Using Ecological Frameworks to Advance a Field of Research, Practice, and Policy on Aging-in-Place Initiatives

Abstract

Initiatives to promote aging in place have emerged rapidly in the United States across various health care settings (e.g., acute care hospitals, skilled nursing facilities) and broader community settings (e.g., public social service agencies). Moreover, recent federal policies include a growing number of provisions for local efforts to promote aging in place. Despite emerging bodies of research that have described singular initiatives in their own right, there has been very little scholarship that forges conceptual linkages across this increasingly vast domain of research, practice, and policy. Integrative theory development is critical to ensure that aging-in-place initiatives do not become fragmented from each other. This article uses insights from ecological frameworks-specifically Urie Bronfenbrenner's bioecological systems theory and M. Powell Lawton's general ecological model of aging-to conceptualize a range of programs as aging-in-place initiatives and for describing their similarities and differences, particularly in terms of the features through which they intend to promote aging in place. Theoretically derived dimensions along which to characterize aging-in-place initiatives include environment-focused aspects (e.g., the types of social systems and structures that the initiatives target for change) and person-focused aspects (e.g., the extent to which the initiatives target particular subgroups of older adults). The article concludes with a discussion on how these theoretically derived dimensions can be used to advance and integrate research, practice, and policy to systematically develop and expand aging-in-place initiatives.

Variation in Older Adult Characteristics by Residence Type and Use of Home- and Community-Based Services

“…The physical (built) environment has been identified as an important contributor to HCBS use [20,21,22]. For example, HCBS use varies substantially across housing types based on service availability, accessibility, and geospatial proximity.…”

Comparing behavioral health models for reducing risky drinking among older male veterans

“…Perhaps factors unobserved in our study such as variations in treatment fidelity, patient–provider ratios, urban and rural locale, number of participants residing in remote areas, specific geriatric services, and attrition across sites partially accounted for our nonsignificant findings. Aging-in-place services and technologies (51) in local communities and civilian health systems within and between Veteran Integrated System Networks (VISN) may also differ, which are other system-level factors that may result in VAMC site variation. Older male veterans may also receive additional health services in civilian health systems because they are dual health care users (i.e., VA and Medicare and/or Medicaid coverage)—a factor which may also influence patient outcomes and vary by VISN and VAMC.…”

Improving housing outcomes: the value of advice and support for vulnerable older people

“…The research drawn upon in this paper uses qualitative methods as a way to complement existing quantitative research on why older people stay put or move (Kahana et al 2003;Erickson et al 2006;Greenfield 2012;Baumker et al 2012). As Baumker et al (2012) note, 'older people move for a complex combination of reasons that are not necessarily discernible with quantitative methods' (pp.…”