Housing Accessibility Methodology Targeting Older Poeple - Reliable Assessments and Valid Standards

Sammanfattning: Older people have more functional limitations than younger people and they form a segment of the population that is more dependent on mobility devices than other age groups. Since they spend most of their time at home, their dwelling is an important environmental arena for performing everyday activities. Barriers in the environment can limit or hinder activity performance. Therefore, older people are sensitive to the accessibility of the environment. To ensure housing accessibility, it is critical that professionals are provided with valid and reliable assessment instruments to identify accessibility problems before the planning of housing intervention strategies. It is also critical that housing standards addressing accessibility intended to accommodate people with functional limitations are valid in the sense that their definitions truly support accessibility. However, there is a paucity of valid and reliable assessment instruments targeting housing accessibility, and in-depth analysis of factors potentially impacting on reliability in complex assessment situations is remarkably absent. Moreover, the knowledge base informing the housing standards appears to be vague. We may therefore reasonably question the validity of the housing standards addressing accessibility. This thesis addresses housing accessibility methodology in general and the reliability of assessment and the validity of standards targeting older people with functional limitations and a dependence on mobility devices in particular. The overarching aim of the thesis was to develop and explore methods applicable for improving housing accessibility assessments and to explore feasible approaches to create housing standards that truly support accessibility and accommodate older people. A main methodological contribution of the present thesis is the development of the content-valid Nordic HE instrument which is deemed sufficiently reliable in Nordic countries, and the recommendations for in-depth examination of inter-rater agreement for the improvement of reliability. A second main contribution of the present thesis is that it explores the consequences of the housing standard definitions in terms of accessibility and provides estimates of the proportion of dwellings considered accessible and the proportion of persons defined as having accessibility problems. Collectively, these results have the potential to improve and influence research, practice and policy in a global context for the benefit of the health and well-being of older people with functional limitations. Moreover, the results provide new knowledge and invite reflections on central concepts and methodology relevant to psychometrics and research on person-environment fit.