Prioritizing supports and services to help older adults age in place: A Delphi study comparing the perspectives of family/friend care partners and healthcare stakeholders

Abstract

Background Aging in place (AIP) is a policy strategy designed to help older adults remain in their community. While planners internationally have modified aspects of the older adult care continuum (e.g., home care, assisted living, nursing homes) to facilitate AIP, further improvements to community-based supports and services are also required. This study compared and constrasted the community-based factors (e.g., supports, services and personal strategies or characteristics) that family/friend care partners and healthcare stakeholders (i.e., planners/providers) view as most important to help older adults successfully AIP. Methods An initial list of factors shown to influence AIP was created from the academic literature. These factors were used to develop a Delphi survey implemented separately on care partners and healthcare stakeholders. Respondents rated the importance of each factor using a 10-point Likert Scale (1 = not important; 10 = absolutely critical). Consensus in each group was defined when at least 80% of participants scored a factor ≥8 (“very important”), with an interquartile range ≤2. Respondents suggested additional factors during Delphi round one. Results Care partners (N = 25) and healthcare stakeholders (N = 36) completed two and three Delphi rounds, respectively. These groups independently agreed that the following 3 (out of 27) factors were very important to help older adults age in place: keeping one’s home safe, maintaining strong inter-personal relationships, and coordinating care across formal providers. While healthcare stakeholders did not reach consensus on other factors, care partners agreed that 7 additional factors (e.g., access to affordable housing, having mental health programs) were important for AIP. Conclusions Compared to healthcare stakeholders, care partners felt that more and diverse community-based factors are important to support older adults to successfully AIP. Future research should replicate these findings in other jurisdictions, examine the availability and accessibility of the priority factors, and develop sustainable solutions to enhance their effectiveness.

Inequality in housing transitions during cognitive decline

“…The prevalence of multiple moves suggests that as dementia progresses, PWD may need to further adjust their home environment to meet changing needs. With this in mind, housing decisions should be a key consideration discussed as part of treatment plans with the collaboration of caregivers, as discussed by Garvelink et al [ 6 , 65 ], Adekpedjou et al [ 11 ], Campbell et al [ 23 ], and Sturge et al [ 66 ].…”

“…Most prior studies in this area focus specifically on nursing home admission, and provide conflicting evidence on whether more socioeconomically advantaged PWD are more likely to be institutionalized [12,[19][20][21]. An emerging body of research is starting to build knowledge around housing preferences and factors influencing the housing choices of PWD and their caregivers, mainly through in-depth qualitative studies, with some synthesis in review articles [4,6,9,10,13,17,22,23]. Yet large-scale studies that examine the various settings where PWD live are scarce, and even less is known about PWDs' actual housing transitions over the course of cognitive decline.…”

Entrusting life to professionals: A phenomenological hermeneutical study of older persons' participation in prehospital emergency care involving municipal home care and ambulance services

“…Older persons are encouraged to remain living at home as part of a sustainable ‘ageing in place’ strategy that promotes well‐being and autonomy [9, 10]. Canadian research identifies service and support as greatly important when ageing in place, characterised by interpersonal relations, being safe in one's home, and coordinated care activities [11]. In Sweden, ageing in place is facilitated by the municipalities that provide services aligned with everyday care needs.…”