The home environment and disability-related outcomes in aging individuals: what is the empirical evidence?

PURPOSE Building on the disablement process model and the concept of person-environment fit (p-e fit), this review article examines 2 critical questions concerning the role of home environments: (a) What is the recent evidence supporting a relationship between home environments and disability-related outcomes? and (b) What is the recent evidence regarding the effects of home modifications on disability-related outcomes? DESIGN AND METHODS Using computerized and manual search, we identified relevant peer-reviewed original publications and review articles published between January 1, 1997, and August 31, 2006. For Research Question 1, 25 original investigations and for Research Question 2, 29 original investigations and 10 review articles were identified. RESULTS For Research Question 1, evidence for a relationship between home environments and disability-related outcomes for older adults exists but is limited by cross-sectional designs and poor research quality. For Research Question 2, evidence based on randomized controlled trials shows that improving home environments enhances functional ability outcomes but not so much falls-related outcomes. Some evidence also exists that studies using a p-e fit perspective result in more supportive findings than studies that do not use this framework. IMPLICATIONS Considerable evidence exists that supports the role of home environments in the disablement process, but there are also inconsistencies in findings across studies. Future research should optimize psychometric properties of home environment assessment tools and explore the role of both objective characteristics and perceived attributions of home environments to understand person-environment dynamics and their impact on disability-related outcomes in old age.

[1]  M. Prince,et al.  Associations between diagnoses, impairments, disability and handicap in a population of elderly people. , 1998, International journal of epidemiology.

[2]  Susanne Iwarsson,et al.  A long-term perspective on person-environment fit and ADL dependence among older Swedish adults. , 2005, The Gerontologist.

[3]  Nandinee K. Kutty.  The production of functionality by the elderly: a household production function approach , 2000 .

[4]  Ineke Maas,et al.  Everyday competence in old and very old age: Theoretical considerations and empirical findings. , 1999 .

[5]  Susanne Iwarsson,et al.  Use of mobility devices and changes over 12 months among very old people in five European countries , 2007, Aging clinical and experimental research.

[6]  L. Waite,et al.  At risk on the cusp of old age: living arrangements and functional status among black, white and Hispanic adults. , 1999, The journals of gerontology. Series B, Psychological sciences and social sciences.

[7]  M. Powell Lawton,et al.  Ecology and the aging process. , 1973 .

[8]  L. Rubenstein.  The Importance of Including the Home Environment in Assessment of Frail Older Persons , 1999, Journal of the American Geriatrics Society.

[9]  Tamara Tse,et al.  The environment and falls prevention: Do environmental modifications make a difference? , 2005 .

[10]  Lindy Clemson,et al.  The Effectiveness of a Community‐Based Program for Reducing the Incidence of Falls in the Elderly: A Randomized Trial , 2004, Journal of the American Geriatrics Society.

[11]  Susanne Iwarsson,et al.  Changes in ADL dependence and aspects of usability following housing adaptation--a longitudinal perspective. , 2005, The American journal of occupational therapy : official publication of the American Occupational Therapy Association.

[12]  L. Nyquist,et al.  Bath Transfers in Older Adult Congregate Housing Residents: Assessing the Person–Environment Interaction , 2006, Journal of the American Geriatrics Society.

[13]  J. Hirdes,et al.  Risk factor for accidental injuries within senior citizens' homes: analysis of the Canadian Survey on Ageing and Independence. , 2005, Journal of gerontological nursing.

[14]  John P Hirdes,et al.  Risk factors for falling among community-based seniors using home care services. , 2002, The journals of gerontology. Series A, Biological sciences and medical sciences.

[15]  ADL dependence in the elderly: The influence of functional limitations and physical environmental demand. , 1998 .

[16]  R. Schulz,et al.  Focus on interventions research with older adults , 1999 .

[17]  P. Shekelle,et al.  Interventions for the prevention of falls in older adults: systematic review and meta-analysis of randomised clinical trials , 2004, BMJ : British Medical Journal.

[18]  R. Cumming.  Intervention strategies and risk-factor modification for falls prevention. A review of recent intervention studies. , 2002, Clinics in geriatric medicine.

[19]  S. Stark.  Removing Environmental Barriers in the Homes of Older Adults with Disabilities Improves Occupational Performance , 2004 .

[20]  Cameron Swift,et al.  Prevention of falls in the elderly trial (PROFET): a randomised controlled trial , 1999, The Lancet.

[21]  W. Hauck,et al.  Evaluating home environments of persons with dementia: interrater reliability and validity of the Home Environmental Assessment Protocol (HEAP) , 2002, Disability and rehabilitation.

[22]  S. Iwarsson,et al.  Home as the Locus and Origin for Participation: Experiences among Very Old Swedish People , 2007 .

[23]  Tiffany Gill,et al.  A Population-Based Survey of Factors Relating to the Prevalence of Falls in Older People , 2005, Gerontology.

[24]  S L Wolf,et al.  Environmental and behavioral circumstances associated with falls at home among healthy elderly individuals. Atlanta FICSIT Group. , 1997, Archives of physical medicine and rehabilitation.

[25]  A. Thevenon,et al.  Benefits of Home Visits for Falls and Autonomy in the Elderly: A Randomized Trial Study , 2002, American journal of physical medicine & rehabilitation.

[26]  H. Allore,et al.  A program to prevent functional decline in physically frail, elderly persons who live at home. , 2002, The New England journal of medicine.

[27]  R. Cumming,et al.  Home Visits by an Occupational Therapist for Assessment and Modification of Environmental Hazards: A Randomized Trial of Falls Prevention , 1999, Journal of the American Geriatrics Society.

[28]  B. Fildes,et al.  An impact evaluation of a falls prevention program among older people. , 2000, Accident; analysis and prevention.

[29]  K. Day,et al.  The therapeutic design of environments for people with dementia: a review of the empirical research. , 2000, The Gerontologist.

[30]  A M Jette,et al.  The disablement process. , 1994, Social science & medicine.

[31]  H. Hricak,et al.  Evidence-based medicine. , 1997, Singapore medical journal.

[32]  Michael Fitzharris,et al.  Randomised factorial trial of falls prevention among older people living in their own homes , 2002, BMJ : British Medical Journal.

[33]  C D Holman,et al.  Preventing Falls in Older People: Outcome Evaluation of a Randomized Controlled Trial , 2001, Journal of the American Geriatrics Society.

[34]  Christianna S. Williams,et al.  Mismatches Between the Home Environment and Physical Capabilities Among Community‐Living Older Persons , 1999, Journal of the American Geriatrics Society.

[35]  Sharon E Straus,et al.  Evidence-Based Medicine: How to Practice and Teach It , 2010 .

[36]  M. Tinetti,et al.  A population-based study of environmental hazards in the homes of older persons. , 1999, American journal of public health.

[37]  J. Desrosiers,et al.  Association between personal and environmental factors and the occurrence of handicap situations following a stroke. , 2001, Disability and rehabilitation.

[38]  J. Lane,et al.  Falls in the elderly population. , 2005, Physical medicine and rehabilitation clinics of North America.

[39]  Jan P Vandenbroucke,et al.  In an observational study elderly patients had an increased risk of falling due to home hazards. , 2005, Journal of clinical epidemiology.

[40]  L. D. de Witte,et al.  Effects of a programme of multifactorial home visits on falls and mobility impairments in elderly people at risk: randomised controlled trial , 2000, BMJ : British Medical Journal.

[41]  R. Lyons,et al.  Modification of the home environment for the reduction of injuries. , 2011, The Cochrane database of systematic reviews.

[42]  H. Hoenig,et al.  Activity Restriction Among Wheelchair Users , 2003, Journal of the American Geriatrics Society.

[43]  L. Verbrugge,et al.  The great efficacy of personal and equipment assistance in reducing disability. , 1997, American journal of public health.

[44]  Christianna S. Williams,et al.  Environmental Hazards and the Risk of Nonsyncopal Falls in the Homes of Community-Living Older Persons , 2000, Medical care.

[45]  M. Laplante,et al.  Living quarters and unmet need for personal care assistance among adults with disabilities. , 2005, The journals of gerontology. Series B, Psychological sciences and social sciences.

[46]  B. Jeune,et al.  Prevention of fall injuries requiring hospital treatment among community-dwelling elderly , 2000 .

[47]  Helen Hoenig,et al.  Wheelchair Users Are Not Necessarily Wheelchair Bound , 2002, Journal of the American Geriatrics Society.

[48]  Laura N. Gitlin,et al.  Bathroom modifications for frail elderly renters: outcomes of a community-based program , 1999 .

[49]  Nancye Peel,et al.  A sustainable programme to prevent falls and near falls in community dwelling older people: results of a randomised trial , 2000, Journal of epidemiology and community health.

[50]  R. Cumming,et al.  WITHDRAWN: Interventions for preventing falls in elderly people. , 2009, The Cochrane database of systematic reviews.

[51]  L. Gitlin,et al.  A Randomized Trial of a Multicomponent Home Intervention to Reduce Functional Difficulties in Older Adults , 2006, Journal of the American Geriatrics Society.

[52]  Ingemar Kåreholt,et al.  According to need? Predicting the amount of municipal home help allocated to elderly recipients in an urban area of Sweden. , 2005, Health & social care in the community.

[53]  F. Oswald,et al.  Everyday competence in visually impaired older adults: a case for person-environment perspectives. , 1999, The Gerontologist.

[54]  O. Svensson,et al.  Early individualized postoperative occupational therapy training in 100 patients improves ADL after hip fractureA randomized trial , 2004, Acta orthopaedica Scandinavica.

[55]  B. Spillman.  Changes in elderly disability rates and the implications for health care utilization and cost. , 2004, The Milbank quarterly.

[56]  Walter W Hauck,et al.  Effects of the home environmental skill-building program on the caregiver-care recipient dyad: 6-month outcomes from the Philadelphia REACH Initiative. , 2003, The Gerontologist.

[57]  S. Iwarsson.  Assessing the Fit Between Older People and Their Physical Home Environments: An Occupational Therapy Research Perspective , 2003, Annual Review of Gerontology and Geriatrics.

[58]  A. Atwal,et al.  Determining the Effectiveness of a Falls Prevention Programme to Enhance Quality of Life: An Occupational Therapy Perspective , 2003 .

[59]  L Schelp,et al.  Evaluation of an inter-organizational prevention program against injuries among the elderly in a WHO Safe Community. , 2001, Public health.

[60]  Linda Resnik,et al.  Promoting independence for wheelchair users: the role of home accommodations. , 2006, The Gerontologist.

[61]  G. Acton,et al.  Effectiveness of home visit falls prevention strategy for Taiwanese community-dwelling elders: randomized trial. , 2004, Public health nursing.

[62]  R W Sanson-Fisher,et al.  Accidents in older people living at home: a community‐based study assessing prevalence, type, location and injuries , 2000, Australian and New Zealand journal of public health.

[63]  W W Hauck,et al.  A randomized, controlled trial of a home environmental intervention: effect on efficacy and upset in caregivers and on daily function of persons with dementia. , 2001, The Gerontologist.

[64]  S. Stark.  Creating Disability in the Home: The role of environmental barriers in the United States , 2001 .

[65]  S. Iwarsson,et al.  Accessibility, usability and universal design—positioning and definition of concepts describing person-environment relationships , 2003, Disability and rehabilitation.

[66]  Seanne Wilkins,et al.  Guidelines for critical review form - Qualitative studies (version 2.0), McMaster University Occupational Therapy Evidence-Based Practice Research Group , 2007 .

[67]  A. O'Connor.  The Cochrane Database of Systematic Reviews , 2004 .

[68]  Susanne Iwarsson,et al.  Cross-national and multi-professional inter-rater reliability of the Housing Enabler , 2005, Scandinavian journal of occupational therapy.

[69]  Helen Hoenig,et al.  Does assistive technology substitute for personal assistance among the disabled elderly? , 2003, American journal of public health.

[70]  Matteo Cesari,et al.  Prevalence and risk factors for falls in an older community-dwelling population. , 2002, The journals of gerontology. Series A, Biological sciences and medical sciences.

[71]  Susanne Iwarsson,et al.  Relationships between housing and healthy aging in very old age. , 2007, The Gerontologist.

[72]  P. Wingo,et al.  Home Environmental Hazards and the Risk of Fall Injury Events Among Community‐Dwelling Older Persons , 1998, Journal of the American Geriatrics Society.

[73]  Robert F Schoeni,et al.  Recent trends in disability and functioning among older adults in the United States: a systematic review. , 2002, JAMA.

[74]  N. Peel,et al.  Home safety assessment in the prevention of falls among older people , 2000, Australian and New Zealand journal of public health.

[75]  Johan Sjöstrand,et al.  Quality of light and quality of life – the effect of lighting adaptation among people with low vision , 2004, Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians.

[76]  T. Nikolaus,et al.  Preventing Falls in Community‐Dwelling Frail Older People Using a Home Intervention Team (HIT): Results From the Randomized Falls‐HIT Trial , 2003, Journal of the American Geriatrics Society.

[77]  J. Beard,et al.  Older people can stay on their feet: final results of a community-based falls prevention programme , 2000 .

[78]  A. Campbell,et al.  Randomised controlled trial of prevention of falls in people aged ≥75 with severe visual impairment: the VIP trial , 2005, BMJ : British Medical Journal.

[79]  R. Lyons,et al.  Modification of the home environment for the reduction of injuries. , 2007, The Cochrane database of systematic reviews.

[80]  Hans-Werner Wahl.  Environmental influences on aging and behavior. , 2001 .

[81]  H. Mollenkopf,et al.  Toward Measuring Proactivity in Person-Environment Transactions in Late Adulthood , 2003 .

[82]  D. Chan,et al.  Evidence-Based Guidelines for the Secondary Prevention of Falls in Older Adults , 2003, Gerontology.

[83]  Christianna S. Williams,et al.  Home-based multicomponent rehabilitation program for older persons after hip fracture: a randomized trial. , 1999, Archives of physical medicine and rehabilitation.

[84]  Joost Dekker,et al.  Occupational therapy for community dwelling elderly people: a systematic review. , 2004, Age and ageing.

[85]  Susanne Iwarsson,et al.  Homeward bound: Introducing a four-domain model of perceived housing in very old age , 2006 .

[86]  Sarah L Barras.  A systematic and critical review of the literature: The effectiveness of Occupational Therapy Home Assessment on a range of outcome measures , 2005 .

[87]  H. Menz,et al.  Home environment risk factors for falls in older people and the efficacy of home modifications. , 2006, Age and ageing.

[88]  T. Dunnagan,et al.  Evaluating the effectiveness of a home-based fall risk reduction program for rural community-dwelling older adults. , 2001, The journals of gerontology. Series A, Biological sciences and medical sciences.

[89]  C. Granger,et al.  Effectiveness of assistive technology and environmental interventions in maintaining independence and reducing home care costs for the frail elderly. A randomized controlled trial. , 1999, Archives of family medicine.

[90]  Hans-Werner Wahl,et al.  Aging independently : living arrangements and mobility , 2003 .

[91]  R. Scheidt,et al.  Environmental Gerontology: Progress in the Post-Lawton Era , 2006 .