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Introduction: What Is Aging-In-Place

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Introduction: What Is Aging-In-Place Department of Environmental Studies DISSERTATION COMMITTEE PAGE The undersigned have examined the dissertation entitled: Aging in Place in Suburbia: A Qualitative Study of Older Women Presented by Marian L. G. Knapp candidate for the degree of Doctor of Philosophy and hereby certify that it is accepted*. Committee chair name Dr. Heidi Watts Title/Affiliation Antioch University New England Committee member name Dr. Alesia Maltz Title/Affiliation Antioch University New England Committee member name Dr. Barbara Vinick Title/Affiliation Boston University Defense Date June 16, 2008 Date Approved by all committee members: June 16, 2008 Date Submitted to the Registrar‘s Office: January 26, 2009 Signatures are on file with the Registrar‘s Office at Antioch University New England. AGING IN PLACE IN SUBURBIA: A QUALITATIVE STUDY OF OLDER WOMEN By Marian Leah Gilbert Knapp A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy Environmental Studies at Antioch University New England (2009) Copyright by Marian L. G. Knapp 2009 All Rights Reserved i DEDICATION I come from a line of long-lived people. My parents Anne and Louis Gilbert, my aunt Lena Bobrow, and my uncle Edward Goldberg all lived into their 80‘s and 90‘s. My aunt Sylvia Goldberg is 90. She represents the best of what it means to ―age in place‖ well. This dissertation is dedicated to all of these proud, independent elders with profound admiration and love. ii ACKNOWLEDGEMENTS I give deep thanks to my dedicated committee members K. Heidi Watts, Alesia Maltz, and Barbara Vinick for their patience and wisdom, and for kindly reading and commenting on numerous drafts of the dissertation. I acknowledge and respect the 20 gracious women who participated in this study and who gave generously of their time and thoughts. They have made a significant contribution to understanding the experience of ―aging in place‖. They have enriched my life and have my greatest appreciation for their interest, and curiosity about my work on this project. This research would not have been possible without the support of Newton Senior Center staff, Jayne Colino and Joanne Fisher, and the director of Discovering What‘s Next, Carol Greenfield. Special family members and friends have made the journey possible through their encouragement and gentle prodding. I am grateful to my sister Paula Gilbert, brother Arthur Gilbert, Judy Gilbert and Bill Sutherland, cousins Sonia Joseph and Irwin Selikson, and friends Valeria Lowe Barehmi, Lois Bienstock, Fredda Chauvette, ―The Debs‖, Bea Franklin, Vivien Goldman, Martha Kurz, Annette Needle, Phyllis Paster, Linda Roemer, Miriam and Alan Sack, Eileen Shaevel, and Azzie Young. Luanne Johnson is the consummate friend and colleague, and Melissa Laser‘s depth of character is an inspiration to me. Finally, I acknowledge and thank my sons and daughters-in-law Philip Knapp, Vicki Jackson Knapp, Daniel Knapp, and Mari Hirono Knapp for their enduring support, their patience, and their excitement in celebrating this achievement with me, and I cherish my grandchildren Hannah and Samuel for the joy they bestow on me. iii ABSTRACT AGING IN PLACE IN SUBURBIA: A QUALITATIVE STUDY OF OLDER WOMEN Marian Leah Gilbert Knapp Antioch University New England, 2009 This research explored ―aging in place‖ among women age 65 and older living in Newton, Massachusetts. Study goals were to understand: the ―places‖ that comprise the environment of ―aging in place‖; the factors that enable ―aging in place‖; ―aging in place‖ in a suburb; and to refine definitions of ―aging in place.‖ Interviews with women used open-ended questions about women‘s early years in Newton and the changes they experienced in personal status, and places over time. Themes emerged using modified grounded theory with inductive and deductive approaches, and which acknowledged ―sensitizing concepts‖. Six places comprised the ―aging in place‖ environment: home, nature, neighborhood, Newton community, city, and the world. Each place had three dimensions: physical, social, and emotional. Factors enabling ―aging in place‖ involved two categories: 1) characteristics of places, which included physical suitability, safety, and service availability, and 2) characteristics of women, which included resilience, economic stability, social connections, access to supports, independence, respectful relationships with children, pride in accomplishments, meaning in one‘s life, and sense of belonging. Women and their families moved to Newton to pursue upward mobility and other aspects of the American Dream. These goals were embedded in women‘s world-view and they were iv reluctant to relinquish suburban living in spite of barriers such as stairs in the home, loss of neighborhood friendships, and lack of driving. They adapted themselves and their surroundings in order to stay. ‖Aging in place‖ definitions suggest passivity and stasis, and imply reluctance to move resistance to change, and that the alternative is a nursing facility. My findings suggest a different view. Women age in multiple places, reside in old or new residences, live for extended periods before decline inhibits activities, receive support in different places, are socially connected, are willing to change, and find alternatives to nursing homes. Findings can be used to encourage individuals, families, and providers to consider the complexity of ―aging in place‖ and the total environment of elders as they plan for the future. Conversations about ―aging in place‖ must challenge the implication that ―aging in place‖ is negative and static, and emphasize its positive, dynamic qualities. v TABLE OF CONTENTS DEDICATION……………………………………………………………………………….....i ACKNOWLEDGEMENTS…………………………………………………………………….ii ABSTRACT……………………………………………………………………………….........iii APPENDICES …………………………………………………………………………………viii TABLES………………………………………………………………………………………..ix CHARTS……………………………………………………………………………………….x FIGURES………………………………………………………………………………………xi CHAPTER ONE……………………..…………………………………………………………1 Introduction…………………………………………………………………………………2 Goals………………………………………………………………………………………...3 Overview of the study………………………………………………………………………7 CHAPTER TWO: CURRENT KNOWLEDGE..........................................................................8 Demographics of the Aging Population…............................................................................. 9 Literature Review……..………………………………………………………….................14 Aging and Stereotypes…………………………………………………………………..15 Aging Process…………………………………………………………………………...19 Aspects of Place…………………………………………………………………………23 Place……………………………………………………………………………………..23 Place and Older Adults………………………………………………………….24 In-place/Out of Place…………………………………………………………...26 ―Aging in Place‖………………………………………………………………...27 Summary……………………………………………………………………..……………..28 vi CHAPTER THREE: CITIES AND SUBURBS…………………………………………….30 History……………………………………………………………………………………...30 Boston………………………………………………………………………………………36 Newton……………………………………………………………………………………..39 Newton Population Age 65 and Over……………………………………………..…....45 Summary……………………………………………………………………………………46 CHAPTER FOUR: METHODS..................................................................................................48 Introduction………………………………………………………………………………...48 Study Site…………………………………………………………………………………..48 Recruitment Venues and Process..………………………………………………………….49 Sample Characteristics………………………………………………………………….51 Limitations of the Sample………………………………………………………………57 Theoretical Approach……………………………………………………………………….59 Interview Process ……………………………………………………………………….60 Interview Content……………………………………………………………………….61 Analysis…………………………………………………………………………………62 Summary………………………………………………………………………………...63 CHAPTER FIVE: FINDINGS………………………………………………………………....65 Introduction………………………………………………………………………………....65 The Early Years …………………………………………………………………………….65 Coming to Newton……………………………………………………………………...65 Selecting Newton……………………………………………………………………….68 Finding a House………………………………………………………………………...70 vii Places of Suburban Life………………………………………………………………....70 Summary………………………………………………………………………………...82 Changes in Places Over Time………………………………………………………..………83 Summary………………………………………………………………………………...91 Places in the Future………………………………………………………………………….91 Summary of Findings………………………………………………………………………..99 CHAPTER SIX: DISCUSSION………………………………………......................................103 Aging and Stereotypes……………………………………………....……………….……..103 Aging and Places…….……………..……………………………………………………….106 CHAPTER SEVEN: CONCLUSIONS……………………………………………..…………113 Enabling ―Aging in Place‖…………………………………………………………….........113 Characteristics of Places………………………………………………………………..113 Characteristics of Women………………………………………………………………117 Summary…..………………..…………………………………………………………..126 Aging in Place in Suburbia…………………………………………………………………127 Aging in Place: New Concepts and Definitions……………………………………………129 Summary…………………………………………………………………………………....134 CHAPTER EIGHT: IMPLICATIONS AND FUTURE RESEARCH……………..………….138 Implications: Individuals, Families and Community Agencies………………….…….......138 Future Research…………………………………………………………………………….141 Conclusion………………………………………………………………………………….144 CHAPTER NINE: LITERATURE CITED……………………………………………………147 viii APPENDICES A. Participant Recruitment Protocol…………………………………………………...161 B. Research Summary Guide…………………………………………………….........163 C. Study Overview for Participants……………………………………………………165 D. Participant Criteria………………………………………………………………….166 E. IRB Approval…………………………………………………………………... ….167 F. Volunteer Consent Form……………………………………....................................168
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