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Ageing out of place: The meaning of home among hispanic older persons living in the United States
Abstract
Aim:
To explore the meaning of home among older Hispanic immigrants who are "aging out of place."
Background:
Emerging evidence supports the concept of older persons ageing in place. Nurse researchers have demonstrated that older person who age in place have better physical, psychological and cognitive outcomes. Less, however, is known about older persons who are "aging out of place," meaning out of their country of origin. With the growth of home health care, there is a need to understand the older immigrants' meaning of home when ageing out of their country of origin.
Design and method:
An inductive, qualitative descriptive research design was used. Seventeen Hispanic participants, ranging in age from 65 to 83 years were interviewed using a semi-structured interview protocol.
Findings:
Two major finding of the study focused on participants' descriptions of home in their country of origin and in the USA. The majority of participants described their home in their native country as the community, countryside or town (pueblo) and in the U.S.A. as family. The level of social isolation and loneliness among participants was evident.
Conclusions:
Older Hispanic immigrants who are "aging out of place" integrate their past experiences of sense of place in their native country with their present experiences of home in the USA. The need to understand the role of the community and the family in the provision of nursing care in the home may be more important than the physical structure or setting in which it is delivered. Further intra- and cross-national studies are needed to provide a framework for understanding the issues of ageing and immigration globally.
Implications for practice:
Gerontological nurses need to recognise the complexity of family relationships for older Hispanic persons who are ageing out of place of origin and their risk of depression, social isolation, and loneliness.
... As Easthope (2004) and others have argued, "home" as a concept cannot simply be defined but rather must be explained as it is understood by different people in various cultural contexts. As such, recent literature on the meaning of home has begun to explore underrepresented populations (e.g., Curtin et al. 2017;Elwood 2000) to include homes for people who are economically disadvantaged (e.g., Mee 2007;Tester and Wingfield 2013;Wiles et al. 2012). ...
Despite a sizable literature on home and “place” in later life, few works have specifically focused on the intersection of home, “place,” ageism, and racism. Here, we therefore explore this intersection through a case study of Mr. M., a 69-year-old African American man living in Baltimore, Maryland. Mr. M described a lifetime of experiences with racism and later, ageism, that affected his everyday experiences with home and place. In his earlier life, he described being viewed as less capable by others because of his race. Later, he experienced ageism in his age-segregated public housing complex, where staff exerted control over his day-to-day life and often treated in childlike manner. Although the city provided Mr. M. with some important freedoms (e.g., choice of restaurants, attending a concert), racism and ageism were still present. Overall, the case offers important insight into some of the complexities of home and place and provides some early groundwork for future research.
... with which they have formed deep-rooted attachments (Curtin et al., 2017), to respond to the exigencies of their immigrant adult children. ...
Immigrating and aging in a foreign environment, or aging out-of-place, is part of the late-life experience for a growing number of older adults. Examining how everyday occupations are part of late-life immigrants’ relationships to multiple places, cultures, and identities can expand upon scholarship addressing immigration in occupational science. This phenomenological study explored how Sinhalese late-life immigrants to Canada connect and engage with places through aging processes, centering the essentiality of daily occupations within such engagement. An interpretive paradigm and a hermeneutic phenomenological approach, informed by the work of van Manen (1984 van Manen, M. (1984). “Doing” phenomenological research and writing: An introduction. The University of Alberta. [Google Scholar], 1997 van Manen, M. (1997). Researching lived experience: Human science for an action sensitive pedagogy (2nd ed.). Althouse Press. [Google Scholar]), guided the inquiry. Two phenomenological interviews were conducted with 10 Sinhalese late-life immigrants who immigrated to Canada within the last 10 years. Grounded in a transactional perspective, the theoretical concept of place integration was used as a lens through which to interpret how late-life immigrants establish relationships to the post-migration context through occupation. The essence of the aging out-of-place experience is elaborated through the presentation of four themes; 1) surrendering occupational roles and meaningful occupations, 2) feeling like an alien, 3) building a sense of continuity through occupation, and 4) integrating into place through occupational change. Sociopolitical forces and scarce interactions with the host society were unique place-based challenges in the aging out-of-place experience that threatened participants’ possibilities for action. Study findings highlight the centrality of occupation in the place integration process and illuminate the intersections between person, environment, and occupation.
... It is important to understand how AOP affects the health and well-being of older adults, as well as the potentially significant policy implications. Curtin et al. (2017) explored the meaning of home to a group of Hispanic older adults living in the United States: when talking about home in the context of their country of origin, these respondents thought of the wider community that they lived in; however, when asked about what home means to them in the United States, they narrowed their definition to their immediate family and relationships instead. The authors proposed that the lack of social relationships in the new community likely contributed to feelings of isolation and loneliness, thus affecting their quality of life. ...
... To keep their health is quite important not only for older people living outside of their native country but also every older person. However, once they have chronic diseases, they face many barriers such as language, difference of culture, and discrimination [29,30]. Since they are a minority compared with native older people, a supportive system is needed from their country. ...
This study aimed to establish the quality of life and mental health status among older Japanese people living in Chiang Mai, Thailand. We conducted a questionnaire survey among Japanese retired people aged 50 years or over who had been living in Thailand. The questionnaire covered socio-demographic variables including health status and ability to communicate in Thai. We measured mental health status using the Japanese version of the General Health Questionnaire-28 (GHQ-28) and quality of life using the Japanese version of EuroQOL-5D-3L. We explored the factors associated with poor mental health and quality of life using logistic regression analysis. In total, 96 (89.7%)participants provided complete responses. Overall, quality of life was generally good, although those with one or more chronic diseases reported significantly lower quality of life. Having one or more chronic diseases and being aged 70–79 were significantly associated with poorer mental health. In total, 21 (21.8%) respondents had a possible neurosis, which was defined as a total GHQ-28 score of more than 6. The logistic regression analysis showed a significant association between possible neurosis and the presence of chronic diseases (adjusted odds ratio: 11.7 1). Quality of life among older Japanese people living in Chiang Mai was generally good, but there was a high level of possible neurosis, especially among those with one or more chronic diseases.
... While they expressed negative attitudes towards nursing homes, most of the women did not have any reservations about using services aimed at relieving the household of some tasks. The norm of family members acting as carers is increasingly becoming difficult to uphold due to changes in the family structure, as well as conflicting responsibilities and roles [46]. Although idealised perceptions of caring for older people can be found within immigrant communities [33], it is important not to yield to assumptions that children from a immigrant background will always want to 'take care of their own', as this can lead to a lack of attention being given to the adaptation of healthcare services for older immigrants and their families [42]. ...
Background:
The aging of Pakistani immigrants in Norway raises questions related to their increased need for care and help from relatives, as well as those concerning what future formal and informal care and healthcare accessibility for older immigrants may look like. The hidden nature of family caregiving means that the circumstances of carers, their views and their dilemmas related to future care are largely invisible. In this study, we explored female Pakistani carers' views of future care and healthcare accessibility for their older relatives in Norway.
Methods:
Our data included interviews with family carers between the ages of 23 and 40 years old, living in Oslo, Norway. We recruited ten family carers, out of which eight were daughters and two were daughters-in-law. Interviews were conducted by the first author in Urdu or English and were recorded and transcribed verbatim.
Results:
Our findings revealed several factors that influenced participants' perceptions about formal and informal caregiving, which can be organised into the following themes: 1) caring for family in Norway as in Pakistan, 2) worries about being 'dropped off' at a care home, 3) concerns about being cared for by outsiders, 4) questions about what other people might say and 5) adhering to society's expectations of a 'good' carer.
Conclusion:
Family carers' traditional views of filial piety do not entirely determine the use of or access to healthcare services of their older relatives. There is a need to develop culturally sensitive healthcare systems so that immigrant families and their carers have more options in choosing care in old age, which in turn will ease their families' care burden. Healthcare professionals and policymakers should not assume that immigrant families will take care of their own older members but should instead secure adequate support for older immigrants and their family carers.
... 26,27 Older Latina/os often have to integrate feelings about their home and country of origin where their family is located, with their current living circumstances in a community of fewer family members that engenders feelings of isolation and loneliness. 28 Just as sociocultural factors (e.g. education, income) can at least partially explain Latinos' lower HRQoL, they experience higher levels of loneliness by virtue of these same contextual factors. ...
Objective: The primary aim of this investigation is to provide a novel dyadic test of a model of loneliness and health-related quality of life (HRQoL) in a sample of Latinas with breast cancer and their informal caregivers.
Design: At baseline, dyads completed measures of loneliness and HRQoL. At a 3-month follow-up, they returned to complete the HRQoL measure. Associations were tested with the Actor–Partner Interdependence Model.
Sample: About 234 Latinas with breast cancer diagnosed within the past year and their informal caregivers participated in the investigation.
Findings: Loneliness was concurrently and negatively associated with HRQoL at baseline for both survivors and caregivers. Survivors’ baseline loneliness, controlling for their baseline HRQoL, negatively predicted their HRQoL at 3 months. Survivors’ HRQoL at baseline also predicted caregivers’ HRQoL at 3 months.
Conclusion: Loneliness is a risk factor for declines in HRQoL among cancer survivors. Their caregivers are also at risk for degraded HRQoL when the survivor experiences compromised HRQoL. Loneliness complicates the HRQoL of the cancer survivor–caregiver dyad.
The concept of “Aging in place” has not been fully validated among older immigrant groups living in diverse cultures. The study used a qualitative research approach and interviewed Chinese immigrant older adults across three Chinese enclave communities in New York City to identify whether Chinatowns are a place for Chinese immigrants to age and explore their experience of aging in Chinatowns. The findings showed that Chinese immigrants did consider Chinatown as the place, which conveyed practical, linguistic, social, emotional and cultural meaning. Aging in Chinatown, older adults sought independence, security, and autonomy through various social resources. However, older adults, especially newly arrived immigrants, have faced obstacles that undermine their aging experience. Older immigrants’ unique aging experience has provided profound insight in understanding migration and AIP, which help develop proper policies and programs to support the AIP initiative.
This study examined the background before admission to a nursing home and the conditions for the continuity of care, of the relatives of older adults of Colombia and Spain. The study sample comprised 546 participants: 278 and 268 from Colombia and Spain, respectively. Structured interviews were conducted with the older adults’ relatives. Sociodemographic similarities predominated, although in the Colombian sample there were significantly more unrelated people. Similarities in previous and current care conditions also predominated too. Cluster 1 included all the cases of Colombian low-resource nursing homes, and Cluster 2 included all the relatives of Colombian high-resource nursing homes and all the Spanish centers. The type of nursing home was the variable more important to identify the abovementioned clusters. Conclusions: Family members from Colombia and Spain continue to care for the elderly admitted to geriatric homes. The type of geriatric center is what establishes the differences in the users.
Literature on transnational grandparenting rarely focuses on how migrant grandparents contribute to the work/care reconciliation of their adult children, how they provide and receive care in contexts of mobility and precariousness, and the ways in which this is shaped by migration and social policy regimes. Drawing on the concept of moral geographies of care, this study reveals how idealized norms of care interact with Australian migration and work/care regimes in complex and contradictory ways to produce configurations of care in migrant families. We conclude that migration and work/care regimes are poorly aligned, compromising migrant families’ well-being and economic security.
This study explores older Pakistani women's preferences and expectations of formal and informal care while ageing in Norway. Our study is based on qualitative interviews with older Pakistani women living in Oslo municipality, Norway. The participants were aged between 48 and 81 years and had been living in Norway for 26 to 46 years. Our analyses resulted in five themes: 1) renegotiating the expectations of informal care in light of the ‘nazaam’ (or social system and practices) of Norway, 2) fear of being left behind in residential care homes, 3) disloyalty and shame of being cared for by outsiders, 4) perceptions about the quality of formal care and 5) concerns about mixing with other cultures and genders. Our findings point to potential barriers beyond culture that influence older Pakistani women's preferences for, expectations of and access to formal care services. The study further highlights the structural barriers that older Pakistani women perceive and experience in accessing formal care services in a majority society.
Finding a sense of home for international migrants is challenging. It is even more so for older adults who migrate to a foreign country later in life to follow their adult children. This study examines Chinese immigrant elders’ report of their sense of home and life-satisfaction. Based on 21 intensive interviews and107 surveys with elderly immigrants of Chinese descent, this research finds that a comfortable living condition in a natural and built environment contribute to Chinese elders’ narrative of a sense of home. The lack of English language, however, makes immigrant Chinese elders feel very unsettled. Being together with children and having good social benefits are major pull factors that contribute to immigrant elders’ decision to settle down in a foreign country. Those who report a stronger sense of home tend to report a higher level of life satisfaction. In conclusion, the authors argue that immigrant elders are defining their sense of home with a greater sense of independence from their adult children. Favorable social policies toward older adults, such as Medicare, Medicaid, low income housing, and social services, are important factors that make older immigrants feel a sense of home in a foreign land, although the inability to communicate is a barrier to a complete sense of home for transnational migrants in old age.
We have witnessed the rise of nationalisms in many parts of Europe since 1989. The dismantling of the USSR and the Warsaw Pact gave rise to wars between states, civil wars (the one in the former Yugoslavia being the most well known) and the birth of new states. In all of these conflicts, nationalist sentiments played a pivotal role. The new millennium has also witnessed a second wave of nationalism, this time sweeping over Western Europe. Although less acknowledged, it is a remarkable development: even in those countries that have long been seen as the most progressive – such as Denmark and the Netherlands – the most heated social and political debates all revolve around questions of national identity, national values, the national canon, citizenship exams for newcomers, etc.
The framing of the nation itself as ‘home’ is a notable character- istic of the debates raging in Western Europe. While this is nothing new in the history of nationalism, the longing for a homogeneous national home is a novel development in those European countries that had so assiduously distanced themselves from traditions of ‘Boden’, ‘soil’ and ‘Heimat’ in the postwar years. Observers may be surprised by the timing of this surge in national feelings in societies that have for decades considered themselves to be ‘post-national’. Western European societies have never been so diverse in terms of ethnicity, religion, and culture as they are today. But it is precisely this increased diversity that largely explains the renewed popularity of the nation-as-home ideal.
Almost all politicians in Western Europe today – from across the political spectrum – apparently believe that some people are more entitled to inhabit particular places than others. Their belief is usually based on a form of ‘primordial reasoning’, where places are owned by ‘native’ groups who enjoy specific rights (prominent among them the right to feel at home). Part of the Left’s (often remarkably inconsistent) sympathy for such ‘nativist’ reasoning is to view the nation as ‘home’: a fixed place where people belong, a place which is theirs. Politicians across Western Europe cham- pion the ideal of nation-as-home to ‘support’ native majorities who feel ‘overwhelmed’ by the arrival of ‘strange’ new neighbors with unknown habits speaking in foreign tongues. Many also believe that ‘native’ citizens will feel compensated for the loss of their communities by giving them a stronghold at the national level, where they still form the majority. If we want to understand rising nationalism in Western Europe and its accompanying debates over ‘Britishness’, ‘Dutchness’ and ‘Frenchness’, we need to better under- stand this framing of nations in terms of ‘home’ and the attendant nostalgia for times past.
But the often-desperate quest for the nation-as-home has unin- tended consequences: instead of reaffirming ‘Dutchness’ or ‘Danishness’, the culturalization of citizenship has led to endless bickering over identities, loyalties and meanings of the national ‘home’. Many of those who see the reaffirmation of national iden- tity as the solution to the current malaise dig deeper and deeper into the national past, fuelling nostalgia for a time when popula- tions were – supposedly – still homogeneous. Nostalgic nations feel a loss of unity, of collective identity; even the most progressive among them look backwards to find a way out of their national crises.
We use the Immigrants Admitted to the United States (microdata) supplemented with special tabulations from the Department of Homeland Security to examine how family reunification impacts the age composition of new immigrant cohorts since 1980. We develop a family migration multiplier measure for the period 1981–2009 that improves on prior studies by including immigrants granted legal status under the 1986 Immigration Reform and Control Act and relaxing unrealistic assumptions required by synthetic cohort measures. Results show that every 100 initiating immigrants admitted between 1981 and 1985 sponsored an average of 260 family members; the comparable figure for initiating immigrants for the 1996–2000 cohort is 345 family members. Furthermore, the number of family migrants ages 50 and over rose from 44 to 74 per 100 initiating migrants. The discussion considers the health and welfare implications of late-age immigration in a climate of growing fiscal restraint and an aging native population.
Experiences of aging refugees or immigrants are significantly different from elders who have not experienced international migration. Eighty-nine interviews with 38 elderly Cambodian refugees were conducted to understand their aging experiences in the United States. This paper explores multiple meanings of aging in place that go beyond the ability to remain in one's preferred geographic location, maintenance of independence and autonomy, and attachment and meanings assigned to place. Of the components normally used in defining aging in place, meaning making had the most salience for this group of elders. One's sense of place, whether such “place” is defined geographically, socially, or culturally, often created challenges for these elders. This group exhibits different forms of coping and require different services than non-refugee elders. An infrastructure that supports aging refugees or immigrants must include a remarkably different set of parameters than one designed to support native-born elders.
'Aging in place' has become a key conceptual framework for understanding and addressing place within the aging process. However, aging in place has been critiqued for not sufficiently providing tools to understand relations or transactions between aging and place, and for not matching the diversity of contemporary society in which people are moving between and across nations more than ever before. In this article, the authors draw from concepts of place and migration that are becoming increasingly visible in occupational science. The concept of 'aging in place' is critically examined as an example of an ideal where the understanding of place is insufficiently dynamic in a context of migration. The authors suggest that the concept of place making can instead be a useful tool to understand how occupation can be drawn upon to negotiate relationships that connect people to different places around the world, how the negotiated relations are embedded within the occupations that fill daily lives, and how this process is contextualized and enacted in relation to resources and capabilities.
There is increasing interest in helping elders to remain independent in their homes. As the nation experiences the unprecedented growth among its oldest residents, public and private efforts are emerging to facilitate aging-in-place. However older people, particularly the oldest old, experience a myriad of issues impacting their health and ability to remain at home. This article presents the findings from a needs assessment of a Naturally Occurring Retirement Community (NORC) (n = 114) that revealed multiple health-related issues among older people residing in high-need neighborhoods. The study utilized a holistic perspective of health to measure physical, mental, and social well-being among the older residents. Implications for community-based health interventions to enhance aging-in-place are discussed.
With the unprecedented emigration from the former Soviet Union (FSU) during the 1990s as context, this study described the living arrangements of older FSU immigrants living in Israel and the US. Living arrangement choices represented an important strategy for coping with the migration process. Census data from Israel and the US were employed to examine the relationships among living arrangements (independent households, multigenerational households, and extended households) and personal characteristics, including duration of residence, Jewish identity, education, and home ownership. Results showed that the less time older immigrants lived in the host country, the more likely they lived in a multigenerational or extended household. The residency length and household relationship was stronger in Israel than in the US. Also, older FSU immigrants who owned their own home and who lived in a metropolitan area were more likely to live in a complex household than in an independent household. We discussed how the economic and social environments in each country contributed to the variability in living arrangement options among these older immigrants.
This study illuminates the concept of "aging in place" in terms of functional, symbolic, and emotional attachments and meanings of homes, neighbourhoods, and communities. It investigates how older people understand the meaning of "aging in place," a term widely used in aging policy and research but underexplored with older people themselves.
Older people (n = 121), ranging in age from 56 to 92 years, participated in focus groups and interviews in 2 case study communities of similar size in Aotearoa New Zealand, both with high ratings on deprivation indices. The question, "What is the ideal place to grow older?" was explored, including reflections on aging in place. Thematic and narrative analyses on the meaning of aging in place are presented in this paper.
Older people want choices about where and how they age in place. "Aging in place" was seen as an advantage in terms of a sense of attachment or connection and feelings of security and familiarity in relation to both homes and communities. Aging in place related to a sense of identity both through independence and autonomy and through caring relationships and roles in the places people live.
Aging in place operates in multiple interacting ways, which need to be taken into account in both policy and research. The meanings of aging in place for older people have pragmatic implications beyond internal "feel good" aspects and operate interactively far beyond the "home" or housing.
Rapidly aging populations with an increased desire to remain at home and changes in health policy that promote the transfer of health care from formal places, as hospitals and institutions, to the more informal setting of one's home support the need for further research that is designed specifically to understand the experience of home among older adults. Yet, little is known among health care providers about the older adult's experience of home. The aim of this study was to understand the experience of home as experienced by older adults living in a rural community in Sweden.
Hermeneutical interpretation, as developed by von Post and Eriksson and based on Gadamer's philosophical hermeneutics, was used to interpret interviews with six older adults. The interpretation included a self examination of the researcher's experiences and prejudices and proceeded through several readings which integrated the text with the reader, allowed new questions to emerge, fused the horizons, summarized main and sub-themes and allowed a new understanding to emerge.
Two main and six sub-themes emerged. Home was experienced as the place the older adult could not imagine living without but also as the place one might be forced to leave. The older adult's thoughts vacillated between the well known present and all its comforts and the unknown future with all its questions and fears, including the underlying threat of loosing one's home.
Home has become so integral to life itself and such an intimate part of the older adult's being that when older adults lose their home, they also loose the place closest to their heart, the place where they are at home and can maintain their identity, integrity and way of living. Additional effort needs to be made to understand the older adult's experience of home within home health care in order to minimize intrusion and maximize care. There is a need to more fully explore the older adult's experience with health care providers in the home and its impact on the older adult's sense of "being at home" and their health and overall well-being.
The importance of a supportive home environment to successful aging has been well-established in the literature, with home modifications increasingly acknowledged as ways of removing barriers to function and increasing independence for older people. Home modification literature and practice primarily focus on the home environment as a physical space in which to perform tasks and on the impact of modification on competencies and function. Home, however, is much more than a physical environment. Within a transactive framework, people and places are seen as engaged in a dynamic, reciprocal relationship through which home becomes a place of significant personal meaning. Through a qualitative framework, this study examines the experience of older people living in the community who are recipients of a home modification service. It explores the impact modifying the physical environment has on their experience of home as a place of meaning and provides insight into how home modifications can strengthen the home as a place of personal and social meaning as well as improve safety and comfort for the older person at home.
The general view of descriptive research as a lower level form of inquiry has influenced some researchers conducting qualitative research to claim methods they are really not using and not to claim the method they are using: namely, qualitative description. Qualitative descriptive studies have as their goal a comprehensive summary of events in the everyday terms of those events. Researchers conducting qualitative descriptive studies stay close to their data and to the surface of words and events. Qualitative descriptive designs typically are an eclectic but reasonable combination of sampling, and data collection, analysis, and re-presentation techniques. Qualitative descriptive study is the method of choice when straight descriptions of phenomena are desired. © 2000 John Wiley & Sons, Res Nurs Health 23:334–340, 2000.
The general view of descriptive research as a lower level form of inquiry has influenced some researchers conducting qualitative research to claim methods they are really not using and not to claim the method they are using: namely, qualitative description. Qualitative descriptive studies have as their goal a comprehensive summary of events in the everyday terms of those events. Researchers conducting qualitative descriptive studies stay close to their data and to the surface of words and events. Qualitative descriptive designs typically are an eclectic but reasonable combination of sampling, and data collection, analysis, and re-presentation techniques. Qualitative descriptive study is the method of choice when straight descriptions of phenomena are desired.
The Hispanic older adult population's rapid growth calls for an awareness of values that can affect the rendering and receipt of care. Familism, or familismo, a traditional Hispanic value, places importance of family over the self and can potentially affect health care perceptions and practices for Hispanic older adults. The current article discusses familism, which is upheld by some Hispanic older adults, and the potential for underuse of health care services. The traditional feminine role, marianismo, and masculine role, machismo, are considered, as well as implications for how decision making may be made by family members rather than the patient. Clinical implications for the provision of health care to Hispanic older adults are provided, along with the importance of considering acculturation and ethnic heterogeneity. Health care management strategies that reflect recognition and respect of familism, yet emphasize optimization of adherence and self-care, are described.
Newcomer elderly immigrants, defined as adults older than the age of 65 who have arrived in the United States in the last 10 years, represent a growing sector of the American population. Newcomers who experience limited English proficiency, financial strain, and acculturative stress are at considerable risk of developing poor health outcomes. Nursing's focus on healthy aging and aging in place has largely ignored the experiences of these older adults, who are said to be "aging out of place." This concept analysis uses Rodgers's evolutionary method to define "aging out of place" and illustrates why existing theories of elderly migration do not necessarily apply to this population. The challenge for nurses is incorporating the family, with whom conflict may arise, into the care of these elders. Community-based strategies that enable social integration and create a greater division of labor in the care of newcomer elders are called for.
This article examines the relationship between migration and identity by complicating our notion of what ‘home’ means, both for the narrative of ‘being at home’ and for the narrative of ‘leaving home’. It offers, not a migrant ontology, but a consideration of the historical determination of patterns of estrangement in which the living and yet mediated relation between being, home and world is partially reconfigured from the perspective of those who have left home. This reconfiguration does not take place through the heroic act of an individual (the migrant), but through the forming of communities that create multiple identifications through collective acts of remembering in the absence of a shared knowledge or a familiar terrain. The article interweaves a variety of different texts: short stories by Asian women in Britain, autobiographical reflection, theoretical constructions of migrancy and literature from two very different nomadic or migrant communities, the Global Nomads International and the Asian Women’s Writing Collective. The article provides a critique of recent theories of migrancy - and nomadism - as inherently transgressive, or as an ontological condition (where what we have in common is the loss of a home). The author argues that it is through an uncommon estrangement that the possibility of migrant communities comes to be lived. That is, it is the uncommon estrangement of migration that allows migrant subjects to remake what it is they might yet have in common.
This qualitative study explored the meaning of home for older women living in a congregate housing complex in a Southeastern city of the United States who have been more or less successful in making it a home. Through in-depth interviews, 20 older women shared detailed descriptions of their thoughts, feelings, and ideas of home and of their current environment as a home. All but one of the women were emotionally attached to their new environment and considered it home. Common themes were that for the women, the meaning of home was manifested in (1) the autonomous decision to find a place somewhere, (2) the deliberate resolve to feel in place anywhere, and (3) the ongoing effort to stay placed there. A successful late-life move depends less on concrete and/or external factors and more on social and/or intrinsic factors. U.S. housing policy must become more reflective of the processes older adults use to be “at home”.
This research presents the results of a qualitative study of a small sample of older adults (n=25), age 55+ who have recently moved to an area that is rapidly changing from a tourist community into a retirement community. The study has two main research objectives: (a) to use Oswald and Wahl's heuristic meaning of home framework to explore the relationships between older adults and their homes and communities, integrating theories from environmental psychology, environmental gerontology and human geography, and (b) to discuss the empirical findings focussing on the core concepts of meaning of home and sense of belonging for new retirees to an area. Findings: For new retirees, there exists a zone between the home and community, that can be viewed as a geographic space comprised of overlapping and interwoven personal, social and physical domains. This zone between the physical house and the surrounding community can be construed as having certain elastic qualities and permeable boundaries that blur the distinctions between home and community. A focus on the micro-environment of the home dwelling and the macro-environment of the neighbourhood and community then appears relevant for understanding place attachment for these persons. This idea of the ‘home beyond the house’ – is one of the most important contributions of this research. Our results view the heuristic framework of Oswald and Wahl as a valuable tool for building understanding about the meaning of home for older adults by drawing attention to the domains themselves, and more importantly, to the interrelationships between them. Consequently, for younger in-migrants, the boundary between home and community blurs into one larger, symbolic entity experienced as ‘home’.
What are older Korean immigrants' cultural conceptions of home arrangements and environments? Does aging affect their family relationships? Why do they decide to move to public housing? How do they adapt to and re-create a feeling of home in public housing? This research in the field of aging-and-environment focuses on these questions. Based on a naturalistic field research of older Korean immigrants to the USA this paper details the transitions from loss of feeling of home in their pre-move life, the decision to move to senior public housing, to settling into the new apartment. The themes delineated are: 1) shifting roles in multigenerational households, 2) altered conceptualizations and changing environments, becoming dut-bang no-in (guest in own home), 3) detachment from prized objects, and 4) re-creation of meaningful environment. Revealed are the complex and interwoven nature of the decision to move involving experiences, events, and nested mini-decisions, as well as the emotional disruptions, loss of sense of self, and detachments that occur. The adjustments made by these older adults to the culturally inappropriate design in order to regain feeling at home are described. Several socio-physical phenomena and concepts identified are: a) spatial oblation, b) environmental and object detachment, c) object meaning linked to persons, and d) planned surrender or disposal of cherished objects.
The home is often viewed as an unproblematic location in which new occupational roles, relationships and uses can be fitted. There has been a marked increase in home-based work, leisure and medical care. How these functions can be accommodated within houses designed for conventional domestic and household activities often remains unclear. Drawing on an in-depth study of teleworking (home-based computer working), this article explores the meaning and experience of real, symbolic and lived household space. The findings suggest that households strive to retain the conventional look, feel and function of the home even when occupants are required to establish new roles and occupations. This resistance to spatial change occurs as a deliberate and rational choice.
The article is theoretical in content and does not directly explore the experiences of disabled people. It provides a sociological perspective of the home, which is often missing from medical and rehabilitation literature. It challenges a number of taken-for-granted notions about the social construction of the home, which will be of interest to therapists whose work often involves the incorporation of new roles and daily activities into the home.
The international growth and the expected size of older populations require effective research strategies in life–course development and aging research across the globe. New conceptual frameworks and empirical research approaches are needed that are sensitive to similarities and differences in aging related processes across national, ethnic, and cultural group boundaries. These models and research approaches should contribute to distinguishing “aging–in–place–of–origin” from “aging–out–of–place–of–origin,” and the influences of such factors as nationality, culturally affected behaviors, acculturation and intra–familial processes, on intra– and cross–country comparisons of aging related phenomena. Brief examples of how these new frameworks can be applied in addressing both theoretical and practical service issues are drawn from the aging research foci of the articles in this issue.
This qualitative study explores the international migration patterns and the family lives of older adults. Informants (N = 54) reported that they came to the United States to help out their grown children with housekeeping, child care, and domestic economizing. They described how they strategically navigated U.S. immigration laws choosing to visit, immigrate, or naturalize in order to balance their ties to the United States and their homeland. Their transnational loyalties sometimes led to lives that did not strictly match their visa categories. There were “permanent” temporary visitors, U.S. permanent residents who maintained a “permanent” home elsewhere, and U.S. citizens who had naturalized in order to spend more time abroad. Implications of the findings for immigration policy and family practice are discussed.
This article compares and contrasts the interactions between caregivers and care–recipients in two nursing homes in the United Kingdom and South Africa. It is argued that the discourse of caring in the two settings is similar in terms of how residents and nurses use interactional strategies to negotiate role relationships. It is also argued that it is the context of the “total” institution that gives rise to these strategies. Differences in the two settings are most noticeable in compliance–gaining situations. The “power struggle” between nurses and residents is much more overt in the South African data where it is reflected and constructed in racist discourse.
In recent years there has been a proliferation of writing on the meaning of home within the disciplines of sociology, anthropology, psychology, human geography, history, architecture and philosophy. Although many researchers now understand home as a multidimensional concept and acknowledge the presence of and need for multidisciplinary research in the field, there has been little sustained reflection and critique of the multidisciplinary field of home research and the diverse, even contradictory meanings of this term. This paper brings together and examines the dominant and recurring ideas about home represented in the relevant theoretical and empirical literature. It raises the question whether or not home is (a) place(s), (a) space(s), feeling(s), practices, and/or an active state of state of being in the world? Home is variously described in the literature as conflated with or related to house, family, haven, self, gender, and journeying. Many authors also consider notions of being-at-home, creating or making home and the ideal home. In an effort to facilitate interdisciplinary conversations about the meaning and experience of home each of these themes are briefly considered in this critical literature review.
Immigration to the US has given rise to a population of older people who migrate here to be close to their children. Although highly integrated into their intergenerational families, these seniors voice dissatisfaction with their lives in the US. Intensive interviews with 28 transnational seniors demonstrate that their dissatisfaction stems from the contradictions between high cultural expectations for family sociability and structural constraints on kin interaction in the US. Their dissatisfaction is exacerbated by factors isolating them from social contacts outside the family. Although mobility limitations and not speaking English contribute to their isolation, immigrant families play a role. Older people are sometimes isolated by heavy domestic responsibilities in their child's household, solicitous offspring who insulate parents from practical aspects of daily life, and by a collective family ethos that calls on aging parents to subordinate their needs to those of other family members.
Using a theoretical framework that encompasses concepts of space and place, this research addresses meanings of place to three groups of older immigrants living in an inner city. This qualitative research is based on multiple interviews with 211 persons over the age of 50 in three ethnic groups: Latinos, Filipino Americans, and Cambodian Americans. Living conditions were found to be complex and difficult for most respondents, yet living arrangements were also sources of intergenerational family support and long-term, intimate friendships. An examination of meanings of place illustrates how seemingly disparate topics such as social relationships, memory, displacement, the reworking of identity, and the presence of identity politics are interwoven in the lives of these elders, and how people work to ameliorate their sense of displacement while living in problematic living conditions in old age.
To identify and define the concept of home and its meaning in the lives of three older women.
For many older adults home is the centre of daily life and increasingly important as a place where health care is delivered. Yet, as a concept, home remains theoretically and empirically underdeveloped.
The Hybrid Model of Concept Development was used to interface theoretical analysis and empirical observation with a focus on definition. A comprehensive, interdisciplinary literature review, semi-structured interviews with three older women and case and cross-case analysis were completed.
Interviewees spoke of childhood, community, residential, church and heavenly homes. Feelings of comfort and security were associated with residential homes, peace and quiet with church homes, safety and pleasure with heavenly homes. The experience of home as being taken for granted, unselfconscious and unrecognized, became obvious when one woman tried to consciously establish a sense of being at home in her new residence.
No single comprehensive and measurable definition was found. However, three major components were identified (place, relationship and experience) and used to define home as a place to which one is attached, feels comfortable and secure and has the experience of dwelling.
Every day assumptions about the meaning of home and home as just another place where health care is provided are called into question. Increased awareness and dialogue is needed among health-care providers working with older adults in their homes. Future research needs to explore the impact of home care on the older adult's meaning of home and its potential impact on recovery.
A state-sponsored evaluation of aging in place (AIP) as an alternative to assisted living and nursing home has been underway in Missouri. Cost, physical, and mental health assessment data reveal the cost-effectiveness and positive health measures of AIP. Findings of the first four years of the AIP evaluation of two long-term care settings in Missouri with registered nurse care coordination are compared with national data for traditional long-term care. The combined care and housing cost for any resident who received care services beyond base services of AIP and who qualified for nursing home care has never approached or exceeded the cost of nursing home care at either location. Both mental health and physical health measures indicate the health restoration and independence effectiveness of the AIP model for long-term care.
We investigated the prospective impact of self-reported loneliness on all-cause mortality, mortality from ischemic disease and mortality from other cardiovascular diseases. We tested these effects through GEE binomial regression models applied to longitudinal data from the Alameda County Study of persons aged 21 and over arranged into person-years. Controlling for age and gender, the chances of all-cause mortality were significantly higher among respondents reporting that they often feel lonely compared to those who report that they never feel lonely. Frequent loneliness was not significantly associated with mortality from ischemic heart disease but more than doubled the odds of mortality from other ailments of the circulatory system in models controlling for age and gender. Subsequent models showed that physical activity and depression may be important mediators of loneliness-mortality associations. Finally, we find support for the contention that chronic loneliness significantly increases risk of mortality but also find reason to believe that relatively recent changes in feelings of loneliness increase risk of mortality as well.
"Whatever Happened to Qualitative Description?" (Sandelowski, 2000) was written to critique the prevailing tendency in qualitative health research to claim the use of methods that were not actually used and to clarify a methodological approach rarely identified as a distinctive method. The article has generated several misconceptions, most notably that qualitative description requires no interpretation of data. At the root of these misconceptions is the persistent challenge of defining qualitative research methods. Qualitative description is a "distributed residual category" (Bowker & Star, 2000). Cambridge, MA: The MIT Press) in the classification of these methods. Its value lies not only in the knowledge its use can produce, but also as a vehicle for presenting and treating research methods as living entities that resist simple classification.
The purpose of this study was to describe the quality of life (QOL) of current adult day center (ADC) clients and their family caregivers in one region of Canada. Semi-structured interviews were conducted with 10 ADC clients and 10 caregivers. Data analysis used a modified constant comparative method. The major categories relating to QOL that emerged in the analysis included Physical Health and Well-Being, Social Networks/Relationships, Aging in Place, Safety, Respite, Activation, Respect and Inclusion, and Adequate Health Care Services. These themes are consistent with those of other studies of QOL of older adults. It was evident that ADCs played an important role in maintaining and improving the QOL of both the older adults and caregivers participating in this study.
Both loneliness and social networks have been linked with mood and wellbeing. However, few studies have examined these factors simultaneously in community-dwelling participants. The aim of this study was to examine the relationship between social network, loneliness, depression, anxiety and quality of life in community dwelling older people living in Dublin.
One thousand two hundred and ninety-nine people aged 65 and over, recruited through primary care practices, were interviewed in their own homes using the GMS-AGECAT. Social network was assessed using Wenger's typology.
35% of participants were lonely, with 9% describing it as painful and 6% as intrusive. Similarly, 34% had a non-integrated social network. However, the two constructs were distinct: 32% of participants with an integrated social network reported being lonely. Loneliness was higher in women, the widowed and those with physical disability and increased with age, but when age-related variables were controlled for this association was non-significant. Wellbeing, depressed mood and hopelessness were all independently associated with both loneliness and non-integrated social network. In particular, loneliness explained the excess risk of depression in the widowed. The population attributable risk (PAR) associated with loneliness was 61%, compared with 19% for non-integrated social network. Taken together they had a PAR of 70%
Loneliness and social networks both independently affect mood and wellbeing in the elderly, underlying a very significant proportion of depressed mood.
A sense of belonging or attachment to place is believed to help maintain a sense of identity and well-being, and to facilitate successful adjustments in old age. Older people in particular have been shown to draw meaning and security from the places in which they live. Qualitative data from multiple conversational interviews held over the period of a year with each of 83 community-dwelling older people in Auckland within the context of a study conducted from 2006 to 2008 are interpreted to explore how older people relate to their social and physical environments, with a specific focus on attachment to place and the meaning of home. The concept of 'social space' is proposed, to capture the elastic physical, imaginative, emotional and symbolic experiences of and connections to people and place across time and in scope. Talking with older people themselves gave a rich account of attachment to place, social spaces, and well-being. Our participants had strong attachments to their homes and neighbourhoods, extensive participation in 'beyond spaces', and shrinking social worlds. They did not, however necessarily view changes as negative; instead there was a delicate negotiation of positive and negative aspects, and complex engagement with 'social space' as a profoundly meaningful construct.
1. Contextual data obtained through open-ended interviewing allows the nurse to individualize the nursing care plan and can maximize the nurse's problem solving skills. 2. The interviewer who obtains credible data obtains believable data which accurately portrays the situation from the subject's point of view. 3. Interviewing techniques which can increase self-esteem in the older adult are: nonjudgmental wording of questions; providing positive reinforcement; giving the individual control; matching gender; allowing time; adapting to hearing and vision impairments; and adapting to reading deficits.
To provide an overview of reasons why qualitative methods have been used and can be used in health services and health policy research, to describe a range of specific methods, and to give examples of their application.
Classic and contemporary descriptions of the underpinnings and applications of qualitative research methods and studies that have used such methods to examine important health services and health policy issues.
Qualitative research methods are valuable in providing rich descriptions of complex phenomena; tracking unique or unexpected events; illuminating the experience and interpretation of events by actors with widely differing stakes and roles; giving voice to those whose views are rarely heard; conducting initial explorations to develop theories and to generate and even test hypotheses; and moving toward explanations. Qualitative and quantitative methods can be complementary, used in sequence or in tandem. The best qualitative research is systematic and rigorous, and it seeks to reduce bias and error and to identify evidence that disconfirms initial or emergent hypotheses.
Qualitative methods have much to contribute to health services and health policy research, especially as such research deals with rapid change and develops a more fully integrated theory base and research agenda. However, the field must build on the best traditions and techniques of qualitative methods and must recognize that special training and experience are essential to the application of these methods.
The general view of descriptive research as a lower level form of inquiry has influenced some researchers conducting qualitative research to claim methods they are really not using and not to claim the method they are using: namely, qualitative description. Qualitative descriptive studies have as their goal a comprehensive summary of events in the everyday terms of those events. Researchers conducting qualitative descriptive studies stay close to their data and to the surface of words and events. Qualitative descriptive designs typically are an eclectic but reasonable combination of sampling, and data collection, analysis, and re-presentation techniques. Qualitative descriptive study is the method of choice when straight descriptions of phenomena are desired.