Adapting the homes of older people: a case study of costs and savings

Meeting the demand for independent living from the increasing number of older people presents a major challenge for society, government and the building industry. Older people's experience of disabling conditions can be affected by the design and layout of their accommodation. Adaptations and assistive technology (AT) are a major way of addressing this gap between functional capacity and the built environment. The degree of adaptability and the differences in the average cost of adaptation of different types of property are large and there is major variation within property type. Based on a series of user profiles, it was found that a comprehensive package of adaptations and AT is likely to result in significant economies arising from a reduction in the need for formal care services. This finding is sensitive to assumptions about how long an individual would use the adaptations and AT, as well as to the input of informal care and the nature of their accommodation. The present study, which focused on social housing, has implications for how practitioners specify ways of meeting individual needs as well as providing a case to support the substantial increase in demand for specialist adaptation work.     

The spatial dimensions of neighbourhood: how older people define it

This paper seeks to develop our understanding of neighbourhood boundaries, as defined by older people. Using interview and mapping methods, research revealed the significance of three factors ? built-form pattern, spatial distribution of the social networks and personal attributes ? as contributing to how older people define their neighbourhood boundaries. Research findings highlighted discrepancies between residents’ perceived neighbourhood boundaries and the statistical unit used as the neighbourhood proxy in most neighbourhood-related research. The findings suggested that the statistical information about the neighbourhood effects on older people does not necessarily reflect the lived experience of older people in their perceived neighbourhood.     

Ageing in Unsuitable Places

Much of the focus of ageing in place policy is concerned with the provision of support to enable older people to age in the community in residences adapted to their needs. There has been little examination of why older people make choices to age in particular places in later life. In this paper, we drew on 143 interviews with older people in New Zealand to examine the narratives older people use to describe their housing preferences in later life. Older people drew upon personal and public narratives to story housing in later life, and construct four identifiable identities: ‘practical planner’, ‘rugged pioneer’, ‘where I belong’ and ‘rooted in place’. This analysis demonstrates that some older people do narrate decisions to age in ‘sensible’ places with good access to services and have clear plans for change as their physical health declines. Other older people live proudly in unsuitable places and do not wish for support to move or accommodations made to their housing. These older people draw upon narratives of place as foundational to their identity, of relationships with people both living and dead as social relationships that bolster their identity and of housing as part of situated lifelong narratives. Both the situation of their home and the condition of the home provide the backdrop to alternative narrative identities that require them to remain in housing because of, or irrespective of, its unsuitability. To understand the limitations and the possibilities of ageing in place, we need to identify the multiple narratives that structure the lives of older people. By doing so, we can support ageing in place processes that do not disrupt the strong identities that have been developed in and through housing.     

The Significance of Demographic Change in the Swiss Approach to Private Rented Housing: A Potential for Ageing in Place?

Recent findings indicate that changing social constructions of age are mirrored in a growing desire for autonomous living in later life. This individualised concept is referred to as ‘ageing in place’. This paper discusses the challenges for the housing industry and examines to what extent maintenance and development strategies of Swiss real estate investors are meeting the changing demands of older people. Drawing on a number of case studies in Switzerland the paper concludes that investors' concepts of older people and their needs are not merely out of step with the reality of older people's lives and choices but obstruct the desire to age in place. Furthermore, an analysis of the market potential of older people's wish to stay in their present home demonstrates that some investors may be failing to exploit serious business opportunities that could arise from providing services to older people.     

重视老年高血压的调控与管理

伴随我国人口老龄化进程加速,老年高血压患者的数量逐年增加。目前通常情况下,年龄≥65岁的高血压患者被定义为老年高血压。与中青年高血压患者相比,老年高血压患者的发病机制、临床表现具有特殊性,患者心脑血管事件显著增加。老年高血压多表现为单纯收缩期高血压、脉压增大、血压易波动、合并疾病多等特点,与年轻患者相比降压治疗的难度增加。老年高血压的治疗目的是保护靶器官、减少心脑血管事件,但老年人的降压获益与患者治疗耐受性以及降压治疗的潜在危害相关,在治疗时应选择个体化治疗方案并全面评估和密切监测患者情况,平稳降压,其降压目标可设为<150/90 mm Hg (1 mm Hg=0. 133 kPa)。     

The World Bank and Urban Development: From Projects to Policy by Edward Ramsamy

Walking as an out-of-home mobility activity is recognised for its contribution to healthy and active ageing. The environment can have a powerful effect on the amount of walking activity undertaken by older people, thereby influencing their capacity to maintain their well-being and independence. This paper reports the findings from research examining the experiences of neighbourhood walking for 12 older people from six different inner-city high density suburbs, through analysis of data derived from travel diaries, individual time/space activity maps (created via global positioning systems (GPS) tracking over a seven-day period and geographic information system (GIS) technology), and in-depth interviews. Reliance on motor vehicles, the competing interests of pedestrians and cyclists on shared pathways and problems associated with transit systems, public transport, and pedestrian infrastructure emerged as key barriers to older people venturing out of home on foot. GPS and GIS technology provide new opportunities for furthering understanding of the out-of-home mobility of older populations.     

Social Differences and Their Consequences for Housing the Aged

Housing for older people must embody consideration of the social needs of its occupants if it is to be satisfactory. However, the social needs and resulting housing requirements of the older population vary widely according to background and living habits. Two studies in which the life patterns of contrasting groups of older people were related to their housing needs point up the variations and suggest a possible method for determining the housing requirements of any specific group of older people.     

Evictions and Prolonged Homelessness

This paper examines the connections between homelessness among older people and both evictions by statutory housing providers and repossessions by mortgage institutions. The evidence is from 45 single homeless people (among 313 in a succession of ethnographic studies) who reported that eviction made a contribution to their homelessness. Using preceding states and events as criteria, a taxonomy of these once-evicted older homeless people is proposed. For the majority, eviction followed a protracted failure to meet their financial obligations or to keep their property in good condition, and for many, mental health problems or exceptionally low competence in basic domestic skills were contributory factors. The experiences of the group strongly suggest that homelessness can be prevented if support is provided to vulnerable people as difficulties mount. Six risk factors for eviction and subsequent homelessness are identified, and the paper concludes that these markers could be used in experiments to recognise marginally housed people and as a primary prevention measure for homelessness.     

改善老年人的住房与社区环境:规划设计如何应对衰弱与独居的挑战?

需要日常照料的老年人数量正在急速增长。即使老年人自理能力不断减弱并越来越趋向于独居,当代社会的主流选择与政策目标仍着重于协助他们在原先的居所度过晚年。然而现阶段,美国和其他很多国家的住房均未针对日益严峻的老龄化挑战采取应对措施,为居家老年人提供的公共服务与支持相当匮乏。本文基于满足老年人在衰弱过程中的各项需求,从空间和社会的视角系统地检视了社区和住房层面的创新模式,内容包括服务强化型社区、集中照料型社区、全龄型社区,为老人服务型住房组团,小规模代际融合居住型住房,以及交通、输送和通信等方面技术手段的创新。这些对策目前尚未得到广泛应用,但有理由相信这些手段有助于推进居家和社区养老战略目标的实现。规划与设计人员应认识到老年人在生理、感官、认知障碍和独居时面临的挑战,利用设计手段改善公共空间及其连接性。     

Thermal comfort and the integrated design of homes for older people with dementia

People with dementia may have an altered sensitivity to indoor environmental conditions compared to other older adults and younger counterparts. This paper, based on literature review and qualitative research, provides an overview of needs regarding thermal comfort and the design and implementation of heating, ventilation and air conditioning systems for people with dementia and other relevant stakeholders through the combined use of the International Classification of Functioning, Disability and Health, and the Model of Integrated Building Design. In principle, older adults do not perceive thermal comfort differently from younger adults. Due to the pathology of people with dementia, as well as their altered thermoregulation, the perception of the thermal environment might be changed. Many people with dementia express their discomfort through certain behaviour that is considered a problem for both family and professional carers. Ethical concerns are raised as well in terms of who is in charge over the thermal conditions, and the protection against temperature extremes in hot summers or cold winters. When implementing heating, ventilation and air conditioning systems one should consider aspects like user–technology interaction, diverging needs and preferences within group settings, safety issues, and minimising negative behavioural reactions and draught due to suboptimal positioning of outlets. At the same time, technology puts demands on installers who need to learn how to work with customers with dementia and their family carers.     

The potential and implications of home equity release in old age

Studies of the implications of wealth accumulation through owner occupation have begun to focus on the inheritance of housing wealth. This paper suggests that such studies give too little emphasis to the consumption of home equity by older people. To date, the use of home equity has been relatively insignificant but this reflects the limitations of existing equity release mechanisms rather than a lack of underlying demand. The scale of equity held by older people, the potential for new mechanisms, and survey evidence relating to the attitudes of older people themselves are examined in detail. In the context of declining standards of state provision of many services many older people may choose or be forced to make use of their wealth to meet a variety of needs. This not only requires a reappraisal of the role of home ownership in providing for old age but also raises major questions in relation to standards of provision for those without access to such wealth.     

Community-based adaptation through ecological design: lessons from Negril,Jamaica

This paper identifies the conceptual similarities between ecological designs and ecosystem-based adaptations to climate change. The former includes approaches grounded in expert knowledge, such as landscape ecological urbanism, while the latter is rooted in local experiential knowledge and relies on community-based adaptations. This paper bridges these expert and experiential knowledge forms through a transactive planning model by deploying design charrettes in the context of Negril, Jamaica. The findings reveal that local people are aware of ecosystems and prefer ecologically sensitive adaptation interventions. This study concludes with planning and design recommendations for climate change adaptation in Negril.     

Understanding Daily Life of Older People in a Residential Complex: The Contribution of Lefebvre's Social Space

This article contributes to the theoretical and applied understanding of daily life and the meaning of home for older people living in purpose-built, age-segregated complexes. Whilst gerontology has embraced spatial perspectives, it often fails to capture their diverse and changing nature. This article considers findings from a larger qualitative study that explored the geography of residential complexes in Brisbane, Australia, through the lens of Henri Lefebvre's theory of social space. Data relating to Lefebvre's concepts of spatial practice and spaces of representation clearly capture the routines, activities, attachments and imaginations that help or hinder older people connecting to their living environment. Talking with older people gave a rich account of how they use, think about and produce space and highlighted the tensions in providing this form of specialised housing. As well as providing theoretical insights, a nuanced understanding of social space informs policy and public discussion of older people's living environments.     

老龄化背景下的底层住宅适应性设计研究

目前随着我国老龄化进程加快,老年人的居住问题日趋突出。两代人分居毗邻居住已经成为老年人倾向的主要居住模式。针对这些情况,根据老年人的生理和心理需求,该文提出住宅小区底层住宅老人化的规划模式。将多层、高层建筑的底层住宅专供老年群体,与楼上的子女毗邻居住。对底层住宅进行分割设计,使之适合老年人的居住需求,既解决老龄化背景下的老年人居住问题,又减轻了底层住宅的销售压力。     

Estimating the Housing Wealth of Older Home Owners in Britain

Household surveys have recently started to collect data on the original purchase price of owner occupiers' homes. This provides a firmer basis for investigating the joint distribution of housing wealth, income and other personal characteristics than has hitherto existed. However, a number of difficulties arise which are discussed in this paper. A method is presented and validated, developed in the course of assessing the housing wealth of older home owners, for dealing with the specific problems associated with those who purchased their properties at discounted prices, whether through the Right to Buy or other routes. The method is based on data from the British Household Panel Survey, and subsequently applied to the UK Family Expenditure Survey to explore the housing wealth of older people. It also yields estimates of housing equity for younger people and can be implemented with other similar surveys.     

The short-term effects of a fire safety education program for the elderly

The high risk of fire dieath and injury among elderly people is well documented. To be effective, fire safety education must reach older adults in the settings in which they reside: nursing homes and other long-term care institutions, board and care homes, and independent living facilities including the person's own home. Training must also be targeted at the people who are responsible for fire safety. In the case of the nursing home or board and care home, the responsible people are the staff and owners. In the case of the majority of older adults who live independently in their homes, it is either the individual or family members. These programs must also be comprehensive.A fire safety education curriculum was developed by a group of experts in a variety of related fields including fire safety, gerontology, health care industry, developmental disabilities, research, and instructional design. Older adults were included in each planning session. Based on that curriculum, workshops and workshop materials were developed for each of the three target populations: staff of health care facilities, staff and owners of board and care homes, and elderly people living independently in their homes. Materials included both print and audiovisuals. A pilot test of each workshop was conducted to test the short-term effects of the programs.Results indicated significant gains in knowledge for all groups and a significant improvement in positive attitudes toward fire safety for most participants. Measures of effects of the programs on intentions to change fire safety practices indicated a potential for change. Results also showed that the measured traits, knowledge of fire safety and attitudes toward fire safety, were relatively stable.     

Housing for the Elderly: The Changing Scenario in India

Like many other countries in the world, a rise in life expectancy means that India is now facing a sharp increase in the older population; a situation that is exacerbated by other social and economic changes such as urbanisation and the erosion of the extended family that leads to greater numbers of older people living alone. Here Radhika Vaidya , an architect and town planner based in Pune, and Anjali Raje , an executive director of the International Longevity Centre – India (ILC-I), combine their expert knowledge to profile the situation in India and to showcase some new housing solutions.     

Homeless for the First Time in Later Life: An Australian Study

This article explores pathways into homelessness by older Australians, with a particular focus on first-time homelessness. Drawing on a multi-method study including data mining of 561 client records and 20 interviews with service providers, the distinctive nature of older people's homelessness is demonstrated. Three pathways to homelessness in later life are identified. With close to 70 per cent of the participants having had a conventional housing history, the article reveals in rich detail the circumstances surrounding critical housing incidents for older Australians. It shows that older people are at risk when they are evicted, are unable to continue to living with family, face unaffordable rent in the private rental market, cannot continue living in inaccessible rental housing, as well as experience a breakdown in an important relationship. The results provide key material to inform the design of services and policy initiatives to prevent and address homelessness for older Australians.     

Children describe their experiences of the city centre: a qualitative study of the fears and concerns which may limit their full participation

A large-scale qualitative study of the views of British 10-12 years olds is reported. The focus is on children's perceptions of their local urban centres, and in particular on the concerns and fears that they have about using the centres. It is argued that, in the context of the debate about such centres retaining business in the face of the challenge from out-of-town malls, designers should be more aware of the comparisons that such children draw between the two, not only for the current and future purchasing power of children, but also in the spirit of wider participation in the planning of our urban areas. Children of this age can give vivid accounts of their perceived threats, from some adults on the street, from older adolescents, and from groups from out of town. Children from the smaller towns more typically stress traffic as their major concern. Poor standards of maintenance may signal that no-one cares. Agents of order, such as police, security guards and the presence of older people on the streets, are welcomed, as is CCTV. Whilst this paper stresses negative perceptions, it is also noted that, despite these, children are overwhelmingly positive about what town and city centres can offer now and in the future. Planners and managers would do well to encourage their participation.