Providing the first UK assessment of environmental gerontology, this book enriches current understanding of the spatiality of ageing.
Sheila Peace considers how places and spaces contextualise personal experience in varied environments, from urban and rural to general and specialised housing. Situating extensive research within multidisciplinary thinking, and incorporating policy and practice, this book assesses how personal health and wellbeing affect different experiences of environment. It also considers the value of intergenerational and age-related living, the meaning of home and global to local concerns for population ageing.
Drawing on international comparisons, this book offers a valuable resource for new research and important lessons for the future.
The housing problems of older people in our society are highly topical because of the growing number of retired people in the population and, especially, the yet-to-come increasing number of ‘very old’ people. Government policies on the care of older people have been forthcoming from Whitehall, but the issue of housing is just beginning to be seriously addressed.
This book represents a first attempt at bringing together people from the worlds of architecture, social science and housing studies to look at the future of living environments for an ageing society. Projecting thinking into the future, it asks critical questions and attempts to provide some of the answers. It uniquely moves beyond the issues of accommodation and care to look at the wider picture of how housing can reflect the social inclusion of people as they age.
Inclusive housing in an ageing society will appeal to a wide audience - housing, health and social care workers including: housing officers, architects, planners and designers, community regeneration workers, care managers, social workers and social care assistants, registered managers and housing providers, health improvement staff and, of course, current and future generations of older people.
When considering the journey made across different environments of ageing, and the wealth of literature covered, there are many paths and views that could have been taken. The aim of this chapter is to foreground contextual issues central to environmental gerontology. The spatiality of ageing started with a global perspective even if knowledge of person–environment (P–E) interaction is commonly local and national. Here a relational approach is taken to these spatial levels, looking at flows captured at different times through people and place. It returns to global concerns to reassess local and national impact that affects social exclusion and inclusion in later life, a part of the iterative theme of environmental living and the concept of home. In seeking a circularity of ideas with global to local, local to global influence relationality is used as a way to understand environments of ageing.
In Chapter 3, a discussion of global concerns focused on the big issues that are part of this challenging time. Thinking relating to global health focuses not only on definitions of active ageing and the ability of individuals to take personal responsibility for diet, exercise, activity and participation, but also the parallel incidence of long-term chronic ill health and end of life. Such experience varies within and between developed and developing countries where inequalities of personal and social health are related. When writing in October 2021, health for all ages is a chief concern as the COVID-19 pandemic has taken hold globally.
… by 2050, one in six people in the world will be over age 65 (16%), up from one in 11 in 2019 (9%). By 2050, one in four persons living in Europe and Northern America could be aged 65 or over. In 2018, for the first time in history, persons aged 65 or above outnumbered children under five years of age globally. The number of persons aged 80 years or over is projected to triple, from 143 million in 2019 to 426 million in 2050. (UN, 2020)
In the preface to this book, it was noted that a key objective was to address environments of ageing at different levels of spatial scale (Figure 0.1). This chapter focuses on the global context. As this quote from the United Nations (UN) shows, population ageing continues to advance, occurring during a period of dynamic change when globalisation is producing time–space compression through technological development, and when global capitalism is resulting in consumerism becoming more universal (Sassen, 2004; Jones et al, 2008). The interface between major transformations in global health, demography and household composition is changing during a time of parallel challenges regarding urbanisation, migration, climate change, the built environment and technological development. Neo-liberalism has become the dominant political force, leading environments to become more or less inclusive for different cohorts, generations and groups (Walker, 2005; Phillips and Feng, 2018; IMF, 2020a, 2020b). The issues addressed here are historic and ongoing, with authors such as Phillipson (2003, 2007a, 2007b) alerting us to their breadth, diversity and impact on the ageing individual (see Figure 3.1).
While different dimensions of environment – physical, social, cultural, political – can be considered separately, together they form the environmental context of place that is central to an ecological perspective. Throughout their lives, people live in dynamic interaction with this context, developing psychological understanding of it (Wahl and Lang, 2004; Keating et al, 2013), a view referred to here as ‘environmental living’. Environmental living in later life is the focus of the following five chapters. We move to national (meso-) and local (micro-) scales of reference, using the UK and England as an example, in which locations, settings and situations can be examined. As these scenarios are central to research undertaken by the author and colleagues over the past decades, Chapter 6 forms a bridge to empirical research connecting issues relating to intergenerational and age-related environments. The concept of ‘home’ alongside associated issues of ‘homeland’ is pivotal in this discussion; it is introduced here and is a running theme throughout.
The word ‘home’ has diverse cultural definitions and is at the heart of a breadth of literature. For many it is a locational term, which is focused on specific housing yet often has a broader base regarding neighbourhood, community, city and nation – connecting with the concept of homeland. This extended definition includes layers of attachment that help to define a person’s identity within a particular place. Space and place merge in a meaning of home that is associated with the personal through positive concepts of belonging, security, familiarity and privacy, while sometimes guarding negative concerns regarding gendered domestic activity, non-decent housing, isolation, loneliness and a life of fear or abuse (Peace, 2015).
More than 90 per cent of older people in the UK live in general needs housing, forming the major component when discussing environments of ageing. Table 5.1 outlines the range of housing forms in later life. Approximately 5–6 per cent of the older population live in age-related communal housing, discussed in Chapter 7 along with co-housing, intentional housing that can be intergenerational or age-related. Additionally, 4–5 per cent live in care homes (residential and nursing care), which includes 15 per cent of the population aged 85 and over (Laing, 2018) and forms the focus of Chapter 8 (comparable typologies are seen in the Housing our Ageing Population: Panel for Innovation (HAPPI) report, written by Barac and Park, 2009, p 2 (see Glossary) and Park and Porteus, 2018, p 131).
This chapter focuses on mainstream housing, where housing type, tenure, standards and markets embed individual housing histories. It begins with a reflection on housing development during the 20th century to contextualise environments of ageing identified through the English Housing Survey. Then it moves to the built environment and housing policy, reflecting on how building regulations affect housing design. Issues regarding inclusive design and how dwellings seen as non-ableing could be retrofitted or adapted are discussed alongside the growing development of assistive technology. The chapter ends with further reflections on housing as home, the impact of receiving care in current housing and how older people are becoming involved in co-designing future housing. This sets the scene for the empirical research that is featured in Chapter 6, where general housing is considered with regard to the meaning of home.
When asked if they might move after retiring from paid employment, and whether this might be to special housing geared towards older people, many research respondents will say they haven’t really thought about it and wish to stay in their own home for ‘as long as possible’. This is despite the fact that their stories show they have thought about it even if it has not been widely discussed, and some have been used to moving throughout their lives (Holland, 2001; Wiles, 2005b; Peace et al, 2006). Attachment to place involves the coming together of levels of environmental understanding, and it has been noted ‘that individual experience of place is layered and that knowledge of personal biography and experience in time and space leads to greater clarification of the complexity of person–environment interaction’ (Peace et al, 2011, p 754).
Here, vignettes from anonymised and real name participants who wished to be named in research are introduced and they have all given consent for their stories to be told. They have been drawn from three British research studies that consider the detail of environment and ageing. The concept of ‘option recognition’, which captures the extent of environmental impact on decision making in later life, is then introduced. Consideration is given to how this theoretical development relates to research within other developed countries, especially the ENABLE-AGE researchers who similarly take into account the normality of environmental continuity and change in very old age. To conclude, the lens of general housing is used to reflect on the meaning of home.
Motivation, agency and choice are key when people make decisions about changing where they live. The concept of option recognition was introduced as a forerunner to this decision, for some being part of rightsizing their accommodation or changing their location, for others a consequence or concern for their health and well-being; the reasons are entangled. As already acknowledged, older people’s housing is part of the public debate about intergenerational relations, the lack of family housing and financial transfers. Independent Age (2016) report that talking to the family about housing, care and end of life are some of the most difficult conversations older people may have that may encourage change. This chapter focuses on alternative environments of housing and care that for some are the outcome of that change.
While discussions may range from good ideas to recognising insufficient knowledge about alternatives, the ability or motivation to move may never be considered by those who decide to stay put. Living with others who are non-family members in a form of communal living is experienced by many across their lives, yet they may not make the comparison with arrangements in later life. Heywood et al, (2002, p 118) comment on collective living in student halls of residence, shared residences in early adulthood, assisted living in later life and (in advanced old age) the experience of residential care and nursing homes. Nevertheless, to date a relatively small percentage of people aged 65 and over in the UK make a change to age-related housing (with care).
Chapter 8 begins by returning to the case study of Jo. You may be wondering what happened next. Eventually, Jo became a little more vulnerable, developed a form of pneumonia and had to be admitted to an acute hospital for a week, followed by three weeks within a community rehabilitation hospital. Members of her family visited almost every day, and in rehab she regained her mobility through daily exercises with a physiotherapist. Eventually, through her insistence, she returned to her home in retirement housing; to the flat she knew well, and with 24-hour care, provided through a combination of daily home carers and her daughters who covered the nights, she lived out the last six weeks of her life before dying in her own home. Her daughters and formal carers felt this was the ‘peaceful death’ that in many ways she had been determined to achieve. She did not have to move to a care home.
Jo’s experience can be seen as a period of long-term care (LTC). This phrase relates to forms of health and social care, formal and informal, for people in need of medical support and personal care such as washing, dressing, meals, assistance with toileting and medication, across a range of contexts. It is defined in this way by the National Institute of Aging in the USA:
Long-term care is provided in different places by different caregivers, depending on a person’s needs. Most long-term care is provided at home by unpaid family members and friends. It can also be given in a facility such as a nursing home or in the community, for example, in an adult day care center. (National Institute of Aging, 2017)
This chapter returns to considering the ways in which environmental gerontologists address key issues. Although the earlier discussion of theoretical development in Chapter 2 did not detail a methodological approach, we are drawn here to the qualitative work of Gubrium, Rowles, Rubinstein and de Mederios, for example, who have developed ethnographic methods and phenomenological approaches that help us to understand the minute detail of everyday living in later life. Like other gerontologists in this field such as Oswald, Wahl, Chaudhury, Golant, Bernard and Burholt, the current author has experience of mixed methods research, in which in-depth perspectives can be viewed within a bigger picture. This may include innovative measurement and the triangulation of data in analysis (see Kellaher et al, 1990; Mertens and Hess-Biber, 2012).
In addition, the approach to research here has been influenced by the author’s colleagues at The Open University (OU) who have expertise in biographical studies, oral history and autobiographical writing (Johnson, 1978; Atkinson and Williams, 1990; Bornat, 1994, 2001; Holland, 2001; Bytheway, 2009, 2011). While these methods emerged through social history and sociology (Chamberlayne et al, 2000; Thompson, 2000), they underpinned the need for in-depth knowledge of personal narrative, leading in 1995 to the launch of the Centre for Ageing and Biographical Studies at the OU’s then School of Health and Social Welfare. Through bringing these traditions together, this author has continued her interest in how environmental experience, both individual and group, can be understood through environmental biography and participatory research that is grounded in place.