The impact of place attachment on well-being for older people in high-density urban environment: a qualitative study

Aging in place has become a popular social policy worldwide. This paper argues that well-being is an important outcome of aging in place, upon which older people develop autonomy and environmental proactivity. The temporal dimension of aging in place highlights development of place attachment, which includes place identity and place dependence. The study explores how older people, who live inhigh-density urban environments, make sense of well-being and place attachment by articulating their daily lives. Community dwelling older people aged 65 and above, who came from neighborhoods with high aging population and residential density but high and low median household incomes, were invited for focus group discussions. Multifaceted meanings of well-being include various dimensions that cover individual-collective and material-spiritual (psychological) construct. Meanings of place attachment include values of, bonding ties to, and memories about places. Three pathways are identified linking place attachment and multifaceted well-being. The study finds that social welfare and material richness are not the only determinants of well-being. Fulfillment of higher psychological needs, such as positive evaluation of life and self-actualization, should be emphasized by which older people can make the most of their life in old age.

Personal Competence or Environmental Characteristics? Factors Influencing Happiness among Ageing Adults in Hong Kong Around the Period of COVID-19 Pandemic

Drawing upon person-environment fit perspective, this study examines the joint and interactive influences of personal competence and environmental characteristics on the happiness of ageing adults around the period of COVID-19 pandemic. Data was collected in two rounds, before and during the pandemic, with 2,028 participants aged 55 years and older in Hong Kong. Personal competence encompassed financial status, physical health, and mental capital, while environmental characteristics included experiences of ageism, perceived social conditions, and age-friendly policies. Ordinary least squares regression was used to examine personal and environmental influences on happiness. Results indicated a significant decline in happiness following the onset of COVID-19 pandemic. Mental capital was found to have the strongest positive influence on happiness, followed by physical health, financial status, and social conditions. Mental capital mitigated the negative relationship between experiences of ageism and happiness. Practical interventions are informed to improve the well-being of ageing adults during pandemic.

Person-Environment Exchange Processes in Transition into Dementia: A Scoping Review

BACKGROUND AND OBJECTIVES

The important role that the environment plays in the lives of older people is widely acknowledged. To date, little is known about person-environment processes during the early stages of dementia. This scoping review aims to provide an overview of the processes involved during early dementia and the relationship to different dimensions of their life space.

RESEARCH DESIGN AND METHODS

A scoping review was conducted according to the Johanna Briggs Institute Manual, which involved searching for research on early dementia and the environment across 3 databases.

RESULTS

A total of 1,358 records were screened, with 284 sources included in the first categorization of the diverse relationships that exist between the environment and the person living with early dementia. Finally, 102 sources were selected that describe person-environment exchange processes of agency, belonging, or stress. People living with dementia actively shape, use, seek out, and avoid their environment as a reaction to both declining abilities and environmental barriers. Specifically, feelings of connectedness and familiarity are important.

DISCUSSION AND IMPLICATIONS

Taking both an environmental gerontology perspective and a processual, that is, transition perspective broadens the understanding of the experience and behavior of people living with early dementia. They constantly interact with and shape their environment and desire a sense of belonging. This sense of belonging might be threatened by dementia but can be actively reinforced by people living with dementia. These person-environment processes and their dynamics over time should be further investigated. Especially, quantitative data and data on socioeconomic environments are lacking.

Links between life-course SES and frailty trajectory moderated by community environment resources: Person-environment Fit perspective

INTRODUCTION

Drawing from the life course and person-environment fit perspectives, this study examined whether life-course SES disadvantages during childhood, adulthood and old- age influence frailty development in late- life and how community environment resources moderated the association between life-course SES disadvantages and frailty trajectories over a seven-year follow-up period.

METHODS

Data from 11,675 participants aged ≥ 50 years at baseline who participated in the four waves (2011-2018) of the China Health and Retirement Longitudinal Survey (CHARLS) were used. Life-course SES disadvantages were self-reported, and community environment resources (basic infrastructure and voluntary organizations) were ascertained from informed officials in the community. Frailty development was measured at each wave by the Frailty Index (FI) based on 39 potential deficits. Multilevel growth modeling was used to examine the interactive effect of life-course SES disadvantages and community environment resources on frailty development.

RESULTS

Life-course SES disadvantage exerted cumulatively negative effects on frailty trajectory, and individuals with SES disadvantages in two or three life stages reported higher initial levels of and faster increases in frailty scores. Community environmental resources (basic infrastructure and voluntary organizations) had a protective effect on frailty development and buffered the negative effects of SES vulnerability experiences accumulated over the life course. Community basic infrastructure resources played an important role in slowing the progression of frailty for individuals with cumulative SES disadvantage and downward mobility.

DISCUSSION

Our findings provided new evidence of person-environmental docility among older adults, documenting the role of community resources in buffering SES disparities in health during later-life.

Navigability of Residential Care Homes From Residents', Family Members', and Staff's Points of View: The Residential Care Home Navigability Scale

BACKGROUND AND OBJECTIVES

Navigational skills display clear signs of decline with increasing age, especially in pathological aging. Therefore, navigability-the extent to which destinations can be reached with reasonable effort and time-should be considered in residential care home design. We aimed to develop a scale assessing environmental features (i.e., indoor visual differentiation, signage, and layout) for navigability in residential care homes: the Residential Care Home Navigability (RCHN) scale. To this end, we examined whether navigability and its factors were associated with a sense of direction within the residential care homes to different degrees for older adult residents, caregivers, and staff. The relationship between navigability and residential satisfaction was also considered.

RESEARCH DESIGN AND METHODS

A sample of 523 participants (230 residents, 126 family caregivers, and 167 staff members) responded to the RCHN, assessed their sense of orientation and general satisfaction, and performed a pointing task.

RESULTS

Results confirmed the RCHN scale's 3-level factor structure, good reliability, and validity. A subjective sense of direction, but not pointing task performance, was associated with navigability and its factors. In particular, visual differentiation is positively associated with a sense of direction regardless of group, whereas signage and layout contributed to a better experience of a sense of direction, especially among older residents. Navigability was not related to residents' satisfaction.

DISCUSSION AND IMPLICATIONS

Navigability supports perceived orientation in residential care homes, especially for older residents. Moreover, the RCHN is a reliable tool for the assessment of RCHN, with important implications for minimizing spatial disorientation through environmental interventions.

A scoping review protocol of age-friendly practices during the COVID-19 pandemic

Background: Actions focused on age-friendly environments contribute to promote and maintain older people’s functional ability and may enable them to contribute to their communities and enjoy life. As such, age-friendly practices require collaboration between diverse stakeholders across multiple sectors responsible for natural, built, and social environments, which can be particularly relevant during public health emergencies when socio-ecological vulnerabilities become more salient and may disproportionally affect older people. This paper presents a protocol for a scoping review aiming to investigate the breadth of evidence concerning the development, implementation, and evaluation of age-friendly practices during the COVID-19 pandemic. The protocol sets out the objectives, methods, and dissemination plans for the review. Methods: The scoping review will be conducted in line with the Joanna Briggs Institute (JBI) scoping review methodology. We will search databases (PubMed, Web of Science, Embase, CINAHL, Scopus, PsychNet) and grey literature sources. Publications relating to practices across the 8 domains of the World Health Organization’s age-friendly cities and communities’ framework will be included. A tabular data extraction tool will be used to facilitate a narrative synthesis of results. Ethics and dissemination: Ethical approval is not required as the methods proposed for this scoping review consist of collecting publicly available data. Findings will be reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews (PRISMA-ScR) and submitted to a journal for academic dissemination. Lay dissemination plans include an infographic and a blog-style article presenting our core results. Conclusion: The publication of this protocol allows for transparency in the systematic process of a scoping review focused on age-friendly practices during COVID-19. Findings emerging from the scoping review will provide insights into the evidence available regarding age-friendly activities during COVID-19 and may inform future age-friendly practices during public health emergencies and beyond.

Codesigning a Culture-Centered Age-Friendly Community for Māori Kaumātua: Cultural Principles and Practices

OBJECTIVES

This study examined a Māori (Indigenous people of Aotearoa New Zealand) age-friendly housing development. Two Māori community groups worked with multiple stakeholders to codesign a culture-centered, kaumātua (older adults) urban housing community. The purpose was to identify codesign and culture-centered principles in the development.

METHODS

Kaupapa Māori (Māori-centered) and participatory research methodologies guided the culture-centered research design. Data collection included 27 interviews with 19 residents and 12 organizational stakeholders; three focus groups with residents' families, service providers, and nonresident kaumātua (n = 16); and project documents. Data analysis used the framework method.

RESULTS

Three codesign process themes emerged: (a) Kaumātua-centered vision; (b) realizing the vision; and (c) living the shared vision.

DISCUSSION

Accounting for cultural practices in codesigning age-friendly and culture-centered housing for and with Indigenous older adults helps meet their cultural, social, health, and economic needs. The research offers a practical pathway to developing age-friendly housing environments for Māori kaumātua, their communities, wider society, and other Indigenous people.

Patients' and Caregivers' Perceptions of Intensive Care Unit Hospitalization and Recovery

BACKGROUND

Telehealth-based intensive care unit recovery clinics (ICU-RCs) can increase access to post-ICU recovery care for patients and their families. It is crucial to understand patients' and caregivers' experience of illness and recovery to build patient- and family-centered ICU-RCs.

OBJECTIVE

To explore patients' and caregivers' perceptions of ICU hospitalization and recovery.

METHODS

Individual semistructured telephone interviews were conducted with 14 patients and 12 caregivers who participated in a telehealth ICU-RC. This study was guided by qualitative description methodology. Conventional content analysis was used to analyze the data.

RESULTS

Patients described their ICU hospitalization as scary, traumatic, and lonely. Participants' feedback on hospitalization ranged from praise to criticism. Patients wanted more realistic and detailed prognostication about post-ICU recovery and more physical therapy after discharge. Patients strongly valued the mental health component of ICU-RC visits, which contrasted with the scant attention paid to mental health in other postdischarge health care settings. Their knowledge about post-ICU recovery and connectedness to a primary care provider varied.

CONCLUSIONS

Examining patients' and caregivers' perceptions of ICU hospitalization and recovery highlights ICU-RC components that can be strengthened to support patient- and family-centered recovery. The ICU-RC staff should invite patients to share feedback about their ICU stay; give a timely, realistic prognosis for recovery; offer mental health consultations; provide physical therapy; and partner with patients and their caregivers to develop and deliver post-ICU care.

Healthy Aging-Relevant Goals: The Role of Person-Context Co-construction

OBJECTIVES

This article considers how individuals' motivation for healthy aging manifests within the myriad of different contexts that older adults are embedded in as they move through later life.

METHODS

Drawing on the concept of co-construction, we argue that persons and contexts both contribute to the emergence, maintenance, and disengagement from healthy aging relevant goals in adulthood and old age.

RESULTS

To promote the understanding of such co-constructive dynamics, we propose four conceptual refinements of previous healthy aging models. First, we outline various different, often multidirectional, ways in which persons and contexts conjointly contribute to how people set, pursue, and disengage from health goals. Second, we promote consideration of context as involving unique, shared, and interactive effects of socio-economic, social, physical, care/service, and technology dimensions. Third, we highlight how the relevance, utility, and nature of these context dimensions and their role in co-constructing health goals change as individuals move through the Third Age, the Fourth Age, and a terminal stages of life. Finally, we suggest that these conceptual refinements be linked to established (motivational) theories of lifespan development and aging.

DISCUSSIONS

In closing, we outline a set of research questions that promise to advance our understanding of the mechanisms by which contexts and aging persons co-construct healthy aging relevant goals and elaborate on the applied significance of this approach for common public health practices.

Aging in place among older adults with histories of traumatic experiences: A scoping review

BACKGROUND AND OBJECTIVES

Adverse childhood and adult experiences can have far-reaching impacts, and when coupled with typical aging-related changes, may impede achievement of a suitable person-environment fit for aging adults. The objective of our study was to determine if extant literature connects older adults with trauma history to successfully aging in place.

RESEARCH DESIGN AND METHODS

We proposed a conceptual model regarding trauma history, adaptive capacity of aging adults, and trauma-informed supports for aging in place. We conducted a scoping review using six databases [key words older adult(s), aging in place, housing, trauma], with a full review of 32 articles.

RESULTS

Insights included: 1) Aging in place does not have to mean living in the same house over time. 2) The uncertainty of the aging process can be traumatic and can be exacerbated by previous traumatic experiences. 3) Environmental sensitivities can result from previous traumatic experiences and cause further trauma. 4) Housing precarity is a traumatic experience. 5) Permanent supportive housing is an important resource for people in crisis. 6) Community supports are critical to aging in place.

DISCUSSION AND IMPLICATIONS

Our review revealed insights about aging in place and trauma, but did not connect the vulnerabilities specific to aging adults with personal trauma histories to aging in place. Research is needed that confirms the relationship between history of traumatic experiences and difficulties with aging in place as well as trauma-informed approaches that can mitigate housing-related stressors and foster community living environments that provide equitable access to aging in place.

Functional Limitations and Perceived Neighborhood Walkability Among Urban Dwelling Older Adults

Older adults with functional limitations (FLs) often experience obstacles to walking. Although health promotion programs targeting physical activity are available in lower-income areas, few studies have compared the walking experiences of older adults who have FLs with those who do not in the community. The purpose of this cross-sectional survey was to compare perceptions of neighborhood walkability among older adults living in lower-income communities with and without FLs. Participants (N = 132) were recruited in 2018 at regional health clinics in Flint, Michigan. To be eligible, participants had to be 65 years of age or older, report no cognitive decline, and be Flint residents. Of the 132 participants, the mean age was 69.74 (SD = 4.97). The majority were female (66%); African American (77%); single, divorced, or widowed (72%); educated below the General Education Development level (57%), and had a FL (67%). Older adults with FLs were significantly (p < 0.05) less likely than those without to visit many places within walking distance, to have well-lit neighborhoods at night, and to reside in neighborhoods where sidewalks were separated from the road and traffic. Multiple regression analyses revealed that having a FL was associated with poorer neighborhood perceptions of mixed-land-use (b = −0.19, p < 0.05) and more walking hazards (b = −0.26, p < 0.05). Findings suggest that a FL is associated with perceptions of walkability. It is essential to develop disability-friendly support systems and accommodations to encourage walking in lower-income communities.

Exploring life-space in the nursing home. An observational longitudinal study

BACKGROUND

Traditional performance-based measurements of mobility fail to recognize the interaction between the individual and their environment. Life-space (LS) forms a central element in the broader context of mobility and has received growing attention in gerontology. Still, knowledge on LS in the nursing home (NH) remains sparse. The aim of this study was to identify LS trajectories in people with dementia from time of NH admission, and explore characteristics associated with LS over time.

METHODS

In total, 583 people with dementia were included at NH admission and assessed biannually for 3 years. LS was assessed using the Nursing Home Life-Space Diameter. Association with individual (age, sex, general medical health, number of medications, pain, physical performance, dementia severity, and neuropsychiatric symptoms) and environmental (staff-to-resident ratio, unit size, and quality of the physical environment) characterises was assessed. We used a growth mixture model to identify LS trajectories and linear mixed model was used to explore characteristics associated with LS over time.

RESULTS

We identified four groups of residents with distinct LS trajectories, labelled Group 1 (n = 19, 3.5%), Group 2 (n = 390, 72.1%), Group 3 (n = 56, 10.4%), Group 4 (n = 76, 14.0%). Being younger, having good compared to poor general medical health, less severe dementia, more agitation, less apathy, better physical performance and living in a smaller unit were associated with a wider LS throughout the study period.

CONCLUSION

From NH admission most NH residents' LS trajectory remained stable (Group 2), and their daily lives unfolded within their unit. Better physical performance and less apathy emerged as potentially modifiable characteristics associated with wider LS over time. Future studies are encouraged to determine whether LS trajectories in NH residents are modifiable, and we suggest that future research further explore the impact of environmental characteristics.

Effects of peri-traumatic stress experienced during Hurricane Sandy on functional limitation trajectories for older men and women

BACKGROUND AND METHODS

Although the short-term effects of disasters on the physical health of mid-life and older people have been documented, little is understood about the long-term effects that disasters have on the physical health of these people. Based on the environmental docility hypothesis and research regarding gender effects on functional limitations and disaster, our analyses examined the effects of peri-traumatic stress experienced during Hurricane Sandy using longitudinal data from 5688 people aged 50 and older collected over six waves (2006-2019).

RESULTS

We found that functional limitations follow three trajectories, with people in each group having a significant linear increase over time and all but the highest functioning people also having a significant quadratic effect, indicating that the linear increase peaked post-Hurricane and then slowed in later waves.

CONCLUSION

Consistent with the environmental docility hypothesis, peri-traumatic stress had its greatest impact on people with more functional limitations before the hurricane. Men experiencing peri-traumatic stress during Hurricane Sandy were more likely to experience an increase in functional limitations than women. These findings, which identify people most likely to experience long-term health effects following a disaster, can be used to inform health policies before, during, and after disaster strikes.

Older people as active agents in their neighbourhood environments: Moving house can improve quality of life

BACKGROUND AND OBJECTIVES

Neighbourhood environments are an important aspect of well-being for older people. Developments of the general ecological model recognise older people as active agents who adapt their environments to fit their changing needs. We provide empirical support for a model suggested by Wahl et al., by examining interactions between neighbourhood environments, personal situations, relocation, and quality of life among older people.

RESEARCH DESIGN AND METHODS

Two statistical models were tested with a sample of community dwelling participants (aged 55-89) in the New Zealand Health, Work and Retirement longitudinal surveys conducted in 2016 (T1) and 2018 (T2). Multiple linear regression assessed the association of perceptions of housing and neighbourhood with quality of life (QoL) at T1 (n = 3682).

RESULTS

QoL was predicted by housing satisfaction, and neighbourhood satisfaction, accessibility, and trust (controlling for age, gender, marital status, home ownership, SES, physical health and mental health). Mixed ANOVA showed that those who moved house between T1-T2 reported lower housing and neighbourhood satisfaction than non-movers at T1. Over time T1-T2, movers reported less decline in housing satisfaction, and more positive change on all neighbourhood perceptions, with higher perceptions of neighbourhood accessibility than non-movers at T2.

DISCUSSION AND IMPLICATIONS

These findings support the theoretical model and provide impetus for more detailed study of the effects of the environment on well-being in older age. Housing and neighbourhood environments are a very practical focus for social policy change at local and national levels.

Advanced old age as a developmental dilemma: An in-depth comparison of established fourth age conceptualizations

Distinguishing the Fourth Age (FoA) from the Third Age (ThA) has become a common practice in aging research. In this theoretical paper, we focus on four established conceptualizations of the ThA-FoA distinction, i.e., (1) Neugarten's work on the young-old vs. the old-old; (2) Laslett's concept of the innovative life period of the ThA; (3) Erikson's 9th life stage approach; and (4) Baltes' approach considering the FoA as the most radical incompleteness of the human condition. After a comparative descriptive analysis, we extract evaluative elements inherent in the four approaches according to six categories: (1) fundamental values; (2) positive evaluative elements; (3) negative evaluative elements; (4) the decline vs. growth view; (5) the continuity vs. discontinuity view; and (6) values related to practical issues. As an overarching result of our analysis, we conclude that all conceptions face - in different ways - dilemmas that seem difficult to solve. One option may be to give up all ambitions toward agency for the FoA and indeed qualify this phase as the "aging without agency" phase of life. Doing so, however, seems ethically questionable, because it would give up acknowledged values connected with a good human life such as human goal-directed autonomy and freedom. In conclusion, the ThA-FoA distinction, although arguably a needed and helpful roadmap for the recent decades of aging science, comes with enduring disadvantages and eventually even risks. Therefore, in future aging science, we recommend avoiding the ThA-FoA distinction or at least using it only in combination with a critical attitude.