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AJPH First Look, published online ahead of print Sep 29, 2005
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November 2005, Vol 95, No. 11 | American Journal of Public Health 1933-1939
© 2005 American Public Health Association
DOI: 10.2105/AJPH.2004.054494

UNDERSTANDING AND ADDRESSING THE CHALLENGES OF DISABILITY

The Role of the Built Environment in the Disablement Process

Philippa Clarke, PhD and Linda K. George, PhD

At the time of this study, Philippa Clarke was a postdoctoral fellow at the Center for the Study of Aging and Human Development, Duke University. Linda K. George is with the Departments of Sociology and of Psychiatry and Behavioral Sciences, Duke University and with the Center for the Study of Aging and Human Development.

Correspondence: Requests for reprints should be sent to Philippa Clarke, Survey Research Center, Institute for Social Research, 426 Thompson Street, Ann Arbor, MI 48106 (e-mail: pjclarke{at}umich.edu).

The Disablement Process model explicates the transition from health conditions to disability and specifically emphasizes the role of intervening factors that speed up or slow down the pathway between pathology and disability.

We used hierarchical Poisson regression analyses with data on older adults from central North Carolina to examine the role of the built environment as a modifying factor in the pathway between lower extremity functional limitations and activities of daily living. We found that, despite declining physical function, older adults report greater independence in instrumental activities when they live in environments with more land-use diversity.

Independence in self-care activities is modified by housing density, in part through the effect of substandard and inadequate housing.




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