Everyday life and home modification for older adults : impacts, concepts and instrument development

The general aim of this thesis was to increase knowledge about the impact of homemodifications (HMs) on aspects of everyday life tasks among older adults living withdisability. The thesis also aimed to further develop an instrument assessing ability to performeveryday life tasks and to explore and describe experiences of safety and security in everydaylife after home modifications.

This thesis included four studies. In Study I the psychometric properties of the Client-Clinician Assessment Protocol (C-CAP) Part I used on older adults in need of HM wereinvestigated using Rasch rating scale model. The C-CAP Part I collects data on self-ratedindependence, difficulty and safety in everyday life tasks. In Studies II and III the C-CAPPart I was used to investigate perceived ability to perform everyday life tasks after HM, usinga pre-post test design with an intervention and a comparison group. In Study II changes ineveryday life tasks after HM were investigated using data from baseline and a two-monthfollow-up. Then in Study III a mixed methods analysis was applied, investigating perceiveddifficulty in everyday life tasks and confounding factors influencing perceived difficulty up tosix months after HM. In Study IV qualitative interviews were conducted with eight olderadults, based on a grounded theory approach focusing on safety and security in everyday lifetasks after HM. The interviews were analyzed using a comparative method in combinationwith a hermeneutic interpretation.

The findings in Study I showed that the three scales in C-CAP Part I had both strengthsand limitations when used on older adults in need of HM. The difficulty scale showedacceptable internal scale validity, person response validity, and person separation reliability,whereas the independence scale did not show internal scale validity and the safety scaleshowed a low person separation reliability. In Studies II and III the results showed thatpersons receiving HM perceived their ability to perform everyday life tasks to be less difficultand safer up to six months after the HM installation. The largest changes in everyday lifecould be seen in tasks related to the received HM, such as showering, getting into and out ofthe home, and transferring on stairs. Furthermore, the time people had to wait for their HM tobe installed was found to have a negative impact on the person s ability to perform everydaylife tasks. In Study IV the findings revealed that to feel safe and secure in everyday life wasbased on three prerequisites: feeling healthy, having someone to rely on and feeling at home.The fulfillment of these prerequisites also impacted on the participants strategies for handlingproblems in everyday life tasks, as well as on the ability to use and benefit from technologysuch as HM.

In conclusion, the studies included in this thesis have contributed new knowledgerelated to older adults and aspects of perceived ability to perform everyday life tasks, impacts of HM, and the development of central concepts and an instrument. The findings show that HM has a positive impact on perceived ability to perform everyday life tasks for older adults. Older adults receiving HM report decreased difficulty and increased safety in the performance of everyday life tasks. Impacts of HM also found to be related to personal aspects were the ability to feel safe and secure, and also the possibility to benefit from HM was based on the degree of fulfilled prerequisites. Furthermore, the C-CAP Part I is considered to be a beneficial instrument to apply when investigating impacts of HM, although it needs to be revised. In the process of evaluating and developing instruments it became apparent that the need of a theoretical understanding and definition of central concepts is of vital importance. The findings provide a useful contribution to clinical practice not only for occupational therapists, but also for other professionals who meet older adults with disabilities who are aging in place.

List of scientific papers

I. Petersson I, Fisher AG, Hemmingsson H, Lilja M (2007). "The Client-Clinician Assessment Protocol (C-CAP) Part I: Evaluation of its psychometric properties for use with people aging with disabilities in need of home modifications." OTJR: Occupation, Participation and Health 27(4): 140-148

II. Petersson I, Lilja M, Hammel J, Kottorp A (2008). "Impact of home modification services on ability in everyday life for people ageing with disabilities." J Rehabil Med 40(4): 253-60
https://pubmed.ncbi.nlm.nih.gov/18382820

III. Petersson I, Kottorp A, Bergstrom J, Lilja M (2008). "Longitudinal changes in everyday life after home modifications for people aging with disabilities." Scand J Occup Ther Sep 27: Epub ahead of print
https://pubmed.ncbi.nlm.nih.gov/18821447

IV. Petersson I, Lilja M, Borell L (2009). "Concepts related to being safe and secure in everyday life- A study of older adults experiences after home modification" (Manuscript)