Designing an Ageless Social Community: Adapting a New Urbanist Social Core to Suit Baby Boomers in Later Life

ABSTRACT

Since 90% of older adults prefer aging in place (Wang, Shepley, & Rodiek, 2012), it is important that neighborhood design supports successful aging. Beyond basic needs, research indicates quality interaction is associated with positive health and well-being benefits, particularly for older adults. In this, design supporting social relationships plays an essential role. This study's purpose was to identify New Urbanist neighborhood and social space design attributes supporting older residents' physiological and social needs. This case study used keyword-in-context analysis with focus group interview data to identify domains supporting social interaction for residents aging in place including: location factors, social factors, design factors, and programmatic factors.     

TigerPlace,A State-Academic-Private Project to Revolutionize Traditional Long-Term Care

ABSTRACT

The Aging in Place Project at the University of Missouri (MU) required legislation in 1999 and 2001 to be fully realized. An innovative home health agency was initiated by the Sinclair School of Nursing specifically to help older adults age in place in the environment of their choice. In 2004, an innovative independent living environment was built and is operated by a private long term care company, as a special facility where residents can truly age in place and never fear being moved to a traditional nursing home unless they choose to do so. With care provided by the home care agency with registered nurse care coordination services, residents receive preventative and early illness recognition assistance that have markedly improved their lives. Evaluation of aging in place reveal registered nurse care coordination improves outcomes of cognition, depression, activities of daily living, incontinence, pain, and shortness of breath as well as delaying or preventing nursing home placement. Links with MU students, faculty, and nearly every school or college on campus enrich the lives of the students and residents of the housing environment. Research projects are encouraged and residents who choose to participate are enjoying helping with developing cutting technology to help other seniors age in place.     

Local Housing and Service Decisions

Abstract

The purpose of this research was to identify factors associated with local housing and service decisions that support aging adults in rural communities. These decisions represent de factostrategies that affect the quality of life of older residents and their ability to age in place. Data were collected from 951 informants in 134 Midwest rural communities. Analyses were undertaken to identify the role of community characteristics in predicting the availability of a group of housing options and support services. Findings support the notion that the community context is important to the delivery of key housing and service needs. Population size, proportion of community residents 65 years and older, and housing planning processes promoted gains in housing and services.     

Lessons on social and health disparities from older lesbians with alcoholism and the role of interventions to promote culturally competent services

ABSTRACT

Older adults who are lesbian, gay, bisexual, or transgender (LGBT) face greater health risks and possibly more costly care because of their reluctance to seek out health and long-term care services because of limited cultural sensitivity of service providers. This is particularly evident in older lesbians who face substantial risk of health problems associated with alcoholism and are less likely to be open with health care providers because of stigma combined with feelings of alienation, stress, and depression. An estimated 4.4 million older adults are predicted to have problems with alcohol by 2020, and the rates of alcohol-related hospitalizations are similar to those for heart attacks, creating exorbitant medical costs. More culturally competent health and long-term care may reduce health care costs by effectively addressing the dynamics of alcoholism, aging, and lesbian culture. Training initiatives such as those developed by the National Resource Center on LGBT Aging have begun to address the need of a more culturally competent aging services network. This article provides exemplars from empirical data on older lesbians with alcoholism to highlight some of the health, economic, and social disparities experienced in the aging LGBT community. Current interventions in the form of cultural competence training for service providers are presented as a potential step toward addressing health disparities among LGBT older adults.     

The Perspectives of Older Greek-Australians Toward Changes in the Nature of Family Support: Implications for Family Care Policies

Internationally, public policies encourage “aging in place,” and the majority of older Australians requiring care in the community receive informal care, supplemented by publicly subsidized formal services. The effect of contemporary social changes on informal care in aging migrant communities is poorly understood. This articles explores the perceptions of older Greek-Australians toward changes in the nature of family support. Bicultural and bilingual researchers carried out in-depth interviews (n?=?27) and five focus groups (n?=?63 total participants) with older Greek-Australians in modern Greek. While “cultures of care” remain among Greek-Australian families, the means for a family to assist have shifted, and these compromises are met with considerable powerlessness among older Greek-Australians. Implications for policy include the need to better involve older migrants and their families in decisions about their care needs, potentially involving consumer-directed care models. Service providers may also need to adopt the use of new technologies to communicate with increasingly time-pressured family members.     

Environmental Evaluations and Modifications to Support Aging at Home With a Developmental Disability

ABSTRACT

Increasing numbers of people with developmental disabilities are living into old age and are now residing in community-based housing, largely due to the deinstitutionalization movement. The overlay of age-related impairments onto pre-existing, lifelong disabilities puts this population at a magnified risk for premature behavioral limitations and loss of independence. This article describes a demonstration project designed to enable people with developmental disabilities to age in place. Interviews and observational assessments with 45 older adults with developmental disabilities were conducted in their community-based homes to identify potential barriers to aging in place. An Individualized Environmental Intervention Plan was developed for each study participant, recommending ways to solve problems and eliminate potential barriers. Individualized Environmental Intervention Plans were implemented to the extent possible through home modifications and assistive technology. Pre- and post-modification task performance and self-report revealed the positive impact that home modifications and assistive technology can have. The study demonstrates the need for ongoing evaluation and assessment sensitive to the needs of people with developmental disabilities and the unique characteristics of supported living settings.     

The “Aging Males’ Symptoms” (AMS) Scale assesses depression and anxiety

Abstract

Objective: Emotional distress may be associated with severe aging symptoms. This study aimed to investigate aging symptoms in male psychiatric outpatients and their relationship with anxiety and depression.

Method: About 176 male psychiatric outpatients aged 40–80?years were enrolled into this single-center cross-sectional study, and completed self-reported questionnaires including “Aging Males’ Symptoms” (AMS) scale and the Hospital Anxiety and Depression Scale (HADS).

Result: Age was correlated with less anxiety (r?=??0.23), less psychological (r?=??0.16) and more sexual symptoms (r?=?0.31). After controlling demographic variables, the partial correlation coefficients of HADS and AMS scores ranged from 0.30 to 0.73. Four groups were defined by HADS: control (C; n?=?103), depression (D; n?=?18), anxiety (A; n?=?26) and mixed anxiety and depression (M; n?=?29). The M group had the most severe aging symptoms, and the C group the least. The A group had more psychological and less sexual symptoms than the D group. “Impaired sexual potency” was the only aging symptom in males not significantly different among the four groups.

Conclusions: Anxiety and depression was associated with more severe aging symptoms in male psychiatric outpatients. Sexual dysfunction could be regarded as the core manifestation to differentiate aging symptoms from syndromal emotional distress.     

Residential Relocation in Later Life: A Comparison of Proactive and Reactive Moves

Proactive coping involves anticipating future events or stressors and preparing for them in advance. Housing is an important consideration in preparing for later life. This study examines residential relocation among older adults, comparing those who moved proactively with those who moved reactively. Data from the Longitudinal Study of Aging included a final sample of individuals who had relocated at Wave 2 (n = 736) and Wave 3 (n = 713). The proactive group of movers was younger, more educated, and had higher incomes. Results provide support for proactive coping theory and its application to residential relocation in later life.     

Restoring and Sustaining Home: The Impact of Home Modifications on the Meaning of Home for Older People

ABSTRACT

The importance of a supportive home environment to successful aging has been well-established in the literature, with home modifications increasingly acknowledged as ways of removing barriers to function and increasing independence for older people. Home modification literature and practice primarily focus on the home environment as a physical space in which to perform tasks and on the impact of modification on competencies and function. Home, however, is much more than a physical environment. Within a transactive framework, people and places are seen as engaged in a dynamic, reciprocal relationship through which home becomes a place of significant personal meaning. Through a qualitative framework, this study examines the experience of older people living in the community who are recipients of a home modification service. It explores the impact modifying the physical environment has on their experience of home as a place of meaning and provides insight into how home modifications can strengthen the home as a place of personal and social meaning as well as improve safety and comfort for the older person at home.     

The Mobility of Elderly Residents Living in Suburban Territories

Abstract

Many authors have observed die elders' unanimous aspirations to age in place. Such residential aspirations echo theoretical concepts such as “environmental-fit.” Aging residents adapt to their residential environment according to their autonomy level, their financial and social resources, as well as the meanings they invest in both residential situations and lifestyle (Lord, 2004; Wagnild, 2001). Therefore, the suburbs constitute a challenge for aging residents' intentions to remain in their home for as long as possible. These low-density environments encourage car dependency for almost every daily activity. In that regard, many studies have investigated the daily mobility patterns of elders living in such areas. However, most of them have focused on aspects linked to transportation and driving security (Rosenbloom, 2003). In this context, with a socio-anthropological (in-depth interviews) method, the elders' daily mobility is explored in a complex layering of issues. Two interdisciplinary qualitative researches on the daily and residential mobility of elderly suburbanites have been used: a group living in Quebec City's Post-War suburbs in Canada (n = 56) and another in Marseille's periurban suburbs in France (n = 36). The results show that we must investigate beyond the elders' “emotional attachment”to their “home” in order to explain the everyday tensions underlying accessibility and daily mobility. Aging in a single-family house is more than a deliberate choice. Moving away from one's neighborhood is considered a last resort alternative by the majority. Instead, the elderly from both milieus will adapt their lifestyles to the environment by redesigning their daily activities and their mobility practices in order to age in place. Therefore, adapting daily mobility practices to social interactions and social representations all become a sine qua nonecondition.     

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.     

The Difficult History of Ancillary Units: The Obstacles and Potential Opportunities to Increase the Heterogeneity of Neighborhoods and the Flexibility of Households in the United States

ABSTRACT

Most aging Americans express the desire to stay in their current home for the rest of their lives. However, as literature and practice indicate, aging in place cannot be successfully achieved in all places, especially in those places where zoning regulations and building codes act as barriers to the flexible adaptation of environments. One possible solution could come from the legalization of what is commonly known as granny flats, or more technically as Ancillary Dwelling Units. This article is divided into three parts. The first part is a brief history of Ancillary Dwelling Units. The second part focuses on the critical role played by local and state urban planning policies in the future of Ancillary Dwelling Units. California is used as a noteworthy example. The third part discusses how positive outcomes for senior residents who have Ancillary Dwelling Units legally present in their neighborhoods are linked to the appropriateness of their design.     

Dating Relationships in Older Adulthood: A National Portrait

Dating in later life is likely common, especially as the proportion of older adults who are single continues to rise. Yet there are no recent national estimates of either the prevalence or factors associated with dating during older adulthood. Using data from the 2005–2006 National Social Life, Health, and Aging Project, a nationally representative sample of 3,005 individuals ages 57–85, the authors constructed a national portrait of older adult daters. Roughly 14% of singles were in a dating relationship. Dating was more common among men than women and declined with age. Compared to non‐daters, daters were more socially advantaged. Daters were more likely to be college educated and had more assets, were in better health, and reported more social connectedness. This study underscores the importance of new research on partnering in later life, particularly with the aging of the U.S. population and the swelling ranks of older singles.     

Elder care as "frustrating" and "boring": Understanding the persistence of negative attitudes toward older patients among physicians-in-training

ObjectivesThis study explores the attitudes of physicians-in-training toward older patients. Specifically, we examine why, despite increasing exposure to geriatrics in medical school curricula, medical students and residents continue to have negative attitudes toward caring for older patients.MethodsThis study used ethnography, a technique used by anthropologists that includes participant-observation, semi-structured interviews, and facilitated group discussions. Research was conducted at two tertiary-care academic hospitals in urban Northern California, and focused on eliciting the opinions, beliefs, and practices of physicians-in-training toward geriatrics.ResultsWe found that the majority of physicians-in-training in this study expressed a mix of positive and negative views about caring for older patients. We argue that physicians-in-trainings' attitudes toward older patients are shaped by a number of heterogeneous and frequently conflicting factors, including both the formal and so-called “hidden” curricula in medical education, institutional demands on physicians to encourage speed and efficiency of care, and portrayals of the process of aging as simultaneously as a “problem” of inevitable biological decay and an opportunity for medical intervention.DiscussionEfforts to educate medical students and residents about appropriate geriatric care tend to reproduce the paradoxes and uncertainties surrounding aging in biomedicine. These ambiguities contribute to the tendency of physicians-in-training to develop moralizing attitudes about older patients and other patient groups labeled “frustrating” or “boring”.     

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.     

Aging in Place or Relocation: Perceived Awareness of Community-Based Long-Term Care and Services

ABSTRACT

This study used data from the Community Partnership for Older Adults Program Survey (N = 4,611) to examine associations between the perceived awareness of community-based long-term care and supportive services and the anticipation for aging in place and relocation. Respondents varied substantially in their knowledge about services and anticipation for aging in place and relocation. Perceived availability and unavailability of a series of community services was associated with the likelihood of anticipating aging in place and relocation, and awareness of the lack of visiting nurses, personal assistance, or transportation was related to respondents reporting a younger age at which they anticipated needing help to age in place or anticipating a need to relocate. Findings have implications for raising the public awareness of community-based services in addressing the needs of community-dwelling elders for aging in place and relocation.     

Health and Aging-in-Place: Implications for Community Practice

ABSTRACT

There is increasing interest in helping elders to remain independent in their homes. As the nation experiences the unprecedented growth among its oldest residents, public and private efforts are emerging to facilitate aging-in-place. However older people, particularly the oldest old, experience a myriad of issues impacting their health and ability to remain at home. This article presents the findings from a needs assessment of a Naturally Occurring Retirement Community (NORC) (n?=?114) that revealed multiple health-related issues among older people residing in high-need neighborhoods. The study utilized a holistic perspective of health to measure physical, mental, and social well-being among the older residents. Implications for community-based health interventions to enhance aging-in-place are discussed.     

TigerPlace, A State-Academic-Private Project to Revolutionize Traditional Long-Term Care

The Aging in Place Project at the University of Missouri (MU) required legislation in 1999 and 2001 to be fully realized. An innovative home health agency was initiated by the Sinclair School of Nursing specifically to help older adults age in place in the environment of their choice. In 2004, an innovative independent living environment was built and is operated by a private long term care company, as a special facility where residents can truly age in place and never fear being moved to a traditional nursing home unless they choose to do so. With care provided by the home care agency with registered nurse care coordination services, residents receive preventative and early illness recognition assistance that have markedly improved their lives. Evaluation of aging in place reveal registered nurse care coordination improves outcomes of cognition, depression, activities of daily living, incontinence, pain, and shortness of breath as well as delaying or preventing nursing home placement. Links with MU students, faculty, and nearly every school or college on campus enrich the lives of the students and residents of the housing environment. Research projects are encouraged and residents who choose to participate are enjoying helping with developing cutting technology to help other seniors age in place.     

Social and Health Factors Affecting Community Service Use by Vulnerable Older People

Abstract

This article reports on Outcomes for older people with complex or chronic care needs, a study undertaken by the Brotherhood of St Laurence and La Trobe University, examining older Victorians’ use of community services following Aged Care Assessment Service (ACAS) recommendations that they remain living at home. The paper reports on interviews with older people and carers undertaken at three-monthly intervals, over 12 months. This paper contributes to understanding the factors that impede or facilitate uptake of community aged care services that are critical to meeting the needs of older people and their carers. The study found that among other factors social isolation, high carer burden, and the older person reporting low mood were important barriers to service uptake. Cost, waiting lists, and service satisfaction were also identified in qualitative data as influencing factors. The study concludes there is a need for better means of identifying and supporting older people and carers at risk to improve community service uptake.