Heterogeneity of Characteristics among Housing Adaptation Clients in Sweden—Relationship to Participation and Self-Rated Health
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Sampling and Participants
2.3. Data Collection and Measurements
- Dependence in ADL was assessed with the ADL Staircase [33]. The instrument comprises nine items on feeding, transfer, using the toilet, dressing, bathing, cooking, transportation, shopping, and cleaning measured on a four point scale (0–3) as “independent without difficulty”, “independent with difficulty”, “partly dependent” and “dependent”, which are combined into a single-sum score (0–27) for dependence.
- The number of functional limitations was recorded using 12 items from the personal component in the Housing Enabler Instrument [34] with a higher score (0–12) indicating a larger number of functional limitations.
- Cognitive impairment was assessed with Montreal Cognitive Assessment (MoCA), in order to gather information on short-term memory, executive functions, visual-spatial abilities, language, attention, concentration, working memory, and temporal and spatial orientation. The scale is continuous (0–30) with “moderate impairment” (10–17 points), “mild impairment” (18–26 points) and “normal cognitive functioning” (more than 26 points) [35].
- Concerns about falling were measured using the short form of the Falls Efficacy Scale-International FES-I [36], which comprises seven activities: getting dressed or undressed, taking a bath/shower, getting in or out of a chair, going up or down stairs, reaching for something above head height or on the ground, walking up or down a slope and going out to a social event, assessed on a on a four point scale (1–4) with a higher score (7–28) indicating more concern. According to guidelines [36] the final FES-I score should be summarized using the person’s responses in 6 or 7 activities. In this study, we used an adjusted formula, taking those persons who responded only to 5 activities (e.g., owing to being unable to walk or using a wheelchair on a permanent basis) into consideration. The rationale for this choice was that the frailest group of the sample should not be excluded.
- Satisfaction with usability in the home was explored using the Usability In My Home (UIMH) Instrument [24], a self-rating instrument that measures client satisfaction with activity performance in relation to the design of the housing environment. Three components of usability were identified through an exploratory factor analysis; together these explained up to 65% of total variance: (a) the “self-care” component (5 items: going to the toilet, personal hygiene, preparing meals, preparing snacks and moving around the home with or without a mobility device); (b) the “social” component (3 items: socializing with family and friends in the home, contacting others via telephone or Skype, and watching TV or listening to the radio); (c) the “leisure and outdoor” component (3 items: entering the house, picking up the mail, engaging in hobbies and leisure activities in the home). A higher score (5–25 for self-care and 5–15 for the social and leisure-outdoor components) indicates more satisfaction with the usability of the home.
- Self-rated health was evaluated by means of the Euro-Qol 5D Visual Analogue Scale (EQ-VAS), a vertical scale ranging from 0 (worst imaginable health state) to 100 (best imaginable health state) [37].
- As a proxy measure of participation, six questions were developed to capture both frequency of, and satisfaction with, contacts in and outside the home, as well as the engagement in activities inside and outside the home, with others or alone. Three questions: (1) being in contact with friends, family or acquaintances at home; (2) doing something outside the home with friends, family or acquaintances; and (3) doing something outside the home alone were asked, each with two response scales, one for frequency and one for satisfaction The response scale for frequency was a five point scale: “almost never”, “yearly”, “monthly”, “weekly” or “daily”. Likewise, the response scale for satisfaction was: “very unsatisfied”, “unsatisfied”, “neither satisfied nor unsatisfied”, “satisfied” or “very satisfied”. For purposes of analysis, frequency of and satisfaction with participation were reclassified as follows: those participating “almost never”, “yearly” or “monthly” were classified as having “low frequency participation”, while those participating “weekly” or “daily” were classified as having “frequent participation”; similarly, those feeling “very unsatisfied”, “unsatisfied” or “neither satisfied or unsatisfied” were classified as being “unsatisfied” with participation while those feeling “satisfied” or “very satisfied” were classified as being “satisfied” with their participation.
2.4. Analytic Approach and Statistics
2.5. Ethics
3. Results
Variable | Min-Max in the Sample | Mean (SD) |
---|---|---|
Age | 36–95 | 75.2 (13.5) |
Dependence in ADL | 0–25 | 10.3 (5.5) |
No. of functional limitations | 0–9 | 3.7 (1.7) |
Cognitive impairments | 10–30 | 22.7 (4.8) |
Concerns about falling | 6–28 | 16.2 (5.6) |
Usability In My Home: | ||
Self-care aspect–five items | 6–25 | 19.0 (4.6) |
Social aspects–three items | 4–15 | 12.5 (2.8) |
Leisure/outdoor aspect–three items | 3–15 | 8.6 (3.7) |
3.1. Heterogeneity Among Housing adaptation Applicants
- “Adults at risk of disability” (cluster 1; n = 15, mean age 49.7), characterized by low dependence in ADL, low number of functional limitations, no cognitive impairment and high level of concern about falling. Usability of their home was rated medium for self-care and leisure/outdoor aspects, high for social relations.
- “Young old with disabilities” (cluster 2; n = 23, mean age 70.7), characterized by high dependence in ADL, high number of functional limitations, mild cognitive impairment, high level of concern about falling and all aspects of usability of their homes rated low.
- “Well-functioning older adults” (cluster 3; n = 20, mean age 78.8), characterized by low dependence in ADL and few functional limitations, mild cognitive impairments and low level of concern about falling. Usability for all aspects of housing was rated high.
- “Frail older adults” (cluster 4; n = 33, mean age 81.5), characterized by medium dependence in ADL and number of functional limitations, mild cognitive impairment and low level of concern about falling. Usability of their homes for all aspects was rated medium to high.
- “Frail older adults with moderate cognitive impairments” (cluster 5; n = 12, mean age 79.6), characterized by high dependence in ADL and high number of functional limitations, moderate cognitive impairment and low level of concern about falling. Usability of their homes was rated low for self-care and social aspects and medium/high for leisure/outdoor aspects.
- “Resilient oldest old” (cluster 6; n = 21, mean age 83.9), characterized by low dependence in ADL, few functional limitations, mild cognitive impairment and a high level of concern about falling. Usability of their homes was rated high for self-care, medium for social aspects and low for leisure/outdoor aspects.
Characteristics | 1. Adults at Risk of Disability | 2. Young-Old with Disabilities | 3. Well-Functioning Older Adults | 4. Frail Older Adults | 5. Frail Older-Moderate Cognitive Impairments | 6. Resilient Oldest Old |
---|---|---|---|---|---|---|
Age | 49.7 ± 8.0 | 70.7 ± 12.2 | 78.8 ± 6.9 | 81.5 ± 7.3 | 79.6 ± 8.0 | 83.9 ± 7.7 |
Dependence in ADL | 8.0 ± 3.2 | 15.4 ± 4.6 | 4.1 ± 3.0 | 11.8 ± 5.1 | 13.8 ± 3.4 | 8.0 ± 3.3 |
Functional limitations | 3.8 ± 1.3 | 5.2 ± 1.4 | 2.1 ± 1.1 | 4.1 ± 1.4 | 4.8 ± 1.3 | 2.6 ± 1.3 |
Cognitive impairments | 27.0 ± 2.0 | 22.8±3.0 | 24.8 ± 3.4 | 21.0 ± 4.2 | 13.4 ± 2.9 | 25.5 ± 2.2 |
Concerns about falling | 18.7 ± 6.0 | 22.1 ± 3.6 | 12.7 ± 3.2 | 12.7 ± 3.8 | 15.3 ± 6.4 | 17.5 ± 4.5 |
Usability in: | ||||||
-self-care | 19.7 ± 4.3 | 14.4 ± 3.8 | 23.6 ± 1.3 | 19.8 ± 2.9 | 15.2 ± 4.3 | 20.3 ± 4.1 |
-social relations | 13.8 ± 1.3 | 11.2 ± 2.4 | 14.7 ± 0.6 | 13.1 ± 2.0 | 8.1 ± 3.4 | 12.3 ± 2.7 |
-leisure/outdoors | 8.9 ± 3.0 | 4.9 ± 2.6 | 10.4 ± 3.1 | 9.9 ± 3.5 | 10.0 ± 4.1 | 8.1 ± 3.0 |
3.2. Relationships between the Clusters, Participation and Self-Rated Health
Participation and Self-Rated Health | 1. Adults at Risk of Disability | 2. Young Old with Disability | 3. Well-Functioning Older Adults | 4. Frail Older Adults | 5.Frail Older with Moderate CI a | 6. Resilient Oldest Old | Total Sample N = 124 | p |
---|---|---|---|---|---|---|---|---|
Participation no. (%) | ||||||||
-Frequently at home | 11 (73) | 16 (70) | 20 (100) | 29 (88) | 12 (100) | 18 (86) | 106 (85) | 0.025 |
-Satisfactory at home | 10 (67) | 12 (52) | 18 (90) | 29 (88) | 8 (67) | 17 (81) | 94 (76) | 0.036 |
-Frequently out w/others | 8 (53) | 6 (26) | 13 (65) | 13 (40) | 1 (8) | 10 (48) | 51 (41) | 0.017 |
-Satisfactory out w/others | 7 (47) | 9 (39) | 16 (80) | 22 (67) | 6 (50) | 14 (67) | 74 (60) | 0.061 |
-Frequently out alone | 8 (53) | 6 (26) | 14 (70) | 15 (45) | 4 (33) | 9 (43) | 56 (45) | 0.092 |
-Satisfactory out alone | 8 (53) | 5 (22) | 14 (70) | 15 (45) | 4 (33) | 9 (43) | 55 (44) | 0.059 |
Self-rated health (mean) | 52.3 | 43.9 | 72.1 | 56.3 | 59.7 | 57.0 | 56.5 b | 0.001 |
4. Discussion
5. Conclusions
Acknowledgments
Author Contributions
Conflicts of Interest
References
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Thordardottir, B.; Chiatti, C.; Ekstam, L.; Malmgren Fänge, A. Heterogeneity of Characteristics among Housing Adaptation Clients in Sweden—Relationship to Participation and Self-Rated Health. Int. J. Environ. Res. Public Health 2016, 13, 91. https://doi.org/10.3390/ijerph13010091
Thordardottir B, Chiatti C, Ekstam L, Malmgren Fänge A. Heterogeneity of Characteristics among Housing Adaptation Clients in Sweden—Relationship to Participation and Self-Rated Health. International Journal of Environmental Research and Public Health. 2016; 13(1):91. https://doi.org/10.3390/ijerph13010091
Chicago/Turabian StyleThordardottir, Björg, Carlos Chiatti, Lisa Ekstam, and Agneta Malmgren Fänge. 2016. "Heterogeneity of Characteristics among Housing Adaptation Clients in Sweden—Relationship to Participation and Self-Rated Health" International Journal of Environmental Research and Public Health 13, no. 1: 91. https://doi.org/10.3390/ijerph13010091