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A Long-Term Perspective on Person–Environment Fit and ADL Dependence Among Older Swedish Adults

Correspondence: Address correspondence to Professor Susanne Iwarsson, Division of Gerontology and Caring Science, Lund University, Box 157, SE-221 00 Lund, Sweden. E-mail: Susanne.iwarsson{at}med.lu.se

Purpose: This study described person–environment (P–E) fit and activities of daily living (ADLs) among older adults, and it explored the relationship between P–E fit and ADL dependence, testing Lawton's docility hypothesis at two points in time. Design and Methods: From a random sample of individuals aged 75–84 living in a Swedish municipality, 72 persons were available for baseline and follow-up interviews over a 6-year period. Interviews and observations were used for data collection at home visits. Results: P–E fit problems as well as ADL dependence increased from baseline to follow-up. Functional limitations and dependence on mobility devices increased; few changes were found concerning environmental barriers. At follow-up, ADL dependence and P–E fit correlated significantly in the frailest subsample. Implications: In advanced age, P–E fit problems in housing are related to ADL dependence. The increase of P–E fit problems mostly results from functional decline, although to some extent it is from environmental changes as well. The methodology used demonstrates the potential to increase our understanding of how the main components of Lawton's model change and interact over time.

Key Words: Accessibility • Docility hypothesis • Functional limitations • Home assessment • Occupational therapy

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