For many older adults, aging in place depends on more than housing. It depends on whether the right supports are available close to home, especially when people are managing several chronic conditions at once. A new study published in the Journal of the American Geriatrics Society and led by Dr. Rachel Savage and Albana Isai, offers an important look at that reality for older adults living in Naturally Occurring Retirement Communities(NORCs) across Ontario.

The findings are significant. Among more than 200,000 older adults living in Ontario NORCs, 84% were living with multimorbidity, meaning at least two chronic conditions. The study also identified six distinct patterns of overlapping conditions, with clear differences in health service use, income, age, and complexity of care needs.

What the researchers wanted to learn

NORCs are buildings or housing developments where large numbers of older adults already live. They are increasingly being recognized as promising places to deliver supportive services that help people remain in their homes and communities as they age. Despite this potential, the health needs of older adults living in NORCs have not been well understood at a population level.

This study set out to better understand multimorbidity in older NORC residents in Ontario. More specifically, the research team wanted to examine how chronic conditions cluster together, and whether those patterns could help inform more tailored, equity-promoting supportive service programs in these settings.

To do that, the researchers analyzed data from 200,565 community-dwelling adults aged 66 and older living in 1,941 NORCs across Ontario. They then used latent class analysis, a method that helps identify shared characteristics in groups of people, in this case those with similar patterns of co-occurring conditions.

What the study found

The first message is clear: multimorbidity is the norm, not the exception, among older adults living in these communities. Overall, 84% of residents were living with at least two chronic conditions. Residents with multimorbidity were older on average and more likely to have low-income status than those without multimorbidity.

The study identified six broad patterns of multimorbidity:

• A lower-complexity group characterized by conditions such as osteoarthritis, osteoporosis, cancer, and mood disorders
• A large hypertension and musculoskeletal group
• A diabetes group
• A cardiovascular group
• A respiratory group
• A very multimorbid group with above-average prevalence across 16 conditions and much higher health service use

The largest group, representing 36% of residents with multimorbidity, was defined by hypertension along with osteoarthritis, osteoporosis, cancer, and mood disorders. Another 23% were in a group defined by diabetes. Ten percent were in a cardiovascular group, 8% in a respiratory group, and 10% in the highest-complexity group.

That highest-need group stood out in particular. Compared with the minimally multimorbid group, residents in the very multimorbid class had a higher average number of chronic conditions, much higher polypharmacy, and more unscheduled emergency department visits. Nearly half had two or more unscheduled ED visits over two years.

The paper also points to important equity considerations. Residents with multimorbidity were more likely to have low-income status, and women with multimorbidity were more likely to be low income and to live in lower-income neighbourhoods. The study also found sex-based differences in condition patterns, including higher rates of osteoporosis and mood disorders in women, and higher rates of coronary syndrome and diabetes in men.

Why it matters

For Diabetes Action Canada (DAC), one finding is especially important: diabetes emerged as a defining feature of one major multimorbidity group and was also present in more complex cardiovascular and high-need profiles. This finding resonates with resident needs assessments, explained Dr. Savage.“Diabetes is a top priority in NORC communities and one where building-based supports can make a real difference.”That reinforces a simple but important point. For many older adults, diabetes care does not happen in isolation. It is often bound up with cardiovascular disease, kidney concerns, medication burden, mobility issues, and mental health needs. To build on this insight, the team is conducting in-depth analyses to better understand NORC residents with diabetes and identify high-prevalence areas to target programming.

This is why understanding NORCs and its residents is crucial. These are not institutional care settings. They are ordinary community settings where older adults already live. That makes them an important opportunity for more practical, place-based models of care that are built around how people actually live and what they are managing day to day.

The authors point to the value of supportive service programs in NORCs that prioritize system navigation, integrated care, and tailored chronic disease prevention and management. Their conclusion is straightforward: if we want to help older adults with multimorbidity age in place, programs need to reflect the real complexity of their needs.

Looking ahead

As Ontario’s population ages, this study offers useful direction for health systems, researchers, and community partners alike. It makes the case for moving beyond single-condition approaches and designing supports around the full picture of people’s health.

It also highlights an important opportunity for more proactive screening and prevention in community settings. For older adults living with diabetes in NORCs, diabetic retinopathy screening is one clear example. These are places where screening could be brought closer to home and better connected to follow-up, education, and ongoing care.

For DAC, that is a meaningful takeaway. Our work in diabetic retinopathy screening has shown the value of reaching people earlier and reducing barriers to access. In a setting like a NORC, that kind of approach could form part of a broader community-based model that supports healthier aging, earlier intervention, and more coordinated care for older adults living with multiple chronic conditions

📖 Read the paper here: https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.70416