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Abstract

Understanding the built environment’s impact on older adults’ wellbeing necessitates the identification of high-quality measures that capture environmental properties, wellbeing, and needs.

Literature searches were conducted to identify instruments that measure (a) objective environmental properties, (b) wellbeing, (c) needs, and (d) environmental perception, which were evaluated using the COSMIN checklist. Another literature search was conducted to explore which instruments are used in studies examining objective and perceived qualities of the environment in relation to wellbeing.

Of the 54 instruments evaluated, most showed strong content or construct validity, but weak or unreported test-retest reliability. Structural validity and internal consistency tended to be satisfactory in instruments assessing wellbeing and the intersection of environment and wellbeing. Instruments evaluating needs and the perceived environment generally had poor results in our evaluation. Our review of studies assessing both perceived and objective built environments alongside wellbeing indicates a lack of consistent use of validated instruments for older adult populations.

We have identified instruments in each category with mostly sufficient psychometric properties, while the rest require improvement, particularly in terms of structural validity and reliability. Environment evaluation instruments mainly focus on outdoor spaces, leaving indoor spaces underrepresented in literature.

Plain Language Summary

Measuring the Wellbeing, Needs, and Environments of Older Adults: What is That Status of Our Measurement Instruments?

We were interested in studying the connection between the environment older adults live in, their wellbeing, and needs. This led us to the decision of which measurement instruments we should use in an upcoming study. We searched the literature for studies investigating the wellbeing of older adults, and for studies that assess subjective and objective environments to narrow our selection. We narrowed the literature selection to those articles that included assessments of the validity and reliability of the instruments used. For environment assessment tools, we included studies that used either subjective or objective evaluations of living environments. We followed the COSMIN checklist to provide an objective evaluation of the 54 instruments found in the 110 articles included in our literature review. The strength of most wellbeing and needs assessment instruments was the validity of their psychometric properties. However, many instruments were lacking in structural validity as well as reliability. Instruments used to evaluate environments were generally evaluated poorly. We only identified five studies that considered both objective and subjective environmental assessments along with assessments of wellbeing. This demonstrates that the relationship between wellbeing and environmental quality is studied infrequently compared to other studies that consider the wellbeing of older adults. In each category of instruments we assessed, we were able to identify at least one with acceptable psychometric properties. Instruments to assess environments objectively considered both indoor and outdoor spaces, while subjective assessment tools focused more on outdoor spaces leaving a gap related to perceptions of indoor environments.

Keywords

ageing questionnaire objective measurement subjective evaluation psychometric properties

Introduction

The European population is ageing rapidly, and many older individuals struggle to live independently. Environmental quality can affect wellbeing as it provides ample opportunities to meet needs, but it may threaten health, too (Altomonte et al., 2020; Andargie & Azar, 2019; Chan & Liu, 2018; Huisman et al., 2012; Mendes et al., 2017; Menec et al., 2011; Oswald et al., 2003, 2007; Reddy et al., 2021; ten Bruggencate et al., 2019). Like most people, older adults spend the majority of their time indoors and mostly in cities, making these environments critical to the overall wellbeing of older adults (Klepeis et al., 2001; Sattari et al., 2023).

Researchers have previously examined the links between older adults’ wellbeing, needs, and the built environment (Altomonte et al., 2020; Bayar & Türkoğlu, 2021; Burton et al., 2011; Firdaus, 2017; Guo et al., 2021; Vásquez Sánchez et al., 2020). However, many tools designed to measure these relationships focus solely on outdoor environments, often overlooking indoor spaces, as well as lacking a clear definition of wellbeing or the needs they aim to measure (e.g., Burton et al., 2011; Nordin et al., 2015). To better understand these connections, robust measurements that include both objective environmental properties and individuals’ perceptions of their surroundings are needed. As with these instruments, selecting an appropriate means to assess psychological constructs poses challenges, too. There are many instruments that address the constructs of interest, but in some cases properties like validity and reliability are underreported or not reported at all.

Psychometric Properties of Instruments

Psychological constructs are typically assessed through self-report instruments. These should be valid – capturing the intended construct – and reliable – consistently providing the same or very similar results when used repeatedly under the same conditions. High validity and reliability are fundamental to all activities that rely on instruments, such as comparing different interventions, testing theories, and making clinical decisions (Gremigni, 2020).

Validity is assessed across three main elements: content, construct, and structural validity. Content validity assesses if items cover the full spectrum of what they are meant to measure. Construct validity examines whether a scale measures what it is designed to measure. Structural validity focuses on the internal structure of the instrument – identifying whether the items within the instrument align with the proposed theoretical model or factor structure (Bannigan & Watson, 2009; Fishman & Galguera, 2003).

Facets of reliability include internal consistency and test-retest reliability. Internal consistency examines whether the instrument items that measure the same construct are related to each other in the expected manner. Test-retest reliability considers whether the results of an instrument are consistent when the test is administered in a similar context at two points in time (Bannigan & Watson, 2009; Fishman & Galguera, 2003).

Validity is the central property of an instrument. Generally, if the instrument is deemed valid, it must also be reliable, because high reliability is a necessary condition for high validity. However, a reliable instrument may not be valid (Fishman & Galguera, 2003).

Validity and reliability are also dependent on other factors, like the population being assessed. For example, valid and reliable instruments for younger populations may not be psychometrically sound for older people (Mokkink et al., 2017; Prinsen et al., 2018; Terwee et al., 2018).

Assessment of Psychosocial Wellbeing

Conceptualizations of wellbeing in the field of psychology are diverse (Cooke et al., 2016). We considered wellbeing from a psychosocial perspective that encompasses psychological or emotional wellbeing, social wellbeing, and collective wellbeing, as these are all highly relevant to older adults (Eiroa-orosa, 2020). Although many conceptualizations of wellbeing overlap, creating an all-inclusive instrument is difficult (Linton et al., 2016). Unsurprisingly, the quality of the psychometric properties of wellbeing measures varies greatly (Cooke et al., 2016).

Assessment of Needs

Measuring needs is complex, as people have many needs encompassing physical, psychosocial, spiritual, and environmental domains. Different disciplines use different frameworks and measures to evaluate needs (Lester, 2013). For example, in gerontological social work, the focus is primarily on measuring medical and physical needs, while the psychological and existential aspects are often overlooked (Olaison, 2010). Some researchers have attempted to learn more about needs by relying on personality scales (Taormina & Gao, 2013). These approaches can lead to results that can be misunderstood or, at the very least, incomplete. To address this gap, the World Health Organization introduced the International Classification of Functioning, Disability and Health (ICF), which encompasses body, activities, social, structural, and community environments, highlighting a holistic assessment of needs, including housing needs (Gitlin, 2019; Murphy et al., 2022; Oswald et al., 2007). The ICF has since served as inspiration for various instruments (e.g., Needs of Care; Åhsberg et al., 2017).

Previous research has reported that instruments measuring needs can lack reliability – particularly internal consistency and test-retest reliability – although content validity appears to be sound in many instruments (Kipfer & Pihet, 2020; Tian et al., 2019).

Perception of the Built Environment

With age, older adults may need to move into long-term residential and care facilities, making those spaces an important aspect of wellbeing (Chaudhury et al., 2013; Stolt et al., 2021). The built environment influences older adults’ wellbeing directly through its physical features and indirectly through their perception of it (Evans et al., 2002; Guo et al., 2021). For example, perceptions of neighborhood safety, accessibility, social cohesion, housing quality, surrounding areas, overcrowding, and household size have all been linked to older adults’ psychosocial wellbeing (Fernandez-Portero et al., 2017; Firdaus, 2017; Gale et al., 2011; Giraldez-Garcia et al., 2012; He et al., 2020; Stephens et al., 2019). While these factors primarily address outdoor environments, the SALIENT checklist – which includes sound, air, light, image, ergonomics, and tint – itemizes elements of indoor environments and how they may affect occupant wellbeing (Dolan et al., 2016).

Assessments of environmental quality may be used to identify shortcomings and opportunities for improvements, making the instruments used for assessment important for occupant wellbeing (Andargie & Azar, 2019; Bicket et al., 2010; Koohsari et al., 2019; Liao et al., 2015; Lin & Moudon, 2010; Nyunt et al., 2015; Oswald et al., 2007). Environmental quality is usually measured with self-reports of the perceived environment, for example, residential satisfaction or post-occupancy evaluation (P. Li et al., 2018). These reports may be connected to objective measurements of the built environment (e.g., residential density, number of rooms in the building, air quality, light levels) to provide more contextual information (Smrke, 2022).

Inadequate theoretical foundations, limited research application, and insufficient psychometric data have been identified as weaknesses in environmental quality studies (Elf et al., 2017).

Objective Assessment of the Built Environment

To recommend useful interventions in the built environment, practitioners need to be able to identify elements or attributes of the environment that have a meaningful impact. Given that self-reported evaluations of environmental quality are susceptible to issues like recall errors, reporting bias, and same-source bias (where individuals in a positive state tend to rate their environment more favourably), combining these with objective assessments can help mitigate these limitations (Burton et al., 2011; Pontin et al., 2022). Objective measures can reduce subjectivity while still allowing consideration of unique circumstances, characteristics, and needs of older adults (Garin et al., 2014; Nyunt et al., 2015).

Frequently assessed environmental features include parks, facilities, land use mix, pollution, housing, street and residential density, walkability, natural spaces, location of buildings, and leisure activities. In contrast, safety, aesthetics, accessibility, and transportation are examined less frequently, despite being known to influence older adults’ wellbeing (Burton et al., 2011; Cottagiri et al., 2022; Firdaus, 2017; Giraldez-Garcia et al., 2012; Guo et al., 2021; Pontin et al., 2022; Stephens et al., 2019; C. J. P. Zhang et al., 2019). Geographic information systems (GIS), which provide objective measurements over extensive geographic areas, are widely used to collect a subset of outdoor environmental data (Nordbø et al., 2018; Pontin et al., 2022).

Capturing both objective properties and subjective perceptions of the environment is crucial. Using only one of the approaches may lead to biased or incomplete results and missed associations between the environmental properties and wellbeing (Ball et al., 2008).

Purpose of the Review

The aim of this review was to identify existing instruments that capture older adults’ wellbeing, needs, perception of the built environment, and objective evaluations of the environment, then to assess their psychometric properties following the COnsensus-based Standards for selection of health Measurement INstruments (COSMIN) checklist (Mokkink et al., 2017; Prinsen et al., 2018; Terwee et al., 2018). The review further examines how these instruments are applied in studies exploring the relationships between environmental qualities – both measured and perceived – and wellbeing outcomes in ageing populations.

Methodology

Overview

We conducted five different literature searches to collect data for our systematic literature review. The first four searches were conducted to identify measurement instruments for the (a) older adults’ wellbeing, (b) needs, (c) perception of the built environment, and (c) objective assessment of the built environment. The fifth literature search examined studies on older adults’ wellbeing in relation to the built environment. The goal was to understand which questionnaires are used in these studies, and whether the selection of those questionnaires meets recommended validity and reliability criteria. We followed the PRISMA statement for reporting systematic reviews (Liberati et al., 2009; see Table S8 in Supplemental Material).

Search Strategy

First, we conducted exploratory literature searches to determine the most appropriate keywords for each of the five searches. The final search strings are available in Table S1 in Supplemental Material. Each of the five searches was complemented by the first author with a selection of previously known articles or articles identified through the reference lists of articles found in the initial searches. The first and second authors reviewed the selected articles, as well as those for which the first author encountered uncertainty regarding their inclusion or exclusion. When the authors were uncertain about inclusion, the third author was consulted.

Inclusion and Exclusion Criteria

For all five searches, articles were included if they (a) involved older adults (60 years old or older or with the mean age of 65 years or higher), including papers addressing different age groups if older adults were discussed separately, (b) included cognitively healthy older adults, (c) were written in English, and (d) were peer-reviewed original articles published in scholarly journals.

Each of the first four searches was conducted on PubMed in October 2024. Articles addressing the wellbeing, needs, or perceptions of the environment were included if they reported related psychometric properties. Searches for instruments used to objectively assess the built environment were conducted on PubMed, Scopus, and Web of Science. Since classic psychometric properties are not applicable to these instruments studies were only included if they provided access to the instrument and they examined at least one domain of psychosocial wellbeing together with both perceived and objectively measured aspects of the built environment. Additionally, we expanded our search by reviewing the reference lists of eligible papers and conducting a Google Scholar search using the names of identified instrument from the initial search. This approach aimed to gather a broader array of instruments and more comprehensive data, enabling us to make more informed conclusions regarding the psychometric properties of the questionnaires.

Studies were excluded if they involved (a) older adults with physical or mental illnesses not related to the ageing process (e.g., depression), (b) pharmaceutical, technological, or other interventions and services that are not related to the built environment, (c) wellbeing not related to psychosocial wellbeing (e.g., international, national wellbeing), (d) only differences between individuals (as opposed to focusing on older adults as a group), (e) only caregivers or other stakeholders, and (f) instruments with proxy reports (e.g., caregivers’ reports on older adults’ wellbeing), observational methods, or anecdotal case reports.

During the search and review process, we identified instruments that measure more than one relevant topic simultaneously (e.g., the same instrument capturing psychological wellbeing and environment). These instruments were added to a new category that we examined separately (Figure 1).

Figure 1.

Flowchart of the article selection process.

Quality Appraisal

Psychometric properties of the instruments and methodological quality for assessing those properties were evaluated using COSMIN checklist (Mokkink et al., 2017; Prinsen et al., 2018; Terwee et al., 2018). The checklist is an established tool that can be used to select the most robust instrument for research or clinical practice.

The identified instruments were evaluated in terms of construct, content, and structural validity, internal consistency, and test-retest reliability.

We first evaluated the methodological quality of studies assessing psychometric properties of instruments. Methodological quality was rated with “very good”, “adequate”, “doubtful”, or “inadequate” (in our reporting, A, B, C, D, respectively). For example, in the evaluation of construct validity, instruments rated as “very good” were those that were compared with reference instruments based on well-defined constructs and good psychometric properties.

The psychometric properties were rated as “sufficient (+)”, “insufficient (−)”, or “indeterminate (?)”. For example, test-retest reliability was assessed as sufficient if the Intraclass Correlation Coefficient or weighted Kappa was equal to or greater than 0.70 (Mokkink et al., 2017; Prinsen et al., 2018; Terwee et al., 2018).

We refrained from assessing criterion validity, which examines the extent to which instrument scores correlate with a gold standard reference, as we believe that no relevant measures can be unequivocally deemed as gold standards (see Coast et al., 2008 and Bowling et al., 2013 for a related discussion).

In certain instances, original articles claimed to evaluate a particular form of validity or reliability (e.g., criterion validity), but their research methodology indicated that a different form of validity or reliability was assessed (e.g., construct validity). We determined the form of validity or reliability assessed based on the research methodology and COSMIN criteria rather than the authors’ assertion.

In line with the COSMIN criteria, when structural validity was not reported, the methodological quality of its testing was marked as doubtful and measurement properties as indeterminate. Since structural validity is a prerequisite for internal consistency, the methodological quality of testing the latter was marked as inadequate, and its measurement properties as indeterminate (Mokkink et al., 2017; Prinsen et al., 2018; Terwee et al., 2018).

Results

General Characteristics of Evaluated Instruments

Across all searches we identified 110 articles that met our inclusion criteria. Amongst these 110 articles 54 instruments were used, of which 22 were original and 19 were translations or adaptations (Table 1). The instruments were developed, translated, or validated in either one or more countries (e.g., in Norway and Sweden; Bergland et al., 2015) and across different continents (mostly in Europe, followed by Asia and North America). Some articles presented multiple instruments or translations of a single instrument into multiple languages.

Table 1.

General Characteristics of Included Articles.

Category	Wellbeing	Needs	Perceived environment	Objective environment	Needs/wellbeing and perceived built environment
No. of articles	20	23	11	42	14
No. of instruments	13	13	8	13	7
No. of newly developed instruments	4	7	6	NR	5
No. of modified, translated, or adapted instruments	9	6	2	NR	2
Country of testing
Europe	Spain, Portugal, Finland, Norway, the UK, Turkey (n = 9)	Sweden, the Netherlands, the UK, Switzerland, Germany, France, Turkey, and Poland (n = 17)	Finland, the UK, Turkey, and the Netherlands (n = 4)		Sweden, Norway, Turkey, Spain (n = 7)
Americas	Canada, the US, Puerto Rico (n = 4)	US (n = 3)	US, Chile (n = 4)		US (n = 2)
Asia	Thailand, Korea, Japan, Iran (n = 6)	Lebanon, Taiwan (n = 4)	China, Iran (n = 4)		China, Taiwan, Iran (n = 4)
Africa					Nigeria (n = 1)
Australia	(n = 1)
Variation of no. of items	5–54	5–62	10–120		13–44

Note. NR = not relevant.

Instruments Examining Psychosocial Wellbeing

Psychological wellbeing was addressed by 7 out of 13 wellbeing instruments, where the most frequently used instrument was Ryff’s Psychological Wellbeing Scale (Table 2). The remaining instruments assessed social, emotional, subjective, and mental wellbeing constructs. Some wellbeing constructs, such as collective wellbeing, were not assessed by any of the identified instruments. However, community-related wellbeing is included in the Psychological Sense of Community instrument, the Community Commitment Scale, and the Older Adults’ Perceptions of Community-based Connectedness with People instrument (Buckley et al., 2022; Kikuchi et al., 2024; J. I. Kim et al., 2018; Kono et al., 2012).

Table 2.

Names, Abbreviations, and General Information of Included Wellbeing Instruments.

Instrument	Number of items	Constructs	Subscales
BSCS − Brief Sense of Community Scale (Buckley et al., 2022)	8	Social, psychological, emotional, community-related wellbeing	Membership, needs fulfilment, influence, emotional connection
CCS-K − Community Commitment Scale (J. I. Kim et al., 2018; Kono et al., 2012)	8	Social and community-related wellbeing	Belonging and socializing
DERS-16 − Difficulties in Emotion Regulation Scale (Visted et al., 2023)	16	Emotional wellbeing	Nonacceptance, clarity, goals, impulse, strategies
PECOCO − Older Adults’ Perceptions of Community-based Connectedness with People (Kikuchi et al., 2024)	22	Community-related wellbeing	Perception of inclusion, perception of reciprocity through provision, perception of reciprocity through reception
OPQoL-35 − Older People’s Quality of Life (Nikkhah et al., 2018)	35	Emotional and psychological wellbeing	Life overall, health, home and neighbourhood, independence, control over life, freedom, financial circumstances, social relationships, religion/culture, psychological and emotional wellbeing
OPQoL-brief − Older People’s Quality of Life – brief (Bowling et al., 2013; Haugan et al., 2020)	8–13	Emotional and psychological wellbeing	None (unidimensional scale)
OWSQLI − Older Women’s Social Quality of Life Inventory (Laganà et al., 2011)	35	Emotional, social, and psychological wellbeing	Life overall, health, social relationships and participation, independence, control over life and freedom, home and neighbourhood, psychological and emotional wellbeing, financial circumstances, culture and religion
QOL-ACC − Quality of Life-Aged Care Consumers (Khadka et al., 2022)	19	Emotional and social wellbeing	Independence, mobility, pain management, emotional wellbeing, social connection, and activities
PANAS − Positive and Negative Affect Schedule (Buz et al., 2015; Humboldt et al., 2017)	20	Emotional and subjective wellbeing	Positive affect and negative affect
PWS − Psychological Wellbeing Scale (Ingersoll-Dayton et al., 2004)	15	Psychological wellbeing	Harmony, interdependence, respect, acceptance, and enjoyment
RPWB − Ryff’s Psychological Wellbeing Scale (Clarke et al., 2001; Ottenbacher et al., 2007; Saajanaho et al., 2021; Triadó et al., 2007)	18–54	Psychological wellbeing	Autonomy, environmental mastery, personal growth, positive relationships, purpose in life, and self-acceptance
WEMWBS − Warwick-Edinburgh Mental Wellbeing Scale (Mavali et al., 2020)	13	Mental wellbeing	None (unidimensional scale)
WHO-5 − World Health Organization – Five Wellbeing Index (S. Eser et al., 2010; Lucas-Carrasco et al., 2012)	5	Psychological wellbeing	None (unidimensional scale)

Researchers reported developing their instruments based on:

- literature reviews (Kikuchi et al., 2024; Laganà et al., 2011; Mavali et al., 2020),

- previous scales (Bowling et al., 2013; Buckley et al., 2022; S. Eser et al., 2010; Haugan et al., 2020; Khadka et al., 2022; J. I. Kim et al., 2018; Kono et al., 2012; Lucas-Carrasco et al., 2012; Visted et al., 2023),

- models (Buz et al., 2015),

- theories (Clarke et al., 2001; Ottenbacher et al., 2007; Saajanaho et al., 2021; Triadó et al., 2007),

- a bottom-up approach, which builds on the input from the individuals for whom the measure is designed (Ingersoll-Dayton et al., 2004).

All studies examining the psychometric properties of wellbeing instruments tested internal consistency, and a large majority of employed methods were evaluated as very good (Table 3, see Table S2 for details). Examinations of test-retest and inter-rater reliability were most often not reported or were inadequate.

Table 3.

Quality of Methodological Analysis of Psychometric Properties and Psychometric Properties of Questionnaires Measuring Psychosocial Wellbeing.

Instrument	Authors	Reliability				Validity
		Internal consistency		Test-retest and inter-rater reliability		Content validity	Construct validity		Structural validity
		Analysis^a	Properties^b	Analysis	Properties	Analysis	Analysis	Properties	Analysis	Properties
BSCS	Buckley et al. (2022)	A	+				A	+	A	+
CCS-K	J. I. Kim et al. (2018)	A	-				A	+	A	+
	Kono et al. (2012)	D	?			B	A	+	C	?
DERS-16	Visted et al. (2023)	A	+				C	+	A	+
OPQoL-35	Nikkhah et al. (2018)	A	-	C	+	B			A	-
OPQoL-brief	Bowling et al. (2013)	C	+				C	+	NA
	Haugan et al. (2020)	A	+				A	+	A	+
OWSQLI	Laganà et al. (2011)	A	?			B	A	+	A	?
QOL-ACC	Khadka et al. (2022)	A	?				B	+	C	?
PANAS	Buz et al. (2015)	A	+				A	+	A	+
	Humboldt et al. (2017)	A	+				B	+	A	+
PECOCO	Kikuchi et al. (2024)	A	+	C	+	B	A	+	A	-
PWS	Ingersoll-Dayton et al. (2004)	A	-	C	?	A	D	+	A	-
RPW	Clarke et al. (2011)	A	-						A	+
	Ottenbacher et al. (2007)	D	?	B	+				C	?
	Triadó et al. (2007)	A	-						A	-
	Saajanaho et al. (2021)	A	-	A	-		A	+	A	+
WEMWBS	Mavali et al. (2020)	A	-	B	+	B			A	-
WHO-5	E. Eser & Özcan (2020)	A	+				A	+	A	+
	Lucas-Carrasco et al. (2012)	A	?				A	-	B	?

Note. A = very good; B = adequate; C = doubtful; D = inadequate; blank = not reported; NA = not applicable; “+” = sufficient; “?” = indeterminate; “−” = insufficient; blank = not reported.

Methodological quality of the psychometric analysis.

Psychometric properties of the instrument.

Content validity was not tested for many instruments. Construct validity was tested more frequently, and the testing approach was almost always adequate or very good. The results showed sufficient construct validity in almost every case. All studies examined structural validity and generally employed a very good methodological approach. However, there were exceptions as some instruments showed only sufficient or insufficient structural validity.

The PANAS, Norwegian OPQoL-brief, Turkish WHO-5, PECOCO, DERS-16, and BSCS instruments were consistently rated well. The methodological quality of the psychometric analysis was good, and internal consistency, construct validity, and structural validity were sufficient. CCS-K, OWSQLI, and the Finnish version of RPW also showed promising validity results, while other instruments demonstrated less favourable psychometric properties.

Instruments Examining Needs

Thirteen different instruments for measuring older adults’ needs were found among 23 articles identified in our search. The most frequently used and translated instrument was the Camberwell Assessment of Need for the Elderly (Abihabib et al., 2011; Reynolds et al., 2000; Stein et al., 2014, 2015; Van Der Roest et al., 2008) (Table 4).

Table 4.

Names, Abbreviations, and General Information of Included Instruments.

Instrument	Number of items	Subscales
ASCOT − The adult social care outcomes toolkit (Malley et al., 2012; Van Leeuwen et al., 2015)	8	Control over daily life, personal cleanliness and comfort, food and drink, accommodation cleanliness and comfort, safety, social participation, occupation, dignity
BAS − Behov Av Stöd (angl. Needs of Care) (Åhsberg et al., 2017)	35	Learning and applying knowledge, general tasks and demands, communication, mobility, self-care, domestic life, interpersonal interactions and relationship, major life areas, community, social and civic life
BNSI − Basic Need Satisfaction Inventory (Leidy, 1994)	25	Physiological needs, needs for safety, belonging needs, esteem needs, needs for self-actualization
CANE − Camberwell Assessment of Need for the Elderly (Abihabib et al., 2011; Reynolds et al., 2000; Stein et al., 2014, 2015; Van der Roest et al., 2008)	24	Environmental needs/autonomy, physical needs, psychological needs, social needs (Abihabib et al., 2011; Reynolds et al., 2000; Stein et al., 2014, 2015)For a different categorization see Van der Roest (2008):Autonomy, physical needs, psychological, emotional and social needs, carer needs
EASY − The Elderly Assessment System (Lee et al., 2015)	55	Eight subscales: seeing, hearing, and communicating, looking after oneself, getting around, safety, accommodation/finance, staying healthy, mental health and wellbeing, social participation
INQ − Interpersonal needs Questionnaire (Marty et al., 2012; Parkhurst et al., 2016)	15	Belongingness, burdensomeness
ICECAP-O − Investigating Choice Experiments for the Preferences of Older People (Coast et al., 2008; Hörder et al., 2016; Makai et al., 2013)	5	Attachment, Security, Role, Enjoyment, Control
HNSI − Health Needs Instrument (Shih et al., 2005, 2008)	62	Tangible type of health needs and of need satisfaction, psychospiritual type of health needs, psycho-spiritual type of need satisfaction, informational type of health needs, informational type of need satisfaction
PNFS-OA − Psychological Need Frustration Scale – older adults (Vanhove-Meriaux et al., 2020)	12	Autonomy, competence, relatedness need frustration
SPF-ILs − Social Production Function Instrument − short (Nieboer & Cramm, 2018)	15	Stimulation, comfort, affection, behavioral confirmation, status
SDAT − Spiritual Distress Assessment Tool (S. M. Monod et al., 2010; S. Monod et al., 2012)	16	Meaning, transcendence, values, and psychosocial identity
SRNS − Self-Reported Neglect Scale (Zawisza et al., 2020)	12	Basic needs, psychological needs
SWON − Social Wellbeing of Nursing (Gerritsen et al., 2010)	9	Affection, behavioral confirmation, status

These instruments were developed based on:

- previously existing instruments (Abihabib et al., 2011; Åhsberg et al., 2017; Lee et al., 2015; Malley et al., 2012; Reynolds et al., 2000; Stein et al., 2014, 2015; Van Der Roest et al., 2008; Van Leeuwen et al., 2015),

- theories (Gerritsen et al., 2010; Leidy, 1994; Marty et al., 2012; Nieboer & Cramm, 2018; Parkhurst et al., 2016; Vanhove-Meriaux et al., 2020; Zawisza et al., 2020),

- models (Vanhove-Meriaux et al., 2020),

- research design that employed qualitative and quantitative research (Shih et al., 2005, 2008).

The methodological quality for assessing internal consistency of these instruments was mostly poor, while the psychometric properties were indeterminate for many studies, with only three studies rated as sufficient (Table 4). Test-retest and inter-rater reliability were examined in about half of the cases, mostly with adequate methodological approaches and sufficient psychometric properties.

Structural validity was examined in all but two studies, with a mix of poor and good methodological approaches resulting in mostly indeterminate ratings, with only five studies showing sufficient properties. Around half of the studies tested content validity, all with adequate or very good methodology. Construct validity was evaluated in most cases, usually with adequate or very good methodological approaches. The results typically showed sufficient construct validity properties (Table 5, Table S3).

Table 5.

Quality of Methodological Analysis of Psychometric Properties and Psychometric Properties of Questionnaires Measuring Older Adults’ Needs.

Instrument	Authors	Reliability				Validity
		Internal consistency		Test-retest and inter-rater reliability		Content validity	Construct validity		Structural validity
		Analysis^a	Properties^b	Analysis	Properties	Analysis	Analysis	Properties	Analysis	Properties
ASCOT	Malley et al. (2012)	D	?	D	?	B	B	+	C	?
	Van Leeuwen et al. (2015)	D	?	A	+		A	+	D	?
BAS	Åhsberg et al. (2017)	D	?	B	+	B	C	?	C	?
BNSI	Leidy (1994)	A	?				A	+	C	?
CANE	Abihabib et al. (2011)	D	+				B	+	B	+
	Reynolds et al. (2000)	D	?	B	+	B	B	+	C	?
	Stein et al. (2014)	D	?				B	+	C	?
	Stein et al. (2015)	D	?			A			C	?
	Van der Roest et al. (2008)	D	?	A	-		B	+	C	?
EASY	Lee et al. (2015)	C	?			B			C	?
INQ	Parkhurst et al. (2016)	D	?				A	+	A	+
	Marty et al. (2012)	A	?				A	-	B	?
ICECAP-O	Coast et al. (2008)	D	?				B	-	D	?
	Hörder et al. (2016)	D	?	C	+	B			D	?
	Makai et al. (2013)	D	?			B	A	+	D	?
HNSI	Shih et al. (2005)	D	?	B	+	B	A	+	D	?
	Shih et al. (2008)	C	?	B	+	A	D	?	C	?
PNFS-OA	Vanhove-Meriaux et al. (2020)	A	-				A	+	A	+
SPF-ILs	Nieboer and Cramm (2018)	A	+				C	+	A	+
SDAT	S. M. Monod et al. (2010)	D	?			A			C	?
	S. Monod et al. (2012)	C	-	C	+		D	+	B	?
SRNS	Zawisza et al. (2020)	A	+	D	?	B	A	+	A	+
SWON	Gerritsen et al. (2010)	A	?	B	-	B			B	?

Note. A = very good, B = adequate, C = doubtful, D = inadequate, blank = not reported; “+” = sufficient; “?” = indeterminate; “−” = insufficient; blank = not reported.

Methodological quality of the psychometric analysis.

Psychometric properties of the instrument.

SRNS displayed satisfactory properties for the most part. The English and Lebanese versions of CANE, (the English version of) ASCOT, INQ, HNSI, PNFS-OA, and SPF-ILs showed potential with some satisfactory properties. Other instruments were problematic because their psychometric properties were not tested, the psychometric testing was conducted with inadequate methodological rigor, or the psychometric properties did not meet the desired standards.

Instruments for Subjective Evaluation of the Built Environment

Eight instruments that measure perceptions of the built environment were found amongst 11 papers (Table 7). The most frequently used questionnaire was Neighbourhood Environment Walkability Scale. The instruments typically capture transportation, social participation, and safety (Table 6).

Instruments were developed based on:

- previously developed instruments (Bailey-Catalán et al., 2019; Cerin et al., 2010, 2021; Starnes et al., 2014; Stolt et al., 2021; Yoon et al., 2015),

- previous research and expert panel (Cerin et al., 2021),

- literature reviews (Lak et al., 2019),

- checklists (Dikken et al., 2020; Garner & Holland, 2020; K. Kim et al., 2022; Özer et al., 2023).

All studies tested internal consistency, two thirds of which applied very good methodology (Table 6). One third of all studies showed sufficient internal consistency properties. Less than half of the studies examined test-retest and inter-rater reliability, mostly with adequate methodological approaches. In all cases, the results showed either insufficient or indeterminate properties.

Table 6.

Names, Abbreviations, and General Information of Included Instruments.

Instrument	Number of items	Subscales
AFC − Age-Friendly Community Survey (K. Kim et al., 2022)	62	Outdoor space and building, transportation, housing, social participation, community, and social services
AFCCQ − Age Friendly Cities and Communities Questionnaire (Dikken et al., 2020; Özer et al., 2023)	23	Housing, social participation, civic participation and employment, communication and information, transportation, respect and social inclusion, community support and health services, outdoor spaces and buildings, financial situation
AFEAT − Age-Friendly Environment Assessment Tool (Garner & Holland, 2020)	10	None (unidimensional scale)
EFUSQ − Elder-friendly urban spaces questionnaire (Lak et al., 2019)	49	Place (functional dimension), place (preferred dimension), process (environments)
NEHA-CIA − Neighbourhood Environment for healthy Ageing – Chinese Immigrants to Australia (Cerin et al., 2021)	120	Resident density, land use diversity, access to services, recreational facilities, physical food environment, destinations for socializing, transportation, physical barriers to walking, street connectivity, infrastructure for pedestrians, indoor places for walking, aesthetics, traffic and road hazards, traffic speed, social disorder/littering, crime, safety (presence of people), social environment and communication (physical activity, healthy eating, socializing)
NEWS-A − Abbreviated Neighbourhood Environment Walkability Scale for seniors (Bailey-Catalán et al., 2019; Starnes et al., 2014)	26	Access to destinations, street connectivity, infrastructure for walking, aesthetics, traffic safety, personal safety
NEWS-CS − Neighbourhood Environment Walkability Scale for Chinese Seniors (Cerin et al., 2010)	76	Residential density, land use diversity, access to services, street connectivity, infrastructure for walking, indoor places for walking, aesthetics, presence of people, crowdedness, traffic and road hazards, traffic speed, social disorder/littering, crime, fence separating sidewalk and traffic, bridge/overpass connecting to services, easy access of residential entrance, sitting facilities
PBEHB − Perceived Barriers to Health-Enhancing Behaviours questionnaire (Cerin et al., 2021)	55	Perceived barriers to leisure-time, physical activity, walking for transport, healthy eating, socializing
PCQ-P − Person-Centered care Climate Questionnaire-Patient (Stolt et al., 2021; Yoon et al., 2015)	17	Climate of everydayness, climate of safety, climate of hospitality

Content and construct validity were tested in more than half of the studies, with either adequate or very good methodology. Structural validity was examined in all studies; in one third of the studies with doubtful methodology and in the remaining studies with adequate or very good methodology. In more than half of the cases, construct validity was indeterminate; in other cases, it was sufficient (Table 7, Table S4).

Table 7.

Quality of Methodological Analysis of Psychometric Properties and Psychometric Properties of Questionnaires Measuring Older Adults’ Perception of the Built Environment.

Instrument	Authors	Reliability				Validity
		Internal consistency		Test-retest and inter-rater reliability		Content validity	Construct validity		Structural validity
		Analysis^a	Properties^b	Analysis	Properties	Analysis	Analysis	Properties	Analysis	Properties
AFC	K. Kim et al. (2022)	A	+						A	+
AFCCQ	Dikken et al. (2020)	A	+			A	A	+	A	+
	Özer et al. (2023)	A	?	C	?	B			A	?
AFEAT	Garner and Holland (2020)	C	+				B	+	NA
EFUSQ	Lak et al. (2019)	A	?			C	D	?	D	?
NEHA-CIA	Cerin et al. (2021)	C	?	B	-	A	A	+	C	?
NEWS-A	Bailey-Catalán et al. (2019)	A	+						A	+
	Starnes et al. (2014)	A	-						A	+
NEWS-CS	Cerin et al. (2010)	D	?	B	-	A			A	+
PBEHB	Cerin et al. (2021)	A	?	B	-	A	A	-	C	?
PCQ-P	Stolt et al. (2021)	A	+				A	+	B	?
	Yoon et al. (2015)	A	+			C	A	+	A	+

Note. A = very good, B = adequate, C = doubtful, D = inadequate, blank = not reported, NA = not applicable; “+” = sufficient; “?” = indeterminate; “−” = insufficient; blank = not reported.

Methodological quality of the psychometric analysis.

Psychometric properties of the instrument.

The AFCCQ, the North American version of PCQ-P, and AFEAT stand out in terms of psychometric properties, demonstrating sufficient reliability as well as construct and structural validity, all tested with sound methodology. NEWS-CS, NEHA-CIA, and the Finnish version of PCQ-P exhibited promising psychometric properties, although with some important shortcomings.

Instruments Measuring Needs or Wellbeing, and Perceived Built Environment

From 14 articles we extracted seven instruments that simultaneously measure perceived built environment and psychosocial wellbeing or needs of older adults. The most frequently used instrument was WHOQoL (Table 8).

Table 8.

Names, Abbreviations, and General Information of Included Instruments.

Name of instrument, abbreviation, and references	Number of items	Subscales
EoH − Experience of Home (Molony et al., 2007)	25	Home, not home, boundary
HCQ − Housing-related Control Beliefs Questionnaire (Boonyaratana et al., 2021)	24	Internal control and external control – powerful others, external control – chance
NHAS − Nursing home adjustment scale (Varer Akpinar et al., 2023)	22	Difficulty fitting in, acceptance of new residence, emotional distress, depressed mood, relationship development
PPFM-OA − Person-Place Fit Measure for Older Adults (Weil, 2020)	44	Basic needs, neighbourhood changes and moving, identity, community, services
PAS − Place Attachment Scale (Arani et al., 2022)	42	Attachment to home and attachment to neighbourhood
TOPAS − Thriving of Older People Assessment Scale (Bergland et al., 2014, 2015)	32	Quality of built environment, resident attitudes towards being in long-term care, quality of care and caregivers, resident engagement, peer relationships, keeping in touch with people and places
Thriving of Older People Assessment Scale Chinese version (TOPAS-C; C. P. Li et al., 2021)	32
WHOQoL-BREF − The World Health Organization Quality of Life Brief Version (Gil-Lacruz et al., 2022; Liang et al., 2009)	26	Physical capacity, psychological wellbeing, social relationships, environment domain
WHOQOL-OLD − World Health Organization Quality of Life Instrument-Older Adults Module (S. Eser et al., 2010; Gebrye et al., 2023)	24	Sensory abilities, autonomy, past, present, and future activities, social participation, death and dying, and intimacy
WHOQOL-AGE − World Health Organization Quality of Life Instrument − AGE (Cheng et al., 2023; E. Eser & Özcan, 2020)	13	Health, environment, mastery, overall quality of life

Instruments were developed based on:

- theory (Arani et al., 2022; Bergland et al., 2015; Molony et al., 2007; Varer Akpinar et al., 2023),

- a bottom-up approach (Weil, 2020),

- existing checklists and instruments (Cheng et al., 2023; E. Eser & Özcan, 2020; S. Eser et al., 2010; Gebrye et al., 2023; Gil-Lacruz et al., 2022; C. P. Li et al., 2021; Liang et al., 2009).

All 14 papers tested internal consistency, and the methodology was very good in nearly all cases. In more than half of the studies, the internal consistency was sufficient. Test-retest and inter-rater reliability were assessed in one third of the cases, with varying degrees of methodological quality, ranging from robust to poor. Sufficient properties were observed in half of these studies.

Content or construct validity was tested in almost all cases. Content validity was generally tested with poor methodological approaches, whereas construct validity assessments generally employed robust methodologies. Construct validity showed sufficient properties in all but one study where it was examined. Structural validity was tested in almost all the cases, for the most part with adequate or very good methodological approaches. The properties were sufficient in half of the cases and the rest were mostly indeterminate (Table 9, Table S5).

Table 9.

Quality of Methodological Analysis of Psychometric Properties and Psychometric Properties of Questionnaires Measuring Perception of the Built Environment and Needs or Psychosocial Wellbeing.

Instrument	Authors	Reliability				Validity
		Internal consistency		Test-retest and inter-rater reliability		Content validity	Construct validity		Structural validity
		Analysis^a	Properties^b	Analysis	Properties	Analysis	Analysis	Properties	Analysis	Properties
EoH	Molony et al. (2007)	A	?	C	+		A	+	B	?
HCQ	Boonyaratana et al. (2021)	A	?				A	+	C	?
NHAS	Varer Akpinar et al. (2023)	A	+				A	+	A	+
PPFM-OA	Weil (2020)	A	+			A	A	+	B	?
PAS	Arani et al. (2022)	A	+	C	+	C			A	-
TOPAS	Bergland et al. (2014)	C	?	C	-	C			C	?
	Bergland et al. (2015)	A	+	A	-				B	?
TOPAS-C	Li et al. (2020)	A	+			C			A	+
WHOQoL-BREF	Gil-Lacruz et al. (2022)	A	+			C			A	+
	Liang et al. (2009)	A	+	B	+				A	+
WHOQoL-OLD	S. Eser et al. (2010)	A	+				B	-	A	+
	Gebrye et al. (2023)	A	-			A	B	+	A	?
WHOQoL-AGE	Cheng et al. (2023)	A	-				A	+	A	+
	E. Eser & Özcan (2020)	A	+				A	+	A	+

Note. A = Very good; B = Adequate; C = Doubtful; D = Inadequate; white = not reported; “+” = sufficient; “?” = indeterminate; “−” = insufficient; “blank” = not reported.

Methodological quality of the psychometric analysis.

Psychometric properties of the instrument.

PPFM-OA, NHAS, and WHOQoL, in all its versions, displayed the best psychometric properties among the tested instruments. EoH and HCQ exhibited promising psychometric properties, although with some important inadequacies. Other instruments showed deficiencies in at least one important aspect.

Instruments for Objective Assessments of the Built Environment

Thirteen different instruments for objectively assessing the built environment were found in the 42 articles included in our study (Table 10). Although Geographic Information Systems (GIS) are not conventional questionnaire-based instruments, we have included them here because they are so frequently used.

Table 10.

Names, Abbreviations, and References of Included Instruments.

Name of instrument	Abbreviations	References
Australian Design Access and Mobility Standard (Adaptable Housing)	AS 4299	Byles et al. (2014)
Community Audit Tool-Analytic Version	CAT-AV	Strath et al. (2012)
COURAGE Built environment Self-Reported Questionnaire	CBE-OUT	Quintas et al. (2014)
Corridor Coding System Scales	CCSS	Lu et al. (2015)
Environment in Asia Scan Tool – Hong Kong version	EAST-HK	Cerin et al. (2013)
Evaluation of Older People’s Living Environments	EVOLVE	Orrell et al. (2013)
Geographical information systemAnd national databases (National Institute of Geographic and Forestry Information, South Australian Government Data Directory, Portland Metro’s Regional Land Information System, Corine Land Cover 2012 raster data, National Land Numerical Information, Public Open Space Tool, Scottish Index of Multiple Derivation)	GIS	Amaya et al. (2022), Arakawa Martins et al. (2021), Barnett et al. (2020), Cerin, Barnett, et al. (2020), Cerin, Van Dyck, et al. (2020), Chang et al. (2021), Chen et al. (2019), Gell et al. (2015), Guan et al. (2022), Hua et al. (2022), Keskinen et al. (2018), Y. Li et al. (2020), Nygren et al. (2007), Okuyama et al. (2020), Pettigrew et al. (2020), Portegijs, Keskinen, et al. (2017), Quintas et al. (2014), Shaw et al. (2017), Strath et al. (2012), Timmermans et al. (2021), Troped et al. (2017), Van Cauwenberg et al. (2022), van Holle et al. (2016), Zandieh et al. (2019
Housing Enabler Screening Tool	HEST	Ekström et al. (2016), Granbom et al. (2014), Lien et al. (2015), Nygren et al. (2007), Oswald et al. (2007), Portegijs, Rantakokko, et al. (2017), Rantakokko et al. (2013), Rantanen et al. (2012), Tomsone et al. (2013)
Home Falls Accidents Screening Tool	HOME FAST	Byles et al. (2014)
Neighbourhood Design Characteristics Checklist	NeDeCC	Burton et al. (2011)
Street Smart Walk Score®	SSWS	Chudyk et al. (2017), Pettigrew et al. (2020)
UrbApp		Amaya et al. (2022)
Other environment audits		Granbom et al. (2019), C. J. P. Zhang et al. (2019)

Many methods are employed to objectively describe the environment. For example, GIS uses spatial data, such as maps, satellite imagery, and geographic coordinates to formulate a detailed representation of the environment. Investigator observations of the environment involve direct observation through sensory perceptions and include qualitative descriptions and/or quantitative measurements. Environmental audits and checklists involve systematic examination of the environment based on predetermined criteria.

Different instruments address different aspects of the built environment, which can be divided into four domains: (a) density, connectivity, proximity, and walkability, (b) availability and accessibility, (c) safety, (d) and quality of the environment:

Density, connectivity, proximity, and walkability encompass various factors such as public transport, seating places, street connectivity, intersections, recreational facilities, and amenities. This domain is assessed predominantly using GIS (e.g., ArcGIS, Seasonal Persistent Green Cover), national databases, and similar tools;

Availability and accessibility focus on relevant factors related to different areas, such as housing (e.g., hallway width) and walkability (e.g., sidewalks). GIS and national databases, as well as HEST, are used frequently in this domain, while EVOLVE, and CBE-OUT may evaluate subsets of this domain;

Safety comprises aspects such as safety from crime, bathroom safety, and pollution. HEST is a prevalent tool for assessing this domain. However, EAST-HK, EVOLVE and CBE-OUT appear to evaluate a greater number of subdomains when compared to HEST;

Quality of the environment focuses on factors such as the quality of the infrastructure, size of dwellings, and the type and shape of streets. HEST remains a widely embraced instrument within this domain. Notably, EVOLVE, CBE-OUT, CCSS, and AS 4299 comprehensively address most subdomains.

These domains are presented in Table 11, where coloured squares indicate the frequency of instrument usage in research studies for each domain, offering a visual representation of the prevalence and emphasis on specific instruments within each domain. Within the table, the symbol “x” signifies the possibility of the instrument measuring a subdomain. Absence of colour indicates that the authors did not employ this particular aspect of the instrument in their study.

Table 11.

Overview of Instruments for Measuring Built Environment Objectively.

Note. An instrument mentioned by 1–3 papers = light blue, 4–6 papers = yellow, 7–9 papers = orange, 10 or more = red; “x” indicates the measurable categories of the instrument. AS 4299 = Australian Design Access and Mobility Standard AS 4299 (Adaptable Housing); CAT-AV = Community Audit Tool-Analytic Version; CBE-OUT = COURAGE Built Environment Self-Reported Questionnaire; CCSS = Corridor Coding System Scales; EAST-HK = Environment in Asia Scan Tool – Hong Kong version; EVOLVE = Evaluation of Older People’s Living Environments; GIS + National databases refer to several tools used, see Supplementary file S6 for details; HEST = Housing Enabler Screening Tool; HOME FAST = Home Falls Accidents Screening Tool; NeDeCC = Neighbourhood Design Characteristics Checklist; SSWS = Street Smart Walk Score®.

The selection of the appropriate tool for objective assessments of the built environment largely depends on the domains one wishes to examine. For example, to measure proximities (of grocery stores), GIS and national databases hold significant potential, while for evaluating safety and quality of the environment, especially indoors, checklists and environmental audits (systematic evaluations of an environment, which follows environmental requirement standards) are a more suitable choice (Table 11; more details in Supplementary file S6).

The categories and subscales identified here are those reflected in the instruments included in this review. Of included instruments, EVOLVE addresses the most categories (20), followed by GIS and national databases, and CBE-OUT (17 each). Additionally, GIS, EVOLVE, CCSS, CBE-OUT, CAT-AV, and AS 4299 can be used to measure at least one subscale from all categories.

Measuring Psychosocial Wellbeing and Objective and Perceived Built Environment

Objective environments have primarily been assessed using national databases, GIS, and checklists. We identified five articles that measured psychosocial wellbeing together with objective and perceived built environment. The instruments employed by the studies varied widely (Table 12).

Table 12.

Instruments Used to Measure Older Adults’ Psychosocial Wellbeing, Together With Perceived and Objective Built Environment.

Reference	Wellbeing (subscales)	Perceived built environment (subscales)	Objective built environment (domains)
Evans et al. (2002)	PANAS (positive and negative affect)	Place attachment (feelings of belongingness, ownership, personalization)	Environmental audit (infrastructure, amenities, support for mobility impairment and spatial requirements)
Engel et al. (2016)	ICECAP-O (attachment, security, role, enjoyment, and control); Collective efficacy scale (social cohesion, informal social control)	NEWS-A (access to destinations, street connectivity, infrastructure for walking, aesthetics, traffic safety, personal safety)	SSWS
Yue et al. (2022)	Mental wellbeing questions from WHOQoL-BREF (residence, travelling, evaluative wellbeing)	Questionnaire created for the study (perceptions of noise, travel fluency, security, and landscape aesthetics)	Google Maps, Open Street Maps, and in-situ observations
Phillips et al. (2005)	WHOQoL-BREF (positive and negative effect); Residential satisfaction	Questionnaire created for the study (dwelling and neighbourhood characteristics, residential satisfaction)	GIS (overcrowding households, high concentrations of older adults, street blocks), types of housing
Guo et al. (2021)	Life satisfaction & happiness; BSCS (needs fulfilment, group membership, influence, and emotional connection)	Selected items from AFC	GIS and national databases (density, design, diversity, and destinations)

Note. PANAS = Positive and Negative Affect Scale; ICECAP-O = Investigating Choice Experiments for the Preferences of Older People; NEWS-A = Abbreviated Neighbourhood Environment Walkability Scale for seniors; SSWS = Street Smart Walk Score; WHOQoL-BREF = The World Health Organization Quality of Life Brief Version; BSCS = Brief Sense of Community Scale; AFC = Age-Friendly Community Survey.

Researchers have combined different instruments to evaluate psychosocial wellbeing alongside perceived and objective built environments. Even when the same tool was used in two studies, it was used differently. Phillips et al. (2005) and Yue et al. (2022) both employed WHOQoL-BREF but used a different number of questionnaire items, and different domains were assessed with GIS.

In terms of wellbeing assessment from the selected studies, PANAS, WHOQoL-BREF, ICECAP-O, and BSCS underwent psychometrics testing within a sample of older adults. Among these, all instruments demonstrated good psychometric properties except for ICECAP-O, which exhibited insufficient reliability and structural validity (Tables 3 and 5). Data regarding residential satisfaction, life satisfaction, and happiness were gathered through single-item measures, introducing potential measurement errors and social desirability bias (Bowling et al., 2013; Sarstedt & Wilczynski, 2009).

In the included studies, perceptions of the built environment were assessed with NEWS-A, AFC, or modified questionnaires that were based on existing instruments (Engel et al., 2016; Evans et al., 2002; Guo et al., 2021; Phillips et al., 2005) or theories (Yue et al., 2022). To the best of our knowledge, the psychometric properties of these instruments were not tested on older adults, except for the NEWS-A (Starnes et al., 2014) and AFC (K. Kim et al., 2022). In both instruments, only structural validity and internal consistency were examined. Both showed good structural validity, but only AFC demonstrated good internal consistency (Table 7).

Discussion

We found that reliability and validity are often insufficiently reported, and when they are reported, are inadequate. Nonetheless, there are instruments with promising psychometric properties that provide useful insights into wellbeing and needs, and those that allow researchers to assess perceptions of the built environment or its objective properties.

Wellbeing, Needs, and Perception of the Built Environment

Conceptual Frameworks and Theories

Definitions and theoretical frameworks behind the instruments for assessing needs and wellbeing are lacking or vary broadly, making the creation of reliable and valid instruments difficult (Zhang & Chen, 2019). We found many cases where structural validity was low, raising questions about the instruments alignment with the theories they are based on.

Many tools seem to capture only a part of the larger construct that might be of interest to researchers exploring the relationship between wellbeing and environment. For example, wellbeing instruments tend to focus only on specific domains, such as emotional wellbeing, and do not examine wellbeing holistically (possibly because of the difficulty defining holistic wellbeing mentioned previously). On top of this, some potential constructs of interest, like collective wellbeing, are not frequently investigated. This may be due to ambiguous definitions, lack of instruments, or substantial overlap with a related wellbeing domain that is being measured.

Additional challenges arise when trying to understand and assess the relationship(s) between older adults’ wellbeing, needs, and the built environment. To explore how the built environment influences older adults’ wellbeing, we might wish to examine how it addresses or hinders their needs along with how their needs satisfaction affects their wellbeing. This is not an easy task, as there are many ways to define and measure these concepts, and there is no agreement on which features of the built environment are most relevant to specific needs, and which needs are most important for different domains of wellbeing.

Psychometric Properties

In the analysis of all identified instruments, we found that examinations of psychometric properties are often lacking. In several cases, aspects of validity or reliability were either not tested at all, were tested poorly, or the resulting psychometric properties failed to meet acceptable standards. Even content validity, which is considered to be a crucial measure (Mokkink et al., 2017; Prinsen et al., 2018; Terwee et al., 2018), was omitted from discussions in more than half of the identified studies (Table 13 and Table S7 in Supplemental Material). Similar findings were reported by other studies examining instruments for analysing wellbeing (Cooke et al., 2016), needs (Kipfer & Pihet, 2020; Tian et al., 2019), and residential satisfaction (Smrke et al., 2018). For example, instruments included in Elf et al.’s (2017) review were mostly tested for either content or construct validity, yet frequently lacked data on reliability.

Table 13.

Summary of Instruments Across Domains With Satisfactory Psychometric Properties.

Instrument	Authors	Underlying construct/subscales	Internal consistency	Test-retest and inter-rater reliability	Construct validity	Structural validity
Measuring wellbeing
BSCS	Buckley et al. (2022)	Social, psychological, emotional, community-related wellbeing	+	NA	+	+
DERS-16	Visted et al. (2023)	Emotional wellbeing	+	NA	+	+
OPQoL-brief	Haugan et al. (2020)	Emotional and psychological wellbeing	+	NA	+	+
PANAS	Buz et al. (2015)	Emotional and subjective wellbeing	+	NA	+	+
	Humboldt et al. (2017)		+	NA	+	+
PECOCO	Kikuchi et al. (2024)	Community-related wellbeing	+	+	+	-
WHO-5	E. Eser & Özcan (2020)	Psychological wellbeing	+	NA	+	+
Needs
SRNS	Zawisza et al. (2020)	Basic & psychological needs	+	?	+	+
Perceived environment
AFCCQ	Dikken et al. (2020)	Housing, social participation, civic participation and employment, communication and information, transportation, respect and social inclusion, community support and health services, outdoor spaces and buildings, financial situation	+	NA	+	+
AFEAT	Garner and Holland (2020)	Unidimensional scale	+	NA	+	NA
PCQ-P	Yoon et al. (2015)	Climate of everydayness, climate of safety, climate of hospitality	+	NA	+	+
Perceived environment and needs or psychosocial wellbeing
NHAS	Varer Akpinar et al. (2023)	Difficulty fitting in, acceptance of new residence, emotional distress, depressed mood, relationship development	+	NA	+	+
PPFM-OA	Weil (2020)	Basic needs, neighbourhood changes and moving, identity, community, services	+	NA	+	?
WHOQoL-BREF	Liang et al. (2009)	Physical capacity, psychological wellbeing, social relationships, environment domain	+	+	NA	+
WHOQoL-OLD	S. Eser et al. (2010)	Sensory abilities, autonomy, past, present, and future activities, social participation, death and dying, and intimacy	+	NA	-	+
WHOQoL-AGE	Cheng et al. (2023)	Health, environment, mastery, overall quality of life	-	NA	+	+
	E. Eser & Özcan (2020)		+	NA	+	+

Only about one fourth of the studies reported both reliability and validity measures, with most of these being more recent – showing a positive trend in assessment methodology. Both types of validity are essential, as they measure different but important properties of an instrument. Even widely used scales like PANAS, RPW, WHOQoL, and WEMWBS lack comprehensive evaluations of content and construct validity, as well as reports on reliability for older populations.

In some cases, instruments that were translated or modified did not receive a thorough psychometric analysis, even though validity is subject to change in such situations, and should always be analysed (Cerin et al., 2010; Linton et al., 2016).

Studies examining instruments to assess older adults’ wellbeing often did not report test-retest reliability, and internal consistency results were generally insufficient. While construct validity was typically sufficient in most cases, there was a notable lack of content validity.

In contrast, studies describing instruments to assess older adults’ needs tended to report results of content and construct validity, supporting previous findings by Kipfer and Pihet (2020) and Tian et al. (2019). In most cases psychometric properties were adequate to very good, while structural validity tended to be weak. Reliability was either omitted or, when reported, usually rated as low (Tables 13). Studies examining instruments for perception of the built environment typically reported content or construct validity, which was generally sufficient, while half of the results on structural validity were indeterminate.

Psychometric properties for instruments measuring multiple constructs (i.e., wellbeing or needs and the built environment) were critically lacking, as construct, content and structural validity, and test-retest reliability, tended to be unreported or insufficient. Although, structural validity and internal consistency were frequently well reported, their psychometric properties were questionable in half of the included studies. This inconsistency likely stems from the lack of a theoretical foundation or conceptual framework linking wellbeing and the built environment. This shortcoming should be carefully considered before designing new instruments for this purpose.

Given these results, it is challenging to pinpoint which questionnaires are more suitable for specific applications. However, some instruments demonstrated more robust psychometric properties than others, these were: PANAS, PECOCO, OPQoL-brief, DERS-16, and BSCS for wellbeing; SRNS for needs; AFCCQ, AFEAT, and PCQ-P for perception of the built environment; and PPFM-OA and WHOQoL for measuring wellbeing and the built environment (Tables 13 and S1).

Another limitation of existing instruments is that questionnaires rarely integrate measurements of both wellbeing and environmental factors. Of those that do, the focus is often limited to outdoor environments, leaving indoor spaces largely unexamined (e.g., E. Eser & Özcan, 2020; Liang et al., 2009; Weil, 2020). Moreover, to our knowledge, no comprehensive tool exists that connects the built environment with the holistic needs of older adults. This gap is due to a lack of theoretical foundations that link the built environment to the needs of older adults, though some efforts have been made (Vásquez Sánchez et al., 2020). Additionally, no instrument currently measures wellbeing or needs and both perceived and objective aspects of the built environment.

Objective Built Environment

Objective measurements of the built environment could be categorised into three groups: (a) GIS, (b) observations (e.g., Google Street views) and audits, and (c) instruments based on building standards. When considering sustainability evaluation, various instruments such as BREEAM, LEED, and Sustainable Sites Initiative are available. Some instruments, including BREEAM for Communities, LEED for Neighbourhood Development, and Green Start for Communities, have also been adapted to assess the age-friendliness of the built environment effectively (Siew, 2016). However, their psychometric properties have not been tested (Elf et al., 2017).

Most often, objective measurement of the environment covers (a) density, connectivity, proximity, and walkability, (b) availability and accessibility, (c) safety, and (d) quality of the environment. Density, connectivity, proximity, and walkability are most often evaluated by GIS and national databases. Availability and accessibility of places showed more diversity in measurement, with GIS and national databases, and checklists such as HEST, CBE-OUT, and EVOLVE being commonly used. Safety and environmental quality are frequently measured using checklists and environmental audits. The tools used most frequently were EVOLVE and CBE-OUT, which may be due to the broad coverage of criteria they include.

Most of the identified instruments orientate towards outdoor environments. Less focus is given to interior spaces, which are important due to the amount of time older adults spend indoors. This oversight leads to a critical gap in assessments of the relationship between the built environment and the wellbeing of older adults. While some studies have addressed some physical aspects of the environment that affect older adult’s health, such as indoor pollutants and lighting, many other environmental factors remain underexplored (Andargie & Azar, 2019; Chan & Liu, 2018; Huisman et al., 2012; Klepeis et al., 2001; Mendes et al., 2017; Reddy et al., 2021). These quantitative factors should be assessed along with subjective preferences of older adults concerning their living space layout, building materials, lighting, and other properties that have an important effect on their wellbeing and fulfilment of needs (Bigonnesse et al., 2014; Burton et al., 2011; Campbell, 2015; Gibney et al., 2020; Lipovac & Burnard, 2021; Nygaard et al., 2021; Serrano-Jiménez et al., 2019).

To our knowledge, no tool currently exists for assessing instruments examining the built environment (i.e., similar to the COSMIN checklist). Therefore, we did not evaluate the quality of the instruments included in this review. At this point, it remains unclear to what degree and with what accuracy the identified instruments capture relevant aspects of the environment.

Research on Older Adults’ Wellbeing, Perceived and Objective Built Environment

Few studies have simultaneously examined older adults’ wellbeing, their satisfaction with the built environment, and objective environmental properties, despite a substantial body of literature on each component and recent research emphasizing the positive effects of age-friendly built environments on wellbeing (Firdaus, 2017; Gale et al., 2011; Nikkhah et al., 2018; Nordin et al., 2017). While some studies evaluated the built environment both objectively and subjectively from older adults’ perspectives (Hoehner et al., 2005; Hou et al., 2020; Koohsari et al., 2015; Y. Li et al., 2020; Lin & Moudon, 2010; Nyunt et al., 2015), they often did not measure psychosocial wellbeing. The studies that did measure wellbeing tended to capture only older adults’ perception of the built environment without measuring the environment objectively (Burton et al., 2011).

Still, we did identify studies that simultaneously measured all aspects – wellbeing, perception of the built environment, and objective environmental properties. From the instruments used in these studies, WHOQoL-BREF, PANAS, BSCS, and ICECAP-O’s psychometric properties were previously tested in a population of older adults and show the most promising results, while they also exhibit some issues. PANAS (measuring wellbeing) lacks reports on test-retest reliability and content validity results, ICECAP-O (measuring needs) lacks reports on structural validity and internal consistency, while BSCS (measuring wellbeing) lacks reports on test-retest reliability and content validity. The WHOQoL-BREF (measuring wellbeing and the environmental domain) mostly lacks results on validity. From the instruments identified for measuring the perception of the built environment, only NEWS was previously tested on older adults. The instrument lacks reports on its psychometric properties, except for structural validity which was found to be sufficient. Other studies (Evans et al., 2002; Guo et al., 2021; Phillips et al., 2005; Yue et al., 2022) utilized instruments that were not psychometrically tested on older adults, potentially undermining the validity of the study outcomes.

Life satisfaction and happiness are often evaluated with single-item measures, which pose challenges for the evaluation of reliability and validity (Bowling, 2005; Sarstedt & Wilczynski, 2009).

We observed a lack of clarity and consensus on definition of psychosocial wellbeing and on a conceptual framework linking wellbeing to the built environment, which may contribute to the challenges we have observed. Additionally, collective wellbeing is notably absent from existing psychosocial wellbeing measures. As a result, we lack appropriate tools to assess collective wellbeing. While instruments such as the Collective Efficacy Scale have been utilized in previous studies we were unable to confirm they had been tested with older adults.

Limitations

Studies on age-friendly environments use diverse keywords and publication strategies (i.e., publishing in a wide range of journals related to construction, materials, psychology, gerontology), making them difficult to discover. To address this issue, we used an exploratory approach before conducting our review to determine the most appropriate keywords, but some relevant studies may not have been included.

Using only PubMed to search for studies that examined both the objective and subjective environment in relation to wellbeing limited the pool of identified instruments. We attempted to mitigate this by looking for additional studies in reference lists of the studies discovered through the initial search.

Cross-cultural validity was not addressed in our assessment of these instruments. This is a relevant factor that should be considered in a future study (Ingersoll-Dayton, 2011).

Conclusion

We have reviewed several instruments that measure older adults’ psychosocial wellbeing and needs, as well as objective and perceived qualities of the built environment. We also examined instrument use in studies that simultaneously investigate all these constructs.

Although many of the reviewed instruments have been widely used, several either (a) do not test reliability or validity with a suitable methodology, (b) do not adequately report on results of reliability and validity testing, or (c) exhibit low reliability or validity.

Despite these limitations, some of the evaluated instruments show stronger psychometric properties and can be cautiously recommended for use. PANAS, WHO-5, PECOCO, DERS-16, BSCS, and OPQoL-brief performed well in measuring psychosocial wellbeing; SRNS showed promise for assessing needs; and AFFCCQ, PCQ-P, and AFEAT exhibited the greatest potential for evaluating perception of the built environment. WHOQoL, NHAS, and PPFM-OA are promising for measuring wellbeing or needs as well as the built environment in the same instrument. Existing instruments and tools for assessing built environments objectively are mostly orientated towards outdoor environments. GIS and checklists are commonly used for assessing many attributes of the physical environment. EVOLVE and CBE-OUT are widely used instruments for objectively evaluating the built environment, covering all domains – including interiors, which are neglected by other frequently used tools, like GIS. Indoor environments are crucial for older adults’ wellbeing and should be investigated more closely. Additionally, we lack psychometrically sound instruments that could evaluate wellbeing or needs together with the built environment.

There is an advantage to using existing, well-established instruments rather than developing new ones. When using an existing instrument with good psychometric properties, there is no need for the long and exhaustive process of new instrument construction that ensures its reliability and validity. The use of existing instruments also eases comparison between studies that have used the same instrument. We call for thorough testing and reporting of psychometric properties, so researchers can compare existing instruments and use the one best suited for their topic of interest. Psychometric properties should be re-evaluated when instruments are modified or translated.

Given the scarcity of studies capturing all three aspects − psychosocial wellbeing, perceived environment, and objective environmental measures − alongside the issues with psychometric rigor and scope, we urge researchers to continue to explore this pertinent topic and to select research instruments with care.

Supplemental Material

sj-docx-1-sgo-10.1177_21582440251380110 – Supplemental material for A Systematic Review and Evaluation of Measurement Instruments Assessing the Needs, Wellbeing, and Living Environments of Older Adults

Supplemental material, sj-docx-1-sgo-10.1177_21582440251380110 for A Systematic Review and Evaluation of Measurement Instruments Assessing the Needs, Wellbeing, and Living Environments of Older Adults by Mateja Erce Paoli, Dean Lipovac and Michael D. Burnard in SAGE Open

Footnotes

ORCID iDs

Mateja Erce Paoli

Dean Lipovac

Michael D. Burnard

Ethical Considerations

There are no human participants in this article and informed consent is not required.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The authors gratefully acknowledge the European Commission for funding the Horizon 2020 projects Pilots for Healthy and Active Ageing (GA# 857188) and InnoRenew CoE (GA# 739574) and the Republic of Slovenia (Investment funding of the Republic of Slovenia and the European Union of the European Regional Development Fund). The authors additionally acknowledge the Slovenian Research and Innovation Agency for supporting the BUILDWELL project (N2-0386).

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data Availability Statement

Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.

Supplemental Material

Supplemental material for this article is available online.

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Supplementary Material

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A Systematic Review and Evaluation of Measurement Instruments Assessing the Needs,Wellbeing,and Living Environments of Older Adults

Abstract

Plain Language Summary

Keywords

Introduction

Psychometric Properties of Instruments

Assessment of Psychosocial Wellbeing

Assessment of Needs

Perception of the Built Environment

Objective Assessment of the Built Environment

Purpose of the Review

Methodology

Overview

Search Strategy

Inclusion and Exclusion Criteria

Quality Appraisal

Results

General Characteristics of Evaluated Instruments

Instruments Examining Psychosocial Wellbeing

Instruments Examining Needs

Instruments for Subjective Evaluation of the Built Environment

Instruments Measuring Needs or Wellbeing, and Perceived Built Environment

Instruments for Objective Assessments of the Built Environment

Measuring Psychosocial Wellbeing and Objective and Perceived Built Environment

Discussion

Wellbeing, Needs, and Perception of the Built Environment

Conceptual Frameworks and Theories

Psychometric Properties

Objective Built Environment

Research on Older Adults’ Wellbeing, Perceived and Objective Built Environment

Limitations

Conclusion

Supplemental Material

sj-docx-1-sgo-10.1177_21582440251380110 – Supplemental material for A Systematic Review and Evaluation of Measurement Instruments Assessing the Needs, Wellbeing, and Living Environments of Older Adults

Footnotes

ORCID iDs

Ethical Considerations

Funding

Declaration of Conflicting Interests

Data Availability Statement

Supplemental Material

References

Supplementary Material