Knowledge about the evidence of environmental adaptations is emerging. There are several different data sources that support this approach. First, large-scale epidemiologic research consistently shows a relationship between increasing frailty and use of adaptations, suggesting that this is one of the preferred and effective approaches for compensating for physical and possibly cognitive declines (Manton et al. 1997). Similarly, studies using population-based samples have shown that use of special equipment is associated with enhanced self-efficacy , whereas reliance on help is not (Verbrugge et al. 1997). Another source of supportive evidence for this approach is from randomized clinical trials with family caregivers and frail elders in which environmental supports are one of the treatment components. While there are few of these studies, they consistently show positive treatment outcomes including reduced falls in fall-risk elders (Cumming et al. 1999), enhanced functioning (Gitlin et al. 2006b; Mann et al. 1999; Szanton et al. 2011), reduced fear of falling, reduced risk of mortality (Gitlin et al. 2006a; Gitlin et al. 2009), and enhanced caregiver self-efficacy and the dementia patients’ quality of life (Gitlin et al. 2003). As environmental adaptations tend to be embedded in multicomponent interventions, it is difficult to tease out the specific effects of any one adaptation on a particular behavior or health outcome. Nevertheless, there is a growing consensus that environmental adaptations are an important component of multifactorial approaches to address the complex consequences of chronic illness and to prevent falls.

Environmental adaptations mitigate impairment and disability by reducing the press in the environment or demands that exceed a person’s capabilities. Of importance is that adaptations be designed to enable an individual to continue participation in valued occupations.

Existing environmental adaptation services have several limitations that must be noted. First, in many countries, and particularly the USA, there is a lack of funding and necessary supports for the delivery of this therapeutic approach. Existing community-based programs typically have restrictive eligibility requirements or programs are specific to a region, not widely available, or are limited in scope with monetary caps or restrictions on the types of environmental modifications that are available. Second, there is the lack of awareness among consumers and health professionals as to the importance of involving OTs in the assessment and training process for such adaptations. As a skilled intervention, OTs have the requisite knowledge and skill for matching persons and environments with adaptive strategies. Third, this approach requires not only an assessment by an OT but also follow-up training. Often, training and follow-up are not provided due to agency budgetary considerations. Fourth, limited research is available on environmental configurations and person–environment fit specifics that might be more amenable to one versus another environmental approach so that OTs must depend upon their own experiences and the collective wisdom of the field. Finally, the evidence is mixed as to whether environmental adaptations prevent falls in and of themselves, whereas there is stronger evidence of its benefits for reducing functional difficulties and enhancing the ability to engage in valued occupations (Mann et al. 1999; Wahl et al. 2009).