Housing accessibility problems for people with Parkinson's disease

Objectives: Promoting accessible housing for all citizens is high on the political agenda. Knowledge is, however, limited regarding housing accessibility problems for people with Parkinson's disease (PD). The objectives were to investigate housing accessibility problems among people with PD at different stages of disease severity and to analyze the potential impact of improved functional ability on accessibility problems. Materials and methods: The study included 253 participants with PD (61% men; mean age 70 years). Disease severity was assessed by the Hoehn and Yahr (HY) I-V stages: HY I, n=50; II, n=73, III, n=66; IV-V, n=64. Using the Housing Enabler (HE) instrument, accessibility problems were investigated by combining assessments of the person's functional capacity with assessments of physical barriers in the housing environment into a person-environment fit measure (HE-score). To analyze potential impact of improved functional ability on housing accessibility problems, data simulation was applied. Results: HE-scores differed significantly (P<.001) in relation to HY stages. Overall balance problems explained 22% and walking devices 17% of the HE-scores, whereas environmental barriers contributed to a lesser extent. The environmental barriers generating the most HE-scores were "no grab bar at shower/bath/toilet" and "wall-mounted cupboards and shelves placed high". A simulation of improved balance significantly (P<.001) lowered the HE-scores in all HY stages. Conclusions: The results suggest that actions targeting balance problems and dependence on walking devices have the greatest potential for reducing housing accessibility problems for people with PD. The study also details environmental barriers that need specific attention when providing housing adaptation services

A scoping review of public building accessibility

Background: The built environment needs to be designed so that all people can participate in the activities they want and need to do. Yet, accessibility is difficult to put into practice, and accessibility issues tend to be overlooked in the building and planning processes. Objectives: The aim of this scoping review was to summarize the research front in the area of accessibility to public buildings. Specific aims were to identify knowledge gaps, to identify access activities in relation to environmental features and to link to predominant activities in terms of the International Classification of Functioning, Disability and Health (ICF). Methods: A literature search was performed in PubMed, PsycINFO, Inspec, Embase and Cochrane databases. Articles in English based on original empirical studies investigating accessibility of public buildings for adults aged ≥18 years with functional limitations were considered. Results: Of the 40 articles included, ten involved study participants, while 30 only examined buildings using instruments to assess accessibility. In addition, the psychometric properties were only tested for a few of them. All articles concerned mobility and several visual limitations, while few addressed cognitive or hearing limitations. Ten main access activities were identified, from using parking/drop-off area to exiting building. Conclusions: By using the ICF and theoretically relating the accessibility problems to activities, the results revealed that there are large knowledge gaps about accessibility to public buildings for older people and people with functional limitations and that there is a need for more methodological considerations in this area of research

A new approach for investigation of person–environment interaction effects in research involving health outcomes

Recurrent use of the Housing Enabler instrument has highlighted methodological challenges of broader scientific interest, namely interactions between personal functional capacity (P) and exposures to features (here potential barriers) in the built housing environment (E). This study aimed to propose and illustrate an analytic approach, separating P × E interaction effects (here accessibility problems) from main effects of P and E, in studies where P and P × E are strongly interrelated. Four datasets representing different populations of older people in the context of housing were used. The datasets (N = 1910) comprised data on P, E and P × E interactions as well as health-related variables. A two-step analytic procedure was performed: (1) a measure of environmental barriers net of functional capacity was obtained from residuals of linear regression analysis between P (independent) and P × E (dependent); (2) logistic regression analyses with self-rated general health and I-ADL, respectively, as dependent variables to explore interaction effects using the P × E residuals from the previous step. The association between P and P × E was similar across the four datasets (r ≥ 0.80, p < 0.001). In the logistic regression analyses, including P, both categorized and continuous P × E residuals were clearly associated with self-rated general health (p < 0.001 and p = 0.026), whereas the associations with I-ADL were less consistent (p = 0.275 and p = 0.002, respectively). The new two-step—instead of single-step—analytic approach proposed for investigating P × E interaction effects in studies involving health outcomes emerged as promising. The new approach has the potential of increasing the possibilities to adequately represent theoretical concepts and assumptions and rigorously test their effects