Everyday competence in visually impaired older adults: a case for person-environment perspectives

Reported Unmet Hearing Aid Need in Older People With Dementia: The US National Core Indicators Survey

OBJECTIVES

Hearing aids have important health benefits for older adults with Alzheimer disease and related dementias (ADRD); however, hearing aid adoption in this group is low. This study aimed to determine where to target hearing aid interventions for American long-term care recipients with ADRD by examining the association of ADRD and residence type with respondent-reported unmet hearing aid need.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional study used data from the United States National Core Indicators-Aging and Disabilities survey (2015-2019) for long-term care recipients aged ≥65 years.

METHODS

We used multivariable logistic regression to model the likelihood of reporting unmet hearing aid need conditional on ADRD status and residence type (own/family house or apartment, residential care, or nursing facility/home), adjusting for sociodemographic factors and response type (self vs proxy).

RESULTS

Of the 25,492 respondents [median (IQR) age, 77 (71, 84) years; 7074 (27.8%) male], 5442 (21.4%) had ADRD and 3659 (14.4%) owned hearing aids. Residence types were 17,004 (66.8%) own/family house or apartment, 4966 (19.5%) residential care, and 3522 (13.8%) nursing home. Among non-hearing aid owners, ADRD [adjusted odds ratio (AOR) 0.90, 95% CI 0.80-1.0] and residence type were associated with respondent-reported unmet hearing aid need. Compared to the nursing home reference group, respondents in their own/family home (AOR 1.85, 95% CI 1.61-2.13) and residential care (AOR 1.30, 95% CI 1.10-1.53) were more likely to report unmet hearing aid need. This pattern was significantly more pronounced in people with ADRD than in those without, stemming from an interaction between ADRD and residence type.

CONCLUSIONS AND IMPLICATIONS

American long-term care recipients with ADRD living in their own/family home are more likely to report unmet hearing aid need than those with ADRD in institutional and congregate settings. This information can inform the design and delivery of hearing interventions for older adults with ADRD.

Low vision home therapy service by occupational therapists: The effectiveness of the Seniors’ Eye Rehabilitation programme, a pilot study

Introduction:

This study aims to explore the effectiveness of the Seniors’ Eye Rehabilitation (SEER) pilot programme, a visual rehabilitation home therapy by specialised low vision occupational therapists (LVOT).

Method:

This was an interventional, longitudinal cohort study. Participants were recruited from Singapore National Eye Centre Low Vision Clinic. The occupational therapy interventions include activities of daily living retraining, activities/home modifications, functional/community mobility training and patient/family education. Each participant set two individualised goals (Priority Goal 1 and Priority Goal 2). The Wilcoxon signed-rank test was used to compare baseline and 6-month follow-up scores for Australian Therapy Outcome Measures for Occupational Therapy (AusTOMs-OT) and the Goal Attainment Scale (GAS) ( p < 0.05).

Results:

Forty-one participants (mean age: 67, 48.8% male) completed SEER. There was statistically significant reduction in activity limitations (1 median point change (MPC), Z = −4.21, p < 0.01), participation restrictions (1 MPC, Z = −3.951, p < 0.01) and improved well-being (0.5 MPC, Z = −3.668, p < 0.01) for Priority Goal 1 using AUSTOM-OT. With GAS, there was a statistically significant improvement in Priority Goal 1 (1 MPC, Z = −3.886, p < 0.01).

Conclusion:

The SEER programme was found to be effective in improving all domains of the AusTOMs-OT and GAS for Priority Goal 1. This provides evidence that visual rehabilitation home therapy by specialised LVOT is beneficial to older adults with visual impairment.

Developing a multisensory methodology to explore older people's landscape experience in Australian aged-care facilities

This paper aims to develop a sensory methodological framework to explore older user's landscape experience. Applying empirical experience in Australian aged-care facilities, it addresses a methodological gap in the current literature to help move beyond the current taken-for-granted approaches such as interviews, cognitive mapping, behavioural observation and visual methods. We propose a more holistic method which enables the exploration of older people's in situ environmental experience. The multisensory framework we propose here is based on the first author's doctoral fieldwork experience that took place in two aged-care facilities in Brisbane, Australia. Findings suggest this framework facilitates an understanding of users’ olfactory, auditory and visual responses to the physical environment, and promotes a deeper engagement with the landscape. We argue that this is essential to promoting good landscape design which genuinely connects with older people's needs.

Psychosocial Adaptation to Age-related Vision Loss: A Six-year Perspective

This comparison of the behavioral and emotional adaptation of elderly visually impaired and sighted people found that age-related visual impairment was associated with other forms of substantial loss that increased over a six-year period. The results underscore the need for the earliest possible intervention and rehabilitation to prevent psychosocial harm to elderly people who experience severe vision loss after a lifetime of seeing.

Health Conditions, Activity Limitations, and Participation Restrictions among Older People with Visual Impairments

Data from the Second Supplement on Aging (1994) were analyzed to evaluate the presence of selected medical conditions, performance of basic and instrumental activities of daily living, and participation in life situations in two groups of visually impaired elders (persons aged 70–74 and persons aged 85 years or older) and two other groups of elders in the same age groups who are not visually impaired. Results indicated that, for both age groups, visual impairment is a significant risk factor for additional medical conditions, activity limitations, and participation restrictions.

Visually Impaired Older Adults and Home-Based Leisure Activities: The Effects of Person-Environment Congruence

This qualitative study explored the effect of person-environment congruence on participation in home-based leisure activities by two legally blind older adults who lived independently in the community. The results indicated that visual impairment increased the time spent in home-based leisure activities and that the participants used various proactive behaviors to engage in these activities.

Occupational performance in the basic and instrumental daily activities of persons with low vision who received rehabilitation services

Introduction

The objective was to describe the occupational performance in basic and instrumental daily activities of persons living in the community who have received comprehensive interdisciplinary low vision rehabilitation services.

Method

The Mesure de l'impact de la déficience visuelle dans les activités quotidiennes (a measure of the impact of visual impairment in daily activities) was administered at home to 102 individuals who participated in a comprehensive low vision rehabilitation program. Performance in 16 near-vision activities was measured with the person's aids and strategies; nine more global tasks were questionnaire-based. Handicap scores were obtained by multiplying performance × importance ratings.

Results

Average performance was satisfactory or very satisfactory for 21/25 items, even if 92% of the participants had a moderate or severe visual impairment. A severe or total handicap was present in at least one activity for 79% of the subjects. The most handicapping activities required visual searches of finely printed information on a complex or visually crowded document, or shopping and mobility.

Conclusion

People with low vision who took part in a comprehensive rehabilitation program generally face no or slight handicap situations in their basic and instrumental daily activities. However, major handicap situations may remain in some important activities.

[Adaptive behaviour of persons with functional limitation: Housing adaptations in Spain]

INTRODUCTION

Most elderly people or those with disabilities wish to stay in their own home rather than any other residential option, even when long-term care is required. The functional adaptation of homes is one of the key factors in doing this with safety and quality of life. This paper investigates whether people with disabilities (arising mainly from their advanced age) develop adaptive behaviours aimed at compensating for their functional loss through improvements in their home and environment, as well as knowing the covariables that explain it.

MATERIAL AND METHODS

It starts from the so-called Lewin equation, which relates individual behaviours to personal and environmental characteristics. In this case the adaptive behaviour would be the economic expenditure on the home for its adaptation or improvement. The microdata of the Spanish EDAD 2008 survey are used, to which a bivariate logit model is applied to estimate the relationship between this adaptive expenditure and different explanatory covariates.

RESULTS

The results show that the Lewin model is fulfilled. The resulting coefficients and odds ratios show that the functional, economic, and environmental characteristics are what determine, above others of a personal or socioeconomic type, the adaptive expenditure.

CONCLUSIONS

Housing adaptation is a voluntary adjustment behaviour justified by the functional conditions of the person and those of the housing and building environment. Given the importance of promoting better conditions for «ageing at home», there is a need to stimulate private expenditure on adaptation as a complementary formula to the necessary increase in existing public subsidy programs.

Environmental Press, Aging in Place, and Residential Satisfaction of Urban Older Adults

Sociologists who study and work with older adults often use the term “aging in place” when discussing older adults' residential environments. Aging in place suggests that what is best for older people (and society at large) is to remain in the residential environment (e.g. home and neighborhood) in which they have lived most of their lives. The goal of this study was to utilize the theory of environmental press in a sample of older adults living in the central city of Detroit to begin to understand their levels of satisfaction with their residential environment, and to examine potential limitations in the theory of aging in place.

A random telephone survey was used in a sample of older adults (n = 604) living in the central city of Detroit, Michigan. Hierarchical logistic regression was used to test residential satisfaction using demographics, home hazards, neighborhood hazards, personal competencies, geographic location, and interaction variables. Home hazards, neighborhood hazards, geographic location, and interaction press measures predicted housing satisfaction (Nagelkerke R2=40.2 percent) and neighborhood satisfaction (Nagelkerke R2=50.5 percent). The environmental press and residential satisfaction of the highest and lowest mentally and physically functioning older adults were also investigated. Respondents who reported the lowest levels of mental and physical functioning also reported the lowest levels of residential satisfaction and faced the greatest environmental challenges. The results suggest that older adults occupying disadvantaged social locations may be overlooked in current practice definitions of aging in place.

The Environmental Production of Disability for Seniors with Age-Related Vision Loss

To date, attention to the environmental production of disability among older adults with age-related vision loss (ARVL) has been limited. This critical ethnographic study aimed to reveal the ways in which environmental barriers produced and perpetuated disability for 10 older adults with ARVL. A modified version of Carspecken's five-stage approach for critical ethnography was adopted with three methods of data collection used, including a narrative interview, a participant observation session, and a semi-structured, in-depth interview. Findings revealed how disability is shaped for older adults with ARVL when they encounter environmental features that are embedded within an ageist and disablist society. These findings are illustrated via presenting analysis of three commonly discussed activities: shopping, eating, and community mobility. Our discussion suggests that addressing the environmental production of disability requires inclusive social policy, advocacy, and a focus on education in order to develop and sustain age and low-vision-friendly environments.

Reshaping understandings of disability associated with age-related vision loss (ARVL): incorporating critical disability perspectives into research and practice

PURPOSE

In this paper, we have sought to stimulate a critical dialog regarding the ways in which disability has been largely conceptualized and studied in literature addressing age-related vision loss (ARVL). We suggest an expansion of this largely biomedically informed research area to include alternative frameworks, namely critical disability perspectives.

METHOD

To demonstrate the potential contributions of adopting a critical disability approach to enhance understandings of ARVL, this article outlined the primary tenets of the biomedical and social models of disability; the key aims, emphases, and assumptions of critical disability perspectives; and provided examples of how such an approach would lead to new research foci in the study of ARVL.

RESULTS

The paper highlighted four qualities of critical disability perspectives that future ARVL research should ascribe to, including (a) a focus on interdependence over traditional notions of independence; (b) a broader conceptualization of 'normalcy'; (c) the influence of language as a means of describing or labeling disabled persons; and (d) the influence of the socio-political environment in the creation and sustainment of disability.

CONCLUSIONS

This paper encouraged the incorporation of critical disability perspectives to provide new ways of conceptualizing, researching, writing about, and practicing in relation to ARVL. Implications for Rehabilitation The application of critical disability perspectives to expand the boundaries of low vision research can broaden low vision rehabilitation services (LVRS) in ways that more effectively attend to environmental features shaping and perpetuating disability for clients with age-related vision loss (ARVL). Low vision research, informed by critical disability perspectives, would inform a shift away from the exclusive focus on independence towards an acknowledgment of interdependence. The integration of participatory research approaches in ARVL research could generate new insights to inform rehabilitation by enhancing space and respect for the stories and knowledge of older adults aging with vision loss. Greater attention in low vision rehabilitation should be paid to how older adults' experiences of disability are tied to both the environmental context in which they exist and by the limitations caused by their impairment.

Understanding the occupational performance experiences of individuals with low vision

Introduction

Occupational therapy practitioners who provide interventions for adults with low vision need to understand challenges with occupational performance from the individual’s perspective in order to implement effective treatment. The purpose of this study was to understand self-described occupational behaviors of persons with low vision.

Method

This qualitative study included semi-structured interviews regarding the occupational experiences of 22 individuals with varying levels of vision impairment. Transcribed data were organized according to the areas of occupation reported in the American Occupational Therapy Association’s Practice Framework.

Results

Participants described occupational performance of activities of daily living, instrumental activities of daily living, and leisure. Within each area of occupation, participants reported lighting, contrast, familiarity, and organization within the environment as facilitators or barriers to participation. Participants with increased vision loss relied heavily on assistive devices, task simplification, and others to perform desired occupations.

Conclusion

The information obtained in this study can assist practitioners in selecting more effective interventions to increase the independence and safety of individuals with low vision.

Compensatory Strategies: Prevalence of Use and Relationship to Physical Function and Well-Being

We examine prevalence of four compensatory strategies (assistive devices, receiving help, changing frequency, or method of performance) and their immediate and long-term relationship to well-being. A total of 319 older adults (>70 years) with functional difficulties at home provided baseline data; 285 (89%) provided 12-month data. For 17 everyday activities, the most frequently used strategy was changing method of performance ( M = 10.27 activities), followed by changing frequency ( M = 6.17), assistive devices ( M = 5.38), and receiving help ( M = 3.37; p = .001). Using each strategy type was associated with functional difficulties at baseline ( ps < .0001), whereas each strategy type except changing method predicted functional decline 12 months later ( ps < .0001). Changing frequency of performing activities was associated with depressed mood ( p < .0001) and poor mastery ( p < .0001) at both baseline and 12 months ( ps < .02). Findings suggest that strategy type may be differentially associated with functional decline and well-being although reciprocal causality and the role of other factors in these outcomes cannot be determined from this study.

An ecological framework of place: situating environmental gerontology within a life course perspective

This article presents an emergent heuristic framework for the core environmental gerontology concept of "place." Place has been a central concern in the field since the 1970s (Gubrium, 1978) for its hypothesized direct relationship to identity, the self, and agency--suggestive of the appropriateness of lateral theoretical linkages with developmental science. The Ecological Framework of Place (EFP) defines place as a socio-physical milieu involving people, the physical setting, and the program of the place, all catalyzed by situated human activity and fully acknowledging that all four may change over time. The article begins with a concise overview of the EFP before moving on to consider it within three theoretical terrains: place theory, developmental science theory, and environmental gerontology theory. The EFP will be argued to be a place theory which subsumes themes of emergent environmental gerontology theories within a developmental science perspective. Implications for theory, method and practice are discussed. One of the strengths of the model is its ability to serve both research and practice, as is exhibited in its ability to incorporate applied design research and inform architectural decision-making so often lacking in other environmental gerontology models. Place should be viewed as an integrative concept providing opportunities for both environmental gerontology and developmental science to more critically concern the profound role places have in terms of agency, identity and sense of self over the life course.

Home environments and adaptations in the context of ageing

‘Ageing in place’ initiatives form an important part of broader ‘ageing well’ strategies that are being developed in response to demographic change. Increasingly, it is acknowledged that it is important to understand how individuals shape and modify the space within their own home and immediate environment to facilitate flexible solutions in the event of a loss of independence. The research presented here aims to understand how individuals construct the space both within their own home and their immediate surroundings and how this construction is linked to their own perception of ageing and growing old. A thematic analysis of 28 qualitative interviews resulted in two differentiated responses in relation to home adaptations: those respondents who had acted to modify their home and environment and those who instead sought to delay or ‘put off’ any modifications. The results demonstrate the multi-dimensional experience of ageing, the diversity of types of home environment, and the interplay between compensatory solutions and the social contexts within which they take place. The need for a more holistic approach that takes into account factors such as an individual's experience of ageing is suggested in order to understand the use of space in home environments and the adaptations that are made to them. Policy initiatives for ‘ageing in place’ can be reinforced by closer user involvement.

The facade of stability in assisted living

OBJECTIVES

The study sought to identify the varied types of change arising from internal and external influences in assisted living (AL) settings, expanding upon the literature's limited focus on resident decline and staff turnover and clarifying the importance of changes to life and work there.

METHOD

This analysis employed qualitative interviews and observations from 4 studies involving 17 ALs to identify elements of change largely absent from the literature. Case material identified by the research team members relating to persons, groups, and settings exemplifying typical changes, as well as variations across settings, are presented.

RESULTS

Multiple domains of AL change were identified, to include those in: (a) the external economic or competitive environments; (b) ownership, management, or key personnel; and (c) physical health or cognition of the aggregate resident population. In many cases, the changes influenced residents' satisfaction and perceived fit with the AL environment.

DISCUSSION

Change of many types is a regular feature of AL; many changes alter routines or daily life; raise concerns of staff, residents, or families; or modify perceptions of residential normalcy. Environmental gerontology should more often extend the environment to include the social and interpersonal characteristics of collective living sites for elders.

Occupational therapy interventions to improve performance of daily activities at home for older adults with low vision: a systematic review

The impact of age-related vision loss on older adults' independence at home is profound. The purpose of this systematic review was to identify the effectiveness of interventions within the scope of occupational therapy practice to maintain, restore, and improve performance in daily activities at home for older adults with low vision. We searched and screened abstracts from multiple electronic databases and identified 17 studies that fulfilled our inclusion and exclusion criteria. Three themes in intervention approaches emerged: multicomponent intervention, single-component intervention, and multidisciplinary intervention. Strong evidence of effectiveness was found in studies that applied a multicomponent approach; these interventions involved teaching knowledge and skills that older adults with low vision need to help overcome the disablement process. Evidence also suggests that multiple sessions of training with low vision devices and special viewing skills to compensate for vision loss are necessary to have a positive effect on daily activities. Finally, multidisciplinary intervention that focused on personal goals yielded greater positive outcomes than interventions that were not personalized.

Factors That Influence the Occupational Engagement of Older Adults with Low Vision: A Scoping Review

Introduction:

Prior research has provided occupational therapists with an understanding of the negative impact of low vision on self care, leisure and productivity. In order to guide future low-vision rehabilitation services, an understanding of the factors that influence the occupational engagement of older adults with age-related vision loss (ARVL) is also needed.

Method:

A scoping review of the literature was conducted in order to identify those factors that have been shown to influence the occupational engagement of older adults with ARVL, and to identify future research needs.

Findings:

As identified in this scoping review, five types of factors were shown to influence occupational engagement for older adults with ARVL including: demographic variables, emotional components, behavioural components, diagnostic components, and environmental aspects.

Conclusion:

Although findings pertaining to personal factors can inform practice, few studies explored the influence of environmental factors on occupational engagement. Given that occupation is a result of person-environment transactions, it is important that future research more fully explores environmental influences in order to enable occupational therapists to deliver services that optimize the occupational performance of seniors with ARVL.

The psychological challenge of late-life vision impairment: concepts, findings, and practical implications

The intention is to summarize the body of evidence speaking to the psychological challenges faced by visually impaired older adults, as well as their coping efforts. This evidence is substantiated by a rich set of concepts, theories, and empirical findings that have accumulated under the umbrella of age-related psychoophthalmology (APO). I introduce the field of APO and continue with a discussion of important concepts and theories for a better understanding of adaptational processes in visually impaired older adults. I then summarize the most relevant and most recent data from four areas: (1) everyday competence, (2) cognitive functioning, (3) social functioning, and (4) subjective well-being-related outcomes, depression, and adaptational processes. Thereafter, major insights related to the current state-of-the art psychosocial interventions with visuallyimpaired older adults are reviewed. I close with the need that the public health community should become more aware of and address the psychosocial needs of visually impaired older adults.

Aging well and the environment: toward an integrative model and research agenda for the future

PURPOSE OF THE STUDY

The effects of the physical-spatial-technical environment on aging well have been overlooked both conceptually and empirically. In the spirit of M. Powell Lawton's seminal work on aging and environment, this article attempts to rectify this situation by suggesting a new model of how older people interact with their environment.

DESIGN AND METHODS

Goals of the paper include (a) integration of the essential elements of the ecology and aging literature, particularly in regard to Lawton's research, (b) development of connections between traditional theories of ecology of aging and life span developmental models of aging well, (c) acknowledgment of the pronounced historical and cohort-related changes affecting the interactions of older people with their environment, and (d) discussion of the implications of this analysis for concepts and theories of aging well.

RESULTS

The model builds on a pair of concepts: environment as related to agency and belonging, founded in motivational psychology, and developmental science.

IMPLICATIONS

After describing the model's key components, we discuss its heuristic potential in four propositions for future gerontological research and identify implications of the model for future empirical research.

Intergenerational Shared Sites

Few studies have examined older adults’ behavior and attitudes within the context of intergenerational shared site (IGSS) environments, where children and older adults receive services at the same facility and typically share space and resources on an ongoing basis. This natural study examined the behaviors of older adults participating in two senior center programs that were co-located with child care facilities. Data collection involved participant observation and in-depth interviews with staff members at each IGSS. The data were systematically coded and analyzed for themes. Although positive informal intergenerational interactions occurred at both centers, many older adults demonstrated negative behaviors and attitudes when their programs shared space and/or relinquished resources to children’s programs. Implications for research and practice are provided.

Managing the patient with dementia in long-term care

The majority of residents in a nursing home have some degree of dementia. The prevalence is commonly from 70% to 80% of residents. This article covers the following topics on caring for patients with dementia in long-term care: (1) the efficacy of cholinesterase inhibitors and memantine, (2) the optimal environment for maintenance of function in moderate dementia, (3) the treatment of depression and agitation, and (4) the evaluation and management of eating problems.

The home environment and disability-related outcomes in aging individuals: what is the empirical evidence?

PURPOSE

Building on the disablement process model and the concept of person-environment fit (p-e fit), this review article examines 2 critical questions concerning the role of home environments: (a) What is the recent evidence supporting a relationship between home environments and disability-related outcomes? and (b) What is the recent evidence regarding the effects of home modifications on disability-related outcomes?

DESIGN AND METHODS

Using computerized and manual search, we identified relevant peer-reviewed original publications and review articles published between January 1, 1997, and August 31, 2006. For Research Question 1, 25 original investigations and for Research Question 2, 29 original investigations and 10 review articles were identified.

RESULTS

For Research Question 1, evidence for a relationship between home environments and disability-related outcomes for older adults exists but is limited by cross-sectional designs and poor research quality. For Research Question 2, evidence based on randomized controlled trials shows that improving home environments enhances functional ability outcomes but not so much falls-related outcomes. Some evidence also exists that studies using a p-e fit perspective result in more supportive findings than studies that do not use this framework.

IMPLICATIONS

Considerable evidence exists that supports the role of home environments in the disablement process, but there are also inconsistencies in findings across studies. Future research should optimize psychometric properties of home environment assessment tools and explore the role of both objective characteristics and perceived attributions of home environments to understand person-environment dynamics and their impact on disability-related outcomes in old age.

Psychologische Alternsforschung: Beiträge und Perspektiven

Zusammenfassung. In den demografischen Wandlungsprozessen unserer Gesellschaft liegen zahlreiche neue Herausforderungen und Chancen für die Psychologie. Die hierbei besonders angesprochene psychologische Alternsforschung sollte im Sinne einer bedeutsamen Querschnittsaufgabe der Psychologie begriffen werden. Einerseits nutzt die psychologische Alternsforschung neue theoretische und methodische Zugänge zur Untersuchung psychologischer Kernfragen und eröffnet neue Berufsfelder. Andererseits unterstützt sie die Vernetzung von Theorien, Methoden und Befunden aus verschiedenen psychologischen Disziplinen. Zuerst zeigen wir, wie meta-theoretische und methodische Innovationen innerhalb der psychologischen Alternsforschung in fruchtbarer Weise zur Psychologie beigetragen haben. Danach wird diese produktive Rolle der psychologischen Alternsforschung anhand des gegenwärtigen Forschungsstands in vier zentralen Themenbereichen ausdifferenziert: (1) Kognitive Leistungsfähigkeit, (2) Altern der Persönlichkeit als System von motivationalen und emotionalen Prozessen, (3) Altern in sozial-räumlichen Kontexten und (4) “Alte“ und “neue“ Entwicklungsaufgaben des Alterns. Schließlich gehen wir noch auf Anwendungsaspekte ein.

Relationships between housing and healthy aging in very old age

PURPOSE

The aim of this work is to examine the relationship between aspects of objective and perceived housing and aspects of healthy aging, defined as independence in daily activities and subjective well-being. Furthermore, this research examined the comparability of relationships between housing and healthy aging in the five European countries.

DESIGN AND METHODS

Data were drawn from the ENABLE-AGE Project, from home interviews with a sample of 1,918 very old people aged 75 to 89 years living alone in their own homes in Swedish, German, British, Hungarian and Latvian urban areas.

RESULTS

Participants living in better accessible homes, who perceive their home as meaningful and useful, and who think that external influences are not responsible for their housing situation are more independent in daily activities and have a better sense of well-being. Moreover, these results apply to all five national samples.

IMPLICATIONS

The findings can widen the perspective when striving for barrier-free building standards, to encompass a holistic approach that takes both objective and perceived aspects of housing into account. Home modification and relocation should not be prescribed, but need to be negotiated with older adults to take into account their personal preferences.

Relationships between objective and perceived housing in very old age

PURPOSE

Our purpose in this study was to explore relationships between aspects of objective and perceived housing in five European samples of very old adults, as well as to investigate whether cross-national comparable patterns exist.

DESIGN AND METHODS

We utilized data from the first wave of the ENABLE-AGE Survey Study. The five national samples totalled 1,918 individuals aged 75 to 89 years. Objective assessments of the home environment covered the number of environmental barriers as well as the magnitude of accessibility problems (an aspect of person-environment fit). To assess perceptions of housing, we used instruments on usability, meaning of home, and housing satisfaction. We also assessed housing-related control.

RESULTS

Overall, the results revealed that the magnitude of accessibility problems, rather than the number of physical environmental barriers, was associated with perceptions of activity-oriented aspects of housing. That is, very old people living in more accessible housing perceived their homes as more useful and meaningful in relation to their routines and everyday activities, and they were less dependent on external control in relation to their housing. The patterns of such relationships were similar in the five national samples.

IMPLICATIONS

Objective and perceived aspects of housing have to be considered in order to understand the dynamics of aging in place, and the results can be used in practice contexts that target housing for senior citizens.

The Impact of Assistive Device Use on Disability and Depression Among Older Adults With Age-Related Vision Impairments

OBJECTIVE

One can conceptualize adaptive technology as a resource used by disabled older adults in order to maintain competence in everyday life. This study examined the independent relationships between optical and adaptive device utilization and change in functional disability and depression among older adults with age-related vision impairments.

METHODS

We interviewed older adults (n = 438) with a recent vision impairment applying for vision rehabilitation services both pre-service and at the 6-month follow-up. We conducted hierarchical regression analyses with functional disability and depressive symptoms as criteria. In order to identify their independent direct effects, we entered optical and adaptive device use into the final step, preceded by Time 1 criterion scores, demographics, baseline disability or depression (depending on criterion), and total rehabilitation service hours.

RESULT

Optical, but not adaptive, device use was significantly associated with declines in functional disability and depressive symptoms over time.

DISCUSSION

We propose that these differential effects result from the fact that optical devices optimize residual vision and thus allow for greater continuity in the way tasks are accomplished (i.e., reading still performed visually), whereas use of adaptive aids (e.g., talking books) involves learning new methods in order to compensate for lost functions and thus is not as desirable either functionally or psychologically.

A Long-Term Perspective on Person-Environment Fit and ADL Dependence Among Older Swedish Adults

PURPOSE

This study described person-environment (P-E) fit and activities of daily living (ADLs) among older adults, and it explored the relationship between P-E fit and ADL dependence, testing Lawton's docility hypothesis at two points in time.

DESIGN AND METHODS

From a random sample of individuals aged 75-84 living in a Swedish municipality, 72 persons were available for baseline and follow-up interviews over a 6-year period. Interviews and observations were used for data collection at home visits.

RESULTS

P-E fit problems as well as ADL dependence increased from baseline to follow-up. Functional limitations and dependence on mobility devices increased; few changes were found concerning environmental barriers. At follow-up, ADL dependence and P-E fit correlated significantly in the frailest subsample.

IMPLICATIONS

In advanced age, P-E fit problems in housing are related to ADL dependence. The increase of P-E fit problems mostly results from functional decline, although to some extent it is from environmental changes as well. The methodology used demonstrates the potential to increase our understanding of how the main components of Lawton's model change and interact over time.

Dual Sensory Loss and Its Impact on Everyday Competence

PURPOSE

This study examined the relation of dual and single sensory impairments, within the context of cognitive function, by using the framework of everyday competence in terms of the probability of difficulty with specific personal and instrumental activities of daily living (ADLs and IADLs, respectively).

DESIGN AND METHODS

The Longitudinal Study on Aging, composed of individuals aged 70 and older in 1984 (N = 5,151), provided data for the present analyses. In each IADL and ADL domain, binary logistic regressions assessed the probability of difficulty associated with sensory impairment and cognitive status after sociodemographic and physical health covariates were controlled for.

RESULTS

One fifth of older adults reported dual sensory impairment, which was associated with greater IADL than ADL task difficulty compared with single sensory loss. Further, high levels of dual impairment were shown to increase the risk of difficulty in three of six IADL tasks (preparing meals, shopping, and using the telephone) over vision impairment alone. Overall, cognitive status was a significant predictor of both ADL and IADL difficulties, which was not expected from the everyday competence framework.

IMPLICATIONS

Findings highlight the importance of sensory resources for everyday competence and suggest the need for effective vision and hearing rehabilitation to assist older adults in improving or maintaining their functional independence.

[Development and perspectives of gerontological research: the sample case of housing research]

The present work addresses the historical development of environmental gerontology and housing research. Emphasis is placed on the development of ecological perspectives in gerontology as a research program, its scientific reception and acknowledgment in gerontology, the unfolding of housing-related theories and housing studies. Furthermore, the situation in Germany is juxtaposed against the situation in the US. As is found, between the 1930s and 1960 housing research gained substantial importance predominantly in the US as a consequence of the emergence of the field of social gerontology. There was however not much theoretical impetus from housing research on social and behavioral gerontology at large. In the time period between the 1960s and the mid 1980s many large-scale studies focused on housing in old age. At the same time, grand theories related to housing were introduced with the Ecological Theory of Aging (Lawton) as its flagship conception, able to have an impact on gerontology and its research guiding fundamental ideas (person-environment view of aging). Germany's social and behavioral gerontology saw during this time period the profound discussion of, as was frequently said, social-ecological approaches, while empirical studies tended to concentrate on institutions for the aged. Since the beginning of the 1990s dementia-related themes have largely been taken over as a driving force of North American housing research. In some contrast, gerontological housing research in Germany has strongly addressed the diversity of aging in the private household situation. In conclusion, housing research was important for gerontology in terms of the promotion of a person-environment perspective of aging on the conceptual and empirical level. This function should continue into the future.

Challenges of cross-national housing research with older persons: lessons from the ENABLE-AGE project

Although it is generally acknowledged that housing is a major issue regarding health in old and very old age, most empirical research still tends to treat the role of the housing environment in a rather superficial manner. The cross-national project Enabling Autonomy, Participation, and Well-Being in Old Age: The Home Environment as a Determinant for Healthy Ageing (ENABLE-AGE) seeks to make a substantial contribution to this shortcoming. The main objective of the project is to examine subjective and objective aspects of housing and their impact on health in very old age, while health is understood mainly in terms of autonomy, participation and well-being. The project involves five European Union member countries, i.e. Sweden (coordinating unit), Germany, the United Kingdom, Latvia and Hungary. The total sample includes 1,918 older adults in the age range of 75-89 years and living in single households. We provide a systematic analysis of major challenges coming with cross-national research in the housing and ageing domain based on the experience of the ENABLE-AGE Project. Treated are: challenges related to sampling and data collection procedures, challenges related to inclusion and exclusion criteria based on housing characteristics, challenges related to differences in housing legislation, norms, and guidelines, challenges related different availability of professional expertise for person-environment assessments, challenges related to valid and reliable person-environment assessments, and challenges related to the interpretation of housing-related findings.

Congruence Between Disabled Elders and Their Primary Caregivers

PURPOSE

This study examines the extent and independent correlates of congruence between disabled elders and their caregivers on several aspects of the caregiving experience.

DESIGN AND METHODS

Participants were 117 visually impaired elders and their caregivers. Correlational analyses, kappa statistics, and paired t tests were used to examine the extent of congruence. Hierarchical multiple regression analyses identified significant correlates of congruence on four target issues: elder's functional disability, elder's adaptation to vision impairment, caregiver's overprotectiveness, and caregiver's understanding of the vision problem.

RESULTS

Caregivers assessed elders as more disabled and rated themselves as more overprotective than did the elders. Although independent correlates varied by target issue, two domains most consistently influenced congruence across measures: the caregiver's assessment of the elder's status and quality of the relationship.

IMPLICATIONS

Findings underscore the importance of addressing congruence by target issue, rather than as a global characteristic of the caregiving relationship.

Adaptation to disability among middle-aged and older adults: the role of assimilative and accommodative coping

The purpose of this study was to investigate the links among coping, disability, and mental health among adults who are confronted with age-related vision loss. Drawing on the model of assimilative and accommodative coping (e.g., Brandtstädter, 1999), hierarchical regressions were designed to examine the effects of coping and disability on mental health. Participants were 55 middle-aged and 52 older adults who had been recruited from a community-based rehabilitation agency. Findings demonstrate a critical role of accommodative coping for adaptation, with beneficial effects on mental health that were more pronounced in the case of high disability for younger participants. Finally, findings suggest that dealing with disability may pose more of a mental health risk in middle than in late adulthood.

The German Center for Research on Aging at the University of Heidelberg: an interdisciplinary approach

In September 1995, the German Center for Research on Aging at the University of Heidelberg had been founded to become a leading national center of excellence with a clear interdisciplinary scope of ageing research activities. So far, three departments have been built up successively: the Department of Social and Environmental Gerontology (established in 1997, chair: Prof. Hans-Werner Wahl), the Department of Adult Development (established in 1998, provisional chair: Prof. Andreas Kruse), and the Department of Epidemiology (established in 2000, chair: Prof. Hermann Brenner). As one of the next steps, the disciplinary spectrum of the Center will be complemented by setting up several junior research groups in molecular ageing research. Within the few years of its existence, the Center has set up multiple large-scale, extramurally funded cross-sectional, case-control and longitudinal studies. These studies provide a unique common basis for interdisciplinary collaboration both within the Center and with the Center's numerous national and international research partners.

Conducting research on home environments: lessons learned and new directions

The study of home environments is a research domain within the field of environmental gerontology that addresses issues related to aging in place. Despite the importance of aging at home, there are few recent studies in this area and most are descriptive and lack theoretical direction. This article examines the current state of research on home environments from which methodological challenges and new directions for future research are identified. Three broad research queries are posed: What should we measure and why in home environments? How do older people and their family members use the home environment in health, illness, and caregiving? What are the interrelationships between the home environment, psychological well-being, and daily functioning throughout the aging process? Suggestions for future research on home environments are discussed and the implications for advancing environmental gerontology highlighted. Specifically, the home environment offers a testing ground for generic environmental constructs and their measurement as well as a unique setting from which new understandings and constructs of person-environment fit can emerge.

Environmental Gerontology at the Beginning of the New Millennium: Reflections on Its Historical, Empirical, and Theoretical Development

Over the past four decades the environmental context of aging has come to play an important role in gerontological theory, research, and practice. Environmental gerontology (EG)--focused on the description, explanation, and modification or optimization of the relation between elderly persons and their sociospatial surroundings--has emerged as a subfield in its own right. The aim of this article is to reflect on the historical, empirical, and theoretical development of recent EG, following Parmelee and Lawton's diagnosis from 1990 that there is a need to move the field beyond its current languishing state. From a historical perspective, EG has clearly played an important and successful role within the gerontology enterprise in terms of explicit consideration of the sociophysical environment in theory and research. A literature analysis of empirical studies supports the view that research has continued on a substantial quantitative level during the 1990s. Findings of these research studies address the whole diversity of classic EG research questions, but mostly in the sense of replication and extension. In terms of theoretical discussion, our analysis leads to the insight that EG may be described as a field high in conceptual aspiration ("world views"), but low with regard to making research and application-productive use of its theoretical achievements.

A German Research Program on the Psychosocial Adaptation to Age-Related Vision Impairment

The present paper argues that psychosocial adaptation in visually impaired older adults is substantially mediated by the use of control strategies. Our first research question against this general conceptual background is whether there are differences between visually impaired older adults and unimpaired older adults in control strategies or variables considered as major adaptational outcome variables in the behavioral and emotional domain. Our second research question addresses the kind of relations between control strategies and outcomes in visually impaired older adults. The findings are based on a sample of N = 90 visually impaired older adults (mean age: 79.5; 64 women, 26 men; all suffering from age-related macular degeneration; visual acuity less than 20/70) as well as a reference group of N = 35 unimpaired older adults. All participants underwent a standardized psychological assessment program based on internationally well-established measures. Findings support the notion that differences between the visually impaired and the unimpaired are most pronounced in behavioral indicators such as activities of daily living and leisure activity level, while control strategies were different in only one instance, pointing to a stronger tendency in visually impaired persons toward compensatory control efforts. Furthermore, selective control, which is investing time and effort to change one's environment, covaries most strongly with behavioral outcomes, while selective control aimed to strengthen the motivational commitment to important life goals covaries most strongly with emotional adaptation. The results generally illustrate the heuristic fruitfulness of psychological control theory in understanding adaptation in visually impaired older adults.

Use of memory compensation strategies is related to psychosocial and health indicators

Research has shown that psychosocial and health characteristics may affect older adults' cognitive performance, self-referent beliefs, and general adaptive resilience. Are such characteristics related specifically to older adults' reported efforts to compensate for memory losses? The Memory Compensation Questionnaire (MCQ) measures 5 mechanisms of everyday memory compensation as well as 2 general aspects of compensatory motivation and awareness. Correlates were derived from indicators of specific health conditions, subjective health ratings, personality, well-being, and memory self-efficacy (MSE). All measures were administered to a cross-sectional sample of 528 healthy older adults between 55 and 94 years of age from the Victoria Longitudinal Study. Specific health composites (i.e., infirmities, respiratory illness), several personality dimensions (e.g., agreeableness, neuroticism), negative affect, and low MSE were associated with more frequent use of everyday memory compensation strategies. Linking healthy older adults' cognitive resilience with individual characteristics is an important contribution to emerging conceptions of adaptation and success in late life.

Conducting research with visually impaired older adults

Due to the frequency of eye disorders among older adults, qualitative researchers who involve older individuals in their work must be sensitive to the multiple ways in which visual deficits can influence the research process. The author addresses some of the difficulties encountered, insights gained, and strategies developed while conducting a phenomenological study in which all the participants were severely visually impaired. The author's insights, drawn from personal experiences, reflections, and log entries kept throughout the study, are shared to help other researchers design and implement studies in which the voices of individuals with severe visual impairments can be skillfully tapped.