Aging in place is a topic that has generated significant public discussion. With the rapid aging of Québec’s population and the prospect that one in four people will be over the age of 75 within the next ten years, it is hardly surprising that issues related to seniors’ living environments raise so many questions and emotions. While various models are being developed to offer new living environments—such as private seniors’ residences or Maisons des aînés—the vast majority of older adults aspire to age in their own homes for as long as possible. These homes are places rich in history and memories, and this desire appears to grow stronger with age.

The latest issue of L’Esquisse magazine examined the challenges of aging in place in the article Chez soi jusqu’au bout (“At home until the end”). But the end of what, exactly? While many seniors envision remaining in their homes for the rest of their lives, it is often the depletion of available resources—financial, social, or related to home-based health and care services—that ultimately triggers the decision-making process and leads them to relocate to an unfamiliar environment.

The decision to age in place or to move is generally discussed by public-sector professionals who guide seniors experiencing loss of autonomy, based primarily on health status, level of independence, access to care, and physical safety considerations (Légaré et al., 2015). However, approaching this sensitive issue solely through a health and autonomy lens reduces the many dimensions of life to a single factor and frames the search for a new living environment around required health and care services. The built environment is then reduced to its objective physical components, overlooking the sense of belonging and attachment to home and community—elements that are essential to maintaining good physical and mental health and supporting autonomy among seniors. In this process, the personal values that older adults associate with their homes are often excluded from the decision-making process.

A synthesis of knowledge on the factors influencing the decision to remain at home or to move reveals a far more complex reality. In fact, this reflection involves 88 influencing factors grouped into six dimensions: socioeconomic and health status; economic factors; social factors; psychological and psychosocial factors; the built and natural environment; and temporal and spatiotemporal dimensions (Roy et al., 2018). While decisions about staying at home must certainly consider objective data related to health and physical capacity (age, physical limitations) and the built environment (housing standards, universal accessibility, proximity to services), they must also take into account memories, daily routines, social and family networks, and the social meanings associated with the home. This is what truly defines a sense of home.

When designing living environments for seniors—whether adapting an existing home or constructing a new facility—it is essential to avoid one-size-fits-all solutions based on generalized issues. Just as no two people age or experience physical decline in the same way, the relationship between a senior and their home is diverse and complex. Adaptation solutions must therefore be equally varied. For example, while a universally accessible layout with wide circulation may meet the needs of a senior using a wheelchair, the same design could increase loss of autonomy for a person with visual impairments who relies on partitions for spatial orientation. Similarly, reconfiguring rooms to create larger spaces that support universal access may limit a senior’s ability to host loved ones overnight, potentially altering their perception of their social role within the family.

As architects, we contribute to addressing seniors’ living environments from a human-centered perspective, proposing targeted interventions aligned with each individual’s needs and values. These interventions are part of a broader approach that highlights emotional attachment, environments that support loss of autonomy, and integration with urban and community contexts. The development of innovative solutions for adapting seniors’ existing homes or redesigning neighbourhoods for aging populations should be further encouraged and valued. When combined with enhanced healthcare and support services, these solutions make it possible to meet seniors’ aspirations to continue aging at home—without sacrificing autonomy, social roles, or personal projects.

References

Légaré, F., et al. (2015). Improving decision-making on location of care with the frail elderly and their caregivers (the DOLCE study): Study protocol for a cluster randomized controlled trial. Trials, 16, 50.

Roy, N., Dubé, R., Després, C., Freitas, A., Légaré, F. (2018). Choosing between staying at home or moving: A systematic review of factors influencing housing decisions among frail older adults. PLoS ONE, 13(1): e0189266.

Photograph: Jacques Nadeau, Le Devoir