The COURAGE in Europe Built Environment Instrument is developed to assess how built-environment characteristics influence health, functioning, accessibility, and disability among ageing populations. It is designed to combine objective observation with individuals’ perceptions of their environment and to support comparisons across countries and populations.
The preliminary instrument includes two components. The outdoor checklist contains 51 items covering streetscapes, walkways, crossings, parking, public facilities, land use, environmental deterioration and street activity. The self-reported questionnaire contains 27 items organized into neighborhood environment, public buildings and facilities and the living place or home.
The instrument is relevant to older adults and people with or without disabilities because it examines environmental barriers and facilitators affecting mobility, safety, accessibility and participation. It is primarily a broad built-environment assessment and should be supplemented with a detailed home-based functional or fall-risk assessment when evaluating individual housing needs.
Health status and risk factors Disability, Functional decline, Fall risk
Age group Adults, Older Adults
Assessor Trained assessors
Sections / items 27 items
Self-administered Yes
Multi-component Self-report and observer questionaire
Indicators Outdoor built environment; neighbourhood environment; home environment
Evidence Level 4 - Cohort study
Authors Quintas, R., Koutsogeorgou, E., Raggi, A., Bucciarelli, P., Cerniauskaite, M., & Leonardi, M.
Organizations Scientific Directorate, Neurological Institute Carlo Besta, Milan, Italy, as part of the Collaborative Research on Ageing in Europe (COURAGE in Europe) Project, funded by the European Commission’s Seventh Framework Programme.
Publication date 2012
Quintas, R., Koutsogeorgou, E., Raggi, A., Bucciarelli, P., Cerniauskaite, M., & Leonardi, M. (2012). The selection of items for the preliminary version of the COURAGE in Europe built environment instrument. Maturitas, 71(2), 147-153. https://doi.org/10.1016/j.maturitas.2011.11.014
Raggi, A., Quintas, R., Bucciarelli, P., Franco, M. G., Andreotti, A., Miret, M., Zawisza, K., Olaya, B., Chatterji, S., Sainio, P., Frisoni, G. B., Martinuzzi, A., Minicuci, N., Power, M., & Leonardi, M. (2013). Validation of the COURAGE Built Environment Self-Reported Questionnaire. Clinical Psychology & Psychotherapy, 20(5), 215-226. https://doi.org/10.1002/cpp.1859
Zawisza, K., Gajdzica, M., Raggi, A., & Tobiasz-Adamczyk, B. (2025). The impact of slow mobility and built environment characteristics on 12.5-year all-cause mortality among older women and men: A prospective cohort study from Poland. SSM – Population Health, 31, 101841. https://doi.org/10.1016/j.ssmph.2025.101841