Agneta Ståhl

Theoretical understanding and methodological challenges in accessibility assessments, focusing the environmental component: an example from travel chains in urban public bus transport.

RETRACTED due to duplication within this journal. Original manuscript available at http://informahealthcare.com/doi/abs/10.1080/09638280210148594

“Let’s go for a walk!”: identification and prioritisation of accessibility and safety measures involving elderly people in a residential area

By emphasising the involvement of elderly people in a project applying a mixed-method approach, the overriding objective of this study was to identify and prioritise concrete measures aimed at increasing accessibility and safety in the outdoor pedestrian environment within a residential area of a Swedish town. Measures generally given priority were: the separation of pedestrians/cyclists, lower speed limits, better maintenance and specific measures in pedestrian walkways such as wider sidewalks, curb levels and form and more even surfaces on pavements. Definition of these priorities offered knowledge to the highway department concerning the importance of small details in relation to the larger infrastructure. The elderly people in the study district found new ways to communicate with and influence those within the community who are responsible for these matters.

Older pedestrians’ perceptions of the outdoor environment in a year-round perspective

This paper focuses on older peoples’ needs as pedestrians by examining their perceptions of the outdoor environment in both bare-ground and snow/ice conditions. Qualitative and quantitative methods are used, including focus group interviews, participant observations, and questionnaires. The results show that older people consider accessibility/usability issues as very important and that the importance depends on such individual background variables as age, sex, occurrence of functional limitations, use of mobility devices, and dependence on walking as transport mode. In bare-ground conditions, physical barriers are more important for the oldest old (80+) and for older people with functional limitations or mobility devices. However, orderliness-related issues (e.g. cyclists in pedestrian areas, lighting, and litter/graffiti) are equally important regardless of the background variables. In snow/ice conditions, ice prevention is considered more important than snow removal. Snow removal on a detailed level (e.g. removal of heaps of snow on pavements and zebra crossings) is emphasised. In conclusion, it is important to study subgroups, not older people as one group, in the analysis of accessibility/usability of outdoor environments. Further, even though those accessibility issues emphasised in current Swedish governmental directives on accessibility are considered as important by older people themselves, especially among the oldest old and among those with functional limitations and mobility devices, the needs will not totally be fulfilled by current directives. For example, winter maintenance, problems with cyclists in pedestrian areas, and the need for benches are neglected.

Toward a Screening Tool for Housing Accessibility Problems A Reduced Version of the Housing Enabler

To present a reduced version of the Housing Enabler, useful as a screening tool in practice contexts and in research, this study identifies the core items of the environmental component of the instrument, that is, the items most important in terms of the instruments overall validity to measure accessibility problems. Utilizing cross-national data and interdisciplinary knowledge through an iterative process, a set of core items was identified. The environmental component of the reduced version comprises 61 items, compared to 188 in the original instrument. The rank correlation between the accessibility scores generated by the original and reduced versions was r ≥ .97 (p < .001). Based on comprehensive empirical research in three countries, the reduced version of the Housing Enabler is a time-efficient and valid screening instrument. It is a powerful tool for research and interventions focusing on housing accessibility problem identification.

Barriers to senior citizens' outdoor mobility in Europe

The aim of this study was to picture perceived problems amongst older citizens in the traffic environment. Moreover, answers to the question why measures that are known to be efficient concerning the mobility of senior citizens are often not implemented. Eight EU countries participated in the study, involving both senior citizens and experts (researchers, decision makers and practitioners who deal with all aspects of seniors’ mobility). Focus group interviews and personal interviews involving 487 senior citizens and 225 experts were carried out in order to chart problems. These were followed by quantitative surveys with 3,309 senior citizens and 490 experts that had the scope to measure the distribution of charted problems in the population. Finally, five workshops were carried out in order to discuss results and to formulate assumptions why promising measures are not implemented, as it appears. Barriers to mobility are by both experts and senior citizens attributed to traffic and infrastructure characteristics, to legal issues, to vehicle design problems, to inter-personal and inter-generational frictions, to lacking lobby power, but also to individual health problems. In order to improve mobility it is suggested by both senior citizens and experts to enforce vehicle speeds. Both groups also agree that public transport vehicles should be brought into an appropriate standard (low floor vehicles, kneeling busses). Senior citizens more than the experts ask for measures to support the sense of security and safety in the public space (police should be visible, appropriate design of infrastructure, public lighting).

Safety as perceived by wheelchair-seated passengers in special transportation services

The aim of this study was to gain a better understanding of, and to help form a more complete picture of, the perceived safety of wheelchair-seated passengers using special transportation services (STS). A questionnaire was sent out and completed by 801 respondents in five Swedish regions. Additional information was acquired by means of 15 subsequent in-depth interviews. It was found that 5% reported personal incident-related injuries during the period that they had been eligible for STS. Injuries were most likely to occur during normal driving, but the passengers were also exposed to risks during boarding and alighting procedures. Nevertheless, 80% of the passengers were basically satisfied with the degree of safety. A large majority (97%) reported that they always use tie-down systems, and 78% always use safety belts. These results indicate that, despite general satisfaction with the STS system as such, malfunction of the existing safety equipment is a problem, since safety is especially critical for STS passengers-a vulnerable road-user group with few alternative travel modes. Therefore, there is a need for wheelchair tie-down and occupant restraint systems (WTORS) that are easier to handle by the operators and more suitable for the passengers and their wheelchairs. A low-floor vehicle concept might also reduce injury risks related to boarding and alighting procedures.

The Personal Component of Accessibility at Group Level: Exploring the Complexity of Functional Capacity

In order to support the development of accessibility research, the main objective of this study was to explore how functional capacity, i.e. the personal component of the concept of accessibility, can be operationalized at group level, and to study its complexity in an ageing process perspective. Prior to this exploration it was necessary to elucidate the relationship between self-reported diagnoses and profiles of functional limitations, and to investigate the frequency of functional limitations longitudinally. At baseline and at six-year follow-up, data were collected with 72 elderly persons. Self-reports on diagnoses were accomplished and functional limitations were assessed by means of a standardized assessment. No general patterns of profiles of functional limitations related to any of the diagnoses could be found. Profiles of functional limitations were classified by means of hierarchical cluster analyses, and common denominators were identified. The results revealed increasing complexity with increasing age. The ultimate goal for accessibility research is to outline a set of profiles of functional limitations representing different user groups that could be utilized in more efficient analyses prior to physical planning decisions at society level, and this study is a first step in this direction.

Traffic engineering and occupational therapy: A collaborative approach for future directions.

Swedish legislation and international norms emphasize societys obligation to ensure general accessibility. The possibility of independent outdoor mobility, transportation, and travel are as important for individuals with reduced functional capacity as for other members of society, but today their mobility is limited. The aim of this article is to outline a novel field for research collaboration between occupational therapy and traffic planning and engineering, focusing on person-environment relationships with an explicit orientation towards advantages to society. Target groups are elderly people and individuals with impairments, and their relation to public transportation provided by society, in terms of general accessibility. Topical research from both disciplines is presented and synthesized, leading to the formulation of joint research questions. The collaborative approach presented increases the potential for continuing, comprehensive, and stable growth of knowledge. The intention is to assist the le...

Functional Status and Patient-Reported Outcome 10 Years After Stroke: The Lund Stroke Register

Background and Purpose— Long-term studies of outcome after stroke are scarce. Our aim was to study functional status and patient-reported outcome 10 years after a first-ever stroke. Methods— Ten-year follow-up was conducted among the survivors from a population-based group of 416 patients included in the Lund Stroke Register, Sweden, between March 1, 2001, and February 28, 2002. The Barthel index was used to assess the functional status and the modified Rankin Scale to assess the degree of disability. The EQ-5D scale was used for survivors’ self-reports about health outcome and the specific Short-Form 36 (SF-36) question for rating their overall health. The patients also reported their frequency of physical activity. Results— Among 145 survivors 10 years after stroke (median age, 78 years), 59% were men, 90% lived in their ordinary housing, 73% were assessed as independent, and 71% had no or slight disability. The need of assistance with mobility and self-care was reported by 14% and with usual activities by 22%. Moderate pain was reported by 39%, and 4% had a high degree of pain. Moderate anxiety/depression was reported by 28% and high degree only by 1%. Overall health status was reported in positive terms by more than two thirds of the survivors. Almost half the cohort reported the same frequency of physical activity (≥4× weekly) as before stroke onset. Conclusions— This study indicates that 10-year stroke survivors in Sweden are mostly independent in daily activities and report good overall health and frequent physical activity, although half of them are ≥78 years.

Independence as a stigmatizing value for older people considering relocation to a residential home

Based on older peoples perspectives, the aim of this article is to reveal how the culture of independence influences the decision-making process preceding relocation to a residential home. Since there is a predominant ideology of ageing in place in Sweden like in many other welfare states, the focus is on how a continued life in ordinary housing is justified versus how relocation to a residential home is excused. Twenty-one older people have been included in open semi-structured interviews and in follow-up contacts. The findings show that the value of independence, originally intended to protect the position of older people, in practice led to stigmatizing processes. In order to bridge the gap between values and declining capacities, expectations and actions, older people develop individual-oriented, family-oriented, and public-oriented justifications and excuses, so-called ‘accounts.’