In order to render reliable assessment of housing accessibility in a cross-national context possible, the objective of this study was to investigate multi-professional, cross-national inter-rater reliability of the ENABLE-AGE project-specific version of the Housing Enabler instrument. The data collection was performed with elderly persons in ordinary housing in five European countries. After participation in rater training courses, 26 raters representing different nationalities and professions performed data collection in independent pairs of raters, n=64. Inter-rater reliability was calculated by means of percentage agreement as well as Cohen's kappa. The results demonstrated moderate to good overall inter-rater reliability of the project-specific version of the Housing Enabler instrument. The mean agreement for the personal component part of the instrument was 91%. For 13 of the 15 items in this part kappa values could be defined, , indicating moderate agreement. In the environmental component part the mean agreement for all 188 items was 85%, while , indicating moderate agreement. Given the complexity of the instrument and the number of different professions and countries involved, we consider the Housing Enabler as useful for cross-national research targeting housing accessibility, even if the agreement levels reached were moderate. However, the moderate agreement levels pinpoint the importance of rater training.

In order to support the development of optimal housing options for older people, we need to increase our understanding of relations between aspects of housing and aspects of health in old and very old age. The objective of this cross-sectional study was to explore whether and how aspects of housing are related to life satisfaction and perceived health among very old, single-living Swedish people. Based on survey study data from the ENABLE-AGE Project (n = 397), correlation and regression analyses were performed with sub-groups of participants defined according to different levels of ADL dependence. The results showed that the aspects of housing related to life satisfaction and perceived health were different in the three ADL sub-groups. Among objective aspects of housing, accessibility problems influenced life satisfaction as well as perceived health, yet differently among the sub-groups. As concerns perceived aspects of housing, aspects of meaning of home (MOH) were influential on perceived health in several sub-groups, while only among persons dependent in I-ADL were social aspects of MOH related to life satisfaction. Among persons dependent in I-ADL, external housing-related control beliefs also played a role. In conclusion, the results indicate that housing matters in very old age, yet differently due to ADL dependence-level differences. Most importantly, different aspects of housing seem to play a role in different phases of the trajectory of disability in very old age, while longitudinal studies are needed to verify these indicative results.

Housing environments that hinder performance of daily activities and impede participation in social life have negative health consequences particularly for the older segment of the population. From a public health perspective accessible housing that supports active and healthy ageing is therefore crucial. The objective of the present study was to make an inventory of environmental barriers and investigate accessibility problems in the ordinary housing stock in Sweden as related to the functional capacity of senior citizens. Particular attention was paid to differences between housing types and building periods and to identify environmental barriers generating the most accessibility problems for sub-groups of senior citizens. Data on environmental barriers in dwellings from three databases on housing and health in old age was analysed (N = 1021). Four functional profiles representing large groups of senior citizens were used in analyses of the magnitude and severity of potential accessibility problems. Differences in terms of type of housing and building period were examined. High proportions of one-family houses as well as multi-dwellings had substantial numbers of environmental barriers, with significantly lower numbers in later building periods. Accessibility problems occurred already for senior citizens with few functional limitations, but more profound for those dependent on mobility devices. The most problematic housing sections were entrances in one-family houses and kitchens of multi-dwellings. Despite a high housing standard in the Swedish ordinary housing stock the results show substantial accessibility problems for senior citizens with functional limitations. To make housing accessible large-scale and systematic efforts are required.

Twenty years of methodological development, empirical research and practice application have resulted in an updated version of the Housing Enabler instrument and a screening version. The methodology rests on Lawton's and Nahemow's ecological model, with accessibility defined as the relationship between the individual's functional capacity and the demands of the physical environment. The complete instrument is based on one checklist of functional capacity in the individual (personal component) and another of environmental barriers (environmental component), followed by an analysis of person-environment fit giving an accessibility score. The Housing Enabler Screening Tool requires a less complex and less time-consuming procedure.

The built environment needs to be designed so that all people can participate in the activities they want and need to do. Yet, accessibility is difficult to put into practice, and accessibility issues tend to be overlooked in the building and planning processes. The aim of this scoping review was to summarize the research front in the area of accessibility to public buildings. Specific aims were to identify knowledge gaps, to identify access activities in relation to environmental features and to link to predominant activities in terms of the International Classification of Functioning, Disability and Health (ICF). A literature search was performed in PubMed, PsycINFO, Inspec, Embase and Cochrane databases. Articles in English based on original empirical studies investigating accessibility of public buildings for adults aged ≥18 years with functional limitations were considered. Of the 40 articles included, ten involved study participants, while 30 only examined buildings using instruments to assess accessibility. In addition, the psychometric properties were only tested for a few of them. All articles concerned mobility and several visual limitations, while few addressed cognitive or hearing limitations. Ten main access activities were identified, from using parking/drop-off area to exiting building. By using the ICF and theoretically relating the accessibility problems to activities, the results revealed that there are large knowledge gaps about accessibility to public buildings for older people and people with functional limitations and that there is a need for more methodological considerations in this area of research.