Relocation and residential reasoning in very old age -Housing, health and everyday life

Introduction: Moving in very old age is considered to be a major life event and relocation and access to appropriate housing options is a hot topic in the public debate across Europe. For very old people, the decision-making process and aspects influencing relocation is not well studied. Occupational therapy interventions mainly focus on ageing-in-place solutions when aiming for independence and well-being for older people. Although theoretically, relocation can be seen as a major form of environmental adaptation that helps counter aspects of age-related functional decline. Aims: The aim was to expand and deepen the knowledge on relocation in very old age in two Western European countries (Sweden and Germany). With a focus on person-environment relations concerning housing and health, predictors and consequences of relocation were explored. Also, residential decision-making was explored with focus on how very old people reason about their home and everyday life in relation to relocation and ageing-in-place. Methods & Results: The thesis is based on the Swedish (studies I to IV) and German (studies III and IV) parts of the ENABLE-AGE Project. At baseline, the participants were 80-89 years old and lived alone in ordinary housing. In study I (N=384), Cox regression models showed dependence in cleaning but perceived functional independence when living in a one-family house predict a move within the ordinary housing stock. Dependence in cooking and cognitive deficits in combination with accessibility problems predicted a move to special housing. After relocation to another dwelling in the ordinary housing stock (N=29) the number of environmental barriers in the new dwelling were fewer than in the former (study II). Usability and accessibility were stable comparing former and new dwellings. Analyses of in-depth interviews of 80 participants in 2002 (study III) and 16 participants in 2003 and 2011 (study IV) revealed ambivalence between moving and ageing-in-place to arise along with increasing problems in everyday life. The findings supported the use of residential reasoning as a concept describing older peoples reasoning on relocation and ageing-in-place as one intertwined topic. Conclusions: The findings contribute to the knowledgebase on relocation in very old age, with practical implications for very old people and their families, occupational therapists and other professionals and for societal planning at large. The knowledge can be used as a first step in designing counselling services to help deal with very old people´s ambivalence and to guide in their decision-making processes. Further, having the potential to integrate theoretical perspectives from different disciplines to enhance our understanding on residential decision-making in old age, theoretical development on the concept residential reasoning is needed