Elderly and heat waves, the case for Stockholm

Elderly people
health in a warmer
Stockholm
Anna Hesselgren
Bilal Fleifel
Carina Jacob
Emelie Falk
Sai Lakshmi
Sandeep Jakkampudi
Shruthi Prakash
R. 16-01 OPENLAB
Valhallavägen 79
11427 Stockholm
openlab.se

The report that you are about to read is the result of a
creative and in some ways chaotic project, where stu-
dents from different disciplines and universities worked
with challenges that Stockholm, as a county and a city,
is facing.
The city is our lab! - is the motto for Openlab. Students
worked with challenges provided by Stockholm City and
Stockholm Council in a wide range of areas. Within the
framework of a 15 credits master-course, students wor-
ked in project-groups of 6-8 persons for one semester.
To develop an understanding of the issue at hand, stu-
dents engaged with the set challenges though the use
of various research methods such interviews and ob-
servations, as well as literature studies. Students then
developed a number of proposals for solutions, one of
which has then been pursued to create a more concrete
solution that is tested within real-world situations.
Whilst working together at Openlab, students from diffe-
rent disciplines met and interacted with each other – not
always without complications.
Ivar Björkman,
Executive Director
Johan Bornebusch
Södertörns University
However, in these meetings something new and exciting
can emerge. Students carry with them experiences of
interdisciplinary discussions and solutions - a very im-
portant competence for meeting challenges of the futu-
re.
The result of all discussions, analysis, and synthesis’s
is here documented in the report. Of course the report
can only cover some parts of this dynamic and creative
process. We who have worked as teachers in this cour-
se have our main function as coaches, providing tools
during different phases of the project. The students work
according to a process model based on Design Thinking
and SCRUM. Creative ideas and systematic thinking
merge together to a final project.
For us this is learning at its best – Freedom, Creativity,
Social interaction, Engagement and FUN! But it is also
based on real challenges in society – the idea is that
Openlab’s project should contribute to a better Stock-
holm for its inhabitants. The city is our lab!
Anders Berglund
Royal Institute of Technology
Hans Jonsson
Karolinska Institutet
Magdalena Holdar
Stockholms University
Preface

13:01 (Swedish)
Hitta rätt i vården
Ett värdigt åldrande
13:02 (Swedish)
Vårdombud och Vårdagram
Rätt bil i rätt ruta
Hem & Vision
15:01 (English)
Increasing Patient Involvement in the Healthcare Sys-
tem
Stockholm in Motion
Green Power of the Ecoflower
14:01 (Swedish)
Levande stadsrum
LivsLabbet
Alla kan falla
14:02 (Swedish)
Spira
Södersken
Zon 164
15:02 (English)
Grassroots Movements & Stockholms Stad: Bridging
the Gap
BikeMeSTHLM
The Step-Up! Planning Tool
The course Openlab’s earlier series of
reports

Abstract Sammanfattning
This report is an outline of the work with the OpenLab
challenge, ‘Elderly people’s health in a warmer Stock-
holm’, that was provided by the Stockholm County Admi-
nistrative Board. A warmer climate in Stockholm results
in a greater risk of more frequent heat waves. The el-
derly people are more vulnerable and sensitive to heat.
The report explains the different phases in the Design
Thinking method and the work that has been carried out
by the team in each phase. The Design Thinking method
is a user-centered process. We start by defining the user
needs, and solutions are developed and tested based on
that. The first part of the report covers the first iteration
where the team worked with a number of different con-
cepts. The second part describes the later phase, where
two concepts were chosen and developed further. The
two final concepts delivered addresses two needs, the
need to generate awareness about heat waves and the
need to create a green cool space for socializing. This is
provided by a number of different types of brochures to
elderly and a Green Backyard Network.
Denna rapport är en översikt av arbetet med utmaning-
en på OpenLab, ”Äldre människors hälsa i ett varmare
Stockholm, som tillhandahölls av Länsstyrelsen i Stock-
holm. Ett varmare klimat i Stockholm ökar risken för mer
återkommande värmeböljor. Äldre människor är mer
sårbara och känsliga för värme.
Rapporten förklarar de olika faserna i metoden Design
Thinking, samt det arbete som teamet har gjort i varje
fas. Design Thinking är en användarcentrerad metod
och genom att definiera olika behov hos användaren
utvecklas sedan lösningar utifrån det som även testas.
Den första delen av rapporten omfattar första iteration
där teamet arbetat med ett antal olika koncept. Den an-
dra delen av rapporten beskriver den senare fasen där
två koncept valdes och utvecklas vidare. De två slutgi-
litga koncepten tillgodoser två behov, att skapa medve-
tenhet om värmeböljor och att skapa en sval grön plats
för umgänge. Detta görs genom en broschyr som skick-
as hem, samt en broschyr som ställs ut på bord på t.e.x.
äldreboenden samt ett nätverk av prunkande gröna bak-
gårdar på äldreboenden, Green Backyard Network.

Content
5. Final concepts
5.1 Our two concepts
5.2 Why is the idea needed?
5.3 How will Länsstyrelsen support the idea?
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31
31
1. Background
1.1 Heat wave
1.2 Challenge
2. Design thinking Process
2.1 Empathize
2.2 Define
2.3 Ideate
2.4 Prototype
2.5 Test
3. Conceptual ideas
3.1 Backyard Network
3.2 Helping green hands
3.3 Automatic Warning System
3.4 Other concepts
3.5 Selection
4. Design thinking process PART 2
Awareness and Automatic Warning System
4.1 Empathize
4.2 Define
4.3 Ideate
4.4 Prototype
4.5 Testing
Green Backyard Network
4.6 Empathize
4.7 Define
4.8 Ideate
4.9 Prototype
4.10 Testing
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13
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14
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23
25
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6. Reflections
7. References
7.1 Literature
7.2 Other sources
8. Appendix
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1. Background
The global climate change is playing a major role in increasing the intensity, frequency and duration of
heat waves. Climate calculations indicate that it will be warmer in the Stockholm county. Towards the end
of the century, the scenarios show that the average annual temperature can be as much as 3-5 ° C higher
and heat waves will occur more frequently and are more prolonged. (SMHI) Oudin Åström et al (2013)
has published that the mortality due to heat waves in Stockholm was significantly increased in the past 30
years and 1,500 people died as a result from it.
Growing population and urbanization might increase the chances of heat waves in Stockholm in the near
future. Stockholm is the fastest growing city in Europe, with an expected growth of 11 % until 2020 (Stock-
holm Chamber of Commerce, 2015). With the densification of Stockholm a large number of temperature
lowering green areas risk to disappear, leading to a stronger urban heat island effect (SvD, 2009). The
densification also leads to more noise, air pollution, pollen and ozone close to people. In other words,
densification in combination with increased temperature, is a risk to human health. (Boverket, 2010, p.30)
In addition, there is a low awareness about the negative health effects heat can bring to the people. The-
refore it is needed to understand the effects of heat waves on the elderly people, both in healthcare but
also in urban planning.
According to Daniel Oudin Åström, mortality associa-
ted with extreme heat during the relevant period doub-
led compared to if we did not have had climate change.
The factors that contributes to the heat waves are glo-
bal warming and the increase in population density of
Stockholm. The increase in the population results in a
need to remove greenery and create more living spa-
ces. The buildings in Stockholm are built for the ideal
temperature of 11 degrees. So in summer the buildings
store more heat and release it slowly at night when there
is no cooling evaporation (SMHI, 2016).
1.1.1 Affecting the elderly
Heat and heat waves are a threat to health of the vulne-
rable groups, particularly people over the age of 65. The
temperature control in the body of the elderly is less ef-
fective than the body of young people. Sick and bedrid-
den people have difficulties to recognize the body’s sig-
nals and also do not have the opportunity to travel from
the city to escape the high temperatures. The population
of Stockholm County is projected to increase by 430,000
1.1 Heat wave
To investigate what a heat wave is, we must first and
foremost define what it means. National Encyclopedia
defines a heat wave as follows:
“Heat wave is a period of exceptionally warm weather”
(ne.se, 2016)
The temperature degree that identifies a heatwave is
different from one place to another. Hence, it is impor-
tant to understand the nature of communities affected
and the building infrastructure of cities. For example,
in Stockholm it is a period in summer when the mean
temperature goes above 20 degrees for 3 days or more
consecutive days. In Stockholm the houses and buil-
dings are designed to store heat inside because of the
cold weather it enjoys most of the year. The heat waves
have affected various parts of Europe in 2003 with the
temperatures reaching a record high. More than 70,000
people died and the main affected country was France
with around 15,000 deaths in that period with tempera-
tures reaching 40 degree.
10

people in 2025 and the age structure of the population
expected according to the forecast will change slightly
during the period. More children and young people aged
up to twenty years of age is assumed to come. Forty
baby boom generation reaches seventies and making
the number of elderly is expected to increase conside-
rably, eg as forecasted, in 2025 the number of 80 year
olds almost becomes double, from about 9000 to about
18000 people.(Mossberg Sonnek et al, 2015, p.23)
There are a number of important social functions in the
sector of health and elderly care. In the summary, the
main impact of heat waves in this sector is the increa-
sing need to take care of people who fall ill or die from
the heat. It can mean as an increase in the inflow of pa-
tients to health centers and hospitals, but also a need for
extra efforts in areas such as municipal home care and
elderly homes. Even health professionals can be negati-
vely affected in a heat wave, which may affect their jud-
gment and perception. Solutions often include additional
cooling of rooms, which can be accomplished in several
different ways. The solutions also often requires more
staffing as well as interaction between municipalities
and county councils (Ibid, p.23).
The average temperature when mortality is the lowest
vary between different geographical regions. In Sweden
it is between 12 and 14 ° C. Every degree increase abo-
ve the optimal temperature increases the relative risk
of deaths by more than one percent. Studies show that
persistent high temperatures increases mortality more
per day as the heat continues. Air pollution in combina-
tion with the heat wave increases health risks because,
high humidity combines with the heat and hence, the
evaporation and cooling effect of the body is reduced. If
the nights are cool the body has the chance to recover
(Ibid, p.23).
The main risk groups in the heat wave are the elderly
and those suffering from cardiovascular diseases, lung
diseases, kidney dysfunction, mental illness and diabe-
tes.Taking certain medications such as diuretics also
increases vulnerability. The greatest increased risk of
dying of heat are people with lung diseases, and that is
irrespective of age(Ibid, p.23).
Older people suffer greatly because of the physiological
changes of the aging that occurs, that affect the tempe-
rature regulation and fluid imbalance. During heat waves
more deaths occur than normal relatively quickly, often
before the patient seeks treatment or go to a hospital.
When the heat wave occurs is important for mortality, as
it will be lower if the heat wave occurs in late summer
compared with the beginning. Since the municipalities
today often do not have air conditioning in their nursing
and care homes, the indoor temperature can quickly be-
come unhealthy and cause illness (Ibid, p.23).
In the heat wave in Europe in 2007 fewer older people
died in the city neighborhoods with many trees than
in those areas of the cities with fewer trees (Boverket,
2010, p. 30). This was because the elderly could seek
shady cooler places outdoors with trees close to home,
while in the areas with fewer trees, they remained in
their warm apartments with fatal consequences. (Ibid,
p.30) The vegetation also reduces the need for cooling
devices by providing shade for buildings, and this hel-
ps society’s efforts to improve energy efficiency. A stu-
dy finds that the use of electricity could be 11.4 percent
lower if a house has 17.5 percent of shadowing greene-
ry. The study was made on buildings without shadowing
trees. (Ibid,p. 28) This shows that to get a cooler indoor
climate in a longer perspective one has to plant trees
outside large windows. Trees are particularly effective to
regulate the climate and a large tree has a evaporation
of about 400 liters per day. (Ibid,p. 29)
1.2 Challenge
The challenge is given by Stockholm County Adminis-
trative Board/Länsstyrelsen in Stockholm which is wor-
king continuously on an action plan for climate adapta-
tion for the Stockholm region (Länsstyrelsen, 2014). The
challenge givers want the team to develop solutions for
elderly people to live happily and feel good in a neigh-
borhood with an expected warmer climate and increa-
sed risk of heat waves in future. We seek answers to
two different questions: how to get a solution to the heat
issue in the urban planning of the city and how to make
life easier for an individual when a heat wave occurs.
How can the various stakeholders in society, such as
health care providers, municipalities, county councils,
property owners and individuals themselves increase
their preparedness for heating periods in future? How
can the City of Stockholm’s elderly care be developed
to help older people to cope up better with a heat wave?
How to modify the existing built environment, both in-
ternally and externally, with innovative cooling systems?
11

2. Design thinking process
2.1 Empathize
The process of design thinking starts with understan-
ding the people or the users, for whom we are designing
in order to find the best possible solutions. One of the
methods our group adopted for the empathize phase
was researching about the topic of heat waves. From
the research study we came to know about what heat
waves are and places around the world where heat
wave have struck before. The research showed us that
the heat waves have affected various parts of Europe in
2003 with the temperatures reaching a record high. We
analysed how these countries coped to the heat wave
and the steps they took during and after the period of
heat waves. Simultaneously, we started to interview el-
derly in order to know more about their needs. As the
users for our challenge were the elderly people living in
Stockholm, we decided to interview them to get a clue to
understand how they feel and think by asking open en-
ded questions about the summer. Analysis of the results
of the interviews were conducted by creating empathy
maps. After the first pilot study we realised that elderly
did not see the dangers of the heat wave. Meeting with
Länsstyrelsen in a later phase allowed us to know more
about the challenge. We also met more people from the
meeting place for the elderly in Odenplan and conduc-
ted interviews. This phase made us aware that this chal-
lenge is more a future problem which people are not
much aware of. We also realized that the first step to
tackle a problem is to find and understand the needs of
the users and make the city prepared for this issue in
future.
2.1.1 Green area
In the present public discussions in Sweden there is a
daily ongoing debate about the huge lack of housing and
how it’s necessary to densify the built environment but
there is almost no discussion that this will occur at the
cost of diminished green areas. More hard surfaces in
the city will also create problems when the heat waves
occur. Amanda Burden (2014) says in her Ted Talk ”How
public spaces makes cities work” on how public environ-
ments generally are designed without green social spa-
ce. She points at that they have “that stylish Spartan
look that we often associate with modern architecture.
There’s nothing to water, nothing to maintain, and no
undesirable people to worry about”.
The importance of how to design the urban environ-
ments is crucial not to make it boring or uncomfortable
(Jacob, 2015).The research by Tara Zupancic (2015) in
“The impact of green space on heat and air pollution in
urban communities: A meta-narrative systematic review”
shows that the reintroduction of green areas into cities
reduces the urban heat island effect. In warm tempera-
te dry summer climates air temperatures of parks are 2
degrees cooler and up to 3 degrees cooler at peak sum-
mer temperature with surface temperatures from 6 to
8 degrees cooler. Cities are cooler and quieter through
shading, evaporative transpiration, and the absorption
of sound by green walls. Green space can help to re-
duce heat and combat air pollution in urban setting (Zu-
pancic, 2015, p.17).
The aim of the first part was to understand the user and who the user is. Through the phases Empathize,
Define, Ideate, Prototype and Testing will the following questions be answered:
Who are we solving for? What are their needs? How do we satisfy the user needs? Showing is better than telling.
Why does our work matter?
12

2.2 Define
In the previous phase “Empathize”, the team understood
how the users see a heat wave and living conditions in
the summer. From that the needs were identified. The
elderly were categorized into two groups: Those who
are living on their own, and the ones who are living
and receiving help from caregivers. The insights of the
needs in both identified groups were the unawareness
of the risks and dangers of summer heat waves and the
need to socialize and stay outdoors during the summer
with shadows and greenery around them. After going
through these insights from the needs of the users four
personas were developed that reflected the different
users kind of needs. The four personas were:
Then the most extreme users with the one most in need
and the one with least need of assistance were identi-
fied and chosen as Point-of-Views for the preparation
for the next phase in Design Thinking : Ideate. The two
Point-of-Views developed from the four personas were:
Ingvar, 80 years old, lives in an elderly home and needs
assistance for his everyday life in order to feel safe and
secure as he has several chronic diseases.
Lily, 75 years old and lives on her own, has back pain
and needs space for social and active daily life.
2.3 Ideate
After formulating the definition of the challenge, ideation
was done after analysing the needs of POV’s develo-
ped. The major needs identified were; a space for the
elderly for social interaction, providing them a life to feel
safe and secure, and a platform for an active daily life.
Everyone in the team were given individual time for bra-
instorming ideas and generating maximum number of
ideas to meet the requirements of the personas deve-
loped. All our ideas were grouped and clustered. Selec-
tion was carried out by giving each person the chance
to vote for the ideas which he/she felt for. The ideas that
did not receive any votes were discharged.
Then we tried to condensate the ideas that got 3 or more
votes. We finally came up with three ideas which we
wanted to prototype:
1. The warning and awareness, in what way should the
information be spread?
2. Green areas / backyard / balcony / pool
3. The organizations, socialising and help with things
like watering plants (no health care tasks).
Elderly home, full assistance
Ingvar is 80 years old and most of time
he lies in bed. He is a widower since 4
years back. He got Parkinson (chronic
disease), and because of that he need
help to go to the bathroom and with pre-
paring food. so the caregivers are very
important for him. As he spend a lot of
time in bed the ventilation is important for
him.
Living home, no help
Lily is 85 and lives on her own with her cat.
She has problem with a little bit of back pain.
She likes cooking, but not drink as much wa-
ter anymore. Likes to go to the park and sit
there on a bench, or meet up with her friend
John 87, or to go shopping. She go to the gym
and like swimming.
Living home, some assistance
Tomas is 75 and lives with his partner. He
needs help with preparing his food and the
cleaning home. He need this assistance due
to pain in the body. He like to go for short
walks, and he and his wife often go to the
park together with their dog. He also likes to
go to the elderly home for a coffee and talk to
friends. He takes some medication for diabe-
tes and blood pressure.
Elderly home, little assistance
Sara is 85 and lives with her partner. She
likes to go for long walks and to meet up
with friends. She also likes to go to the
park and sit there and observe people.
Every morning she has her fika. She is ti-
red of cooking and therefore like to eat at
the elderly home (lunch). Every tuesday
afternoon she plays bridge at the elderly
home.
13

me summer heat. Some in the elderly home said that
they often suffered from heat and seeked a cooler place.
They would also appreciate to be checked by the staff.
Having extra people, like the association taking care of
the plants and backyards, keeping an extra eye on them
in case of sudden illness, they all liked. Many also enjoy
spending time in their backyards during summertime,
watching others or socializing. Some said they enjoy sit-
ting on their balconies looking down at a beautiful green
backyard with flowers, trees and people.
However, we felt that was not enough testing so after
the concept delivery we went out to for a second test
run. This was done to gain more information before ma-
king a SWOT analysis as a tool for choosing concept.
We divided the group and half went to the elderly home
again and the other half went and talked to middle aged
and elderly people on the street to gain more knowled-
ge.
However, while talking to the elderly in various stages of
testing, there was a lack of experience, knowledge and
awareness about summer heat waves. The elderly’s fo-
cus was on how they love the summer and appreciated
to be able to go out and enjoy it. This indicates that there
were two insights of needs that were important, one to
create awareness, and the other was to create a safe
and cooler nearby environment where elderly can soci-
alize during warm summers.
2.4 Prototype
The aim of prototyping the ideas is to create something
visual. By visualising the idea it can be easier to discuss
and talk about it and ensure that both parties understand
the idea on hand. In the first part of the challenge we
chose to draw our ideas and build small models in 3D.
At this point we had three ideas that we prototyped on
cardboards. We prototyped a drawing of a green jung-
le-like backyard and balcony, one for the organization of
youngsters to help the elderly and in cardboard devices
for alarm like a radio, an sms alarm device, an alarm
loudspeaker to put above the door.
2.5 Test
The aim of the testing phase is to verify the concepts
and ideas with the user, to ensure they are fulfilling their
need/needs. We first went to an elderly home where we
showed and explained all the three prototyped concepts.
One insight from testing was that awareness of heat wa-
ves was lacking, hence there is a need to establish that.
People tend to think that an alarm system was exag-
geration and that heat waves were not a real problem.
Some people whom we interviewed, rather emphasized
that they love the summer and warm weather.
Another insight was the need for a cooler environment
with shade and greenery and that it should be close-
by to where they live. We described the situation with
storytelling, placing the elderly in a scenario of extre-
Prototyping
14

Testing situation at Väderkvarnen
15

3. Conceptual ideas
3.1 Green Backyard Network
The need of having a cooler space with natural shadow
where the elderly can socialize placed not far from the
elderly home made us come up with the concept of an
eco-urban network that consists of many self-managed
backyards where people create a jungle-like garden of
their backyards (both in elderly homes and ordinary hou-
sings) and maintain them during the summer months.
There will be a lot of plants, fruits and flowers. The walls
will be covered with green panels and waterfalls.There
will be movable chairs, benches and tables. A “green
igloo” placed in the backyard will provide a cooler place
for sitting. A mud pot with sand in the middle of the igloo
with water. The backyards will be opened daytime for
anyone in the city to visit.
3.2 Helping Green Hands
The need of having people taking care of the backyards
and checking on the elderly. It can be for young people
working in the summer.
It is an association of people from different backgrounds
with an aim to socialize with the elderly and helping
them to take care of green spaces indoor and outdoor.
This could be organized so some are volunteers and
some are paid. The volunteers will not handle any medi-
cal tasks, instead they would be a company to the elder-
ly while maintaining the vegetation.
In a case of a heatwave, the association will provide va-
rious tips and assist the elderly, such as checking on
them and urge them to drink water and how to deal with
the heatwave.
3.3 Automatic Warning System and Awareness
The concept of “Automatic Warning System and Aware-
ness” is divided into two main needs: First, the need to
have a warning system that can reach the end user ef-
fectively and smoothly. Second, sending awareness and
information to the elderly in order to make educate and
inform them about dangers in cases of extreme heat
and how to deal with it.
SMHI has a system in place that issue different kind of
weather warnings to different cities. It sends the war-
nings through SOS which sends it to MSB or to Tibs in
County Administrative Board. Then they will act accor-
ding to that information manually.
At the time the system is not fully working, and the infor-
mation about the heat is not going through. The need is
to automate the process and make it work in real-time
with a two-way feedback confirmation it would be more
efficient. The human involvement will be only for moni-
toring. This will guarantee that information will reach the
intended users (the elderly) in real-time.
To guarantee this will work, we need to categorize elder-
ly according to health conditions. There will be different
approaches to different needs. The communication will
be conducted through various devices: TV, Radio, SMS,
phone call, and email. .
3.4 Other concepts
There were other ideas that the team formulated in the
ideation phase that did not get qualified for the final
rounds of concept delivery. We decided to investigate
and try to see the possibilities of using these ideas if
The aim of the halfway was to understand the importance of how the concepts satisfy the user needs.
Some other concepts were also discussed but these ideas were never further developed in the halfway
process. A SWOT analysis with a voting system was applied to find an understanding of the different con-
cepts.
16

possible. We could not develop these four ideas com-
pletely but shared them with the challenge givers. Some
of these ideas were :
- Methods to improve ventilation.
- Interactive clothes like sunvest, sun hat and sun slip-
pers that can read the body temperature and then the
material adapts to the climate and cools.
- Evacuation plans during a heat waves by using exis-
ting war shelters.
- Use of refractive building materials which refracts back
sun radiation and keep cool inside building.
3.5 Selection
The Strength Weaknesses Opportunities and Threats
(SWOT) analysis method was used in the concept se-
lection phase, that was done to gain a deeper and objec-
tive understanding of each concept before voting. This
was initially done individually and then put together in
the group. In addition to that, before voting, we conduc-
ted a Failure Mode Effective Analysis (FMEA) to identify
the different risks within the different concepts. FMEA
is more detailed on a need level in finding ”severity of
risks” while SWOT is more general. The information ga-
ined was then added to the SWOT as these data were
identified as either weaknesses or threats. Once our
SWOT board was prepared we voted. Everyone in the
team had six votes each. Each vote to be used on the
most important bullet points in the SWOT board. In order
to eliminate any bias towards one of the concepts, we
hid the titles of each group of concepts , e.g. the voting
was only based on what we defined as important without
linked to the concept. The voting result was very close
for both the two concepts Green Backyard Network and
Awareness and Automatic Warning System and reflec-
ted that the needs were met by both. From here on we
decided to continue developing both the concepts in two
SWOT
18

4. Design thinking process PART 2
Awareness and Automatic Warning System
4.1 Empathize
In this phase we conducted several interviews with the
end users at the elderly home in Odenplan. The inter-
views and observing the elderly allowed us to develop
further knowledge of the challenge and the user needs.
We now identify the users to be elderly, caregivers and
also authorities. According to Center for Disease Con-
trol and Prevention (CDC, 2016), research shows that
their bodies capacity to sweat is less and they get thirsty
more and ultimately dehydration will occur. The elderly
does not realize that high level of heat is dangerous for
their health and also they are unaware of how to react to
a heat wave. We realise that the end users needs to be
notified prior to the heat waves with suggested advices
on what actions to take during a heat wave. It is impor-
tant also that the caregivers are given instructions on
what to do in case of a heat wave and how to prioritize
the cases during emergency and how to make sure that
the elderly are no longer in danger.
4.2 Define
After meeting again with elderly and the caregivers we
noticed that they didn’t know what to do in case of a
heatwave. So we decided to research how awareness
is transmitted from the top level to the end users in the
present situation. We also wanted to understand how
the alarm system works, and what are the main actions
taken in case of a heatwave. We interviewed (E., Ham-
berg personal communication at MSB/Länsstyrelsen,
April 25, 2016), and she explained how the current war-
ning system works. She explained that SMHI (Sveriges
meteorologiska och hydrologiska institut) sends weekly
updates to länstyrelssen and the latter organize a me-
eting with the municipalities. This system is truly func-
tional until the information reaching the municipalities.
There was also a lack of knowledge on how the munici-
palities should act after receiving a warning. There was
also a lack of a feedback system if the information has
reached everyone? Another problem was that there is
no system at the municipality level to send awareness
and warning directly to the end users. The challenge
was thus redefined on how can the existing system be
improved, and how can we facilitate the information to
reach the end users smoothly without disruptions. The
team wanted also to standardize how the municipalities
should act in an event of a heat wave like, what actions
to take, whom to contact , what information to pass and
how.
4.3 Ideate
The idea of a warning system emerged to be one of
our two final concepts. The solution will focus on how
to make it better set and more innovative to meet the
requirements of the changing environment. We thought
of creating a device that can provide voice warnings,
messages, and display temperature. After prototyping
the device and testing it, we decided to drop the idea of
To satisfy the users needs the concepts “Green Backyard Network” and “Awareness and Automatic War-
ning System” were chosen to be developed further. The aim of the first part was to understand the user
and who the user is. Through this second cycle of the phases of the Design Thinking method Empathize,
Define, Ideate, Prototype and Testing will the following questions be answered again and refined to deve-
lop further the now chosen concepts:
Who are we solving for? What are their needs? How do we satisfy the user needs? Showing is better than
telling. Why does our work matter?
19

creating a device because of feasibility and desirability
concerns. With fast evolving technology we believed it
is better for the concept to use existing technology. Ad-
ditionally, in a large number of the interviews people
tend to be critical about using a new device too. So we
thought that it is better to implement the components of
the device with the available technologies and means of
communication.
Our first approach for the solution was to fully under-
stand the current warning system that is in place from
the SMHI ie, Swedish Meteorological and Hydrological
Institute and to identify the main players responsible for
issuing weather related warnings in case of emergency
and how the message is moving from top to end users.
Our goal is to make the process simple, automated, and
can provide feedback to the responsible bodies. We
thought about a system that will be connecting the hig-
her level authorities with the end users, the elderly in
this case. This system will provide a notification for the
elderly if a heat wave is forecasted. The system will also
provide awareness about what to do in a case of a heat
wave for both the elderly and the caregivers.
This inspired our team to expand the methods that a
user can be reached and to add to some of these
methods the ability to have a feedback. We wanted to
make sure that the user is notified and in the same time
we wanted to make the process simple and not com-
plicated or annoying. The problem on one hand is that
information transmitted by the current warning system
is getting stuck due to various reasons such as the hu-
man intervention. Our team approach was to provide the
users with an accessible method that can warn them
about heatwave and in the same time assist them on
how to deal with it. SMHI is already spreading informa-
tion through radio and TV. They also have a warning
system on their website. We discovered that the best
way to grab the attention of the elderly is to send them a
brochure with all the information about heatwave and a
form to fill on how they prefer to receive the warning and
awareness in case of a heatwave. The options to chose
from are mail, email, SMS, or an automated phone call.
We designed two versions of a brochure and they both
included the following content:
Brief about heat waves and their dangers on health
Checklist on what to do in the case of extreme heat
Contact details for more information
Contact details in a case of emergency
Form to fill out their details and their prefered method of
communication to receive information
To give the importance needed to grab attention of the
elderly, the brochure will be sent with a sealed envelope
with the logo of the municipality. Each municipality will
provide a database of elderly people. We also thought
of making the brochure and the form available online
on various community websites. We believe the idea for
a brochure will give us the various insights on how to
communicate with our user groups and will provide the
much needed knowledge and awareness.
We researched how the SMS and email system will
work.The sms system will work as follows. The user
will enter the contact details of the elderly manually or
can upload a database that contain all the information
of elderly. This database will be uploaded to the system
using excel or .cvs formats. The text can be scheduled
and can address users by their name. This will grab the
attention of the user to read the SMS. The email, sms,
and the automated phone call can be programmed to be
delivered automatically without any human intervention
when forecasted temperatures reach a certain limit.
Another idea was the tripod brochure that will contain
all the information stated in the brochure above but will
be place in elderly care restaurants and hospital waiting
spaces which are spaces where elderly spend a majori-
ty time of their day.
4.4 Prototype
The different types of brochures were prototyped, a re-
gular 2-page brochure and a tripod brochure. They were
both prototyped in Microsoft Word, and printed in color
for testing. In order to see the feasibility we contacted
a printing company to get an offer what the cost would
be to supply this in Stockholm municipality. The calcula-
ted price for this can be found in table 1. The warnings
system did not include any prototyping. One of our
team members communicated with a company called
BulkSMS and they provided information about how the
technology works and the price of the service. The price
is less than 0,25 SEK per SMS for a bulk of 50,000+.
4.5 Testing
In this phase there were multiple products in the concept
that needed to be tested.
Regular brochure and tripod brochure
A first draft of the regular 2-page brochure was conduc-
20

ted in different colors, different font size, and altering in
pictures. The reason to use two different prototypes was
to make it easier for the user to be critical and discuss
different options.
A larger test was conducted to quantitatively see the use
of this concept. A total of 45 people in the age group
60-86 were approached for a short interview. Each per-
son was asked about their knowledge about heat wave
and whether they would like to receive more information
about it. If the answer was yes, they were showed the
different folders and asked what they thought about the
brochures and what they wanted to see different. Addi-
tionally they were asked whether they would consider
to sign up the form to get a warning if there is a risk of
a heat wave. If yes, they were asked what type of com-
munication mean they prefered; SMS, automatic phone
call, or email. The summary of the main findings are li-
sted in Table 2.
Feedback were provided on font size, color, and amount
of information which led us to develop the brochure fur-
ther.
The testing of the tripod brochure was done in two steps.
A first run was done at Vasaträffen at Odenplan. Feed-
back provided was on the size of the font. The second
run included a larger number of participants. It was te-
sted with all the people available at that time, a total of
seven people with 1-3 people at each table. The tripod
brochure was placed on the table and when the people
arrived they were observed from a distance by the team
whether they picked up the brochure or not. In five out
of seven tables, the elderly noticed and read it before
we approached the table. This also triggered them to
start talking and discussing about the heat waves. When
asked about their feedback, four out of this five found
the information useful and noteworthy. The fifth person
did not see any point with it as it was common sense to
him. Everyone asked was comfortable with the design
and content in terms of colour and font size of the tri-
pod. After the test was concluded, the brochures were
collected. However the elderly asked if we could leave
them as they thought that more people are coming la-
ter and would be important for them to benefit from the
information. Lastly, one of the staff suggested that we
should make the tripod brochure yellow with black text
as that was proven to be the best for short sighted el-
derly people.
Automatic warning
We tested the messaging system on all Swedish mo-
bile networks and it worked fine. When signing in with
an SMS service, a variety of options are available for
example:
A computer software that is user friendly.
From the company’s main website using login informa-
tion. This will provide easy access anywhere.
From a smartphone/tablet.
An addon can be added to any municipality website so
that the administration of that website can easily con-
nect and send information.
The email system and the automated phone calls are
similar to the concept of the SMS. There are many provi-
ders for such services and the process can be persona-
lized according to the user’s needs and specifications.
Prototype
Testing
21

Table 1. Shows a price example what the set of brochure would cost.

Product Price for 135 000 (SEK)
Broschyr in A4 size (folded A3) in color 50.000
Postcards in color 40.000
Adding address to them 15.000
Prepaid stamp 380.000
Bookmark 35.000
Total, A5 resp. A4 510.000 or 520.000

Number of
interviewed
Would you like to
receive information
about heat waves?
Positive to the
brochure
Additional warning
by SMS
45 31 (69 %) 29 (64 %) 22 (49 %)

Table 2. Showing the result from the quantitative testing.

Product Price for 135 000 (SEK)
Postcards in color 40.000
Adding address to them 15.000
Prepaid stamp 380.000
Bookmark 35.000
Total, A5 resp. A4 510.000 or 520.000

Number of
interviewed
Would you like to
receive information
about heat waves?
Positive to the
brochure
Additional warning
by SMS
45 31 (69 %) 29 (64 %) 22 (49 %)

22

4.6 Empathize
We have in this second phase of Design Thinking con-
tinued with more interviews and also deepened our text
research to make the concept Green Backyard Network
stronger and identify possible threats.
Our main target group in this challenge is the end users
the elderly but in order to further understand the needs
of the context of elderly when creating the concept other
stakeholders in society, responsible for the space in
which the elderly live during summer heat, have to be
identified.
Literature research
There is a lack of knowledge in society of the crucial
significance of urban green areas for the urban heat
system and rainwater system. The hard surfaces increa-
se the water runoffs and cause floods (Wingren et al,
2015, p.115) whereas greenery absorbs the water and
prevents floods. Wingren points on that In England the
regulation is very strong against permitting hard made
surfaces and means that this needs to be considered in
Sweden too (Ibid,p. 147).
In the densification trend of today’s development of sus-
tainable cities greenery diminishes and people grow in
numbers. However, could there be a new way of defining
densification and sustainable urban development so
that is not only about buildings but rather about people,
activities, sound, smells, experiences and use of green
areas? (Ibid, p.18). GYF (Green Area Factor) defines
the demand on the microclimate, living environment, ve-
getation, water supplies and is used in Västra Hamnen
in Malmö and Norra Djurgårdstan in Stockholm.(Ibid, p.
61-63) Green areas closer than 50m are stress redu-
cing and green islands contributes to the mental health
proven in research studies by Adevi in 2007-2014 (Ibid,
p.71).
Wingren holds that there is a need to develop strategies
for how models for describing how the greenery should
be integrated where the citizen’s experiences are inte-
grated in the planning processes along with the care
for the greenery that otherwise would lose its positive
value. The green areas weave the city together like a
morphological construction perceived like a whole when
you move in it (Ibid, p.72).
Barcelona network of social urban farming
In Barcelona City similar ideas to the Green Backyard
Network concept, about social urban green structures
and elderly, has been implemented since two decades
as a network of urban gardens in a participation pro-
gramme of organic urban farming for citizens 65+. Part
of this is also a coexistence between generations in
teaching schoolchildren about urban farming. (Barcelo-
na, 2016)
The red-blue-green structures in the urban setting
To fully benefit of the urban ecosystem services the
green and blue structures must be intertwined more in
the urban landscape today but Gustafsson means that
also another color structure has to be added, the activity
based red. It is in the mix of colors that makes enriched
interactivity zones occur between human beings in the
city and the urban nature. The RGB(red-blue-green)
agents constitute a multifunctional surface program and
performative form elements which create the cluster of
different kind of lives in urban environments (Gustafs-
son, 2015, p.33).
Vectors and allergies - threats to be aware of
In order to understand why greener backyards haven’t
been implemented more already we searched and found
a research on vectors as a possible threat to making
green areas. In the article ”Making green infrastructure
healthier infrastructure” the researchers Mare Löhmus
at Karolinska Institutet/Department of Environmental
Medicine, Stockholm points at the importance to consi-
der that rats and ticks as vectors of serious diseases is
a problem when cities want to build more green space.
Awareness of these pests must be taken when increa-
sing biodiversity so that no serious health problems ari-
se. It is possible and desirable to increase the greenery
but knowledge of these issues must be included in the
design of green areas in order to reach the full potential
of the greenery as a health promoter. Concerning pollen
allergies that may increase they consider finding plants
that are pollinated by insects and not by the wind (Löh-
mus and Balbus, 2015).
Interviews
We interviewed Anna Pettersson, head gardener at The
Department of Ecology, Environment and Plant Scien-
ces /Stockholms University who didn’t see any problem
with creating green backyards. Planting trees and other
23

vegetation is possible with the existing planting techni-
ques - what is needed is just a root protection and soil
of 50 cm for trees. She doesn’t think rats in the city can
be avoided by having backyards without greenery. Re-
sponsible property owners work constantly on this iss-
ue. But not having cafes and fruit trees is the best way to
prevent rats, designing the backyard as an unpleasant
space for them to thrive. Björn Embrén at Traffic Office/
Stockholm Stad, expert on trees, says they use maka-
dam combined with layers of biocarbon to stop rats from
digging themselves through. And concerning pollen al-
lergies they avoid the most known plants to trigger aller-
gies but for tics they take no measures.
The property owner’s lack of knowledge of the technical
possibilities for vegetation in backyards and the opinion
on the cost of implementation and maintenance seem to
be the major reasons why so few backyards are made
greener in Stockholm. As both Gunnar Kempe, mana-
ger at Micasa elderly homes and My Pensaluu Park and
Environmental Department/ Stockholm Stad say there
are no general municipal guidelines for making the cities
greener, only recommendations in the comprehensive
plan. It is entirely up to the property owner to decide
whether to make greener yards or not.
The City’s Park department’s task is only to maintain
and strengthen the existing ecosystems in the public
green spaces, not to create new ones and within that
work on climate adaptation. They hire subcontractors to
do the maintenance and also convey summer jobs for
youngsters for shorter periods and minor tasks to these
private companies.
Gunnar Kempe thinks however that it would be impor-
tant to implement more natural shadow from trees and
that it should be included and made mandatory in the de-
tail plan. He points on the fact that buildings in Sweden
don’t have a standard for a cooling system which unfor-
tunately can make it hot indoor during warm summers.
He thinks we don’t yet see the sun as harmful in Sweden
and our electricity net is not designed for room cooling
systems. Whenever there has been a big problem in
warm summers with elderly that cannot be moved their
tenants have used room cooling devices, opened the
windows for air draft and urging the elderly to drink.
The yards at the elderly homes are meant to be the out-
door space of the residents where they can spend time.
During the years he says they have worked on improving
the standard of the backyards which is especially obvio-
us at the elderly home Riddarsporren with a rather well
designed greenery on the ground but not on the walls.
But what is astonishing is the installed artificial plastic
grass both here and on the terrace at Väderkvarnen
which shows that there is little knowledge of the many
possibilities to make a natural grass ground, f.i. with a
grid of paving that gives a flat surface for wheelchairs
and still a feeling of a green lawn (Veg Tech, 2016).
There seems to be a general lack of enough knowledge
or interest of the radical improvements, as mentioned
above referring to research in the article of Zupancic,
that the greenery can bring to the urban setting regar-
ding ecosystem services like better air with the evapora-
tion through the photosynthesis, absorption of rainwater
thus limiting the damage of climate change floods, a bet-
ter kind of shade instead of shadow from buildings and
an overall cooler urban environment.The urban heat is-
land effect also diminishes with green areas.
Further interviews with elderly and caregivers at Väder-
kvarnen
Interviews were also made with the elderly, and this time
choosing the most extreme persons in need of full assis-
tance and their close caregiver.
Roland Hans Norrby, 63 years old, physically disab-
led in a wheelchair. He said every day is the same and
would like that more young people came because the
staff does not have time to socialize as they are too busy
writing the reports. He is a very curious and social per-
son.
Margit Walldén, 99 years old in a wheelchair. She has
Anna Pettersson
24

hard to remember but after a while she remembers. She
likes to be social, misses her family life and describes
that one of her ward neighbour’s husband comes to visit
his wife everyday telling about the growing garden at
their home. She enjoys to watch social activities from a
from green balcony and cultivate friendship with people
caring for the plants indoor and outdoor.
“Odla lite trevlig vänskap” - Margit
Mats Lindholm, working as nurse since 2008. He feels
the house is like a fortress and the courtyard like a well
with no sunlight, the only spot with sunlight is occupied
by the restaurant. He also points out that the building
from the 80’s is not well built, a lot of cheating in the
materials can now be seen, like bad water pipes and
many other construction flaws. The large outdoor terra-
ce for the residents is not easy accessible. If it would be
designed better they would use it more. The balconies
have no light. It’s very close to everything in the city but
they cannot get anywhere because of the hill, the top of
the Brunkebergsåsen. The building is hot in the summer
and cold in the winter. To cope with the summer heat
they use indoor fans, but he says also that during the
summer the most vulnerable elderly die of the heat.
At the opening of the exhibition at Arkdes Bo.Nu.Då.
(Bo.Now.Then) on housing in Sweden during 99 years,
we talked to the curator Dan Hallemar, also the director
of the magazine ARKITEKTUR. He finds the concept on
the green backyards interesting and suggests writing
about it in their next issue. The show asks among other
issues questions on how we can build for the ageing po-
pulation concerning safety and social life: “How can the
green values, ecosystems services and meeting places
be integrated into the living environment? Participation
and safety are keys to freedom and independence of
older people - how to integrate this into the design of
future care homes?” (Bo.Nu.Då., 2016)
4.7 Define
We analysed the old Empathy Map again and realise it
was never completed properly and that the needs of so-
cializing and green space are dominating the mapping
from the interviews. This implied that the Point-Of-Views
(POV) were not correctly formulated. It was discovered
that the method for creating POV:s had not been app-
lied properly so we refined and made them better from
the insights of the needs of the personas. According to
BootlegBootcamp “a Point-of- View (POV) is your refra-
ming of a design challenge into an actionable problem
statement that will launch you into generative ideation”.
The POVs should capture, discover and articulate the
meaningful challenge. The three elements of a POV are:
user, need and insight (Bootleg Bootcamp, 2016, p.21).
New empathy maps for the newer interviews were also
made. From that we came up with the refined POVs:
Lily, living on her own with no assistance, needs to
have a nearby green and cooler space where she can
socialise with other people in the summer heat because
she wants to feel independent and safe.
Ingvar, living in an elderly ward home with daily assis-
tance, needs to have a social space to sit with natural
shadow close to his apartment because he needs to feel
safe and taken extra care of in the summer as the mor-
tality in this group of elderly is high during heat waves.
4.8 Ideate
To satisfy the users’ needs a brainstorm was made with
the help of some HMW-questions based on the insights
from the empathy map.
HMW decrease the temperature in the summer heat wa-
ves for the elderly?
HMW redesign the backyards to be more attractive for
the elderly?
HMW make the elderly feel independent during the sum-
Bo.Nu.Då. (2016)
25

mer heat wave?
HMW create a safe and social living space for elderly in
the summer heat wave?
HMW make the backyards possible to implement ? And
the maintenance?
The development of the concept Green Backyard
Network
Directives
There should be strong municipal guidelines for imple-
menting green backyards of elderly homes in the de-
tail plan when the densification of Stockholm is procee-
ding, both for existing areas and for new housing areas.
When planning and building elderly homes there should
be municipal and government subsidies for implemen-
ting green backyards, green balconies for every flat and
green belts connecting the backyards.
The design of the backyards
Redesign the existing backyards to facilitate easy ac-
cess for the elderly with physical disabilities. Take away
the level between the different areas of the backyards.
Green walls will be implemented in the backyards on a
system of wires with big leave vegetation. Trees, plants,
bushes and flowers will be installed to create a massive
green backyard. Vegetation will be chosen to avoid the
existence of vectors and pollen allergies.
Changing the ground surface from hard cement into a
grid of grass reinforcement.
Waterfall walls and water fountains and ponds with fish
should be implemented in the backyards. A green igloo
in the backyard should be made with a cooling system
as a calmer and cooler place to sit for extra shade and
intimate talks.
Green belts
Green belts with trees and vegetation between the
backyards that are care free, only for pedestrians and
bikes. Only those who live there are permitted to come
in with a car for loading off/on. The green belts will also
have free drinking water taps placed out.
Social activities
Workshops will be held to activate with those elderly that
would like to work with caring for the plants in the backy-
ard.Make space in the larger backyards for outdoor ga-
mes like boule, krocket, kubb etc. No commercial activi-
ties would be allowed like cafes etc.
Indoor
In the shared living space in the wards there should be
green walls with waterfalls.
Map
A map for Green Backyard Network where every backy-
ard of the property owner MICASA in the inner city is
marked is to be distributed to every elderly above 65
of age in Stockholm. There will be information on every
unique backyard, when they are open to the public, how
to get there using the green belts. There will also be in-
formation on the activities offered along with advices on
how to be prepared and behave in the very hot summer
days. There will be a phone number to a contact person
at Helping Green Hands.
Helping Green Hands
The organization Helping Green Hands is a part of the
concept. It is occupied with maintaining the green backy-
ards, socializing with and helping the elderly. The orga-
nisation should have an administration that is respon-
sible for finding new persons, planning and organising
the work in the backyards. Helping Green Hands should
be research based to create a bank of knowledge for
the development of the concept, led by a head garden-
er like Anna Pettersson at The Department of Ecology,
Environment and Plant Sciences/Stockholms University
with employed gardeners, volunteers and summer job
for youngsters. The work will develop a research plat-
form on how to create green social backyards in elderly
homes as a long-term commitment in helping munici-
palities with the knowledge about the possibilities. The
work is implemented and followed up with directives from
Länsstyrelsen in Stockholm. A network will be establis-
hed with researchers in Geriatric Medicine and Environ-
mental Medicine, but also the City Planning Committee
and Office and other stakeholders concerned with the
health of the elderly.
Feasibility
The feasibility of the concept Green Backyard Network
is made through collaboration with a property owner like
Micasa with many elderly homes in Stockholm inner city.
Also the fact that Micasa is a company run by the muni-
cipality of Stockholm will give the project implementation
a larger impact and publicity as a role model for other
property owners and other cities in the region.
Part of the funding for the concept will be applied for
from a research fundation f.i. Vinnova that develops
26

Sweden’s innovation capacity for sustainable growth
and benefiting society. Like BOODLA , an organisation
that has received funding from Vinnova for a long-term
ecological greenhouse project with residents combi-
ning urban farming with social growth (BOODLA, 2016).
Other potential fund givers would f.i . be the Swedish
Research Council and Riksbankens Jubileumsfond, an
independent foundation supporting research in the Hu-
manities and Social Sciences.
We also made two different blueprints for how the con-
cept Green Backyard Network during a normal day
could look like for Lily and Ingvar. This gave us more
understanding for what is going on different levels for
the implementation of the concept something that we
did not think about before.
4.9 Prototype
The first intention was to make small models of backy-
ards on a map of Stockholm printed from a DWG-file
given by Hans Hauska at KTH. After trying to print out
the models of the blocks of the backyards using the 3D
printer it was decided instead to cut them by hand in
foam and fill them with paper. The insight was that we
wouldn’t get enough feedback from the testing if we
made it too professional so the the prototype was made
more in a more free way.
Four backyard modules were made with greenery, bal-
conies, waterfall walls and green igloo, then glued on
a Kapa board. Green belts were visualized with green
dots connecting the backyards. Yellow dots visualized
the heating effect of the sun. The testing was planned
as a performance: two workers (us) from Helping Green
Hands dressed in green shirts pulling a wheelbarrow
with the cardboard model walking through the city.
Prototyping
Map
27

A map for Green Backyard Network was made using an
ordinary free tourist map of Stockholm on which every
backyard of the property owner MICASA in the inner city
was marked. Instead of the printed adverts information
on every unique backyard, their opening hours and their
particular stories were added along with recommenda-
tions on how to cope and behave in the very hot summer
days. We also made a sound with waterfall and birds
singing to bring when testing to people to listen to in
headphones.
4.10 Testing
Gunnar Kempe (Micasa), Anna Pettersson ( Stockholm
University), Mare Löhmus (KI), Hanna Sundkvist (Läns-
styrelsen), three pensioners not living in the elderly
home but on their own were invited. Roland an elderly
and caregivers at the elderly home Väderkvarnen that
we met before were asked to come down and meet us in
the backyard for the testing. Due to bad weather (it was
+6 degrees C) only Hanna, Roland and the caregivers
Stine and Mats turn up. The performance and the model
were tested with these people.
On our way to Väderkvarnen we walked through the city
and our appearance was met with curiosity as we were
talking about heat wave in the cold weather that day.
“Prata sig varm” - Elderly living on his own.
Roland, resident at the elderly ward, physical disabled
in a wheelchair.
Roland was happy with some distraction from the daily
routines that he finds so monotonous. He enjoyed the
nice company and so did we, as we get to know each
other more every time we come back. Roland thinks the
backyard is nice as it is and likes the warm summers.
He has asked to be transferred to an elderly care house
in Gotland where he grew up. He finds the air pollution
from cars is the worst and understands that green areas
help cleaning the air.
Mats
He asked about references from other places with green
belts and backyards and mentions Berlin, he thinks the
concept is complex when we ask what he thinks.
Mats says that we could have a “bartender” serving le-
monade to the elderly. About elderly living on their own
that can come to join them in backyard during daytime
he finds positive as it makes everyday different and
more social.
Hanna
She likes that we are involving the property owner that
is needed to implement the concept. She listens to the
waterfall and birds which she likes. She enjoys the Hel-
ping Green Hands trying to explain to Roland and Mats
the concept with the map. She explains to the group that
towards the end of the century we will have over 30 days
of heat waves and that’s why we need to think about
how to deal with the environment. Green areas are im-
portant.
Man in the ward
Comments on the green plastic bags we had in our
pockets that they were not good for the environment
Man in the street
We met a man 60+ in the street who stopped and looked
at the model asking if we really would make the greene-
ry covering the windows too. An interesting insight that
“flaws” in the prototyping involves people to think and
add comments to the design.
Insights from the testing are that we, as acting people
from Helping Green Hands, really were needed helping
Roland down and out on the backyard ast the caregi-
vers didn’t have much time. Roland and the caregivers
trusted us completely. We realized that the access to
the backyard is really hard for a person in wheelchair
as even though the doorstep is tiny it is large enough
to make Roland hurt his feet and the doorway is almost
too narrow for a wheelchair. This makes it impossible for
Roland to roll out on his own. We feel we are needed
also on a social plan and we also become happy of all
these encounters. The head of the ward and the caregi-
vers also appreciate our presence and interest in their
situation and they so easily let us come for interviews
and testing. It was hard to talk about the heat when
everyone was freezing in the cold weather.
Manager from property owner of the two elderly homes.
She thinks that it’s nice with caring for the elderly as
she also is getting older herself. She is surprised to hear
about the article on the concept in Dagens Nyheter the
28

same day. She didn’t know that the ground can be pre-
pared with a grass grid instead of artificial grass that
they now use in the backyards. But then she compares
this to how it is made easier for fire vans to pass on
grass when there is installed a strong grid of cement on
the grass. She says they at Micasa really do care how
the environment is for the elderly. The backyards have
to be locked as they are today not to attract people that
shouldn’t be there. They don’t want to have burglaries
and other people that shouldn’t be there. Green belts
she wonders what that means, is it bushes and trees?
She didn’t know that artificial grass might be toxic: “I will
have to talk to my ground maker”. She says it sounds
like very expensive to create and maintain the backy-
ards.
Daughter
“Mummy you must listen to this!” She tried to convince
her mother and with a smile on her lips she continued to
listen to the waterfall and the birds in the headphones.
She smiles ”It’s wonderful!” The calmness she feels is
unbeatable.
Cafe employee
She lives in the forest (Haninge) now because she was
not feeling well in town, her skin gets better, she says.
As she listens to the sound, she mentions that it is ex-
actly how it sounds, where she lives. She has a creek
that runs by the house and she really means that she
lives in the countryside. At first she thought this would be
the sound of the backyards but after we explained that
it is possible to create a real waterfall and a green oasis
to be in she was totally excited and continued to ask and
said that she would like to have it. She also mentions
that it is such a poor air quality in the city and this would
help. She also mentions that there is a difference of 3
degrees between where she lives and the town. She
does not like the terrible heat.
Testing at Väderkvarnen
Testing at
Riddarspor-
ren/Vasaträf-
fen
Walking to
Väderkvar-
nen through
the city
29

5. Final concept
5.1 Our two concepts
5.1.1 Awareness and Automatic Warning System
This concept is about creating awareness of heat wa-
ves. The concept can be divided into two parts.
Firstly, today there is a warnings system for heat waves.
This is the same system that is used for other emer-
gencies e.g. terrorism or harsh weather condition etc. In
the case of heat waves SMHI sends a warnings to MSB
(Myndigheten för samhällsskydd och beredskap) that
informs the County Administrative board, who will send
the information to the municipalities. Once at the muni-
cipality level the information often get stuck and there is
no direct way to reach the end user. We created a sys-
tem that will send the warning directly to the end user.
This would be sent out as SMS, email, and/or automatic
phone calls, depending on the user’s preferences. Tech-
nology for such a system is already existing today, which
brings down the cost for implementing it.
Secondly, for people to take action when heat waves are
coming they need to have the knowledge what a heat
wave is, understand it severeness, and know what pre-
cautions that need to be taken. This is solved by sending
out a brochure in the spring to vulnerable groups like
the elderly, i.e. people above 65 years and people with
chronic diseases. A second part of providing this infor-
mation by placing tripod brochure with the information in
settings where the risk groups are. This is e.g. common
rooms in elderly homes or waiting rooms at primary care
settings.
5.1.2 Green Backyard Network
The concept Green Backyard Network consists of lush
green oasis with green balconies in the many existing
(and also future) elderly care homes in the inner city
of Stockholm. The backyards are interconnected with
green belts into a network.
Green walls, big leave trees, plants and flowers will
be installed to create a massive green backyard. The
ground surface from hard cement into a grid of grass
reinforcement. Waterfall walls and water fountains and
ponds with fish should be implemented in the backy-
ards. A green igloo in the backyard should be made with
a cooling system as a calmer and cooler place to sit for
extra shade and intimate talks.
The organisation Helping Green Hands will maintain
the vegetation daily in the backyards, have gardening
workshops for those interested among the elderly and
keep an extra surveillance eye on the elderly in the
backyards during the heat waves. The organisation
should have an administration that is responsible for fin-
ding new persons, planning and organising the work in
the backyards.
A map where every backyard in the inner city is marked
will be distributed to every elderly above 65 of age in
Stockholm. In the map there is information on every uni-
que backyard and their stories, when they are open to
the public, how to get there using the green belts. Their
you also find information about the offered activity pro-
grams (workshops, games etc) along with advices on
how to be prepared and behave in the very hot summer
days. There will be a phone number to contact persons
at Helping Green Hands.
To satisfy the user’s needs the concepts “Green Backyard Network” and “Awareness and Automatic War-
ning System” were the final concepts. Both concepts satisfy in different ways the needs of the users, the
elderly, and their health during summer heat waves but Why are the ideas needed? How will Länsstyrel-
sen support the ideas?
30

No commercial activities would be allowed like cafes in
the backyards but drinking water taps will be installed.
5.2 Why are the ideas needed?
Heatwaves are more frequent nowadays because of
global warming effects. Heat waves is a severe weather
conditions with a high risk of affecting people’s health
that could also lead to death. Groups which are of hig-
her risks is elderly and people with chronic diseases.
However, for people to take precautions they first need
to be aware of the danger, and second they need to be
informed when a heat wave coming. These issues emp-
hasize the need of this concept.
The green backyards in a network satisfy the elderly’s
needs for a cooler and safe place nearby during sum-
mer heat waves. It also meets needs for easy access to
socializing with friends but also to cultivate new relations
over the generation borders with the mix of youngsters,
volunteers and employed people from Helping Green
Hands. The socializing is also part of the safety during
hot summers as if they would suddenly feel ill in the heat,
feel safe that someone will see their need of help. The
map will facilitate for those elderly living on their own to
find a green backyard closeby where they can spend
time in a cooler environment during the hot summer.
The concept’s emphasize on abundant greenery is
needed to provide an overall cooler environment in
Stockholm city for the most vulnerable. It also meets
the needs of the long term climate adaptation program-
me, Vision 2030, that the City of Stockholm is working
on (Stockholm Stad, 2013).
5.3 How will Länsstyrelsen support the ideas?
Looking at the future development of the warning sys-
tem, Länsteressen need to hire consultants to further
develop and work on improvement of tools that were de-
veloped at OpenLab. Consultations are very important
to share knowledge across continents and within europe
about climatic changes and how heat is affected locally.
By doing so, there will be far better understanding about
heat changes and how to adapt to the local conditions.
Consultants can also monitor and test the warning and
awareness system.
There will be a project group which on a long-term basis
assumes the responsibility to coordinate and ensure
the implementation, continuity and funding for the con-
cept.
Directives
There should be mandatory directives from Länsstyrel-
sen on the municipalities to create strong guidelines for
specifically implementing green backyards of elderly ho-
mes in the detail plan when the densification of Stock-
holm is proceeding, both for existing areas and for new
housing areas. When planning and building elderly ho-
mes there should be government subsidies for imple-
menting green backyards, green balconies for every flat
and green belts connecting the backyards.
Research platform
The organisation Helping Green Hands should be re-
search based to create a bank of knowledge for the de-
velopment of green backyards, led by a head garden-
er like Anna Pettersson at The Department of Ecology,
Environment and Plant Sciences/ Stockholm University
with employed professional gardeners, apprentices, vol-
unteers and summer job for youngsters.
The work will be developed as a research platform on
how to create green social backyards in elderly homes
as a long-term commitment in helping municipalities
with the knowledge about the possibilities and needs for
the elderly.
Feasibility
The feasibility of the concept Green Backyard Network
is made through collaboration with a property owner like
Micasa with many elderly homes in Stockholm inner city.
Also the fact that Micasa, the elderly care housing com-
pany run by the municipality of Stockholm, will give the
project implementation a larger impact and publicity as a
role model for other property owners and other cities. In
order to ensure that the knowledge of the development
is documented and evaluated, part of the funding for the
concept will be applied for from a research fundation f.i.
Vinnova that develops Sweden’s innovation capacity for
sustainable growth and benefiting society. Other poten-
tial fund givers would f.i. be Swedish Research Council
and Riksbankens Jubileumsfond, an independent foun-
dation supporting research in the Humanities and Social
Sciences.
A network, coordinated by Länsstyrelsen and the project
group, will be established with researchers in Geriatric
Medicine and Environmental Medicine, but also the City
Planning Committee and Office and other stakeholders
concerned with the health of the elderly and the growing
city.
31

6. Reflection
Working with this challenge through the design thinking
method has been an exciting journey with an interdis-
ciplinary group like ours with many strong personalities
as well as different backgrounds. One limitation has
been time, more time would have gained more insights
through both text research and interviews with different
stakeholders and users. But still our outcome of the
work shows that a lot of work, insights and ideas can be
generated for the development of a new design solution
on an urgent and huge challenge in quite a short time.
The simplicity of using already existing technology ma-
kes the feasibility of the Warnings system and Aware-
ness creation easy and possible to implement with low
costs. If implemented and over years more and more
user are added we believe this could save lives during
future heat waves. However, follow ups would be needed
during the implementation to modify the concept. We
would recommend to start with a smaller part of Stock-
holm municipality and later include the whole Stockholm
region.
Regarding the concept Green Backyard Network, ad-
ditional testing is needed, for instance, in full scale in
a backyard as we first planned. Working with the chal-
lenge through design thinking has resulted in a concept
that is innovative in its combination of elements where
the focus is on the need to care for elderly, creating a
new kind of social and safe space in the summer heat
that will be as useful in the present summer as in the
future heat waves. We will continue developing the con-
cept and make a pilot project involving some backyards
in the inner city of Stockholm.
32

7. References
7.1 Literature
Gustafsson, M., (2015), Rödgrönblå stadsbyggnads-
konst, PLAN Nr.3, Årgång 69, 33
Le Tertre A, Lefranc A, Eilstein D, et al, (2006). Impact
of the 2003 heatwave on all-cause mortality in 9 French
cities. Epidemiology ;17:75–9.
Oudin Åström, D., Forsberg, B. (2013). Attributing mor-
tality from extreme temperatures to climate change in
Stockholm, Sweden. Nature Climate change 2013; 1-5
Wingren, C., Alsanius, B., Karlén, H., Lidström, V (2015),
Urbana nyanser av grönt - Om grönskans roll i en för-
tätad klimatsmart stad, Stad & Land nr 187, Movium,
SLU, 18, 61-63, 71-72, 115, 147
7.2 Other sources
Barcelona, http://ajuntament.barcelona.cat/eco-
logiaurbana/en/services/the-city-works/mainte-
nance-of-public-areas/management-of-biodiver-
sity-and-green-areas/urban-gardens, Retrieved
2016-05-20
Bo.Nu.Då., (2016), http://www.arkdes.se/bo-nu-da, Re-
trieved 2016-05-25
BOODLA, (2016), http://boodla.se/, Retrieved 2016-05-
02
Bootleg Bootcamp, (2016), Stanford University Institute
of Design,
http://dschool.stanford.edu/use-our-methods/the-boot-
camp-bootleg/, Retrieved 2016-02-15
Boverket, (2010), Mångfunktionella ytor - Klimatanpass-
ning av befintlig bebyggd miljö i städer och tätorter ge-
nom grönstruktur, http://www.boverket.se/globalassets/
publikationer/dokument/2010/mangfunktionella_ytor.pdf
Burden, A. - TED TALK, (2014). ”How public spaces ma-
kes cities work” http://www.ted.com/talks/amanda_bur-
den_how_public_spaces_make_cities_work#t-438653
Retrieved 2016-02-04
Center for Disease Control and Prevention, http://emer-
gency.cdc.gov/disasters/extremeheat/older-adults-heat.
asp, Retrieved 2016-04-13
Dagens Nyheter, (2016), http://www.dn.se/sthlm/har-
kan-grona-bakgardar-ge-svalka-at-seniorer-i-city/, Re-
trieved 2016-05-20
Delrapport 1- Inventering av Stockholms stads klimat-
anpassningsarbete, (2013), 11 https://insynsverige.se/
documentHandler.ashx?did=1747781,Retrieved 2016-
05-18
Jacob, C.(2015) - Attractiveness and Urban Space and
the Public Life in Cities, a Case Study of Stadshagen in
Stockholm
http://pure.ltu.se/portal/en/studentthesis/stads-
rummets-attraktivitet-och-det-offentliga-stads-
l i v e t - f a l t s t u d i e - f o e r - s t a d s h a g e n - i - s t o c k -
holm(a04b3ff0-57e6-48f1-a6c4-b5a33fae8e6e).html
Löhmus, M and Balbus,J., (2015), Making green in-
frastructure healthier infrastructure, http://www.infec-
tionecologyandepidemiology.net/index.php/iee/article/
view/30082, Retrieved 2016-04-20
Länsstyrelsen i Stockholm, (2014), r2014-14-ett-ro-
bust-samhalle-handlingsplan-klimatanpassning.pdf,
Mossberg Sonnek, K., Carlsson-Kanyama, A., Denward,
C (red.), (2015). Värmens påverkan på samhället – en
kunskapsöversikt för kommuner med faktablad och re-
kommendationer vid värmebölja, Myndigheten för sam-
hällsskydd och beredskap (MSB), Totalförsvarets forsk-
ningsinstitut (FOI), https://www.msb.se/RibData/Filer/
pdf/27620.pdf, Retrieved 2016-05-26
Nationalencyklopedin, http://www.ne.se/ , Retrieved
2016-05-12
SMHI, http://www.smhi.se/en/weather/sweden-weather/
warnings#district=none,page=wpt-warning-alla,Retri-
eved 2016-05-22
http://www.smhi.se/k-data/klimatpresentation/smhi4.
34

swf, Retrieved 2016-05-20
Stockholm Chamber of Commerce, (2015) http://www.
chamber.se/nyheter/stockholm-vaxer-snabbast-i-euro-
pa-2.htm, Retrieved 2016-05 14
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tryter-nar-stockholm-vaxer, Retrieved 2016-05-13
Zupancic, T., 2015, “The impact of green space on heat
and air pollution in urban communities: A meta-narrative
systematic review”, David Suzuki Foundation, Vancou-
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ties.pdf,, 17, Retrieved 2016-02-15
Veg Tech, www.vegtech.se, Retrieved 2016-05-22
35

8. Appendix
8.1 Empathize map for Anna Petersson gardener
36

8.3 Blueprint - Elderly living on their own
38

8.4 Blueprint - Elderly living in care home
39

Openlab is a creative centre that provides opportunities for finding solutions to chal in society. In coopera-
tion with our partners and other actors, we create proposals for innovative solutions for the Stockholm re-
gion. We do this across the lines between different disciplines and professions. The reports from Openlab
are results from students interdisciplinary cooperation within the framework of a 15 ECTS master course.
This report is an outline of the work with the OpenLab challenge, ‘Elderly pe-
ople’s health in a warmer Stockholm’, that was provided by the Stockholm
County Administrative Board. A warmer climate in Stockholm results in a gre-
ater risk of more frequent heat waves. The elderly people are more vulnerable
and sensitive to heat.
The report explains the different phases in the Design Thinking method and the
work that has been carried out by the team in each phase. The Design Thinking
method is a user-centered process. We start by defining the user needs, and
solutions are developed and tested based on that. The first part of the report
covers the first iteration where the team worked with a number of different con-
cepts. The second part describes the later phase, where two concepts were
chosen and developed further. The two final concepts delivered addresses two
needs, the need to generate awareness about heat waves and the need to cre-
ate a green cool space for socializing. This is provided by a number of different
types of brochures to elderly and a Green Backyard Network.
Elderly people health in a warmer Stockholm

Elderly and heat waves, the case for Stockholm

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