Ageing and Place

Gavin J. Andrews, David R. Phillips

• Publisher: Routledge
• Year: 2004
• eBook ISBN: 9781134361373
• Edition: 1
• Topic: Physical Sciences
• Subtopic: Geography
• Index: Geography

During recent years, an increasing amount of academic research has focused on older people with a particular emphasis on settings, places and spaces. This book provides a comprehensive review of research and the policy area of 'ageing and place'.

An insightful book on an important topic, Andrews and Phillips have together edited a valuable information and reference source for those with interests in the spatial dimensions of ageing in the twenty-first century. Ranging from macro-scale perspectives on the distribution of older populations on national scales, to the meaning of specific local places and settings to older individuals, on the micro-scale, the book spans an entire range of research traditions and international perspectives.

1
GEOGRAPHICAL STUDIES IN AGEING
Progress and connections to social gerontology

Gavin J. Andrews and David R. Phillips

The study of ageing has traditionally been wide ranging, involving social scientific and health and social care professional disciplines. It is possible to question the extent to which these disciplines have communicated and combined their efforts in true inter-disciplinary fashions. Still, the academic study of ageing has not lacked sustained and wide-ranging attention and has especially benefited in recent years through the multi-disciplinary study of social gerontology (Hooyman and Kiyak, 2002). One consequence is that it is possible to identify a range of disciplinary perspectives on ageing. These may be related to older people’s use of, and relationships with, particular housing types or social care and health services. They may also be related to features of older people’s social, economic and cultural lives. Cross-cutting both of these disciplinary and subject contexts, older people’s relationships with their environments have been a sustained field of research interest.

Most recently, the concern in ageing research for environment, space and place has become even more widespread. Two reasons may be suggested for this. First, this interest may be part of a wider emphasis on place as a central focus of investigation within a range of social science disciplines. Indeed, as part of cultural turns, many social sciences have recently undergone what may be termed ‘spatial turns’ and have increasingly embraced the importance of space and place and how they may impact on, and represent, human experiences, behaviour and activity. Moreover, place has increasingly been conceptualised not only in a physical sense, but as a complex symbolic and cultural construction. Second, and more practically, academic interest in space and place has also been motivated by unprecedented demographic, social, fiscal and technological changes that have impacted simultaneously in many countries (McKeever and Coyte, 1999). Indeed, these are well documented, and include rapidly ageing populations, changing kinship relationships and responsibilities, an ever broader range of health and social care and increasingly limited resources with which to provide it. Together they have radically altered, and broadened, both the ways and the places in which health and social care is provided. Importantly, change has meant that the health care system is no longer hospital-based, discrete and bounded, but diffuse. Health care sites now include virtually every setting where human beings reside in, frequent and, importantly, live in (McKeever and Coyte, 1999). Being substantial recipients of welfare and care services, and a social group particularly vulnerable in economic and social change processes, older people have often experienced these changes most acutely. Researchers of older people from a range of disciplines have therefore, almost by implication, found themselves investigating, comparing and conceptualising a wide range of social care, health care and residential settings.

Early beginnings

Just as the study of ageing is multi-disciplinary, so too is the study of ageing and place. Indeed, studies which specifically explore space and place and bring them to the fore in their analysis have originated not only from the more obvious academic disciplines of social and health geography, environmental psychology and architecture, but also from a range of other social science disciplines including sociology, social policy and health economics, together with professional disciplines including public health, nursing, occupational therapy and social work research. In this chapter we briefly outline changing geographical perspectives, but with a view to locating them within the wider multi-disciplinary endeavour of ageing and place research.

The early origins of geographical gerontology can be traced through a small number of key studies and commentaries. The first substantive geographical study on ageing was published over 30 years ago. The Residential Location and Spatial Behavior of the Elderly (Golant, 1972) focused on the spatial behaviour of older people in Toronto, Canada, and on local demographic trends and population distributions, local transport and housing issues and activity levels. Golant’s later work A Place to Grow Old: The meaning of environment in old age (Golant, 1984), bridged early geographical, ecological and psychological disciplinary perspectives on older age, and certainly set the agenda for geographical gerontology to be a sub-discipline highly connected to others. Particular subsections focused on the behavoural relationships between older people and their environments, territorial environment experiences, physical environment experiences and social environment experiences. Certainly the best-known and most frequently cited early work in geographical gerontology is Prisoners of Space? Exploring the geographical experience of older people (Rowles, 1978). Notably, this is also a very early example of geographical gerontology to use qualitative research methods. The research described in depth the lives of five older persons living in a working-class neighbourhood of a North American city and investigated their very different responses to growing old over a two-year period and how this is connected with their local environmental context. Engaging critically with other disciplines, the book was the first to argue that older persons’ environmental experiences were far more complex than the progressive spatial restrictions described by psychologists in classical disengagement theory and its derivatives (see chapter 9). Five years later, Graham Rowles co-edited another influential book with Russell Ohta, Aging and Milieu: environmental perspectives on growing old (Rowles and Ohta, 1983). Similarly ahead of its time, it introduced many new issues to ageing research, including foci on clinical and therapeutic environments; the relationship between time, space and social activity; the meaning of community and neighbourhood; experiences of ageing in rural environments; environmental learning and adaptation; the meaning of place in old age; sex roles and social environment; and the role of place in age stereotyping.

Geographical gerontology began to develop as a distinct and recognisable sub-discipline in the early 1980s and at about the same time as Geographical Perspectives on the Elderly was edited by Tony Warnes (Warnes, 1982). This collection was the first to bring together applied geographical research based in a number of countries. With foci predominantly on the distributive features of older population and services for the older population in space, the book very much reflected the theoretical and methodological priorities of the parent discipline of human geography at the time. Particular chapters focused on issues including population movement, retirement migration, specialised housing, activity patterns, travel difficulties and the distribution and planning of service provision. Over the past 20 years Tony Warnes has continued to make many other influential contributions to, and pioneer, geographical gerontology. In particular, his later edited book Human Ageing and Later Life: Multidisciplinary perspectives (Warnes, 1989) brought together a range of perspectives from health psychology, medical and social geography and social gerontology. Moreover, Tony Warnes’ positions outside geography as head of a gerontology research centre and as editor of the journal Ageing and Society have helped to make geographical gerontology visible to a wider academic audience.

The early 1980s also witnessed the commencement of dedicated progress reports and agenda-setting papers in geographical gerontology published in the journal Progress in Human Geography. Rowles (1986) reported that geographical research on ageing had flourished but had, to that time, been relatively descriptive in terms of concentrations of ageing population, migration and service delivery. He explained this as an information accumulation phase that precedes the emergence of a dominant paradigm in any new field of research or sub-discipline. Attempting to set a cohesive and comprehensive agenda for geographical gerontology, Rowles’ focus was on ageing from a transactional perspective, instead of describing older people as a group, emphasising the relationship between the older person (individual) and their environment. Rowles both reviewed and called for research on the meaning of place and place memories and, in particular, on home. Finally, he called for a greater appreciation of the diversity of environmental contexts in which older people reside and for a greater appreciation of different ages of older persons and different cultures of older persons. The types of place and context included retirement communities, neighbourhoods, retirement homes and migration locations. Notably, he commented that gerontologists had long been taking such perspectives, albeit without explicit geographical foci.

Shortly after, although not necessarily conflicting in his view, Warnes (1990) took a different perspective by reviewing the contribution of geographical gerontology to gerontology and developing an agenda which could maximise this contribution. From the outset, Warnes described this as an uneven contribution and argued that geographers needed to shift their priorities and objectives away from servicing human geography and onto social gerontology and the needs of older people. For Warnes, the most important objective of social gerontology is, in the face of public misunderstanding and stereotyping, to increase human understanding of the ageing process. Warnes highlighted three issues which had not been given enough attention by geographers: the global evolution in demographic ageing and its implications, locational dimensions in the circumstances of older people’s lives and temporal change in the interaction between the environment and older people.

The latest progress report on geographical studies in ageing was published almost one decade ago (Harper and Laws, 1995). While Harper and Laws’ report makes it clear that some of the issues had been addressed within these broad areas in the preceding five years, it reaffirmed that geographical gerontology remains low-profile and a limited research endeavour. Furthermore, counter and in contrast to Warnes, the authors argued for geographical gerontology to learn theoretical and methodological lessons from human geography and that this would open new possibilities for the geographical study of ageing. The authors went further and argued that these may provide approaches that even gerontologists (non-geographers) might find useful. Harper and Laws critiqued geographical gerontology for continued empiricism, for the dominance of positivistic approaches and for using a general and unproblematic notion of ‘old’, and for not exploring the causes and nature of age segregation. The authors argued for the greater use of social theory, as has been used by cultural geography, in particular in the areas of political economy, gender roles, sterotypes and the role of the state in service provision, and argued for attention to postmodern life courses through postmodern research perspectives. More generally, regardless of whether geography or gerontology is the more ‘critical’, ‘radical’ or ‘postmodern’, the differences in emphasis between Warnes’ commentary and that of Harper and Laws reflects a wider tension and predicament for many geographical gerontologists regarding what discipline to speak from and to – to be a geographer who studies older people or a gerontologist who takes a geographical perspective.

Current perspectives

Almost ten years on from the last review published in Progress in Human Geography, we can briefly reflect on current perspectives and theory in geographical gerontology. Following one of the more established research traditions, research has continued to consider demographic transitions and spatial distributions of older people within international and national contexts (Bartlett and Phillips, 1995; 2000). Migration patterns of older people have continued to be an important focus and the specific socio-spatial trend of ‘retirement migration’ has also been researched more expansively to consider migration across national borders (King et al., 2000). In this respect, research had answered both Rowles’ and Warnes’ more traditional requests. However, research has been more expansive and spatial distributions of older populations have also been contextualised in terms of changes in family interactions and cohesiveness over time, and the increased spatial separation of family members (Lin and Rogerson, 1995; Greenwell and Bengston, 1997). Another established research tradition again answers Rowles’ and Warnes’ requests and continues to examine the spatial allocation and use of resources provided by both the private and public sectors, specifically for older people. In particular, the distribution of home-based social care facilities and residential accommodation on the national (Smith and Ford, 1998) and regional scales have been the main foci of this research. These perspectives however have been refined and updated, and the distribution of social care provision for older people has been contextualised in terms of market regulation (Bartlett and Phillips, 1996) and the wider political economy of health and social care ( Joseph and Chalmers, 1999; Andrews and Phillips, 2000; 2002). Older people’s own experiences of residential settings have also demanded attention, and certain studies provide insights into residential home life (Higgs et al., 1998). Consistent with an international policy emphasis on community-based care, are an emerging number of studies which focus on older people’s own homes as new sites of health care consumption (Wiles, 2003a; 2003b) and other support services (Andrews et al., 2003). Taking a novel approach, uses of complementary and alternative medicine have also become an interest and how older people have gained empowerment and health benefit through what are heavily emplaced experiences in the community and home (Andrews, 2002a; 2003).

Another strand of research is concerned with older persons’ personal and evolving relationships with places and spaces. Much of this more recent research has considered the environmental constraints affecting older people’s access to services ( Joseph and Hallman, 1998; Stainer, 1999). Also investigated are the problems encountered by older people in both urban and rural living environments, and the consequences for local planning and wider social policy (Bartlett and Phillips, 1997a; Cloutier-Fisher and Joseph, 2000). Increasingly attention is paid to the immediate environmental components that affect older persons’ abilities to achieve successful ageing and in the context of constraints (personal and environmental) (Phillips et al., 2004). Indeed, internal environments in the home are, for example, increasingly recognised as imposing constraints and often offering hazards and allowing accidents to occur (Carter et al., 1997). More generally, environment and ageing are now key planning issues in many rapidly ageing countries, for example in the Asia–Pacific region, where interest extends to interactions with long-term care, housing and other areas of social policy and service provision (Phillips, 2000; Phillips and Chan, 2002). The planning aspects of urban expansion, urban renewal and redevelopment have also become key foci in such areas (Phillips and Yeh, 1999). Meanwhile, the concept of ageing-in-place has been analysed as a complex geographical process (Cutchin, 2003).

These above areas of emerging research have started to address Rowles’ early concerns for emphasis in research to be placed on the meaning of place and on individuals. However, despite these developments, a pertinent question is whether or not research has addressed Harper and Laws’ more recent requests for postmodern perspectives, the integration of social theory and perspectives from cultural geography. If anything, however, despite a small number of exceptions (for example, Cutchin, 2003; Wiles, 2003a; 2003b), during the past decade social gerontologists have been most active in integrating sophisticated theory in ageing and place research (for example, Kontos, 1998). This has been undertaken quite independently from mainstream debate in cultural geography. Indeed, research considers the way that various forms of media are involved in imaging of ageing and place (Blaikie, 1995; 1997; Featherstone and Wernick, 1995), how particular sites of older people’s care hold strong cultural and symbolic meanings for older people (Hockey et al., 2001), inform societal attitudes of older age (Gubrium and Holstein, 1999) and are associated with negative images and stigma (Bytheway, 2003). Indeed, ironically, Harper and Laws’ requests have not been fully explored by geographers and an important question for the future remains the potential for geographers to follow the lead of social gerontologists and develop their own postmodern and critical geographical gerontology. Given the emergence of critical perspectives and social theory in geographies of care, caring and the body (Parr, 2002; 2003) and in geographies of disability (Butler and Parr, 1999), the potential for such has clearly been signposted elsewhere in geography.

At the time of writing, the Tenth International Symposium in health geography had recently been held in July 2003 at Manchester, UK. Notably, Mark Rosenberg’s opening keynote address called for health geographers to take age and ageing much more seriously in their research. Rosenberg’s calls were based on a simple observation: that although some innovative research on ageing had occurred in health geography, the volume and range of work does not reflect the varied challenges that ageing populations pose to health and welfare services worldwide. His comments were verified at the conference in that although many later papers connected with ageing indirectly (older people being a proportion of service users or patients) only three of over 100 papers dealt directly and specifically with ageing as a distinct subject. To speculate, one might expect to find the same lack of attention to ageing in social and cultural geography conferences and significantly more attention to space, place and settings at social gerontology conferences. Arguably, then, although much progress has been made, many challenges remain for the future, both in terms of geographical issues to be studied and theories that are applied and developed to study them. This book indicates the range of issues and perspectives at the heart of such a project.

2
PLACING AGEING
Positionings in the study of older people

Robin A. Kearns and Gavin J. Andrews

Ageing is not only an embodied process but is emplaced as well.

(McHugh, 2003: 169)

Introduction

Two trends have signalled an integration of research on ageing and research on place within recent scholarship: a placement of geographical work within the broader field of health geography, and the embracing of the fundamentally geographical theme of place by researchers in other disciplines. This chapter selectively reviews the recent shifts in thinking among geographers that have – at least in name – transformed medical geography and brought with them new possibilities for incorporating concerns with ageing into geographical scholarship. Such shifts led to a reconceptualised ‘health geography’ and have involved a philosophical and empirical distancing from concerns with disease and the interests of the medical world. The net result has been the deployment of a sharper focus on people’s situated well-being often invoking social models of health and health care. These moves within geography over the last 15 years have occurred contemporaneously with a key shift beyond geography, as suggested: the increasing centrality of place within research elsewhere in the social sciences. Given these contexts, this chapter reviews ways in which research on ageing and place can be interpreted through the lens of a medical geography, recently revitalised through a health orientation. First, the centrality of place in health geography is considered. Second, three key sites in the geography of ageing are examined: the body, the home and the institutional setting. Third, the application of the more generalised concept of ‘landscapes of ageing’ is considered. A short set of conclusions closes the chapter.

The centrality of place within health geography and ageing research

Just as birth gradually became the domain of doctors and hospitals through the twentieth century, so too the daily experience of ageing, and changing health status in older age, have tended to become medicalised. Reflecting a broader problematising of older age within society, much research on geographical aspects of ageing has conventionally been ‘placed’ within medical geography. Indeed. the sub-discipline of medical geography has traditionally been divided according to health status and service characteristics and most geographical research on older age has fallen under the latter category. Through the 1990s, however, a variety of critical research perspectives, involving political–philosophical standpoints (e.g. feminism) and methodological approaches (i.e. the qualitative ‘turn’), highlighted an over-emphasis in research on disease and disease services. The resulting move towards a ‘post-medical geography of health’ (Kearns, 1993) was an attempt to be informed by both political and post-structural perspectiv...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Figures and Tables
• Contributors
• Introduction
• 1: Geographical Studies in Ageing Progress and Connections to Social Gerontology
• 2: Placing Ageing Positionings in the Study of Older People
• 3: Multi-Disciplinary Configurations in Gerontology
• 4: International Demographic Transitions
• 5: Residential Homes From Distributions in Space to the Elements of Place
• 6: Home As A New Site of Care Provision and Consumption
• 7: Healthy Ageing in the Community
• 8: the Physically Ageing Body and the Use of Space
• 9: Environment and Psychological Responses to Ageing
• 10: Ageing in Rural Communities Vulnerable People in Vulnerable Places
• 11: Ageing and the Urban Environment
• 12: Imagined Landscapes of Age and Identity1
• 13: Cataloguing old Age
• 14: Making Space for Identity
• References