Aging in a Place of Choice

ABSTRACT

Aging in place is a concept most people desire (i.e., to live in their own homes for as long as possible). However, that is not always possible. To account for this reality, this article introduces an alternative concept called aging in a place of choice (a novel theoretical insight) alongside five new articles (a pragmatic collection of practical insights) in the latest issue of Activities, Adaptation and Aging: Purposeful and Dignified Living for Older Adults. Therefore, this article should be useful to gain a theoretical and practical understanding of aging in a place of choice.

KEYWORDS:

• Aging in place
• aging in a place of choice
• autonomy
• choice
• older adult
• older person
• older people

Introduction

Mainstream media often highlights the fact that older adults are a growing population and thus reiterates the necessity to look into their needs. While this message is clearly well-intended, it is pivotal that the society moves away from the reactive practice of responding to the needs of a community only when that community becomes substantially large, or when the society gets reminded by others about the needs of that community. Regardless of the size of the older adult population, continuing effort to curate and improve long-term care (LTC) that is conducive for dignified and purposeful aging is inarguably important and necessary – without this mind-set and investment, older adults’ quality of life may be neglected.

The reality indicates that LTC for aging is not perfect. The efforts to improve older adults’ quality of life may be well-intended, but not necessarily well-executed. This can be seen in numerous instances, ranging from the language applied to describe older adults (e.g., “elderly”), the initiatives available for older adults to partake (e.g., “therapies,” “treatments”), and the homes that older adults live in (e.g., “institutions”) (Bowman & Lim, 2021) to the treatment of older adults in non-individualized and undignified ways (e.g., “prescription of social care,” “medicalized life”) (Bowman & Lim, 2022).

The goal of efforts to improve older adults’ quality of life is not to reach a state of perfection. Instead, it is to engage in continuous improvement and adjustment to meet the evolving needs of older adults in a way that enables them to live with dignity and purpose, or to put it simply, a life that they aspire to live, not one that is dictated by others.

To improve the intention and execution of efforts dedicated to enhancing older adults’ quality of life, this article introduces the concept of aging in a place of choice alongside five new articles in the latest issue of Activities, Adaptation and Aging: Purposeful and Dignified Living for Older Adults.

Moving from aging in place to aging in a place of choice

Aging in place is a noteworthy concept (Aday, Wallace, & Krabill, 2019; Gonot-Schoupinsky, Garip, & Sheffield, 2022). The Centers for Disease Control and Prevention (2022) 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.” Many older adults aspire to live in their own homes until the end. Though aging in place seems ideal, it may not always be the best option, especially for older adults who may be vulnerable (e.g., few or no community ties) (Schappi, 2022). Moreover, older adults may aspire and decide on their own to live in a home that they may not own or to live in a home with others, including those whom they may not know, for various reasons (e.g., health, social). This highlights the importance of acknowledging the choice that older adults have, which should be safeguarded and not dictated by others. Moreover, innovations to support older adults are proliferating, for example, a retirement village (Lee, 2021; Poh, 2021), where older adults can choose to live and enjoy the convenience of a wide range of activities and services that they wish to participate in or use, thereby enabling older adults to experience active and independent living. Nevertheless, the language used to promote such innovations is important to translate good intentions into successful implementation and desired impact (Bowman & Lim, 2021). Regardless of where older adults choose to live, the idea of a home (e.g., a place where one lives and feels most comfortable, loved, and protected) needs to be upheld – otherwise, we risk turning the home into a “facility” or an “institution,” which is the cause for many problems that advocates of culture transformation are trying to address (Bowman & Lim, 2021, 2022).

This article argues that it is best to focus on (i) how older adults can choose the life that they wish to live and (ii) how society can support older adults’ life aspirations, wherein the former enables older adults to live with dignity and purpose, whereas the latter enables the society to focus on how they can support older adults based on the voices of older adults themselves, not what society believes or perceives older adults need/want. To support endeavors in this direction, a novel concept called aging in a place of choice is put forth: Aging in a place of choice refers to older adults living in homes and communities of choice in a dignified and purposeful way, wherein older adults and their choice are honored. This proposed definition has several noteworthy implications.

First, the novel concept aging in a place of choice enables the society to “think outside the box” as it is not confined to aging in older adults’ own home and community – it includes instances within and outside older adults’ own home and community, thereby providing older adults with greater opportunities and options to age in a place of choice.

Second, the novel concept aging in a place of choice emphasizes the importance of “choice” (or decision), wherein the home and community that older adults live in are based on their own choice/decision, not that of others. Respecting this choice/decision is important in order to safeguard the dignity of older adults (i.e., the right to make their own choice/decision) and the purpose of that choice/decision (i.e., what older adults aspire/need/want).

Third, the novel concept aging in a place of choice does not prescribe any aspect of diversity (e.g., ability, age, income) nor any form of experience (e.g., comfortable, independent, safe). This does not mean that diversity and experience are not important; instead, the non-specification of any aspect or form leaves room open for exploring and recognizing the extent of diversity that may exist (e.g., demographic, geographic, psychographic) and the range of experiences that older adults wish to have (e.g., utilitarian, hedonic).

Fourth, the novel concept aging in a place of choice highlights the need to consider dignity and purpose. Noteworthily, ensuring that older adults’ dignity and purpose are respected and safeguarded are of utmost importance – saying otherwise is hypocritical of any effort that is supposedly meant to improve older adults’ quality of life.

Taken collectively, the novel concept aging in a place of choice is meant to promote greater opportunities for aging in a respectful manner, not limiting them. Like any novel proposals, the next logical step would be to engage in new research to generate new ideas (e.g., relationships) and provide empirical validation (e.g., qualitative, quantitative).

Hot off the press

In this latest issue of Activities, Adaptation and Aging: Purposeful and Dignified Living for Older Adults, we present five exciting articles contributed by scholars from Canada, Finland, Indonesia, Sweden, and the United States.

In a triple-helix collaboration between academic, public, and nonprofit institutions in Canada, Hand, Schouten, Dellamora, Letts, and Drenth (2022) explored the benefits, barriers, and facilitators of a neighborhood-based Seniors’ Satellite (i.e., a place that runs classes for older adults in the neighborhood). Using a mix-methods approach (i.e., questionnaires, interviews) with a before-and-after component (i.e., when the satellite first opened compared to three to five months later), the authors found that older adults who participated in the satellite gained social and health benefits, and they valued the social contact, exercise, and fun in a local, friendly setting. Among the main reasons for (i) starting to attend the satellite include the opportunity to improve health, the location (i.e., neighborhood), and social influence (i.e., friends attending), (ii) continuing to attend the satellite include the atmosphere, the enjoyment, the feeling of being supported, the improvement in health, and the location, and (iii) stopping attendance to the satellite include injury/health reasons, inability to do class exercises, and social influence (i.e., friends not attending). The prominence of social influence for aging in a place of choice is noteworthy, reaffirming the importance of social influence, particularly friends, in older adults’ participation in activities (Lim, 2022; Sen & Prybutok, 2021).

Using a systematic literature review, Lazarus and Soejono (2022) explored the efficacy of unsupervised home-based exercises among older adults who were community-dwelling in rural areas with pre-frail and frail health conditions. The authors found six relevant studies, showing that unsupervised home-based exercises can (i) be useful for aging in a place of choice, (ii) be a valuable substitute for supervised exercises, and (iii) can support older adults with frailty health conditions by improving their flexibility, strength, and overall quality of life. However, the authors did not find any relevant rural study that is in an underdeveloped setting, and thus, are calling for more research into rural underdeveloped settings, which may yield potentially different insights into rural developed settings.

Moving onto a study from Sweden, Ranada and Österholm (2022), the promotion of active and healthy aging at social day centers was explored. Through a qualitative study using interviews, the authors found two categories of factors that shape active and healthy aging at social day centers. The first category pertains to staff actions at social day centers (e.g., facilitating activities, facilitating social interaction, and engaging leadership), whereas the second category relates to the conditions affecting activities at social day centers (e.g., administrative guidelines and regulations that limit the type of activities that could be offered, financial conditions that necessitate activities to be low cost, and physical environment conditions that affected the type of activities that could be curated). These insights advance the health benefits of social day centers reported by past scholars (Barrett, et al., 2021; Kim & Kim, 2021).

The next study is from Finland, where Siira, Elo, Kyngäs, and Falck (2022) explored the impact of a well-being supportive home environment on health-related quality of life among older adults. Using a structured well-being supportive environment instrument and a general health-related quality of life instrument that were administered to 37 older adults with visual challenges, the authors found that older adults generally saw their home environment to be comfortable and supportive of well-being, though they also felt that their life was restricted in the home environment. The authors also reported that the health-related quality of life of these older adults correlated with their home environment, living-related fears, and feelings of general restrictiveness. These findings reaffirm the need to dive deeper into the necessities for aging in a place of choice.

Finally, the last study is from the United States, where Tommerdahl, Biggan, McKee, Nesbitt, and Ray (2022) explored the relationship between physical fitness and two independent aspects of cognition in the form of deductive and probabilistic reasoning. Using a sample of 65 community-dwelling older adults, the authors found that older adults’ deductive reasoning is positively correlated with their physical fitness, particularly in terms of lower body strength, aerobic fitness, and agility/dynamic balance, though no relationship was found between physical fitness and probabilistic reasoning. These findings reaffirm the importance of maintaining physical fitness among older adults (Barrett et al., 2021; Carrasco, Ortiz-Maqués, & Martínez-Rodríguez, 2020) as it also affects their cognitive health, which are important considerations for aging in a place of choice.

Conclusion

Aging in a place of choice is a novel concept we advocate. The naming and meaning of this concept emphasize the importance of recognizing and respecting the individual’s choice. New research is required to provide a deeper understanding of this concept along with the associated peculiarities for older adults to age in a place of choice seamlessly. Therefore, future research is encouraged to answer this call, which may include answers to questions relevant to aging in a place of choice, such as:

• What does age(ing) in a place of choice mean to older adults?

• How can one plan ahead to age in a place of choice?

• How much does it cost to age in a place of choice?

• What innovations and opportunities are available for aging in a place of choice?

• What activities, competencies, infrastructures, modifications, and supports do older adults need/want so that they can age in a place of choice seamlessly?

• How can society contribute/what can society do to support older adults to age in a place of choice seamlessly?

• What resources would be useful and should be made available to help older adults age in a place of choice seamlessly?

• Other than one’s own home and community, where else can one choose to age in a place of choice?

• Why do/might older adults choose to age in a place of choice outside their own home and community?

• What are the concerns for aging in one’s own home and aging in a place of choice within the community?

• What are the enablers and barriers for aging in one’s own home and aging in a place of choice within the community?

• How can we gather and act on the voices of older adults who age in their own homes and age in a place of choice within the community?

• What is the impact of aging in one’s own home and aging in a place of choice within the community on older adults’ quality of life?

Disclosure statement

No potential conflict of interest was reported by the author(s).