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. 2025 Jul 2;25(1):457.
doi: 10.1186/s12877-025-06083-5.

Frail older people ageing in place alone and their perception of the built environment in rural and urban sites: a mixed-methods study

Maria Gabriella Melchiorre  1 , Marco Socci  2 , Giovanni Lamura  1 , Sabrina Quattrini  1
Affiliations

Frail older people ageing in place alone and their perception of the built environment in rural and urban sites: a mixed-methods study

Maria Gabriella Melchiorre et al. BMC Geriatr. .

Abstract

Background: When older people have limited physical ability, several difficulties could arise from a built environment that is not appropriate for their needs, especially when they live alone without cohabiting with their relatives. The study explores how frail older people with functional limitations are ageing in place alone and how they perceive and manage the built environment, i.e., housing (home and building) and neighbourhood, with regard to both urban and rural sites.

Methods: Data were collected for the main IN-AGE "Inclusive Ageing in Place" study, which was carried out in 2019 in Italy. For this paper, semi-structured interviews involving 40 participants aged 65 years and over in the Marche Region (Central Italy) were processed, and a mixed-methods analysis (quantitative/qualitative) was conducted. Simple quantitative/descriptive elaborations (univariate and bivariate analyses) were integrated with thematic content analysis.

Results: The findings suggested, among others, the following issues: high costs for managing the home, poor relationships with neighbours in some cases, scarcity of proximity services especially in rural sites, and the presence of architectural/mobility barriers, even though the latter are little perceived when inside the home. Moreover, the majority of seniors were emotionally attached to their living place, although feelings of loneliness and isolation emerged, also following depopulation in rural areas.

Conclusions: Despite the small/not representative sample size, the results highlight how, a built environment that is perceived as inadequate, could hamper ageing in place and participating in communities for frail seniors. This could be managed with appropriate interventions to be implemented taking into account the diversity between rural and urban sites.

Clinical trial number: Not applicable.

Keywords: Ageing in place; Built environment; Frail older people; Functional status; Loneliness; Rural; Social isolation; Urban.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was conducted in accordance with the Declaration of Helsinki, and before starting the data collection, the approval to carry out the study was provided from the Ethics Committee of the Polytechnic of Milan (POLIMI, Research Service, Educational Innovation Support Services Area, authorization n. 5/2019, 14 March, 2019). The participants were informed on the study’s aim, were assured on privacy/confidentiality and anonymity of their personal information collected, and that they could withdraw their consent at any time without consequence. Before the interviews started, all subjects signed a written informed consent for their inclusion in the study. The study was conducted in accordance with the ethical issues indicated by EU General Data Protection Regulation (GDPR) no. 679 of 27 April 2016. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Framework of the contents that emerged from the study
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