Academic journal article British Journal of Occupational Therapy

Developing a Housing Adaptation Genome Project

Academic journal article British Journal of Occupational Therapy

Developing a Housing Adaptation Genome Project

Article excerpt

The problem

Reviews of research (Mountain 2000, Awang 2004, Bridge et al 2006, de Jonge 2011) have consistently identified the weakness of the evidence base for the effectiveness of adaptations and home-based assistive technology. The proposed project focuses on housing adaptation--fixed physical change to the home environment--but the connections with equipment and electronic devices are so strong that there is no clear division. An international English-language literature search commissioned by the Office for Disability Issues (Heywood and Turner 2007) was conducted to discover the best current evidence. This, too, showed how the fragmented nature of adaptation research frustrates attempts to build a strong body of evidence.

Work by those undertaking master's dissertations (see examples in Mountain 2000 and Awang 2004) is, of necessity, small scale and, because of diverse methodologies, cannot easily be drawn together to make a more powerful whole. The few larger research projects (for example, Plautz et al 1996, Mann et al 1999, Cornillon et al 2002, Nikolaus and Bach 2003) have also focused on different variables and used different outcome measures. This results in a lack of additionality (no extra gain beyond the individual study) and little building of an evidence base.

Adaptation research exhibits the problems of housing-health research. It crosses disciplines; there are too many confounding variables; and, although randomised controlled trials carry most weight in medical research, in this field they are expensive and ethically problematic. These, and additional problems relating specifically to adaptation research by occupational therapists, have been discussed elsewhere (Heaton and Bamford 2001, Heywood 2004).

Heaton and Bamford (2001) drew together the key literature on housing adaptation and equipment, highlighting missing areas, such as the impact on carers and the effect of service delivery. They raised the problem of timing (when to measure) and of potential incompatibility between measures in hospital and home settings. Their work showed the plethora of measures occupational therapy researchers were already employing 10 years ago, even without the outcome measures widely used in the medical world, such as the General Health Questionnaire -12 (GHQ-12), or any economic measures. Above all, their review was important for its analytical approach. It clarified the distinction between standardised and individualised outcome measures and gave guidance on validity, reliability, and the need to consider whether a measure was usable in routine practice. The work was a foundation on which the housing adaptation genome project could build.

Why evidence matters

In the United Kingdom, the number of disabled older people is projected to double from 2.3 million in 2002 to 4.6 million in 2041 (Wittenberg et al 2006). As the majority of older people are expected to remain living in their own homes (Department for Communities and Local Government 2008), there will be a need for increased resources for adaptation, especially to help the least well off.

Yet budgets are already inadequate to meet need. English house condition survey data have identified that, although 157 million [pounds sterling] was allocated for disabled facilities grants in 2009/10, the actual need for individuals who are theoretically eligible for grants stands at 1.9 billion [pounds sterling] (at 2005 prices) -staggeringly, this is more than 10 times that which is being provided (Communities and Local Government 2011). In addition, many older people are denied a service through the application of priority criteria that prevent even an assessment (Scott 1998, Mandelstam 2009). In these circumstances, evidence that investment in adaptations could reduce costs in the medical and social sectors is urgently needed. At present, for example, it is impossible to say with any confidence how many hip fractures will be prevented by a particular level of adaptation investment. …

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