Contours of "here": Phenomenology of space for assisted living residents approaching end of life

• Type of Material: Article
• Authors: Ann Vandenberg, Emory University; Mary Ball, Emory University; Candace L. Kemp, Georgia State University; Patrick J. Doyle, Johns Hopkins School of Nursing; Meredith Fritz, Emory University; Sean Halpin, Emory University; Lee Hundley, Emory University; Molly Perkins, Emory University
• Language: English
• Date: 2018-12-01
• Publisher: ELSEVIER SCIENCE INC
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2018 Elsevier Inc.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.jaging.2018.03.001
• Title of Journal or Parent Work: JOURNAL OF AGING STUDIES
• Volume: 47
• Start Page: 72
• End Page: 83
• Grant/Funding Information: This project was funded by the National Institute on Aging (End-of-Life in Assisted Living: Links between Structure, Process, and Outcomes, R01AG047408-01A1 awarded to Molly M. Perkins, PI).; Data management was supported through Emory Research and Woodruff Health Sciences IT Division grant support(UL1 TR000424).
• Keywords: End-of-life care; Assisted living; Gerontology; Life Sciences & Biomedicine; Geriatrics & Gerontology; PERSON-CENTERED CARE; HOME; Phenomenology; Place integration; ENVIRONMENT; INTEGRATION; Science & Technology; Environmental gerontology; HEALTH; PAIN; OLDER-PEOPLE; DEMENTIA
• Research Categories: Gerontology

Abstract

Informed by theory from environmental gerontology, this study investigates how assisted living residents who are approaching end of life navigate and experience space. Since its development, environmental gerontology has moved beyond the concept of person-environment fit to encompass aspects of place attachment and place integration, processes by which inhabited impersonal space becomes a place of individual personal meaning and this person-place relationship evolves with changing needs. Our study is a secondary data analysis of in-depth interviews completed with the first 15 residents (mean age 88, range 65–103; 8 white and 7 black) recruited from four diverse assisted living communities in metropolitan Atlanta. Using interpretative phenomenological analysis, we identify five overarching themes within and across assisted living communities and their subthemes. Findings show that participants experience a neutral theme of shrinking space, negative themes of confinement and vulnerability, and positive themes of safety and intimacy. Results dovetail with other phenomenologically based environmental gerontology research from community-dwelling populations that indicate behavioral changes to accommodate aging and health decline. Findings have implications for interventions to improve place integration in AL and enhance residents’ quality of life at end of life, including developing strategies to promote small meaningful journeys within context of shrinking life space.