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.
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.
The aim of this study was to explore independence in the home as experienced by very old single-living people in Sweden. A grounded theory approach was used and interviews were conducted with 40 men and women aged 80-89. Data analysis revealed the core category "Home as a signification of independence" with two main categories: "Struggle for independence" and "Governing daily life". The findings showed that home is strongly linked to independence, and being independent is extremely valued. Explicit descriptions of the ageing process as an individual process of changing living conditions within the home emerged from the findings. Hence, the ageing process influences the participants' perception of themselves as independent persons. Along the ageing process the participants' view of independence changed from being independent in activity performance without help from others to experiencing independence in being able to make autonomous decisions concerning daily life at home. Consequently, there is a need to develop strategies to support very old people in staying as active and independent as possible in their own homes. In addition, since the findings highlight that independence is a complex construct, there is a need for conceptual differentiation between independence and a construct often used synonymously, namely autonomy.
Participation in everyday life and society is generally seen as essential for health-related outcomes and acknowledged to affect older people's well-being.
To investigate if aspects of performance- and togetherness-related participation influence on mortality among very old single living people in Sweden.
ENABLE-AGE Survey Study data involving single-living participants in Sweden (N?=?314, aged 81-91 years), followed over 10 years were used. Multivariate Cox regression models adjusted for demographic and health-related variables were used to analyse specific items influencing mortality.
Participation in performance- or togetherness-oriented activities was found to significantly influence mortality [HR 0.62 (0.44-0.88), P value 0.006, and HR 0.72 (0.53-0.97), P value 0.031, respectively]. Talking to neighbours and following local politics had a protective effect on mortality, speaking to relatives on the phone (CI 1.10-2.02) and performing leisure activities together with others (CI 1.10-2.00) had the opposite influence. That is, those performing the latter activities were significantly more likely to die earlier.
The main contribution of this study is the facet of the results showing that aspects of performance- and togetherness-related participation have a protective effect on mortality in very old age. This is important knowledge for designing health promotion and preventive efforts for the ageing population. Moreover, it constitutes a contribution to the development of instruments capturing aspects of participation influencing on mortality.
In the development of health promotion and preventive efforts the inclusion of participation facets could be considered in favour of potential positive influences on longevity.
To study and compare associations between life satisfaction and standard of living, health, and coping behaviour in older single-living women in two countries with different political, economical and cultural situations: Latvia and Sweden. Cross sectional data included 260 Latvian and 288 Swedish women, aged 75-84 and 80-89, from the ENABLE-AGE Survey Study. Life satisfaction was assessed by the question: All in all, how satisfied are you with your life? Standard of living was assessed by economic and housing conditions, and health by perceived and objective health and activities in daily living. Three factors, Fight, Helplessness, and Distraction, were obtained from the Coping Patterns Schedule. Correlations between Life satisfaction and standard of living, health, and coping were calculated. The variance in Life satisfaction explained by these variables was obtained in each sample by ordinal regression models. Life satisfaction was significantly lower in the Latvian sample than in the Swedish. Standard of living was lower and health poorer in the younger Latvian sample than in the Swedish, but more of the variance in Life satisfaction was explained in the Latvian sample by standard of living (18% vs 2%) and less by health (6% vs 15%). Coping factors explained 29% of the variation in Life satisfaction in the Latvian sample as opposed to 15% in the Swedish. For single-living older women low standard of living seems to be a more serious obstacle than poor health, making it difficult to obtain a reasonable life satisfaction.
There is a scarcity of longitudinal studies examining how functional decline develops among very old people. The aim of the current study was to detect and characterize typical patterns of functional decline in a sample of very old people.
We utilized longitudinal data from a sample of people aged 80-89 at baseline from Sweden and Germany (N = 847). Three follow-up assessments were completed and 159 participants completed the last assessment 9 years after baseline. Death (45 %) and contact no longer possible (40 %) were main reasons for dropout. We used latent transition analysis (LTA) to estimate the probabilities of latent class membership at each measurement point, as well as the transition probabilities of moving from one class to another.
Three latent classes were revealed, labeled Mobility Problem Stayers, Hearing Problem Advancers and Visual Problem Advancers. The first class had a low probability of additional problems throughout the study period, while the two latter had increased probabilities of additional limitations. In terms of class membership change, Mobility Problem Stayers moved either towards Hearing Problem Advancers or towards Visual Problem Advancers.
The results suggest that mobility problems are most common when people reach the age of 80+. Further decline is typically characterized by the addition of either visual problems or hearing problems, which are both associated with an increased risk of limitations in upper extremities. These findings warrant further research to analyze the association between the detected typical patterns of functional decline and health-related outcomes.
The importance of the home environment increases with age. Perceived aspects of home influence life satisfaction, perceived health, independence in daily activities and well-being among very old people. However, research on health and perceived aspects of home among senior citizens in earlier phases of the aging process is lacking. Therefore, the main aim was to explore whether perceived aspects of home are related to number of and specific domains of symptoms in a cohort of people aged 67-70. Interview and observation data on aspects of home and health, collected with 371 individuals living in ordinary housing in urban as well as rural areas in southern Sweden, were used. Descriptive statistics, correlations, multiple linear and logistic regression models were employed. The results showed that the median number of symptoms was 6.0. Reporting fewer reported symptoms was associated with a higher meaning of home (p=0.003) and lower external housing related control beliefs (p=0.001) but not with usability in the home. High external control beliefs were significantly associated with symptoms from head (p=0.014), gastrointestinal (p=0.014) and tension symptoms (p=0.001). Low meaning of home was significantly associated with heart-lung symptoms (p=0.007), and low usability was associated with depressive symptoms (p=0.003). In conclusion, showing that perceived aspects of home are important for health in terms of physical and mental symptoms, this study contributes to the knowledge on the complex interplay of health and home in the third age.
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.
The objective of this study was to examine the relationship between self-reported and professionally assessed functional limitations in community-dwelling very old individuals. In total, 306 single-living adults aged 81-90 years were included in this cross-sectional study. The main outcome measure was the presence and absence of self-reported and professionally assessed functional limitations. A significant correlation was found between the total number of self-reported and professionally assessed functional limitations in the total sample (intraclass correlation=0.65) as well as in subgroups with respect to sex, age, and depression. When item-wise differences in the two assessments were assessed, the results showed significant differences for nine of the 15 functional limitations. In general, the participants reported more functional limitations as present than the professional did. In conclusion, research on self-reported and professionally assessed functional limitations contributes toward the understanding of how different modes of data collection influence the results. In this study, functional limitations were examined on a broad basis, including physical as well as cognitive and perceptual limitations. Once the assessments of self-reporting have been refined, we will have a more nuanced picture of functional limitations, incorporating self-report as well as professional assessments.
To describe the most prominent use of or perceived unmet need of assistive technology (AT) and to compare the characteristics of users, non-users and those expressing perceived unmet need with respect to overall health, independence in everyday life, environmental barriers and socio-demographic features.
The study is based on data collected in the "Home and Health in the Third Age Project". In all, 371 individuals participated and data were collected during home visits in southern Sweden by interviewers trained specifically for this project. The data collection comprised well-proven self-report scales and observational formats on the home environment and health indicators as well as questions about basic demographics and socio-structural data.
The proportion of users constituted almost half of the total sample. The most common types of AT used were for furnishing/adaptation (35%) and the highest perceived unmet need concerned AT for communication, in total 8%. Those cohabiting were to a higher extent users of AT for furnishing/adaptation, compared to those who lived alone. A higher perceived unmet need was seen among those who lived alone compared with cohabiting people.
These findings are of importance for future planning and development of policy to improve health services for the new generation of elderly. Implications for Rehabilitation In order to support the ageing process, the need for assistive technology has to be monitored in the third age. Assistive technology for furnishings and adaptation are frequently used by individuals in their third age and are important to support ageing in the home. Not only do health aspects impact the use of assistive technology, but gender, living conditions and social situation also matter - older men especially need to be monitored thoroughly according to their perceived unmet needs as well as do older persons living alone.