Benyamin Schwarz

Environmental Gerontology: What Now?

During the past two decades, environmental gerontology has not flourished as scholars in the field once anticipated. This article considers reasons for this claim, focusing specifically on the place of theory and, more broadly, on the undergirding functions of paradigms for the field. It is argued that progress in this diverse field has slowed in recent years due the decline of useful theoretical research on practice, the limited applicability of current research in the field, and a positivist approach that focuses on predictive, context-independent processes while ignoring the physical environment is an essential contextual element in the aging process. Moreover, it is argued that claims that adoption of a natural or “hard” science paradigm will reinvigorate research in environmental gerontology are misguided. Rather, the case is made that environmental gerontology is not a “normal” science (judged against Kuhnian criteria) but appears currently to be in a pre-paradigmatic stage. Debates within the social-behavioral sciences about their “real science” status directly affect environmental gerontology, particularly with regard to context-dependent and independent findings. Consistent with an interpretive perspective, it is argued that because environmental gerontology ultimately solution-driven, it must focus on practical activity and practical knowledge generated from context-bound, every-day practices. This requires holistic methodologies such case studies, precedents, and exemplars necessarily and directly tied to their actual local contexts.

Dementia Special Care Units

Abstract Despite continued interest and growth in special care units in the United States, there is no uniform agreement on characteristics for these units, specific outcomes, or satisfaction with them. This study examined family satisfaction with Dementia Special Care Units (SCUs) using a modified standardized instrument and follow-up interviews. The study included five SCUs in one state, three participating in a dementia SCU demonstration project. Family outcomes were evaluated using surveys and interviews. The only significant difference between facilities in the demonstration project and the comparison facilities was one variable noting family with residents in the demonstration project had more positive perceptions regarding resident safety. The study illustrates a need for policy makers to more clearly identify and regulate special aspects of SCUs, taking family perceptions into consideration.

M. Powell Lawton's Three Dilemmas in the Field of Environment and Aging

Abstract Three scholarly dilemmas have characterized Powell Lawtons career: basic versus applied research; theory-driven versus empirically-dominated research; and the intrinsic psychological dilemma of person-environment transactions. These themes serve as an organizing framework for the analysis of the discipline of environment and aging studies. Researchers in this field share a social mission as well as the responsibility to gain theoretical and applied knowledge for intervention that can improve the quality of older peoples lives. At the same time, research in this field hinges on the willingness of those who are supposed to benefit from the research, to try it out, and use the results. The chapter is an attempt to use Lawtons seminal contribution to this field in order to look to the future of theory, practice and policy in environment-aging studies.

Place of Death and Dying: Introduction

The subject of death is of a considerable interest to all of us, as it has been since the beginning of civilization. However, the place of dying has seldom been studied in the field of environmental gerontology. The concept of aging in place is often explored in the field, but the discussion normally stops short of the last stages as if aging in place is a condition that never ends. Still, dying is part of the inevitability of aging. And even though a number of scientists and statisticians argue whether people die of old age, there is plenty of evidence that life has its natural, inherent limits. Clearly, intrinsic physical developments associated with aging inevitably cause an individual to become more vulnerable to mortality, which “ends in all cases we know of, in death” (Ehrenreich, 2018, p. xv). Even the most successful aging process eventually involves accumulation of disabilities as a result of the ongoing conflict at the cellular level of our bodies. Sadly, “successful” aging is an ideal that hardly accommodates the realities of decline and death (Ehrenreich, 2018). Conforming to the modern demographic pattern, the majority of people in the Western society reach old age, and consequently they are destined to die of one of its ravages. No matter how good our medical care or our exercise and hygienic regimens are, our ability to control the biological continuum between “normal” aging and disease is very limited. We are all susceptible to chronic diseases and death (Cole, 1992), as the paradoxical nature of aging and death discloses.

The “Medicalized Death”: Dying in the Hospital

Abstract This article is part of a larger study dedicated to the place of death and dying. The focus of this article is on the “medicalized death” of older people who died in hospitals in Israel and the United States and is based on the experiences of four family members who cared for them at the end of their lives. In-depth interviews were conducted with each participant, and narrative analysis methods were utilized to identify themes in the data. In the findings section, participant accounts are presented as individual monologues, each followed by the authors’ theoretical commentary. Despite the fact that the process of dying in a hospital is often depicted in the media as being fraught with excessive and aggressive procedures, the cases described in this article suggest there is marked ambiguity and contradiction experienced by caregivers and patients regarding the hospital setting for the process of dying. In some cases, the hospital was perceived as a preferred place for dying because it often reduced caregiver strain. However, participants also remarked on many undesirable aspects about hospital deaths, including dying in the company of strangers; the lack of empathy from physicians; existential dilemmas about the withdrawal of treatment; and several more.

The Last Habitat: Living and Dying in Residential Care Facility

Abstract This article is a part of a larger study regarding the place of dying. Through narrative analysis methods, we strived to obtain rich descriptions and idiosyncratic accounts of the experience of dying in institutional settings, predominately in the nursing home. The quality of the physical environment can impede or greatly enhance the extent to which a disabled older person can remain in his or her own home. Most of long-term care is provided by family members. However, as the condition of the care recipient deteriorates and the stress level of the caregiver increases, the need to supplement the informal care with formal care resources grows. Consequently, frail older adults may be relocated to a residential care facility. In other cases they may be discharged from a hospital to these institutional settings. Nursing homes are considered the last resort for frail, old people. Despite attempts to improve the environment of long-term care settings through “cultural change,” the overriding theme of much of the literature about the nursing home experience is one of rejection, loss, and in some extreme accounts, a “double burial” that equates relocation to a nursing home with a person’s final terminus of life.

Care Pathways for the Dying Patients: Physician Perspective

Abstract The overriding care philosophy in medicine is to prevent death, rather than focus on dying. However, increasing longevity in most parts of the world has resulted for many people in prolonged periods of declining health toward the end of life. This has complicated our understanding of when the dying process begins. As a result, there has been a growing movement within society and among health care systems to focus on finding ways to contribute to the quality of life of patients just before they die. The modern hospice and palliative-care movement has gained distinction as an alternative way of looking at health care. These care philosophies perceive dying as a natural part of the life cycle. Staff members prioritize comfort and quality of life over longevity. However, the goals of hospice and palliative care are often misunderstood by the public. This article is based on interviews with two palliative-care physicians that were conducted as part of a larger study about the place of dying. The goal of these interviews was to obtain the physician perspective of dying at a hospital, at home, and in an institutional setting, as well as to provide readers greater clarity on the palliative and hospice care perspectives within these contexts.

The Motivations and Consequences of Dying at Home: Family Caregiver Perspectives

Abstract Although ample research suggests that individuals prefer to die at home, the realities of a home death experience, from the perspective of family members, are not well understood. The following study addresses this gap in knowledge via a narrative analysis about the process of dying at home. Five family caregivers participated in semistructured interviews about their experiences witnessing and supporting the end-of-life process of an older family member who died at home. Their stories paint a vivid picture about the motivations and consequences of the experience, including themes such as caregivers’ immense feelings of uncertainty regarding their caregiving abilities and decision making, the significance of the home environment as a symbol of comfort and security, the influence of family and social networks, and “dying well” as a social justice issue. Overall, the caregivers’ narratives support the notion that being at home is considered an essential aspect of ”dying well.” However, the narratives also demonstrate that dying at home presents many challenges for family members, especially to those with limited resources and social support. Thus, the authors caution against viewing the home death as a proxy for a good death.

Internalizing Values: Universal Design in the Design Studio

AbstractInternalizing values is a critical issue in environmental design education. The hidden curriculum in environmental design education in the design studio can be changed to include real-world problems and to implement the universal design concept. Universal design can promote social consciousness and focus the studio experience on process rather than on product. Using a design studio in assisted living housing for older adults, students were confronted with going beyond problem solving to problem setting. Coaching students to internalize the values of universal design is the mission of educators because universal design is a pivotal, sustained and valid base for the expansion of environmental design knowledge in discourse and application.