Relationships Among Active Engagement in Life Activities and Quality of Life for Assisted-Living Residents

This cross-sectional research explored the relationships between active engagement in life activities (leisure, social, and instrumental activities of daily living) and quality of life for seniors aged 65 and older residing in assisted living facilities. It is increasingly recognized that active participation in diverse physical, cognitive, and social activities can promote older adults’ quality of life, including physical and mental health, but there is limited information about this in the population of residents in assisted living facilities. It is estimated that there are one million older adults residing in assisted living facilities, making assisted living facilities a rapidly growing segment of senior housing. Older adults who relocate to assisted living facilities commonly experience lifestyle changes, often related to their altered physical and social environment, reduced demands regarding household chores and meal preparation, and new opportunities for recreation and socialization. In this study, interviews were conducted with 131 ambulatory residents from assisted living facilities in the New York City metropolitan area using the 55-Item Activity Checklist, SF-36v2, Life Satisfaction Index-Z, and demographic questions. Results found significant low to moderate correlations between retained engagement in life activities (leisure, social, and instrumental activities of daily living) and life satisfaction, and several quality of life domains, including physical functioning, mental health, general health, and vitality. Older adults continued to engage in a greater percentage of everyday life activities they identified as important. This data supports exploration of client-centered activity programs to promote participation of residents in assisted living facilities in diverse activities to both maintain resident functional abilities and manage functional decline.     

Neighborhood-level influences on physical activity among older adults: a multilevel analysis

There is a need for greater understanding of setting-specific influences on physical activity to complement the predominant research paradigm of individual-centered influences on physical activity. In this study, the authors used a cross-sectional multilevel analysis to examine a range of neighborhood-level characteristics and the extent to which they were associated with variation in self-reported physical activity among older adults. The sample consisted of 582 community-dwelling residents age 65 years and older (M = 73.99 years, SD = 6.25) recruited from 56 neighborhoods in Portland, OR. Information collected from participants and neighborhood data from objective sources formed a two-level data structure. These hierarchical data (i.e., individuals nested within neighborhoods) were subjected to multilevel structural-equation-modeling analyses. Results showed that neighborhood social cohesion, in conjunction with other neighborhood-level factors, was significantly associated with increased levels of neighborhood physical activity. Overall, neighborhood-level variables jointly accounted for a substantial variation in neighborhood physical activity when controlling for individual-level variables.     

Neighborhood disadvantage, disorder, and health.

We examine the question of whether living in a disadvantaged neighborhood damages health, over and above the impact of personal socioeconomic characteristics. We hypothesize that (1) health correlates negatively with neighborhood disadvantage adjusting for personal disadvantage, and that (2) neighborhood disorder mediates the association, (3) partly because disorder and the fear associated with it discourage walking and (4) partly because they directly impair health. Data are from the 1995 Community, Crime, and Health survey, a probability sample of 2,482 adults in Illinois, with linked information about the respondent's census tract. We find that residents of disadvantaged neighborhoods have worse health (worse self-reported health and physical functioning and more chronic conditions) than residents of more advantaged neighborhoods. The association is mediated entirely by perceived neighborhood disorder and the resulting fear. It is not mediated by limitation of outdoor physical activity. The daily stress associated with living in a neighborhood where danger, trouble, crime and incivility are common apparently damages health. We call for a bio-demography of stress that links chronic exposure to threatening conditions faced by disadvantaged individuals in disadvantaged neighborhoods with physiological responses that may impair health.     

A multilevel analysis of change in neighborhood walking activity in older adults

The article reports on a multilevel analysis conducted to examine change in neighborhood walking activity over a 12-month period in a community-based sample of 28 neighborhoods of 303 older adults age 65 and over. The study employed a multilevel (residents nested within neighborhoods) and longitudinal (4 repeated measures over 1 year) design and a multilevel analysis of change and predictors of change in neighborhood walking activity. Results indicated a significant neighborhood effect, with neighborhood-level walking characterized by a downward trajectory over time. Inclusion of baseline variables using selected perceived neighborhood-level social- and physical-environment measures indicated that neighborhoods with safe walking environments and access to physical activity facilities had lower rates of decline in walking activity. The findings provide preliminary evidence of neighborhood-level change and predictors of change in walking activity in older adults. They also suggest the importance of analyzing change in physical activity in older adults from a multilevel or macrolevel framework.     

Promoting walking among older adults living in retirement communities

The authors tested the feasibility and acceptability, and explored the outcomes, of 2 walking interventions based on ecological models among older adults living in retirement communities. An enhanced intervention (EI) was compared with a standard walking intervention (SI) among residents in 4 retirement facilities (N = 87 at baseline; mean age = 84.1 yr). All participants received a walking intervention including pedometers, printed materials, and biweekly group sessions. EI participants also received phone counseling and environmental-awareness components. Measures included pedometer step counts, activities of daily living, environment-related variables, physical function, depression, cognitive function, satisfaction, and adherence. Results indicated improvements among the total sample for step counts, neighborhood barriers, cognitive function, and satisfaction with walking opportunities. Satisfaction and adherence were high. Both walking interventions were feasible to implement among facility-dwelling older adults. Future studies can build on this multilevel approach.     

Homes of Choice

Abstract

State policymakers increasingly recognize that housing is not only an important shelter resource for older persons, but also a key element of community-based care. Over the last two decades, significant state and local activity has led to an increase in service-enriched housing for older persons. Service-enriched housing refers to living arrangements that include health and/or social services in an accessible, supportive environment. Emerging forces are leading to increased pressure for the expansion of service-enriched housing. These forces include: a growing and diverse population of older renters; older adults' preferences to age in place; the increasing frailty of subsidized housing residents; the development of assisted living (AL); the enactment of Medicaid waivers; and implementation of the Olmstead decision. Although studies have not included cost-analysis, available research demonstrates that service-enriched housing promotes resident satisfaction, successfully provides services to frail populations, and supports aging in place.

Given both limited resources and research, this article addresses how states can adequately respond to and capitalize on these forces in order to best meet the long-term needs of older adults.     

Seven years later: effects of a neighborhood mobility program on poor Black and Latino adults' well-being

This study explored program effects on adults' well-being seven years following the implementation of a court-ordered neighborhood mobility program. Low-income black and Latino adults residing in poor, segregated neighborhoods in Yonkers, New York were randomly selected to relocate to publicly funded townhouses in middle-class neighborhoods within the city. Adults who moved (n = 141) and demographically similar adults who were not selected to move (n = 106) were interviewed. Data indicate that 85 percent of adults who moved to the new housing remained there at follow-up. Results revealed that adults who moved resided in neighborhoods with higher collective efficacy and less disorder and danger but had fewer neighborhood social ties than adults who stayed in poor neighborhoods. Movers were also more likely to work and less likely to receive welfare than nonmovers. Adults who remained in low-poverty neighborhoods at the time of the follow-up reported better physical health than adults residing in poor neighborhoods, but mental health did not vary by neighborhood.     

Natural neighborhood networks — Important social networks in the lives of older adults aging in place

Neighborhoods are important places of aging and meaningful contexts of life for many older people. The overall aim of this study was to explore the public life of older people aging in place in order to understand neighborhoods as the material places where public life occurs, networks as the social places of public life, and to examine how these neighborhoods and networks influence the experience of aging and wellbeing. Adopting a friendly visiting methodology, data was collected over an 8-month period using participant observation, visual methods and an innovative interview technique called the “go along method”. Data were analyzed using grounded theory and a coding strategy that integrated textual, visual, and auditory data. Results provide insights into the micro-territorial functioning of neighborhoods and highlight third places and transitory zones as significant sites for older residents. Embedded within these places is a natural neighborhood network — a web of informal relationships and interactions that enhance well being and shape the everyday social world of older adults aging in place.     

Examining the Interaction of Daily Hassles Across Ecological Domains on Substance Use and Delinquency Among Low-Income Adolescents of Color

The increased risk for substance use and delinquency among adolescents of color has been partially attributed to increased exposure to daily hassles. Although a certain number of hassles are normative, especially among family and peers, adolescents of color experience more stressors in their neighborhood or directly related to fewer resources than their White counterparts. These hassles may interact across ecological systems to impact behavioral outcomes among adolescents. This may be especially true for young people living in public housing. Based on ecological systems theory, this study tests the relationship between experiences of hassles across multiple ecological levels and problem behaviors in a sample of 315 ethnically diverse early adolescents (M_age = 12; 51% female) living in public housing neighborhoods in two large metropolitan areas in the United States. A positive relationship was found between family hassles and both substance use and delinquency, as well as between school hassles and substance use. When the interactions between family, peer, school, and neighborhood/resource hassles were considered, five statistically significant interactions were found. The study results reinforce the role of contextual factors, such as living in low-income neighborhoods and the complexity of hassles interacting at multiple levels of a young person’s daily ecology, on adolescent outcomes.     

Facility Ownership and Resident Satisfaction with Assisted Living

Abstract

Although the majority of assisted living facilities operate as for-profit organizations and serve increasingly frail elderly populations, little is known about the impact of ownership on the quality of care in assisted living. This study examines the relationship between facility ownership and the quality of care in assisted living, using resident satisfaction as a quality indicator. The assessed aspects of satisfaction include health care, housekeeping, physical environment, relationships with staff, and social life/activities. The relationship of facility ownership to resident satisfaction is examined controlling for resident psychological well-being, functional ability, facility size, and staff resources. Data were collected in personal interviews with 156 residents, including 96 residents in eight for-profit facilities and 60 residents in five nonprofit facilities in Maryland. Residents in the sampled nonprofit facilities were more satisfied with assisted living than were residents in the for-profit facilities. In particular, residents in nonprofit facilities were more satisfied with health care, physical environment, and social life/activities in the facility. Better understanding of the relationship between facility ownership and resident satisfaction can help administrators create environments that maximize resident satisfaction in both nonprofit and for-profit facilities.     

Balancing required resources and neighborhood opposition in community-based treatment center neighborhoods.

This paper analyzes the compatibility of two characteristics of neighborhoods containing community-based treatment centers (CBTCs): the availability of resources that can be used in treatment and the likelihood of neighborhood opposition. Do CBTC neighborhoods having high levels of geographically based resources also have characteristics associated with low opposition to these centers? The findings suggest that among neighborhoods with centers serving adults, inner-city transitional neighborhoods where low opposition would be expected have significantly higher levels of treatment resources than do more affluent, suburban neighborhoods. The implications of these findings for selecting sites for community-based treatment centers are discussed.     

A latent class analysis of resilient development among early adolescents living in public housing

The aim of this study was to identify types of early adolescents living in public housing neighborhoods based on patterns of resilient development. Informed by ecological-transactional theory, we evaluated a broad range of individual, relational, and contextual influences on resilient development among an ethnically diverse sample of 315 early adolescents (M_age = 12; 51% female) living in public housing neighborhoods. Results of a latent class analysis of 11 indicators and 2 outcome variables suggest three empirically derived classes representing overall patterns of favorable and unfavorable behavior. Daily hassles, low neighborhood cohesion, and a relaxed attitude towards substance use corresponded with a higher probability of substance use and delinquency. Significant differences in favorable behavior patterns reflecting resilient development between classes were found in attitudes towards substance use, academic efficacy, and school commitment. Results suggest important implications for preventive interventions for early adolescents living in public housing neighborhoods that are discussed.     

Resurgent Ethnicity among Asian Americans: Ethnic Neighborhood Context and Health

In this study I investigate the associations of neighborhood socioeconomic and social environments with the health of Asian Americans living in both Asian ethnic neighborhoods and non-Asian neighborhoods. I use a sample of 1962 Asian Americans from the National Latino and Asian American Study (NLAAS, 2003-04). Three key findings emerge. First, absolute levels of socioeconomic and social resources do not differ greatly between the Asian ethnic neighborhoods and non-Asian neighborhoods in which Asian Americans live. Second, the ethnic neighborhood context conditions the effects of neighborhood education on health so that higher neighborhood education is related to better self-rated health among Asian Americans only when they live in Asian ethnic neighborhoods. Finally, the social environment, measured by everyday discrimination and social cohesion, does not differ in its health effects for individuals living in Asian ethnic and non-Asian neighborhoods. Together, these findings illuminate the complex ways that racial and ethnic neighborhood concentration impacts health.     

Evaluating Potential Environmental Variables and Active Aging in Older Adults for Age-Friendly Neighborhoods in Malaysia

As Malaysia's population is aging rapidly, and since there is no specific housing policy for the elderly, it is vital that neighborhoods meet the different needs of elderly for active aging to maintain their quality of life. This study aims to investigate the neighborhood environmental variables, the outcome active aging, and potential variables that inhibit active aging in the elderly that lead to their quality of life. It examined quality-of-life determinants that are influenced by the existence of certain neighborhood characteristics. In the study, 385 older adults aged 60+ years residing in two different cities in Malaysia were surveyed. Multiple regression was used to explore how much variance in active aging variables the neighborhood environmental factors explained as a group. The results showed that permeability, accessibility, and facilitators to walking are key determinants of active aging. There is a need to improve the physical design of the neighborhoods with regard to these three factors.     

THE ECOLOGY OF AGING: NEIGHBORHOOD SATISFACTION IN AN OLDER POPULATION*

This paper explores the determinants of neighborhood satisfaction for a population of older persons. Here neighborhood satisfaction is presumed to be the result of a complicated process involving: objective qualities in the neighborhood, the psychological and physical state of the person making the evaluation, as well as the person's own subjective definitions of the neighborhood. The intent of this research is to weigh the significance of these objective neighborhood conditions, subjective definitions, and the individual's level of environmental docility for the determination of neighborhood satisfaction among the elderly. To investigate this issue a random sample of 1,185 respondents 60 years and older was interviewed in the Albany-Schenectady-Troy, New York SMSA. The data suggest that while all three general factors are significant in the production of neighborhood satisfaction, mental portraits of the neighborhood are the most significant source of neighborhood satisfaction. This finding indicates support for a synthesis of symbolic interactionist and traditional ecological models of environmental response. Clearly, for this sample, older persons sharing the same neighborhoods do not necessarily occupy the same environmental worlds.     

Collective threat, trust, and the sense of personal control

A threatening and dangerous neighborhood may produce distressing emotions of anxiety, anger, and depression among the individuals who live there because residents find these neighborhoods subjectively alienating. The author introduces the idea that neighborhood disorder indicates collective threat, which is alienating-shaping perceptions of powerlessness and mistrust. The author presents a theory of trust that posits that mistrust develops in places where resources are scarce and threat is common and among individuals with few resources and who feel powerless to avoid or manage the threat. Perceived powerlessness develops with exposure to uncontrollable, negative conditions such as crime, danger, and threat in one's neighborhood. Thus, neighborhood disorder, common in disadvantaged neighborhoods, influences mistrust directly and indirectly by increasing perceptions of powerlessness among residents, which amplify disorder's effect on mistrust. The very thing needed to protect disadvantaged residents from the negative effects of their environment-a sense of personal control-is eroded by that environment in a process that the author calls structural amplification. Powerlessness and mistrust in turn are distressing, increasing levels of anxiety, anger, and depression.     

The Role of Environmental Features in Social Engagement Among Residents Living in Assisted Living Facilities

The objective of this study was to describe how physical and social environmental features of assisted living facilities influence social engagement behaviors of older residents. A secondary objective was to identify the environmental features that were important to residents’ social engagement based on their perspectives. Using a qualitative approach, the authors depicted the environmental features and the social engagement patterns of older residents in two assisted living facilities in urban Saint Louis, Missouri. A stratified sample of 10 participants participated in in-depth interviews and 16 participant observations were conducted. Five physical and social features were identified as factors that influenced residents’ social engagement patterns. Environmental features that supported social engagement appeared to differ according to participant activity level. Findings from this study have the potential to inform design guidelines that will enhance social engagement in future assisted living facilities.     

Limits to social capital: comparing network assistance in two New Orleans neighborhoods devastated by Hurricane Katrina

Sociological research emphasizes that personal networks offer social resources in times of need and that this capacity varies by the social position of those involved. Yet rarely are sociologists able to make direct comparisons of such inequalities. This study overcomes this methodological challenge by examining network activation among residents of two unequal neighborhoods severely devastated by Hurricane Katrina. Results indicate that local network capacities of Lower Ninth Ward residents relative to those of the more affluent Lakeview neighborhood dissipated before, during, and after the disaster to erode the life chances of individual residents and the neighborhood they once constituted.