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Evaluating the Impact of the Built Environment on Community Living and Participation

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Independence (1= use person & device assist, 2=use person only, 3= use device ... Life Space Profile (Owsley, Allman, Gossman, Kell, Sims, Baker, 1999) ... – PowerPoint PPT presentation

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Title: Evaluating the Impact of the Built Environment on Community Living and Participation


1
Evaluating the Impact of theBuilt Environment on
Community Living and Participation
  • Presenter Joy Hammel
  • Research Team Jon Sanford, Lou Fogg, Deb Walens,
    Jennifer Garcia Dahl, Andrea Gossett, Laurie
    Rockwell Dylla
  • Collaborators University of Illinois at Chicago,
    Chicago Department on Housing, Chicago Mayors
    Office for People with Disabilities, Extended
    Home Living Services, Access Living Progress
    Center Centers for Independent Living
  • This research has been funded in part through a
    grant from the Retirement Research Foundation

2
Presentation Goals
  • Examine how the built environment, and changes to
    it, impact community living and participation for
    people who are aging with disabilities.
  • Highlight assessment tools to document
    environmental impact
  • Provide evidence on the effectiveness of
    environmental interventions to
  • a. justify services
  • b. inform design (accessible and universal) and
    future research

3
Previous Research on HM
  • Research showing increasing unmet need for
    environmental access such as HM
  • Studies showing impact of AT however, HM not
    included or funded in most
  • Many case examples of HM done with middle and
    upper SES, with few on low SES and/or in older,
    urban housing stock
  • Research on specific access guidelines (like grab
    bar placement in bathrooms) but not on overall
    impact of HM on community living participation
    across large sample

4
RRF HM Outcome Study 3 yr study
  • Phase I Controlled Intervention Trial
  • 165 subjects (94 HM treatment, 71 wait list
    control)
  • Age (ave 63 yrs.) 40-59yrs. 72 (44)
  • 60-69 30 (18)
  • 70 63 (38)
  • Gender 138 women (84), 27 men (16)
  • Race 134 African American (81), 27 Caucasian
    (16), 3 Latino (2), 1 Other
  • SES Average 13,136/yr. (range 0-50,000)
    Median 10,000
  • No significant differences between treatment and
    control groups on age, sex, race, SES or
    functional status at baseline

5
Home Modifications Intervention
  • HM structural modifications to the physical
    home environment to address functional access,
    mobility participation in context
  • High Priority Areas
  • 1. Getting in and out of the home
  • E.g., stairs outside ramps lifts, doorway
    access, accessible locks, railings in/out,
    threshold leveling, intercoms
  • 2. Navigating inside stairs or level changes
  • E.g., Inside stair lifts, railings inside
  • 3. Moving through the house and rooms within it
  • E.g., Hallway railings, doorway widening/changes,
    lighting
  • 4. Performing self-care activities in the
    bathroom
  • E.g, Tub/shower adaptations, roll in or sit down
    shower stalls, grab bars, elevated toilet,
    accessible sink, accessible faucets/controls,
    nonslip flooring, safety adaptations

6
Community Collaborators HM Providers
7
Data collection
  • Assessed in home by OTRs
  • Interview (qualitative quantitative) coupled
    with accessibility audit pictures
  • 3 times baseline (no HM), 3 months post (right
    after HM for Tx), and 12 months post
  • Examined impact of HM upon function (OT
    consumer ratings), home community access
    participation, quality of life
  • Does the environment flexibly meet diverse needs
    of diverse consumers who are all aging in place?

8
Results What did people get?
  • Type of HM received
  • Entry way access 69
  • Bathroom modifications 41
  • Mobility inside home 5
  • Inside stairs 4
  • Cost ranges
  • 400 to 13,500 range
  • Average 4822
  • Median 4462

9
Environmental Impact CCAP Client-Centered
Assessment Protocol
  • By Gitlin Corcoran, available through Laura
    Gitlin at the Center for Applied Research on
    Aging and Health at Thomas Jefferson University
    laura.gitlin_at_jefferson.edu
  • Assesses function in multiple ways
  • independence, safety, efficiency difficulty
  • consumer ratings clinician ratings
  • across self care, IADL, and social

10
Functional Impact of HM CCAP Independence
  • Significant independence improvements in

Control wait list (C) vs. Treatment (TX)
Baseline to 3 mo. post
11
Impact of HM on Difficulty, Safety Efficiency
(CCAP observed)
Control wait list (C) vs. Treatment (TX)
Baseline to 3 mo. post
12
Clinical Significance Effect Sizes
SHORT TERM LONG TERM
Effect Size Interpretation (Cohen) 0small
1medium 2large )
13
Environmental Impact Function, Safety
Efficiency
  • BEFORE AFTER

14
Environmental Impact Function, Safety
Efficiency
BEFORE AFTER
15
CASPAR Comprehensive Assessment Solution
Process for Aging Residents
  • by Jon Sanford Extended Home Living Services,
    Inc. (EHLS)
  • In home assessment of function accessibility to
    inform HM planning implementation
  • Adapted to include an Environmental Measure of
    Need, Difficulty and Magnitude across 4
    functional areas

16
Specific EM Impact Entry Way (CASPAR
Environmental Measure)
Control wait list (C) vs. Treatment (TX) scores
at Time 2 3 months post HM
17
Specific Impact Bathroom (CASPAR Environmental
Measure)
Control wait list (C) vs. Treatment (TX) scores
at Time 2 _at_ 3 months post HM
18
The Built Environment Impact on Social
Participation
Cartoon from Don't Worry, He Won't Get Far on
Foot, by John Callahan
19
Environmental Impact on Community Participation
  • Life Space Profile (Owsley, Allman, Gossman,
    Kell, Sims, Baker, 1999)
  • Assesses access to different contexts of
    participation
  • Bedroom to bathroom
  • Bed to rest of house
  • Place where you can look out
  • Places attached mailbox, yard, laundry, garage
  • Immediate block
  • Neighborhood/community/town
  • Outside community and outside state
  • Adaptation Are you able to get to a place when
    you need to and/or want to? (versus frequency/how
    often you go there)

20
Participation Restriction(those that give up use
of space over time)
21
Participation Expansion Spread Effect of HM
  • HM affects participation across activities and
    across people in household
  • Since I got the bathroom done, I go out a lot
    more because I can take care of myself and Im
    not as worried about accidents or being clean
    when I go out.
  • I got the ramp for my mother who was declining.
    Now that Ive got MS, Im using it all the time
    and my husband doesnt have to carry me up the
    front steps.
  • With the new bathroom, I feel safe using it and
    it also helps my attendant so he doesnt hurt
    himself lifting me. It takes a lot less time.
    Less anxiety and I dont feel like a burden.
  • (the ramp is) A blessing to me and to my
    grandchildren I can now visit all 20 and the
    family can socialize! It has been a tremendous
    help.

22
How HM can restrict or expand participation
depending on design
  • Creating or maintaining Surveillance zones
    important strategy to increase sense of security
    social connection with immediate community

23
Consumer Choice, Satisfaction and Long term Use
  • Before HM After HM

24
Environmental Impact on Quality of Life Effect
Sizes
SHORT TERM LONG TERM
Effect Size Interpretation (Cohen) 0small
1medium 2large )
25
Implications for Service Delivery, Policy
Future Research
  • Modifications to the built home environment
    significantly affect functional independence,
    safety, efficiency and difficulty for people
    aging in place on limited or low incomes in
    urban, older housing stock
  • Even small changes have moderate and large
    effects across ages and across diverse needs
  • Even small amounts of invested show significant
    effects
  • Effects are maintained over time, and spread to
    other areas over time (e.g., added function,
    improved control, and QOL)
  • Changes within the home environment significantly
    influence community participation outside the
    home
  • Accessible and universal design intersect and can
    inform each other, including in the design of
    affordable and accessible housing
  • Environmental and participation measures can
    inform both accessible and universal design and
    could be applied to community environments and
    participation

26
What cant be measured Impact on freedom
control
  • I havent left my house for over 2 years except
    being carried out for emergencies. I cant tell
    you what this means to me.
  • Its opened a whole new world to me. Its been
    so long since Ive been out. I couldnt leave
    the house before this.
  • Im free, thank God Almighty, Im free at last!

27
Added Impact Flexible add-ons as universal
practice

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