Frank Oswald

Aging Well and the Environment: Toward an Integrative Model and Research Agenda for the Future

PURPOSE OF THE STUDY The effects of the physical-spatial-technical environment on aging well have been overlooked both conceptually and empirically. In the spirit of M. Powell Lawtons seminal work on aging and environment, this article attempts to rectify this situation by suggesting a new model of how older people interact with their environment. DESIGN AND METHODS Goals of the paper include (a) integration of the essential elements of the ecology and aging literature, particularly in regard to Lawtons research, (b) development of connections between traditional theories of ecology of aging and life span developmental models of aging well, (c) acknowledgment of the pronounced historical and cohort-related changes affecting the interactions of older people with their environment, and (d) discussion of the implications of this analysis for concepts and theories of aging well. RESULTS The model builds on a pair of concepts: environment as related to agency and belonging, founded in motivational psychology, and developmental science. IMPLICATIONS After describing the models key components, we discuss its heuristic potential in four propositions for future gerontological research and identify implications of the model for future empirical research.

The Home Environment and Disability-Related Outcomes in Aging Individuals: What Is the Empirical Evidence?

PURPOSE Building on the disablement process model and the concept of person-environment fit (p-e fit), this review article examines 2 critical questions concerning the role of home environments: (a) What is the recent evidence supporting a relationship between home environments and disability-related outcomes? and (b) What is the recent evidence regarding the effects of home modifications on disability-related outcomes? DESIGN AND METHODS Using computerized and manual search, we identified relevant peer-reviewed original publications and review articles published between January 1, 1997, and August 31, 2006. For Research Question 1, 25 original investigations and for Research Question 2, 29 original investigations and 10 review articles were identified. RESULTS For Research Question 1, evidence for a relationship between home environments and disability-related outcomes for older adults exists but is limited by cross-sectional designs and poor research quality. For Research Question 2, evidence based on randomized controlled trials shows that improving home environments enhances functional ability outcomes but not so much falls-related outcomes. Some evidence also exists that studies using a p-e fit perspective result in more supportive findings than studies that do not use this framework. IMPLICATIONS Considerable evidence exists that supports the role of home environments in the disablement process, but there are also inconsistencies in findings across studies. Future research should optimize psychometric properties of home environment assessment tools and explore the role of both objective characteristics and perceived attributions of home environments to understand person-environment dynamics and their impact on disability-related outcomes in old age.

Is Aging in Place a Resource for or Risk to Life Satisfaction

PURPOSE Given age-related health restrictions, the importance of the environment for life satisfaction may increase in later life. This study investigated whether objective and perceived physical and social environmental aspects of the home and of the surrounding neighborhood represent resources for or risks to life satisfaction among young-old and old-old individuals. DESIGN AND METHODS A population-based sample of 381 community-dwelling individuals aged 65-94 years reported on their sociophysical environment and life satisfaction using questionnaires. RESULTS On average, young-old differ from old-old in indoor physical environmental indicators but not in neighborhood characteristics or social aspects of housing. Regression analyses revealed that apartment size, perceived neighborhood quality, and outdoor place attachment explained life satisfaction independently, whereas social housing aspects played only a minor role. Separate analyses for both age groups revealed age differential explanation patterns. Apartment size was positively related to life satisfaction in the young-old but was negatively related in the old-old. For the old-old, perceived neighborhood quality and outdoor place attachment were more important than for the young-old. Living with others was positively related to life satisfaction only for the young-old.  IMPLICATIONS Environmental characteristics at home and in the neighborhood need to be considered to better understand differential processes of aging in place with respect to well-being.

The use of advanced tracking technologies for the analysis of mobility in Alzheimer's disease and related cognitive diseases

BackgroundOne of the more common behavioral manifestations of dementia-related disorders is severe problems with out-of-home mobility. Various efforts have been attempted to attain a better understanding of mobility behavior, but most studies are based on institutionalized patients and the assessment usually relies on reports of caregivers and institutional staff, using observational approaches, activity monitoring, or behavioral checklists. The current manuscript describes the research protocol of a project that measures mobility in Alzheimers disease and related cognitive disorders in an innovative way, by taking advantage of advanced tracking technologies.Methods/designParticipants are 360 demented persons, mildly cognitively impaired persons, and unimpaired controls aged ≥ 65 in Israel and Germany. Data regarding space-time activities will be collected via a GPS tracking kit for a period of 4 weeks in 3 waves (one year apart) with the same participants (using a repeated measures design). Participants will be interviewed by use of a battery of instruments prior to and following GPS data collection. Further, a family member will complete a questionnaire both before and after data tracking.Statistical analyses will strive to explain differences in mobility based on a wide range of socio-structural, clinical, affect-related and environmental variables. We will also assess the impact of the use of advanced tracking technology on the quality of life of dementia patients and care givers, as well as its potential as a diagnostic tool. Systematic assessment of ethical issues involved in the use of tracking technology will be an integral component of the project.DiscussionThis project will be able to make a substantial contribution to basic as well as applied and clinical aspects in the area of mobility and cognitive impairment research. The innovative technologies applied in this study will allow for assessing a range of dimensions of out-of-home mobility, and provide better quality data.

Person—environment fit predicts falls in older adults better than the consideration of environmental hazards only

Objective: To test the hypotheses that the empirical consideration of objective person—environment fit in the home environment is a stronger predictor of indoor falls among older adults than the assessment of environmental barriers only, and that perceived aspects of home play a role as predictors for falls. Design: Survey study with data collection at home visits, followed up by self-reports about falls at home visits one year later. Setting: Urban districts in Sweden, Germany, Latvia. Participants: Eight hundred and thirty-four single-living, older adults (75—89 years), in ordinary housing. Measurements: An assessment of objective person—environment fit in the home environment (housing enabler), a self-rating of the perceived home environment (usability in my home) and retrospective self-reports on indoor falls. Results: The participants reporting falls tended to be frailer than the non-fallers. The number of environmental barriers in the home was similar for the fallers and non-fallers; the magnitude of person—environment fit problems was higher among the fallers. The person—environment fit problem variable was a stronger fall predictor (odds ratio (OR) = 1.025; P=0.037) than number of environmental barriers (n.s.), even after controlling for confounders. Fallers also experienced lower usability of their home. Conclusion: The results suggest that much of the inconclusiveness of the data in the relationship between environmental hazards and falls in the previous falls literature could be due to the neglect of person—environment fit assessment. The effectiveness of environmental interventions based on the notion of person—environment fit compared with traditional home hazard checklists remains to be tested.

Voices on Relocation and Aging in Place in Very Old Age—A Complex and Ambivalent Matter

PURPOSE This cross-national qualitative study explores how very old people reflect upon relocation and aging in place. DESIGN AND METHODS Swedish and German data are utilized in this study. About 80 community-living participants, 80-89 years of age, were interviewed with open-ended questions at home by trained interviewers. The interviews were analyzed by using conventional qualitative content analyses. RESULTS Reasoning about relocation or aging in place in very old age is a complex and ambivalent matter. A variety of reflections, emotions, and behaviors for and against a move are revealed. Reasons to move reflect the urge to maintain independence, to stay in control, and to avoid loneliness. This is mainly expressed reactively. Reasons not to move reflect a strong attachment to the home and neighborhood. Moreover, reasons not to move reflect practical aspect such as economy and strain, as well as fear of losing continuity of habits and routines. IMPLICATIONS There is a need for society to develop counseling systems to meet very old peoples ambivalence and practical considerations to move or not to move. Thus, the ambivalence to stay put or to relocate needs to be further explored from an applied perspective by also taking nonmovers into account.

Toward Measuring Proactivity in Person-Environment Transactions in Late Adulthood

Abstract Both a life-span developmental control perspective as well as an environmental gerontology view, particularly Lawtons notion of environmental proactivity, served as the theoretical background to suggest a new dimension of domain-specific control, namely housing-related control beliefs. The newly developed 23-item Housing-Related Control Beliefs Questionnaire (HCQ) is based on the widely used dimensions of Internal Control, External Control: Powerful Others, and External Control: Chance. In two studies of older adults (N= 485; 66-69 years and N= 107; 65-91 years), we examined the psychometric quality of the questionnaire and explored its relation with socio-structural variables, general control beliefs, and a set of housing-related aspects. Psychometric results indicate satisfactory levels of internal consistency and re-test stability in all three scales of the instrument and factor analysis supported the theoretically expected three-factor solution. Also, HCQs external control subscales were correlated with higher age, lower education, and lower income and the correlational pattern between the HCQ and a general control measure was substantial and consistent with theoretical expectations. Relations between the HCQ and objective and subjective housing-related variables tended to be low in size. These preliminary findings suggest the potential usefulness of the HCQ as a measure to address environmental proactivity in late adulthood.

Housing-related control beliefs and independence in activities of daily living in very old age

Control beliefs, i.e. a persons perceived control over his or her own behaviour, are important predictors of psychological functioning in old age. The aim of this study is to examine the mediating effect of housing-related control beliefs on the relationship between housing accessibility and independence in activities of daily living (ADL). Moreover, cross-national differences in five European countries were analysed, based on data from the ENABLE-AGE Project. Data were collected at home visits with 1 918 very old people aged 75–89 years, living alone at home in Swedish, German, British, Hungarian, and Latvian urban areas. Assessments were based on standardized instruments with good psychometric properties. Correlations showed small to medium relationships between accessibility, housing-related control beliefs, and ADL independence. Further, multi-group structural equation modelling revealed that not only housing accessibility but housing-related control beliefs explain unique portions of variation in the independent performance of daily activities. In particular, participants with lower external control beliefs performed more independently in ADL. Though some differences among countries were observed, cross-national similarity in correlative patterns existed regarding control beliefs and independence in ADL. Introducing the concept of housing-related control beliefs into occupational therapy, comprehensively and cross-nationally, has the potential to increase our professional understanding of older peoples housing situation.

Out-of-Home Behavior and Cognitive Impairment in Older Adults Findings of the SenTra Project

This study explores differences in the out-of-home behavior of community-dwelling older adults with different cognitive impairment. Three levels of complexity of out-of-home behavior were distinguished: (a) mostly automatized walking behavior (low complexity), (b) global out-of-home mobility (medium complexity), and (c) defined units of concrete out-of-home activities, particularly cognitively demanding activities (high complexity). A sample of 257 older adults aged 59 to 91 years (M = 72.9 years, SD = 6.4 years) included 35 persons with early-stage Alzheimer’s disease (AD), 76 persons with mild cognitive impairment (MCI), and 146 cognitively healthy persons (CH). Mobility data were gathered by using a GPS tracking device as well as by questionnaire. Predicting cognitive impairment status by out-of-home behavior and a range of confounders by means of multinomial logistic regression revealed that only cognitively demanding activities showed at least a marginally significant difference between MCI and CH and were highly significant between AD and CH.

Natural Occurrence of Subjective Aging Experiences in Community-Dwelling Older Adults

OBJECTIVES The subjective experience of aging is a relevant correlate of developmental outcomes. However, traditional approaches fall short of capturing the inherent multidimensionality of subjective aging experiences (SAEs). Based on the concept of Awareness of Age-Related Change (AARC; Diehl, M. K., & Wahl, H.-W. (2010). Awareness of age-related change: Examination of a (mostly) unexplored concept. Journals of Gerontology: Series B: Psychological Sciences and Social Sciences, 65, 340-350. doi:10.1093/geronb/gbp110), this study provides a description of SAEs that is facet rich, and based on their natural occurrence, analyzes interindividual differences and associations with well-being. METHOD Data came from 225 participants (70-88 years) of the ongoing BEWOHNT study. Open-ended diary entries about age-related experiences were collected for more than 14 days and coded according to AARC domains and subdomains. RESULTS Seventy percent of all participants had SAEs about physical functioning. About half of the sample reported experiences in the domains interpersonal relations, social-emotional and social-cognitive functioning (COGN-EMOT), and lifestyle. Thirty percent experienced aging in terms of changes in cognitive functioning. Contents of SAEs varied by gender, age group, and functional status. SAEs about COGN-EMOT were most consistently related to affective components of subjective well-being. DISCUSSION Our results demonstrate the benefits of an open-ended approach to a multidimensional understanding of SAEs. Content-related, social-cognitive and social-emotional changes more than functional age-related changes were most important for well-being.