Reflections on Cross-Cultural Comparison of the Impact of Housing Modification/Adaptation* for Supporting Older People at Home: A Discussion

Housing adaptations and older adults' health trajectories by level of initial health: evidence from the English Longitudinal Study of Ageing

BACKGROUND

In many ageing societies, the housing stock is poorly designed to meet the needs of older people with health limitations. Housing adaptations may enable older people to retain functional ability in the home, improve well-being and reduce the risks of falls. There is mixed evidence on whether adaptations are most beneficial for those who have limitations or whether they have a greater impact if implemented before people experience substantial disability. This study aimed to identify socio-demographic factors associated with obtaining housing adaptations and whether and how the impact of adaptations on changes in mental and physical health varied by initial level of health measured using objective indicators.

METHODS

We used data from the English Longitudinal Study of Ageing to analyse socio-demographic factors associated with acquiring housing adaptations using logistic regression. We then estimated mixed-effects models to assess how a measure of baseline physical health, derived from observer-measured indicators of physical function, modified the association between acquiring housing adaptations and health and disability outcomes for two cohorts each followed up for three waves.

RESULTS

Having more activities of daily living (ADL) limitations was positively associated with acquiring housing adaptations, but we found no evidence for socio-demographic variations. Acquiring housing adaptations was associated with slower development of instrumental ADL/ADL disability among older people with initially good latent physical health. Sensitivity analysis suggested that housing adaptations mitigated the predicted probability of falls for those with severe mobility impairments.

CONCLUSIONS

Housing adaptations may slow down development of disability in older people with initially good health.

Exploring the contribution of housing adaptations in supporting everyday life for people with dementia: a scoping review

The primary aim of this scoping review was to explore the contribution of housing adaptations to supporting everyday life for people with dementia living at home in the community. The study adopted a scoping review methodology which was guided by the Joanna Briggs Institute Reviewers Manual. Four review questions were developed which subsequently informed the inclusion criteria and search terms. Eight databases were searched resulting in 2,339 records, with 13 papers being included in the review. Evidence from the review found that the most common adaptations were recommended and/or implemented to compensate for a person's physical limitations and for safety reasons, rather than adaptations to support activities of daily living for a person with dementia. Support to implement adaptations was provided by a range of professionals coupled with ‘trial and error’ approaches adopted by the person themselves, and these were seen as key enablers. Barriers to implementing and using adaptations were fourfold: (a) access to information, (b) knowing when to make changes, (c) carer resistance, and (d) the unsuitability of the home. It would appear that housing adaptations have a positive impact on both the person with dementia and the carer (where one is present), with some adaptations having a relatively sustained impact and being particularly effective if implemented early in the lived trajectory of dementia.

Current Condition of Home Environment and Necessary Home Modifications for Elderly in Community

This study aimed to investigate the home environment conditions of the elderly living in the community and to confirm the needs of the residential environment. This study was conducted from January 15th to 25th, 2018, in 12 elderly households in Chungcheongnam-do, using a structured questionnaire and a home environment checklist. The elderly did not feel uncomfortable with their current home, but they wanted to modify their home environment to improve their quality of life. Investigation using home environment checklists showed that demands for supportive design were lacking in the overall areas. On the results of this study, it was confirmed that it is essential to reflect the residents’ occupation, physical characteristics, and needs when constructing the home environment for the healthy life of the elderly in the community.