Narratives of home and place: findings from the Housing and Independent Living Study

The Different Aspects of the Housing Quality of Older Adults: Which Criteria Should Be Prioritized?

Various studies have identified that older adults' assessment of their housing quality differs from that deemed as good-quality housing by housing professionals. This has prompted the need to advance academic discourse beyond simply reporting high levels of satisfaction in older adult's housing surveys. This study attempts to achieve this by using empirical data gathered through a mixed quantitative and qualitative research approach conducted with older adults in Slovenia. While the quantitative survey revealed generally high levels of satisfaction, the qualitative face-to-face interviews revealed numerous deficiencies, irrespective of whether older adults tended to express satisfaction with their dwellings. Therefore, our findings suggest that attributes such as ownership, period of residence, and neighborhood relations are far more important in determining housing satisfaction. Thus, we conclude that policies and programs for modifying housing for older adults must be based on a deeper understanding of their specific needs. During the policy formulation process and the implementation of specific housing improvement programs, emphasis should be placed on the social-historical aspects related to the lifestyle of each specific older adult.

Understanding home modification outcomes from the perspective of older people and people with a disability: informing home modification evaluation

PURPOSE

There is limited evidence to guide therapists in home modification outcome evaluation. Involving consumers in evaluating home modifications is critical to progressing practice. This study investigated the home modification experience and outcomes most valued by older adults and individuals with a disability in Australia.

MATERIALS AND METHODS

An interpretive description approach was used. Twenty participants aged 24-93 who had received major home modifications were interviewed and transcripts were analysed thematically.

RESULTS

Two major themes emerged: life before and during modifications - "it was all hard," and life after modifications - "to have a life." People's prior experience of home, the circumstance of and time to plan modifications, the perceived value of the modifications, and the home modification process and funding influenced perceptions of outcomes. Valued home modification outcomes included those that enable people to experience emotional and physical health, and safety; do what they want; maintain the image of the home; and plan for the future. Experiences and perceptions of modifications ranged from supportive to disruptive.

CONCLUSIONS

These findings point to the need for therapists to deeply understand and evaluate their clients' experiences of home and life as an initial and critical step in the home modification process.Implications for rehabilitationMajor home modifications result in broad and meaningful outcomes of importance to clients.Occupational therapists need to partner with clients to understand their life before and during modifications to achieve positive outcomes.Evaluation of major home modifications needs to be integrated and prioritised in daily practice.

Middle aged and older adult's perspectives of their own home environment: a review of qualitative studies and meta-synthesis

BACKGROUND

Most people prefer to remain in their homes and communities as long as possible. Staying at home is widely beneficial as ageing within the home promotes independence and costs less than residential aged care. Understanding meanings and drivers of remaining at home is an area of importance.

OBJECTIVE

The objective of this systematic review of qualitative studies was to synthesise middle and older aged adult's perspective of their home environment and determine the factors that are important when making decisions about future housing.

METHODS

This review and meta-synthesis was conducted in accordance with JBI (formally known as the Joanna Briggs Institute) methodology for systematic reviews of qualitative evidence. Meta-aggregation was used as the method of synthesis. Included qualitative studies involved middle and older aged adults and their views about ageing and housing. Published studies were identified in four electronic databases and grey literature. Critical appraisal and extraction were conducted using JBI tools and findings were categorised and synthesised into findings.

RESULTS

A total of 46 papers with 5183 participants on the concept of home were included. Most of the participants were older (> 65 years old) and the perspectives of middle-aged people were largely absent. Factors impacting on future housing decisions among individuals were identified. Seven synthesized findings emerged-independence, finances, stigma, attitudes towards ageing, attachments with home, aesthetics, and family connection.

CONCLUSION

Older people have a greater sense of independence and autonomy if they remain in their own home. Multiple external factors impacted on their perspectives including a sense of stigma about ageing, fear of being a burden to others and their own financial position which in some cases restricted their options. This review provides a comprehensive description of the different factors that need to be considered when planning future housing needs; both for individuals and for communities.

Exploring the place attachments of older migrants in Aotearoa: A life course history approach

Migrants are faced with the task of creating a sense of home in a new context. As migrants grow older in their host countries, they are also making important decisions on where to live out the rest of their lives, making salient the places they attach themselves to. Place attachment, and its subcomponents of place identity and place dependence, are concepts that have been explored in the ageing and migration literature, demonstrating that positive, emotional attachments to places are positively correlated with better health outcomes. Although it has been established that individuals' attachments to places are dynamic, multidimensional and change over the life course, there is a paucity of research exploring the place attachments of migrants as they age using a life course approach. This study adopted a life course approach to investigate how the components of place attachment shifted over time for migrant people in Aotearoa New Zealand as they aged, and to better understand the mechanisms and barriers to establishing a sense of home in a foreign land. We examined the narratives of ten older migrants (65 years or older) who migrated to Aotearoa before the age of 50. Key findings illustrated that all participants had strong place identities (i.e., explicit self-identification and sense of belonging) to their countries of origin before migrating to Aotearoa, all participants developed strong place dependence (i.e., fulfilment of functional needs) to Aotearoa over their life course, but not everyone was able to develop place identity to Aotearoa. Mechanisms such as language, cultural attitudes, and values can both facilitate and prevent attachments to either home or host country. These results uncover how Aotearoa's ageing migrants negotiate their attachments to places over the life course.

Healthy Lifetime (HL): An Internet-Based Behavioral Health Coaching Protocol for Older Adults

By 2060, the number of Americans 65 years and older will more than double, comprising nearly one-quarter of the population in the United States. While there are many advantages to living longer, a byproduct of aging is also a growing incidence of chronic illness and functional health limitations associated with a concurrent rise in chronic disease and disability that impair independent living in the community. We describe a personalized, behavioral health coaching protocol for early intervention that is delivered online to enhance a participant's independent functioning and to increase their self-care capacity with a goal to maintain independent living throughout aging. The electronic platform provides secure access to fillable surveys, health tracking, “just in time” communication with coaches and scheduling of two-way videos launched from the platform site. The 2-month protocol used two-way video conferencing which allowed high fidelity communication to sustain a complex behavioral intervention. Participants indicate high satisfaction with the intervention, the use of the platform, and the technology. While many health systems across the U.S. have ramped up virtual delivery of care in a proactive manner with now more than 70% of out-patient visits conducted through virtual delivery modes in some health systems, there remains much unevenness in this capability across the U.S. Our approach is to create a stable, interoperable, virtual outreach system for personalized professional health coaching that is complementary to medically oriented services that supports the health and functioning of participants as they age.

Residential reasoning: how childless older adults choose between ageing in place (AIP) and institutionalisation in rural China

The decision of whether to grow old in one's home (also referred to as ageing in place (AIP)) or relocating to an institution is an ongoing negotiation process, which involves residential decisions and adaptation. This research aims to explore how childless older adults in rural China choose between AIP and institutionalisation. Through a qualitative study conducted in rural China among childless older adults, we explored the reasons why they make certain residential choices and how they adapted during the decision process. Twenty-five childless participants (aged 60–83) were interviewed. Findings suggested that they referred to the term ku (literally meaning ‘bitterness’; and a metaphor referring to ‘conducting farming and farm-related activities’) to explain their residential decisions. If a person could endure ku – sustain food and basic living through farming and farm-related activities, they tended to choose to age in place; otherwise, they chose to relocate to institutions. Ku represents a sense of mastery, encompassing the stressfulness and suffering aspect that requires adaptation. Three adaptive strategies were identified: (a) positive reappraising of the negative aspect of ku, (b) routinising ku, and (c) transcending the narrative of ku into a toughness identity. Our findings suggest that childless older adults struggled to achieve residential mastery while making residential decisions, even though a sense of mastery was shaped by the individual and structural constrictions.

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.

Mobility-based disadvantage in older age: insecure housing and the risks of moving house

This paper develops knowledge of the logistics of moving house amongst older people living in insecure housing. These people typically do not move once and settle into a new house, but face ongoing moves driven by factors including housing affordability, tenure conditions and eviction. The paper identifies four domains of experience faced by people undergoing cumulative, involuntary residential moves: the material (process of relocating oneself and possessions), economic (costs of moving house), embodied (physical experience) and affective (how relocation is experienced and felt). The logistics of relocation are examined through the experiences of single older women living in insecure housing in the greater Sydney region of Australia. The accounts of these women foreground the costs and challenges of insecure housing that are a consequence of relocation. Conceptually this work contributes to understandings of mobility-based disadvantage in older age through drawing out the ways that the logistics of moving house – of relocating oneself and possessions – contribute in distinct ways to mobility-based disadvantage through risks to identity and senses of home. Empirically it addresses gaps in gerontological and housing scholarship through developing knowledge of the logistics and experiences of ongoing, involuntary residential moves.

Using Community-Based Participatory Research Strategies in Age-Friendly Communities to Solve Mobility Challenges

The number of older adults is steadily increasing in the United States and across the globe. Aging is linked to an increased risk of disability. Disabilities that limit one or more major life activities such as seeing, hearing, walking, and motor skills impact a person's ability to drive a car. Low utilization of alternative transportation by older adults and people with disabilities may put them at risk for social isolation. Social isolation is associated with a variety of negative health outcomes. While communities are challenged to create available, acceptable, accessible, adaptable and affordable mobility options, there are widely held, inaccurate biases around older adults' abilities to contribute to the development and improvement of alternative transportation options. Gerontological social workers are well-positioned to address this bias. This paper presents a case study of a large metropolitan county in the Midwest where community-based participatory research (CBPR) strategies were used to engage older residents to support the development of alternative transportation options supporting the tenets of environmental justice.

Social frailty: the importance of social and environmental factors in predicting frailty in older adults

Frailty can have multifaceted contributors, including physical, psychological, social and environmental elements. There is a lack of clarity surrounding frailty as it lacks a universal common definition, multiple factors are attributed to frailty and no definitive assessment tool is available. The evidence suggests that there is a lack of research to indicate causal relationships between the various determinants of frailty in ageing individuals. This review discusses the important role that social and environmental factors play in predicting the risk of frailty in older adults, as well as discussing the various signs of frailty. Health professionals in primary and community care settings are well placed to prevent and identify social frailty in the persons they care for.

Senior Co-Housing in the Netherlands: Benefits and Drawbacks for Its Residents

Senior co-housing communities offer an in-between solution for older people who do not want to live in an institutional setting but prefer the company of their age peers. Residents of co-housing communities live in their own apartments but undertake activities together and support one another. This paper adds to the literature by scrutinizing the benefits and drawbacks of senior co-housing, with special focus on the forms and limits of social support and the implications for the experience of loneliness. Qualitative fieldwork was conducted in eight co-housing communities in the Netherlands, consisting of document analysis, interviews, focus groups, and observations. The research shows that co-housing communities offer social contacts, social control, and instrumental and emotional support. Residents set boundaries regarding the frequency and intensity of support. The provided support partly relieves residents’ adult children from caregiving duties but does not substitute formal and informal care. Due to their access to contacts and support, few residents experience social loneliness. Co-housing communities can potentially also alleviate emotional loneliness, but currently, this happens to a limited degree. The paper concludes with practical recommendations for enhancing the benefits and reducing the drawbacks of senior co-housing.

What Can Be Done To Better Support Older Adults To Age Successfully In Their Homes And Communities?

The rapid growth of the US population ages seventy-five and older in the coming years will increase the need for housing that accommodates mobility limitations and helps connect residents with supportive services and opportunities for socialization. While expanding the supply of housing with services such as those provided by independent and assisted living facilities is needed, so too are greater supports to allow older adults with disabilities to age successfully in their homes and communities. These include financial support for modifications to the home, the delivery of supportive services in the home by both family and paid caregivers, and the expansion of housing options in communities where older adults live.

Living Independently: Exploring the Experiences of Visually Impaired People Living in Age-Related and Lifetime Housing Through Qualitative Synthesis

OBJECTIVES

The aim of this study is to gain a deeper understanding of the experiences of visually impaired older people living independently at home.

BACKGROUND

As populations are aging globally, there is now an increase in the prevalence of visual impairment. That means for ongoing and future aging-in-place strategies that seek to enable older people to remain independent for longer, more attention needs to be given to the needs of those with visual impairment. As people develop visual impairment, they use adaptive strategies including modifying long-term homes or relocating to more suitable accommodation. In the United Kingdom, aging-in-place strategies include employing statutory lifetime home standards (LTHS) in the home or relocating to sheltered housing to live independently with support available if required.

METHODS

To get a better understanding of the needs of the visually impaired in the home, 12 interviews with six visually impaired occupants of LTHS homes and six from sheltered accommodation were analyzed separately using interpretative phenomenological analysis. Secondly, qualitative synthesis was used to further analyze themes generated from both samples before interview results were conceptualized in two superordinate concepts, namely, "negotiating priorities" and "understanding visual impairment."

RESULTS

Participants from both groups had similar needs and were willing to compromise by living with some negative features. Those who coped well with moving utilized various resources.

CONCLUSIONS

These findings will shed more understanding on providing good quality housing for those with visual impairment wanting to live either independently or within healthcare home environments.

Beyond widowhood: Do prior discovered themes that describe the experiences of older Australian widowed women persist over time?

In previous cross-sectional studies researchers have explored the experiences of widowed women in the 1921-1926 cohort of the Australian Longitudinal Study on Women's Health and identified three major themes: health, social relationships and support, and financial and structural issues. In the current study the authors examine longitudinal data collected over 15 years to assess whether these themes persisted and/or evolved over time. The sample included 162 widowed women aged 70-90 years. Thematic analysis was used with a constant comparison method. Many women reported good health despite managing comorbidities. Social relationships frequently shifted from friends to family to more formal support. Most financial and structural issues related to managing increasing health costs as women aged. These results confirmed that the three major themes previously reported persisted over time, and underscore the importance of continuing to support women, and their changing needs, well beyond the initial period of bereavement.