Improved Housing Accessibility for Older People in Sweden and Germany: Short Term Costs and Long-Term Gains
Abstract
:1. Introduction
2. Materials and Methods
2.1. Theoretical Model
2.2. Data Sets and Variables
2.3. Simulation Methodology
- the most prominent barriers in the two national housing stocks;
- the association of accessibility problem score and I-ADL dependence;
- the overall reduction of accessibility problems following the barrier’s removal;
- the cost of the barrier removal policy;
- the potential savings (in terms of home care provision cost) related to the policy impact.
2.3.1. Step 1: Criteria to Prioritize Barriers for Removal
- the barriers should be located indoors or at entrances;
- the barriers should have high impact on the range of potential accessibility problems generated, i.e., generating problems in relation to several functional capacities, such as vision, movement, handling and gripping etc., as shown by Slaug and colleagues [25];
- the impact should also be potentially high in terms of severity, i.e., barriers more difficult to overcome, scoring at least 3 on the 1–4 scale;
- the barriers should be prevalent in ordinary housing, i.e., occurring in at least 33% of the surveyed dwellings.
2.3.2. Step 2: Estimating the Association between Housing Accessibility Problems and I-ADL Dependence Using ENABLE-AGE Data
2.3.3. Step 3: Simulating the Impact of Barrier Removal Policy Using ENABLE-AGE Data
2.3.4. Step 4: Estimating Potential Costs of the New Barrier Removal Policy
2.3.5. Step 5: Estimating Potential Savings
2.4. Ethical Approval
3. Results
3.1. Step 1: Barriers Prioritized for Removal
3.2. Step 2: Estimating the Relation between Accessibility Problem Score and I-ADL Dependence
3.3. Step 3: Simulating the Impact of the Policy on I-ADL
3.4. Step 4: Costs for Barrier Removal Policy
3.5. Step 5: Potential Savings
4. Discussion
5. Conclusions
Acknowledgments
Author Contributions
Conflicts of Interest
References
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Germany | Sweden |
---|---|
1. Wall-mounted cupboards and shelves placed extremely high in the kitchen | 1. Wall-mounted cupboards and shelves placed extremely high in the kitchen |
2. Doors at entrance that do not stay in open position/close quickly | 2. No grab bars at shower/bath and/or toilet |
3. Insufficient maneuvering areas in the kitchen | 3. Doors at entrance that do not stay in open position/close quickly |
4. Heavy doors without automatic opening at entrance | 4. Insufficient maneuvering areas in the kitchen |
5. Very high, very low, and/or irregular heights of risers at entrance stair | 5. High thresholds and/or steps at the entrance |
I-ADL Type by Country | a1. Cases of I-ADL Dependence Baseline n (%) | a2. Cases of I-ADL Dependence: Follow Up n (%) | * b. Risk of Dependence in I-ADL or (95% CI) | c. Cases of I-ADL Dependence—Simulated Intervention Effect | d. Absolute Risk Reduction (c–a2, %) | f. Number Needed to ”Treat” |
---|---|---|---|---|---|---|
Germany (n = 322) | ||||||
Cooking | 56 (17.5%) | 64 (19.9%) | 1.004 (1.000 to 1.008) | 60 (18.7%) | 1.2% | 86 |
Shopping | 118 (36.8%) | 150 (46.6%) | 1.003 (1.000 to 1.007) | 143 (44.3%) | 2.2% | 45 |
Cleaning | 141 (44.1%) | 143 (44.4%) | 1.001 (0.998 to 1.005) | 141 (43.6%) | 0.8% | 130 |
Transportation | 44 (14.7%) | 80 (25.7%) | 1.005 (1.001 to 1.008) | 75 (24.0%) | 1.7% | 58 |
Sweden (n = 314) | ||||||
Cooking | 54 (17.2%) | 65 (20.7%) | 1.005 (1.002 to 1.009) | 59 (18.9%) | 1.8% | 56 |
Shopping | 64 (20.4%) | 88 (28.0%) | 1.004 (1.001 to 1.008) | 82 (26.0%) | 2.0% | 50 |
Cleaning | 95 (30.4%) | 122 (38.9%) | 1.011 (1.007 to 1.015) | 100 (32.0%) | 6.8% | 15 |
Transportation | 127 (40.4%) | 125 (39.9%) | 1.004 (1.001 to 1.007) | 117 (37.4%) | 2.5% | 39 |
Sub-Steps to Calculate Policy Cost | Germany | Sweden |
---|---|---|
Target Population | ||
Total population age 80–90 * | 3,740,395 a | 427,940 b |
Estimated proportion living in assisted living | 9% a | 14% c |
Number of people living in private homes | 3,399,072 | 368,028 |
Number of people independent in I-ADL but with difficulty (estimation from ENABLE-AGE samples) | 1,142,088 (34%) | 134,330 (37%) |
Number currently receiving home services | 664,496 a | 82,774 c |
Number to target for barrier removal policy | 477,592 | 51,556 |
Home modifications | ||
Number of home modifications | 477,592 | 50,913 |
Cost per home modification (Euro) | 2557 d | 1570 e |
Total Cost (Euro) | 1,221,203,235 | 79,933,207 |
I-ADL Dependence | Cases Averted (95% CI) | Reduction of Hours/Week a (95% CI) | Reduction of Cost/Year (Euro) b (95% CI) |
---|---|---|---|
Germany | |||
Shopping | 10,684 (701 to 20,694) | 138,886 (9111 to 269,026) | 312,065,586 (20,470,775 to 604,479,229) |
Transportation | 8275 (2011 to 14,563) | 107,571 (26,138 to 189,316) | 241,702,602 (58,730,065 to 425,378,494) |
Cooking | 5555 (367 to 10,765) | 72,215 (4768 to 139,939) | 162,261,974 (10,713,949 to 314,431,098) |
Cleaning | 3673 (−6319 to 13,695) | 47,751 (−82,145 to 178,032) | 107,291,727 (−184,572,996 to 400,023,804) |
Weighted total | 434,362,835 (−49,939,164 to 920,253,167) | ||
Sweden | |||
Shopping | 1035 (314 to 1757) | 8083 (2456 to 13,725) | 19,241,787 (5,847,783 to 32,674,489) |
Transportation | 1313 (199 to 2432) | 10,262 (1552 to 19,000) | 24,429,313 (3,694,727 to 45,231,298) |
Cooking | 914 (269 to 1562) | 7143 (2104 to 12,202) | 17,005,439 (5,008,795 to 29,045,992) |
Cleaning | 3531 (2282 to 4784) | 27,585 (17,831 to 37,373) | 65,667,948 (42,449,297 to 88,970,055) |
Weighted total | 62,662,789 (28,270,459 to 97,170,909) |
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Slaug, B.; Chiatti, C.; Oswald, F.; Kaspar, R.; Schmidt, S.M. Improved Housing Accessibility for Older People in Sweden and Germany: Short Term Costs and Long-Term Gains. Int. J. Environ. Res. Public Health 2017, 14, 964. https://doi.org/10.3390/ijerph14090964
Slaug B, Chiatti C, Oswald F, Kaspar R, Schmidt SM. Improved Housing Accessibility for Older People in Sweden and Germany: Short Term Costs and Long-Term Gains. International Journal of Environmental Research and Public Health. 2017; 14(9):964. https://doi.org/10.3390/ijerph14090964
Chicago/Turabian StyleSlaug, Björn, Carlos Chiatti, Frank Oswald, Roman Kaspar, and Steven M. Schmidt. 2017. "Improved Housing Accessibility for Older People in Sweden and Germany: Short Term Costs and Long-Term Gains" International Journal of Environmental Research and Public Health 14, no. 9: 964. https://doi.org/10.3390/ijerph14090964