Older Adults in a Naturally Occurring Retirement Community (NORC): Predicting Those in Need of Mental Health Care

Background and Purpose: Little empirical knowledge is available on Naturally Occurring Retirement Communities (NORCs) and the influence of neighborhood factors associated with seeking social support and mental health services among older adults. Only a few studies have investigated the relationship between neighborhood contexts and their contribution to depression in middle-aged adults, yet this is unknown for older adults. The purpose of this study is to fill this knowledge gap and understand how neighborhood factors affect the mental health of older people living in NORCs. The setting is a 2.1 square mile Naturally Occurring Retirement Community (NORC) in a New York metropolitan county comprised of older homeowner residents age 60 and over who make up 47% of the neighborhood population. This NORC community is served by an interfaith partnership of several senior services, religious, health, and other community organizations providing information and support, social activities, and enhanced access to health and social services.

Methods: A community survey was designed to identify potential areas of mental health need requiring new or expanded geriatric services. A random sample of 226 NORC residents age 60 and over completed questionnaires measuring demographics, depression, anxiety, aspects of health, help-seeking, mastery, loneliness, and health locus of control. The neighborhood-level measures were characterized by census-based characteristics including residential stability, age structure, racial/ethnic heterogeneity and socioeconomic advantage.

Results: Approximately 18% of the sampled residents reported at least one symptom of depression during the previous week, while 50% reported at least one symptom of anxiety during the past month. The best-fitting linear regression model indicated that overall psychological distress was significantly higher in residents who were younger, living alone, and reported higher levels of loneliness, lower levels of mastery over their environment, worse general health, or a negative change in health over the last year (F = 17.823, p = .000). Over the past year, very few respondents reported accessing help from formal services. Although 67% reported receiving help from their primary care physicians, less than 5% reported help from religious leaders, mental health counselors, social workers, psychiatrists, support group programs, or the NORC program.

Conclusions and Implications: Neighborhood NORCs are emerging as significant entities for continuous independent living for older adults who want to remain in their own homes and age-in-place. The potential cost-savings in services for government and enhanced quality of life for older community-residing individuals are significant. These findings suggest that more vigorous outreach efforts to homebound and frail elderly may be needed to identify and link at-risk residents to mental health and other services available through the NORC program.