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Contents

Aging In Place: Overview

The elderly population has been increasing and will continue to increase over the next few decades[1]. People are living much longer now and the ‘baby boomers’ are starting to become part of the elderly population[2]. ‘By 2030, one out of every five residents will be over the age of 60’[1]. The increase in the elderly population is going to push communities to make changes to accommodate this shift in population, some examples are changes to housing, transportation, community resources, care in the home, and the community lay out[1]. The importance of where these men and women will age has become a very important topic. The majority of people over the age of 65 years are still living in the community in their own homes and not in long term care facilities[3]. Research has been conducted around the differences between aging at home in comparison to aging in a supportive care facility, some advantages and disadvantages have been found for both settings. It is widely known that these men and women do prefer to stay in the home as long as they can, this is known as ‘aging in place’[4]. ‘Aging in place is a process of individuals growing older in their own homes or community without moving out to another residential setting’[2]. The popularity around the concept of aging in place is becoming very important to many individuals and families. Decisions and plans have to be made with the aging person to their wishes where they would like to age as well as to the ability they have to support themselves in the home. The elderly want to stay in their homes for many different and arguable reasons.


Positives to aging in place… • Comfort/Familiarity/Routines • Privacy • Independence • Control over their own lives • Less financial cost • Positive psychosocial benefits


Some reasons for staying in the home to age is that the comfort level that they have within their own homes is usually very established as they more than likely have been living there for many years[3]. They are comfortable in their own homes, they have made their home to what suits them, they have routines that they follow, and they are familiar with their surroundings[3]. They have an attachment to the items they have in their homes, they possibly have collected items throughout their life and now sit in their home to be constant reminders of what they have accomplished or completed in their life, it is their personal identity[3] [5]. They have their own privacy and they can be seen as independent[1] [5]. As well the communities they live are very important to them and provide many benefits to their ability to stay in the home[3]. This option can also be more cost effective for the family to allow the person to stay in the home and if needed implement services in the home to help that individual[5].Social support in the home and community increases the likelihood of the person staying in the home[2]. Specifically, family support, community support, good housing, social interactions are all very important to promote the opportunity for that person to stay in the home longer[4][2].



Negatives to aging in long term facilities… • No longer independent • Depression/Loss of friend and family connections • Not able to or used to change • Loss of control • Long term care is not appealing • Loss of personal space • Loss of privacy


There are major concerns in terms of overall health, well being and life satisfaction when it comes to the elderly moving out of the home into long term care facilities. If these men and women move out of the home to age in a supportive care facility, some may believe that there is a stigma attached to that, and that they are giving up, they are unable to care for themselves, so essentially they may feel that they are not independent any longer. This loss of independence can create many problems for these individuals. Some research has pointed out that people who are relocated in late life may develop depression, increased dependency and dislocation from friends and family . Many of these people are not fond of change; the thought of change is not appealing to these individuals . They may see this move as the transition from independent to dependent as a lot of decisions are now taken away from them. They loose control over aspects of their lives for example when they take their medication, what they eat, and activities they may participate in. Another issue with aging outside of the home is the long term care facilities in their community may not be very appealing, they have to adjust to a much smaller area, for example they go from a home and must downsize to a room or even sometimes a shared room . They also loose their privacy, as they may now share sleeping, eating and social areas with many other people.

The long term care facility is essentially a newer concept and still needs to be developed to suit the needs of the elderly population. It was common for the family to care for the elderly population in the home but now western society is getting further away from this concept and depending more on long term care facilities to care for the aging population.


Some Useful Links

Seniors Info: A Collaborative Online Resource

Local Health Integration Network: Aging at Home Strategy

Aging in Place: The Home

As the population ages new issues are coming to our attention. As such, we must develop plans to deal with the potential problems which may result. One of the trending movements in the aging communities is aging at home. Research as shown that the number one reason behind the aging populating wishing to remain in the home is to maintain the maximum level of independence they can, for as long as they can [6]. It has been stated that as a person ages and passes various milestones, their location needs change. As an older adult is entering a new period in their life, they will face changes with their needs at home. [6] These changes can be influenced by emotional attachment to the home structure, any necessary homecare that may be needed, finances and the structural layout of the home.


Emotional Attachment


There are three different terms that can all be used when discussing a place someone lives, there is a house, which is the objective space, a home which refers to the emotional attachment to the building and a dwelling, simply referring to a comfortable space [7]. The importance of a house during older age can come down to the emotional attachment to the building, their home. At all ages, having a place to call home is important, somewhere familiar, and safe place that you can return to at the end of the day. The home can hold place to a person's sense of identity, self-expression and belongingness [7] and may even contribute to positive health benefits [8]. The importance of a home does not change as individuals age. Aging in place can provide the aging individual the opportunity to feel a sense of protection against determination as they age, may boost their esteem and can add to their sense of independence [7]. Researchers believe that by aging in the home, the elder will age in a healthier environment, by knowing the environment, having a social network and a sense of belonging the home environment will provide positive emotions and support while the individual ages and may need more support than they did when they were younger [9]. While the world around them is changing, and their bodies are not working quite as well as they did when they were younger, a familiar home can provide the comfort and support an aging individual needs in their lives.


In-home care and finances

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It is inevitable, that if an individual remains in their home for long enough, that they will at some point need some assistance in their living, whether it be for a short-time, or more long-term, it is an issue that must be addressed. Not only must the individuals find the in-home support necessary, they must also find a way to pay for the added care.

There are broad variations when considering what help may be needed to an aging individual, however when deciding if aging at home is the right option, one must explore all possibilities. Care that one can receive at home can range from someone coming in to take care of housework, to someone coming in to help with daily activities, such as hygiene, transportation, control medications etc. Or, the individual maybe in such poor health that a 24-hour nursing service is required [8]. If an individual does enough research, resources are available to help the aging community in all stages of aging [10]. For someone aging at home, it is highly likely that they will need to look into seeking some assistance while living in the home [8].

However, with such intensive help, comes expensive costs. Currently, the older population spends a larger portion of their income on fuel and food when compared to any other age group, demonstrating that money can be tighter [8]. This is likely a due to the fact that much of the older population depends on pensions and many are facing a new way of living, as their spouses pass away [8]. In an attempt to help with the financial strains that many elderly face, the Ontario government has developed a new "aging at home strategy" which will include more that $700 million in funding throughout the provinces with various health networks to aid seniors who are aging at home [10].

Structural changes in the house


Knowing that many older individuals are looking to stay at home, while acknowledging that declining health and mobility likely results in structural changes being necessary for the home in order for the individual to live comfortably [11]. There are some guidelines and standards set in place to make homes as accessible as possible. These guidelines include accessibility, ease of movement indoors and between levels, easy toileting and bathing as well as a controllable environment [9]. In addition to structural changes, moderate changes to the house can be developed through a chairlift to provide mobility throughout floors, the inclusion of a walk-in shower and more. The list of amenities available to those with disabilities is endless. These structural guidelines are put in place to ensure that seniors will have proper mobility and independence within their own houses for as long as possible [11].

Healthy and Happy Aging in Place: The Community

There are many factors within a community that need to be present for successful aging in place. Unlike many of the factors in the home, factors in the community are not as easily changed or controlled by the seniors that are affected by them. All of these dynamic and intertwined factors can contribute in some way to the physical and/or mental health of seniors aging in place, but can also be barriers depending on the community in which they live and the programs that are in place.


The Social Nature of Neighbourhoods

Much of the literature on aging in place references the utmost importance of creating and maintaining a reciprocal social network.[12] In truly reciprocal social relationships people need to feel a sense that both they and the other person are contributing to the relationship. Both people need to contribute to the social (phone calls and conversations) and care (shopping, household chores or yard work) exchanges that characterize our relationships. These are key to the relationships of seniors aging in place.

Although neighbourhoods are usually considered in a purely physical way, they are really very important social contexts.[13] These physical spaces provide key opportunities for seniors to create and maintain those key social relationships outside those of their families and/or immediate caregivers.[13] These can be important relationships because they can bring real satisfaction to seniors while expanding their social networks, and help them feel comfortable and safe in their home communities. Membership in a community is paramount to the health of seniors aging in place. It is a process of acting together to accomplish goals, identifying common interests and building relationships.[14]
The outdoor spaces on and around the properties of seniors, such as porches, back yards, and sidewalks, can provide easy access to conversations with neighbours, who can be key resources and provide social relationships for seniors.[13] Some seniors baby sit for younger couples with children on the street, or give advice and help in situations where they have experience, and in return are invited for meals, and offered help with yard work, shopping and household chores. There is also an opportunity to develop relationships with other seniors in the community.[12] This can be especially beneficial to both parties, as they can more easily understand the help that someone aging may need, and they have more time to spend as a social contact than other neighbours.

Favourite small grocery stores, butcher shops, fruit stands, local cafés, farmers markets and parks can also be key places where seniors develop relationships, not just with the other people who regularly use these spaces, but with the staff of the area as well. Such spaces providing a ‘home away from home’ where seniors feel comfortable spending time.[13] These can be important places to feel independent, as they do their shopping, have coffee and visit with other locals to hear the latest news and discuss the ins and outs of daily life. They are also provided an opportunity to stay physically active while shopping, walking and visiting their favourite local spots.[13]


Community Access and Safety

While these areas can provide significant benefit to seniors, in many communities seniors are having trouble accessing these local resources and businesses, even within their own close neighbourhoods. The main barriers are safety and accessibility and that can affect many factors of living for seniors, such as transportation, and physical exercise.[15]
With many aging seniors unable to drive the options for transportation begin to dwindle.[15] Many older seniors are not comfortable using public transportation as it can be difficult and unsafe getting on and off busses, subways and street cars if you have a mobility issue or are a little unsteady on your feet.[16] This leaves the options of taking cabs to every outing, appointment and shopping excursion, which can become prohibitively expensive, or taking local volunteer transportation often offered to seniors, which can be limiting, as they mostly cover the essential services such as doctors appointments, and not much else.[16]

Walking, as both a mode of transportation and exercise can be unsafe if the sidewalks are broken, uneven, or in some rural areas non-existent.[16][15] Some seniors who do not live right in city centers may not attempt to walk if they believe it is too far, if they tire easily, or believe it is unsafe.[15] Also, in city centers with traffic lights that change quickly, and where people drive aggressively, seniors can be at higher risk for traffic related injury. Hearing or sight impaired seniors are at particular risk because not hearing traffic, or not being able to see crossing signals change can put them at extra risk for injury.[16]


What We Can Do

As our population ages, cities will need to begin to consider some of these issues that affect the well being of seniors. Some municipalities have begun to do so with maps of services, green spaces and health care facilities provided to seniors, with improvements to infrastructure, and even with beginning to talk about what changes need to be made, consulting seniors in the process. Urban planning could be reinvented to make the design for transportation, infrastructure and green spaces friendlier to seniors aging in place.[17] Seniors can also find internet sites giving advice about planning for aging at home (community resources).

Notes and References

  1. ↑ 1.0 1.1 1.2 1.3 Keyes, L., Rader, C., & Berger. C. (2011). Creating Communities: Atlanta’s Lifelong Community Initiative. Physical & Occupational Therapy In Geriatrics, 29(1), 59-74.
  2. ↑ 2.0 2.1 2.2 2.3 Tang, F. & Lee, T. (2011). Social support networks and expectations for aging in place and moving. Research on Aging, 33(4), 444-464.
  3. ↑ 3.0 3.1 3.2 3.3 3.4 Oswald. F., Jopp. D., Rott, C., & Wahl. H. (2010). Is aging in place a resource for or risk to life satisfaction? The Gerontologist, 51(2), 238-250.
  4. ↑ 4.0 4.1 Jorgensen. D., Arksey. H., Parsons. M., Senior. H., & Thomas, D. (2009). Who do older people in New Zealand enter residential car rather than choosing to remain at home and who makes that decision? Ageing Int. 34, 15-32.
  5. ↑ 5.0 5.1 5.2 McDermott, S., Linahan, K. & Squires, B. (2009). Older people living in squalor: Ethical and practical dilemmas. Australian Social Work. 62(2), 245-257.
  6. ↑ 6.0 6.1 Van Wezemael, J.E., Gilroy, R. (2007). The significance of demographic change in the swiss approach to private rented housing: A potential for ageing in place. Housing Studies, 22(4), 597-614. doi:10.1080/02673030701387713
  7. ↑ 7.0 7.1 7.2 Cristoforetti, A., Gennai, F., & Rodeschini, G. (2011). Home sweet home: The emotional construction of places. Journal of Aging Studies, 25, 225-232. doi: 10.1016/j.jaging.2011.03.006
  8. ↑ 8.0 8.1 8.2 8.3 8.4 Rolls, L., Seymour, J.E., Froggatt, K.A., & Hanratty, B. (2010). Older people living alone at the end of life in the UK: Research and policy challenges. Palliative Medicine, 25(6), 650-657. doi:10.1177/0269216310373165
  9. ↑ 9.0 9.1 Bevan, M. (2009). Planning for an ageing population in rural england: The place of housing design. Planning, Practice & Research, 24(2), 233-249. doi: 10.1080/026974509028277386
  10. ↑ 10.0 10.1 Ontario ministry of health and long-term care: Ontario's aging at home strategy. Retrieved October 29, 2011, from http://www.health.gov.on.ca/english/public/program/ltc/33_ontario_strategy.html
  11. ↑ 11.0 11.1 Johansson, J., Lilja, M., Pettersson, I. & Borell, L. (2007). Performance of activities of daily living in a sample of applicants for home modification services. Scandinavian Journal of Occupational Therapy, 14, 44-53. doi: 10.1080/110381200601094997
  12. ↑ 12.0 12.1 Riche, Y., & Mackay, W. (2010). PeerCare: Supporting awareness of rhythms and routines for better aging in place. Comupter Supported Cooperative Work, 19, 73-104. doi 10.1007/s10606-009-9105-z
  13. ↑ 13.0 13.1 13.2 13.3 13.4 Gardner, P.J. (2011). Natural neighborhood networks – Important social networks in the lives of older adults aging in place. Journal of Aging Studies, 25, 263-271. doi:10.1016/j.jaging.2011.03.007
  14. ↑ Bookman, A. (2008). Innovative models of aging in place: Transforming our communities for an aging population. Community, Work and Family, 11(4), 419-438. doi: 10.1080/13668800802362334
  15. ↑ 15.0 15.1 15.2 15.3 Dye, C.J., Willoughby, D.F., & Battisto, D.G. (2010): Advice from rural elders: What it takes to age in place. Educational Gerontology, 37(1), 74-93. DOI: 10.1080/03601277.2010.515889
  16. ↑ 16.0 16.1 16.2 16.3 Chippendale, T.L., & Bear-Lehman, J. (2010). Enabling “aging in place” for urban dwelling seniors: An adaptive or remedial approach? Physical and Occupational Therapy in Geriatrics, 28(1), 57-62. doi: 10.3109/02703180903381078
  17. ↑ Vrkljan, B.H., Leuty, V., & Law, M. (2011). Aging-in-place: Exploring the transactional relationship between habitats and participating in a community context. Occupation, Participation and Health, 31(3), 151-160
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