Examining Community-Based Housing Models to Support Aging in Place: A Scoping Review

Abstract

Background and Objectives

With the global population aging, there is a demand for older adults to age in place, that is, to live and age well in their home and community with some level of independence. Community-based housing models exist and may support this process. This scoping review aimed to describe and synthesize the ways in which community-based housing models relate to older adults’ aging in place and identify strengths and gaps in the literature.

Research Design and Methods

The housing models explored were villages, naturally occurring retirement communities, congregate housing and cohousing, sheltered housing, and continuing care retirement communities. This exploratory scoping review examined international peer-reviewed literature published from 2004 to 2019. Six databases were searched using terms related to housing models and older adults. Forty-six articles met the inclusion criteria. Descriptive numerical summary and thematic analysis were used to synthesize study characteristics and findings.

Results

Our analysis revealed 4 themes relating to aging in place in the housing models: Social Relations, Health and Well-being, Sense of Self and Autonomy, and Activity Participation. Further analysis identified housing-specific characteristics that appeared to pose barriers to, or enable, aging in place.

Discussion and Implications

To best support aging in place, the findings of the review suggest multiple characteristics worth considering when developing or relocating to a community-based housing model. Further research is required to understand how facilitating characteristics can promote aging in place for community-dwelling older adults.

The global population, aged 65 or older, will increase by 188% from 2010 to 2050 (World Health Organization, 2011), with estimates of up to 85% preferring to age in place (Lantz & Fenn, 2017). While there are varying definitions of what constitutes “aging in place” within policy and literature, the concept can be defined as living and aging well with some level of independence in a community-based home (Lantz & Fenn, 2017; National Institutes of Health [NIH], 2017). Additionally, studies have demonstrated that older adults hope to have a sense of connectedness to their home through associations with their neighborhoods, communities, and spiritual or cultural groups (Andrews et al., 2007; Peace et al., 2006; Wiles et al., 2012). Aging in place appears to support physical and mental health as well as independence and capacity in activities of daily living (ADLs), such as bathing, dressing, and grooming (Marek et al., 2005; Rantz et al., 2011). Lastly, aging in place is cost-effective at a societal and organizational level as it reduces admittance to institutional care facilities (Bookman, 2008; Graybill et al., 2014; Rantz et al., 2011), which can be perceived as unappealing by older adults (Alders et al., 2019).

Given the rapidly aging population, there is a greater need for community-based housing models to support aging in place. In recent years, a variety of housing models have developed to meet the needs of older adults living in the community (Greenfield, 2012). For housing models to effectively promote aging in place, they should have flexible and adaptable physical layouts, offer accessible care and service delivery, enable social connections (Lantz & Fenn, 2017), and provide opportunities to participate in formal and informal activities (Bookman, 2008). In this scoping review, we synthesized the ways in which community-based housing models relate to older adults aging in place and identified strengths and gaps in the literature. We considered housing models that enabled some level of independence within the community and facilitated aging in place, as opposed to institutional or residential care. These housing models included villages, naturally occurring retirement communities (NORCs), congregate housing and cohousing, sheltered housing, and continuing care retirement communities (CCRCs; Table 1). This review also aimed to present novel information, as currently, no known review compares aging in place across community-based housing models.

Method

Guiding Question and Study Design

This scoping review addressed the following research question: How do community-based housing models relate to aging in place among older adults? A scoping review approach was used to address this question as it enables the inclusion of studies with diverse methodologies and is designed to identify common themes and trends as well as gaps in a body of literature (Arksey & O’Malley, 2005; Rumrill et al., 2010). This scoping review adhered to Arksey and O’Malley’s (2005) framework and recommendations by Levac et al. (2010); however, the authors of this study did not complete the optional stakeholder consultation stage.

Identifying the Relevant Studies

Keywords and subject headings related to housing models and older adults were identified through preliminary searches. Terms within each concept were combined with a Boolean “OR” and the two main concepts were combined with a Boolean “AND.” The search was implemented on May 1, 2019 and involved six databases: Medline, Embase, CINAHL, PsycINFO, Sociological Abstracts, and Scopus (Table 2). Additionally, the reference lists of the included articles were hand-searched to identify any relevant studies not captured by our search strategy.

Study Selection

Study selection involved a title and abstract screen, followed by a full-text review. The same process was performed for the included hand-searched studies. Six coauthors worked in pairs for study selection to independently screen and review each article. When conflicts in opinion occurred, a third author made the final decision to accept or reject the article. Inclusion criteria for this scoping review included peer-reviewed articles of all study designs, written in or translated to English, published from 2004 to 2019, that investigated housing models, and the potential links to older adults aging in place. Non-peer-reviewed sources and gray literature were excluded from the database search. We excluded studies in which any of the following criteria were true: (a) participants were dependent for the majority of their care; (b) the article solely described a housing model and did not provide evidence to demonstrate how its characteristics may link to aging in place; (c) the mean age of the study population was less than 60 years; or (d) more than half of the study population was younger than the age of 55. Our iterative process also led us to exclude articles that focused on smart homes or family members living together as these did not focus on communal aspects of aging in place.

Charting the Data

In the data extraction phase, the researchers identified key characteristics of the articles (Arksey & O’Malley, 2005; McKinstry et al., 2014). In this stage, articles that met the inclusion criteria were divided equally between three pairs of researchers for full-text review. The following information was extracted: author(s), year of publication, study population (size and demographic characteristics), methodology, study objectives and purpose, study setting, methods, study limitations, type of housing model(s) discussed, and the potential links between the housing model and aging in place. Within each pair, one researcher independently reviewed the full text and extracted information that pertained to the given housing models into a Microsoft Excel sheet and the other reviewed the extracted data for accuracy. If any discrepancies were identified, a third author reviewed the text and if needed, corrected the extracted data for accuracy.

Collating, Summarizing, and Reporting the Results

The researchers performed a descriptive numerical summary of the methodology, population, and limitations of the included articles to identify any gaps in the literature (Levac et al., 2010). During thematic analysis (Maguire & Delahunt, 2017), the authors closely reviewed the findings sections of the included articles and coded information that linked housing model characteristics to aspects of aging in place, that is, any aspect of living and aging well (NIH, 2017). Six authors met to organize the codes into larger categories and began to create themes. The authors further refined the themes and identified specific housing model characteristics that related to aspects of aging in place.

Results

Descriptive Summary

Forty-six articles were included in this review (Figure 1) including qualitative (n = 16), quantitative (n = 26), and mixed-methods (n = 4) studies (Table 3). Notably, only 6 of the 46 articles (13%) utilized longitudinal design. Of the studies, 76% reported an average participant age of 70 years or greater and approximately 75% had a sample population that was majority female. Descriptive information pertaining to health, living arrangements, marital status, duration in residence, education, race and ethnicity, and income were largely unreported.

Articles addressed five housing models: villages (17), NORCs (9), congregate and cohousing (11), sheltered housing (5), and CCRCs (4). Despite including university-based retirement communities in our search, no articles met the criteria for inclusion in this review. Due to the inconsistency of definitions across the literature, we created definitions for the housing models based on the existing literature and categorized articles accordingly. Our definitions of the housing models are as follows: villages are older adult-specific neighborhoods that provide residents with access to a variety of services, activities, and amenities to foster independent living; NORCs are communities that unintentionally accumulate a significant proportion of older adults within a specific geographical area; congregate and cohousing models offer private living arrangements with access to common spaces and promote interdependence between residents; sheltered housing models offer living arrangements that foster independent living with a secondary focus on providing affordable accommodations for its residents; and CCRCs offer a spectrum of care services and shared service amenities to its residents (Table 1).

Thematic Results

Analysis identified four themes related to aging in place: Social Relations, Health and Well-being, Sense of Self and Autonomy, and Activity Participation. These themes represent aspects of aging in place that each model appears to support, or fails to support, with evidence for such relationships encompassing both subjective reports and objective measures (Table 4). The themes also delineate characteristics of the housing model that may act as facilitators or barriers to the identified aspects of aging in place. The characteristics are generally related to the built environment, the availability and access to services or programs, social support, attitudes of inclusion and exclusion among other residents, secure living environment, cost, and proximity to amenities and neighbors.

Theme 1: Social Relations

The theme of social relations encompasses an individual’s engagement with and connection to others in their community. The theme was addressed in the literature as an important aspect of aging in place for older adults and appeared throughout all the explored housing models. While several housing characteristics seemed to relate to positive social relations, the most frequently reported characteristic was the built environment. The built environment can facilitate an increased sense of community, social connectedness, and opportunities to socialize among residents (Anetzberger, 2009; Choi & Paulsson, 2011; Dupuis-Blanchard et al., 2009; Elbert & Neufeld, 2010; Evans, 2009; Glass, 2012, 2016; Glass & Vander Plaats, 2013; Graham & Tuffin, 2004; Grant, 2007; Jolanki & Vilkko, 2015; Kennedy & Coates, 2008; Matthews et al., 2016; Motevasel, 2006; Nathan et al., 2013; Shippee, 2012; Teston & Marcon, 2014), demonstrating the benefit of creating environments that are conducive to resident interaction and socialization. For example, shared spaces and proximity of living units can maximize opportunities for companionship, development of social relationships, and participation in and satisfaction with social activities, as well as relate to less perceived loneliness (Crisp et al., 2015; Dupuis-Blanchard et al., 2009; Evans, 2009; Gardner et al., 2005; Shippee, 2012).

The communal programming offered within village, NORC, sheltered housing, and CCRC models also appeared to facilitate social satisfaction and socialization among residents and reduced social isolation (Anetzberger, 2009; Cohen-Mansfield et al., 2010; Elbert & Neufeld, 2010; Evans, 2009; Glass, 2012; Shippee, 2012; Taylor & Neill, 2009; Teston & Marcon, 2014). Specifically, having a variety of communal programs and leisure activities, such as coffee time, day trips, or group meals, may encourage interaction outside of residents’ private units (Anetzberger, 2009; Evans, 2009; Taylor & Neill, 2009).

Interdependence, social arrangements, and social support influenced the social relations between residents in all housing models. Particularly, a “neighbor-helping-neighbor” mentality was noted, in which residents could depend on each other for assistance and support when needed (Choi & Paulsson, 2011; Dupuis-Blanchard et al., 2009; Greenfield, 2016; Kennedy & Coates, 2008; Shippee, 2012; Teston & Marcon, 2014). Village, congregate and cohousing, and CCRC models provided an increased opportunity for companionship and social inclusion within the community through intentionally designed communal areas (Choi, 2004; Choi & Paulsson, 2011; Dupuis-Blanchard et al., 2009; Glass, 2013, 2016; Glass & Vander Plaats, 2013; Kennedy & Coates, 2008; Shippee, 2012). Similarly, Teston and Marcon (2014) noted that the close proximity of residential living units provided the opportunity for residents to establish social relationships and mutual support among neighbors.

In Anetzberger’s (2009) study of a NORC, the presence of on-site resource coordinators proved to be a unique support service as they were available to provide information and assist with navigation of the appropriate social and health services. Similarly, within a village model, Evans (2009) noted that the presence of an activity coordinator, who created formal programming specific to the interests of residents, facilitated social interaction and the development of a sense of community.

In village and CCRC models, the physical environment combined with the declining health status of residents was identified as a barrier to social inclusion and social interaction (Evans, 2009; Nielson et al., 2019; Shippee, 2012). Residents with poorer physical health found it more challenging to participate in activities, which contributed to their social isolation (Evans, 2009; Nielson et al., 2019; Shippee, 2012). Additionally, stigmatizing attitudes and intentional exclusion from activities by healthier peers furthered their social disconnectedness (Evans, 2009; Nielson et al., 2019; Shippee, 2012).

As seen in mixed tenure villages and multilevel NORCs and CCRCs, the physical structure can unintentionally create a physical and social divide, which can hinder social relations for residents (Evans, 2009; Glass, 2012; Shippee, 2012). Notably, Motevasel (2006) acknowledged a negative group mentality may result from the forced interactions of residents in communal areas, which could impede an individual’s sense of integrity and exacerbate the negative aspects of collective aging. Unique to the study by Evans (2009), one village resident stated “it still doesn’t feel like a community. It can’t, can it, when it’s all one age?” (p. 211), suggesting that the uniform age of residents was a barrier to establishing a true sense of community. Moreover, due to the lack of transportation, residents of certain sheltered housing models experienced high levels of social isolation from the greater community (Taylor & Neill, 2009). Moon et al. (2013) suggest that relocation to CCRCs may negatively affect the establishment and maintenance of social relations as it was associated with high levels of emotional and social loneliness, more depressive symptoms, feelings of hopelessness, and a sense of worry. Moreover, Glass (2016) and Glass and Vander Plaats (2013) noted that relocating to a congregate and cohousing model contributed to a lack of family and friends and therefore increased social isolation and loneliness. Thus, while many housing models support social relations, relocation may disrupt the connection to friends and family and residents may feel that they are more isolated, are unable to participate, or that they are not a member of the greater community.

Theme 2: Health and Well-Being

This theme encompasses a diversity of ways that housing model characteristics such as services, programs, and the built environment were linked to various dimensions of residents’ physical and mental health, as well as well-being. Several articles identified characteristics that positively influenced residents’ self-reported quality of life and general life satisfaction, including the design and built environment, community activities, and the ability to age in place (Cohen-Mansfield et al., 2010; Elbert & Neufeld, 2010; Glass, 2012; Tremoulet, 2010). In the NORC and congregate and cohousing models, the built environment appeared to enhance residents’ overall satisfaction and mental health by facilitating activity participation and social connection through shared spaces (Choi & Paulsson, 2011; Tremoulet, 2010; Wikström, 2007). In these models, shared spaces, such as parks, gardens, or pools, and common activities, such as meals and coffee or tea, were noted to positively relate to residents’ quality of life and general life satisfaction (Choi & Paulsson, 2011; Tremoulet, 2010; Wikström, 2007). In congregate and cohousing and sheltered housing models, contextual characteristics, such as the accommodation conditions, physical structure, and availability of services and recreational programming, contributed to improvements in overall quality of life, life satisfaction, and one’s general health and well-being (van Bilsen et al., 2008; Teston & Marcon, 2014). Increased quality of life was also found in a longitudinal study that followed up residents for 1 year after relocating to a congregate and cohousing model, which may be related to residents’ ability to access both independent living units and shared spaces (Wolf-Ostermann et al., 2012). Moreover, relocation to a supported living environment, such as a village or sheltered housing model, was associated with improvements in depressive symptoms, cognition, perceived health, and increased quality of life (Gardner et al., 2005; Holland et al., 2017; Taylor & Neill, 2009). In particular to the CCRC model, the comprehensive provision of care services was associated with a high resident-reported quality of life (Young, Inamdar et al., 2010; Young, Spokane et al., 2010). Also, Cohen-Mansfield et al. (2010) noted that memberships with access to programming within the NORC model were linked with lower levels of depression. Additionally, McClive-Reed and Gellis (2016) found that 75% of NORC residents demonstrated help-seeking behaviors, such as making appointments with health care providers or attending information sessions about their chronic diseases, which was linked with improved health and reduced psychological distress.

Analysis also demonstrated that the built environment has the potential to facilitate the physical health, functioning, and engagement of residents. The sense of safety provided by the NORCs’ built environment appeared to enable residents to be more physically active by walking, swimming, and gardening, leading to improvements in physical health (Tremoulet, 2010). Similarly, in congregate and cohousing models, residents felt positive life satisfaction, which they attributed to the built environment, the availability of amenities, and the safety and security within the community (Choi, 2004). Moreover, the built environment of the village model emphasizes safety for residents, as it was reported to decrease residents’ fear of falling and improve their quality of life and satisfaction (Wert et al., 2010).

Although the built environment appears to support resident health and well-being, failure to provide an environment conducive to engagement and socialization may have deleterious effects. Harrison et al. (2010) and Teston and Marcon (2015) noted a positive relationship existed between residents’ health status and their physical activity, social participation, and quality of life. Furthermore, it was identified that poorer baseline health status was associated with marked functional limitations, increased likelihood of depressive mood, decreased socialization, and poorer life satisfaction as residents either perceived that they were unable to participate or were physically unable to engage in activities (Anetzberger, 2009; Choi & Paulsson, 2011; Corneliusson et al., 2019; Ivery, 2014; Moon et al., 2013; Phillips, 2015).

A notable and unique barrier within a fee-for-service CCRC is the cost associated with home health services (Young, Inamdar et al., 2010). Young, Inamdar et al. (2010) suggested that the constant worry about the financial burden associated with accessing care services in the future has the potential to have negative effects on residents’ health and well-being.

Theme 3: Sense of Self and Autonomy

The theme of sense of self and autonomy captures literature addressing the potential links between housing models and one’s sense of self-efficacy, independence, and ability to age in place. For older adults residing in different housing models, the built environment, a secure living environment, and the availability of support services seemed to support their sense of self and autonomy. Specifically, an individual’s sense of self appeared to be facilitated through the built environment of the NORC, congregate and cohousing, and sheltered housing models; a walkable environment provided opportunities to engage in meaningful activities and empowered individuals to be independent and manage their ADLs (Choi, 2004; Grant-Savela, 2010; Taylor & Neill, 2009; Teston & Marcon, 2014), which subsequently seemed to contribute to an enhanced sense of self-efficacy (Grant-Savela, 2010). Elbert and Neufeld (2010) and Glass (2012) found that the supportive services and contextual characteristics offered by the NORC model, such as design elements, equipment, and home modifications, facilitated safety within the home and appeared to influence the residents’ self-efficacy to function independently. Additionally, Holland et al. (2017) indicated that residents’ self-reported limitations improved after relocation to a village model, which may contribute to the development of one’s sense of self-efficacy. Furthermore, Taylor and Neill (2009) found that in sheltered housing, a positive sense of self and autonomy was facilitated through privacy. Residents stated that having their own front door gave them a sense of privacy and safety, enabled choice and control over their lives, and made it feel more like a home (Taylor & Neill, 2009). Lastly, residents felt more autonomous and independent when the built environment facilitated access to the community’s services and engagement with neighbors (Choi, 2004; Shippee, 2012).

Across housing models, an individual’s sense of security and safety facilitated their autonomy and independence to complete ADLs and participate in programming or services (Gardner et al., 2005). Village, congregate and cohousing, and sheltered housing models facilitated a sense of security and safety through secure living environments, services and supports that satisfy and meet the needs of the residents, and opportunities to socialize in the community or housing unit (van Bilsen et al., 2008; Choi, 2004; Choi & Paulsson, 2011; Dupuis-Blanchard et al., 2009; Gardner et al., 2005). Specifically, residents experienced security and safety through the ability to give and receive mutual support from neighbors, allowing individuals to feel less vulnerable and afraid to live on their own (van Bilsen et al., 2008). Unique to CCRCs, Young, Spokane et al. (2010) noted that residents had a greater sense of safety and control over their health compared to their counterparts in an independent living community due to the comprehensive spectrum of care services.

The availability of formal and informal support services and activities in village, NORC, congregate and cohousing, and sheltered housing models facilitated residents’ autonomy; residents were able to select the services or activities that they would participate in, which fostered the development of their sense of self (Anetzberger, 2009; van Bilsen et al., 2008; Evans, 2009; Glass & Vander Plaats, 2013; Grant, 2007; Kennedy & Coates, 2008). In Grant’s (2007) study, residents stated that villages make “life worth living” (p. 49) as they were able to make autonomous decisions about accessing the necessary supports, services, and activities. It was noted that in NORCs, if a resident had low self-efficacy, it was likely that social support would be provided to assist this individual with engaging in activities (Anetzberger, 2009). Moreover, Shippee (2012) found that participation in activities in a CCRC was a strong facilitator in improving residents’ sense of belonging and self-identity.

Cultural and religious rejuvenation, facility maintenance, resident satisfaction, and affordability were found to influence an individual’s sense of self and autonomy in village, congregate and cohousing, and sheltered housing models (Choi, 2004; Grant, 2007; Kennedy & Coates, 2008; Teston & Marcon, 2014). Uniquely, relocation to villages fostered a sense of rejuvenation, which was found to facilitate an individual’s sense of self, as residents felt as though their identity had been restored and that they were able to transition into a new life through self-discovery and self-expression (Grant, 2007). Two studies identified that opportunities and amenities supporting cultural and religious practices further enhanced resident satisfaction and development of their religious and cultural identity (Grant, 2007; Kennedy & Coates, 2008). Facility maintenance in congregate and cohousing also enabled one’s sense of self as it provided autonomy and control for residents who aspired to independently maintain their home (Choi, 2004). As well, Teston and Marcon (2014) noted that the affordability of sheltered housing enabled residents to pay their own rent, which empowered residents to have a greater sense of independence and autonomy.

In the village model, the rules or regulations of the community were noted as barriers associated with an individual’s sense of self and autonomy (Gardner et al., 2005). Also, individuals residing in villages felt a negative stigma created by the greater community, which affected their sense of autonomy (Gardner et al., 2005). Furthermore, Gardner et al. (2005) noted that because individuals residing in a village are close in proximity and share resources, an individual’s sense of self can be negatively affected if relationships with others in the village become strained. To add to this, individuals residing in a village may not feel as though they have the opportunity or choice to socialize with those outside of the village, hindering their sense of self and autonomy (Gardner et al., 2005). Thus, an individual residing in a village may feel bound by the negative societal attitudes and regulations of the community and, consequently, lack independence and control over their choices.

Theme 4: Activity Participation

Activity participation includes the completion of ADLs and instrumental ADLs (IADLs) and engagement in physical, social, and leisure activities which, in the reviewed studies, were framed to support aging in place by enabling older adults to contribute to their community and spend their time more meaningfully. Communal programs were the primary facilitator of meaningful activities, beyond ADLs and IADLs. Programs that catered to the residents’ interests and needs and that were held within the community increased social connectedness and participation as they were easily accessible and intentionally developed to support the residents (Anetzberger, 2009; Choi & Paulsson, 2011; Cohen-Mansfield et al., 2010; Corneliusson et al., 2019; Evans, 2009; Miller & Buys, 2007; Nathan et al., 2013; Shippee, 2012). Kennedy and Coates (2008) found that being surrounded by people at similar life stages increased social participation. Similarly, Grant (2007) noted that compared to their previous living arrangements, residents who relocated to a village model engaged in frequent informal leisure activities as they felt they had the autonomy to self-organize a broader variety of leisure activities. However, as demonstrated by Young, Inamdar et al. (2010) and Young, Spokane et al. (2010), cost can play a role in accessing programming as residents of CCRCs with all-inclusive programming participated more frequently in activities compared to those that only offered pay-per-use programming.

The contextual characteristics of the housing model, such as design elements, affordability, external perceptions, social expectations to support neighbors, and reduced barriers to daily living can influence one’s perceived ability to complete ADLs within their home and participate in social, physical, and leisure activities (Evans, 2009; Glass, 2012; Holland et al., 2017; Shippee, 2012; Teston & Marcon, 2014). Housing models with smaller, more manageable spaces reduced the physical demands for participation in ADLs and IADLs, allowing more time and energy for residents to engage in other, more meaningful activities (Harrison et al., 2010; Tremoulet, 2010), thereby emphasizing the importance of having a built environment that is structured to address the needs and capabilities of the residents. As social, physical, and leisure activities commonly took place outside the private residential space, the built communal or neighborhood environment acted as a major facilitator for enabling activity participation for residents (Nathan et al., 2013, 2014a, 2014b, 2014c; Wert et al., 2010). Pettigrew et al. (2019) noted higher-density living environments constrained the activity levels of residents, emphasizing the role that housing density and proximity to amenities play in the frequency and quality of physical activity, particularly in walking for leisure or transportation. Residents’ physical and social activity participation was supported when housing models had either accessible environments within the model or were in close proximity to environments in the greater community that were conducive to leisure and social activities (Anetzberger, 2009; van Bilsen et al., 2008; Evans, 2009; Grant-Savela, 2010; Motevasel, 2006; Shippee, 2012; Tremoulet, 2010). Furthermore, Greenfield (2016) found that the NORC programming led to the development of close friendships between residents, which influenced resident participation in social gatherings outside of the scheduled programming. The intrinsic draw to nature was also evident, with access to walkable natural trails and environments appearing to support leisure and social walking in villages (Nathan et al., 2014b; Phillips, 2015). Several articles also noted that pedestrian friendliness of the community and safety from vehicles played a major role in fostering physical activity (Anetzberger, 2009; Grant-Savela, 2010; Phillips, 2015; Tremoulet, 2010). Notably, within all the housing models, a common barrier to activity participation was the residents’ overall health, well-being, and functional status as it impeded their ability to physically access or engage in activities (Anetzberger, 2009; Choi & Paulsson, 2011; Corneliusson et al., 2019; Evans, 2009; Moon et al., 2013; Ivery, 2014; Shippee, 2012).

Discussion

Existing literature has alluded to a lack of high-quality evidence surrounding the strengths and limitations of community-based housing models (Shum, 2014). To support research in this area, this scoping review compares and discusses the characteristics of villages, NORCs, congregate and cohousing models, sheltered housing models, and CCRCs that appear to support aging in place. Table 4 provides an overview of the aspects of aging in place that were outlined in the reviewed articles and allows for simple comparison across the explored housing models. Given that individuals vary in what is required to support aging in place and each housing model may not be appropriate for all older adults, we do not make explicit conclusions regarding the “best” housing model. Instead, in Table 4, we highlight the benefits and limitations that each housing model appears to offer in relation to the identified themes.

Limitations of Review Methods

There are some methodological limitations present in this scoping review. The decision to exclude gray literature and articles not published in or translated to English limited the diversity of information included in this review. In addition, due to the inconsistency of definitions across the literature, we created definitions for the housing models reported in this review; however, it is possible that our definitions may differ from other understandings and conceptions of these models.

Implications

Within existing literature, we noticed variance and vagueness in the definitions of the five housing models included in this review. As such, we presented definitions to provide consistency and clarity for stakeholders working within this field.

While the high prevalence of cross-sectional studies in this scoping review prevents firm conclusions, this review highlights the characteristics of housing models that appear to support successful aging in place. As such, we present recommendations that may be valuable to health care providers, researchers, policymakers, potential residents, and their caregivers to support aging in place when recommending, designing, or relocating to community-based housing.

To foster meaningful social relations, one should consider how aspects of the built environment, such as proximity of living units and shared spaces, can facilitate frequent resident interaction and increase socialization. Also, it is worth considering residents’ access to the greater community and their emotional well-being, as such access may support their social relations, sense of community, and social connectedness. Moreover, a variety of inclusive social activities and communal programming appear beneficial for facilitating good social relations among residents and addressing stigmatizing attitudes between older adults living in the same community-based housing arrangements and from their greater community. Lastly, one should consider the availability of on-site staff to support residents in engaging with their community and facilitating access to relevant social, leisure, and health services.

In order to support older adults’ health and well-being, housing models should emphasize safety, inclusivity, and support resident socialization and engagement in activities through the built environment. As well, models should consider the program offerings, social arrangements, and the cost and availability of comprehensive care services offered, as this review identified that these characteristics may support the physical and mental health and well-being, quality of life, and general satisfaction of residents.

To cultivate older adults’ sense of self and autonomy, there is value in considering the built environment of housing models. Housing models should be designed intentionally for the needs of older adults to support a positive sense of self, provide a sense of privacy, security, and safety, and instill confidence to live independently. Furthermore, one should consider the availability of formal and informal activities and supports within the housing model and respect the individual’s choice. Having residents select activities or services that align with their interests may facilitate a greater sense of self and autonomy, allow residents to feel more comfortable with aging, and support aging with others in their community. As such, to support one’s sense of self at the individual and community level, it is worthwhile to consider the implications of societal stigma and the diversity of residents’ identities, such as religion and socioeconomic status, when designing or relocating to community-based housing models.

To facilitate the activity participation of older adults, we encourage consideration of the following: proximity to amenities and neighbors, safety and interdependency between residents, and the built and natural environment. It is beneficial to create an inclusive and accommodating environment to support the activity participation of residents with poorer health or functional status. Lastly, facilitating accessible and affordable communal programming is recommended for increasing activity participation and enabling aging in place.

Gaps in the Current Literature and Future Research Directions

Several gaps in the literature were highlighted within this review. Existing literature predominantly focused on village, cohousing or congregate living, and NORC models, with limited attention paid to how CCRCs or sheltered housing may relate to aging in place. Across studies, as most participants were female, the potentially different experiences of men were underexplored. Similarly, other axes of diversity, such as marital status, education level, ethnicity, and income, that may shape older adults’ experiences in the different housing models have received little attention. In addition, basic demographic information was often not reported, such as health and housing tenure, making it difficult to understand the applicability of the findings across various settings. In addition, approximately 87% of the studies included in this review did not utilize a longitudinal design and therefore could not definitively attribute any benefits to the housing model.

Future research could include a greater variety of housing models and diverse older adult populations to gain a more complete understanding of how housing models relate to aging in place. Longitudinal designs can help to better understand the impacts of housing characteristics on aging in place, and additional in-depth qualitative research could allow for better comprehension of the processes through which housing characteristics relate to aging in place.

Conclusions

The findings of this scoping review suggest that a variety of housing models may support older adults’ social relations, health and well-being, sense of self and autonomy, and activity participation, contributing to successful aging in place within their communities. Additionally, the review identified specific characteristics of these housing models that may support aging in place, including aspects of the built environment, opportunities for activities, and the sociocultural environment. It was apparent that consideration of the unique context and needs of the residents, in conjunction with the services and supports available, in each of the models is necessary to support and empower older adults aging in place. As such, this scoping review may contribute to the development and improvement of community-based housing models that are inclusive and conducive to older adults aging in place within their communities. Future studies should address the gaps in the literature outlined in this review and further investigate the characteristics within housing models that enable and hinder aging in place.

Funding

None declared.

Conflict of Interest

The authors declare no potential conflicts of interest with respect to the research, authorship, or publication of this article.

References