Older People in Vulnerable Situations Ageing in Place in Sweden

Background. The debate about increased welfare and health service costs is well-known in relation to the growing ageing population. Over the past thirty years, ageing in place has been the guiding principle for policies concerning older people and housing in Sweden and other Western countries. Sweden is among the countries in the European Union and internationally whose populations have the longest life expectancies. Moreover, Sweden's universal welfare system ensures social security for its older citizens, making it a safe and supportive country for people to grow old. Older people typically spend most of their time at home and in their local neighbourhood, making the context of the home and neighbourhood essential to their health, autonomy, and active participation in society. However, several Western countries, including Sweden, have reformed their housing-, work and pensions, and healthcare policies and experienced a substantial increase in migrant populations, contributing to sociodemographic changes. Given the recent extensive political reforms and sociodemographic changes, there is a lack of knowledge about how older people's daily lives have been affected, what opportunities or barriers they face, and the strategies they use to cope, and to seek out and receive support in and around vulnerable situations.Aim. To explore how older people in vulnerable situations cope with ageing in place in Sweden.Methods. The four sub-studies that make up this thesis project are grounded in three projects. In total, 488 older people and 29 janitors and maintenance staff were included. The thesis project adopted cross-sectional designs, and the methods used both qualitative and quantitative methodologies, including multi-method and mixed-method approaches. A final deductive content analysis based on a categorisation matrix was conducted to address the overarching aim of the thesis.Findings and conclusion. The findings are significant as they indicate that older people in Sweden have strong internal and/or external coping resources that can contribute to their resilience and the mitigation of vulnerable situations. The deductive content analysis led to the identification of vulnerable situations in three main categories: Housing preferences and lack of affordable and age-friendly housing, health-related functional decline, and financial vulnerability. Coping with ageing in place and vulnerable situations encompasses numerous Person-Environment exchanges. These Person-Environment exchanges are affected by limited financial resources, health-related functional decline, including cognitive challenges and lack of internal and/or external coping resources; furthermore, a lack of informal networks, including insufficient municipal home care and social services, housing and neighbourhood factors, including difficulties in accessing affordable and/or age-friendly housing. While only a minority of the older people included in the thesis project seemed to struggle to cope with vulnerable situations, monitoring and preventing these situations is still important. The findings recognise and address the complex relationship between older people and their environment, and can inspire policymaking and practical and social efforts to improve circumstances and prevent vulnerable situations among older people who are ageing in place.