Enablers and Barriers in the Physical Environment of Care for Older People in Ordinary Housing: A Scoping Review

Figures & data

Figure 1. PRISMA 2009 flow diagram. Adapted from: Moher, Liberati, Tetzlaff, and Altman (2009)

Table 1. Characteristics of the publications included in the scoping review (n = 8).

First author, year	Aim	Research design and methods	Setting (country)	Participants (n); Age (years), mean (SD) or mean (range)	Main results: aspects focusing on safety and accessibility
Birnholtz, 2010	Describe how seniors balance their desire for independence with the need to interact, and how caregivers and relatives help them do this.	Qualitative Individual interviews	Rural and small cities (USA)	Seniors (n = 11); 74(7.9) Professional program workers or caregivers (n = 10); 40(13) Family members; (n = 9); 58(13)	Safety Strategies promoted safety from the family members’ perspective; retaining a familiar environment supported recognition and a sense of security.
Björkman Randström, 2012	Explore older people’s experience of environmental factors that impact on activity and their participation in home rehabilitation.	Qualitative Individual interviews	Urban (Sweden)	Older people (n = 10); 79(68–93)	Safety Participants reported that safety systems affected their activities and participation. Technology for sending and receiving information gave older people confidence to perform activities at home. People receiving home rehabilitation expressed the importance of assistive products in the bathroom. Accessibility A lift enabled participating in activities outside the home and green space for walking facilitated home rehabilitation.
Damme & Ray-Degges, 2016	Examine the beliefs and attitudes of primary caregivers for people with dementia who live at home to understand their perceptions of the effect of the home environment on their family member’s independence.	Qualitative Individual interviews	Rural (USA)	Family caregivers (n = 6); 63(58–75)	Safety Bedrooms were moved downstairs to avoid the hazard of no immediate proximity to the bathroom. Shower seats and grab bars in the shower and near the toilet were installed to enable safety in the home. Ramps were installed in homes constructed for retirement years. Accessibility Doorways to bedrooms and sanitary rooms should have enough space for a walker and a wheelchair to turn around.
Murphy, 2006	Examine how independently bathing, older adult residents of communal housing facilities perform a typical transfer into and out of their own shower or tub.	Quantitative	Not defined	Older residents (n = 89); 82.6(5.7)	Safety Available environmental safety features were grab bars on the back wall, vertical bars by the entry, and assistive devices. Unsafe environmental features were sliding glass doors, tubs, shower curtains, tub seats, and towel bars by the entry.
Skoglind-Öhman, 2011	Explore whether home care service personnel having participated in transfer technique training programs used their knowledge and skills in their daily work. A second aim was to identify factors that could hinder and support their use.	Qualitative Individual interviews	Urban (Sweden)	Personnel in large town (n = 6); age range: 23–49 Personnel in medium-sized town (n = 6); age range: (37–57)	Safety Narrow working spaces and physical obstacles hindered the use of safe work techniques or assistive devices and equipment.
Szanton, 2011	Determine effect size and acceptability of a multicomponent behavior and home repair intervention for low-income disabled older adults.	Quantitative	USA	Disabled older adults (n = 40); 78.0(7.8) Intervention group (n = 26) Control group (n = 14)	Safety Holes in floors, uneven carpeting, and lack of railings or banisters constituted safety risks, and home modifications such as grab bars, rails, and raised toilet seats were installed.
van Hoof, 2006	Not presented	Not presented	Not presented	Not presented	Safety Grab bars, handles. and thermostat taps installed in bathrooms. Accessibility Doorways to bedrooms and sanitary rooms should have enough space for a walker and a wheelchair to turn around. Open floor plans to enable an overview for residents and caregivers. Doors and traffic zones must allow passage by wheelchairs, front doors should be conspicuous and distinguished by colors, and doors should not have windows or doorsteps.
van Hoof, 2010	Combine demand and supply in terms of design goals and environmental interventions.	Qualitative Literature study and focus groups sessions	Netherlands	Not presented	Safety Environments that provide and ensure security and safety and minimize hazard risk of falls and injury. Environmental interventions were suggested to support activities, toileting, bathing and personal care activities, dressing, doing laundry, sleeping, domestic and homemaking activities, eating and drinking, and to improve safety and security at home.

Table 2. An overview of enablers and barriers presented in the publications included in the scoping review (n = 8).

Safety	Accessibility	Older peoplés perception
Enablers	Enablers	Enablers
Retaining a familiar environment to support recognition and a sense of security (Birnholtz & Jones-Rounds, 2010). Moving the patient’s bedroom downstairs to allow immediate proximity to the bathroom (Damme & Ray-Degges, 2016). Shower seats and grab bars in the shower and near the toilet, and ramps (Damme & Ray-Degges, 2016). Grab bars on the back wall in shower, vertical bars by the entry, other grab bars on the sidewalls, and assistive devices such as canes or walkers (Murphy et al., 2006). Grab bars, handles, and thermostat taps in the bathroom (van Hoof & Kort, 2009). Grab bars, rails, and raised toilet seats (Szanton et al., 2011).	Doorways to bedrooms, toilets, and bathrooms in the homes of older people with dementia should have enough space for a walker or a wheelchair to turn around (Damme & Ray-Degges, 2016; van Hoof & Kort, 2009). Toilet seats and wash-basins should be adaptable in height (van Hoof & Kort, 2009). Accessible outdoor environment (garden) (van Hoof & Kort, 2009). Installing a lift, and having a green space (Björkman Randström et al., 2012). Open floor plans in public and private spaces, indoors and outdoors, are important to older people with dementia (van Hoof et al., 2010). Doors and traffic zones must allow the passage of wheelchairs, and front doors should be made conspicuous by their color and not have any glass openings or doorsteps (van Hoof & Kort, 2009).	Being able to get to the telephone in case of emergency (Björkman Randström et al., 2012). Technology for sending and receiving information (Björkman Randström et al., 2012). Assistive products in the bathroom (Björkman Randström et al., 2012).
Barriers Sliding glass doors, tubs, shower curtains, tub-seats, and towel bars by the entry (Murphy et al., 2006) Narrow working spaces and physical barriers made it difficult to use safe work techniques or assistive devices and equipment (Skoglind-Öhman & Kjellberg, 2011). Uneven floors, uneven carpeting, and lack of railings or banisters (Szanton et al., 2011)	Barriers Home modifications installed to support family members may cause confusion for older people with dementia (Damme & Ray-Degges, 2016). Rain and snow could cause slippery and obstructed walkways (Björkman Randström et al., 2012). Corridoors (van Hoof et al., 2010).

Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., The PRISMA Group. (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Med, 6(7), e1000097. doi: 10.1371/journal.pmed1000097

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Birnholtz, J., & Jones-Rounds, M. (2010, April). Independence and interaction: Understanding seniors’ privacy and awareness needs for aging in place. 28th Annual CHI Conference on Human Factors in Computing Systems. CHI 2010: Privacy Awareness and Attitudes, Atlanta, GA.

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Björkman Randström, K., Asplund, K., & Svedlund, M. (2012). Impact of environmental factors in home rehabilitation – a qualitative study from the perspective of older persons using the International Classification of Functioning, Disability and Health to describe facilitators and barriers. Disability and Rehabilitation, 34(9), 779–787. doi:10.3109/09638288.2011.619621

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Damme, M. J., & Ray-Degges, S. (2016). A qualitative study on home modification of rural caregivers for people with dementia. Journal of Housing for the Elderly, 30(1), 89–106. doi:10.1080/02763893.2015.1129384

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Murphy, S. L., Nyquist, L. V., Strasburg, D. M., & Alexander, N. B. (2006). Bath transfers in older adult congregate housing residents: Assessing the person–environment interaction. Journal of the American Geriatrics Society, 54(8), 1265–1270. doi:10.1111/j.1532-5415.2006.00814.x

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Skoglind-Öhman, I., & Kjellberg, K. (2011). Factors that influence the use of safe patient transfer technique in home care service. International Journal of Occupational Safety and Ergonomics, 17(4), 433–444. doi:10.1080/10803548.2011.11076906

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Szanton, S. L., Thorpe, R. J., Boyd, C., Tanner, E. K., Leff, B., Agree, E., … Gitlin, L. N. (2011). Community aging in place, advancing better living for elders: A bio-behavioral-environmental intervention to improve function and health-related quality of life in disabled older adults. Journal of the American Geriatrics Society, 59(12), 2314–2320. doi:10.1111/j.1532-5415.2011.03698.x

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van Hoof, J., & Kort, H. S. M. (2006). Healthy living environments for older adults with dementia.Vol. III. In: E. de Oliveira Fernandes, M. Gameiro da Silva, & J. Rosado Pinto (Eds.), HB2006: Proceedings of the 8th International Conference on Healthy Buildings (pp. 89-96), Lisbon, Portugal. ISBN 989-95067-1-0

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van Hoof, J., Kort, H. S. M., van Waarde, H., & Blom, M. M. (2010). Environmental interventions and the design of homes for older adults with dementia: An overview. American Journal of Alzheimer’s Disease & Other Dementiasr, 25(3), 202–232. doi:10.1177/1533317509358885

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van Hoof, J., & Kort, H. S. M. (2009). Supportive living environments: A first concept of a dwelling designed for older adults with dementia. Dementia, 2, 293–316. doi:10.1177/1471301209103276

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