Work Package 1: Existing Evidence, Context, and Outcomes

Evaluating existing evidence about home adaptations & supportive home design

While the DesHCA project represents a rare opportunity to draw together stakeholders from across the UK to explore the different ways that homes can be designed and adapted to support people as they age, we are not the first research project to explore adaptations or design. 

One of the first tasks of the project was to identify where existing research could help us lay a strong foundation for our own activities. We did this in four ways: conducting a literature review, exploring existing data using secondary analysis, capturing different perspectives using an eDelphi consultation, and drawing this information together into a cost/benefit framework. 

A Rapid Systematic Literature Review (led by Dr Alison Dawson

Academic research usually begins with some kind of literature review. 

A literature review allows academics to identify where research already exists on the topic and highlight any flaws or gaps that they notice. Conducting a systematic literature review means ensuring that the research team plans ahead and clearly documents each step of the process. This usually includes their search strategy (what they looked for, where, and how), how many items they found, how they sorted through those papers and decided which were relevant to their question, and what literature was included at the end of the process. 

It is not uncommon for a systematic review to take over a year to complete. A rapid literature review can shorten this process by skipping certain steps or narrowing the scope of the search.

The team at DesHCA conducted a rapid systematic literature review, between August and December 2021. This meant that the project looked for information on a narrow topic (to create a rapid review), while planning and documenting each step of the process carefully (making it a systematic review).

The team at DesHCA conducted a rapid systematic literature review, between August and December 2021. This meant that the project looked for information on a narrow topic (to create a rapid review), while planning and documenting each step of the process carefully (making it a systematic review).

Our search strategy initially identified over six thousand papers that might be relevant to how housing adaptations could help to support for older people with and without cognitive impairment to live in the home of their choice. 

Reviewing these papers allowed the team to identify some key issues with the existing research knowledge: it often focused on very specific adaptations, such as specific pieces of technology; it rarely discussed issues of inequality or lack of access to adaptations; and there was limited information on how cost-effective adaptations could be. 

This represents a significant gap in the research literature, as it is impossible to make good, evidence-based recommendations about adaptations and cognitively supportive housing for older people without knowing 

  • What older people want and need
  • How homes can be designed to plan for this (and the issues that prevent this)
  • How existing homes can be adapted to support the people that live there (and the problems people experience with this)
  • How supportive homes can help different local authorities and businesses meet their goals 


These gaps show how important it is for projects like DesHCA to examine these issues from multiple perspectives as impossible to create good guidance without understanding what motivates, frustrates, and challenges different groups.

You can read the full literature review here.

Secondary Data Analysis (led by Professor Alasdair Rutherford)

Most research in the social sciences deals with either primary data, which researchers collect themselves during a project, or secondary data which involves using data that already exists. Therefore, secondary data analysis simply means analysing pre-existing data to answer new questions as part of a different study.

Research using secondary data often uses quantitative methods to look for patterns in datasets with responses from hundreds or thousands of people. This type of research is ideal for collecting a (relatively) small amount of data from many people, to answer particular questions about what is happening at a group or population level. In fact, if you’ve ever answered a survey, or taken part in the census, it is likely your answers were analysed in this way!

The quantitative researchers at DesHCA, led by Professor Rutherford, used data from the English Longitudinal Study of Ageing (ELSA) and the Scottish Household Survey (SHS) to explore how adaptations to someone’s home related to their health and wellbeing.

The team used ELSA and SHS data to find out the relationship between certain characteristics (such as cognitive impairment, age, wealth, or tenure) and how likely a person was to have adaptations installed in their home. Adaptations could include structural changes like widening doorways or the installation of stairlifts, as well as smaller changes like using a shower chair to make personal care easier. ELSA data also captured whether people had problems with their home, such as the property being too small, having issues with damp, or if there were problems with anti-social behaviours, like vandalism, happening nearby.

Exploring the major datasets helped identify if people in particular groups might have found it more difficult to make adaptations to their home when they needed it. This insight was then used to tailor later research to answer questions about why this might have been the case and what could have been done to change things in the future.

The quantitative team worked extensively with the ELSA and SHS datasets to gain a better insight into the presence or absence of age-inclusive adaptations in homes across the UK. Some key insights from their analysis include:

  • Adaptations could be usefully broken down into three categories- property based adaptations (i.e. ramps, widened doorways), movement based adaptations (i.e. stair lifts, hand rails), and bathroom adaptations (specific toilet, bath and shower aids).
  • Home adaptations are common, with 56% of the ELSA sample reporting one or more adaptations to their home.
  • Approximately 93% of adaptations made to the home will be made in the bathroom.
  • Property based adaptations were more commonly found in tenements, flats, or newer buildings, as well as in homes rented from housing associations and local authorities.
  • Movement based adaptations were more common in ground floor properties and those rented from housing associations and local authorities, but less likely to be installed in private homes or homes rented from a private landlord.
  • The presence of adaptations was not only linked with personal factors such as age and disability, but key property factors such as the age of the building (properties build between 1919 and 1944 had more bathroom-based adaptations than newer homes or properties built before 1919).

You can read more about DesHCA’s quantitative findings by reading the Statistical Insights on our resources page.

The team are also preparing an academic paper for publication, which will be linked here and included in our resource section when it becomes available.

eDelphi Consultations with Stakeholders (led by Dr Cate Pemble)

One of the challenges facing the DesHCA Project is that tackling the issues around developing housing that can support people as they age involves working with a wide variety of groups, or stakeholders.

Its vital that we hear the voices of older people, for example, so that we know what kind of changes they might welcome, and what kind of adaptations they might need. But if we think about the process that a person might have to go through to get something adapted, then we realise we also need to be talking to builders, who might carry out the changes, or local authorities who might provide them. Following that logic, we should also talk to architects, because they design our homes in the first place, and third sector organisations who provide information and signposting so people know what they can ask for… The list goes on and on.

A Delphi (or eDelphi, when it is conducted online) consultation process allows us to capture the insights from each of these groups at a time that suits them, without the challenges associated with traditional methods like focus groups.

DesHCA’s eDelphi process worked like this:

Participants were invited to take part in the eDelphi as long as they were either ‘experts by experience’ (people over the age of 55 who owned, rented, or occupied a home in the UK), or ‘experts by profession’ (someone who worked in a housing related field). This allowed us to examine issues around adaptation and age-inclusive housing from three perspectives: those of older people, those of professionals, and those of older professionals.

Asking our older participants about themselves showed us that:

  • 23 were women, 8 were men.
  • 13 were aged 55 – 65, 13 were 66 – 75, 4 were 76 – 85, and 1 was over the age of 86.
  • 21 considered themselves to have ‘good’ or ‘very good’ health, 11 said that they had ‘fair’ health, and 4 reported having  ‘bad’, or ‘very bad’ health.
  • 24 were living with a long term illness
  • 10 reported having an issue with their memory.


For our professional participants:

  • 20 were women, 11 were men.
  • 1 was between 26 – 45, 25 were 46 – 65, 3 were 66 – 75, and 2 were between 76 – 85.
  • 9 worked for a for-profit company, 9 worked for a not-for-profit organisation, and 12 worked in the public sector.
  • 1 had less than 5 years of experience, 4 had 6 – 10 years of experience, 4 had 11 – 15 years of experience, and 22 had over 16 years of experience.
  • 60% of participants had experience working with mobility issues, 59% had experience working with cognitive impairment, and 56% had experience working with sensory loss.


DesHCA’s eDelphi was made up of 3 rounds.

The first round focused explored how people prioritised different outcomes, exploring what options they thought were the ‘most important’ when thinking about age-inclusive homes.

The second round started to explore people’s understanding of age-inclusive design, what it could accomplish, and the different ways people thought about activities like exercising, socialising, and getting dressed.

The final round of the eDelphi asked about the wider impact of creating more age-inclusive homes, including how creating age-inclusive houses would impact communities, health and social care, and the housing sector.

Rounds two and three also included an opportunity for panellists to look at the results of the previous round and comment on the patterns they saw, allowing the team to get an insight into areas of disagreement or tension.

There was as strong idea about what an age inclusive home should be:

  • It  should be designed to support people who experienced difficulties with their mobility, thinking and cognition, or senses.
  • It should be within walking distance of a vibrant, mixed-age community
  • It should be affordable, and easy to keep warm or cool
  • It should be easy to adapt and change to fit peoples preferences and needs
  • It should be a beautiful, modern home.


When asked about how people should feel when they lived in an age-inclusive home, answers painted a clear picture of a home that helped people to feel safe, secure, independent, happy, connected with others, and in control of their own home.

Participants also highlighted a number of ways communities could benefit from the creation of more age-inclusive homes, including becoming more accessible, more intergenerational, and more connected.

The repeated design of the eDelphi also allowed the team to dig into areas of disagreement to better understand the results. For example, while many participants said that age-inclusive home design should make it easier to “stay physically active” (82%)  and “stay independent” (90%), only 41% said that age-inclusive design make it easier to go to the toilet, and only 15% said it should make it easier to do the laundry. Asking follow up questions allowed the team it better understand these results and identify asking participants to “pick their top 10” meant that many participants were choosing options that represented ‘overarching categories’ rather than individual activities.

The eDelphi was also able to pick up on key differences in opinion. This was particularly useful in highlighting how important factors like ‘living in a beautiful home’, or age-inclusive homes being designed to ‘appeal to anyone’ was to older people, while professionals rarely considered aesthetics among their top priorities.

You can read more about the outcomes of the eDelphi in our blog.

There is also an eDelphi paper currently under review. You will find the link to that paper here as soon as it is published.

Developing an Economic Framework (led by Professor Alasdair Rutherford

While most people will not have used a formal cost benefit framework as part of their day-to-day lives, the idea itself isn’t overly complicated.

The first step in creating a Cost/Benefit framework is examining the costs and benefits (or pros and cons) of a particular action. This could be something as simple as buying a new vacuum cleaner, or as complicated as adapting someone’s home to meet their needs.

The second step is to turn this process into a framework. This would involve laying out your thinking in a way that would allow someone else to follow in your footsteps the next time that they wanted to think about whether buying a new vacuum would be worth the expense (for example).

The main difference between thinking about costs and benefits as a person buying or doing something for themselves and examining the costs and benefits of something as a research project is scale. If I replace my vacuum, it mostly effects my family and people who visit my home. It becomes much more complicated when we look at changes at a larger scale, such as encouraging architects and builders to design housing that supports people as they age or supporting people to adapt homes they already live in to better meet their needs.

DesHCA’s goal was to pull together everything that we learned about the costs and benefits of home adaptation and create an economic framework that people in a variety of positions and industries could use to assess how promoting and implementing supportive designs and adaptations might have impacted their organization.

This meant collecting the perspectives of older people, housing professionals, allied health professionals, local authority representatives, as well as the academic literature to create a robust model that people could use when considering the costs and benefits of adaptation and age-inclusive design.

We hope that this framework would allows people in a variety of positions to see the  benefits of supportive design, while still giving a realistic idea of the costs involved.

Drawing together the insights from across the DesHCA project and beyond, Professor Rutherford produced an easy to use resource intended to help people think critically about the costs and benefits involved in home adaptation. You can find the economic framework in our resources section here.