While health status is an important factor in whether a person is able to grow old in their home and community (age in place), researchers at McGill University have shed new light on the social factors that can also have an impact, both directly and through their impact on health over a lifetime.
"The main takeaway from our research is that aging in place is not equally accessible to everyone," said Amélie Quesnel-Vallée, the senior author on the paper and the Inaugural Chair and Professor in the Department of Equity, Ethics and Policy and the Canada Research Chair in Policies and Health Inequalities.
"What we wanted to do was highlight the fact that there's an enormous potential for inequity even here in Canada, despite the existence of universal health care."
Situation of highly educated people was surprising
Surprisingly, the researchers found that people with higher levels of education are less likely to age in place.
"This is surprising because higher education is usually linked with having more resources, which could support aging in place," said Clara Bolster-Foucault, a PhD candidate in the Department of Epidemiology, Biostatistics, and Occupational Health at McGill University who is the first author of the study, published in Age and Ageing.
"This could be because of how education influences family structure, as people with more education tend to have children later in life and have fewer children as a result," Bolster-Foucault said. "All these factors make it less likely for people with more education to receive care if they need support to age in place. People with more education also tend to live longer and may need more care in later life."
Researchers examined data from higher-income countries
The researchers analyzed data from 55 studies that focused on aging populations in North America, Europe, Australia and the United Kingdom.
Less surprisingly, they discovered that those with greater socio-economic resources and/or stronger social connections were more likely than others to age in place.
People living in rural areas, as well those who were members of racial or ethnic minorities or who were immigrants were also more likely than urbanites, non-minorities and non-immigrants to age in the community. This could be due to lack of access to long-term care, stronger community ties and/or cultural values that prioritize family caregiving, the researchers suggested.
Seeking to influence policy development
These findings can inform the development of policies, programs and services to help ensure that all older adults can remain in their homes and communities for as long as they wish and are able, the researchers said.
Quesnel-Vallée said the researchers' next steps will be to look at social inequities in aging in place in Quebec, by examining disparities in admissions to residential long-term care facilities as well as potentially avoidable hospitalizations and emergency-department use.
The study: "Social inequity in ageing in place among older adults in Organisation for Economic Cooperation and Development countries: a mixed studies systematic review" by Clara Bolster-Foucault et al was published in Age and Ageing.
DOI: https://doi.org/10.1093/ageing/afae166
Funding: Canadian Institutes of Health Research, Fonds de recherche du Québec-Santé, Canada Research Chair in Policies and Health Inequalities.
