Aging In Place Research Articles

Systematic scoping review of ageing in place strategies in Japan, Singapore and Thailand: A comparative analysis.

Given the differing cultural contexts and service needs of older persons in the west and the east, programs or policies should be thoughtfully redesigned to accommodate these diverse societies. This paper presents a systematic scoping review of ageing in place (AIP) strategies in Japan, Singapore and Thailand, emphasising how they are tailored to address the unique challenges of ageing populations in Asia. A systematic literature search was conducted through seven databases. Empirical, peer-reviewed studies in English that discussed AIP-related programs or policies involving aged populations in the target countries were included. Themes were identified using the policy triangle framework, allowing for a comprehensive comparison of AIP across the countries. Three key components of AIP, place, support network and workforce, were identified from 44 included studies. Each country exhibits distinctive approaches to implementing these components. Japan has extensive AIP systems with comprehensive services and strong community and family support. Singapore offers innovative aged care with significant government involvement, though on a smaller scale. Thailand's localised initiatives focus on community health care and age-friendly city assessments, with a less developed AIP infrastructure. The study proposes a comprehensive framework for developing ageing policies in Asia, emphasising the need for a person-centred approach in developing AIP strategies that cater to the diverse needs of ageing populations, and underscores the importance of integrating health-care services, community support and home environment modifications. The three AIP elements advocate for a person-centred approach, providing valuable insights for policymakers to effectively manage challenges of rapidly ageing populations.

제주지역 노인의 지역사회 계속거주에 미치는 영향요인 연구

This study examined the factors influencing Aging-in-Place(AIP) in older adults in the Jeju region. Also, the study tried to find supporting ways of AIP for older adults. The study used data from the 2020 Ministry of Health and Welfare Survey on Korea Older Adults and analyzed 375 cases of older adults in Jeju. The influencing factors of AIP consisted of functional, structural, phenomenological, and ecological factors. The main results are as follows: First, 98.2% of older adults in a healthy situation chose AIP, but this number drops to 59.5% when their health becomes weak and unhealthy. Second, the factors influencing the AIP of older adults in the Jeju area were age as a functional factor, household type and economic satisfaction as a structural factor, housing and residential environment satisfaction variables with a phenomenological factor, and satisfaction with neighborhood relationships as an ecological factor. Based on the above results, this study suggested the policy to support older adults in the Jeju area as they lead their daily lives and face old age. In particular, the willingness to AIP decreases significantly when the health of older people in the Jeju region deteriorates; the study emphasized and discussed the importance of creating a residential environment.

Publicly subsidized senior housing: the national profile of independent living models in South Korea

ABSTRACT Understanding alternative senior housing arrangements is important because of the expanding global aging population, increasing cost concerns for long-term care, and the desire of older people to age in place (AIP). Using a convergent mixed-method design, we examined the South Korean case using national data on independent living models for older adults. We examined the socioeconomic and health characteristics of residents and the service and operational environment of their housing. Based on quantitative and qualitative information collected by the executive director and key staff in senior housing, we discussed areas of mismatch between aging individuals’ needs and housing resources. Our findings suggest that the current service delivery model of housing needs to be reformed to address (1) the heterogeneous support and care needs of residents, (2) limited operational capacity, and that the spatial design needs to be restructured to ensure privacy. We discuss several programmatic and policy-level reforms to build and expand sustainable publicly subsidized senior housing.

"What choice do we have?" Reactive and proactive decision-making for aging in place with dementia.

Promoting options for aging in place (AIP) has broad appeal to policymakers and professionals providing services to persons living with dementia (PWD). However, the benefits or burdens of AIP likely vary among individuals and families. We sought to describe factors influencing decision-making to age in place versus seek a higher level of residential care for PWD. A qualitative study was undertaken as part of a larger mixed-methods study utilizing semi-structured interviews with PWD, family care partners, and dementia clinicians. Interview transcripts were analyzed using qualitative content analysis with constant comparison. Sample size was determined by thematic saturation within subgroups. We conducted 74 interviews among 14 PWD, 36 care partners, and 24 clinicians. Preferences for AIP were driven by (1) desire to preserve independence, (2) a sense that the "best care" is delivered by loved ones and in a familiar environment, (3) distrust and fear of care facilities, and (4) caregiver guilt. PWD and care partners frequently considered moving from home as a "last resort" and wanted to avoid planning for future care needs. Many decisions to move were reactive and triggered by patient safety events, physical dependency, or the loss of caregiver. Proactive decision-making was facilitated by (1) prior experience witnessing the challenges of caring for a person with advanced dementia in the home; and (2) having substantial financial resources such that participants could seek major home adaptations or avoid "lower quality" institutions. Decisions regarding care setting for PWD frequently do not feel like a choice and are made under imperfect conditions. Programs using AIP as an outcome measure should recognize the various patient-centered and non-patient-centered factors that influence such choices, and interventions should be designed to promote more informed and equitable decision-making for care setting in dementia.

Addressing Aging-in-Place Policy Challenges in Canada: A Call to Action.

Aging in place (AIP) has emerged as a critical priority in policy to support older adults living in their homes and communities. However, achieving equitable support for older adults demands a multi-faceted approach that embraces their choices, capabilities and lived experiences while considering that place is a dynamic concept. This commentary explores the challenges older adults may encounter while AIP and identifies technological and policy areas to explore. Drawing insights from the UK, policy makers in Canada are urged to adopt inclusive definitions of AIP, prioritize technological solutions for recognized challenges and actively involve older adults in policy development.

주관적 건강 상태에 따른 노인의 지역사회 계속거주 영향 요인

Low birth rate and aging are rapidly changing the demographic of our society and pushing us entering into a super aged society. In the super-aged society where more than 20% of the total population is over 65 years old, the residence problem for elderly has become a growing social problem as life expectancy increases. This study used the '2020 Survey on the Elderly' and a multinomial logistic regression model to analyze factors affecting AIP (Aging in Place) attitudes among the elderly. As a result, first, AIP attitudes against 'moving to good housing' when healthy are seen when sample are older, single, live in their own home, and do not have a private or retirement pension. AIP attitude toward 'moving to a house with care and convenience services' appears in those who are unmarried, have a short period of education, live in monthly rentals, and receive housing pension and farmland pension. Next, AIP attitude against ‘living with children’ when having difficulty with mobility appears in male, single, living in own home, and not receiving a private or retirement pension. The AIP attitude against 'moving to welfare housing' appears in cases where the period of education is short, living in a self-owned house, receiving housing pension or farmland pension, and having many financial assets or low debt. The study highlights the importance of cash flow for elderly households. AIP attitudes are linked to private and public income. Securing regular income for retired seniors and improving cash flow policies is crucial for realizing AIP.

Aging in Place in Hong Kong and Its Implications for Sustainable Development: A Qualitative Study Exploring the Needs, Beliefs, Behaviors, and Well-Being of Older Adults through Self-Determination Theory and Social Cognitive Theory

With the rapidly aging population, Aging in Place (AIP) assumes an increasingly pivotal role, as it aligns with SDG 3 (Good Health and Well-being) and Environmental, Social, and Governance (ESG) principles. Despite the contributions of AIP, there is a dearth of studies investigating the corresponding needs and well-being of older adults from psychological and sociocultural perspectives. This study aimed to investigate older adults’ needs, beliefs, behaviors, well-being, as well as perceived challenges and opportunities pertaining to AIP. Adopting a qualitative design, in-depth semi-structured interviews were conducted with 41 older adults on an individual basis. Through thematic analysis, a theoretical framework with reference to Self-Determination Theory (SDT) and Social Cognitive Theory (SCT) was established. Findings reveal that the psychological needs of autonomy, competence, relatedness, and dignity are conducive to well-being and decision making. Fear of being a burden to others emerges as a dominant sociocultural construct. This research extends SDT by incorporating the need for dignity as an overarching factor intersecting with SDT needs. Fulfilling psychological needs, honoring cultural beliefs, and aligning with SDG3 and ESG principles are crucial to the successful implementation of AIP. AIP policies should not only consider older adults’ practical needs but also their psychological needs, thereby fostering an age-friendly environment through sustainable development.

향후 건강 상태에 따른 노인의 현 주택 계속 거주 의사에 미치는 요인 건강 상태와 주택환경 중심으로

This study aims to explore the association between the current health status and housing environment and the decision to age in place (AIP), taking into account the future health status of older Korean adults. The study utilized data from the 2020 National Survey of Older Koreans, with a total sample size of 9,920 participants who conducted a self-report. The results showed that, when maintaining the current health status, the decision of AIP had a statistically significant difference with factors such as education level, having a partner, living situation, residential area, and annual household income. However, when considering a weaker health status, the decision of AIP showed a statistically significant difference with sex, educational level, having a partner, and living situation. The results of the logistic regression analyses revealed that when maintaining the current health status, participants with better subjective health conditions and higher depressive scores were more likely to move to a better housing environment. Also, participants who have lived in a single house, townhouse, and multiplex unit, who are not homeowners, have lower satisfaction with their current house, and have higher needs for services for living in their current house were likely to move to a better housing environment. When having a weaker health status, participants who have lower cognitive status, live in a townhouse and multiplex unit, are not homeowners, have lower satisfaction with their current house, and have higher needs for services for living in their current house were less likely to decide on AIP. The study provided evidence for building a community care system by exploring the association of factors related to the decision of AIP with health status.

Comparative Analysis of Social Networks in Institutionalized Older Adults versus Aging-in-Place Scenarios.

(1) Background: This research aims to compare social networks among institutionalized and aging-in-place (AIP) older adults through the validation of a new questionnaire. (2) Methods: The cross-sectional study included 100 older adults (mean age: 73.53 ± 5.49 years; age range: 65-85 years), with 48 institutionalized subjects and 52 AIP subjects. We developed, validated, and administered a new questionnaire, the Social Network Assessment for Older People Questionnaire (SNAOPQ), to assess older adults' social networks using descriptive and inferential statistical methods. (3) Results: The SNAOPQ demonstrated excellent internal consistency (Cronbach's alpha of 0.91 and McDonald's omega of 0.91). Statistical analysis revealed significant associations between variables, highlighting differences in social networks between institutionalized and AIP individuals (p ≤ 0.001). Sociodemographic factors like age, education, living arrangement status, and number of descendants significantly influenced SNAOPQ scores (p ≤ 0.001). Age and residence type notably impacted participants' scores, indicating reduced social network size with age. Tertiary education and living in a couple were associated with more extensive social networks, while a higher number of descendants correlated with social network expansion. (4) Conclusions: Our study highlights significant differences in social networks among older adults based on residence type, emphasizing the impact of sociodemographic factors such as age, education, living arrangement, and the number of descendants.

Aging in Place with Few Children and Social Services-- Understanding Structural and Cultural Lags in Rural China.

This study uses mixed methodologies to reveal how structural and cultural changes are changing the connotations of home and aging in rural China. Based on surveys (n = 830) and 33 intensive interviews with older migrant workers, this study found that having rural public pensions, adult children living nearby, and owning land in their hometowns were associated with the respondents' desire for aging in place (AIP). Moreover, although the image of the rural home is idyllic, the reality is difficult. Aging migrant workers are gaining a strong sense of financial independence and their children's lack of parental care. The authors argue that having no social-care services, while adult children are rarely available for old-age care, is changing the connotations of AIP in rural China. These social and cultural transformations are making AIP more of a romantic ideal than a practical reality for migrant workers.

한국·미국노인에 있어 지역사회 AIP(Aging in place)를 위한 물리적 고령친화도시환경 중요요인 비교연구

한국·미국노인에 있어 지역사회 AIP(Aging in place)를 위한 물리적 고령친화도시환경 중요요인 비교연구

A Review on Social Foundations to Promote AIP (Aging in Place) for the Elderly

A Review on Social Foundations to Promote AIP (Aging in Place) for the Elderly

SENSOR-ENHANCED CARE COORDINATION TO ADDRESS OLDER ADULT HEALTH: LESSONS FROM AN INTERDISCIPLINARY RESEARCH TEAM

Abstract Researchers at the University of Missouri have a history of developing and testing aging in place (AIP) care coordination models for clinical translation. Vital to this work are in-home, residentially installed sensors to detect early illness and functional decline over time. While much smart home research is focused on older adults living in continuing care retirement communities, our team developed a novel sensor-enhanced care coordination approach for community-dwelling and disabled older adults as part of two ongoing, federally funded projects. For this symposium, we will highlight the Age-friendly Sustainable Smart and Equitable Technologies for Aging in Place (ASSETs for AIP) demonstration program, funded by the Department of Health and Human Services. Our first presentation will overview our interdisciplinary approach to creating this novel care coordination model, with specifics about research team composition, population focus, and methods. Our second presentation will highlight recruitment strategies and share lessons learned from reaching and enrolling this population that often experience residential transitions. Our third presentation will overview the open-source smart home and consumer-grade technologies deployed in this work, and practical considerations for technology installation, support, and sustainability and clinical team training. Our symposium will close with a presentation of selected client case studies that illustrate how clinical care coordinators use sensor data to remotely monitor and empower older adults for behavior change via telehealth consultations. This symposium will help inform other care coordination research, particularly that which uses sensor technologies and telehealth to facilitate aging in place.

PREDICTORS OF DECISION MAKING FOR AGING-IN-PLACE SUPPORT IN ALZHEIMER’S DISEASE

Abstract Older adults with Alzheimer’s Disease (AD) need additional support in their lifetime, yet little is known about how the decision to accept help is made. Our goal is to better understand how older adults’ aging-in-place (AIP) decision making is impacted by worsening cognition, functional loss, social influences, and environmental factors. This longitudinal study consists of older adults from an NIA-funded cohort (LitCog) with extensive cognitive testing. The intervention, PlanYourLifespan.org (PYL), facilitates making decisions about AIP needs, including AD. After viewing PYL, subjects are surveyed every 6 months with cognitive, social, functional, health literacy, environmental and decision-making variables. Of 293 subjects, (mean age 73.5, 72.7% female, 40.4% under-represented minority) almost half (47.4%) experienced cognitive decline with 10.3% identifying worsening memory loss from the prior timepoint. Subjects were asked: If you developed AD, have you decided your living/support preferences? At 1-mo, subjects were significantly more likely to have made decisions if they had: limited health literacy (OR 4.36 [p< 0.01, 1.69-11.24]), larger social networks (OR 1.08 [p< 0.05, 1.01-1.15]), completion of a living will (OR 2.43 [p< 0.05,1.11-5.33]. At 6-mo, sufficient social support (OR 3.39 [p< 0.05, 1.19-9.70]. At 12-mo, higher social isolation (OR 1.05 [p< 0.05, 1.01-1.08]) and self-efficacy (OR 1.07 [p< 0.01, 1.04-1.11]). In the event of worsening cognition, the likelihood of making care decision is associated with external (social support) and internal (self-efficacy, health literacy) variables, which change in significance over time. Catastrophic factors (COVID-19) impacted comfortability of utilizing long-term care facilities.

Age-friendly Environment and Aging in Place: Finding from Latent Profile Analysis.

Older adults prefer ageing in place (AIP) rather than institutionalized facilities. Although its advantages, AIP can be challenging when communities are unable to meet residents' needs. This study aims to identify the relationship between the level of age-friendliness of community and AIP. We used AARP Age-friendly Community Survey data with 6670 older adults in the USA. We used responses from 63 items assessing various aspects of a community's age-friendliness to identify different types of age-friendly communities (AFCs) through latent profile analysis (LPA). We then ran multinomial logistic regression to examine whether the types of AFC were associated with AIP. LPA revealed three types of AFC: Underdeveloped, developing, and developed. Regression results showed older adults living in underdeveloped and developing communities are less likely to AIP compared to those in the developed community. These results show a positive impact of AFC on intention to AIP. Policymakers should consider expanding AFC initiatives for the growing number of older adults.

Aging in Place or Institutionalization? A Multiscale Analysis of Independent-Living Older Adults From Four Large Cities in China's Yangtze River Delta.

Aging in place (AIP) has been adopted as a key strategy to cope with the global public health challenge posed by population aging. The current study aimed to understand the association between older adult's AIP preference and various social and physical environmental factors at different scales. Following the ecological model of aging, this paper conducted a questionnaire survey of 827 independent-living older adults (60 years old and above) from four big cities in China's Yangtze River Delta region and employed a structural equation modeling method for analysis. Older adults from more developed cities exhibited a stronger preference for AIP than those from less developed cities. Individual characteristics, mental health, and physical health had a direct impact on AIP preference, whereas the effect of the community social environment was not significant. The perceived and objectively measured community-built environment indirectly affected AIP preference via mediation and chain effects. Complex paths affecting AIP preference were identified. At the city level, the social environment had a stronger influence than the physical environment on AIP, and the opposite pattern was observed at the community level. Mental health and physical health had opposite effects on AIP preference. Although physical health was negatively associated with AIP, age-friendly communities with compact, diverse, and accessible built environments have a positive impact on older adults' physical health and therefore should be promoted.

Factors Associated with Aging in Place among Community-Dwelling Older Adults in Korea: Findings from a National Survey.

Ever since baby boomers started turning 65 years old in 2020, Korea is set to become a super-aged society by 2025. This makes it the world's fastest-aging society. Aging in place (AIP) has become a policy direction to prepare for an aging society and improve older adults' quality of life. It refers to the ability of older adults to remain in their homes and communities as they age, allowing them to reside in their place of preference and access the services they require to promote their quality of life. A cross-sectional study design was employed using data sampled from the 2020 National Survey of Older Koreans. In total, 9930 older adults (aged between 65 and 99 years old) participated. The results confirmed that the intention to pursue AIP is related to personal factors (education, income, house ownership, smoking, exercise, depression), interpersonal and communal factors (unmet healthcare needs, need for home care services, family contact), and policy level factors (basic pension beneficiary, long-term care services) using an ecological model. The findings may promote individual health behaviors and help fill the gap between unmet healthcare needs and community care services that positively influence older adults' AIP.

Practice Models of Rural China’s Ageing in Place: From the Perspective of Multiple Collaborative Governance

China’s large-scale rural-urban migration and the ageing of its rural population has intensified the challenges of traditional family care. However, the majority of its rural elderly are reluctant to leave the village acquaintance society even after they are too old or sick to take care of themselves, and ageing in the village community is their primary choice. While various practice models of ageing in place (AIP) supported by the local government and communities have emerged in some pioneering areas of rural China, the existing literature has provided very little comparative analysis on these practice models. Based on firsthand data collected from field studies in rural Jiangsu, East China, this article compares and analyses three main AIP practice models, i.e., home-based care funded by the government and provided by volunteers, day care provided by community care centres, and institutional care provided by village-based “happiness homes” and senior apartments. The roles and operational mechanisms of the government, social organisations, market, and local community in promoting AIP in rural areas are discussed from a perspective of multiple collaborative governance. Moreover, effective partnership between different stakeholders for further development of AIP in rural China for the construction of rural age-friendly communities with improved socialised elder care facilities and systems is discussed. The research has significant implications for the promotion of AIP worldwide.

COGNITIVE FUNCTION AND INDEPENDENCE IN THE OLDEST-OLD: REVIEW STUDY BASED ON AGING IN PLACE

Some older adults desire to continue living in the community in which they reside. The concept of Aging in Place (AIP) is appropriate for this idea. For AIP to be successful, the oldest-old need to demonstrate their abilities and live safely, independently, and comfortably in their homes and communities. Conversely, AIP in an inappropriate manner, without a safe environment, and without support provided, comprising dangerous situations caused by declining cognitive and physical function, lead to reduced quality of life for older people. Therefore, this study aimed to examine cognitive function in the oldest-old to understand differences between normal aging and cognitive decline due to dementia. Cognitive decline due to normal aging in the oldest-old is caused by impaired frontal lobe function, while decline due to Alzheimer’s disease is caused by impaired temporal-parietal lobe function, suggesting that this impairment may be useful for achieving independence for AIP.

AGING IN PLACE: TURNING TO THE VOICES OF EXTENSION EDUCATORS

Abstract Most adults report a preference for aging-in-place (AIP) – remaining safely in their own home and community as they age, even as they become more dependent on others. When attempting to determine options and feasibility for AIP, older adults and/or their families – especially those living in non-metropolitan rural areas and small towns, may turn to Extension educators for information and guidance. For the current study we interviewed seven family-focused Extension educators responsible for 25 counties throughout a Midwestern state to explore the challenges, supports, patterns of experience, and service/policy recommendations that these professionals find relevant to AIP in their regions. The principal investigator (PI) conducted each semi-structured interview by phone; each audio-recorded interview lasted approximately 60 minutes. Two trained research assistants and the PI applied combined deductive-inductive thematic analyses to the transcribed interview data following Braun and Clarke (2012), utilizing MAXQDA, and ensuring trustworthiness during the coding process. Five major categories with sub-themes emerged: Challenges to AIP (e.g., transportation), Supports to AIP (e.g., churches), Most-Challenged Populations (e.g., middle-income families who neither can afford in-home assistance nor are eligible for government aid), Attitudes Toward AIP (e.g., caution against social isolation), and Recommendations for Services/Policies to Facilitate AIP (e.g., government funding, in-home technology assistance). Some variation across counties was apparent with, for example, one county making concerted efforts to retain young adults in its communities (i.e., reducing out-migration), thus enhancing family presence making AIP more feasible, non-isolating. Our findings will be especially noteworthy to social service providers and aging-focused public policymakers.