Identifying naturally occurring retirement communities: a spatial analysis

Factors associated with transition to a nursing home in older adults living in naturally occurring retirement communities

BACKGROUND

Naturally occurring retirement communities (NORCs) are geographic areas (generally high-rise buildings or neighborhoods) that have a high concentration of individuals 65 years and older. Supportive service programs in NORCs can address resident needs and delay nursing home (NH) admission but understanding what factors are associated with NORC residents requiring NH admission is needed to tailor such programs. Our aim was to examine individual- and neighborhood-level factors associated with NH wait-list status in NORC residents in Ontario.

METHODS

We conducted a population-based, cross-sectional study of Ontario adults 65 years of age or older living in a NORC building as of January 1, 2020, by linking a provincial registry of NORC high-rise buildings with health administrative data. Older adults were classified as being on the NH wait-list if they had an open application for a NH on the index date. We conducted a multilevel logistic regression analysis using generalized estimating equations to determine individual- and neighborhood-level factors associated with NH wait-list status, including sociodemographic, clinical, healthcare use, and building factors. We explored the role of sex and age through stratification by sex (male, female) and age (65-80 and 80+ years).

RESULTS

Among 220,864 NORC residents, 4710 individuals (2.1%) were on the NH wait-list. Female sex, older age, immigrant status, dementia diagnosis, receiving homecare, multimorbidity, and polypharmacy (five or more unique drug names) were associated with an increased odds of wait-list status. Several neighborhood-level variables were associated with a significantly increased likelihood of wait-list status, including low income, high dependency, high ethnic diversity, and living in a building with supports.

CONCLUSION

NORC supportive service programs can be tailored to account for the factors associated with NH wait-list status, allowing NORC residents who are living in the community to age in their desired place and achieve optimal health outcomes.

Identification and engagement of naturally occurring retirement communities to support healthy aging in Canada: A set of methods for replication

BACKGROUND

Naturally occurring retirement communities (NORCs), unplanned communities with a high proportion of older adult residents, offer a model to support older adults to age well in place. The aim of this paper is to provide a comprehensive description of the methods used to identify and engage NORCs appropriate for the development of supportive service programming in Canada.

METHODS

Three steps were used to identify and select NORCs in which to develop supportive service programming including: 1) identification of potential NORCs using Canadian Census Dissemination Areas, the Ontario Marginalization Index and Google Maps, 2) engagement of property owner/manager to determine the availability of common space for communal programming and willingness of the owner to support programming and, 3) engagement of older adult residents within the NORC to co-design programming.

RESULTS

Four cities in the south-east, south-central, and south-west of Ontario, Canada were identified to develop NORCs with supportive service programming. Using the methods described, six NORCs were identified, landlords and older adult residents were engaged, and programs initiated between April 2018 and March 2019. The sites included two private high-rise apartments, a city-owned low-rise subsidized apartment complex, two multi-building private high-rise complexes and a mobile home community. An average of 35 (min 20, max 78) older adult members were engaged in an average of 20.5 unique activity sessions at each site per month. On average, social (54%) and physical activities (30%) were more common than nutritional (10%) and knowledge-sharing (8%).

CONCLUSIONS

The increased prevalence of unplanned, geographically-bound NORCs creates an opportunity for governments, social and health service providers and policy makers to support healthy aging in their communities. Our experience with the creation of six new NORCs with supportive service programming provides a tested set of methods that can be applied in other communities.

An Overview of Naturally Occurring Retirement Communities (NORCs) for Ageing in Place

As an alternative to ageing at home in the community, naturally occurring retirement communities (NORCs) have great potential to facilitate ageing in place; however, they have not attracted much research attention. This study conducts an overview of NORCs, aiming to examine the previous research in a comprehensive manner in order to explore how NORCs impact ageing in place, with the goal of guiding future research. The research presented here employs the content analysis method to review prior NORC-related studies and categorise research themes and findings following top-down coding principles. A total of 49 articles were selected from the Scopus and Web of Science databases, and the results show that the “social environment”, which was the most discussed topic (n = 24), provides the necessary mental support and physical motivation for older adults to live actively in NORCs, and that NORCs play a positive role in preserving public resources and promoting individual health. The limitations of this study include the fact that there is little public information on NORC programs and the subjective classification of themes, among others. This study acts as a foundation for future research on NORCs, which serve as a perfect model for healthy ageing in place.

Understanding Spatial Distribution of Retirement Villages: An Analysis of the Greater Brisbane Region

The nature of the increasingly ageing populations of developed countries places residential issues of these populations at the heart of urban policy. Retirement villages as housing options for older adults in Australia has been growing steadily in recent years; however, there have been a dearth of geographical studies looking into the distribution of existing retirement villages at the regional level. This study aims to reveal the geographical distributions and cluster patterns of retirement villages in the Greater Brisbane Region of Australia to better understand and serve the living requirements of current and potential retirement village residents. The geovisualization method was adopted to visually explore the distribution patterns of retirement villages. The Global Moran’s I and Local Moran’s I measures were employed to analyze the spatial correlation and the clusters of retirement villages in the study region. The study revealed that distribution of retirement villages was not random (z-score = 7.11; p < 0.001), but clustered in nature and included hotspot patterns, especially along the coastline and Brisbane River areas. Moreover, for-profit and not-for-profit retirement villages have different distribution patterns and adopted significantly different tenure agreements. In the study region, the spatial distribution of retirement villages aligns with the aggregation trend of older residents. The findings of this study disclosed the spatial distribution patterns of retirement villages and will provide developers and policymakers with geographically referenced data for the choice of new development sites to meet the market demand of potential customers, forming aged-friendly development strategies, and eventually leading to improved quality of life for older Australians.

Naturally Occurring Retirement Communities: A Scoping Review (Preprint)

Background

As Canada’s population ages, there is a need to explore community-based solutions to support older adults. Naturally occurring retirement communities (NORCs), defined in 1986 as buildings or areas not specifically designed for, but which attract, older adults and associated NORC supportive service programs (NORC-SSPs) have been described as potential resources to support aging in place. Though the body of literature on NORCs has been growing since the 1980s, no synthesis of this work has been conducted to date.

Objective

The goal of this scoping review is to highlight the current state of NORC literature to inform future research and offer a summarized description of NORCs and how they have supported, and can support, older adults to age in place.

Methods

Using a published framework, a scoping review was conducted by searching 13 databases from earliest date of coverage to January 2022. We included English peer- and non–peer-reviewed scholarly journal publications that described, critiqued, reflected on, or researched NORCs. Aging-in-place literature with little to no mention of NORCs was excluded, as were studies that recruited participants from NORCs but did not connect findings to the setting. A qualitative content analysis of the literature was conducted, guided by a conceptual framework, to examine the promise of NORC programs to promote aging in place.

Results

From 787 publications, we included 64 (8.1%) articles. All publications were North American, and nearly half used a descriptive research approach (31/64, 48%). A little more than half provided a specific definition of a NORC (33/64, 52%); of these, 13 (39%) used the 1986 definition; yet, there were discrepancies in the defined proportions of older adults that constitute a NORC (eg, 40% or 50%). Of the 64 articles, 6 (9%) described processes for identifying NORCs and 39 (61%) specifically described NORC-SSPs and included both external partnerships with organizations for service delivery (33/39, 85%) and internal resources such as staff, volunteers, or neighbors. Identified key components of a NORC-SSP included activities fostering social relationships (25/64, 39%) and access to resources and services (26/64, 41%). Sustainability and funding of NORC-SSPs were described (27/64, 42%), particularly as challenges to success. Initial outcomes, including self-efficacy (6/64, 9%) and increased access to social and health supports (14/64, 22%) were cited; however, long-term outcomes were lacking.

Conclusions

This review synthesizes the NORC literature to date and demonstrates that NORC-SSPs have potential as an alternative model of supporting aging in place. Longitudinal research exploring the impacts of both NORCs and NORC-SSPs on older adult health and well-being is recommended. Future research should also explore ways to improve the sustainability of NORC-SSPs.

Sustainable Urban Development for Older Australians: Understanding the Formation of Naturally Occurring Retirement Communities in the Greater Brisbane Region

As most older Australians prefer to age-in-place, providing sustainable and age-friendly communities poses a significant challenge to urban policymakers. The naturally occurring retirement communities (NORCs) have organically emerged as a collaborative model of care to support older adults to age-in-place, but neither academic research nor government policies recognise this housing option for older Australians. This paper aims to analyse the distributions and temporal patterns of NORCs in the Greater Brisbane Region, Australia, to understand the formation and development of NORCs. The geovisualisation method was employed to identify the distribution changes of NORCs between 2006 and 2016. The Global Moran’s I and Local Moran’s I measures were utilised to analyse the spatial correlation and the clusters of NORCs. The results show that NORCs increased significantly from 2006 to 2016, and their distribution was mainly clustered or co-located along the coastline and Brisbane River areas. The evolvement of NORCs reflected the change of aggregation pattern of older population between 2006 and 2016. Understanding the distribution trend of NORCs informs government policy and decisions in addressing issues of service delivery and community cooperation, and eventually leads to sustainable urban development and successful ageing in place for older Australians.

UNDERSTANDING THE DYNAMIC BEHAVIOUR OF THE AUSTRALIAN RETIREMENT VILLAGE INDUSTRY: A CAUSAL LOOP DIAGRAM

The retirement village industry in Australia has been accommodating an increasing number of residents in recent decades. However, a thorough understanding of the dynamic behaviour of the industry remains largely unknown, which prevents a better prediction of its future growth. This study incorporates system dynamics thinking into residents’ relocation decisions and aims to develop a causal loop diagram to have a full understanding of the complex interactions of variables affecting their relocation, which in turn determines the future growth pattern of the industry. Based on thematic analysis using literature review and interview data, five primary causal loops are identified, including the positive reinforcing loops of word-of-mouth effect and new-supply effect, and three negative balancing loops of the move-out effect, price effect and home-village distance effect. Of these five causal loops, the most dominant ones in determining the system behaviour are the word-of-mouth (reinforcing) and home-village distance (balancing) effects. The causal loop diagram provides a better understanding of the underlying structure of the retirement village industry and will help guide the industry and policy makers in formulating strategies to create a more ageing-friendly living environment for seniors in Australia.

Neighborhood Age Composition and Self-Rated Health: Findings from a Nationally Representative Study

Neighborhood age composition is an understudied area. Furthermore, existing empirical and conceptual work is conflicting, with some scholarship-indicating neighborhoods with older adults are beneficial and other scholarship suggesting it can be detrimental. Combining data from 7,197 older adults from the first wave (2011) of the National Health & Aging Trends Study and census tract data from the National Neighborhood Change Database, the purposes of our study were to: 1) identify the characteristics of neighborhoods experiencing different types of changes in age composition, and 2) examine the association between neighborhood age composition and self-rated health. Findings indicate that neighborhoods experiencing Concentration (where the number of older adults are declining but their percentage of the total population are increasing), the majority of which are in urban areas, have less aggregate economic resources, more indicators of neighborhood disorder, and less access to services and supports. Regression models also suggest older adults living in Concentration neighborhoods reported lower self-rated health compared to those living in the other three neighborhood types. Findings point to the importance of considering neighborhood age composition when targeting interventions and resources, and the potential consequences of being stuck in place in a neighborhood that does not meet elders' needs.

Loss of Community-Dwelling Status Among Survivors of High-Acuity Emergency General Surgery Disease

OBJECTIVES

To examine loss of community-dwelling status 9 months after hospitalization for high-acuity emergency general surgery (HA-EGS) disease among older Americans.

DESIGN

Retrospective analysis of claims data.

SETTING

US communities with Medicare beneficiaries.

PARTICIPANTS

Medicare beneficiaries age 65 years or older hospitalized urgently/emergently between January 1, 2015, and March 31, 2015, with a principal diagnosis representing potential life or organ threat (necrotizing soft tissue infections, hernias with gangrene, ischemic enteritis, perforated viscus, toxic colitis or gastroenteritis, peritonitis, intra-abdominal hemorrhage) and an operation of interest on hospital days 1 or 2 (N = 3319).

MEASUREMENTS

Demographic characteristics (age, race, and sex), comorbidities, principal diagnosis, complications, and index hospitalization disposition (died; discharged to skilled nursing facility [SNF], long-term acute care [LTAC], rehabilitation, hospice, home (with or without services), or acute care hospital; other) were measured. Survivors of index hospitalization were followed until December 31, 2015, on mortality and community-dwelling status (SNF/LTAC vs not). Descriptive statistics, Kaplan-Meier plots, and χ² tests were used to describe and compare the cohort based on disposition. A multivariable logistic regression model, adjusted for age, sex, comorbidities, complications, and discharge disposition, determined independent predictors of loss of community-dwelling status at 9 months.

RESULTS

A total of 2922 (88%) survived index hospitalization. Likelihood of discharge to home decreased with increasing age, baseline comorbidities, and in-hospital complications. Overall, 418 (14.3%) HA-EGS survivors died during the follow-up period. Among those alive at 9 months, 10.3% were no longer community dwelling. Initial discharge disposition to any location other than home and three or more surgical complications during index hospitalization were independent predictors of residing in a SNF/LTAC 9 months after surviving HA-EGS.

CONCLUSION

Older Americans, known to prioritize living in the community, will experience substantial loss of independence due to HA-EGS. Long-term expectations after surviving HA-EGS must be framed from the perspective of the outcomes that older patients value the most. Further research is needed to examine the quality-of-life burden of EGS survivorship prospectively. J Am Geriatr Soc 67:2289-2297, 2019.

Do long-term care services match population needs? A spatial analysis of nursing homes in Chile

Chile is experiencing a period of rapid aging, which increases the need of long-term care services in the country. Nursing homes have been the traditional alternative to deal with the increase of elderly population in the country, with services supplied by a mix of for-profit and nonprofit providers. Additionally, population exhibits a high degree of geographical concentration. The study aims to identify the determinants of the geographical location of nursing homes in Chile at municipality level. The analysis takes into account the different location criteria for different types of nursing homes as well as potential spatial effects. The paper uses spatial analysis tools to identify clusters of nursing homes and population characteristics and to estimate the determinants of nursing homes availability and coverage in the country. The analysis–based on spatial global and local tests, and spatial autoregressive models- show the existence of clusters of nursing homes as well as clusters of municipalities according to elderly population, income, poverty, population density, and public health insurance coverage. Residuals from ordinary least squares regressions were spatially autocorrelated, showing the need of using spatial models. Estimations show that availability and coverage of nursing homes are positively related with municipality income, and that for-profit and nonprofit facilities respond differently to different factors. A negative coefficient was found for poverty in nonprofit nursing homes, raising doubts about the effectiveness of giving public subsidies to incentive the installation of facilities in areas with high needs and low income.