In the last ten to fifteen years the ageing of the population has seen the emergence of the idea of “ageing in place”. In most European countries 90% of people over 65 live at home. The percentage is smaller in Southern and Eastern Europe. Only here does the tradition of older people living with their children persist.

That tradition is being undermined by demographic changes. The biggest is the decline in fertility. The increasing prevalence of one child families. When that child grows and marries, they may partner with another only child. The result in later life is that there is only one couple trying to support four “grandparents”. They will often have an infant child of their own. There are no siblings to help. This is in its most pronounced in Japan. A country with deep-seated norms of caring for elders. It is putting the traditional family structure under pressure.

There are many other contributing factors. Two income families are the norm and reduce the capacity for “care”. Divorces are more common. Common law unions and out of wedlock births are increasingly common. With all these changes has come a change in the care preferences of the over 65s.

The vast majority of people want to age in their own “place”. It provides independence. The opportunity to live in an environment with which they are familiar. This in turn reinforces a sense of self-reliance, self-management and indeed self-esteem. It provides an all-important sense of perceived control and predictability. The result is that ageing in this way prolongs physical and mental health. From a Governmental point of view “age in place” offers massive financial benefits. The costs to the State are much lower than more specialized and sheltered facilities.

A “Place” is not just a House.

People become attached to their homes, they are more than houses. They carry memory and meaning, not just a source of shelter and security. They have often been curated by the individual and are a true representation of that person. They can be reminders of events and of people. Particularly if people have lived there for long periods. Home is deeply psychological.

For an older person “a place” is far more than even a home. It includes the physical and the social. The home itself of course is a key component. People are much more likely to move when there are problems with the house rather than the neighborhood. However affluent older people have been known to “trade down” in the same area. As people age they will retrofit their homes so they can still function within them. They will increase accessibility and mobility. Everything from handrails to stair lifts is a booming business.

The home sits in a wider environment. A familiar environment gives people a wider sense of security. That environment can be physical. The familiar roads, streets and parks. It can be the shops, the grocery stores and the pharmacies. The regular bus journeys. All provide a sense of safety. The environment can also be social. The acquaintances and friends. The familiar faces on the streets and in the stores. The informal and formal carers are all part of the “network”.

So strong is the need for familiarity that it can often overcome family ties. It is another part of modern-day demographics that families are dispersed. Moving “closer to family” can often mean a complete loss of “place”. The family may be more strangers than the people on the street in their “place”. In any case they “have their own lives to live” as parents will often admit.

The age of a first child has moved by ten years in a generation. Women are often having their first child after the age of thirty. Healthy ageing has moved the onset of frailty back by 20 years. The dynamics are changing. If we are going to live until the age of ninety our children will be sixty when we need care. Their own children will be having their first child. They are needed as grandparents.

A Moving Target

“Ageing in Place” creeps up gradually and evolves. Is a 75-year-old living in the family home already ageing in place. They can be there for the next 20 years if they are lucky. The Center for Disease Control in the US defines “ageing 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.”

That is quite an “ask”. It means levels of support of all kinds. It means support that is completely different for the 75-year-old and the 95-year-old. That support must be provided to individuals who do not want to be perceived as old. It must intrude on a complex mixture of physical, social and psychological place. Helping is not going to be easy