Older people and their social spaces: a study of well-being and attachment to place in Aotearoa New Zealand.

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.

Living with diabetes on Baffin Island: Inuit storytellers share their experiences.

BACKGROUND: The prevention and management of Type 2 diabetes mellitus has become a concern in Inuit communities across Canada. Although Inuit living with diabetes in remote Canadian Arctic communities could help guide the development of health services, their voices have not been heard. The experiences and perceptions of Inuit themselves are often overlooked in research. In this study, Inuit living in a small rural Arctic community on Baffin Island were invited to share their experiences of living with diabetes. METHODS: A qualitative multi-case study approach was taken. In-depth interviews (n=4), field observations, and informal interviews over one month in the community were used to build and contextualize the cases. In-depth interviews were transcribed, and analyzed using holistic thematic analysis and open coding. RESULTS: Accessibility was a concern with respect to foods, health knowledge, language interpretation and health services. In all methods of analysis, the importance of language and effective cross-cultural communication figured prominently. It was also evident that trust and rapport is crucial when discussing diabetes. There was strong interest in promoting diabetes education and prevention within the community. INTERPRETATION: These findings suggest that current health education and services may not be adequate for this setting. The voices of Inuit should be integral in steering the direction of their future diabetes education and health service delivery. Focusing on language barriers may help to improve the accessibility of knowledge about diabetes and nutrition, and enhance relationships between non-Inuit health service providers and Inuit.

Attachment to place in advanced age: A study of the LiLACS NZ cohort.

An extensive body of research theorises that attachment to place is positively associated with health, particularly for older people. Building on this, we measure how indicators of attachment to place are associated with health for in people of advanced age in New Zealand. We use data from a cohort study (LiLACS NZ), which includes an indigenous Maori cohort aged 80-90 years and a non-Maori cohort aged 85 years from a mixed urban/rural region in New Zealand. Each cohort undertook a comprehensive interview and health assessment (n = 267 Maori and n = 404 non-Maori). Using multivariate regression analyses, we explore participants' feelings for and connectedness with their home, community and neighbourhood; nature and the outdoors; expectations about and enthusiasm for residential mobility; and how all these are associated with measures of health (e.g., SF-12 physical and mental health related quality of life) and functional status (e.g., NEADL). We demonstrate that people in advanced age hold strong feelings of attachment to place. We also establish some positive associations between attachment to place and health in advanced age, and show how these differ for the indigenous and non-indigenous cohorts. For older Maori there were strong associations between various health measures and the importance of nature and the outdoors, and connectedness to neighbourhood and community. For older non-Maori, there were strong associations between health and liking home and neighbourhood, and feeling connected to their community and neighbourhood. Place attachment, and particularly its relationship to health, operates in different ways for different groups.

Socioeconomic correlates of quality of life for non-Maori in advanced age: Te Puawaitanga o Nga Tapuwae Kia ora Tonu. Life and Living in Advanced Age: a Cohort Study in New Zealand (LiLACS NZ).

AIM: To establish socioeconomic and cultural profiles and correlates of quality of life (QoL) in non-Maori of advanced age. METHOD: A cross sectional analysis of the baseline data of a cohort study of 516 non-Maori aged 85 years living in the Bay of Plenty and Rotorua areas of New Zealand. Socioeconomic and cultural characteristics were established by face-to-face interviews in 2010. Health-related QoL (HRQoL) was assessed with the SF-12. RESULTS: Of the 516 non-Maori participants enrolled in the study, 89% identified as New Zealand European, 10% other European, 1% were of Pacific, Asian or Middle Eastern ethnicity; 20% were born overseas and half of these identified as 'New Zealand European.' More men were married (59%) and more women lived alone (63%). While 89% owned their own home, 30% received only the New Zealand Superannuation as income and 22% reported that they had 'just enough to get along on'. More than 85% reported that they had sufficient practical and emotional support; 11% and 6% reported unmet need for practical and emotional support respectively. Multivariate analyses showed that those with unmet needs for practical and emotional support had lower mental HR QoL (p<0.005). Reporting that family were important to wellbeing was associated with higher mental HR QoL (p=0.038). Those that did not need practical help (p=0.047) and those that reported feeling comfortable with their money situation (0.0191) had higher physical HRQoL. High functional status was strongly associated with both high mental and high physical HR QoL (p<0.001). CONCLUSION: Among our sample of non-Maori people of advanced age, those with unmet support needs reported low HRQoL. Functional status was most strongly associated with mental and physical HRQoL.

Receiving support when older: what makes it ok?

PURPOSE: Older people are seen as needing to receive support from other people as they age. But what are the experiences and expectations older people have of being "support receivers"? DESIGN AND METHODS: Community-dwelling childless elders (n = 38, aged 63-93) were interviewed about their experiences and expectations of support, as they comprise a group "at risk" of lack of support. Responses were analyzed within a narrative gerontology framework of positioning theory as to how receiving support was "positioned" and how it related to growing older. RESULTS: Participants defined support in widely diverse ways; it was not a straightforward concept. Receiving support could be warranted by particular circumstances such as illness, made acceptable by the qualities of the support giver, and/or by being part of reciprocal exchanges across time. Support receiving was resisted when associated with difficult interpersonal dynamics or assumptions of incapacity. It was also in tension with preferred positions of being "independent" or of needing "no support." Participants positioned "oldness" negatively and as both equivalent to the need for support and as a potential outcome of being a support receiver. IMPLICATIONS: This research shows that support can be hard to define and hard to receive. Needs assessors and researchers asking "Do you have enough support?" need to consider how support is positioned to better target appropriate help. Assumptions about at-risk groups can be misleading; many childless participants had a lifetime of self-support or an intentionally developed "web of contacts" at a size that suited them, even if they looked unsupported to others.

Care for place: the contributions older people make to their communities.

Older people are often positioned as passive recipients of care and dependent on resources or as overly productive and active. In this paper, we seek a more nuanced, middle ground between such stereotypes, by exploring the question: what contributions do older people make to the places they live in? Drawing on qualitative research from Aotearoa New Zealand, involving focus groups and interviews, we examine the varied and active ways many older people are involved in and contribute to their neighbourhoods and communities, or what we term 'care for place'. In particular, we identify the different forms of older people's care for place, including volunteering, activism, advocacy, and nurturing, and consider how these efforts positively impact on older people and the communities in which they live. Whilst we caution against assumptions that all older people should be productively involved, we argue that greater understanding of older people's care for place is central to challenging stereotypes of older people as either passive and dependent, or highly active.

The utility of positioning theory to the study of ageing: Examples from research with childless older people.

Growing older is hard to make sense of. Opposing perspectives are presented on everything from individual to population ageing, and there is widespread ambivalence towards many aspects of ageing. Positioning theory is a research approach that can tolerate such ambiguity and provides a clear, useful framework to make sense of research data, while doing justice to its complexity. It is starting to be used in gerontology; the aim of this paper is to give gerontologists the tools and impetus to use it more. The positioning triad is outlined, comprising positions (how we position ourselves and others within a single conversation or across a lifetime), storylines (the individual and social narratives which furnish those positions), and the speech acts (and acts of research) through which storylines and positions are enacted. In addition, considering the rights and duties associated with different positions and storylines can usefully illuminate some of the tensions around competing positions on ageing. Worked examples from a qualitative study on childless older people (38 participants aged 63 to 93) in terms of their positioning of childlessness, views on residential care, and positioning of emotional support show how the complexity of such diverse topics can be usefully studied using a positioning theory framework.

Resilience from the point of view of older people: 'There's still life beyond a funny knee'.

Resilience is a concept of growing interest in relation to older people and within the context of population ageing. In this paper we explore older people's understandings and experiences of resilience, drawing on interviews and participant-led focus groups with 121 older people living in two case-study communities in Aotearoa, New Zealand. Close reading of extended conversations about what characterises resilience, such as positive attitude, counting blessings or keeping busy, reveal how all of these apparently internal or personal characteristics are deeply embedded in social and physical contexts. We argue that resilience should be seen as a contextualised process which can be both individual and environmental. Older people's experiences highlight the need to consider the effectiveness of environmental community resources and social-political structures such as state-funded service availability, as well as the personal characteristics that are usually focused on when considering resilience in old age. We also argue that it is important to consider different aspects of resilience, so that a person or group might face constraints in one area, such as physical or economic wellbeing, but be strong in other areas such as social relationships or mobility. Resilience can mean acknowledging and incorporating 'vulnerability' and balancing wellbeing across a range of areas. Thus even those living with significant illness or hardship can be understood to be ageing well and indeed to be resilient. Far from using resilience as a narrow measure against which to succeed or fail, resilience is a useful concept framing how ageing well can incorporate multidimensional pathways including both vulnerability and flourishing. We must pay adequate attention to the broader physical and social contexts and scales that underpin--or undermine--individual resilience.

The meaning of "aging in place" to older people.

PURPOSE: 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. DESIGN AND METHODS: 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. RESULTS: 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. IMPLICATIONS: 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.

Methodological consideration of story telling in qualitative research involving indigenous peoples.

BACKGROUND: The use of storytelling in qualitative research involving Inuit compliments the oral tradition of Inuit culture. The objective of the research was to explore the use of qualitative methods to gain understanding of the experience of living with diabetes, with the ultimate goal of better formulating health care delivery and health promotion among Inuit. METHODS: In-depth interviews were analyzed and interpreted using thematic analysis, open coding, and structured narrative analysis. Inuit community members acted as partners through all stages of the research. RESULTS: ''Because the more we understand, the more we're gonna do a prevention on it ... What I want is use my, use my diabetes, what I have ... so that it can be used by other people for prevention because they'll have understanding about it'' - an Inuk storyteller speaks to the value of education in health promotion. Key methodological issues found relevant to improving qualitative research with Indigenous Peoples include: (i) participatory research methods, grounded in principals of equity, through all phases of research; (ii) the presentation of narratives rather than only interpretations of narratives; (iii) understanding of culture, language, and place to frame the interpretation of the stories in the context within which storytellers experience living with their diabetes, and (iv) the value of multiple methods of analyses. INTERPRETATION: This article comments on the challenges of conducting rigorous research in a cross-cultural setting and outlines methodologies that can improve qualitative narrative analyses research. The research highlighted experiences of living with diabetes and the ways in which storytellers coped and negotiated social support.