Examining Community-Based Housing Models to Support Aging in Place: A Scoping Review

Psychosocial Profiles of Older Adults by Dentition Status and Dental Utilisation History

OBJECTIVE

Psychosocial factors can affect health. Patterns of psychosocial stressors and resources among older adults were examined for oral health status.

METHODS

The Health and Retirement Study (HRS) is a representative sample of US adults > 50 years. Participants completed the 2018 HRS CORE survey and the Psychosocial and Lifestyle Questionnaire-Panel A "Leave Behind" survey (HRS-LB) (N = 4703). All measures were self-reported and stratified into outcome groups: (1) edentulous/dentate, (2) with/without a recent dental visit in the last 2 years. Psychosocial measures covered three domains: well-being, beliefs, and lifestyle. Specifically, loneliness, life satisfaction, perceived age, social status, control, mastery, and chronic stressors were included in this analysis. Latent class analysis (LCA) identified profiles of adults based on the distribution of psychological and social stressors and resources. Associations between latent classes and being edentulous and a recent dental visit were examined in logistic regression models.

RESULTS

About 30% reported no recent dental visit; 14% were edentulous. Three latent classes were identified; profiles had different distributions of psychosocial factors. About half (47%) were in Class A: "Satisfied/Connected" (n = 2230), 28% in Class B: "Satisfied/Lonely" (n = 1293), and 25% in Class C: "Unsatisfied/Lonely" (n = 1180). "Satisfied/Connected" adults had the fewest psychosocial risk factors, most resources, were dentate, and had a recent dental visit. "Unsatisfied/Lonely" adults exhibited the most psychosocial risk factors and fewest resources and lacked a recent dental visit. "Satisfied/Lonely" adults exhibited characteristics between Classes A and C. In fully adjusted regression models, Class B adults had 1.29 (1.03-1.62) times greater odds than Class A to be edentulous and 1.26 (1.07-1.50) times greater odds to not have a recent dental visit. Class C adults had 1.22 (0.97-1.53) times greater odds than Class A to be edentulous and 1.31 (1.10-1.57) times greater odds to not have a recent dental visit.

CONCLUSION

Adverse psychosocial factors are associated with edentulism and lack of routine dental visits. Exposure to psychosocial risk and resource factors can affect oral health. Health providers should assess older adults for loneliness and other psychosocial risk factors, and policies and programmes that support older adults' psychosocial needs should be expanded.

A portrait of older adults in naturally occurring retirement communities in Ontario, Canada: A population-based study

BACKGROUND

Naturally occurring retirement communities (NORCs) are geographical areas that have naturally become home to a large concentration of older adults. This density means that NORCs have the potential to become a pillar for aging in place strategies, but at present, there is limited data on residents and their health needs. Our objective was to describe and compare the health and healthcare use of older adults living in high-rise NORC buildings to those in all other housing types in the community.

METHODS

We conducted a population-based descriptive study of community-dwelling older adults aged ≥65 years by linking a provincial NORC registry in Ontario, Canada with health administrative records. Individuals were classified as NORC residents if their residential postal code on January 1, 2020 matched the NORC registry. Sociodemographic, clinical, and healthcare use characteristics were compared by NORC status using standardized differences (STD) and stratified by rurality, and further by age and sex in urban settings.

RESULTS

Overall, 219,995 (7.7%) of 2,869,706 older adults were NORC residents. Compared to community-dwelling older adults, NORC residents were older (mean 77.4 vs 74.6 years; STD 0.34), and more were female (61.8% vs 52.2%; STD 0.19) and had low income (16.0% vs 9.3%; STD 0.11). NORC residents also had more active chronic conditions (mean 1.9 vs 1.5; STD 0.27), medications (mean 3.4 vs 2.8; STD 0.21), home care use (15.3% vs 9.8%; STD 0.17), and primary care visits (mean 9.7 vs 7.6 visits in prior 2 years; STD 0.22). Findings were robust across rurality, age, and sex.

CONCLUSIONS

Our findings suggest that NORC residents have greater health needs than other older adults living in the community and underscore NORCs as important targets for equity-focused strategies to support aging in place.

Sequential multiple mediating effect of loneliness and family health on physical frailty and willingness to age at home in older adults: a national survey in China

BACKGROUND

With the rapid ageing of the global population, the number of older adults with physical frailty has been gradually increasing, making ageing at home a key strategy for coping with this demographic change. The opinions of older adults regarding their willingness to age at home deserve to be considered respectfully. As a result, this study aimed to investigate willingness to age at home and any associated underlying mechanisms involving physical frailty among older Chinese adults.

METHODS

This study was a national cross-sectional survey. Stratified random and quota sampling were used before and after the individual level respectively. Willingness to age at home was compared between older adults with different characteristics using the Mann-Whitney U test and Kruskal-Wallis H test. A Spearman rank test was conducted to explore the correlations among physical frailty, loneliness, family health, and willingness to age at home. The path hypothesis that loneliness and family health influence the relationship between physical frailty and willingness to age at home among older adults was further tested through sequential multiple mediation analysis.

RESULTS

A total of 3,837 older adults were included in this study. They returned a median score of 78 in terms of willingness to age at home. Physical frailty (β = - 0.044, P < 0.01) and loneliness (β = - 0.070, P < 0.001) were negatively associated, and family health (β = 0.275, P < 0.001) was positively associated with a willingness to age at home among older Chinese adults. Loneliness and family health played sequential multiple mediating role (β = - 0.018, Boot SE = 0.002, 95% CI = [-0.022, - 0.014]) between physical frailty and willingness to age at home.

CONCLUSIONS

Reducing physical frailty in older adults, reducing their sense of loneliness, and enhancing their family health is essential, as it can increase their levels of confidence with regard to ageing at home.

Barriers to accessing home and community-based services among family caregivers of Veterans

BACKGROUND

The Department of Veterans Affairs (VA) has long recognized the importance of having a rich complement of home and community-based resources for the Veteran population. For Veterans experiencing disability-related impairments, home- and community-based services (HCBS) facilitate aging in place and alleviate family caregivers' burden. However, even in the enriched VA context, HCBS are underutilized. Our objective was to understand unmet needs and barriers to accessing HCBS from the perspectives of Veterans' family caregivers.

METHODS

This multi-method study recruited family caregivers of Veterans seen within a major VA Health Care System. Eligible caregivers provided care for at least 8 h/week in the prior 6 months, to a Veteran with 1+ impairments in instrumental activities of daily living. Recruitment was conducted via flyers, physician referrals, registries, and chart reviews. Participants completed 1-h semi-structured interviews to assess unmet psychosocial needs and barriers to accessing VA and non-VA HCBS. Interviews were analyzed using a thematic analysis approach.

RESULTS

A total of 23 caregivers (62.9 + 13.5 years; 74% women; 52.2% White; 26.1% Black; 95.2% pre-9/11) provided 8.4 ± 6.3 h of daily care. Most had provided care for more than 1 year; nine had cared for their Veteran for 5+ years. The following themes were identified: (1) need for clear, accurate, timely information about HCBS; (2) lack of time, amplified by COVID-19 restrictions; (3) need for respite to manage their own health and other caregiving responsibilities; and (4) perceived difference in care needs that can strain caregivers' relationship with the care recipient.

CONCLUSIONS

In addition to known barriers including lack of timely knowledge, service delays, and caregiver stress, Veteran-caregiver disagreements emerged as a novel barrier to using HCBS. A multi-pronged approach that addresses these barriers may increase timely access to HCBS.

Serviced Housing for Older People and Prevention of Functional Decline: A One-year Follow-up Study in Japan

Serviced Housing for Older People (SHOP) is a community-based housing model in Japan that provides barrier-free apartments and support services for residents. Whether the SHOP model has positive effects on residents' health remains unclear. This follow-up study examines the association between living in SHOPs and functional decline. Using data from the Japan Gerontological Evaluation Study, we compared functional decline risks at one-year follow-up between older adults living in conventional housing (n = 2202) and SHOP residents (n = 160). Functional decline risk was assessed using the Kihon Checklist (KCL) and Care-Need Risk Assessment Scale (CNRAS). SHOPs residents had lower KCL and CNRAS scores than older adults living in conventional housing. In sensitivity analyses, these associations remained unchanged. The results, thus, showed that residing in SHOPs was associated with reduced functional decline; therefore, SHOPs designed to support residents' physical and social health could be important for supporting aging in place.

Urban-Rural Disparities in the Association Between Home- and Community-Based Service Utilization and Levels of Disability Among Chinese Older Adults With Disabilities

Home- and community-based services (HCBS) are optimal ways to deal with disability problems among older adults. This study aims to analyze urban-rural disparities in the relationship between HCBS utilization and levels of disability among Chinese older adults with disabilities, so as to meet the long-term care needs of them. In applying the Andersen Behavioral Model, bivariate analysis and multivariate regression models were employed using data from 843 older adults with disabilities from the 2018 China Longitudinal Aging Social Survey (CLASS). After adjusting covariates, disability levels among Chinese older adults with disabilities were significantly correlated with HCBS utilization in urban areas but not in rural areas. The urban-rural disparities may be due to the low utilization of HCBS in rural areas (only 11.2%) among older adults with disabilities compared with their urban counterparts (22.7%).

Subsidized Senior Housing in the US: A Scoping Review

Subsidized senior housing (SSH) is important to support healthy aging among vulnerable subgroups of older adults, yet progress in developing and expanding SSH has been limited. This scoping review had two research questions: (1) What are the trends in SSH empirical studies? (2) What are the main topics in the existing literature on SSH in the US? We reviewed a total of 61 articles and found several notable trends, including a focus on racial and ethnic minorities, cognitive impairment among SSH residents, and collaborative partnerships between housing operators and healthcare providers. More than half of the studies were quantitative, while the rest were qualitative or mixed-methods. The lack of longitudinal or causal design research reflects the limited empirical knowledge of SSH. Four themes emerged: health and well-being, healthcare use and health behaviors, social relations, and housing relocation. We discussed implications for future research and program development efforts in SSH.

Redefining Age-Friendly Neighbourhoods: Translating the Promises of Blue Zones for Contemporary Urban Environments

The longevity and healthy ageing observed in Blue Zones offer valuable insights for contemporary urban neighbourhood planning and design. This paper reviews the age-friendly features of the built environment in Blue Zones, aiming to translate these insights into actionable strategies for urban neighbourhood development. Employing a systematic literature review and Convolutional Neural Networks (CNNs) analysis of Google Street View imagery, this study assesses the built environments in Blue Zones, including housing, public spaces, and transportation systems. Key findings highlight the presence of adaptable housing, building designs that foster a connection with nature, and semi-public spaces that encourage social interaction and physical activity. A notable emphasis on walkability and limited public transport access was observed. The CNN analysis corroborated these findings, providing a quantitative view of age-friendly features. This research contributes to the academic discourse in urban planning and design by providing practical insights for developing age-friendly neighbourhoods, inspired by Blue Zones. It concludes by offering policy advice and future research directions for creating sustainable and inclusive urban environments conducive to ageing populations.

Subsidized Versus Unsubsidized Senior Housing Communities in PA: A Window on Variation in Health, Function, and Access to Services in Old Age

Introduction: Independent Living residences for older adults can be divided into two categories and require better definitions for research purposes; the purpose of this manuscript is to provide those definitions and explore variation in provided services and resident characteristics: (a) Subsidized age-based housing (55+) (Department of Housing and Urban Development (HUD) housing units for low-income adults), and (b) non-subsidized age-based housing. Methods: Residents in the two settings were compared: 37 subsidized locations (p = 289 residents) and 19 non-subsidized (p = 208). Aging support services in each housing type were quantified. Results: Subsidized residents are more likely to be female (84.6% vs. 70.2%, p = .0002) and have fair-poor health (36.5% vs. 12.5%, p < .0001), frequent pain (28.4% vs. 12.8%, p < .0001), and fair-poor mobility (37.5% vs. 23.5%, p = .0298). Non-subsidized locations are more likely to offer support services; on average, residents are older (mean age 83vs. 75; p < .0001) and white (97.6% vs. 69.2%, p < .0001). Conclusion: Significant differences exist between populations living in subsidized and non-subsidized housing, suggesting the effect of cumulative disadvantage over the lifespan; populations in poorer health have access to fewer services. Research is needed to explore generalizability on a national level.

Comparing quality of care outcomes between assisted living and nursing homes before and during the COVID-19 pandemic

BACKGROUND

While assisted living (AL) and nursing home (NHs) residents in share vulnerabilities, AL provides fewer staffing resources and services. Research has largely neglected AL, especially during the COVID-19 pandemic. Our study compared trends of practice-sensitive, risk-adjusted quality indicators between AL and NHs, and changes in these trends after the start of the pandemic.

METHODS

This repeated cross-sectional study used population-based resident data in Alberta, Canada. Using Resident Assessment Instrument data (01/2017-12/2021), we created quarterly cohorts, using each resident's latest assessment in each quarter. We applied validated inclusion/exclusion criteria and risk-adjustments to create nine quality indicators and their 95% confidence intervals (CIs): potentially inappropriate antipsychotic use, pain, depressive symptoms, total dependency in late-loss activities of daily living, physical restraint use, pressure ulcers, delirium, weight loss, urinary tract infections. Run charts compared quality indicators between AL and NHs over time and segmented regressions assessed whether these trends changed after the start of the pandemic.

RESULTS

Quarterly samples included 2015-2710 AL residents and 12,881-13,807 NH residents. Antipsychotic use (21%-26%), pain (20%-24%), and depressive symptoms (17%-25%) were most common in AL. In NHs, they were physical dependency (33%-36%), depressive symptoms (26%-32%), and antipsychotic use (17%-22%). Antipsychotic use and pain were consistently higher in AL. Depressive symptoms, physical dependency, physical restraint use, delirium, weight loss were consistently lower in AL. The most notable segmented regression findings were an increase in antipsychotic use during the pandemic in both settings (AL: change in slope = 0.6% [95% CI: 0.1%-1.0%], p = 0.0140; NHs: change in slope = 0.4% [95% CI: 0.3%-0.5%], p < 0.0001), and an increase in physical dependency in AL only (change in slope = 0.5% [95% CI: 0.1%-0.8%], p = 0.0222).

CONCLUSIONS

QIs differed significantly between AL and NHs before and during the pandemic. Any changes implemented to address deficiencies in either setting need to account for these differences and require monitoring to assess their impact.

CONDITIONS FOR THE DEVELOPMENT OF SOCIAL HOUSING IN UKRAINE

Aim: The aim of the study was to determine the conditions, tools and mechanisms necessary for the statepolicy of Ukraine to provide Ukrainians with social housing during and after the war. Methods: The studyused a set of scientific methods, including generalization, theoretical and methodological grouping, analysisand synthesis. Results: Based on the analysis of the solutions in Ukraine and selected European countries sofar, the conceptual apparatus was generalized, and the features of social housing were defined. Conclusions:A list of entities entitled to social housing, sources and mechanisms of its financing and support programswere defined. Based on the obtained results, recommendations were presented for the policy of supportingsocial housing in Ukraine.

Naturally Occurring Retirement Communities: Scoping Review

BACKGROUND

As Canada's population ages, there is a need to explore community-based solutions to support older adults. Naturally occurring retirement communities (NORCs), defined in 1986 as buildings or areas not specifically designed for, but which attract, older adults and associated NORC supportive service programs (NORC-SSPs) have been described as potential resources to support aging in place. Though the body of literature on NORCs has been growing since the 1980s, no synthesis of this work has been conducted to date.

OBJECTIVE

The goal of this scoping review is to highlight the current state of NORC literature to inform future research and offer a summarized description of NORCs and how they have supported, and can support, older adults to age in place.

METHODS

Using a published framework, a scoping review was conducted by searching 13 databases from earliest date of coverage to January 2022. We included English peer- and non-peer-reviewed scholarly journal publications that described, critiqued, reflected on, or researched NORCs. Aging-in-place literature with little to no mention of NORCs was excluded, as were studies that recruited participants from NORCs but did not connect findings to the setting. A qualitative content analysis of the literature was conducted, guided by a conceptual framework, to examine the promise of NORC programs to promote aging in place.

RESULTS

From 787 publications, we included 64 (8.1%) articles. All publications were North American, and nearly half used a descriptive research approach (31/64, 48%). A little more than half provided a specific definition of a NORC (33/64, 52%); of these, 13 (39%) used the 1986 definition; yet, there were discrepancies in the defined proportions of older adults that constitute a NORC (eg, 40% or 50%). Of the 64 articles, 6 (9%) described processes for identifying NORCs and 39 (61%) specifically described NORC-SSPs and included both external partnerships with organizations for service delivery (33/39, 85%) and internal resources such as staff, volunteers, or neighbors. Identified key components of a NORC-SSP included activities fostering social relationships (25/64, 39%) and access to resources and services (26/64, 41%). Sustainability and funding of NORC-SSPs were described (27/64, 42%), particularly as challenges to success. Initial outcomes, including self-efficacy (6/64, 9%) and increased access to social and health supports (14/64, 22%) were cited; however, long-term outcomes were lacking.

CONCLUSIONS

This review synthesizes the NORC literature to date and demonstrates that NORC-SSPs have potential as an alternative model of supporting aging in place. Longitudinal research exploring the impacts of both NORCs and NORC-SSPs on older adult health and well-being is recommended. Future research should also explore ways to improve the sustainability of NORC-SSPs.

Adapting a whole health model to home-based primary care: Bridging person-driven priorities with veteran and family-centered geriatric care

Through the integration of Whole Health for Life into the Department of Veterans Affairs (VA) health care system, the VA aims to transform health care delivery from a disease management approach to one that embraces person-centered care. The home-based primary care (HBPC) program is a care model that, within the VA, provides holistic primary care services to homebound veterans with multiple chronic medical conditions, mental health issues, and functional declines. These veterans may have limited access to VA programs delivered in a traditional outpatient format. This article describes adaptations to the whole health model of care that could improve its accessibility and applicability to HBPC veterans, caregivers, and the interdisciplinary teams that serve this population. These modifications are informed by whole-person geriatric and gerontological and family-systems theories and address population-based differences in the focus and approach to care. The focus on care is expanded to (a) reflect the importance of attending to caregiver needs and well-being and (b) shift from a preventative model to one that prioritizes resilience and maintenance. The approach to care emphasizes alternative modes of delivery, adaptations to interventions, and integration of geriatric-specific medical considerations into the self-care domains and more directly centers the collaboration between family, the VA, and community partners. This adapted model also addresses the unique needs of health care teams providing in-home services to medically complex veterans and offers suggestions for enhancing self-care and preventing burnout. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Promising Aging in Community Models in the U.S.: Village, Naturally Occurring Retirement Community (NORC), Cohousing, and University-Based Retirement Community (UBRC)

Aging in Community (AIC) is the preferred way to age. This systematic review identified promising AIC models in the U.S. and analyzed model characteristics and push-pull factors from older adults’ perspectives. Push factors are those driving older adults to leave, while pull factors attract them to stay in a community. We conducted a two-phase search strategy using eight databases. Phase I identified promising AIC models and Phase II expanded each specific model identified. Fifty-two of 244 screened articles met the criteria and were analyzed. We identified four promising AIC models with the potential to achieve person-environment (P-E) fit, including village, naturally occurring retirement community (NORC), cohousing, and university-based retirement community (UBRC). Each has a unique way of helping older adults with their aging needs. Similar and unique push-pull factors of each AIC model were discussed. Analyses showed that pull factors were mostly program factors while push factors were often individual circumstances. Continued research is needed to address the challenges of recruiting minority older adults and those of lower socio-economic status, meeting older adults’ diverse and dynamic needs, and conducting comparative studies to share lessons learned across the globe.