Susanne Iwarsson

Indicators for return to work after stroke and the importance of work for subjective well-being and life satisfaction.

OBJECTIVES This study focuses on the continuation of gainful employment after experiencing stroke, addressing factors indicative of readiness for return to work, subjective well-being and life satisfaction. METHODS The target group comprised 120 patients, studied by means of medical records and postal questionnaires. RESULTS A total of 41% had returned to work, although there were changes concerning employers, assignments and working hours. Individuals who had returned to work reported a significantly higher level in subjective well-being and life satisfaction. Being able to walk meant the greatest chance of returning to work (odds ratio = 3.98) followed by white-collar worker (odds ratio = 2.99) and having preserved cognitive capacity (odds ratio = 2.64). CONCLUSION Returning to work after stroke is a major factor for high subjective well-being and life satisfaction. Three factors indicative of readiness for return to work were identified, providing implications for more efficient vocational rehabilitation programmes.

Aging Well and the Environment: Toward an Integrative Model and Research Agenda for the Future

PURPOSE OF THE STUDY The effects of the physical-spatial-technical environment on aging well have been overlooked both conceptually and empirically. In the spirit of M. Powell Lawtons seminal work on aging and environment, this article attempts to rectify this situation by suggesting a new model of how older people interact with their environment. DESIGN AND METHODS Goals of the paper include (a) integration of the essential elements of the ecology and aging literature, particularly in regard to Lawtons research, (b) development of connections between traditional theories of ecology of aging and life span developmental models of aging well, (c) acknowledgment of the pronounced historical and cohort-related changes affecting the interactions of older people with their environment, and (d) discussion of the implications of this analysis for concepts and theories of aging well. RESULTS The model builds on a pair of concepts: environment as related to agency and belonging, founded in motivational psychology, and developmental science. IMPLICATIONS After describing the models key components, we discuss its heuristic potential in four propositions for future gerontological research and identify implications of the model for future empirical research.

The Home Environment and Disability-Related Outcomes in Aging Individuals: What Is the Empirical Evidence?

PURPOSE Building on the disablement process model and the concept of person-environment fit (p-e fit), this review article examines 2 critical questions concerning the role of home environments: (a) What is the recent evidence supporting a relationship between home environments and disability-related outcomes? and (b) What is the recent evidence regarding the effects of home modifications on disability-related outcomes? DESIGN AND METHODS Using computerized and manual search, we identified relevant peer-reviewed original publications and review articles published between January 1, 1997, and August 31, 2006. For Research Question 1, 25 original investigations and for Research Question 2, 29 original investigations and 10 review articles were identified. RESULTS For Research Question 1, evidence for a relationship between home environments and disability-related outcomes for older adults exists but is limited by cross-sectional designs and poor research quality. For Research Question 2, evidence based on randomized controlled trials shows that improving home environments enhances functional ability outcomes but not so much falls-related outcomes. Some evidence also exists that studies using a p-e fit perspective result in more supportive findings than studies that do not use this framework. IMPLICATIONS Considerable evidence exists that supports the role of home environments in the disablement process, but there are also inconsistencies in findings across studies. Future research should optimize psychometric properties of home environment assessment tools and explore the role of both objective characteristics and perceived attributions of home environments to understand person-environment dynamics and their impact on disability-related outcomes in old age.

A public health perspective to environmental barriers and accessibility problems for senior citizens living in ordinary housing

BackgroundHousing environments that hinder performance of daily activities and impede participation in social life have negative health consequences particularly for the older segment of the population. From a public health perspective accessible housing that supports active and healthy ageing is therefore crucial. The objective of the present study was to make an inventory of environmental barriers and investigate accessibility problems in the ordinary housing stock in Sweden as related to the functional capacity of senior citizens. Particular attention was paid to differences between housing types and building periods and to identify environmental barriers generating the most accessibility problems for sub-groups of senior citizens.MethodsData on environmental barriers in dwellings from three databases on housing and health in old age was analysed (N = 1021). Four functional profiles representing large groups of senior citizens were used in analyses of the magnitude and severity of potential accessibility problems. Differences in terms of type of housing and building period were examined.ResultsHigh proportions of one-family houses as well as multi-dwellings had substantial numbers of environmental barriers, with significantly lower numbers in later building periods. Accessibility problems occurred already for senior citizens with few functional limitations, but more profound for those dependent on mobility devices. The most problematic housing sections were entrances in one-family houses and kitchens of multi-dwellings.ConclusionsDespite a high housing standard in the Swedish ordinary housing stock the results show substantial accessibility problems for senior citizens with functional limitations. To make housing accessible large-scale and systematic efforts are required.

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

Home as a signification of independence and autonomy: Experiences among very old Swedish people

The aim of this study was to explore independence in the home as experienced by very old single-living people in Sweden. A grounded theory approach was used and interviews were conducted with 40 men and women aged 80–89. Data analysis revealed the core category “Home as a signification of independence” with two main categories: “Struggle for independence” and “Governing daily life”. The findings showed that home is strongly linked to independence, and being independent is extremely valued. Explicit descriptions of the ageing process as an individual process of changing living conditions within the home emerged from the findings. Hence, the ageing process influences the participants’ perception of themselves as independent persons. Along the ageing process the participants’ view of independence changed from being independent in activity performance without help from others to experiencing independence in being able to make autonomous decisions concerning daily life at home. Consequently, there is a need to develop strategies to support very old people in staying as active and independent as possible in their own homes. In addition, since the findings highlight that independence is a complex construct, there is a need for conceptual differentiation between independence and a construct often used synonymously, namely autonomy.

Older people's use of powered wheelchairs for activity and participation

OBJECTIVE The aims of this study were to investigate outcomes of older peoples use of powered wheelchairs and risk factors for negative outcomes. DESIGN The study was a cross-sectional interview-study including 111 powered wheelchair users over 65 years of age. RESULTS All participants used their powered wheelchair in the summer; nearly all users regarded it as important and found that it gave them independence. The wheelchair made activity and participation possible for the users. The most frequent activity in the summer was going for a ride, and in the winter it was shopping. However, some could not use the wheelchair for visits, and supplementary travel modes are called for. Users who could not walk at all or who could not transfer without assistance were more likely not to be able to carry out prioritized activities. Furthermore, other risk factors for negative outcomes and need for further research were identified. CONCLUSION The use of powered wheelchairs is a relevant societal intervention in relation to older people with limited walking ability in order to make activity and participation possible. It is likely that a larger proportion of older people could benefit from this intervention, in particular if current practices are improved taking activity and participation outcomes into consideration.

Fear of moving outdoors and development of outdoor walking difficulty in older people

OBJECTIVES: To study which individual characteristics and environmental factors correlate with fear of moving outdoors and whether fear of moving outdoors predicts development of mobility limitation.

Accessibility and usability in housing: construct validity and implications for research and practice

Purpose: The aim of this study was to validate the conceptual definitions of accessibility and usability, and to explore differences between objective accessibility assessments and subjective ratings of usability in different client groups. Method: The Housing Enabler and the Usability in My Home instruments were used for 131 persons above 18 years of age, living in ordinary housing and receiving a housing adaptation grant. Covariation between accessibility in four different housing sections and three different usability aspects were explored, for the total sample and for six sub-samples reflecting person-environment-activity transactions or demographic factors. Results: Significant correlations were found in the total sample, among clients aged 75 – 84, women, clients living alone, as well as among clients with high dependence in personal and instrumental ADL and in outdoor activities. Subjective usability evaluations of activity aspects and physical environmental aspects were correlated to accessibility indoors and outdoors, while personal and social aspects of usability were correlated to outdoor accessibility. Conclusions: Accessibility and usability are concluded to be different but related concepts. The results indicate that e.g. age, civil status and ADL dependence affect how clients assess aspects of their housing situation. For efficient planning and evaluation of housing adaptations, assessment of housing accessibility, usability, and dependence in ADL is recommended.

The multiple meaning of home as experienced by very old Swedish people

The aim of this study was to explore aspects of the meaning of home as experienced by very old single-living people in Sweden. A grounded theory approach was used, and interviews were conducted with 40 men and women aged 80–89. The findings indicate that home has a central place in the lives of very old people because it is where they live and spend so much time. The significance of the home is based on the fact that it means so many different things to the participants. The theme comprises two key categories: home means security and home means freedom. Each of these has three sub-categories. In home means security, these are: living in a familiar neighborhood, everything functions, and having memories to live on. Home means freedom comprises a place for reflection, a social meeting-point, and leaving your own mark. Home is part of the environment and influences the meaning and selection of activities that very old people decide to engage in. When occupational therapists prescribe assistive devices or recommend changes in the home environment, they must be very well aware of and reflect on what home means to their clients and base their measures on that.