Ageing Population And Milieu Sociology Essay

The ageing population and urbanisation are major forces shaping the 21st century. Similar to most developed countries, the ageing of Australia’s population can be attributed to increased longevity, falls in fertility and the maturing of the baby boomer generation (PC 2008). The impact of the ageing population has often been dominated by the potential negative burden on health and social system framed by a homogenised view of what it means to be an older person (Landorf et al. 2008). However, if alternatively, as reflected by Beard (2010), ‘older people can maintain their health until the last years of life, and if they live in an environment that allows their ongoing productive engagement in society, ageing populations might instead be considered an overlooked societal resource.’

In Australia low density urban developments, a characteristic of many urban communities, are not particularly conducive as enabling environments for the ageing. The provision and access to services (for example; doctors) and amenities (for example; libraries) are lacking, which are important for maintaining productive engagement in society. This is in addition to the majority of Australians living in major cities already, and the increased transition from rural to urban living is expected to continue (ABS 2008). This historic transformation brings into focus what role the design of the urban environment may play in achieving a more positive outlook for Australia’s ageing population.

Current state of knowledge in the area

Although it can be argued that; ‘the right to a decent environment is an inalienable right’ (Lawton 1980 p.160), social change needs to be guided by an understanding of what constitutes a ‘decent’ environment alongside the implications of what this study would have in a holistic sense. Current evidence suggests that existing housing environments for older people are already providing inadequate physical environments and therefore, are having a disabling impact (McLauhlin & Mills 2008). Further to this, Stirling (2010) argues that it is not only the micro environment of housing that is deficient, but the macro environment of the urban or neighbourhood setting. Many different key factors have been proposed as possible determinants to provide equal opportunities and quality of life within urban cities for the population across all ages. While distinct in their emphasis, these generally share the common goal of addressing needs related to health (references), participation (references), and security (references).

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The interaction between an individual’s physical ability and their environment is a complex one (Lord et al. 2006). A large body of research supports the positive outcomes associated with ageing in a familiar home environment (Cutler et al. 2006, Stark 2004, Gitlin 2003), however due to the growing lack of access to the surrounding community, this agenda can have equally negative outcomes (Murphy et al. 2008).

Problems in research to date

The mission of environmental gerontology has been viewed as understanding a number of key tasks facing older adults in diverse physical and ecological settings. These include: ‘preserving as-independent-as-possible everyday life in the face of physical and mental impairments by using environmental resources outside the home environment (‘ageing in place’), initiating processes of relocation if desired or necessary, and adapting to new living environment settings (such as nursing homes or other planned housing) after relocation’ (Wahl and Lang 2003 pg 7). However, much of this work is high in conceptual aspiration but low in application in respect to its theoretical achievements (Wahl and Weisman 2003). In particular, little research has explored the link between later life and urban sustainability linking the ageing person to form a positive part of the wider environmental context. This is despite there being consistent evidence to support an association between neighbourhood factors and individual health (Parkes and Kearns 2004, Prohaska et al. 2006, Subramanian et al. 2006).

Aim and Objectives

The changing landscapes of demographics and urban environments, coupled with a lack of practical resolution of gerontology demands a study into the environments available to older people, and the role that supportive neighbourhood and urban environments can have in assisting a more positive outlook for the ageing. As a result, the purpose of this paper is to investigate these concerns, with the aim of providing a clear and comprehensive understanding of the current environmental situation and proposed practical means of improvement. This involves the following key areas:

Revisit and refocus environmental gerontology research for an urban ageing agenda;

Identify critical factors that foster and hinder ageing within an urban environment; and

Identify current and potential urban initiatives that can foster healthy ageing.

Thesis plan

This paper acknowledges the critical interplay between theory, a changing landscape, and the realities of implementation. As such, the chapters will progress from theory-based study towards the reality of the current urban environment, and how these can be realistically unified. Chapter 1 revisits the literature and debate on the person-environment relationship. It draws on conceptual and empirical literature to form a theoretical framework that establishes the place that environment and social construct have in sustaining older people. Chapter 2 begins to unravel the experience of ageing in the urban city. It presents trends in demographics ageing, globalisation and urbanisation. Consideration is given to factor that have been found to foster, as well as hinder, positive ageing in an urban environment. Chapter 3 seeks to unravel the experience of ageing in the urban city and seeks to understand the forces behind urban change in Australia. Focus is given to research and policy responses that answer appropriately to support the needs and aspirations of an ageing population.Chapter 4 will present and discuss research about the delivery of elderly friendly communities and explore the possibility of combining the agenda into sustainable urban planning policy and/or tools. This is primarily done by drawing on the policy context of Australia.

CONCEPTUAL FRAMEWORK: AGEING PERSON AND THE ENVIRONMENT

INTRODUCTION

The goal of environmental gerontology research, according to Lawton (1986), is to investigate the possible solutions for society to meet the needs of its ageing population. The relationship between the ‘ageing person’ and the ‘environment’, particularly relating to place and location, have progressed as major theme within gerontology (Kendig 2003; Wahl, Schiedt and Windley 2003; Wahl and Weisman 2003). This literature, as part of a diverse multi-disciplinary field (for recent overviews see Oswald and Rowles 2006; Peace et al. 2007), reviews largely gerontology research, that establishes the place the environment and social construct have in sustaining older people. It also reviews other themes relevant to the study, including and not limited to the concepts of; the environmental press, ageing in place, functional capacity, social rational and classification. These themes are explored, as they connect and contribute to an understanding to current policy and practice.

ENVIRONMENTAL PRESS

There is increasing evidence to suggest that the physical environment plays a critical role in determining individual quality of life outcomes (Dannenberg et al. 2003, Thomson and Petticrew 2005). As the ageing process continues and the gap between the demands of the environment and the older persons’ competence, widens, a loss of mastery over necessary environmental characteristics can result in older persons’ living limited lives in their environments or prematurely moving to supportive housing. Existing research supports the contention that a person’s behaviour in his or her environment is directly related to the design of the space, and that an optimal environment is needs to be designed to meet the specific needs and preferences of a given person (Christenson, 1990; Cutler, 2000; Kahana, 1975).

Figure 1 – Environmental- Press

Source: Lawton and Nahemow 1973 p661.

Such research is based on the well-established ecological theory (Lawton & Nahemow, 1973), which holds that behaviours are a function of the interaction of individual factors with the physical, social, psychological, and cultural dimensions of their environment. To function at the highest level possible, a person’s ability must match demands placed on it by the environment. Too little demand results in lack of stimulation, boredom, and even deconditioning, whereas too much demand can result in stress and inability to negotiate the environment. According to the docility hypothesis, an outcome of the ecological theory, the lower the level of competence, the greater the influence of the environment (Lawton and Simon 1968 – see Figure 1 above). The ideal adaptation between persons and their environments is dynamic; adjusting as levels of function change.

Gerontologists rightly rely heavily on the ecological theory in environmental research, yet used in isolation, it can lead to overemphasis on a specific population at the group level, which may lead to neglect for taking individual housing needs, and underplaying of the role of cultural norms and values in preferences and satisfaction. It may also emphasize how the environment stimulates competence and social activities, at the expense of considering how the environment fosters other desirable outcomes, such as maintaining a sense of continuity and individuality.

AGEING IN PLACE

The interaction between an individual’s physical ability and their environment is a complex one (Lord et al. 2006); a large body of research supports the positive outcomes associated with ageing in a familiar home environment (Cutler et al. 2006, Stark 2004, Gitlin 2003). ‘Ageing in place’ is concerned with understanding the process of ageing in a familiar environment; remaining in a familiar environment promotes a sense of personal autonomy and control (Landorf et al. 2008). This is important as the home increasingly becomes the context for the delivery of health services and support. Research literature finds that the majority of older people would prefer to remain in their own homes and communities, even when faced with increased fragility (Ball et al. 2004, Rowles 1993, Godfrey et al. 2004).

‘Ageing in place’ is a primary strategy for adaptating to increasing levels of impairment (Gitlin 2003) and, for governments at least, a more economically sustainable option, as opposed to institutionalised care (Andrews 2001, Crowley and Cutbush 2000). Indeed, over 90% of older Australians currently live independently in the community. Historically, this meant remaining in the family home, but evidence suggests growing numbers are seeking diverse housing types and residential developments to maintain independence for longer (ABS 2001) and to satisfy individual quality of life and well-being needs (Olsberg 2005). Individuals were found to proactively preserve and protect a sense of well-being and identity when they have the option of adapting their environment , which also assisted in maintaining a level of mastery in their lives. Failing this, they were made to consider their housing options, such as the possibility of relocation to more suitable location. Peace et al (2006) described this process as ‘option recognition’ which was resulting decision from a variety of push factors that will be explored throughout this paper.

SOCIAL INSIDENESS

To be developed further. Smith 2009 p163, Seamon 2008

The existential crux of place experience

The degree which a person or group belong to and identifies with a place

Different meanings and identities for different individual

Perceived destruction of identity of place can result in environment press

Place identity change can occur due to population migration, intensification, loss of land mark, development etc.

FUNCTIONAL CAPACITY

While life expectancy has increased, annual surveys conducted in Australia since 1981 indicate that this has been offset by an increasing level of impairment suffered during those additional years (McCallum 1999). The inclusion of varying levels of disability provides a more complex view of population health than has traditionally been used to develop health policy and interpret health outcomes. Singular fatal diseases in older people are becoming less dominant than combinations of non-fatal health conditions and events that lead to a reduction in quality of life. The Survey of Disability, Ageing and Carers (2003) found that 22% of older Australians had a profound or severe limitation in their daily activity that resulted from a health condition. These conditions are also associated with a progressive increase in the level of impairment, and a correlating decrease in autonomy and quality of life (AIHW 2006).

The relationship between age and disability is explored in Figure 2. Some individuals will enjoy good health and high functional capacity until very late in life. Others will be less fortunate, and chronic conditions, ill health or frailty may start to interfere with our ability to negotiate our way around our homes and neighbourhoods (Kalache and Kickbusch 1997). Statistics relating to older people have to be understood from a life course perspective that recognizes that older people are not a homogeneous group and that individual diversity increases with age. However, the ageing process has been shown to have a direct correlation with a decline in functional capacity with those falling below the threshold requiring environmental adjustments and interventions aimed at improving quality of life (Kalache and Kickbusch 1997).

Figure 2 – Maintaining functional capacity over the life course

Source: Kalache and Kickbusch 1997.

SOCIAL RATIONAL IMPLICATIONS

The ageing population debate has typically been dominated by negative economic and social arguments that frame a very limited view on what it means to be an older person (Oldman 2002). This debate often correlates age to disability, and although chronological age does not necessarily translate to poor health, a correlation has previously been established. As a result, it is argued that the physical and mental decline associated with older age reduces the capacity to engage in physical, social and community activity outside the immediate home environment (Glass et al. 2006, Newson and Kemps 2005).While this may be true, it is the philosophy behind this that is a highly contested issue. Oldman (2002) strongly contends that this thinking of perceived reduced capacity is a product of social values and the limitation of the environment, rather than that of physical capacity. Such thinking has translated social policies that advocate for dependency that affords the person to be treated or managed like any other illness. This philosophy assumes a medical model of disability that has implications for self-worth and civic engagement (Landord et al. 2008). Recently, a social model has emerged, within which, disability is considered in the context of interpersonal and physical environments; cultural attitudes; and social structures (Murphy et al. 2008). Conditions such as social isolation and depression, under a social model of disability, as an example, would be the product of a disabling environment rather than an individual disability, as prescribed by the medical model of disability (see Figure 3).

Figure 3 – Medical Model vs Social Model

MEDICAL MODEL

SOCIAL MODEL

Disability is a deficiency or abnormality

Disability is a difference.

Being disabled is negative.

Being disabled, in itself, is neutral.

Disability resides in the individual.

Disability derives from interaction between the individual and society.

The remedy for disability-related problems is cure or normalization of the individual.

The remedy for disability related problems are a change in the interaction between the individual and society.

The agent of remedy is the professional.

The agent of remedy can be the individual, an advocate, or anyone who affects the arrangements between the individual and society.

Adapted from Carol J. Gill, Chicago Institute of Disability Research (YEAR)

Older people with a disability face many challenges in maintaining independence and a reasonable quality of life. Murphy et al. (2008) suggests that the supporting environment ‘should work with older people with a disability in ways which focus on nurturing and developing the internal resources of individuals within a supportive empowering environment’. To date, this debate has centred on social care and housing policy rather than the broader urban environment. However, the focus has also moved from the individual being responsible for managing their disability to societal responsibility for removing barriers to full participation (D’Eath et al., 2005). The built environment, partly as a product of social structures, must see its future in the social model ideology, which engages older people with the physical and social environment as stated by the World Health Organisation (2003):

‘Societies that enable all citizens to play a full and useful role in the social, economic and cultural life of their society will be healthier than those where people face insecurity, exclusion and isolation.’

CLASSIFICATION

Successful ageing (which can be contributed to collective healthy ageing, positive ageing and productive ageing) is a common rhetoric upon which all government responses are constructed in matters of ageing. Although ‘positive ageing’ is based on the principles of the Ottawa Charter (World Health Organization, 1986) and the Jakarta Declaration (World Health Organization, 1997), in the translation from principles to policies, Australian governments have (re)framed population ageing as a deficiency (medical model) that must be managed, primarily by individuals (Asquith 2009). Despite the fact that the discourse of successful ageing sounds positive, a variety of criticisms have been levelled at the concept (Minkler and Fadem 2002). The narrow definition of successful ageing tends to marginalise those incapable of meeting the benchmarks of a successful ageing experience. Which means that rather than promote a universal approach to the design of the built environment, that accommodate the broadest range of functional limitations, disability is viewed as an individual problem requiring specific modification of the built environment. Andrews (1999: p. 305, cited in Calasanti 2003, p. 200) notes ‘the unspecified but clearly preferred method of positive ageing is, by most accounts, not to age at all, or at least to minimize the extent to which it is apparent that one is ageing, both internally and externally.’ Classification has enabled societies to progress and to develop laws that are ‘fair’ and medical treatments that are effective in combating disease and illness. However, the classification is intrinsically a subjective procedure that ‘fit’ the prevailing concepts of the time, be it for better or worse.

CONCLUSION: ENVIRONMENTS AS A MEANS OF VALUING OLDER PEOPLE

As the ageing process continues and the gap between the demands of the environment and the older person’s competence widens, a loss of mastery over necessary environmental characteristics can result in older persons living limited lives in their environments or prematurely moving to supportive housing. Existing research supports the contention that a person’s behaviour in his or her environment is directly related to the design of the space, and an optimal environment needs to be designed to meet the specific needs and preferences of a given person (Christenson, 1990; Cutler, 2000; Kahana, 1975).

‘Ageing in place’ is a primary strategy for successful adaptation to increasing levels of impairment (Gitlin 2003) and, for governments at least, is a more economically sustainable option compared to institutionalised care (Andrews 2001, Crowley and Cutbush 2000). However, the classification and resulting ‘treatment’ on a medical model basis, is hindering personal well-being and fulfilment of later life. Much of the resulting research has centred on the impact of the micro-environments of medical model care settings (Peace et al 2003). There continues to be less research that situates the micro (dwelling) within the macro-environments of neighbourhoods, towns or the wider context of where and how older people live (Kendig 2003). Problems remain in connecting this work to wider theoretical perspectives, notably those relating to urbanisation and the demographic shift of society. These themes will be developed further throughout the next chapter.

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URBAN AGEING – DRIVERS AND CHALLENGES

INTRODUCTION

Urban environments, like any other, present physical and institutional barriers separating them from the mainstream of economic and social life (Gleeson 2001). As outlined below it can be seen that as people age, the consequence of environment can have an enabling or disabling impact:

‘…unsupportive environments (poor transport, poor housing, high levels of crime, etc) discourage active lifestyle and social participation. Indeed, disability can be defined not as a physical state that exists without reference to other factors but as a mismatch between what a person can do and what their environment requires of them.’

(House of Lords Science and Technology Committee 2005 p53)

Unravelling the experience of ageing in the urban city and understanding the forces behind urban change will itself be central to developing an environmental response.

 

DEMOGRAPHIC CHANGE: BABY BOOMERS RETIRE

The ageing of Australia’s 5.5 million baby boomers (defined as those born between 1946-1965) is anticipated to effect significant change on Australian society. The Australian Bureau of Statistics (2011) projects that by 2056 one in four Australians (compared to current figures of around one in eight) will be aged 65 years and over, and approximately 6% will be aged 85 years and over. The Productivity Commission (2008) calculates the current and future structural shift of Australia’s age demographic to; a sizeable decline in fertility rates since the 1960s; and an increase in longevity through advances in medical technology and public health initiatives. As a consequence, there are a number of trends/concerns relating to an ageing population. These include: a reduction in the labour force participation; a change in consumer and lifestyle patterns; and, most significantly in regard to this paper; the demands on housing and the resulting environment.

In Australia, retirement, at around age 65, is a life event which is highly correlated with housing changes (Haas and Serow 2002; Longino et al 2002; Schiamberg and McKinney 2003). Although there is no statutory retirement age in Australia, research conducted by The Australian Institute of Health and Welfare (2007) shows that of the 65 and over cohort, only 13% of men and 4.4% of women were employed or looking for work. However, over the last decade, labour force participation rates for the same cohort have risen by 2.7%, and are expected to continue to rise in the coming decades (AIoHaW 2007). This is due to: public policy emphasis on incentivising older workers to stay in the workforce longer; increase participation of women in the work place; and a willingness of the cohort to retire later (Hamilton & Hamilton 2006).

The culminating circumstances for those in retirement can significantly alter the economic security of older people and therefore influence their choice in housing location and subsequent environment (Beer at al. 2004). Migration research suggests that for current retirees with the financial means, early retirement is often associated with a move to areas of climatic or recreational appeal, while those with inadequate resources may become what Robidon and Moen (2000) term ‘involuntary stayers’. While there will be increasing numbers of the baby boomers with the financial resources to opt for ‘early retirement’, research by Hamilton and Hamilton (2006) challenges this notion of the ‘sea change phenomenon’, stating that ‘very few … envisage moving after retirement, and of those who do, their plans are vague.’ This correlation of housing trends is further convoluted with other reports arguing a desire of the cohort to downsize in similar areas and ‘age in place’ (Beer et al. 2009).

The nexus between retirement housing location, labour participation and social trends is complex and would indicate the baby boomers are a heterogeneous group. However, regardless of what the future choices of the retired cohort, a number of environment challenges exist in their chosen settings. Firstly, many of the houses owned by the baby boomers are typically located in a suburban area which is not conducive to the physical impairments associated with growing old (Smith 2009). Secondly, the boomers who choose to relocate in their retirement may face the same challenges as those who do not relocate, unless purpose built housing/neighbourhoods or retirement village settings are sought. Thirdly, while baby boomers are reported to have ‘high average annuity, moderate debt and high levels of homeownership’ (Bosman 2012), there will be a significant minority that are not positioned (as an example, through unemployment; the global financial crisis, or divorce) to fund their retirement. 

GLOBALISATION

Gerontology theory and social policy has theorised ageing within the context of the borders of nation states, however, in a world of globalisation there will be increased permeability and mobility within and across international societies, which is supported by the rise of different kinds of trans-national communities (Eade 1997). Further to this, globalisation is a process that stimulates population movement and migration on one side, but with increased numbers of people (especially older people) endeavouring to maintain a strong sense of attachment to particular places on the other (Phillipson et al. 2001). Philipson (2004) argues that global cities are evolving as a contradiction of values that result in urban form that is non-inclusive, which polarises the demands of ‘hypermobile minority on the one side, and the needs of a majority including older people, women living alone with children, disabled people and other groups, on the other side’.

 

URBANISATION AND SPRAWL:

Australia is an extremely urbanised country, with around 85 per cent of the population living in coastal areas, and over two-thirds of Australia’s 21 million residents lived in major cities (2006 figures, ABS, 2008). Together, these areas only comprise of around one per cent of Australia’s total land mass. As our big cities have grown away from the centre to accommodate peoples’ settlement needs, suburbs have mushroomed outwards, producing what is referred to as ‘urban sprawl’. Traditionally, Australian cities have been regarded as about as dense as American cities, at 10-18 persons/ha, although, American per capita vehicle fuel use is far higher. European cities have been regarded as 2-6 times denser than Australian cities, and Asian cities 4-30 times denser (reference). From this urban sprawl, a culture of automobile dependency has resulted, and there are now few true town centres where multiple errands can be accomplished during one trip. For an ageing person that may not drive, this has the result of few pedestrian-friendly communities that can offer the essential services required to fulfil the needs of everyday life. Beard and Petitot (2010) suggest that to break through the barriers that have sprung out of urban sprawl will require an approach that addresses public transport; improving walkability; the creation of destinations that encourage older people to leave their homes; and strengthened intergenerational links. Many of these barriers could potentially be addressed by urban intensification, however, many researchers predicted that Australia would never accept this model (McLoughlin 1991). Widespread multi-unit construction is occurring across Australian cities, and to some extent in regional centres (Buxton 2006). If introduced correctly, it has the potential to insight a paradigm shift, as well as reduce urban sprawl, which will both suit the ageing population.

DIVERSITY IN HOUSING OR SEGREGATION

To be developed further – Smith 2009 p165, Laws 1993, Holstein and Minkler 2007

Necessity to evaluate the need for housing diversity

Forming of intergeneration relationship

Housing that seeks to create segregation (for example retirement villages) fosters the perception that segregation is acceptable.

Housing diversity is contrary to many Western government policy agendas to tackle social exclusion, create community and build sustainable neighbourhoods

Responding to this requires designing for intergenerational and life course perspective

ARCHITECTUAL DISABILITY

The physical environment is a place that can either enable or constrain functionally impaired people. ‘Architectural disability’ is a term that has been used to describe built environments that confront people with barriers that may prevent some people using the environment (Goldsmith 1997). The word ‘disability’ has been shown to imply a loss of function, but in this case, refers to poorly designed or maintained layout and construction of buildings or places. Lawton (1974) described the effects of environmental pressure, in particular, showing older people are only able to adapt within a relatively narrow range of architectural variables. In general, design of the current urban landscape, is based on the utilisation of anthropometric data for the young, physically fit, educated, middle class and (usually) male adults (Handson 2004). This data reinforces the view that humans have a standard shape and size and that designing outside this is seen as a ‘special needs’ scenario. However, this ideology of the medical model of thinking enshrined within the design profession is continually being challenged, and is moving towards one of ‘inclusive design’ (Hanson 2004). An inclusive approach is one that creates a design for all, rather than a product for a special group that requires adaption for others. This ambition arises out of the understanding that disability is socially defined. While inclusive design is a complex process outside the scope of this paper, Hanson (2004) compares the approach to the medical model of ‘special needs’ as outlined below in Figure 4

Figure 4 – From ‘special needs’ to ‘inclusive design’

SPECIAL NEEDS

INCLUSIVE DESIGN

Designer client. Persona of a young, fit,

active, male, white adult the yardstick for good design.

People are individuals, who have different needs and requirements during their life course.

Others – older people and people with disabilities – are not ‘normal’ clients.

Us – we all have goals / aspirations as well as problems / impairments.

They have ‘special needs’.

We share ‘generic needs’.

Micro-environmental approach

Macro-environmental approach

Ethos of specialisation and pragmatism.

Ethos of normalisation and enablement.

Tailors the environment so that it is ‘just right’ for each client group.

Extends parameters of design until

no one is excluded

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