Developing a Weighting System to Evaluate Physical and Cognitive Stimulation and Safety in Older Adults’ Living Environments

Ageing well in place requires a living environment that meets the evolving needs of older adults. While the role of safety in healthy ageing is widely recognised, the contribution of a stimulating environment has received less attention. This study aims to develop an expert-weighted system quantifying how living environments provide physical and cognitive stimulation, as well as safety for older adults. Following an iterative process, multidisciplinary experts in ageing and housing weighted the importance of items for assessing an older adult’s level of physical and cognitive stimulation, and safety. They then judged sub-items for their influence (increase, decrease, or neutral) within each domain. Each sub-item was also assessed as beneficial, harmful, or person-dependent. Final weights were computed by multiplying importance and influence values. Agreement was assessed using the Median Absolute Deviation for importance (MAD < 2.5) and a ≥75% threshold for influence. For importance, 76% of stimulation-related items and 85% of safety items reached consensus, with remaining outliers explored through qualitative analyses. For influence, ≥75% agreement was achieved for 50% of physical-stimulation sub-items, 33% of cognitive-stimulation sub-items, and 59% of safety sub-items. Most sub-items were considered beneficial across domains. This weighting system allows an older adult’s living environment to be evaluated in terms of physical and cognitive stimulation, as well as safety. However, as some items and sub-items did not reach the predefined agreement thresholds, these weightings should be used with caution. These weightings enables benchmarking, environmental audits and targeted design interventions to support ageing well in place.