Open Access Research article

Environmental barriers, person-environment fit and mortality among community-dwelling very old people

Merja Rantakokko1*, Timo Törmäkangas1, Taina Rantanen1, Maria Haak2 and Susanne Iwarsson2*

Author Affiliations

1 Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland

2 Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden

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BMC Public Health 2013, 13:783  doi:10.1186/1471-2458-13-783

Published: 28 August 2013

Abstract

Background

Environmental barriers are associated with disability-related outcomes in older people but little is known of the effect of environmental barriers on mortality. The aim of this study was to examine whether objectively measured barriers in the outdoor, entrance and indoor environments are associated with mortality among community-dwelling 80- to 89-year-old single-living people.

Methods

This longitudinal study is based on a sample of 397 people who were single-living in ordinary housing in Sweden. Participants were interviewed during 2002–2003, and 393 were followed up for mortality until May 15, 2012.

Environmental barriers and functional limitations were assessed with the Housing Enabler instrument, which is intended for objective assessments of Person-Environment (P-E) fit problems in housing and the immediate outdoor environment. Mortality data were gathered from the public national register. Cox regression models were used for the analyses.

Results

A total of 264 (67%) participants died during follow-up. Functional limitations increased mortality risk. Among the specific environmental barriers that generate the most P-E fit problems, lack of handrails in stairs at entrances was associated with the highest mortality risk (adjusted RR 1.55, 95% CI 1.14-2.10), whereas the total number of environmental barriers at entrances and outdoors was not associated with mortality. A higher number of environmental barriers indoors showed a slight protective effect against mortality even after adjustment for functional limitations (RR 0.98, 95% CI 0.96-1.00).

Conclusion

Specific environmental problems may increase mortality risk among very-old single-living people. However, the association may be confounded by individuals’ health status which is difficult to fully control for. Further studies are called for.

Keywords:
ENABLE AGE-project; Environment; Mortality; Older people; Housing Enabler