Population-based study of home accessibility features and the activities of daily living: Clinical and policy implications

Purpose. To empirically test a biopsychoecological model referred to as Health Environmental Integration (HEI) by showing associations between the perception of unmet need for home accessibility features and the experience of Activities of Daily Living (ADL) difficulties. Method. A USA population-based cross-sectional study of the 1994 and 1995 National Health Interview Survey (NHIS) supplements on Disability (NHIS-D). Estimated likelihood of ADL difficulty, comparing those who perceived unmet needs for home accessibility features to those who did not, were obtained through logistic regression after controlling for severity and socioeconomic differences. ADLs included dressing, eating, getting in and out of chairs, or getting to and using the bathroom. Results. There were 12,743 people with physical limitations, 10.3% of whom perceived an unmet need for at least 1 home accessibility feature. After accounting for severity of physical limitations and socioeconomic differences, the odds of an ADL difficulty were 3.7 times larger (95% confidence interval, 2.9-4.6) among people who perceived an unmet need for accessibility feature(s). Conclusions. Findings support concepts of HEI. When attempting to understand the aetiology of ADL difficulty, it is essential to look beyond biomedical and socioeconomic factors to effects of the environment. Rather than single root causes, disability aetiologies occur through linkages among biological, psychological, socioeconomic, and environmental mechanisms.