An increasing number of older U.S. adults are choosing to age in place and grow older in their homes within a traditional community.
Aging in place may offer a number of benefits, such as the ability to maintain one’s independence while being surrounded by familiar objects, family and friends.
However, choosing to age in place requires certain considerations and planning, and may pose potential challenges, risks and safety concerns for older adults and their loved ones.
A recent Forbes Health survey of 1,000 U.S. adults age 65 and older who are electing to age in place examines their main concerns about growing older at home, as well as the concerns of their family members and friends.
The survey also explores home modification options to improve safety for people aging in place, whether individuals are aging in place on their own or with assistance and attitudes toward alternative housing options like assisted living communities or nursing homes.
Some key survey findings include:
Over 50% of survey respondents are aging in place on their own (as opposed to living with family members in their own homes), and this percentage increases with age. Just below half of respondents ages 65 to 69 (47%) report living alone, while 55% of people ages 70 to 74, and 56% of people at least 75 years old say the same.Most older adults choose to age in place because they feel happier in their own homes (84%).Other reasons for aging at home include feeling safer (60%), wanting to remain close to family and friends (49%), the affordability of aging at home (45%) and not wanting to pack and relocate their household belongings (36%).While survey results indicate 34% of respondents worry about falling or needing medical attention while aging in place, only 9% of participants use a medical alert system.Over half (52%) of respondents say they are aging in place on their own rather than living with family members in their own homes.The most popular reason for older adults wanting to age in place is to maintain independence (86%).
How do older adults feel about aging in place?
Individuals choose to age in place for various reasons, and the majority of respondents (86%) listed independence as their top reason.
Meanwhile, 84% of respondents say they feel happier aging in their own homes as opposed to alternative living arrangements, such as assisted living communities.
Additional reasons older adults say they prefer aging in place include:
Feeling safer living at home compared to other places (60%)The desire to remain close to friends and family members (49%)The relative affordability of aging in place (45%)Not wanting to pack and move their belongings (36%)
“It’s important to understand that everyone ages individually,” says Hollis Day, M.D., chief of geriatrics at Boston Medical Center. “So although we talk about people aging in place and aging alone, many older adults are doing so while actively engaged in volunteer activities, working or hobbies. [They] are very much out and about a lot,” she adds. Dr. Day emphasizes the importance of not lumping all older adults together when it comes to attitudes and feelings this group may have about aging in place.
Attitudes toward aging at home vary as well. Per survey results, 60% of respondents say they feel content, and 51% say they feel happy about living in their own homes as they age.
However, one in 10 participants (10%) disclosed feeling lonely. Of those who reported loneliness, 15% live at home alone and 5% live with someone else.
It’s important to note that not everyone who lives alone is lonely, says Dr. Day, adding that older adults may find community through the telephone and technology. “That said, there’s no question that loneliness can impact people. Without support [older adults] may not eat as well or take their medications. [They also may] become more depressed or feel like they’ve lost a sense of purpose or meaning.”
Research suggests social isolation and loneliness among older adults can have wide-ranging effects, from higher mortality rates to cognitive and mental health concerns.
A 2020 consensus study report by the National Academies of Sciences, Engineering and Medicine concludes loneliness can negatively impact the health outcomes of cardiovascular disease and stroke, dementia and cognitive concerns, anxiety and depression, chronic diseases and more among adults over the age of 50.
Older adults worry about alternative housing options
There are a number of options available to older adults choosing how and where to age, including independent and assisted living, memory care communities and skilled nursing care.
These communities offer older adults access to varying levels of community living, assistance with activities of daily living (ADLs) like bathing, dressing, using the toilet and medication management.
Some communities also provide round-the-clock medical care.
A significant number of older adults (33%) say they worry about aging in housing alternatives, according to survey findings.
Of note, slightly more women (34%) than men (30%) felt uneasy about aging somewhere other than their private homes. Meanwhile, these worries appear to decrease with age, with older age groups feeling more content about different housing options:
9% of adults ages 65 to 69 and 70 to 74, respectively, express feeling content about housing alternative options13% of adults at least 75 years old feel content about housing alternative options
Risks of aging in place
Remaining in one’s home can offer older adults some degree of control and personal agency that can be very important in the aging process, says Dr. Day.
However, that independence can come with some risks, particularly when an individual’s home isn’t arranged to accommodate their physical needs, she adds. For example, older adults with mobility issues or arthritis might find navigating their home difficult without the proper home modifications.
The overarching worry expressed by all age groups (36% for older adults living alone and 32% for those living with others) is falling or needing medical assistance while living at home, per survey results. Falling can lead to dangerous health concerns for older adults. In fact, approximately 3 million older adults visit emergency rooms per year in the U.S., often with fall-related injuries like head trauma and hip fractures, according to data from the Centers for Disease Control and Prevention (CDC).
Next to falling and needing medical assistance, many older adults (33%) worry about being unable to perform daily tasks like cooking and cleaning. “Where concerns start to arise are when people become more frail and less independent in their abilities to do ADLs, such as getting transportation to appointments, cooking, cleaning and shopping, or when they [get to the] point of having difficulty independently bathing, dressing or walking around,” says Dr. Day.
Other prominent concerns among older adults aging at home include:
Worrying about the affordability of at-home care (20%)Worrying about mental health decline (19%)Worrying about access to transportation (18%)Worrying about feeling isolated (16%)
Of note, 20% of survey respondents living alone worry about isolation while only 12% of participants experience the concern of isolation if they live with someone.
Ensuring safety while aging at home
Individuals who choose to live at home might consider certain lifestyle and home modifications to help ensure their health, safety and overall satisfaction while aging in place.
“Having the (older adult’s) housing set up to be safer is really helpful,” says Dr. Day, noting that individuals with significant mobility challenges, cognitive impairment, memory loss and who are prone to frequent falls may be less safe living at home on their own. For example, a person with memory loss may leave the stove on and forget they are cooking, she adds.
Almost a third of survey respondents (29%) say they’ve physically modified their homes to enhance safety, such as installing grab bars in the shower and stair lifts where they’d otherwise have to walk up steps.
Other participants say they have someone in their homes to help with daily activities like cooking and cleaning (25%), as well as alternative transportation to medical appointments and other events rather than driving themselves (21%).
Older adults who experience frequent falls and who don’t have a personal response system, like a medical alert device, may have elevated risks of adverse events when aging at home alone, says Dr. Day. However, despite survey participants reporting significant concerns about falls and receiving medical assistance at home, only 9% say they use a medical alert system.
According to survey results, participants who are at least 75 years old are more likely to use a medical alert system (15%) while only 8% of participants ages 70 to 74 and 7% of respondents ages 65 to 69 note using the systems.
Those living alone were slightly more likely to use a medical alert system (10%) compared to individuals living with someone (7%).
Only 6% of respondents say their friends and family are connected to a medical alert system of any kind.
To make a home safer for older adults aging at home, Dr. Day suggests the following:
Remove any tripping hazards, such as throw rugsClear away clutter to make safe paths from room to roomPlace commonly used items on lower shelvesIf necessary, use a shower chairWhere possible, try to have a walk-in shower or specialized walk-in tub (not a bathtub you have to climb over) for bathingInstall grab bars in the shower, as well as a non-stick surface on the floorEnsure there’s bright lighting throughout the homeIdeally, arrange your home so you can live on one floor, as stairs can become more problematic with ageOrganize medications in pill boxes or blister packs to enhance accessibility and increase ease of medication management
In fact, survey results show the most common home modifications are as follows:
Bathroom modifications (77%)Rearranging furniture (36%)Adding non-slip flooring or mats (35%)Adding a voice-controlled home device (27%)Installing easy-grip door knobs or pulls (19%)Adding a ramp (9%)Kitchen modifications (5%)Widening doorways (3%)Installing a stair lift (3%)
Support from family and friends
Relatives and friends can be a significant source of support for older adults aging at home. Not only can a support network help with transportation and everyday tasks, but it can also provide a sense of community.
Support may come in many forms, such as caregiving or performing chores that have become difficult with age. Just under half of respondents (42%) say their significant other helps with caregiving aspects of aging at home, and 40% say they help out around the house.
One in five survey respondents (20%) say they receive caregiving help from their children, and 18% say their children help around the house.
The source and type of help a person’s support network provides may change based on an older adult’s age.
While support statistics remained similar in the younger age brackets, respondents at least 75 years old are more likely to receive help from their children or grandchildren.
They are also the most likely to receive help in general, with only 36% saying they don’t receive any caregiving support, and 39% noting they don’t have anyone helping around the home.
39% receive help from their spouse or partner in the form of caregiving while 38% say their significant other helps around the house.Adults at least 75 years old receive nearly equal amounts of help with personal care (24%) and household chores (23%) from their children.
Less frequently, adults in this age group (at least 75 years old) receive caregiving help from neighbors (9%), grandchildren (8%), friends (8%) and housekeepers (3%).
Across age groups, living alone or with someone else correlates with the level of care and support a person receives.
Despite concerns of social isolation, 49% of participants say family and loved ones keep them company. Family and friends also offer older adults support by cleaning their house (48%), shopping (37%), cooking (37%) and providing transportation (31%).
There are a number of available community resources available for older adults looking to age in place. “Every county in the country has an Area Agency on Aging that can connect older adults with resources available in their community to help keep them living at home as long as possible,” says Dr. Day. The services available through these resources may vary based on a person’s location, but may include assistance with bathing and dressing, house cleaning and light chores. Some agencies may be able to connect older adults with visitor services for companionship, transportation to appointments or grocery shopping, she adds. Faith-based communities and volunteer organizations may also provide older adults with support and community.
“ââHaving a community, no matter how you define it, is key to having meaning and purpose, which we know are critical for aging in place positively,” she says.
For more information, check out the full study here.
