Aging in Place
To age in place means to grow old in one’s own home rather than in an institution such as a nursing home or assisted living facility (Abramsson and Andersson 2016; Schorr and Khalaila 2018). Ideally, this is also in a long-term family home (Barrett et al. 2012), as well as in their own surrounding neighborhoods and broader communities (Kim et al. 2017). Aging in place is also about being able to live independently (Schorr and Khalaila 2018). More specifically, aging in place is the ability of older people to live in their own homes and communities safely, independently, and comfortably, regardless of age, income, or functional limitations (World Health Organization 2017). To age in place is therefore to “stay put” in one’s home and community (Wiles et al. 2012, 2017). As Thang and Hong (2015) point out, aging in place is growing old in the home, community, and environment that one is familiar with, with minimal change or disruption to one’s life and thus also one’s activities. Broadly speaking, to age in place is to continue to live in the same “place” as always (Lofqvist et al. 2013).
Attachment to Place
There has been a significant amount of cross-sectional research done on the attachment to place, particularly in relation to one’s home. Home is a place where familiar routines and habits are enacted (Bostrom et al. 2017; Coleman et al. 2016; Granbom et al. 2014; Lindley and Wallace 2015; Roy et al. 2018). Personal possessions for public display (Cristoforetti et al. 2011; Lindley and Wallace 2015; Shen and Perry 2016) and familiar smells and sounds (Board and McCormack 2018) bring a sense of comfort, control, and security. A home is where memories are built and shared that forge connections between past and present selves (Degnen 2016; Stones and Gullifer 2016). A home is an autobiographical symbol of who we were and who we have become (Rowles 1993). Private spaces provide opportunities for quiet reflection on one’s past life experiences (Cristoforetti et al. 2011). A home is a showcase (Cristoforetti et al. 2011) and an extension of the self (Grenier et al. 2016; Peace et al. 2011), enhancing psychological well-being and autonomy (Board and McCormack 2018), and perceived health (Barry et al. 2018) in older age.
Physical and Social Insideness
Attachment to place grows with aging (Abramsson and Andersson 2016; Granbom et al. 2014; Cramm et al. 2018; Wiles et al. 2017). Maintaining a relationship with one’s neighborhood through living close to it while also having easy access to everyday services is a resource for aging in place (Roy et al. 2018). Proximity and access are thus part of what makes a community a good place to live in older age (van der Pas 2015). Familiarity with and access to physical surroundings enhances feelings of connectedness to place and reduces loneliness (Schorr and Khalaila 2018). Changes to familiar neighborhoods are associated with depression and anxiety (Smith et al. 2018). Neighborhoods are physical spaces to develop meaningful connections through mundane everyday social practices (Degnen 2016). Familiar local social contacts help older people feel connected to their neighborhood (Lager et al. 2016; Wiles et al. 2012, 2017). Everyday social practices provide a sense of neighborhood identity (Ye and Chen 2014) and become an extension of the self (Severinsen et al. 2016; Wiles et al. 2012). Being part of the social fabric of local life affords older people social insideness or a sense of social affinity (Rowles 1993). Neighborhoods and communities are therefore part-and-parcel of older people’s homes (Lager et al. 2016).
Aging in place is also about maintaining and sustaining a home, particularly when one’s physical functioning declines (Barry et al. 2018). Older people often physically reconfigure living spaces to carry on with familiar activities of daily living (Hillcoat-Nalletamby and Ogg 2014). These continuing routine activities foster a sense of self-in-place (Peace et al. 2011), enhance psychological well-being (Freedman et al. 2017), and provide a sense of security and control (Bostrom et al. 2017), continuity (Lindley and Wallace 2015), and comfort (Peace et al. 2011). Older people indicate that the ability to carry out familiar activities demonstrates their ability to live independently (Granbom et al. 2014; Lofqvist et al. 2013; Roy et al. 2018) and keeps normal daily life on track (Barrett et al. 2012). Doing for oneself enhances the sense of control and autonomy (Barry et al. 2018; Dupuis-Blanchard et al. 2015; Stones and Gullifer 2016) and psychological well-being (Board and McCormack 2018). A sense of physical insideness comes from the repetitive use of spaces in the home for carrying out familiar activities (Rowles 1993).
Key Research Findings
It is abundantly clear that older people value aging in place. Aging in place is about expressing and retaining a sense of identity, social relationships, and autonomy or independence and choice (World Health Organization 2017). At the heart of aging in place then is the intrinsic need for residential normalcy, for not surrendering the life and home that one has carefully and thoughtfully constructed over time (Golant 2011). Older people have the basic need and right to have a life (World Health Organization 2017, p. 18) and to exercise their intrinsic capacity to do so (World Health Organization 2015). Intrinsic capacity refers to older people’s combined physical, mental, and social capabilities (World Health Organization 2017). An interesting application of intrinsic capacity is Peace et al.’s (2011) notion of “option recognition”: where older people are said to strategically modify and remodify their behavior and living environments to maintain self-identity. The physical reconfiguring of the home are options that older people have recognized and exercised. Downsizing to meet future limitations has helped some physically redesign their lives; age-friendly homes make the very idea of spending more time at home palatable and a place to display pictures of foregone but cherished possessions (Lindley and Wallace 2015). Others selectively engage in or give up cherished activities (Granbom et al. 2014) and have friends and neighbors help with physically demanding self-care tasks (Thang and Hong 2015).
Older people socially reconfigure their homes as well. Most often, older people reach out to available supports from existing social networks for emotional and practical reasons (Cristoforetti et al. 2011; Greenfield 2016; Peace et al. 2011; Roy et al. 2018; Severinsen et al. 2016; Shen and Perry 2016; Wiles et al. 2012; Dupuis-Blanchard et al. 2015; Coleman et al. 2016). Neighbors check in and give advice (Greenfield 2016). Indeed, family and long-term friends help with household chores (Lofqvist et al. 2013). Accepting help from others can be a way of normalizing one’s current living situation (Granbom et al. 2014; Peace et al. 2011). Moreover, some older people speak of volunteering while they are still able to be out and about to expand their instrumental and emotional informal support networks in preparation for future functional limitations (Shen and Perry 2016). For very-old people living with limited mobility, watching and listening to the comings and goings of people in the neighborhood through a window helps them retain some semblance of a normal life (Lager et al. 2016). Even a restricted or more isolated life is preferred to being a burden to others and letting go of a normal life (Barry et al. 2018; Peace et al. 2011).
Age-friendly environments or AFEs are designs said to complement older people’s intrinsic capacity to carry on doing what is important to them (World Health Organization 2015, 2017). An exemplar of this is the Community Aging in Place, Advancing Better Living for Elders program (Szanton et al. 2015) which was designed for urban dwellers living with multiple functional and income limitations. Home modifications and repairs with Occupational Therapists and handymen and ongoing assessments by registered nurses help participants carry on with routine activities. Another innovative example is NORCs or Naturally Occurring Retirement Community Supportive Service Programs (Greenfield and Mauldin 2017). NORCs are community-based programs that consist of older people, local service providers, and housing managers. NORCs offer accessible group recreational and health promotion activities, and volunteer work, and link older people to home repair and transport services. These key features of AFEs potentially help older people carry on or extend social networks (World Health Organization 2015). NORC programs have also been found to enhance older people’s sense of community and friendships (Greenfield and Mauldin 2017).
AFEs often make use of “assistive” technologies, ones suited to the needs and wants of older people who wish to remain at home (World Health Organization 2015). Downsizers have used technology to create visible images of cherished possessions or to carry on meaningful music hobbies that bring a sense of continuity to daily life (Lindley and Wallace 2015). Telehealth services such as lifelines for emergency response support appear to curtail the continuity of desirable and thus important activities outside the home (Aceros et al. 2016). Yet, very little is known about how home-based technology affects people’s desires and expectations to age in place.
Future Directions of Research
The rich narratives of older people tell us that they are anything but passive in their relationship with their environment (World Health Organization 2015, p. 35). Further exploration of how older people retain their ability to still have a life, such as through option recognition and everyday life designs, is warranted. For example, which options do older people recognize and exercise for future changes in physical functioning? What do everyday designs look like outside of the home? How do these intrinsic abilities bring a sense of normalcy or continuity to everyday life and self-identity over time? Studies examining whether and how these intrinsic abilities are exercised earlier in the life course are also necessary.
Some argue that significant and irreversible changes in functioning make older people feel “stuck in place” (Lehning et al. 2015; Lindley and Wallace 2015). Longitudinal studies will help us better understand how changes in physical functioning shape older people’s desires and expectations to age in place. This would also necessitate identifying age-friendly features of built and social environments that older people themselves believe make a home, neighborhood, and community a place to still have a life. In survey studies, perceived neighborhood quality and outdoor place attachment had been found to enhance the satisfaction with life in older age (Oswald et al. 2011). Frail older people also report missing and needing safe outdoor spaces in their neighborhoods to age in place (Cramm et al. 2018). Perceived threats to physical safety can also limit older people’s expectations to age in place (Lehning et al. 2015). In a similar vein, how do older people perceive and respond to changes in familiar built and social environments? Very little is known about how changes to familiar places over time shape older people’s desires and expectations to age in place (World Health Organization 2015). Further research is needed with respect to technology or other innovations related to aging in place. For example, in keeping with Lindley and Wallace’s (2015) study about downsizing, how do older people make use of assistive technologies to still have a life at home, both as they age and experience changes in physical functioning? It is also not known whether and how innovative programs such as the CAPABLE and NORC programs affect older people’s desires and expectations to age in place. In conclusion, future research must explore interactions between older people’s intrinsic abilities and living environments and their desires and expectations to age in place.
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