Aging in place: implementation facilitators, barriers, and strategies in population health-oriented active aging...

As populations age rapidly, community-based care is crucial to support aging-in-place. Yet, few models successfully integrate health promotion, social engagement and care coordination at scale. Singapore's Active Aging Centers (AACs) represent a novel, nationally coordinated and funded model that integrates health promotion, social engagement, and care coordination for older adults. Despite the increasing policy importance, little is known how such models are implemented and sustained in practice.

This study examined the facilitators and barriers of implementation of AACs from the perspective of frontline staff.

We conducted a qualitative study guided by the Consolidated Framework for Implementation Research (CFIR). Semi-structured interviews were performed with 21 center managers and staff in Singapore. Participants were purposively sampled to reflect diversity in operating models and local demographics. Transcripts were analyzed using an inductive-deductive approach, and themes were mapped to CFIR domains.

Participants viewed the AAC model as conceptually strong and well-aligned with aging-in-place goals. Key facilitators included holistic policy design and community partnerships. Barriers included resource constraints, difficulty engaging underrepresented senior groups and a top-down approach in implementation. Findings also highlight implementation dilemmas of control against frontline flexibility. Novel strategies such as the thematic approach, senior volunteers, and culturally-tailored outreach were adopted to improve engagement and sustainability.

Singapore's AAC model demonstrates promise as a population health-oriented, community-based aging intervention. Effective implementation requires flexibility in policy and closer alignment between frontline experiences and central governance. These insights can guide policymakers and aging-in-place systems globally and across the region aiming to build resilient, integrated community care ecosystems.