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As you might expect, aging in place refers to an individual residing in their preferred dwelling. We generally think of this to mean that an older adult prefers to reside at a familiar residence where he or she has lived for many years, and this is generally the case, but this description seems too narrow.  For instance, an older adult may choose to move to a smaller residence but remain in the same community. Or, an older adult may choose to move out of their community entirely and reside alongside other like-minded, or demographically similar, folks or choose to reside in a more hospitable climate.  

Keeping the aforementioned description in mind, a good start to defining aging in place is stating that it involves remaining in the community, with some level of independence, rather than in residential care (link to source).  Add to this the notion of having the ability to live safely and comfortably, regardless of age, income, or ability level (link to source), and we are almost at a well rounded definition of what aging in place means.  

The definition above is slightly skewed toward tangible aspects of aging in place.  For instance, it focuses on physical (dwelling) and financial (income) matters. I acknowledge the impact that familiarity and attachment with one’s home and surroundings have on a person’s well-being and quality of life, but I think something is missing.    

As such, how about we add to the following statement to the definition of aging in place: that it allows for maintaining and creating new social connections (link to source), including facilitating cultural engagement, creating physical and recreational activities and widening the informal support network.  

So, combining the elements above, here is my definition of Aging in Place: 

Aging in place involves being able to choose to remain in the community, with some level of independence, rather than in residential care. It is having the ability to live safely and comfortably, regardless of age, income, or ability level and it allows for maintaining and creating social connections, including facilitating cultural engagement, physical and recreational activities and widening one’s informal support network. 

I want to emphasize the importance of the notion that an older adult should be able to choose where he or she lives and have the resources available to realize that choice.  

The above definition brings together the most important elements of successfully aging in place.  The physical environment is intimately connected to achieving well-being as we age, and the social connectedness facilitated by our surroundings contributes greatly to continued sense of belonging, attachment, and happiness.   

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I suggest reading the following research paper by Wiles et al.  Its broader view of aging in place provide insights on the importance of one’s physical environment along with discussions of the symbolic and social importance of place, and the acknowledgement that these dimensions are rarely static, if ever, and are negotiated and renegotiated by the older adults who perceive and interact with them.   

Janine L. Wiles, PhD, Annette Leibing, PhD, Nancy Guberman, MSW, Jeanne Reeve, PhD, Ruth E. S. Allen, PhD, The Meaning of “Aging in Place” to Older People, The Gerontologist, Volume 52, Issue 3, June 2012, Pages 357–366, https://doi.org/10.1093/geront/gnr098 

Image credit: Genevieve Russo

The 2011 Canadian Federal Disability Report provides some interesting numbers with respect to mobility and agility disabilities (both terms defined below) among older Canadians.  The report indicates that 17 percent and 16 percent of Canadians aged 55 to 64 experience mobility and agility disabilities respectively. These statistics increase to 24 percent and 23 precent of seniors aged 65 to 74, and then jumps to 41 percent and 38 percent of seniors aged 75 to 84, and 61 percent and 57 percent of seniors aged 85 and over.  

According to the Canadian Institute for Health Information, Canada’s seniors population — those age 65 and older — is expected to grow by 68%.  Over the last 40 years, it has more than tripled in size. Between 1977 and 1997, the seniors population grew from about 2 million to 3.5 million. In 2017, it sat at about 6.2 million. In 2037, it is expected to number 10.4 million.

If we assume that the percentages of older Canadians with mobility and agility challenges remains stable over the next decade or so, this would mean a large increase in the total number of older Canadians experiencing these challenges.  Add to this that 78 percent of Canadians want to age in their current homes, as a national survey on aging-in-place conducted by the March of Dimes indicated, it will become necessary to adopt, operationalize and fund universal design initiatives so that more Canadians are able to age in place for as long as possible (there are many benefits associated with aging in place but these will be discussed in a future blog posts).

The Irish National Disability Authority defines Universal Design as the design and composition of an environment so that it can be accessed, understood and used to the greatest extent possible by all people regardless of their age, size, ability or disability. An environment (or any building, product, or service in that environment) should be designed to meet the needs of all people who wish to use it.

Seven principles were developed by a multi-disciplinary working group at the North Carolina State University in the mid-nineteen nineties. The purpose of the principles is to guide the design of environments, products and communications.  Below is a chart by Carr et al. that outlines these principles.

Drawing on universal design principles, below are some typical modifications a person may make to their home to facilitate aging in place (I always try including practical examples).

Typical Exterior Modifications:

• • • Wheelchair ramp (provide zero step entry)
    • Increased access around exterior
    • Improved lighting

Typical Interior Modifications:

• • • Grab bars and handrails throughout home
    • Non-slip flooring
    • Stair lifts or elevators
    • Door lever and offset door hinge hardware
    • Light switch / Thermostat and wall receptacle heights
    • Appropriate lighting (Ambient/General, Task and Accent lighting)
    • Widening hallways and doorways (if possible)
    • First Floor Bedroom (Ranch or Cape Cod style home)
    • Adaptable & Useable Kitchens (Appropriate heights for counters, sinks, & appliances)
    • Accessible Bathroom

The 2021 March of Dimes survey indicated that 78 per cent of working age adults (age 18-64) and 93 per cent of seniors (65 and over) agree that home modifications help people to age-in-place. However, the cost of home modifications was identified as a barrier by over 50 per cent of both working age adults and seniors.

The adoption of universal design principles will be a key component to help Canadians stay in their homes longer and enjoy all the benefits that come with aging in place.  

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Mobility Disability, def. difficulty walking up and down a flight of stairs, standing in one spot for 20 minutes or moving from one room to another.  This is most the common disability type among seniors and is experienced more by women than men.

Agility Disability, def. difficulty bending down, dressing or undressing, getting in and out of bed or grasping small objects.  This is the second most common type of disability among seniors and is more common in women than men.

Image credit: Genevieve Russo

Caregivers face a host of challenges when caring for clients with dementia, including challenges associated with bathing. Some clients experience agitation severe enough that a seemingly straightforward activity such as bathing can become a stressful ordeal for both the client and the caregiver. Using music to soothe anxiety can be an effective intervention to assist with lessening this agitation.

Drawing from research on the therapeutic benefits of music for people with dementia, two American researchers (Kendra D. Ray and Suzanne Fitzsimmons) have sought to provide a practical guide for music-assisted bathing for individuals with dementia.

The researchers suggest the following steps should be taken to successfully conduct a music assisted bathing protocol:

Step one: determine whether the client’s mood would likely be affected using music. For instance, a client who gets agitated while bathing but also likes music may see benefit.

Step two: create a personalized play list that considers the cultural background, tempo, volume and the mood of the client with dementia (do not select music that evokes negative emotions). The authors suggest consulting with nursing home staff, in addition to input from the client, to get a sense of the client’s favourite music. I would add that family could also be a valuable resource in this regard.

Step three: safety must be considered. For instance, a portable battery powered music player (not connected to a wall outlet) placed in a waterproofed area should be used.

Ideally, music should be set up anywhere the client prepares for bathing and where the bathing takes place. Advise the client that music will be playing during this time and pay attention to the client’s verbal and non-verbal cues to adjust the music as needed.

The use of music-assisted bathing can lessen agitation and improve the mood of the client, as well as increase job satisfaction for the caregiver. The authors rightly describe this as a win-win.

Reference

Ray, Kendra D. and Fitzsimmons, Suzanne (2021). Music-Assisted Bathing: Making Shower Time Easier for People with Dementia. Journal of Gerontological Nursing, 40:2. https://pubmed.ncbi.nlm.nih.gov/24550123/