In order to render reliable assessment of housing accessibility in a cross-national context possible, the objective of this study was to investigate multi-professional, cross-national inter-rater reliability of the ENABLE-AGE project-specific version of the Housing Enabler instrument. The data collection was performed with elderly persons in ordinary housing in five European countries. After participation in rater training courses, 26 raters representing different nationalities and professions performed data collection in independent pairs of raters, n = 64. Inter-rater reliability was calculated by means of percentage agreement as well as Cohen's kappa. The results demonstrated moderate to good overall inter-rater reliability of the project-specific version of the Housing Enabler instrument. The mean agreement for the personal component part of the instrument was 91%. For 13 of the 15 items in this part kappa values could be defined, kappa = 0.43, indicating moderate agreement. In the environmental component part the mean agreement for all 188 items was 85%, while kappa = 0.50, indicating moderate agreement. Given the complexity of the instrument and the number of different professions and countries involved, we consider the Housing Enabler as useful for cross-national research targeting housing accessibility, even if the agreement levels reached were moderate. However, the moderate agreement levels pinpoint the importance of rater training.

The ambition underlying this study is to provide a valid and efficient screening tool targeting accessibility problems in the ordinary housing stock. The study aims to test the feasibility and interrater agreement of a screening-tool version of the Housing Enabler in a real estate company practice context. Two rater pairs administer the screening in 35 apartments in a Swedish municipality. The overall agreement for the rater pairs was 83% and 78%. For 29 of the 61 items of the tool, the agreement was >80% for both rater pairs; for 8 items, it was <80%. The findings show that the tool is feasible for use in a real estate practice context but that there is a need for more rater training and an instrument manual. This study contributes to the development of research-based strategies for the identification of accessibility problems in ordinary housing, with the long-term aim to increase accessibility in the housing stock, ultimately supporting activity and participation among senior citizens.

Twenty years of methodological development, empirical research and practice application have resulted in an updated version of the Housing Enabler instrument and a screening version. The methodology rests on Lawton's and Nahemow's ecological model, with accessibility defined as the relationship between the individual's functional capacity and the demands of the physical environment. The complete instrument is based on one checklist of functional capacity in the individual (personal component) and another of environmental barriers (environmental component), followed by an analysis of person-environment fit giving an accessibility score. The Housing Enabler Screening Tool requires a less complex and less time-consuming procedure.

In order to support the development of optimal housing options for older people, we need to increase our understanding of relations between aspects of housing and aspects of health in old and very old age. The objective of this cross-sectional study was to explore whether and how aspects of housing are related to life satisfaction and perceived health among very old, single-living Swedish people. Based on survey study data from the ENABLE-AGE Project (n = 397), correlation and regression analyses were performed with sub-groups of participants defined according to different levels of ADL dependence. The results showed that the aspects of housing related to life satisfaction and perceived health were different in the three ADL sub-groups. Among objective aspects of housing, accessibility problems influenced life satisfaction as well as perceived health, yet differently among the sub-groups. As concerns perceived aspects of housing, aspects of meaning of home (MOH) were influential on perceived health in several sub-groups, while only among persons dependent in I-ADL were social aspects of MOH related to life satisfaction. Among persons dependent in I-ADL, external housing-related control beliefs also played a role. In conclusion, the results indicate that housing matters in very old age, yet differently due to ADL dependence-level differences. Most importantly, different aspects of housing seem to play a role in different phases of the trajectory of disability in very old age, while longitudinal studies are needed to verify these indicative results.

This study addresses development of a content-valid cross-Nordic version of the Housing Enabler and investigation of its inter-rater reliability when used in occupational therapy rating situations, involving occupational therapists, clients, and their home environments. The instrument was translated from the original Swedish version of the Housing Enabler, and adapted according to accessibility norms and guidelines for housing design in Sweden, Denmark, Finland, and Iceland. This iterative process involved occupational therapists, architects, building engineers, and professional translators, resulting in the Nordic Housing Enabler. For reliability testing, the sampling strategy and data collection procedures used were the same in all countries. Twenty voluntary occupational therapists, pair-wise but independently of each other, collected data from 106 cases by means of the Nordic Housing Enabler. Inter-rater reliability was calculated by means of percentage agreement and kappa statistics. Overall good percentage agreement for the personal and environmental components of the instrument was shown, indicating that the instrument was sufficiently reliable for application in practice and research in the Nordic context. The varying kappa results highlight the need for further study in order to understand the influence of prevalence more profoundly, which should be kept in mind when interpreting the results.