AN ABSTRACT OF THE DISSERTATION OF Megan Lee for the degree of Doctor of Philosophy in Design and Human Environment presented on November 12, 2008. Title: Aging in Place: A Contemporary Social Phenomenon Abstract approved: Carmen D. Steggell Most aging individuals prefer to remain in a self-determined home environment, and generally aging adults want to remain in the same home or same community. The benefits of remaining in a self-determined private home environment while aging have been established. Because individuals present a diversity of needs, it takes interdisciplinary and multifaceted approaches with options to keep older adults in their communities. Aging in place (AIP) represents an interdisciplinary approach to creating options that facilitate remaining in a self-determine environment. The purpose of this research was to examine the current state of the interdisciplinary concept aging in place (AIP). The need to understand AIP is more globally relevant as the U.S. becomes an aging society facing rapid change due to technology, globalization, and mobility. Guided by the tenants of theory development, and the ecological model of housing choice, two manuscripts were developed focusing on the current state of AIP. The first research study titled, An Evolutionary Concept Analysis: Aging in Place, used the content analysis method to examine the concept across diverse disciplines. A derived definition was developed that includes research, practice, policy, and those individuals involved in the aging process. The definition reflects the contemporary state of AIP and can be used for theory development and to unify all users of the AIP concept. The second research study titled, The Current State of Older Women Aging in Place in Oregon, used qualitative case study methods to examine seven cases of aging in place. The aim of the project was to examine seven women’s current and past experiences, and the dynamic process of aging in place in a self-determined private home environment. Two common themes were identified (1) The AIP reflects the woman’s process of self-preserving actions that maintain current AIP independence, and (2) AIP situational independence suggests that the participants’ pathways to their current AIP began after they each experienced an individualized trigger event. The findings have theoretical and practice implications that provide a comprehensive and interdisciplinary approach to identifying the current status of AIP and the development of options that facilitate the AIP process. ©Copyright by Megan Lee November 12, 2008 All Rights Reserved Aging in Place: A Contemporary Social Phenomenon by Megan Lee A DISSERTATION submitted to Oregon State University in partial fulfillment of the requirements for the degree of Doctor of Philosophy Presented November 12, 2008 Commencement June 2009 Doctor of Philosophy dissertation for Megan Lee Presented on November 12, 2008 APPROVED: Major Professor, representing Design and Human Environment Chair of the Department of Design and Human Environment Dean of the Graduate School I understand that my dissertation will become part of the permanent collection of Oregon State University libraries. My signature below authorizes release of my dissertation to any reader upon request. Megan Lee, Author ACKNOWLEDGEMENTS Thank you to Dr. Carmen Steggell for your years of mentorship. The journey through the program and dissertation was made possible with your unwavering support. Thank you to Dr. Atiya Mahmood for your generous mentorship over the years and exposure to the environment-behavior paradigm that has greatly influenced the dissertation. Thank you to Dr. Mark Edwards who has been an instrumental source of support and exposure to the sociological paradigm that has greatly influenced the dissertation. Professor Carol Caughey was instrumental in influencing my decision to attend graduate school at Oregon State University. I will always be grateful for the crossing of our paths . Thank you to Dr. Chris Ward for your generous service on my committee as the graduate representative. To my family for your unwavering love and support throughout this journey. CONTRIBUTION OF AUTHORS Dr. Carmen Steggell assisted with the instrumental development and completion of both manuscripts seen in Chapter Two and Chapter Three. TABLE OF CONTENTS Page CHAPTER ONE - Aging in Place: A Contemporary Social Phenomenon …...…… 1 Introduction ………………………………………………………………. 1 Overall Statement of Problem ……………………………………………. 2 Theoretical Development …………………………………………………. 3 Concept Development for Future Theory Development…………. 4 What is theory? ................................................................... 4 Theoretical Framework …………………………………………… 5 Definition of Terms ………………………………………………. 6 Two Aging in Place Related Manuscript…………………………………. 8 Manuscript One (Chapter Two) – An Evolutionary Concept Analysis: Aging in Place …………………………………………..…………. 8 Purpose of Study …………………………………………………… 8 Rationale for Journal Selection ……………………………………. 8 Relationship to Overall Purpose …………………………………… 9 Brief Description of Method ………………………………………. 10 Manuscript Two (Chapter Three) – The Current State of Older Women Aging in Place in Oregon……………………………………………………… 11 Purpose of Study …………………………………………………… 11 Rationale for Journal Selection …………………………………….. 11 Relationship to Overall Purpose ……………………………………. 12 Brief Description of Method ……………………………………….. 12 Research questions ………………………………………….. 12 Sample ………………………………………………………………. 13 Primary case study participants ……………………………… 13 Supportive case study participants …………………………… 13 Data collection ……………………………………………….. 13 Data Analysis ………………………………………………………… 13 TABLE OF CONTENTS (Continued) Page Narrative analysis …………………………………………... 14 Summary …………………………………………………………………… 14 MANUSCRIPT ONE (CHAPTER TWO) – An Evolutionary Concept Analysis: Aging in Place ………………………………………………………………. 16 Abstract ……………………………………………………………………. 17 Introduction ………………………………………………………………… 18 Background …………………………………………………………………. 19 The Use of Aging in Place ………………………………………….. 19 AIP as an Interdisciplinary Concept ………………………………… 22 Theoretical Challenges in Aging in Place Research ………………... 24 Conceptual Framework …………………………………………….. 26 Method ……………………………………………………………………… 28 Procedure …………………………………………………………… 28 Evolutionary Method Activity #1: Identification of Concept………… 29 Evolutionary Method Activity #2: Selection of Setting and Sample… 29 Sample ……………………………………………………… 29 Criteria for inclusion and exclusion of resources …………... 30 Databases Described ………………………………………………… 31 Academic Search Premier …………………………………... 31 AgeLine ……………………………………………………... 32 Google Scholar ……………………………………………… 32 CSA Sociological Abstracts …………………………………. 33 Evolutionary Method Activity #3 and #4: Data Collection …………. 34 Definitions …………………………………………………… 34 Antecedents ………………………………………………….. 34 Consequences ………………………………………………… 35 Surrogate terms ………………………………………………. 35 Related concepts ………………………………………………35 TABLE OF CONTENTS (Continued) Page Evolutionary Method Activity #5: Data Analysis Using Content Analysis ………………………………………………….. 35 Data analysis of definitions ………………………………. 35 Data analysis of attributes ……………………………….... 36 Data analysis of antecedents and consequences ………… 36 Data analysis of surrogate terms, related concepts ……… 36 Evolutionary Method Activity #6: Conduct Interdisciplinary or Temporal Comparison, If Needed ………………………. 36 Discipline or field of origin ……………………………… 36 Evolutionary Method Activity #7: Identify a Model Case if Appropriate ……………………………………………. 37 Evolutionary Method Activity #8: Identify Implications for Future Development ……………………………………………… 37 Data analysis and implications of results ………………… 37 Internal validity as inter-rater reliability …………………. 37 Results ……………………………………………………………………. 38 Definition of Terms ………………………………………………. 38 Sample Description ………………………………………………. 38 Year of resource publication ……………………………… 38 An international interest, eight countries in sample …….... 38 Type of housing or innovation …………………………… 39 Types of resources, scholarly or non-scholarly ………….. 40 Discipline or trade of author(s) ………………………….. 40 Unidentified disciplines or trades of author(s) …………... 41 Definition of Aging in Place ……………………………………………… 41 Aging in Place Defined Explicitly ……………………………….. 42 The Defining Characteristics of the Explicit Definitions ………… 42 Aging in Place Defined Implicitly ……………………………….. 44 Summary of AIP Definition ……………………………………… 44 Operational Definition of Aging in Place ………………………... 44 Is AIP a Concept, Phenomenon, Philosophy, or Trend? ………… 46 Attributes …………………………………………………………………. 47 A Paradigm Shift Toward an Evolving Social Phenomenon of Aging in Place …………………………………………… 47 Demographic changes and pressure …………………….. 48 TABLE OF CONTENTS (Continued) Page Waves of AIP thought …………………………………… 48 Early wave of AIP thought ………………………………. 48 Current wave of AIP thought …………………………….. 49 Future wave of AIP thought ……………………………… 51 Summary of Paradigm Shift Towards an Evolving Social Phenomenon of AIP …………………………………….. 52 Balance of Innovative Parts Support AIP ………………………………… 52 Top Down Innovative Actions and Options ……………………… 53 AIP related policy ………………………………………… 54 Programs, Services, and Products ………………………………… 56 Services …………………………………………………… 56 Services to programs ……………………………………… 57 Products …………………………………………………… 58 Summary of Top Down Innovations, Actions, and Options ……… 59 Collaboration of Multiple AIP Contributors …………………….. 60 Twelve categories of diverse disciplines and/or trades in sample