Implications of elevators in high-rise buildings: a systematic mapping review
We were commissioned to conduct a systematic review of empirical research about the implications of elevators in multi-story buildings.
Having an accessible home is important for people in any stage of life, but particularly for the elderly and people with reduced mobility. Elevators in residential building are one practical mobility support for such populations.
The Division of Health Services in the Norwegian Institute of Public Health was commissioned by the Norwegian State Housing Bank to conduct a systematic review of empirical research about the implications of elevators in multi-story buildings.
We conducted a systematic review. In February 2018 a research librarian searched in major databases for empirical research. We also undertook searches in reference lists and grey literature (i.e. non-formal, commercial channels). Two independent reviewers screened all retrieved records. We extracted data from the included studies, collated the data and performed descriptive analyses.
We included six studies that addressed implications of elevators in multi-story buildings. The results showed:
- All were quantitative observational studies; we found no controlled studies.
- The studies were from China, Spain, Sweden and the USA.
- The participants were older people.
- Five of the studies found that access to elevator was one factor related to various events in the elderly: lower risk of falls and mortality, higher residential satisfaction and desire to engage in activities outside the home.
- One study found differences between those who needed help to use the elevator and those who did not.
There is a scarcity of studies about the implications of elevators for elderly and people with reduced mobility. Overall, the study results support the assumption that elevators can be an important intervention for elderly to remain in their homes longer.
Having an accessible home is important for people in any stage of life and will become even more important as the number of older people increases. As people age and pass through various stages of life, they may experience changes in family composition, health status, and financial situation that may impact their housing needs. Older people may need more accessible housing that is responsive to their lifestyle and needs.
Having to climbing stairs in multi-story buildings may be taxing for older people, who often have reduced mobility, and other people with reduced mobility. Using stairs can increase the risk of falling and limit social activities, which undermines people’s quality of life. Such residential environments can also increase care personnel’s and service providers’ burdens, for example home nurses and paramedics.
Elevators in multi-story buildings are one practical mobility support for older people. They can enable older people to remain in their homes longer and ease the burden of the social welfare sector. Increased knowledge about the implications of elevators is important to promote high quality of life for the elderly and others with reduced mobility and to allocate scare resources judiciously.
We aimed to conduct a systematic review of the effects of post-installation of elevators in older multi-story buildings. After having considered all references identified in the literature search, we found no controlled studies about the effects of post-installation of elevators. In accordance with the project protocol we therefore conducted a systematic mapping review of all empirical research about the implications of elevators (influence of and experiences with elevators).
In February 2018, a research librarian searched for literature in social science databases. We also searched through reference lists and in grey literature (i.e. non-formal, commercial channels). Two independent reviewers screened all retrieved records. Our screening showed that there were no controlled studies on the effects of post-installation of elevators in multi-story buildings. In accordance with the review protocol, we conducted a systematic mapping review based on the same search, to give an overview of which research exists on the implications of elevators (influence and experience) for older people and others with reduced mobility.
We assessed relevance of all identified studies based on the following inclusion criteria:
Older people, defined as 65 years or older. People with reduced mobility. Users of municipal social welfare services. Other residents of multi-story buildings with unique needs, such as pregnant women and families with young children.
Access to elevator/lift in multi-story buildings.
All types of outcomes were of interest, but especially: Increased quality of life, financial savings (including, but not limited to home nursing care, primary healthcare services, specialized healthcare services and institutions), living in own home, independence, need for home care, need for nursing care home or hospice, time needed for home care services, falls (in stairs), safety, social participation and accessibility.
All relevant studies were of interest, regardless of language.
We included all empirical research irrespective of study design, as long as the study addressed the implications of elevators in multi-story buildings. We developed a data extraction sheet and extracted relevant data from each study, performed descriptive analyses, using frequencies and percent. We presented the results in text and tables.
We included six studies that addressed the implications of elevators in multi-story buildings. The participants in all of the studies, which were published in 1997 - 2017, were older people. All of the studies were quantitative observational studies (four cross sectional studies and two cohort studies) and they included in total 12,651 older people. The setting of the studies was China (two studies), Spain, Sweden, and the USA (two studies).
None of the studies had the same research objective, but five examined whether access to elevator was associated with various outcomes (events) in the elderly. The last study, from Sweden, examined differences between elderly who needed assistance operating the elevator, and those who did not need assistance.
Summary of main results from the included studies
The study by Jing and colleagues examined risk factors for falling among elderly in Beijing. The results showed that having an elevator in one’s building was associated with lower risk of experiencing one fall in the last year.
Kwon and colleagues conducted a study among older people in the USA. They found that compared with older people who did not have an elevator, the ones who did have an elevator reported greater residential satisfaction with the multifamily community, fewer reported intention to move, but they did not have greater residential satisfaction with the unit design.
The study from Sweden compared older people who needed assistance operating the elevator, and those who did not need assistance. The results showed that there were some differences between these two groups with respect to activities such as moving around inside and outside the residence, and grocery shopping.
Niu and colleagues’ study from China found that among the elderly who did not have access to an elevator, compared to the ones who did, more participated only in activities inside their home, fewer participated in activities outside their residence, and more had a strong wish to engage in activities outside their residence.
Safran-Norton and colleagues conducted a retrospective cohort study in the USA to examine factors in the physical home environment associated with housing transition. They found that more older people without an elevator, compared with people who had an elevator, changed residence within a two-year period (but this applied only to couple households, not single households).
The last of the six studies, by Zuluaga and colleagues, was a prospective cohort study from Spain. It showed that not having an elevator was associated with mortality among older people previously hospitalized for heart failure.
With six observational studies included, despite wide inclusion criteria and no limitations concerning country or publication year, it is clear that the implications of elevators has low interest among researchers. However, with five of six studies published in the last ten years, there may be an increase in interest in this topic.
The majority of the results in the six studies support the importance of elevators in high-rise buildings with older residents. Based on the study results, it is, not surprisingly, fair to assume that residing in buildings equipped with an elevator is beneficial for older people. The results of the studies indicate that for older people, having access to an elevator can be associated with lower risk of falls and mortality, as well as residential satisfaction and both intention to move and actual housing transition.
Overall, the results in the six studies support the supposition that access to an elevator is an important intervention for older people to remain in their homes longer, but there is a scarcity of robust documentation on the implications of elevators in multi-story buildings.