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.
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.
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.
The aim of this study was to investigate how occupational therapists in Sweden administer housing adaptation cases, how they perceive the housing adaptation process, and which improvements they consider necessary.
A total of 1 679 occupational therapists employed by the county councils or the local authorities (and involved in housing adaptations) participated in a web-based survey. The survey targeted issues related to referral and needs identification, assessment, certification, case progress feedback, and evaluation.
Less than half of the occupational therapists systematized the assessment prior to intervention and very few conducted any evaluation afterwards. Feedback from workmen or grant managers to the occupational therapists on each case's adaptation progress was often asked for but rarely given. The majority of the participants were satisfied with the housing adaptation process in general, while at the same time they indicated a need for further improvements in the process. Differences between occupational therapists related to employer and year of graduation were found on the majority of the targeted issues.
To conclude, to a very large extent housing adaptations seem to be based on non-standardized procedures for assessment, and only a few of them are evaluated systematically.
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.
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
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.
Task modification refers to performing a task differently than before. While task modification in walking may be a sign of looming walking difficulty, it may also be adaptive in and postpone the decline in life-space mobility. However, this has not been studied. This study examined whether changes in life-space mobility over a 2-year period differ between people who at baseline report no walking difficulty and no task modification, those who report no walking difficulty but task modification, and those who report walking difficulty.
Community-dwelling people aged 75-90 years were interviewed face-to-face at baseline (N = 848), and over phone one (n = 816) and two (n = 761) years later. Life-space mobility was assessed annually with the Life-Space Assessment (range 0-120, higher scores indicate better life-space mobility). Self-reported ability to walk 2 km was assessed at baseline and categorized into "no difficulty," "no difficulty but task modifications" (reduced frequency, given up walking, walking slower or resting during walking) and "difficulty." The analyses were adjusted for age, gender, number of chronic conditions, cognitive impairment, lower extremity performance and education.
The life-space mobility score was highest and remained stable over 2-years among those with no walking difficulties at baseline and lowest and showing a steady decline among those with walking difficulties. Those with task modifications formed the middle group. They showed no marked changes in life-space mobility during the first year, but significant decline during the second year.
Task modifications in walking may help community-dwelling older people to postpone life-space mobility decline.