Universal Design,Autonomy,and Psychological Wellbeing of Older Adults With Mobility Disabilities

Abstract

Objectives

This study investigates the relationship between universal design (UD) attributes, autonomy, and the psychological wellbeing of older adults with disabilities. The goal is to provide evidence-based design guide for aging-in-place, prioritizing UD elements that promote autonomy and psychological wellbeing.

Method

A total of 165 older adults participated in the online survey. Using structural equation modeling, the latent factors of UD were identified for the kitchen, bathroom, and general areas within home environments.

Results

Results revealed that bathroom UD features, including walk-in bathtubs, curb-less showers, shower seats, and grab bars, significantly predicted autonomy, whereas kitchen and general UD features did not. Additionally, autonomy was positively associated with psychological wellbeing and fully mediated the relationship between UD features and wellbeing.

Conclusion

Implications for aging-in-place design are provided, emphasizing the importance of prioritizing functionally essential design factors in residential planning and remodeling for older adults with disabilities.

Keywords

universal design aging in place psychological wellbeing autonomy older adults disability

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References

AARP. (2024). New AARP Report: Majority of adults 50-plus want to age in place, but policies and communities must catch up. MediaRoom. https://press.aarp.org/2024-12-10-New-AARP-Report-Majority-Adults-50-plus-Age-Place-Policies-Communities-Catch-Up

AARP. (2025). AARP HomeFit Guide. AARP. https://www.aarp.org/livable-communities/housing/info-2020/homefit-guide-download.html

Bigby

(2004). Ageing with a lifelong disability: A guide to practice, program, and policy issues for human services professionals. Jessica Kingsley Publishers.

Brucker

D. L.

Lauer

Boege

(2023). Americans aging with disabilities are more likely to have multiple chronic conditions. Journal of Disability Policy Studies, 34(1), 52–60. https://doi.org/10.1177/10442073221107079

Carr

Weir

P. L.

Azar

N. R.

(2013). Universal design: A step toward successful aging. Journal of Aging Research, 2013(1), 324624. https://doi.org/10.1155/2013/324624

Center for Disease Control and Prevention. (2024, July 16). CDC Data Shows Over 70 Million U.S . Adults Reported Having a Disability. CDC. https://www.cdc.gov/media/releases/2024/s0716-Adult-disability.html

Centre for Excellence in Universal Design. (2025). About Universal Design. Centre for Excellence in Universal Design. https://universaldesign.ie/about-universal-design

Clark

C. M.

Czaja

S. J.

Weber

R. A.

(1990). Older adults and daily living task profiles. Human Factors, 32(5), 537–549. https://doi-org.ezproxy.lib.ou.edu/10.1177/0018720890032005 https://doi.org/10.1177/001872089003200504

Deci

E. L.

Ryan

R. M.

(2000). The “what” and “why” of goal pursuits: Human needs and the self-determination of behavior. Psychological Inquiry, 11(4), 227–268. https://doi.org/10.1207/S15327965PLI1104_01

10.

Ellis

Y. J.

(2023). Systematic review on environmental design for adaptive and problem behaviors of people with intellectual and developmental disabilities. HERD: Health Environments Research & Design Journal, 16(4), 213–239. https://doi.org/10.1177/19375867231173393

11.

Evans

G. W.

Kantrowitz

Eshelman

(2002). Housing quality and psychological well-being among the elderly population. The Journals of Gerontology: Series B, 57(4), P381–P383. https://doi.org/10.1093/geronb/57.4.P381

12.

Florence

C. S.

Bergen

Atherly

Burns

Stevens

Drake

(2018). Medical costs of fatal and nonfatal falls in older adults. Journal of the American Geriatrics Society, 66(4), 693–698. https://doi.org/10.1111/jgs.15304

13.

Fuller-Thomson

Nowaczynski

MacNeil

(2022). The association between hearing impairment, vision impairment, dual sensory impairment, and serious cognitive impairment: Findings from a population-based study of 5.4 million older adults. Journal of Alzheimer’s Disease Reports, 6(1), 211–222. https://doi.org/10.3233/ADR-220005

14.

Gitlin

L. N.

(2003). Conducting research on home environments: Lessons learned and new directions. The Gerontologist, 43(5), 628–637. https://doi.org/10.1093/geront/43.5.628

15.

Gitlin

L. N.

Winter

Dennis

M. P.

Corcoran

Schinfeld

Hauck

W. W.

(2006). A randomized trial of a multicomponent home intervention to reduce functional difficulties in older adults. Journal of the American Geriatrics Society, 54(5), 809–816. https://doi.org/10.1111/j.1532-5415.2006.00703.x

16.

Hasan

(2024). Psychological well-being for elderly population with disability: Implications of universal design. https://hdl.handle.net/11244/340399

17.

Holt-Lunstad

(2022). Social connection as a public health issue: The evidence and a systemic framework for prioritizing the “social” in social determinants of health. Annual Review of Public Health, 43, 193–213. https://doi.org/10.1146/annurev-publhealth-052020-110732

18.

Bentler

P. M.

(1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal, 6(1), 1–55. https://doi.org/10.1080/10705519909540118

19.

Kahana

Lovegreen

Kahana

(2003). Person, environment, and person-environment fit as influences on residential satisfaction of elders. Environment and Behavior, 35(3), 434–453. https://doi.org/10.1177/0013916503035003007

20.

Kane

R. A.

(2001). Long-term care and a good quality of life: Bringing them closer together. The Gerontologist, 41(3), 293–304. https://doi.org/10.1093/geront/41.3.293

21.

Kopec

(2017). Health and well-being for interior architecture. Taylor & Francis.

22.

Kuoppamäki

Tuncer

Eriksson

McMillan

(2021). Designing kitchen technologies for ageing in place: A video study of older adults’ cooking at home. The Proceedings of the ACM on Interactive, Mobile, Wearable and Ubiquitous Technologies, 5(2), 69:1-69:19. https://doi.org/10.1145/3463516

23.

Lawlor

Thomas

M. A.

(2008). Residential design for aging in place. John Wiley & Sons.

24.

Lawton

M. P.

Nahemow

(1973). Ecology and the aging process. In Eisdorfer

Lawton

M.P.

(Eds.), The psychology of adult development and aging (pp. 619–674). American Psychological Association. https://doi.org/10.1037/10044-020

25.

Livingston

Huntley

Ames

Ballard

Banerjee

Mukadam

(2020). Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. The Lancet 396(10248), P413–P446. https://www.thelancet.com/article/S0140-6736(20)30367-6/fulltext/information-for-press https://doi.org/10.1016/S0140-6736(20)30367-6

26.

Lynch

(2023). Grab Bars Remain the most Common Aging-in-Place Remodel. https://eyeonhousing.org/2023/05/remodeling-market-index-rmi-special-question-analysis-aging-in-place/

27.

Mullins

(2019). Aging in Place with Smart Home Technology [University of Oklahoma]. https://hdl.handle.net/11244/323214

28.

Pynoos

Steinman

B. A.

Nguyen

A. Q. D.

(2010). Environmental assessment and modification as fall-prevention strategies for older adults. Clinics in Geriatric Medicine, 26(4), 633–644. https://doi.org/10.1016/j.cger.2010.07.001

29.

Rogers

(2024). Best practices for your confirmatory factor analysis: A JASP and lavaan tutorial. Behavior Research Methods, 56(7), 6634–6654. https://doi.org/10.3758/s13428-024-02375-7

30.

Rosseel

(2012). Lavaan: An R package for structural equation modeling. Journal of Statistical Software, 48(2), 1–36. https://doi.org/10.18637/jss.v048.i02

31.

Ryan

R. M.

Deci

E. L.

(2006). Self-regulation and the problem of human autonomy: Does psychology need choice, self-determination, and will? Journal of Personality, 74(6), 1557–1586. https://doi.org/10.1111/j.1467-6494.2006.00420.x

32.

Ryff

C. D.

Almeida

D. M.

Ayanian

J. Z.

Carr

D. S.

Cleary

P. D.

Coe

Davidson

R. J.

Krueger

R. F.

Lachman

M. E.

Marks

N. F.

Mroczek

D. K.

Seeman

T. E.

Seltzer

M. M.

Singer

B. H.

Sloan

R. P.

Tun

P. A.

Weinstein

Williams

D. R.

(2021). Midlife in the United States (MIDUS 2), 2004-2006 [Dataset]. Inter-university Consortium for Political and Social Research. https://doi.org/10.3886/ICPSR04652.v8

33.

Shaw

Cartwright

Craig

(2011). The housing and support needs of people with an intellectual disability into older age. Journal of Intellectual Disability Research, 55(9), 895–903. https://doi.org/10.1111/j.1365-2788.2011.01449.x

34.

Steptoe

Deaton

Stone

A. A.

(2015). Subjective wellbeing, health, and ageing. The Lancet, 385(9968), 640–648. https://doi.org/10.1016/S0140-6736(13)61489-0

35.

Story

M. F.

Mueller

J. L.

Mace

R. L.

(1998). The universal design file: Designing for people of all ages and abilities. NC State University, Center for Universal Design.

36.

Sutin

A. R.

Stephan

Terracciano

(2018). Psychological well-being and risk of dementia. International Journal of Geriatric Psychiatry, 33(5), 743–747. https://doi.org/10.1002/gps.4849

37.

United Nations. (2024). World Population Prospects. https://population.un.org/wpp/

38.

US Census Bureau. (2020). The Older Population : 2020. https://www.census.gov/library/publications/2023/decennial/c2020br-07.html

39.

U.S. Department of Housing and Urban Development. (2013). Measuring the Costs and Savings of Aging in Place .

40.

Wang

Lin

Huang

(2022). Research on the aging-friendly kitchen based on space syntax theory. International Journal of Environmental Research and Public Health, 19(9), 5393. https://doi.org/10.3390/ijerph19095393

41.

WHO. (2023). Progress report on the United Nations decade of healthy ageing, 2021-2023. World Health Organization.

42.

Yeniaras

Akarsu

T. N.

(2017). Religiosity and life satisfaction: A multi-dimensional approach. Journal of Happiness Studies, 18(6), 1815–1840. https://doi.org/10.1007/s10902-016-9803-4

43.

(2017). Housing design standards for the aging in place for people with intellectual disabilities. https://shareok.org/handle/11244/53081

44.

Y. J.

(2021). The environmental design factors associated with functional independence of people with intellectual and developmental disabilities. https://shareok.org/handle/11244/329573

45.

Y. J.

Boeck

Ellis

(2018). Correlation analysis between domestic environments and independence of people with intellectual disabilities and their desire to age in place. In Social equity by design: Designing connections through community, proceedings of the 49th annual conference of the Environmental Design Research Association (pp. 141–147). ISBN: 978-1-387-97114-5. https://cdn.ymaws.com/www.edra.org/resource/collection/01EE5570-8A84-4B82-92B4-D8066ABF9E15/EDRA49-Proceedings-forWebsite.pdf

46.

Y. J.

Ellis

(2023). Associations between environmental factors and adaptive skills of people with intellectual and developmental disabilities in educational settings. Social Sciences & Humanities Open, 7(1), 100410. https://doi.org/10.1016/j.ssaho.2023.100410