Environment: Where and How We Promote Aging in Place

Beth Fields, PhD, OTR/L

April 1, 2019

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Question

What assessments do you recommend to use in order to promote aging in place?

Answer

There are also several assessment tools to promote aging in place. One is the Assessment of Life Habits. It is designed specifically for adults, and this tool assesses the level of performance in life habits within various contexts, and contexts meaning situations. It could be within the community or within their home, and certain areas that are specifically addressed include the older adult's nutrition, their fitness, communication and social rapport with others, their housing, community, and then some of those demographic pieces, including their education and employment status as well. Another one that comes to mind that has been around for quite a long time is the Instrumental Activities of Daily Living Scale, from Lawton. He introduced that scale way back in the late '60s, so that is more commonly used in practice as well. There have been several adaptations to that tool. It is specifically for older adults, so 65 years plus, and assesses independence particularly in the different instrumental activities of daily living categories that are outlined in the Occupational Therapy Practice Framework.

There are a significant number of tools to assess the environment surrounding our client, and these tools can range in settings in populations served. I do want to note that there is no gold standard for occupational therapy providers for an environmental assessment to help support our clients to age in place. However, I do want to point out several existing environmental assessments that occupational therapy providers can use in practice to gauge safety, comfort, and independence when aging in place.

The Home-Fast Assessment (Mackenzie et al., 2000) takes about 20 minutes to complete and is focused on home hazards and the client safety perspective. Another home-based assessment is the Safety Assessment of Function and the Environment for Rehabilitation-Health Outcome Measurement and Evaluation Tool, or SAFER-HOME Tool (Chiu et al., 2006). This assessment takes a bit longer and can range from 45 to 60 minutes. It goes beyond assessing home hazards and safety and includes domains focused on that person's environmental fit and suggests solutions based on different responses. Because aging in place also involves community participation, I wanted to suggest the Measure of Quality of the Environment (Fougeyrollas, 1999). This tool takes about 30 minutes and is focused on that goodness of fit with the PEO model but tends to have more of a focus on mobility impairment and ability level of getting around within the community.


beth fields

Beth Fields, PhD, OTR/L

Beth Fields, Ph.D., OTR/L is a registered and licensed occupational therapist. She is a postdoctoral associate in the School of Health and Rehabilitation, Department of Occupational Therapy at the University of Pittsburgh. Dr. Fields is an expert in developing and testing nonpharmacological interventions that address healthcare systems and physical and social environments for older adults with and at risk for disability. Her expertise has been informed by scholarship in disability studies, environmental gerontology and psychology, occupational therapy and science, nursing, and rehabilitative science.


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