Review of Wellbeing Indicators

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As people grow older, they spend relatively more time in their homes; on average, very old people tend to spend 80% of their time at home (M. M. Baltes, Maas, Wilms, Borchelt, & Little, 1999).The conditions in which people live and the appropriateness of the home environment to the older person’s needs are therefore likely to have a big impact on their quality of life and health. Irish people in particular have a strong regard for being assisted to remain in their homes for as long as possible. A Eurobarometer report (2008) found that virtually all Irish people were in favour of using public budgets for support services allowing older people to stay longer in their homes - 76% felt that this was very important, compared with an EU average of 61% (Gallup Organization, 2008). Only 31% of Irish people would consider moving to a smaller house in retirement (compared to almost 60% of Danish people or 57% of Dutch people), while only 4.5% would consider moving to sheltered housing (compared to 40% of Slovenians or 24% of Austrians).

Remaining in the same home as a person ages or “ageing-in-place” can have a number of positive benefits. For many people the home is a place that allows them to have control of everyday life (Rioux, 2005). For example, the familiarity with the interior of a house that develops over a lifetime living in the same home can play a significant part in helping to compensate for vision impairment or for the early stages of dementia (Boerner, 2004).

Ageing in place can also support continued social contact and relationships with family, neighbours and friends. Remaining in the same community can contribute to wellbeing and quality of life by allowing people to maintain local friendships and ties, shop and obtain medical care in familiar places and rely on neighbours for emergency support. As families become more geographically dispersed, these community relationships may become more important for many older people (Wethington & Kavey, 2000).

As people grow older they may become more attached to their own home and community, but that is also accompanied by increased sensitivity to the social and physical environment (Gilleard, Hyde, & Higgs, 2007). The benefits of staying home may therefore depend of the condition and quality of the home, which is an important determinant of physical and mental health (Thomson, Petticrew, & Morrison, 2001). Poor housing conditions (e.g., poor lighting and poor state of repair) are associated with increased risk of injuries or falls, and increasing disability over time (Garin et al., 2014). Older people are especially vulnerable to inadequate heating, and cold has been found to be a predictor of poorer respiratory symptoms and overall health status among older people (Garin et al., 2014; Windle, Burholt, & Edwards, 2006). Damp and mould has also been associated with higher rates of asthma and respiratory symptoms among people who spend a lot of time at home (Howden-Chapman, Crane, & Signal, 1999).

Sixsmith et al highlight several challenges for older people remaining at home (A. Sixsmith & Sixsmith, 2008). These include the need for adaptations to the home; dependence on informal care which may not be adequately supported by the state; difficulties in getting around neighbourhoods with poor walkability and limited social support structures; and difficulties in accessing adequate formal care. In addition, adaptations may be perceived as intrusive or threatening to a person’s identity (J. Sixsmith et al., 2014). People may want their home to stay as it has always been, even if it is more difficult to live in. And in fact, those challenges (such as stairs) can be seen as important for maintaining physical and cognitive capacities. Home improvements therefore need to balance the symbolic meanings attached to home with practical considerations.

It is also important to acknowledge that not all older people own their homes. Older adults who rent their home tend to report worse health and wellbeing relative to owner-occupiers, likely due to worse housing quality and poorer area-level characteristics (Connolly, 2012). Renters also have a higher risk of admission to long-term care compared with owner-occupiers, independent of wealth.

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