Your parents or grandparents are getting older. They need daily care. You fear that they will fall and hurt themselves…
You may think that the best solution for them would be to leave their home and move to a small apartment, an assisted-living facility or a nursing home. The decision seems logical and straightforward, but have you considered the social and psychological impact that such a change has on older adults? The decision to leave their home is sometimes painful. They must leave an environment to which they are attached and where they feel good. They must leave their neighbourhood and their friends. They may be afraid of sacrificing their autonomy and privacy.
In Canada, about 90% of people aged 65 and over still live in their homes.(1) It is estimated that 30% of people aged 75 and over and 50% of those aged 85 and over receive care at home.(2) When help becomes insufficient and their autonomy and capacities diminish (both physical and cognitive), older adults and their loved ones must evaluate their options. These may be to stay in their home and adapt it, or to move to more suitable housing with or without additional care delivered. Such reflections are complex. It is therefore important to understand what the home represents for an older adult, as well as the range of factors that can influence their decisions.
What the research tells us
A systematic review examined the factors influencing housing decisions of frail older adults over the age of 65 (without cognitive impairment).(3) The studies included in this systematic review identified 88 factors grouped in six dimensions:
1) the psychological and psychosocial dimension (for example, level of control, perceived safety, and physical and psychological comfort);
2) the socio-economic and health dimension (for example, factors related to age and health status, income, and level of education);
3) the economic dimension (for example, factors related to property, financial investment, savings and affordable housing);
4) the social dimension (for example, places of socialization, concepts of intimacy and refuge);
5) the time and space-time dimension (for example, living in an environment we know, to which we are attached, and which offer us memories); and
6) the built or natural environment dimension (for example, factors related to urban or natural environments, access to commercial services and facilities, safety of the living environment, and accessibility of housing).
The results reveal that the factors that had the greatest effect in housing decisions are often those related to social, psychological and psychosocial dimensions. Among the most important factors are the sense of control over the decision and the environment, relationships with the neighbourhood, routines and lifestyle, access to amenities, access to health professionals, feelings of comfort and independence, social activities and networks, proximity to services and siblings, the ability to adapt homes, familiarity with the environment, as well as triggering events (including events that can precipitate a decline in physical, cognitive, or mental health). Conversely, the socio-economic dimension appeared to have less weight in housing decisions.
Deciding to stay or leave is a very delicate and complex decision. That said, having a better understanding of the range of factors influencing older adults’ housing decisions will help loved ones and professionals better support their decision-making process. Ultimately, it will help older adults make the best possible decision about housing based on their own circumstances and values.
Research shows that we cannot focus housing decisions on care needs only, because the social, psychological and psychosocial factors are so important to older adults. We have everything to gain by adopting a holistic approach considering the full range of needs, values and preferences of older adults. The research also suggests the need to explore housing options that meet the social, comfort and independence needs of older adults. This could take the form of home modifications to avoid uprooting older adults who wish to stay in their house and community for as long as possible, or to design alternative housing in which older adults truly feel at home.