Hans-Werner Wahl

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.

Awareness of Age-Related Change: Examination of a (Mostly) Unexplored Concept

This theoretical article discusses the emerging concept of awareness of age-related change (AARC). We propose that a focus on AARC extends the research traditions on subjective age experiences and age identity and that examination of this concept can serve a stimulating role in social gerontology. After defining and contrasting AARC against similar concepts, several reasons for the relevance of this mostly unexplored construct are provided. The sample domains of health and physical functioning, cognitive functioning, and interpersonal relations are used to illustrate the relevance of AARC. Based on this review, we then provide a heuristic framework that describes antecedents, processes, and outcomes related to AARC. Overall, we argue that research on AARC should become an integral part of social gerontological research.

The dependency-support script in institutions: generalization to community settings.

This study tested the generalizability of the dependency-support script, a behavioral system describing and explaining dependent behaviors of the institutionalized elderly. A comparative study with 22 community-dwelling elderly was conducted, which identified typical interaction patterns between the elderly and family members or home health nurses. The dominant interaction pattern in the community setting, too, was the dependency-support script. In addition, however, a significant social response to independent self-care behavior was observed, which created a highly ambivalent response contingency. Independent behaviors were followed about twice as often by an incongruent (dependence-supportive) than by a congruent (independence-supportive) response. Expectations of incompetence and of the helping role are offered as explanations.

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.

The influence of subjective aging on health and longevity: A meta-analysis of longitudinal data

Evidence is accumulating on the effects of subjective aging-that is, how individuals perceive their own aging process-on health and survival in later life. The goal of this article is to synthesize findings of existing longitudinal studies through a meta-analysis. A systematic search in PsycInfo, Web of Science, Scopus, and Pubmed resulted in 19 longitudinal studies reporting effects of subjective aging on health, health behaviors, and longevity. The authors combine the outcomes reported in these studies using a random effects meta-analysis, assuming that there would be differences in effect sizes across studies. The meta-analysis resulted in an overall significant effect of subjective aging (likelihood ratio = 1.429; 95% confidence interval = 1.273-1.604; p < .001). The analyses revealed heterogeneity, with stronger effects for studies with a shorter period of follow-up, for studies of health versus survival, for studies with younger participants (average age of the studies varies between 57 and 85 years with a median of 63 years), and for studies in welfare systems where state provisions of welfare are minimal. However, effects did not vary either across different operationalizations of subjective aging or by study quality. Subjective aging has a small significant effect on health, health behaviors, and survival. Further theoretical conceptualizations and empirical studies are needed to determine how subjective aging contributes to health and survival.

Continuity and change in older adults' perceptions of out-of-home mobility over ten years: a qualitative–quantitative approach

ABSTRACT This research report starts from the assumption that a solely geriatric and transport-related view of out-of-home mobility needs to be extended to incorporate other aspects of perceived and experienced mobility. In particular, our goal is to understand better the stability and change in peoples perceptions of out-of-home mobility over ten years. We concentrate on: (a) the subjective meaning of mobility over time, including perceived changes in mobility and perceived reasons for change; (b) trends in satisfaction with various mobility domains; and (c) a case-oriented exploration of inter-individual variation over time. A qualitative–quantitative data-analytic approach was applied to data collected from 82 participants on three occasions over ten years in 1995, 2000 and 2005. The mean age of the sample in 2005 was 75.2 years. The results indicate overall stability in the meaning attached to mobility between 1995 and 2005, while the perceived changes point to major losses in the array of mobility experiences and decreasing satisfaction with mobility opportunities, out-of-home leisure activities and travelling, but in contrast satisfaction with public transport increased. Case studies exemplified the reasons for the pronounced variation in satisfaction with mobility dynamics over time. In conclusion, the findings confirm that out-of-home mobility remains of utmost importance when people move from late midlife into old age.

The many faces of health, competence and well-being in old age: Integrating epidemiological, psychological and social perspectives

Preface. Part 1: Focusing on Social-Ecological Research - Contributions to Health, Competence, and Well-Being in Old Age. Introduction: The Person-Environment Perspective in Ageing Research. The Role of the Home Environment in Middle and Late Adulthood. Commentary: A House is Not a Home: But Can it Become One?. Outdoor Mobility in Late Life: Persons, Environments and Society. Commentary: Mobility - A Key to Understanding and Improving Transportation Services for Seniors and Others. Age-Related Loss in Vision: A Case to Learn About Ageing in Context. Commentary: Age-Related Loss in Vision: A Case to Learn About Ageing in Context. Part 2: Focusing on Psychological Research - Contributions to Health, Competence, and Well-Being in Old Age. Introduction: Developmental Perspectives in the Second Half of Life. The Influence of Social Support on Marital Support: Age and Gender Differences?. Commentary: Changed Gender Roles and Their Impact on Marital Support and Satisfaction. Stressful Life Events, Protective Factors, and Depressive Disorders in Middle Adulthood. Commentary: Stressful Life Events, and Depressive Disorders: The Paradigm Shift. Predictors of Well-Being in Very Old Age. Commentary: Well-Being in Very Old Age - Old and New Issues. Part 3: Focusing on Epidemiological Research - Contribution to Health, Competence, and Well-Being. Introduction: Epidemiological Perspectives in Ageing Research. Cancer Among Older Adults. Incidence, Prognosis and New Avenues of Prevention. Commentary: Cancer in the elderly: prevention and better care needed. Cardiovascular Disease among Older Adults. Incidence, Prognosis and New Avenues for Prevention. Commentary: Cardiovascular Disease among Older Adults. Incidence, Prognosis and New Avenues for Prevention. Medical Care for Nursing Home Residents. National Perspectives in International Context. Commentary: Medical Care for Nursing Home Residents. National and International Perspectives. Part 4: Synergies betweenSocial-Ecological, Psychological and Epidemiological Research. The Impact of Internal and External Resources on Health, Competence, and Well-Being: Longitudinal Findings from the ILSE. Determinants and Prognostic Relevance of Depression and Anxiety in Patients with Coronary Heart Disease: An Interdisciplinary Approach within the KAROLA Study. Commentary: Interdisciplinary Longitudinal Studies of Ageing. Part 5: Applications and Social Policy Implications. Ageing Europe: Challenges for Policy and Research. On the Relevance of Ageing Research for Policy and Practise. Appendix. Abstracts of Poster session.