Ageing in place: where is best? Village or city?
- 1In Spain, of the total of people aged over 65 years (1,596,675 people), 20.1% reside in homes that suffer from extreme residential vulnerability, defined by an accumulation of serious problems in the dwelling.
- 2Of the total number of elderly people in a situation of extreme residential vulnerability (592,366 personas), 37.1% live in medium-sized towns or cities (10,000 to 100,000 inhabitants).
- 3The most serious housing problems are: having no toilet inside the dwelling, having no running water, lack of a public sewage system and living in buildings that are run-down.
- 4The most common housing problems are lack of accessibility and lack of heating.
There is a higher probability of finding elderly people in a situation of extreme residential vulnerability in municipalities with between 20,001 and 50,000 inhabitants firstly; in municipalities with between 50,001 and 100,000 inhabitants secondly, and lastly, in municipalities of between 10,001 and 20,000 inhabitants. The extremes (living in a village with fewer than 10,000 inhabitants, but especially in the smallest villages, or alternatively in a city with over 500,000 inhabitants), are those that offer the greatest protection to elderly people. Therefore, less vulnerability is suffered by elderly people who live in very small or very large municipalities.
We are increasingly living longer lives. We are also preferring to grow old independently, in an environment that is familiar to us and, whenever possible, in our own homes. But is ageing in place the same as ageing well? To be able to enjoy quality of life in old age, the dwelling must meet certain minimum requirements. At any life stage, there is a close relationship between living conditions in the home and health, physical and mental alike (Navarro, 2006; Roizblatt et al., 2006). This effect is even more pronounced during old age (Zuluaga, 2010). So, by analysing the conditions of the housing in which elderly people live, it is possible to evaluate whether, despite living longer lives, we can really talk about quality of life in old age in Spain. This analysis also tackles a broader question: is it better to grow old in a village or a city?
In Spain, there are 1,596,675 people aged over 65 years who are living in their own homes and suffering from what could be called extreme residential vulnerability. This means they are residing in houses that have accrued a series of problems: these have a negative impact on habitability or salubriousness, increase isolation or do not offer the minimum facilities necessary for wellbeing. Such problems never appear alone; rather they come together in such a way that they seriously affect the quality of life of people inhabiting such buildings. The more severe the problems suffered (having no toilet or running water, problems in the building’s structure that jeopardise people’s safety, etc.), the more likely it is that other problems considered to be of a more minor nature will also be faced (for example a lack of heating or no lift). We call it extreme residential vulnerability when such a combination of problems arises within the same dwelling.
Extreme vulnerability does not have the same incidence everywhere. Depending on the size of the municipality in which one lives, in Spain there are different qualities of ageing that can be determined by the conditions of the homes available. This is explained because difficulty in accessing housing is not the same in a municipality with 1,000 inhabitants as in one with over 500,000. Property maintenance costs are not the same either, and the problems that affect houses are also different.
This study shows that it is better to grow old in very small municipalities or in very large cities, whereas in middle-sized cities and towns there is a higher percentage of older people suffering from an accumulation of serious problems. In other words: growing old in rural communities or in macro-cities guarantees higher probabilities of wellbeing than growing old in middle-sized cities and towns, those numbering between 10,000 and 100,000 inhabitants.
1. Old age and housing today
The life experience of growing old has changed, because we are living more years in better conditions (Sanderson and Scherbov, 2013). The behaviour and preferences shown by people aged over 65 years confirm a change with respect to the way in which old age is being experienced.
Among these changes, one of the most relevant is the desire to age in place. According to the census, 96.4% of elderly people remain in society, where possible, in their own home, versus 3.6 per cent who live in care homes or institutions of some other kind where, in general, they are more isolated (Population and Housing Census 2011, Spanish Statistical Office, INE). This percentage is a little higher among women (4.3%) than among men (2.6%).
Preferring to remain in one’s own home in old age is not only a majority preference, but it also has benefits for the health and wellbeing of elderly people, including those in a situation of dependency (Barratt, 2007; Pinzón Pulido, 2016). Furthermore, and this is an important aspect in an economic context like today’s, old people remaining in their own homes is the most economical option for the State (Oldman, 2003).
Thus then, remaining at home is the best option from numerous viewpoints. The question lies in knowing whether own homes really favour quality ageing or, to the contrary, they expose the people living in them to situations of vulnerability. Undoubtedly, if certain basic facilities (such as access to running water) have not been resolved over the course of life, then a situation of residential vulnerability will occur that will have a greater effect in old age, which is when physical and also economic capabilities are more likely to decline. If a person has not been able to adequately resolve needs within their home in the earlier stages of their life, it will be very difficult for them to do so when they become inactive or retire and their income decreases.
2. The preferences of elderly people: ageing in villages or in cities
According to the 2011 Census, 17.03% of the population who form part of a household in Spain (whether alone, with their partner, or with other people) are aged over 65 years. This represents a total of 7,933,769 people. These data point to the need to pay attention to a population group that is increasingly numerous. Insofar as society pursues the inclusion of all its members, it must also promote the inclusion of elderly people and promote quality in ageing. For this it is necessary to consider the situation of the homes in which they are living.
At the same time, it is necessary to take into account the fact that the distribution of elderly people across the territory is unequal. This is especially relevant when municipality size has been found out to be a variable that marks differences in profiles related to ageing (García Sanz, 1998).
Although in smaller-sized (rural) municipalities there is a comparatively higher percentage of people aged over 65 years who live in their own homes (27.1% of the population in municipalities with fewer than 2,000 inhabitants and 19.9% in villages with between 2,000 and 5,000 inhabitants), the large cities (over 500,000 inhabitants) also have a high proportion. Medium- and small-sized cities have a lower percentage of elderly people.
It is helpful to offer clarification regarding this distribution: greater ageing in rural areas does not necessarily mean a return of the elderly to their villages of origin. People who were born in a village and migrated to the city usually remain in the latter as they grow old. The high proportion of elderly people living in small villages is explained, not so much by their return to their place of birth but rather by the depopulation of the rural fabric in Spain.
To understand that the relevance of this question, it must be asked how many municipalities exist by size in Spain. How many rural municipalities are there? How many towns of between 20,000 and 50,000 inhabitants?
3. Housing problems: the indicator of vulnerability
The concept of extreme vulnerability refers to the situation of people who are suffering from an accumulation of serious problems in their dwelling. Problems that jeopardise the continuity of elderly people in their own environment do not usually appear in an isolated way: the more major-impact problems elderly people suffer, the more likely it is that they will also suffer minor-impact problems (Lebrusán, 2017), thus increasing the loss in quality of life that these represent.
Some of these shortages, which have a major impact at any age, indicate the existence of substandard housing: housing which falls below the generally accepted level in Spain.
Other shortages that seem to have a lesser impact, not only hinder the everyday life of elderly people, but also their participation in society and, even, their ease for receiving care in the case of accidents such as, for example, a fall. These people suffer difficulties such as living in buildings with structural problems, not being able to get outside or having enormous difficulty in doing so, living in buildings where they remain isolated once offices reach closing time, or having no access to telecare services because they are cut off from the telephone network. The severity of these shortages, even those that are considered minor issues, is increased when some are combined with others.
How can all these variables be integrated into a single measure that is useful for evaluating the vulnerability of housing units? To be able to consider all these shortages, the different impact of each them, and how they combine with each other, a synthetic indicator has been constructed. For this, different weightings have been assigned to the shortages, according to objective need, urban development regulations and the generalisation of the enjoyment of that asset by society. Thus, for example, running water is a necessary asset; it is obligatory to have running water to obtain a housing habitability certificate and almost the entire population has access to it, which indicates its relative importance in society. Therefore, this shortage is assigned a high value. In addition to the three criteria mentioned, validation has been sought from architects, experts and elderly people affected by such shortages.
The source used is the 2011 Population and Housing Census (INE), which is conducted every ten years. It is the only source that includes these variables and, in addition, enables results to be crossed with the data on the size of the municipality of residence. Subsequently, the establishment of a vulnerability threshold (the most affected 10% of the population) shows us who is in the worst situation in relation with these parameters.
4. Who suffers the most problems, the elderly people living in villages or those who live in the city?
With all the information available, it is possible to detect where the people who accumulate the largest number or the most serious combination of problems reside. The vulnerability indicator enables us to confirm that it is most likely that elderly people suffer severe problems in housing when they reside in middle-sized cities.
If 20.1% of elderly people in Spain (1,596,675 people) are living in a situation of extreme residential vulnerability, this percentage is higher in towns and cities that have between 10,001 and 100,000 inhabitants, reaching up to 23.5% of the total elderly population. This difference may seem small, but it implies that 37.1% of the total of elderly people in a situation of extreme vulnerability in Spain are residing in medium-sized towns and cities. With regard to vulnerability derived from housing conditions, there is a difference of nearly seven percentage points between living in medium-sized cities and residing in a rural municipality with fewer than 2,000 inhabitants.
Finding elderly people in a situation of high vulnerability is more probable in municipalities ranging from 20,001 to 50,000 inhabitants first of all; in municipalities ranging from 50,001 to 100,000 inhabitants in second place and, finally, in municipalities with between 10,0001 and 20,000 inhabitants. The extremes (residing in a village with fewer than 10,000 inhabitants, but especially in the smallest villages, or alternatively in a city with over 500,000 inhabitants) are those that offer the greatest protection to elderly people. Thus, elderly people who live in very small or very large municipalities suffer less vulnerability.
According to these data, elderly people who reside in medium-sized towns and cities (from 10,000 to 100,000 inhabitants) would be experiencing a “second-class ageing” of lower quality, with respect to elderly people who live in urban groupings of other sizes.
What are these differences due to? Firstly, large-sized cities have benefited from measures aimed at eradicating substandard housing and a greater control over construction parameters. However, it is smaller-sized municipalities that offer the greatest protection against extreme vulnerability during the final life phase. The reason lies in a greater range of forms of supported access to housing (transfers, inheritance) that have permitted the resolution of problems of greater severity (thanks to self-builds of relatively high quality and the importance of the inheritance of lands and the consequent financial saving which is allocated to the quality of the dwelling) (Lebrusán, 2017).
In this sense, medium-sized cities and towns have not been able to benefit from either the solidarity measures of rural municipalities, nor from the control measures and public resources to fight against substandard housing in larger-sized municipalities.
Ageing in place has many benefits. However, the housing vulnerability indicator makes it possible to confirm that there is a high proportion of elderly people who are living in houses that do not meet the required standards for ageing of quality. With this confirmation, the need for a change in the behaviour of elderly people is not being affirmed and nor are alternative forms of living being defended, rather greater attention is being demanded towards these situations that indicate the existence of substandard housing.
In houses with deficient living conditions wellbeing is not possible, regardless of the age of the occupants. However, the problems detected affect people of advanced age in particular. They may see the vulnerability that is generally associated with old age accelerated in their case due to the poor conditions or deficiencies affecting their housing.
These are deficiencies that not only prevent the basic activities of everyday life but that, combined, even if they do not affect basic questions such as personal hygiene or physical safety, do prevent the full participation of elderly people in society. For correct social participation coverage is needed of such basic needs as personal hygiene, privacy in the home or, simply, accessibility to the outdoors in order to be able to establish and maintain social relations. In short, an autonomous old age that is also one of quality, but above all one that is integrated into society, begins with the coverage of basic needs in housing.
Correcting these serious problems should be a priority for the different intervention systems (residential, social, etc.). Only then will it be truly possible to talk of quality ageing and, above all, of meeting targets for integration and equality throughout the entire life cycle.
Barratt, J. (2007): «Major developments and trends in creating enabling environments for older persons» (Briefing paper prepared for AARP and United Nations Programme on Ageing), Nueva York: United Nations.
García Sanz, B. (1998): «Los mayores y el mundo rural», Documentación social, 112.
Lebrusán Murillo, I. (2017): La vivienda en la vejez: problemas y estrategias para envejecer, tesis doctoral, Universidad Complutense de Madrid.
Navarro Ruiz, C. (2006): La exclusión en vivienda en España: un análisis económico de su extensión, dinámica y efectos sobre el bienestar, Madrid: Consejo Económico y Social.
Oldman, C. (2003): «Deceiving, theorizing and self-justification: a critique of independent living», Critical Social Policy, 23(1).
Pinzón-Pulido, S.A. (2016): Atención residencial vs. atención domiciliaria en la provisión de cuidados de larga duración a personas mayores en situación de dependencia, tesis doctoral, Universidad de Sevilla.
Roizblatt, A., M. Corón, R. Verdugo, C. Erazo and V. Miño (2006): «Familia, vivienda y medio ambiente: algunos aspectos psicosociales», APAL (Chile).
Saiegh Saiegh, B. (2012): Relación entre condiciones de la vivienda y mortalidad en la población española mayor de 65 años, tesis doctoral, Universidad Rey Juan Carlos (Madrid).
Sanderson, W.C., and S. Scherbov (2013): «The characteristics approach to the measurement of population aging», Population and Development Review, 39(4).
Zuluaga, M.C. (2010): Depresión, calidad de vida y condiciones de la vivienda como predictores de la mortalidad en ancianos con insuficiencia cardiaca, tesis doctoral, Universidad Autónoma de Madrid.
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