Assignment 1: Architecture & Morality Essay
The Benefits of Aging in Place Vs Institutional Care in Protecting the Welfare of the Elderly Community
Introduction
In this new age, there is a greater need for better support in the ageing process as we are witnessing a significant increase in the ageing population as a result of an improved quality of life due to better healthcare services and lifestyles as well as development in technology. Following a trend across much of the developed world, the population of Malaysia is growing, and ageing with statistics for 2020 showing an estimated number of 2.4 million older persons (thestar.com.my, 2018). Moreover, by 2030, Malaysia will be in the category of ageing nations with the percentage of those aged 60 and above constituting more than 15% of the population (Country Reports Malaysia, 2012). Thus, addressing the issues and concerns associated with meeting the needs of the elderly has become ever more relevant. Also, it is important to reassess the current services and facilities to more properly address current and future generations of elderly as the challenges faced by the elderly of previous generations are not mirrored by the elderly of today. The reason for this is, these days most older people aged 65 and over are healthier and more functionally independent compared to before.
The term “ageing in place” is becoming popular in current ageing policies and is defined as “remaining living in the community, with some level of independence, rather than in residential care” (Wiles et al., 2012). In Malaysia, 77.6% of senior citizens have no desire to leave their current abode and wish to “age in place” or continue to dwell in the community while maintaining their independence (healthyageing.org, 2017). Widely perceived as the “opposite” of assisted living, aging in place offers various benefits such as fulfilling the aspiration of the elderly, cost effectiveness, quality of life and prolonged physical and mental health.Thus, implying that future older adults will be able to live independently in the community as even now, the majority of older people want to “age in place”, to remain autonomous, active, and independent as long as possible while surrounded by family and friends (Iecovich, 2014)
Fulfilling the aspirations of the elderly
The first benefit of aging in place is that it meets the aspirations of the elderly themselves who wish to remain in the community as they age. Thus, giving them the option of living where they choose as well as deciding how they want to spend their retirement years. This includes deciding how their home will be set up, what their healthcare choices will be, the types of assistance that are right for them and their wishes for major life events such as sickness, housing transitions and financial decisions (greatcall.com, 2020). The ability to make these choices is important as it allows seniors to maintain control over their independence, quality of life and dignity as well as retain the familiarity and comfort of “home” which holds a greater importance to older adults who become more attached to their accustomed environments in which they feel most safe.
Cost-effective solution
Besides older people’s preferences, aging in place is also often seen as a cost-effective solution for an aging population and is favourable to policy makers, health providers and seniors themselves as they are able to age in their homes and communities while avoiding the higher cost of institutional care (Wiles et al., 2012). The reason for this is that assisted living is all-inclusive, and therefore more expensive (greatcall.com, 2020). On the other hand, aging in place at home allows one to customise the level of help and care required with options to hire part time housekeeping and organise home health care visits in accordance with their health and financial capabilities.
Quality of Life
Furthermore, an individual’s quality of life is also able to benefit from aging in place as by maintaining the home which one has resided in for a large period of one’s life, one is naturally able to maintain the social connections as well as autonomy that have been enjoyed (greatcall.com, 2020). Firstly, social connections are maintained in the form of intimate relations with friends and relatives which are naturally bound to the long-term place of residence. Thus, offering a sense of comfort and familiarity as well as the psychological and emotional benefits of aging amongst existing friends, family and community ties. Furthermore, autonomy is maintained through routines like routine walks around the neighbourhood and get-togethers at favourite restaurants. Therefore, giving a sense of independence in getting around as well as maintaining a sense of purpose by being able to have the freedom of going about daily activities.
Prolong physical and mental health
Another benefit of aging in place is that it is able to prolong physical and mental health and thus delay the need for institutional care. This is important as, in Malaysia, the system of healthcare is currently better tailored to facilitate short term care and hospitalisation (Mafauzy, 2000). Similarly, existing elder care facilities in Malaysia for a long time have always prioritised cure over prevention where seniors are isolated in aged care facilities when they are deemed no longer fit to live on their own. When a problem arises in seniors who are living in their own residences they are forced to turn to assisted living to receive care and medical treatment however this poses a problem as higher rates of medical and psychological problems are observed in nursing homes compared to those living alone (healthyageing.org, 2017). Thus, for older adults that still maintain the ability to live on their own the option of aging in place should be made available to them to improve and maintain their well being and keep them active to enjoy life as long as possible.
On the contrary, although there are many benefits of aging in place as previously discussed, there also exist many disadvantages such as the inability of the built environment to support the aspirations of the elderly to age in place, excessive burden on informal care givers, adverse effect on quality of life and difficulties faced by older adults in carrying out everyday activities on their own.
Inability of the built environment to support the aspirations of the elderly
First, the inability of the built environment to support the aspirations of the elderly to age in place. Correspondingly, although there is a growing emphasis on ageing in place in more developed nations, indications show that local industries related to architecture and the built environment have yet to catch up with and adapt to the aging population's changing needs. Studies have shown that it is important to question the adequacy of design features of the built environment which can support the mobility of older adults (Yen and Anderson, 2012). For example, the design of sidewalks and streets is important for the health of older adults whereby good design can encourage mobility. Consequently, there is a necessity to increase public awareness, construct the required infrastructure, and deliver various facilities along with accomplishment-oriented research in order to look after the aging populations.
Burden on informal care givers
Second, aging in place can place an excessive burden on informal care givers in the case of carrying out modifications to homes and providing care to elderly family members. For example, families will have to deal with issues such as remodelling homes to be accessible through implementation of universal design as well as balancing work and family responsibilities of caregiving and managing emotional and physical stress (ageinplace.com, 2020). Hence, aging in place is not for everybody as it requires responsibility in putting together a plan which considers the welfare of all parties such that that one is able to maintain his quality of life and live it out in dignity, without being a burden to family or community.
Adverse effects on quality of life
Third, although there are cases where aging in place is able to benefit an older person’s quality of life there are also cases where the opposite is true and instead quality of life is adversely affected. This occurs when the home and environment which one had previously found comfort and security in instead causes distress due to the house and neighbourhood being physically unfit to support the needs of the elderly, a poor social network and insufficient access to health and social-care (Vanleerberghe et al., 2017). Thus, quality of life is threatened as the home becomes a place of frustrations and intense negative emotions and experiences such as loneliness and helplessness. Thus, what this means is that not all homes and neighbourhood are conducive for aging in place and this should be taken into consideration when an older person decides where and how he wishes to spend his older years.
Difficulties faced by elderly
Finally, another negative aspect of aging in place are the various difficulties faced by older adults in carrying out everyday activities on their own. This is especially true in the case of home maintenance activities such as cleaning floors, replacing lightbulbs and lawn mowing which may be too much to handle for older people with decreased functional activities (Vanleerberghe et al., 2017). Nevertheless, these activities cannot be ignored as regular home maintenance is essential to ensure a safe and healthy environment and if a home is not maintained, it can become a dangerous environment that threatens one’s ability to successfully age in place. As of such, architects, designers and home service should aim to understand how older adults are maintaining their homes such as to create helpful interventions and solutions that can enable aging in place.
Conclusion
In conclusion, aging in place provides many benefits over institutional care however it should not be considered a solution to institutional care but rather an alternative as both offer different benefits and are suitable for different people and situations. However, it cannot be denied that the focus should always be to improve the well-being of the elderly and the most important thing to consider regarding aging in place is the aspirations of the aging community. At a time of their life where many options are taken away from them it is important that the elderly have the opportunity to choose where and how they want to spend the later years of their life. As of such it is important for architects, planners, designers and policy makers to realise that the needs of the elderly are not static and one dimensional but instead are growing and changing with every new generation. Thus, it is vital to improve the design of the built environment to address the well-being of the aging and elderly and emphasise the lack of strategies being carried out to re-imagine housing and the built environment to capture the ever-changing needs of the aging population.