Int J Older People Nurs. 2024;19:e12603.  | 1 of 17 https://doi.org/10.1111/opn.12603 wileyonlinelibrary.com/journal/opn Received: 20 May 2023  | Revised: 8 January 2024  | Accepted: 9 January 2024 DOI: 10.1111/opn.12603 R E V I E W A R T I C L E Older individuals' perspectives on the prerequisites for living at home: A mixed- methods systematic review Minna Ylönen PhD, RN, Post- Doc Researcher1  | Minna Stolt PhD, Professor (Acting)1,2  | Dominika Kohanová PhD, RN, Researcher3  | Riitta Suhonen PhD, RN, FEANS, MAE, Professor, Director of Nursing1,4 This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. © 2024 The Authors. International Journal of Older People Nursing published by John Wiley & Sons Ltd. 1Department of Nursing Science, University of Turku, Turku, Finland 2Satakunta Wellbeing Services County, Satakunta, Finland 3Department of Nursing, Faculty of Social Sciences and Health Care, Constantine the Philosopher University in Nitra, Nitra, Slovakia 4The Wellbeing Services County of Southwest Finland, Turku, Finland Correspondence Minna Ylönen, Department of Nursing Science, University of Turku, Turku, Finland. Email: misuyl@utu.fi Funding information Konung Gustaf V:s och Drottning Victorias Frimurarestiftelse Abstract Introduction: Living at home for as long as possible is a central ageing policy goal. Older individuals usually expect to stay at home, if possible, and their goals regarding living at home generally include holistic wellness, prevention and treatment of age- ing effects and the retention of satisfaction. Previous research on older individuals living at home has mostly focused on their physical performance, usually evaluated by healthcare professionals. However, there is limited research on older individuals' identification of the prerequisites for living at home. Methods: The aim was to identify older individuals' views on the prerequisites for living at home. We conducted a mixed- methods systematic review with a data- based convergent design. We carried out a computerized search in MEDLINE (1966 to the end of August 2021) and CINAHL (1982 to the end of August 2021). All types of study designs were included. We evaluated the methodological quality of the included articles. Results: Of the 1052 articles identified, 28 were eligible. The prerequisites for older individuals to be able to live at home include lifestyle and self- care capability and physical, psychosocial, environmental and socio- economic components. Conclusion: The review provided knowledge that can be used to inform measures for supporting independent at- home living. Older individuals' perspectives on prerequi- sites for at- home living are unique and individually specific. A checklist can be de- veloped to detect individuals' singularity and the strengths and limitations impacting independent living. Therefore, assessments of each older individual's own perspec- tive are needed to better identify the prerequisites for at- home living. K E Y W O R D S gerontological nursing, home, older individual, prerequisites, review 2 of 17  |     YLÖNEN et al. 1  |  INTRODUC TION Living at home for as long as possible is a central ageing policy goal (WHO, 2020). The aim of this study was to identify older people's views to the prerequisites for them to be able to live at home. This is important for several reasons. First, the population aged 65 and over is projected to increase to nearly 30% by 2060 in EU coun- tries (OECD, 2021). For example, at the end of 2019, there were 874,314 older individuals aged 70 or older in Finland (Statistics Finland, 2020), most of whom lived at home (Finnish Institute for Health and Welfare, 2021). Furthermore, rising life expectancy in- dicates likely increases in the prevalence of long- term conditions, disability and dependence, leading to societal challenges such as the need to develop social and health care (Eurostat, 2021; Mitnitski et al., 2017; WHO, 2020). Second, social and healthcare policies in Western coun- tries underscore that older individuals would benefit from living in their own homes for as long as possible (Sixsmith et al., 2014; WHO, 2015, 2020), and older individuals usually expect to stay at home if possible (Molina- Mula et al., 2020). Older individuals per- ceive home as an intimate area where they can feel safe, have the right to be themselves and can hold onto their routines (Markel- Reid et al., 2006). Older individuals living at home make an effort to cope with unexpected needs and challenges in adapting their home environment and connecting with important people (Rosenwohl- Mack et al., 2020). Third, healthy ageing is important to older individuals in terms of their subjective experience of self- determination, well- being and independence (Sixsmith et al., 2014). The goals of older individ- uals regarding living at home include holistic wellness, prevention and treatment of ageing effects and the retention of satisfaction (Lommi et al., 2015). Older individuals consider that functional ca- pacity is related not to physical traits but, rather, attitudes towards life. They have the tendency to minimize problems and delay solu- tions (Molina- Mula et al., 2020). Facing life with optimism, a good mood and self- irony can help in difficult situations. Usually, living at home positively influences older individuals' attitudes towards life and the future (Dale et al., 2012). Furthermore, home is a safe place where older individuals can live daily, free from worry (Kivimäki et al., 2020). The main problems threatening older individuals' capa- bility to live at home are related to physical frailty and malnutrition (Verlaan et al., 2017). Approximately 80% of older individuals main- tain high- level functional capacity. However, 6% of them experience rapid decline after 65 years and are at greater risk of cardiovascular, non- cancer and all- cause mortality (Taniguchi et al., 2019). While social activities often decrease in older age, participation in them can decrease the risk of dependence. Social activities also help in maintaining functional capacity and activities of daily living (ADLs) (Verbrugge & Jette, 1994; Zunzunegui et al., 2005). Fourth, previous systematic reviews have focused on self- care among older individuals (Lommi et al., 2015; Naik et al., 2008; Van Het Bolscher- Niehuis et al., 2016), technologies that help older individuals cope at home (Dermody et al., 2020; Holthe et al., 2018) and transitions in care (Luker et al., 2019; Schick- Makaroff et al., 2021). There are several systematic reviews on the impact of home care compared to alternative care locations on older individuals' health outcomes (Boland et al., 2017), complex interventions to improve physical function (Beswick et al., 2008) and sustaining independence (Crocker et al., 2021), health- related decision- making by older individuals (King et al., 2018) and physical frailty among community- dwelling malnourished older individuals (Verlaan et al., 2017). Furthermore, based on a systematic review and meta- ethnography of qualitative studies, Rosenwohl- Mack et al. (2020) developed a new conceptual model of ageing in place in the United States. Summary statement of implications for practice What does this research add to existing knowledge in gerontology? • Our research provides new knowledge from the per- spective of older individuals regarding the prerequisites for living at home • The results of the research identify that prerequisites for living at home are unique for each older individual and they are expressed in individual situations What are the implications of this new knowledge for nursing care for and with older adults? • Nurses and nursing managers can use this new knowl- edge to inform measures for supporting independent living at home • A checklist can be developed to detect individuals' sin- gularity and the strengths and limitations impacting in- dependent living How could the findings be used to influence practice, education, research and policy? • There is a need for nursing care policies to address ways to promote the identification of the importance to iden- tify older individuals' perspectives on the prerequisites for living at home • Future research is needed on developing instruments and methods to assist social and healthcare profession- als in obtaining information regarding older individuals' prerequisites for living at home. • Further research is warranted on interventions based on the perspectives of older individuals regarding how to sustain at- home living, including how to support in- dividual perspectives on living at home for as long as possible. 17483743, 2024, 2, D ow nloaded from https://onlinelibrary.w iley.com /doi/10.1111/opn.12603 by U niversity of Turku, W iley O nline Library on [20/02/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on W iley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License     |  3 of 17YLÖNEN et al. To summarize, previous research on older individuals living at home has mostly focused on their physical performance, usually evaluated by healthcare professionals. However, studies on older individuals' identification of the prerequisites for living at home re- main limited. While the nursing care of older individuals is based on individual assessment and planned activities, there is an urgent need to understand the prerequisites for at- home living from the perspective of older individuals. This study focused on older in- dividuals' views on the prerequisites for living at home. We used mixed- methods systematic review method to get a broad under- standing of the prerequisites. In this review, the home is defined as a place where older individuals live either alone or in co- habitation. This may also refer to independent living facilities, including senior housing, but excludes assisted living facilities. Prerequisites are de- fined as things that must happen or exist as preconditions, from the viewpoint of older individuals, before they can live at home (Collins Dictionary, 2022). 2  |  MATERIAL S AND METHODS 2.1  |  Aim The aim of the study was to identify older individuals regarding their views on the prerequisites for them to be able to live at home. 2.2  |  Design A mixed- method systematic review with a data- based convergent design (Hong et al., 2017) was conducted. 2.3  |  Search methods This review follows the Preferred Reporting Items for Systematic Reviews and Meta- Analysis (PRISMA) guidelines (Page et al., 2021). The SPIDER (sample, phenomenon of interest, design, evaluation, research type) tool was used to create the search terms to ensure that the search would produce a fit with the research question (Table 1) (Cook et al., 2012). 2.4  |  Search strategy A computerized search strategy identified relevant studies in two electronic databases: MEDLINE (PubMed) from the earliest record in 1966 to the end of August 2021 and CINAHL (Ebsco) from the earliest record in 1982 to the end of August 2021. Search terms and strategies were developed in collaboration with a health and medical science library informatics expert using keywords relating to older individuals, independent living and evaluations of preconditions for living at home based on different variations. (Appendix S1 Search Strategy). The searches were limited to English language and indi- viduals aged 65+ years. Grey literature was not searched. 2.5  |  Study eligibility This review included empirical studies with all types of designs. To be included in the review, a study had to (1) be published in a peer- reviewed scientific journal, (2) be empirically based, (3) describe older individuals' (aged 65+) views regarding the prerequisites for at- home living and (4) be written in English. Studies were excluded if they described older individuals' views after transitioning from hospital or emergency department care and if they evaluated pre- requisites based on a specific disease or disorder (e.g. hip fracture, Alzheimer's disease and osteoarthritis). Conference abstracts, edito- rials, comments, protocols, reviews, meta- syntheses and discussion papers were also excluded. 2.6  |  Data management The titles and abstracts of the records identified from the system- atic search were stored on SeaFile, an open- source file, sync and TA B L E 1 Spider tool terms. Criteria Inclusion Exclusion Sample Older individuals aged 65 years and older Individuals younger than 65 years Phenomenon of interest Prerequisites for living at home No prerequisites for living at home Design All designs None Research type Empirical research Conference abstracts, editorials, reviews, commentaries, protocols or no abstract available Evaluation Older individuals' perspectives Other than older individuals' perspectives Time frame From the inception of the database to the end of August 2021 After August 2021 Language English Languages other than English Setting Home Settings other than home 17483743, 2024, 2, D ow nloaded from https://onlinelibrary.w iley.com /doi/10.1111/opn.12603 by U niversity of Turku, W iley O nline Library on [20/02/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on W iley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License 4 of 17  |     YLÖNEN et al. share solution used in the university (https:// www. seafi le. com/ en/ home/  ). 2.7  |  Study selection All 1052 identified records (669 from MEDLINE [PubMed] and 383 from CINAHL [EBSCO]) were screened. The first stage involved two researchers reading the abstracts to determine their relevance re- garding the aim of the review and the inclusion and exclusion criteria. The next stage involved two researchers independently considering the full texts of these articles in terms of meeting the inclusion cri- teria (Figure 1). 2.8  |  Data analysis and synthesis Two researchers independently analysed the data, and one re- searcher completed the analysis of the final results. The data were synthesized by using the convergent integrated approach. Quantitative data and qualitative evidence were integrated using thematic synthesis by coding and developing descriptive themes to generate an overall summary of the study results (Hong et al., 2017). Each article was searched for words and sentences containing older individuals' views of prerequisites for living at home. The words and sentences were grouped under sub- themes and then into themes, which were named according to content (Table 2). 3  |  RESULTS 3.1  |  Search results We identified in total 1052 articles. Because of lack of relevance, we excluded 967 articles during the first stage of the screening process, leaving 82 articles for further assessment. After the full- text screen- ing, 28 articles were included in this review (Figure 1). 3.2  |  Description of the studies reviewed The studies (n = 28) were concluded in the United Kingdom (UK) (n = 6), Australia (n = 3), Canada (n = 3), Sweden (n = 3), United States (USA) (n = 3), Finland (n = 2), Germany (n = 2), Spain (n = 2), France (n = 1), Ireland (n = 1), Netherland (n = 1) and Slovenia (n = 1). Most of them were cross- sectional studies (n = 18), and data in these were collected with interview (n = 8), questionnaire (n = 8) and both inter- view and questionnaire (n = 2). The sample size of the studies (n = 28) varied from 12 participants in a qualitative real- life- approach study (Breitholtz et al., 2013) to 9447 in cross- sectional study (Stineman et al., 2012). The bibliometric information, authors, years of publi- cation, country, design, sample and data collection methods of the studies are presented in Table 3. 3.3  |  Quality appraisal of the studies The Mixed Method Appraisal Tool (MMAT) was used to evaluate the methodological quality of the included articles (Hong et al., 2018), that is, both qualitative (n = 6) and quantitative descriptive (n = 22) studies. Two researchers completed the quality appraisal indepen- dently. Possible differences in assessment were discussed until a consensus was reached. All of the qualitative articles (n = 6) and nine of the 22 quantitative descriptive articles fulfilled all the MMAT cri- teria. There was a lack of sample representativeness (many refusals and small samples) in 10 quantitative descriptive articles, and in 10 of them, the risk of nonresponse bias was high. In one article, the sample strategy was deemed not to be relevant, and in one article, the measurement was very broad, making it impossible to evaluate its accuracy (Tables 4 and 5). 3.4  |  Older individuals' perspectives on the prerequisites for living at home The prerequisites for older individuals to be able to live at home in- cluded lifestyle and self- care capability and physical, psychosocial, environmental and socio- economic components (Table 6). 3.5  |  Lifestyle and self- care capability Older individuals used what they learned from experience to enable them to remain autonomous and self- reliant and relied on the knowledge and skills they had gained from their parents, partner and others. They knew that in order ‘to remain control autonomous’, they needed to stay in control and not allow oth- ers to make decisions for them (Hatcher et al., 2019). According to them, keeping busy and occupied (Ballesteros et al., 2013; Hatcher et al., 2019; Saajanaho et al., 2014; Strobl et al., 2013; Tomandl et al., 2021) and remaining mentally and physically ac- tive (Hatcher et al., 2019; Klomstra et al., 2019) were part of their healthy lifestyle practices. Also, having enough daily sleep time was deemed important as it impacted the physical prerequisites (Wang et al., 2019). Older individuals believed that self- care capability was import- ant. The oldest (aged 85+) individuals perceived their health as being better than that of younger individuals (Damian et al., 1999). According to older individuals, good health meant not only the abil- ity to take care oneself, sometimes with assistance, but also the ab- sence of disease (Partridge et al., 1996). Older individuals believed that impairment in the unaided performance of ADL was one of the main determinants of self- assessed health (Damian et al., 1999). Those who reported the fewest difficulties with mobility, no illness- related physical restrictions on their social activities and the abil- ity to look after themselves were more likely than others to report their quality of life (QoL) as ‘very good’ (Bowling et al., 2002). Health status was rated lower among older individuals who reported a low 17483743, 2024, 2, D ow nloaded from https://onlinelibrary.w iley.com /doi/10.1111/opn.12603 by U niversity of Turku, W iley O nline Library on [20/02/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on W iley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License     |  5 of 17YLÖNEN et al. instrumental ADL (IADL) status (Bowling et al., 2002; Stineman et al., 2012). 3.6  |  Physical prerequisites According to older individuals, physical capabilities and mobility were among the strongest predictors of sustaining at- home living (Tomandl et al., 2021). They wanted to do as much as possible for themselves as well as retain their independence for as long as possi- ble (Breitholtz et al., 2013). They made compromises and renounced to some responsibilities for others to carry out (Hatcher et al., 2019), and according to them, managing well did not always mean managing independently (Partridge et al., 1996). When help was needed, they were satisfied when caregivers could fulfil their needs in a flexible manner. They experienced need fulfilment when caregivers were available whenever a problem occurred. However, they expressed that caregivers' work was not always organized according to their individual needs. They also felt that caregivers could prevent them from making their own decisions and that they could not influence the timing of a caregiver's arrival (Breitholtz et al., 2013). Older individuals spoke about the importance of visual capa- bility (Hébert et al., 1999) and how eye diseases contributed to disability (Strobl et al., 2013; Wang et al., 2019). Loss of contrast sensitivity vision was strongly associated with the ability to in- dependently carry out daily activities. In particular, older women F I G U R E 1 The retrieval process. Identification of studies via databases Records removed before Records identified from Medline (n = 669) Cinahl (n = 383) Total (n = 1052) Records screened (n =1044) Records assessed for eligibility (n = 82) Records included in review (n = 28) * Abstract was not available screening: Duplicate records removed (n = 0) Records removed for other reasons (n = 8) * Records excluded based on title and abstract (n = 954), Duplicates removed (n = 8) Records excluded: Validation study or not in the focus of the review (n =33), Setting not home (n = 2) Age group less than 65 (n = 19) In cl ud ed Sc re en in g Id en tif ic at io n TA B L E 2 Example of the data analysis and synthesis. Theme Sub- theme Original expression Reference Lifestyle and self- care capability Nutritional habits ‘good nutrition’ Hatcher et al. (2019) ‘never quick meals’ Hatcher et al. (2019) ‘hot meal per day’ Hatcher et al. (2019) Physical Vision ‘eye disease’ Hébert et al. (1999) ‘loss of contrast sensitivity vision’ Dargent- Molina et al. (1996) 17483743, 2024, 2, D ow nloaded from https://onlinelibrary.w iley.com /doi/10.1111/opn.12603 by U niversity of Turku, W iley O nline Library on [20/02/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on W iley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License 6 of 17  |     YLÖNEN et al. TA B LE 3   Su m m ar y of t he r ev ie w ed a rt ic le s. Re se ar ch er (s ) a nd ye ar Co un tr y A im Sa m pl e; a ge D es ig n/ m et ho d Re su lts a D ar ge nt - M ol in a et a l. (1 99 6) Fr an ce To e xa m in e th e re la tio ns hi p am on g vi su al a cu ity , de pt h pe rc ep tio n, c on tr as t s en si tiv ity a nd h ea rin g di ff ic ul ty a nd th e ab ili ty o f o ld er w om en li vi ng a t ho m e to a cc om pl is h in st ru m en ta l a ct iv iti es o f d ai ly liv in g in de pe nd en tly 12 10 ; 7 5+ C ro ss - s ec tio na l/ in te rv ie w O ld er w om en w ith v is io n pr ob le m s w er e lik el y to e xp er ie nc e gr ea te r p hy si ca l d ep en de nc y th an t ho se w it h go od v is io n. S el f- re po rt ed he ar in g di ff ic ul ty w as a ss oc ia te d w ith p hy si ca l de pe nd en cy P ar tr id ge e t al . ( 19 96 ) U K To in ve st ig at e di sa bi lit y an d he al th in a s am pl e of el de rly p eo pl e liv in g at h om e in th e co m m un ity 20 0; m ea n 75 .8 C ro ss - s ec tio na l/ in te rv ie w G oo d he al th m ea nt n ot o nl y th e ab ili ty to ta ke ca re o ne se lf, b ut a ls o th e ab se nc e of d is ea se . W al ki ng a bi lit y w as a s a cr uc ia l v ar ia bl e in di sa bi lit y Jo hn so n et a l. (1 99 8) U K To a ss es s th e fo od s to ra ge k no w le dg e an d pr ac tic e of el de rly p eo pl e liv in g at h om e 8 09 ; 6 5+ C ro ss - s ec tio na l w ith fo llo w - u p/ in te rv ie w , di et ar y di ar ie s O ld er in di vi du al s re po rt ed h av in g di ff ic ul tie s in re ad in g fo od la be ls , a nd a s su ch , f oo d w as n ot al w ay s st or ed a pp ro pr ia te ly Sc hu dd s an d R ob er ts on (1 99 8) C an ad a To d et er m in e w he th er p hy si ca l d is ab ili ty w as as so ci at ed w ith th e pr es en ce o f m us cu lo sk el et al pa in in a s am pl e of s en io r ci ti ze ns 88 7; 6 5– 94 C ro ss - s ec tio na l/ qu es tio nn ai re Pa in c au se d di ff ic ul tie s in w al ki ng o ut si de o n fla t g ro un d, c ho re s su ch v ac uu m in g an d ya rd w or k, c lim bi ng a t l ea st fi ve s ta irs a nd b at hi ng in a tu b D am ia n et a l. (1 99 9) Sp ai n To id en tif y th e m ai n de te rm in an ts o f s el f- as se ss ed he al th a m on g co m m un ity - d w el lin g el de rly 67 7; 6 5+ C ro ss - s ec tio na l/ in te rv ie w O ld er in di vi du al s be lie ve d th at im pa irm en t i n th e un ai de d pe rf or m an ce o f A D L w as o ne o f t he m ai n de te rm in an ts o f s el f- as se ss ed h ea lth H éb er t et a l. (1 99 9) C an ad a To a na ly se th e fa ct or s as so ci at ed w ith fu nc tio na l de cl in e an d im pr ov em en t i n a co m m un ity - d w el lin g po pu la ti on o f p eo pl e ag ed 7 5  ye ar s an d ol de r 50 4; 7 5+ C ro ss - s ec tio na l a nd lo ng itu di na l/ qu es tio nn ai re V is ua l a nd h ea rin g ca pa bi lit y w er e im po rt an t. Th os e w ho li ve d al on e re po rt ed m or e di ff ic ul ti es w it h A D L B ow lin g et a l. (2 00 2) U K To d ef in e th e co ns tit ue nt s an d in di ca to rs o f Q oL in ol de r a ge in o rd er to o ff er a m or e m ul tid im en si on al an d us ef ul m od el o f Q oL b as ed o n th e pe rs pe ct iv es of o ld er p eo pl e th em se lv es 99 9; 6 5+ C ro ss - s ec tio na l/ qu es tio nn ai re H ea lt h st at us w as r at ed lo w er a m on g ol de r in di vi du al s w ho re po rt ed a lo w in st ru m en ta l A D L (IA D L) s ta tu s. T ho se w ho r ep or te d th e m os t s oc ia l a ct iv iti es a nd w ho h ad s om eo ne to w ho m th ey c ou ld tu rn fo r h el p ra te d th ei r Q oL as ‘v er y go od ’ m or e of te n th an o th er o ld er in di vi du al s Sk el to n et a l. (2 00 2) U K To c on si de r d iff er en ce s in le g m us cl e st re ng th , l eg m us cl e po w er , a sy m m et ry a nd a ct iv ity b et w ee n ag e- m at ch ed c om m un ity - d w el lin g w om en a ge d 65 an d ov er w ho d o an d do n ot h av e a hi st or y of fa lls 35 (2 0  +  15 ); 65 + C as e– co nt ro l/ qu es tio nn ai re Th os e w ho w er e w or rie d ab ou t f al lin g or h ad fa lle n in th e la st y ea r r ep or te d fe w er a ct iv iti es B oy le (2 00 4) Ir el an d To e xp lo re th e ex te nt to w hi ch re fo rm s ac tu al ly en ab le d ol de r p eo pl e re ce iv in g do m ic ili ar y ca re to ha ve g re at er c ho ic e an d co nt ro l i n th ei r d ai ly li ve s th an o ld er p eo pl e liv in g in in st itu tio ns 44 ; 6 5+ C ro ss - s ec tio na l/ in te rv ie w Th os e w ho li ve d al on e re po rt ed h av in g gr ea te r le ve l o f c ho ic e th an th os e liv in g w ith o th er s 17483743, 2024, 2, D ow nloaded from https://onlinelibrary.w iley.com /doi/10.1111/opn.12603 by U niversity of Turku, W iley O nline Library on [20/02/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on W iley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License     |  7 of 17YLÖNEN et al. Re se ar ch er (s ) a nd ye ar Co un tr y A im Sa m pl e; a ge D es ig n/ m et ho d Re su lts a B ar r et a l. (2 00 5) A us tr al ia To d et er m in e w he th er fo ot a nd le g pr ob le m s ar e in de pe nd en tly a ss oc ia te d w ith fu nc tio na l s ta tu s in a co m m un ity s am pl e of o ld er p eo pl e af te r a dj us tin g fo r t he in flu en ce o f s oc io de m og ra ph ic , p hy si ca l a nd m ed ic al fa ct or s 10 0 0; 6 5– 94 C ro ss - s ec tio na l/ in te rv ie w Fo ot a nd le g pr ob le m s w er e as so ci at ed w ith s el f- re po rt ed d iff ic ul ty c lim bi ng s ta irs , d iff ic ul ty w al ki ng o ne k ilo m et re a nd a h is to ry o f f al lin g in th e pr ev io us y ea r B ow lin g an d St af fo rd (2 0 07 ) U K To in ve st ig at e as so ci at io ns b et w ee n ty pe o f a re a, in di vi du al s' p er ce pt io ns o f t he ir n ei gh bo ur ho od s, an d in di ca to rs o f s oc ia l a nd p hy si ca l f un ct io ni ng 76 1; 6 5– 85 C ro ss - s ec tio na l w ith fo llo w - u p/ in te rv ie w Th os e w ho li ve d al on e re po rt ed m or e di ff ic ul tie s w it h A D L V an B ils en e t al . ( 20 0 8) N et he rla nd s To a ss es s th e im po rt an ce o f h ou si ng fo r f ra il el de rly p eo pl e an d el de rly p eo pl e at ri sk o f in st it ut io na liz at io n 31 7; m ea n 83 .3 C ro ss - s ec tio na l/ in te rv ie w Th os e w ho li ve d in s he lte re d ac co m m od at io n ha d gr ea te r p er ce iv ed a ut on om y th an th os e liv in g in de pe nd en tly in th e co m m un ity D em er s et a l. (2 00 9) C an ad a To e xp lo re th e re la tio ns hi ps b et w ee n co gn iti ve a nd be ha vi ou ra l c op in g st ra te gi es a nd th e so ci al pa rt ic ip at io n of c om m un ity - d w el lin g ol de r a du lts 35 0; 6 5– 95 C ro ss - s ec tio na l/ qu es tio nn ai re So ci al c on ta ct s w er e lo w er a m on g th os e w ho di d no t o w n th ei r h om e, th os e in lo w er s oc ia l cl as se s, th os e w ith le ss fo rm al e du ca tio n an d th os e w ho li ve d al on e El or an ta e t al . ( 20 10 ) Fi nl an d To e xp lo re a nd c om pa re o ld er h om e ca re c lie nt s' a nd th ei r pr of es si on al s' p er ce pt io ns o f t he c lie nt s' ps yc ho lo gi ca l w el l- b ei ng a nd c ar e an d id en tif y po ss ib le d iff er en ce s in th es e pe rc ep tio ns 12 0; 6 7– 96 C ro ss - s ec tio na l/ qu es tio nn ai re Se lf- re po rt ed d ep re ss io n an d lo ne lin es s w er e co m m on N un ne y et a l. (2 01 1) U K To d et er m in e ho w th e at tit ud es a nd b el ie fs o f o ld er pe op le a nd h ea lth ca re p ro fe ss io na ls im pa ct th e us e of m ul ti- co m pa rt m en t c om pl ia nc e ai ds b y ol de r pe op le li vi ng a t h om e 15 ; 7 2– 92 G ro un de d th eo ry / in te rv ie w M ul ti - c om pa rt m en t co m pl ia nc e ai ds (M C A s) w er e se en in v ar io us w ay s Po rt ac ol on e (2 01 1) U SA R os e' s th eo ry a nd t he p ol it ic al e co no m y pe rs pe ct iv e se rv e as fr am ew or ks b y w hi ch to e xa m in e ho w di sc ou rs es a ro un d in de pe nd en ce a re tr an sl at ed in to th e ex pe rie nc es o f 2 2 ol de r a du lts a ge d 75 + liv in g at h om e al on e in t he B ay A re a of S an Fr an ci sc o 22 ; 7 5+ Et hn og ra ph y/ in te rv ie w Li vi ng a lo ne w as n ot a c ho ic e; o ld er in di vi du al s fe lt th at it w as a n at ur al p ar t o f t he ir id en tit y or s om et hi ng in ev ita bl e St in em an e t al . ( 20 12 ) U SA To d es cr ib e th e co nc ep tu al fo un da tio n an d de ve lo pm en t o f a n ac tiv ity li m ita tio n an d pa rt ic ip at io n re st ric tio n st ag in g sy st em fo r co m m un ity - d w el lin g pe op le 94 47 ; 7 0+ C ro ss - s ec tio na l/ qu es tio nn ai re T ho se w ho r ep or te d a lo w A D L st at us a ls o re po rt ed a n un m et n ee d fo r e nv iro nm en ta l ac ce ss ib ili ty fe at ur es B al le st er os et a l. (2 01 3) Sp ai n To c om pa re th e w ay tw o gr ou ps o f h ea lth y ol de r ad ul ts w ho d iff er in th ei r p ar tic ip at io n in p hy si ca l ac tiv iti es p er fo rm ed o n te st s of e xe cu tiv e co nt ro l, pr oc es si ng s pe ed , a nd c on tr ol p ro ce ss in g an d in ve st ig at e th e ef fe ct o f l on g- te rm p hy si ca l a ct iv ity re pe tit io n pr im in g fo r a tt en de d an d un at te nd ed ob je ct s 4 0; 6 5– 78 C ro ss - s ec tio na l/ qu es tio nn ai re Ke ep in g bu sy a nd o cc up ie d w er e pa rt o f o ld er in di vi du al s he al th y lif es ty le p ra ct ic es ( C on ti nu es ) TA B LE 3   (C on ti nu es ) 17483743, 2024, 2, D ow nloaded from https://onlinelibrary.w iley.com /doi/10.1111/opn.12603 by U niversity of Turku, W iley O nline Library on [20/02/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on W iley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License 8 of 17  |     YLÖNEN et al. Re se ar ch er (s ) a nd ye ar Co un tr y A im Sa m pl e; a ge D es ig n/ m et ho d Re su lts a B re it ho lt z et a l. (2 01 3) Sw ed en To il lu m in at e th e m ea ni ng o f o ld er p eo pl e' s de pe nd en ce o n ca re gi ve rs ' h el p an d op po rt un it ie s to m ak e in de pe nd en t d ec is io ns 12 ; 8 0– 91 A q ua lit at iv e an d lif e- w or ld a pp ro ac h/ in te rv ie w O ld er in di vi du al s w an te d to d o as m uc h as po ss ib le fo r t he m se lv es a s w el l a s re ta in th ei r in de pe nd en ce fo r a s lo ng a s po ss ib le Sa aj an ah o et a l. (2 01 4) Fi nl an d To in ve st ig at e th e as so ci at io ns b et w ee n pe rs on al g oa ls an d ex er ci se a ct iv ity a nd th e re la tio ns hi ps b et w ee n ex er ci se - r el at ed a nd o th er p er so na l g oa ls a m on g ol de r w om en 30 8 at b as el in e, 23 9 at fo llo w - u p; 66 –7 9 C ro ss - s ec tio na l lo ng itu di na l/ in te rv ie w an d se lf- re po rt Ke ep in g bu sy a nd o cc up ie d w er e pa rt o f o ld er in di vi du al s he al th y lif es ty le p ra ct ic es St ro bl e t al . ( 20 13 ) G er m an y To e xa m in e th e fr eq ue nc y, d is tr ib ut io n an d de te rm in an ts o f f un ct io ni ng a nd d is ab ili ty in a ge d pe rs on s an d as se ss th e co nt rib ut io n of d is ea se s to th e pr ev al en ce o f d is ab ili ty 41 17 ; m ea n 73 .6 C ro ss - s ec tio na l/ in te rv ie w an d qu es tio nn ai re Ey e di se as es c on tr ib ut ed to d is ab ili ty Ta ub e et a l. (2 01 5) Sw ed en To e xa m in e lo ne lin es s, H R Q oL , a nd h ea lt h co m pl ai nt s in re la tio n to h ea lth ca re c on su m pt io n of in - a nd ou tp at ie nt c ar e am on g fr ai l o ld er p eo pl e liv in g at ho m e 15 3; 6 5+ C ro ss - s ec tio na l/ in te rv ie w Th os e w ho re po rt ed lo ne lin es s us ed m or e ou tp at ie nt s er vi ce s th an th os e w ho d o no t r ep or t l on el in es s. T he y al so h av e po or er o ve ra ll he al th , b ot h ph ys ic al ly a nd ps yc ho so ci al ly P ri ce e t al . ( 20 17 ) A us tr al ia To e xp lo re th e pe rs pe ct iv es o f o ld er p eo pl e fo llo w in g th ei r re ce nt p ar ti ci pa ti on in a 7 5+ H ea lt h A ss es sm en t (7 5  +  H A ) a nd in te rr og at e th es e pe rs pe ct iv es u si ng a p er so n- ce nt re d le ns 19 ; 7 5– 89 Q ua lit at iv e de sc rip tiv e/ in te rv ie w O ld er in di vi du al s va lu ed th e nu rs e go in g th ro ug h th ei r m ed ic in e w ith th em a nd id en tif yi ng o ut - of - d at e m ed ic in es a nd th os e w ith s id e ef fe ct s if ta ke n in ap pr op ria te ly K im a nd P or ti llo (2 01 8) U SA To id en tif y si gn ifi ca nt re la tio ns hi ps b et w ee n en vi ro nm en ta l h az ar ds a nd f al ls a m on g ol de r ad ul ts 88 ; 7 1– 98 C as e– co nt ro l/ in te rv ie w an d qu es tio nn ai re O ld er in di vi du al s w er e ab le to fi nd a lte rn at iv e w ay s to c op e w ith e nv iro nm en ta l c ha lle ng es , fo r e xa m pl e, u si ng a to w el ra ck in st ea d of in st al lin g a gr ab b ar G al of e t al . ( 20 19 ) Sl ov en ia To e xp lo re th e ne ed fo r a ss is ta nc e in d ai ly a ct iv iti es am on g ol de r Sl ov en ia n pe op le li vi ng a t ho m e 35 8; 6 5– 97 C ro ss - s ec tio na l/ qu es tio nn ai re Sh op pi ng a nd h ou se w or k w er e th e ac ti vi ti es w he re th ey n ee de d th e m os t a ss is ta nc e H at ch er e t al . ( 20 19 ) A us tr al ia To u nd er st an d ol de r pe op le 's p er sp ec ti ve s on t he ex pe ri en ce s an d st ra te gi es t he y ut ili ze t o re m ai n liv in g at h om e 21 ; 6 6– 97 A g ro un de d th eo ry m et ho do lo gy / in te rv ie w a nd fo cu s- gr ou p di sc us si on O ld er in di vi du al s kn ew th at in o rd er ‘t o re m ai n co nt ro l a ut on om ou s’, th ey n ee de d to s ta y in c on tr ol a nd n ot a llo w o th er s to m ak e de ci si on s fo r t he m . T he y st riv ed h ar d to s ta y co nn ec te d w ith p eo pl e in th e co m m un ity , a nd co m m un ic at in g an d so ci al iz in g w it h ot he rs en ab le d th em to fe el c on ne ct ed K lo m st ra e t al . ( 20 19 ) Sw ed en To in ve st ig at e fa ct or s re la te d to H R Q oL in o ld er pe op le li vi ng a t h om e w ith m ul tim or bi di ty a nd h ig h he al th ca re c on su m pt io n 23 8; 7 5– 96 Lo ng itu di na l d es ig n/ in te rv ie w Th ey k ne w th at in o rd er ‘t o re m ai n co nt ro l au to no m ou s’; th ey n ee de d to re m ai n m en ta lly an d ph ys ic al ly a ct iv e To m an dl e t al . ( 20 21 ) G er m an y To e xp lo re re le va nt a re as o f f un ct io ni ng fr om th e pe rs pe ct iv e of c om m un ity - d w el lin g ad ul ts 27 in te rv ie w s, 2 4 fo cu s gr ou ps ; m ea n 8 0. 8 Q ua lit at iv e st ud y/ in te rv ie w a nd fo cu s- gr ou p di sc us si on A cc or di ng to o ld er in di vi du al s, p hy si ca l c ap ab ili ti es an d m ob ili ty w er e am on g th e st ro ng es t pr ed ic to rs o f s us ta in in g at - h om e liv in g a R es ul ts re la te d to th e to pi c of th e re vi ew a re p re se nt ed in th e ta bl e. TA B LE 3   (C on ti nu es ) 17483743, 2024, 2, D ow nloaded from https://onlinelibrary.w iley.com /doi/10.1111/opn.12603 by U niversity of Turku, W iley O nline Library on [20/02/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on W iley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License     |  9 of 17YLÖNEN et al. with this problem were more likely to experience greater physical dependency than those with good vision (Dargent- Molina et al., 1996). Older individuals also reported having difficulty reading food labels, and as such, food was not always stored appropriately (Johnson et al., 1998). Hearing capability was deemed important (Hébert et al., 1999), with self- reported hearing difficulty being strongly associated with physical dependency (Dargent- Molina et al., 1996; Wang et al., 2019). However, using a hearing aid was not significantly asso- ciated with physical disability. Many older individuals tried hearing aids but stopped using them because they were of no help (Dargent- Molina et al., 1996). Walking ability was seen as a crucial variable in disability (Partridge et al., 1996). Older individuals expressed that living at home independently became difficult when there were problems walking inside, climbing stairs, sitting and getting up, lifting and car- rying objects and bending (Taube et al., 2015). Changes in mobility were mostly perceived in relation to locomotor functions (reach and grip) and problems with joint functions (Strobl et al., 2013). Shopping and house work were the activities where older individuals needed the most assistance (Galof et al., 2019). Those who reported muscu- loskeletal pain were three times more likely to experience difficul- ties relating to ADL. Most difficulties caused by pain were related to walking outside on flat ground, chores such vacuuming and yard work, climbing at least five stairs and bathing in a tub (Schudds & Robertson, 1998). Older individuals who were worried about falling or had fallen in the last year reported fewer ADL and fewer activities overall (Skelton et al., 2002; Wang et al., 2019). Some older individuals used walking sticks or frames as physical aids to minimize the risk of fall- ing (Hatcher et al., 2019). Foot and leg problems were associated with self- reported difficulty climbing stairs, difficulty walking 1 km and a history of falling in the previous year (Barr et al., 2005). Older individuals experienced changes in hygiene because of physical con- straints (Strobl et al., 2013), and they mostly needed assistance for bathing (Galof et al., 2019). Older individuals expressed the need to better understand their medications and how to use them safely. They valued the nurse going through their medicine with them and identifying out- of- date medicines and those with side effects if taken inappropriately (Price et al., 2017). They saw multi- compartment compliance aids (MCAs) in various ways. Some of them thought that the use of MCA re- moved their independence and took away their control; thus, they were reluctant to use them. For others, MCAs were seen as one way of retaining independence, thereby making it easier to use them (Nunney et al., 2011). 3.7  |  Psychosocial prerequisites Self- reported depression was common among older individuals (Eloranta et al., 2010), with women experiencing more nervous dis- orders and depression (Damian et al., 1999). Loneliness was also common among older individuals (Eloranta et al., 2010), who re- ported lower health- related quality of life (HRQoL) and poorer over- all health, both physically and psychosocially, compared to peers who were not lonely. They also reported more health complaints and used more outpatient services compared to individuals who did not experience loneliness (Taube et al., 2015). They believed that partici- pation in activities (especially recreation and leisure) is very impor- tant (Tomandl et al., 2021). Living alone was not a choice for older individuals; they felt that it was a natural part of their identity or TA B L E 4 Quality evaluation results of the qualitative articles. Nunney et al. (2011) Portacolone (2011) Breitholtz et al. (2013) Price et al. (2017) Hatcher et al. (2019) Tomandl et al. (2021) Criteria Is the qualitative approach appropriate to answer the research question? Y Y Y Y Y Y Are there qualitative data collection methods adequate to answer the research question? Y Y Y Y Y Y Are the findings adequately derived from the data? Y Y Y Y Y Y Is the interpretation of the results sufficiently substantiated by the data? Y Y Y Y Y Y Is there coherence between the qualitative data sources, collection, analysis, and interpretation? Y Y Y Y Y Y Abbreviations: CT, Can't tell; N, No; Y, Yes. 17483743, 2024, 2, D ow nloaded from https://onlinelibrary.w iley.com /doi/10.1111/opn.12603 by U niversity of Turku, W iley O nline Library on [20/02/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on W iley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License 10 of 17  |     YLÖNEN et al. TA B LE 5   Q ua lit y ev al ua ti on r es ul ts o f t he q ua nt it at iv e de sc ri pt iv e ar ti cl es . Dargent- Molina et al. (1996) Partridge et al. (1996) Johnson et al. (1998) Schudds and Robertson (1998) Damian et al. (1999) Hébert et al. (1999) Bowling et al. (2002) Skelton et al. (2002) Boyle (2004) Barr et al. (2005) Bowling and Stafford (2007) C rit er ia Is th e sa m pl in g st ra te gy re le va nt to a dd re ss th e re se ar ch q ue st io n? Y Y Y Y Y Y Y Y Y Y Y Is th e sa m pl e re pr es en ta tiv e of th e ta rg et p op ul at io n? Y Y Y Y Y Y Y N Y Y Y A re t he m ea su re m en ts ap pr op ria te ? Y Y N Y Y Y Y Y Y Y Y Is th e ris k of n on re sp on se b ia s lo w ? Y Y N Y C T Y Y Y Y Y Y Is th e st at is tic al a na ly si s ap pr op ria te to a ns w er th e re se ar ch q ue st io n? Y Y Y Y Y Y Y Y Y Y Y VanBilsen et al. (2008) Demers et al. (2009) Eloranta et al. (2010) Stineman et al. (2012) Ballesteros et al. (2013) Strobl et al. (2013) Saajanaho et al. (2014) Taube et al. (2015) Kim and Portillo (2018) Galof et al. (2019) Klomstra et al. (2019) C rit er ia Is th e sa m pl in g st ra te gy re le va nt to a dd re ss th e re se ar ch q ue st io n? Y Y Y Y Y Y C T Y Y Y Y Is th e sa m pl e re pr es en ta tiv e of th e ta rg et p op ul at io n? N Y C T C T N Y C T N C T N N A re t he m ea su re m en ts ap pr op ria te ? Y Y Y Y Y Y Y Y Y Y Y Is th e ris k of n on re sp on se b ia s lo w ? N C T N C T N Y C T N C T N Y Is th e st at is tic al a na ly si s ap pr op ria te to a ns w er th e re se ar ch q ue st io n? Y Y Y Y Y Y Y Y Y Y Y A bb re vi at io ns : C T, C an 't te ll; N , N o; Y , Y es . 17483743, 2024, 2, D ow nloaded from https://onlinelibrary.w iley.com /doi/10.1111/opn.12603 by U niversity of Turku, W iley O nline Library on [20/02/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on W iley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License     |  11 of 17YLÖNEN et al. TA B L E 6 Prerequisites for living at home. Prerequisite (theme) Expression (sub- theme) Reference Lifestyle and self- care capability Ability to take care oneself = good health Partridge et al. (1996), Damian et al. (1999), Bowling et al. (2002), Stineman et al. (2012) Unaided performance Damian et al. (1999) Healthy habits Hatcher et al. (2019) Nutritional habits Hatcher et al. (2019) Hot meals per day Hébert et al. (1999) Keeping busy and occupied Ballesteros et al. (2013), Strobl et al. (2013), Saajanaho et al. (2014), Hatcher et al. (2019) Keeping mentally active Hatcher et al. (2019), Klomstra et al. (2019) Keeping physically active Hatcher et al. (2019), Klomstra et al. (2019) Learning from past experience Hatcher et al. (2019) Remain autonomous Hatcher et al. (2019) Stay in control Hatcher et al. (2019) Physical Physical capability and mobility Tomandl et al. (2021) No physical restriction Bowling et al. (2002) Doing self as much as possible Breitholtz et al. (2013) Making compromises Hatcher et al. (2019) Giving up some things for others Hatcher et al. (2019) Vision Hébert et al. (1999), Strobl et al. (2013), Dargent- Molina et al. (1996) Hearing Hébert et al. (1999), Dargent- Molina et al. (1996) Weight Hébert et al. (1999) Shopping Galof et al. (2019) Locomotors functions (reach, grip) Strobl et al. (2013) Walking ability Partridge et al. (1996) Going outdoors Eloranta et al. (2010) Foot and leg health Barr et al. (2005) Falling, falls, worrying about falling Skelton et al. (2002), Bilotta et al. (2011) General fitness Strobl et al. (2013) Physically active lifestyle Strobl et al. (2013) Exercise program, doing exercise Clemson et al. (2012) Joint function, joint disease Strobl et al. (2013) Chronic musculoskeletal pain Schudds and Robertson (1998) Taking care of hygiene Strobl et al. (2013) Taking a bath Galof et al. (2019) Housework Galof et al. (2019) Medication taking Nunney et al. (2011) Goals related to cultural activities Saajanaho et al. (2014) Psychosocial Cognitive status Hébert et al. (1999) Mini Mental State Examination result Hébert et al. (1999) Depressive symptoms Hébert et al. (1999), Klomstra et al. (2019) Depression Eloranta et al. (2010), Klomstra et al. (2019) Loneliness Taube et al. (2015) Perceived health Partridge et al. (1996), Damian et al. (1999), Hébert et al. (1999) Health- related quality of life Stineman et al. (2012), Taube et al. (2015) Number of days off regular activities Hébert et al. (1999) Others around at home Hatcher et al. (2019) (Continues) 17483743, 2024, 2, D ow nloaded from https://onlinelibrary.w iley.com /doi/10.1111/opn.12603 by U niversity of Turku, W iley O nline Library on [20/02/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on W iley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License 12 of 17  |     YLÖNEN et al. something inevitable (Portacolone, 2011). Those who lived alone re- ported more difficulties with ADL (Bowling & Stafford, 2007; Hébert et al., 1999). However, they reported having a greater level of choice than those living with others (Boyle, 2004). One study showed that older individuals who lived in sheltered accommodation had greater perceived autonomy than those living independently in the commu- nity (VanBilsen et al., 2008). Older individuals strived hard to stay connected with people in the community, and communicating and socializing with others enabled them to feel connected (Hatcher et al., 2019). Those, who reported the most social activities and who had someone to whom they could turn for help rated their QoL as ‘very good’ more often than other older individuals (Bowling et al., 2002). Higher expressed levels of ADL were associated with higher participation in social ac- tivities. Older individuals thought that it was important to recognize and gain knowledge about available outsourcing services and how they could be obtained and used (Hatcher et al., 2019). Social activities were significantly more limited for older individ- uals living in less affluent areas and for those who found their areas to be less neighbourly. Social contacts were lower among older in- dividuals who did not own their home, those in lower social classes, those with less formal education and those who lived alone (Bowling & Stafford, 2007; Demers et al., 2009). 3.8  |  Environmental prerequisites Older individuals who reported a low ADL status also reported an unmet need for environmental accessibility features (Stineman et al., 2012). Older individuals also saw the bathroom as the place with the highest fall risk, the kitchen being the next, followed by the living/dining room. The bedroom was viewed as the place pre- senting the lowest fall risk. Some older individuals underestimated the prevalence of the risks in their homes; for example, they knew that the floor was slippery but did not see this as problematic as they believed that they were always cautious. They were able to find alternative ways to cope with environmental challenges, for example, using a towel rack instead of installing a grab bar (Kim & Prerequisite (theme) Expression (sub- theme) Reference Level of reciprocal support Hatcher et al. (2019) Connections with people in the community Hatcher et al. (2019) Knowing about available services Hatcher et al. (2019) Recognizing the need to outsource Hatcher et al. (2019) Perceived level of activity Demers et al. (2009) Goals related to cultural activities Saajanaho et al. (2014) Someone to turn to for help Partridge et al. (1996), Bowling et al. (2002) Social activities and participation Bowling et al. (2002) Neighbourly living area Bowling and Stafford (2007) Owning own home Bowling and Stafford (2007) Living with someone Bowling and Stafford (2007) Environment Environmental accessibility Stineman et al. (2012) Safety precautions Hatcher et al. (2019) Staying aware of the risks in the home Hatcher et al. (2019) Staying aware of the risks out of the home Hatcher et al. (2019) Pendant with emergency button Hatcher et al. (2019) Friend or neighbours on speed dial Hatcher et al. (2019) Living upstairs to minimize the risk of intruders Hatcher et al. (2019) Safe bathroom Kim and Portillo (2018) Safe kitchen Kim and Portillo (2018) Safe living and dining rooms Kim and Portillo (2018) Realistic evaluation of the prevalence of risks in the home Kim and Portillo (2018) Finding alternative ways to deal with environmental challenges Kim and Portillo (2018) Socio- economic Schooling Demers et al. (2009) Social class Bowling and Stafford (2007) Income Demers et al. (2009) TA B L E 6 (Continued) 17483743, 2024, 2, D ow nloaded from https://onlinelibrary.w iley.com /doi/10.1111/opn.12603 by U niversity of Turku, W iley O nline Library on [20/02/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on W iley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License     |  13 of 17YLÖNEN et al. Portillo, 2018). Some older individuals took safety precautions and made changes to improve safety in the home. For example, they wore a water- resistant pendant with an emergency button. Older individuals could ensure that someone was present in their lives, meaning that support was readily available. Having another person at home provided a sense of security and safety. Some older individ- uals had friends or neighbours on speed dial in case of an emergency. Some of them preferred living in an upstairs apartment to avoid the risk of intruders (Hatcher et al., 2019). Knowledge about food hygiene could be low. Only 41% of re- spondents (n = 279) knew the star rating of their freezer. In a smaller sub- sample, knowledge of ‘use by’ and ‘sell by’ dates was good. Storing foods at the inappropriate temperatures tended to be more likely among poorer individuals and those who did not live alone (Johnson et al., 1998). 3.9  |  Socio- economic prerequisites Older individuals on lower incomes tended to report the worst health ratings. This was not explained by possible differences in life- style variables such as alcohol consumption, tobacco use, body mass index and medication use (Damian et al., 1999). Older individuals in higher social classes, those on higher incomes and those who owned their homes rated their lives as ‘very good’ more often than others (Bowling et al., 2002). 4  |  DISCUSSION The reviewed articles provide new knowledge and understanding, from the points of view of older individuals, about the prerequisites for them to be able to live at home, although not necessarily fully recognized by healthcare professionals. Based on the results of this review, the prerequisites for at- home living, as reported by older in- dividuals, are multidimensional. The prerequisites reported by older individuals were mostly physical in nature. To sustain living at home, older individuals need insight into their changes to maintain self- care capability (Hatcher et al., 2019). A positive state of mind is an important resource for them; it mo- tivates them to improve self- care and positive thoughts (Lommi et al., 2015). A low HRQoL is related to older age, a higher symp- tom burden and higher levels of depression. In contrast, a better HRQoL is related to higher levels of physical activity (Klomstra et al., 2019). Also, the number of chronic conditions is one of the clearest determinants of self- assessed health among older individ- uals (Damian et al., 1999). Low total scores in older individuals' QoL were independently associated with a greater risk of falling and emergency department admission (Bilotta et al., 2011). If health- promoting interventions are used, they should be based on assessments of older individuals' attitudes and beliefs towards life and ageing (Lommi et al., 2015). Physical abilities are affected by the amount and severity of dis- eases (Damian et al., 1999; Hébert et al., 1999; Partridge et al., 1996; Wang et al., 2019). In particular, Alzheimer's disease, dementia (Stineman et al., 2012), asthma and bronchitis (Hébert et al., 1999) can have an impact on physical coping at home. The number of days without regular activities, the number of hot meals per day and cogni- tive status are the most important factors associated with functional decline (Hébert et al., 1999). Notably, physical activity, obesity and malnutrition are identified as modifiable factors for future targeted interventions (Strobl et al., 2013). Exercise programmes can produce positive outcomes such as increased energy to perform more tasks, improved functioning during activities and enhanced participation in daily life (Clemson et al., 2012; Saajanaho et al., 2014); mobility im- provements are also associated with fewer hospitalizations (Shuman et al., 2020). Furthermore, better physical health is associated with higher mental well- being and greater resilience (Jeste et al., 2019), and functional capacity decline is associated with depressive symp- toms in older individuals (Boström et al., 2014; Hébert et al., 1999). Importantly, lack of social support and somatic health problems should be addressed in mental health promotion among older indi- viduals as they are both important risk factors for psychological dis- tress. Better mental health is associated with higher optimism and self- compassion, lower levels of loneliness and sleep disturbances, and better self- rated successful ageing (Jeste et al., 2019). To facil- itate better delivery of appropriate health care to older individuals, it might be helpful to assess depression and changes in symptom burden over time (Klomstra et al., 2019). Social networks prevent social isolation (Kivimäki et al., 2020), and living alone is associated with the risk of functional decline over time (Bowling & Stafford, 2007; Hébert et al., 1999). Older individ- uals reporting loneliness use more outpatient services than those who do not report loneliness. They also have poorer overall health, both physically and psychosocially (Taube et al., 2015). Many pro- fessionals believe that they motivate older individuals to participate and communicate with others, but older individuals do not support this view (Eloranta et al., 2010). Environmental factors are also im- portant to older individuals (Tomandl et al., 2021). Some of them uti- lize OTs (occupational therapist) to help them recognize their needs in the context of making changes in the home. This often involves modifying the home environment by removing existing structures, such as bathtubs or steps deemed unsafe, or making other changes recommended by the OT (Hatcher et al., 2019). 4.1  |  Practice and policy implications Older individuals' views of the prerequisites for living at home war- rant careful analysis for several reasons. Studies have found high levels of unmet care needs of older individuals (OECD, 2021). At the same time, strategies have shown a strong commitment to individual assessments of care needs and the provision of tailored services (MSHA, 2020). The results call not only for standardized support but 17483743, 2024, 2, D ow nloaded from https://onlinelibrary.w iley.com /doi/10.1111/opn.12603 by U niversity of Turku, W iley O nline Library on [20/02/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on W iley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License 14 of 17  |     YLÖNEN et al. also for individual considerations of a variety of ways to tailor ser- vices to support living at home. The prerequisites identified herein may provide valuable knowledge with which to predict or anticipate the rapid growth in the provision of services early enough to sup- port older individuals in their self- management and independence (OECD, 2021). The prerequisites reported by older individuals were predom- inantly physical in nature. However, other prerequisites are also noteworthy because they impact the physical prerequisites and older individuals' coping at home. This is important in terms of de- veloping social and health care relating to ageing policy to support older individuals to live in their own homes for as long as possible (MSHA, 2020; WHO, 2020). Social and healthcare professionals need a holistic view of older individuals and the willingness to listen to them to understand and take into account the various prerequi- sites identified herein in order to fulfil policy requirements. 4.2  |  Research implications Based on the results, future research should focus on developing instruments and methods to help social and healthcare profession- als to get information on older individuals' prerequisites for living at home. In addition, there should be further research on interventions containing older individuals' views regarding how to sustain at- home living for as long as possible. 4.3  |  Strengths and limitations A methodological strength of this review is the synthesis of qualita- tive and quantitative research, providing rich and detailed informa- tion on the prerequisites reported by older individuals (Granheim & Lundman, 2004). To strengthen methodological rigour, the Spider tool (Cook et al., 2012) was used to create the search terms. The selection and evaluation of the quality of the studies were com- pleted by two researchers independently. While the sampling was performed in two databases (MEDLINE and CINAHL), they are the most comprehensive databases for nursing- related topics (Subirana et al., 2007). No additional studies were searched from the article references, grey literature was not searched, and only studies writ- ten in English were included in the search. 5  |  CONCLUSION The review provided knowledge that can be used to inform meas- ures for supporting independent living at home. Older individuals' perspectives on the prerequisites for living at home are unique and individually specific. A checklist can be developed to detect individuals' singularity and the strengths and limitations impacting independent living. Thus, an assessment of each older individual's perspective is needed to better identify the prerequisites for living at home and familiar environment. AUTHOR CONTRIBUTIONS Study design: MY, RS; data collection: MY; data analysis: MY, MS, DK, RS; manuscript preparation: MY, MS, DK, RS. ACKNO WLE DG E MENTS We wish to thank the Konung Gustaf V:s och Drottning Victorias Stiftelse for funding and Leeni Lehtiö, Information Specialist, Turku University Library, for her expert guidance in developing the search terms and strategies in the current study. CONFLIC T OF INTERE S T S TATEMENT The authors declare no conflict of interests. DATA AVAIL ABILIT Y S TATEMENT Data sharing not applicable to this article as no datasets were gener- ated or analysed during the current study. 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How to cite this article: Ylönen, M., Stolt, M., Kohanová, D., & Suhonen, R. (2024). Older individuals' perspectives on the prerequisites for living at home: A mixed- methods systematic review. International Journal of Older People Nursing, 19, e12603. https://doi.org/10.1111/opn.12603 17483743, 2024, 2, D ow nloaded from https://onlinelibrary.w iley.com /doi/10.1111/opn.12603 by U niversity of Turku, W iley O nline Library on [20/02/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on W iley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License