Chapter 3 Decision-Making and Satisfaction with a Continuing Care Retirement Community

Abstract

We draw on both life course and decision-making theories to examine decision strategies prior to moving to a continuing care retirement community (CCRC) and subsequent satisfaction following the move. Multivariate analyses drawing on panel data for a sample of 92 older adults (age 64 to 94) before and after their move to a CCRC show that frequent residential relocation in the adult years reduces the odds of considering staying in one's own home. Cognitive orientations at time 1 predict subsequent satisfaction with the move to a CCRC: mastery increases the odds, desiring age-integrated housing reduces the odds.     

Exercises for mental wellness. Couldn't we all benefit?

For most of us, our cognitive functioning could be improved in many ways. Many of us struggle with our thinking skills at times, especially during times of stress and information overload. Some of the research that supports the use of prescribed cognitive exercises to slow cognitive decline in older adults may ultimately prove to be beneficial for all of us. Mental health nurses should encourage regular daily mental workouts, along with aerobic physical exercises, for everyone, not just older adults. Personal fitness training should focus not only on physical fitness, but also on mental fitness.     

Elder Abuse and Barriers to Help Seeking in Chennai,India: A Qualitative Study

This qualitative study attempts to understand why older persons abused by their family members in India do not seek help. In-depth interviews over three visits were conducted with six adults aged 65 years and above who had been physically abused by their sons/daughters-in-law. The interviews were transcribed and themes identified using a thematic analysis method. The barriers preventing a person from seeking help were service-related (accessibility, lack of trust); religious (Karma); family (deleterious effects on family, family members’ responses to help seeking); and individual (socioeconomic dependency, self-blame). The unique findings that surfaced were fear of losing one's identity by losing one's family, attributing abuse to past sins, and concern over not attaining salvation if one's sons did not perform funeral rites. The authors propose a checklist to explore and assess the barriers to seeking help. Recommendations for geroprofessionals in overcoming barriers include implementing outreach programs and changing the misconceptions regarding Karma.     

Functional Ability,Neighborhood Resources and Housing Satisfaction among Older Adults in the U.S.

The purpose of this study was to explore neighborhood resources that influence the housing satisfaction of older adults. The study included 10,146 participants from the 2009 panel of the American Housing Survey who were 65 years and older. Hierarchical regression modeling was performed to examine older adults’ perceptions of neighborhood resources and consequently the role these resources play in predicting housing satisfaction among community dwelling and residents of assisted living, controlling for age, sex, ethnicity, education, and housing maintenance. In addition, three levels of physical functioning among residents of assisted living were examined. Results showed that there were differences in housing satisfaction by residences and levels of physical functioning. Subjective evaluations of neighborhoods and the near surrounds were significant predictors of housing satisfaction. Results of the study suggest that policy makers and housing professionals need to continue to consider the role of supportive neighborhoods and social environments in promoting successful aging particularly for frail older adults.     

Housing Conditions and Risk: Reporting on a European Study of Housing Quality and Risk of Accidents for Older People

The declining capacities in older people often lead to limitations in activities of daily living and a simultaneous rising demand for care services. Many of these limitations in daily activities are to a varying degree caused, enhanced or facilitated by disadvantageous housing and environmental conditions. Home modifications have been credited as an important part of the solution, allowing for an extended and safer use of the home. In order to examine this issue in more detail, this paper provides empirical evidence on the type and extent of risks associated with accidents around the home. It reports on findings from a European case study on the difficulties using the home and risks of accidents which may lead to injury. It is argued that healthy housing conditions for older persons are important to maximize the supportive capacity of one's home, to stimulate an active and healthy lifestyle, and to avoid unnecessary institutionalization.     

Jealousy and Couple Satisfaction: A Romantic Attachment Perspective

The overarching objective of this study was to examine a novel model investigating romantic attachment as a moderator of the relation between an individual's jealousy or an individual's perception of his or her partner's jealousy and one's couple satisfaction. The sample comprised of 502 university students currently involved in a relationship of at least 12 months. An original and comprehensive model concurrently investigating emotional, cognitive, and behavioral facets of jealousy was used. The implementation of hierarchical models revealed that cognitive jealousy was negatively associated with couple satisfaction, whereas emotional jealousy demonstrated a positive association; behavioral jealousy did not add incremental value in one's couple satisfaction. Results were applicable to both one's own and one's perception of his or her partner's jealousy for each respective facet. Cognitive jealousy was demonstrated to explain the greatest variance in one's couple satisfaction. Findings also revealed romantic attachment as a moderator of the relation between certain facets of jealousy and couple satisfaction, with attachment anxiety and avoidance leading to a strengthened or weakened relation, respectively. As such, results suggest that the negative and positive consequences of jealousy on couple satisfaction may be exacerbated among those exhibiting higher attachment anxiety. The applied and clinical implications of all findings are discussed.     

Happiness of Hong Kong youth from 2000 to 2014: empirical evidence on the differential impact of socioeconomic conditions on youth versus other age groups

This paper aims to explain why Hong Kong youth have become unhappier than older people in recent years. We test in this connection six hypotheses, using random effects ordinal logistic regressions with a combined macro-micro dataset from official statistics and a longitudinal opinion survey project from 2000 to 2014. The results show that the decline in the happiness level in recent years is more significant for Hong Kong youth than for older people. We also find evidence of age heterogeneity in the impacts of both macroeconomic conditions and the housing price on happiness. GDP per capita has a weaker positive effect on youth’s happiness than it does on older people. The positive correlation between housing price and happiness is valid for older people only. Rapid economic growth and the rise in the price of housing have made older people happier than youth since the early 2010s.     

SOS—Satisfied or Stuck,Why Older Rural Residents Stay Put: Aging in Place or Stuck in Place in Rural Utah*

As rural communities undergo substantial demographic and economic changes, understanding the migration intentions and their antecedents of rural elderly persons becomes increasingly important. Using data drawn from a survey of adults from 24 rural Utah communities conducted in 2008, we examine whether rural residents 60 years of age or older plan to remain in their present communities (N= 621). We use structural equation models (SEM) to estimate the relationships between a variety of individual and community-level background measures, including perceptions of local service quality, leaving one's community for health care, Internet use, attachment to and satisfaction with community, and plans to age in place. Results suggest that even as the rural context of economic decline, population loss, and distance to medical services may reduce the viability of staying in a community, a desire to remain in the community is primarily a function of perceptions of the quality of local services and community satisfaction. This research highlights the need to better understand the interplay between the availability of medical services and perceptions of distance as well as to understand the complex relationship between individual and community level characteristics for migration intentions.     

Children's interaction with urban play spaces in Tabriz,Iran

While children have the least influence on their physical environment they are deeply affected by it. Play areas for children have been increasingly limited in third‐world cities. In many developing countries population growth has encroached on play areas as low‐density housing and open space are transformed into high‐rise apartment complexes; the availability of urban open space for children is being constricted. While adults design the urban to meet their requirements, they tend to give too little thought to the needs of children. This essay reports on a visual study of urban open spaces for children in Tabriz, a city in northwestern Iran. Children between 6 and 12 years of age were asked to paint pictures of their ideal play spaces. The children's imaginary spaces are contrasted with photographs of actual playgrounds and open spaces in Tabriz. The goal is to understand why children's active use of existing urban playgrounds and open space is on the decline.     

Elderly Living in the Community:

Helping an older individual remain in the community requires the creation of living environments that maximize the individual's strengths while providing supportive services in the areas of decreasing competency. Historically, the community care system has not been viewed by reimbursers as terribly important. The aging of the population, plus the high cost of institutional care has resulted in renewed interest in services provided in one's own home. However, there are both challenges and opportunities in providing such service. Adapting supportive housing and neighborhood environments which help unstable persons remain in their homes is crucial to this effort.     

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.     

Harnessing Fortune: Personhood,Memory, and Place in Mongolia by Rebecca M. Empson

ABSTRACT

Since the change of regimes in 1989, private property has become the symbol of the new era in the postsocialist part of Europe—an ideological tool as well as a vessel for creating and realizing identities. For young people in Bratislava, the capital of Slovakia, buying an apartment is the most common way to secure one's housing. However, it is accompanied by personal sacrifices and debt, resulting in uncertainties for many years to come. Therefore, the decision whether to buy or rent significantly influences young people's modes of life. Nevertheless, securing one's housing is not solely an economic question, but also a part of an intimate process of creating a personal space. To feel at home means to make it one's own, hence to dive into the process of constant re-negotiation. The aim of this article is to analyze the relationship between property relations and the process of creating a home. The research data originates from intensive year-long qualitative fieldwork with thirty-five informants in Bratislava. As the results show, in a postsocialist society of uncertainties, private property is conceptualized as a personal goal and point of stability, but it also adds specific tensions and dilemmas to the notion of home. In relation to this, both home and property are parts of the same ongoing process of appropriation—influenced by preferences in taste, ideal notions, and social aspirations, as well as by broader social and economic factors.     

Does physical exercise improve perceptual skills and visuospatial attention in older adults? A review

Neuroimaging studies suggest that when the brain ages, more areas are involved to perform a task in order to obtain the same results. This, together with the increase in crystalized intelligence and wisdom, is usually considered as a compensatory strategy. Research has demonstrated that physical activity might also act as a strategy and be one of the main factors that can slow down age-related perceptual and cognitive decline. Research also suggests that different types of physical exercise and sport lead to different changes in perceptual and cognitive skills as well as in several areas of the brain, especially those involving multiple domains, such as exergaming, dance or some sports. This review summarizes the findings of recent studies with older adults investigating the brain and cognitive benefits of different forms of physical exercise. Visuospatial attention, which plays a critical role in our daily lives, especially for older adults, is a central part of this analysis.     

The relevance of situation awareness in older adults’ cognitive functioning: a review

Age-related declines in cognition may have detrimental effects on older adults’ ability to complete everyday activities that young- and middle-aged individuals perform automatically. Theories of cognitive aging have found deficits in older adults’ fluid intelligence, capacity for inhibition, number of processing resources, and speed of processing, and in recent years, studies have proposed cognitive strategies to ameliorate these declines. However, few strategies directly train the cognitive strategies necessary to improve performance in dynamic environments and physical activities. One such strategy may be the enhancement of situation awareness, the capability to perceive and understand one’s environment. Although the term has typically been applied to pilots and other expert performers, situation awareness may also be relevant to cognitive aging, where older adults’ perception and comprehension of their environment become critical to everyday functioning and physical activities. If older adults’ situation awareness can be facilitated, then it may be possible to reduce the impact of age-related cognitive declines, allowing older adults to successfully participate in dynamic situations and sports where the environment is constantly changing (e.g., driving and tennis). The following review outlines cognitive deficits in aging, details their relation to situation awareness, and discusses how training in situation awareness may reduce cognitive declines. Portions of this paper were reported at the annual meeting of the North American Society for the Psychology of Sport and Physical Activity in June, 2005.     

Financial worry among older people: Who worries and why?

This study sought to clarify what drives economic worries among older people. Based upon the data from a national sample of adults aged 65 and older in Israel (N = 550), we examined associations between financial worry and economic status, lifestyle, social network, concerns about functional health, long term care needs and cognition, and population group. The main financial worry was that pension funds will not suffice for one's entire life. Multivariate analysis revealed that financial worry was negatively related to perceived income adequacy and age, and positively related to concerns about care and to apprehensions regarding one's ability to make decisions. Immigrants from the former Soviet Union were found to worry less. Understanding the different sources of financial worries among older people is essential insofar as older people are increasingly expected to take personal responsibility for their financial futures. Dealing with negative outcomes that stem from financial worries are important programming and policy goals in an era of population aging.     

Intergenerational Remote Exergaming with Family and Friends for Health and Leisure

Global guidelines for physical activity are not being met by most of the world’s youths, adults, and older adults. Family and friends who engage in physical activity across generations derive emotional, social, cognitive, and physical benefits from their interaction. Youths depend on adult assistance to travel long distances, adults are encumbered with obligations to work, and older adults often live more than 200 miles from their extended families. Intergenerational physical activity is difficult because generations are distant and lead busy lifestyles. Remotely played exergames can connect family and friends for intergenerational physical activity. Internet exergaming can help to make physical activity convenient and enjoyable as well as eliminate the effect of distance on playing with family and friends.     

Refashioning one's place in time: Stories of household downsizing in later life

Older adults face a daunting task: while continuing engagements in multiple relationships, investment in their own and others' futures, and developing life interests and capacities, they also reexamine and sometimes reconfigure the place where their social lives and objects are housed. Some relocate, downsize, to a new smaller place and reducing possessions to ensure an environment supportive of their capacities and desired daily activities. This article examines how key contours of the experiences of place during residential downsizing are infused with unexpectedly heightened awareness and cultivation of one's sense of place in multiple timeframes. In a discovery mode, the downsizing stories of 40 older adults in southeast Michigan are examined. Findings indicate conflicting temporalities and the natures of cognitions related to decision-making and thinking about being leave-taking and being in place. Findings also highlight in particular how making sense of one's place is predicated on notions of its time, of being on time and downsizing on time. Further, these characterizations of the lived worlds of older adults' modes of conceptualizing the nature of downsizing show how an understanding of the meaningfulness of place in later life relocations requires a layered sense of home as places-in multiple timelines.     

Resource Accessibility and Walkability Among Older Adults in Extended-Stay Hotels

Older adults represent a large and growing population group in the United States. This population cohort is projected to grow to 72.1 million, or 19% of the total population, by 2030, up from 40 million in 2010 (Administration on Aging, 2011; Federal Interagency Forum on Aging-Related Statistics, 2012). Despite reported decreases in the proportion of older adults living in poverty in recent years, inequities prevail. Approximately 40% of older American households reported housing cost burdens¹Cost burdens are expenditures on housing and utilities that exceed 30% of household income. (Federal Interagency Forum on Aging-Related Statistics, 2012). Many of these low-income older adults live in socially and economically marginalized positions, and housing them remains a major challenge complicated by (a) limited affordable housing options and (b) chronic health conditions that seriously undermine long-term health and mobility. In a study on the impacts of public housing transformation in Atlanta, Oakley, Reid, & Ruel (2011) reported that 26% of seniors entered public housing because of a health condition or disability. According to Smith (2006), seniors in public housing are in worse health than other older Americans, even other poor older Americans suffering from such chronic health conditions as hypertension, diabetes, arthritis, and asthma. Despite these realities, Ball (2012) has noted that older adults receive little attention in comprehensive development planning beyond specialized age-segregated retirement and care communities. Salkin (2009) echoes similar concerns about the tendency toward housing initiatives and designs for more affluent older adults. She commented that most states have focused attention on programs that are best suited for seniors who do not have the same income limitations as those who are truly on fixed incomes and living close to the poverty level (Salkin, 2009). While public housing remains the predominant affordable housing option for low-income older adults, such housing is out of reach for many low-income older adults who find themselves displaced and homeless. As a result, some of these adults move into extended-stay hotels to remain sheltered.     

Expertise and aging: maintaining skills through the lifespan

As lifespan continues to increase in many developed countries, so too does the age at which we see extraordinary achievements from older adults. Examples from running, golf, and other domains continue to redefine what is possible as we age. Evidence suggests, however, that progression through adulthood is associated with a dramatic decline in all manner of physical and cognitive abilities, from physiological capacities (e.g., VO2 max) to cognitive and perceptual functions (e.g., IQ scores, reaction time). In the face of such precipitous decline in specific abilities, how do we account for maintenance of skilled performance and expertise amongst those supposedly well along the age-decline curve? Expert performers are seemingly able to sustain high levels of achievement in the face of an overall deterioration in general capacities. Moreover, experts maintain this performance in spite of reduced involvement in their field. There are three primary explanations for the ability of experts to maintain superior performance in spite of an overall decline in abilities: (a) preserved differentiation, (b) compensation, and (c) selective maintenance. Overall, research into the high achievements of older adults may reveal a great deal with respect to skill preservation and how to best counter age-related decline.     

Should I Stay or Should I Go?

Abstract

Data from a longitudinal study of older adults in an upstate New York county (N = 333) show that poor housing “fit” increases the likelihood that older adults are currently considering a move, as does lower residential satisfaction. Those adults who said only that they “might consider moving” focused on health transitions that might signal a need for a new housing situation. Residential satisfaction predicts actual moves even when controlling for moving plans. Older adults may be “pushed” to make a move by a crisis, but those older adults planning moves tend to be “pulled” into housing arrangements with desirable features.