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Int J Environ Res Public Health. 2019 Aug 8;16(16). pii: E2826. doi: 10.3390/ijerph16162826.

A Novel Adaptation of the HOME Inventory for Elders: The Importance of the Home Environment Across the Life Course.

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Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC 27710, USA.
Center for Aging Research and Education, Duke-NUS Medical School, Singapore 169857, Singapore.
Department of Community Medicine, Faculty of Medicine, University of Ruhuna, Galle 80000, Sri Lanka.
Department of Psychology, Arizona State University, Tempe, AZ 85287, USA.
Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.


The context in which dependents, regardless of age, receive care affects their health. This study adapted the Home Observation for Measurement of the Environment (HOME) Inventory, originally designed for child development research, to assess the quality of stimulation and support available to elders in their habitual households in Sri Lanka. Whether the adapted domains correlated with indicators of health and well-being in ways consistent with the child development literature was then examined. Through mixed-methods research based on 248 household surveys, four focus groups, and 15 interviews, three domains emerged: Physical Environment, Variety of Stimulation, and Emotional and Verbal Responsiveness. Regression modeling revealed that a higher quality physical home environment correlated with two measures of cognitive function after adjusting for covariates, but no consistent association with two psychological well-being scales. In contrast, higher Variety of Stimulation scores correlated with better cognitive function and lower psychological distress. There was no consistent correlation between Responsiveness and selected health outcomes. Qualitative data indicate that elders are active household contributors who strive to achieve harmonious relations with coresident kin. These findings reveal notable synergies between early and late life efforts to improve cognitive and psychological health, and highlight household considerations for future healthy aging research.


Sri Lanka; caregiving arrangements; developmental life course; elderly; healthy aging; home environment; mental health; mixed methods

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