A variety of housing models can support older adults who wish to age in place

Chum K, Fitzhenry G, Robinson K, Murphy M, Phan D, Alvarez J, Hand C, Laliberte Rudman D, McGrath C. Examining community-based housing models to support aging in place: A scoping review The Gerontologist. 2020.

Review question

•      What types of community-based housing models are available to support aging in place?

Background

•      The global population, aged 65 or older, will increase by 188% from 2010 to 2050, with estimates of up to 85% preferring to age in place.

•      While there are varying definitions of what constitutes “aging in place” within policies and the literature, the concept can be defined as living and aging well with some level of independence in a community-based home.

•      Additionally, studies have demonstrated that older adults hope to have a sense of connectedness to their home through associations with their neighborhoods, communities, and spiritual or cultural groups.

•      Along with supporting the physical and mental health of older adults, aging in place is cost-effective at a societal and organizational level as it reduces admittance to institutional care facilities.

•      The aim of this scoping review is to explore aging in place across community-based housing models.

How the review was done

•      Review authors conducted a detailed search of six research databases in May 2019 for English-language studies describing community-based housing models.

•      Keywords used in the search included: co-housing, communal housing, elderly, and aging in place.

•      A total of 15,272 articles were retrieved from the initial search, of which 46 were included in this review.

•      The authors declared no conflicts of interest.

What the researchers found

•      Articles included in this review addressed five housing models: villages, naturally occurring retirement communities (NORCs), congregate and cohousing, sheltered housing, and continuing care retirement communities (CCRCs).

•      Review authors defined villages as older adult-specific neighborhoods that provide residents with access to a variety of services, activities, and amenities to foster independent living.

•      NORCs are communities that unintentionally accumulate a significant proportion of older adults within a specific geographical area.

•      Congregate and cohousing models are those that offer private living arrangements with access to common spaces and promote interdependence between residents.

•      Sheltered housing models offer living arrangements that foster independent living with a secondary focus on providing affordable accommodations for its residents.

•      CCRCs are housing options that offer a spectrum of care services and shared service amenities to its residents.

•      Review authors identified four themes related to aging in place: 1) social relations; 2) health and wellbeing; 3) sense of self and autonomy; and 4) activity participation. These themes were generally related to the built environment, the availability and access to services or programs, social support, attitudes of inclusion and exclusion among residents, secure living environment, cost, and proximity to amenities and neighbors.

•      Social relations: The communal programming offered within village, NORC, sheltered housing, and CCRC models also appeared to facilitate social satisfaction and socialization among residents and reduced social isolation. Specifically, having a variety of communal programs and leisure activities, such as coffee time, day trips, or group meals, may encourage interaction outside of residents’ private units.

•      Health and wellbeing: In the NORC and congregate/cohousing models, the built environment appeared to enhance residents’ overall satisfaction and mental health by facilitating activity participation and social connection through shared spaces. In congregate/cohousing and sheltered housing models, contextual characteristics, such as the accommodation conditions, physical structure, and availability of services and recreational programming, contributed to improvements in overall quality of life, life satisfaction, and one’s general health and wellbeing.

•      Sense of self and autonomy: For older adults residing in different housing models, the built environment, a secure living environment, and the availability of support services seemed to support their sense of self and autonomy. Specifically, an individual’s sense of self appeared to be supported through the built environment of the NORC, congregate/cohousing, and sheltered housing models. A walkable environment provided opportunities to engage in meaningful activities and empowered individuals to be independent and manage their activities of daily living, which subsequently seemed to contribute to an enhanced sense of self-efficacy. In the village model, the rules or regulations of the community were noted as barriers associated with an individual’s sense of self and autonomy.

•      Activity participation: Activity participation includes the completion of activities of daily living and engagement in physical, social, and leisure activities. Programs that catered to the residents’ interests and needs and that were held within the community increased social connectedness and participation as they were easily accessible and intentionally developed to support the residents found that being surrounded by people at similar life stages increased social participation.

Conclusion

•      The findings of this review suggest that a variety of housing models may support older adults’ social relations, health and well-being, sense of self and autonomy, and activity participation, contributing to successful aging in place within their communities.

•      Additionally, the review identified specific characteristics of these housing models that may support aging in place, including aspects of the built environment, opportunities for activities, and the sociocultural environment.