title: Housing accessibility problems for people with Parkinson's disease.
abstract: OBJECTIVE
  Promoting accessible housing for all citizens is high on the political agenda. Knowledge is, however, limited regarding housing accessibility problems for people with Parkinson's disease (PD). The objectives were to investigate housing accessibility problems among people with PD at different stages of disease severity and to analyze the potential impact of improved functional ability on accessibility problems.
  
  
  METHODS
  The study included 253 participants with PD (61% men; mean age 70 years). Disease severity was assessed by the Hoehn and Yahr (HY) I-V stages: HY I, n=50; II, n=73, III, n=66; IV-V, n=64. Using the Housing Enabler (HE) instrument, accessibility problems were investigated by combining assessments of the person's functional capacity with assessments of physical barriers in the housing environment into a person-environment fit measure (HE-score). To analyze potential impact of improved functional ability on housing accessibility problems, data simulation was applied.
  
  
  RESULTS
  HE-scores differed significantly (P<.001) in relation to HY stages. Overall balance problems explained 22% and walking devices 17% of the HE-scores, whereas environmental barriers contributed to a lesser extent. The environmental barriers generating the most HE-scores were "no grab bar at shower/bath/toilet" and "wall-mounted cupboards and shelves placed high". A simulation of improved balance significantly (P<.001) lowered the HE-scores in all HY stages.
  
  
  CONCLUSIONS
  The results suggest that actions targeting balance problems and dependence on walking devices have the greatest potential for reducing housing accessibility problems for people with PD. The study also details environmental barriers that need specific attention when providing housing adaptation services.
authors.affiliation: Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden.
authors.forename: B
authors.identifier: http://orcid.org/0000-0001-7386-2224
authors.initials: B
authors.lastname: Slaug
authors.affiliation: Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden.
authors.forename: S
authors.initials: S
authors.lastname: Iwarsson
authors.affiliation: Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.
authors.forename: J A
authors.identifier: http://orcid.org/0000-0002-5220-5820
authors.initials: JA
authors.lastname: Ayala
authors.affiliation: Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden.|Memory Clinic, Skåne University Hospital, Malmö, Sweden.
authors.forename: M H
authors.identifier: http://orcid.org/0000-0002-6580-6721
authors.initials: MH
authors.lastname: Nilsson
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D001107:Architectural Accessibility; D005260:Female; D006798:Housing / Q000592:standards*; D006801:Humans; D008297:Male; D010300:Parkinson Disease / Q000453:epidemiology*; D012656:Self-Help Devices
keywords: Parkinson's disease; accessibility; assistive devices; housing; physical barriers; postural balance