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

Immigrant Older Adults' Experiences of Aging in Place and Their Neighborhoods: A Qualitative Systematic Review

Engaging in one's neighborhood fosters independence, promotes social connectedness, improves quality of life, and increases life expectancy in older adults. There is a lack of evidence synthesis on immigrant older adults' neighborhood perceptions and experiences, essential for addressing neighborhood-level influences on aging in place. This study systematically synthesizes qualitative evidence on immigrant older adults' perceptions and experiences of their neighborhoods. A comprehensive search was conducted from inception to 5 April 2023, in multiple databases. This review considered studies including immigrant older adults aged ≥60 years, included studies from any country where the neighborhood was the focus, and only considered qualitative data while excluding review studies, theoretical publications, and protocols. Eligible studies were appraised using the JBI critical appraisal checklist for qualitative research. The Joanna Briggs Institute meta-aggregation approach was used to synthesize findings, and the ConQual approach established confidence in the synthesis. A total of 30 studies were included. Most studies were conducted in North America and explored phenomena such as aging in place, social capital, social cohesion, sense of community, and life satisfaction. Key contextual factors were walkable safe access to social spaces, accessible transportation to amenities, social cohesion with neighbors, and pre-migration neighborhood experiences. Immigrant older adults have varied experiences related to their sense of belonging and social cohesion. Factors such as racial discrimination, feeling unsafe, and social isolation contributed to negative perceptions. This review highlights the need for inclusive neighborhoods that align with the needs and values of immigrant older adults aging in place.

Place Attachment and Aging in Place: Preferences and Disruptions

This paper examines the links between place attachment and older persons' preferences to age in place, and factors that disrupt these preferences. We use data from the 2001-2021 Household, Income and Labour Dynamics in Australia Survey and panel-data modelling to confirm strong associations between several place attachment dimensions and aging-in-place preferences. Strong ties to children, strong social capital, residence in social housing, homeownership status, housing wealth, and home and neighborhood satisfaction are all positively linked to a stronger preference to age in place. Our findings reveal important differences between older homeowners and older non-owners. For owners, closeness to children is a strong predictor of aging-in-place preferences, although mortgage debt can trigger involuntary moves. For non-owners, tenure security achieved through longer durations at one's address of residence is linked to stronger aging-in-place preferences. However, private renters are more often exposed to involuntary moves. We discuss the policy implications of these disruptions.

Aging in Place Through the COVID-19 Pandemic: Perspectives from Aging Service Providers

Formal and informal networks of resources are critical to supporting the growing number of older adults aging in place (AIP). Data are needed from aging-service providers about assets and barriers that impact their abilities to support AIP during the pandemic, as well as emergent needs resulting from response measures. A series of World Café workshops were conducted with aging-service providers in Salt Lake City, Utah, to understand supportive factors, service gaps, and future needs. Novel domains to support AIP in the context of the pandemic were identified: digital access and literacy, social isolation and mental health, and emergency preparedness. Issues related to access, equity, and affordability were identified as overarching themes across domains. Issues reflect concern over how the pandemic exacerbated socioeconomic and cultural disparities impacting older adults who benefit from aging services. Networks of advocacy and support are needed to bolster resources for older adults, caregivers, and aging-service providers.

Factors of Parental Preparation of Children with Mental Illnesses for Their Independent Living after Their Own Death

Families of children with mental illnesses are often concerned about living in the community after their parents' death. The cross-sectional study aimed to examine the association between how parents prepare adult children with mental illnesses to live independently after the death of the parent(s). The participants were 1112 members of 46 family support groups for mental illnesses in Tokyo, Japan. The age of the people with mental illness was 40s, and that of their parents was 70s. Logistic regression analysis showed that mothers' support in daily living, no income or pension for disabled people, staying at home during free time, and parental livelihood being the same as the person with mental illness were factors that were negatively associated with the independent living of people with mental illness. In contrast, parental participation in the family group and creating a system for securing regular living expenses of the person with mental illness were positively associated with independent living. The results suggest that parents need to promote their children's recovery and prepare them financially by forecasting their independent living after their own death.

Being in Place: Toward a Situational Perspective on Care

An optimum focus in any care situation is creating and sustaining environments that facilitate an ongoing sense of "being in place" for all involved. Using this rationale, we propose a Situational Model of Care for exploring dynamic relationships among aging persons receiving care, the convoy of persons offering this care and support, and the place where this occurs, as evolving situations throughout the course of a disease. The model is grounded in extant literature and illustrated through a case study derived from in-home observations and interviews. Emphasizing an underlying goal of fostering a sense of being in place as a desirable outcome facilitates situationally nuanced directions in research and clinical care.

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.

Perceptions of community among suburban and urban-dwelling adults aging in place

Community is important for late-midlife adults, offering a sense of belonging and opportunities for social engagement during the transition to older age. The current study examines perceptions of community and geographical ties among a sample of older adults aging in place. Using data from the Foley Longitudinal Study of Adulthood (FLSA; N = 163; aged 61-64) and a qualitative GIS approach, major themes were categorized and mapped to create a comprehensive picture of how perceptions of community varied among respondents and neighborhoods. Core themes were connections to place, space, people, and relational benefits gained from community involvement. Residents of a suburban enclave more frequently noted connections to people as being important to community, compared to residents in more densely-populated areas. Implications for future research are discussed.

Healthy Aging-Relevant Goals: The Role of Person-Context Co-construction

OBJECTIVES

This article considers how individuals' motivation for healthy aging manifests within the myriad of different contexts that older adults are embedded in as they move through later life.

METHODS

Drawing on the concept of co-construction, we argue that persons and contexts both contribute to the emergence, maintenance, and disengagement from healthy aging relevant goals in adulthood and old age.

RESULTS

To promote the understanding of such co-constructive dynamics, we propose four conceptual refinements of previous healthy aging models. First, we outline various different, often multidirectional, ways in which persons and contexts conjointly contribute to how people set, pursue, and disengage from health goals. Second, we promote consideration of context as involving unique, shared, and interactive effects of socio-economic, social, physical, care/service, and technology dimensions. Third, we highlight how the relevance, utility, and nature of these context dimensions and their role in co-constructing health goals change as individuals move through the Third Age, the Fourth Age, and a terminal stages of life. Finally, we suggest that these conceptual refinements be linked to established (motivational) theories of lifespan development and aging.

DISCUSSIONS

In closing, we outline a set of research questions that promise to advance our understanding of the mechanisms by which contexts and aging persons co-construct healthy aging relevant goals and elaborate on the applied significance of this approach for common public health practices.

"They're not leaving their home; this is where they were born, this is where they will die.": Key Informant Perspectives From the U.S. Counties With the Greatest Concentration of the Oldest Old

The "oldest old," age 85 and older, constitute one of the fastest growing segments of the U.S. population. Yet, surprisingly little is known about the characteristics of U.S. counties with the highest percentage of the oldest old, nearly all of which are rural. We used qualitative analysis of key informant interviews (n = 50) with county commissioners and other county-level representatives from rural counties with the highest prevalence of the oldest old, targeting the 54 rural counties with ≥5% of the population age 85+. We found that the rural counties with the highest proportion of residents age 85+ face unique challenges to supporting successful aging among the oldest old, including resource constraints, limited services, isolated locations, and widespread service areas. Still, interviewees identified particular reasons why the oldest old remain in their counties, with many highlighting positive aspects of rural environments and community.

Profiles of Expectations Regarding Aging After Relocation to Assisted Living

This study classified assisted living (AL) residents by expectations for future physical, cognitive, and socioemotional health in later life. The authors analyzed cross-sectional data from 202 AL residents. Study participants completed the 12-item expectations regarding aging survey. A K-means cluster analysis identified three subgroups: "lower expectations" (n = 55), "higher expectations" (n = 70), and "expecting adaptiveness" (n = 77). Subgroups varied by select demographic, health, and relocation-related factors. Results suggest that, despite similarities in physical and cognitive functioning, AL residents reported different expectations for health. Socioemotional functioning may help explain observed discrepancies between current health and future health-related expectations.

Advanced old age as a developmental dilemma: An in-depth comparison of established fourth age conceptualizations

Distinguishing the Fourth Age (FoA) from the Third Age (ThA) has become a common practice in aging research. In this theoretical paper, we focus on four established conceptualizations of the ThA-FoA distinction, i.e., (1) Neugarten's work on the young-old vs. the old-old; (2) Laslett's concept of the innovative life period of the ThA; (3) Erikson's 9th life stage approach; and (4) Baltes' approach considering the FoA as the most radical incompleteness of the human condition. After a comparative descriptive analysis, we extract evaluative elements inherent in the four approaches according to six categories: (1) fundamental values; (2) positive evaluative elements; (3) negative evaluative elements; (4) the decline vs. growth view; (5) the continuity vs. discontinuity view; and (6) values related to practical issues. As an overarching result of our analysis, we conclude that all conceptions face - in different ways - dilemmas that seem difficult to solve. One option may be to give up all ambitions toward agency for the FoA and indeed qualify this phase as the "aging without agency" phase of life. Doing so, however, seems ethically questionable, because it would give up acknowledged values connected with a good human life such as human goal-directed autonomy and freedom. In conclusion, the ThA-FoA distinction, although arguably a needed and helpful roadmap for the recent decades of aging science, comes with enduring disadvantages and eventually even risks. Therefore, in future aging science, we recommend avoiding the ThA-FoA distinction or at least using it only in combination with a critical attitude.