Ageing well in the right place: partnership working with older people

Factors Influencing Older Persons' Transitions to Facility-Based Care Settings: A Scoping Review

BACKGROUND AND OBJECTIVES

Older adults (≥65 years) are living longer with complex health needs and wish to remain at home as their care needs change. We aimed to determine which factors influence older persons' transitions from home living to facility-based care (FBC) settings such as long-term care facilities or assisted living.

RESEARCH DESIGN AND METHODS

Through a scoping review of 7 databases, we considered all academic literature examining factors influencing transitions from home living to FBC. Only English articles were reviewed. Based on the Meleis' Health Transition (MHT) model, we categorized findings into: (a) transition conditions; (b) patterns of response; and (c) health services and interventions.

RESULTS

We included 204 unique studies. Age, cognitive/functional impairments, and caregiver burden were the most consistent risk factors for older persons' transitions to FBC. Caregiver burden was the only consistent risk factor in both quantitative and qualitative literature. Other factors around health service use or nonmedical factors were examined in a small number of studies, or demonstrated mixed or nonsignificant results. Key research gaps relate to transitions to intermediate levels of FBC, research in public health systems, and research employing qualitative and interventional methods.

DISCUSSION AND IMPLICATIONS

We expanded the MHT model to capture informal caregivers and their critical role in transitions from home to FBC settings. More research is needed to address practical needs of clients and caregivers while at home, and self-directed care funding models could be expanded. Theory-driven interventional research focusing on caregivers and successful hospital discharge is critically needed.

Enhancing Community Participation through Age-Friendly Ecosystems: A Rapid Realist Review

This rapid realist review explored the key components of age-friendly ecosystems that promote community participation among older adults. The study (undertaken in 2021 and updated in 2023) synthesized evidence from 10 peer-reviewed and grey literature databases to identify the underlying mechanisms and contextual factors that shape why, under what circumstances, and for whom an age-friendly ecosystems might be effective as well as the intervention outcomes. A total of 2823 records were initially identified after deduplication. Title and abstract screening produced a potential dataset of 126 articles, reducing to 14 articles after full text screening. Data extraction focused on the contexts, mechanisms, and outcomes of ecosystems for older adults' community participation. Analysis suggested that age-friendly ecosystems that aim to promote community participation are characterized by the provision of accessible and inclusive physical environments, the availability of supportive social networks and services, and the creation of opportunities for meaningful engagement in community life. The review also highlighted the importance of recognizing the diverse needs and preferences of older adults and involving them in the design and implementation of age-friendly ecosystems. Overall, the study has provided valuable insights into the mechanisms and contextual factors that contribute to the success of age-friendly ecosystems. Ecosystem outcomes were not well discussed in the literature. The analysis has important implications for policy and practice, emphasizing the need to develop interventions that are tailored to the specific needs and contexts of older adults, and that promote community participation as a means of enhancing health, wellbeing, and quality of life in later life.

Co-creating inclusive spaces and places: Towards an intergenerational and age-friendly living ecosystem

Introduction

Evolving aging societies, ongoing digitalisation and circumstances of COVID-19 are changing living conditions for growing older. There is an increased urgency to view public health with a focus on integrating people of all ages into the matrix of opportunities afforded in their communities. This study initiates the conceptualization of an intergenerational, age-friendly living ecosystem (AFLE) to enhance public health planning.

Methodology

A participatory study was conducted using a multi-methods approach. Six virtual co-creation sessions (n = 35-50 participants), alongside a mainly open-ended INTERGEN survey designed specifically for this study (n = 130) were conducted to conceptualize multilevel ideas for building intergenerational age-friendly places using Bronfenbrenner's ecological systems model. At the height of COVID-19, virtual applications (Zoom, Moodboard) and case studies, creative methods (drawing, photography, storytelling and spotlight sessions) were applied to engage academic and non-academic participants between ages 5 - 80+ years, across eight countries. Sessions were video-recorded with visual themes captured by a graphic facilitator. The survey covered issues of multigenerational interactions; intergenerational and age-friendly place features; place safety; and necessary stakeholders required for creating intergenerational and age-friendly places. Data were reflexively analyzed using a team approach to thematic analysis.

Results

Findings present both the thematic analysis of Virtual Co-creation Camps (VCCs) and the INTERGEN survey results. These findings are addressed in three overarching categories that highlight the necessary characteristics of AFLEs as suggested by the VCC participants and survey respondents: (i) Sensory factors: feeling and emotion as starting points for physical design; (ii) Physical and digital factors in designing AFLE spaces and places; and (iii) Socio-cultural factors: tackling ageism and exclusion as part of the solution.

Discussion

The analysis resulted in a pathway toward enhanced understandings on how multi-generations can better interact with fluctuating organizational domains (industry, voluntary, academic and public sectors) in urban and rural settings to facilitate intergenerational connectivity. Through processes of co-creation, an AFLE proof of concept and roadmap for public health planning was developed to support and provide opportunities for people as they age to reap the socioeconomic benefits of their local and virtual communities and help them become well integrated, valued and contributory members of society.

Researching with older people

The multidimensionality of the aging process involves changes in different capacities. The age-friendly cities strategy addressed the need for adaptations in urban spaces that meets the demands of older people’s wellbeing. Thus, the aim of this study was to explore how Participative Mapping and World Café techniques could assist in identifying challenges to the delivery of services and resources to create communities that promote active aging, from the perspectives of older people and stakeholders. The techniques generated co-constructed discussion and shared understandings about the barriers residents face in negotiating and accessing services. Demands associated with the precariousness of local infrastructure, the absence of leisure activities, and a generalized feeling of insecurity in their neighborhoods were recurring themes. The demands led to the conclusion that for healthy aging, the interrelation of objective and subjective factors that take into 

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.

Shelter/housing options, supports and interventions for older people experiencing homelessness

While experiences of later-life homelessness are known to vary, classification of shelter, housing and service models that meet the diverse needs of older people with experiences of homelessness (OPEH) are limited. To address this gap, a scoping review was conducted of shelter/housing options, supports and interventions for OPEH. Fourteen databases were searched for English-language peer-reviewed and/or empirical literature published between 1999 and 2019, resulting in the inclusion of 22 sources. Through a collaborative, iterative process of reading, discussing and coding, data extracted from the studies were organised into six models: (1) long-term care, (2) permanent supportive housing (PSH), including PSH delivered through Housing First, (3) supported housing, (4) transitional housing, (5) emergency shelter settings with health and social supports, and (6) case management and outreach. Programme descriptions and OPEH outcomes are described and contribute to our understanding that multiple shelter/housing options are needed to support diverse OPEH. The categorised models are considered alongside existing ‘ageing in place’ research, which largely focuses on older adults who are housed. Through extending discussions of ageing in the ‘right’ place to diverse OPEH, additional considerations are offered. Future research should explore distinct sub-populations of OPEH and how individual-level supports for ageing in place must attend to mezzo- and macro-level systems and policies.

Development of a Binational Framework for Active and Healthy Ageing (AHA) Bridging Austria and Slovenia in a Thermal Spa Region

In view of ongoing demographic developments resulting in a longer life expectancy of the European population, the creation of “age-friendly” environments represents an initiative picked up by the European Union and its Member States to enable active and healthy ageing. The present study aims at the co-creation of a cross-border framework model to deploy a healthy ageing region linking Austria and Slovenia, building on previous work dealing with the development of an integrated regional ecosystem for active and healthy ageing. A qualitative, community-based action research method based on focus group discussions allowed the development of an exemplary framework model for active and healthy ageing building on cross-border collaboration in the region of Promura. Within the project group, twelve cross-border regional key assets were identified. In the course of further open discussions, an exemplary model for the deployment of a cross-border healthy ageing region was developed, comprising underlying fundamental environmental aspects, regional structures in the field of health and care as well as crosscutting features spreading across all levels. This article presents a promising, strategic co-creation approach on how to span a model on active and healthy ageing across two cross-border regions with similar characteristics and assets.

Ageing as well as you can in place: Applying a geographical lens to the capability approach

Despite policy commitments to support ageing in place, we know very little about the everyday realities and experiences of older people living in different environmental circumstances, with varying personal capabilities. This paper: 1) examines the valued place-based functionings of older people through the use of geo-spatial and in-situ methods, where functionings are defined as states of being and doing, and place-based functionings are defined as places, activities, interactions, routes, and routines that support these beings and doings; and 2) demonstrates the utility of a capability approach by amalgamating the interconnected concepts 'ageing in place' and 'ageing well'. Three in-depth individual experiences of ageing at home in a Dublin (Ireland) suburb show how differing health and mobility challenges are managed, and illustrate how conceptions of ageing well in place can be identified from geographically-grounded lifeworlds. Participants' place-based functionings are identified by combining qualitative and geo-spatial approaches through the use of annotated maps, using data obtained from traditional interviews, go-along interviews, and mapping exercises. Results demonstrate the diversity of place-based functionings valued by each individual, and how functionings are negotiated depending on different needs, wishes, and health or mobility challenges. Results also highlight the importance of supportive environments and social supports in enabling older people to realise their most valued functionings over time, which include being able to get out and about, engage and connect with others, carry out daily tasks and errands confidently, and remain independent. By paying attention to subjectively valued place-based functionings, as well as the specific supports required to sustain them, we can facilitate older people to not just age in place, or age well, but to age - as well as they can - in place.

"Fiercely independent": Experiences of aging in the right place of older women living alone with physical limitations

This study explores the experience of aging among older Canadian women with physical limitations who live by themselves. While aging in place has been a policy priority in rapidly greying Canada, a lack of complementary public supports poses challenges for many older adults and their family members. Employing a qualitative methodology, and drawing from the notion of aging in the right place, we collected personal narratives of 12 women (aged 65 to 92) in two geographic areas in Ontario, including residents of regular houses, apartments, condominiums, assisted living and community housing for seniors. Through thematic analysis, we identified four overarching themes: 1) striving to continue on "at home", 2) living as a "strong independent woman", 3) the help needed to support their "independence", and 4) social activities to maintain self. Our findings illustrate how, despite their mobility limitations, older women can change their residential environment and their behavior by deploying the coping strategies and resources they have developed over time. However, we also found that older women are largely silent about their needs, and that experiences varied depending on life histories, health conditions, and the availability of supports in their wider environment (home care, alternative housing options, accessible transportation, opportunities for social and physical activities). We hope these findings will incite further studies and discussion to help make aging in the right place a real choice for anyone who wishes to do so.

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.

Everyday challenges facing high-risk older people living in the community: a community-based participatory study

BACKGROUND

Considering the real-world experiences of those with cognitive impairments is important in building a positive community for older people. Community-based participatory research is an important methodology for investigators focused on improving community health. The aim of this study was to 1) investigate factors associated with the continuation of community dwelling among high-risk older people and 2) to create a model of an inclusive community space for older people in the largest housing complex district in Tokyo.

METHODS

From 198 residents who completed all three steps (mail, face-to-face, and home-visit) of a previous large-scale epidemiological survey, we identified 66 residents who were at high-risk of moving out of the community. These participants underwent 6 months of regular assessments by experienced researchers to identify the factors associated with continuing to live in the community. We also employed a community action approach to develop a community space for residents in the study district where more than two researchers who were medical professionals served as staff. The services offered by the space were continuously improved according to user feedback. The function of this center was evaluated during interdisciplinary research meetings.

RESULTS

After 6 months, among the 66 high-risk residents, 49 people were living in the community and 12 people had moved out of the community. Those who could not continue to live in the community had greater unmet needs in terms of social support, especially daily living support and housing support. In addition, their families perceived a heavier burden of care. Interestingly, dementia diagnosis via the DSM-5, clinical dementia rating, physical health, mental health, and long-term care usage did not predict the outcome. Through discussions with guests, we equipped the space with various services such as coordination of community care and networking with existing organizations.

CONCLUSIONS

Merely providing healthcare and long-term care might not be sufficient to support community living in people with cognitive impairments. Daily living support and housing support should be provided in the context of a broad health services package. For this purpose, creating a comfortable community space for residents and community workers is essential.

Factors Influencing the Application of Connected Health in Remote Areas, Taiwan: A Qualitative Pilot Study

This pilot study investigated factors influencing the application of connected health (CH) in Taiwanese remote areas. These factors cover issues of cost, infrastructure, technology, business sustainability, business model, collaboration, and communication. It aimed to explore the significance and to assess the feasibility of researching CH in Taiwan. A qualitative exploratory study was conducted by interviewing relevant stakeholders (n = 18). The majority were healthcare providers as most of them are the CH end users. Their feedback was essential in reflecting the effectiveness of CH products and services. Therefore, understanding their views is significant in the design of a successful and user-friendly interactive system. A theoretical framework on the introduction of innovations in healthcare was employed to guide data collection and thematic analysis. Additionally, stakeholders proposed strategies for enhancing the implementation of CH in remote areas. This pilot study also contributed to identifying future directions and information for conducting the multi-stage interviews for collecting the data more effectively. Although the results reveal that the study of CH is meaningful, there is an issue of business sustainability which is obscured by some barriers that need to be addressed. These barriers will be further investigated in the first-stage interview and second-stage interview in future research. The research findings also suggest that strategies and sustainability for CH implementation should be included from the planning phase to benefit all the stakeholders in the CH ecosystem.

Understanding User Involvement in Research in Aging and Health

User involvement in research is advocated as an avenue for efficient societal developments. In this article, we identify potentials, problems, and challenges related to research on aging and health, and identify and illustrate research priorities using an evolving research program as an example. Involving user representatives in the development phase, the UserAge program engages researchers at four universities in Sweden. The program builds upon previous and ongoing research with user involvement. The goals are to maximize the impact of user involvement, enhance the execution of high-quality research, increase the knowledge about what difference user involvement can make, and evaluate the impact of research about and with user involvement. Taken together and communicated in the international scientific community as well as in a wide range of public arenas, the empirical results, capacity-building, and modeling efforts of UserAge will have an impact not only on the present situation but also on the future.

Constructing and negotiating social participation in old age: experiences of older adults living in urban environments in the United Kingdom

The age-friendly cities and communities movement has focused on how to better support older adults to age well within urban environments. Central to ‘ageing well’ and ‘active ageing’ agendas is ensuring that older adults can participate in meaningful forms of social participation. The benefits of social participation in old age have been well documented, and research amongst community-dwelling older adults has explored some of the neighbourhood qualities that facilitate or impede such forms of engagement. However, understandings of how older adults construct and negotiate social participation within everyday urban environments have been largely unexplored. To address this gap, we present results from 104 interviews conducted with older adults living in three cities and nine neighbourhoods in the United Kingdom (UK). The findings explore three themes generated from the research: ‘constructing meaningful social participation in old age’, ‘negotiating access to social participation’ and ‘navigating home and community’. Across these themes, the paper describes how experiences of social participation in old age involve a number of inter-connected physical, psychological and social processes experienced by individuals across a range of environmental settings including the home, outdoor spaces and community facilities. The paper concludes by discussing the implications of the findings for practice, specifically in the delivery of age-friendly communities.

The Best Day of the Week: New Technology Enhancing Quality of Life in a Care Home

Older people living in residential aged care facilities tend to be physically as well as socially inactive, which leads to poorer health and reduced wellbeing. A lack of recognition of the importance of social support, limited resources, lack of training and task-oriented work routines leave little time for staff to meet the social needs of residents. Through qualitative ethnographic fieldwork, this study investigates the potential for new technologies to enhance quality of life and facilitate meaningful engagement in physical and social activities among culturally and linguistically diverse residents and staff in care facilities. A continuum from nonparticipation to full participation among residents was observed when Touch Screen Technology activities were implemented. Data indicate that resident’s engagement is impacted by five interdependent factors, including environmental, organisational, caregiver, patient, and management- &government-related. Findings show that new technologies can be used to increase meaningful physical and social engagement, including transcending language and cultural barriers. However, the successful application of new technologies to enhance quality of life is dependent on their integration into the daily routine and social relationships of staff and residents, with the full support of management. Guidelines governing the use of new technologies to support meaningful engagement of older people in residential care are lacking: this project highlights the importance of attention to the social relational dimensions of technology interventions to support best practice in their use.

Hearing the voices of older adult patients: processes and findings to inform health services research

PLAIN ENGLISH SUMMARY

Whilst Patient and Public Involvement and Engagement (PPIE) are widely regarded as critical to developing clinical research, there is a perception that older adults may not be able to contribute and there is less emphasis on gaining a wide range of opinions before developing research questions or projects; for example an organisational change. This PPIE initiative used three PPIE processes including existing panels and wider networking to access older adults in the community who had used the hospital services and been discharged. Older adults expressed a range of views about their experience of discharge planning and this provided an important perspective on patients' research priorities associated with their personal independence. Efforts were taken to ensure representative views across a cross section of the population. As a result of this initial PPIE, a permanent, co-ordinated 'elders' panel has been established to ensure a representation of older adult views for research, service development and evaluation. This panel has permanent, fully supported members who provide reflection and feedback on any projects and programmes relating to older people's services in the City.

ABSTRACT

Background Clinical academic research and service improvement is planned using Patient and Public Involvement and Engagement (PPIE) but older PPIE participants are consulted less often due to the perception that they are vulnerable or hard to engage. Objectives To consult frail older adults about a recently adopted service, discharge to assess (D2A), and to prioritise services improvements and research topics associated with the design and delivery of discharge from hospital. To use successive PPIE processes to enable a permanent PPIE panel to be established. Participants Following guidance from an established hospital PPI panel 27 older adult participants were recruited. Participants from Black, Asian and Minority Ethnic (BAME) communities, affluent and non-affluent areas and varied social circumstances were included. Methods Focus groups and individual interviews were conducted in participants own homes or nearby social venues. Results Priorities for discharge included remaining independent despite often feeling lonely at home; to remain in hospital if needed; and for services to ensure effective communication with families. The main research priority identified was facilitating independence, whilst establishing a permanent PPIE panel involving older adults was viewed favourably. Conclusions Taking a structured approach to PPIE enabled varied older peoples' voices to express their priorities and concerns into early discharge from hospital, as well as enabling the development of health services research into hospital discharge planning and management. Older people as participants identified research priorities after reflecting on their experiences. Listening and reflection enabled researchers to develop a new "Community PPIE Elders Panel" to create an enduring PPIE infrastructure for frail older housebound people to engage in research design, development and dissemination.