Are We Oversimplifying Home Safety Modifications for Older Adults?

Recent research suggests we may need to rethink our approach to home safety modifications for older adults. While removing hazards and barriers is often recommended, a new study indicates that some environmental challenges, like stairs, may actually help maintain functional abilities in certain older individuals.

A large-scale prospective cohort study published in BMC Geriatrics examined the relationship between home type and instrumental activities of daily living (IADL) in over 6,700 community-dwelling older adults in Japan. The researchers found that older women who lived in walk-up residences (homes with stairs and no elevator) were significantly less likely to experience IADL decline over a 3-year period compared to those living in one-story homes.

Specifically, women in walk-up residences had 28% lower odds of IADL decline compared to those in single-story homes, even after adjusting for various health and lifestyle factors. Interestingly, this association was not observed in men or in residences with elevators.

The study authors propose several potential explanations for this finding:

1. The concept of Person-Environment Fit suggests that environmental challenges may be beneficial for those with higher functional capacity.
2. Regularly using stairs may provide incidental physical activity, contributing to overall health maintenance.
3. Navigating stairs engages multiple physical and cognitive functions, potentially helping preserve complex functional abilities.

This research challenges the conventional wisdom that we should remove all environmental obstacles for older adults. While safety modifications are crucial for those with existing disabilities, we may need a more nuanced approach for high-functioning older adults.

The findings align with the “use it or lose it” principle, suggesting that some environmental demands may help maintain functional abilities in older age. However, it’s important to note that this study focused on adults who were initially independent in IADL. For those with existing functional limitations, removing barriers remains essential.

As we consider home safety recommendations, perhaps we should aim for a balanced approach:

1. Assess individual needs and capabilities rather than applying a one-size-fits-all solution.
2. Consider preserving some environmental challenges for high-functioning older adults.
3. Focus on creating adaptable living spaces that can be modified as needs change over time.
4. Encourage regular physical activity and engagement in complex tasks to maintain functional abilities.

While further research is needed to confirm these findings, this study highlights the importance of evidence-based approaches to aging in place. As we strive to support older adults’ independence, we must consider both safety and the potential benefits of environmental engagement and challenges. 

Tomioka, K., Kurumatani, N., & Hosoi, H. (2018). Association between stairs in the home and instrumental activities of daily living among community-dwelling older adults. BMC Geriatrics, 18(1), 132.