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A 10-year follow-up study on subjective well-being and relationships to person-environment (P-E) fit and activity of daily living (ADL) dependence of older Swedish adults.

https://arctichealth.org/en/permalink/ahliterature154920
Source
Arch Gerontol Geriatr. 2009 Jul-Aug;49(1):e16-22
Publication Type
Article
Author
Monica Werngren-Elgström
Gunilla Carlsson
Susanne Iwarsson
Author Affiliation
Department of Health Sciences, Lund University, Box 157, SE-221 00 Lund, Sweden.
Source
Arch Gerontol Geriatr. 2009 Jul-Aug;49(1):e16-22
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Aged
Aged, 80 and over
Environment
Female
Follow-Up Studies
Humans
Interpersonal Relations
Male
Middle Aged
Quality of Life - psychology
Questionnaires
Sweden
Abstract
In order to investigate how well-being and ill health is affected by the process of aging, the main aim was to investigate these self-perceived aspects of health over a 10-year period among older Swedish adults. The aim was also to study how these aspects correlated with objectively assessed functional limitations, use of mobility device, person-environment (P-E) fit (also denoted accessibility), problems in housing, and activity of daily living (ADL) dependence. Using the Swedish national population register, a baseline sample of persons aged 75-84 years was identified. Out of the 133 participants at baseline (1994), the 31 participants still available 10 years later were included. The data were collected by means of interview and observation at home visits. Overall, the participants rated their subjective well-being as high and a stable prevalence of ill-health symptoms over time was reported. Changes in subjective well-being as related to changes in functional aspects seem to mainly occur earlier in the aging process, while as time goes by these relations weaken. ADL dependence, however, is more influential in more advanced age. The results confirm the complexity of the construct of health. A main contribution is that the results shed light on the importance of taking the impact of environmental factors into consideration.
PubMed ID
18829123 View in PubMed
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Aspects of housing and perceived health among ADL independent and ADL dependent groups of older people in three national samples.

https://arctichealth.org/en/permalink/ahliterature113316
Source
Aging Clin Exp Res. 2013 Jun;25(3):317-28
Publication Type
Article
Date
Jun-2013
Author
Signe Tomsone
Vibeke Horstmann
Frank Oswald
Susanne Iwarsson
Author Affiliation
Department of Health Sciences, Faculty of Medicine, Lund University, Box 157, 221 00, Lund, Sweden. Signe.Tomsone@med.lu.se
Source
Aging Clin Exp Res. 2013 Jun;25(3):317-28
Date
Jun-2013
Language
English
Publication Type
Article
Keywords
Activities of Daily Living - psychology
Aged
Aged, 80 and over
Aging - psychology
Dependency (Psychology)
Female
Geriatric Assessment
Germany
Health status
Housing
Humans
Independent Living - psychology
Latvia
Male
Regression Analysis
Residence Characteristics
Self Concept
Sweden
Abstract
Good housing solutions are important for the ageing population in order to promote health and maintain functional ability. The objective of this study was to investigate whether and how objective and perceived aspects of housing were related to perceived health among ADL independent and ADL dependent groups of older, single-living people within three national samples.
The current study was based on national samples (German, n = 450; Latvian, n = 303; Swedish, n = 397) from the European ENABLE-AGE Project, using data on ADL dependence, perceived health, objective and perceived aspects of housing. Descriptive statistics, correlations and multivariate ordinal regression models were used to analyze the data.
The participants in the ADL dependent groups generally were older, had more functional limitations and perceived their health as poorer compared to ADL independent groups. With regard to perceived housing, usability as well as meaning of home indicators was often lower in the ADL dependent groups, housing satisfaction was at the same level while housing-related external control beliefs were higher. The differences among the national samples were highly significant for both ADL groups, for all variables except number of outdoor environmental barriers in the ADL independent groups. The relations between perceived health on one hand and objective and perceived aspects of housing on the other show great diversities among the ADL groups and the national samples.
The results serve to alert health care practitioners that it is important to draw attention to how older people perceive their housing situation and to the fact that different levels of functional independence demand different interventions.
PubMed ID
23740591 View in PubMed
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Do Associations Between Perceived Environmental and Individual Characteristics and Walking Limitations Depend on Lower Extremity Performance Level?

https://arctichealth.org/en/permalink/ahliterature291084
Source
J Aging Health. 2017 Jun; 29(4):640-656
Publication Type
Comparative Study
Journal Article
Date
Jun-2017
Author
Ritva Sakari
Merja Rantakokko
Erja Portegijs
Susanne Iwarsson
Sarianna Sipilä
Anne Viljanen
Taina Rantanen
Author Affiliation
1 University of Jyvaskyla, Finland.
Source
J Aging Health. 2017 Jun; 29(4):640-656
Date
Jun-2017
Language
English
Publication Type
Comparative Study
Journal Article
Keywords
Activities of Daily Living
Aged
Aged, 80 and over
Cross-Sectional Studies
Disability Evaluation
Environment
Female
Geriatric Assessment - methods
Humans
Independent living
Interviews as Topic
Lower Extremity - physiopathology
Male
Mobility Limitation
Perception
Physical Fitness - physiology
Sweden
Task Performance and Analysis
Walking - physiology
Abstract
The aim of this study was to analyze whether the associations between perceived environmental and individual characteristics and perceived walking limitations in older people differ between those with intact and those with poorer lower extremity performance.
Persons aged 75 to 90 ( N = 834) participated in interviews and performance tests in their homes. Standard questionnaires were used to obtain walking difficulties; environmental barriers to and, facilitators of, mobility; and perceived individual hindrances to outdoor mobility. Lower extremity performance was tested using Short Physical Performance Battery (SPPB).
Among those with poorer lower extremity performance, the likelihood for advanced walking limitations was, in particular, related to perceived poor safety in the environment, and among those with intact performance to perceived social issues, such as lack of company, as well as to long distances.
The environmental correlates of walking limitations seem to depend on the level of lower extremity performance.
PubMed ID
27056910 View in PubMed
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Environmental barriers, person-environment fit and mortality among community-dwelling very old people.

https://arctichealth.org/en/permalink/ahliterature265500
Source
BMC Public Health. 2013;13:783
Publication Type
Article
Date
2013
Author
Merja Rantakokko
Timo Törmäkangas
Taina Rantanen
Maria Haak
Susanne Iwarsson
Source
BMC Public Health. 2013;13:783
Date
2013
Language
English
Publication Type
Article
Keywords
Aged, 80 and over
Architectural Accessibility
Environment
Female
Frail Elderly
Housing for the Elderly
Humans
Male
Mobility Limitation
Mortality - trends
Proportional Hazards Models
Sweden - epidemiology
Abstract
Environmental barriers are associated with disability-related outcomes in older people but little is known of the effect of environmental barriers on mortality. The aim of this study was to examine whether objectively measured barriers in the outdoor, entrance and indoor environments are associated with mortality among community-dwelling 80- to 89-year-old single-living people.
This longitudinal study is based on a sample of 397 people who were single-living in ordinary housing in Sweden. Participants were interviewed during 2002-2003, and 393 were followed up for mortality until May 15, 2012.Environmental barriers and functional limitations were assessed with the Housing Enabler instrument, which is intended for objective assessments of Person-Environment (P-E) fit problems in housing and the immediate outdoor environment. Mortality data were gathered from the public national register. Cox regression models were used for the analyses.
A total of 264 (67%) participants died during follow-up. Functional limitations increased mortality risk. Among the specific environmental barriers that generate the most P-E fit problems, lack of handrails in stairs at entrances was associated with the highest mortality risk (adjusted RR 1.55, 95% CI 1.14-2.10), whereas the total number of environmental barriers at entrances and outdoors was not associated with mortality. A higher number of environmental barriers indoors showed a slight protective effect against mortality even after adjustment for functional limitations (RR 0.98, 95% CI 0.96-1.00).
Specific environmental problems may increase mortality risk among very-old single-living people. However, the association may be confounded by individuals' health status which is difficult to fully control for. Further studies are called for.
Notes
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PubMed ID
23981906 View in PubMed
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Evaluation of housing adaptation interventions: integrating the economic perspective into occupational therapy practice.

https://arctichealth.org/en/permalink/ahliterature262808
Source
Scand J Occup Ther. 2014 Sep;21(5):323-33
Publication Type
Article
Date
Sep-2014
Author
Carlos Chiatti
Susanne Iwarsson
Source
Scand J Occup Ther. 2014 Sep;21(5):323-33
Date
Sep-2014
Language
English
Publication Type
Article
Keywords
Architectural Accessibility - economics
Cost-Benefit Analysis
Disability Evaluation
Housing - economics
Humans
Independent living
Occupational Therapy - methods
Program Evaluation
Quality of Life
Self-Help Devices
Sweden
Abstract
The home environment is a key determinant of health, quality of life, and well-being. Given its relevance for such aspects, the scarcity of evaluations of housing adaptation (HA) interventions aimed at removing environmental barriers and accessibility problems in the homes of people with disabilities is surprising. This article aims to contribute to the development of strategies for economic evaluations of HA interventions, by stimulating the dissemination and application of the concepts of effectiveness, cost, and cost-effectiveness as used within health economics.
The focus is limited to three overarching questions for the evaluation of HA interventions. Considering X and Y as two hypothetical interventions for the same individual case, the article asks: (i) Will X be more effective than Y?; (ii) Will X cost more than Y?, and (iii) Will X be more cost-effective than Y? Vignette-like descriptions of fictional cases are used to exemplify the economic concepts explained in the article.
In the conclusion, the need is stressed for new experimental data regarding both costs and outcomes of HA interventions, in order to realize sound evaluations with the potential to inform policy and professionals in this field. Given the heterogeneity among national contexts, systematic approaches applied in a coherent manner could strengthen cross-national research and collaborations.
PubMed ID
24784725 View in PubMed
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Fear of moving outdoors and development of outdoor walking difficulty in older people.

https://arctichealth.org/en/permalink/ahliterature151341
Source
J Am Geriatr Soc. 2009 Apr;57(4):634-40
Publication Type
Article
Date
Apr-2009
Author
Merja Rantakokko
Minna Mänty
Susanne Iwarsson
Timo Törmäkangas
Raija Leinonen
Eino Heikkinen
Taina Rantanen
Author Affiliation
Department of Health Sciences, Finnish Centre for Interdisciplinary Gerontology, University of Jyväskylä, Jyväskylä, Finland. merja.rantakokko@sport.jyu.fi
Source
J Am Geriatr Soc. 2009 Apr;57(4):634-40
Date
Apr-2009
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Aged
Aged, 80 and over
Chi-Square Distribution
Cross-Sectional Studies
Environment
Fear
Female
Finland
Geriatric Assessment
Humans
Interviews as Topic
Logistic Models
Male
Mobility Limitation
Musculoskeletal Diseases - complications
Prospective Studies
Residence Characteristics
Risk factors
Socioeconomic Factors
Abstract
To study which individual characteristics and environmental factors correlate with fear of moving outdoors and whether fear of moving outdoors predicts development of mobility limitation.
Observational prospective cohort study and cross-sectional analyses.
Community and research center.
Seven hundred twenty-seven community-living people aged 75 to 81 were interviewed at baseline, of whom 314 took part in a 3.5-year follow-up.
Fear of moving outdoors and its potential individual and environmental correlates were assessed at baseline. Perceived difficulties in walking 0.5 km and 2 km were assessed twice a year over a 3.5-year period.
At baseline, 65% of the women and 29% of the men reported fear of moving outdoors. Poor socioeconomic status; musculoskeletal diseases; slow walking speed; and the presence of poor street conditions, hills in the nearby environment, and noisy traffic correlated with fear of moving outdoors. At the first 6-month follow-up, participants with fear of moving outdoors had more than four times the adjusted risk (odds ratio (OR)=4.6, 95% confidence interval (CI)=1.92-11.00) of developing difficulties in walking 0.5 km and a three times greater adjusted risk (OR=3.10, 95% CI=1.49-6.46) for developing difficulty in walking 2 km compared with those without fear. The difference in the prevalence of walking difficulties remained statistically significant over the 3.5-year follow-up (P=.02 and P=.009, respectively).
Fear of moving outdoors is common in older adults and increases the risk of developing self-reported difficulties in walking 0.5 km and 2 km. Knowledge about individual and environmental factors underlying fear of moving outdoors and finding ways to alleviate fear of moving outdoors are important for community planning and prevention of disability.
PubMed ID
19392955 View in PubMed
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Home and health among different sub-groups of the ageing population: a comparison of two cohorts living in ordinary housing in Sweden.

https://arctichealth.org/en/permalink/ahliterature277620
Source
BMC Geriatr. 2016 Apr 26;16:90
Publication Type
Article
Date
Apr-26-2016
Author
Henrik Ekström
Steven M Schmidt
Susanne Iwarsson
Source
BMC Geriatr. 2016 Apr 26;16:90
Date
Apr-26-2016
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Aging - psychology
Cohort Studies
Cross-Sectional Studies
Environment
Female
Health status
Housing - standards
Humans
Male
Perception
Personal Satisfaction
Population Surveillance - methods
Sweden - epidemiology
Abstract
At present a majority of older people remain in their ordinary homes. Research has generated knowledge about home and health dynamics and increased the awareness of the complexity of housing as related to ageing. As this knowledge is based mainly on research on very old, single-living people in ordinary housing there is a need to study other sub-groups of the ageing population. Thus, the aim of the present descriptive study was to compare a younger old cohort with a very old cohort living in ordinary housing in Sweden in order to shed new light on home and health dynamics in different sub-groups of the ageing population.
Cross-sectional study of two population-based cohorts: one aged 67-70 years (n = 371) and one aged 79-89 years (n = 397) drawn from existing Swedish databases. Structured interviews and observations were conducted to collect data about socio-demographics, aspects of home, and symptoms. Besides descriptive statistics we computed tests of differences using the Chi-squared test and Mann-Whitney U-test.
Accessibility was significantly lower in the very old cohort compared to the younger old cohort even though the former were objectively assessed to have fewer environmental barriers. Those in the very old cohort perceived aspects of their housing situation as worse and were more dependent on external influences managing their housing situation. Although a larger proportion of the very old cohort had more functional limitations 22% were independent in ADL. In the younger old cohort 17% were dependent in ADL.
Keeping in mind that there were cohort differences beyond that of age, despite fewer environmental barriers in their dwellings the very old community-living cohort lived in housing with more accessibility problems compared to those of the younger old cohort, caused by their higher prevalence of functional limitations. Those in the very old cohort perceived themselves in a less favourable situation, but still as satisfied with housing as those in the younger old cohort. This kind of knowledge is indicative for prevention and intervention in health care and social services as well as for housing provision and societal planning. Further studies based on truly comparable cohorts are warranted.
Notes
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PubMed ID
27117314 View in PubMed
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Home and health in people ageing with Parkinson's disease: study protocol for a prospective longitudinal cohort survey study.

https://arctichealth.org/en/permalink/ahliterature106795
Source
BMC Neurol. 2013;13:142
Publication Type
Article
Date
2013
Author
Maria H Nilsson
Susanne Iwarsson
Author Affiliation
Department of Health Sciences, Lund University, Box 157, SE-221 00 Lund, Sweden. Maria_H.Nilsson@med.lu.se.
Source
BMC Neurol. 2013;13:142
Date
2013
Language
English
Publication Type
Article
Keywords
Aging
Cohort Studies
Environment
Female
Health
Health Surveys
House Calls - statistics & numerical data
Humans
Male
Parkinson Disease - epidemiology - psychology
Questionnaires
Self Administration
Self-Help Devices - statistics & numerical data
Sweden
Abstract
With an increased life expectancy for the general population as well as for those ageing with chronic diseases, there are major challenges to the affected individuals and their families, but also to health care and societal planning. Most important, an increasing proportion of older people remain living in their ordinary homes despite health decline and disability. However, little is known about the home and health situation of people ageing with Parkinson's disease (PD), and older people are often excluded from PD-research.
The overall aim of the present project is to generate knowledge on home and health dynamics in people with PD, with an explicit attention to PD-specific symptomatology. We will concentrate on aspects of home and health captured by state-of-the-art methodology from gerontology as well as PD-research, health science and rehabilitation. This study protocol describes a longitudinal cohort survey study that includes a baseline data collection and a 3-year follow-up. Both data collection waves include self-administered questionnaires, structured interviews, clinical assessments and observations during home visits effectuated by research staff with project-specific training. In order to arrive at a follow-up sample of N=160, 250 participants identified by PD specialist nurses are being recruited from three hospitals in southern Sweden. With no lower or upper age limit, only those diagnosed with PD since at least one year were included. The exclusion criteria were: difficulties in understanding or speaking Swedish and/or cognitive difficulties/other reasons making the individual unable to give informed consent or to take part in the majority of the data collection. The data collection targets environmental factors such as assistive devices, social support, physical environmental barriers, accessibility problems and perceived aspects of home. A broad variety of instruments tap PD-specific problems (e.g. freezing of gait, fear of falling) and health-related issues such as general self-efficacy, body functions, activities and participation.
This project will produce knowledge to the benefit of the development of health care and societal planning that targets people ageing with PD, ultimately promoting activity and participation and an increase of the number of healthy life years for this sub-group of the population.
Notes
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PubMed ID
24107116 View in PubMed
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Home and health in the third age - methodological background and descriptive findings.

https://arctichealth.org/en/permalink/ahliterature260797
Source
Int J Environ Res Public Health. 2014 Jul;11(7):7060-80
Publication Type
Article
Date
Jul-2014
Author
Maya Kylén
Henrik Ekström
Maria Haak
Sölve Elmståhl
Susanne Iwarsson
Source
Int J Environ Res Public Health. 2014 Jul;11(7):7060-80
Date
Jul-2014
Language
English
Publication Type
Article
Keywords
Accidental Falls
Activities of Daily Living
Aged
Attitude to Health
Depression
Environment Design
Female
Health status
Housing
Humans
Male
Personal Satisfaction
Sweden
Abstract
The understanding of the complex relationship between the home environment, well-being and daily functioning in the third age is currently weak. The aim of this paper is to present the methodological background of the Home and Health in the Third Age Study, and describe a sample of men and women in relation to their home and health situation.
The study sample included 371 people aged 67-70, living in ordinary housing in the south of Sweden. Structured interviews and observations were conducted to collect data about objective and perceived aspects of home and health.
The majority of the participants were in good health and had few functional limitations. Women had more functional limitations and reported more symptoms than men. Environmental barriers were found in every home investigated; the most were found in the kitchen and hygiene area. Environmental barriers were more common in multi-family than in one-family dwellings.
This study will increase our knowledge on home and health dynamics among people in the third age. The results have potential to contribute to societal planning related to housing provision, home care and social services for senior citizens.
Notes
Cites: Scand J Occup Ther. 2007;14(1):25-3217366075
Cites: Scand J Occup Ther. 2007;14(1):16-2417366074
Cites: Age Ageing. 2008 Jan;37(1):45-5018032400
Cites: J Rehabil Med. 2009 Feb;41(3):150-619229447
Cites: Scand J Occup Ther. 2010 Dec;17(4):258-6620078255
Cites: Scand J Public Health. 2012 Dec;40(9 Suppl):95-12023238403
Cites: Aging Clin Exp Res. 2013 Jun;25(3):317-2823740591
Cites: BMC Neurol. 2013;13:14224107116
Cites: Can J Occup Ther. 1999 Dec;66(5):250-6010641377
Cites: Gerontology. 2003 Mar-Apr;49(2):123-3512574672
Cites: Gerontologist. 2003 Oct;43(5):628-3714570959
Cites: Disabil Rehabil. 2003 Dec 2;25(23):1316-2514617438
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PubMed ID
25019267 View in PubMed
Less detail

Individual and environmental factors underlying life space of older people - study protocol and design of a cohort study on life-space mobility in old age (LISPE).

https://arctichealth.org/en/permalink/ahliterature118779
Source
BMC Public Health. 2012;12:1018
Publication Type
Article
Date
2012
Author
Taina Rantanen
Erja Portegijs
Anne Viljanen
Johanna Eronen
Milla Saajanaho
Li-Tang Tsai
Markku Kauppinen
Eeva-Maija Palonen
Sarianna Sipilä
Susanne Iwarsson
Merja Rantakokko
Author Affiliation
Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, P,O,Box 35, Jyväskylä, FI-40014, Finland. taina.rantanen@jyu.fi
Source
BMC Public Health. 2012;12:1018
Date
2012
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Aged
Aged, 80 and over
Aging
Cohort Studies
Female
Finland
Humans
Male
Quality of Life
Walking
Abstract
A crucial issue for the sustainability of societies is how to maintain health and functioning in older people. With increasing age, losses in vision, hearing, balance, mobility and cognitive capacity render older people particularly exposed to environmental barriers. A central building block of human functioning is walking. Walking difficulties may start to develop in midlife and become increasingly prevalent with age. Life-space mobility reflects actual mobility performance by taking into account the balance between older adults internal physiologic capacity and the external challenges they encounter in daily life. The aim of the Life-Space Mobility in Old Age (LISPE) project is to examine how home and neighborhood characteristics influence people's health, functioning, disability, quality of life and life-space mobility in the context of aging. In addition, examine whether a person's health and function influence life-space mobility.
This paper describes the study protocol of the LISPE project, which is a 2-year prospective cohort study of community-dwelling older people aged 75 to 90 (n?=?848). The data consists of a baseline survey including face-to-face interviews, objective observation of the home environment and a physical performance test in the participant's home. All the baseline participants will be interviewed over the phone one and two years after baseline to collect data on life-space mobility, disability and participation restriction. Additional home interviews and environmental evaluations will be conducted for those who relocate during the study period. Data on mortality and health service use will be collected from national registers. In a substudy on walking activity and life space, 358 participants kept a 7-day diary and, in addition, 176 participants also wore an accelerometer.
Our study, which includes extensive data collection with a large sample, provides a unique opportunity to study topics of importance for aging societies. A novel approach is employed which enables us to study the interactions of environmental features and individual characteristics underlying the life-space of older people. Potentially, the results of this study will contribute to improvements in strategies to postpone or prevent progression to disability and loss of independence.
Notes
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PubMed ID
23170987 View in PubMed
Less detail

Long-Term Predictors of Social and Leisure Activity 10 Years after Stroke.

https://arctichealth.org/en/permalink/ahliterature274375
Source
PLoS One. 2016;11(2):e0149395
Publication Type
Article
Date
2016
Author
Anna Norlander
Emma Carlstedt
Ann-Cathrin Jönsson
Eva M Lexell
Agneta Ståhl
Arne Lindgren
Susanne Iwarsson
Source
PLoS One. 2016;11(2):e0149395
Date
2016
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Female
Follow-Up Studies
Humans
Leisure Activities
Male
Middle Aged
Models, Biological
Predictive value of tests
Stroke
Survivors
Sweden
Abstract
Restrictions in social and leisure activity can have negative consequences for the health and well-being of stroke survivors. To support the growing number of people who are ageing with stroke, knowledge is needed about factors that influence such activity in a long-term perspective.
To identify long-term predictors of the frequency of social and leisure activities 10 years after stroke.
145 stroke survivors in Sweden were followed-up at 16 months and 10 years after a first-ever stroke. Data representing body functions, activities & participation, environmental factors and personal factors at 16 months after stroke, were used in multiple linear regression analyses to identify predictors of the activity frequency after 10 years, as assessed by the 'Community, social and civic life' sub-domain of the Frenchay Activities Index (FAI-CSC).
At the 10-year follow-up the frequency of social and leisure activities varied considerably among the participants, with FAI-CSC scores spanning the entire score range 0-9 (mean/median 4.9/5.0). Several factors at 16 months post stroke were independently related to the long-term activity frequency. The final regression model included four significant explanatory variables. Driving a car (B = 0.999), ability to walk a few hundred meters (B = 1.698) and extent of social network (B = 1.235) had a positive effect on activity frequency, whereas an age = 75 years had a negative effect (B = -1.657). This model explained 36.9% of the variance in the FAI-CSC (p
Notes
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PubMed ID
26901501 View in PubMed
Less detail

Perceived environmental barriers to outdoor mobility and changes in sense of autonomy in participation outdoors among older people: a prospective two-year cohort study.

https://arctichealth.org/en/permalink/ahliterature290462
Source
Aging Ment Health. 2017 Aug; 21(8):805-809
Publication Type
Journal Article
Date
Aug-2017
Author
Merja Rantakokko
Erja Portegijs
Anne Viljanen
Susanne Iwarsson
Markku Kauppinen
Taina Rantanen
Author Affiliation
a Gerontology Research Center and Department of Health Sciences , University of Jyväskylä , Jyväskylä , Finland.
Source
Aging Ment Health. 2017 Aug; 21(8):805-809
Date
Aug-2017
Language
English
Publication Type
Journal Article
Keywords
Aged
Aged, 80 and over
Aging
Community Participation - statistics & numerical data
Environment
Female
Finland
Humans
Independent Living - statistics & numerical data
Male
Mobility Limitation
Personal Autonomy
Abstract
The aim was to study whether perceived environmental barriers to outdoor mobility affect changes in sense of autonomy in participation outdoors among community-dwelling older people over a two-year period.
Community-dwelling people aged 75-90 years (n = 848) in central Finland were interviewed on two occasions, face-to-face at baseline and over the telephone two years later. Perceived environmental barriers to outdoor mobility were assessed using a 15-item structured questionnaire, and the sum scores categorized into tertiles (0, 1 and 2 or more barriers). Autonomy in participation outdoors was assessed with the 'Impact on Participation and Autonomy' (IPA) questionnaire using the autonomy outdoors subscale (score range 0-20, higher scores indicating more restricted autonomy).
Scores for autonomy in participation outdoors were available for 848 participants at baseline (mean 6.2, SD = 3.8) and for 748 participants at the two-year follow-up (mean 6.7, SD = 3.9). At baseline, those reporting multiple environmental barriers had the most restricted autonomy, while those reporting no environmental barriers had the least restricted autonomy (p
PubMed ID
26979293 View in PubMed
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Perceived environmental barriers to outdoor mobility and feelings of loneliness among community-dwelling older people.

https://arctichealth.org/en/permalink/ahliterature259883
Source
J Gerontol A Biol Sci Med Sci. 2014 Dec;69(12):1562-8
Publication Type
Article
Date
Dec-2014
Author
Merja Rantakokko
Susanne Iwarsson
Satu Vahaluoto
Erja Portegijs
Anne Viljanen
Taina Rantanen
Source
J Gerontol A Biol Sci Med Sci. 2014 Dec;69(12):1562-8
Date
Dec-2014
Language
English
Publication Type
Article
Keywords
Activities of Daily Living - psychology
Aged
Aged, 80 and over
Aging
Cross-Sectional Studies
Environment
Female
Finland
Follow-Up Studies
Geriatric Assessment - methods
Humans
Loneliness - psychology
Male
Mobility Limitation
Motor Activity - physiology
Odds Ratio
Prospective Studies
Questionnaires
Abstract
We examined the association between perceived environmental barriers to outdoor mobility and loneliness among community-dwelling older people. In addition, we studied whether walking difficulties and autonomy in participation outdoors affected this association.
Cross-sectional analyses of face-to-face home interview data with 848 people aged 75-90 years (mean age: 80.1 years; 62% women) gathered within the "Life-Space Mobility in Old Age" (LISPE) project. Self-reports of loneliness, environmental barriers to outdoor mobility, and difficulties in walking 2 km were obtained with structured questionnaires. Autonomy in participation outdoors was assessed with the "Impact on Participation and Autonomy" questionnaire.
Altogether, 28% of participants reported experiencing loneliness sometimes or often. These participants also reported more difficulties in walking 2 km, restricted autonomy in participation outdoors, and more environmental barriers to outdoor mobility than people not experiencing loneliness. Snowy and icy winter conditions (odds ratio: 1.59 [95% confidence interval: 1.15-2.20]), long distances to services (odds ratio: 1.57 [1.00-2.46]), and hills in the nearby environment (odds ratio: 1.49 [1.05-2.12]) significantly increased the odds for loneliness, even after adjustments for walking difficulties, autonomy in participation outdoors, perceived financial situation, living alone, and health. Path modeling revealed that environmental barriers increased loneliness either through direct association or indirectly through restricted autonomy in participation outdoors.
Prospective studies should investigate whether removing environmental barriers to outdoor mobility improves autonomy in participation outdoors and alleviates loneliness among older people.
PubMed ID
24864307 View in PubMed
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Person--environment fit predicts falls in older adults better than the consideration of environmental hazards only.

https://arctichealth.org/en/permalink/ahliterature151258
Source
Clin Rehabil. 2009 Jun;23(6):558-67
Publication Type
Article
Date
Jun-2009
Author
Susanne Iwarsson
Vibeke Horstmann
Gunilla Carlsson
Frank Oswald
Hans-Werner Wahl
Author Affiliation
Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden. susanne.iwarsson@med.lu.se
Source
Clin Rehabil. 2009 Jun;23(6):558-67
Date
Jun-2009
Language
English
Publication Type
Article
Keywords
Accidental Falls - prevention & control - statistics & numerical data
Activities of Daily Living
Aged
Aged, 80 and over
Architectural Accessibility
Environment
Female
Germany
Humans
Interior Design and Furnishings
Latvia
Logistic Models
Male
Multivariate Analysis
Residence Characteristics
Risk assessment
Self-Help Devices - utilization
Sweden
Abstract
To test the hypotheses that the empirical consideration of objective person-environment fit in the home environment is a stronger predictor of indoor falls among older adults than the assessment of environmental barriers only, and that perceived aspects of home play a role as predictors for falls.
Survey study with data collection at home visits, followed up by self-reports about falls at home visits one year later.
Urban districts in Sweden, Germany, Latvia.
Eight hundred and thirty-four single-living, older adults (75-89 years), in ordinary housing.
An assessment of objective person-environment fit in the home environment (housing enabler), a self-rating of the perceived home environment (usability in my home) and retrospective self-reports on indoor falls.
The participants reporting falls tended to be frailer than the non-fallers. The number of environmental barriers in the home was similar for the fallers and non-fallers; the magnitude of person-environment fit problems was higher among the fallers. The person-environment fit problem variable was a stronger fall predictor (odds ratio (OR) = 1.025; P=0.037) than number of environmental barriers (n.s.), even after controlling for confounders. Fallers also experienced lower usability of their home.
The results suggest that much of the inconclusiveness of the data in the relationship between environmental hazards and falls in the previous falls literature could be due to the neglect of person-environment fit assessment. The effectiveness of environmental interventions based on the notion of person-environment fit compared with traditional home hazard checklists remains to be tested.
PubMed ID
19403554 View in PubMed
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A public health perspective to environmental barriers and accessibility problems for senior citizens living in ordinary housing.

https://arctichealth.org/en/permalink/ahliterature284656
Source
BMC Public Health. 2016 Aug 11;16(1):772
Publication Type
Article
Date
Aug-11-2016
Author
Marianne Granbom
Susanne Iwarsson
Marianne Kylberg
Cecilia Pettersson
Björn Slaug
Source
BMC Public Health. 2016 Aug 11;16(1):772
Date
Aug-11-2016
Language
English
Publication Type
Article
Keywords
Aged
Architectural Accessibility - statistics & numerical data
Databases, Factual
Environment Design
Female
Housing - statistics & numerical data
Humans
Mobility Limitation
Public Health
Self-Help Devices - statistics & numerical data
Sweden - epidemiology
Time Factors
Abstract
Housing environments that hinder performance of daily activities and impede participation in social life have negative health consequences particularly for the older segment of the population. From a public health perspective accessible housing that supports active and healthy ageing is therefore crucial. The objective of the present study was to make an inventory of environmental barriers and investigate accessibility problems in the ordinary housing stock in Sweden as related to the functional capacity of senior citizens. Particular attention was paid to differences between housing types and building periods and to identify environmental barriers generating the most accessibility problems for sub-groups of senior citizens.
Data on environmental barriers in dwellings from three databases on housing and health in old age was analysed (N?=?1021). Four functional profiles representing large groups of senior citizens were used in analyses of the magnitude and severity of potential accessibility problems. Differences in terms of type of housing and building period were examined.
High proportions of one-family houses as well as multi-dwellings had substantial numbers of environmental barriers, with significantly lower numbers in later building periods. Accessibility problems occurred already for senior citizens with few functional limitations, but more profound for those dependent on mobility devices. The most problematic housing sections were entrances in one-family houses and kitchens of multi-dwellings.
Despite a high housing standard in the Swedish ordinary housing stock the results show substantial accessibility problems for senior citizens with functional limitations. To make housing accessible large-scale and systematic efforts are required.
Notes
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PubMed ID
27514631 View in PubMed
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Residential normalcy and environmental experiences of very old people: changes in residential reasoning over time.

https://arctichealth.org/en/permalink/ahliterature104667
Source
J Aging Stud. 2014 Apr;29:9-19
Publication Type
Article
Date
Apr-2014
Author
Marianne Granbom
Ines Himmelsbach
Maria Haak
Charlotte Löfqvist
Frank Oswald
Susanne Iwarsson
Author Affiliation
Department of Health Sciences, Faculty of Medicine, Lund University, Box 157, SE-221 00 Lund, Sweden. Electronic address: marianne.granbom@med.lu.se.
Source
J Aging Stud. 2014 Apr;29:9-19
Date
Apr-2014
Language
English
Publication Type
Article
Keywords
Activities of Daily Living - psychology
Adaptation, Psychological
Aged, 80 and over - psychology
Attitude to Health
Environment Design
Female
Germany
Homeless Persons - psychology
Housing for the Elderly
Humans
Independent Living - psychology
Interviews as Topic
Loneliness - psychology
Longitudinal Studies
Male
Memory, Long-Term
Object Attachment
Patient Safety
Privacy - psychology
Skilled Nursing Facilities
Social Distance
Social Environment
Sweden
Abstract
The decision to relocate in old age is intricately linked to thoughts and desires to stay put. However, most research focuses either on strategies that allow people to age in place or on their reasons for relocation. There is a need for more knowledge on very old peoples' residential reasoning, including thoughts about aging in place and thoughts about relocation as one intertwined process evolving in everyday life. The aim of this study was to explore what we refer to as the process of residential reasoning and how it changes over time among very old people, and to contribute to the theoretical development regarding aging in place and relocation. Taking a longitudinal perspective, data stem from the ENABLE-AGE In-depth Study, with interviews conducted in 2003 followed up in interviews in 2011. The 16 participants of the present study were 80-89years at the time of the first interview. During analysis the Theoretical Model of Residential Normalcy by Golant and the Life Course Model of Environmental Experience by Rowles & Watkins were used as sensitizing concepts. The findings revealed changes in the process of residential reasoning that related to a wide variety of issues. Such issues included the way very old people use their environmental experience, their striving to build upon or dismiss attachment to place, and their attempts to maintain or regain residential normalcy during years of declining health and loss of independence. In addition, the changes in reasoning were related to end-of-life issues. The findings contribute to the theoretical discussion on aging in place, relocation as a coping strategy, and reattachment after moving in very old age.
PubMed ID
24655669 View in PubMed
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The Swedish Aging With Spinal Cord Injury Study (SASCIS): Methodology and Initial Results.

https://arctichealth.org/en/permalink/ahliterature291664
Source
PM R. 2016 07; 8(7):667-77
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
07-2016
Author
Sophie Jörgensen
Susanne Iwarsson
Lizette Norin
Jan Lexell
Author Affiliation
Department of Health Sciences, PO Box 157, Lund University, SE-221 00 Lund, Sweden; and Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden(*). Electronic address: sophie.jorgensen@med.lu.se.
Source
PM R. 2016 07; 8(7):667-77
Date
07-2016
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Aged
Cohort Studies
Cross-Sectional Studies
Female
Humans
Male
Middle Aged
Quality of Life
Spinal Cord Injuries
Sweden
Abstract
Advances in acute treatment, physiatric care, and rehabilitation have improved survival greatly after spinal cord injury (SCI) and increased longevity. This has led to a need for an in-depth understanding of factors associated with healthy aging in people with long-term SCI.
To present the methodology and initial results of the Swedish Aging with Spinal Cord Injury Study, a longitudinal cohort survey targeting older adults with long-term SCI.
Cross-sectional cohort study.
Home and community settings.
People aged 50 years or older with SCI for at least 10 years.
Data were collected through interviews and assessments during home visits and from the participants' medical records.
Study-specific protocol with custom-designed questions, and validated generic and SCI-specific assessment tools focusing on functioning, disability, health, well-being, lifestyle, and personal and environmental factors.
Of 795 potential participants, 184 matched the inclusion criteria and the final sample comprised 123 participants (67% response rate; 36 women and 87 men, mean age 63 ± 9 years, mean time since injury 24 ± 12 years). Traumatic SCI accounted for 62%, and 31% had sustained a complete SCI. A majority was married or had a partner, and used some form of assistance and/or mobility device. Thirty-five percent were working full-time or part-time. Based on the American Spinal Injury Association Impairment Scale (AIS), 3 groups of SCI severity were formed. There were no significant differences in chronological age, marital status, or vocational situation between the tetraplegia AIS A-C group (n = 22), the paraplegia AIS A-C group (n = 41), and the all AIS D group (n = 60). Participants in the all AIS D group were significantly older at injury, had a shorter time since injury, and were less likely to use mobility devices compared with the other 2 groups.
These baseline data of the Swedish Aging with Spinal Cord Injury Study provide a description of older adults with long-term SCI. Forthcoming studies and subsequent follow-ups will generate new insights into factors that promote healthy aging, minimize disability and enhance participation, quality of life, and life satisfaction in people aging with long-term SCI.
PubMed ID
26548969 View in PubMed
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Unmet physical activity need in old age.

https://arctichealth.org/en/permalink/ahliterature144173
Source
J Am Geriatr Soc. 2010 Apr;58(4):707-12
Publication Type
Article
Date
Apr-2010
Author
Merja Rantakokko
Susanne Iwarsson
Mirja Hirvensalo
Raija Leinonen
Eino Heikkinen
Taina Rantanen
Author Affiliation
Department of Health Sciences, Finnish Centre for Interdisciplinary Gerontology, University of Jyväskylä, Jyväskylä, Finland. merja.rantakokko@jyu.fi
Source
J Am Geriatr Soc. 2010 Apr;58(4):707-12
Date
Apr-2010
Language
English
Publication Type
Article
Keywords
Aged - psychology
Attitude to Health
Cross-Sectional Studies
Depression - psychology
Exercise - psychology
Exercise Test
Fear
Female
Finland
Geriatric Assessment
Health Services Accessibility
Health Services Needs and Demand - organization & administration
Humans
Life Style
Logistic Models
Male
Mobility Limitation
Multivariate Analysis
Musculoskeletal Diseases - psychology
Prospective Studies
Questionnaires
Residence Characteristics
Socioeconomic Factors
Walking
Abstract
To examine which individual and environmental factors correlate with unmet physical activity need in old age and predict development of unmet physical activity need (the feeling that one's level of physical activity is inadequate and thus distinct from the recommended amount of physical activity) over a 2-year follow-up.
Observational prospective cohort study and cross-sectional analyses.
Community and research center.
A total of 643 community-living ambulatory people aged 75 to 81 took part in face-to-face interviews and examinations at baseline and 314 at the 2-year follow-up.
Unmet physical activity need and its potential individual and environmental correlates were assessed at baseline. Development of unmet physical activity need was assessed over the 2-year follow-up period.
At baseline, all participants were able to walk at least 500 m outdoors, but 14% perceived unmet physical activity need. Unmet physical activity need was more prevalent in those with musculoskeletal diseases, depressive symptoms, and mobility limitations. Hills in the nearby environment, lack of resting places, and dangerous crossroads correlated with unmet physical activity need at baseline; the association was especially strong in those with walking difficulties. Significant baseline predictors for incident unmet physical activity need (15%) included fear of moving outdoors, hills in the nearby environment, and noisy traffic.
Unmet physical activity need is common in ambulatory community-living older people who have health and mobility problems and report negative environmental features in their neighborhood. Solutions to overcome barriers to physical activity need to be developed to promote equal opportunities for physical activity participation.
PubMed ID
20398151 View in PubMed
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The use of assistive devices and change in use during the ageing process among very old Swedish people.

https://arctichealth.org/en/permalink/ahliterature122887
Source
Disabil Rehabil Assist Technol. 2013 Jan;8(1):58-66
Publication Type
Article
Date
Jan-2013
Author
Marianne Kylberg
Charlotte Löfqvist
Vibeke Horstmann
Susanne Iwarsson
Author Affiliation
Department of Health Sciences, Lund University, Lund, Sweden. marianne.kylberg@med.lu.se
Source
Disabil Rehabil Assist Technol. 2013 Jan;8(1):58-66
Date
Jan-2013
Language
English
Publication Type
Article
Keywords
Activities of Daily Living - psychology
Aged, 80 and over
Aging
Cross-Sectional Studies
Female
Humans
Male
Self Care - psychology - utilization
Self Efficacy
Self-Help Devices - utilization
Sweden
Abstract
To investigate the characteristics and change in use among very old Swedish users and non-users of assistive devices (ADs) for mobility and personal care, over a six-year period, and to investigate factors predicting AD use over a six-year period.
Descriptive statistics and logistic regression were used to analyse quantitative data from a subsample from the Swedish part of the ENABLE-AGE Survey Study, n = 154. Variables according to socio-demographics, environment and health were utilized.
The number of users increased over time, particularly those using both types of ADs (mobility and personal care). There were differences in health between users and non-users, while no such differences were seen regarding socio-demographics or environmental factors. Health factors most prominent predicted AD use after six years, but also variables within socio-demographics and the environment had an impact on the use; income for ADs for personal care and aspects in the outdoor environment for ADs for mobility.
As ADs increases over time, it is important, to pay attention to health as well as other factors, among users and non-users of ADs, to provide important information in planning for and supporting healthy and active ageing. [Box: see text].
PubMed ID
22762149 View in PubMed
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Very old Swedish women's experiences of mobility devices in everyday occupation: a longitudinal case study.

https://arctichealth.org/en/permalink/ahliterature99078
Source
Scand J Occup Ther. 2009 Sep;16(3):181-92
Publication Type
Article
Date
Sep-2009
Author
Charlotte Löfqvist
Carita Nygren
Ase Brandt
Susanne Iwarsson
Author Affiliation
Department of Health Sciences, Faculty of Medicine, Lund University, Sweden. charlotte.lofqvist@med.lu.se
Source
Scand J Occup Ther. 2009 Sep;16(3):181-92
Date
Sep-2009
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Aged, 80 and over
Attitude to Health
Canes
Female
Frail Elderly
Health Surveys
Humans
Interviews as Topic
Longitudinal Studies
Mobility Limitation
Sweden
Urban Population
Walkers
Abstract
The use of mobility devices, such as walking sticks and rollators, increases during the ageing process. Our aim was to explore how very old single-living Swedish women experience the use of mobility devices over time, in relation to everyday occupation. A multiple case study strategy involving quantitative and qualitative data was used. The findings indicate that the use of mobility devices, rollators in particular, starts off as support for walking but over time becomes more involved in occupational performance, resulting in complex transactions between personal, environmental, and task components. Personal factors such as ability to adjust and adapt to different situations seem to be crucial for optimal mobility device use. Strategies and adaptive behavior were developed over the years while striving for maintained independence and participation. The use of mobility devices was described as something one has to accept, but also a constant reminder of your limitations, or as a possibility to remain active and to manage everyday occupation. The findings stress the need to adopt a comprehensive view when trying to facilitate everyday occupations in very old age. Physical, social, psychological aspects, combinations among assistive devices, and home modification all need to be reflected on and monitored over time.
PubMed ID
19085321 View in PubMed
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