Not ageing in place: Negotiating meanings of residency in age-related housing

THE ROLES OF GOVERNANCE IN PROVIDING STRATA HOUSING FOR AGING IN PLACE

Ageing in place in strata housing is becoming an aspiration among the elderly in Malaysia, especially in Klang Valley. Accordingly, multiple stakeholders have different roles in providing strata housing for the elderly to age in place. By using thematic analysis, the qualitative analysis analyses their roles in providing strata housing for the elderly to age in place, from different points of view. Fifteen stakeholders from multiple disciplines took part in the interview. Analysis of the interview identified 3 major themes. These themes were Planning, Approvals and Passion. These themes evidenced the importance of stakeholders’ roles in strata housing attributes for the elderly to age in place. Explicitly, they demonstrated greater awareness of the importance of strata housing attributes for ageing in place. This research paper demonstrated that states and local governments, as well as private sectors, are preparing for the rapid ageing of the Malaysian population. With this shared understanding, states and local governments, as well as private sectors, can better support those who aim to age in place in strata housing.

Residing in communal senior housing: situating the ageing self within debates of the universal welfare state

Currently, Nordic welfare societies are at a crossroads. Ongoing demographic changes – such as ageing, accompanied by challenges in financing adequate services for all – have highlighted the need to consider the roles of citizens and the state in a novel way. Balancing rights and responsibilities has always been at the core of universalism, even though, traditionally, trust in the welfare state's ability to fulfil its basic function of providing necessary services for all has been strong. However, of late, subtle signs of change have become more visible, and in practice, older people's housing and care provisions have been marked by the state's withdrawal. By employing narrative analysis, this study explores, through the experiences of residents in age-related intermediate housing, how older people make use of, negotiate and embed the arguments being made in societal debates on the rights and responsibilities of ageing citizens. The accounts showcase the ways in which these narrators are able to accommodate the sometimes contradictory elements in their narration, accept the demand for increased responsibility for their later-life arrangements and construct plausible portraits of themselves as morally responsible citizens. These subtle negotiations and the acceptance of personal responsibility indicate a change in their perceptions of and expectations from the citizens and the state. Whilst the findings comprise stories of good outcomes, they also question the legitimacy of the current welfare system's universalism and its ability to guide the way to achieve equally good outcomes for all in the future.

Defining Your "Life Territory": The Meaning of Place and Home for Community Dwellers and Nursing Home Residents-A Qualitative Study in Four European Countries

The meaning of place and home for community dwellers and nursing home residents remains unclear. We explored the relationship between older people and their “life territory”, to propose a working definition of this concept, which could be used to orient policy decisions. Individual, semi-structured interviews were performed with older people, nursing home staff, and representatives of local institutions/elected officials in four European countries (France, Belgium, Germany, Italy). Interviews were transcribed and analysed using thematic analysis. In total, 54 interviews were performed. Five main themes emerged: (i) working definition of “your life territory” (a multidimensional concept covering individual and collective aspects); (ii) importance of the built environment (e.g., public transport, sidewalks, benches, access ramps); (iii) interactions between nursing homes and the outside community (specifically the need to maintain interactions with the local community); (iv) a sense of integration (dependent on social contacts, seniority in the area, perceived self-utility); and (v) the use of new technologies (to promote integration, social contacts and access to culture). This study found that the “life territory” of older people is a multidimensional concept, centred around five main domains, which together contribute to integrating older people into the fibre of their community.

Cross-National Perspectives on Ageing and Place: Implications for Age-Friendly Cities and Communities

BACKGROUND AND OBJECTIVES

The age-friendly cities and communities (AFCC) agenda has led to a range of policy initiatives aimed at supporting ageing-in-place for older people. Whilst there is case study evidence of how people age across urban contexts, there has been little research exploring cross-national understandings of age-friendly places amongst older people. The objective of this paper is to identify the place experiences of older people living across cities and communities in India, Brazil and the UK and to discuss implications for the AFCC agenda.

RESEARCH DESIGN AND METHODS

A total of 300 semi-structured interviews were undertaken with older people across nine cities and 27 communities in India, Brazil and the UK. The data was analysed using thematic analysis undertaken by each national team and then discussed and revised at collaborative workshops with researchers from each of the three country teams.

RESULTS

The data captures the ways in which place is constructed from the perspective of older people drawing upon social, community and cultural dimensions of ageing across diverse urban environments. We explore how older people negotiate place in the context of their everyday life and identify the relational and interconnected ways in which place attachment, belonging and identity is constructed.

DISCUSSION AND IMPLICATIONS

Age-friendly interventions need to attend to the changing physical, social and cultural dimensions of ageing and place. Integrated place-making practices are required to support older people to age in the right place across rapidly transforming urban contexts globally.

"Human Flourishing with Dignity": A Meta-Ethnography of the Meaning of Gardens for Elderly in Nursing Homes and Residential Care Settings

This study aims to identify and synthesize qualitative research regarding residents' experiences of gardens while living in nursing homes and residential care facilities. To provide an optimal nursing environment inspired by nature, we need to derive knowledge from the residents' perspective. An interpretive meta-synthesis approach, a meta-ethnography, was chosen for this study. Altogether, six articles representing three continents and comprising 124 participants were included. The six articles that fulfilled the inclusion criteria were analyzed and synthesized according to Noblit & Hare's seven phases of meta-ethnography and the recent eMERGe guidelines. Four themes were identified: (1) The garden-a place to feel a connection with life, (2) the garden-a place to sense and find comfort, (3) the garden-a place to feel healthy and alive, and (4) the garden-a place to relate past and present. An overarching metaphor, "human flourishing with dignity," offers a deeper understanding of the meaning of the garden for older people in nursing homes and residential care. This meta-ethnography provides a reflective, systematic, data-driven synthesis based on literature spanning ten years. Rather than simply relying on retelling, the narration of experiences according to the primary researcher's descriptions and interpretations results in new knowledge. The significance of gardens for older people's health and well-being needs to be given greater attention and space in nursing practice, education, and health policies.

My home in later life: A phenomenographic study of older adults' experience of home

Home environments are especially important for older adults whose lives are more home-based than earlier life stages. Despite a focus on ageing in place, there often remains a mismatch between housing options prioritised by government and industry, and the needs and preferences of older adults. This paper considers the breadth of home environments experienced by diverse older Australians and highlights the varied ways they use and think about their homes. Data from three national online focus groups (n1 = 33, n2 = 37, n3 = 33) with people aged 50-92 were analysed using phenomenographic approaches to explore the different ways older adults perceived their home environments, resulting in four hierarchical conceptions. People displayed vastly different lifetime housing pathways (Clapham, 2005), leading to diverse perceptions about the place and experience of home in their later lives. In assessing the suitability of their housing, older people considered a large number of household members: current, expected or desired co-residents; transitory, short, medium and long-term residents; near and extended family, friends and dependents. This has important implications for policy and design responses on older adult's homes, which are typically focussed on occupancy by one or two individuals. To avoid assumptions about household makeup and usage based solely on the chronological age of residents, the perspective of older adults must be embraced in designing their future housing.

Ageing in place processes in the neighbourhood environment: a proposed conceptual framework from a capability approach

The concept of "ageing in place" has become increasingly significant in the environmental gerontology literature. Despite its predominance, there have been limited efforts to offer a more comprehensive and nuanced conceptualization of this topic. Definitions found in the literature are often too simplistic and only partially capture the various aspects of older adults' experience while ageing in place. This paper presents a conceptual framework on ageing in place in the context of neighbourhood environment which aims to address this gap by proposing a multi-faceted understanding of ageing in place processes through the lenses of a capability approach, a more comprehensive definition of the concept, and related overarching principles. Building on predominant theories in environmental gerontology, this conceptual framework offers new insights into the interactions between "place" and the "ageing individual". It is meant to offer opportunities for discussion, to suggest new paths of inquiry, and to explore implications for policy and practice.

Experiences in the Decision-Making Regarding the Place of Care of the Elderly: A Systematic Review

The objective of this review was to understand how participants experience the decision-making process regarding the place of care for the elderly. Therefore, we conducted a systematic review of qualitative studies. The articles were included if they were original studies with qualitative/mixed methodology, written in English/Spanish, and that approached the decision-making process regarding the place of care for the elderly, already experienced by the participants. Forty-four articles were included, identifying experiences, both negative and positive. Negative experiences have been the most frequently reported experiences by all population groups; fear was the most relevant experience for the elderly, whereas concern was the most relevant for family members and professionals. This review has not only found a great variability of experiences, but also, it has deepened the differences between groups and the situations motivating/generating these experiences. This review highlights a wide range of experiences of those directly involved in the entire decision-making process on the place of care for the elderly. In future research it would be interesting to carry out qualitative primary studies conducted with professionals and other relevant people involved in this decision-making process, in order to know first-hand how they experience this process.

Reasons for the Place of Care of the Elders: A Systematic Review

BACKGROUND

Relocation is a very important event in people's lives in general, but really significant in old age. However, some predictors of relocation still need to be improved. The objective of this review was to synthesize qualitative evidence to understand the reasons of the participants to decide on the place of care of the older people.

METHODS

Systematic review of qualitative studies was conducted in six databases: Scopus, SciELO, PubMed, PsycINFO, Web of Science and CINAHL, from its beginning until 29 November 2017. Qualitative or mixed studies, written in English or Spanish and addressing the decision-making process (already experienced by participants) on the place of care of older persons (65 years or older), were included in the review. PROSPERO (registration number: CRD42018084826).

RESULTS

A total of 46 articles were finally included in the analysis. Our main result is the distinction of multiple reasons for each population group involved in the decision-making process, ranking these reasons into three factors: Retention, pull and push.

CONCLUSION

This differentiation allows for a more detailed and in-depth analysis of the motivations of the different groups involved in this process.

The distance to death perceptions of older adults explain why they age in place: A theoretical examination

Older persons prefer to age in place or stay put in their current dwellings and move less frequently than any other age group. However, current residential mobility theories do not fully account for these preferences and behaviors because they focus on why older people move rather than on why they remain in their dwellings and do not consider the temporal or human developmental context of these residential decisions. It is essential to understand why older persons are reluctant to move because their ability to age successfully-have healthy, independent, active, and enjoyable lives-depends on where they live. When they stay put, they also rely more on family caregivers and paid home care providers to maintain their independence, rather than on the supportive services offered by senior group facilities, such as assisted living. They demand more home modification and financial service products, and their residential decisions influence the supply of housing that younger populations can potentially buy or rent. This paper's theoretical analysis proposes that Carstensen's socioemotional selectivity theory (SST), a lifespan theory of motivation, improves our understanding of why older persons age in place-either in their dwellings or more broadly in their communities. It offers an alternative interpretation of how life-changing events, such as retirement, lower incomes, spousal death, physical limitations, and health declines, influence their residential decisions. Whereas residential mobility theories view these transitions as disruptions that change the appropriateness or congruence of where older people live, SST proposes that older persons perceive these events as signs or cues that they are closer to death and must differently prioritize their goals and emotional experiences. Feeling their time is "running out," older persons are motivated to stay put because moving requires preparations that are physically and emotionally trying and they are able to adapt to their current housing shortcomings. Their residential environments are now also a source of difficult-to-replace positive emotions and provide them with a supportive network of intimate and reliable interpersonal relationships. It is challenging for them to learn how to safely and efficiently conduct their usual activities and routines in another location and to establish new residential attachments and social connections. They would benefit from any net positive emotional payoffs only in a distant future, an unattractive prospect when they perceive a limited time left to live. Empirical studies must test the theoretical propositions presented in this paper. However, the disproportionally large projected future growth of the age 75 and older population with a heightened awareness of their limited time left to live should be a strong rationale for such investigations.

Ageing in Urban Neighbourhoods: Exploring Place Insideness Amongst Older Adults in India, Brazil and the United Kingdom

The ageing in place agenda emphasises the importance of supporting older adults to age in their communities surrounded by the personal resources to age well. In exploring the relationship between older people and their environment, the concept of place insideness is seen as central to constructing feelings of identity, belonging and attachment in old age. Yet there has been little research exploring how older adults experience place insideness across different urban, social and cultural contexts which is an impediment to identifying effective interventions for age-friendly cities and communities. This article explores how place insideness is experienced amongst older adults across India, Brazil and the United Kingdom. The article presents qualitative findings from 294 semi-structured interviews collected across 9 cities and 27 neighbourhoods. The findings reveal that older adults cultivate their sense of place insideness in old age through dimensions of physical insideness (i.e., environmental competence in navigating and engaging in the community), social insideness (i.e., knowing others) and autobiographical insideness (i.e., shared place histories). In drawing on older people’s understanding of their communities, this article explores the opportunities and challenges in developing a sense of place insideness to support ageing well. We identify implications for policy and practice in terms of how we can better design urban environments as age-friendly communities which support a greater sense of place for older people.

When Frail Older People Relocate in Very Old Age, Who Makes the Decision?

Background and Objectives

Older people are likely to transition to a new home closer to family who can provide assistance or to long-term residential care as their health declines and their care needs increase. A minority choose to move to "age-friendly" housing before the onset of disability, but the majority prefer to "age in place" and defer moving until health crises compel a transition. Older people living with dementia are likely to move into residential care, but not much is known about the role they play in decision making around these moves. This qualitative study addresses this gap in knowledge by examining how a rare cohort of "older old" people, most with some level of cognitive impairment, were involved in decisions surrounding assistance seeking and moving to a care home.

Research Design and Methods

Thematic analysis of qualitative interview data from Cambridge City over-75s Cohort (CC75C) study participants aged 95 years and older, who had moved in later life, and their proxy informants (n = 26).

Results

Moves at such an old age were made due to a complexity of push and pull factors which had layered dynamics of decision making. In most cases (n = 22), decision making involved other people with varying degrees of decision ownership. Only four older people, who moved voluntarily, had full ownership of the decision to move. Many relatives reported being traumatized by events leading up to the move.

Discussion and Implications

"Older old" people are sometimes unable to make their own decisions about moving due to the urgency of health crisis and cognitive decline. There is a need to support relatives to discuss moving and housing options at timely junctures before health crises intervene in an effort to optimize older people's participation in decision making.

Housing Choices of Older People: Staying or Moving in the Case of High Care Needs

Despite the development of various housing options across Europe, older people often face the choice of staying at home with the support of family and/or formal services or moving to a care home, but how people vary regarding these preferences and how newer cohorts will be different is under-researched. This study explores the housing choices of older people under the condition of liminality, which is defined as the hypothetical condition of high care needs. The most common choices available are compared; that is, staying at home (with social home-care support or visits to a daycare centre) or moving to supported housing or a care home. Cluster analysis revealed five distinct groups of older people that were differentiated in their choices between various options of moving versus staying at home, either by using home care or daycare. Differences between the clusters along three dimensions that influence decisions to move or stay, namely levels of attachment, satisfaction with housing and availability of support, which often function as limits on the options that are preferred, were explored. The results present the complexity of the decision-making process under imagined conditions of liminality and show a great diversity among people’s preferences. They also indicate that a significant share of older people have a strong preference for only one option (two of the cluster groups).

Systematic review of qualitative studies on participants in the decision-making process about the location of care of the elderly

OBJECTIVES

To understand who are the participants in the decision-making process about the location of care of the elderly.

DESIGN

Systematic review of qualitative studies.

DATA SOURCES

The following databases were consulted: Web of Science, MEDLINE, Scopus, CINAHL, PsycINFO and SciELO (from the beginning until 29 November 2017). The bibliographical references in the studies that were finally included in the review were also searched.

STUDY SELECTION

The studies had to deal with the decision-making process (already experienced by the participants) on the location of care of the elderly (adults who are 65 or older), had to use a qualitative methodology and had to be written in English or Spanish.

DATA EXTRACTION AND SYNTHESIS

A data extraction tool was used. Data analysis was conducted through the constant comparative method from Glaser and Strauss' grounded theory.

RESULTS

46 studies were included in this review. Most of them were carried out in the USA, and in 21 of them the study population focused exclusively on the elderly. This review has found that there are many participants, with different roles and degrees of involvement, who may act jointly, separately or sequentially. These participants may be: the elders, family members, professionals and other relevant.

CONCLUSIONS

The main result of this review has been the variability found on how this decision is made, even varying the way of acting/perceiving the situation of the involved persons on certain occasions, simply due to the influence of some of the other groups of participants studied. Besides, this review has focused its results on the main participant in this process, the elders and how their family members interact with them when it comes to making this decision. This has allowed relevant results to be obtained about roles and degrees of involvement.

PROSPERO REGISTRATION NUMBER

CRD42018084826.

A logic of choice: Problematizing the documentary reality of Canadian aging in place policies

The home environment is pivotal in the lives of older people, intimately intertwined with one's sense of self and belonging. Aging in place (AIP), continuing to live in the same or familiar place or community for as long as possible not only fulfills a neoliberal and economic imperative but aligns with the wishes of a majority of older Canadians, who prefer to age in place. Despite policies' contributions to differing experiences of aging, the potential bearing of the narratives embedded within AIP or age-friendly policies remains unexamined. Within an institutional ethnography method of inquiry, this study applied Bacchi's "What's the Problem Represented to be?" (WPR) approach to structure the discovery of governing narratives about familial care work embedded within seven Canadian aging in place policies at the municipal, provincial, and federal level. I analyzed these policies for their role in coordinating the experiences of caring for an older adult who is aging in place in London, Canada's first age-friendly city. Of particular interest for this study is uncovering whether these texts recognize the work, and in particular the information work, of providing care to an older adult who is AIP. The policies' overall focus on self-reliance, independence, and resourcefulness frames aging in place as a process that can and should be responsibly managed. Information is introduced as a helpful tool to secure and preserve older adults' independence and usefulness to their community. The policies' problematizations frame successful aging in place as governed through a logic of choice, where a complex problem is framed as a matter of choice. Ultimately, however, while the policies offer a number of different "choices" for older adults to AIP, a critical unpacking of the problematizations reveals the choice to AIP to be illusory. There is only one option presented in the policies and that is to AIP.

The meaning of home for ageing women living alone: An evolutionary concept analysis

The concept of home to women ageing should be visited in the light of ongoing cultural, political, temporal and disciplinary evolutions. In part, to compliment policies increasing focus on supporting older adults to age in place and a growing attention on the home as a place where healthcare is designed and provided. The following concept analysis utilises Rodgers' evolutionary method to inductively analyse literature in order to elicit the meaning and experience of home among older women who are ageing at home. Literature was collected over an 18-month period during 2014-2015 and the sample was made up of 49 articles. The analysis led to the concept of home among women ageing in communities to be defined by four attributes. These attributes are home as (i) a resource, (ii) an attachment, (iii) the precariousness of maintaining and sustaining home and (iv) a cultural expectation. This analysis of the meaning and experience of home among women ageing at home has shed light on the needs for this group of women, while highlighting the need to continue to further clarify and define the concept through research.