'It's where I belong': what does it mean to age in place from the perspective of people aged 80 and above? A longitudinal qualitative study (wave one).

BACKGROUND: Most people want to remain at home as they age. Ageing in place - remaining at home and connected to the community - is a national and international policy priority; however, to better understand how policy might be implemented, a more nuanced understanding is required about older adults' lived experiences of ageing in place, especially the experiences of those aged 80 and above. OBJECTIVE: To describe and explore the social processes which enable ageing in place from the perspective of community-dwelling older people (80+). METHODS: Forty-six respondents (80-100+ years) participated in the first wave of a longitudinal qualitative study set in North East England. Semi-structured interviews were conducted in participants' homes between June 2022 and January 2023. Interviews were analysed using reflexive thematic analysis. RESULTS: Participants positioned their homes as a place of freedom and as the antithesis of a 'care home'. Remaining in place was important for all participants; a key priority for them was to remain physically active to enable this. However, many participants faced significant hurdles to remaining in place. These were primarily related to health and mobility issues. Some participants were able to overcome such barriers by drawing on financial resources and available social networks. CONCLUSION: The home is central to understanding older peoples' (80+) experiences of ageing. In a socio-political context which promotes ageing in place, the social factors shaping experiences of ageing in place must be considered. This involves attending to the challenges of later life, particularly health and especially mobility and physical function. Currently, those with resources (social and economic) are better equipped to respond to such challenges, thus potentially exacerbating widening inequalities in ageing. By foregrounding the perspectives of those ageing in place alongside social factors shaping their experiences, our study has important implications for policy and health and social care. We show that a more equitable allocation of resources is vital to fulfil the ageing in place policy agenda. Furthermore, we highlight a need to recognise commitments to ageing in place displayed by people aged 80 and above, especially when remaining in place becomes difficult to achieve.

Perceived Loneliness, Social Isolation, and Social Support Resources of Frail Older People Ageing in Place Alone in Italy.

This paper presents some findings from the IN-AGE ("Inclusive ageing in place") study, which the authors carried out in 2019 in Italy. It explores the available social support resources for frail older people with functional limitations ageing in place alone, and possible links between their social isolation and perceived loneliness. The authors conducted qualitative/semi-structured interviews involving 120 participants aged 65 years and over, and used a mixed-methods analysis (quantitative/qualitative). The main results show the family as the main help resource for daily activities, but also for intimate confidences against social isolation, especially when said relatives live close. Family confidants are less present when seniors are supported by friends/neighbours or/and public services. Moreover, the family is valuable for decreasing loneliness, although not always. However, some older people feel particularly alone when they are supported by public services. Such a complex context draws attention on the need of support for frail seniors living alone and could provide insights for policymakers on adequate policies for preventing and managing loneliness and social isolation in later life. This is especially relevant when family (and other) resources are not available or scarce, also considering the opportunities offered by technology, which can help seniors remain socially connected to relatives, friends and their overall community.

Proud but Powerless: A Qualitative Study of Homecare Workers´ Work Experiences and Their Suggestions for How Care for Homebound Older Adults Can Be Improved.

Many older adults with complex care needs live at home due to ageing-in-place policies. This study explored homecare workers' experiences and suggestions for improvements of care. Twelve semi-structured interviews were analyzed thematically, and revealed pride, capability, and satisfaction in their work, yet they feel undervalued and lack support. They advocate for integrated care models, recognition of their competence, flexible work approaches, and committed leadership. This would enhance patient care and address their own working conditions, addressing concerns from being relegated to the bottom of the hierarchy. They emphasize the need for comprehensive approaches, spanning from housekeeping to end-of-life palliative care.

Attitudes towards Technology: Insights on Rarely Discussed Influences on Older Adults' Willingness to Adopt Active Assisted Living (AAL).

BACKGROUND: European research policy promotes active assisted living (AAL) to alleviate costs and reach new markets. The main argument for massive investments in AAL is its potential to raise older adults' Quality of Life and enhance their freedom, autonomy, mobility, social integration, and communication. However, AAL is less widely spread in older adults' households than expected. RESEARCH AIM: We investigate how the variable "technology acceptance" is connected to socio-economic-, social, health, "personal attitude towards ageing", and "Quality of life" variables. METHOD: We conducted a study in Vienna between 2018 and 2020, questioning 245 older adults (M = 74, SD = 6.654) living in private homes. We calculated multivariate models regressing technology acceptance on the various exploratory and confounding variables. RESULTS: Experiencing an event that made the person perceive their age differently changed the attitude towards using an assistive technological system. Participants perceived technology that is directly associated with another human being (e.g., the use of technology to communicate with a physician) more positively. CONCLUSION: Older adults' attitudes towards technology may change throughout their lives. Using major events in life as potential entry points for technology requires awareness to avoid reducing the lives of older adults to these events. Secondly, a certain human preference for "human technology" may facilitate abuse if technology is given a white coat, two eyes, a nose, and a mouth that may falsely be associated with a natural person. This aspect raises the ethical issue of accurate information as a significant precondition for informed consent.

Exploring a career pathway for home support workers in Ireland: a systematic scoping review of the international evidence.

Background: In prosperous nations like Ireland, home support workers (HSWs) play an increasingly vital role in providing person-centred care to ageing populations. However, challenges such as workforce shortages, role ambiguity, low pay, and limited career advancement, hinder workforce development and career building. Method: A scoping review using key terms for "HSWs" and "career pathways" was conducted following the Joanna Briggs Institute Methodology, examining electronic databases (Web of Science, PubMed, MEDLINE, EMBASE, CINAHL, PscyINFO, Social Care Online, Social Sciences Citation Index). Inclusion criteria were applied, and a thematic analysis followed and inductive-deductive approach. Results: The review encompassed 261 relevant articles from different countries. Four key themes were identified: (1) Data-driven decision-making on the future workforce, (2) Attracting and developing a competent and motivated home support workforce, (3) Enhancing working lives and retention at every stage of career pathways, and (4) Crafting career pathways to improve quality and impact. Discussion: Leadership, collaboration, and data-driven decision-making across policy, research and practice are pivotal for expanding and enhancing home support. Emphasising a shift towards preventative self-management models, supported by digitally skilled and regulated HSWs, could enhance independence and quality of care. Clear career structures, professional development, and inclusive organisational environments are essential to attract, retain, and empower a competent and motivated workforce, fostering quality and impact. Conclusion: This scoping review provides foundational evidence to establish career pathways for HSWs, identifying key areas for development such as data collection, care model transformation, career progression structures, and systems for safety and quality improvement.

Othering Older People's Housing: Gaming Ageing to Support Future-Planning.

The 'othering' of ageing is linked to an integrated process of ageism and hinders planning for the future for both individuals and practitioners delivering housing and health services. This paper aims to explore how creative interventions can help personalise, exchange knowledge and lead to system changes that tackle the 'othering' of ageing. The Designing Homes for Healthy Cognitive Ageing (DesHCA) project offers new and creative insights through an innovative methodology utilising 'serious games' with a co-produced tool called 'Our House' that provides insights into how to deliver housing for older people for ageing well in place. In a series of playtests with over 128 people throughout the UK, the findings show that serious games allow interaction, integration and understanding of how ageing affects people professionally and personally. The empirical evidence highlights that the game mechanisms allowed for a more in-depth and nuanced consideration of ageing in a safe and creative environment. These interactions and discussions enable individuals to personalise and project insights to combat the 'othering' of ageing. However, the solutions are restrained as overcoming the consequences of ageism is a societal challenge with multilayered solutions. The paper concludes that serious gaming encourages people to think differently about the concept of healthy ageing-both physically and cognitively-with the consideration of scalable and creative solutions to prepare for ageing in place.

The timescapes of older adults living alone and receiving home care: An interview study.

In this study, we drew on Barbara Adam's (1998) timescape perspective and applied a timescape lens to our analysis of how nine older adults who live alone, receive home care and are considered by home care professionals to be frail, experience living (in) time. Over a period of eight months, we conducted three interviews with each of the nine participants. We analysed the data using reflexive thematic analysis and drew on timescapes to further interpret our preliminary analysis. Our results show that situated everyday time, place across time, and large-scale time interact in the framing and shaping of older adults' everyday lives. Older adults' embodied experiences of being of advanced age, living alone and receiving home care influenced their timescapes. We propose that paying attention to older adults' timescapes can enable home care professionals and other supporters to consider older adults' health, well-being, vulnerabilities and strengths from a broader perspective than the 'here and now' and thereby enhance the provision of person-centred care.

User Perception of Smart Home Surveillance Among Adults Aged 50 Years and Older: Scoping Review.

BACKGROUND: Smart home technology (SHT) can be useful for aging in place or health-related purposes. However, surveillance studies have highlighted ethical issues with SHTs, including user privacy, security, and autonomy. OBJECTIVE: As digital technology is most often designed for younger adults, this review summarizes perceptions of SHTs among users aged 50 years and older to explore their understanding of privacy, the purpose of data collection, risks and benefits, and safety. METHODS: Through an integrative review, we explored community-dwelling adults' (aged 50 years and older) perceptions of SHTs based on research questions under 4 nonmutually exclusive themes: privacy, the purpose of data collection, risk and benefits, and safety. We searched 1860 titles and abstracts from Ovid MEDLINE, Ovid Embase, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials, Scopus, Web of Science Core Collection, and IEEE Xplore or IET Electronic Library, resulting in 15 included studies. RESULTS: The 15 studies explored user perception of smart speakers, motion sensors, or home monitoring systems. A total of 13 (87%) studies discussed user privacy concerns regarding data collection and access. A total of 4 (27%) studies explored user knowledge of data collection purposes, 7 (47%) studies featured risk-related concerns such as data breaches and third-party misuse alongside benefits such as convenience, and 9 (60%) studies reported user enthusiasm about the potential for home safety. CONCLUSIONS: Due to the growing size of aging populations and advances in technological capabilities, regulators and designers should focus on user concerns by supporting higher levels of agency regarding data collection, use, and disclosure and by bolstering organizational accountability. This way, relevant privacy regulation and SHT design can better support user safety while diminishing potential risks to privacy, security, autonomy, or discriminatory outcomes.

Immersive participatory design of assistive robots to support older adults.

Assistive robots have the potential to support independence, enhance safety, and lower healthcare costs for older adults, as well as alleviate the demands of their care partners. However, ensuring that these robots will effectively and reliably address end-user needs in the long term requires user-specific design factors to be considered during the robot development process. To identify these design factors, we embedded Stretch, a mobile manipulator created by Hello Robot Inc., in the home of an older adult with motor impairments and his care partner for four weeks to support them with everyday activities. An occupational therapist and a robotics engineer lived with them during this period, employing an immersive participatory design approach to co-design and customise the robot with them. We highlight the benefits of this immersive participatory design experience and provide insights into robot design that can be applied broadly to other assistive technologies.

Stakeholder needs assessment for developing ageing in place solutions - a qualitative study.

BACKGROUND: Ageing in place is a common desire among older adults and people in need of care. Accessible housing and ambient assisted living (AAL) technologies can help to live independently at home. However, they cannot replace the human support network of informal caregivers, healthcare professionals and social workers. The needs of these stakeholders should be considered and analysed in order to develop user-friendly and acceptable (digital) solutions for ageing in place while supporting human support networks in fulfilling their roles. This paper presents the first step for a comprehensive multi-level needs analysis within the framework of an user-centered design thinking approach. METHODS: Guideline-based interviews were conducted with healthcare professionals, social workers and an informal caregiver to collect data about the needs of older adults as well as people in need of care, and their human support networks. RESULTS: The call for more information that is easier to find is a common desire of the three groups. There is agreement on system-based communication and orientation problems, the existence of physical and psychological stress exacerbated by a lack of human resources, the desire for personalised care, the need to feel safe and supported in emergencies, and the need for advice and help with administrative tasks. Overall, the needs of one group are closely linked to those of the other. CONCLUSION: Stakeholder selection and diversity are decisive for findings about ageing in place. The overlaps between the stakeholders' needs offer chances and challenges at the same time for the development of user-friendly, acceptable (digital) solutions and products that support ageing in place.

The domestication of remote monitoring: The materialisation of care?

Recent years have seen an influx of technologies aimed at enabling older people to remain at home. Remote monitoring is one such technology. By tracking the body as it moves through time and space, remote monitoring enables a care connection which transcends the physical boundaries of the home. Based on 43 interviews conducted with 21 older people trialling remote monitoring, this study critically explores how older people integrate (or not) remote monitoring into the material and symbolic fabric of their homes. Drawing on the concept of domestication alongside materialities of care, we explore the active ways in which participants make sense of, and incorporate, remote monitoring into the intimacy of their homes. We find that domesticating remote monitoring, an apparently mundane and ordinary object, is a complex and conflicting process which has consequences for the ageing body. Through its domestication, remote monitoring occupies an ambiguous symbolic and material position at the intersection of public and private. While the rationale behind remote monitoring is to minimise physical risk, we find that its proximity to intimacy and its capacity to 'monitor' everyday practice poses symbolic and social risks to people's sense of home and their identities. Our findings highlight how ageing bodies are mediated and reconfigured through these technologies and how ageing bodies are potentially viewed as in decline and/or risky. Remote monitoring was viewed as a 'safety net'; however, acknowledging that safety was a concern, simultaneously positioned participants as 'at risk', a category associated with decline and dependency. Once incorporated into the home, the technology represented an 'active ageing' gaze which, through its imagined capacity to judge, risked disrupting the flow of everyday routines; it elicited a heightened awareness of otherwise taken-for-granted practices. Despite this, for some participants, remote monitoring was appropriated to enact care for others, a way to alleviate the emotional labour of family members, and thus refute normative assumptions underpinning remote monitoring about older people as passive recipients of care. Remote monitoring is not passively incorporated into the domestic setting. On the contrary, older people actively assign symbolic meaning to it.

Experienced barriers in the use of ICT for social interaction in older adults ageing in place: a qualitative systematic review protocol (SYSR-D-22-00848).

BACKGROUND: Several information and communication technologies (ICT) have been developed to enhance social connectedness of older adults aging in place, although they are not accessible for all. Barriers in using ICT might for example relate to health issues, sensory loss, lack of technical skills, or reluctance to use technologies. Though knowledge on these barriers is crucial for the development and implementation of ICT for older adults, no systematic review was found on this subject. The proposed qualitative systematic review aims to explore barriers experienced by older adults aging in place in using ICT for social interaction. METHODS: The review will be conducted in accordance with the JBI methodology. Databases for search will include MEDLINE (via PubMed), CINAHL (via EBSCO), and Web of Science (ISI), among others. Included studies focus on older adults ageing in place 60 years or older. Pairs of authors will independently, by following agreed guidelines, assess the eligibility of studies, and extract data. The testing of eligibility criteria and screening of titles, abstracts, and full texts will be performed. The findings will describe for example populations, context, culture, and the phenomena of interest. Qualitative research findings will, where possible, be pooled by using JBI SUMARI for the meta-aggregation approach. DISCUSSION: The mapping of published studies has the potential to identify research gaps in the existing literature, which again may inform developers and stakeholders in designing more user-friendly and adaptive ICT solutions for older people ageing in place. SYSTEMATIC REVIEW REGISTRATION: CRD42022370044.

'I can see what's going on without being nosey ': What matters to people living with dementia about home as revealed through visual home tours.

OBJECTIVES: This paper considers home from the perspective of people living with dementia supporting ongoing discourse around ageing in place and the significance of creating more inclusive communities. METHODS: Forty-six home tour interviews led by people living with dementia were conducted in England and Scotland to better understand the connectivity between home and neighbourhood for people living with dementia. These interviews used a range of participatory and creative approaches including video, photographic images and in situ interviews. Data were analysed via reflexive thematic analysis. RESULTS: Three themes were identified in data analysis. 1. Connected home and neighbourhood, where participants revealed the dynamic relationship between home and neighbourhood; 2. Practices of home, where participants discussed the everyday nature of their homes and routines; and 3. Displaying home and family, which reflected participant's biographical homes in the context of living with dementia. DISCUSSION: The findings show that home holds multiple meanings for people living with dementia. For example, home is understood as a part of the neighbourhood and an extension of the home space into gardens and backyards, thus extending existing discourses that solely focus on the inside of people's homes. For people living with dementia, homes are also sites of negotiation and renegotiation where new meanings are created to reflect the changing nature and context of the home. There is not one fixed solution to these issues. Support and understanding for people living with dementia will need to evolve to adapt to the shifting dynamics and multiple meanings of home.

Multisite Lifestyle for Older People after the Fukushima Nuclear Disaster.

After the Fukushima nuclear power plant disaster in 2011, the Japanese government implemented a return policy, lifting most evacuation orders in former evacuation areas. Consequently, the return of residents is currently underway. However, it has become common for a large number of residents to carry out multisite living, a lifestyle involving returning to their hometown while maintaining their house at the evacuation site, or living at more than two sites. This report focuses on one aspect of the secondary effects of the nuclear incident, which forced affected residents to adopt a multisite lifestyle. Disasters always have a strong impact, via displacement, on those who are socially vulnerable, such as older people in an ageing society. They need intense support to resume their daily life as it was before the incident. For this report, we interviewed an elderly lady in her 90s, who is executing "multisite living" at evacuation sites, in order to obtain reassurance from neighbours and the local community. Our findings may provide valuable suggestions on how older people can restart their lives with the local community in an ageing society after disasters, which could apply to any kind of disaster preparedness.

A systematic review of ageing in place among Indigenous People in Canada, USA, México, Chile and New Zealand.

The ageing in place (AIP) model enjoys widespread recognition in gerontology and has been strongly encouraged through social policy. However, progress remains to be made in terms of analysing AIP for minority groups and groups with diverse life pathways in old age. This systematic review aims to identify studies that address the AIP model in indigenous communities, answering the following questions: In which geographical contexts and for which Indigenous Peoples have AIP been researched? Which physical dimensions are considered in the assessment of AIP? Which social dimensions are considered in the assessment of AIP? This systematic review applied the SALSA (Search, Appraisal, Synthesis and Analysis) method to AIP among Indigenous older adults on the Web of Science, PsycINFO, MEDLINE and Scopus digital platforms for publications from 2011 to 2021. We identified 12 studies conducted in five countries in North and South America and Oceania. The results show that the following elements of the physical environment are assessed: household, neighbourhood, local surroundings or reserve and native territories. Meanwhile, assessed elements of the social environment are as follows: personal characteristics, attachment to place, social networks, social participation and social policies. There is discussion of the need to develop AIP in order to promote successful ageing among Indigenous older adults.

Elucidating and Expanding the Restorative Theory Framework to Comprehend Influential Factors Supporting Ageing-in-Place: A Scoping Review.

Exposure to stress and attention fatigue resulting from changes in capabilities and residing in environments that do not align with individual needs can adversely impact older adults' mental health and complicate ageing-in-place. Research into the psychological restoration process can help assist in alleviating these issues. Existing research on restoration perspectives has predominantly centred on university students and lacks comprehensive insights into older adults. Consequently, this study seeks to acquire a deeper understanding of the restorative theory framework within the context of ageing populations. We identified and analysed thirty-nine papers on the restoration process of older adults employing the scoping review method. Our findings indicate that adjustments to the general restorative theory framework are imperative for ageing populations. By incorporating additional features-such as being with and familiarity-the framework can more effectively support the development of age-inclusive neighbourhoods that enhance the mental health of the older population and facilitate healthy ageing-in-place. While more in-depth research is required on the restoration process of older adults, this research marks the initial in adapting the general framework to ageing populations. Furthermore, insight is given into how the adapted framework can contribute to help address the challenges of global ageing and support ageing-in-place.

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.

Representations of Ageing in Contemporary Zimbabwe: A Gerontological Reading of NoViolet Bulawayo's (2013) We Need New Names.

While many studies have interrogated the novel We Need New Names, on topics such as citizenship, migration, and transnationalism, there is still much more that readers can learn through interrogating the author's depiction of older adults' experiences of ageing in place, ageism, healthy ageing and intergenerational relationships in Post-colonial Zimbabwe. It is argued that in so far as ageing is concerned, the novel presents a very grim picture of older adults caught up and responding to the circumstances of a country in the throes of a deep social, political and economic crisis. Urban poverty is portrayed as a real challenge affecting Zimbabweans and so are the weak social bonds that connect the younger and older generations. Social gerontologists stand to benefit from studying this novel which clearly depicts the challenges of migration, urban renewal and development projects, and poverty on the most vulnerable of all populations - the older adults. The novel portrays the Zimbabwean economic crisis as not just an isolated phenomenon, but one of the processes of globalization, which creates opportunities, and improves people's lives while at the same time destabilizing the lives of older adults by not only severing connections with the younger generations but also with the departed ancestors in the hereafter. The novel provides an important contribution to our understanding of ageing issues in Zimbabwe as it goes against the grain by giving voice and space to older adults who are often ignored by mainstream media.

Residential Age Segregation: Evidence from a Rapidly Ageing Asian City.

The problem of residential age segregation has been relatively under-studied, since spatial separation of older and younger people tends to be normalized. Prior literature demonstrates that age segregated environments may be socially isolating, especially for older adults, which may have detrimental impacts on their physical and mental health. While there are some studies on residential age segregation in Western contexts, there is scarce literature on age segregation in Asian cities. This mixed methods study examines changing patterns of residential age segregation in Hong Kong, through analyzing a combination of secondary census data and qualitative, in-depth interview data. The findings reveal that the extent of age segregation has remained consistently low from 2006 to 2016, although age segregation appears to be more pronounced between young adults in their early 20s and older adults above 65. Furthermore, in-depth interviews with 26 older people reveal that older people perceive themselves as being socially separated from younger people, especially older people who remain in ageing housing estates in urban districts. The findings add to the growing international literature on generational divides in spatial inequalities, while highlighting the influence of local housing policies on age segregation. The paper concludes by considering the policy implications of the findings, and the practical interventions that might contribute to reducing social isolation experienced by older people.

Healthy Ageing Should Be a Key Component of Ageing in Place: Case Study from Hong Kong.

As part of a knowledge-transfer project consisting of a series of three talks on the topic of healthy ageing and ageing in place, we explored what participants (older adults, students, the general public, as well as professionals in architecture, urban planning and property management) consider to be key requirements for ageing in place and healthy ageing. Feedback is captured using survey questionnaires and a post-talk discussion group. Safety, a comfortable and spacious environment, age-friendly facilities and meeting the needs of older adults, the availability of caring support and home maintenance services were the most frequently mentioned desirable features of ageing in place. Future models for different types of support for ageing in place may be explored by management companies working with the residents themselves, to develop a sustainable business model.