LIFE-SPACE FOR THE LIFESPAN: A MIXED METHODS EXPLORATION

OF AGING IN THE ENVIRONMENT

By

AMBER JOPLIN

A dissertation submitted in partial fulfillment of the requirements for the degree of

DOCTOR OF DESIGN

WASHINGTON STATE UNIVERSITY Interdisciplinary Design Institute

MAY 2013

© Copyright by AMBER JOPLIN, 2013 All Rights Reserved

© Copyright by AMBER JOPLIN, 2013 All rights reserved

To the Faculty of Washington State University:

The members of the Committee appointed to examine the dissertation of AMBER JOPLIN find it satisfactory and recommend that it be accepted.

______Nancy H. Blossom, M.A., Chair

______Kerry R. Brooks, Ph.D.

______Bob Scarfo, Ph.D.

ii

ACKNOWLEDGMENT

My committee members, Nancy H. Blossom, Kerry R. Brooks, and Bob Scarfo, have been patient, supportive, and unrelenting throughout this entire demanding and overwhelming process. Thank you for practical support and theoretical assistance in developing and articulating integrative approaches to complex problems.

Thank you to the twenty eight individuals who participated in the interview portion of my study. I appreciate your time, openness, and enthusiasm for life.

Thank you family and friends, especially Lois Kieffaber, Bob Horner, Kitty Bendixen-Park,

Wendy Ann Hall, Deborah Napier, Ali Ilhan and Isil Oygur, Mike and Megan McKinlay, the

Swagerty family, and the faculty and staff of the Interdisciplinary Design Institute, and Student

Affairs at Washington State University, Spokane for innumerable acts of kindness, knowledge, and grace.

Thank you to God, Country, and the taxpayers of Washington State for this golden moment. I am continually amazed at the places created by our shared vision and work.

iii LIFE-SPACE FOR THE LIFESPAN: A MIXED METHODS EXPLORATION

OF AGING IN THE ENVIRONMENT

Abstract

by Amber Joplin, D. Des. Washington State University May 2013

Chair: Nancy H. Blossom

Aging seniors in Western society face a built environment that challenges wellbeing by progressively limiting their life activity space, excluding increasingly frail individuals from their environments of choice. Further, health effects and their economic consequences, and resource use are interconnected, thus, the disabling impact of most existing built environments must be included in any meaningful discussion of urban sustainability. While there is much research on lifespan development, aging, disability, and environments, there is a gap in the integration of knowledge from across disciplines, and in its availability to designers.

The guiding paradigm of this research is Nigel Cross’ designerly ways of knowing, an iterative and emergent approach, using abductive reasoning through visualization to represent data and discover relationships. Models of contexts, values, aging, health, sustainability, and person-place relationships were identified in an interdisciplinary literature review and integrated via concept charts. Major elements were mapped using geographic information systems data across a medium sized city to identify neighborhoods of interest from which to

iv recruit cases, and subsequently for data development and analysis of interviews with twenty eight community living seniors.

Individuals express strong self-actualization, social dependence, and infrastructure concerns in accessing needed and desired goods, services, activities, and places. Poorly maintained sidewalks, traffic lights, steep hills, long distances to bus stops, long waits for bus and paratransit limited access for non-drivers. Drivers identified traffic, large parking lots, and crime as limitations. Home and property maintenance and estate issues were reasons to give up meaningful homes. Transportation, walking strength, and companionship were most often cited as essential for accessing meaningful places.

The lifespan ecologic model emerged through iterative and sequential examination of theoretical models (qualitative), personal experiences (qualitative and quantitative), and geographic data (quantitative). Interviews and spatial analysis clarified the role of person-place processes of meaning, belonging, activity, and time, and integration of values with person-place processes propose a holistic approach to sustainability. This emergent model needs further testing in a variety of locales and age groups, as well as with populations that are not engaged in communities of belonging or meaning.

v Table of Contents

ACKNOWLEDGMENT ...... III ABSTRACT ...... IV LIST OF TABLES ...... XI LIST OF FIGURES ...... XIII DEDICATION ...... XV CHAPTER ONE ...... 1 1.1 Introduction ...... 1 1.2 Deficiency in the literature ...... 2 1.3 Statement of the research problem ...... 3 Significance for design and planning literature ...... 4 Significance for practice ...... 5 Significance for policy ...... 5 1.4 The limitations of the research processes ...... 6 Interdisciplinary models ...... 6 Participant selection ...... 6 Mapping with GIS ...... 7 1.5 Structure of the dissertation ...... 8 CHAPTER TWO: LITERATURE REVIEW OF INTERDISCIPLINARY MODELS ...... 10 2.1 Introduction ...... 10 2.2 Key Terms ...... 13 Aging ...... 13 Disability ...... 14 Context ...... 15 Sustainability ...... 16 Systems ...... 17 2.3 Theoretical Approaches Illustrated through Models: Models of Contexts ...... 17 Hierarchy of Purpose Model ...... 18 Human Ecology Model ...... 21 Interior Ecosystem Model ...... 26 Summary of Context Models ...... 28

vi 2.4 Values Model ...... 29 Modal Patterns for the Treatment of the Aged ...... 29 Summary of Values Model ...... 36 2.5 Person – Environment Interaction Models ...... 36 Ecological Model of Aging (Competence-Press Model) ...... 37 Social-Physical Places over Time ...... 42 Summary of Person – Environment Interaction Models ...... 45 2.6 Models of Health and Disability ...... 48 Relationship of the health and disability models to the built environment ...... 49 Social Determinants of Health ...... 49 Human Ecology Model of a Settlement ...... 54 2.7 Disablement Process Models ...... 57 Disablement Process ...... 57 Health Environmental Interaction ...... 60 Summary of health and disability models ...... 62 2.8 Life Space Models ...... 63 2.9 Sustainability Models ...... 64 Criteria for Corporate Sustainability ...... 65 Sustainable Development: A Systems–based Approach ...... 67 Summary of Sustainability Models ...... 68 2.10 Models of Systems ...... 69 Introduction to System Dynamics ...... 70 Fundamental Properties of System Environments ...... 74 Summary of System Models ...... 79 2.11 Conclusion ...... 80 CHAPTER THREE: METHODS ...... 82 3.1 Introduction: Access to Meaningful Places ...... 82 Discussion of alternative methods of data collection ...... 83 Discussion of literature search and analysis and secondary sources used ...... 84 Discussion of Geographic Information Systems and sources used ...... 85 3.2 Environmental analysis used to target research areas ...... 87 3.3 Accessing participants ...... 89

vii 3.4 Interview Process ...... 90 Collaborative Mapping:...... 93 3.5 GIS Mapping and data development ...... 93 Introduction to mapping ...... 93 Introduction for data development ...... 94 Destinations: “During the past four weeks have you visited…?” ...... 94 Destination Buffers ...... 95 Modes and Routes: “How do you get there?” ...... 95 Life Spaces: Visited & Meaningful...... 97 Extent ...... 97 Data development ...... 98 Analysis ...... 98 3.6 Ethical considerations ...... 99 Validity of process ...... 99 Protection of participants ...... 100 CHAPTER FOUR: RESULTS AND DISCUSSION ...... 101 4.1 Introduction ...... 101 4.2 Discussion of literature findings ...... 102 Transforming theoretical ideas into constructs related to the design models .. 102 4.3 Lifespan ecologic model ...... 104 Discussion of spatial analysis with Geographic information Systems: ...... 108 Environmental analysis used to target research areas ...... 108 Confounding characteristics ...... 110 4.4 Findings from interviews...... 111 General information on the participants ...... 112 General emotional, physical and financial wellbeing ...... 114 General satisfaction with housing and neighborhood ...... 115 Activities and destinations ...... 116 Preliminary findings by model group ...... 118 4.5 Categories and constructs ...... 119 4.6 Narratives of person-place relationships ...... 120 Individuals: I can’t do any of that, but I don’t think about it.” ...... 127

viii 4.7 Findings from spatial analysis of mapped life spaces ...... 127 Mapped life-space polygons “refer to your life-space” ...... 129 Service space vs. life space ...... 131 Contact site population differences ...... 134 Primary transportation mode ...... 135 Measures “great and small” ...... 136 Scale of measures ...... 138 4.8 Recommendations for further research ...... 140 CHAPTER FIVE: CONCLUSION ...... 142 5.1 Introduction ...... 142 Statement of the problem ...... 142 5.2 Major Themes ...... 144 The diverse experience of aging ...... 144 Wellbeing and satisfaction despite limitations ...... 145 Independence and belonging ...... 145 Relocation ...... 146 Excluded and disabled ...... 146 Adaptability ...... 147 5.3 Events or processes that result in changes to access of places ...... 148 5.4 Structure and form of Spokane ...... 149 5.5 Theoretical Implications ...... 149 Implications for practice ...... 151 Policy implications ...... 153 5.6 Recommendations for further research ...... 154 5.7 Conclusion ...... 155 BIBLIOGRAPHY ...... 157 APPENDIX ...... 165 Research Study Consent Form ...... 166 Recruiting Flyer: Research Study Opportunity ...... 170 Recruitment Telephone Script ...... 171 Chart of Measures, Sources and Conversions to Feet, Meter, Kilometer and Mile ...... 172 Database Example ...... 173

ix GIS Data Sources ...... 174 Traffic: ...... 174 Land Cover NALC06 ...... 174 Sidewalk data: ...... 174 Interview Form: Participant # ...... 175 Comparison of Terms from All Models ...... 178

x LIST OF TABLES

Table 1 Human Ecology comparison of ranges ...... 25

Table 2 Patterns of Treatment for the Aged (Moody 1974, 11-12} ...... 30

Table 3 Modal Patterns for the Treatment of the Aged alongside the contextual models ...... 35

Table 4 Person - Environment Fit Dynamics in SPOT (Wahl and Lang 2004, 24) ...... 44

Table 5 Comparison of Person-Environment Models with the Context and Values Models ...... 46

Table 6 Disablement process (Nagi 1965 in Wunderlich 2002) ...... 58

Table 7 GIS data linked to wellbeing constructs ...... 86

Table 8 Sample Maps ...... 88

Table 9 Activities by destination ...... 91

Table 10 Feelings & Perceptions about Destinations, Home and Neighborhood ...... 92

Table 11 Wellbeing, Satisfaction with Health & Finances ...... 92

Table 12 Map-able Reported Data Linked to Wellbeing Constructs ...... 94

Table 13 Developed and implicit categories in the design context models ...... 103

Table 14 Lifespan Ecologic Model: concepts organized into major constructs ...... 105

Table 15 Construct elements related to Bio-ecological Systems Theory ...... 107

Table 16 Confounding characteristics of the data layers ...... 111

Table 17 Access sites for participants ...... 112

Table 18 Basic information about the participants ...... 113

Table 19 Overall satisfaction with health and finances ...... 114

Table 20 Overall satisfaction with home and neighborhood area ...... 116

Table 21 Activities by category ...... 117

xi Table 22 Summary of findings from the literature by model group ...... 118

Table 23 Individual construct: locations and related interview comments ...... 119

Table 24 Social construct ...... 123

Table 25 Production construct ...... 125

Table 26 Natural construct ...... 126

Table 27 Characterizing home areas...... 128

Table 28 Minimum bounded areas by Area: 359 square miles ...... 133

Table 29 Distances between home and major type of destination (in feet) ...... 134

Table 30 Comparison by contact site ...... 135

Table 31 Distances by primary transportation mode ...... 136

Table 32 Access to services by measurement type ...... 138

Table 33 Land cover results by buffer size ...... 139

Table 34 Lifespan Ecologic Model with values and processes ...... 150

Table 35 Significance of constructs at design scales ...... 152

xii LIST OF FIGURES

Figure 1 Hierarchy of purpose (Meadows 1998, 41) ...... 19

Figure 2 Human Ecology Model (Bubloz, Eicher, and Sontag 1979) ...... 22

Figure 3 Comparison of Human Ecology Model with Hierarchy of Purpose (adapted) ...... 23

Figure 4 Interior Ecosystem Model (Guerin 1992) ...... 27

Figure 5 Competence-Press Model (CPM) by Lawton and Nahemow (1973) ...... 38

Figure 6 Person-environment processes with developmental outcomes (Wahl 2008) ...... 41

Figure 7 Change over time (Wahl and Lang 2004)...... 43

Figure 8 Main determinants of health (Whitehead and Dahlgren 1991) ...... 50

Figure 9 Human ecology model of a settlement (Barton 2003) ...... 55

Figure 10 A model of the determinants of health. (Evans and Stoddart 1990, 1359) ...... 56

Figure 11 Disablement process model (Verbrugge and Jette 1994) ...... 59

Figure 12 Spheres of health environmental integration (Stineman 2001, 36) ...... 61

Figure 13 Life Space model variations ...... 64

Figure 14 Criteria for Corporate Sustainability (Dyllick and Hockerts 2002, 138) ...... 66

Figure 15 Sustainable Development: A systems–based approach (Chiras 1997) ...... 67

Figure 16 Sustainability matrix ...... 68

Figure 17 System dynamics (Forrester 1991, 13) ...... 71

Figure 18 Interconnected system (Forrester 1991, 14) ...... 72

Figure 19 Human Ecosystem Model (Machlis and Force 2005) ...... 73

Figure 20 Major systems of the anthrosphere (Bossel 1999)...... 76

Figure 21 Fundamental properties of system environments and their basic counterparts ...... 77

xiii Figure 22 Basic orienters in psychological, social, lifestyles, social systems & ecosystems ...... 78

Figure 23 Stages of research ...... 84

Figure 24 Examples of overlapping buffers ...... 96

Figure 25 Bio-ecological system's theory adapted to lifespan development (based on

Bronfenbrenner, 2005) ...... 106

Figure 26 Uniform and random distribution maps ...... 110

Figure 27 Life space showing destinations and routes ...... 130

Figure 28 Comparison of life spaces ...... 131

Figure 29 Types of destinations ...... 132

Figure 30 Measures by census block, buffer and life space ...... 137

Figure 31 Land cover calculated by scale ...... 139

Figure 32 Graphic representation of the Lifespan Ecologic Model ...... 151

xiv

Dedication

Bob, Dave, Val…

…and always to mom

xv Chapter One

1.1 Introduction

The US Census Bureau projects the number of people aged 65 and over will increase from 39 million in 2010 to 69 million in 2030, with the 85+ population, doubling by 2025 (Day

1996). Declining birth rates and increasing life spans result in a shift in population age structure, with nearly one in five U.S. residents expected to be 65 or older by 2030 (Vincent 2010).

Individuals are aging in homes, neighborhoods and communities that are designed for active, mobile, sighted adults. As their health and mobility begins to deteriorate, elders are no longer able to operate fully in the shared community environment. The magnitude of population aging challenges our current system of progressively relocating aging individuals from their homes and communities to senior-targeted environments, whether to amenity rich retirement communities, near an amenable adult child’s home, or an assistive living facility (Heumann

2001). The costs of our current system to individuals, families, society and the natural environment are enormous (Landorf 2008).1

Real-life issue

That human existence and activity throughout the life course depends upon a habitable environment is a given; however in Western society the significance of the environment in human wellbeing is poorly understood and often neglected in the general discourse. This omission is particularly evident in design for aging where unsustainable levels of effort and expense are expended in maintaining life and activity while seniors report dissatisfaction with

1 Limited text from Chapters One and Two is being concurrently published in a book chapter by this author, “The Maturing Interior in Context: In search of person-centered, sustainable, life-span design,” in Thompson and Blossom, eds. The Blackwell Handbook of Interior Design. (In Press)

1 the structures and systems that are created on their behalf (Landorf 2008).2 The underlying issue of a built environment that excludes and disables individuals is largely unseen by designers, planners, and policy makers. Deliberate integration of life span needs of individuals requires appreciation for person-place processes to address intractable issues of legacy infrastructure, planning systems, and codes.

1.2 Deficiency in the literature

My analysis of the models in the literatures of design identifies a significant lack of articulation of persons, wellbeing and lifespan needs. Bubolz, Eicher, and Sontag (1979) and

Guerin (1992) in abstracting Morrison’s Man and Environment analytical framework (1974) focus primarily on categories of environments, sidestepping the complex system of interactions

Morrison proposes; and moving only incrementally from her categorizations of humans as environed units, to human environed unit (Bubolz) or human organism (Guerin). Examples of human variables in their research include units of scale (group, community, institution) or quantifiable characteristics (age, sex, family composition). The aspects of change over time and the human qualities of what is “perceived, desired, feared, thought about, or acquired as belief

(Lewin, in Bronfenbrenner 2005, 55)” are overlooked.

“There is nothing so practical as a good theory (Lewin 1951)”

Purposeful positive changes in the built environment to support health and wellbeing, require new holistic theories of person environment interaction that include the full range of individual and contextual elements required for human wellbeing across the life span in a sustainable built environment. The main objective of this research project is to identify the

2 Further, negative health consequences are related to the built environment (Northridge, 2003).

2 significant elements required for such a comprehensive theory for designers and planners of the built environment. The need for this research is validated by the fact that scholars from across the disciplines call for more inclusive approaches to design that include support of health impacts (Dannenberg, Frumkin, and Jackson 2011), sustainability (Landorf 2008), life span needs (Heumann, McCall, and Boldy 2001), and human wellbeing (Rubenstein and de Medeiros

2004).

1.3 Statement of the research problem

This study addresses the deficiencies identified in the design models by exploring connections between wellbeing and access to personally significant places over time. The following are questions that I am trying to answer; 1) Are individuals accessing places needed to meet wellbeing needs throughout their life span? 2) What are the events or processes that result in changes to access of places associated with wellbeing? 3) What is the experience of spatial constraints in terms of wellbeing?

These issues are not restricted to any one age group or developmental stage. However this is too large a group for the scope of any single project. Thus, participants over the age of 55 were targeted for interviewing, because they are diverse, experienced and potentially articulate. These are people who are moving through multiple expected and unexpected life changes in family structure, career, and health; experiencing needs that are often not fully addressed. I recruited participants who are associated with churches and community centers located in areas of Spokane which were selected to maximize variation of environmental features and avoid locales characterized by extreme conditions. Participants were expected to

3 discuss issues of agency, belonging, and meaning, significant components of wellbeing (Wahl and Lang 2004).

A triangulation strategy was designed employing 1) interdisciplinary review of literature related to human wellbeing in environments across the life span; 2) spatial analysis using geographic information systems; and 3) qualitative interviews with seniors. The thoughts and feelings shared by these individuals integrate person-processes with the places where they live out their lives. Geographic information systems (GIS) mapping technology generates quantitative data about individuals’ life spaces, allowing contrasts and comparisons of distances traveled and meaningful destinations accessed and those not accessed. The narratives of participants provide connections between life processes and access to meaningful places, clarifying specific environmental challenges. This research illuminates where seniors go and wish to go, and the constraints that they experience from individual, social, natural, and infrastructure perspectives.

Significance for design and planning literature

The issue of a built environment that excludes aging or disabled individuals needs to be addressed by designers and planners of the built environment as well as by society at large.

However, implementing research into the design of environments that meet peoples’ lifelong needs is a challenge not being met. This is due, in part, to the complexity of individuals, the complex effects of environments on individuals and of individuals on environments, and existing social and infrastructure systems. Between individuals, processes of aging differ in onset, duration, termination, direction, and order (Baltes 1987). Variables impacting individuals over their life span include the following: place, space, and relocation (Litwak and Longornio

4 1987); meaning and significant activities (Rubenstein 2004); family and community connections, programs and policies, access to good and services, stigma, poverty, safety hazards, crime and pollution (Dahlgren 1991; WHO 2001); access to nature (Ulrich 2002); and to spiritual connection (Sadler and Biggs 2006). True “human centered” design theory must encompass the diverse aspects of human experience. This integrative research project increases understanding of the interplay between persons and environments over time and helps to fill these gaps and refine a comprehensive ecological model for the environmental design field.

Significance for practice

The work of designers is to invent, advocate for, model, and create environments that broadly support health and safety, and are economically and environmentally sustainable. This study illuminates significant ways in which design and planning professionals must re-imagine the built environment in order to support the overall health of people and the planet. The resulting integrative model affirms sustainability values, and supports lifespan needs; informing designers and helping them communicate required changes to clients and other decision- makers.

Significance for policy

We are in the midst of dramatic demographic changes that require correspondingly dramatic changes in the built environment. The modern American community structure has not just “happened to us; rather we legislated, subsidized and planned it (Jackson 2011, xvii).” This study identifies key factors that can be addressed through legislation, zoning, and planning in order to create more sustainable and life-affirming homes and communities. This study also

5 confirms the disabling impact of the car-favoring practices at large and small scales which must be addressed at the policy level.

1.4 The limitations of the research processes

All of the findings from this study must be understood in view of the limitations of the processes used.

Interdisciplinary models

First the literature review was limited to models which are symbolic representations of theories. I selected respected models relevant to aging and sustainable design. My analysis of these models did not exhaust all of the possible meanings and variants in the host literatures.

Participant selection

Second, participants in the study were not randomly selected and do not represent a cross section of typical seniors. They represent themselves: 28 community dwelling seniors in

Spokane, Washington, who are affiliated with organizations in the community. Interviews were conversational, so there was variation in how questions were presented, and participants did not provide directly comparative information in every case. For example, drivers and walkers were quick to map specific routes, while non-drivers tended to circle general areas where they went. Despite these limitations, I am including all of the individuals who responded to my request for an interview and signed the disclosure form during the two months that I scheduled interviews because each provided unique perspectives that were useful to the study.

Accessing participants was challenging. I had hoped to interview individuals from many faith backgrounds as well as individuals who were no longer involved in community activities.

Most of the churches, synagogues and temples I contacted did not respond to my letters and

6 calls. Several times when I called to follow up, I was strongly rebuffed. Five of the six senior centers I contacted responded positively, but although one center’s group of seniors invited me to lunch, none of them chose to be interviewed. Another center had many interested and friendly seniors who declined talk to me “on the record” after I presented the research study consent form.

I had also expected to find interviews by referral, hoping to identify a comparison group of individuals who were no longer participating in the organization. Although I asked in every interview, I only received referrals to other current participants.

Interviews varied in length, location, levels of privacy, and level of completeness. Some interviews came to a sudden halt when I asked for a signature or asked to tape the conversation. One scheduled interview was cancelled because an adult child was concerned about privacy. Another was cancelled because of a death in the family. Many participants did not want to be taped. At the other extreme, two participants came with activity diaries and completed very comprehensive maps.

In any case, data based on participant recall of activities is not as accurate as physically tracking individuals with GPS devices. In some interviews the mapping portion did not identify all of the destinations mentioned in the interview questions, and if I did not have enough information to make a legitimate location point for mapping I had to omit that destination from the mapping analysis.

Mapping with GIS

The third major limitation, mapping with GIS includes multiple forms of symbolic communication (Duncan 2006). Not only is each layer designed to represent (symbolize) a

7 specific goal, but the combination of layers depends on a shared geographical alignment of information between layers, which is created by the layer author, and the techniques used to integrate layer information are subject to statistical and process errors. Most of the work involved in GIS based mapping is that of identifying relevant data layers, and assuring that significant components are reasonably aligned.

1.5 Structure of the dissertation

The guiding paradigm of this research is Nigel Cross’ designerly ways of knowing, an iterative and emergent approach, using abductive reasoning through modeling and visualization to represent data and discover relationships. The introduction chapter of this dissertation is deliberately brief as the triangulation strategies employed throughout require specific introductory discussions and definitions. The introduction does include an extensive discussion of the limitations of this research project as the individual methods and combinations of methods used are best understood within the overall limitations of the project.

Chapter two presents the initial phase of this research: A cross disciplinary review of literature that addresses aging and environments. Models from the literatures of aging, health, economics, education, sociology, geography, and sustainability are identified and sequentially integrated via concept charts into a comprehensive concept table. The resulting table provides an interdisciplinary foundation for identifying target areas, generating questions, and organizing findings.

Chapters three (Methods) and four (Findings and Discussion) present a second iterative aspect of the research, as GIS is used initially to identify areas potentially providing maximum information on multiple person environment processes. Semi-structured interviews with

8 collaborative mapping of destinations and routes are completed with participants in the community. The information from interviews is brought into the lab and participant destinations, routes, and meaningful areas, are entered into the GIS map. Further spatial analysis is completed contrasting and comparing participant destinations, life-spaces and patterns related to the concept table.

Chapter five concludes the dissertation by integrating findings from the triangulation strategy: analysis of models in the interdisciplinary literature, analysis of environmental access and satisfaction, and spatial analysis of the general community and specific life-spaces. Major themes identified in the literature and observed in the cases are highlighted. In addition, the theoretical and policy implications of the lifespan ecologic model are presented together with suggestions for future research.

9 Chapter Two: Literature Review of Interdisciplinary Models

2.1 Introduction

This chapter utilizes multidisciplinary theoretical models to integrate theories on aging within the environment as an initial step in developing a comprehensive model that can be flexibly applied to the design of living and community environments. Models are symbolic artifacts of knowledge used by all disciplines to create, hold, or transfer complex and/or developing information about relationships, processes, change, etc (Ewenstein 2007). In order to distill the primary concepts identified in behavioral and social sciences, education, health, sustainability, systems, and design literatures, I focused my literature search on models of person and/or environment relationships and then deconstructed the model elements into tables. The resulting comparative tables identify relationships and significant issues that must be considered in person-centered sustainable lifespan design.3

Meaningful research on the built environment as it relates to sustainable aging requires an examination of the multiple contexts in which aging occurs (Clarke and Nieuwenhuijsen

2009). The literatures illustrate the complexity of this topic, identifying numerous interrelated natural, human-created, and personal contexts of aging, and suggesting relevant indicators of wellbeing and social or physical sustainability. While many significant linkages are identified across these broad contexts, the models presented in the literatures do not comprehensively

3 Limited text, tables, and figures from this chapter (primarily materials regarding contexts, values, and person-environment interaction) are being concurrently published in a book chapter by this author, “The Maturing Interior in Context: In search of person-centered, sustainable, life-span design,” in Thompson and Blossom, eds. The Blackwell Handbook of Interior Design. (In Press)

10 identify or operationalize sustainability across the entire system that creates and maintains the current built environment.

This review will focus on theoretical models applicable to aging and the built environment because models are traditional tools designers use to develop and share their ideas. Models, like sketches, are not intended to contain entire concepts or complete information. They are however “intelligence amplifiers” just as drawing and writing are intelligence amplifiers (Cross 2006, 33). Over the course of the review I will create and use comparative tables (models) of the major terms or concepts identified in each model from the literature as a device to identify related constructs, similarities, differences, relationships and subjects that are addressed - or conversely not addressed - by each model.

Six areas of literature will be examined for interrelationships and indicators of sustainable environments for aging. The areas are models of: 1) contexts, 2) values, 3) person- environment interaction, 4) health and disability, 5) sustainability, and 6) systems. Organizing the review by models, rather than by discipline, also highlights the interdisciplinary4 nature of environments for aging. Models relating to aging contexts originate from the fields of health, design, sociology, gerontology, environmental psychology, geography, environmental science, and business. Most address multi-disciplinary relationships and several models are adopted across disciplines, particularly Lawton and Nahemow’s ecological model of aging (1973) from yet in industrialized countries the number of centenarians is doubling every decade (Kinsella

4 “Interdisciplinary research occurs when at least some of the independent, intervening, and dependent variables in a specific hypothesis being tested are derived from the specialized knowledge of different disciplines (Machlis 2007).”; National Academy of Sciences, 2004. Facilitating Interdisciplinary Research.

11 and Velkoff 2001). Meaningful models of sustainability in the built environment must be capable of addressing the needs of the population across the entire life span.

The literatures included in this review variously classify aging individuals using chronological age, health, work status, living situation,5 or other capacity. A number of non- academic reports prepared for general audiences describe all individuals over 65 as older adults.6 Most studies identify age ranges that are statistically, socially, or legally associated with their classification. For purposes of comparison between studies this review will demarcate near old (55-64), young old (65-74), old old (75-84), and oldest old (85 and above).7 Age classifications in built environment applications are lacking in the literatures, essentially limited to the terms active seniors, or frail elderly, which is applied to people 65 and older with significant physical and/or mental problems.8

U.S. Census data show the continuation of good health “free of problems with personal and instrumental activities of daily living” ranges for women from the ages of 37 – 76, and for men from ages 45 – 80 with many individuals experiencing good health into their 80’s and 90’s

(Kinsella and Velkoff 2001). However there is a correlation of age with increasing levels of frailty and with chronic illnesses leading to functional limitations. Age-related physiological changes may include losses in mobility, intellectual functioning, and sensory acuity (affecting hearing,

5 Older studies identified relative ability or disability of elderly individuals by residential type, independent, assisted living or nursing home. 6 For example: Partnership for Prevention (Organization), and United States. 2001. Creating communities for active aging: a guide to developing a strategic plan to increase walking and biking by older adults in your community. Washington, DC: National Highway Traffic Safety Administration. 7 US Census Bureau reports variously define elderly and aging individuals, particularly at the younger ranges, however more consistently identify the oldest old as those 85 and above (Brault 2008). 8 “This term [frail elderly] is used to emphasize the fact that a majority of the elderly, especially the young old, do not have serious health problems (Kinsella and Velkoff 2001, 1).”

12 vision, touch, taste, and smell); as lung capacity, blood flow, muscle mass, and gerontology, and the social determinants of health model disseminated by the World Health Organization (WHO)

(Dahlgren, and Whitehead 1991).

2.2 Key Terms

These key terms are identified in the literatures and defined by combining perspectives of scholars acknowledged by other researchers. Each model discussed in the following review will be related to these key terms.

Aging

Aging is a natural, developmental, life-course process9 that involves bi-directional gains and losses over time in spiritual (Sadler and Biggs 2006), emotional, intellectual, social,

(Samanez-Larkin, et.al 2009) and physical arenas (Koncelik 2003). Human variability begins at birth and grows throughout the life-cycle, resulting in very heterogeneous aging population that challenges categorization.10 For some, clinically significant aspects of aging can begin to evidence around age forty, physiological efficiency declines (Ebersole 2004). Functional deficits occur at different rates for each individual and may be episodic, chronic, progressive, or cascading, as from a major illness or accident.

9 The notion of life-long development implies two aspects. First, there is the general idea that development extends over the entire life span. Second, there is the added possibility that life-long development may involve processes of change that do not originate at birth but lie in later periods of the life span. Considered as a whole, life-long development is a system of diverse change patterns that differ, for example, in terms of timing (onset, duration, termination), direction, and order (Baltes 1987). 10 “As a dynamic human factor, aging is a complex blending of physiological, psychophysical psychological and sociological change. Aging is a process of change personality through intensification of individual characteristics. People who have reached advanced years (75-95) will be a very diverse population with increased differences between individuals than younger populations.” (Koncelik 2003, 121).

13 Disability

Central to this review is the significance of the term disability. Contrasting with the typical usage synonymous with sensory, physical and cognitive limitations; 11,12 the World

Health Organization (WHO) specifically distinguishes disability from physical impairment situating it within a context of place and time. The 2001 International Categories for Measuring

Functioning, Disability and Health (ICF) propose that every human being can experience a decrement in health and thereby experience some degree of disability. This dynamic and interactive definition links the adaptive ability of the individual with the adaptive ability of the environment, thus the disability is a state experienced when the environment limits the potential activity of the individual.13 Contextual factors implicated in functioning, health, and disability include social, political, economic and physical (natural and built) environments, which can be identified in order to assess the impact of the factor on the person’s functioning

(WHO 2001; Verbrugge and Jette 1994). As elements of the built environment are identified which exacerbate or reduce the experience of disability, informed planners and designers are empowered to advocate and design for change.

11 “An individual with a disability is defined by the ADA as a person who has a physical or mental impairment that substantially limits one or more major life activities, a person who has a history or record of such an impairment, or a person who is perceived by others as having such an impairment. The ADA does not specifically name all of the impairments that are covered.” (United States. 2005. A guide to disability rights laws). 12 “The Census Bureau defines disability as a long-lasting sensory, physical, mental, or emotional condition. This condition can make it difficult for a person to do activities such as walking, climbing stairs, dressing, bathing, learning, or remembering. It can impede a person from being able to go outside the home alone or to work at a job or business, and it includes persons with severe vision or hearing impairments.”(US Census Bureau. 2005. American Community Survey: 2005 Subject Definitions.31-32). 13 See example in Putnam 2002.

14 Context

The literatures provide evidence that mortality, disease, function and mental health of aging populations vary depending on the environments in which people live, work and play

(Clarke 2009). Research topics as diverse as neighborhood resources, mobility, crime, pollution, peer influence, educational level, and religious coping, illustrate that psychological and spiritual aspects, as well as political, economic and physical environment factors significantly affect health and wellbeing.14 In order to include the full range of factors involved in sustainable environments for aging, this review will adopt the broadest definition of context, adding to

Lawton’s “all that lies without the individual,” (Gitlin 2003) aspects of the aging self, the internal and external socio-cultural contexts that “affect and construct the life course.”

(Rubinstein, and de Medeiros 2004). Several ecological models from within and outside of the design field are considered for organizing the contextual factors.

Values

Design is the human activity concerned with planning, inventing, and creating objects and processes that make up the artificial environment (Cross 2006; Simon 2001). The social process of designing and the kind of imagination that designers engage in involve ethical decision making and contain episodes that are ethical in nature (Lloyd 2009). Design is a problem-solving activity: The identification of – and solution for – each problem requires value

14 “In its broadest sense, environmental health comprises those aspects of human health, disease, and injury that are determined or influenced by factors in the environment. This includes not only the study of the direct pathological effects of various chemical, physical, and biological agents, but also the effects on health of the broad physical and social environment, which includes housing, urban development, land-use and transportation, industry, and agriculture.” U.S. Department of Health and Human Services. 2000 Healthy People 2010).

15 judgments.15 Design theoreticians from Papanek (1985) to Friedman (2003) contend that good design must be socially and environmentally responsible, which is one measure of a product’s success. Further, design is an integrative discipline situated to provide the practical link between scientific research and cultural values (Buchanan 1992). This review seeks linkages between values and their expression in the built environment. Values prevalent in the literatures are related to wellbeing, equity, efficiency, and sustainability. Meadows’(1998)

Hierarchy of Purpose model, Moody’s (1976) Modal Patterns for Treatment of the Aged, and

Chiras’(1997) operating principles for sustainability, suggest frameworks for integrating ethical criteria into evaluating design processes and solutions.

Sustainability

Recognizing that preservation of the natural environment is inextricably entwined with the human processes that overuse resources and create excessive waste; proponents of sustainability promote a systemic approach to social and personal changes (Meadows 1972). In

1987 The World Commission on Environment and Development (WCED) defined sustainable development as “development that meets the needs of the present without compromising the ability of future generations to meet their needs (Chiras and Herman 1997, 110).” The concept of sustainability thus implies an enduring and balanced use of resources that values needs of all persons. The Sustainable Futures Society posits that sustainable development both benefits and integrates environmental, social and economic goals through operationalizing long term

15 Nevertheless, the issue of responsibility, once a possible ethical consequence has been imagined, is important to resolve, and one way of doing this might be to argue that the process of designing is intrinsically responsible, forcing extreme consequences to be considered and ‘designed for’. (Lloyd 2009, 167).

16 local solutions that solve local, regional and global issues. The literatures of sustainability, of aging, and of the built environment begin to converge around the need to create enduring, maintainable social and physical structures and processes, variously described as sustainable aging, sustainable housing, sustainable sites, sustainable communities and urban sustainability

(Landorf, Brewer and Sheppard 2008).

Systems

The literatures express the need for a systems approach to built environments for aging because of the dynamic, multi-directional interrelationships between elements of the environment and its inhabitants. A change in one system has an effect on others, and is in turn affected by subsequent changes in those individuals and systems. Human systems are in the continuous process of being deliberately designed and re-designed through law or policy, as well as personal and cultural expression, need and limits. Forrester (1984) posits that failures to achieve goals through policy can be attributed to a lack of consciousness that these are systems and need systems testing. Machlis provides this comprehensive definition, “…the human ecosystem is defined as a coherent system of biophysical and social factors capable of adaptation and sustainability over time (Machlis and Force 1997, 353).”16

2.3 Theoretical Approaches Illustrated through Models: Models of Contexts

Three models of contexts are examined to identify a framework capable of embracing the full range of factors relevant to aging. Each of these models is intended to be

16 “For example, a rural community can be considered a human ecosystem if it exhibits boundaries, resource flows, social structures, and dynamic continuity. Human ecosystems can be described at several spatial scales, and these scales are hierarchically linked. Hence, a family unit, community, county, region, nation, even the planet, can fruitfully be treated as a human ecosystem (Machlis and Force 1997, 353).“

17 comprehensive, categorizing large swaths of personal, social, and physical domains and proposing relationships between the identified segments. Meadows (1998, 41) implementation of Daly’s hierarchy of purpose, an economic approach that is grounded in environmental sustainability and oriented toward values provides a starting point to which I introduce two holistic models from interior design that expand the applications and reveal the limitations of context models to the design of the built environment. In subsequent sections of the review connections are made to aging and values via Moody’s (1976) Modal Patterns for Treatment of the Aged, and disability contexts in the social determinants of health model of the World Health

Organization (WHO 2001). Systems are addressed in greater detail in the section on models of systems, as Meadows explicitly critiques the hierarchy of purpose model as inadequate to describe dynamic interactions.

Hierarchy of Purpose Model

The literatures show that the full range of factors making up the environment in which individuals age include “all that lies without the individual” and interact with all that lies within.

This section begins with a model from environmental economics that organizes contextual elements in terms of natural, built, social, and individual factors hierarchically based on their purpose as ends or means.

The hierarchy of purpose (HOP) adapted from Daly (1973) by Meadows (1998) as a framework for organizing indicators of sustainability situates the human economy in a hierarchy resting on the foundation of natural resources and serving an ultimate purpose of human wellbeing (Figure 1). The model identifies 1) the natural world as the ultimate means or source for the economy. 2) Science and technology as the intermediate means for transforming the

18 Figure 1 Hierarchy of purpose (Meadows 1998, 41) natural resources to 3) intermediate ends, the goods and services which are distributed by the political economy to achieve the 4) ultimate ends: wellbeing and transcendence, the summum bonum subject of theology and ethics.

The HOP triangle graphic is hierarchical, illustrating the dependence of each successive layer on the preceding one, thus production facilities are dependent on natural resources, goods and services are dependent on facilities, and wellbeing is dependent on the distribution of goods and services. Despite the model’s clarity in emphasizing the fundamental importance of natural capital, Meadows group expressed frustration with the order and linearity of the model because the actual processes link independently and flow bi-directionally. Wellbeing, for

19 example, is directly influenced by contact with the physical environment (Ulrich 1999) as well as, by the intervening layers. Further, impacts are multi-directional, as human wellbeing expressed through desire for comfort, convenience, or wealth increases demand for physical resources.

Categorizing components as being either a means or an end, and intermediate or ultimate establishes the values orientation of the model. The foundation of the triangle, the ultimate means, affirms the naturalistic view that the source of everything is nature. At the apex, the value is human wellbeing, the purpose for all economic (and perhaps human) activity, though the only purpose for nature.17 Meadows and Daly do not identify a form of capital associated with this category, as it is desired for itself and not as a means to achieve other goals. Intermediate categories describe the much broader arenas of human activity, with multiple and divided forms of capital such as service capital, social capital, household capital and public infrastructure; however, these are placed in the service of ultimate ends, with clear dependence on ultimate means.18

This foundational model can provide a rudimentary structure for organizing the multiple contexts related to aging and the built environment because it provides easily visualized organization and multiple entry points to link additional content. The major limitations are the linearity and unclear flows between elements. A weakness of the model for designers is the lack of clarity regarding the built environment. Economic terms such as built capital and household

17 “Rather I see the triangle as saying there’s no way human ends can be realized without healthy, functioning natural and economic and social systems (Meadows 1998, 44).” 18 Meadows articulates the overarching value as, “good lives for all people in harmony with nature (1998, 12).”

20 capital must be translated into the concepts of the design disciplines. The strength of this model is its explicit values orientation, a significant theme in critical gerontology, disability and sustainability literatures.

Human Ecology Model

The literatures of home economics in the 1970’s reflect the reorientation of the field toward the terminology of human ecology which more distinctly characterizes the scope and practice of the disciplines.19 The Human Ecology Model (HEM) (Bubloz, Eicher and Sontag 1979) reframes the content of Meadows hierarchy of purpose in constructs more familiar to the fields of design, and focuses particular attention on the near environment, the subject area of much environmental design. This complex model highlights interdependence between individuals, and their total social, and physical environment, including the consequences of human behavior on those environments.

The Human Ecology Model (Figure 2) is non-linear, multi-directional and visualized in two separate images, a triangle showing major environmental categories with their inner workings, and a series of nested circles to illustrate how the environments are “embedded within each other” in the near environment (Bubolz 1979, 29). Presented by the authors as a step toward a dynamic system model, it attempts to illustrate stock and flows through identifying circulation, transformation and storage of energy, and information. Aspects of biological, physical and social activity are included in each of the central organizing concepts,

19 In presenting their model, Bubloz, Eicher and Sontag suggest it as a comprehensive framework not only for the study of human behavior, but also as a basis for delineating and integrating the subject matter of their field. (1979, 28 )

21 Figure 2 Human Ecology Model (Bubloz, Eicher, and Sontag 1979) the categories identified as the Natural Environment, the Human Behavioral Environment and the Human Constructed Environment.

At the center of both variations is the Human Environed Unit (HEU) a place-holder element that represents any individual or body of humans that share an identity, needs, or goals, such as a family, work group, community, or state. Its central location in the model is significant, as it illustrates the circumstance of human placement in space and time. Actual human corporeality and psychology: presence, actions, beliefs and values, are classified within the behavioral and built environments. The arrows indicate interactions occur between the

HEU and the environments, and within and between the environments. Corresponding to

Simon’s artificial world, the Human Constructed Environment (HCE) category includes all of the

“consequences of our collective artifice (Simon 2001, 3).” Any environment created by humans

22 Hierarchy of Purpose re-visualized

Climatic Zone U-Ends Well-being Land Human Capital Neighborhood Social Community Capital Energy Health I-Ends Food Wealth Clothing Leisure Shelter Human Knowledge Family, Friends, Colleagues, Consumer Social Capital Goods Schoolmates Norms I-Means Values Built Labor, Tools HE HB HC NE Natural Factories Capital Processed Raw Materials E Other U-Means U SentimentsE Natural Resources Aesthetics Solar Energy, the Biosphere, Earth Materials, Biochemical Cycles

Figure 3 Comparison of Human Ecology Model with Hierarchy of Purpose (adapted)

or adapted to human goals, including all modifications of physical, biological, social and cultural constructs is included: the positive constructions of language, art, housing, and domesticated foods, as well as, the less desirable outcomes of human action such as pollution or repressive cultural patterns. By definition this complex and rapidly expanding category is the domain of the designer. For urban residents the HCE is ubiquitous: for fragile adults it is essentially universal. Meaningful analysis often requires framing smaller units such as the near environment, as suggested in the embedded circles model visualization (Figure 3).

The second version of the human ecology model illustrates (in general agreement with the hierarchy of purpose model) that behavioral and constructed environmental constructs

23 occur within, and are dependent on the Natural Environment (NE). In addition to physical and biological components, this category includes a third, less evident component, a combination of space and time. Aligning space with time may blur the significance of each element in human adaptive and environmental processes.

Based on the short rationale provided in the text, space refers to the “unlimited three- dimensional expanse in which events occur and … matter and energy exist” and credits the motion of the earth through space as the basis of time (Bubolz 1997, 29). Outer space, or the universe, can be understood via physical – and possibly biological components, while the more abstract meanings of space are related to location (physical or built) and place (behavioral),20 are major aspects of the environment both for human identify, and design of the built environment (Cloke and Johnston 2005). Time also impacts all of the processes of nature and human life and is a significant variable both in the study of aging and of sustainability. Systems modeling may be required to capture time’s dynamic effects.

Comparing the two models, as in Table 1, clarifies both sets of contexts. In addition to sharing the foundation of the natural environment, both models are concerned with human wellbeing, although for the ecological model it is an implicit goal within the HEU. The major difference in approaches occurs in the intermediate means and ends of the hierarchy of purpose model which are reorganized by the ecology model into constructed and behavioral environments. At the midpoint of Meadows’ Hierarchy, the delineation between means and ends cuts across the significant economic grouping of human capital, distinguishing between

20 “In the simplest sense, space refers to location somewhere, and place to the occupation of that location (Agnew 2005).”

24 production-oriented functional human capital (labor and management) and human capital

(individuals) that has worth beyond productive capacity, which is significant to consideration of a values approach to aging individuals.

Meadows’ means/ends Table 1 Human Ecology comparison of ranges Hierarchy of Purpose Comments Human Ecology Wellbeing is the goal of Human Environed Unit distinction also cuts across the Ultimate Ends the designed (HEU) Wellbeing environment (Implicit) Happiness, Internalized values are a Human Behavioral HCE, identifying social Enlightenment significant component of Environment (HBE) personal wellbeing Psychological: Self-realization, Identity environments, and consumer Sentiments, Aesthetics Fulfillment, Self-respect Transcendence goods in the category of desirable Intermediate Ends Individuals and groups Social: Family, Friends, are valuable even if not Human capital, Leisure Colleagues, Schoolmates productive ends. However, HCE subject matter Health Biophysical HBE and HCE include Human Created Social capital the non-desirable Environment (HCE) integrates the undesirable with Harmony, consequences of the Socio-cultural: Social Communication HCE, on the individual, Norms, Values desirable consequences of human society, the built Community, Community environment and the Neighborhood natural environment. activity, thus negative impacts at Mobility , Knowledge Socio-biological Wealth

Socio-physical: Food, all levels are drawn into the Consumer Goods Clothing, Shelter Intermediate Means Built capital: Tools, analysis. When the model locates

Production Facilities

Processed Raw Materials social problems in the (socio-biological & socio- Human capital: Labor cultural) NE does not include Natural Environment Ultimate Means HBE, and environmental pollution, bioengineered (NE) Natural Capital crops, domesticated Other Natural Resources Earth Materials, animals, etc. as these problems in the HCE, it also locates Land, Energy Biosphere are in the HCE Biochemical Cycles Solar Energy Climactic Zone the arenas of conflict over the Unclear placement of space and time, although they are part of the natural environment, they are also Space – Time actual identity of positive and cultural constructs negative factors.

The Human Ecology model clarifies non-linear relationships between environments by integrating biology, physicality and sociology into each of the environmental constructs. The

25 built environment, of particular concern to design practitioners, is broadly identified and articulated, and approaches are provided to focus applications. First, the HEU may be defined as one individual or a group, with differing scales of social, psychological and physical interaction. Secondly, the model can be used to conceptualize large as well as small ecosystems, showing relationships between distal and near environments. Integration with the values-oriented economic HOP model helps clarify boundaries and interfaces needed to move closer to a dynamic systems model of aging in contexts. The ecology model benefits from articulation of wellbeing as a goal in the HEU, and needs further development of the constructs of space and time.

Interior Ecosystem Model

Clearly building on the human ecology model and its antecedents, Guerin (1992) proposes an interior ecosystem model to assist in framing integrative research in interior design. Streamlining the representation of the human ecology model, Guerin adds a construct of interest component to visually locate the research topic within the model. It is relevant to aging and the built environment precisely because it is facilitates identification of variables in complex systems that interact simultaneously.

There are few changes to the constructs or inter-relationships in comparison with the human ecology model. The major constructs are renamed, and slightly modified, but not reordered

(see Figure 4). Presupposing understanding of the contents of the constructs, the article provides little specific direction, but illustrates variations by examples. The Human Organism

(HO) at the center, identified as a basis for user centered design (Guerin 1992, 257) holds demographic information such as age, income, education, or number of household members.

26 Multiple HO’s based on behaviors, capacities, NE

21 Micro - Macro or other criteria can be modeled. Environment Construct Reflecting a focus on interior design applications, the IEM Built Environment (BTE) HO does not include the

entire “artificial” world. Socio-political and BHE BTE HO = Human Organism NE = Natural Environment economic structures are included in the BHE = Behavioral Environment BTE = Built Environment Behavioral Environment, and negative effects ---- = Interaction Network of human activity such as pollution are de facto Figure 4 Interior Ecosystem Model (Guerin 1992) considered within the Natural Environment.

A useful addition to the model, the construct of interest text box holds the research topic which may have scale and time based versions. It is designed to prompt the user to consider both macro and micro aspects of the research problem on each of the environments in order to avoid overlooking important variables that should be controlled or measured.22 This nimble model relies on the researcher to determine content and has the capacity to adapt its structure and elements to accommodate the interacting issues under examination. The simplified structure, multiple HO’s, and external construct of interest suggest the IEM’s applicability to the built environment for aging.

21 See the example of energy usage over time with three distinct HO’s (conserving, no change, non- conserving) (Guerin 1992, 260). 22 Guerin (1992) cites a study by Davis & Ginther (1990) regarding incomplete variable identification in lighting research.

27 Summary of Context Models

Meadows’ hierarchy of purpose, Bubolz, Eicher and Sontag’s human ecology model and

Guerin’s interior ecosystem model conceptualize relationships between humans and their multiple physical, social and personal contexts. Each specifically deals with contexts internal and external to the individual, and is adequate to address various ranges and scales for aging individuals, their families, communities, and policy research. While all models provide a platform in which environmental issues of aging, such as frailty or disability can be visualized, they are not specifically articulated.

Values of human wellbeing and environmental sustainability are explicit in the Meadows

HOP model, but implicit in the others, since their composition is ecological, representing human reliance on the health of the planet.23 Values driving intermediate constructs are not articulated. Each model presents itself as a step toward developing a systems model, identifying interactions and dependencies, but only Guerin’s model begins to visualize dynamic systems, with the construct of interest component facilitating integration of time into the model.

While Meadows and Bubloz populate their models with significant classifications and processes to describe relationships, Guerin provides a bare framework intended to facilitate integrative research. For the experienced researcher this model is useful for applying concepts, such as those identified through the content–rich models. Not articulated in any of these models are values such as empowerment of individuals, or the impact of environments on disabled or fragile individuals, which the literatures indicate are significant to aging. As such,

23 Bubolz and Sontag write about the ethical underpinnings of the Human Ecology Theory in Boss, et al, eds. 1993. Sourcebook of Family Theories and Methods: A Contextual Approach. New York, NY: Springer.

28 these must also be included in meaningful study, design, and advocacy for sustainable environments for aging.

2.4 Values Model

One model is introduced and related to the previous context framework to identify values associated with the major categories identified above. Like the context models, Moody’s

(1976) modal patterns for the treatment of the aged (MPTA), intends to examine broadly characteristic approaches to aging, focusing on the relationship between values, social perceptions and environmental outcomes. Moody bases his model upon a lifespan approach to aging, positing that aging has unique developmental goals that transcend values of industrial society. Literatures on risk in service provision for aging adults (Phillipson and Powell 2004), and service approaches to aging and disabled individuals (Heumann, McCall, and Boldy, eds. 2001) support the relationship between MPTA and the environmental constructs. The link between

MPTA and HOP also highlights resource use for aging individuals, significant to the subject of sustainability. Specific social values are shown to be a factor in creating and maintaining the system that results in the built environment for aging.

Modal Patterns for the Treatment of the Aged

The literatures of aging and the built environment are variously concerned with values of access, empowerment, participation, wellbeing, aesthetics, efficiency, and sustainability; however these values are rarely made explicit within the models presented. Moody’s MPTA model, originally presented in 1976 as a means of analyzing educational programming for seniors; has been applied more recently to social values related to the empowerment of frail elderly people through service design, implementation and financing (Heumann, McCall, and

29 Boldy 2001); and to residential environments for seniors (Hofland 1990). This model organizes characteristic patterns of behavior toward aging adults and posits that underlying attitudes about life - and aging - produce particular sorts of outcomes in the treatment of aging adults.

Moody posits four distinct philosophical bases for treatment of older adults: rejection, social services, participation, and self-actualization. Each reflects modal patterns, “ways society tends to regard old people (Moody 1976, 2),” and exhibits specific characteristics (Table 2).

Types of values Table 2 Patterns of Treatment for the Aged (Moody 1974, 11-12} underlying attitudes Modal pattern Characteristics Basic attitude Self-actualization Individuation, psychological growth, and Wisdom, ego-integrity Psychology, Spirituality (Stage 4) self-transcendence (transcendence) Participation Second careers (employment or volunteer Social integration, Political (equality, (Stage 3) activity); senior advocacy; autonomy “normalization” freedom, happiness) Social Services Transfer payments (welfare, social Social conscience, Liberalism, Welfare (Stage 2) security); professional care, senior centers liberalism State (ameliorates) Rejection Separation, mandatory retirement; Repression, avoidance Economic (uncorrected (Stage 1) poverty, neglect; family abandonment abuses of capitalism)

Moody cites Spengler, Becker and Mumford in identifying the pattern of rejection that arises from a modern consciousness of functionality which prizes growth, development and progress, but shuns decline, death and “recognition of the ultimate limitations of life (1976,

3.).” This social pattern excludes aging seniors from their roles and locations in the society as their usefulness comes to an end. Moody posits this stage is “based largely on economic values and represents the uncorrected abuses of capitalism and technological society in general (1976,

11).” Limiting resource expenditures on over-priced and outdated workers, mandatory retirement requires that seniors withdraw from the workplace and accept the lower standard of living represented by fixed-incomes. In the built environment, successful retires may enjoy

30 the ‘gold coast’ retirement communities, while less successful are segregated in low-income apartments, and eventually, nursing homes.

A more egalitarian pattern, participation, is similar to disability rights models described by Putnam (2002). Oriented toward self-determination, this approach calls for advocacy and autonomy. Old people should have dignity equal to that of any adult and should be included in the mainstream of the community. If they have symptoms the underlying causes should be treated and they should be supported in pursuing meaningful roles and activities. Institutions and services that create dependence and/or isolation must be changed in order to support integration of seniors in the community. Moody posits this stage is “characterized by predominantly political values. It challenges the age-graded distribution of power and status in society by demanding for old people rights that have been denied them, sometimes through the policies alleged to be in their welfare (1976, 11).” Built environments expressing the value of equity include co-operatives, mixed age housing, participatory group homes, and programs facilitating aging in place.

The pattern of self-actualization differs from participation and the earlier patterns because it is not based on, or reacting to the economic values of modern society, but is based on humanistic values. Old age constitutes a distinct phase of human development rooted in the particular experience of being aged and presents opportunities “uniquely possible in old age

(1976, 9).” The reality of aging is that over time, many adults are no longer able to be involved in active and powerful ways, thus are no longer capable of maintaining their middle-adult roles.

Self-actualization “accepts aging on its own terms and discerns in the experience of growing old not a problem to struggle against but an opportunity to reach deeper levels of meaning. Thus

31 the prevailing values of Stage 4 are inner-directed and are psychological and spiritual in their orientation (1976, 12).” Built environments expressing values of self-actualization evidence qualities of choice, meaning, aesthetics, and provide for meaningful activities and roles.

Heumann, et al. (2001) propose that in a self-actualizing society, conventional housing is designed to adapt and support human needs through the entire life cycle.

The second pattern, social services, is a response to the needs of aging individuals who have been marginalized (retired) and are identified to be in need of care. Moody links this approach to “the values of liberalism and the welfare state: redistribution of resources to ameliorate the worst excesses of Stage 1 but no fundamental challenge to the prevailing institutions, whether the family or the corporation (1976, 12).” Corresponding to Putnam’s

(2002) “medical model,” case managers and service providers assume that professionals are most qualified to assess needs and provide services. “Old people are portrayed as human beings who have become something less than human, that is, they are not seriously engaged in projects and demands of life that are validated by the entire community as supremely worthwhile, such as work, child rearing, artistic creation, or spiritual devotion (Moody 1976,

6).” Transfer payments such as social security, food stamps, or welfare, managed by providers are provided as a “safety net” and are monitored to maintain resource-limited individuals at the poverty level. The structures of the stage 1 built environment (low income housing, nursing homes) are supported by these transfer payments, as are senior centers, and leisure activity programs.

Comparing Moody’s MPTA with the contextual models illustrates relationships between values and environmental categories (Table 3). The relationship is indirect, as the MPTA does

32 not describe contexts, but identifies instrumental ways of valuing individuals viewed through the lens of contextual priorities. Moody posits that environments where ideal humans are defined as ‘productive members of society’ limit expenditures on the non-productive members.

This is illustrated in the range of environments from rejection, through social services, to participation. In contrast, the humanistic environment valuing all individuals at all periods of life equally, invests to the degree that all human needs, including those of self-actualization, are addressed

The most obvious link between Meadows HOP and Moody’s MPTA occurs at the self- actualization level. Both models use virtually identical language to describe characteristics of this environmental construct. Reading across all four models, a merged model might suggest the “Ultimate End” goal for “Human Environed Units/Human Organisms” is “Self-actualization” characterized by spiritual and psychological values of wellbeing, transcendence, and ego- integrity. This reading suggests that one aspect of the design brief in “user-centered” environmental design is an obligation to enable users for wellbeing across their life span.

The relationship between MPTA participation and HOP’s intermediate ends is also very evident. The social and political constructs identified by Moody that promote engagement in family and society match the positive social intermediate ends desired by Meadows. In advanced societies this stage corresponds to the political civil rights and disability equality movements, requiring consciousness raising within the aging community, retraining of providers, reducing ageism, and implementing built environments changes such as those enforced by the American’s With Disabilities Act. Movement toward participation/equal rights

33 is bolstered by the positive impact of personal engagement in health outcomes, in contrast to negative health outcomes for disenfranchised populations (Marmot 2007).

Societies characterized by the social services model privilege the service industry over the needs of participating individuals (Heumann, McCall, and Boldy 2001, 240). MPTA social services and HOP intermediate means are linked by the production related components [labor, facilities, and funding streams] of the bureaucratic systems created to provide services.

Provision of services, whether in a nursing home or in the community, requires cost-benefit analysis similar to manufacturing (Hofland 1990). Investment in facilities and costs for labor are managed to create maximum efficiencies for providers. In the built environment this translates into minimal spaces for consumers that are arranged for staff convenience. Phillipson and

Powell describe this society as offering seniors two choices, living independently in a “no care” zone or receiving care in a “no identity zone (2004, 24).”

The correlation between the natural environment and MPTA’s rejection stage occurs in the intersection of strictly economic approaches to resource use and aging individuals. If aging individuals are no longer productive members of society (particularly those representing failures of earning, savings, personal habits, and/or health) they are expendable (Moody 1979).

The shared public built environment makes no specific provision (capital investment) for needs of aging, leaving needed modifications the responsibility of individuals, families, or segregated specialized environments. All of the values identified in the four environmental constructs; resource preservation, efficiency, equality, and wellbeing; are in fact properly applied within the environment that they represent. Thus, for example, resource preservation is a sustainable approach to the natural environment, while efficiency operationalizes sustainability in the built

34 environment. Creating and managing the built environment efficiently typically requires greater initial resource inputs, however the results are more sustainable (resource preserving

Table 3 Modal Patterns for the Treatment of the Aged alongside the contextual models

CONTEXTUAL MODELS VALUES MODEL Hierarchy of Interior Ecosystem w/ Comments Modal Patterns for Human Ecology Purpose Construct of Interest Treatment of the Aged Human Environed Ultimate Ends Human Organism (HO) Self-actualization Unit (HEU) Strong Correlation: Wellbeing, based on common terms: (Implicit) (Implicit) User- centered Spirituality, transcendence Transcendence Individuation Enlightenment, Self- transcendence Wisdom, ego-integrity realization, Identity Human Behavioral Behavioral Environment

Environment (HBE) (BHE) Psychological: Fulfillment, Self-respect Psychological Moody includes the value Psychology Sentiments, Aesthetics of ‘happiness’ in the Happiness Participation stage Participation Social integration, Intermediate Ends Social: Family, Friends, socio-behavioral “normalization” Colleagues, Strong Correlation: Political (equality, freedom, Human capital, Leisure Schoolmates socio-political based on social and happiness) political constructs Health Biophysical bio-physical Engaged Human Created Social capital [Each modal pattern has Environment (HCE) human created social Harmony, Socio-cultural: Social and physical

Communication Norms, Values environments.] Knowledge Socio-biological Community, Community Neighborhood Wealth Moody links leisure ( in Mobility, Consumer Socio-physical: Food, contrast to meaningful Built Environment (BTE) Goods Clothing, Shelter activity) with Social Intermediate Means Services Social Services Social conscience, Built capital: Tools, site integration Correlation: liberalism based on values such as Production Facilities energy system efficiency oriented to Welfare State (ameliorates Processed Raw meet the needs of building materials worst abuses of economic Materials service providers (Labor) (socio-biological & system) Human capital: Labor design and facilities. socio-cultural) Weak correlation: Ultimate Means Natural Environment Natural Environment Rejection Desire to limit use of Other Natural resources on Natural Capital Resources (+availability) Repression, avoidance Resources marginalized Earth Materials, populations. Land, Plants, Air, Water Economic values Biosphere (uncorrected abuses of Biochemical Cycles Literal “dust to dust” image of burial, waste capitalism) Solar Energy Energy Climactic Zone Daylight, Energy, Climate products No services

35 and waste minimizing) over the long term, than designs based strictly on minimal resource use

(Chiras, and Herman 1997). Similarly, self-actualization is the sustainable value relating to human wellbeing; however it is unsustainable when applied across all environments.

Citizenship in society requires balancing individual desires (choice) with the common good, and preserving opportunities and benefits to all members, rather than only privileged individuals

(Heumann 2001, 253).

Summary of Values Model

Moody’s MPTA conceptualizes four types of approaches to aging adults based on a range of economic and humanistic values. His modal patterns correspond to Meadows HOP context levels and identify characteristic values for each level. They also illustrate that constructive values can be misapplied to create unsustainable outcomes.

This model is specifically concerned with the unique potential of aging individuals and accommodates the range of capabilities and characteristics of this heterogeneous population. It is particularly relevant to frail and disabled seniors, as care and support options are identified under several sets of values. While not specific to the built environment, this model identifies characteristics of facilities based on funding priorities of types of social values. In identifying social values underlying the built environment, Moody provides a significant element needed for developing a comprehensive system model not articulated in other models.

2.5 Person – Environment Interaction Models

Three models from Environmental Gerontology are selected to provide theoretical bases for environmental impacts on aging individuals. These models focus on the interrelationship between persons and their entire social and physical milieu. Lawton and

36 Nahemow’s ecological model of aging is the classic person-environment (P-E) interaction model, illustrating effects of incongruence between persons and their environment. Wahl and

Oswald’s flow diagram delineates pathways to autonomy and identity by linking person– environment process with developmental outcomes. Wahl and Lang’s SPOT Analysis incorporates changes over time, showing changes in fundamental human motivations across the adult life span. These three models specifically apply to aging persons. While the socio- physical environment considered is much broader in scope than the built environment, these models provide a background for examining wellbeing, ability, and disability as an interaction between person and environment.24 Values typically articulated in the literatures include the self-actualization values of wellbeing, autonomy, and identify; and political values of equality; often balanced with economic values of cost and efficiency.

Ecological Model of Aging (Competence-Press Model)

Environmental Gerontology is based on the concept that there is a relationship between persons and their environment and that this relationship can be described, explained, and modified in order to improve quality of life for aging individuals (Wahl and Lang 2004). The foundational model, Lawton and Nahemow’s (1973) Ecological Model of Aging (Figure 5), commonly referred to as the Competence-Press Model (CPM), provides b a representation of the intersection of the individual’s level of competence and environmental demands. Focusing on capability, competence is defined as “relatively stable capacities of biological health, sensory and motor skills, and cognitive function” that can change because of illness or injury (Lawton and Nahemow quoted in Scheidt and Norris-Baker 2003, 91). Environmental press in CPM

24 These models do not address issues of environmental sustainability.

37 includes both objective environmental conditions and subjective assessment of their impacts, consisting of external “forces appraised by the individual as possessing a demand or supporting quality (Scheidt 2003, 35).” Both of these qualities are dynamic, thus the model presents a theoretical aggregate surface on which a particular moment can be plotted.

Figure 5 Competence-Press Model (CPM) by Lawton and Nahemow (1973)

Theoretical competence (on the y-axis) ranges from low to high, and press (on the x- axis) from weak to strong. The mapping surface of the model shows alternative outcomes identified as behaviors and affect (mood) resulting from the level of match between the capacities of the person and the environment. An optimal match between person and environment results in positive affect and behavior, while a poor match results in negative affect and behavior. Sub-zones such as the zone of maximum performance potential illustrate benefits of moderate challenge, and the zone of maximum comfort the relaxing experience of reduced press. To either side of the optimal area lie narrow marginal zones buffering the great

38 negative expanse where press is overwhelming (to the right), or conversely, demands are so low (on the left) that they lead to helplessness. Individuals with low competence adapt to less demanding environments and have narrower optimal zones than individuals with high levels of competence, thus the former are more quickly overwhelmed or under-challenged.

The overall goal of optimizing environments to personal abilities is human wellbeing; however this value is not clearly represented in the model. Competence in the CPM relates to the bio-psychological or health categories identified in the social/behavioral level of the context models, and environmental press relates to three environments: the social, built and physical.

Assuming adaptation, rather than transcendence, as the predominant response of the aging individual to the environment, the values implied are primarily materialistic.

Elements of wellbeing are partially addressed in the mapped surface which represents the individual’s behaviors (social) and affect (social and self-actualizing) and in the press which refers to the individual’s perception of the environment. This enhancement occurs in the move from Lewin’s (1951) ecological equation positing that behavior is a function of both the person and the objective environment [B = f(P,E)], to Lawton’s third construct, (P x E), the individual’s perception of the environment, indicating being in a place rather than a space. The revised formula states behavior is a function of the person, the objective environment and the individual’s perception of the environment [B = f(P, E, (PxE))] (Calkins and Weisman 1999, 131).

Despite this inclusion, the CPM has been criticized because it describes an organism’s response to the environment rather than a person’s response. Rubinstein and de Medeiros (2004) posit that it is not the outside environment that directly presses on the individual, but that person’s culturally influenced internal standard. Similar to the anthological concept of cultural

39 competence: there is a minimum necessary to know and feel to be a member of a culture. The elder abstracts meanings from the originating culture and interprets it to establish standards for personal competence. Over the lifetime, these meanings become a sort of personal morality of the self, thus if the elder can no longer perform a personally distinguishing activity – which can be as simple as making tea - their identity is diminished.25 This suggests that a comprehensive formula for environmental fit should include self in addition to person, environment and person x environment.

If wellbeing (self-actualization) depends on the full development and the essential preservation of both identity (self-actualization) and autonomy (social), pathways need to be identified and protected. In terms of the home environment, Wahl and Oswald identify parallel processes leading to wellbeing based on relatedness vs. competence. Their flow diagram

(Figure 6), Person-environment processes with developmental outcomes (PEDO), proposes that experience of belonging in place primarily supports identity and secondarily supports autonomy, while personal behavior related to agency (control, activity, fit) primarily supports autonomy and secondarily, identity. Thus optimal P-E fit (based on competence as health) i primarily supportive of engagement and equality at the social level and only secondarily supportive to identity and self-actualization. The definition of CPM competence could be expanded to include aspects of spirituality that increase positive affect or behaviors, but since these outcomes would be evaluated on the (materialistic) behavioral mapping surface, the

25 “Moreover, these activities and routines are at the core of the self and are symbolically significant to the person; they are what the person does and who she is. Routines and activities are embodied within the person through their unconscious nature and the habitus (quoted from Bourdieu, 1977, in Rubinstein and de Medeiros 2004, 72).”

40 CPM’s narrow characterization of wellbeing limits its usefulness for assessing self-actualization.

Person-environment Developmental processes outcomes

Experience Belonging Identity Concepts Residential satisfaction Place attachment Meaning of home Well-being

Behavior Agency Autonomy Concepts Housing-related control beliefs Environmental docility and proactivity Person-environment fit Figure 6 Person-environment processes with developmental outcomes (Wahl 2008)

Distinguishing between the processes and outcomes of personal experience and behavior is significant for research since experience is internal and difficult to outwardly assess, while behavior is external and more easily observed. Behavior, identified as an outcome in the

CPM, has been repeatedly demonstrated to be affected by the ability to function, whether due to control, permission or well-matched facilities (Clarke and Nieuwenhuijsen 2009). On the other hand, experience that is affected by the environment at the level of meaning, satisfaction, and attachment over time is more difficult to access and measure.26 This is the self/place interaction described by Rubinstein and de Medeiros that contrasts with an organism/space interaction. The self requires place and becomes one with place just as the

26 “Stronger consideration of the p-e fit concept is needed to guide studies in this area and the measurement of the environment. Measuring environmental barriers without consideration of the person and the fit with the person appears to have only limited potential to explain variance in disability-related outcomes. This represents both a conceptual and a methodological challenge (Wahl, et al., 2009, 365).”

41 organism requires space for existence.27 Self/place environmental fit would benefit from a theoretical model to focus this research conversation.

Social-Physical Places over Time

Additionally, the relevance of agency and belonging changes over the life span.

Relocation research on the moves of older adults identify that first moves are expected in the early years after retirement and are often selected to enhance agency (e. g. fewer stairs, close to places of activity, etc.). Second moves appear later in life and are motivated by desire for both supports and continuity. “Relocation to be closer to one’s children is a typical example

(Wahl and Lang 2004).” Third moves such as to a nursing home are problematic as this move is required to provide care (agency) at a later time in life when the personal priority has shifted to belonging. Wahl and Lang’s (2004) Social-Physical Places over Time (SPOT) model (Figure 7 and

Table 4) illustrates the trajectory of human motivation from prioritizing agency in middle adulthood, to valuing social-physical belonging for the oldest old.

The SPOT model is intended to integrate the developmental world view with the environmental fit model. It is based on three concepts: place, its social construction, and dynamic nature. Place is central, because “…every aging person’s day-to-day behavior is embedded within given physical and spatial surroundings (Wahl and Lang 2004, 17)” that have

27 “Beings surround themselves with the places they find themselves, the way one wraps oneself up in a garment that is at one and the same time a disguise and a characterization. Without places, beings would be abstractions. It is places that make their image precise and that give them the necessary support thanks to which we can assign them a place in out mental place, dream of them and remember them. (Poulet 1977, quoted in Chaudhury 2003, 26).”

42 (FigureSocial1) -Physical Places Over Time Model (SPOT): Implications for Future QoL in Old Age

Expected intra- Intensity of Social-Physical SPOT Processes individual trajectories Belonging

[Relatedness]

[Autonomy, Competence]

Societal opportunity Social-Physical structure Agency Historic Time – QoL in the future Middle Young- Old- Adulthood Old Old

Source. Wahl & Lang, 2006; see also Deci & Ryan, 2000.

Figure 7 Change over time (Wahl and Lang 2004) meaning rooted in characteristics and experiences.28 These places are “socially constructed, socially filled out, and socially shaped physical environments” and consequently places are dynamic, showing stability and change over time as people age and environments are modified

(Wahl and Lang 2004, 17). Wahl and Lang’s argument that the social and physical environment must be considered as an entity in future research on aging29, is “preaching to the choir” as the field is replete with examples of this relationship. The critical point identified in this and the previous PEDO model is the pathway between belonging and wellbeing that becomes essential for the wellbeing of aging individuals as their social-physical agency is declining. This identifies a

28 “Having lived in a specific place implies an enormous amount if implicit knowledge related to everyday routines, geographical distances inside and outside the home, distinguishing neighbors from strangers, seasonal changes of the sunlight and community services (Wahl 2004, 20).” 29 “…We argue that the social and physical environment as an entity must be considered more strongly as a major and inseparable element of this existential dynamic in future conceptual and empirical work in aging research (Wahl 2004, 25).”

43 humanistic values-based point of intervention for the design of the built environment, and not merely another behavioral adjustment that is required of marginalized aging seniors.

A reference table of wellbeing precursors over time, such as Person-Environment Fit

Dynamics (Table 4) an earlier presentation of SPOT, would enrich the conversation for designers of built environments because it sheds light on the specific needs that should be accommodated in the environment for phases of adulthood. In middle age, when the relevance of agency is high, the need is for stimulation and action. For the young old, the relevance of agency and belonging is balanced, as are needs for stimulation, activity, safety, familiarity, continuity and meaning. In old age, as the relevance of belonging increases and agency declines, the need increases for safety, familiarity, continuity and meaning.

Table 4 Person - Environment Fit Dynamics in SPOT (Wahl and Lang 2004, 24)

Relevance of Relevance of Person - Environment Fit Dynamics in SPOT Stage of Aging Social-Physical Social-Physical Stimulation & Safety & Continuity & Agency Belonging Activation Familiarity Meaning Middle Adulthood +++ + +++ + + Early Age/ “Young old” ++ ++ ++ ++ ++ “Old-Old”/ Oldest Old + +++ + +++ +++ A sustainable and humanistic approach to design would infuse essential elements required for safety, familiarity, continuity and meaning into environments built for middle adulthood and early age to maintain wellbeing throughout the entire life span. The reference table could expand to integrate the needs of disabled adults who lose agency earlier in the life- course and suggest strategies for populations with differing types of functional deficits.

Comparing terms from the person environment models (Table 5) with those previously identified in the context and values models reveals their orientation to behavior. The interface between the individual and the social and built environment neglects aspects of wellbeing

44 related to self-actualization that are internal to the individual. The models also essentially disregard the natural environment despite research showing the importance of access to nature in maintaining physical and mental health(Ulrich 1999). On the other hand, they clearly articulate multiple interacting levels of the social environment and demonstrate sensitivity to residential issues, including mention of neighborhoods and distances. 30

Summary of Person – Environment Interaction Models

Person – environment models from Environmental Gerontology provide an indispensable basis for understanding the centrality of the environment for individual agency and behavior. As such, they provide a theoretical underpinning for addressing social processes implicated in enabling and disabling behavioral environments, as well as providing justification for intervention in the built environment.

Lawton and Nahemow’s CPM is classic precisely because it continues to provide a clear presentation of foundational concepts, facilitating multi-disciplinary interaction regarding P-E fit. Wahl and Oswald’s PEDO, integrates concepts from psychology of aging and environmental psychology, proposing that interactive P-E processes can be pathways to wellbeing, thus extending the connection between person and environment into the self-actualization level.

Person-environment fit dynamics in SPOT develop the connections identified in PEDO and add the dynamic elements of time and place significant to understanding P-E processes as part of a system.

30 Not discussed in this text, but included in the chart for robustness, are Lawton’s five strata of an environment: physical, personal, small-group, supra-personal, and mega-social, four of which are social constructs. (Wahl and Lang 2004, 7-8).

45 Table 5 Comparison of Person-Environment Models with the Context and Values Models CONTEXTUAL MODELS VALUES PERSON ENVIRONMENT Hierarchy of Interior Terms from Person- Human Ecology Modal Patterns Purpose Ecosystem Environment Models Human Environed Human Self- Ultimate Ends Unit Organism actualization Wellbeing, (Implicit) Spirituality, Wellbeing (PEDO) (Implicit) Transcendence User- centered transcendence Enlightenment, Human Behavioral Identity (PEDO) Wisdom, ego- Self-realization, Environment Behavioral integrity Identity Psychological: Environment Fulfillment, Self- Sentiments, Psychological Affect (CPM) Psychology respect Aesthetics Continuity / Meaning (SPOT) socio- (Positive affect) Happiness Social: Family, Participation behavioral Friends, Colleagues Social Behavior (CPM - P) Press Intermediate socio-political integration, (CBM – E) Relatedness (SPOT) Ends “normalization” Biophysical Political Autonomy (PEDO & SPOT) Human capital, (equality, Comfort (CPM - P) bio-physical Leisure freedom, Simulation / Activation (SPOT) Human Created happiness) Health Environment Engaged Competence (CBM – P & Socio-cultural: Social SPOT) Safety (SPOT) Social capital Norms, Values Harmony, Press (CPM – E, PxE) Socio-biological Communication Knowledge Community, Familiarity (SPOT) Community Neighborhood Press (CPM - E) supra- Wealth Built personal environment: age Socio-physical: Food, Mobility, Environment mix of one’s neighborhood or Clothing, Shelter Consumer Goods range of health mix in a nursing home (L) physical Intermediate site environment: housing Means integration Social Services characteristics, the amount of Built capital: energy system seating space, and distances Production building (L) Safety (SPOT) Facilities, Tools, mega-social environment: (socio-biological & materials Social Processed Raw legislative regulations and socio-cultural) design conscience, Materials liberal capitalism (L) liberalism Human capital: Natural Natural Performance (CPM - P) Welfare State Labor Environment Environment Ultimate Means Other Natural Resources, Air, Rejection Press (CPM - E) Natural Capital Resources Plants, Water, Repression, KEY: CPM – Competence- Earth Materials, Land Energy, avoidance press model, PEDO – Person- Biosphere Energy Climactic Daylight, Economic values environment processes Solar Energy Zone Climate No services Developmental outcomes SPOT – Social-physical places over time, L = Environments identified by Lawton (Wahl & Lang 2004, 7-8)

46 While these models are oriented toward positive outcomes for aging adults, the values implied by the models do not reflect humanistic values such as transcendence, spirituality, wisdom and ego-integrity. P-E fit evaluated by behavior and affect limits the scope of analysis to the materialistic aspects of the P-E interaction and may result in failure to notice – or pursue the significant benefits for aging individuals for assessing and supporting P-E fit with both spirituality and nature. The focus of research centered on CPM, particularly for housing, actually supports sustainability of existing bureaucratic systems (Moody 1993), modulating service provision toward the participation level, by demonstrating positive behavioral and affective outcomes.31 Values of sustainability for the natural environment and the benefits of outdoor activities are also marginal to the models.

The strength of the models is illustrated in their application to residential structure and organization, particularly significant for identifying characteristics that create or reduce disability.32 Although specific markers have not been clearly identified, the models explain that over care or over support is equally disabling to lack of care, suggesting that facilities and services must be calibrated to needs of individual persons. Further, by targeting environmental causes for disability P-E fit models can direct resource use more effectively, holding the possibility of identifying opportunities for sustainable use of resources.33

P-E fit models are also significant to the development of a system model for the built environment, While Lawton and Nahemow’s CPM presented on the two dimensional page is

31 For examples applied to place experience see Calkins and Weisman. 1999. p. 130 – 140. 32 For a comparison of therapeutic goals for environments for the elderly see Calkins and Weisman. 1999. p. 134. 33 For examples of expending resources on direct care rather than supporting self-care see Heumann, 2001.

47 static, it is both premised on and has the capacity to map change if considered with a third dimension of time. Wahl and Oswald’s PEDO is a flow diagram of a developmental process proposing significant linkages between environments and wellbeing. Finally, Wahl’s and Lang’s

SPOT analysis identifies a significant dynamic in human motivation affecting P-E fit.

2.6 Models of Health and Disability

Models from public health and epidemiology related to the social determinants of health and to disablement are considered together in this section because they focus on enabling and disabling effects of the environment.34 These models are not specific to either aging or the built environment but include these topics within their scope. The social determinants of health models share characteristics with the context models and the person- environment interaction models, explicating physical, social and cultural environments’ systemic effects on health. Disablement models seek to identify specific links between environmental factors and individual disability. Both approaches are relevant to developing a systems model for aging in the built environment. Values in the public health literature are centered on optimizing human health and function; however the effects of poverty, inequality, stigma, pollution, nature and spirituality are included as factors in the models.

34 I have relied to a great extent on the publications of World Health Organization (WHO), the National Institutes of Health (NIH), the Centers for Disease Control (CDC), the Institute of Medicine (IOM) of the National Academies and the research of the Robert Wood Johnson Foundation (RWJF) to identify significant health literature related to aging, ability, disability and the built environment. The WHO global focus on equity, while broadly oriented, is relevant because of the connected and systemic approach toward health and the environment. The NIH, IOM and CDC documents include references to environmental effects on health; however the structure of the information is less integrated, making it more difficult to identify specific research related to living environments. Interestingly, more targeted research may soon be available, as the upcoming CDC 2009 Healthy Aging Network Conference topic is Promoting Environmental and Policy Change to Support Healthy Aging.

48 Relationship of the health and disability models to the built environment

The foundational Dahlgren and Whitehead (1991) determinants of health model incorporates aspects of the built environment into the “causes of causes” of individual or community health, linking housing, neighborhood contexts, and planning issues such as access and transportation, with social equity and access to health care. This approach is reflected in the WHO World Health Report, 2002: Reducing Risks, Promoting Healthy Life; the Centers for

Disease Control and Prevention (CDC) Longitudinal Studies of Aging: LSOA II, and is mentioned in other public health related documents.35

While this literature provides explicit links between regional or urban planning and health (Tomlinson 2007), the disablement process models apply to the more immediate scales of architecture, interior design and landscape architecture, specifically emphasizing the intervening factors that "speed up and slow down" the pathway between pathology and disability (Clarke and George 2005). Preliminary research suggests links between the built environment and mental health (Evans 2003), and a large body of research has developed around the concept of healing environments (Ulrich and Zimring 2004). Research bridging health and design provides the basis for specific building design guidelines, particularly for care facilities (Malkin 2008).

Social Determinants of Health

In models based on the social determinants of health (SDH), the built environment is considered a contextual variable related to social and behavioral factors that directly or

35 Centers for Disease Control and Prevention and The Merck Company Foundation. The State of Aging and Health in America 2007. Whitehouse Station, NJ: The Merck Company Foundation; 2007.

49 indirectly exert an influence on health of individuals and populations. Whitehead and Dahlgren

developed this model (Figure 8) in 1991 as part of a comprehensive WHO strategy to promote

greater equity in health between different social and occupational groups. Their report stressed

the need for “comprehensive approaches,” “different policy levels for interventions” and

provided a “strategy matrix” for implementation. The model is applied to study – and help

mitigate – the effects of political, economic, social status, propose education, improve working

and living conditions, create a social protection policy, and promote walk-able neighborhoods.

The environmentally oriented WHO Healthy Settings and Healthy Cities programs, as well as

the Aging Friendly Cities initiative, are based on this model,36 as is genome –environment

research (Hernandez and Blazer 2006), and many projects less oriented to the physical

environment such as the John D. and Catherine T MacArthur Research Network on Socio-

Figure 8 Main determinants of health (Whitehead and Dahlgren 1991)

36 WHO. 2007. Health Update, Vol.2, No.11

50 economic Status and Health.37

Specific applications of this model for aging and disability are infused throughout the

2001 World Health Organization (WHO) International Categories for Measuring Functioning,

Disability and Health (ICF 2001), which is based on concepts that relative levels of health and disability affect all people across their life span, and that the incidence and severity of disability is influenced by contextual factors. The ICF documents and questionnaires consider both physical and social environments, which are expressed in policies and services. They also address the limiting effects of stigma and internalization, both related and unrelated to access, economics, technology, and the direct impacts of the built and natural environment.

The WHO ICF training materials state “reductions in the incidence and severity of disability in a population can be brought about both by enhancing the functional capacity of the person and by improving performance by modifying features of the social and physical environment (WHO ICF Training Beginner’s Guide).”38 In order to recommend interventions the

ICF checklist evaluates bodily functions, domains of activities and environmental factors, and specifically assesses products and technology for use in daily living, mobility and transportation, communication; and the design, construction and technologies of public and private buildings.

Natural and artificial climate, light and sound are also noted. Each category is rated as a barrier or facilitator for functioning on a scale from 0 – 4, as none, mild, moderate, severe or complete

(WHO ICF Checklist).39 The identification of the importance of the environment in disability

37 MacArthur SES & Health Network. http://www.macses.ucsf.edu/Network/Mission.htm 38 http://www.who.int/classifications/icf/training/icfbeginnersguide.pdf 39 http://www.who.int/classifications/icf/training/icfchecklist.pdf

51 changes the locus of the problem from the individual, to the environment where the individual lives or acts. Thus the disability is not a feature of the individual, but an “outcome of the interaction between the person with a health condition, and the environmental factors

(Schneidert, Hurst, Miller and Ustun 2003, 558).”

Stineman and her collaborators (2006) critique the SDH model because proponents often minimize environmental features, or insist these must be addressed by social or political means. Research demonstrates a clear reduction in experienced disability when home modifications were made to address the specific activities of daily living (ADL) client needs.

Stineman argues that since the WHO ICF and the US Department of Health Healthy People 2010 objectives are to reduce barriers to for people with disabilities, immediate built environment interventions, which have a great effect in reducing disability, can occur before all of the social inequities are resolved. ADL difficulties are a greater known risk factor for long-term institutionalization than socio-economic status, thus systemic lack of accessibility leads to unjustifiable institutionalization. According to the authors, the most useful approaches combine interventions at both the patient level (home modification and therapy) and the population level (removing environmental barriers and social policies) and are based on theoretical models of the human as a dynamic system within the environment as a dynamic system.40

Bonnefoy argues for a ‘thick description’ approach to public health research, explaining that strictly empirical research eliminates much of what is essential to understanding the full

40 Dynamic systems theory, which informs health sciences ranging from stem cell biology through studies on states of consciousness, visualizes change driven by the internal dynamics of a smaller system (here the human being) reacting to and exchanging with a larger system (here the physical world and society) (Stineman 2006, 1166).

52 range of phenomena and interrelationships.41 She also emphasizes that much SDH reported data excludes the local context because of the emphasis of the SDH on social factors42, while the factors described in the evidence base actually occur in places, houses, communities, workplaces, etc.

"The molecules in the human body behave differently according to the social position someone occupies, the country they live in, the global political situation around them. The molecules behave differently according to the job someone does, according to their experience of class, gender and ethnic relations, according to their education, and according to a whole range of social factors which affect them over their life course.

41 "From a methodological point of view, even within the Eurocentric paradigm very few studies reach an ideal gold standard. This observation is not just the very obvious and commonplace one that inevitably there will always be practical, resource and other real world difficulties in conducting research, and that these will reflect themselves in the way that final results are presented. Nor is the point that bias is an inevitable part of the scientific endeavor. The observation is more fundamental than that. The nature of scientific research designs means that critical variables, of vital interest to practice, are frequently excluded from consideration. In the interest of increasing the degree of certainty that the observed relationships between two variables are real, a range of other potential confounding factors are controlled out of the analysis. To some extent all science inevitably involves abstraction from the complexities of messy reality in order to make sense of phenomena and the relationships between them. However in public health this means that the search for scientific purity, particularly as the evidence hierarchy is ascended, is traded off against the loss of two sorts of important information. The first is process data, i.e. material relating to the practical problems associated with doing the research, or of doing the intervention upon which the research is based, or both. This may well include all sorts of material relating to the actions, motives and behaviors of people, including the investigators as well as the subjects who are involved in the study. The second missing data relate to the mediating effects of variables like the local context and circumstances (Bonnefoy 2007, 213). 42 At least four groups of theories have been proposed to explain inequities in health and its relation to socioeconomic position. The materialist/ structuralist theory proposes that inadequacy in individual income levels leads to a lack of resources to cope with stressors of life and thus produces ill health (Goldberg et al., 2003; Frohlich et al., 2001; Macintyre, 1997). The psycho-social model proposes that discrimination based on one’s place in the social hierarchy causes stressors of various kinds which lead to a neuroendocrine response that produces disease (Karasek, 1996; Siegrist & Marmot, 2004; Evans & Stoddart, 2003; Goldberg et al., 2003). The social production of health model is based on the premise that capitalist priorities for accumulating wealth, power, prestige and material assets are achieved at the cost of the disadvantaged. The ecosocial theory brings together psycho-social and social production of health models, and looks at how social and physical environments interact with biology and how individuals ‘embody’ aspects of the contexts in which they live and work (Goldberg et al., 2003; Krieger, 2001). It builds on the ‘collective lifestyles’ approach and the neo-Weberian theory that lifestyle choices are influenced by life chances defined by the environment in which people live (Frohlich, 2001; Cockerham, 1997). (Bonnefoy, Morgan, Kelly, Butt, Bergman. 2007.)

53 Their genetic structure and their immunity, their nutritional status, their resilience, their ability to cope – all act as mediating factors, but ultimately there is a plausible causal pathway from a number of social factors or social determinants to biological structures in the individual human body (Bonnefoy 2007, 13).

Social determinants are regard as “the media through which the social world impacts directly on life experiences and exerts direct effects on the human body (Bonnefoy 2007, 13-

14)” rather than the somewhat obvious effect of doors and windows identified by the research

(Stineman 2006; Ulrich 2004).

Human Ecology Model of a Settlement

The WHO Healthy Cities movement links the fields of public health and planning. Writing

“health and urban planning are natural bedfellows,” Barton (2003) reviews the historical basis of town planning, the need for clean water, sanitation, light and air, and decries the current rupture between the fields. Barton has developed a variant of the SDH model that emphasizes the importance of the physical environment on all of human activity and centrally, health. The

Human Ecology Model of a Settlement (HEMS) (Figure 9) identifies spatial and aspatial influences on human health within the urban context, and illustrates layers of influence across and between systems. The significant idea in his model is that the outer circles of the model constrain the options of the inner circles, thus the biosphere limits the places, which limit the local economy, and so forth, similar to Meadow’s hierarchical relationships, However, Barton places health where the HOP places wellbeing. Barton’s model is designed to illustrate the city system, thus it doesn’t discuss the smaller scale built environment, the home and the spaces within.

54 SPATIAL

7) Global ecology and environmental capital 6) Adapted spaces and channels 5) Economic operations and markets 4) Activity systems and movement 3) Social groups and networks 2) Lifestyle / behavioral choice 1) Quality of life 2-3) Cultural beliefs, values and norms 4-6) General social, political, economic, technological conditions, governance and institutions

ASPATIAL

Figure 9 Human ecology model of a settlement (Barton 2003)

An early dynamic system model of the determinants of health (DSM) (Figure 10) proposed by Evans and Stoddart (1990), adds an economic environment, labeled prosperity, to the social and physical environments. While the society-wide economic cost of health is often referred to as an “investment in health”, the major users of health services, the elderly and chronically ill, are generally outside of the labor force, thus this investment is not directly economic but must have other significant social value. The authors describe the ‘problemic’ global nature of the WHO definition of health policy, “because implicitly it includes all policy as health policy (Evans and Stoddart 1990, 175),” yet they reflect Moody’s values by placing the argument for social health in a larger context of individual and social wellbeing. The writers posit the lack of intellectual categories in which to assemble systemic data leads to this data being ignored, in preference to the simpler mechanical model of disease where “the machine

55 (us) is damaged or breaks, and the broken part is repaired (or perhaps replaced) (Evans and

Stoddart 1990, 178).”

Evans and Stoddart’s model, which includes the factor of genetic endowment, suggests

links to research that could be predictive for built environment needs, by identifying types of

FigureFigure 10 10 A Amodel model of of the the determinants determinants of of health. health. (Evans (Evans and and Stoddart Stoddart 1990, 1990, 1359) 1359 )

health issues that benefit from environmental intervention. The Behavioral and Social Research

(BSR) program at the National Institute on Aging (NIA) supports research on the effects of

environments on genes. Typically research subjects are twins, fruit flies or mice, but the

complexity and significance of the environment on gene expression has led to the development

of dynamical systems that have potential for the study of aging. In the 2002 workshop,

Genetics, Behavior and Aging, the presentations covered the range of issues: “The environment

is multi-level, multi-dimensional, and hierarchical, with bi-directional linkages between these

many levels.” “The environment operates in historical and individual time.” “How do we assess

environment across the life span?” “Environments are not independent of individuals’

genotypes. Individuals actively select their environments, and react differently to the

56 environments they encounter, and genetic predispositions play a role in these processes (NIA

2002, 2).” These models have potential for the study of aging; however require more robust theoretical confirmation with more fully developed parameters (NIA 2002, 5).

2.7 Disablement Process Models

The SDH models use statistical research on social, political, economic, and physical conditions to produce general population-wide guidelines based on generalizable data.

Disablement models share this broad background but focus on the immediate interactions that impact individuals: the near (physical and social) environment and the inner experiences of individuals. Similar to the person-environment fit models, disability is regarded as the consequence of the gap between individual capabilities and social or physical demands. 43 This approach is more applicable to aging than the Social Security Administration’s definition of a disability as the “inability to work as the result of physical or mental impairment (Wunderlich,

Rice, and Amado 2002).” Significant disablement processes occur in the built environment, and these models identify circumstances where changes in the built environment can enable aging individuals.

Disablement Process

Predating the SDH and the P-E Fit models, Nagi (1965) proposed the conceptual framework of disability as the expression of a physical or mental limitation in a social context.

43 “Thought and action are the substrates of experience. Inputs from joints, soft tissues, and other internal organs, along with “realtime” physical and social experiences, produce neural activity, which rises to the level of consciousness. These real-time experiences are then mediated through memories, as each moment’s compiled stimuli drives the next moment’s behavior and actions. Actions affect the environment, which, in turn, form substrates for the next experiences. There are complex networks and feedback loops among the body, mind, physical world, and society spheres that can be supported empirically (Stineman 2001, 38).”

57 His disablement process model (Table 6) accounts for the reality that “not all impairments or functional limitations precipitate disability, and similar patterns of disability may result from different types of impairments and limitations in function. Furthermore, identical types of impairments and similar functional limitations may result in different patterns of disability.

Table 6 Disablement process (Nagi 1965 in Wunderlich 2002) Active Impairment Functional Disability pathology Limitation Description Interference with Physical or mental Performance Limitation in task or normal processes abnormality or loss limitation of person role in environment Example Arthritis Abnormal hand Weakness of grip Difficulty opening door structure

This simple flow model reflects personal experiences of the impairment, responses of the factors that “speed up or slow down” the pathway from a disease or injury to a functional disability. “The main pathway in the model starts with pathology (e.g., disease, injury), which in turn influences impairments (e.g., dysfunctions in specific body systems), which lead to functional limitations (restrictions in basic physical and mental actions), which ultimately influence the ability to perform everyday activities, or disability (Clarke and George 2005).

58 Verbrugge and Jette add risk, intra-individual and extra-individual factors to this basic model in order to map more of the processes that occur within the system. Their disablement process model (V-DP) has retained the basic uni-directional flow. The V-DP addresses criticism of Nagi’s model for omitting the self (limited to impact on functioning), but does not address not the moral issues of rehabilitation and the bureaucratic consequences of disability management in this country44,45

Figure 11 Disablement process model (Verbrugge and Jette 1994)

44 “Rehabilitation programs do more than evaluate client applications. They shape and alter self- conceptions, personal careers, and social relationships. By failing to include data on the subjective experiences of disabled persons, Nagi's study largely passes over the human tragedy contained within our society's welfare systems. That people lie, cheat, and rewrite their biographies to beat or get into the system is a reflection on the system. Conversely, it must be noted that welfare and clinical workers are cast into positions of making moral-not just statistical-judgments about social selves (Denzin 1971, 576).” 45 See also criticism of the disablement process scope of inquiry (Oldman, 2002).

59 Health Environmental Interaction

Stineman’s (2001) Health Environment Interaction Model (HEI) combines concepts from

SDH, DM, biomedical, biophysical, health-related quality of life and organic unity theory in order to provide a holistic model of the disablement process. The goal is to conceptualize the interaction between the individual and total environment. The model centers on the discrete steps of the disability models, the handicap creation process, however adds additional disease stages (on the left) and an entire structure of spheres (on the right) representing mind, body, society and physical environments.

Stineman posits that handicap creation is related to specific combinations of environments, thus the level of Participation Restriction occurs primarily in the physical and social environment, Activity Limitation is created by an interaction of all environments, and

Impairment and Functional Limitation primarily occurs in the body or the mind. The HEI model addresses all of environments identified by the context models and provides conceptual space to consider various combinations of personal experience. Like Guerin’s approach to the addressing the complexity of environments in the IEM, Stineman accommodates the volume of information in each environment by providing empty spaces for what she describes as the

“structured hierarchies” of objects and interactions that make up each environment.

The HEI model clearly is oriented to a medical approach, as the environmental structures are intended to explain disablement and optimize functional outcomes. However, it accommodates the activities of each of the environments, for example, the phenomenological experience of disability within and outside of the self, or the benefits of connecting with nature.

60 It also directs the focus of built environment accommodations to elements of participation and activity.

Figure 12 Spheres of health environmental integration (Stineman 2001, 36)

Clarke’s research on mobility verifies that even small improvements in proximal environments, such as sidewalks, have significant impacts on mobility for individuals with impaired gait or balance. The positive consequences of sidewalk repair include social interaction, recreation, and meeting daily needs (Clarke 2008).

The terms from health and disability models clearly center on the biophysical and health category in the intermediate ends level of Meadows HOP. Individual behavioral, the built environment, health care services and a range of social factors are also primary topics. In contrast to the previously discussed models, economics (and prosperity) are factors, both because prosperity is linked to better health and because poverty reduces access to medical care. The disablement models specifically cite human wellbeing or quality of life, while it is

61 implicit in SDH models because of the central placement of people in the model. Both sets of models mention elements of the natural environment.

Summary of health and disability models

Health and disability models in the current literatures provide valuable approaches to design of the built environment for aging. The SDH underscores the significance of social responsibility in creating and maintaining health for all. The effects of equality, stigma, racism, and poverty become evident in the built environment before they become evident in the health of residents. Equal access for all people is reflected in infrastructure, zoning, and capital investment in mobility for all, etc. Stigma, racism and poverty are evident in lacking or marginal housing, deficient services, unequal protection of individual property, and privileging certain communities, etc. Aging individuals who cannot remain in their homes and communities because the necessary capital investment has not been made in their community are victims of stigma, ageism and economic inequality. Unfortunately, these factors also lead to decrements in their health, from reduced participation, and limited activities, to the effects of transfer trauma, when aging individuals must give up the places of belonging they call home.

The SDH models consider the built environment as a contextual variable related to social or behavioral factors that directly influence health, but the disablement process models identify direct impacts. Evidence based design (EBD) applies research from medical and related fields to the specific design of facilities, both for creating ‘healing environments’ for patients, but also because of the impact of the built environment on quality of care, patient safety, and staff efficiency (Malkin 2008).

62 Putnam proposes that aging theories can benefit from disability models because of their clear recognition of the significance of the environment in limiting participation and orientation toward the social value of the disabled individual. Aging models tend to assume the medical model of providing services in a care management approach (Putnam 2002). The purpose of the medical model of aging is to identify the optimal supports and services for the individual, similar to Moody’s social services level. Disability models are oriented more towards self- determination arising from the disability rights movement. Their purposes are both physical and social enablement, corresponding to the participation level of the MPTA. The health and disability models incorporate a great deal of complex information and identify important linkages for creating a model of sustainable aging.

2.8 Life Space Models

The term life-space has been used in the social sciences and aging literature variously, but is most commonly applied to a life space model proposed by Mays (1985) and codified by the Life-space Questionnaire (Stavley 1999) which tracks the general spaces individuals move through, categorizing by definition or distance, rather than mapping specific locations. Mays

(1985) life space model is used in gerontology to assess the range, independence and frequency of movement, primarily with older and fragile adults. Rowles (1983) has also studied aging populations but from the perspective of geography, thus his model is applicable to mapping distances (Figure 13). Bronfenbrenner’s ecologic model (presented in Chapter 4: Findings and discussion), abstracts the concepts of environments and was designed to elucidate human development person, place, time and multiple contexts

63 Life Space model (Peel 2005, 1010) Life Space model (Rowles and Ohta 1983)

Figure 13 Life Space model variations

2.9 Sustainability Models

Sustainability models arise from diverse physical, social and technological literatures and reflect the organizing structures of their fields, whether from environmental sciences, economics, design, ethics and systems. In this section two models of sustainability, one from business and the other from rural economic development, will be considered in order to identify specific values and approaches to operationalizing the concepts of sustainability. This section could also include the initial Meadows hierarchy of purpose context model oriented to identifying the range and values of the subject, and Machlis’ human ecosystem model, which applies a system approach and will be addressed in the following section.

Sustainability models are concerned with ethics, ecology and economics in that they seek to correctly identify and value the inputs required for long term survival (at an acceptable

64 level) of a planet, natural environment, society, community or individual. Sustainability models typically do not target aging or disability, but are significant in the design of the built environment, the habitat of aging people, a growing demographic with even more quickly growing needs for built environment supports (Landorf, Brewer and Sheppard 2008).

Criteria for Corporate Sustainability

Corporations are concerned with profitability, thus classically business sustainability is often defined as either the capacity for long term success of the company or at best, eco- efficiency, the efficient use of resources. Dyllick and Hockerts (2002) posit that the long term success of the company actually requires a sustainable approach to all three major areas of capital: economic, social, and natural, on which company health relies. In each case the company must ensure that it consumes the income and not the capital needed for production.

These areas of needed capital become the three dimensions of sustainability, and anchor the vertices of their model (Figure 14), the corporate criteria for sustainability (CCS).

Along each side of the triangle the relevant concepts of sustainability are operationalized. For example, along the continuum from business to nature lie two applications, one oriented to each sustainability goal. Oriented to business is the practice of eco-efficiency, the efficient use of resources. Oriented to nature is the practice of eco- effectiveness, reducing ecological degradation. Between business and society lie socio-efficiency

(minimizing negative/ maximizing positive social impacts) and socio-effectiveness (serving the neediest). Finally between nature and society are the practices of sufficiency (not marketing- driven) and ecological equity (equitable distribution of natural capital). The authors propose these practices are the six criteria of corporate sustainability.

65

Figure 14 Criteria for Corporate Sustainability (Dyllick and Hockerts 2002, 138)

This elegant and simple model simplifies and integrates earlier concepts of economic, environmental and social sustainability by considering corporate goals within the context of social and environmental realities over the very “long term”.46 The application of identified criteria is not as straightforward as the definitions, for example it is difficult to imagine a business plan designed for ecological-equity, since the authors point out that “indicators to guide firms on this sustainability criterion do not yet exist (Dyllik 2002, 138).” It is also difficult to place the “process” terms from this model into the comparison table, despite the clear relationship between the concepts of economic, social and natural capital and the HOP model.

While this model provides an exemplary standard for corporate sustainability, and reaffirms the values of equity and efficiency previously related to environments by Moody’s MPTA, it is

46 For a more complex integrative visualization see the STAR model assembled by Hockerts, K. 1999. "The SusTainAbility Radar: A Tool for the Innovation of Sustainable Products and Services". Greener Management International. (25): 29-49.

66 clearly focused on the material aspects of life, thus does not incorporate concepts of wellbeing or self-actualization. In this model the ultimate goal of sustainability is “continuous satisfaction of human needs (Brundtland, 1987 in Chiras. 1997, 120, 122).”

Sustainable Development: A Systems–based Approach

Another simply structured sustainability model with application matrix, is provided by

Chiras and Herman. Entitled Sustainable Development: A Systems–based Approach (SDA)

(Chiras 1997), (Figure 15). The systems referred to are not dynamically illustrated in the model, but are the systems in the rural community that need to become sustainable. This two part model is included because it suggests another means for operationalizing the concepts of sustainability.

Primary Input Secondary Throughput Primary Output Energy housing Waste Materials transportation Management Water business/industry agriculture telecommunication health care education government Figure 15 Sustainable Development: A systems–based approach (Chiras 1997)

The authors identify seven “human systems”, housing, transportation, business/industry, agriculture, telecommunication, health care, education, and government.

Each of these systems requires the primary input of energy, material and water. Each has a primary output of waste management. All of the terms in the model are related to either the natural environment or to the production and provision of services in the built environment. As the application matrix is completed, the terms will likely continue to be oriented toward the

67 physical environment; however the process will occur in a human/social environment, thus expand participation and build additional social capital in practice.

This matrix (Figure 16) is used in community-based workshops where participants collaborate to identify operating principles which can be applied by the specific community rather than directive principles of how things “ought to be.” While this approach is less sophisticated than the earlier model and does not address the broad range of sustainability needs, it is practical for immediate and direct action when participants and identified systems come to agreement. The collaborative approach to sustainability may also begin to address the difficult issues faced by individuals (and individual corporations) attempting to live sustainably in a world caught in Hardin’s (1968) tragedy of the commons.

Principle of sustainable Conservation Recycling and Growth management development (efficiency and frugality) Composting (controlling growth patterns Systems and stabilizing growth) Transportation (surface, Fill in each box with ideas air and water-based) for policies and actions that implement the principle in each system Housing and other Some systems should buildings (construction be considered systems) together Agriculture, Food Some policies and actions processing and may overlap – i. e. have Distribution effects on more than one system Figure 16 Sustainability matrix

Summary of Sustainability Models

The sustainability models considered in this section represent a limited set of approaches; however they highlight the necessity of modeling sustainability beyond the natural and “industrial” environments, into the social and personal. The Meadows HOP comes closest to addressing the impact of sustainability on human wellbeing, however its hierarchical form

68 inserts “mediating factors” of the built environment and society between human wellbeing and the natural environment, thus obscuring the other reality that humans are natural parts of the natural environment, Earthlings, on and of the Earth.

The literatures use terms such as sustainable communities, urban sustainability, and sustainable aging, and call for more research and theories regarding these topics, particularly on the health benefits of promoting sustainable communities that are places “conducive to mental and physical wellbeing”.47 In assessing the urban environment for what he terms sustainable aging, Landorf’s research links to both business and disablement models. He identifies the same three conceptual dimensions of sustainability as Dyllick’s business oriented

CCS, economic, environmental and social. He also posits that the “disabling impact of the urban environment on aging people should be a consideration in the urban sustainability debate,” identifying that disablement processes in the urban environment create an unsustainable environment for aging individuals (Landorf 2008, 497). Models of sustainable aging can begin to address the “sustainable aging vs. successful aging (von Faber 2001) conversation as a more inclusive approach to an empowered and meaningful conception of aging.

2.10 Models of Systems

System models are designed to be descriptive, explanatory, and predictive of the mutual effects (outcomes) of a set of interconnected factors. My search of the literatures did not identify a system model specifically about either aging or the built environment. I have selected

47 “The President’s Council in 1993 offered a working definition for sustainable communities as ‘healthy communities where natural and historic resources are preserved, jobs are available, sprawl is contained, neighborhoods are secure, education is lifelong, transportation and health care are accessible, and all citizens have opportunities to improve the quality of their lives’ (Srinvasan, O’OFallon and Dearry 2003, 1447).”

69 two approaches for review because system modeling may provide a means for understanding how the current built environment for aging is created and where the system can be modified in order to infuse positive changes. Machlis’ Human Ecosystem model links human behavior to the ecosystem in order to incorporate the effects of human systems on the health of the larger environment. Bossel builds on Forrester’s classic approach to present a strategy for identifying significant components and indicators of the condition of the anthroposphere, “the sphere that is affected by and affects human society (Bossel 1999, 18).”

Introduction to System Dynamics

System modeling is a specific form of modeling related to expressing the mutual effects of related elements and activities on one another and on the system as a whole. Since components of systems have relationships that change or impact each other, models of systems identify feedback loops and clarify the connections. For example, if suburban sprawl takes place on productive agricultural land, then a model showing urban growth should include the resulting reduction of agricultural land.

A system is defined as “two or more elements interconnected for some purpose (Ford,

1999, 12).” Dynamic systems change through growth, decay and oscillations. Dynamic systems operate in an inherent sequence driven by components within the system. Stocks, the available amounts of a component measured at a specific point in time, whether acres of agricultural land or barrels of oil; and flows, the changes and directions of change in stocks, such as “acres of agricultural land converted to residential use in the last year” are the building blocks that form the infrastructure of a system. Feedback loops demonstrate the connections between the components, both positively in growth and negatively as stocks diminish.

70 System models may be designed as mental models to focus on identifying the domains

and elements of a system that are linked to each other, in order to support analysis that

considers how changes in one domain impact related domains. Computer based models build

on mental models, assigning mathematical values to elements in order to simulate the workings

of the system, particularly in cases where it would not be possible to perform actual

experiments.

The following diagrams from Forrester illustrate how system models are structured.

Figure 17 illustrates the contrast between the typical perception of decision-making as a linear

process (gather information, make a decision, have consequences) and Figure 3, a single system

process (a decision is made within a context which has been shaped by earlier decisions and the

results will shape later decisions). The environment in which a decision is made rarely has only

one influence or outcome.

Figure 17 System dynamics (Forrester 1991, 13)

Figure 18 illustrates a set of mutually influential events, decisions, and outcomes that

result in second and third order consequences. Since the longer term (downstream)

consequences of decisions are removed from the immediate situation, they are often not

considered in future decisions; rather the (upstream) immediate needs and pressures take

71 precedence. The complexity of multiple interactions and influences occurring over extended periods of time makes computer simulation the only viable choice for many applications.

Figure 18 Interconnected system (Forrester 1991, 14) Modeling to understand dynamic systems has grown in environment science, not only to study physical processes, such as hydrology cycles, but increasingly to research the complex human relationship with the natural environment. Considering “…human variables as both the cause and consequence of system change” Machlis and Force’s (1997) Human Ecosystem Model

(HEM) (Figure 19) links critical resources with social systems accounting for flows and feedback between biophysical, socioeconomic, and cultural resources; and institutions, cycles, and social orders. Referencing Udry (1995) they rationalize “an ecology that includes humans is like other zoological studies in that it begins with the biological and environmental conditions of the observed species, rather than a determined assertion as to how little such factors matter in explaining the observed behavioral patterns (p. 352).”

72 The HEM is a mental model that is also used as the basis for computer simulations can be used at larger and smaller scales. “A family unit, community, county, region, nation, even the planet, can fruitfully be treated as a human ecosystem.” This model is particularly useful for anticipating interrelated impacts between environmental changes and social consequences.

“For example, changes in land use (such as a shift from timbering to recreation) may impact a full range of social institutions in ways that ecosystem managers and citizens need to anticipate

(Machlis and Force 1997, 352).”

Figure 19 Human Ecosystem Model (Machlis and Force 2005)

73 HEM rearranges the material environments identified by the context models and places them in the category of critical resources. These resources include biophysical (natural environment), socioeconomic (economic and human capital) and cultural (social capital).

Machlis’second major category, social systems, reconsiders the functional structures contained within or made up of human, social and economic processes (essentially the artificial Human

Created Environment identified by Buboltz). This category includes social institutions (family, government), timing cycles (life-cycle, election cycle) and social order (demographics, power) within the social capital system.48 In application, base conditions are identified for each critical resource, and inputs (or flows) and timing cycles are determined from each social system. The entire set is also embedded in a larger system and both open to incoming elements and producing outgoing elements.

Terms from the HEM model range the full span of environments with few terms related to individual wellbeing, but primary focus on the social and technological structures that influence the actual shape of the built environment. Implicit in the system is the fact that this specific built environment will challenge the resources and carrying capacity of the natural environment. It is this interplay of social, institutional and cultural factors that the broader literatures also focus on in addressing the built environment for aging.

Fundamental Properties of System Environments

Following in the tradition of Forrester’s (1971) system dynamics and Meadows (1999) sustainability indicators, Bossel presents a comprehensive explanation of the relationship

48 A fruitful comparison might be made with Stineman’s HEI, as Machlis suggests relevant content for Stineman’s categories while Stineman locates disabling impacts.

74 between human behavior and global sustainability, with a focus on the ecological impact of economic development. In his 1999 report to the Balaton group49, he explicates the fundamental processes that viable (sustainable) organisms and systems must evidence. Two of his models are included in this review. The first organizes the six major systems into three categories: natural, supportive and human systems. The second illustrates how the external environment of each system places predictable sorts of demands requiring internal capacities matched to each of these demands. Thus the internal needs of the viable organism are a response to the external demands of the environment and lead to specific characteristics which are the orientators of system behavior.

Bossel’s organization of the six major systems of the anthrosphere (SMA) is presented in three levels, but actually corresponds to all four of the environment identified by the context models. The natural system relates to the natural environment, the economic and infrastructure systems to the built environment and social and government systems to the social environment. The area of individual development includes primarily aspects of social interactions (civil liberties, equity, and health) but also contains elements identified as ultimate ends in the HOP (autonomy, self-determination).

49 The Balaton group was founded by Donela and Dennis Meadows, the principle authors of Limits to Growth, an international network for researchers on resource use, environmental conservation, systems modeling, and sustainability. For more information see http://www.balatongroup.org/FAQ.html

75

Figure 20 Major systems of the anthrosphere (Bossel 1999)

This model (Figure 20) is particularly easy to understand and clarifies the relationships of these systems to their respective environments. Each of the systems in the model also represents potential for action. Individual potential contains the possibilities for competent human action and is the result of accumulated cultural knowledge as well as political and economic conditions. Social potential holds the possibilities of constructive social action, and so on. These systemic potentials are needed as the viable organism deals with environmental challenges such as resource scarcity, change, and other systems. Viability, defined as health or sustainability over the long term, is actually the result of a successful balance between the organism and its environment, thus depends on characteristics of both the organism and the environment.

The fundamental properties of system environments and their basic orienter counterparts in systems (FPS) are illustrated in Figure 21.

76

Figure 21 Fundamental properties of system environments and their basic counterparts

Existence is the property in the organism’s normal environmental state, while effectiveness is the property required to deal with resource scarcity, freedom of action to manage variety in the environment, adaptability to respond to change, and so forth around the model. Bossel posits that these types of environmental demands are completely predictable, whether the system is a bacteria, human or nation, thus existing (viable, sustainable) systems will exhibit levels of these properties. For individuals, since these characteristics are essential to survival it is reasonable to expect that there will be associated emotions for each of these needs. Bossel finds related concepts in psychology, sociology, and ecology (Figure 22).

77 Figure 22 Basic orienters in psychological, social, lifestyles, social systems & ecosystems

Bossel posits that different phases of the organism’s life-cycle favor different life strategies in order to maximize viability, suggesting a relationship between aging and values.

• The renewal and growth phase requires an emphasis on EFFECTIVENESS and FREEDOM OF ACTION, corresponding to the organizer and the individualist life strategies.

• The conservation phase requires an emphasis on SECURITY, corresponding to the hierarchist life strategy.

• The innovation phase requires an emphasis on ADAPTABILITY, corresponding to the innovator strategy (Bossel 1999, 47).

• The deterioration phase requires an emphasis on EXISTENCE, and perhaps COEXISTENCE, corresponding to the fatalist and the egalitarian life strategy.

78 Summary of System Models

System models are designed to address the complex interactions between organisms and their environments. They have the capacity to include a full range of environmental, personal, social and time factors. The models included in this review demonstrate that one model can deal with “unlike” elements, for example, time, social structures and shelter, and can articulate plausible relationships.

The literatures also show that system models, particularly those done with computer simulation often face a great deal of suspicion. The still controversial Limits to Growth, (1972) by Meadows, et al., used computer simulation to illustrate the non-sustainability of unrestrained population and material growth in a world of finite resources. Promptly characterized as “Malthus with a computer” because of their concern with exponential population growth, major criticism of their work focused on the information, assumptions and theories used, as much as the actual use of either system dynamics or computer modeling (Cole et al. 1973). Although the Meadows’ model is freely available and shows that exponential growth is not indefinitely sustainable, thirty-six years later, despite many corroborating studies,

New York Times editorial writer and Nobel Prize winner in economics, Paul Krugman, casually dismisses the enterprise as “hard-science arrogance” (New York Times Blog 2008).

79 2.11 Conclusion

This review has considered models of contexts, values, person-environment fit, health and disability, sustainability and systems in order better understand the complex relationships between aging and the built environment, and the system that creates and maintains our current environment. The models of context suggest that the entire society and economic system is involved in the structure of our system. Moody’s model of values exposes the lack of capital investment that results in a built environment that effectively rejects aging and disabled individuals. The person-environment fit models illustrate the importance of matching environments to needs. The health and disability models identify how environmental barriers limit opportunities for health. The sustainability models speak to the importance of operationalizing sustainable practices, and the system models confirm that every action – or inaction - has consequences.

The work of designers is to imagine, invent, advocate for, model and create environments that work for their users and for society at large. This is challenging for the imagination and the current business model if we need to reinvent our built environment to be supportive of the health of people and the planet. New models of values, needs, structures can help inspire and inform designers and help them communicate the significance of needed changes to clients and decision-makers.

This review also illustrates how many forms of visualization can be labeled a “model.”

Models can be words, illustrations, tables, line drawings, three dimensional objects or computer simulations. While the models in this review were discussed in terms of content and terminology, they could also have been reviewed for effectiveness in presentation. Some

80 designs, such as the Lawton/Nahemow P-E Fit model were exceptionally comprehensible, while others, with equally significant content, such as the SPOT model were very difficult to decipher, prompting me to include the same content in an explanatory table. It is likely that successful models that inspire years of debate are models that communicate well visually.

My practice of tracking the concepts articulated in each model in the ever-growing comparative table of terms was beneficial for clarifying the specific subjects of individual models and identifying the relationships between models. Growing from three columns to three pages, it illustrates the range of approaches and the differences and commonalities of subjects. It provides a sort of reference or look-up table for topics covered, and can be a resource for developing a more comprehensive model of the built environment for aging.50

Clearly, this review also shows that a comprehensive model of aging in the built environment has not yet been published. Many very solid models are available but a model that incorporates the broad context, significant values, and characteristics of fit, health, and sustainability for aging individuals is still pending.

50 “Design knowledge resides secondly in processes: in the tactics and strategies of designing. A major area of design research is methodology: the study of the processes of design, and the development and the application of techniques, which aid the designer. Much of the research revolves around the study of modeling for design purposes. Modeling is the “language” of design. Traditional models are the sketches and drawings of proposed design solutions, but which in contemporary terms now extend to ‘virtual reality’ models. The use of computer based models has stimulated a wealth of research into design processes (Cross 2006, 101).”

81 Chapter Three: Methods

3.1 Introduction: Access to Meaningful Places

This chapter discusses the triangulation strategy and related methodologies employed throughout the research project. The modeling processes used in the literature review are linked to the quantitative mapping and qualitative interviewing that are the major focus of this section. The guiding paradigm, designerly ways of knowing (Cross), is an iterative and emergent approach, using abductive reasoning through modeling and visualization in order to represent data and discover relationships. This chapter presents the research design, data sources, targeting of study areas, participant recruiting, data collection steps, study variables, and approach to modeling. Section 3.1 reviews the literature search and analysis technique. Section

3.2 explains the preliminary environmental analysis of the City of Spokane used to target research areas. Section 3.3 and 3.4 describes the access to and interviews of participants.

Section 3.5 describes mapping of interview information and data development. Section 3.6 reviews ethical considerations of the process. This chapter provides the specific information and actions which shaped the research project upon which rest the validity of the findings.51

The study explores connections between wellbeing and access to personally significant environments in order to develop a theory of the person-process as it relates to place-process

(Bronfenbrenner 2005). The questions that I am trying to answer are 1) how do persons

51 The literature of the social sciences, and particularly geography, suggests the need to add a critical component to assess the validity and meaning of the work we are doing. Responsible use of GIS as a tactic for design decision-making and design research requires accountability for the content, choices, assumptions, and applications used by the researcher in order to provide a theoretically sound basis for the work (Fisher, 2005).

82 experience wellbeing in relation to spaces and places, 2) what are the events or processes that result in changes to access of places associated with wellbeing and 3) what is the experience of spatial constraints in terms of wellbeing? The target group is persons over the age of 55, because these diverse, experienced and often articulate individuals are moving through multiple expected and unexpected changes in family structure, career, and health. Twenty eight individuals, including four married couples and a mother/daughter couplet, were interviewed.

Discussion of alternative methods of data collection

Many alternative methods could be employed to explore the connection between wellbeing and place. For example, action research with photovoice (Nowell, 2006) would promote documenting specific places of wellbeing for seniors, creating a visual record.

Neighborhoods could be mapped with geographic information systems (GIS) software for positive and negative elements identified in the literature and compared with disability and mortality rates (Parenteau 2008). An extensive survey could be devised to include a broad sample of seniors (Schiller 2005). Each of these approaches has benefits and limitations. Action research with photovoice shares both research design and findings with the participants, making it more difficult to focus the work on abstract concepts needed for design models.

Quantitative mapping, comparing statistically defined areas with other statistically defined areas removes the research from the context of the person and place. A meaningful survey would require a means collection of data from a large population that was willing to identify of specific personal locations. Further, more research is needed to design a comprehensive and valid survey instrument.

83 For these reasons I sequentially and iteratively combined theoretical concepts from the literature, key environmental characteristics utilizing Geographic Information Systems mapping, and semi-structured interviews with seniors. This combination of methods places my research in the contexts of visualization (models and mapping), personal experience (interviews), and quantitative data (reported events and GIS data) and focuses the findings toward enriching design models with person process content.

Figure 23 Stages of research

Discussion of literature search and analysis and secondary sources used

In order to identify the systemic issues of sustainable and supportive environments for seniors, I undertook to broadly research the relationship between aging individuals and the built environment. Using multiple search engines, principally, Web of Science available through the WSU library; Google Scholar; and WorldCat.org; I identified articles that included any combination or variation of the terms: systems, aging, and environments. I focused on models

84 in the literature, as these synthesized and symbolized the major concepts. As described in the literature review, the models were compared with available models from the design literatures by charting words and concepts presented. The resulting charts illustrated the gap of person processes within the design models. Literature modeling formed the first leg of the triangulation strategy, providing the organizing structure for mapping, and targeting participants.

Discussion of Geographic Information Systems and sources used

Geographic Information Systems (GIS) capacity for computer modeling provides a mechanism to layer, integrate, analyze and visualize relationships among key factors (social, built, and natural) identified from the literature. The usefulness and validity of GIS outcomes

[maps, charts, and statistical data] depend on the availability, accuracy, and resolution of the data layers the researcher enters into the software. Each layer of data embodies previous spatial and representational decisions (boundaries/extents, definitions, time frames, significance, and priority) by creators/providers. Limitations on data availability and suitability include sample sources, sizes, relevance and individual privacy. In practice, even highly accurate data layers present opportunities for introducing researcher error, through inclusion, exclusion, data reduction, and comparison.52

52 “To date, the field has largely ignored the issue surrounding data reduction of environmental variables. In this nascent field, a more thorough description of the environmental variables considered as potentially important, data reduction steps taken, any testing and creation of latent variables, and the final environmental data included and excluded would be very useful to other researchers. Lack of transparency with regard to decisions made may misrepresent the challenges in collecting and analyzing environmental data. Articles that simply report that they “. . . recorded and analyzed the foods available in vending” may lead the inexperienced researcher to believe that this is a simple task and may mask the many decisions that were made in the process of data collection and analysis. By describing the protocol for data collection and the process of data reduction in manuscripts or through methods papers, other

85 GIS mapping formed the second leg of the triangulation strategy, providing the theoretical geography for identifying neighborhoods of interest from which to recruit participants (Duncan, 2005), and for data development and analysis after interviews were completed. I identified six representational layers from criteria indicated in the literature as affecting health and active living: crime, traffic, income, destinations, and sidewalks. Data selected for mapping Spokane neighborhoods came from government, industry and academia.

Federal agencies track income (American Community Survey, 2009); and land cover (United

States Geological Survey, 2010). Business establishments are tracked using a standard North

American Industry Classification System (InfoUSA 2009). The Cities of Spokane and Spokane

Valley, and the County of Spokane maintain data on traffic (2010), crime (2010) and emergency calls for service (2010). Information on sidewalks is provided by Washington State University’s

Pedestrian Network project.53

Table 7 GIS data linked to wellbeing constructs Individual NA Social Median Family Middle range, avoid lowest and highest (Dolan, 2008) Income Incidence of Crime Low to high (Kawachi, 1999) Built Destinations Most destinations, least destinations (Cerin, 2007)) Traffic Flow Low to high (Brugge, 2007) Availability of High to low sidewalks Natural Land cover: Most impervious to least impervious (built/paved) Impervious

scientists can better evaluate potential sources of bias and also learn from others’ experiences and approaches (Lytle 2009, S138).” 53 GIS & Simulation Lab, Interdisciplinary Design Institute, Washington State University, JARC Pedestrian Network (2011 update)

86 3.2 Environmental analysis used to target research areas

Target neighborhoods for this research were identified using ArcGIS software54 to analyze social (median family income, incidence of crime), built (destinations, sidewalks, traffic flow) and natural (impervious land cover) characteristics. The City of Spokane boundary provided the initial research extent. Data layers containing points (crimes, destinations), lines

(traffic, sidewalks) polygons (census block group), and a raster showing percentage of impervious surface were added to a base map. Because of the different ranges of values and the different types of numbering in each input layer, each factor needed to be transformed to a common ratio scale. Point and line densities were calculated to create rasters [continuous surface predicted by available points or lines]. Due to the nature of the data, the specific locations and boundaries between classes were not discrete, so fuzzy membership tools were used to estimate strengths of spatial relationships within each layer. Finally, fuzzy overlay tools merged the layers and quantified each location's possibility of providing a supportive environment for wellbeing in aging. 55

54 ArcGIS for Desktop, Version 10.0, Environmental Systems Research Institute, Redlands, CA 55 Neighborhood may seem to be an appropriate context to identify in an ecologic model, but operationalizing the term is much more difficult. Ball et al. outline several important issues that pose challenges to defining neighborhoods, including: (1) people live and function in multiple settings and contexts; (2) people live and work in multiple geographic areas and influential environments are often nested; and (3) single neighborhoods contain multiple types of environments, including physical, social, cultural, and policy environments. Therefore, making associations using one definition of neighborhood (i.e., based on census tract or postal code); the availability of healthful and affordable options in that same census tract or postal code (i.e., inexpensive and quality fresh produce in stores); and some health-related behavior of individuals in the neighborhood (i.e., eating fruits and vegetables) relies on many assumptions about where people shop, how far they are willing to travel, and a host of other individual-level preference, knowledge, and motivational factors. (Lytle 2009, S140)

87 Table 8 Sample Maps

88 3.3 Accessing participants

“To maximize the utility of information from small samples … cases are selected on the basis of expectations about their information content.” (Flyvbjerg 2006, p.426)

The environmental analysis highlighted the need for more specific geographic and personal information, as the final overlay of data largely reflected the patterns of income and crime in estimating support for wellbeing. To maximize information from a focused number of cases, participants were recruited from churches and community centers located in areas showing maximum variation of environmental features while avoiding isolated locales or those characterized by extreme conditions (Flyvbjerg 2006). Participants were required to live or be active in the targeted areas. I selected churches and community centers as contact venues to identify seniors who were utilizing social or spiritual facilities because issues of meaning and belonging are at the heart of wellbeing (Wahl 2006).

Accessing participants required numerous contacts with community centers and churches. Informational pieces including a flier, post card, business card, and recruitment script, were prepared and employed via phone, email, postal mail, and in person [see appendix: informational pieces]. Five community centers invited me to visit and meet with their participants. Seven faith organizations did not respond to my contacts and five indicated after follow-up that they were not interested in participating. Two pastors called for more information resulting in invitations to church events. One pastor presented the study to a senior group and returned a list to me with multiple contacts. Buddhist temple staff posted my flyer resulting in one contact. As more connections were made, participants from distinct areas and employing various transportation modes were targeted to provide diverse cases.

89 3.4 Interview Process

Semi-structured interviews provide the third leg of the triangulation strategy, informing the model generated in the literature review by linking personally significant places and spaces to the individual, social, built and natural constructs. In order to quantify how wellbeing is affected by access to personally significant places over time, I ask about places where participants spend time, how they access these places, and if they have changes or challenges in getting to personally significant locations. I inquire about the personal importance to participants of accessing these locations, and how participants are affected by being able to be in these specific places. I conclude the interview with a collaborative mapping exercise to illuminate participants’ feelings about the spaces identified, the larger geographic area, and probe for additional feeling or belief comments.

Twenty-eight individuals, including four married couples and a mother/daughter couplet, agreed to participate and were interviewed in a total of 23 separate one to two hour meetings. Participants selected our meeting locations. Typical locations were the community center, church, restaurant or participants’ home. Two interviews required follow up meetings in order to complete the mapping portion of the initial interview. After review and signing of the consent forms, the voice recorder was turned on (if permitted) and the activity location questions (see appendix) were presented, followed by the environment and self-rating questions. Throughout the three question sets and mapping participants were encouraged to elaborate on locations and how access and lack of access to these locations affected their life or wellbeing. [see interview form in the appendix].

90

Table 9 Activities by destination During the past four weeks have you … Follow up questions Gone to a general goods store, grocery store, or pharmacy Visited a café, bar, casino, senior center, library, school, Number: How often did you get there? gallery, theater, sporting event Been in a place where you could spend time with family or Mode: How did you travel there? friends Equipment: Did you use aids of Were visited by service providers, i.e. snow shoveled, equipment? Person: Did you need help meals, assistance from another person? Visited a service provider i.e. beautician, massage therapist, barber, dry cleaner, car repair Visited a doctor, dentist, therapist optometrist, chiropractor Discretionary or obligatory: Was this or hospital something you had to do, or wanted to Participated in an activity such as walking, dancing, do? swimming, golf, bowling, etc. Gone somewhere to work, assist, volunteer, teach, speak, play music, give a ride, etc.56. Positive or negative: How does it affect Spent time in – or had a good view of - an aesthetically your life to go here? satisfying place, park, green space, garden Restrictions: Were there times you Went to a chapel, meditation space, or other place that is wanted to go but were restricted in some important to you spiritually way? (Number & Reason):

In order to obtain quantifiable data and refresh participants’ memories of the places they visit, the first set of questions asks them to recall destinations where they may have participated in activities during the previous four weeks [Table 9]. These destination questions are categorized in terms of my theorized purpose for the activity related to the individual, social, built or natural constructs, (see appendix: questions and constructs).

The second question set considers feelings and beliefs regarding housing, self-defined neighborhoods and general accessibility to infrastructure elements (Kahana, 2002). Review

56 “Being productive included reporting any of the following: (a) paid employment, (b) caring for a child or grandchild, (c) active volunteering, or (d) cleaning house. (The last item for productivity is specifically included by Rowe and Kahn, 1998.) (Strawbridge 2002, 729).”

91 questions probe for especially meaningful places that may have been overlooked in the destination questions (Table 10).

Table 10 Feelings & Perceptions about Destinations, Home and Neighborhood We have talked about many places. Are there any that you have particularly strong feelings about? Are there any places that you no longer are able to go to that you have strong feelings about? Can you tell me more about them? Please rate the following home and neighborhood elements as satisfactory, mostly satisfactory, mostly unsatisfactory, or unsatisfactory. [Track comments: perception, desire, fear, concern, spirituality] Housing Neighborhood Access to shops and Roads (including traffic, safe crossings, noise) services Safety Bus service Access to parks and Sidewalks (including slope, accessibility, and nature. condition)

The third question set assesses the participant’s general wellbeing and satisfaction with personal health and finances. (Table 11) The literature of wellbeing is complex and a full exploration is beyond the scope of this project, however, researchers have found connections between wellbeing and finances.57(Diener and Seligman 2004), and physical and mental health

(Ubel 2005, Lawton et.al. 2001).

Table 11 Wellbeing, Satisfaction with Health & Finances Please tell me if you agree strongly, agree somewhat, disagree somewhat, or disagree strongly with the following statements: I am doing well for my age I consider myself to have a disability58 I have satisfactory overall health I have adequate income or resources for my current needs I have good emotional health What is your age range: 55-64, 65-74, 75-75, 85-94, 95+

57 The analyses presented here show that the wealthy are considerably happier than the poor or even those with average incomes (Lucas 2009, 78) 58 Disability has been shown to be linked to higher levels of poverty, lower levels of education and employment (Lustig & Strauser 2004; O’Hara 2004; Social Policy Research Centre 2000; Takamine 2004), and increased social exclusion (Peat 1997; Schuller 2005; Social Policy Research Centre 2000; World Bank 2000a). (Green 2011, 219)

92 The statement “I am doing well for my age” is a variant of a validated measure of wellbeing for seniors (Strawbridge 2002).59

Collaborative Mapping:

After completing the questions, participants marked destination and meaning locations, and sketched major travel routes on a paper map of Spokane. Finally, we considered the arrangement of points and routes on the map and discussed related feelings to areas of the city. Participants were thanked and were offered a follow-up visit with results of our conversation, compared with the GIS data being used in the study.

3.5 GIS Mapping and data development

Introduction to mapping

This second phase of GIS mapping involved creating personal geographies of significant spaces based on participant identified home areas, destinations, routes and other significant locales. These points, lines and polygons were plotted on the GIS base map developed in the targeting phase. Buffers for destinations and routes were selected and assigned to include adjacent areas where relevant characteristics would be geographically linked.60 The broad extent of each individual’s travel and meaning areas were determined and defined as life space.

The final research extent for this study was determined by the combined life space extents of all of the participants, limited to Spokane County.

59 We measured self-rated successful aging by asking participants a single question: How strongly did they agree or disagree with the statement “I am aging successfully (or aging well) (Strawbridge 2002, 727-33.) 60 I used measured circular areas centered on the mapped points to represent the experienced area.

93 Introduction for data development

Data development involved calculating distances and relationships between destinations, and extracting location based information about the home areas, destinations and life spaces from GIS data layers. Since many participants lived or traveled beyond the city limits.

Data layers for the entire county similar to those used in the GIS targeting phase were accessed or created as needed. A large database was assembled to track the various relationships and quantities. The entire process was iterative with additional calculations called for to clarify the raw data.

Table 12 Map-able Reported Data Linked to Wellbeing Constructs Scales at which the desired geographic data is available. Note: Resolution differs for various parameters. Scale: Home area and/or One mile radius Neighborhood/ block Life-space 200 meter radius around home group Minimum bounded area Individual Self-reported Social Income NA Median family income, US Census

Crime Geo-referenced Crime data available only for City of Spokane Spokane County 911 Calls for Service, include calls for assistance. Built Destinations Distance to nearest number number number Traffic Nearest road Highest flow NA NA segment Sidewalks Along parcel percent Natural Impervious Nearest point Average in buffer/ life-space Land cover Nearest point % open space, % med to high development by buffer

Destinations: “During the past four weeks have you visited…?”

Participants reported the number of visits and locations for each destination, resulting in a count for each type of activity at each location, i.e. meals, socializing and exercise at the senior center. For each destination, participants reported on their transportation mode,

94 assistance received, the discretionary or obligatory nature of the visit, the positive or negative impact of the visit, and the number of times and reasons they were restricted in some way from going to the desired destination. All reported destinations were recorded on individual maps, which were afterward combined into one master map, combining tables for comparison.

Destination Buffers

Buffers for destinations provide measured boundaries to capture mapped data that is geographically linked to nearby points [address point], lines [street or sidewalk segment line], or areas [census block]. Euclidian buffer distances of 200 ft [home], 250 ft [small business], 500 ft [medium commercial], 750 ft [large commercial], or 1000 ft [big box store, mall] were assigned based on visual inspection of aerial imagery to include adjacent green space, street approach and parking. In order to preserve privacy and reduce stress on interviewees I did not request the addresses of medical service providers, but asked if they were in the “Sacred Heart area” or the “Deaconess area.” In most cases participants showed general location of medical providers during the mapping phase of the Interview. [See Appendix: Chart of Measures, includes sources for setting buffers.]

Modes and Routes: “How do you get there?”

Participants reported their mode of transportation to destinations, such as driving, walking, or getting rides, informally or via formal services. Drivers were asked if they drove on the freeway, after dark, if they trip chained, and if they purchased gasoline as a separate trip, or en route to a destination. Participants who drive or walk were asked to identify routes that they typically use. Primary emphasis in identifying routes was on major routes to significant locations.

95 Figure 24 Examples of overlapping buffers

Some participants chose to highlight areas rather than routes, or stated that a geographic area had significant meaning to them, so I also tracked general areas they identified. 61 Buffers for routes were set at 200 ft. to approximate the visual space and capture

61 Daisy lives in an apartment in a continuum of care(COC) retirement community and her husband (not interviewed) is cared for in the skilled facility on the other side of the COC campus. She regularly visits him by walking across the campus, and also participates in multiple activities on and off the campus of the facility. While she drives, she occasionally uses the facility ride service for special events. Daisy didn’t provide routes; she identified areas that she navigates regularly and secondary areas. I showed routes with dotted lines. The car route to her home is used 28 times as she reported 29 “off campus” events. Cindy gives rides to a friend more than once a week to other friend’s homes, physical therapy and the doctor. These destinations are not mapped, however this friend lives in Cindy’s old “home area” and her home appears on Cindy’s routes. Also Cindy’s medical providers in Spokane Valley are indicated by a point near the intersection of Pines and I90.)

96 elements and destinations geo-positioned along routes. Figure 24 illustrates relative sizes and placements of buffers in comparison to each other and the background elements. The buffers capture contiguous neighborhood elements not specifically marked by the destination point or route line, but likely to include relevant neighborhood information.

Life Spaces: Visited & Meaningful

On the map the life-space is drawn by connecting the outlying destinations to include all of the destinations and their buffers.62 Since the destination buffers and life-space polygons are used as containers to measure geo-located data, I added the reported routes and redrew the polygons, as in many cases major routes, clearly part of the geographic interaction areas, fell outside of the minimum bounds as drawn by the software. Two sets of life-space polygons were prepared for each participant to distinguish between visited and non-visited areas, routes, and destinations. These are referred to as visited life space and meaningful life space. Meaningful life spaces are those the participants reported as significant, but not visited, in the past month.

The operational definition of the life space is the portion of the polygon that falls within the county of Spokane, with notations for other visited or meaningful places outside the area.

Extent

The final extent for all maps was determined by the combined extents of the individual life spaces, limited by the county border because of data availability constraints.

62 ArcGIS Minimum Bounded Geometry tool, convex hull, which results in the smallest possible fully inclusive irregular polygon.

97 Data development

Developing the data required merging the new mapped spaces, with the background map information and calculating various characteristics to identify significant variations.63

Initially I measured linear distances between participant’s homes and destinations64, then multiplied each distance by the number of visits to approximate travel distances. These are not actual travel distances along road networks, but are useful for comparison between cases and types of destinations. A large database was assembled to track the various relationships and quantities. The entire process was iterative with additional calculations called for to sort, group, and compare the raw data [see appendix: protocol for data development and maps of the life spaces].

Analysis

Analysis involves examining the results of the interviews to see if they address and align with my initial goals and how they support my theoretical constructs. Participants comments are compared to the assumptions I made based on the literature. Destinations and visits provide quantifiable data to contrast and compare between individuals and groups. Results are grouped by initial contact site [church or senior center], transportation limitations, and types of activity goals.

63 ArcGIS Intersect tool 64 ArcGIS Point Distance tool

98 3.6 Ethical considerations

Validity of process

In order to insure the validity and transparency of the research process I recorded interviews (with permission) and maintain the full set of notes, and memos for inspection by my committee. In qualitative research, data is collaboratively constructed between the researcher and the subject (Wertz 2011). Qualitative research relies on the researcher to interpret the data. My analysis will be influenced by life experiences with aging and disability. I cared for my mother in my home for six years and observed her progressive loss of vision, balance, and occasionally speech. I relinquished her to a nursing home after the death of my husband because I could not push her wheelchair up or down the ramp which had been built for her.

I also worked for three years as a psychiatric rehabilitation practitioner, helping individuals who had profound developmental disabilities, mental illness, or brain damage, to regain meaningful roles in living, work or education. This experience fostered the lens of personal empowerment I bring to this study. The process of participating in interviews on the meaning of personally significant places is likely to impact participants, potentially sensitizing some to the importance of retaining or regaining access to places of personal importance.

While the goal of this research is not making changes for the specific individuals, sharing personal findings and maps with participants may be a tool they can use to better articulate their needs to powerful others.

99 Protection of participants

Persons participating in the research are treated with respect and empathy. I provide and explain the permission to participate in research form, and remind participants that they can withdraw from the study at any time, and can withdraw their materials from the study until submission to my graduate committee (March 2013). In order to protect confidentiality, interview and map files are coded by pseudonym and kept in locked or encrypted files. Contact sites [church, senior center] are also provided with pseudonyms to protect privacy. No personally identifiable information will be included in the dissertation and appendix materials.

Published maps will be generalized to the nearest census block. All interview recordings and personal maps will be destroyed after three years.

100 Chapter Four: Results and Discussion

4.1 Introduction

This chapter integrates the findings derived from the triangulation strategies employed throughout this research project. The constructs developed from models in the literature structure the initial spatial analysis and interview questions, and are employed to organize the findings from qualitative and quantitative data analysis of interviews and maps. Modeling, primarily through charting and mapping, presents – and represents - data and relationships that elucidate place-person processes. This chapter reviews the theoretical constructs and limitations of the processes used, and summarizes the results and emergent themes. Section

4.2 reviews the constructs identified in the literature review. Section 4.3 applies the constructs to the lifespan ecologic model. Section 4.4 details both the interview findings related to the constructs, and the person/process elements identified. Section 4.5 examines the finer grained results of spatial analysis. Section 4.6 presents narrative person-place process relationships.

Section 4.7 presents findings from finer grained spatial analysis and Section 4.8 provides recommendations for further research.

Human wellbeing results from complex interactions between individuals, society, the built environment and production infrastructures, and nature. Each of these systems is interrelated and is involved in processes of change over time. Findings from literature, interviews, and mapping, validate the importance of integrating the individual’s lifespan needs with natural and man-made places and processes in order to design environments that are efficient, inclusive, affordable, and sustainable. The lifespan ecologic model presented in this chapter incorporates specific components for promoting holistic design outcomes.

101 4.2 Discussion of literature findings

The literature review identified multidisciplinary models applicable to the design of lifespan sustaining environments and integrated them via concept charts. The major themes identified in the review are introduced in Chapter Two ; however themes are reviewed to signal the reader that these topics are significant: lifespan development, values, disability, wellbeing, person-environment fit, agency and belonging. The literature presents aging as a natural, developmental, life-course process (Baltes 1987) that involves bi-directional gains and losses over time in emotional, intellectual (Samanez-Larkin 2009), social, spiritual (Sadler 2006) and physical arenas (Koncelik 2003).65 Significant disablement processes occur in, and can be ameliorated by, changes to the built environment (Verbrugge 1994). Societal attitudes toward aging or disabled adults become embodied in the built environment. For example, the social and political pattern of rejection is expressed in a built environment that disregards the needs of elders (Heumann 2001) or individuals with disabilities. The significance to the individual of agency and belonging changes over the life span (Wahl 2004). Environmental elements required for safety, familiarity, continuity, and meaning are required to sustain wellbeing throughout the life span.

Transforming theoretical ideas into constructs related to the design models

The comparative tables in the literature review illustrate the gap of person processes within the design models. Table 13 highlights the developed and implicit constructs (recognized

65 “As a dynamic human factor, aging is a complex blending of physiological, psychophysical psychological and sociological change. Aging is a process of change personality through intensification of individual characteristics. People who have reached advanced years (75-95) will be a very diverse population with increased differences between individuals than younger populations (Koncelik 2003, 121).”

102 but not developed) in the Human Ecology (Bubolz 1979) and Interior Ecosystem (Guerin 1992) models. Missing are the personal identify characteristics of self-actualization; empowerment; and the impact of environments on fragile individuals, which the literatures indicate are significant to wellbeing. The costs of providing separate life space zones or retrofitting current environments for lifespan needs is a significant contributor to unsustainable uses of resources and inefficiency in the current infrastructure and ongoing production of the built environment

Table 13 Developed and implicit categories in the design context models Interior Ecosystem Human Ecology Comments . w/ Construct of Interest Human Environed Unit Human Organism ( Implicit - Self-actualization, Identify (Implicit) (Implicit) User- centered Spirituality, Transcendence ) Human Behavioral Environment Behavioral Environment Individuals discussed in terms of units, Biophysical bio-physical organisms, descriptors: demographic,

Individual behavior characteristics, etc. Psychological: Sentiments, Aesthetics Psychological Social: Family, Friends, Colleagues, socio-behavioral Interactions,

Schoolmates attitudes, values Developed social category: Human Created Environment (HCE) conservation behaviors, national energy

Social Socio-cultural: Social Norms Values socio-political policies, global energy concerns Community, Neighborhood Built Environment site integration, design

Socio-physical: Food, Clothing, Shelter energy system building materials Developed production/built environment category, energy costs socio-biological & socio-cultural)

Production Natural Environment

Socio-biological Natural Environment (NE) Resources (+availability)

Land Plants, Air, Water ( Implicit - Sustainability factors) Climactic Zone Climate Otherwise developed in terms of resources, climate, time Natural Energy Daylight, Energy Space - Time

103 4.3 Lifespan ecologic model

Bubolz’ and Guerin’s holistic design models provide an effective structure on which to build the lifespan ecologic model by explicitly integrating lifelong wellbeing and overall sustainability. Four constructs: Individual, Social, Production, and Nature are used to organize all of the components of systems that are involved in lifespan wellbeing. This organizational structure both extends and refines the constructs used in Bubolz and Guerin models, and facilitates identifying built environment features for design applications.

The individual construct refers to all of the internal and external qualities of the person including spirituality and transcendence, as well as, heredity, choices, body, and developmental situation. The social construct incorporates all person to person66 relationships, both immediate (friends, family, and peers) and also historically and politically based cultural and political human relationships. The production construct covers all of the human created systems and infrastructures that provide shelter, transportation, goods and services, including persons

(human capital) while they are performing in a professional capacity. The natural system refers to the earth and all of her energy, air, and water subsystems, along with climate, seasons, and time.

My intent in organizing to these constructs is to include within them each personal, social, and physical element that effects and is affected by persons throughout their lifespan.

As such, the constructs are inclusive, interrelated, and fluid in structure; they also cannot be completely defined as they symbolize unknown, undefined, and emergent conditions. Table 14

66 Includes pets.

104 summarizes the literature review tables from Chapter 2 by construct and major complementary values, listing subsets of the constructs and associated concepts.

Table 14 Lifespan Ecologic Model: concepts organized into major constructs Construct Sub-categories Concepts (Value) Individual Spirituality Transcendence, enlightenment, fulfillment, meaning Identity, self-actualization Ego-integrity, choice, self-respect, aesthetics (Wellbeing) Mind, emotion Wisdom, preference, perception, adaptability Body Heredity, development, ability, skill, health Social Access / Protection Belonging, class, caste, clan, status Personal Access to friends, family, pets, 3rd places, (Participation) Cultural/ society Learning, communication, social integration Political/ economic Community participation, economic sufficiency, safety Production Access / Protection Goods/ objects Consumer goods, assistive devices, nutrition (Efficiency) Labor/ services Assistance, providers, care Built environment / Shelter, mobility, communication, food, infrastructure Natural Access / Protection Energy, water, sun Global – personal (Preservation) Climate / season /time of day Assistive, climate change Pollution Clean air, water

Comparing the lifespan ecologic model to Bronfenbrenner’s bio-ecological systems model (2005) clarifies the personal, systemic, spatial, and dynamic interactions that must be considered in assessing intervention points for creating holistically sustainable environments.

Bronfenbrenner places human (individual) development within five theoretical systems: microsystem, mesosystem, exosystem, macrosystem (represented by a series of concentric circles), and the chronosystem (represented by an arrow),

The microsystem comprises the immediate social, physical and natural environment that directly touches the individual including the family, friends, home, neighborhood, church, grocery store, language, media, and weather. The mesosystem represents the theoretical

105 space in which the exosystem and macrosystem interact with the microsystem and the individual. The next largest circle, the exosystem includes the local social, political and economic systems that do not directly touch the individual, but guide the local context. Often these systems are associated with institutions and make rules for the behavior of significant others, for example, insurance rules made in corporate headquarters govern the treatment options provided by our doctor (who is in our microsystem). The outer circle, the macrosystem symbolizes overarching cultural values, economic patterns and political philosophies that shape the systems within it. Figure 25 is adapted from the more recent versions of the bio-ecologic model that incorporates person – process – context. I have added curved arrows to highlight both the interactive relationships of the mesosystem, and the reciprocal relationship between the individual and their environment. The bidirectional chronosystem arrow represents continuous gains and losses over time.

• Cultural values, economic Macrosystem patterns, political philosophies • Community structures, local Exosystem medical & service systems • Dynamic interactions between Mesosystem contexts • Immediate environment Microsystem • Family, peers, church • Age, sex, health, dispositions Individual • Ability, experience, knowledge, skill

Chronosystem  Continuous change over time

Figure 25 Bio-ecological system's theory adapted to lifespan development (based on Bronfenbrenner, 2005)

106 Table 15 Construct elements related to Bio-ecological Systems Theory Bronfenbrenner: Bio-ecological Systems Theory Individual Microsystem Mesosystem Exosystem Macrosystem Sex, age, health, Immediate Dynamic Institutions, friends Attitudes and ideologies dispositions, environment, interaction of family, mass of the culture Ability, Family friends between contexts media, social experience, neighborhood welfare service,

knowledge, skill health services Spirituality, Activity Cultural Resources: Transcendence accommodations Arts, craft Enlightenment, Psychosocial hereditary attributes & factors coping Self- Activity accom- actualization, Self- modations

realization, Identity Body, gender, Genetic Functional health Endowment, Limitation Individual Disease, Manifestations,

INDIVIDUAL response Pathology, Impairment, Lifestyle / class, caste, Social integration, Activity Social system behavioral choice clan, status, “normalization accommodations Socio-cultural: Leisure Engaged Family, Friends, Harmony Institutional Social Norms, Value Competence Social capital Socio-political Autonomy Press Social & Governance General

(IEM) Safety Information, freedom, equality, community socio-economic and (SPOT) Technological Comfort networks cultural environment Knowledge conditions); Simulation / Social Environment Economic operations

SOCIAL Happiness Activation Local economy, and markets Human capital: Human capital, Socio-efficiency No services Social conscience, Labor health care Local building liberalism Recycling & code Welfare State

Composting Built capital: Press Agriculture & Food Processed Raw Shelter, Tools, site integration production Materials energy Production system Facilities, building

PRODUCTION materials Natural Capital, Rejection Press Sufficiency No services Repression, Earth Materials, avoidance Eco-effectiveness) Economic values

Biosphere, (+availability), Conservation Solar Energy Land, Energy Climactic Zone

NATURAL Plants, Air, Water

107 Table 15 shows the adapted bio-ecological systems with the constructs from the life- span ecologic theory. Construct elements from Table 5 are listed under the system in which they are primarily associated. The mesosystem column highlights the interaction between systems and contexts, for example where institutional policies direct local provision of services, within the framework of larger ideological and cultural values. Individuals, who are changing over time, do not just react to, but choose, alter and create their environments (Lawton 1999).

Discussion of spatial analysis with Geographic information Systems:

Spatial analysis of the City of Spokane and of participant life spaces generated maps and data that reveal the complexity of person-place processes. The initial spatial analysis of the City of Spokane demonstrated the need for person data from interviews, and also validated research showing the inescapable effect of socio-economic status in the built environment.

Targeted analysis of life spaces of participants [Section 4.7] combined with the findings from interviews illustrates the ranges of personhood elements and place elements that impact person-space access.

Environmental analysis used to target research areas

The initial spatial analysis of crime, traffic, sidewalks, destinations and land cover in the

City of Spokane, highlighted a broad northwest to southeast band containing the maximum variation of environmental features. The southwest area of the city is characterized by higher income and lower levels of crime, and the northeast area is characterized by lower median income and higher levels of crime than the remaining residential areas. This was useful information in targeting participants as the goal was to identify individual life-space areas that crossed multiple environments and avoided extreme conditions.

108 The conditions for health and wellbeing most often cited in health, active living and wellbeing literatures include good relative income, safety from crime and traffic, and amenities such as sidewalks and green space. 67 My hope was that by overlaying mapped data on crime, availability of sidewalks, traffic flow, and land cover would create a visualization of a “relative plane of wellbeing” that would predict locations where seniors would more likely experience wellbeing. However, the resulting outcome map primarily reflected the relationship between median income and wellbeing. This aligns with the literatures that show a strong correlation between income and crime, health and wellbeing, but does not identify other specific environmental details of interest.

“All things are related, but nearby things are more related than distant things”68

This outcome is likely the result of the small scale [1:100,000] at which I was working and my undifferentiated approach to the data.69 The impervious groundcover map (Figure 26a) shows Spokane’s homogeneous built environment. Most housing is single family residence, lot sizes are fairly uniform, and sidewalk systems are not complete in any area of the city with the exception of the downtown area. The sidewalk availability map (Figure 26b) displays the random distribution of sidewalks mirroring the incomplete system. In contrast, the crime map

(Table 8) identifies higher crime rates corresponding to business areas and lower income areas.

67 Initial attempts to map a wellbeing surface included accessibility of sidewalks. The Americans with Disabilities Act (ADA) criteria for accessibility excludes most of the city since only 33% of Spokane’s roadsides have sidewalks, and many of these sidewalks do not provide wheelchair accessible routes because of steep driveways, unpaved alley crossings, and barriers. In order to include more of the city in a potential wellbeing area I counted all sidewalks, rather than only ADA accessible pedestrian areas. 68 Tobler’s first law (Tobler 1970 in Miller, Harvey J. 2004). 69 All crime points were considered equivalent, rather than categorizing by type i.e. personal vs. property crime, or minor violations vs. felonies. A future study could to incorporate theories from criminal justice studies to target types of crimes specifically detrimental to wellbeing.

109

Figure 26 Uniform and random distribution maps

Confounding characteristics

Beyond this, the elements I selected to map had confounding characteristics that became clear during the iterative mapping and evaluation process. The literature suggests that individuals are more active and healthy in low crime, low traffic areas, with good sidewalks, access to green space, and nearby shopping and activity destinations. In mapping these layers at the city-wide scale I discovered that most crimes occur at businesses, thus the benefit of living near a shopping or activity destination is confounded by the crime rate in the area of that destination. Public destinations are usually located along major roads, where there is more traffic, again cancelling the destination benefit with the traffic volume. Table 16 summarizes

110 the major confounding relationships I discovered in my data analysis. Section 4.7 presents findings from more nuanced data examined at closer scales.

Table 16 Confounding characteristics of the data layers Layer Scale of data Confounding relationships Income Census tract Higher income areas have fewer crimes Crime Address points Many crimes occur at places of business (destinations) Destinations Address points Restaurants and activity sites, tend to be located on major roads Traffic Major roads Major roads have higher traffic Sidewalks Segments Very few areas have accessible sidewalks, most new sidewalks are along major roads. Impervious % 30 meter squares Lot sizes are generally uniform across most of the city

4.4 Findings from interviews

Interviews were arranged through churches and community centers in order to access individuals who belonged to a place within the study area. Table 17 shows the groupings and general category of the contact sites as these are significant in the findings. Two types of centers and two types of churches were identified. Although there was much overlap, the community centers, River Center and Welcome Center, were primarily resource centers and appeared to serve lower income participants. At these sites I was only successful in interviewing individuals who volunteered at the center. Participants conversed with me but declined to commit to an interview that required signing a consent form. Unity Center and Park Center scheduled activities for seniors to which I was invited by coordinators. Park Center was primarily social, while Unity Center was a supportive day activity program with a full schedule and lunch served Monday through Friday. I arranged four interviews with Park Center participants at a health fair, however, all but one cancelled later. Unity Center participants were hesitant initially, but after they observed the first interview, three more granted interviews. I presented my research project to an on-going grief support group at a third senior center, and

111 was warmly welcomed, however none of these individuals agreed to an interview. It was not clear with this group if they were too busy, or may not have been ready to talk about their lives.

Churches are categorized by whether they draw seniors from the Greater Spokane area

(commuter) or if participants live (or lived) in the nearby community. Very few churches I contacted responded to my letters and follow-up calls. Only Hillside Church invited me to meet with their seniors.70 Falls Church staff was very helpful, sharing the research need with their senior group and collecting a list of phone numbers. View Church staff contacted an individual who they felt was appropriate for my research. Serenity Church staff posted my flyer after my third contact.

Table 17 Access sites for participants Code Type Pseudonym Number and roles

RIV Community center River Center 2 (Volunteers) WEL Community center Welcome Center 1 (Volunteer who participated) PARK Senior center Park Center 1 (Participant) UNI Senior center Unity Center 4 (Participants, one volunteered) FALL Commuter church Falls Church 13 (Participants, most volunteered) VIEW Commuter church View Church 1 (Participant) SER Commuter church Serenity Church 1 (Participant who volunteered) HILL Community church Hillside Church 5 (Participants, most volunteered)

General information on the participants

The twenty eight individuals interviewed demonstrated a broad range of diversity in interests, activities, abilities, health, wealth, and life-space, but an almost uniform high level of satisfaction with their homes, neighborhoods, and current situations.71 Table 18 provides

70 I was introduced to the pastor of Hillside Church by a mutual friend. 71 Income, education, career, and racial profile data were not specifically collected, all participants spoke English with native proficiency, and two participants were observed to be black.

112 information on the age range, marital state, and major means of transportation, recruitment site, focus or major activity, and housing situation of the participants. Ages ranged from 56 to

99, with a median age of 80 (±5). Almost half were currently married. One married participant lived in an apartment in a continuing care community while her husband lived nearby in the associated assisted living facility. Twenty-one (75%) live in single family residences.

Table 18 Basic information about the participants

Name(s) Age Range Married Drives Shared Major Housing type +-5 years site activity 56 – 99 years Yes 13 Yes 19 SFR (21) = Single Family Residence 78 average No 15 No 9 (driver) CCC (4) = Continuing Care Community Senior (4) = Senior Community (not CCC) Ann 80 Y N (husband) WEL family SFR (family) Bailey 80 Y Y FALL family SFR in Senior Cindy 70 N Y HILL pickelball SFR Clarisse 70 N Y FALL family SFR (outlying) Daisy 80 Y Y FALL family Apartment in CCC Dani 90 N N (daughter) HILL bingo SFR (w Daughter) Dan & Pam 80 Y Y Pam, N Dan FALL walk Condo in Senior Electa 80 N N (friends, taxi) HILL friends SFR Elsie & Mel 80 Y Y FALL travel SFR (outlying) Georgia 70 Y Y SER poetry SFR Jane 80 N Y RIV volunteer APT Lilian 90 N Y UNI friends Senior Apartment Liz 70 N N (paratransit) UNI friends SFR (family) Loretta 80 N N (paratransit) UNI friends APT Lynn 60 N Y HILL bingo SFR (cares 4 mother) Painter 80 N Y FALL singing SFR Reid & Mary 70 Y Y FALL dancing SFR Sara 90 N N (family+) HILL family SFR (family) Scarlett 70 N Y RIV animals SFR (outlying) Tina 60 N N (paratransit) UNI friends SFR Ursula 100 N Y FALL friends Duplex in CCC Vanessa 90 N Y PARK yoga SFR (outlying) Walt 70 Y Y VIEW consult SFR (outlying) Zac & Niki 90 Y Y Zac, N Niki FALL garden SFR in CCC

One participant lives next door to her daughter’s family, and one married couple and two single women lived with a child or child’s family. Only nine no longer drove, although most

113 drivers chose to limit night time, rush hour, and freeway driving. Three of the non-drivers had a spouse that could drive, two got rides from friends or extended family, and four relied primarily on paratransit. Walking was practiced for exercise more than for transportation.

General emotional, physical and financial wellbeing

Wellbeing questions were presented toward the end of the interview, after participants had reviewed their activities, destinations and neighborhoods. Despite the range of reported health, disability and resources, all participants agreed with the statements “I am doing well for my age (strongly =24, somewhat = 4)” and “I have good emotional health (strongly =22, somewhat = 6).”

Table 19 Overall satisfaction with health and finances Agree Strongly = 4; Agree Somewhat = 3; 4 3 2 1 Average Disagree Somewhat = 2, Disagree Strongly = 1 I am doing well for my age 24 4 - - 3.82 I have satisfactory overall health 19 4 4 1 3.34 I have good emotional health 22 6 - - 3.73 I consider myself to have a disability (reverse scoring) 11 7 8 2 2.86 I have adequate income or resources for my current needs 26 1 - 1 3.82 Average satisfaction 3.52 The most interesting responses came to the statement “I consider myself to have a disability.” Many participants agreed with the statement, but a number who had just described difficulties in accessing meaningful places due to reduced physical abilities, disagreed with the statement. A few also noted that their doctors would consider them disabled, but they personally did not.72

72 Electa reported that she can’t drive because of heart problems and has limited mobility because of arthritis. She uses a cane indoors and a walker outside, but finds the sidewalks too uneven for her to walk outside alone. However, when asked if she considers herself to have a disability, she considered the question before deciding that she didn’t really have a disability because she could get around pretty well, besides her two health issues. She also rated her overall health as “For the most part health is ok, except for those two things.”

114 Only one participant reported not having enough resources for current needs. Another had recently received a lump sum payment, removing her from the “inadequate resource” category. Several expressed concerns about the expense of on-going assisted living costs, particularly Daisy, whose husband was in a higher level of care, leaving her alone in the large apartment, and Zac and Niki, who also live in a continuing care community.

General satisfaction with housing and neighborhood

Most participants expressed high levels of satisfaction with their homes and neighborhoods (Table 20) and frustration with the condition of the roads and sidewalks in their life space. Sidewalks had the second highest number of complaints and also the second highest number of “not applicable” statements, because the participants home area did not have sidewalks. Most participants indicated that bus service was either not available73 or not applicable to their lives. Of the remaining bus users, most used the paratransit services and reported satisfaction with the service, and frustration with wait times. Lower rankings for access to shops and services were awarded by individuals who had reduced physical mobility and did not drive, or reported undesirable neighborhood changes. Several individuals stated that access to shops would be difficult if they could no longer drive, but only one included that concern in his rating.

73 Electa reported no longer being able to walk to her bus stop since the recent bus stop reductions.

115 Table 20 Overall satisfaction with home and neighborhood area

Satisfactory = 4, Mostly Satisfactory = 3; 4 3 2 1 NA Average Mostly Unsatisfactory = 2; Unsatisfactory = 1 Housing 23 3 2 - - 3.68 Neighborhood 23 2 3 - - 3.62 Roads (including traffic, safe crossings, noise) 12 9 3 4 - 2.95 Sidewalks (including slope, accessibility, and condition) 15 1 2 5 5 2.82 Bus service 8 2 - 1 17 3.17 Safety 24 3 - 1 - 3.73 Access to shops and services 24 2 - 2 - 3.64 Access to parks and nature 25 2 -0 1 - 3.77 Average satisfaction 3.48

Activities and destinations

Participants varied greatly in their patterns of outings and destinations. The most active visited almost four times as many destinations as the least active. However, the difference drops to three times as much if services and activities in the home are considered. In this study restaurants were the most visited destinations, followed by shopping, church and medical care.

In the mid range were social activities and events, which were slightly more popular than beauty providers. Everyone went shopping at least once a month, but most reported one weekly shopping trip (to a grocery store). After groceries, drugs, gifts for grandchildren, clothing or electronics were the remaining items mentioned. Interestingly, everyone needed to be prompted about if and where they purchased gas. Most combined gas purchases with other outings, but a few made special trips to the military commissary, or a club-type grocery store, where they received a discount. A few participants shopped for fun, with friends, or to treat

116 themselves. In contrast, the particular destinations that received the most repeated visits per month were a care center and a senior center.74

Table 21 summarizes activities by category, listing from left to right the most cited examples. Individual visit ranges and averages are provided for each category. At the bottom of the table are the number of unique (different) destinations visited during the month, the total number of destinations visited outside of the home during the month, and the total number of targeted activities that occurred at all destinations including home.75 The ratio of activities to places estimates the number of activities that occur at each location, such as classes, meals and

Table 21 Activities by category Category Location most mentioned Minimum Maximum Average Private social family, friends, meeting room 0 23 2 Service in care, meals, cleaning, lawn, snow, plumbing 0 28 1 Service out hairdresser, nails, car maintenance, tax preparation, bank, post office, transportation 0 5 1 Medical care doctor, tests, hearing, dentist, hospital 0 10 2 Exercise walking, dancing, yoga, singing 0 28 5 Work, home, care center, friend’s home, church, book store, 0 22 6 volunteer dance center, senior center, hospital Beauty nature, church, music, art 0 14 0, [15] Spirituality nature, church, home, river 0 10 4 Minimum Maximum Average Min/ Max Average unique destinations visited 5 18 10 3.6 Total places visited per month 18 70 33 3.9 Total activities (multiple, plus home) 46 140 72 3.0 Activities that occur at each destination 1.4 5 2.2 3.5

74 Daisy visited her husband in the nearby care center most days, while Lilian ate at the senior center across the street from her apartment Monday – Friday. 75Lilian visited only eight unique places during the study period, but she attended the senior center daily, and made multiple trips to church and shopping for a total of 34 outings. At the senior center Lilian participated in some exercise classes, and at home she reported access to beauty, so her overall number of activities is 99. Lilian averages 3 activities for each outing.

117 exercise at a senior center. However, since activities that occur at home are included, a high ratio may signify that services are provided at home.76

Preliminary findings by model group

Based on the models identified in the literature review I theorized that the total environment which is experienced by the individual is the result of individual, social, production

(artificial) and natural systems and choices which are driven by values implicit in each system.

Human wellbeing is dependent on access to needed social, production, and natural elements, and simultaneously requires protection from disproportionate social, production, and natural pressures which are individually experienced in a constantly changing manner throughout the life span. When environmental (or individual) challenges exceed individual capacity, opportunities for health and wellbeing are compromised. Challenges to health and wellbeing result in costs to the individual, social, production and natural systems. Excessive costs to any of these systems are unsustainable. Table 22 summarizes each model type and its contribution to the concept of the lifespan ecologic model.

Table 22 Summary of findings from the literature by model group Type of model Findings from the literature Context Human wellbeing rests on social, built, and natural systems Values Values drive resource allocation Person-Environment Fit Environments must match needs Health/Disability Environmental barriers limit opportunities Sustainability Practices must be sustainable, current practices are not Systems Health effects, their economic consequences, and resource use are interconnected

76 Sara receives services at home from family so reports under both service in and spending time with family. I count both if reported as such. For example, the meals are prepared (service) and then shared (social). Ursula also has a high ratio based on reporting access to both beauty and spiritual practice at home.

118 4.5 Categories and constructs

Participants did not express surprise or confusion about any of the categories I presented, except for one, access to beauty. That question generally took the longest for them to consider before answering. Outings to aesthetically pleasing places were the most likely to be curtailed because of mobility limitations and were subsequently mentioned as places that were missed.77 I expected there would be a need to explain spirituality, but participants were quick to respond. Most participants attend a church or temple, but “nature” was often cited as a stronger spiritual connection than church. Also, areas in the home, old neighborhoods, and places of service were identified in the spirituality category. The following four tables compare the types of locations where I expected participants’ needs would be met, with the actual places individuals cited. Included are quotes from participants reflecting the range of positive and negative response to activities and locations.

Table 23 Individual construct: locations and related interview comments Individual – Wellbeing Cited Wellbeing Expected Places Locations Connections Spirituality chapel, home area, Expression of God in Unspoiled nature; Identity: self- meditation road, view, Bible study group is my real spiritual community; actualization space, hospice, river bank, Most meaningful spiritual experiences are alone; most Mind park, trail, church, spiritual places are in my office and in nature. transcendence, green space community I’ve been getting a lotta things to lift me up this week. Choice/meaning aesthetically center, old Helping makes me feel good; Volunteering at the preference satisfying neighborhood Community Center is where I get all that. perception multiple I don’t do anything I doesn’t want to do and I don’t see choices anyone I don’t want to see. tenure Body personal care physical Does a good job, Exercise controls diabetes; Care, safety, enabling therapist Sometimes I can’t drive after I get a shot; p/e fit hospital, doctor I can’t do my nails anymore; doctor, dentist, nail No longer attend (church) services: I don’t like to get up chiropractor, technician during the service and go to the bathroom. therapists

77 Liz can no longer walk to a nearby park. Jane misses the symphony.

119 4.6 Narratives of person-place relationships

During interviews, I asked participants about the personal importance of accessing each cited destination and for any effects of not being able to go to meaningful places. Also, as part of the collaborative mapping exercise, I asked participants to articulate their feelings about the spaces they identified, and about the Spokane region. I probed repeatedly for feeling or belief comments. The narratives that emerged amplify the raw data about destinations by increasing knowledge about the individuality of person-place processes.

“I don’t do anything I don’t want to do and I don’t see anyone I don’t want to see.”

Individuality, spirituality and the physical body expose their internal interactions as outward behavior reflects the internal balance of power. Georgia expresses new-found freedom to eliminate “shoulds” from her life, by only going where, and doing what, she wants to do. Sara accepts severe restrictions from her family because she knows they love her and are concerned about her best interests. Bailey is frustrated that he is not free to travel because of continuing family responsibilities. Niki stopped attending church services because she doesn’t want to leave the sanctuary during the service. Her need to use the bathroom illustrates a physical limitation amplified by personal identity in a social environment. It may or may not be physically difficult for Niki to access the rest room, but her desire for privacy affects her evaluation of her person-environment fit with Sunday church, and results in her avoiding this significant environment.

“It’s more than just a social club”

Churches were cited as spiritual, social and productive places. Despite moving away from the neighborhood, and being involved in multiple outside activities, Hillside Community

120 Church remains very important to Cindy spiritually. She attended there her whole life, her parents were married there, and she was married there. Clarisse says “religion is private,” but church is part of her week. Walt sees church as a commitment to the larger human community and the natural world. Elsie finds fellowship, support and beauty. Mel values the “magnitude of the things the church is doing” in the community, and the talents that members share.

“I feel like I’m giving back”

Volunteering meets many different needs. Jane gets spiritual satisfaction from helping at a community center three times a week. She also takes a disabled grandson shopping every week, but that feels like work. Bailey gets peace of mind and satisfaction from volunteering at

St. Steven’s Hospital, meals on wheels, church and teaching English. Cindy maintains connections teaching leadership and Bible study classes, giving rides and helping friends. Walt makes a difference participating in state-wide advocacy groups, coaching and consulting. Elsie and Mel protect the rights of nursing home residents, working for years as long term care ombudsmen. Scarlett has been volunteering at community center for twenty years, and has been able to access food assistance when needed.

“We go everywhere together”

Relationships with persons, animals and places significantly enable and disable individuals. Dan and Pam go “wherever they want” even though Dan doesn’t drive any longer.

Daisy gave up going to symphony concerts when her husband moved to the care center. She hopes to attend this year, using the private community bus. Jane doesn’t walk near her new (of

10 years) apartment. She moved there after her husband died, and hasn’t gotten used to walking alone. Loretta used to love walking to Pleasant Park, but now can only go twice a year,

121 when her daughter takes her. Clarisse doesn’t like to go alone out of town. Scarlett lives outside of the city limits because she loves her fourteen Chihuahuas, ten more than the city zoning limit.

“I would be sitting at home, watching TV and eating myself to death”

Senior centers meet companionship, educational, exercise, transportation and nutrition needs. Liz travels by paratransit from an outlying community to Unity Center four days each week as an alternative to a more expensive program closer to her home. She loves the friendships, programs and “just seeing the people.” Tina can’t wait for her upcoming move to an apartment across the street from her senior center. Although she has lived in her current home for 23 years, she is much more attached to the community of friends at the center and expects to be able to get out more by utilizing the programs in the new environment.

“Fun, good people”

Cultural connections and activities also provide multiple benefits. Reid and Mary love to square dance. They go four times each week, and regularly volunteer to teach new folks.

Painter sings in a competitive barber shop quartet. His group practices for 2.5 hours each week, not including the hours spent coaching, competing, and performing. Painter says singing provides beauty and spiritual fulfillment, but is rigorous enough to count as exercise. He misses past family boating outings where they listened to music and sang. Cindy is a serious club pickleball and table tennis player. Lynn and Dani play Bingo three times a week, and although they spend $40 each time, they win enough money to pay for vacation trips.

122 “If there’s anything I miss about retirement, it’s those conversations”

Mel, a published writer, and Georgia, an aspiring poet, both belong to writers groups which help them with ideas and encouragement. Walt moved out of the city into a wonderful

new energy efficient home after he retired several years ago, but he hasn’t given up the old life-space either. He continues to shop at the “old neighborhood” Beagles Grocery, despite driving past numerous other grocery stores, including two larger Beagles Supermarkets, along his route. Walt also continues to schedule meetings, order books, and relax at a café near his old place of employment.

Table 24 Social construct Social – Participation Cited Locations Wellbeing Expected Places Connections Belonging, near family, home I haven’t got used to my new apartment (10 years) I Access to friends, friends home haven’t got used to walking alone, so I don’t walk there. friends/family volunteer daughters home Don’t feel so closed in; Freedom to have animals; No / pets, café, bar, cabin one is going to make that decision for me (14 dogs); Very Healing, 3rd senior center special time with my sister’s family, nephew has a cabin places, next door. “He’s so cute, He’s so sweet,” He puts out my breakfast every morning. We go everywhere together. Cultural/ library, school, library, café Use Skype once a week to talk to friend overseas; society theater senior center The workplace created an environment for intellectual Learning, phone, phone, college interaction. I don’t have a ready community for that kind communicatio computer arena, theater of conversation. I go to a writers group n Political/ bank, voting bank I miss the kids, not the place. Going out to eat is my economic information, organization entertainment. When you live with old people, it’s a Community community volunteering relief to see young people. I’m moving to get out more, participation betterment working feel safer, and more affordable. I know it’s smaller (the Economic groups, consulting store) but people know who you are and what you like. sufficiency personal They decided I can’t go out there anymore. I don’t feel Safety safety safe, my house was broken into.

“I want to go out more”

Relatively “minor” features of the built environment and of service systems have a profound effect on individuals with physical limitations. Jane drives everywhere, even across

123 the street to the grocery store because the walk light doesn’t stay on long enough. Loretta has the same problem at another stoplight, but since she doesn’t drive she would have to schedule a trip with paratransit to go across the street to her local grocery. Instead she typically orders from Schwann’s and picks up small items at Walgreens, across a less busy street. Jane however hasn’t been able to get to a store in the mall because she cannot walk from the parking area to the desired department.

Transportation is a major factor in our car oriented environment. Unfortunately, bus services can present challenges to individuals with limitations. Since the recent bus stop reductions, Electa can’t walk to the new bus stop. Loretta has a hard time waiting for the fixed route bus and then getting seated before the bus begins to move forward. Sara uses paratransit to go to medical appointments, but hesitates to attend Women’s Club meetings because the wait for the van after the event is too tiring.

“It’s ideal, really”

Good personal and financial health enables a much larger life-space. Elsie and Mel, married 56 years, have visited 61 countries, and two weeks earlier returned via RV from a family trip to Mexico, describe their health as “better than well.” Living outside of Spokane, they report that their access to shops and services is very satisfactory. “We live 19 miles from church, but it only takes 15 minutes. It’s ideal, really. I can be downtown faster than my friend who lives in Spokane.”

“Rite of passage”

Home maintenance and personal safety issues are important to individuals who have sold cabins or moved from their homes. Zac and Niki just sold the cabin they loved. Purchased

124 in the 1950’s the family cleared the land, built the cabin, and spent summers there with children and grandchildren, “because we had to get away from steps and from falling out of trees.” They miss it, but describe the sale and move from their home to a continuing care community as a “rite of passage.” Jane sold her home of 42 years while it was in “top notch” condition. She felt she could not care for it on her own and wanted to sell it before it became run down.

Table 25 Production construct Production – Access Cited Wellbeing Expected Places Locations Connections Goods/ objects general goods Grocery store, Exciting to treat myself; Use rider carts in store; store, grocery pharmacy I can’t walk from the parking lot to JC Penney in the Consumer store, Big box store mall goods, assistive pharmacy, Discount store Shopping is a way to “get out”, entertainment. devices, I use Schwann’s delivery for most of my food and buy nutrition the rest at Walgreens. No longer interested in cooking. Labor/ services Service beauty shop, It was getting to be too much responsibility. assistance providers copy shop Moving to the CCC is a “rite of passage”; Sometimes I mailing service wish I could get out and go when I want to go; I miss my driving privileges, but didn’t give in too soon. Built Housing Rural I can’t do stairs; If I buy more I need help taking it in; environment / Roads Main floor I’m not supposed to go to the basement. Don’t walk infrastructure Sidewalks Roads there; Have to drive across Broadway to SuperMax Shelter, Bus service Traffic because the walk light doesn’t stay walk long enough; mobility, Traffic signals We get anywhere we want to get! Hard to get seated on the bus before it begins to move.

“What a difference that makes!”

Daisy and Don owned a boat store and lived on the river. Now she treasures the view of the river from her apartment and puts off moving to a smaller unit without that view. For Daisy the river seems to provide continuity as well as beauty. She and her husband moved to

Waterford Retirement Community when his health declined. “My mom had lived in this community; we knew what we were getting into.” The continuing care community meets some needs, but she worries about the expenses. She would like to bring Don back to their apartment

125 but has trouble pushing his wheelchair over curb cuts and carpeting. Vanessa and her late husband built their home on the open prairie north of town. She loves the views of nature from her windows and tries to accept “all of the new buildings covering prime agricultural land.”

“I can’t go out there anymore”

Weather and climate are significant to wellbeing. Elsie and Mel have lived all over and travel two or three times a year, but chose to live on a lake near Spokane, citing the climate as one major factor. Ursula spends the summer at her lake cabin. Cindy goes out to her cabin at least once a month, and more in the summer. Sara gave up staying alone at her lake home during the summer when her family insisted. Zac and Niki sold their cabin although they still have strong feelings about it.

Table 26 Natural construct Natural - Access/protection Cited Wellbeing Expected Places Locations Connections Resources Trees, animals Parks We live on a park and don’t use curtains, and have four parks and the bluff in walking distance Energy, water, windows I enjoy walking through the woods, picking sun huckleberries; Views from windows – dislikes new access buildings blocking her views; I can’t do any of that but I don’t think about it Climate / season Protection/ Don’t drive in snow or dark; I spend the summer at my /time of day access cabin. We lived in Oregon for 18 years, but don’t want to go back into the rain. Like the change of seasons. Pollution protection freeway, Back roads have less traffic so she can enjoy the Clean air, water brownfields, scenery; Rock climbing, I can’t do that anymore. Needed to move away from falling out of trees.

“If I were out at night, I probably would worry.”

Weather and time of day are most often mentioned in terms of safety. Ann says they’ve always liked all of Spokane and feel very safe and happy here, and then adds, “Of course, they

126 have more murders now than before.” Don drives in the daytime. Vanessa doesn’t drive at night or in the snow. Vanessa, Daisy, and Jane get rides when they go out in the evening.

Individuals: I can’t do any of that, but I don’t think about it.”

The participants made it clear that each of them was quite unique and that they had multiple reasons for doing and not doing certain things they liked or didn’t like – and that not being able to do some things was acceptable. Georgia does only what she likes and feels very free for the first time in her life. Sara gave up doing what she liked, but feels encircled by love and concern. Dan and Pam set up their lives to be independent despite Dan’s heart problems.

Bailey wants to do some of the travel his friends are doing while he is asymptomatic, but feels constrained by family obligations. Clarisse is lonely despite living next door to her daughter and participating in her grandchildren’s activities. Lilian finds joy in seeing neighborhood children play with those of another race or ethnic background. Vanessa expresses hope for the future of the human race.

4.7 Findings from spatial analysis of mapped life spaces

Analysis involves mapping destinations and routes identified in interviews to find patterns that address my theoretical constructs. Participants travel patterns, numbers of visits, and meaningful places not accessed, are weighed against the constructs developed from the literature. Destinations, visits, and spatial extents provide quantifiable data to contrast and compare between individuals and groups. Results are explored by person, initial contact site

[church or senior center], transportation limitations, and activity goals. Spatial analysis of participants’ home areas, destinations, and life spaces augments narrative data from

127 interviews, and findings validate the importance of both individual processes, and environmental structures in patterns of access.

Table 27 Characterizing home areas Name(s) Home / Land Cover: Traffic Safety Median Life D=Developed U=Undeveloped family space income area SFR= Single family residence Impervious R < 500 911 Perceive Census Square APT=Apartment, DUP= Duplex Paved/built day Calls d Safety block miles Ann SFR D: Low 43% R 0 3 73207 141 Bailey APT U: Shrub 7% 1870 0 4 89432 202 Cindy SFR D: Low 25% 23400 0 4 61538 465 Clarisse SFR U: Shrub 0 R 0 4 63152 645 Daisy APT D: Medium 56% 4400 36 4 21375 174 Dani & Lynn SFR D: Low 48% 24500 77 3 44810 360 Dan & Pam APT D: Low 43% R 43 4 38333 56 Electa SFR D: Medium 42% R 0 4 63814 106 Elsie & Mel SFR D: Low 19% 2100 1 4 76944 1579 Georgia SFR D: Medium 54% 1500 13 4 68224 53 Jane APT D: High 71% 2200 120 4 29851 233 Lilian APT D: Low 43% 1500 65 4 30809 49 Liz SFR D: Medium 51% 12471 34 4 45917 1037 Loretta APT D: Medium 63% 11700 75 4 71944 99 Painter SFR D: Low 39% R 1 4 100125 1057 Reid & Mary SFR D: Open 21% R 31 4 105438 810 Sara SFR D: Medium 42% R 20 4 63846 77 Tina SFR D: Low 41% R 73 1 30848 325 Ursula DUP D: Low 31% R 0 4 44375 94 Vanessa SFR U: Grassland 0 R 0 4 93725 644 Walt SFR D: Low 8% 682 0 4 90400 817 Zac & Niki SFR D: Medium 42% R 0 4 44375 12

I used a range of buffer sizes for spatial analysis of destinations. The “home” was primarily defined as a 200 ft circular buffer centered toward the front of the home, including the entire parcel, the street and the visual space in front of the home. This buffer represents the home territory and natural surveillance zone. Additional measures are used depending on the data source included census blocks, 500 foot and one mile buffers and total areas traveled

Table 27 provides a snapshot of the variety of environments where participants live, including

128 housing type, land cover, traffic levels near the home, perceptions of safety, 911 calls geo- located to the 200 ft buffer, median family income of the census block group, and the overall size of the life space that the participant visited in the past four weeks

The home point is the smallest comparative unit and has the smallest range of variation.

For example there are three types of residences, and six types of land cover. The 200 ft buffer affords much more variety, including traffic counts for nearby roads that range from quiet residential streets to busy arterials. Life spaces afford the greatest variety, as the scale of life space ranges from Zac and Niki’s modest twelve square mile visited life-space, to Elsie and

Mel’s 1579 square mile life-space region.

Mapped life-space polygons “refer to your life-space”

Mapped life space polygons created with GIS software represent the total geographic areas participants visited or reported as meaningful.78 These polygons are in fact a statistical comparison tool, as some points in the life-space polygon are inhabited, some points are frequented, and others are never visited. These polygons also reflect the form of the community: the main roads, shopping clusters, and medical districts. Life-space polygons are an abstract measurement device allowing quantitative comparisons and revealing person-space relationships.

Walt’s map (Figure 27) illustrates one of the larger life space areas, and would be even larger if I included his monthly drive to the west side of the state. His home is located outside of

78 Life space data for Dani & Lynn and for married couples who interviewed together is mapped together, as there were few spatial differences between their activity destinations. Scarlett is omitted from life space maps, both because her home is outside of the county and her mapping session was incomplete.

129 Spokane to the south and east, but occasional events find him north and west of the city. The majority of his destinations, however, are located in a much smaller area, the area around his former home and workplace. The only new site, besides his home, is a library, on route to the previously established destinations.

Figure 27 Life space showing destinations and routes

The map in Figure 28 also shows some nearby destinations that Loretta would like to access but is no longer able to. Since these “missed” destinations are not far from her current life-space, the map illustrates that issues other than raw distance are involved in accessing destinations.79

79 Some “missed” destinations were no longer in existence, such as a grand old department store downtown.

130

Figure 28 Comparison of life spaces

Service space vs. life space

Combining accessed destinations by type highlights the design of the community. Figure

30 presents destination points by type, home, shopping, medical, etc. The points are also combined as minimum bounded polygons by type, and identify the areas of Spokane where participants accessed needs by type. Homes are widely distributed, and those farthest out of

Spokane have few other types of destinations nearby, illustrating the car dependency of these locations.

131

Figure 29 Types of destinations .

This map reveals why Dan and Pam’s choice to live in the center of Spokane is highly satisfactory for them. Dan has a bad heart and he doesn’t drive, accordingly they moved to a location close to medical care. As Dan benefits from regular exercise, he and Pam walk four miles daily, despite the weather. Dan and Pam say, “We can go wherever we want. Want! We set up our lives so that we can be independent!” Even so, Dan and Pam are quite fit and although their minimum destination distance is 75 feet (to the clubhouse), and average destination distance is two miles, their maximum destination distance is six miles, so they also use bus services and drive.

Table 28 compares the sizes of the service areas by type of destination within the study area. Consumer and medical services are located in the smallest extent, only 12% of the total

132 minimum bounded study area. Mapped meaningful places include previous residences, workplaces, parks, activity sites and a cemetery. Since meaningful places outside of the study area are not mapped, this category does not include previous out of area residences, or favorite vacation spots. Social sites occur across 34% of the area. These include restaurants, and friends’ homes, as well as, outlying locations such as the state fairgrounds, or heritage sites. The shopping distribution, at 49%, shows the much greater spread of retail locations, and is exceeded only by the home distribution area, at 69%.

Table 28 Minimum bounded areas by Area: 359 square miles Type Area in square miles Percent of total extent of visited areas Compared to home area . Service Out 43 12.2% 17 % Health 44 12.4% 18 % Meaning 93 26.1% 38 % Social 121 33.8% 48 % Shopping 174 48.5% 70 % Home 249 69.0% 100 %

Both proximity and preference can be seen in the distances to visited destinations.

Social, shopping, services, and meaning events are reported at a very large range of distances.

Minimum distance to restaurants, the most often visited type of place, are much greater than the minimum distance to grocery shopping, the universal activity. Preference is evident in grocery shopping, as only eleven of the 38 grocery stores visited were located within one mile of home. The NAICS database indicates that 18 participants have a supermarket or other grocery store within one mile of home. Walt, driving to his old neighborhood grocery; Scarlet, treating herself at Bonanza Foods; and retired military folks shopping at the Commissary, are expressing belonging and self-actualization in their choice of grocery store.

133 Table 29 Distances between home and major type of destination (in feet) Euclidian distance to home by master types and major subgroups (in feet) In miles Sub-group (monthly Type (monthly visits) Minimum Maximum Average Average visits) Social (99) 75 91109 24776 4.26 Restaurant (43) 1919 85450 18670 3.21 Event (18) 5855 65651 37400 6.43 Social (16 other) 75 64651 22908 3.94 Shopping (86) 141 104034 21554 3.70 Grocery (36) 141 104034 25911 4.45 Shop (36 other) 428 79227 15954 2.74 Meaning (47) 216 82559 22436 3.85 Church (26) 216 82559 22882 3.93 Service Out (27) 409 62357 15632 2.69 Medical (26) (excluding exercise) 3931 91109 16531 2.84

Table 29 confirms the importance of the community structure as the other powerful determinant of distances traveled. Corresponding to locations of event sites such as arenas, fairgrounds or college campuses, special events required the greatest travel distance averaging

6.6 miles. The relatively small size of the medical service area is collaborated by the large minimum distance to medical services; interestingly the average distance this group traveled to medical services is relatively small, suggesting that individuals needing greater access to medical services locate closer to these services, as Dan and Pam have.

Contact site population differences

In order to identify relevant indicators to explain the variety of life- spaces and travel patterns, I compared participants several ways. I examined the three contact sites where I had four or more participants, and validated my initial description of Hillside Church as being a

134 community church and Falls Church a commuter church. Table 30 shows that the average distance from home to Falls Church, is 2.8 times great as the average distance to Hillside.

This willingness to travel is echoed in average distances Falls and Hillside members travel to all places monthly, a factor of 2.5 larger. Unity Senior Center average travel distances fell between the two churches. This may be because Unity offers a service that is not available at very many sites, and is often needed by participants who no longer drive independently.

Table 30 Comparison by contact site Distances traveled by contact site (Euclidian distances in feet, couples travel not duplicated) Distance to contact site Single destination distances Monthly travel distances

Contact Site Min Max Average Min Max Average Min Max Average Falls Church 4166 82559 27659 75 104034 23532 600 1248408 147031 Unity Center 178 43725 15435 141 44199 10416 818 1399200 113437 Hillside Church 946 32397 9829 946 53605 14991 7158 518352 58435

Primary transportation mode

For my participants, the impact of primary transportation mode is unmistakable. Table

31 presents average distances to unique destinations, average monthly distances traveled, and percent of meaningful life space visited. Participants who drive, average much higher distances to both unique destinations, and for monthly travel. Those who live with a driver, have a more limited travel pattern, but express satisfaction with their range of travel. Alternatively, participants who must arrange rides from outside of the home not only have much smaller average travel distances to unique locations, and monthly travel; but also visit a much smaller extent of their meaningful life space.

135 Table 31 Distances by primary transportation mode Primary transportation Average distance to Average monthly Percent of meaningful destinations distance traveled life-space visited Drive car 4.55 20.55 82 % Rides from family in home 2.41 6.24 96 % Friends, taxi, paratransit, etc. 1.02 1.76 58 %

Further study is needed to explore the high percent of meaningful life space access of the participants who have live in transportation. These participants report accessing 96% of their meaningful life-space in the previous four weeks. Participants who drive, did not access their full meaningful life space for many reasons. Their driving “affords” them a larger life-space that can include out of the way, highly personal, or seasonal destinations. Vanessa has an annual calendar of event-oriented travel, rather than a weekly or monthly pattern of travel.

Vanessa, like Jane, misses places she no longer goes because of the loss of her partner. Jane can drive, but walks with difficulty, so she misses places with inaccessible parking. Ursula and Cindy go out to their cabins more often in the summer.

Measures “great and small”

Measures are another key aspect of person-place research. The spatial measures used in characterizing the participants’ homes, neighborhoods and life spaces describe very different places depending on the measure type and scale used. Life-spaces determined by my participants’ destinations have very little in common with a large circular buffer of the home, used by most studies to determine access to goods and services. It is even more different from using a census block unit, typically used to characterize a community. Figure 30 contrasts various measures of Ann and Liz’ home areas to illustrate the different outcomes that result.

Ann’s areas are represented by the green tinted zones, Liz by the red tinted zones. Ann and Liz

136 have similar life situations. Neither Ann nor Liz drives any longer. They both live with extended family, but Ann’s husband is still driving. Ann and her husband volunteer at Welcome Center twice a week. During the school year, Liz would be home alone during the day, so she takes paratransit to Unity Center four times a week. Ann and Liz shop and go to restaurants in the commercial area located between their homes. Their visited life spaces overlap considerably. .

Figure 30 Measures by census block, buffer and life space Despite these shared commercial zones, if considered by census block or by one mile buffer, Ann and Liz do not appear to share common areas. Liz and Ann live in neighboring census blocks with very different median family incomes. Ann lives toward the edge of the irregularly shaped green census block group, whose median family income is over $73,000. The median family income of the irregularly shaped red census block where Liz lives is under

$46,000. Ann’s green one mile buffer contains shops and restaurants on the east that are closer

137 by Euclidian distance than the shops and restaurants Ann actually visits in Liz’ red buffer. Table

32 shows that each type of measure provides a different set of results and that none of these measures is an obvious predictor of actual activities.

Table 32 Access to services by measurement type Grocery Restaurant Census One Mile Visited Total Life Census One Mile Visited Total Life Block Buffer Space Block Buffer Space Ann 0 1 1 8 4 2 6 113 Liz 1 2 1 20 3 14 0 108

Scale of measures

The NALC land cover maps are part of a federal research project to provide standardized land cover data at 30 square meters. The effect of scale on measure outcomes is exhibited in the Figure 31 which compares two types of land cover measures at point scale, 200 ft buffer and 500 ft. buffer. The Land cover by NALC Type map on the left labels the specific kind of land use, while the cells in the Percent Impervious map on the right show an estimate of the percent of paved and built surface. If the land cover around Electa’s home is characterized using NALC land cover types closest to her geo-referenced home point, she lives in a medium density area, with 37% of the nearby surface imperious to water. However, measured with a 200 foot buffer, her home area has lower intensity development and higher levels of impervious ground cover.

138 Figure 31 Land cover calculated by scale At 500 feet, the measures indicate the area is developed at a low intensity, includes small areas of evergreen forest, and is 37% impervious. The size of the buffer used can result in real and artificial skewing. Large scale comparisons, such as land cover in a one mile buffer, may be meaningless when talking about Electa’s access to nature, at close up scales, the size of home, driveways, sidewalks, and intersections near the home will impact the apparent percentage of impervious cover (Table 33).

Table 33 Land cover results by buffer size Land cover: number of cells Immediate 200 foot buffer 500 foot buffer 1 km buffer 21: Developed, Open Space 5 332 22: Developed Low intensity: 9 63 2037 23: Developed, medium 1 4 14 549 24:Developed, high intensity 43 42: Evergreen 20 529 Average Percent Impervious 37% 42% 37% 31%

139 Percent impervious measures provide less initial information, but are easier to compare across different landscape types and buffer sizes. Often the researcher has little choice in the scale of data available. Demographic data is typically only available at the census tract or block group level. Table 33 gives examples of data that is available in a 200 foot buffer compared to data that is only available by census unit. The 200 foot buffer is actually too small to meaningfully account for 911 calls in several home areas. Nine participants have “no” 911 calls within a 200 ft. buffer of their home, however, in checking the accuracy of this result, I observed that most have geo-located points representing 911 calls just outside of their buffer.

4.8 Recommendations for further research

These findings are the outcomes of a preliminary study of person-place processes using targeted cases of seniors identifying with an organization within the City of Spokane. Every step of the research and analysis process required establishing limits to the extent of research and analysis. Thus countless variations and extensions to this study seem useful. The most general need to further understanding of life span design needs is targeting wider populations in terms of age and race. Mid-range research is needed on populations who do not have communities of belonging, or who are no longer able to access the sites where they identify.

For this set of participants it would be instructive to revisit the participants a year later to record changes in health, activities, and also in their awareness of place. During the research processes I learned it was very difficult for people to identify and articulate their own person- place relationships. Walt was unaware that he spent so much time in the old neighborhood.

Jane couldn’t articulate why River Center was such a welcoming place. Tina expected to get out

140 more if she moved closer to the senior center. Georgia commented that she found her participation in the study valuable in helping her see how satisfied she was with her life.

As I introduced findings for each step of the process, I also noted many specific areas of knowledge needed for more robust results, such as the sorts of crimes most threatening to my target group, or the optimal measure for each element. Additionally, the GIS data is not exhausted, as each visited and meaningful destination could have been characterized and more data layers introduced. Optimally, follow-up interviews combined with further mapping would provide the most information on person-place processes.

141 Chapter Five: Conclusion

5.1 Introduction

Within the larger framework of the life course, this study set out to explore the relationship of connected community living seniors to their living environment, the types of environmental issues they experience, the extent of the problems they face, the resources they require, and the impact of environmental access and constraints on their wellbeing. The study has also sought to examine how self-actualization in terms of choice, belonging, and meaning relate to person-environment processes. The general theoretical literature on this subject, while vast, is fragmentary and poorly integrated into the design, planning, and policy fields that shape the urban environment.

This chapter integrates findings from the triangulation strategy: analysis of models in the interdisciplinary literature, analysis of environmental access and satisfaction, and spatial analysis of the general community and specific life-spaces. The material is presented in seven sections. Section 5.1 reviews both the statement of the problem and major study questions.

Section 5.2 discusses major themes emerging from the study. Section 5.3 lists the events and processes that affect access. Section 5.4 discusses the structure and form of the City of

Spokane. Section 5.5 analyzes theoretical implications of the findings summarized by the life- space ecologic model with applications for practice and policy implications. Section 5.6 proposes recommendations for further research. And finally, Section 5.7 is the conclusion.

Statement of the problem

This study explores connections between wellbeing and access to personally significant environments in order to integrate person-process with place-process (Bronfenbrenner 2005)

142 into environmental design. The questions that I am trying to answer are; 1) Are individuals accessing the places needed to meet wellbeing needs throughout their life span? 2) What are the events or processes that result in changes to access of places associated with wellbeing; and 3) what is the experience of spatial constraints in terms of wellbeing?

While life-space issues affect all people, for this research I targeted persons over the age of 55 because of the diversity of their experiences from a lifetime of multiple expected and unexpected changes in family structures, careers, and health. I recruited these participants via local churches and community centers in order to identify individuals that were likely to be involved in activities and experiencing belonging or meaning.

A central premise of mixed method research is that qualitative and quantitative methods used in combination, provide a better understanding of research problems than either method alone (Creswell and Plano 2007). Research on wellbeing and person-place processes requires accessing both personal information on behavior not necessarily at the level of everyday awareness, and objective community information (for example, crime, traffic counts, etc.) beyond the specific or conscious knowledge of typical persons. Unexamined or unarticulated connections between wellbeing and place are explored with questions about destinations, and feelings associated with accessing, or not accessing, needed and personally meaningful places.

Quantifiable data was produced from interview questions about destinations and spatial analysis of the specific locations and areas accessed, and not accessed. (Where do you go?

Where are you not able to go?) Qualitative information came from asking participants to identify feelings, and levels of satisfaction with the access and lack of access. (How does it

143 affect your life to go there? How does it affect your life to not be able to go there?) These two data streams were analyzed separately, and then linked together via the key concepts that emerged from the interviews, the maps, and the literature.

5.2 Major Themes

Connected community living seniors report fulfilling wellbeing needs across as wide a range of environments as they can currently access: physically, emotionally, and financially.

Individuals express strong self-actualization, social dependence, and infrastructure concerns in accessing needed and desired goods, services, activities, and places. Parks, concerts, club meetings, dancing, fishing, nature in general, favorite stores and beloved vacation spots were mentioned as currently difficult to access, although not in the past. Adaptation and compromise are crucial, as connected community living seniors continue meeting personal wellbeing needs in more restricted environments, and maintain meaning and belonging despite the environmental limitations.

The diverse experience of aging

Processes of aging, stages of fragility, marital status, and living situations were widely divergent across my cases as expected (Baltes 1987). Participants ranged in age from fifty-six to ninety-nine. In this group the two youngest participants used paratransit to get around, indicating a level of disability, while the oldest participant still drove her car 150 miles to family events. Some individuals were in excellent health and cared for others, while others required care. Relationship status ranged from never married, to currently married, divorced, widowed, and/ or living independently, with a spouse or with children. Individuals, couples, and extended families lived in stand-alone dwellings, apartments, and in continuing care communities.

144 Wellbeing and satisfaction despite limitations

Participants in this group generally reported high levels of over-all wellbeing regardless of their physical health. Several of the most apparently physically limited individuals, who described themselves by enumerating their physical limitations, did not agree with the statement “I consider myself to have a disability.” A few participants who reported poor mental or physical health partially agreed with the statement. Partial agreement also came from individuals who reported private assistance or public services based on having a disability.

Those who fully agreed with the statement were relatively younger, received disability based assistance, and also reported recent or current financial constraints.

There was no apparent pattern between relative personal wellbeing and neighborhood satisfaction ratings. Some participants gave higher rating to their own overall wellbeing while others gave higher ratings to their neighborhoods. All but one participant, who was planning to move, expressed overall satisfaction with their homes and neighborhoods, despite multiple complaints about road and sidewalk maintenance. Several participants were living in their ideal homes or locations. All participants identified places of belonging and meaningful activities.

However, most participants also spoke of current or anticipated limitations related to their age, health, social situation, transportation, or financial capacity.

Independence and belonging

The value that participants most often articulated was independence, and the overriding factor in making decisions for this group was belonging. Independence was presented in terms of freedom of association (Georgia), freedom to keep pets (Scarlett), living in a walk-able neighborhood (Dan and Pam); freedom from housework (Reid and Mary) and home

145 maintenance (Zac and Niki); and freedom limited by family responsibilities (Bailey). Many seniors made deliberate choices, including relocation, to maintain independence as they or their spouse required access to services or more support. Sara accepted unwelcome limitations to her freedom imposed by her children, possibly as a condition of receiving their care, however was able to continue living in her own home. The loss of a spouse (Jane, Vanessa) or life-long friends (Ursula), negatively affected access to activities and destinations.

Relocation

Relocation choices reflected the stages identified by Litwak and Longino (1987).

Younger and more active individuals described moves to homes with amenities (Walt, Cindy,

Clarisse); others moved closer to family (Lilian, Ursula); to live with family (Ann, Liz); to live in more supportive environments (Zac and Niki, Daisy, Ursula); and to live closer to needed services (Tina, Dan and Pam). Daisy’s husband Dan represented the third move, to an enhanced care facility. Sara’s situation resembled that of a care facility, as full care was provided by live-in children, and limitations were imposed by family pressures. Moves resulting from stressful life events or circumstances have been found to be particularly difficult for aging individuals

(Bradley and Van Willigen 2010).

Excluded and disabled

The literature tells us that seniors are progressively excluded from the community environment (Heumann 2001) and that the environment shares in the creation of disability for physically limited individuals (Verbrugge and Jette 1994). Poorly maintained sidewalks, traffic lights, steep hills, long distances to bus stops, and long waits for bus or paratransit service were mentioned as reasons for not getting out. High traffic, poor lighting, large parking lots, and

146 crime limited access to desired locations for drivers. Home and property maintenance, and anticipated estate settlement issues were given as reasons to give up meaningful homes.

The most obvious factor that emerged as limiting access to significant places is the car oriented structure of the Spokane community. At the large scale, drivers access larger life- spaces and visit higher percentages of their meaningful life space than those who rely on transportation from outside of the home. At the fine scale, cars are favored even at intersections, limiting Jane and Loretta from crossing the street because of the short timed walk signal. While transportation was cited as a problem for non-drivers, active drivers did not appear to anticipate a time that they would no longer drive. Only Bailey identified the distance from his home to shops and services as a potential problem.

Transportation problems highlight the importance of economic ability to purchase needed wellbeing services or places. Those with greater resources (Zac and Niki) relocate to supportive facilities close to preferred destinations. Electa arranges regular taxi service. Those with fewer resources (Tina, Liz) rely on social supports, such as paratransit and subsidized senior programs funded by taxpayers. Financial resources were challenging for all individuals needing assistance, and socially funded services were needed even for those who live with extended families.

Adaptability

This group of connected community living seniors embodied life-times of adapting to family, work, housing, and health changes and challenges. Clearly an important life skill, adaptability and ingenuity, coupled with financial means, appeared to temporarily obscure real issues of access, including loneliness, exclusion, and identity. This study focused on accessing

147 meaningful destinations and the progressively smaller numbers of meaningful destinations that more frail individuals reported accessing are accompanied by personal stresses and compromises. Sara expressed high levels of satisfaction with the love and care her family provided, and high levels of satisfaction with being able to live in her own home, but also great loss of personal freedom in no longer being able to walk to the park or spend the summer at her cabin.

Fragile seniors I interviewed were reducing personal expectations as a means of maintaining wellbeing. Daisy shared that it was “easier for her” to move to a continuing care community because her mom had lived there.80 Zac and Niki called this move a “rite of passage.” These are statements of resignation and acceptance by seniors with good financial resources, and not the enthusiastic responses Walt, Reid and Mary, Elsie and Mel, Georgia and others gave in describing their current ideal living situations.

5.3 Events or processes that result in changes to access of places

Transportation, walking strength, and companionship are the three essentials most often cited for accessing meaningful places. A fourth implicit essential is season or time of day.

In our community, driving or living with a driver, is key to accessing meaningful environments.

Participants were divided over the difficulties of air travel. Walking difficulties make all forms of travel more taxing, including driving and flying. Evening and winter outings were limited for both fragile and non-driving participants. Loss of the ability or right to drive, and injuries related

80 However, Daisy was resisting a move to a smaller unit where she would no longer have a view of the river.

148 to walking created major life space changes. Several participants could physically access significant environments, but chose not to do so after the loss of their companions.

5.4 Structure and form of Spokane

The life space maps not only illustrated the travel extents of participants, but also clearly highlighted the structure and form of the Spokane area. Describing its planning strategy as based on “centers and corridors,” Spokane directs businesses to arterials and existing neighborhood centers (spokaneplanning.org). The pattern shows up clearly on the life-space maps, with destinations clustered along the major routes and at several shopping areas.

“Centers and corridors” are a typical suburban structure based on car transportation and zoning restrictions that exacerbates car dependence and related exclusionary aspects of our urban environment. The “corridor” streets serve large volumes of traffic and are difficult to cross, particularly on foot. Both neighborhood centers and shopping centers engender parking and walking difficulties for those with walking limitations. A lifespan friendly city would have to reconsider the corridors and centers plan.

5.5 Theoretical Implications

The lifespan ecologic model, which I have developed, is intended to address the full life course of individuals. The model presented in both tabular and graphic formats (Table 34 and

Figure 32) emerges from the triangulation strategy employed throughout the research. Sub- categories identified for each of the major constructs were developed from the literature and organized elements identified from interviews. Interviews and spatial analysis clarified the role of person-place processes of meaning, belonging, activity, and time, and integration of values with person-place processes propose a holistic approach to sustainability. The model emerged

149 through iterative and sequential examination of theoretical models (qualitative), personal experiences (qualitative and quantitative), and geographic data (quantitative). Stages of mixed methods research refined and connected significant (qualitative) environments (quantitative) with major themes (qualitative).

Table 34 Lifespan Ecologic Model with values and processes Construct (Value) Sub-categories Processes Spirituality, transcendence, fulfillment Individual (Wellbeing) Identity, self-actualization, mind, emotion Meaning

Body, heredity, development, skill, health >> << Sustainability Personal, friends, family, pets Social (Equality) Cultural/ society, learning, communication Belonging Political/ economic, participation, safety Goods/ objects, food, assistive devices Production (Efficiency) Labor/ services, assistance, providers Activity Built environment / infrastructure, shelter, mobility

Energy, water, sun Natural (Preservation) Climate / season /time of day Time

Pollution

The lifespan ecologic model adds three important components to the legacy design models: explicit values, developed constructs, and significant processes. Clearly identified values (supporting wellbeing) and sustainability provide a theoretical basis for discussion of priorities. These values of resource preservation, efficiency, equality, and wellbeing are each essential for sustainability related to the construct to which they correspond. For example, resource preservation is a sustainable approach to the natural environment, while efficiency operationalizes sustainability in the built environment. Social sustainability requires equality, and individual human sustainability is based on wellbeing.

Lifespan ecologic model constructs provide details to cue users. Concepts and processes do not always fit neatly into only one construct. For example, the graphic model (Figure 32)

150 places the individual at the center of a set of nested environments that all impact the potential wellbeing of the individual. While wellbeing may be primarily experienced within the individual, the experience of belonging is associated with social (or beyond) environments and activity occurs in the built and natural environments. Processes of time occur to individuals, societies, infrastructures and nature.

Nature • Energy, water, sun • Climate, season, time of day (Preservation) • Pollution Activity, place Production • Goods, nutrition,assistive devices • Services, providers (Efficiency) • Infrastructure, shelter, mobility • Personal, friends, pets Belonging Social • Cultural, learning, integration

(Equality) • Political/economic, safety, inclusion Sustainability Meaning Individual • Spirituality, fulfillment • Identify, self-actualization (Wellbeing) • Body, heredity, development

Time (Passage)  Continuous change over time

Figure 32 Graphic representation of the Lifespan Ecologic Model

Implications for practice

Designers specialize at particular scales of interest, the interior vs. landscape, or community development. Each scale shown in Table 35 (below) incorporates elements that impact individual wellbeing, social equality, efficient production, and ought to consider the preservation of nature. However each scale would apply the concepts in wholly different ways and requires the cooperation of designers at larger and smaller scales. For example, the home

151 designer may include windows, however if no trees are planted, if there are no parks, trails, woods, etc., the windows contribute little to wellbeing (Ulrich 2002).

Table 35 Significance of constructs at design scales Categories Home Area / Landscape Neighborhood / City / County / State / National Individual Interior Exterior Places / Planning / Codes / Incentives Spirituality Meditation space Beauty Chapel, hospice, church, temple, park Identity Self-determination Garden Hobbies, Activity spaces, study group Body Main floor bath, etc. Walk-able Fitness, Medical care, Healing garden Social Access / Protection Personal Visit-able, pets Connected Meeting places, pet friendly, community room Cultural/ society Appropriate Included Theater, gallery, library, book shop, cafe Political/ economic Safe, income Safe Safety, protection, voting, club, volunteering Production Access / Protection Goods Delivery Delivery Grocery, café, drug store, community garden Labor Assistance Services Helping places, beauty shop, barber, tax, repair Built Connects to home Maintained Transportation, sidewalk, ramps, timers Natural Access / Protection Energy, water, Windows Trees, river Parks, trails, woods, animals, birds, cabin Climate / season Insulation Orientation Maintenance , lighting, clearing snow Pollution Clean air, water, Traffic

Sustainability specifically requires consideration of temporal processes and effects.

Architects and engineers calculate service lives of buildings and roadways; planners forecast transportation needs. Facilities designed without consideration of human needs from the adventures of childhood, through mishaps in adulthood, potential disabling conditions, and aging processes are not sustainable. Buildings without elevators, roads without sidewalks, and streets that cannot be crossed reduce wellbeing and demand additional services and labor to retrofit or build new structures. The lifespan ecologic model is designed to address these issues, and applying this model to aging individuals illustrates pervasive deficiencies in our design processes.

152 Policy implications

Aging is the new normal and that is good for everyone (Plouffe and Kalache 2010).

According to studies by the World Health Organization, aging-friendly cities are designed for diversity and enablement rather than disablement, and result in communities that are “friendly for all ages.”81 In the short term, the challenges of a growing aging and disabled population require multiple temporary housing and transportation solutions. In the long term, as costs to society skyrocket, it will be less expensive to provide better services for the entire population rather than piecemeal try to accommodate the needs of individuals. It will also create a healthier and more sustainable community for all residents

Currently seniors are required to reduce their expectations, yet the financial costs of our inadequate infrastructure are high for both these individuals and society. Policies for providing services to aging and disabled individuals need to be revisited at all levels with greater focus on extending needed services to the entire community, as the entire community is aging and experiencing incremental levels of need for support (WHO 2007). Current aging in place services for aging and disabled individuals are not adequate to the current needs and will be less adequate as needs grow. National and local policy bodies must plan for a dramatic increase of population aging and longer life spans.

81 Design for diversity emerged as another cross-cutting characteristic of an age-friendly city. According to the project participants, it should be normal for the natural and built environment to anticipate users with different capabilities: an age-friendly city emphasizes enablement rather than disablement: it is thus friendly for all ages and not just “elder friendly.”

153 5.6 Recommendations for further research

These findings are the outcomes of a preliminary study of person-place processes using targeted cases of seniors identifying with an organization within the City of Spokane. Every step of the process required establishing limits to the extents of research and analysis. Thus countless variations and extensions to this study would be useful. The most general need is to target wider populations in terms of age, race, and location, for example persons of different ages, abilities, demographic groups, and living in small towns or dense urban areas. Mid-range research is needed on populations who do not have communities of belonging, or who are no longer able to access the sites where they identify.

For this set of participants it would be instructive to follow up with them a year later to record changes in health, activities, meanings, and also in their awareness of place. During the research processes I learned it was very difficult for people to identify and articulate their own person-place relationships. For example, Walt was unaware that he spent so much time in the old neighborhood, and Jane couldn’t articulate why River Center was such a welcoming place.

Perhaps taking part in this study has made a difference in how some participants think about or make choices to access meaningful places. Also it would be interesting to compare expectations with the actual experiences when Tina moves to the apartment across from the senior center.

As I introduced findings for each step of the process, I also noted many specific areas of knowledge needed for more robust results, such as the sorts of crimes most threatening to my target group, or the optimal measure and scale for each element. GIS technology allows much finer and more personalized approaches to research on person-place processes. The life spaces

154 identified in the research instruct that reliance on census block data or arbitrary buffers to capture information on accessibility is inadequate. More specialized life space areas, focused on destinations and routes can provide more robust findings for future research..

Additionally, the GIS data generated in this study has not been fully explored, as each visited and meaningful destination could be more fully characterized. Optimally, follow-up interviews combined with further mapping would enrich understanding of person-place processes and could lead to developing a large scale survey integrated with public health research.

5.7 Conclusion

This study has used triangulation to show that in spite of the personal and public expenditures, and growing support for aging in place, the current built environment is unsustainable and threatens independence and wellbeing over the life span. An environment that is designed to exclude growing numbers of individuals for growing periods of time (from as young as 55 to 100 years old or more) is neither ethical nor affordable. This debate includes public health, community development, and environmental science and is therefore extensive and multifaceted even at the local level. To generate achievable strategies and development targets with regards to lifespan communities, there is need for more studies at the local level to allow further assessment of specific needs and to explore local dimensions of the systems and policies that are creating the current environment. Self-referential design, business as usual, and legacy infrastructure are inadequate to meet upcoming challenges. In order to claim the mantle of sustainability, environmental design fields must acknowledge and support self- actualization, social, and infrastructure needs throughout the life span.

155 Public health and epidemiology researchers are identifying lifespan health and wellbeing benefits in communities that support active living, healthy aging, walk-able neighborhoods, complete streets, and design for diversity (Healthy Places 2010). Lifespan design is essential at all scales, from interiors, to landscaping, transportation, and urban planning Integrating public health research back into planning and design education is fundamental, as is exposing the full social, economic, and natural impact of unsustainable design approaches.

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164

Appendix

WASHINGTON STATE UNIVERSITY Interdisciplinary Design Institute

Research Study Consent Form

Study Title: Wellbeing and access to personally significant environments Researchers: Nancy Blossom, Professor & Director, 509-358-7513 Amber Joplin, Research Assistant, 509-217-7721 Kerry Brooks, Associate Professor & Director, GIS & Simulation Lab, 509-358-7911 Bob Scarfo, Associate Professor, 509-358-7913 Interdisciplinary Design Institute Washington State University PO Box 1495, Spokane WA 99210-1495.

You are invited to take part in an important research study carried out by Professors Blossom, Brooks and Scarfo; and Doctor of Design Candidate, Amber Joplin. This form explains the research study and your part in it if you decide to join the study. Please read the form carefully, taking as much time as you need. Ask the researcher to explain anything you don’t understand. You can decide not to join the study. If you join the study, you can change your mind later or quit at any time. There will be no penalty or loss of services or benefits if you decide to not take part in the study or quit later.

What is this study about?

This research study is being done develop a theory of how personal wellbeing is affected by individual access to personally significant places over time.

You are being asked to take part because you are over age 55.

Taking part in the study will take about one - two hours.

You cannot take part in this study if you are under age 55, or if you are mentally, cognitively or legally incompetent.

What will I be asked to do if I am in this study?

If you take part in the study, you will be asked to talk about places that you find personally significant and any changes you have experienced in access to these places. The interviewer will also ask for demographic information (for example if you are between the ages of 55-64, 65- 74, 75-84, or over 85) and information that indicates locations of places significant to you.

166 You will be free to refuse to answer any question in the interview, or the demographic information or location information. The interview will be recorded and the researcher will take notes.

Are there any benefits to me if I am in this study?

There is no direct benefit to you from being in this study. If you take part in this study you may help others in the future.

Are there any risks to me if I am in this study?

The potential risks from taking part in this study are feeling stressed or sad about places you miss.

Will my information be kept private?

The data for this study will be kept confidential to the extent allowed by federal and state law. No published results will identify you, and your name or address will not be associated with the findings. Under certain circumstances, information that identifies you may be released for internal and external reviews of this project.

Personal information, taped records, and maps will be kept in a locked office and all personally identifying information will be removed prior to any research publication. A code will be assigned for each participant so no one can accidentally learn of your identify. The only people who will have access to your data are the researchers (above), and Washington State University’s Institutional Review Board.

The results of this study may be published or presented at professional meetings, but the identities of all research participants will remain anonymous

The data for this study will be kept for 3 years and then destroyed.

Are there any costs or payments for being in this study?

There will be no costs to you for taking part in this study.

You will not receive money or any other form of compensation for taking part in this study.

Who can I talk to if I have questions?

If you have questions about this study or the information in this form, please contact Nancy Blossom, Professor & Director, 509-358-7513, [email protected] or

Amber Joplin, Research Assistant: 509-217-7721, [email protected] .

167 What are my rights as a research study volunteer?

Your participation in this research study is completely voluntary. You may choose not to be a part of this study. There will be no penalty to you if you choose not to take part. You may choose not to answer specific questions or to stop participating at any time.

What does my signature on this consent form mean?

Your signature on this form means that:

 You understand the information given to you in this form  You have been able to ask the researcher questions and state any concerns  The researcher has responded to your questions and concerns  You believe you understand the research study and the potential benefits and risks that are involved.

Statement of Consent

I give my voluntary consent to take part in this study. I will be given a copy of this consent document for my records.

______Signature of Participant Date

______Printed Name of Participant Initial above for permission to tape record interview

168 Statement of Person Obtaining Informed Consent

I have carefully explained to the person taking part in the study what he or she can expect.

I certify that when this person signs this form, to the best of my knowledge, he or she understands the purpose, procedures, potential benefits, and potential risks of participation.

I also certify that he or she:

 Speaks the language used to explain this research  Reads well enough to understand this form or, if not, this person is able to hear and understand when the form is read to him or her  Does not have any problems that could make it hard to understand what it means to take part in this research.

______Signature of Person Obtaining Consent Date

______Printed Name of Person Obtaining Consent Role in the Research Study

169 Recruiting Flyer: Research Study Opportunity

Study Title: Wellbeing and access to personally significant environments You are invited to take part in an important research study being done at Washington State University to understand how individual wellbeing is affected by access to personally significant places. You are being asked to take part because you are over age 55. Taking part in the study will take about one - two hours. If you take part in the study, you will be asked to talk about places that you find personally significant and any changes you have experienced in access to these places. The interviewer will also ask for demographic information (for example if you are between the ages of 55-64, 65-74, 75-84, or over 85) and information that indicates locations of places significant to you.

What are my rights as a research study volunteer? Your participation in this research study is completely voluntary. You may choose not to be a part of this study. There will be no penalty to you if you choose not to take part. You may choose not to answer specific questions or to stop participating at any time.

Who can I talk to if I would like to participate or have questions? If you have questions about this study, please contact Nancy Blossom, Professor & Director, Interdisciplinary Design Institute, Washington State University, Spokane, WA. 509-358-7513, [email protected] . To enroll in the study, please contact Amber Joplin, Research Assistant, 509-217- 7721, [email protected]

For more information see the attached Research Study Consent Form.

170 Recruitment Telephone Script

Hello, my name is Amber Joplin. I am a graduate student at Washington State University on the Riverpoint Campus in Spokane. Working under the supervision of faculty in the Interdisciplinary Design Institute, I am doing research on access to personally significant environments and wellbeing in aging.

This research project involves interviewing a small number individuals over the age of 55 who live or are active in the community where your organization is located.

Participants will be asked to talk about places that they find personally significant and any changes they have experienced in access to these places. The interviewer will also ask for demographic information (for example if the participant is between the ages of 55-64, 65-74, 75-84, or over 85) and information that indicates locations of significant places.

Are you aware of any seniors who would be interesting in participating in this study? What would be the best way for me to be in touch with this individual? May I send you more information on this research project?

Thank you for your assistance.

171 Chart of Measures, Sources and Conversions to Feet, Meter, Kilometer and Mile

Element Assigned buffer radius in feet Home 200 Small business, service 250 Medium commercial 500 Large commercial 750 Big box store, Mall 1000 Route 200 on both sides

Sources Feet Meter Kilometer Mile

Rowles 1983, Home Author, 2013 house buffer incl. road 200 61 .06 .04 Author, 2013 sm commercial buffer 250 76 .08 .047 Rowles 1983, Visual Field “Typical” block size 300 91 .09 .057 Author, 2013 medium commercial buffer 500 152 .15 .09 Author, 2013 large commercial buffer 750 228 .23 .14 Moudon 2006 Restaurant Walk Threshold 860 262 .26 .16 Author, 2013 big box commercial 1000 305 .3 .19 Boruff 2012,Typical 5 min walk 1320 402 .4 .25 Moudon 2006 Grocery Walk Distance Threshold 1445 440 .44 .27 Moudon 2006 Recommended near measure 1500 457 .46 .28 Moudon2006 attractors and deterrents to walking 1758 531 .53 .33 Rowles Vicinity 2640 805 .8 .5 Boruff, Moudon Maximum Recommended measure 3281 1000 1 .62 Boruff, 2012 Typical 20 min walk 5280 1609 1.6 1 Rowles Community 10560 3219 3.22 2 Rowles Sub-Region 40 25 Rowles Region 402 250 Rowles Nation

172 Database Example

173 GIS Data Sources

Traffic:

Spokane County http://maps.spokanecounty.org/?maptype=roads

Spokane County Traffic Count Interactive Mapping http://www.wsdot.wa.gov/mapsdata/geodatacatalog/Maps/noscale/DOT_TDO/TrafficPlanning Trends/2011_TPTTrafficSections.htm

Citation Information:

Originator: WSDOT Statewide Travel and Collision Data Office Publication Date: 201205 Title: TPT Traffic Sections 2011, WSDOT- Statewide Travel and Collision Data Office (STCDO) Geospatial Data Presentation Form: vector digital data Other Citation Details: The dataset contains estimated AADT that relates to 2011.

Abstract: A data set to provide 2011 estimated Annual Average Daily Traffic volumes along the state highway system. Data represents all directions of travel for the given roadway segment.

Land Cover NALC06

North American Landscape Characterization (NALC) Project/Campaign Document http://edc2.usgs.gov/pathfinder/nalc_proj_camp.php

Summary: The North American Landscape Characterization (NALC) project is a component of the National Aeronautics and Space Administration (NASA) Landsat Pathfinder Program. Pathfinder projects focus on the investigation of global change while utilizing remote sensing technologies. The NALC project is a cooperative effort between the U.S. Environmental Protection Agency (EPA), the U.S. Geological Survey (USGS), and NASA to make Landsat data available to the widest possible user community for scientific research and general public interest.

Sidewalk data:

JARC Pedestrian Network

Washington State University GIS and Simulation Laboratory

Interdisciplinary Design Institute, Spokane, Washington

174

Interview Form: Participant #

This research study is being done to understand how wellbeing is affected by access to personally significant places over time. I will ask you about places where you may spend time, how you access these places, and if you have had any changes or challenges in getting to locations that are important to you. I am interested in the importance to you of accessing these places, and how you are affected by being able to be in these specific places.

These questions refer to your life-space and activities during the last four weeks. The questions are basically: Where do you go? How do you get there? How important is it for you to go to this place? Do you have difficulty going to this place sometimes? We can talk about these questions in any order. During the past four weeks have How often How did you travel there? Did you use aids Was this something you How does it affect your Were there times you wanted to go you … did you get or equipment? Did you need help from had to do, or wanted to life to go here? but were restricted in some way? there? another person? do? [desire] Mode Equipment Person Discretionary Obligatory Positive Negative Number Reason Gone to a general goods store, grocery store, or pharmacy Visited a café, bar, casino, senior center, library, school, gallery, theater, sporting event Been in a place where you could 175 spend time with family or friends Were visited by service providers, i.e. snow shoveled, meals, assistance Visited a service provider i.e. beautician, massage therapist, barber, dry cleaner, car repair Visited a doctor, dentist, therapist optometrist, chiropractor or hospital Participated in an activity such as walking, dancing, swimming, golf, bowling, etc. Gone somewhere to work, assist,, volunteer, teach, speak, play music, give a ride, etc.. Spent time in – or had a good view of - an aesthetically satisfying place, park, green space, garden Went to a chapel, meditation space, or other place that is important to you spiritually

Participant #

These questions refer to your life-space and how it affects your activities. Please rate the following home and neighborhood elements as satisfactory, mostly satisfactory, mostly unsatisfactory, or unsatisfactory. [Perception] Satisfactory Mostly Mostly Unsatisfactory Comments: perception, desire, fear, concern, spirituality. Satisfactory unsatisfactory Housing Neighborhood Roads (including traffic, safe crossings, noise) Sidewalks (including slope, accessibility, and condition) Bus service Safety Access to shops and services 176 Access to parks and nature

These questions refer to your general health and sense of wellbeing. Please tell me if you agree strongly, agree somewhat, disagree somewhat, or disagree strongly with the following statements Agree Agree Disagree Disagree Comments strongly somewhat somewhat strongly I am doing well for my age I have satisfactory overall health I have good emotional health I consider myself to have a disability I have adequate income or resources for my current needs What is your age range 55-64 65-74 75-84 85-94 95+

Participant #

We have talked about many places. Are there any that you have particularly strong feelings about? Can you tell me more about them? perception, desire, fear, How often did How did you travel there? Did you use Was this something you How does it affect Were there times you wanted to go concern, and spirituality. you get there? aids or equipment? Did you need help had to do, or wanted to do? your life to go but were restricted in some way? from another person? [desire] here? Name and closest intersection Number Mode Equipment Person Discretionary Obligatory Positive Negative Number Reason

Are there any places that you no longer are able to go to that you have strong feelings about? Can you tell me more about them? perception, desire, fear, How often would How would you travel there? Would you Is this something you How does it affect Why are you no longer able to get to concern, and spirituality. you like to go? use aids or equipment? Will you need have to do, or want to your life not to go this place? 177 help from another person? do? [desire] here?

Name and closest intersection Number Mode Equipment Person Discretionary Obligatory Positive Negative Reason

Comparison of Terms from All Models

CONTEXT MODELS VALUES P-E FIT HEALTH & DISABILITY SUSTAINABILITY SYSTEMS CPM = Competence- SDH-WHO = Social HEM = Human press determinants of health; Ecosystem CCS = Criteria for Modal PEDO = P-E HEMS = Human ecology SMA = Six Major HOP = Hierarchy of Purpose, Corporate Sustainability; Patterns for processes model of a settlement; DSM = Systems of the HEM = Human Ecology, SDA = Sustainable Treatment of Developmental System model DOH; N-DP Anthroposphere IEM = Interior Ecosystem Development: A systems the Aged outcomes = Nagi; V-DP = Verbrugge HEI FPS= Fundamental approach SPOT – Social- = Health environmental Properties of Systems physical places integration. over time Ultimate Ends (HOP); Human Environed Unit Self- Individuals (HEM)

(HEM); Human Organism actualization Existence (FPS) (IEM)

178 Quality of Life (HEMS) Well- Well-being, Transcendence Spirituality, Well-being being (DSM) (HOP) (Implicit) (HEM) User- transcendence (PEDO) (Implicit: human–centered: centered (IEM) SDH-WHO) Identity: Age, gender People (HEMS) Age, sex & Enlightenment, Self- Wisdom, ego- (HEM) Identity (PEDO) hereditary factors (SDH- realization, Identity (HOP) integrity Individual development WHO) (SMA) Human Behavioral Environment Behavioral Aspatial (HEMS) Adaptability (FPS) Environment Cultural Resources: Arts, Fulfillment, Self-respect Affect (CPM) craft, myth, belief, faith (HOP); Psychological: Continuity / Mind (HEI); Psychosocial Psychology (HEM) Sentiments, Aesthetics (Hem) Meaning attributes & Coping (V-DP) Psychological needs (IEM) (SPOT) (FPS) Happiness (HOP) Participation (Positive affect)

Individual Lifestyle factors Intermediate Ends Institutional (HEM) (SDH-WHO); Lifestyle / Societal case (CCS) behavioral choice (HEMS) (V- Social system (SMA) Behavior (CPM Social DP); Individual Response: - P) Press socio-behavioral (IEM) integration, Behavior, Social Environment (CBM – E) “normalization (DSM;) Body, Functional Relatedness ” Limitation (HEI) (N-DP); (SPOT) Family (HEM) Human capital (HOP) Social: Psychosocial attributes & Identity: class, caste, Family, Friends, Colleagues, coping, Activity Socio-effectiveness (CCS) clan, status (HEM) Schoolmates (HEM) accommodations (V-DP) Coexistence (FPS)

Justice, governance, Political Autonomy power (HEM) (equality, socio-political (IEM) (PEDO) (SPOT) Freedom of action (FPS) freedom, Government system happiness) Social & community networks (SMA) 179 (SDH-WHO) (HEMS) Social Comfort (CPM - Environment (V-DP) P) Leisure (HEM) Leisure (HOP) Simulation / Effectiveness (FPS) Activation (SPOT) Health & Function, Genetic Endowment, Disease, Health, physiological Competence Individual Response: Biology Health (HOP) (CBM – P) (DSM); (HEM) Biophysical (HEM), (IEM) Engaged (SPOT) Disease/Condition, Etiology, Safety (SPOT) Pathology, Manifestations, Impairment, (HEI) (V-DP)(N- DP) Human Created Environment General socio-economic and Socioeconomic (HOP) Social capital (HOP) cultural environment (SDH- Resources Harmony (HOP); Socio- WHO); Governance (HEMS) Population, cultural: Social Norms, organizations, Press (CPM – E, Cultural beliefs, values & Values(HEM) commerce(HEM) PxE) norms (HEMS) Participation Economic System (SMA)

restriction, Society (HEI)

Communication (HOP) Knowledge (HOP) Familiarity Information, education, Education (SDH-WHO) Socio-biological (HEM) (SPOT) knowledge (HEM) Ecological equity (CCS) Community (HOP), (HEM) Safety (SPOT) Community (HEMS) Growth management Neighborhood (HEM) (SDA) Wealth (HOP) Prosperity (DMS) Wealth (HEM) Transportation (SDA) Living conditions (SDH-WHO) Mobility (HOP) Physical Environment (DSM) Adapted spaces and channels, Consumer Goods (HOP) Activity systems and Socio-physical: Food, movement, Place, Spatial Clothing,(HEM) Comfort (CPM - (HEMS) Activity limitation P) Participation restriction, Housing (SDA) Built Environment Press (CPM - E) Physical (HEI) Medications, Shelter (HEM)

180 (IEM) Shelter(HEM) Built environment (V-DP) Disability (N-DP)

General environmental Territory (HEM) conditions (SDH-WHO); Local Business case (CCS) Intermediate Means (HOP) Social Services Social Press (CPM - E) economy, Economic Infrastructure System (SMA) conscience, operations and markets liberalism (HEMS) Education, government Built capital: Tools, Welfare State (SDA) Production Facilities (ameliorates Institutions (HEMS) Processed Raw worst abuses

Materials(HOP); site of economic Working conditions (SDH- integration system) WHO) Technological Technology (HEM) energy system conditions (HEMS)

building materials (HEM) Eco-efficiency (CCS)

business/industry, Agriculture & Food agriculture, Sustenance, defense (HEM)

production (SDH-WHO) telecommunication, waste management (SDA)

Health care services (SDH- Socio-efficiency (CCS) Human capital: Labor (HOP) WHO) (DSM); Medical care Recycling & Composting Performance (socio-biological & socio- & Rehabilitation, External Labor (HEM) (CPM - P) health care (SDA) cultural) (HEM) design (IEM) supports (V-DP) Unemployment (SDH-WHO) Biophysical Resources, Ultimate Means (HOP) General environmental Environmental (HEM) Natural Environment (HEM) Rejection Press (CPM - E) conditions (SDH-WHO) Natural Case (CCS) Environment &Resource (IEM) Global ecology and environmental capital (HEMS) System (SMA) Natural Capital, Earth Physical Environment (V-DP)

181 Materials, Biosphere, Repression, Energy, Materials, Water Biochemical Cycles avoidance (SDA) Solar Energy (HOP); Other Economic Energy, air & water, Natural Resources, Land, values land, flora & fauna,

Energy Climactic Zone (HEM;) (uncorrected Water, sanitation (SDH-WHO) nutrients, materials Sufficiency (CCS) Resources (+availability), abuses of Biosphere (HEMS) (HEM) Conservation (SDA) Plants, Air, Water capitalism) Eco-effectiveness (CCS) Daylight, Energy, Climate No services (IEM)