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Social Work and Aging in Place: A Scoping Review of the Literature

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 Social Work and Aging in Place: A Scoping
Review of the Literature
Amanda J. Lehning, Emily Joy Nicklett, Joan Davitt, and Hilary Wiseman

Aging in place (AIP) has become a major focus of aging policies, programs, and scholarship
in recent years. This article presents a scoping review of the social work literature on AIP.
Based on predefined eligibility criteria, the authors identified 22 empirical articles published
between 1980 and 2014. Many of these studies focused on settings that are particularly rele-
vant to gerontological social work practice, including congregate housing alternatives to
nursing homes, grassroots and volunteer-run organizations, and agency-based programs.
The majority of the studies examined in this scoping review presented AIP as a rationale for
the study, but very few examined AIP as a predictor or outcome of interest. As this body of
research is still in its early stages, many of the articles are descriptive rather than analytical in
nature. This is a necessary first step in the development of research to inform policies and
programs to promote AIP. The authors conclude with recommendations for further advance-
ment in this area of research, including the potential for social work scholars and practitioners
to examine and address inequities in opportunities for older adults to age in place.

KEY WORDS: aging in place; gerontological social work; older adults

A ging in place (AIP), defined as the ability

of older adults to “live in their homes or
communities as long as possible” (Yen &
Anderson, 2012, p. 951), is a major focus of aging-
related policies, programs, and scholarship. For exam-
ple, the Older Americans Act Reauthorization Act of
2016 (P.L. 114-144) provides funding for a variety of
community-based services that aim to promote AIP.
In addition, federal and state governments have im-
plemented promising programs and interventions,
such as Money Follows the Person and the State Bal-
ancing Incentive Program (both expanded through
the Patient Protection and Affordable Care Act), to
help older adults who need assistance to remain in or
return to their community (Kane, 2012). Nonprofit
organizations, including the increasingly popular Vil-
lage model, offer supports and services to help their
members age in place (Greenfield, Scharlach, Lehning,
Davitt, & Graham, 2013). This proliferation of pro-
grams is in response to a variety of factors, including
the high costs of institutional care (Scharlach &
Lehning, 2012), reduced access to informal supports
(Szinovacz & Davey, 2008), the potential benefits of
AIP for older adults’ independence and positive self-
image (Rubinstein & Parmelee, 1992), and the pref-
erence of the majority of older adults to remain in
their own home or community and avoid relocation
(Feldman, Oberlink, Simantov, & Gursen, 2004).
Concomitant with this increase in policies and
programs are efforts by gerontological scholars to
develop an evidence base on AIP (Vasunilashorn,
Steinman, Liebig, & Pynoos, 2012). Although this
scholarly literature has explored various lines of
inquiry, critical gaps remain in our understanding
of AIP. Conceptually, for example, there is a lack
of consensus about terms (for example, AIP versus
aging in community), the specific living arrange-
ments that encompass AIP (for example, avoiding
institutionalization, remaining in the same home,
relocating to another home or community), and
whether AIP is an end to itself, or more of a means
to achieve health and well-being. Empirically, there
is limited information regarding the causes and con-
sequences of AIP, including whether these may
vary among more vulnerable populations. Charac-
terizing the literature is an important step toward a
more consistent and systematic approach for study-
ing this concept.
Social work practitioners are often involved in
the development, implementation, and evaluation
of policies and programs to promote AIP, and
could particularly benefit from the advancement of
an evidence base for these interventions. Further-
more, reflecting the profession’s focus on social
justice and serving vulnerable populations, social
work scholars have the potential to add critical

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 knowledge to this area of research, particularly in
terms of ensuring that AIP policies and programs
do not perpetuate or exacerbate inequities in
health and well-being. The purpose of this review
is to examine the contributions of social work to
the scholarly literature on AIP and to identify op-
portunities for further social work involvement
that informs policy and practice.
BACKGROUND
The concept of AIP has received increased atten-
tion in light of the aging of the U.S. population.
By the year 2030, one in five Americans are pro-
jected to be age 65 or older, totaling 72 million
people (Federal Interagency Forum on Aging-
Related Statistics, 2012). In addition, the number
of Americans age 85 or older, who are much more
likely to require assistance due to health problems
or disability, will triple between 2010 and 2050
(U.S. Census Bureau, 2010).
Older adults with a desire to age in place face a
number of barriers to doing so. First, aging is often
accompanied by declines in physical or cognitive
functioning that can restrict health, quality of life,
and independence. About one-third of Medicare
recipients (the majority of whom are 65 and older)
have a limitation in performing personal and house-
hold care tasks, as measured by activities of daily
living and instrumental activities of daily living,
respectively (Federal Interagency Forum on Aging-
Related Statistics, 2012). Approximately 80% of
older adults have been diagnosed with at least one
chronic illness, and half have at least two (Centers
for Disease Control and Prevention, 2011). Second,
in the United States, declines in fertility rates, high-
er participation of women in the workforce, and
increased longevity impose challenges on family
and friends to continue to provide informal care
(Spillman & Pezzin, 2000; Szinovacz & Davey,
2008). Third, despite increased availability of
home- and community-based services, the U.S.
long-term care system remains fragmented, expen-
sive, and unable to meet the needs of many older
adults (Scharlach & Lehning, 2012), particularly
those seeking community-based alternatives to nurs-
ing home care (Zarit, Shea, Berg, & Sundstrom,
1998). Finally, the physical and social infrastructure
of many cities and towns in the United States do
not support the needs of older adults. For example,
zoning ordinances in many suburban communities
limit legal occupancy to a single family, dictate
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large minimum lot sizes, and restrict building addi-
tional structures on properties (Byun, Waldorf, &
Esparza, 2005), limiting the housing alternatives
available to older adults who wish to remain in
their community but have difficulty maintaining a
larger single-family home.
In spite of these challenges to AIP, there are in-
dicators that the proportion of older adults staying
in their own home and community is increasing.
The percentage of older Americans living in a
long-term care facility has declined since the
1970s, particularly among those in the 85-and-
older population, 26% of whom lived in a nurs-
ing home in the 1970s compared with 14% by
the mid-2000s (Hayutin, 2012). Furthermore, data
suggest that more older adults are remaining in their
communities rather than relocating to new ones.
For example, 4.4% of those age 65 and older moved
in 1999–2000 (U.S. Census Bureau, 2001) com-
pared with only 3.2% in 2010–2011 (U.S. Census
Bureau, 2012). These statistics support the prop-
osition by scholars that older adults’ housing arrange-
ments have become increasingly stable (Forrest &
Kearns, 2001).
The benefits of AIP potentially emerge from the
strong feelings of place attachment older adults
develop if they have lived in their home or com-
munity for many years. Furthermore, the home
and neighborhood environment is thought to
become increasingly important as people grow
older and leave the workforce, develop health pro-
blems and disabilities, or experience mobility chal-
lenges (Burns, Lavoie, & Rose, 2012). Thus, older
adults may also develop strong feelings of place
attachment because they spend the majority of
their time in their home and immediate neigh-
borhood environment. Place attachment in turn
may contribute to health and well-being in later
life because it fosters physical insideness (that is, the
ability to easily navigate familiar environments),
social insideness (that is, feelings of belonging and
confidence in accessing informal assistance), and
autobiographical insideness (that is, deriving mean-
ing and self-concept) (Rowles, 1983).
Along with the increasing number of policies and
programs that aim to promote AIP, as well as a
growing recognition of the barriers to doing so,
there has been a rise in the number of scholarly
publications examining AIP. In their analysis of peer-
reviewed articles published in 11 leading gerontology
journals from 1980 to 2010, Vasunilashorn and
Social Work Research
Volume 41, Number 4 December 2017
 colleagues (2012) documented a dramatic increase
in the number of AIP publications per year, particu-
larly after 2000. For example, AIP was mentioned
in fewer than five articles per year in the 1980s, but
it was discussed in more than 60 in 2010. Although
Vasunilashorn and colleagues (2012) provided an
important overview of the AIP literature; they also
raised concerns regarding the potential for this liter-
ature to inform programs and policies that aim to
help older adults age in place in a way that is safe
and supports their quality of life. The authors re-
ported that 70% of the publications mentioned AIP
only indirectly, meaning that it was not the primary
focus of the study. The lack of studies including AIP
as a predictor or outcome suggests limited empirical
support for the benefits of AIP. The authors noted
that designing studies that can capture the variety of
individual and environmental factors involved in
AIP and subsequent outcomes is difficult because it
is not a “one-size-fits-all” concept. In addition, the
authors identified four topics typically addressed in
the literature on AIP: environment, services, tech-
nology, and health. It is likely that these topics do
not encompass the numerous factors that influence,
or are influenced by, AIP. Therefore, there is a need
for additional assessments of the state of AIP litera-
ture to complement and build on this prior work.
PURPOSE OF THE REVIEW
In this scoping review we aimed to characterize
the contributions of social work to the existing lit-
erature on AIP. There are several reasons why it is
valuable to assess the state of the literature, specifi-
cally within the field of social work. First, social
work scholars are well positioned to increase our
empirical understanding of the complex interplay
of individual and contextual factors that help or
hinder older adults’ ability to remain in their own
home and community. This focus on the person
and his or her surrounding environment has been
described as “the unique contribution of the social
work profession” (Silverstone, 2005, p. 309), and
in recent decades there has been a call for social
work researchers to incorporate more environ-
mental characteristics into their work (Holland,
Burgess, Grogan-Kaylor, & Delva, 2011). Second,
social work’s concern for vulnerable populations
highlights social work scholars’ potential to call
attention to AIP inequities in terms of who bene-
fits from different policies and programs, as well as
who is aging in place compared with who is stuck in
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place in a way that is detrimental to safety, health,
and well-being. One of the first publications to
discuss this concept of being stuck in place, for
example, was coauthored by a social work scholar
(Torres-Gil & Hofland, 2012). Finally, social work
scholarship on AIP can inform the practice of clinical
and macro social workers in the field. For example,
because more than 80% of older adults indicated that
they want to remain in their current homes and com-
munities as long as possible (Feldman et al., 2004),
promoting AIP aligns with strengths-based and
empowerment-oriented social work practice
(Chapin & Cox, 2001). Furthermore, social work
practitioners are key implementers, both indepen-
dently and as members of interdisciplinary teams,
of policies and programs that aim to help older
adults age in place. Given social work’s focus on
the environment and complex social systems, geron-
tological social work scholars are well positioned
to contribute to translational and interdisciplinary
research on AIP (Burnette, Morrow-Howell, &
Chen, 2003).
In this scoping review we aimed to map the AIP
literature in the social work field, and therefore ad-
dressed two questions: (1) What topics are ad-
dressed by the social work literature on AIP? and
(2) What empirical evidence from this social work
literature can inform programs and policies focused
on AIP?
METHOD
We conducted a scoping review to examine
social work contributions to the literature on
AIP. A systematic review synthesizes the research
literature on a particular question and typically
excludes studies due to sample size, study design,
or quality; however, a scoping study can be used
to summarize an area of research more broadly
(Arksey & O’Malley, 2005). We searched for ar-
ticles published between January 1, 1979, and
December 31, 2014, in the following databases:
Family and Society Studies Worldwide, Social
Services Abstracts, PsychINFO, PubMed, Sco-
pus, Cochrane Central Register of Controlled
Trials, Social Sciences Citation Index, Ageline,
and Proquest Research Library. We used the fol-
lowing search terms: “age in place,” “age-in-place,”
“aging in place,” “aging-in-place,” “ageing in
place,” “aging in community,” and “ageing in
community.” For each of these terms, we also
limited our search by combining those terms
237
 with the following terms: “social work,” “social
worker,” and “social welfare.”
A summary of our abstraction process and eligi-
bility criteria is presented in Figure 1. We excluded
any articles not written in English or published
before 1979. We also excluded publications that
were not peer reviewed, such as reports and other
products from the gray literature. Our eligibility
criteria specified that the article is part of the social
work literature, which we defined as (a) first author is
a current faculty member, researcher, or student in
a school of social work; (b) first author holds a
graduate degree from a school of social work; or
(c) article was published in a social work journal.
We then assessed whether the article’s population
of interest is older adults, which we defined
broadly as at least 50 years old in light of the wide
variation of age ranges included in gerontological
studies. We then conducted a more in-depth
review to determine whether the article examined
AIP, which we based on the extent to which AIP
and relevant synonyms appeared in the text, as well
as whether the findings and conclusions of the arti-
cle could inform policies, programs, and research
on AIP. We excluded a number of articles, for
example, that referred to AIP briefly in the Intro-
duction or Discussion sections without attempting
to connect study findings to this concept. Finally,
we limited the review to articles reporting empiri-
cal findings.
The first author then reviewed all 22 eligible ar-
ticles, with each coauthor reviewing a subsample,
so that each publication was reviewed by two
authors. For each article, we examined the specific
aims (including the context of AIP), methods,
findings, and implications. For the majority of arti-
cles, interpretation of these characteristics was simi-
lar between the two reviewers, and we resolved
any inconsistencies through discussion before cate-
gorizing and summarizing the publications.
RESULTS
We identified 22 articles from the social work liter-
ature that focus on AIP. Details about the articles,

Figure 1: Literature Search Strategy and Exclusion Criteria (Articles Published

January 1, 1979–December 31, 2014)

211 articles

66 excluded: duplicates, not published in English,

and/or appeared before 1979

145 articles

17 excluded: not peer reviewed

128 articles

94 excluded:
• 36 not in social work literature
• 4 not focused on older adults
• 54 not substantive enough focus on aging in place

34 articles

12 excluded: not reporting empirical findings

22 articles

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 including specific aims, data collection, sample,
and findings, are presented in Table 1. Although
publication dates ranged from 1991 to 2014, the
overwhelming majority of studies were published
within the last decade. Reflecting the diversity of
topics addressed, which we detail later, the sample
sizes and inclusion criteria varied widely, ranging
from large representative samples of all older adults
living in a geographic area (for example, Tang &
Lee, 2010) to small purposive samples of vulnera-
ble elders (for example, Witso, Vik, & Ytterhus,
2012). Most of the articles examined individual
or organizational outcomes, with only one study
(Silverstein, Johns, & Griffin, 2008) focusing on the
community as the unit of analysis.
Topics Addressed by the Social Work
Literature
For our first research question, we identified six to-
pics within the social work literature on AIP. Four
articles (Bryant, 2003; Chapin & Dobbs-Kepper,
2001; Janicki, McCallion, & Dalton, 2002; Sheehan &
Wisensale, 1991) examined AIP in alternative resi-
dential settings, such as age-segregated housing. We
categorized four articles (Carpenter et al., 2007;
Tang & Lee, 2010, 2011; Tang & Pickard, 2008) as
addressing anticipatory relocation (that is, not AIP)
or the expectation to age in place, particularly the
role of formal and informal supports in predictions
about future living arrangements. Another three ar-
ticles (Soderberg, Stahl, & Melin Emilsson, 2013;
Wiles, Leibing, Guberman, Reeve, & Allen, 2012;
Witso et al., 2012) explored older adults’ perspec-
tives on AIP, including the experience of remaining
in the same home and community. Two articles
(Norstrand & Chan, 2014; Smith, Lehning, &
Dunkle, 2013) examined characteristics of the phys-
ical or social environment that may support AIP, such
as aging-friendly communities. The largest category
was composed of studies, primarily descriptive, of
community-based interventions to support AIP,
such as Villages or Naturally Occurring Retirement
Community supportive service programs (NORC
SSPs). This category included seven articles (Black,
2008; Bronstein, Gellis, & Kenaley, 2011; Gonyea &
Burnes, 2013; Greenfield, 2014; Greenfield et al., 2013;
Osterkamp & Chapin, 1995; Scharlach, Graham, &
Lehning, 2012). Finally, two articles (Marken,
Moxley, & Fraley, 2011; Silverstein et al., 2008)
presented an evaluation of a service learning or train-
ing program related to AIP.
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Empirical Evidence to Inform Policies and
Programs
To address our second research question, we first
reviewed each study to determine how the authors
conceptualized and measured AIP. Although the
conceptualization of AIP differed between articles,
the majority took a more inclusive view of this
term, aligning with our own definition of living in
one’s home or community. Several articles also
emphasized that AIP reflects personal choice, not
simply living arrangement (for example, Scharlach
et al., 2012; Wiles et al., 2012). Among the quanti-
tative studies, only one of the 22 articles in this
review operationalized AIP as either a predictor or
outcome variable. Specifically, Bryant (2003) mea-
sured AIP as the length of time the respondent re-
ported living in his or her current community and
found that AIP can contribute to better self-reported
health and well-being outcomes. The three qualita-
tive studies on older adults’ perspectives asked partici-
pants directly about their experience with AIP. Two
of these studies identified the role of AIP in elders’
feelings of autonomy, independence, and dignity
(Wiles et al., 2012; Witso et al., 2012), while the
third raised concerns about the ways an overem-
phasis on AIP may discourage older adults from
seeking needed assistance (Soderberg et al., 2013).
Several articles measured closely related con-
cepts that can inform policies and practices to pro-
mote AIP. Specifically, the articles by Chapin and
Dobbs-Kepper (2001), Janicki and colleagues (2002),
and Sheehan and Wisensale (1991) indicated a need
for housing providers to develop clear strategies and
policies to support higher-need residents to age in
place. The four articles on anticipatory relocation or
expectation to age in place suggest that a significant
proportion of older adults are concerned about
whether they will be able to remain in their own
home, and raise questions about whether those who
are at a higher risk for unwanted relocation are plan-
ning for future service needs. Furthermore, these
studies indicate that older adults have only limited
knowledge about the community supports avail-
able to help them age in place.
Approximately half of the articles (12 of 22) did
not measure AIP or a closely related concept, but
instead described the need to promote AIP as a
rationale for conducting their study or discussed the
implications of study findings on AIP. Some of these
studies reported significant associations between
various community characteristics (for example,
239
 Table 1: Characteristics of Social Work Studies on Aging in Place (AIP)
Study Specific Aims
AIP in Alternative
Residential Settings
Bryant (2003) Relationship between AIP in a
religious community and
variety of health and social
outcomes
Chapin & Dobbs- Admission and retention
Kepper (2001) policies in assisted living that
could support or create
barriers to AIP
Janicki, McCallion, & Strategies of group homes to
Dalton (2002) support the AIP of residents
with intellectual disability
(ID) and dementia
Sheehan & Wisensale Discharge policies in senior
(1991) housing for frail residents
Anticipatory Relocation or
Expectation to Age in
Place
Carpenter et al. (2007) Contributors to concerns about
future relocation
Tang & Lee (2010) Older adults’ perceptions about
services needs to age in place
Tang & Lee (2011) Relationship between social
support and expectations to
age in place
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Data Source Sample
Standardized self- 72 African American nuns (ages
administered survey 30 to 84 years) living in
religious communities
Standardized self- 141 administrators from assisted-
administered survey living/residential health care
facilities in Kansas
Unstructured self- Representatives from 54 group
administered survey homes in the United States,
United Kingdom, Ireland with
at least one resident with an
ID and dementia
Standardized self- 98 administrators from senior
administered survey and housing in Connecticut
unstructured in-person
interviews
Standardized in-person 324 adults age 65 and older
interviews living in a suburban area of St.
Louis with a high percentage
of older adults
Secondary analysis of 4,501 adults age 50 and older
standardized self- living in 13 U.S. communities
administered survey participating in Community
Partnerships for Older Adults
(CPFOA) program
Secondary analysis of 4,501 adults age 50 and older
standardized self- living in 13 U.S. communities
administered survey participating in CPFOA
program
Findings
AIP was associated with better perceptions of health status,
stress, and depression as well as greater satisfaction with
community and relationships.
Admissions and discharge criteria were less supportive of AIP
for residents with severe cognitive impairment, behavioral
problems, or health conditions they cannot self-manage.
Identified three strategies for individuals with both an ID and
dementia: (1) continuing provision of AIP supports, (2)
developing in-place progression options (for example,
creating a specialized dementia unit), and (3) referring out to
long-term care.
Few housing providers have written discharge policies to guide
decisions about relocation to higher level of care, despite
growing concern about the ability of residents to age in place.
Concerns about future relocation were most often due to health
and financial limitations, barriers to safely moving around
the home, household maintenance, and keeping social
connections.
Those older, in poorer health, female, less educated, and with
lower income were less likely to perceive future service needs
to age in place. Previous use of in-home personal services was
associated with greater perceived need for services to age in
place.
Formal support was associated with longer perceived ability to
age in place, while informal support was not associated with
expectations about AIP.
 Table 1: Characteristics of Social Work Studies on AIP (Continued)
Study Specific Aims Data Source Sample Findings
Tang & Pickard (2008) Older adults’ awareness of Secondary analysis of 4,611 adults age 50 and older Found low awareness of long-term services and supports
services to facilitate AIP standardized self- living in 13 U.S. communities available in their community. Respondents who reported
administered survey participating in CPFOA that services were not available in their community were
program more likely to anticipate needing regular help to age in place
or having to relocate at a younger age.
Older Adults’ Perspectives
on AIP
Soderberg, Stahl, & Melin Older adults’ decision-making Unstructured in-person Purposive sample of 21 older Identified two approaches: (1) justifying remaining in their own
Emilsson (2013) process about relocating and interviews, field notes, and adults ages 73 to 94 living in home, and (2) making excuses for the need to relocate to a
AIP observations Sweden residential home. Interview findings indicated that (a) older
people push limits, (b) older people lay modest claims to
assistance as long as possible, (c) older people feel bad for not
meeting expectations.
Wiles, Leibing, Views of older adults about Unstructured in-person Snowball sample of 121 older Older adults reported wanting choices about where they live. AIP
Guberman, Reeve, & Allen AIP interviews and focus adults ages 56 to 92 living in was described as not only related to staying in a particular
(2012) groups two communities in New house, but remaining a part of a neighborhood and
Zealand community. AIP was identified as an advantage representing
independence, autonomy, and identity.
Witso, Vik, & Ytterhus Experiences of older adults AIP Unstructured in-person Purposive sample of 10 older Main theme was importance of older adults maintaining their
(2012) with support of in-home interviews adults ages 72 to 89 with dignity and pride by actively participating as long as possible.
services health impairments in Norway Older adults described “getting oneself going” by organizing
their life in a way that they could still participate. They also
discussed “keeping one’s place at home, in the neighborhood,
and in the family” even with their reduced capacity.
Characteristics of the
Physical or Social
Environment That May
Support AIP
Norstrand & Chan Changes in social capital, and Secondary analysis of 2,344 adults age 65 and older High levels of social capital were generally associated with better
(2014) its relationship to health, standardized self- living in five counties in health and functioning. Unexpectedly, among the oldest-old
with age administered survey Pennsylvania higher neighborhood trust was associated with more
instrumental activities of daily living limitations.
Smith, Lehning, & Measures of aging-friendly Secondary analysis of 1,376 adults age 60 and older Identified six factors for future measurement of aging-friendly
Dunkle (2013) community characteristics standardized self- living in Detroit communities: access to business and leisure, social
administered survey and interaction, access to health care, neighborhood problems,
administrative data social support, and community engagement.

(Continued)

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 Table 1: Characteristics of Social Work Studies on AIP (Continued)
Study Specific Aims
Community-Based
Interventions to Support
AIP
Black (2008) Health needs of residents in a
naturally occurring
retirement community
(NORC)
Bronstein, Gellis, & Evaluation of a neighborhood
Kenaley (2011) NORC program
Gonyea & Burnes Evaluation of program combining
(2013) aspects of Village model,
NORC supportive service
program (SSP) model, and
program in Israel
Greenfield (2014) Develop a conceptual
framework examining the
social–relational activities of
NORC SSPs and initial and
long-term outcomes for
participants
Greenfield, Scharlach, Organizational characteristics
Lehning, Davitt, & of NORC SSPs and Villages
Graham (2013)
Osterkamp & Chapin Adequacy and effectiveness of
(1995) volunteer home repair and
maintenance programs
Scharlach, Graham, & Organizational characteristics
Lehning (2012) of Villages
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Data Source Sample
Standardized in-person needs Purposive sample of 114 adults
assessments age 60 and older living in a
NORC in southwest Florida
Unstructured in-person Five directors of partner
interviews organizations and four
members of the Resident
Council of NORC program in
Albany
Standardized in-person 33 older adults ages 69 to 95
interviews and participating in Aging Well At
standardized follow-up Home program in Boston
telephone interviews
Secondary analysis of Representatives from all 10
unstructured in-person (representing 15 programs)
interviews lead agencies of NORC SSPs
in New Jersey
Standardized self- Organizational leaders from 62
administered survey and NORC programs and 69
unstructured follow-up Villages in operation in 2012
telephone interviews
Semistructured telephone Program coordinators or
interviews administrators from 80
programs using volunteers in
home repair programs
Self-administered surveys Representatives from 30 Villages
including standardized in operation in 2010
and unstructured
questions
Findings
Those age 80 and older reported lower levels of physical,
psychological, and social well-being.
Identified four themes: (1) AIP is preferable and NORCs can
support AIP, (2) there is a need to develop informal support
systems, (3) concrete support (for example, home
maintenance) is needed, and (4) collaboration with
community services agencies is critical.
Program participation was associated with a decrease in
perceived stress, but no significant change in loneliness or
depression.
NORC SSPs facilitated social capital by forming relationships
between staff and residents, creating partnerships with
professionals in the community, and facilitating relationships
among residents.
Village members were more likely to be younger, less
functionally impaired, more economically secure, and live in
communities with higher socioeconomic status. NORC SSPs
offered more traditional health and social services, have more
paid staff, and receive more government funding.
Ongoing handyman services were effective in affecting health
and well-being of older adults, but also most difficult to
provide and coordinate. Emergency repairs were often
difficult for volunteer services to provide due to cost and skill
level needed.
Villages differed from other service models that promote AIP by
(a) combining formal services with peer support and consumer
engagement, (b) members being the main source of financial
and human resources, and (c) maintaining autonomous control
of the organization.
 social capital) or community-based interventions

Described service-learning opportunities as valuable to student’s

(for example, NORC SSPs) and outcomes that
may in turn facilitate AIP, such as less stress (for

beneficial for students and the older adult being served.

communities and expressed a desire to make their own

education, and the provision of in-home treatment as

Students learned about the variability of livability across

example, Gonyea & Burnes, 2013). Others sought
to clarify interventions or organizational charac-
teristics, which is presented as a necessary first step
toward more rigorous evaluations (for example,
Greenfield et al., 2013).
Findings

communities an ideal one for AIP.

DISCUSSION
The findings from this scoping review of social
work’s contributions to the empirical literature on
AIP indicate that social work scholars are engaged
Table 1: Characteristics of Social Work Studies on AIP (Continued)

in research that enhances our understanding of this

topic, while pointing to critical areas for future
research. Furthermore, many of the challenges to
conducting rigorous research on AIP that have
been observed in other disciplines (for example,
receiving occupational therapy

Seven neighborhoods in Boston

Vasunilashorn et al., 2012) are also evident within

living in rural Kentucky and
13 older adults ages 65 to 89

the examined social work literature.

In line with social workers’ roles in the provi-
Sample

metropolitan area

sion of supports and services to promote AIP,

many of the articles focused on settings for geron-
tological social work practice, including congregate
housing alternatives to nursing homes, grassroots or
volunteer-run organizations, and agency-based pro-
grams. In addition, several articles explored older
Communitywide assessment
combining administrative

adults’ perspectives on AIP, including those experienc-

unstructured in-person
Unstructured in-person

ing declines in capacity. The information gathered

Data Source

data, standardized
observations, and

through these qualitative inquiries suggests the need

for empowerment-oriented interventions that take
interviews

interviews

into account elders’ preferences around AIP and relo-

cation. Many of the articles provide a foundation for
future research that has the potential to inform AIP
policies and programs. The articles focused on
occupational therapy students

NORC SSPs and Villages illustrate how this is a

to support independence of

examine elder livability of

Service-learning project for
enhance understanding of

gerontology students to

necessary first step—because these are relatively

Service-learning project to
Specific Aims

nearby communities

new models that have received limited attention

by researchers, little is known about their inter-
vention strategies or the ways they may differ
older adults

from other service models that promote AIP.

Greenfield (2014), for example, used data collected
from organizational leaders to identify potential path-
ways through which NORC programs’ enhance-
ment of social relationships can improve access to
Learning or Training
Evaluation of a Service-

Silverstein, Johns, &

Marken, Moxley, &

community services and supports, which ultimately

will promote AIP. The next step would be to empiri-
Griffin (2008)
Fraley (2011)

cally test these relationships, and future studies should

Program

build on the work of the articles in our review. As

Study

one example, preliminary findings from evaluations

of a single program that use a convenience sample

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 and focus on a specific geographic region could
inform research drawing from more representative
samples and using more rigorous designs.
One important gap identified from this review
relates to social work scholarship’s capability to
advance our understanding of some of the poten-
tial negative consequences of AIP for older adults,
their families, and their communities. Among these
22 articles, only Soderberg and colleagues (2013) ad-
dressed this topic in depth, and their findings that
older adults living in Sweden may experience guilt
and negative self-perceptions if they are unable to
age in place should continue to be explored with
other cohorts and cultures. The broader literature
on AIP has noted that segments of the older adult
population may be at a higher risk for detrimental
outcomes if they age in place, including loneli-
ness, social isolation, restricted mobility, and lim-
ited access to supports and services (Phillipson, 2007;
Sixsmith & Sixsmith, 2008). Although the over-
whelming majority of older adults report that they
want to age in place as long as possible (Feldman
et al., 2004), a significant minority, such as those
who are Latino or African American or have low
incomes, may be stuck in place because they lack
the resources to change their living situation (Torres-
Gil & Hofland, 2012). Furthermore, questions have
been raised regarding the proposition that AIP with
community-based supports is a less-expensive alter-
native to moving into a long-term care institution
(Golant, 2008). However, none of the studies in this
review analyzed the costs of AIP. Social work schol-
ars have the opportunity to conduct research that
questions the assumption that AIP is an optimal out-
come for everyone, while also ensuring that policies
and programs take into consideration older adults’
self-determination and do not perpetuate or exacer-
bate existing inequities.
The prevailing assumption that AIP is a positive
outcome, and what Golant (2008) referred to as
“irrational exuberance” for the concept, may in
part stem from the methodological barriers to con-
ducting rigorous research in this area. Similar to a
previously published review of articles on AIP in
the gerontology literature (Vasunilashorn et al.,
2012), the majority of the articles in our scoping
review did not directly examine AIP. In part this
reflects the difficulty of operationalizing AIP in a
way that reflects staying in the home or commu-
nity. Much of the prior work that could be relevant
to understanding AIP examines living situations that
244
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are too broad (for example, avoiding nursing home
placement [Bharucha, Pandav, Shen, Dodge, &
Ganguli, 2004; Gaugler, Duval, Anderson, & Kane,
2007]) or too narrow (for example, remaining in
the same home from earlier in life [Sixsmith &
Sixsmith, 2008]). For example, does AIP also
encompass when an older adult relocates within
the same community, such as downsizing from a
single-family home to an apartment? What about
when an older adult chooses to move in with other
family members? To what extent should AIP reflect
elders’ self-determination?
Due to a combination of this conceptual confu-
sion, the underlying assumption that AIP is often
an optimal outcome, and the challenges to con-
ducting rigorous studies on this topic, the existing
empirical literature on AIP is more descriptive than
analytic. To improve the state of the science on
AIP, there is a need for a more consistent defini-
tion and operationalization of AIP as well as greater
attention to potential inequities in AIP among vul-
nerable groups. Further research is needed that uses
rigorous quantitative and qualitative methodolo-
gies, with clear implications for policy and practice.
For example, for quantitative approaches using
either primary or secondary data collection, addi-
tional research is needed using prospective, longitu-
dinal data on representative samples. Furthermore,
given the wide range of individual and environmen-
tal characteristics integral to understanding the expe-
rience of AIP, more studies are needed that collect
and analyze data on both older adults and their com-
munities. As a final example, research on interven-
tions and organizational practices often occurs too
late in the process to fully capture individual, organi-
zation, and community change. Future social work
research should address these limitations.
To our knowledge this review is the first to
examine the social work scholarship on AIP in a
systematic way, but we acknowledge several lim-
itations of our approach. First, we limited our
search to peer-reviewed articles, thereby excluding
chapters, reports, and other publications that have
been coauthored by social workers. Our search
strategy likely excluded articles that address the
concept of AIP without using the specific termi-
nology specified in our search criteria. By restrict-
ing our review to social work scholarship, we are
unable to compare the contributions of social
work with those of other disciplines and fields.
Finally, reflecting the state of the literature, the
Social Work Research
Volume 41, Number 4 December 2017
 studies we reviewed included a variety of research
designs, measures, and analytic approaches; there-
fore, we were unable to conduct a formal meta-
analysis.
Nevertheless, our review critically analyzes the
social work scholarship on AIP to date and identi-
fies directions for future work, such as conducting
more rigorous studies that build on and move
beyond descriptive findings, bringing a more criti-
cal perspective to the underlying assumptions of
AIP, and collecting and analyzing primary and sec-
ondary data sources that address the complex inter-
play of individual and contextual factors over time.
Social work practitioners play a critical role in the
development, implementation, and evaluation of
AIP policies and programs; therefore, social work
scholars should also play a key role in advancing
our understanding of AIP. SWR
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