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[edit] Aging In Place

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. Some examples will include, 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 critical topic. The majority of people over the age of 65 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, and some advantages and disadvantages have been found for both settings. It is widely known that men and women prefer to stay in their homes 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 as to their wishes of where they would like to age whether that be staying in the home or moving to a long term care facility. Throughout the decision process the cognitive abilities of that person needs to be looked at as well as their capability to stay in the home safely? There are a number of different reasons why the elderly want to stay in their homes.

As the population ages, new issues are coming to society's attention and a plan must be developed to deal with the potential problems which may result. One of the trending movements in the aging communities is aging at home [5]. Research has shown that the number one reason behind the aging population wishing to remain in the home is to maintain the maximum level of independence they can, for as long as they can [5]. It has been stated that as a person ages and passes various milestones, their location needs to be adjusted to fit their needs. [5] A number of factors can influence an older adults decision to age at home both positive aspects as well as potential challenges.

Positives of aging in place… • Comfort/Familiarity/Routines • Privacy • Independence • Control over their own lives • Less financial cost • Positive psychosocial benefits • Emotional Attachment• Social nature of the neighbourhood

One reason for staying in the home to age is that the comfort level that people have within their own homes is usually very established as they have likely been living there for many years[3]. They have made their home to reflect them as a person, their individuality. 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 have collected items throughout their life and these items now sit in their home to be constant reminder of what they have accomplished or where they have been in their life, it is their personal identity[3] [6]. They have their own privacy, and they can be seen as independent[1] [6]. As well, the communities they live in are very important to them and provide many benefits to their ability to stay in the home. Some examples being having friends and neighbours in the area for social interaction, and local stores, parks, recreation activities they are comfortable visiting, which all can increase their quality of life[3]. It 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[6].Social support in the home and community increases the likelihood of the person staying in the home[2]. Specifically,emotional attachment, family support, community support, and social interactions are all very important factors that allow a person to stay in the home longer[4][2].

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 which simply refers to the comfortable space [7]. The importance of a home during older age can come down to the emotional attachment to the building. The home can influence an individuals sense of identity, self-expression and belongingness, [7] and may even contribute to health benefits [8]. The importance of a home does not change as individuals age. Aging in place can provide the aging individual with the opportunity to feel a sense of protection against descrimination as they age, it 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 [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 aging individuals need in their lives.

In addition to the home, 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.

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.[10] 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 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.[11] 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.[11] 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.[12]
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.[11] 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.[10] 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.

Individuals develop relationships with the community, such as favourite small grocery stores, butcher shops, fruit stands, local cafés, farmers markets and parks. These locations 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.[11] 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.[11]

[edit] Challenges to Aging In Place

In-home care and finances

It is inevitable, that if an individual remains in their home for long enough, they will at some point need some assistance in their living. Whether this care occurs be for a short-time, or more long-term, it is an issue that must be addressed.

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 possible complications that may arise. 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, and assisting with medications. In some cases, the individual may be in such poor health that a 24-hour nursing service is required [8]. Not only must the individuals find the in-home support necessary, they must also find a way to pay for the added care. If an individual does enough research, resources are available to help the aging community in all stages of aging [13]. Currently, the older population spends a larger portion of their income on fuel and food when compared to other age groups, 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 [13].

Community Access and Safety

In many communities seniors are having trouble accessing local resources and businesses, even within their own close neighbourhoods. Seniors access to transportation and physical exercise can be affected by unsafe or unaccessible resources (sidewalks, buses, public parks) which can negatively affect their quality of life .[14]
With many aging seniors unable to drive, the options for transportation begin to dwindle.[14] 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 there is a mobility issue or unsteadiness.[15] This leaves the option of taking cabs to every outing, appointment and shopping excursion, which can become prohibitively expensive. Seniors sometimes have the option to take local volunteer transportation. This can be limiting, as they mostly cover driving for the essential services such as doctors appointments but not much else.[15]

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.[15][14] 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.[14] Also, in city centers with traffic lights that change quickly and where people drive aggressively, seniors can be at higher risk for traffic related injuries. 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.[15]

[edit] What Can We Do?

Structural changes in the house

As an individual ages,declining health and mobility becomes a reality. As such, structural changes to the home may be needed in order for the individual to live comfortably [16]. 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]. For instance, moderate changes to the house can be made by installing a chairlift to provide mobility between floors,or a walk-in shower to ease the bathing routine. 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 [16].

Changes to Infrastructure and Environment

As the population ages, individuals, governments and 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 by providing maps of services, green spaces and health care facilities to seniors. Also making necessary improvements to infrastructure, and consulting seniors about what changes need to be made. 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 that provide advice about planning for aging at home (community resources).

Negatives of aging in long term care 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 about overall health, well being and life satisfaction when it comes to the elderly moving out of their homes 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, or 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 on others for care and dislocation from friends and family [4]. 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 independance to dependance as a lot of decisions are now taken away from them. They loose control over aspects of their lives including 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. Traditionally, 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

[edit] 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 4.2 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 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
  6. 6.0 6.1 6.2 McDermott, S., Linahan, K. & Squires, B. (2009). Older people living in squalor: Ethical and practical dilemmas. Australian Social Work. 62(2), 245-257.
  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 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 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
  11. 11.0 11.1 11.2 11.3 11.4 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
  12. 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
  13. 13.0 13.1 Ontario ministry of health and long-term care: Ontario's aging at home strategy. Retrieved October 29, 2011, from
  14. 14.0 14.1 14.2 14.3 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
  15. 15.0 15.1 15.2 15.3 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
  16. 16.0 16.1 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
  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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