The Multidimensional Concept of Aging: Addressing Challenges and Enabling Participation in an Aging Society

Abstract

As societies around the world face the challenges of aging populations, it becomes essential to explore the period of aging and identify opportunities and support mechanisms within the national framework. This article discusses the challenges faced by various professions in engaging older people in their daily activities and highlights the importance of providing options for local community support. By receiving daily assistance, older people can continue to actively participate in meaningful activities despite the limitations that come with age, illness, or injury, thus maintaining their sense of self-worth and ensuring a secure home environment. This multidimensional approach involves collaboration among formal and informal caregivers from diverse disciplines to enable older adults to age in place and live independently in their communities for as long as possible. While this approach brings immense benefits, it also presents unique challenges for all stakeholders involved in the care of older people.

1. Introduction

Aging is an inevitable and natural process that occurs throughout our lives. It is a fundamental part of the life cycle, starting from birth and continuing as an ongoing process. As we progress through different stages of life, we undergo physical and psychological changes that shape our identity and individual growth. However, many individuals struggle to embrace these changes, particularly during the later stages of life. Therefore, it becomes crucial to adequately prepare for the challenges and opportunities that come with this phase.

The transition from an active working life to retirement is a critical period that calls for contemplation and planning for the future. Age-related health issues can arise unexpectedly, leaving individuals unprepared and vulnerable. Lack of knowledge about available resources and support systems in their local environment can lead to temporary, social, and material distress. It is important to acquire knowledge about potential solutions to address the basic needs of the older people, both for their own well-being and to ensure a smooth transition into the later stages of life.

Caring for the older people is a concept deeply ingrained in our society. However, the urgency and significance of this task may be better understood by those directly experiencing the less favorable aspects of aging, as opposed to policymakers who often delay and legislate older people care decisions.

The desire of older people to age gracefully within the comfort and security of their own homes is becoming increasingly vocal. Often, economic circumstances prevent them from living in a dignified manner within institutionalized settings. While financial factors contribute to this decision, it is not the sole determinant. Moreover, it affects the dignity of the older people that has enriched society with their knowledge, shared valuable experiences with younger generations, and served as a wellspring of wisdom. Among the positive aspects of aging within familiar surroundings, the warmth and familiarity of one’s own home hold significant importance. We firmly believe that every individual should have the right to spend their later years in a home environment.

The challenges posed by modern society have brought the issue of aging to the forefront, along with its associated needs and characteristics. It is undeniable that society is experiencing a demographic shift toward an aging population, presenting a growing concern about how to effectively address this challenge and involve all stakeholders in the process. However, proposed solutions that may seem reasonable independently may not be viable due to economic consequences or impacts. As we address these challenges, it is essential not to forget that meeting the basic needs of an aging society, in the face of environmental challenges, is crucial for maintaining social integration and facilitating daily living activities.

The purpose of this paper is to answer the research question of what the multidimensional concept of aging entails and to highlight possible intergenerational solutions from the author’s perspective.

The paper highlights individual important areas that can make a significant contribution to enabling aging at home, focusing on the integration of intergenerational relationships. A brief numerical overview of the current state of the aging population provides a starting point for understanding the importance of enabling and ensuring integration in daily activities for aging at home. The context in which older people live provides both enabling and inhibiting factors for living at home, both in terms of environmental challenges and those arising from individual and social circumstances. In the conclusion itself, we summarize the dilemmas highlighted and address the limitations and opportunities for further research on this topic.

1.1 Aging through numbers

The statistical data provided by the World Health Organization (WHO) [1] are indeed alarming, as it reveals that the proportion of the global population over 60 years old is expected to nearly double, from 12–22%, between 2015 and 2050.

The advent of the COVID-19 pandemic presents an unexpected period that will likely have significant implications on societal longevity. Recent data on life expectancy [2] indicate that Spain (83.3 years), Sweden (83.1 years), Luxembourg, and Italy (82.7 years each) have the highest life expectancy at birth in Europe, while Bulgaria (71.4 years), Romania (72.8 years), and Latvia (73.1 years) have the lowest.

A study conducted by a researcher from the Jefferson School of Population Health [3] examined and compared life expectancy trends in Europe and America. The research findings suggest that life expectancy in the United States has seen a significant increase over the past century. Currently, the average life expectancy for American males is 73.2 years, while for females it is 79.1 years. In contrast, data from comparable countries in Europe show an average life expectancy of 80.0 years for males and 84.7 years for females in 2021.

Traditionally, it is well known that women tend to outlive men by approximately 5 years. However, this gender disparity in life expectancy has remained relatively stable. Nevertheless, the study proposes that the lifestyles of women have undergone noticeable changes in the late twentieth and early twenty-first centuries, leading to potential impacts on life expectancy. These changes primarily include increased smoking habits and heightened stress levels experienced by women.

1.2 Method

A review of relevant literature from the last 10 years using the checklist is provided by Prisma, using the Boolean operators AND and OR, using the following keywords and phrases: social challenges, environmental challenges, gerontology, longevity, supportive factors, home living environment, older adults, healthy aging, and intergenerational support.

The results of the thematic analysis of the selected papers were grouped into three main themes, with subthemes representing our factors or the substantive strands of the work: promoting healthy aging to enable intergenerational relationships; enabling participation in daily activities; context; environmental, personal, and social challenges.

2. Promote healthy aging to enable intergenerational relationships

Healthy aging is a comprehensive scientific concept that addresses the physiological changes and processes associated with aging, with the primary goal of promoting overall well-being and health in later life. This approach encompasses a wide range of factors, including biological, psychological, and social aspects, and aims to identify effective strategies for maintaining health and functionality as we age. Both objective measurements and subjective perceptions are considered when assessing health in the context of healthy aging [4].

The concept of successful aging, which emerged in America half a century ago, has significant implications for funding programs that recognize older people as capable and valuable members of society who can actively participate in various aspects of life. This view emphasizes the importance of maintaining physical and cognitive activity and promoting active participation in activities of daily living (ADL). The decline in functional abilities is seen as a change in older people’s own actions that exemplifies successful aging. Extensive discussion and research in the field of gerontology has contributed to the development and study of the model of successful aging.

Successful aging is often equated with healthy aging and consists of three core elements: a low likelihood of morbidity or disease, well-preserved physical and mental functioning, including cognitive abilities, and active participation in daily activities [5]. These elements are interrelated and complementary, providing a comprehensive understanding of the concept of successful aging.

In addition, the concept of active and independent aging, also referred to as “aging at home” or “aging in place,” has received considerable attention in research programs, strategic plans, and action plans. This perspective underscores the importance of older people’s autonomy in deciding where and with whom they live and how they go about their daily lives. Independent living requires an accessible built environment, adequate transportation, availability of technical and medical aids, accessible information channels, and support services. These factors play a critical role in creating an environment that promotes active and independent living for older people in their communities [6, 7].

Promoting healthy aging to facilitate intergenerational relationships has been extensively documented scientifically and has numerous benefits for both older people and younger generations [8]. Research strongly suggests that promoting interactions between people of different ages has positive effects on individual well-being and strengthens social cohesion. Specifically, intergenerational emotional support has been linked to improved cognitive health in older people [9]. These meaningful relationships not only reduce stress in older people but also provide a sense of importance and attention, which promotes well-being and cognitive health.

Intergenerational relationships, whether characterized by conflict or solidarity, can have a powerful impact on an individual’s physical, mental, and social health. Relationships in which intergenerational conflict occurs have the potential to generate ageism, both self-directed and external. Ageism toward and among older people is associated with negative health outcomes, such as lower quality of life, early death, slower recovery from disability, depression, social isolation, loneliness, and overall poorer physical and mental health [10].

Intergenerational relationships provide cognitive benefits for both older and younger people. Older people experience mental stimulation through the sharing of knowledge and experiences, while younger generations gain valuable wisdom and insight from older people.

From a public health perspective, intergenerational programs can play an important role in maintaining cognitive health. Such programs accomplish this by promoting greater social interaction, physical activity, and cognitive engagement, often through a naturalistic approach that encompasses multiple domains [11].

Positive social interactions, particularly those that are intergenerational, are associated with improved physical health in older people. These interactions are associated with lower stress levels, improved immune function, and even increased life expectancy [8].

Promoting healthy aging and enabling intergenerational relationships are supported by solid scientific evidence that underscores many benefits to individuals, families, and society as a whole. Fostering such relationships can lead to a harmonious and supportive community where people of all ages are valued and celebrated.

To achieve healthy aging, researchers and health professionals are focusing on interventions and strategies that target the various aspects of aging. These include lifestyle changes such as regular physical activity, balanced diet, and adequate sleep, which have been shown to improve overall health and reduce the risk of chronic disease. In addition, cognitive training programs and social support interventions can be implemented to maintain mental well-being. In addition, preventive measures such as regular screenings and immunizations are essential for early detection and treatment of age-related health conditions.

Healthy aging is a multidimensional concept that involves understanding and addressing the biological, psychological, and social changes that occur with age. By promoting optimal health and functionality in later life, healthy aging aims to improve older people’s overall well-being, quality of life, and intergenerational relationships.

3. Enabling and enhancing participation in everyday life occupations for aging in place

One of the key considerations regarding longevity is the choice of caregivers for older individuals who wish to age in place within their own homes. Understanding their preferences and relationships with existing providers of daily living assistance can offer valuable insights for planning services and interventions from a user-centered perspective. Experts and researchers in the field of aging consistently emphasize that older people desire to age at home. Numerous approaches can facilitate this aspiration. For instance, there are four primary sources of assistance for older adults’ care: formal institutional care, public home care services, support from family members or other informal caregivers, and informal caregiving, where family members assume responsibility for looking after their elderly relatives [12].

Legislation and local policies play a crucial role in supporting and providing different forms of care for older people. Establishing measurement tools (entry thresholds) to allocate support resources and infrastructure can contribute to the care pathway [13]. Furthermore, a national care model can foster intergenerational care for older adults and facilitate the involvement of relatives, regardless of their kinship.

Given the evolving nature of family structures in society, characterized by fewer traditional families, it becomes even more critical for the state to provide informal care for its citizens who have contributed to the development of the society in which they now spend their later years. This care can come in the form of financial compensation, income replacement, bridging social security gaps, or simply by conveying a socially recognized, honorable moral value.

Aligning with national initiatives in aging and age-related disease research, it is vital to promote international collaboration and resources to strengthen various research domains and enhance decision-making processes and initial strategies. International and developmental activities rooted in the interdisciplinary field of age-related research at the national level, supported by clinical research on age-related diseases, health services, and strategies, should be pursued [14]. The primary focus of such research efforts should be on preventing, managing, and treating age-related diseases, while improving public support and health services for older adults. Nationally funded projects tend to be clinical research-oriented, intended to promote active aging.

It is worth noting that different countries exhibit varied potentials for formal and informal care due to socioeconomic status [13], cultural or spiritual values, and gender disparities in caregiving involvement. Analysis of data collected from the Survey of Health, Aging, and Retirement in Europe (SHARE) [15] in 17 countries reveals that women often bear the responsibility of providing care themselves, while men share caregiving duties, and others outsource care entirely. In most cases, partners and spouses are the primary caregivers, with the burden often falling on women. Informal family assistance is most prevalent in Portugal, Italy, Spain, and Poland, while informal help from outside sources is more common in Mediterranean and Eastern European countries. Formal external assistance is highest in Switzerland, Belgium, Luxembourg, and Poland.

The scope of human activity is narrower than activities of daily living (ADL). ADL refers to the essential skills needed for self-care, which are divided into several subsections: bathing, feeding, dressing, toileting, and mobility. The inability to perform ADLs can lead to dependence on others or the use of assistive devices, impacting an individual’s quality of life [16].

Instrumental activities of daily living (IADL) include tasks such as using the telephone, shopping, meal preparation, housekeeping, laundry, community mobility, and medication management. ADLs and IADLs are particularly significant for older adults, as they encompass intimate aspects of self-care and play a vital role in maintaining independence and well-being [17].

For instance, an older lady might aim to establish a routine that incorporates personal hygiene activities, such as brushing teeth, washing face, applying lotion, combing hair, and getting dressed. Maintaining such habits is advantageous for promoting healthy behaviors and overall well-being. Habits tend to persist, even in the face of external stressors, making them more likely to be maintained than non-habitual behaviors [18].

Research indicates that old men typically require more assistance with ADL compared to old women [19]. Among ADLs, bathing and controlled elimination of urine and feces tend to require the most assistance, followed by toilet use, walking, dressing, transferring, and grooming. Notably, the majority of older people (95.7%) can independently feed themselves. In terms of IADLs, assistance is most needed for laundry and shopping, followed by housekeeping and neighborhood mobility [20].

The ability to perform ADLs is crucial for older individuals to maintain their independence and age in place. When assistance is required for ADLs, individuals are more likely to be institutionalized [21, 22]. Therefore, maintaining independence in ADLs is essential for older adults to continue living in their own homes.

In conclusion, understanding and promoting activities of daily living, such as ADLs and IADLs, are important for maintaining independence and well-being in various populations, particularly in older people. Further research and interventions focused on supporting and enhancing these activities can greatly benefit individuals’ quality of life.

A study conducted in New Zealand on aging at home has found similar results to previous research, showing that a majority of older people require some form of assistance with tasks like transportation, meal preparation, and shopping [23]. Studies from Sweden [24, 25], Canada [26], and various European countries [27] have also discovered that older people require more assistance with IADLs compared to ADLs. Cultural context and environment play a significant role in the performance of IADL activities, as even healthy older adults may require more time to complete them [28].

Providing support with IADLs is generally easier through informal networks than assisting with ADLs, which often require involvement from external health agencies [23, 29, 30, 31]. Moreover, ADL performance is often linked to a person’s immediate safety and physical well-being, making it a priority [32]. While family members can assist with IADLs, professional services should be available for ADLs when needed [33].

In Slovenia, a survey revealed that older individuals who received assistance primarily relied on unpaid helpers such as family members, aligning with previous findings in the country [34, 35, 36]. Regardless of their living situation, participants’ preferred informal caregivers, and statistical analysis showed that the current and preferred providers of assistance often matched, suggesting an isomorphic relationship. Among formal care providers, district nurses, paid carers, and occupational therapists were strongly preferred. In the Slovenian healthcare system, district nurses provide medical care, paid carers assist with ADLs, and occupational therapists promote general independence. This suggests that these are the specific needs older individuals prioritize, and they should be considered when planning home-based services. The fact that the actual providers of care were often the preferred option could positively impact older people’s psychological health and well-being.

“Promoting health, well-being, and active engagement in daily activities through occupational therapy” is a statement that encompasses the domain and process of occupational therapy. Therefore, occupational therapists can be considered formal caregivers, given their specialized training. In this context, the following topics are relevant to the work of occupational therapists in providing care for older people.

When examining different theoretical models such as the American [37], Canadian [38], and Slovenian [39] models, it becomes evident that occupational therapy for older adults follows a process-oriented approach that is grounded in occupation and supported by evidence-based and client-centered practices. These frameworks assist professionals in various settings, including working with individuals, families, groups, or populations.

In this article, we will explore elements of the Canadian [38], American [37], and Slovenian [39] models. Each model emphasizes the selection of essential needs, care arrangements, and independent performance of daily activities. For occupational therapists, enabling older people to engage in meaningful occupation is both a means and an end in the therapy process.

The American Occupational Therapy Practice Framework [37] places emphasis on intervention, including the therapeutic use of self and activity. The goal of therapy intervention is to facilitate satisfactory progress in activity performance. Occupational therapists provide interventions that encompass a variety of activities and occupations to improve motor skills and promote independent engagement in activities of daily living. These activities encompass personal care, instrumental tasks, health management, rest, visual impairment, education, work, play, leisure, and social participation. The assessment and treatment of activity participation involve evaluating the skill level, performance patterns, environmental context, task demands, and individual factors. Motor, procedural, and interactive skills are assessed, and activity patterns consider an individual’s habits, roles, and routines. Furthermore, the impact of contextual factors, activity requirements, and individual characteristics on activity performance is taken into account. The Canadian practice process framework [38] aligns with the Canadian Model of Occupational Performance and Engagement (CMOP-E) [38]. This framework consists of three main components: initial assessment, treatment delivery, and outcome assessment. It illustrates the dynamic interaction between the therapist and the client, focusing on activity performance within specific contexts. The Canadian practice process framework is a versatile tool that enables occupational therapists to work effectively with a diverse range of clients. From a therapeutic and skill-building perspective, it serves as a catalyst for therapists to help clients achieve their aspirations and goals related to occupation. This framework guides occupational therapists through an evidence-based, occupation-centered, and client-centered treatment process aimed at fostering occupational competence and professional engagement.

In Slovenia, a model [39] for health management of older adults performing daily activities in the home environment is based on a spiral model that involves citizens, formal and informal caregivers, and policymakers. This model recognizes the importance of collaboration among all stakeholders to ensure holistic care for older people.

In conclusion, these models provide a comprehensive foundation for occupational therapists working with older adults. By utilizing evidence-based and client-centered approaches, occupational therapists can help older people achieve health, well-being, and active participation in their daily lives.

Home care for older individuals is a complex endeavor that requires effectiveness in addressing their health and social needs. One potential solution to this challenge is the implementation of the spiral model from Figure 1 within an interdisciplinary team. By incorporating informal caregivers into the team, a multidisciplinary approach can be adopted to maintain the independence of older individuals in their daily activities, taking into account their specific needs and psychophysical health status. This model from Figure 1 integrates formal professional competencies of the multidisciplinary team to provide care in the home environment, while also offering preventive advice on the functional design of the home and appropriate support and education for family members. The utilization of assistive technologies, such as medical devices, electronic systems for home control, and communication technology, is also considered as part of this comprehensive treatment approach.

Figure 1.

A community-based care process model of aging in place characteristic. Typical areas (A–F) and levels (I–IV) of the spiral model, adapted to LTC needs (A—Communication with potential users, B—Planning, C—Risk analysis, D—Design, E—Implementation in practice, F—Evaluation, I—Concept development project, II—New product development project, III—Product growth project, and IV—Product maintenance project). Source: Own elaboration.

Stakeholders in the health and social sectors who share common goals in improving quality of life organize and collaborate through project management processes. This involves iterative phases and process improvements, allowing each stakeholder to form a continuous spiral that incorporates the six spatial fields (A through F) of the modified Boehm model (communication, planning, risk analysis, design, implementation in practice, and evaluation) at each level. A national care model can also facilitate intergenerational care for older people by involving family members, regardless of their specific familial relationships.

It is important to note that informal care should only supplement formal forms of care and not act as a replacement [13]. Both types of support should aim to maintain independence in daily activities that individuals are capable of performing.

To illustrate the practical application of models and their elements in supporting older individuals to age in place, consider the case of a 79-year-old man who suffered a hip fracture from a fall outside his home. After the operation, his daughter cared for him in his home environment within an intergenerational relationship, with the help of a physiotherapist and an occupational therapist. Their expertise helped him manage his daily activities independently. Formal caregivers focused on exercises to improve hip joint mobility, strengthen muscles in the lower and upper limbs and trunk, and gradually integrate the use of walking and mobility aids. The occupational therapist concentrated on activities of daily living such as getting up, dressing, and personal hygiene. The daughter received instruction from the formal caregivers on appropriate care strategies. Through the integration of formal and informal resources, progress was made, and the gentleman was able to engage in independent daily activities.

4. Contexts as environmental challenges

According to the World Health Organization [40], the environment includes the home, the community, and society more broadly, as well as all factors within these contexts. This broad definition includes the built environment, interpersonal relationships, attitudes and values, health and social policies, support systems, and services provided. However, certain situations, such as ongoing wars like those in Ukraine or pandemics like COVID-19, can deviate significantly from the ideal context for healthy aging. This highlights the importance of living in an environment that supports and sustains human capabilities and function—an opportunity that has been denied in several historical and contemporary challenges, including the World War era II.

The intergenerational relationships individuals maintain with their environment are influenced by a variety of factors, including the family into which they are born, gender, ethnicity, education level, and financial resources [40]. These factors shape individuals’ experiences with their environment and contribute to their overall well-being and pathway to healthy aging.

The concept of context encompasses a variety of factors that significantly influence an individual’s life. Factors such as satisfaction with basic life activities and personal freedom are often associated with the home environment, which is highly valued in the individual’s value system. The home environment also provides individuals with the opportunity to assume various roles associated with aging, which increase in importance and prestige over time. As people age, they gain valuable life experiences and stories that are invaluable. Throughout our lives, we take on various roles and activities that become more important as we age. During this phase of life, we spend much of our time at home [41]. A positive home environment provides older people with a sense of security, privacy, and relaxation and facilitates their participation in activities they enjoy [42, 43].

More broadly, the construct of context includes both environmental and personal factors. Environmental factors include aspects such as the natural environment, human-induced environmental changes, products and technologies, support systems and relationships, attitudes, services, and social systems and policies. Personal factors, on the other hand, are individual and include elements such as customs, beliefs, activity patterns, behavioral norms, age, race and ethnicity, cultural identification, social background, education, lifestyle, and health status [37]. The interaction between these combined factors plays a critical role in shaping an individual’s experience of his or her environment and significantly influences his or her overall well-being and healthy aging.

Understanding the impact of the various contexts and environmental conditions is critical to promoting healthy aging and developing effective strategies to support the well-being of older people. By addressing these factors, we can create environments that foster intergenerational relationships and enable individuals to age gracefully with optimal health and functionality.

4.1 Environmental challenges and interventions for aging at home

Environmental factors play a critical role in shaping a person’s life and include physical, social, and relational dimensions [38]. The World Health Organization [40] defines these factors as external elements that significantly influence overall well-being. In the context of interventions for aging at home, understanding and incorporating environmental issues is essential for effective care and support. This paper explores the various dimensions of environmental factors and their impact on professionals, formal caregivers, clients, and intergenerational relationships.

Environmental factors and their categorization include the following contexts [37]: cultural, physical, social, personal, spiritual, temporal, and virtual.

Cultural norms, customs, beliefs, and patterns of behavior influence a person’s identity and daily activities and are often passed down through generations.

The physical environment consists of both the natural environment, which is influenced by seasonal changes and living organisms, and man-made elements such as buildings and infrastructure [44].

The social environment includes the people, groups, and relationships that individuals interact with and belong to, which affects their support networks and community engagement.

Factors such as age, gender, socioeconomic status, and educational attainment contribute to the individual’s unique experiences and perspectives in their environment.

Spiritual context is based on religious or ideological teachings and reflects the individual’s relationship to the sacred and includes personal actions and rituals practiced in religious communities.

Temporal elements such as daily routines, historical periods, and the timing of activities influence the individual’s experience of his or her environment.

Modern technologies such as smartphones and computers are increasingly integrated into everyday life and provide opportunities for intergenerational relationships as younger people share their technological knowledge with older people.

Professionals, including therapists and formal caregivers, play an important role in creating appropriate living environments and implementing preventive measures. Comprehensive environmental assessments, conducted by trained community services staff, help identify fall risks and assess an older person’s functional abilities in their environment.

Home environments can be adapted based on three principles: universal design, assistive technology, and remote monitoring networks. Assistive devices such as information and communication technology (ICT) help to reduce barriers and simplify tasks for older people so that they can feel comfortable in their homes [45, 46].

Environmental factors that influence the professional relationship between formal and informal caregivers and older people emerge in social and contextual practice. Collaboration and open dialogs are critical to ensure positive interactions and promote the development of intergenerational relationships [47].

Understanding and addressing environmental issues are essential for effective home aging interventions. By incorporating the concept of “big hands guiding little hands,” an environmental education system can promote positive intergenerational relationships and support healthy aging at home [47]. Together, these efforts help create a supportive environment for older people and promote a sense of autonomy, independence, and well-being.

4.2 Personal factors challenges in older people: implications for physical activity and independent living

Personal factors challenges refer to the difficulties or obstacles that individuals may face in relation to their personal characteristics, abilities, or circumstances. These challenges can impact their ability to engage in certain activities or achieve desired outcomes. Examples of personal factors challenges may include physical limitations, cognitive impairments, emotional barriers, lack of knowledge or skills, conflicting values or beliefs, and low self-efficacy. These challenges can affect the individual’s participation in various contexts, including professional relationships, and may require additional support or interventions to overcome.

When a user enters the context of practice, whether it is an individual, family, or group entry, both the formal caregiver and the user bring their personal resources, knowledge, abilities, skills, habits, values, beliefs, and relationships into each interaction. Thus, the experiences of both will be included in the context of practice, influencing the process of treatment, the content of the relationship, and the course and conclusion of their professional collaboration. Although personal factors are listed under environmental factors in the WHO’s framework [48], they are not classified in detail precisely because of their social dimension and cultural breadth. The personal aspect is classified as capacity, consisting of cognitive, emotional, and physical abilities; skills and knowledge; and mediators for motivation/interests, significance, and self-efficacy. Personal factors also include the shared experiences of a group or individual with family members. Examples of personal factors at the community, organizational, or population level classify shared experiences at the level of the collective personality in the community or at the level of education of the population.

Maintaining a physically active lifestyle is associated with better health and improved longevity. The activity levels of older people are a result of their awareness of the beneficial effects of physical exercise on their overall health. Incorporating new physical activities during old age significantly improves physical health and cognitive abilities in older people. Discussions on quality of life, which have been frequently mentioned and emphasized in recent times, directly influence the physical activity of older people. Regular and appropriate physical activity can slow down the aging process, thereby contributing to increased or maintained levels of good quality of life in old age [49, 50, 51].

From the perspective of assessing the functional abilities of an older people, it is advisable to first focus on improving/maintaining their balance, vision, and fitness, and then on environmental factors that enable living in their own home and contribute to the occurrence of falls, as emphasized in the concluding part by Draksler [52]. By assessing the health status and determining the body constitution, which is just one of the factors influencing our physical and mental health, we gain insight into the anatomical structure of the body (examining the body’s structure with the naked eye or studying organs under a microscope) and the issues faced by older individuals on a daily basis [53]. This enables us to subsequently focus on providing appropriate support for independent living in the community and laying the foundations for the deinstitutionalization process.

Good and sufficient information on ways to make life easier and enable safer aging often contributes to a better quality of life for older people. By using various assessment mechanisms that evaluate the risk of falls, we shed light on the risk factors faced by older individuals in performing basic and supportive daily activities and highlight the most obvious deficiencies in their functioning. Independent living in the community is associated with enabling active aging and fall prevention. Independent mobility and changing positions depend on the motor skills of older individuals, the use of aids (walking sticks, crutches, walkers, wheelchairs, and cars), and the environment [54]. Since maintaining balance is primarily associated with its assessment, various assessment scales are used in the reviewed studies to evaluate balance (Berg Balance Scale) [55], physical capacity by incorporating basic motor skills (Timed Up and Go test) [56], and assessing physical capacity with an added cognitive task (Timed Up and Go test with an added cognitive task) [57, 58].

Among the daily important tasks of independent living, the Berg Balance Scale assesses static and dynamic balance tasks such as rising from a chair, standing without support, sitting on a chair without back support with feet on the ground, sitting down, transferring, standing with eyes closed without support, standing with feet together without support, reaching forward in a standing position, picking up an object from the floor while standing, looking back over the left and right shoulder in a standing position, turning 360 degrees, alternating leg placement on a step or stool while standing without support, standing without support with one foot in front of the other, and standing on one leg.

A valid indicator of falls in older people [58] is the Timed Up and Go test [56], which assesses basic motor skills such as rising, walking, turning, and sitting, as well as the ability to change positions (dynamic balance) and walking speed. An enhancement of this test is the Timed Up and Go test with a cognitive task [57, 58].

In order to live independent and autonomous lives in the community, older people must be able to perform tasks safely and reliably. These tasks are assessed using assessment tools presented in research papers in the field of balance assessment. The purpose of these assessments is to enable and ensure the inclusion of older people in the performance of ADLs and IADLs. By assessing and treating balance problems, older adults can maintain their functional independence and actively participate in their daily lives.

This is extremely important and to some extent reflects a reality heavily influenced by globalization and modernization, in which younger generations no longer follow the lifestyle of their parents and therefore do not adhere as closely to traditional values, leading to intergenerational conflict. In addition, as adult children grow older, they face greater pressures in their daily lives and must also take care of their own children. This, in turn, may make them less available to their parents, reducing the frequency of contact and structural-associative solidarity between the two generations [59].

4.3 Exploring the impact of social factors on longevity and the role of caregiving in addressing social challenges

Social factors challenges refer to the difficulties or obstacles that arise from the social context in which individuals or groups interact. These challenges can impact various aspects of life, including relationships, communication, and access to resources and opportunities. Some common social factors challenges include: social inequality; discrimination and prejudice; social norms and expectations; social isolation; and cultural differences and social stigma.

In the context of longevity, it is important to address social challenges, generational solutions, and gerontology. Despite having a rich social network, older people often experience a loss or significant reduction in social connections due to illness or injury. Occupations related to caregiving also involve collaboration with others. Referring back to the examples presented earlier, in each occupation within the realm of caregiving, whether involving formal or informal caregivers, there is an interaction between at least two individuals and their involvement in the execution of the occupation.

According to Woodman et al. [60], the loss of social contacts and social isolation is one of the common consequences of stroke and can greatly affect individuals both emotionally and physiologically. It is also known that individuals tend to isolate themselves and focus on other activities, which may be less important to them, while concentrating on improving their physical condition during the rehabilitation period following a stroke, for example.

Seniors’ participation in social activities is crucial for preventing social isolation. They have a desire to socialize and integrate with other age groups and cultures within their communities. Intergenerational activities are mutually beneficial, as older people can pass on knowledge, traditions, and experiences, while younger individuals can assist seniors with new technology and practices [61]. Belonging to groups, whether they are friends or organized groups, has been positively associated with better health and health-related outcomes [62, 63]. Social opportunities are necessary to maintain social interactions and participation in later life [64]. A photo-based ambulatory assessment study revealed that there are older people who spend most of their time engaged in activities without interaction, leading to feelings of loneliness. Additionally, there are older individuals who spend less time in social interaction and those who spend the most time outside of their homes helping others or participating in community activities [65].

Social participation was found to be linked to the quality of life among older adults in Europe. According to data from the SHARE study [15], older individuals in Southern European countries (Italy and Spain) consistently reported lower quality of life compared to their counterparts in Scandinavian countries. The highest level of quality of life was observed in the Northern European region, while the lowest was reported in the Southern European region [66].

By actively and passively involving our gentleman in formal and informal care, we not only improved his participation in daily activities and communication with care providers but also reintroduced him to a lost occupation that allowed him a certain level of independence, improved his emotional state, established personal identity, autonomy, and increased his desire for further activity and improvement of motor skills [60, 67].

To understand the contribution of formal and informal care to preventing social exclusion or enabling social inclusion, we can look for examples of good practice in each occupation that is part of the care for older people.

The social challenges of the society we live in also include intergenerational responsibilities and tolerance in coexistence with older people, which is a socially conditioned value that can vary greatly between different countries and within them.

5. Conclusion

This study examines the complex concept of aging from different perspectives, focusing on intergenerational relationships, as indicated by the thematic analysis. The findings shed light on facilitating and ensuring the active participation of older people in daily activities at home. The context in which older people live provides both enabling and constraining factors for aging in place and includes environmental, individual, and social challenges. All of these elements are interwoven with the intergenerational challenges we face in an aging society, urging us to give them the attention they rightly deserve. The study not only raises awareness but also paves the way for further comprehensive research, particularly on individual factors through qualitative studies. Furthermore, it aims to create awareness of the factors that enable a supportive home environment and promote intergenerational cooperation.

The multidimensional concept of aging encompasses various aspects that need attention to promote healthy aging and active participation in an aging society. It is critical to recognize and understand the challenges older people face in their daily lives. Environmental factors play an important role in influencing occupational therapy interventions and aging at home, underscoring the need to create environments that support older people in their activities and participation. Personal factors present unique challenges to older people, particularly in areas such as physical activity and independent living, and require tailored interventions to overcome these barriers. Social factors also play a key role in longevity and care outcomes, underscoring the need to address the social challenges older people face.

To achieve successful aging at home, it is important to consider context as a comprehensive construct. This includes understanding the individual’s environment, personal factors, and social context and designing interventions accordingly. A collaborative approach involving multiple stakeholders, such as health professionals, caregivers, and community organizations, is critical to addressing challenges and promoting active participation.

Personal factors pose challenges for older people, especially when it comes to maintaining physical activity and independence. Identifying and addressing these challenges is critical to promoting their overall health and well-being. This can be achieved by offering tailored physical activity and exercise opportunities and providing support and resources to maintain independence.

Social factors also play an important role in the aging process. The impact of social factors on life expectancy and the critical role of caregiving in addressing social challenges cannot be underestimated. Therefore, fostering social ties, creating opportunities for social participation, and establishing adequate support systems for older people and their caregivers are essential components of the aging process.

In summary, addressing the challenges and enabling active participation in an aging society requires a holistic approach that recognizes the multidimensional nature of aging. By understanding and recognizing the influence of environmental, personal, and social factors, effective interventions and strategies can be developed to promote healthy aging, improve participation in daily activities, and fully support older people as they age at home.

Conflict of interest

The author declares no conflict of interest.