Evaluating home environments of persons with dementia: interrater reliability and validity of the Home Environmental Assessment Protocol (HEAP)
Abstract
PURPOSE: This article reports on an interrater reliability and preliminary validity study of an investigator-developed tool, the Home Environmental Assessment Protocol (HEAP) for use in homes of persons with dementia. METHOD: The HEAP consists of 192 items that are summed into separate indices representing the number of hazards, adaptations, and level of clutter and comfort in eight areas of the home. Interrater reliability was examined among four raters, two environmental experts and two non-experts, who observed 22 dementia households. RESULTS: The Kappa statistic was used to evaluate agreement level for each measured item and found that agreement ranged from slight to almost perfect. Intraclass correlations (ICCs), were used to evaluate agreement level for indices. The hazard index in each room ranged from fair (0.36) to moderate (0.66) for all raters. For the adaptation, clutter and comfort indices in each room, ICCs ranged from 0.51 to 0.90 for all raters. Agreement level between expert and non-expert raters differed minimally for all indices. Adaptations to dining rooms (r= -0.080, p = 0.001), kitchens (r = -0.52, p = 0.02) and bedrooms (r = -0.76, p = 0.001) were associated with patient deficits such that more adaptations were made in homes of dependent persons. Low Mini-Mental Status Examination scores were associated with fewer hazards, more adaptations, and less clutter. CONCLUSION: Findings show that both experts and non-expert raters use the HEAP consistently. Also, measured attributes are related to cognitive and functional status in the expected direction.
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Dementia-specific adapted home environment and related assistive devices may be helpful for both the patient and the caregiver.
“Dementia-specific adapted home environment and related assistive devices may be helpful for both the patient and the caregiver (300–302).”
From The Multidisciplinary Approach to Alzheimer’s Disease and Dementia. A Narrative Review of Non-Pharmacological Treatment (2018) · cites this paper as [300]
Cites
Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975) · Journal of Psychiatric Research · doi:10.1016/0022-3956(75)90026-6 · Cited by 88,282 · see citing works
The Measurement of Observer Agreement for Categorical Data
Landis, J. R., & Koch, G. G. (1977) · Biometrics · doi:10.2307/2529310 · Cited by 81,148 · see citing works
Ecology and the aging process.
Lawton, M. P., & Nahemow, L. (1973) · The psychology of adult development and aging. · doi:10.1037/10044-020 · Cited by 2,191 · see citing works
A Research and Service Oriented Multilevel Assessment Instrument
Lawton, M. P., Moss, M. S., Fulcomer, M. C., & Kleban, M. H. (1982) · Journal of Gerontology · doi:10.1093/geronj/37.1.91 · Cited by 990 · see citing works
The measurement of interrater agreement
Fleiss, J. (1981) · Medical Entomology and Zoology · Cited by 686 · see citing works
The Measurement of Interrater Agreement
Fleiss, J. L., Levin, B., & Paik, M. C. (2003) · Wiley series in probability and statistics · doi:10.1002/0471445428.ch18 · Cited by 519 · see citing works
Mace, N. L., & Rabins, P. V. (1999) · Medical Entomology and Zoology · Cited by 160 · see citing works
Home Environmental Hazards and the Risk of Fall Injury Events Among Community‐Dwelling Older Persons
Sattin, R. W., Rodriguez, J. G., DeVito, C. A., Wingo, P. A., & Study to Assess Falls Among the Elderly (SAFE) Group (1998) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.1998.tb03799.x · Cited by 158 · see citing works
Selecting, developing, and evaluating research instruments
Switzer, G. E., Wisniewski, S. R., Belle, S. H., Dew, M. A., & Schultz, R. (1999) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s001270050161 · Cited by 134 · see citing works
The statistical analysis of kappa statistics in multiple samples
Donner, A. P., & Klar, N. S. (1996) · Journal of Clinical Epidemiology · doi:10.1016/0895-4356(96)00057-1 · Cited by 95 · see citing works
Preventing falls: home hazard checklists to help older patients protect themselves.
Tideiksaar, R. (1986) · PubMed · Cited by 68 · see citing works
Person–Environment Assessments in Occupational Therapy
Letts, L. J., Law, M., Rigby, P., Cooper, B. A., Stewart, D., & Strong, S. (1994) · American Journal of Occupational Therapy · doi:10.5014/ajot.48.7.608 · Cited by 67 · see citing works
Development of the Safety Assessment of Function and the Environment for Rehabilitation (SAFER) Tool
Oliver, R., Blathwayt, J., Brackley, C., et al. (1993) · Canadian Journal of Occupational Therapy · doi:10.1177/000841749306000204 · Cited by 45 · see citing works
Gitlin, L. N., & Corcoran, M. (1996) · Topics in Geriatric Rehabilitation · doi:10.1097/00013614-199612000-00006 · Cited by 44 · see citing works
Self-citationGitlin, L. N., & Corcoran, M. (1993) · Technology and Disability · doi:10.3233/tad-1993-2104 · Cited by 39 · see citing works
Self-citationEnvironmental Problems in Homes of Elders with Disabilities
Mann, W. C., Hurren, D., Tomita, M., et al. (1994) · The Occupational Therapy Journal of Research · doi:10.1177/153944929401400307 · Cited by 38 · see citing works
Types of Hazards in the Homes of Elderly People
Clemson, L. M., Roland, M., & Cumming, R. G. (1997) · The Occupational Therapy Journal of Research · doi:10.1177/153944929701700304 · Cited by 35 · see citing works
In-Home Interventions for Persons with Alzheimer's Disease and Their Caregivers
Pynoos, J., & Ohta, R. J. (1991) · Physical & Occupational Therapy In Geriatrics · doi:10.1080/j148v09n03_07 · Cited by 34 · see citing works
Innovative Intervention Approaches for Alzheimer's Disease Caregivers
Coon, D. W., Schulz, R., & Ory, M. G. (1999) · doi:10.1093/acprof:oso/9780195111552.003.0013 · Cited by 28 · see citing works
Assessing Special Care Units for Dementia
Norris-Baker, C., Weisman, G. D., Lawton, M. P., et al. (1999) · Springer eBooks · doi:10.1007/978-1-4615-4841-6_8 · Cited by 23 · see citing works
Gitlin, L. N., Corcoran, M., Winter, L., Boyce, A., & Hauck, W. W. (2001) · The Gerontologist · Cited by 15 · see citing works
Self-citationIn-Home Interventions for Persons with Alzheimer's Disease and Their Caregivers
Pynoos, J., & Ohta, R. J. (1991) · Physical & Occupational Therapy In Geriatrics · doi:10.1300/j148v09n03_07 · Cited by 8 · see citing works
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Gitlin, L. N., Kales, H. C., & Lyketsos, C. G. (2012) · JAMA · doi:10.1001/jama.2012.36918 · Cited by 495 · see citing works
Self-citationWahl, H.-W., Fange, A., Oswald, F., Gitlin, L. N., & Iwarsson, S. (2009) · The Gerontologist · doi:10.1093/geront/gnp056 · Cited by 315 · see citing works
Zucchella, C., Sinforiani, E., Tamburin, S., Federico, A., Mantovani, E., Bernini, S., Casale, R., & Bartolo, M. (2018) · Frontiers in Neurology · doi:10.3389/fneur.2018.01058 · Cited by 297 · see citing works
Gitlin, L. N., Winter, L., Dennis, M. P., Hodgson, N., & Hauck, W. W. (2010) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2010.02971.x · Cited by 257 · see citing works
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Marquardt, G., Johnston, D., Black, B. S., Morrison, A., Rosenblatt, A., Lyketsos, C. G., & Samus, Q. M. (2011) · Journal of Housing for the Elderly · doi:10.1080/02763893.2011.595612 · Cited by 52 · see citing works
Fraker, J., Kales, H. C., Blazek, M., Kavanagh, J., & Gitlin, L. N. (2014) · Occupational Therapy In Health Care · doi:10.3109/07380577.2013.867468 · Cited by 33 · see citing works
Self-citation
- Authors
- Gitlin, L. N., Schinfeld, S., Winter, L., Corcoran, M., Boyce, A. A., & Hauck, W.
- Affiliations
- Thomas Jefferson University (US)
- George Washington University (US)
- Cornell University (US)
- Venue
- Disability and Rehabilitation
- Publisher
- Informa UK Limited
- Published
- 2002-01
- Volume
- 24
- Issue
- 1-3
- Pages
- 59-71
- ISSN
- 0963-8288 (ISSN-L)
- 1464-5165
- OpenAlex
- W2145011639
- Cited by
- 77
- References
- 22
- Citations by year
- 2025: 3 · 2024: 4 · 2023: 2 · 2022: 2 · 2021: 6 · 2020: 4 · 2019: 5 · 2018: 4 · 2017: 1 · 2016: 6 · 2015: 5 · 2014: 1 · 2013: 7 · 2012: 3
- FWCI
- 0.64
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Disability and Rehabilitation (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (1r03ag015517-01)
- National Institute on Aging (R03-AG15517, U01-AG13265, U01AG013265)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Health Professions › General Health Professions › Geriatric Care and Nursing Homes
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Balance, Gait, and Falls Prevention
- Keywords
- dementia, family environment, inter-rater reliability, validity, home hazards, home modification, clutter, residential comfort, caregiver burden, cognitive status, functional status, Mini-Mental State Examination, dementia care
- MeSH terms
- Activities of Daily Living, Cognition, Dementia, Housing, Humans, Psychometrics, Reproducibility of Results, Caregivers, Safety Management
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