Gunilla Carlsson

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.

Person—environment fit predicts falls in older adults better than the consideration of environmental hazards only

Objective: To test the hypotheses that the empirical consideration of objective person—environment fit in the home environment is a stronger predictor of indoor falls among older adults than the assessment of environmental barriers only, and that perceived aspects of home play a role as predictors for falls. Design: Survey study with data collection at home visits, followed up by self-reports about falls at home visits one year later. Setting: Urban districts in Sweden, Germany, Latvia. Participants: Eight hundred and thirty-four single-living, older adults (75—89 years), in ordinary housing. Measurements: An assessment of objective person—environment fit in the home environment (housing enabler), a self-rating of the perceived home environment (usability in my home) and retrospective self-reports on indoor falls. Results: The participants reporting falls tended to be frailer than the non-fallers. The number of environmental barriers in the home was similar for the fallers and non-fallers; the magnitude of person—environment fit problems was higher among the fallers. The person—environment fit problem variable was a stronger fall predictor (odds ratio (OR) = 1.025; P=0.037) than number of environmental barriers (n.s.), even after controlling for confounders. Fallers also experienced lower usability of their home. Conclusion: The results suggest that much of the inconclusiveness of the data in the relationship between environmental hazards and falls in the previous falls literature could be due to the neglect of person—environment fit assessment. The effectiveness of environmental interventions based on the notion of person—environment fit compared with traditional home hazard checklists remains to be tested.

Travelling by urban public transport: Exploration of usability problems in a travel chain perspective

Travelling is an important precondition for other occupations, and to support travelling for people with functional limitations in-depth information about usability problems in urban public transport is needed. Therefore, the aim of this study was to explore usability problems in public transport in a travel chain perspective focusing on the physical environment and inherent aspects of it. Service Route travellers were contacted on board buses and a strategic sample of 20 persons participated in focus group interviews. The participants were used to travelling but the results demonstrated that they faced a broad range of usability problems when travelling. By analysing the usability problems in a travel chain perspective, several aspects of the personal, environmental, and occupational components in usability problems were elucidated. The results provide a structure for further analysis of usability problems in urban public transport, in research as well as in practice. Knowledge about the usability problems different groups of people experience when travelling increases knowledge of the environmental impact on occupational performance and how to design supportive traffic environments for people with functional limitations.

Very old people's experience of occupational performance outside the home: Possibilities and limitations

To support occupations outside the home for older people with functional limitations it is important to understand how the person, environment, and occupations influence performance. Therefore the purpose of this study was to describe how very old people experience occupational performance outside the home. Twenty-one single-living, very old persons, above 80 years, were strategically selected and interviewed. A phenomenographic approach was used for this study and the interviews were analyzed using contextual analysis. The findings showed a variation in the experience of occupational performance described in three referential aspects: keeping on doing as before, drawing on available resources, and living in constrained circumstances. Referring to everyday occupations the participants described how they continued to do what they had done before, but decline in functional capacity made it more difficult to overcome environmental barriers. They also described how they sometimes could put functional limitations aside and use their utmost capacity to reach their goals. When they could not do that any more, they had to find possibilities for occupations close to home. In order to support very old peoples occupational performance outside the home, outdoor mobility has to be facilitated, including the design of the physical environment as well as possibilities for social interaction.

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.

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.

A 10-year follow-up study on subjective well-being and relationships to person–environment (P–E) fit and activity of daily living (ADL) dependence of older Swedish adults

In order to investigate how well-being and ill health is affected by the process of aging, the main aim was to investigate these self-perceived aspects of health over a 10-year period among older Swedish adults. The aim was also to study how these aspects correlated with objectively assessed functional limitations, use of mobility device, person-environment (P-E) fit (also denoted accessibility), problems in housing, and activity of daily living (ADL) dependence. Using the Swedish national population register, a baseline sample of persons aged 75-84 years was identified. Out of the 133 participants at baseline (1994), the 31 participants still available 10 years later were included. The data were collected by means of interview and observation at home visits. Overall, the participants rated their subjective well-being as high and a stable prevalence of ill-health symptoms over time was reported. Changes in subjective well-being as related to changes in functional aspects seem to mainly occur earlier in the aging process, while as time goes by these relations weaken. ADL dependence, however, is more influential in more advanced age. The results confirm the complexity of the construct of health. A main contribution is that the results shed light on the importance of taking the impact of environmental factors into consideration.

Defining profiles of functional limitations in groups of older persons: how and why?

Objective: Addressing the complexity of multiple health problems in the older population, the objective was to identify combinations of functional limitations for use in simulation analysis, to enable predictions of the potentially most severe person—environment fit (i.e., accessibility) problems among groups of older persons. Method: Utilizing data from 1,542 persons aged 75 to 89 years and applying Configuration Frequency Analysis, we tested which combinations of functional limitations that occurred more or less often than expected. Significant combinations were defined as type profiles and used in simulated accessibility analyses. Results: Eleven combinations occurred more often and eight less often than expected (p < .05). Simulations with ten type profiles predicted varied patterns of accessibility problems. Conclusion: The use of type profiles has potential to contribute to the knowledge of combinations of functional limitations among groups of older persons. Variation in predicted accessibility problems for different type profiles helps identifying priorities in societal planning.

Changes in person-environmental fit and ADL dependence among older Swedish adults. A 10-year follow-up

Background and aims: In order to investigate the relation between personal functional capacity and the physical housing environment during the aging process, the aim of this study was to give a long-term description of person-environmental fit (P-E fit) problems in terms of housing accessibility and ADL dependence among older adults, and to study their relationships at three points in time. Methods: A 10-year longitudinal design was used: baseline (1994), follow-up 1 (2000) and follow-up 2 (2004). Using the Swedish national population register, a baseline sample of persons aged 75–84 years was identified. Of the 133 participants at baseline, the 31 participants still available at follow-up 2 were included in this study. Data on housing accessibility, functional limitations and dependence in ADL were collected by means of interviews and observations at home visits. Results: P-E fit problems increased significantly between baseline and follow-up 1 and between follow-ups 1 and 2. No significant changes in overall ADL dependence were recorded. The total number of functional limitations, dependence on walking aids and P-E fit were significantly correlated to ADL dependence, at both follow-up 1 and follow-up 2, but not at baseline. Conclusions: Results confirm that functional decline is a major driver toward increased ADL dependence during the aging process, whereas environmental barriers per se are not related to such disability. Instead, P-E fit is significantly related to ADL dependence, and the relationship grows stronger with advancing age.