an 'exo-brain' for ageing and cognitively impaired populations.

Full summary

3,828 CHARS

**Background:** The paper addresses the convergence of two major societal trends: population ageing and the digital revolution. By 2050, one in five people globally will be over 60 (2.1 billion), and 70% of the world's population will live in cities. The EU4Health Programme projects that by 2070, one in three Europeans will be over 65, with an active-to-inactive population ratio of 1:4 (currently 1:2). The authors argue that while technology (IoT, ambient intelligence, smart homes) has advanced rapidly, the architectural and spatial dimensions of assisted living have been neglected. The concept of Active Assisted Living (AAL) originated from an EU programme launched in 2008 (initially called Ambient Assisted Living, renamed in 2014), but the authors contend it lacks a theoretical framework for architectural design.

**Methods:** This is a critical narrative review using a search, appraisal, analysis, and synthesis framework. Databases searched include Web of Science, Scopus, PubMed, Science Direct, Avery (Columbia University), and RIBA (Royal Institute of British Architects). Keywords included 'Active Assisted Living', 'Ambient Assisted Living', and combinations with 'Ageing Population', 'Cognitive Disabilities', and 'Smart Cities'. Publications were filtered by date (focusing on the last 15 years, with special attention to 2006–2008 for the concept's origins and 2014 for the reterming). The analysis revealed that approximately 40% of publications came from medical disciplines and over 45% from technical fields, with very few from architecture.

**Key Results:** The review identifies several key findings: (1) Of 155 projects financed by the AAL-1 Programme (2008–2013), only 19 introduced market solutions—a market maturation rate of approximately 1 in 10. (2) The PERSONA Project classified four types of services needed by older adults: services for Instrumental Activities of Daily Living (IADL), injury prevention, social integration, and mobility. It defined four spatial levels for service distribution: the person, the home, the neighbourhood, and the city. (3) The AALIANCE Project proposed three spheres: domestic ('ageing at home'), work ('active ageing at work'), and social ('ageing in the community'). (4) The AAL-2 programme (2014–2020) had a budget of approximately 600 million Euros under Horizon 2020. (5) Most implemented services focus on home environments (telemonitoring, fall prevention, vital sign monitoring), with very few in professional or social environments. (6) Major barriers include: limited technology adoption by current older adults, privacy and ethical concerns regarding data handling, reliability and maintenance issues, lack of interoperability between proprietary systems, and—critically—the absence of an articulated theory connecting AAL to architecture and urban planning.

**Clinical Implications:** The paper highlights that current AAL implementations do not adequately segment the older adult population, particularly neglecting people with cognitive disabilities such as Alzheimer's disease. The authors argue that meaningful AAL requires architectural design that integrates ambient intelligence with cultural and symbolic dimensions of space, creating environments that serve as an 'exo-brain'—adapting to gradually changing needs while preserving a sense of belonging, identity, and autonomy. The paper calls for legal frameworks to regulate data privacy, population-specific AAL development for cognitive disabilities, and a paradigm shift from technology-centric services to holistic, architecturally integrated solutions. The authors conclude that future smart cities must add dedicated 'layers' or 'grids' to support healthy ageing and cognitive disability, with adapted housing and services designed for a constantly evolving ageing population.

STUDY TYPE

narrative_review

SPECIALTY

geriatrics

SUMMARISED BY

AI pipeline

FIDELITY CHECK

100% · A

ORIGINAL PAPER

PMC10218107

Active and Assisted Living, a Practice for the Ageing Population and People with Cognitive Disabilities: An Architectural Perspective

International Journal of Environmental Research and Public Health

READ THE FULL PAPER

JUMP TO SECTION

ABSTRACT

Abstract The current digital revolution is causing a paradigm shift encompassing all environments in which human beings conduct their daily activities. Technology is starting to govern the world, gradually modifying not only individual and social behaviour, but also ways of living. The necessary adaptation to new information and communication technologies forces societies to rethink both public and private spaces, in which evolution is slower than rapid social transformation. As part of this change, the concept of Active Assisted Living (AAL) has developed. Assisted spaces can be designed to provide older adults, carers, or people who have cognitive disabilities, such as Alzheimer’s disease or other dementias, with a healthier, safer, and more comfortable life, while also affording them greater personal autonomy. AAL aims to improve people’s quality of life and allow them to remain in their own homes for as long as possible, not in residences. This study conducted a critical review about AAL from an architectural point of view. The research adopted a qualitative approach in which we collected the studies during the last twenty years, then used descriptive, narrative and critical analysis methods. Based on these, this paper aims to explain this new technological paradigm, its characteristics, its main development trends, and its implementation limitations. The results obtained show how the development of AAL will be in the next ten years, and how this concept, and its application, can influence architecture and provide the bases for further research into the design of buildings and cities. Keywords: Active Assisted Living, ambient intelligence, Ambient Assisted Living, health humanities, healthy architecture, ageing, ambient adapted to Alzheimer’s outpatients, cognitive architectural design

CITATION EXPORT

Santiago Quesada-García, Pablo Valero-Flores, María Lozano-Gómez. Active and Assisted Living, a Practice for the Ageing Population and People with Cognitive Disabilities: An Architectural Perspective. International Journal of Environmental Research and Public Health. (2023). https://doi.org/10.3390/ijerph20105886

AUTHORS

3 · 2 CENTRES

Santiago Quesada-García, Pablo Valero-Flores, María Lozano-Gómez

1Department of Architectural Design, University of Seville, Av. Reina Mercedes 2, 41012 Seville, Spain; [email protected]
2Faculty of Medicine, Campus Teatinos, University of Malaga, Blvr. Louis Pasteur, 32, 29010 Malaga, Spain; [email protected]