Non-medical barriers and facilitators of ageing in place: a cohort study in the Netherlands

Most western countries lack the capacity to maintain institutional care levels for the ageing baby boom generation. To date, the non-medical drivers of the decision to "age in place" versus using expensive institutional long-term care (LTC) have not been comprehensively studied. This study, based on data from the Longitudinal Aging Study Amsterdam, aims to better understand why some individuals, with comparable medical needs, decide or are able to remain living independently longer than others. The sample included a representative cohort of Dutch adults aged 58 and older (n = 1,792), followed from 2005-06 to January 1, 2024. Cox Proportional Hazard models were used to better understand the relationship between potential non-medical barriers and facilitators and the duration of ageing in place. Several factors that facilitate ageing in place were identified. Individuals with comparable medical needs, but who are homeowners, who have a strong social network, or who have been living longer in their neighbourhood were less likely to be granted access to institutional care. This was also the case for those who value independence more or feel in control of their care. In contrast, emotional loneliness or having a partner living separately (typically in a nursing home) were associated with a higher likelihood of being granted institutional care. The actual move to a nursing home was delayed for those who feel that they receive sufficient home help. Developing community-based care approaches that address these factors may improve the ability to age in place.