The role of home adaptations in improving later life

This report summarises the findings of a systematic review of the best, available scientific evidence on how home adaptations can contribute to improving later life. Living in a suitable home is crucially important to a good later life. The right home environment can maintain or improve people’s physical and mental health, wellbeing and social connections,enable them to carry out day-to-day activities safely and comfortably, and help them to do thethings that are important to them. More than 90% of older people in England live in mainstream housing, as opposed to specialist housing or residential care. However, current UK housing stock is often not accessible or adapted to meet people’s needs as they get older, with small room sizes, steep internal stairs, baths rather than showers and steps outside.While many people will maintain good health and fitness for much of their later years, the likelihood of having one or more long-term condition, physical impairments,disabilities and frailty that make day-to-day life at home more difficult does increase with age. The percentage of people who have difficulty with at least one activity of daily living (basic routine activities like eating, bathing and dressing) increases dramatically from 16% at age 65 to around half of those aged 85. By people’s late 80s, more than one in three people have difficulty undertaking fiveor more activities of daily living unaided (Marmot et al 2016). Installing aids and adaptations into people’s homes, such as grab rails and level access showers, can improve the accessibility and usability of a person’s home environment, maintaining or restoring their ability to carryout day-to-day activities safely and comfortably.The last comprehensive review of the evidence on home adaptations was published in 2007. Since then, there has been increasing policy attention paid to the benefits of home adaptations, particularly in relation to how they can reduce health and social care costs, many of which are outlined in this review. However, there should be much greater focus and action given to the widely acknowledged and unsustainable pressures on our health and social care systems, coupled with the fact that we are living for longer and the proportion of older people in our society is growing. In the last Spending Review, the budget for the Disabled Facilities Grant was increased to enable greater access to home adaptations for more people, yet there is still an unacceptable and under-reported number of people not getting the equipment and support they need. This review aims to provide an up-to-date analysis of evidence of the importance and effectiveness of home adaptations

Stair Gait in Older Adults Worsens With Smaller Step Treads and When Transitioning Between Level and Stair Walking.

Older people have an increased risk of falling during locomotion, with falls on stairs being particularly common and dangerous. Step going (i.e., the horizontal distance between two consecutive step edges) defines the base of support available for foot placement on stairs, as with smaller going, the user's ability to balance on the steps may become problematic. Here we quantified how stair negotiation in older participants changes between four goings (175, 225, 275, and 325 mm) and compared stair negotiation with and without a walking approach. Twenty-one younger (29 ± 6 years) and 20 older (74 ± 4 years) participants negotiated a 7-step experimental stair. Motion capture and step-embedded force platform data were collected. Handrail use was also monitored. From the motion capture data, body velocity, trunk orientation, foot clearance and foot overhang were quantified. For all participants, as stair going decreased, gait velocity (ascent pA = 0.033, descent pD = 0.003) and horizontal step clearance decreased (pA = 0.001), while trunk rotation (pD = 0.002) and foot overhang increased (pA,D A D = 0.001) and their foot clearance tended to be smaller. With a walking approach, the older group (Group x Start interaction) showed a larger trunk rotation (pA = 0.011, pD = 0.015), and smaller lead foot horizontal (pA = 0.046) and vertical clearances (pD = 0.039) compared to the younger group. A regression analysis to determine the predictors of foot clearance and amount of overhang showed that physical activity was a common predictor for both age groups. In addition, for the older group, medications and fear of falling were found to predict stair performance for most goings, while sway during single-legged standing was the most common predictor for the younger group. Older participants adapted to smaller goings by using the handrails and reducing gait velocity. The predictors of performance suggest that motor and fall risk assessment is complex and multifactorial. The results shown here are consistent with the recommendation that larger going and pausing before negotiating stairs may improve stair safety, especially for older users