Of all the buildings that can benefit from better sound, healthcare environments often have the most to gain.

Soundscaping in age care isn’t commonplace yet. There’s been relatively little research into the subject specifically, but the information we do have suggests that carefully considered soundscapes in care homes and nursing homes could bring real benefits to residents.

One pilot study in Saudi Arabia found that biophilic design strategies – including sound – create real wellness opportunities in old-age care. Researchers at Ghent University have also reviewed the potential benefits and pitfalls of soundscapes in age care.

Crucially, the design considerations for soundscapes in age care are different from other environments. Care homes and nursing homes face unique challenges and soundscapes must be sensitive to that.

Design considerations for age care soundscapes

• Daily structure
• Memory
• Orientation
• Stimulation
• Safety and social presence
• Health and wellbeing

Soundscapes for daily structure

Memory-loss and confusion is common in care home residents. Scheduled soundscapes can potentially reduce those stressors by identifying time of day and upcoming events. Importantly, this approach to soundscaping can bring a sense of predictability and reassurance.

Care home patients can be easily startled. In the same way that kitchen sounds are associated with the preparation of a meal, scheduling soundscapes around daily events can create a Pavlovian response to orientate residents in their daily schedule and prepare them for daily events that might otherwise cause stress by seemingly coming out of the blue.

Scheduled soundscapes can also give explicit information about time of day. For example, researchers propose that an hourly church bell sound can be easily recognised, incorporates time information, orientates people spatially, and provides regular reassurance.

Lastly, biophilic sounds like birdsong can be used to actually cue our body’s circadian rhythms. Scheduled biophilic sound – like a dawn chorus at sunrise – can help residents feel more awake in the day and sleep better at night.

Music and memory

Sound and music can trigger powerful emotions and memories in dementia patients when there is a personal connection to their past experiences. Dementia patients benefit hugely from individual music listening and active participation in making music.

While soundscapes can integrate musical elements, soundscapes cannot replace a controlled listening session. This link between sound and memory also highlights potential pitfalls in designing musical soundscapes for age care. It’s important to remember that everyone’s past experiences are personal. For one patient a certain musical sound might bring back positive memories and for another it might be negative. When incorporating music into soundscapes, designers should be aware of wider shared experiences too – for example, by avoiding musical references that might have been heard frequently during war times.

Soundscapes for orientation

While biophilic soundscapes can bring about measurable wellbeing benefits, it should be introduced carefully in age care.

Relevance is key. Subtle, local biophilic soundscapes can ground residents in their wider surroundings. And sounds might be used to bring together sight and sound. But, haphazard nature sounds can potentially cause unnecessary stress and confusion.

For example, the sounds of the ocean could be appropriate if the building is in close proximity to the sea, but could otherwise be disorientating. Likewise, birdsong in a space with green views might have many benefits, but birdsong in a windowless room will likely be confusing.

In age care, there will never be a one-size-fits-all solution for every building and bespoke soundscapes will be important in orientation.

Soundscapes for stimulation

When it comes to sound, everyone has different preferences and sensitivities. Typically, higher pitched, denser sounds are more arousing, while lower slower sounds tend to reduce arousal and have a calming effect.

Soundscapes in age care can be zoned across different spaces to give residents options in terms of content and intensity level (whilst always avoiding anything chaotic or too unpredictable).

In age care, residents’ hearing abilities will be significantly lower than average. So, zoning is an opportunity on a practical front too, with areas that are louder and quieter. While it may be tempting to set soundscape levels higher across the space, employee wellbeing should be of equal importance and soundscape levels should not be uncomfortable or unhelpful for staff.

Researchers also suggest that soundscape stimulation levels in age care will ideally vary across the day too to bring diversity to daily experiences.

Active listening exercises with soundscapes

Predictability should be at the core of soundscape design for main spaces in age care. However, more novel soundscapes and soundscapes with higher stimulation levels might be beneficial in the form of organised listening activities with residents.

For example, with user control and forewarning, a carer in a designated zone could select and rainforest soundscape and ask people “What can you hear?”, “Can you hear the birds?”, or “What do you think this space looks like?”.

Safety and social presence

Beneficial sounds for safety and reassurance in age-care include distant, regular sounds of general activity (human and natural). Too much novelty should be avoided.

Unsurprisingly, the sounds of human speech increase our perception of social presence. Where it gets interesting, though, is that birdsong can have a similar effect. Researchers think this is because of the similarity between birdsong and human speech – they’re both complex sounds designed for communication and can both sooth us and make us feel safer.

Soundscapes for health and wellbeing

Mental health

There are too many potential psychological benefits of biophilic soundscapes to talk about here. Improved mood and motivation, decreased depression, better focus, lower pain perception, improved memory and learning, psychological restoration, and stress recovery are just a few examples. These are all so relevant to the struggles of people in old-age care.

There are knock-on effects from nature-based restoration too. Researchers think it gives people a greater sense of escape, fascination, creativity, and freedom of thinking. Whether it’s introduced carefully into background sound or foreground active listening soundscapes, these are the benefits that can take age care patient experiences to another level in terms of quality of life.

Physical wellbeing

Sound affects our bodies too. Biophilic sound has been shown to have many positive effects, including reduced muscle tension, lower blood pressure, and better breathing.

Many of these wellbeing benefits are universal, so it’s not just residents who can benefit – staff wellbeing can be improved too.