This domain considers the physical environment and the ways in which this can either increase resilience or create vulnerability in relation to an older person’s quality of life. The physical environment includes our homes, but also the many other places that we visit as we live our lives.
Objective physical aspects of a person’s environment tend to come most immediately to mind in this domain, but other important although more subjective aspects, such as the safety or security of an area, should also be considered.
At the most immediate level, this domain considers a person’s clothing and footwear. The next level is the physical aspects of an older person’s home, such as whether it is a flat, a bungalow or a house with stairs, as well as the space, layout and furnishing within the home. It also considers other practical aspects such as the general state of repair of the home and the nature and functionality of key features, including the utilities and heating systems. Other more general features, such as the accessibility, safety and security of the home itself, are also important.
Within the home there may be adaptations either relating to the use of the environment (for example, converting a room downstairs into a bedroom) or to fixed adjustments within the environment (such as installing a stair-lift or a grab rails). The physical environment can also include other specific aids, equipment and systems, such as walking aids, bathing equipment and communication systems.
The nature of the environment outside of the home also plays an important part in increasing resilience or creating vulnerability for older people. Features of importance in the immediate external environment might include physical features such as the state of repair of the pavement, presence of street lighting or distance to local facilities such as shops. It can also include more general aspects such as the safety and security of the neighbourhood.
Similar consideration should be given to the wider environment, in the places that older people need or wish to visit as they live their lives. These are many and varied, including the homes of family or friends, shops, community centres, religious buildings and public buildings. Furthermore, the transport systems that exist to provide links between an older person’s home and the other places that they wish to visit are also an important part of that person’s environment. The nature, extent, accessibility, convenience and physical condition of transport systems available play an important part in people’s lives and can have either a positive or negative impact upon that person’s quality of life.
Weather conditions are another environmental variable that can have a significant impact upon an older person’s resilience and vulnerability. The physical environment domain of frailty has close interactions and interrelationships with other domains of frailty, for example:
- Aspects of an older person’s physical environment, such as their access and transport systems, might impact upon their ability to maintain social contacts outside their home;
- A poorly maintained or cluttered home might increase the risk of acute health events (such as falls), whilst the provision of appropriate aids and equipment might reduce this vulnerability.
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