An environmental approach to frailty management: needs of older people to age in place

Introduction : A combination of the growing ageing population and the willingness to ‘age in place’ puts a huge burden on society, not in the least for frail older people.  Research showed that frail older people are such a diverse group with distinct and complex needs that the provision of health and social services cannot keep up. Moreover, contextual pressures challenge the effectiveness of interventions of integrated care. Additionally, research has seldom focused on the needs of individuals managing frailty from a positive, consumer perspective. In response to this, our study includes older people as key players by identifying their needs to manage frailty, enabling ageing in place. Theory/Methods : Based on multiple case study in Brussels, this study identifies the needs of home-dwelling older people N=50 to manage potential frailty and verifies whether the environment has an impact. In order to identify all needs, an iterative process of interviews was held in both high-risk and low-risk neighbourhoods. Results and discussions – case study analysis : Overall the needs of community-dwelling older people are strongly related to the specific environmental characteristics . Analyses identified a distinction between needs: context independent needs, and 2 needs depending on the risk profile of the environmental context. In high-risk neighbourhoods respondents emphasised informal care and access to care as a premise to receive any care or support at all, whereas in low-risk neighbourhoods respondents focused more on formal care and quality of service delivery. Hence, a hierarchy of needs emerged as the needs in high-risk neighbourhoods are considered to be more urgent as to the needs in low-risk neighbourhoods. Conclusions : Our results stress a paradigm shift and a redesign of the care system as we know it towards a holistic and empowering approach. Regardless of the context, older people need a holistic and accessible care and support system that takes the capabilities of community members into account to ensure effective frailty management. Moreover, enabling aging in place requires not only individually tailored social and other services, but also should encompass the specific assets or thresholds of neighbourhoods. Lessons learned : Assessment of needs of older people to manage frailty; Impact assessment of the geographical context on older people’s needs; Prioritisation of policy actions; and Determination of the relationship between needs and context characteristics. Limitations : Empirical evidence is limited to the Brussels’ situation. Suggestions for future research : Further research is required to develop a concrete care paradigm that includes the specific characteristics of the neighbourhood. We also propose a reiteration of this research across other urban and rural environments to compare and assess the impact of other contexts, and to depict learning curves.