Local environments and older people's health: Dimensions from a comparative qualitative study in Scotland
Introduction
The population of the developed world is ageing. In 2005, 17.4% of the population of Western Europe and 12.4% of North America were aged 65 and older; by 2020 these figures are projected to be 21.3% and 16.1% (United Nations, 2005). Whilst a minority of the older population reside in hospitals and care homes, the great majority continue to live in the wider community until their very final years; indeed, this is the option generally preferred by both the individual and the state. It is therefore imperative that our communities are planned and designed in a way that facilitates the health and well-being of this significant sector of the population.
That said, it is also essential to recognise that older people are not a homogeneous group (Golant, 1984, Daatland and Biggs, 2006). Physical ageing is a process that starts in our earliest years and happens at different rates and with different outcomes, depending on a myriad of circumstances and choices over the life course. Nevertheless, as a group, older people (defined by the World Health Organisation as aged 60 and over) are more likely to experience a range of health-related changes and challenges, with the likelihood of these increasing with increasing age: immunity to infectious disease is lowered (Pawelec, 2006); the incidence of many chronic illnesses including cardiovascular disease, cancer, and diabetes increases (World Health Organisation, 1998, World Health Organisation, 2003); senses become impaired (WHO, 2003); muscle strength and the range of motion in joints decline with age (WHO, 1998, Schultz, 1992); and disturbances in gait are more common (Imms and Edholm, 1981), making older people more prone to falls (Lord et al., 2001). Additionally, circumstances such as restrictions in activity and the loss of friends and partners can pose challenges to mental health: depression, although not an essential feature of ageing, appears to be a not uncommon experience (Beekman et al., 1999; Help the Aged, 2007).
Given the range of physical changes that tend to accompany ageing, it is to be expected that older people might, as a cohort, be especially sensitive to their physical surroundings (Robert and Li, 2001; Glass and Balfour, 2003). Further, it is likely that the context of the residential neighbourhood will have a greater impact on older people relative to other age cohorts, as people tend to spend a greater proportion of their lives closer to home as they age (Rowles, 1978; Golant, 1984; Kellaher et al., 2004; Phillips et al., 2005). For these reasons, the need to pay attention to older people's environments may be understood as an environmental equity issue: there is a need to ensure that the neighbourhood environment does not impact most negatively on its older residents. Such an inequity, occurring within any given locality, may be additional to any inequity that occurs between places. This article is concerned in part with both these dimensions.
Section snippets
Older people, neighbourhoods, and well-being
Conceptual models in environmental gerontology and associated work recognise that the ability for older people to function in their living environments is an outcome of the dynamic between the competencies of the individual and the demands of the specific environment (Lawton, 1980, Lawton, 1982; Carp, 1987; Glass and Balfour, 2003; see also Verbrugge and Jette, 1994 on the disablement process). As Glass and Balfour (2003) usefully note, the environment may challenge competence but may also
Case study areas
Data for this study were gathered in three different case study areas in the Glasgow and Strathclyde region of Scotland, between July 2005 and June 2006. The three areas were selected in order to provide examples of different types of local urban environment, covering an inner urban area, a suburban neighbourhood, and a Small Coastal Town with a rural hinterland. They also reflect a range in terms of levels of community socio-economic status. For all three areas, the proportion of the
Methods
In each of the three case study areas, data collection made use of interviews and field observation. After visiting each area, local community groups whose members included senior citizens, for example lunch clubs, senior citizens’ social clubs, and voluntary organisations, were contacted. Through these contacts, individuals were recruited for one-to-one interviews; interviewees were then asked to recommend acquaintances as further participants. Care was taken that participants were not all
A healthy outdoor environment is clean and free from pollution
a healthy place …. I suppose clean, fresh air
[Woman, 80s, Coastal Town]
The importance of air quality was one of the first points raised by many research participants, in talking about connections between environmental conditions and health. This was common to all study areas. Fresh air was believed to be good for people in general, with sea air viewed as particularly pleasant and beneficial to health. Assessments of the local air quality however differed between the three places. In the Coastal
Discussion and conclusions
Working from the discussions with older people and with further evidence from observing their practices, it has been possible to identify several dimensions of the local outdoor environment that they experience, and theorise, as impacting on their health, for better or for worse. These dimensions have been summarised here as cleanliness, peacefulness, exercise facilitation, social interaction facilitation, and emotional boost. An environment that is poor on any of these dimensions will
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