Needed: seating that supports the aging process; Interview with Roger Leib, furniture designer and former proprietor of ADD Specialized Seating Technology.

Iconoclast" is a word that seems to fit Roger Leib to a tee. Alongtime designer/developer of furniture for healthcare settings, including long-term care, he has little patience with commonly accepted tenets of design. For example, while the shape, style, and look of a piece of furniture are important, he says, they are not sufficient in defining the piece's ultimate quality. "For the most part," wrote Leib several years ago in an article on long-term care seating, "we view these objects only in static (three-dimensional) terms. We usually fail to consider the fourth dimension--time, or the quality that defines time: movement." Which means? Well, here's another quote from the article: "Too many older people are pigeonholed as either able or not able to walk. For the majority of nursing home residents who fall somewhere between these two categories, there is no functional middle ground in equipment terms. Devices must be developed that better accommodate the range of needs, from ambulatory but unsteady to semi-ambulatory to non-ambulatory." Put another way, seating must support the aging occupant in more ways than simply off the ground. Recently Leib, a design consultant after having sold his medical furniture manufacturing company, ADD Specialized Seating Technology, to national manufacturer KI several years ago, discussed some of his current observations on long-term care seating design trends with Nursing Homes/Long Term Care Management Editor-in-Chief Richard L. Peck.

Peck: In designing seating for elderly nursing home and assisted living residents, what would the ideal specifications be?

Leib: If you're talking about seat height, depth, and other dimensions, you are asking the wrong question. I think anyone who focuses on that sort of thing is missing the boat. Basically, furniture design for the elderly is a question of providing musculoskeletal support, of supplementing a weakened musculature by assisting the person in exiting and entering the chair and holding oneself upright while sitting (figure 1, A and B, figure 2). We are endoskeletal beings, with the body keeping the spine, nerves, and blood vessels in proper alignment through most of life. As muscles weaken with age, however, problems are created up and down the skeleton. Which is why I've changed my view of things. When I started out, I thought the main function of seating was to accommodate people comfortably in the curved position as they grew older. I have since learned differently.

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When one slumps in a chair, adverse effects are created such as irregularities in breathing, sleep, and excretory function, as well as anxiety and pain. This is why I've been concerned to see some modern design taking a backward step, with chairs getting wider, arms splaying out beyond reasonable support, and not enough attention being paid to preventing an older person from slumping. Designers are looking too much at form and shape, which is actually icing on the cake, and when you've got a bad cake....

Peck: And the "cake" is furniture taking a more active role in supporting older people musculoskeletally?

Leib: Yes, which in turn will motivate people to remain upright and active, as opposed to going back to bed as soon as possible, a disastrous outcome. Also, people--and busy staffs--tend to rely more than they should on wheelchairs, which are at least more convenient for moving about. But wheelchairs started as an option for relatively healthy paraplegics, not frail elderly. Today's wheelchair use is based on perceived risks, such as falling, and on staff convenience in moving people about, as opposed to genuine physical need. The wheelchair encourages people to remain seated, in a relatively static position--and, in my view, a static resident is a dead resident.

A chair should encourage people to continue moving even while in place, and to feel energized to get up and out of it now and then. My company initiated an attempt at this with the Warren chair (named after my father), which was spring-loaded to gently push back as the occupant leaned back, encouraging him or her to use core muscles in moving back and forth (figure 3). It was what we called "Dynamic Seating[R]," providing vestibular stimulation that, for reasons still unknown, results in a calming, sedative effect. It's because of concepts like these that I say--when you talk about seating height, depth, etc.--well, let's not go there.

Peck: Have you seen any advances of late in seating design that you find encouraging?

Leib: I'm more concerned about people focusing on the wrong things--for example, an overemphasis on coverings to provide infection control. I was amazed recently to learn, while visiting a fancy long-term rehabilitation hospital filled with patients from a nearby prestigious teaching hospital, that more than 99% of its patients, mostly hip and knee replacement patients, are admitted with pressure ulcers. This is, of course, a very high-risk situation for cross-infection. For this you just don't turn to fabric treatment--you need seating that is easily cleanable and breathable. I have also heard of problems in VA hospitals (and I'm guessing it is not uncommon in some smaller nursing homes) of vermin infestations in seating, which indicate a need for eliminating all the nooks and crannies that encourage this by, for example, reducing stuffing without compromising comfort. There are ways to engineer this, it's just that they aren't talked about much.

Peck: What other features would you look for or recommend in geriatric seating?

Leib: On retractable lounge chairs, I would look for unbreakable leg- or footrests. These tend to break when staff use their feet to retract them while holding a resident, for instance, which leads to an endemic need for servicing of these chairs. These legrests also tend to be too short for some residents, leading to heel drop and the resulting painful elongation of tendons. Legrests need to have a longer throw, yet be able to fold easily under the chair when someone gets up from the chair. Also, seating pads should be long enough to prevent cutting into thighs and causing circulatory and neurological problems. Because of inadvertent results such as these, I sometimes think we're manufacturing injuries and falls with our seating design.

A couple of innovations I would like to see would be V-shaped couches, with armrests in the V, so that people seated on them can lean in toward each other for conversation. I'd like to see dining room chairs with high backs to augment hearing with reflected sound and block ambient noise from behind. I'd like to see more use of chairs with built-in controllable swivels so that a person can easily move about and, when done, have the swivel default to lock.

There are so many things that chairs can do to help people age comfortably and healthily, and it would be nice to see more attention paid to developing these possibilities.

For further information from or about Roger Leib, phone [phone] or e-mail [e-mail]. To send your comments to the editors, e-mail [e-mail].