"There's no place like home, but…": dependent older adults' narratives on the health and well-being limits of ageing in place

“没有什么地方比得上家,但是……”:依赖型老年人讲述居家养老对健康和福祉的限制

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Abstract

BACKGROUND: In ageing societies, understanding the lived experiences of dependent older adults is essential for designing care policies that support health, dignity, and well-being. While ageing in place is widely promoted, less is known about how dependent older adults themselves define its limits. AIM: This study examines how dependent older adults describe the conditions under which ageing in place supports-or undermines- their dignity and quality of life. METHODS: We conducted 30 in-depth interviews with individuals aged 65 and older in Barcelona, Spain, all officially recognized as having some degree of dependency. Interviews were analysed using a thematic approach, according to environmental gerontology and person-environment fit frameworks. RESULTS: Ageing in place emerged not as a fixed preference but as a fragile and continuously negotiated process of the person-place relationship. Remaining at home is sustained by symbolic autonomy and attachment to familiar environments, supporting control over daily routines and a sense of dignity. At the same time, participants described a state of care liminality, continuously reassessing their ability to remain at home in light of anticipated health decline. Three interconnected boundaries emerged: deteriorating health, perceived burden on family members, and loneliness. CONCLUSIONS: Ageing in place among dependent older adults should be understood as a conditional and relational process rather than a universal ideal. Recognising older adults' own definitions of its limits is essential for designing responsive care policies.

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