Importance of the Home Environment for Healthy Aging: Conceptual and Methodological Background of the European ENABLE–AGE Project

Abstract

Currently in Europe as well as in the United States, an increasing proportion of very old people remain living in their homes despite declines in physical and mental health. Together with the fact that the population of very old people is rapidly increasing (Mathers, Sadana, Salamon, Murray, & Lopez, 2001; United Nations Development Programme, 2001), this poses new challenges to societal planning and housing development (Gitlin, 2003). In addition, the home environment is a major arena for aging research focusing on objective as well as perceived housing and relying on both quantitative and qualitative methods (Scheidt & Windley, 2006). As earlier research has consistently shown, daily activities are predominantly performed in the home and its close surroundings. As people grow older, they spend relatively more time in their homes; on average, very old people tend to spend 80% of their time at home (Baltes, Maas, Wilms, Borchelt, & Little, 1999). Strong cognitive and affective ties to the home environment are formed as people age, and, as a consequence, aging in place and preventing relocation are among the strongest needs of older adults as well as their families (Gitlin, 2003). Thus, an important goal in health promotion is to create home environments that support healthy aging. Promoting health framed within a person–home environment perspective requires robust knowledge underscoring the way good home environments can help to alleviate or prevent illness and declining health. Although such knowledge has been gathered in recent decades (see, for review, Gitlin, 2003; Iwarsson, 2004; Oswald & Wahl, 2004; Scheidt & Windley, 2006; Wahl & Gitlin, in press; Wahl, Scheidt, & Windley, 2004), the evidence still is fragmented and scattered (Wahl & Weisman, 2003). Researchers designed the European project “Enabling Autonomy, Participation, and Well-Being in Old Age: The Home Environment as a Determinant for Healthy Aging” (ENABLE–AGE) to address this major research gap. Their main objective in the project was to examine the home environment and its importance for major components of healthy aging. In the ENABLE–AGE Project, researchers used the term healthy aging to address selected aspects of physical, mental, and social health that are assumed to be particularly relevant to housing. Among the core concepts chosen for the project were independence in daily activities and subjective well-being (Iwarsson, Wahl, & Nygren, 2004). It is widely accepted that an active life is positively associated with better health (Mendes de Leon, Glass, & Berkman, 2003). Engagement in activities is of crucial importance in promoting and maintaining health and well-being throughout life (Law, Steinwender, & Leclair, 1998), and thus independence in daily activities constitutes an important aspect of health in very old age. The point of departure for the definition of subjective well-being is the World Health Organization's definition of health “as a state of complete physical, mental, and social well-being [and] not merely the absence of disease and infirmity” (World Health Organization, 1946, as cited in Christiansen & Baum, 2005). The three elements of well-being (physical, mental, and social) are part of an integrated whole, and therefore they should not be separated (Stanley & Cheek, 2003). In relation to gerontological research in general, the hallmark of the ENABLE–AGE Project is the richness of variables in covering aspects of housing. What is most important, and in contrast to most other projects in this field, in this project equal emphasis was given to the assessment of objective and perceived aspects of housing. Very old individuals, particularly those living in single households, have been described as particularly sensitive to “environmental press” (Lawton, 1999), because of sensory, mobility, and cognitive declines (Baltes & Smith, 1999). Because community-residing, very old participants living alone have a pronounced risk of losing independence and becoming socially isolated, the ENABLE–AGE Project targeted this group. In addition, major studies that targeted this at-risk segment of the aging population (see, e.g., Baltes & Mayer, 1999; Myers, Juster, & Suzman, 1997) narrowly focused on variables related to the person and his or her social environment, but not on the home environment. Researchers gathered data in urban regions in five European countries representing economically well-developed “old” European Union member states, that is Germany, the United Kingdom, and Sweden, as well as “new” member states that joined the European Union in 2005 and are still in a period of major social and political transformation, that is, Hungary and Latvia (Széman & Harsanyi, 2000). The goal of the project was to deliver evidence-based guidelines for home assessment and home modifications among older people (also see http://www.enableage.arb.lu.se). Several empirical studies have focused on the home environment as a potential threat