Author: Roslyn Aclan
Aclan, Roslyn, 2024 Planning the home environment and home modifications ahead of time for middle-aged and older adults, Flinders University, College of Nursing and Health Sciences
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With the growing number of older people worldwide, governments are investigating how to support health and wellbeing in older age (World Health Organization, 2021b). Most older people prefer to age in place, aligning with the Australian government's objective of providing care within the home environment (Hatcher et al., 2019; Kramer & Pfaffenbach, 2015; Stones & Gullifer, 2014; Tanner et al., 2008). Staying in one's own home reflects a desire to maintain independence, autonomy and community connections as residential care is generally viewed as a service for end-of-life care. Remaining in one's own home is influenced by factors such as the home's design and surroundings, evolving care requirements, and the availability of alternative housing choices (like retirement communities) in one's own neighbourhood (Hatcher et al., 2019). Age-friendly communities and homes are considered a priority in Australia and globally, with numerous initiatives underway, including access to a home with age-friendly features such as elevators or wide passages to accommodate wheelchairs, access to affordable health services along the continuum of aged care and access to affordable public transport to enable people to remain engaged int their communities (World Health Organization, 2020a). Less attention has been given to the development of viable solutions for ageing adults to remain and age in their own homes. It is not only necessary but also a preferred alternative to residential care. There is currently limited information about the perspectives and opinions of older adults regarding living independently in older age and the factors that are essential to their future housing requirements.
This thesis outlines a program of research consisting of four research studies that were undertaken to explore home and home safety for people as they age. The first study identified and synthesised international evidence related to the perspectives of the significance of home for middle-aged and older individuals, the consequences of any alterations to their home environment and factors that influence their housing decisions. The second study aimed to gain insight into the perceptions of middle-aged and older individuals regarding their home environment, home safety and the ageing process at home. Furthermore, the study sought to explore the difficulties faced by individuals with older relatives and the challenges that their older relatives encounter as they age. In the third study, a prospective cohort design was used to explore the hazards present in the living environments of healthy older adults, with the aim of gaining a deeper understanding of the necessary environmental modifications and supportive requirements for ageing in place. Then in fourth study, a validity study was conducted to investigate whether middle-aged and older people could self-assess their own homes through the use of a digital self-assessment tool. This study aimed to determine agreement (validity) by recruiting older adults to complete the home environment self-assessment tool normally used by an occupational therapist. The agreement (validity) was used to evaluate whether older people could assess their own homes and produce the same information that could be gained from an occupational therapy assessment.
This thesis offers a significant contribution to the field of age-friendly housing research, with the intention of developing effective strategies that support active ageing. The first study showed that individuals over the age of 50 prefer to stay in their homes. To achieve this, these adults require information on enhancing their homes' safety and accessibility. In addition, middle-aged and older adults consider several factors when making future housing choices, such as financial constraints, societal stigma, aging perspectives, emotional aspects, and support networks. Urban and rural planners and policy makers should consider these factors when designing and planning communities. Findings from the second study indicated, when middle-aged and older individuals embrace the ageing process, they typically have a more positive outlook on their future housing choices. In contrast, those who wait for crises tend to overlook the need for adjustments to their homes. Furthermore, these findings suggest that ageing adults are open to learning and would benefit from a tool in either printed or digital format to aid them in future housing decisions. The third study revealed common living spaces that could pose potential risks for older adults. The areas of the bathroom, toilet, and backyard may require attention or modification in the future. This study once again highlighted the significance of offering education and resources at an earlier stage to empower ageing adults to proactively plan for ageing in place. The fourth study demonstrated that older people can self-assess their homes using a digital health tool. It showed that digital heath tools can enable older people to start thinking about their future housing needs whilst reducing the likelihood of being forced to leave one’s current living situation or relocate to a residential care facility. The use of such tools has demonstrated that older adults can effectively perform self-assessments in their own homes and arrive at results that align with those of an occupational therapist. This study confirms the usefulness of a digital health intervention in fulfilling the needs of older individuals, thereby enabling them to age in place, while also emphasising the importance of occupational therapy assessments for those with more complex requirements. This advanced digital solution offers practical guidance and support, empowering individuals to make informed decisions that enhance their quality of life as they age, ultimately enabling them to continue living in their homes as they grow older.
Keywords: age-friendliness; aging; digital; home environment; self-assessment; tool
Subject: Ageing Studies thesis
Thesis type: Doctor of Philosophy
Completed: 2024
School: College of Nursing and Health Sciences
Supervisor: Professor Kate Laver