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

Abstract

Our aim was to explore enablers and barriers in ordinary housing for older people in care. We systematically searched Scopus, Web of Science, and Google Scholar for relevant published research and gray material. The search resulted in a final sample of eight publications, four of which focused on accessibility for older people with dementia. Thematic analysis resulted in two themes: safety and accessibility. Future studies should focus on modifications to ordinary housing to achieve safe and comfortable environments for people who want to age in place and those who provide them with care.

Keywords:

• Homecare
• home healthcare
• architecture
• design
• older person

Background

The rapid demographic trend of increasing proportions of older people and people aging with disabilities (Beard & Bloom, 2015) will have considerable effects on planning and economy in the municipal sector most often responsible for older people’s home and health care. Since these older people spend most of their time at home (Nygren et al., 2007), it is important that their housing conditions supports both their own activities and those of the professionals providing them with home and health care. Most countries around the world foresee aging populations, which call for multiple solutions for the housing, care, health, and safety of both older people and home and health care staff. More research and innovation is needed in new and existing housing to promote comfortable lives for older people (Ahrentzen & Tural, 2015; Duke & Street, 2003; Oudshoorn, Ward-Griffin, & McWilliam, 2007).

The increasing provision of health care in ordinary housing involves more and more staff in work outside of institutional settings. In the United States (U.S.), approximately 156,000 registered nurses worked in home health settings in 2008 (U.S. Department of Health & Human Services Health Resources & Services Administration, 2010); only 4 years later that had increased to 164,000 (U.S. Bureau of Labor Statistics Registered Nurses, 2014). More knowledge of design features is required to ensure good and safe workplaces for home and health care staff and age-friendly ordinary housing for older people. Society has much to gain by supporting people who choose to remain in ordinary housing instead of assisted living facilities, but when someone’s home becomes the workplace of others, the resultantly complex context raises conflicts between how caregivers and people receiving help need or wish to organize the home.

Very few recent scientific reviews on home and health care and the physical environment of ordinary housing are available. Hignett, Edmunds Otter, and Keen’s (2016) systematic review on safety risks associated with physical interactions between patients and caregivers showed risk factors in both the design and layout of ordinary housing and the clutter and barriers in individual physical environments. However, the review added limited value since risk factors were not described in detail and both the time frame of the included studies and the ages of the study population were missing. Because the authors focused only on risks in the physical environment, knowledge of other factors that may facilitate home and health care was not presented. To offer good ordinary residential settings for older people receiving care, it is important to understand enablers as well as barriers in the physical environment. Wright, Zeeman, Kendall, and Whitty (2017) focused on adults aged 18–64 with a neurological disability in a systematic review of the housing domains of design, location, and neighborhood. Of the 26 included publications, only four of 142 design features (air-conditioning units in the bedroom and living room, a ceiling/tracking hoist, and a spare bedroom for a non-family paid care provider) supported home and health care staff.

Most older people and people with disabilities prefer having help and health care in their own homes because they usually have more privacy than in an institution (Breitholtz, Snellman, & Fagerberg, 2013; Dale, Sævareid, Kirkevold, & Söderhamn, 2011; Gillsjö, & Schwartz-Barcott, 2011; Holmberg, Valmari, and Lundgren (2012). However, family members may feel that the home has become a healthcare facility (Borgstrand & Berg, 2009) and might resent the intrusion of necessary technical equipment and care activities. Relationships between patients in ordinary housing and home and health care staff have been studied (Lindahl, Lidén, & Lindblad, 2011; Oudshoorn et al., 2007), as have nursing roles in home care (Duke & Street, 2003), health care professionals’ views of frailty in older people (Gustafsson, Edberg, & Dahlin-Ivanoff, 2012), and nurses’ perceptions of their work with the elderly (Josefsson, Åling, & Östin, 2011). Although these studies contribute important knowledge about care in ordinary housing, they do not focus on enablers and barriers in the physical environments of older people’s home- and health care.

In a recently published scoping review (Stans, Dalemans, de Witte, Smeets, & Beurskens, 2016), 16 publications were analyzed to find factors that affect communication in different settings. The authors concluded that small adjustments in the home environment such as improved lighting and a quiet environment could provide essential support to people with communication problems, but that such factors have received little attention and are in need of further study.

The first necessary step toward a safe working environment for home care is to review the literature on how ordinary housing designs can be adapted to support older people and the staff who provide in-home care. The aim of this scoping review was to explore enablers and barriers to care in the environment of ordinary housing for older persons. As recommended for scoping reviews, a broad approach was taken to formulating the research questions:

• What is known from the existing literature about enablers and barriers in the physical environment in caregiving in ordinary housing situations?

• What is known about how older people perceive caregiving situations in their ordinary homes?

Method

Study design

This scoping review was conducted according to the five framework stages described by Arksey and O’Malley (2005): (a) identifying the research question(s); (b) identifying relevant studies; (c) selecting studies; (d) charting the data; and (e) collating, summarizing, and reporting the results. According to Armstrong, Hall, Doyle, and Waters (2011), scoping reviews provide an overview of the existing literature but do not include the detailed information found in systematic reviews. Unlike systematic reviews, scoping reviews do not usually assess the quality of the in-depth studies they include. Among other reasons, scoping reviews are undertaken to determine whether it would be useful to proceed with a thorough systematic review or to identify research gaps in the evidence base when the research is limited (Arksey & O’Malley, 2005).

Identifying relevant studies

The literature search included internationally published research and gray literature such as specialized technical journals, peer-reviewed abstracts, and conference proceedings. The search was conducted in late 2016 by the first author in close cooperation with an information specialist at the library at Chalmers University in Gothenburg, Sweden.

Eligibility criteria

Studies were selected based on the following inclusion criteria: all types of studies published in 2000–2016 in international peer-reviewed scientific journals, gray literature, or conference papers focused on people aged ≤65 living in ordinary housing and in need of home service, home health care, or home rehabilitation. Studies that focused on service or care provided in facilities other than ordinary housing and studies published in a language other than English, Swedish, Danish, or Norwegian were not considered.

Search strategy and selection process

The Scopus, Web of Science, and Google Scholar databases were searched. First, different keywords related to care and physical environment were used in various combinations: ordinary housing, apartments, villas, multi-family housing, architecture, design, apartment-layout, home-service, home-care, rehabilitation, older persons, elderly, old age, >65 years of age, spouse, relatives, personnel, caregiver, nurses, nurse’s aides, physiotherapist, occupational therapist, and physical environment. This search generated many titles not relevant to the aim of this scoping review. For example, in architecture the term rehabilitation means renovating buildings and is not connected to rehabilitation performed by caregivers in home and health care. Therefore, based on discussions with and recommendations from the librarian, another search was conducted in all three data bases using the two keywords care and physical environment in all three data bases. To investigate whether any other research had been published, a manual search was performed of reference lists and key journals such as Health Environments Research and Design Journal, authors of the included articles, and relevant research groups (Arksey & O’Malley, 2005). This search did not result in the inclusion of any additional articles in this scoping review.

Study selection

First, to screen the 3600 titles identified according to the inclusion criteria, the first author scanned all titles and abstracts (Scopus: n = 1065, Google Scholar: n = 1930, and Web of Science: n = 605). Abstracts found not to be relevant to the aim and duplicates were removed (n = 3449), and the remaining abstracts (n = 151) were read independently by three of the authors: the first and second authors examined the abstracts found in Google Scholar and Scopus, and the first and fourth authors examined those found in Web of Science. We then discussed our first impressions of the success of the inclusion criteria. This procedure was repeated with the full papers, and copies were obtained of the full articles judged relevant to the research questions. Finally, the first, second, and fourth authors validated the selection of the included publications. The reference lists of the selected papers were also checked, revealing a systematic review focused on home building design (Ahrentzen & Tural, 2015). All 37 studies included in that systematic review were reviewed, 35 studies were not relevant for the research questions, and two were included in our scoping review. In Figure 1, a flow diagram adapted from PRISMA (Liberati et al., 2009) illustrates our search and selection procedure.

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

Data analysis

A narrative synthesis was used to describe the data obtained from the selected publications. This was considered appropriate because of the heterogeneity of the studies’ designs, methods, interventions, and measures (Hackett et al., 2014). Data were summarized according to the research questions. Initial analysis was conducted and summarized by the first author and discussed with the other authors.

Charting the data

The results were summarized and organized according to the research questions formulated for this scoping review as recommended by Arksey and O’Malley (2005).

Results

The search and analysis process resulted in a final sample of eight publications as described in Figure 1.

Description of the publications

The included publications were published from 2006 to 2016. Six were scientific articles published in a wide range of journals representing rehabilitation (n = 1), housing (n = 1), geriatrics (n = 2), safety and ergonomics (n = 1), and Alzheimer disease and dementia (n = 1). Two publications were proceedings of conferences focused on (a) privacy awareness and attitudes and (b) healthy buildings. Most of the publications had a qualitative design (n = 5), two had a quantitative design, and one, a discussion paper, did not specify the design (see Table 1). In the publications in the sample, terms used to describe ordinary housing included private apartments and villas (Björkman Randström, Asplund, & Svedlund, 2012; Murphy, Nyquist, Strasburg, & Alexander, 2006), private homes with assisted living facilities (Birnholtz & Jones-Rounds, 2010), and mobile homes (Damme & Ray-Degges, 2016). The other publications did not explicitly define the types of housing in question.

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.

Summary of the results

The analysis resulted in two themes: safety (10 publications) and accessibility (4 publications). In some publications, more than one theme was represented. According to the two themes, enablers, barriers and older peoples´ perspectives of receiving care in their homes are presented in Table 2.

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).

Safety

Strategies to promote safety from the family members’ perspective included retaining a familiar environment to support recognition and a sense of security (Birnholtz & Jones-Rounds, 2010) and moving the patient’s bedroom downstairs to allow immediate proximity to the bathroom (Damme & Ray-Degges, 2016). Older people in need of home rehabilitation mentioned the importance to their safety of being able to get to the telephone in case of emergency (Björkman Randström et al., 2012).

Technology for sending and receiving information gave older people the confidence to perform activities at home. Findings also showed that older people receiving home rehabilitation reported that assistive products in the bathroom were important for them to be independent of home care (Björkman Randström et al., 2012). Shower seats and grab bars in the shower and near the toilet were found to enable a safer home, as were ramps installed in homes constructed for people in their retirement years (Damme & Ray-Degges, 2016). In their 2006 study, Murphy et al. examined older people’s transfers from shower or tub and found that environmentally safe features were grab bars on the back wall, vertical bars by the entry, other grab bars on the side walls, and assistive devices such as canes or walkers. In contrast, unsafe environmental features were sliding glass doors, tubs, shower curtains, tub-seats, and towel bars by the entry. Safe transfers were also studied by Skoglind-Öhman and Kjellberg (2011), who focused on home care service providers.

Findings showed that narrow working spaces and physical barriers made it difficult to use safe work techniques or assistive devices and equipment. Grab bars, handles, and thermostat taps in the bathroom were recommended for people with dementia (van Hoof & Kort, 2009). Another study focused on people with dementia (van Hoof, Kort, van Waarde, & Blom, 2010) highlighted the importance of an environment that provides and ensures security and safety and minimizes the risks of falls and injuries. Specific environmental interventions, that were required to enable toileting, bathing, and personal care activities, dressing, laundry, sleeping, domestic and homemaking activities, eating and drinking, and improved safety and security at home, were also presented.

Finally, a study evaluating safety, efficiency, difficulties, and environmental enablers and barriers in the home environment showed that uneven floors, uneven carpeting, and lack of railings or banisters constituted safety risks and called for the installation of grab bars, rails, and raised toilet seats (Szanton et al., 2011).

Accessibility

Findings showed that 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). Likewise, toilet seats and wash-basins should be adaptable in height. Another important indoor environmental factor was lighting (van Hoof & Kort, 2009). Findings also showed that home modifications installed to support family members may cause confusion for older people with dementia (Damme & Ray-Degges, 2016), and this must be considered when planning such interventions. The importance of an accessible outdoor environment (garden) was emphasized in many studies (van Hoof & Kort, 2009), as was installing a lift (to enable older people to leave the home and participate in outside activities) and having a green space (for walking to facilitate home rehabilitation; Björkman Randström et al., 2012), although rain and snow could cause slippery and obstructed walkways and increase risks of falling. The weather can therefore be a barrier to both home rehabilitation and older people’s outdoor activities. Findings showed that both public and private spaces, indoors and outdoors, are important to older people with dementia (van Hoof et al., 2010), and open floor plans instead of corridors were recommended to allow both residents and caregivers unobstructed views. 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).

Discussion

This scoping review aimed to explore enablers and barriers in the environment of care for older people in ordinary housing, but studies published in 2000–2016 focused on these topics are scarce. The two themes that emerged (safety and accessibility), show the importance of considering the perspectives of older people and their family members living in ordinary housing. Despite the emerging focus on the patient’s perspective, relatively little attention has been paid to the potential of the physical environment to enable or present barriers to such person-centered care (McCormack & McCance, 2010). In line with the person-centered approach originated by Carl Rogers (1961) and Tom Kitwood (1997), the physical environment can play an important role in protecting and respecting the person’s right to privacy, integrity, autonomy, and participation.

Safety

The findings presented here also show the importance to safety of taking caregivers’ perspectives into account when home and health care is performed in ordinary housing. Skoglind-Öhman and Kjellberg (2011) found that narrow working spaces and physical barriers made it difficult to perform safe transfers, use safe work techniques, or use assistive devices and equipment. This illustrates the complex context that can be created when someone’s home becomes an arena for care, including the possible conflicts between retaining a feeling of home and providing a supportive and attractive workplace (Sinclair, Hicks, & Gibbs, 2000). However, our findings show that, with a few exceptions, the caregivers’ perspective is not studied. This also emphasizes the importance for future studies focusing on caregivers´ needs when they perform home and healthcare.

Some publications included in the present scoping review focused on people with dementia, for whom grab bars, handles, and thermostat taps in the bathroom were recommended (van Hoof & Kort, 2009) along with strategies to minimize risks of falls and injuries (van Hoof et al., 2010). People with lower functional abilities due to dementia are more sensitive to the environment than those with higher abilities, and the influence of the environment increases as the functional ability of the older person decreases (Lawton & Nahemow, 1973). The physical and cognitive disabilities of dementia can greatly affect the daily lives of many older people. It follows that the design of the physical environment can either reduce psychiatric disturbance and increase well-being or cause confusion and disorientation among people with dementia-related impairments (Cohen-Mansfield, 2016). It is therefore important to design the home correctly right from the beginning. Environmental features can support recognition and orientation in people with cognitive decline due to dementia and facilitate their sense of identity. Personal belongings and artifacts in the home that contribute to a feeling of normality should be clearly displayed, and alterations and modifications to the environment minimized to avoid confusion and disorientation (Rowles & Bernard, 2013).

Accessibility

Four studies in this review focused on accessibility in the care of older people with dementia. Highlighted aspects included having enough space for a walker or a wheelchair to turn around, ensuring that toilet seats and wash-basins are adaptable in height (Damme & Ray-Degges, 2016; van Hoof & Kort, 2009), and adjusting lighting to appropriate levels for older peoples’ needs (van Hoof & Kort, 2009). Products such as wheelchairs and walkers are important to older people receiving home rehabilitation (Björkman Randström et al., 2012) as they facilitate general mobility, transfers from beds, and accessibility in ordinary housing, which are all important for older people with dementia and/or in need of home rehabilitation. Accessibility is also related to safety for caregivers as narrow working spaces and physical barriers make it difficult to use safe work techniques or assistive devices and equipment. This illustrates the importance of considering the different perspectives and needs of older people and caregivers for accessibility. Wipfli, Olson, Wright, Garrigues, and Lees (2012) called for further research on strategies to improve safety, care, and injury prevention for home and health care staff. Markkanen et al. (2014) suggested that supportive equipment in the home should be considered during the architectural design stage and asserted that designing safe ordinary housing is not a challenge, but rather an opportunity to address hazards and eliminate them as early as possible. For example, another study found that shower seats and grab bars installed in the shower and near the toilet create a safer home (Damme & Ray-Degges, 2016). At the same time, these authors stated that home modification might lead to confusion and irritation among family members with dementia. The lack of grab bars in hygiene areas, even in newer dwellings, is a problem that could be avoided (Pettersson, Slaug, Granbom, Kylberg, & Iwarsson, 2017). It is also known that inaccessible housing contributes to dependence on others in activities of daily living (Petersson, Lilja, Hammel, & Kottorp, 2008) and to falls (Chang et al., 2004). As noted in previous research, inaccessible housing increases the risk of lower social participation (Hitch, Larkin, Watchorn, & Ang, 2012), which may be reflected in poorer self-management, isolation, and higher health care needs.

The findings of the present scoping review indicate a need for more research focused on healthcare architecture in ordinary housing. Because of the strong trend of aging in place, it is important that architects involved in designing ordinary housing are informed about and anticipate the future needs of older people and their caregivers. Ahrentzen and Tural (2015) recommend that architects, housing providers, and policy makers rely upon valid and reliable information when constructing their plans and policies. For example, Van Hoof et al. (2006) focus on aspects such as architectural and interior design; physical indoor environment; and technological solutions connected to the dwelling. In another study, focused on dementia, Van Hoof et al. (2013) present the design and development of a demonstration home that can be used for training and education. Because society cannot possibly meet the housing needs of the increasing aging population through individual housing modifications or special housing, it is vitally important to promote the evidence-based design of buildings right from the start to enable safer environments for older people, good conditions for home and health care in ordinary housing, and safe working environments for caregivers. Every effort to consider the needs of older people and caregivers in residential layouts in the early stages of planning will likely be cost-effective in the long run. Home modification can never be the primary means of providing good in-home accessibility, but it can be the second best, and it often works well in existing housing. Previous research suggests that eliminating the most common environmental barriers in housing from the design phase forward will result in a decreased need for home modification (Pettersson et al., 2017).

Methodological considerations

In this scoping review, a methodological strength is that we followed recommendations and the framework stages described by Arksey and O’Malley (2005) and did not assess the quality of the included publications according to grade or any other such system. Inspired by Levac, Colquhoun, and O’Brien (2010), we also recognized the importance of including gray literature in scoping reviews. We decided to use three databases for the search (Scopus; Web of Science; and Google Scholar) following Falagas, Pitsouni, Eleni, George, and Georgios (2008), who found that these databases cover most scientific fields, and Kulkarni, Aziz, Shams, and Busse (2009), who found that these databases produce quantitatively and qualitatively different citations. Given the attention paid recently to conditions for a good and safe working environment in ordinary housing in Sweden and throughout the western world, we decided upon a search period of 10 years.

Many publications were excluded because they focused on institutions other than ordinary housing. Others were excluded because they did not focus on home and health care or on people aged ≥65 years. Therefore, the final sample in this scoping review was very limited. This underlines the need for more research in the field. However, although the results are based on a relatively limited number of publications, the different perspectives of older people, family members, and caregivers were captured and analyzed.

The publications included in this review defined types of housing in different ways and most lacked clarity about what the different housing types implied. Thus, the results of this review demonstrate that the terms for different housing types and the definitions of home and health care require more attention and clarification.

Conclusions

The state of the art on enablers and barriers to care in the environment of ordinary housing for older persons, based on the literature produced between 2000 and 2016, was limited, and more research in this area is necessary. The strong trend toward aging in place means that healthcare activities in ordinary housing are fast increasing. Thus, to ensure both age-appropriate and care-friendly ordinary housing for older people and safe workplaces for caregivers in home and health care, more innovative design features that take into account important aspects of safety, accessibility, and technology need to be investigated. Future studies should focuson caregivers’ perspectives for enabling a safe working environment, andto ensure safe environments for older people who wish to age in place. These aspects were not sufficiently covered in the publications included in our sample.

Acknowledgment

We would liketo acknowledge the support provided by Chalmers Library at Chalmers University of Technology for help with the initial major systematic search of the literature for our scoping review.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This inquiry was supported by Örebro University and Formas Research Council for Sustainable Development within the interand transdisciplinary research environment AIDAH, Architectural Inventions for Dwelling, Ageing and Healthcaring, hosted by Chalmers ACE, Gothenburg, Sweden (https://www.chalmers.se/en/projects/Pages/Integrative-ways-of-residing.aspx).