To understand how older adults perceive and navigate their neighborhoods, we examined the implications of activity in their neighborhoods for their health. We interviewed 38 adults (ages 62–85) who lived in San Francisco or Oakland, California. Seven key themes emerged: (1) people express a wide range of expectations for neighborliness, from “we do not bother each other” to “we have keys to each other’s houses”, (2) social distance between “other” people impede a sense of connection, (3) ethnic differences in living arrangements affect activities and activity locations, (4) people try to stay busy, (5) people able to leave their homes do many activities outside their immediate residential neighborhoods, (6) access to a car is a necessity for most, and (7) it is unusual to plan for the future when mobility might become limited. Multiple locations influence older adults’ health, including residential neighborhoods. Older adults value mobility, active lives, and social connections.
The phenomenon known as “aging in place” refers to the people wanting to stay in their residence as they age [
A review of the quantitative literature (1997–2007) describing how neighborhoods might be associated with health for older adults identified some key limitations: (1) primarily cross-sectional studies, (2) not taking into consideration specific characteristics of older people (e.g., functional capacity and household composition), and (3) few studies which featured ethnic minority study samples [
Qualitative research has examined the meanings of place for older adults and how they cope with loss (e.g., changes in the social interactions, their ability to engage with place as their capacity declines) as they age [
We sought to address the gaps in the quantitative literature by embarking on a qualitative interview study with the ultimate objective to translate these qualitative findings into survey methodology to do larger-scale studies. Two conceptual frameworks guided our investigation: social and physical insidedness [
Environmental press is one of the earliest and most comprehensive ecological models of aging [
More recent developments in environmental gerontology have emerged and expanded the place attachment and environmental frameworks, explicitly contributing concepts of behavior, agency, and emphasizing that these are dynamic processes [
The epidemiologic literature investigating how neighborhoods affect health could benefit from stronger conceptual underpinnings [
Face-to-face interviews took place in participants’ homes or a location of the participant’s choosing. Interviews were conducted in English or Spanish, lasted between 30 and 180 minutes, were digitally recorded, and transcribed verbatim. After the interview, we asked the respondents to answer a brief demographic survey that included a question on self-rated health. Participants received a $25 gift card as a “thank you.” Study procedures were approved by the University of California, San Francisco (UCSF) Institutional Review Board.
To create an interview guide, we reviewed research literature that documented associations between neighborhood environment and health in older adults. We created a list of overarching topics on the basis of reported associations in the research, the two conceptual frameworks (place attachment and environmental press), and the gaps we located (e.g., not taking into consideration specific characteristics of older adults and defining neighborhood as census or administrative boundaries). Examples of these topics are name of the neighborhood, time in neighborhood, positive or negative characteristics of neighborhood, activities undertaken in the neighborhood, changes in the neighborhood over time, typical activities in a week, and other activities. Within each overarching topic, we generated a set of specific questions to elicit people’s accounts of their lived experiences, typical activities (e.g., exercise, food shopping and volunteer activities), the person-environment dynamic, how their activities might contribute to place attachment, and whether the environment created press on the person while engaging in typical activities (e.g., if food shopping was difficult because stores were far away).
In order to allow participants to describe their experiences in their own words, questions were open-ended with probes as necessary. New questions were added on the basis of the analysis of earlier interviews. The new interview questions were then applied to subsequent interviews. For example, several participants in early interviews were very active and going to a variety of destinations on a regular basis either by driving or through adept use of public transit. In subsequent interviews, we asked about typical activities and how they got to the locations, rather than focus more narrowly on activities in the residential neighborhood.
We recruited a purposive sample of older adults from diverse ethnic groups with a range of economic circumstances, aiming for a total of 40 participants. We recruited participants through the organizational contacts of the University of California San Francisco’s Center for Aging in Diverse Communities and through professional and personal contacts of one of the authors (IHY).
Eligibility criteria included (a) aged 65 or older, (b) self-identified as White, African American or Black, Asian American, or Latino/Hispanic, (c) lived in Oakland or San Francisco, (d) lived in the same residential neighborhood for at least one year at the time of the interview, and (e) spoke either English or Spanish. Recognizing the population trends discussed above, we wanted to include participants from four ethnic groups in our interview sample, those that are strongly represented in the San Francisco Bay Area. We aimed to split the sample of 40 as evenly as possible across the four ethnic groups; moreover, recognizing that in all included groups women have a longer life expectancy than men, we aimed to interview six women and four men in each of the four ethnic groups.
Excluded were people who lived in predominantly low-income neighborhoods. Excluded neighborhoods were determined on the basis of the research team’s prior experience in these areas, Chambers of Commerce data, and representations in the local media. There were two reasons for this exclusion criterion. First, was the necessity to keep the amount of variation among study participants to a manageable level given the desire to target a widely diverse group, on the basis of age, sex, and ethnicity. Second, the decision was made to concentrate the sample selection in order to maximize the chances of exploring positive features of neighborhoods.
Two of the authors analyzed transcripts by systematically coding text independently, guided by the interview topics as well as themes that emerged from the data [
Our final sample, diverse in terms of ethnicity and sex, comprised 38 persons ages 62 to 85 (see Table
Descriptive information of respondents (
Demographic characteristics | Overall |
---|---|
Age | Mean = 74 (range: 62–85) |
Sex | |
Men | 14 (37%) |
Women | 24 (63%) |
Race/ethnicity | |
White | 9 (24%) |
African American | 9 (24%) |
Latino | 10 (26%) |
Asian | 10 (26%) |
City | |
San Francisco | 20 (52%) |
Oakland | 18 (48%) |
Housing tenure—own | 25 (66%) |
Educational attainment | |
Did not graduate from high school | 6 (16%) |
High school graduate | 4 (11%) |
Some college | 10 (26%) |
College degree | 8 (21%) |
Graduate degree | 6 (16%) |
Missing | 4 (11%) |
Living arrangements | |
Lives alone | 18 (47%) |
Lives with spouse or significant other | 14 (37%) |
Lives with adult child | 6 (16%) |
Car ownership—yes | 21 (55%) |
Years living in neighborhood | |
<10 | 10 (26%) |
11–20 | 7 (18%) |
21–40 | 13 (34%) |
41+ | 7 (18%) |
Self-rated health | |
Excellent | 4 (11%) |
Very good | 15 (13%) |
Good | 9 (24%) |
Fair | 5 (13%) |
Poor | 2 (5%) |
Missing | 3 (8%) |
On the basis of the analytic process described above, we identified seven key themes that fit within the Wahl and Oswald person-environment processes and place attachment framework. For experience or place attachment (belonging), there was a cluster of three themes highlighting social relations and living arrangements: (1) people express a wide range of expectations for neighborliness, from “we don’t bother each other” to “we have keys to each other’s houses”, (2) perceptions of “social distance” between older people and “other” people (e.g., different ages or race/ethnicities) impede a sense of connection in neighborhoods, and (3) ethnic differences in living arrangements affect activities and activity locations—living with extended family, taking care of grandchildren being more common for Latinas. A second cluster of themes highlighted how behaviors might contribute to agency: (4) people try to stay busy, (5) people able to leave their homes do many activities outside their immediate residential neighborhoods, and (6) access to a car is a necessity for most people. A final theme emerged that indicated that many participants (those who were quite socially and physically active) did not anticipate transitioning into another phase of life should their activity levels decline and their relationship with their home and neighborhood environments shift: (7) it is unusual to plan for the future when mobility might become limited.
Participants described a range of experiences with their neighbors, from detachment to friendships. Having detached or limited social relations with neighbors was common. In general, they expressed satisfaction with the way things were. At times, people noted that over several years, the turnover in neighbors had created a situation where they were not familiar with their neighbors. In these instances, they also pointed out that the newer neighbors were working age and busy during the day. The differing schedules between the older adults and the working adults meant lower likelihood of running into each other coming and going. One woman (82, Caucasian) did not know many of her neighbors, saying: Participant: Interviewer: Participant: Interviewer: Participant
Twenty of the 38 participants had lived in their neighborhoods for over twenty years. These people often observed that there had been a lot of change in the composition of the neighborhood population and that they used to know more of their neighbors. A common experience was that the participant would recall that when their children were young, they knew neighbors who also had school-aged children. Over time, households would relocate as children moved out. The newer neighbors might be working aged, away during the day, busy with their own young children, and less available for intermittent neighborhood socializing. Sometimes, the lack of familiarity caused uncertainty or insecurity. People’s discomfort was frequently a result of perceived social distance from the neighbors, being far apart in age or of a different ethnicity. A man (70, Latino) commented on young people hanging around in the neighborhood, giving him a feeling of insecurity:
Latina participants tended to live with other family members, in particular adult children, more than did the White, African American, or Asian participants. Four of the Latinas lived with adult children. In two of these instances, their primary activity was to look after grandchildren during the work week. In contrast, one White woman (age 71) lived with her adult daughter. However, it was not until the end of the interview, when asked whether neighbors looked after her home when she went out of town that she mentioned her daughter lived with her. The woman did very little with her daughter regularly, including sharing meals. One African American man (age 66) lived with two of his grandsons who would drive him to places, because he had chronic health problems and some difficulty walking. An Asian couple (both aged 74-years) had retired from work in the Philippines and were living with an adult son. Apart from these four people, all the other African American, White, and Asian participants lived alone (
Living arrangements somewhat affected use of services, in combination with an individual’s gender and type of neighborhood (i.e., whether there were retail services close by and/or easy access to public transport). Living in close proximity to family was important for all participants. Those who had children living close by could easily get assistance when necessary. For example, an 85-year-old Latina woman was an avid gardener; her son would help her carry large bags of soil or mulch. People who lived alone did all their own food shopping, with the exception of one person who had significant mobility issues. If people lived in a suburban area with no retail close by, they would drive, often selecting the destination on the basis of prices or if they had other errands to do on the way. If people lived with a spouse, usually the woman did more of the food shopping. For one couple who lived close to shopping, the man did all the shopping because the woman had difficulty walking. They had a fixed income. He used the shopping list as his reason for walking in the morning to look at price differences at the various stores close to their home. A Latina woman (age 66) who lived with her daughter and the daughter’s family might accompany her daughter to the store; however, most of her activity day during the week was at the senior center near her daughter’s work and her granddaughter’s school.
Many of the participants were very active with social activities, work, volunteering, classes, and leisure travel. Several people talked about being “on the go,” wanting to get out every day. In some cases, people intentionally went out to keep mentally and physically active. One woman (69, African American), who was in poor health by her own assessment, commented on how she likes to be on the go: Interviewer Participant
Perhaps in part because people are generally busy in mainstream US culture, older adults express a value in staying busy. There did not seem to be a difference amongst respondents by gender or race/ethnicity about the level of busyness [
Half of the participants went out of their neighborhoods at least once a week for a variety of reasons. In addition to the activities listed above, weekly activities included going to the movies, participating in hobby or social groups (e.g., bowling league and hiking group), food shopping, caregiving for a friend or relative, window shopping at the mall, or visiting family. Other regularly occurring (monthly or quarterly) events included going to doctor’s appointments and picking up prescriptions. The neighborhood was not a key location for the majority of these activities. The most common activity done close to home, mentioned by 13 of the participants, was walking in their neighborhoods. Half of the participants lived close to retail areas with a large array of businesses or were within easy walking distance to smaller commercial districts where there might be a café, a few stores, and a couple of restaurants.
Combined with the emphasis of striving to be busy and on the go described above, this theme highlights the sometimes extensive geographic distance covered by many older adults on a regular basis. While each person’s sense of neighborhood physical boundaries differed, activities outside perceived residential boundaries were very common. For example, an 82-year-old man went to the movies twice a week, generally travelling on foot and by bus to go to his favorite theatre about three miles away from his home. A 69-year-old woman drove about seven miles from her home in Oakland to Oakland’s Chinatown, two to three times per week, to volunteer activities and buy food. A 78-year-old man travelled by bus Monday through Friday morning five miles to a senior center in the Mission District of San Francisco to visit with friends.
Two people did not leave their neighborhoods. One woman (age 63, African American) had severe arthritis and needed someone to do her grocery shopping for her. Her busyness came in the form of watching television and speaking to siblings on the telephone frequently. The other (an 84-year-old Asian woman) lived in a retail-rich area of San Francisco and did some errands in her neighborhood. When she left the neighborhood, it was for doctors appointments.
Related to the theme above, having easy access to a car was a perceived to be a necessity. Twenty-one people either drove themselves or had access to a car when, for example, a child or grandchild would drive the person where they needed to go. A woman living in Oakland (72, Caucasian) said, “Well, we wouldn’t be able to stay here without being able to drive. I suppose we could use taxis, but that would be the only alternative.” A 69-year-old, African American man in Oakland said, “I would say that there are no stores. And that’s one of the major difficulties of living here is that if you don’t have an automobile you’re up the creek.”
As noted above, we spoke to many people who were socially and physically active, commonly driving outside of their neighborhoods for their activities. We asked people if they had made plans for a time when they might not be so mobile or able to get out so easily (e.g., if they could no longer drive). Five participants were living with an adult child. One couple who had retired in the US from another country, assumed that at a certain point when they were frailer, they would move back to their home country for access to affordable support services. A Latina woman, widowed, originally from Nicaragua, mentioned a similar plan. The others assumed they would continue to live with their adult child and would be able to rely on them. Three participants mentioned that if a time came when they could not get around easily, they would likely move in with an adult child living close by. Some people indicated that they would move to an institution. Others mentioned that they have thought about having a paid caregiver move in to their home. More commonly, people had not given too much thought about it:
The US population is aging and is increasingly non-white. Current population projections for the US predict that by 2050, the proportion of non-Whites over age 65 will double (from 19% to 39% of the population of age 65 and older people), the proportion of Latinos will triple (from 6% to 18%), the proportion of African Americans will increase by one-third (from 9% to 12%), and the proportion of Asians will nearly triple (from 3% to 8%) [
Through qualitative interviews, we learned about urban older adults’ activities both in their residential environments and elsewhere. Participants spent time in their neighborhoods walking and had varying levels of engagement with their neighbors. For participants who were physically able to move about, other than walking or socializing, if the neighborhood did not include retail locations (as was more common in Oakland than San Francisco), then it was not the setting for regular activities. Participants drove their cars to many other destinations to volunteer, exercise, shop, and socialize.
When applied to these data, the Wahl and Oswald conceptual framework (2010) uncovers some new perspectives on the neighborhood-health dynamic for older adults. Since many of these older adult participants maintain a high level of “busyness” and travel to nonneighborhood locations for a variety of activities, this suggests that it is common to live on a geographic scale greater than the residential neighborhood and that social and material needs are fulfilled by doing activities in a broader space. This has implications for social policy addressing “aging in place,” suggesting the need to provide access to spaces beyond the residential setting. The neighborhood does provide opportunities for social interactions and at times social connections, a basis for the experience-to-belonging piece of the Wahl and Oswald framework (2010). But for the most part, participants in our study largely described detached and distant relations with their neighbors and furthermore expressed satisfaction with this state of affairs. Indeed, the social distance theme reflects a trajectory from that of a form of place attachment (knowing ones neighbors well and having lots in common because children are going to the same schools) to a position of feeling a poorer fit with the neighbors, a form of environmental press, with the change in composition to households that are different in age and/or ethnicity. At the time of the interview, for a relative few, the social ties within neighborhoods were positive characteristics, but in most other cases, the social interactions were sources of tensions or negative environmental press, using the language of Lawton’s person-environment framework. Lawton’s conceptualization of environment encompassed the personal environment (e.g., spouses and coworkers) and the group environment which referred to the influences of an aggregation of individuals (e.g., neighbors) [
We found that people prefer to stay busy and their ability to do so is heavily dependent on having access to a car. Indeed, while all but three people very much wanted to continue living where they were, their primary social and shopping activities occurred outside of their immediate neighborhoods. When asked to think about a time when they might not be able to drive or get around on their own, most people had not given serious consideration as to what they would do under those circumstances. Therefore, for those without access to a car or for those who have no relatives close by and who would likely experience constrained mobility in the future, the features and resources within the neighborhood are and would be important.
As concepts in environmental gerontology have been refined in the last twenty years, the dynamic process of aging has been more explicitly incorporated [
Our longer-term objective in conducting these interviews is to translate the findings to conduct larger-scale survey research. The quantitative research literature on neighborhood-health associations for older adults sometimes uses age (as measured by the proportion of people age 65 and older in the census tract) or ethnic composition (quantified by measures of segregation) among the important demographic characteristics to describe the neighborhood. Our qualitative study supports the significance and continued inclusion of these variables. Our participants confirm what past research, in particular on intentional communities for older adults or age-segregated residential facilities [
For ethnic composition, existing evidence and our study findings are more equivocal. Studies have reported that African Americans who live in areas with higher proportions of African Americans have poorer health compared to African Americans who live in areas with lower proportions of African Americans [
Epidemiologists seek to conduct large-scale, longitudinal studies in multiple locations to produce generalizable population-based findings. The findings from this qualitative research project can be used to inform the contents of a survey for a larger-scale study. On the basis of the key themes reported here, future studies should ask questions about older adults’ perceptions of their neighborhood boundaries, where else they regularly spend time, the extent to which they are influenced by the social and physical environment of other neighborhoods in which they spend a significant amount of their time, and their use and reliance on a car or public transit. Future research could extend the Wahl-Oswald framework to these other locations, sometimes referred to as activity spaces [
This study was supported by a grant from the National Institute on Aging (K01 AG 027273). The authors thank the participants for their interviews, Anita Stewart for advice and mentoring, Jochebed Catungal for data support, and an anonymous reviewer for critical comments.