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The U.S. Centers for Disease Control and Prevention defines aging in place as "the ability to live in one's own home and community safely, independently, and comfortably, regardless of age, income, or ability level". [1]
Research in environmental gerontology indicates the importance of the physical and social environment of housing and the neighborhood (public space), as well as its implications for aging in place. [2] [3] [4]
Most adults would prefer to age in place—that is, remain in their home of choice as long as possible. In fact, 90 percent of adults over the age of 65 report that they would prefer to stay in their current residence as they age. [5] One-third of American households are home to one or more residents 60 years of age or older. [6]
Technology can be an enabler for aging in place—there are four categories of technology that acts as an enabler—Communication and Engagement, Health and Wellness, Learning and Contribution, and Safety and Security. [7] Caregiving technologies help those who care for older adults provide that care in the most effective way—and include new technologies for smart phones and tablets, as well as websites—such as Caring.com or AARP.org/Caregiving.
There exist many risks for injury to older adults in the common household, therefore impacting upon their capability to successfully age in place. Among the greatest threats to an ability to age in place is falling. According to the CDC, falls are the leading cause of injurious death among older adults. [8] Therefore, engagement in fall prevention is crucial to one's ability to age in place. Common features in an everyday household, such as a lack of support in the shower or bathroom, inadequate railings on the stairs, loose throw rugs, and obstructed pathways are all possible dangers to an older person. However, simple and low-cost modifications to an older person's home can greatly decrease the risk of falling, as well as decreasing the risk of other forms of injury. Consequently, this increases the likelihood that one can age in place. [ citation needed ]
Some examples of home modifications include: increased lighting, accessible switches at both ends of the stairs, additional railings, grab bars, nonskid flooring, a hand-held flexible shower head, walk-in bathtubs, and the removal of throw rugs and clutter. [9] In most cases, home modifications can be simple and cost-effective, while simultaneously offering substantial benefits to the individual. Other modifications to the home – especially those that require retrofitting – are a little more costly due to increased complexity of installation. These can include: ramps for accessible entry and exit, walk-in shower, sliding shelves, stairlifts, or even home elevators. Many homes are built or retrofitted with the Universal design model in mind, which makes everything in the home accessible to all people with or without functional limitations. [9]
Naturally occurring retirement communities, also known as NORCS, are another source of support for older adults wishing to age in place. A NORC, though not built specifically for a certain age demographic, occurs where a congregation of residents 60 and older live cooperatively. Some offer recreational activities, preventative health and social services for the community. This model can be supported by local, state, and federal dollars as well as community businesses, neighborhood associations and private foundations. [10]
In some cases, the caregivers of people who are aging in place seek to persuade them to adopt new technology, which may include learning new skills and changing their daily routine to incorporate the technology. [11] As of 2014 [update] , there is research about how people aging in place try to use new technology when persuaded, but not much research about the extent to which they continue to use it after trying it for some time. [11] Factors which contribute to the decision to try to technology are the anticipated benefits of the technology, the difficulty using it, the extent to which the user feels that harm will come from not using it, the availability of alternatives, support from others in their social circle, and their own personal attitudes and disposition. [11]
Many elders have difficulties with everyday functioning that require modifications to the houses or apartments they live in. There are several reasons why these changes happen:
Aging in place can be further defined by:
By working with a person's regular physician and other doctors, an Occupational Therapist (OT) can suggest changes to be made to a person's home in order to uniquely compensate for that particular patient's capabilities and disabilities. [12] By making an appointment and meeting with an Occupational Therapist, a patient is getting a one-on-one based session where the therapist is focused solely on that patient's limitations and is making strategies in order to modify the patient's home, making it safer and letting them keep their independence. OT's will work with contractors and occasionally local groups and volunteers to make home modifications ranging from small changes like better lighting to more extreme changes such as chair lifts instead of stairs. An OT will typically try to make low-cost adjustments in the initial stages, but once again this is based on each individual. [13] OT's also provide services to older adults in community based scenarios focusing in health promotion.
In Ontario, Canada, aging in place is known as aging at home, and has received considerable financial support from the Ministry of Health and Long Term Care.
According to the United States Census, 46 million people age 65+ lived in the United States in 2014 and this same segment of the population will grow to 74 million in 2030. [14]
Websites and organizations have sprung up all across the nation, in individual communities, states and nationwide to help people to remain in their own homes for as long as possible. Aging in Place is an initiative of Partners for Livable Communities and the National Association of Area Agencies on Aging. It was developed to help America's communities prepare for the aging of their population and to become places that are good to grow up, live in and grow old. They have been working directly with nine laboratory communities to assist them in advancing policies, programs and services to promote Aging in Place. [15] A similar network is the Elder Villages. [16]
Smart homes are also another development to help promote aging in place by integrating a range of monitoring and supportive devices. These homes have technology for physiological monitoring, functional monitoring for emergency detection and response, safety monitoring and assistance, security monitoring and assistance, social interaction monitoring and assistance and cognitive and sensory assistance. [17]
Georgia Institute of Technology has developed a smart house. This house would help to address issues older adults face when living alone, such as physical and mental decline as well as awareness for family members. The house includes technology such as pendants which understand commands in the form of hand gestures. It could open and lock doors, close blinds, turn on lights, and more. There is also an in-home monitoring system that can inform family members about an older relative's daily activities, health status, and potential problems. This would allow older adults to remain in their own home while still maintaining their independence without their families having to worry about their well-being. This is not the only smart house that has popped up. The University of Florida has created one as well. It has smart refrigerators and pantries which can detect food consumption and expired products. Their smart laundry machines can coordinate with the smart closet to notify the resident when it is time to do laundry as well as aid in sorting the laundry. Every room is specially designed with these and many more smart features to aid their living situation. [18]
Similar technology has been done at the Washington State University, University of Texas, University of Massachusetts, Massachusetts Institute of Technology, University of Missouri, as well as in Osaka, Japan.
In December 2011, AARP Policy Institute and the National Conference of State Legislatures released a report entitled, "Aging in Place: A State Survey of Livability Policies and Practices" [19] to foster aging in place by giving state legislators examples of how laws, policies and programs can support this goal. In addition to such governmental initiatives, livability can be optimized through the incorporation of universal design principles, telecare and other assistive technologies. Assistive technologies include communications, health and wellness monitoring, home safety and security. Semico Research published a report in July 2013 claiming the health and wellness monitoring market for Aging in Place will reach $30 billion by 2017. [20]
The Program of All-Inclusive Care for the Elderly (PACE) model was created in the early 1970s in order to meet the chronic care needs of older people through their community. As an assistance program, one must be at least 55 years of age, certified by their state to need nursing home care, are able to live safely in the community at the time of enrollment, and live in a PACE service area. The goal of the PACE program is to care for the chronic care needs of older individuals while providing them with the ability to live independently, or age in place in their homes, for as long as possible. In order to make independent living possible for this population, the PACE program provides services, such as physical therapy, respite care, prescription drugs, social services, nutritional counseling, and much more. Since 2011, PACE has 82 operational programs in 29 states, and is continuing to expand today. [21]
For many countries in the Middle and Far East, it is part of the cultural beliefs for older adults to age in place. Many children believe it to be their duty to care for their parents as they age and therefore will move in with their parents when their assistance is needed. In many Middle Eastern countries, nursing homes are just recently coming into existence due to cultural and generational shifts towards Western values. [22]
Smart facilities are provided in some housing estates serve the elderly. In one of the ageing-in-place housing estates, a smart device tracks door movement every 24 hours to make sure the tenants of the apartment building are awake and attentive. If not, a notification will be sent to the control center asking for emergency assistance. Each day, tenants are allowed to monitor and record their body temperatures, heart rates, and blood pressure. An alarm will be sent when a tenant's health information departs from pre-set personal boundaries, and the duty nurse will take action after examining the findings. A sensor checks the motion of the unit to see if the tenants have been idle for eight hours straight before sending a call for emergency help to the control centre. [23]
AARP, formerly the American Association of Retired Persons, is an interest group in the United States focusing on issues affecting those 50 years old and older. The organization, which is headquartered in Washington, D.C., said it had more than 38 million members as of 2018. The magazine and bulletin it sends to its members are the two largest-circulation publications in the United States.
Geriatrics, or geriatric medicine, is a medical specialty focused on providing care for the unique health needs of the elderly. The term geriatrics originates from the Greek γέρων geron meaning "old man", and ιατρός iatros meaning "healer". It aims to promote health by preventing, diagnosing and treating disease in older adults. There is no defined age at which patients may be under the care of a geriatrician, or geriatric physician, a physician who specializes in the care of older people. Rather, this decision is guided by individual patient need and the caregiving structures available to them. This care may benefit those who are managing multiple chronic conditions or experiencing significant age-related complications that threaten quality of daily life. Geriatric care may be indicated if caregiving responsibilities become increasingly stressful or medically complex for family and caregivers to manage independently.
Elder abuse is a single or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust, which causes harm or distress to an older person. This definition has been adopted by the World Health Organization (WHO) from a definition put forward by Hourglass in the UK. Laws protecting the elderly from abuse are similar to and related to laws protecting dependent adults from abuse.
Elderly care, or simply eldercare, serves the needs of old adults. It encompasses assisted living, adult daycare, long-term care, nursing homes, hospice care, and home care.
A retirement community is a residential community or housing complex designed for older adults who are generally able to care for themselves. Assistance from home care agencies is allowed in some communities, and activities and socialization opportunities are often provided. Some of the characteristics typically are: the community must be age-restricted or age-qualified, residents must be partially or fully retired, and the community offers shared services or amenities.
An adult daycare center is typically a non-residential facility that supports the health, nutritional, social, and daily living needs of adults in a professionally staffed, group setting. These facilities provide adults with transitional care and short-term rehabilitation following hospital discharge. The majority of centers provide meals, meaningful activities, and general supervision. The care provided is often a social model or a medical model provided in order to improve participants health and guide their progress in the right direction. Demand for adult daycare centers is increasing with the need for assistance in old age or guidance to reintegrate into society after injury, illness or addiction, and accommodation to return to their former lives or improve upon their quality of life.
Gerontechnology, also called gerotechnology is an inter- and multidisciplinary academic as well as a professional field that combines various disciplines of gerontology and technology. Sustainability of an aging society depends upon our effectiveness in creating technological environments, including assistive technology and inclusive design, for innovative and independent living and social participation of older adults in any state of health, comfort as well as safety. In short, gerontechnology concerns matching technological environments to health, housing, mobility, communication, leisure, work and also the personality/individual dispositions of older people. Gerontechnology is most frequently identified as a subset of HealthTech and is -- since the 2010s -- more commonly referred to as AgeTech or Agetech in Europe and the United States. Research outcomes form the basis for designers, builders, engineers, manufacturers, and those in the health professions, to provide an optimum living environment for the widest range of ages.
A naturally occurring retirement community is a community that has a large proportion of residents over 60 but was not specifically planned or designed to meet the needs of seniors living independently in their homes.
Geriatric care management is the process of planning and coordinating care of the elderly and others with physical and/or mental impairments to meet their long term care needs, improve their quality of life, and maintain their independence for as long as possible. It entails working with persons of old age and their families in managing, rendering and referring various types of health and social care services. Geriatric care managers accomplish this by combining a working knowledge of health and psychology, human development, family dynamics, public and private resources as well as funding sources, while advocating for their clients throughout the continuum of care. For example, they may assist families of older adults and others with chronic needs such as those suffering from Alzheimer's disease or other dementia.
Program of All-inclusive Care for the Elderly (PACE) are programs within the United States that provide comprehensive health services for individuals age 55 and over who are sufficiently frail to be categorized as "nursing home eligible" by their state's Medicaid program. The ultimate goal of PACE programs is to keep eligible older adults out of nursing homes and within their communities for as long as possible. Services include primary and specialty medical care, nursing, nutrition, social services, therapies, pharmaceuticals, day health center services, home care, health-related transportation, minor modification to the home to accommodate disabilities, and anything else the program determines is medically necessary to maximize a member's health. If you or a loved one are eligible for nursing home level care but prefer to continue living at home, a PACE program can provide expansive health care and social opportunities during the day while you retain the comfort and familiarity of your home outside of day hours.
Gerontological nursing is the specialty of nursing pertaining to older adults. Gerontological nurses work in collaboration with older adults, their families, and communities to support healthy aging, maximum functioning, and quality of life. The term gerontological nursing, which replaced the term geriatric nursing in the 1970s, is seen as being more consistent with the specialty's broader focus on health and wellness, in addition to illness.
Home automation for the elderly and disabled focuses on making it possible for older adults and people with disabilities to remain at home, safe and comfortable. Home automation is becoming a viable option for older adults and people with disabilities who would prefer to stay in the comfort of their homes rather than move to a healthcare facility. This field uses much of the same technology and equipment as home automation for security, entertainment, and energy conservation but tailors it towards old people and people with disabilities.
A professional live-in caregiver provides personal care and assistance to individuals, including those suffering from chronic illness, Alzheimer's disease, and dementia, within the home setting. Typical duties of a live-in caregiver include meal planning and preparation, assistance with grooming, dressing and toileting, medication management, laundry and light housekeeping, and transportation/escorts to doctor's appointments or social engagements. Professional live-in caregivers are often provided by an outside agency, which may also coordinate their services with the client's preferred in-home health agency and other medical providers.
The Pennsylvania Department of Aging is a cabinet-level agency charged with providing aid to Pennsylvania's approximately three million individuals age 60 and older. Although the bureau operates some services directly, such as the Pharmaceutical Contact for the Elderly (PACE) prescription drug program, it generally serves as a clearinghouse of funding and information for county-level Area Agencies on Aging. The department was formed under the governorship of Milton Shapp.
Independent senior living communities are housing designed for seniors 55 and older.
The John A. Hartford Foundation is a private United States–based philanthropy whose current mission is to improve the care of older adults. For many years, it made grants for research and education in geriatric medicine, nursing and social work. It now focuses on three priority areas: creating age-friendly health systems, supporting family caregivers and improving serious illness, and end-of-life care.
An adult-gerontology nurse practitioner (AGNP) is a nurse practitioner that specializes in continuing and comprehensive healthcare for adults across the lifespan from adolescence to old age.
As of 2017, approximately 1.4 million Americans live in a nursing home, two-thirds of whom rely on Medicaid to pay for their care. Residential nursing facilities receive Medicaid federal funding and approvals through a state health department. These facilities may be overseen by various types of state agency.
LGBT ageing addresses issues and concerns related to the ageing of lesbian, gay, bisexual and transgender (LGBT) people. Older LGBT people are marginalised by: a) younger LGBT people, because of ageism; and b) by older age social networks because of homophobia, biphobia, transphobia, heteronormativity, heterosexism, prejudice and discrimination towards LGBT people.
Aging in Canada has emerged as a focal point of societal discussions and policy considerations in Canada. This reality has impacts that vary from demographic trends, healthcare nuances, social implications, economic dimensions, government policies, housing considerations, technological innovations, and the cultural and ethical facets that shape the experiences of the aging population.