INSTRUMENTOS PARA AVALIAÇÃO DO AMBIENTE DOMICILIAR DO IDOS: UMA REVISÃO SISTEMÂTICAsistemática

O objetivo deste estudo foi identificar instrumentos utilizados por profissionais e pesquisadores para avaliação do ambiente domiciliar de idosos, bem como descrever propriedades psicométricas e dimensões avaliadas por estes instrumentos e locais da realização dos estudos. Trata-se de uma revisão sistemática da literatura, na qual foram revisados estudos publicados no período de 2006 a 2017, nos idiomas inglês, espanhol e/ou português e que tinham como público-alvo idosos com 60 anos ou mais residentes na comunidade. Foram excluídos estudos que avaliavam, exclusivamente, o ambiente externo, instituições de longa permanência para idosos e os que abordavam questões não gerontológicas. Foram encontrados 1.270 artigos, dos quais 34 foram selecionados para revisão. Verificou-se predomínio do uso de instrumentos padronizados, com evidências de validade e precisão, sendo o Housing Enabler o mais utilizado. Embora haja essa predominância, alguns estudos incluíram instrumentos q ue buscavam a percepção do indivíduo sobre o ambiente. As dimensões mais amplamente avaliadas foram as barreiras ambientais e as adaptações. Conclui-se que instrumentos objetivos para avaliação do ambiente estão sendo produzidos, o que pode facilitar a elaboração de estratégias de monitoramento e de implantação de mudanças no ambiente capazes de interferir positivamente na saúde de idosos. Ressalta-se também a importância de integrar a avaliação dos aspectos objetivos às necessidades subjetivas dos indivíduos em relação ao ambiente.

Assessing Housing Accessibility for Older Adults in Japan: A Content Validity Study

Scientifically validated tools to assess housing accessibility for older adults in Japan have been lacking. To address this, a rigorous procedure of adapting an existing housing assessment tool—the Housing Enabler, developed in Sweden—for valid use in Japan was conducted. The original tool was translated into the Japanese language, using established translation procedures. In the process, researchers checked the appropriateness of technical terms and adjusted specifications to be in accordance with Japanese standards. An expert panel approach was used to validate the content of the Japanese Housing Enabler. Thirteen certified occupational therapists, architects and care-managers (average experience=14.5 years) participated as experts in the content validity study. They rated each item with regard to relevance for assessing housing accessibility in Japan, on a scale from 1(=Not relevant) to 4(= Highly relevant). They suggested adjustments and additions that they found to be relevant to capture particularities of Japanese housing and building design. After individual ratings, the experts gathered for consensus discussions on suggested revisions of the item list. As a result, the number of items was substantially increased (from 161 to 283). A content validity index (CVI) was calculated for each item (i.e., the proportion of experts rating the relevance as at least 3). Using a recommended threshold of CVI ≥0.78, more than 90% of the items were considered relevant, thus supporting the content validity. However, the large amount of items might jeopardize the feasibility of the instrument. Further studies are needed to evaluate feasibility, criterion-related validity and aspects of reliability.

Function-Focused Person–Environment Fit for Long-Term Care Residents With Dementia: Impact on Apathy

Background and Objectives Apathy is a common symptom in dementia and is associated with rapid cognitive decline, poor quality of life, and higher mortality. Lawton’s Competence and Environmental Press model suggests that an individual’s behavior and affect are influenced by the fit of their functional abilities with the environmental demands. Yet, empirical evidence on the association between person–environment (P–E) fit and apathy is lacking. Thus, this study examined the relationship between P–E fit and apathy in dementia. Specifically, this study focused on the extent the physical environment fits individual functional limitations. Research Design and Methods This is a cross-sectional study using the baseline data from long-term care residents with dementia. The sample included 199 residents with moderate-to-severe cognitive impairment from 4 assisted living and 4 nursing homes. Function-focused P–E fit was measured using the Housing Enabler scale. Apathy was measured using the Apathy Evaluation Scale. Multilevel linear models were used to analyze the relationship between P–E fit and apathy. Results Findings revealed that greater P–E fit, specifically indoor environment, was significantly associated with lower apathy after controlling for age, gender, and years living in the facility. Yet, the association became not significant after controlling for individual physical function. Discussion and Implications Findings support the association between function-focused P–E fit and apathy, but the association is no longer significant after physical function is adjusted. Future research may explore other aspects of P–E fit and the impact of social and organizational environment on apathy in dementia.

The Housing Enabler instrument: Assessing threats to reliability and validity

Introduction The Housing Enabler instrument, designed to measure housing accessibility, has not been used in samples with long-standing spinal cord injury. We aimed to investigate potential threats to the reliability and validity of the instrument when used among older adults with spinal cord injury. Method Cross-sectional data from the Swedish Aging with Spinal Cord Injury Study ( N = 123, injury levels C1–L5) were utilised. The potential effect on the reliability and content validity of the House Enabler was qualitatively considered and reviewed in an iterative evaluation procedure. To analyse the potential effect on construct validity, simulations adjusting accessibility problem scores for housing adaptations and use of mobility devices were conducted. Findings Considerable threats to the reliability and content validity of the Housing Enabler were identified. The simulated analysis of construct validity showed a modest overall effect on the accessibility problem scores, although this was substantial in some individuals. Conclusion Data collection and analyses of housing accessibility with the Housing Enabler in samples characterised by high frequencies of housing adaptations and/or use of mobility devices (such as powered wheelchairs) require particular attention. Further studies are needed to propose optimisation of the instrument for use in such contexts, followed by psychometric testing to maintain reliability and validity.

Connection between competence, usability, environment and risk of falls in elderly adults

Objective: to determine connections between competence, usability, environment and risk of falls in elderly adults. Method: correlational descriptive study, 123 elderly adults, both male and female, aged 70 years and older were included. Data was collected via the Tinetti Scale, CESD-7 Scale, Montreal Cognitive Assessment, Usability Questionnaire on Housing and Housing Enabler; and sociodemographic and health background certificate data. For data analysis, descriptive and inferential statistics were used, multivariate linear and logistic regression models were adjusted. Results: 42.0% of the elderly adults had presented with falls, with a higher prevalence in women, and in the group of 70-75 years. The physical environment of the house, gait, and usability were set as risk factors for falls. A negative relationship between usability and depressive symptoms, cognitive health, balance, gait, the social and physical environment was found, p <0.05; and a strong positive correlation between walking and balance, p <0.05. Conclusion: this study helps to better understand the phenomenon of falling, to find a connection between usability with the risk of falls, and other variables.