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- Publisher
- Hindawi Publishing Corporation
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- Copyright © 2012 Sarinnapha Vasunilashorn et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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- 2090-2204
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- 2090-2212
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- 10.1155/2012/120952
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Abstract
Hindawi Publishing Corporation Journal of Aging Research Volume 2012, Article ID 120952, 6 pages doi:10.1155/2012/120952 Research Article Aging in Place: Evolution of a Research Topic Whose Time Has Come 1 2 3 3 Sarinnapha Vasunilashorn, Bernard A. Steinman, Phoebe S. Liebig, and Jon Pynoos Office of Population Research, Princeton University, Princeton, NJ 08544, USA Center for Gerontology and Health Care Research, Brown University, Providence, RI 02912, USA Andrus Gerontology Center, University of Southern California, Los Angeles, CA 90089, USA Correspondence should be addressed to Sarinnapha Vasunilashorn, svasunil@princeton.edu Received 16 May 2011; Revised 24 July 2011; Accepted 7 September 2011 Academic Editor: Frank Oswald Copyright © 2012 Sarinnapha Vasunilashorn et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Over the past 30 years, policy makers and professionals who provide services to older adults with chronic conditions and impairments have placed greater emphasis on conceptualizing aging in place as an attainable and worthwhile goal. Little is known, however, of the changes in how this concept has evolved in aging research. To track trends in aging in place, we examined scholarly articles published from 1980 to 2010 that included the concept in eleven academic gerontology journals. We report an increase in the absolute number and proportion of aging-in-place manuscripts published during this period, with marked growth in the 2000s. Topics related to the environment and services were the most commonly examined during 2000–2010 (35% and 31%, resp.), with a substantial increase in manuscripts pertaining to technology and health/functioning. This underscores the increase in diversity of topics that surround the concept of aging-in-place literature in gerontological research. 1. Introduction themselves), which illuminates a greater number of options aimed at stemming rising costs of care, and accommodating Over time, the goal of aging in place has become a focal and facilitating the wishes of older adults to remain indepen- concept by policy makers as well as researchers in their col- dent. Initial efforts to conceptualize and define aging in place lective efforts to create communities that facilitate the widely as an important discussion topic focused on understanding recognized preference by a majority of older adults to remain older adults in terms of changes occurring both in them- in their homes and communities as long as possible [1–4]. selves and in their surrounding environments. For instance, Efforts to reform how and where long-term care services in describing the concept of environmental press,Lawton are provided have produced substantial programs enacted and Nahemow [5] examined dynamic interactions between to reduce reliance on the most expensive forms of care to housing environments and the physical capabilities of older address disability associated with chronic disease and im- people. In optimal settings, characteristics of the environ- pairment. A shift in priorities and resources toward deinsti- ment should function to accommodate losses of physical tutionalization has resulted in explicit policies and programs function. Thus, Lawton recognized the necessity of a variety that reflect a paradigm shift from nursing homes as the most of specialized living environments that could address the likely alternative for older adults requiring multiple services full range of functioning from independence to dependence to nursing homes as an option of last resort. on institutional care, with community housing, congregate Corresponding to greater policy aimed at facilitating housing, and boarding homes falling within this spectrum. aging in place, there has also emerged a growth in academic Since this early seminal work, concepts of aging in place literature, reflecting the concerns of stakeholders (includ- evolved to emphasize services and technology as important ing policy makers, care providers, families, and older adults contributors to an older adult’s ability to remain in his/her 2 Journal of Aging Research home. Indeed, Brink [6] highlighted the importance of minimal number of manuscripts that utilized the alternate integrating services with housing in stating that the goal terms pertaining to aging in place, this criteria should not of aging in place would be seriously hampered if support substantially bias our results. services are unable to keep up with their demand. Consistent Journals were chosen based on the frequency of appear- with Lawton’s [5] view, the primary goal of services and ance of the 3 critical terms and their variations (aging/ageing technology is to match the level of support provided by the in place, aging/ageing at home, and naturally occurring housing environment to the level of capabilities (or need) of retirement community(s)) in a preliminary search using the individual. Google Scholar. If terms appeared in each journal 20 or Over the past 30 years, policy makers and professionals more times during the 30-year period of interest, we included who provide services to older adults with chronic conditions the journal in our main analysis. These journals included and impairments, as well as researchers, have placed greater Ageing & Society; Ageing International; Generations; The emphasis on conceptualizing aging in place as an attainable Gerontologist; Journal of Aging and Social Policy; Journal of and worthwhile goal. Nevertheless, there is little known of Applied Gerontology; Journal of Gerontological Social Work; the changes over time in the attention given to aging in Journal of Gerontology; Journals of Gerontology Series B: place within gerontological literature. With respect to the Psychological Sciences and Social Sciences; Journal of Housing quantity and substance of the literature on aging in place, the for the Elderly; Research on Aging. Next, the sum total of all current study was designed to provide important insight as to articles for each journal and a grand total number of articles the prominence of environmental, service based, technology, were calculated. These totals were used to compute the and health factors associated with an older adult’s ability, proportion of articles dedicated to the topic of aging in place inability, or choice to age in place. Moreover, given the over time. Retrieved articles were excluded from analyses if increasing number of older adults who express a preference their contents were book or audiovisual reviews, conference to remain in their home, understanding and tracing the evo- abstracts, or editorials. Finally, we used the advanced search lution of this topic in gerontology is more timely today than option on each journal’s official website, where possible, to ever before. Perhaps more importantly, in studying changes identify articles containing any of the three exact phrases and in empirically based aging in place publications, light can be their variations in titles, abstracts, key words, or in the bodies shed on how such temporal changes may influence policy of articles—articles were not counted in this step if key terms related to services, environment, and technology. appeared only in the bibliographies of papers. For journal In our analyses, we examined the trajectory of aging in websites without this advanced search option, the advanced place within the context of scholarly discussions in major search option under Google Scholar was used for searching gerontology journals. Specifically, the purpose of our re- within the specific journal. A similar approach was used by search was to examine how the literature on aging in place Carr and colleagues [7] in their review of arts and aging has changed over time in highly visible gerontology journals, research. with a focus on analyzing trends related to the amount, Articles that were retained were coded according to three location, and variety of research topics. We hypothesize that criteria. First, articles were sorted according to whether their generally there would be an increased proportion of articles content dealt directly with the concept of aging in place dedicated to the topic of aging in place, and that among those (direct) or whether key terms were mentioned only in pass- articles, the diversity of topics covered in publications would ing in articles primarily about other topics (indirect). Next, increase over time. we indicated whether aging in place articles were focused on five areas that influence the capacity of older adults 2. Methods to age in place—these included subcategories for housing/ environmental considerations (e.g., neighborhood charac- In this study, we analyzed scholarly articles published from teristics and home modifications); community/social ser- 1980 through 2010 in eleven leading gerontology journals vices (e.g., influence of church groups, barriers to access with content areas that focus on research and/or policy per- of services); assistive devices/technology (e.g., telemedicine, taining to older adults. In a preliminary analysis, we exam- remote assessments, and silver alerts); health and functioning ined a broad array of terms that capture the concept of aging (e.g., supportive housing for frail adults); a miscellaneous in place. These included aging/ageing in place, aging/ageing category that contained factors that did not fit into the other at home, naturally occurring retirement community(s), elder four subcategories, such as issues pertaining to migratory friendly community(s), aging in the community, home patterns or municipal zoning regulations. Any single article independence, and staying put. For the terms that yielded could be categorized in one or more of these topic areas, less than 20 manuscripts within our 1980–2010 timeframe, depending on the range of scope of the article. Finally, we we excluded these terms from our final search list. This left sorted articles by whether the content was primarily research 3 critical search terms: aging/ageing in place, aging/ageing oriented, or whether articles discussed policy pertaining to at home, and naturally occurring retirement community(s). aging in place. Articles were categorized as research oriented Given that our interest was in examining trends in aging in if concepts of aging in place were analyzed empirically as place, we operationalized our definition of aging in place an antecedent (an independent variable), a mediator (a search items to include only the most commonly used terms. process variable), or an outcome (a dependent variable). This approach results in a more conservative estimate of documenting trends in aging in place; nevertheless, given the Articles were categorized as policy oriented if their content Journal of Aging Research 3 discussed program development or implementation of pro- 2000–2010 (35% and 31%, resp.), with 15% of the articles grams where aging in place was a stated goal. pertaining to health and functioning and 10% representing The search and review of manuscripts were conducted the “other” category. Articles related to technology became by two readers (SV and BAS), who determined the criteria more prominent during the 2000s, representing 9% of aging- for inclusion and categorization of manuscripts prior to in-place publications. When we examined the entire 1980– review. Each reader independently reviewed the possible 2010 time frame, this trend resembled that of the lattermost manuscripts. When the readers disagreed on the catego- decade: environment (36%), services (29%), health and rization of any article, disparate cases were discussed and functioning (15%), other (13%), and technology (7%). an agreed upon consensus for classification was established Upon classifying articles as empirical research based and recorded, before data were analyzed. We conducted and/or explicitly pertaining to or mentioning policy, we frequency analyses and computed the proportion of aging noted an increasing absolute number of both empirical and in place articles relative to the total articles published during policy-related articles over time (Figure 1(d)). Interestingly, the period of interest. We also conducted frequency analyses the proportion of research-based to policy-related articles differentiated by whether articles mentioned aging in place markedly increased between the 1990–1999 and 2000–2010 as an indirect concept, or whether aging in place was the period. During 1990–1999, research articles were nearly 1.5 central issue discussed by the article (direct concept). Finally, times as prevalent as policy-related manuscripts. This ratio we calculated the frequency of aging in place articles by increased over the 2000–2010 timeframe, where the propor- subcategory topic (i.e., whether articles addressed housing, tion of research to policy articles on aging in place was 2.5. services, technology, health, and/or some other topics), and Our initial efforts to determine how aging in place by whether articles were research focused or policy focused. has developed over time and across topics have yielded a number of important points. Of note in our analyses was the increase over time of the “other” category, which 3. Results was comprised mostly of issues surrounding older adult Among the journals examined, there was an increase in migration between regions in the US, concerns surrounding older immigrant adults, and municipal-level factors, such the publication of aging in place manuscripts from 1980 to 2010 (Figure 1(a)). During the 1980s, very few publications as zoning regulations. In addition, we noted four other included this concept. The number of these articles nearly important trends in the literature that affect the ability of older people to age in place. First, aging in place publications doubled in the 1990s, and a marked increase in the absolute number of manuscripts pertaining to aging in place began span a wide spectrum ranging from broad to specific in 2001, with the highest number of publications in the investigations. Some broad depictions of manuscripts discuss most recent year of 2010. The initial inclusion of “aging this concept within the context of the worldwide greying of in place” in the literature (1980s) generally mentioned this our communities [8] and exploratory, qualitative analyses concept indirectly, and it became a central part of some (e.g., determining the amenities that individuals currently published articles in the 1990s, where the ratio of direct to utilize to age in place [9]). The more specific papers on indirect mention was about 0.55. From 2000 to 2010, this aging in place focus on services (e.g., nursing homes and assisted living facilities [2], health monitoring [10], housing ratio of direct to indirect mentions increased to 0.75, with an excess of direct mentions relative to indirect mentions and social support [11, 12], and palliative care [13]). published in 2001 (ratio: 1.22). During the overall 1980– Second, with respect to the environment, aging in place has two prongs: aging in place in the home and in other 2010 period, nearly 70% of all aging in place manuscripts indirectly mentioned this concept. structured settings in the community. While the definition When we considered the number of aging in place pub- of “home” varies (e.g., single or multiple family home) and lications relative to the number of overall journal publica- continues to remain an essential component of aging in tions (Figure 1(b)), the trends over time were remarkably place, increasing attention has highlighted the importance of community care as a means to either support aging in place similar to the absolute number of aging in place manu- scripts (Figure 1(a)). This suggests that the proportion of or as an initial step in fostering the goal of aging at home aging in place articles has increased over time. Aging in place [14, 15]. Third, aging in place is not a one-size-fits-all concept. articles have also expanded in the diversity of the topics covered (Figure 1(c)) from 1980 to 2010. In the earliest There are multiple issues surrounding differences in aging decade (1980–1989), environment and the “other” category in place among diverse populations. Such diversity arises (including mostly articles pertaining to migration) dom- from differences in preferences and access to services with inated the aging-in-place literature. Over the following regards to differences in rural versus urban settings [16, ten years (1990s), aging in place manuscripts extended to 17], income [18], orientation (e.g., lesbian, gay, bisexual, areas of service, and there was some mention of health and transgender sensitivities [19]), older adults with special and functioning. During this time, topics related to the needs (e.g., intellectual disabilities [20] and prisoners [21]), older adults with special circumstances (e.g., adults who are environment remained a leading area of focus for aging in place publications. The 2000s marked a time of increased caring for children with developmental disorders [22]), more breadth of topics covered among the aging-in-place lit- general differences in eastern versus western views on aging in place [23], and broad international differences in services erature. The topic of the environment and services were the most commonly examined areas during the period that individuals require, want, and need [24]. Regardless of 4 Journal of Aging Research 1980 1985 1990 1995 2000 2005 2010 1980 1985 1990 1995 2000 2005 2010 Indirect Direct (a) Total aging-in-place articles (b) Percent of all articles 1980 1985 1990 1995 2000 2005 2010 1980 1985 1990 1995 2000 2005 2010 Other Services Policy Health Environment Research Technology (c) Total mentions by topic (d) Total research/policy mentions Figure 1: (a) Absolute number of aging-in-place articles (direct and indirect mention), 1980–2010; (b) proportion of aging-in-place articles relative to the total published articles, 1980–2010; (c) absolute number of categorical mentions among aging in place articles published, ∗ ∗ 1980–2010 ; (d) total aging in place articles by research/policy designation. Categorical mentions are not mutually exclusive (e.g., one manuscript may have multiple category mentions). these differences, the concept of aging in place has established of place is not always accompanied by a continuity of roles, itself internationally, with studies documented in Sweden relationships, and lifestyles (often the case for adults with [25], China [26], the United Kingdom [27], Japan [28], New dementia). Further evidence for this is provided by reports Zealand [29], Australia [30], Malaysia [31], and Taiwan [32]. that changes in the environment can be associated with Fourth, technology has become an increasingly impor- positive outcomes [37], in which older adults relocate to tant component to the literature on aging in place. The enhance individual development, pursue personal interests, worker interactive networking project is an example of the and overcome restrictive environments. growing number of studies that examine the influence of technology in supporting working-family caregivers of frail 4. Discussion and memory-impaired older adults [33]. Other studies focus on the mobile and e-communications among older Japanese This study documents the increasing attention given to aging adults [28], telecare initiatives to address issues related to the in place in the gerontological research community over the potential negative experiences associated with aging in place past 30 years. Our findings indicate the growing variety of (e.g., lack of informal support [27]), and pain management topics pertaining to aging in place, ranging from housing through videoconferencing [34]. and environment to health and technology. The relevance of Although a number of articles focus on the importance of this topic, we believe, has increased over time, in part due to aging in place [35], others highlight the potentially negative the acknowledged preference of older persons (and younger experiences (e.g., isolation and loneliness) associated with persons with disabilities) to maintain independence, and to remaining in the same location [27]. Such ideas are echoed the greater availability of noninstitutional care. In addition, by LeRoy and colleagues [36] who cautioned that aging in concerns about the escalating costs of institutional long-term place does not assure a high quality of life, since continuity care on the part of policy makers have made a priority (%) Journal of Aging Research 5 of concerns by older persons and their families, regarding technology influence aging in place, as well as the degree to the desire to avoid relocation in order to receive needed which aging in place research informs and influences policy assistance. As a result of this reprioritization, new grants have and services. Perhaps the biggest question surrounding our been initiated to foster aging in place efforts that are based results pertains to how trends in aging-in-place literature on evidence-based research findings, under the auspices of translate to the needs and services currently provided to older the National Institute on Aging (NIA), the Administration adults. Additional studies are warranted in order to address on Aging (AoA), and other federal agencies. this important and pressing question. Although aging in Although we believe that our findings illuminate a real place seems to have come of age over this 30-year time and important growth in the quantity and diversity of aging- period, we expect that future trends will exhibit a greater in-place publications, we acknowledge some limitations of diversity of aging-in-place topics and that this concept will the current study. Namely, by including only academic continue its upward trajectory within gerontology publica- manuscripts in the eleven designated gerontology journals, tions. we excluded books, scholarly publications from other related journals (e.g., those specifically pertaining to housing, eco- Acknowledgments nomics, and technology), and reports by organizations that This paper was completed with support from a train- have focused specific attention on this issue (e.g., AARP). ing Grant provided by the Agency for Healthcare Re- Our selected search terms also limited the inclusion of some search and Quality (AHRQ), a National Research Ser- publications, because of different terminology used among vices Award (NRSA) for postdoctoral fellowship training countries and cultures. For instance, some Europeans often (5T32HS000011-24), and the Archstone Foundation. use the term “staying put,” while other articles have used “home independence” to encompass the concept of aging- in-place. 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