Investigating preferences and influencing factors of age-friendly housing environments across different age groups using the Delphi-Kano model and entropy weight TOPSIS method

Abstract

China's escalating aging population has made home-based care the primary means of elderly support. However, current residential environments frequently fail to meet seniors' needs. Research on elderly housing lacks comparative studies across different demographic groups. This study employs the Delphi method to identify improvements for Age-Friendly Housing (AFH) and develops a Kano model questionnaire to analyze preferences among various age groups of elderly individuals. Additionally, it evaluates how living arrangements and health conditions impact these preferences. Results show that individuals aged 60-74 prioritize visual connections with the external environment and monitoring the surroundings outside their homes, while those aged 75 and above focus more on bathroom safety and indoor mobility. Seniors aged 60-74 living with children, and those aged 75 and above living with caregivers or in nursing homes, generally exhibit less concern for most design strategies. Conversely, seniors with arthritis, visual impairments, or hearing disabilities tend to favor design improvements more. Policymaking and implementation related to AFH should account for elderly individuals' diverse ages and living arrangements to set appropriate priorities, thereby aiding in optimizing resources and enhancing residents' satisfaction and quality of life.

Keywords

Age-friendly housing design strategies / Chinese old adults / Delphi-Kano model / Entropy weight TOPSIS analysis / Living environment for old adults / Prioritization

References

[1] AARP , 2020. The AARP HomeFit Guide. AARP Education & Outreach/Livable Communities, Washington, DC, USA.

[2] Ambagtsheer, R.C. , Borg, K. , Townsin, L. , Pinero de Plaza, M.A. , O'Brien, L.M. , Kunwar, R. , Lawless, M.T. , 2024. The effectiveness of technology interventions in reducing social isolation and loneliness among community-dwelling older people: a mixed methods systematic review. Arch. Gerontol. Geriatr. 1, 100008.

[3] Beard, J.R. , Montawi, B. , 2015. Age and the environment: the global movement towards age-friendly cities and communities. J. Soc. Work. Pract. 29, 5- 11.

[4] Bianchin, M. , Heylighen, A. , 2018. Just design. Des. Stud. 54, 1- 22.

[5] Bland, J.M. , Altman, D.G. , 1997. Statistics notes: Cronbach's alpha. BMJ 314, 572.

[6] Bloem, B.A. , van Tilburg, T.G. , Thomese, G.C.F. , 2008. Residential mobility in older Dutch adults: influence of late life events. Int. J. Ageing Later Life 3, 21- 44.

[7] Booker, S.Q. , 2021. Living with pain in "age-(un)friendly" housing environments: a qualitative study with African American older adults. Geriatr. Nurs. 42, 1294- 1302.

[8] Bungau, C.C. , Bendea, C. , Bungau, T. , Radu, A.-F. , Prada, M.F. , Hanga-Farcas, I.F. , Vesa, C.M. , 2024. The relationship between the parameters that characterize a built living space and the health status of its inhabitants. Sustainability 16, 1771.

[9] Choi, N.G. , 2004. Stability and changes in living arrangement among unmarried older persons-the influence of housing environments. J. Hous. Elder. 18, 69- 89.

[10] Costa-Font, J. , Elvira, D. , Mascarilla-Miró O. , 2009. "Ageing in place"? Exploring elderly people's housing preferences in Spain. Urban Stud. 46, 295- 316.

[11] Cramm, J.M. , Dijk, H.M.V. , Nieboer, A.P. , 2018. The creation of age-friendly environments is especially important to frail older people. Ageing Soc. 38, 700- 720.

[12] Cumming, R.G. , Thomas, M. , Szonyi, G. , Frampton, G. , Salkeld, G. , Clemson, L. , 2001. Adherence to occupational therapist recommendations for home modifications for falls prevention. Am. J. Occup. Ther. 55, 641- 648.

[13] Dekker, D. , Buzink, S.N. , Molenbroek, J.F.M. , de Bruin, R. , 2007. Hand supports to assist toilet use among the elderly. Appl. Ergon. 38, 109- 118.

[14] Delcampo-Carda, A. , Torres-Barchino, A. , Serra-Lluch, J. , 2019. Chromatic interior environments for the elderly: a literature review. Color Res. Appl. 44 (3), 381- 395.

[15] Dendup, T. , Astell-Burt, T. , Feng, X. , 2019. Residential selfselection, perceived built environment and type 2 diabetes incidence: a longitudinal analysis of 36,224 middle to older age adults. Health Place 58, 102154.

[16] Department of Civil Affairs of Zhejiang Province , 2020. Zhejiang Province veterans affairs department on the issuance of "Zhejiang Province in 2020 life difficult elderly family aging transformation implementation program" notice.

[17] Erichsen, N.-B. , Büssing, A. , 2013. Spiritual needs of elderly living in residential/nursing homes. Evid.-Based complement. Altern. Med. ECAM 2013, 913247.

[18] Fitzgerald, K.G. , Caro, F.G. , 2014. An overview of age-friendly cities and communities around the world. J. Aging Soc. Pol. 26, 1- 18.

[19] Graham, B. , Regehr, G. , Wright, J.G. , 2003. Delphi as a method to establish consensus for diagnostic criteria. J. Clin. Epidemiol. 56, 1150- 1156.

[20] Halicka, K. , Gola, A. , 2024. Gerontechnology ranking using the TOPSIS methods. Eng. Manag. Prod. Serv. 16, 93- 103.

[21] Henwood, B.F. , Stanhope, V. , Brawer, R. , Weinstein, L.C. , Lawson, J. , Stwords, E. , Crossan, C. , 2013. Addressing chronic disease within supportive housing programs. Prog. Community Health Partnersh. Res. Educ. Action 7, 67- 75.

[22] Ho, H.-H. , Tzeng, S.-Y. , 2021. Using the Kano model to analyze the user interface needs of middle-aged and older adults in mobile reading. Comput. Hum. Behav. Rep. 3, 100074.

[23] Huang, L. , Liu, C. , 2018. Patent quality evaluation with entropy weight method and improved TOPSIS: the case of geriatric technology. In: 2018 International Conference on Management Science and Engineering (ICMSE). Presented at the 2018 International Conference on Management Science and Engineering(ICMSE), pp. 156-164.

[24] Hutchings, B.L. , Olsen, R.V. , Moulton, H.J. , 2008. Environmental evaluations and modifications to support aging at home with a developmental disability. J. Hous. Elder. 22, 286- 310.

[25] Imrie, R. , Luck, R. , 2014. Designing inclusive environments: rehabilitating the body and the relevance of universal design. Disabil. Rehabil. 36, 1315- 1319.

[26] Jacobs, D.E. , 2011. Environmental health disparities in housing. Am. J. Publ. Health 101 S115- S122.

[27] Jong, P. , Rouwendal, J. , Hattum, P. , Brouwer, A. , 2012. Housing Preferences of an Ageing Population: Investigation in the Diversity Among Dutch Older Adults.

[28] Kano, N. , Seraku, N. , Takahashi, F. , Tsuji, S. , 1984. Attractive quality and must-Be quality. J. Jpn. Soc. Qual. Control 14, 147- 156.

[29] Katunský D. , Brausch, C. , 2018. Environmental issues related to the elderly and physically disabled people in different life situations.

[30] Kendig, H. , Gong, C.H. , Cannon, L. , Browning, C. , 2017. Preferences and predictors of aging in place: longitudinal evidence from Melbourne, Australia. J. Hous. Elder. 31, 259- 271.

[31] Kim, H. , Ahn, Y.H. , Steinhoff, A. , Lee, K.H. , 2014. Home modification by older adults and their informal caregivers. Arch. Gerontol. Geriatr. 59, 648- 656.

[32] Kim, D. , Chang, C. , Margrett, J. , 2021. Understanding older adults' perception and usage of indoor lighting in independent senior living. HERD Health Environ. Res. Des. J. 14, 215- 228.

[33] Li, M. , Cai, Q. , Li, C. , Wu, X. , Wang, T. , Xu, J. , Wu, Z. , 2022. A study in bedroom living environment preferences of the urban elderly in China. Sustainability 14, 13552.

[34] Lin, H. , Jin, M. , Liu, Q. , Du, Y. , Fu, J. , Sun, C. , Ma, F. , Li, W. , Liu, H. , Zhang, X. , Zhu, Y. , Chen, Y. , Sun, Z. , Wang, G. , Huang, G. , Yan, J. , 2021. Gender-specific prevalence and influencing factors of depression in elderly in rural China: a cross-sectional study. J. Affect. Disord. 288, 99- 106.

[35] Liu, R. , Zhou, Y. , Liu, Y. , Guo, R. , Gao, L. , 2023. Association between living environmental quality and risk of arthritis in middle-aged and older adults: a national study in China. Front. Public Health 11, 1181625.

[36] Livable Housing Australia , 2010. Livable housing design guidelines.

[37] Melchiorre, M.G. , D'Amen, B. , Quattrini, S. , Lamura, G. , Socci, M. , 2022. Caring for frail older people living alone in Italy: future housing solutions and responsibilities of family and public services, a qualitative study. Int. J. Environ. Res. Publ. Health 19, 7413.

[38] Ministry of Civil Affairs of China , 2020. Guidance on accelerating the implementation of ageing-related retrofitting projects for the elderly at home.

[39] Ministry of Civil Affairs of China , 2021. Response of the Ministry of Civil affairs to the proposal on further accelerating the construction of the home-based elderly service system.

[40] Ministry of Health, Labour, and Welfare , 1999. Welfare appliances·Residential renovation.

[41] Moss, P. , 1997. Negotiating spaces in home environments: older women living with arthritis. Soc. Sci. Med. 45, 23- 33.

[42] Murata, C. , Kondo, T. , Tamakoshi, K. , Yatsuya, H. , Toyoshima, H. , 2006. Factors associated with life space among communityliving rural elders in Japan. Publ. Health Nurs. 23, 324- 331.

[43] National Bureau of Statistics of China , 2021. Statistical communiqué of the people's Republic of China on the 2020 national economic and social development.

[44] National Health Commission of China , 2022. Notice on issuing the 14th five year plan for healthy agingdstate council bulletin No. 15 of 2022.

[45] Olij, B.F. , Erasmus, V. , Kuiper, J.I. , van Zoest, F. , van Beeck, E.F. , Polinder, S. , 2017. Falls prevention activities among community-dwelling elderly in The Netherlands: a Delphi study. Injury 48, 2017- 2021.

[46] Oswald, F. , Jopp, D. , Rott, C. , Wahl, H.-W. , 2011. Is aging in place a resource for or risk to life satisfaction? Gerontol. 51, 238- 250.

[47] Ouslander, J.G. , Beck, J.C. , 1982. Defining the health problems of the elderly. Annu. Rev. Publ. Health 3, 55- 83.

[48] Pandelaki, E.E. , Wijayanti, Pribadi, S.B. , 2014. The elderly friendly high-rise housing: a comparison study between Indonesia & Japan. Procedia Environ. Sci., The 4th International Conference on Sustainable Future for Human Security Sustain 2013 20, 146- 153.

[49] Pauls, J. , Johnson, D. , 2021. Why, how, and how effectively do USA and Canadian building codes address two leading fall sites in homes? In: Black, N.L., Neumann, W.P., Noy, I. (Eds.), Proceedings of the 21st Congress of the International Ergonomics Association (IEA 2021). Springer International Publishing, Cham, pp. 674-681.

[50] Safran-Norton, C.E. , 2010. Physical home environment as a determinant of aging in place for different types of elderly households. J. Hous. Elder. 24, 208- 231.

[51] Shenzhen Civil Affairs Bureau , 2023. Notice of shenzhen municipal Bureau of Civil affairs on the issuance of the implementation measures for carrying out the "0570" home adaptation retrofitting for the elderly in Shenzhen (trial)-issue No. 17, 2023(total issue No. 1287).

[52] Shin, Y.-C. , Park, D.-S. , Cho, E.-H. , Won, K.-A. , Han, D.-S. , Park, J.-H. , Kim, J.-R. , 2019. Deriving the components of a lifestylerelated intervention program for the elderly through the delphi technique. Alzheimers Dement., Alzheimer's Association International Conference 2019 15, 1593- 1594.

[53] The Housing & Development Board (HDB), Singapore , 2007. HDB|Home Improvement Programme (HIP).

[54] The State Council of China , 2019. The Implementation of Home-Based Elderly Care Renovation Projects Is in Accordance with the "Opinions of the General Office of the State Council on Promoting the Development of Elderly Care Services. State Council Office[2019] No. 5).

[55] Torres, A. , Serra, J. , Llopis, J. , Delcampo, A. , 2020. Color preference cool versus warm in nursing homes depends on the expected activity for interior spaces. Front. Archit. Res. 9, 739- 750.

[56] van Der Kruk, E. , Silverman, A.K. , Reilly, P. , Bull, A.M.J. , 2021. Compensation due to age-related decline in sit-to-stand and sitto-walk. J. Biomech. 122, 110411.

[57] Verhaak, P.F.M. , Dekker, J.H. , de Waal, M.W.M. , van Marwijk, H.W.J. , Comijs, H.C. , 2014. Depression, disability and somatic diseases among elderly. J. Affect. Disord. 167, 187- 191.

[58] Wang, D. , Wu, J. , Lin, Q. , 2018. A novel method for designing and optimizing the layout of facilities in bathroom for the elderly in home-based rehabilitation. Disabil. Rehabil. Assist. Technol. 13 (4), 333- 341.

[59] Wang, Y. , Lin, D. , Huang, Z. , 2022. Research on the aging-friendly kitchen based on space syntax theory. Int. J. Environ. Res. Publ. Health 19, 5393.

[60] World Health Organization , 2018. WHO Housing and Health Guidelines: Executive Summary. World Health Organization, WHO/CED/PHE/18.10.

[61] Woudenberg, F. , 1991. An evaluation of Delphi. Technol. Forecast. Soc. Change 40, 131- 150.

[62] Wu, W. , Yun, Y. , Zhai, J. , Sun, Y. , Zhang, G. , Wang, R. , 2021. Residential self-selection in the greenness-wellbeing connection: a family composition perspective. Urban For. Urban Green. 59, 127000.

[63] Wu, S. , Fu, Y. , Yang, Z. , 2022. Housing condition, health status, and age-friendly housing modification in Europe: the last resort? Build. Environ. 215, 108956.

[64] Xu, J. , Liu, Yaolin , Liu, Yanfang , An, R. , Tong, Z. , 2023. Integrating street view images and deep learning to explore the association between human perceptions of the built environment and cardiovascular disease in older adults. Soc. Sci. Med. 338, 116304.

[65] Yang, Y. , Cao, L. , Xia, Y. , Li, J. , 2023. The effect of living environmental factors on cardiovascular diseases in Chinese adults: results from a cross-sectional and longitudinal study. Eur. J. Prev. Cardiol. 30, 1063- 1073.

[66] Yi, D. , Deng, X. , Fan, G.-Z. , Ong, S.E. , 2018. House price and co-residence with older parents: evidence from China. J. R. Estate Finance Econ. 57, 502- 533.

[67] Zhang, F. , Chan, A.P.C. , Darko, A. , Li, D. , 2021. BIM-enabled multilevel assessment of age-friendliness of urban housing based on multiscale spatial framework: enlightenments of housing support for "aging-in-place.". Sustain. Cities Soc. 72, 103039.

[68] Zhou, Z. , Wang, L. , Dong, Y. , 2023. Research on innovative design of community mutual aid elderly care service platform based on Kano model. Heliyon 9 (5), e15546.

RIGHTS & PERMISSIONS

The Author(s). Publishing services by Elsevier B.V. on behalf of Higher Education Press and KeAi.