1. 21 May 2013 Home and Health Workshop / Charlotte Löfqvist, Maria Haak Aspects of Home and Health over Nine years among Very Old People in Latvia and Sweden CHARLOTTE LÖFQVIST 2 PHD, REG OT, MARIA HAAK 2 PHD, REG. OT CO-AUTHORS: SIGNE TOMSONE 1, VIBEKE HORSTMANN 2, SUSANNE IWARSSON 2 1 Riga Stradins University, Department of Rehabilitation 2 Lund University, Department of Health Sciences, Centre for Aging and Supportive Environments

2. 21 May 2013 Home and Health Workshop / Charlotte Löfqvist, Maria Haak Aim To present preliminary results from a longitudinal study on home and health among single-living very old people in Latvia and Sweden, 2002-2011

3. 21 May 2013 Home and Health Workshop / Charlotte Löfqvist, Maria Haak ChangesLatviaSweden 2002201120022011 Population, mil. 2.32.28.99.5 Over working age, %21.620.217.218.5 Life expectancy for males / females 65/77 69/7878/8280/84 Unemployment, %8.514.36.58.5 Health care expenses, % of GDP 6.36.29.29.4 Average pension per month,USD 1003331 2002 100

4. 21 May 2013 Home and Health Workshop / Charlotte Löfqvist, Maria Haak Material and methods Data from the Latvian and Swedish parts of the ENABLE- AGE Survey Study: Baseline (2002/2003) Follow-up (2011) Single living Urban regions in Latvia (Riga and Jūrmala) and Sweden (Lund, Helsingborg, Halmstad)

5. 21 May 2013 Home and Health Workshop / Charlotte Löfqvist, Maria Haak Study participants Latvia N=303, 75-84 yrs N=59, 86-90 yrs Baseline 2002/03 Follow-up 2011 Sweden N=397, 80-89 yrs N=67, 91-99 yrs

6. 21 May 2013 Home and Health Workshop / Charlotte Löfqvist, Maria Haak Reasons for drop-out Deceased Health reasons Not possible to reach (more common in Lv than Sw) No interest in participating

7. 21 May 2013 Home and Health Workshop / Charlotte Löfqvist, Maria Haak Instruments HousingHealth ObjectiveObjective -Part of The Housing Enabler (Iwarsson, S.& Slaug,B., 2001) - nb of environmental barriers,184 items -(188 – communication) - Part of The Housing Enabler (Iwarsson, S.& Slaug,B., 2001) - functional limitations, 15 items -ADL Staircase (Hulter Åsberg & Sonn, 1989; Sonn & Hulter Åsberg, 1991), difficulty in performing 9 activities PerceivedPerceived -Housing satisfaction (Sixsmith & Sixsmith, 2000), single question -Housing related control beliefs - external (Oswald, Wahl, Martin, & Mollenkopf, 2003), 16 items -Meaning of home (Oswald, Mollenkopf, & Wahl, 1999), 23 items -Geriatric depression scale (Yesavage & Brink, 1983), 15 items -Perceived functional independence (Oswald et al., 2001), single question -Perceived health (Sullvan & Karlsson, 1994), single question -Perceived physical mobility (Sullvan & Karlsson, 1994), single question -Life satisfaction, single question

8. 21 May 2013 Home and Health Workshop / Charlotte Löfqvist, Maria Haak Results: Participants description At baseline Participants Lv N=59 Participants Sw N=67 Age, years, Md (q1,q3)78 (77-81)83 (81-86) Sex, males, n (%)6 (10)14 (21) Lv/Sw identity, n (%)42 (71)67 (100) Marital status, widowed, n (%)35 (59)48 (72) Type of housing, multifamily, n (%) 51 (86)59 (88) Number of rooms, Md13

9. 21 May 2013 Home and Health Workshop / Charlotte Löfqvist, Maria Haak Results: Objective housing Latvia, N=54 Sweden, N=58 Changes 2002-2011 in each country Direction of changesP-value Direction of changes P-value Environmental barriers Indoor (0-100) Higher nb** Higher nb*** Outdoor (0-33) n.s. Entry (0-49) Higher nb*** Higher nb*** p<.05*, p<.01**, p<.001***

10. 21 May 2013 Home and Health Workshop / Charlotte Löfqvist, Maria Haak Results: Perceived housing Latvia, N=54Sweden, N=58 Changes 2002-2011 in each country Direction of changes P-valueDirection of changesP-value Housing satisfaction (1- 5) Unchanged (n=14) Increased (n=13) Decreased (n=24) n.s. Unchanged (n=43) Increased (n=9) Decreased (n=5) n.s. Housing related control beliefs, external control (1-5) Slightly higher external control believe n.s. Higher external control believe *** Meaning of home (0-10) - physical bonding More important * Less important * - behavioral bonding Slightly less important n.s. Less important** - cognitive emotional bonding More important *** Slightly less important n.s. p<.05*, p<.01**, p<.001***

11. 21 May 2013 Home and Health Workshop / Charlotte Löfqvist, Maria Haak Results: Objective health Latvia, N=59Sweden, N=67 Changes at individual and group level 2002-2011 in each country Direction of changesP- value Direction of changesP- value Nb. of functional limitations, 15 items Increased* *** P-ADL, nb. of items performed without difficulty, 5 activities Unchanged (n=9) Increased (Better) (n=6) Decreased (Worse) (n=44) *** Unchanged (n=30) Increased (Better) (n=19) Decreased (Worse) (n=18) n.s. I-ADL, nb. of items performed without difficulty, 4 activities Unchanged (n=7) Increased (Better) (n=5) Decreased (Worse) (n=47) *** Unchanged (n=20) Increased (Better) (n=5) Decreased (Worse) (n=42) *** Statistical tests for differences: Wilcoxon signed rank test with p<.05*, p<.01**, p<.001***

12. 21 May 2013 Home and Health Workshop / Charlotte Löfqvist, Maria Haak Results:Perceived health Latvia, N=59Sweden, N=67 Changes at individual and group level 2002-2011 in each country Direction of changes P- valueDirection of changesP- value Depression score 0.04 (-3,1.57)n.s. 1(0;2.03) *** Perceived health, 1- 5 Unchanged (41) Better health (13) Worse health (4) * Unchanged (17) Better health (15) Worse health (35) * Perceived functional independence, 1- 10 Unchanged (16) Less dependent (7) More dependent (33) *** Unchanged (24) Less dependent (4) More dependent (35) *** Perceived physical mobility, 1- 5 Unchanged (6) Better mobility (5) Worse mobility (45) ** Unchanged (8) Better mobility (28) Worse mobility (31) n.s. p<.05*, p<.01**, p<.001***

13. 21 May 2013 Home and Health Workshop / Charlotte Löfqvist, Maria Haak Latvia, N=59Sweden, N=67 Changes at group level 2002-2011 in each country Baseline Follow-up P- value Baseline Follow-up P- value Depression score 54n.s.23*** Health, 1- 5 * 44 * 23* Functional independence, 1- 10** ** Higher score indicate higher independence 86 *** 108 *** Physical mobility, 1- 5* * Higher score indicate worse health/mobility 44 (4; 4.25) ** 2 (2; 3)3 (2; 3) n.s. p<.05*, p<.01**, p<.001***

14. 21 May 2013 Home and Health Workshop / Charlotte Löfqvist, Maria Haak Results: Life satisfaction Latvia, N=59Sweden, N= 67 Changes at individual and group level 2002-2011 in each country (n) P-value Life satisfaction (0-10) Unchanged (12) Better satisfaction (30) Worse satisfaction (12) ** Unchanged (18) Better satisfaction (24) Worse satisfaction (22) n.s.

15. 21 May 2013 Home and Health Workshop / Charlotte Löfqvist, Maria Haak Concluding remarks One of the first studies of detailed information among very old people taking housing as well as health aspects into account. Objective and perceived aspects of home changes over time even in advanced age. Need to be further investigated in order to develop suitable and appropriate services and living conditions for very old people in different European contexts.

16. 21 May 2013 Home and Health Workshop / Charlotte Löfqvist, Maria Haak Thank you for your attention! For more information please contact: charlotte.lofqvist@med.lu.secharlotte.lofqvist@med.lu.se or maria.haak@med.lu.searia.haak@med.lu.se Please visit us on the web: http://www.med.lu.se/casehttp://www.med.lu.se/case

17. 21 May 2013 Home and Health Workshop / Charlotte Löfqvist, Maria Haak Discussion How does these results on housing and health correspond with our experiences of very old peoples everyday life in Latvia? Perceived aspects of housing – why does it differ between countries – according to satisfaction, control believe, meaning of home etc?