Household Accessibility and Residential Relocation in Older Adults

Safety in Housing for Older Adults-A Qualitative Case Study

Housing solutions for older adults aim at providing a safe environment to live in. The construction is heavily based on aspects of physical safety, often disregarding the social aspects of feeling safe. The older adults themselves are looking for a living environment that supports their individual capacities and social networks. The living environment can contribute to their physical, social, and emotional safety by providing accessible housing and spaces for community building. Interviews with older adults who had recently lived through a building fire highlighted the importance of the community in daily life, in emergency as well as in recovery from hazards. The results show that community building is related to access to common-use spaces and daily interaction with neighbors. The shared spaces in the immediate surroundings can enhance community cohesion and generate peer support. The common-use spaces and public facilities in urban environment have a significant role in emergencies and in the process of recovery from adversities.

Aging in climate change: Unpacking residential mobility and changes of social determinants of health in southern United States

The southern coastal states of the United States are susceptible to extreme weather and climate events. With growing move-in and -out older populations in the region, health implications of their residential mobility lack sufficient knowledge. Using 126,352 person-level records from 2012 to 2021, we examined geospatial and temporal patterns of older populations' residential mobility, considering the changing social determinants of health and disparities. We found the moves of older populations with socioeconomic or health disadvantages were related to increased exposure to environmental hazards and reduced access to health resources. The findings inform targeted strategies for climate adaptation that address the needs of vulnerable aging populations.

Do Health and Housing Attributes Motivate Residential Moves Among Older Chinese Adults? Evidence From an 8‑Year Follow‑up Study

Background and Objectives

Despite the widespread belief in aging-in-place as the preferred housing arrangement for older adults, they are increasingly embracing moving. The person-environment fit theory explains that environmental changes due to residential moves can pose health risks, discouraging older people from moving. However, it also suggests that moves may be suitable when living conditions no longer meet their physical needs. The correlation between older people's health, housing, and their subsequent moving or staying actions in China remains underexplored.

Research Design and Methods

Using alternative operating variables of key concepts and the China Family Panel Studies 2012-2018 data sets, this study examines the effects of health and housing status on older people's residential moves in China. The study outlines changes in health indicators and housing characteristics during multiple moves, as well as examines the relationship between the health and housing status of older adults and moving over a relatively long period of time using both regression models with lagged explanatory variables and fixed effects binary choice models.

Results

The results reveal that: (1) higher rates of subsequent moves were observed among older adults with better self-rated health, positive self-rated health changes, and no ADL impairment, but no significant associations were found between most health variables and moving; and (2) the correlation between older persons' house ownership/type and their residential moves was significant and consistent over time, steady and lasting.

Discussion and Implications

Potential mechanisms explaining the association between specific housing types and ownership statuses on moving are discussed. The findings encourage a focus on the positive benefits of moving in later life and how to provide additional housing options for older individuals.

Socially sustainable housing and built environments to support the health and social inclusion of older adults: protocol for a scoping review and stakeholder consultation

INTRODUCTION

Housing and the ageing population are issues that pose challenges for social, health and economic policies. Therefore, there is a need for more knowledge on how to design housing and public infrastructure to improve the social engagement and well-being of older adults who age in place. This project aims to provide an overview of the existing literature on design features that support socially sustainable living environments for older adults.

METHODS AND ANALYSIS

A systematic scoping methodology was used to identify and summarise the findings. Four databases were searched (CINAHL (Cumulative Index to Nursing and Allied Health Literature), Scopus, Medline and Embase) to identify the articles. Articles were included if published in English in the last 15 years (eg, from January 2008 to June 2023) without restricting the study location or country. Articles were included if they were based on empirical qualitative, quantitative and mixed-method data. The results of the review will be discussed with a panel of 15 stakeholders (n=15) from Canada, Sweden and the Netherlands (five per country). The interdisciplinary stakeholders will have expertise in housing, architecture, engineering and social and health services. The consultations will provide content expertise to the literature findings and an opportunity to build evidence-based solutions that support the design of socially sustainable living environments for older persons.

ETHICS AND DISSEMINATION

Ethical clearance for this project has been granted by the Swedish Ethical Review Authority for Dalarna University (dnr 2023-01543-01) and the Natural Sciences and Engineering Sciences (NES) Ethics Committee at the University of Twente in the Netherlands (dnr 230407) has approved this project. Stakeholders will be asked to provide signed consent to participate in the study. The results of this project will be disseminated through web seminars, community advisory groups, peer-reviewed journals and policy documents to support the development of housing and public health policy.

TRIAL REGISTRATION NUMBER

OSF, https://doi.org/10.17605/OSF.IO/PR2NC.

Relationship between person, environmental factors, and activities of daily living performance among physically disabled older adults living at home: a structural equation model

BACKGROUND

Older adults with physical disability need long-term services and support, which incur enormous costs. However, supportive environments may reduce disability and promote aging in place. It is unclear how the physical and social environment affect different types of functional impairments and influence the performance of activities of daily living (ADL) in physically disabled older adults.

OBJECTIVE

The purpose of this study was to examine the relationship between person, environmental factors, and ADL performance among physically disabled older adults living at home.

METHODS

This was a cross-sectional study. Using long-term care insurance claims data from a pilot city in China, we used a structural equation model to assess the potential paths among person, environmental factors, and ADL performance.

RESULTS

Education and income had different influences on the social environment and physical environment. The functional impairments had significant effects on ADL performance, either directly or through physical environment (with handrails) and social environment (family support).

CONCLUSIONS

The present findings offer crucial evidence for understanding the interactions between a person and the environment, as well as their influence on physical ADLs, suggesting the importance of a supportive environment and a subpopulation-targeting strategy for disabled older adults.

Longitudinal Associations Between Disaster Damage and Falls/Fear of Falling in Older Adults: 9-Year Follow-Up of Survivors of the 2011 Great East Japan Earthquake and Tsunami

Background and Objectives

Fear of falling and falls are common in older adults. However, their associations with natural disaster exposures remain poorly understood. This study aims to examine longitudinal associations between disaster damage with fear of falling/falls among older disaster survivors.

Research Design and Methods

In this natural experiment study, the baseline survey (4,957 valid responses) took place 7 months before the 2011 Great East Japan Earthquake and Tsunami, and 3 follow-ups were conducted in 2013, 2016, and 2020. Exposures were different types of disaster damage and community social capital. Outcomes were fear of falling and falls (including incident and recurrent falls). We used lagged outcomes in logistic models adjusting for covariates and further examined instrumental activities of daily living (IADLs) as a mediator.

Results

The baseline sample had a mean (standard deviation) age of 74.8 (7.1) years; 56.4% were female. Financial hardship was associated with fear of falling (odds ratio (OR), 1.75; 95% confidence interval (CI) [1.33, 2.28]) and falls (OR, 1.29; 95% CI [1.05, 1.58]), especially recurrent falls (OR, 3.53; 95% CI [1.90, 6.57]). Relocation was inversely linked with fear of falling (OR, 0.57; 95% CI [0.34, 0.94]). Social cohesion was protectively associated with fear of falling (OR, 0.82; 95% CI [0.71, 0.95]) and falls (OR, 0.88; 95% CI [0.78, 0.98]) whereas social participation increased the risk of these issues. IADL partially mediated observed associations between disaster damage and fear of falling/falls.

Discussion and Implications

Experiences of material damage rather than psychological trauma were associated with falls and fear of falling, and the increased risk of recurrent falls revealed a process of cumulative disadvantage. Findings could inform targeted strategies for protecting older disaster survivors.

Return to community living and mortality after moving to a long-term care facility: A nationally representative cohort study

BACKGROUND

Recent long-term care facility (LTCF) policy has focused on transitioning nursing home (NH) residents back to community settings, yet we lack recent descriptions of this phenomenon and how it compares in assisted living (AL).

METHODS

Using the National Health and Aging Trends Study, we studied adults over age 65 who had moved from community living into an LTCF between 2011 and 2018. Persons or their proxies reported residence in annual interviews. NH was defined by facility staff. ALs were multi-unit buildings helping with activities of daily living. We excluded temporary short-stay NH patients and independent AL residents. Our primary outcome was cumulative incidence of return to community living, with death as co-primary outcome and modeled as a competing risk, stratified by NH versus AL entry. We identified covariates (age, gender, race/ethnicity, dementia, activity limitations, and prior living arrangement) associated with return to community living through bivariate and multivariable logistic regression.

RESULTS

Among 739 participants, weighted mean age was 84 years (SD 7.5), 66% were women, 13% were non-White, 57% had dementia, and 41% entered NH. At 1, 2, and 4 years, the cumulative incidence of return to community living was 2.9% (95% CIs: 1.9%-4.3%), 6.4% (4.7%-8.4%), and 7.4% (5.5%-9.8%); the cumulative incidence of death was 28% (95% CIs: 24%-31%), 44% (40%-48%) and 66% (61%-70%). Outcomes were similar in persons entering NH versus AL. Older persons (aOR 0.88, 95% CI 0.83-0.94), those with dementia (aOR 0.33, 95% CI 0.12-0.88), and those previously living alone (aOR 0.39, 95% CI 0.17-0.89) were less likely to return.

CONCLUSIONS

Few returned to community living after entering either NH or AL. Mortality was similar. Results highlight limits in transitioning persons out of LTCFs and the need to observe AL use to ensure policies do not merely displace persons between institutional care sectors.

Effectiveness of a co-designed technology package on perceptions of safety in community-dwelling older adults

OBJECTIVES

Increasing numbers of older people are living longer, often alone, in their own homes. Services and products that enable older people to remain safely in their own homes are required. The My Smart Home project recruited 30 community-dwelling people aged 65+ to co-design a package of technology to address their individual goals for safety and security at home. The technology package, up to the value of $4000, included installation of health monitoring, communication and entertainment devices, and security alarms, with 6 hours of technology coaching.

METHODS

Participants completed the Personal Wellbeing Index (PWI), the Australian Quality of Life-8 Dimensions (AQoL-8D) and the Canadian Occupational Performance Measure (COPM) at baseline, and after 4 weeks' use of the technology package. Semi-structured interviews were also used to qualitatively understand the challenges, enablers and outcomes of the project with respect to safety and security in the home.

RESULTS

Significant improvements in PWI (p < 0.01), AQoL-8D (p < 0.000) and COPM for goal performance (p < 0.000) and goal satisfaction (p < 0.000) were reported. Participants also reported feeling safer and more secure in their own homes. Common barriers to adoption of technology, cost, integration with already-owned technology and lack of confidence were overcome with this technology and coaching package.

CONCLUSIONS

An individualised package of technology, with coaching, that supports older people to realise their personal goals with technology resulted in improved well-being, quality of life and sense of safety and security in community-dwelling older people. Ultimately, this should support a longer and better quality of life at home.

Exploring Associations of Housing, Relocation, and Active and Healthy Aging in Sweden: Protocol for a Prospective Longitudinal Mixed Methods Study

BACKGROUND

While housing and neighborhood features have the potential to impact opportunities for active aging, there is a lack of knowledge related to how older people reason regarding their housing situation and how housing and fulfillment of relocation are associated with active and healthy aging.

OBJECTIVE

The objectives of Prospective RELOC-AGE are to study housing choices and relocation and explore effects on active and healthy aging among men and women aged 55 years and older in Sweden considering relocation.

METHODS

The estimated sample (2800) will include people aged 55 years and older being listed for relocation at either of two housing companies: a local public housing company in Southern Sweden and a national condominium provider. Prospective RELOC-AGE has a 2-level longitudinal mixed methods design and includes quantitative surveys (implemented by a professional survey company) and a telephone interview for baseline data collection in 2021, with follow-ups with the same procedures in 2022 and 2023. The survey and interviews include questions related to present housing and neighborhood, relocation plans and expectations, a range of perspectives on active and healthy aging, and demographics. Linking to national registers will provide additional data on home help and health care use, objective housing, and neighborhood characteristics. To explore what housing attributes older adults considering relocation find important and to what extent when making their decisions on housing, we will develop a discrete choice experiment to be implemented with a subsample of participants. Further, a grounded theory approach will be applied to collect in-depth interview data from participants who have moved to another dwelling, within 6 months of the move. A follow-up interview 12 months later will focus on participants' deepened experience over time in terms of fulfilled expectations and relocation experiences.

RESULTS

As of submission of this protocol (June 2021), recruitment has commenced with approximately 960 respondents to the survey and ongoing telephone interviews. We anticipate recruitment and data collection based on surveys and interviews to continue during 2021.

CONCLUSIONS

Prospective RELOC-AGE has the capacity to generate new policy-relevant knowledge on associations of housing, relocation, and active and healthy aging. Such knowledge is relevant for the development of proactive approaches to housing in old age on the individual, group, and societal levels.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04765696; https://clinicaltrials.gov/ct2/show/NCT04765696.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/31137.

Characteristics of Indoor Flood Fatalities: Evidence from Greece

Despite the important advances in flood forecasting and protection, floods remain one of the most lethal types of natural hazards. Previous works have explored several factors influencing the risks of flooding to human life and health. However, there is limited research and understanding on indoor flood fatalities and the circumstances under which they occur. This study explores victim-, building-, and situation-related characteristics in order to provide a better understanding of the conditions that lead to flood-related indoor deaths, exploiting a fatality database developed for Greece (1960–2020). The correlation analysis showed that indoor victims, compared with outdoor ones, tend to be older individuals, with high percentages of disabilities. A significant statistical association of the building material, roof type, and distance from the river with the building collapse was also found. The profile of the buildings in which flood fatality occurred was further compared with that of neighboring non-fatal buildings that were inhabited during the flood events. The statistical results indicated that the buildings with a fatality occurrence are mostly single-storey structures, made from masonry as the main building material. The findings have practical implications in risk communication and mitigation in terms of identifying the specific populations, circumstances, settings, and mechanisms that lead to dangerous indoor situations during flooding events.

Black-White Disparities in Moves to Assisted Living and Nursing Homes Among Older Medicare Beneficiaries

OBJECTIVES

Investigate black-white disparities in older adults' moves to assisted living and nursing homes and draw from the Andersen Healthcare Utilization Model to test explanations for any disparities.

METHODS

Data are from a nationally representative sample of older community-dwelling Medicare beneficiaries from the 2015 (N = 5,212) National Health and Aging Trends Study (NHATS). We use stepwise multinomial logistic regression to examine black-white disparities in moves out of community housing to assisted living or a nursing home over 2 years, before and after adjusting for predisposing (age, gender), enabling (income, housing tenure, Medicaid, living arrangement) and need (activities of daily living [ADL] limitation, physical capacity, self-rated health, and dementia) factors.

RESULTS

Black older adults are less likely to move to assisted living and are more likely to move to a nursing home compared to white older adults. Black-white disparities in moves to nursing homes are explained by black-white differences in enabling and need factors, whereas black-white disparities in moves to assisted living remain even after adjusting for enabling and need factors.

DISCUSSION

Unmeasured factors related to systemic racism (e.g., residential racial segregation, racial discrimination) and/or black-white differences in care preferences might further explain black-white disparities in moves to assisted living and warrant further investigation.

Ageing in the right place - a prototype of a web-based housing counselling intervention for later life

Background: Despite a strong desire among most older adults to age in place, there are few widely available services to support planning and preparing for one's future housing needs.Objective: To develop a prototype of a web-based housing counselling intervention for use in later life, by employing a user-centred design.Material and Methods: As the first step in intervention development, we employed a development process based on research circle methodology. Nine older adults participated in three sessions. Findings from literature reviews, a meeting with a technology and design panel (n = 6) and interviews with representatives of nonprofit organizations, companies, and municipalities (n = 7) served as discussion points.Result: An on-paper prototype was derived, composed of the THINK, LEARN and ACT module reflecting different stages of the decision-making process. Each module addressed preferences, health, home and social and financial resources. Key design features and theoretical underpinnings were included.Conclusion and Significance: A user-centred design process can result in services that are aligned with older adults' preferences for obtaining housing information. Services for planning and preparing future housing needs have the potential to increase older adults´ well-being at home as well as reduce costs for care and housing provision by the municipalities.