Norway wants more older people to live safely at home. This is what it will take

Norway's population is growing older. Statistics Norway’s (SSB) 2026 projections expect the number of people aged 80 and over to more than double by 2050 and to approach a million by the end of the century. For municipalities, families, and health services, this is fast becoming one of the defining public health questions of the next few decades.

When asked, most people want to grow old at home, in familiar surroundings, with dignity and as much independence as possible. Norwegian policy points the same way. The Bo trygt hjemme reform is built around helping older people stay safely at home through better planning and prevention, more age-friendly communities, adapted housing, competent staff, and support for both users and their relatives.

There is one distinction, though, that we cannot afford to blur. Living longer at home is not the same as being left at home longer.

Good intentions will not close that gap

If Norway wants more older people to live safely in their own homes, municipalities have to provide structured, evidence-informed support that helps people hold on to the things independent living actually rests on: walking, balance, strength, memory, confidence, social contact, the ability to manage one’s own health, and the capacity to get through an ordinary day.

This is the central message of our recent systematic review in Frontiers in Public Health. We brought together 91 publications reporting on 85 independent randomised controlled trials of community-based interventions delivered outside institutions: physical activity, cognitive and psychological support, multidomain programmes, health education and self-management, nutrition, and social engagement, along with rehabilitation and supportive care, including approaches such as home modification and person-centered care.

Independence in old age has many dimensions, so prevention must work on several fronts simultaneously.

Movement is the foundation, but not the whole house

Physical activity and exercise produced the most consistent benefits, especially for mobility. That matters because mobility is often what separates someone who can still take part in the life around them from someone who becomes increasingly dependent on services.

Walking, strength training, balance work, and other structured activities were linked again and again to better physical function and 'exercise' is really shorthand for being able to do the shopping, visit a friend, get to an appointment, use public spaces, stay part of a community.

This sits comfortably with Norwegian public health thinking. Our health authorities already accept that physical activity and fall-prevention training affect how long someone can live at home and look after themselves. Knowing this is the easy part. The difficulty is getting every municipality to turn that knowledge into activities that are regular, easy to reach, and worth turning up for.

Municipalities must braid together various programmes

However, people do not lose their independence simply because their muscles weaken. They lose it to a fear of falling, to depression and loneliness, to fading confidence, to cognitive decline, to a home full of hazards, or to services that never quite talk to one another.

Our evidence map shows that multidomain programmes tend to shift several outcomes together. Cognitive and psychological programmes mainly strengthened the enablers of independence, including cognitive function, mood, and confidence in coping with daily life. Social and community programmes were tied closely to participation, while rehabilitation and supportive care helped most with everyday functioning and quality of life.

A municipality that runs nothing but exercise classes will reach some people but miss others whose real obstacles are loneliness, transport, low confidence, cognitive change, or an unsafe home. One that steps in only once the decline has already set in tends to arrive too late. Any serious ageing-in-place strategy has to braid these strands together: prevention, rehabilitation, social participation, home adaptation, and practical help.

An honest reading of the evidence

None of this should be oversold. Community-based interventions are promising, but they do not work everywhere or for everyone. Effects varied by programme, population, outcome, and length of follow-up, and a fair number of well-designed trials found little or no significant benefit.

In our review, 45 per cent of the publications were at low risk of bias, 31 per cent at moderate risk, and 24 per cent at high risk. What works in one place still has to be adapted, tried, and properly evaluated in Norwegian municipalities.

Our study argues in favour of a national approach that allows municipalities to test, adapt, scale, and measure interventions, so we can learn what works, for whom, and under what conditions.

Norway already has most of the building blocks

The most promising interventions in our review ran in people’s homes, senior centres, walking groups, services linked to primary care, community facilities, home visits, and local activity arenas.

That is good news for Norway, because the country already has many of the pieces in place: municipalities, home care services, physiotherapists and occupational therapists, senior centres, libraries, GPs, volunteer organisations, and local associations. What is missing is the connective tissue: coordination, scale, stable funding, and a habit of evaluation.

This is no small matter, given the workforce squeeze ahead. In its report Time to Act, the Healthcare Personnel Commission warned that the health and care services cannot keep claiming a larger share of the total workforce. Norway will not be able to staff its way out of an ageing population, and it cannot ask the staff it already has to keep moving faster.

That changes how we should see prevention. It stops being a nice-to-have bolted onto health policy and becomes part of the workforce answer. Every extra month of independence is a month of pressure taken off services that have nowhere left to expand.

A practical Norwegian model

The sensible move is to invest earlier, closer to where people live, and in ways that protect ability before dependency sets in hard. Four elements would carry most of the weight.

First, every municipality should have a visible prevention pathway for residents aged 65 and over, with light-touch screening for falls risk, mobility problems, loneliness, self-management needs, and home safety. The aim is to open a door to support.

Second, municipalities should run activities and balance-training programmes grounded in evidence and pitched at different ability levels. They need to be regular, local, affordable, and sociable.

Third, home modification and rehabilitation deserve to be treated as mainstream public health tools rather than afterthoughts. Small changes protect independence: clearing hazards, better lighting, an adapted bathroom, the right assistive device, and everyday function supported through occupational therapy and reablement.

Fourth, social participation should count as health infrastructure. Loneliness, isolation, and lost confidence all speed up decline. Peer groups, cultural and intergenerational activities, volunteer-supported engagement, and somewhere to meet are not luxuries; they are part of what keeps people independent in the first place.

Ageing in place must not become a privilege

Those best placed to benefit from ageing-in-place policies are often people who already have more: higher income, better housing, family nearby, and sufficient digital skills.

Those who live alone, in rural areas, on low incomes, with an immigrant background, with cognitive impairment, or with complex illness can face far steeper barriers. Design community programmes without that in mind, and ageing in place quietly becomes a privilege rather than a right.

A humane policy supports autonomy while taking vulnerability seriously. Some people will need a nursing home; some will need intensive home care; some will need specialist rehabilitation. But many more could keep their function for longer if municipalities invested in prevention, activity, social contact, and early rehabilitation.

There is no need for Norway to wait for a crisis. The work now is to move closer to a national architecture for prevention in later life: stable municipal funding, shared quality measures, room for local judgment, closer work across the health and social sectors, and steady evaluation of what actually works.

Will Norway build the support around old people that makes living at home safe, meaningful, and realistic?

References:

1.   Kisa A and Kisa S (2026) Community-based interventions to support aging in place and functional independence in older adults: a systematic review of randomized controlled trials. Front. Public Health 14:1828271. doi: 10.3389/fpubh.2026.1828271. https://doi.org/10.3389/fpubh.2026.1828271

2.   Statistics Norway (SSB). National population projections, 2026. Oslo: Statistics Norway; 2026. https://www.ssb.no/en/befolkning/befolkningsframskrivinger/statistikk/nasjonale-befolkningsframskrivinger

3.   Norwegian Ministry of Health and Care Services. Meld. St. 24 (2022–2023) Fellesskap og mestring – Bo trygt hjemme (Community and Mastery – Living Safely at Home). https://www.helsedirektoratet.no/om-oss/forsoksordninger-og-prosjekter/bo-trygt-hjemme (Storting record: https://www.stortinget.no/no/Saker-og-publikasjoner/Saker/Sak/?p=94759)

4.   Health Personnel Commission. NOU 2023:4 Tid for handling (Time to Act): Personnel in a Sustainable Health and Care Service. Oslo: Norwegian Ministry of Health and Care Services; 2023. https://www.regjeringen.no/no/dokumenter/nou-2023-4/id2961552/ English summary (PDF): https://www.regjeringen.no/contentassets/9704e2bfd8af492ebeca5a64ec5f11c0/norwegian-2023-health-personnel-commission-english-summary.pdf

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