Implications of Aging-in-Place

1. Jeroen Knies MSc. Implications of Aging-in-Place

2. 19 February, 2012 J.Knies 2 Implications of Aging-in-Place Place Building Values Home Aging Health The Disablement Process Implications Scenario Person-Environment Fit Design

3. 19 February, 2012 J.Knies 3 Place: Building Values

4. 19 February, 2012 J.Knies 4 Place: Building Values - Basale Waarde Gebouw – Mens Bescherming Veiligheid Gezondheid & Behaaglijkheid Ruimtelijke Beleving - Gebruikswaarde Gebouw – Organisatie Productieondersteuning Beheerbaarheid Betrouwbaarheid - Belevingswaarde Gebouw – Gemeenschap Uitstraling - Ecologische waarde Gebouw – Milieu Energie- & watergebruik Materiaalgebruik Emissies Afval - Strategische waarde Gebouw – Tijd Veranderbaarheid - Economische waarde Gebouw – Eigenaar Stichtingskosten / marktwaarde Operationele kosten - Basale Waarde Gebouw – Mens Bescherming Veiligheid Gezondheid & Behaaglijkheid Ruimtelijke Beleving - Gebruikswaarde Gebouw – Organisatie Productieondersteuning Beheerbaarheid Betrouwbaarheid - Belevingswaarde Gebouw – Gemeenschap Uitstraling - Ecologische waarde Gebouw – Milieu Energie- & watergebruik Materiaalgebruik Emissies Afval - Strategische waarde Gebouw – Tijd Veranderbaarheid - Economische waarde Gebouw – Eigenaar Stichtingskosten / marktwaarde Operationele kosten

5. 19 February, 2012 J.Knies 5 Place: Building Values

6. 19 February, 2012 J.Knies 6 Place: Building Values Basic Values Security Safety Health & Well-Being Privacy (Acoustic, Visual & Social) Air Quality & Thermal comfort Sound & Acoustics Light & Visual comfort (daylight & artificial light) Radiation Spatial Experience

7. 19 February, 2012 J.Knies 7 Place: The Home Home (noun) The place where one lives permanently. An institution for people needing professional care. Be/feel/look at home to be/feel/look relaxed and comfortable in a particular place or situation

8. 19 February, 2012 J.Knies 8 Place: The Home As security and control As a reflection of one’s ideas and values As acting upon and modifying one’s dwelling As permanence and continuity As relationship with family and friends As a centre of activities As a refuge from the outside world As an indicator of personal status As a material structure As a place to own Despres (1991, p. 97-99) 10 general categories of ascribed meaning of home Home as: Security and control in the sense of the individual’s feeling in control of the area and physically secure. 2. A reflection of one’s ideas and values. How people see themselves and want to be seen by others. 3. Acting upon and modifying one’s dwelling. The extent to which the home provides a sense of achievement, a place for self-expression and/or freedom of action. 4. Permanence and continuity. This meaning marries the concept of home with the time dimension whereby home may be a place of memories or an environment which has become intimately familiar over a period. 5. Relationships with family and friends: i.e., a place to strengthen and secure the relationship with the people one cares for. Home is perceived and experienced as the locus of intense emotional experience, and as providing an atmosphere of social understanding where one’s actions, opinions, and moods are accepted. Ideas such as a place to share with others, to entertain with relatives and friends, and to raise children, are related to this dimension. 6. Centre of activities. These activities may be related to simple physiological needs such as eating or they may include pastimes or the support of other activities conducted away from the home such as work or sport. 7. A refuge from the outside world. This relates to the need for privacy and independence; the need to “get away” from external pressures and seek solace or at least be able to control the level and nature of demands upon one. 8. An indicator of personal status. “Although ranked among the least important categories of meaning for the home, it is relatively important for people that their home show their economic status, status being mostly understood by individuals’ socio-economic position” (p. 99). 9. Material structure including not only consideration of the physical attributes of the actual dwelling and its aesthetic features, but also the physical characteristics of its surrounds and the neighbourhood. 10. A place to own. Ownership is imbued with connotations of freedom, permanency, pride and significant economic investment. Després, C. (1991). The meaning of home: Literature review and directions for future research and theoretical development. The Journal of Architectural and Planning Research, 8 (2), p. 96-111. Despres (1991, p. 97-99) 10 general categories of ascribed meaning of home Home as: Security and control in the sense of the individual’s feeling in control of the area and physically secure. 2. A reflection of one’s ideas and values. How people see themselves and want to be seen by others. 3. Acting upon and modifying one’s dwelling. The extent to which the home provides a sense of achievement, a place for self-expression and/or freedom of action. 4. Permanence and continuity. This meaning marries the concept of home with the time dimension whereby home may be a place of memories or an environment which has become intimately familiar over a period. 5. Relationships with family and friends: i.e., a place to strengthen and secure the relationship with the people one cares for. Home is perceived and experienced as the locus of intense emotional experience, and as providing an atmosphere of social understanding where one’s actions, opinions, and moods are accepted. Ideas such as a place to share with others, to entertain with relatives and friends, and to raise children, are related to this dimension. 6. Centre of activities. These activities may be related to simple physiological needs such as eating or they may include pastimes or the support of other activities conducted away from the home such as work or sport. 7. A refuge from the outside world. This relates to the need for privacy and independence; the need to “get away” from external pressures and seek solace or at least be able to control the level and nature of demands upon one. 8. An indicator of personal status. “Although ranked among the least important categories of meaning for the home, it is relatively important for people that their home show their economic status, status being mostly understood by individuals’ socio-economic position” (p. 99). 9. Material structure including not only consideration of the physical attributes of the actual dwelling and its aesthetic features, but also the physical characteristics of its surrounds and the neighbourhood. 10. A place to own. Ownership is imbued with connotations of freedom, permanency, pride and significant economic investment. Després, C. (1991). The meaning of home: Literature review and directions for future research and theoretical development. The Journal of Architectural and Planning Research, 8 (2), p. 96-111.

9. 19 February, 2012 J.Knies 9 Place: The Home The Territorial Interpretation The Psychological Interpretation The psycho-analytical perspective ‘Maslow’s theory of personality’ The psychological need for privacy Social recognition and empowering The Socio-Psychological Interpretation The Phenomenological and Developmental Interpretations The Territorial Interpretation [Territorialiteit wordt beschouwd als een mechanisme waarmee de grens tussen mensen aan gegeven wordt door middel van personificatie of markeren van een object of locatie, hiermee aangevend dat dit ‘eigendom’ is van een persoon of groep. Het markeren van een object kan iets simpels zijn als een jas over een stoel hangen om aan te geven dat dit ‘jou’ stoel is. Als gevolg hiervan kan men zich, zowel fysiek als mentaal, veiliger en meer in controle voelen. Het ‘thuis’ als territorium heeft dezelfde uitkomst, hierbij kan eigendom helpen bij het markeren.] The Psychological Interpretation The psycho-analytical perspective [Hierbij wordt ‘thuis’ gezien als een symbool van de individualiteit. De behoefte om een woning te veranderen en om eigen ideeën en waarden te uiten wordt geïnterpreteerd als een onbewuste expressie van het innerlijke. Het ‘thuis’ helpt met het integreren van de verschillende kanten van de persoonlijkheid en vergroot mentale zelf-regulatie. Het ‘thuis’ veroorlooft / reguleert de definitie en het onderhoud van de drie verschillende innerlijke niveau’s: het Ego, het Id en het Superego.] ‘Maslow’s (1954) theory of personality’ [Het ‘thuis’ moet de hiërarchische menselijke behoeften voldoen, van de meest elementaire fysieke behoeftes, zoals een dak boven het hoofd, tot hogere mentale behoeftes, zoals een plek om vrienden te (ver)maken. (De aanpassing van deze theorie naar het wonen toe zijn hieronder beschreven met een aantal opmerkingen erbij.)] The psychological need for privacy [Dit is een van de krachtigste concepten. Het verklaart ‘thuis’ als een schuilplaats. Onder privacy valt de behoefte aan controle over de mate van, bijvoorbeeld, visuele en auditieve inbreuk van buren, de behoefte aan vrijheid om te handelen en ook de mogelijkheid tot eenzaamheid.] Social recognition and empowering [Vooral het exterieur van het ‘thuis’ geeft informatie over de sociale positie van de bewoners, in termen van economische en professionele status, politieke associaties etc. In de Verenigde Staten is het moeten aflossen van een hypotheek een signaal dat je het ‘gemaakt hebt’. Het krijgen van een lening geeft iemand het teken dat hij of zij respectabel is.] The Socio-Psychological Interpretation [Hierbij wordt de zelfidentiteit gedefinieerd in relatie tot een breder sociale entiteit. Het heeft meerdere niveau’s: een persoonlijke zelf, een sociale zelf en een kosmische zelf. Het persoonlijke zelf refereert naar o.a. de gedachten, emoties, percepties en het karakter van het individu. Het sociale zelf refereert naar het proces waarbij objecten betekenis krijgen in het geheugen van het individu en andere. Het kosmische zelf refereert naar de menselijke drang naar een algemene grotere harmonie. Het ‘thuis’ speelt een cruciale rol in de definitie van de zelfidentiteit van mensen. Het fungeert als een dialoog tussen de inwoners en de rest van de gemeenschap. Als een container vol betekenisvolle objecten voorziet het ‘thuis’ van de informatie benodigd voor het ontwikkelen van de zelfidentiteit. Het ‘thuis’ is ook een belangrijk symbool van de sociale identiteit van het individu. Bedoelt of niet, het exterieur van het ‘thuis’ geeft de gemeenschap informatie over de sociale status van de inwoners.] The Phenomenological and Developmental Interpretations [Deze twee theorieën gaan ervan uit dat ‘wonen’ een proces is dat alleen in de loop der tijd beleefd kan worden en dat het bepaalde levensgebeurtenissen het begrip ‘thuis’ beïnvloeden. De, in het begin al genoemde, persoonlijke woongeschiedenis blijkt een sterke invloed te zijn op ideeën, beelden en motivaties van het ‘thuis’. Het ontwikkelen van een bekendheid en routine met hoe de dingen gedaan moeten worden helpen bij het ‘thuis’ gevoel.]The Territorial Interpretation [Territorialiteit wordt beschouwd als een mechanisme waarmee de grens tussen mensen aan gegeven wordt door middel van personificatie of markeren van een object of locatie, hiermee aangevend dat dit ‘eigendom’ is van een persoon of groep. Het markeren van een object kan iets simpels zijn als een jas over een stoel hangen om aan te geven dat dit ‘jou’ stoel is. Als gevolg hiervan kan men zich, zowel fysiek als mentaal, veiliger en meer in controle voelen. Het ‘thuis’ als territorium heeft dezelfde uitkomst, hierbij kan eigendom helpen bij het markeren.] The Psychological Interpretation The psycho-analytical perspective [Hierbij wordt ‘thuis’ gezien als een symbool van de individualiteit. De behoefte om een woning te veranderen en om eigen ideeën en waarden te uiten wordt geïnterpreteerd als een onbewuste expressie van het innerlijke. Het ‘thuis’ helpt met het integreren van de verschillende kanten van de persoonlijkheid en vergroot mentale zelf-regulatie. Het ‘thuis’ veroorlooft / reguleert de definitie en het onderhoud van de drie verschillende innerlijke niveau’s: het Ego, het Id en het Superego.] ‘Maslow’s (1954) theory of personality’ [Het ‘thuis’ moet de hiërarchische menselijke behoeften voldoen, van de meest elementaire fysieke behoeftes, zoals een dak boven het hoofd, tot hogere mentale behoeftes, zoals een plek om vrienden te (ver)maken. (De aanpassing van deze theorie naar het wonen toe zijn hieronder beschreven met een aantal opmerkingen erbij.)] The psychological need for privacy [Dit is een van de krachtigste concepten. Het verklaart ‘thuis’ als een schuilplaats. Onder privacy valt de behoefte aan controle over de mate van, bijvoorbeeld, visuele en auditieve inbreuk van buren, de behoefte aan vrijheid om te handelen en ook de mogelijkheid tot eenzaamheid.] Social recognition and empowering [Vooral het exterieur van het ‘thuis’ geeft informatie over de sociale positie van de bewoners, in termen van economische en professionele status, politieke associaties etc. In de Verenigde Staten is het moeten aflossen van een hypotheek een signaal dat je het ‘gemaakt hebt’. Het krijgen van een lening geeft iemand het teken dat hij of zij respectabel is.] The Socio-Psychological Interpretation [Hierbij wordt de zelfidentiteit gedefinieerd in relatie tot een breder sociale entiteit. Het heeft meerdere niveau’s: een persoonlijke zelf, een sociale zelf en een kosmische zelf. Het persoonlijke zelf refereert naar o.a. de gedachten, emoties, percepties en het karakter van het individu. Het sociale zelf refereert naar het proces waarbij objecten betekenis krijgen in het geheugen van het individu en andere. Het kosmische zelf refereert naar de menselijke drang naar een algemene grotere harmonie. Het ‘thuis’ speelt een cruciale rol in de definitie van de zelfidentiteit van mensen. Het fungeert als een dialoog tussen de inwoners en de rest van de gemeenschap. Als een container vol betekenisvolle objecten voorziet het ‘thuis’ van de informatie benodigd voor het ontwikkelen van de zelfidentiteit. Het ‘thuis’ is ook een belangrijk symbool van de sociale identiteit van het individu. Bedoelt of niet, het exterieur van het ‘thuis’ geeft de gemeenschap informatie over de sociale status van de inwoners.] The Phenomenological and Developmental Interpretations [Deze twee theorieën gaan ervan uit dat ‘wonen’ een proces is dat alleen in de loop der tijd beleefd kan worden en dat het bepaalde levensgebeurtenissen het begrip ‘thuis’ beïnvloeden. De, in het begin al genoemde, persoonlijke woongeschiedenis blijkt een sterke invloed te zijn op ideeën, beelden en motivaties van het ‘thuis’. Het ontwikkelen van een bekendheid en routine met hoe de dingen gedaan moeten worden helpen bij het ‘thuis’ gevoel.]

10. 19 February, 2012 J.Knies 10 Aging: Health De Klerk, M.M.Y. (Ed.) (2000). Rapportage gehandicapten 2000: Arbeidsmarktpositie en financiële situatie van mensen met beperkingen en/of chronische ziekten. [Report handicapped persons 2000: Labour position and financial situation of people with limitation and/or chronic diseases]. Den Haag: Sociaal en Cultureel Planbureau. ISBN: 90-377-00-136.De Klerk, M.M.Y. (Ed.) (2000). Rapportage gehandicapten 2000: Arbeidsmarktpositie en financiële situatie van mensen met beperkingen en/of chronische ziekten. [Report handicapped persons 2000: Labour position and financial situation of people with limitation and/or chronic diseases]. Den Haag: Sociaal en Cultureel Planbureau. ISBN: 90-377-00-136.

11. 19 February, 2012 J.Knies 11 Aging: Health

12. 19 February, 2012 J.Knies 12 Aging: Disablement process Body Functions Body Structures Activity Limitations & Participation Restrictions Environmental Factors Personal factors Body Functions Body Structures Activity Limitations & Participation Restrictions Environmental Factors Personal factors

13. 19 February, 2012 J.Knies 13 Aging: Disablement process Body Functions b1. Mental functions b2. Sensory functions and pain - - - b8. Functions of the skin and related functions Body Structures s1. Structure of the nervous system s2. The eye, ear and related structures - - - s8. Skin and related structures Body Functions b1. MENTAL FUNCTIONS b2. SENSORY FUNCTIONS AND PAIN b3. VOICE AND SPEECH FUNCTIONS b4. FUNCTIONS OF THE CARDIOVASCULAR, HAEMATOLOGICAL, IMMUNOLOGICAL AND RESPIRATORY SYSTEMS b5. FUNCTIONS OF THE DIGESTIVE, METABOLIC AND ENDOCRINE SYSTEMS b6. GENITOURINARY AND REPRODUCTIVE FUNCTIONS b7. NEUROMUSCULOSKELETAL AND MOVEMENT RELATED FUNCTIONS b8. FUNCTIONS OF THE SKIN AND RELATED STRUCTURES Body Structures s1. STRUCTURE OF THE NERVOUS SYSTEM s2. THE EYE, EAR AND RELATED STRUCTURES s3. STRUCTURES INVOLVED IN VOICE AND SPEECH s4. STRUCTURE OF THE CARDIOVASCULAR, IMMUNOLOGICAL AND RESPIRATORY SYSTEMS s5. STRUCTURES RELATED TO THE DIGESTIVE, METABOLISM AND ENDOCRINE SYSTEMS s6. STRUCTURE RELATED TO GENITOURINARY AND REPRODUCTIVE SYSTEM s7. STRUCTURE RELATED TO MOVEMENT s8. SKIN AND RELATED STRUCTURESBody Functions b1. MENTAL FUNCTIONS b2. SENSORY FUNCTIONS AND PAIN b3. VOICE AND SPEECH FUNCTIONS b4. FUNCTIONS OF THE CARDIOVASCULAR, HAEMATOLOGICAL, IMMUNOLOGICAL AND RESPIRATORY SYSTEMS b5. FUNCTIONS OF THE DIGESTIVE, METABOLIC AND ENDOCRINE SYSTEMS b6. GENITOURINARY AND REPRODUCTIVE FUNCTIONS b7. NEUROMUSCULOSKELETAL AND MOVEMENT RELATED FUNCTIONS b8. FUNCTIONS OF THE SKIN AND RELATED STRUCTURES Body Structures s1. STRUCTURE OF THE NERVOUS SYSTEM s2. THE EYE, EAR AND RELATED STRUCTURES s3. STRUCTURES INVOLVED IN VOICE AND SPEECH s4. STRUCTURE OF THE CARDIOVASCULAR, IMMUNOLOGICAL AND RESPIRATORY SYSTEMS s5. STRUCTURES RELATED TO THE DIGESTIVE, METABOLISM AND ENDOCRINE SYSTEMS s6. STRUCTURE RELATED TO GENITOURINARY AND REPRODUCTIVE SYSTEM s7. STRUCTURE RELATED TO MOVEMENT s8. SKIN AND RELATED STRUCTURES

14. 19 February, 2012 J.Knies 14 Aging: Disablement process Activity Limitations & Participation Restrictions d1. Learning and applying knowledge d2. General tasks and demands d3. Communication d4. Mobility d5. Self care d6. Domestic life d7. Interpersonal interactions and relationships d8. Major life areas d9. Community, social and civic life Activity Limitations & Participation Restrictions d1. LEARNING AND APPLYING KNOWLEDGE d2. GENERAL TASKS AND DEMANDS d3. COMMUNICATION d4. MOBILITY d5. SELF CARE d6. DOMESTIC LIFE d7. INTERPERSONAL INTERACTIONS AND RELATIONSHIPS d8. MAJOR LIFE AREAS d9. COMMUNITY, SOCIAL AND CIVIC LIFE Activity Limitations & Participation Restrictions d1. LEARNING AND APPLYING KNOWLEDGE d2. GENERAL TASKS AND DEMANDS d3. COMMUNICATION d4. MOBILITY d5. SELF CARE d6. DOMESTIC LIFE d7. INTERPERSONAL INTERACTIONS AND RELATIONSHIPS d8. MAJOR LIFE AREAS d9. COMMUNITY, SOCIAL AND CIVIC LIFE

15. 19 February, 2012 J.Knies 15 Aging: Disablement process Environmental Factors e1. Products and Technology e2. Natural environment and human made changes to environment e3. Support and relationships e4. Attitudes e5. Services, systems and policies Environmental Factors e1. PRODUCTS AND TECHNOLOGY e2. NATURAL ENVIRONMENT AND HUMAN MADE CHANGES TO ENVIRONMENT e225 Climate, e240 Light, e250 Sound e3. SUPPORT AND RELATIONSHIPS e4. ATTITUDES e5. SERVICES, SYSTEMS AND POLICIESEnvironmental Factors e1. PRODUCTS AND TECHNOLOGY e2. NATURAL ENVIRONMENT AND HUMAN MADE CHANGES TO ENVIRONMENT e225 Climate, e240 Light, e250 Sound e3. SUPPORT AND RELATIONSHIPS e4. ATTITUDES e5. SERVICES, SYSTEMS AND POLICIES

16. 19 February, 2012 J.Knies 16 Aging: Disablement process Personal factors, e.g. Age, Race, Sex Education, Occupation Social background, Upbringing Personality, Lifestyle, Habits Independence, Experience Capabilities, Competence General physical condition Other disorders - - - Personal factors, e.g. Age, Race, Sex Education, Occupation Social background, Upbringing Personality, Lifestyle, Habits Independence, Experience Capabilities, Competence General physical condition Other disorders - - - Personal factors, e.g. Age, Race, Sex Education, Occupation Social background, Upbringing Personality, Lifestyle, Habits Independence, Experience Capabilities, Competence General physical condition Other disorders - - -

17. 19 February, 2012 J.Knies 17 Implications: Scenario Six Health Types Typology of the elderly’s health status based on results for wave I COPD and cancer patients (profile I). The first dimension is characterized by the prevalence of two life-threatening diseases: COPD and cancer. The probability of having continuous medical treatment, which accounts for the severity of the disease, is 50% for COPD and 35% for cancer. Pure type I is also characterized by physical limitations (the score of the self-report test on physical ability is considerably higher than the sample mean) and the individual is more likely to be depressed than others. Other chronic diseases patients (profile II). The health status of the second pure type is very good. However, profile II is characterized by the presence of ‘other chronic diseases’: these are mainly diseases which are not specific to the elderly and are generally not too serious. Examples of these are hypertension, back trouble or eye diseases. Cognitive impaired (profile III). The third pure type is physically healthy but has poor cognitive function (low MMSE test score). Arthritis patients (profile IV). The fourth pure type is characterized by the prevalence of serious arthritis (almost all respondents receive continuous medical treatment). Moreover, the probability of having another chronic disease in addition to arthritis is very high. As expected, pure type IV is physically impaired (both tests on physical ability account for severe physical limitations). Not surprisingly there is a strong association between being depressed (high CES-D scores) and having serious physical impairments. Finally, the cognitive function of pure type IV is also relatively poor (low MMSE test score). Cardiovascular patients (profile V). Difficulties with cardiovascular diseases (heart diseases, atherosclerosis, stroke and diabetes) characterize the fifth profile. Vision is much poorer than the mean, likely because of the presence of diabetes and stroke. Healthy elderly people (profile VI). Finally, the sixth dimension is the healthy one. Portrait, F., Lindeboom, M., & Deeg, D.J.H. (1999). Health and mortality of the elderly: The grade of membership Method, Classification and Determination. Health Economics, 8, 441-457.Typology of the elderly’s health status based on results for wave I COPD and cancer patients (profile I). The first dimension is characterized by the prevalence of two life-threatening diseases: COPD and cancer. The probability of having continuous medical treatment, which accounts for the severity of the disease, is 50% for COPD and 35% for cancer. Pure type I is also characterized by physical limitations (the score of the self-report test on physical ability is considerably higher than the sample mean) and the individual is more likely to be depressed than others. Other chronic diseases patients (profile II). The health status of the second pure type is very good. However, profile II is characterized by the presence of ‘other chronic diseases’: these are mainly diseases which are not specific to the elderly and are generally not too serious. Examples of these are hypertension, back trouble or eye diseases. Cognitive impaired (profile III). The third pure type is physically healthy but has poor cognitive function (low MMSE test score). Arthritis patients (profile IV). The fourth pure type is characterized by the prevalence of serious arthritis (almost all respondents receive continuous medical treatment). Moreover, the probability of having another chronic disease in addition to arthritis is very high. As expected, pure type IV is physically impaired (both tests on physical ability account for severe physical limitations). Not surprisingly there is a strong association between being depressed (high CES-D scores) and having serious physical impairments. Finally, the cognitive function of pure type IV is also relatively poor (low MMSE test score). Cardiovascular patients (profile V). Difficulties with cardiovascular diseases (heart diseases, atherosclerosis, stroke and diabetes) characterize the fifth profile. Vision is much poorer than the mean, likely because of the presence of diabetes and stroke. Healthy elderly people (profile VI). Finally, the sixth dimension is the healthy one. Portrait, F., Lindeboom, M., & Deeg, D.J.H. (1999). Health and mortality of the elderly: The grade of membership Method, Classification and Determination. Health Economics, 8, 441-457.

18. 19 February, 2012 J.Knies 18 Implications: Scenario Health Progression

19. 19 February, 2012 J.Knies 19 Implications: Scenario Well-being Aging-in-Place According to Altman (1975), the ultimate in privacy is the ability to be alone or to be with others when you want to. Breach of privacy arouses feelings of distress. Altman, I. The environment and social behaviour: Privacy, personal space territoriality and crowding. Monterey: Brooks; 1975 According to Altman (1975), the ultimate in privacy is the ability to be alone or to be with others when you want to. Breach of privacy arouses feelings of distress. Altman, I. The environment and social behaviour: Privacy, personal space territoriality and crowding. Monterey: Brooks; 1975

20. 19 February, 2012 J.Knies 20 Implications: Mobility Activity & Participation d4. Mobility d430 Lifting and carrying objects d440 Fine hand use (picking up, grasping) d450 Walking d465 Moving around using equipment (wheelchair, skates, etc.) d470 Using transportation (car, bus, train, plane, etc.) d475 Driving (riding bicycle and motorbike, driving car, etc.)

21. 19 February, 2012 J.Knies 21 Implications: Privacy Type of Privacy Solitude Isolation Anonymity Reserve Intimacy with friends Intimacy with family `Solitude: Solitude refers to placing yourself in a situation where other people cannot see or hear what you are doing, e.g. going to one's bedroom and closing the door. This permits a person to be undisturbed. (This is different from getting away from others by going to a place where there are no other people around.)' `Reserve: Reserve is controlling verbal disclosure of personal information to others (especially to strangers). For example, it involves keeping one's ideas and feelings to one's self, rather than expressing them openly to other people.' `Isolation: Isolation involves using physical distance to separate oneself from others to obtain privacy. Examples are going on a hike into the mountains by oneself or going for a drive in a car alone.' `Intimacy with family: Intimacy with family refers to being alone with members of one's family to the exclusion of other people. An example would be going to a cabin to restrict input from others or leaving the phone off the hook while engaging in a family activity at home.' `Anonymity: Anonymity is seeking privacy by going unnoticed in a crowd of strangers. Going to a concert alone or going shopping in a large shopping mall would be examples.' `Intimacy with friends: Intimacy with friends is like intimacy with family except that the reference group is friends. For both types of privacy the intent is to reduce contact with outsiders while increasing interaction with the group. Having a party with friends would be an example.’`Solitude: Solitude refers to placing yourself in a situation where other people cannot see or hear what you are doing, e.g. going to one's bedroom and closing the door. This permits a person to be undisturbed. (This is different from getting away from others by going to a place where there are no other people around.)' `Reserve: Reserve is controlling verbal disclosure of personal information to others (especially to strangers). For example, it involves keeping one's ideas and feelings to one's self, rather than expressing them openly to other people.' `Isolation: Isolation involves using physical distance to separate oneself from others to obtain privacy. Examples are going on a hike into the mountains by oneself or going for a drive in a car alone.' `Intimacy with family: Intimacy with family refers to being alone with members of one's family to the exclusion of other people. An example would be going to a cabin to restrict input from others or leaving the phone off the hook while engaging in a family activity at home.' `Anonymity: Anonymity is seeking privacy by going unnoticed in a crowd of strangers. Going to a concert alone or going shopping in a large shopping mall would be examples.' `Intimacy with friends: Intimacy with friends is like intimacy with family except that the reference group is friends. For both types of privacy the intent is to reduce contact with outsiders while increasing interaction with the group. Having a party with friends would be an example.’

22. 19 February, 2012 J.Knies 22 Implications: Privacy Function of Privacy Autonomy Confiding Rejuvenation Contemplation Creativity Autonomy: (4) break some social norms; (7) do things that don't ¢t my usual role; (12) experience failure; (20) try out some new behaviours. Confiding: (2) share personal ideas with loved ones; (11) let others in on who I really am; (13) confide in others I trust; (16) express my emotions freely. Rejuvenation: (3) recover my self-esteem; (6) protect myself from what others say; (9) take refuge from the outside world; (18) recover from bad social experiences. Contemplation: (5) discover who I am; (10) determine what I want to be; (14) meditate and reflect; (19) plan future social interactions). Creativity: (1) engage in creative activities; (8) develop a new thought or idea; (15) work on solutions to problems; (17) nourish my creativity. Each privacy function scale was scored by finding the mean rating given to the items constituting the scale. The five response categories on the rating scale and their numerical values were: never (1), rarely (2), occasionally (3), often (4), usually (5).Autonomy: (4) break some social norms; (7) do things that don't ¢t my usual role; (12) experience failure; (20) try out some new behaviours. Confiding: (2) share personal ideas with loved ones; (11) let others in on who I really am; (13) confide in others I trust; (16) express my emotions freely. Rejuvenation: (3) recover my self-esteem; (6) protect myself from what others say; (9) take refuge from the outside world; (18) recover from bad social experiences. Contemplation: (5) discover who I am; (10) determine what I want to be; (14) meditate and reflect; (19) plan future social interactions). Creativity: (1) engage in creative activities; (8) develop a new thought or idea; (15) work on solutions to problems; (17) nourish my creativity. Each privacy function scale was scored by finding the mean rating given to the items constituting the scale. The five response categories on the rating scale and their numerical values were: never (1), rarely (2), occasionally (3), often (4), usually (5).

23. 19 February, 2012 J.Knies 23 Implications: Socialization Social Participation The involvement in actual activities which have a social element Social Networks The number of contacts with friends and relatives and memberships of groups and organisations Social Support The level of instrumental and emotional help available to an individual

24. 19 February, 2012 J.Knies 24 Implications: Socialization Social Participation Informal social activity Formal social activity Social Context With Spouse With Family With Friends Alone

25. 19 February, 2012 J.Knies 25 Implications: Person-Environment Fit The Ecological Theory of Adaptation and Ageing Nahemow & Lawton’s model of the Ecological Theory of Adaptation and Ageing; Individual competence = is the enduring ability that enables an individual to function; Environmental press = are used to refer to aspects of the environment that act in concert with a personal need to evoke behaviour by the subject; Adaptive behaviour = is the externally observable behaviour of the individual; Adaptation level (AL) = is the perceiver’s receptor status when a value when the value of a stimulus is perceived as neutral According to Nahemow & Lawton, an elderly person’s satisfaction with an environment is dependent on two things: Individual competence and Environmental press. They reasoned that any given environment puts certain demands on a person. That person then has to deal with those demands. If one is unable to do so, negative affect and maladaptive behaviour will follow. Not enough demands will have the same effect. The degree of competence needed to deal with given demands, differs from person to person. The demands, or press, differ among environments as well. Figure 1 graphically represents this model. This graph clearly visualises what is going on at one point in time. There is an individual environmental fit in the shaded zones. Outside these zones, individuals will exhibit negative affect and/or maladaptive behaviour. The ‘optimization function’ suggests that for moderate levels of stimulation positive affect is engendered by stimuli that depart in either direction from the Adaptation Level. There are several studies supporting this basic model. For instance, the fit between personal needs of an elderly and the characteristics of a setting, has been found to be important in relocation44. Nahemow & Lawton43, introduced the factor time in their model as well. They argued that over time, a person gets used to its environment. Consequently, the environmental press will become smaller. An environment can therefore shift towards, or from the Adaptation Level. Furthermore, they speculated that the competence could change over time as well. If the environmental press is just too strong for a person, he or she is motivated to get the balance (AL) back. Consequently, the person’s competence will rise. This is what happens in the light grey zone in figure 1. The reverse can happen as well. If the environment is too weak, the person will relax and regain balance. Ergo, some competence will be lost. Nahemow & Lawton’s model of the Ecological Theory of Adaptation and Ageing; Individual competence = is the enduring ability that enables an individual to function; Environmental press = are used to refer to aspects of the environment that act in concert with a personal need to evoke behaviour by the subject; Adaptive behaviour = is the externally observable behaviour of the individual; Adaptation level (AL) = is the perceiver’s receptor status when a value when the value of a stimulus is perceived as neutral According to Nahemow & Lawton, an elderly person’s satisfaction with an environment is dependent on two things: Individual competence and Environmental press. They reasoned that any given environment puts certain demands on a person. That person then has to deal with those demands. If one is unable to do so, negative affect and maladaptive behaviour will follow. Not enough demands will have the same effect. The degree of competence needed to deal with given demands, differs from person to person. The demands, or press, differ among environments as well. Figure 1 graphically represents this model. This graph clearly visualises what is going on at one point in time. There is an individual environmental fit in the shaded zones. Outside these zones, individuals will exhibit negative affect and/or maladaptive behaviour. The ‘optimization function’ suggests that for moderate levels of stimulation positive affect is engendered by stimuli that depart in either direction from the Adaptation Level. There are several studies supporting this basic model. For instance, the fit between personal needs of an elderly and the characteristics of a setting, has been found to be important in relocation44. Nahemow & Lawton43, introduced the factor time in their model as well. They argued that over time, a person gets used to its environment. Consequently, the environmental press will become smaller. An environment can therefore shift towards, or from the Adaptation Level. Furthermore, they speculated that the competence could change over time as well. If the environmental press is just too strong for a person, he or she is motivated to get the balance (AL) back. Consequently, the person’s competence will rise. This is what happens in the light grey zone in figure 1. The reverse can happen as well. If the environment is too weak, the person will relax and regain balance. Ergo, some competence will be lost.

26. 19 February, 2012 J.Knies 26 Implications: Design Environmental Factors e1. Products and Technology e110 For personal consumption (food, medicines) e115 For personal use in daily living e120 For personal indoor and outdoor mobility and transportation e125 Products for communication e150 Design, construction and building products and technology of buildings for public use e155 Design, construction and building products and technology of buildings for private use

27. 19 February, 2012 J.Knies 27 Implications: Design Seven Principles of Universal Design Equitable use Flexibility in use Simple and intuitive Perceptible information Tolerance for error Low physical effort Size and space for approach and use Universal Design 1 principle one: equitable use The design is useful and marketable to people with diverse abilities. * Provide the same means of use for all users: identical whenever possible; equivalent when not. * Avoid segregating or stigmatizing any users. * Provisions for privacy, security, and safety should be equally available to all users. * Make the design appealing to all users. 2 principle two: flexibilty in use The design accommodates a wide range of individual preferences and abilities. * Provide choice in methods of use. * Accommodate right- or left-handed access and use. * Facilitate the user's accuracy and precision. * Provide adaptability to the user's pace. 3 principle three: simple and intuitive Use of the design is easy to understand, regardless of the user's experience, knowledge, language skills, or current concentration level. * Eliminate unnecessary complexity. * Be consistent with user expectations and intuition. * Accommodate a wide range of literacy and language skills. * Arrange information consistent with its importance. * Provide effective prompting and feedback during and after task completion. 4 principle four: perceptible information The design communicates necessary information effectively to the user, regardless of ambient conditions or the user's sensory abilities. * Use different modes (pictorial, verbal, tactile) for redundant presentation of essential information. * Provide adequate contrast between essential information and its surroundings. * Maximize "legibility" of essential information. * Differentiate elements in ways that can be described (i.e., make it easy to give instructions or directions). * Provide compatibility with a variety of techniques or devices used by people with sensory limitations. 5 principle five: tolerance for error The design minimizes hazards and the adverse consequences of accidental or unintended actions. * Arrange elements to minimize hazards and errors: most used elements, most accessible; hazardous elements eliminated, isolated, or shielded. * Provide warnings of hazards and errors. * Provide fail safe features. * Discourage unconscious action in tasks that require vigilance. 6 principle six: low physical effort The design can be used efficiently and comfortably and with a minimum of fatigue. * Allow user to maintain a neutral body position. * Use reasonable operating forces. * Minimize repetitive actions. * Minimize sustained physical effort 7 principle seven: size and space for approach and use Appropriate size and space is provided for approach, reach, manipulation, and use regardless of user's body size, posture, or mobility. * Provide a clear line of sight to important elements for any seated or standing user. * Make reach to all components comfortable for any seated or standing user. * Accommodate variations in hand and grip size. * Provide adequate space for the use of assistive devices or personal assistance.Universal Design 1 principle one: equitable use The design is useful and marketable to people with diverse abilities. * Provide the same means of use for all users: identical whenever possible; equivalent when not. * Avoid segregating or stigmatizing any users. * Provisions for privacy, security, and safety should be equally available to all users. * Make the design appealing to all users. 2 principle two: flexibilty in use The design accommodates a wide range of individual preferences and abilities. * Provide choice in methods of use. * Accommodate right- or left-handed access and use. * Facilitate the user's accuracy and precision. * Provide adaptability to the user's pace. 3 principle three: simple and intuitive Use of the design is easy to understand, regardless of the user's experience, knowledge, language skills, or current concentration level. * Eliminate unnecessary complexity. * Be consistent with user expectations and intuition. * Accommodate a wide range of literacy and language skills. * Arrange information consistent with its importance. * Provide effective prompting and feedback during and after task completion. 4 principle four: perceptible information The design communicates necessary information effectively to the user, regardless of ambient conditions or the user's sensory abilities. * Use different modes (pictorial, verbal, tactile) for redundant presentation of essential information. * Provide adequate contrast between essential information and its surroundings. * Maximize "legibility" of essential information. * Differentiate elements in ways that can be described (i.e., make it easy to give instructions or directions). * Provide compatibility with a variety of techniques or devices used by people with sensory limitations. 5 principle five: tolerance for error The design minimizes hazards and the adverse consequences of accidental or unintended actions. * Arrange elements to minimize hazards and errors: most used elements, most accessible; hazardous elements eliminated, isolated, or shielded. * Provide warnings of hazards and errors. * Provide fail safe features. * Discourage unconscious action in tasks that require vigilance. 6 principle six: low physical effort The design can be used efficiently and comfortably and with a minimum of fatigue. * Allow user to maintain a neutral body position. * Use reasonable operating forces. * Minimize repetitive actions. * Minimize sustained physical effort 7 principle seven: size and space for approach and use Appropriate size and space is provided for approach, reach, manipulation, and use regardless of user's body size, posture, or mobility. * Provide a clear line of sight to important elements for any seated or standing user. * Make reach to all components comfortable for any seated or standing user. * Accommodate variations in hand and grip size. * Provide adequate space for the use of assistive devices or personal assistance.

28. 19 February, 2012 J.Knies 28 Implications of Aging-in-Place Person Individual Dynamic - - - Design Support Adaptable - - -