Adaptive strategies after health decline in later life: increasing the person-environment fit by adjusting the social and physical environment

Abstract

Following the press-competence model (PCM) of Lawton and associates, we tested two expectations as to the adaptations older adults make to their socio-physical environment following health decline: (1) depending on the change in their functional limitations, older adults use adaptive strategies ranging from mobilizing informal care to moving into a residential setting; (2) the more people succeed in realizing suitable adaptations, the higher their wellbeing, measured as depressive symptoms, after a health decline. Data come from two waves of a longitudinal study among Dutch people aged 60-85 and living independently at baseline (Longitudinal Aging Study Amsterdam, LASA). The 819 respondents with a decline in selfreported functional disability within 3 years time were selected for analysis. Results of multivariate logistic and regression analyses show that (1) all adaptive strategies under study occur in response to health decline; (2) mobilization of informal care and moving to a care setting alleviates the negative eVect of health decline on depressive symptoms. Furthermore, mobilization of professional home care was associated with more depressive symptoms independent of health decline, whereas adjustment of the home had no eVect on depressive symptoms. We argue that some support was found for Lawton's PCM, but that evidence can be improved by studying more closely which adaptive strategies alleviate the environmental stress induced by speciWc physical disabilities.

Negotiating and effectuating relocation to sheltered housing in old age: a Swedish study over 11 years

“…One testimony to the validity of our findings is that health decline appeared as a major indicator for relocation to sheltered housing in old age, as demonstrated by others (Castle 2001;Cheek et al 2006;Larsson et al 2006;Svidén et al 2002;Thomése and Broese van Groenou 2006). Further, our findings confirm that relocation is closely related to perceptions of home and health (Fänge and Dahlin Ivanoff 2009), and shed light on how very old people themselves reason about these issues.…”

“…Declining health is an important predictor of relocation to sheltered housing in old age (Puts et al 2005; Thomése and Broese van Groenou 2006), especially dementia (Bharucha et al 2004). Moreover, declining health in combination with other factors, such as age and/or sex, cohabitation or not (Nuotio et al 2003;Tomiak et al 2000) are important.…”

De Longitudinal Aging Study Amsterdam: een overzicht van 17 jaar onderzoek naar verandering in dagelijks functioneren

“…58,59 Gevoelens van depressiviteit bleken af te nemen als ouderen na achteruitgang in lichamelijk functioneren werden opgenomen in een zorginstelling. 60 Functieverlies beïnvloedt ook het sociaal functioneren: netwerken worden kleiner, mensen ontvangen meer instrumentele steun maar geven minder, en de sociale participatie neemt enigszins af. 61,62 Vooral sportieve activiteiten hebben te lijden onder lichamelijke achteruitgang.…”

A brief report on an action learning group exploration of how older people adapt to change in later life

“…However, alterations in functional ability, social networks, socioeconomic factors and other demographic changes frequently have a negative impact upon the quality of life reported by those in later life 3,4,5,6,7,8 .…”

“…When this was not possible, having established primary or secondary (cognitive adaptation) 5 control and influence over informal care 8 and/or external help and services 3,6,26 was seen as an important component of maintaining a good quality of life.…”