Psychological Reports, 1990, 66, 147-150. O Psychological Reports 1990
EFFECTS OF ENVIRONMENT O N PSYCHOLOGICAL WELL-BEING OF ELDERLY PERSONS ' SALIM QASSIS AND DAVIS C. HAYDEN \Vestern Washington University Summary.-This study reports an investigation of the psychological well-being of 90 elderly persons living in independent, retirement, and nursing homes. In previous studies elderly persons have not been matched on high levels of social and physical functioning across these living environments. Analyses indicated significantly that elderly persons living in their own homes or retirement homes reported greater well-being than their matched cohorts in nursing homes.
One of the most important factors that can affect cognitive ability, sociability, morale, adjustment, and other psychological aspects of elderly persons is suitable living environments (see, for example, Lawton, 1977). As the U.S. Senate's Committee on Aging (1965) has pointed out, housing and its immediate surroundings influence well-being and the quahty of life of people in any age group but is doubly important to the retired person whose home is the center of virtually all of his activities. Although elderly people live in many environments (see, for example, Beland, 1987), the three investigated were independent, retirement, and nursing homes. Previous studies on well-being have either not used all three settings and/or have not matched their subjects for physical and social functioning (Lieberman & Tobin, 1983). We wanted to clarify empirically what is often alluded to by researchers: that the well-being of elderly people is differentiated by their living environment (Hendrick, Wells, & Faletti, 1982; Lawton, 1977; Lawton & Cohen, 1974; Lieberman, 1774; Millet, Pon, Guibud, & Auriol, 1980; Noelke & Harel, 1981).
Subjects The subjects, ages from 65 to 95 yr., lived in the community of Bellingham, Washington (population approximately 50,000). The independent home residents included 16 women and 14 men (M = 76.0 yr., SD = 6.1) randomly selected from the community. All were Caucasian, 17 earned less than $5,000 a year, and 5 did not complete high school. The retirement home residents included 22 women and 8 men (M= 8 0 yr., SD= 7.5) randomly selected from six retirement homes where 29 were Caucasian, 26 earned less
'Address correspondence to D. C. Hayden, Ph.D., Western Washingon University, Bellingharn, Washington 98225.
148
S. QASSIS &
D.C. HAYDEN
than $5,000 a year, and 11 did not complete high school. After eliminating residents with serious physical problems, nursing-home residents included 21 women and 9 men (M= 78.0 yr., SD = 7.1) randomly selected from five nursing homes where 28 were Caucasian, 19 earned less than $5,000, and 8 did not complete high school.
Instruments The authors designed scales for physical and social functioning as no published scales measured both in a common format (some used only a single item). The physical scale assesses ability to brush one's hair, brush one's teeth, bathe oneself, dress and undress oneself, feed oneself, and move about. The social scale assesses amount of visitation by relatives, visitation by friends and neighbors, readng of books and watching TV, pursuing social interest, attending activities, exercising, and general recreation. Subjects rate all items on a 5-point scale. A rating of 4 or higher on average represents high physical functioning (total = 24 to 30) and high social functioning (total = 28 to 35). The coefficient alpha was .746 for the physical scale and ,776 for the social scale. The second instrument is the General Well-being schedule (National Center for Health Statistics, 1973). The schedule is easy for subjects to comprehend, is relatively short (33 items), and has a rational approach to assessing self-representation of depression and tension anxiety (Fazio, 1977). A high score reflects a self-representation of well-being. The test-retest correlation over three months is ,851, and internal consistency coefficients are ,912 for men and .945 for women. Procedure Two meetings took place at the subjects' residences between 2 and 6 p.m. The initial meeting consisted of establishing rapport with the subjects, informing them of the nature of the study, obtaining consent, and collecting demographic information. Subjects answered orally the questions on the scales and schedule which were given in a counterbalanced order at the second meeting. Communicating verbally helped to remove confusion (O'Brien & Holborn, 1979) and aided in establishing rapport with the subjects rapidly. To refine the scales, practice, and standardize the procedures trial runs were completed with several elderly persons before data were collected.
Student's t tests analyzing the order of administering the scales and the schedule were not significant (lowest p = .16). We did not use income or marital status as covariates as the correlation between income and well-being was low (.0006) and the comparison of married versus nonmarried persons
149
WELLBEING OF ELDERLY PERSONS
on well-being was not significant (t,, = -1.77, p = .078). In addition, the retirement-home group had the same ratio of married to nonmarried as the nursing home group. The Pearson correlations between well-being and the physical and social scales were ,426 and ,332, respectively. Since the two scales correlated low (.176), we did not collapse them which meant doing two analyses of variance. Both yielded significant differences for well-being across living arrangements (F,,,, = 18.74, p < .0001, using only subjects with high physical functioning, and F,,,, = 22.63, p < .0001, using only subjects with high social functioning). Table 1 reports means and standard deviations of well-being scores. TABLE 1 MEANSAND STANDARD DEVIATIONS: WELL-BEING FOR SUBJECTS WHO AND SOCIALSCALES SCORED HIGHO N PHYSICAL Groups Independent Home Retirement Home Nursing Home
Physical Scale
Social Scale
n
M
SD
n
M
SD
30 30 28
116.6 110.4 91.2
16.9 14.7 17.5
13 13 17
130.1 119.2 96.1
12.2 13.8 15.8
Scheff6 post hoc comparisons indicated that only the nursing home environment differed significantly ( p < .001) for well-being from retirement and independent homes.
This study indicates that there are individuals in nursing homes with sirniIar levels of physical and social functioning as those who live in retirement centers and their own homes yet these nursing home residents have significantly lower mean self-reports of psychological well-being. Possible explanations that have been explored by others include (a) negative stereotyping by staff at nursing homes (see Wright, 1988), (b) negative stereotypes of society being incorporated by nursing home residents (Butler, 1980; Estes, 1780), (c) lack of control in nursing homes (Berkowitz, Waxman, & Yaffe, 1988), (d) insecurity and insufficient privacy at nursing homes (Firestone, Lichman, & Evans, 1980), and (e) loss of contact with family and friends (Millet, Pon, Guibud, & Auriol, 1980). One limitation of this study is that subjects came from a small urban and a rural area. Our subjects might have quite d i f f e ~ n characteristics t from elderly persons living in large metropolitan cities. I n addition, although the retirement homes and nursing homes used may be typical, there is variance in how these living environments are staffed and maintained (VandenBos & Buchanan, 1983; Wright, 1988).
S. QASSIS & D. C. HAYDEN REFERENCES B L A N DF. , (1987) Living arrangement preferences among elderly people. The Gerontologist, 27, 797-803. BERKOWITZ,M. W., WAXMAN,R., & YAFFE, L. (1988) The effects of a resident self-help model on control, social involvement and self-esteem among the elderly. The Gerontologist, 28, 620-624. BUTLER,R. N. (1980) Ageism: a forward. Jozrrnal of Social Issues, 36, 8-11. ESTES,C. L. (1980) Construction of reality. Journal of Social Issues, 36, 117-132. FAZIO,A. F. (1977) A concurrent validation study of the NCHS General Well-being schedule. (Vital and Health Statistics Series 2, No. 73, DNEW Publication No. HRA78-1347) Hyattsville, MD: National Center for Health Stat~s~ics. FIRESTONE, I. J., LICHMAN,C. M., & EVANS, J. R. (1980) Privacy and solidarity. International Journal of Aging and Human Development, 10, 230-241. HENDRICK, C., WELLS,K. S., & FALETTI, M. V. (1982) Social and emotional effeccs of geographical relocation on elderly retirees. Journal of Pe~sonalityand Social Psychology, 42, 951-962. LAWTON, M. P (1977) The impact of the environment on aging and behavior. In J. E. Buren & K. W. Schaie (Eds.), Handbook of the psychology of aging. New York: Van Nostrand Reinhold. Pp. 276-301. LAWTON,M. l?, & COHEN,J. (1974) The ,generality of housing impact on the well being of older people. Journal of Gerontology, 29, 194-204. LIEBERMAN, M. (1974) Relocation research and social policy. The Gerontologist, 14, 494-501. LIEBERMAN, M., & TOBIN,S. (1983) The experience of old age. New York: Basic Books. MLLLET,L. J., PON,J., GUIBUD, J. M., & AURIOL,G. (1980) Moving: psychopachological reactions to a change of house. Annales Medico-Psycholagigues, 138, 212-221. NATIONALCENTERFOR HEALTHSTATISTICS.(1973) The psychological section of the current health and nutrition examination survey. Proceedings of the Public Health Conference on Records and Statistics, meeting jointly with the National Conference on Mental Health Statistics, 14th national meeting June 12-15, 1972. [DHEW Pub. No. (HRA) 74-1214, Health Resources Administration] Washington, DC: U.S.Government Printing Office. No-, L. S., & HAREL,2. (1981) Residential choice and the well-being of the aged and disabled public housing residents. Journal of Gerontological Social Work, 4(2), 17-29. O'BRIEN, J. S., & HOLBORN, S. W. (1979) Verbal and non-verbal expressions as reinforcers in verbal conditioning of adult convenation. Journal of Behavior Therapy and Experimentul Psychiatry, 10, 267-277. U.S. SENATE'SCOMMITTEE ON AGING. (1965) Developments in aging. (Report No. 124) Washington, DC: U.S. Government Printing Office. VANDENBOS, G. R., & BUCHANAN, J. (1983) Aging, research on aging, and national policy. American Psychologist, 38, 300-310. WRIGHT,L. K. (1988) A reconceptualization of the "negative staff attitudes and poor care in nursing homes" assumption. The Gerontologist, 28, 813-820.
Accepted January 17, 1990.
EFFECTS OF ENVIRONMENT O N PSYCHOLOGICAL WELL-BEING OF ELDERLY PERSONS ' SALIM QASSIS AND DAVIS C. HAYDEN \Vestern Washington University Summary.-This study reports an investigation of the psychological well-being of 90 elderly persons living in independent, retirement, and nursing homes. In previous studies elderly persons have not been matched on high levels of social and physical functioning across these living environments. Analyses indicated significantly that elderly persons living in their own homes or retirement homes reported greater well-being than their matched cohorts in nursing homes.
One of the most important factors that can affect cognitive ability, sociability, morale, adjustment, and other psychological aspects of elderly persons is suitable living environments (see, for example, Lawton, 1977). As the U.S. Senate's Committee on Aging (1965) has pointed out, housing and its immediate surroundings influence well-being and the quahty of life of people in any age group but is doubly important to the retired person whose home is the center of virtually all of his activities. Although elderly people live in many environments (see, for example, Beland, 1987), the three investigated were independent, retirement, and nursing homes. Previous studies on well-being have either not used all three settings and/or have not matched their subjects for physical and social functioning (Lieberman & Tobin, 1983). We wanted to clarify empirically what is often alluded to by researchers: that the well-being of elderly people is differentiated by their living environment (Hendrick, Wells, & Faletti, 1982; Lawton, 1977; Lawton & Cohen, 1974; Lieberman, 1774; Millet, Pon, Guibud, & Auriol, 1980; Noelke & Harel, 1981).
Subjects The subjects, ages from 65 to 95 yr., lived in the community of Bellingham, Washington (population approximately 50,000). The independent home residents included 16 women and 14 men (M = 76.0 yr., SD = 6.1) randomly selected from the community. All were Caucasian, 17 earned less than $5,000 a year, and 5 did not complete high school. The retirement home residents included 22 women and 8 men (M= 8 0 yr., SD= 7.5) randomly selected from six retirement homes where 29 were Caucasian, 26 earned less
'Address correspondence to D. C. Hayden, Ph.D., Western Washingon University, Bellingharn, Washington 98225.
148
S. QASSIS &
D.C. HAYDEN
than $5,000 a year, and 11 did not complete high school. After eliminating residents with serious physical problems, nursing-home residents included 21 women and 9 men (M= 78.0 yr., SD = 7.1) randomly selected from five nursing homes where 28 were Caucasian, 19 earned less than $5,000, and 8 did not complete high school.
Instruments The authors designed scales for physical and social functioning as no published scales measured both in a common format (some used only a single item). The physical scale assesses ability to brush one's hair, brush one's teeth, bathe oneself, dress and undress oneself, feed oneself, and move about. The social scale assesses amount of visitation by relatives, visitation by friends and neighbors, readng of books and watching TV, pursuing social interest, attending activities, exercising, and general recreation. Subjects rate all items on a 5-point scale. A rating of 4 or higher on average represents high physical functioning (total = 24 to 30) and high social functioning (total = 28 to 35). The coefficient alpha was .746 for the physical scale and ,776 for the social scale. The second instrument is the General Well-being schedule (National Center for Health Statistics, 1973). The schedule is easy for subjects to comprehend, is relatively short (33 items), and has a rational approach to assessing self-representation of depression and tension anxiety (Fazio, 1977). A high score reflects a self-representation of well-being. The test-retest correlation over three months is ,851, and internal consistency coefficients are ,912 for men and .945 for women. Procedure Two meetings took place at the subjects' residences between 2 and 6 p.m. The initial meeting consisted of establishing rapport with the subjects, informing them of the nature of the study, obtaining consent, and collecting demographic information. Subjects answered orally the questions on the scales and schedule which were given in a counterbalanced order at the second meeting. Communicating verbally helped to remove confusion (O'Brien & Holborn, 1979) and aided in establishing rapport with the subjects rapidly. To refine the scales, practice, and standardize the procedures trial runs were completed with several elderly persons before data were collected.
Student's t tests analyzing the order of administering the scales and the schedule were not significant (lowest p = .16). We did not use income or marital status as covariates as the correlation between income and well-being was low (.0006) and the comparison of married versus nonmarried persons
149
WELLBEING OF ELDERLY PERSONS
on well-being was not significant (t,, = -1.77, p = .078). In addition, the retirement-home group had the same ratio of married to nonmarried as the nursing home group. The Pearson correlations between well-being and the physical and social scales were ,426 and ,332, respectively. Since the two scales correlated low (.176), we did not collapse them which meant doing two analyses of variance. Both yielded significant differences for well-being across living arrangements (F,,,, = 18.74, p < .0001, using only subjects with high physical functioning, and F,,,, = 22.63, p < .0001, using only subjects with high social functioning). Table 1 reports means and standard deviations of well-being scores. TABLE 1 MEANSAND STANDARD DEVIATIONS: WELL-BEING FOR SUBJECTS WHO AND SOCIALSCALES SCORED HIGHO N PHYSICAL Groups Independent Home Retirement Home Nursing Home
Physical Scale
Social Scale
n
M
SD
n
M
SD
30 30 28
116.6 110.4 91.2
16.9 14.7 17.5
13 13 17
130.1 119.2 96.1
12.2 13.8 15.8
Scheff6 post hoc comparisons indicated that only the nursing home environment differed significantly ( p < .001) for well-being from retirement and independent homes.
This study indicates that there are individuals in nursing homes with sirniIar levels of physical and social functioning as those who live in retirement centers and their own homes yet these nursing home residents have significantly lower mean self-reports of psychological well-being. Possible explanations that have been explored by others include (a) negative stereotyping by staff at nursing homes (see Wright, 1988), (b) negative stereotypes of society being incorporated by nursing home residents (Butler, 1980; Estes, 1780), (c) lack of control in nursing homes (Berkowitz, Waxman, & Yaffe, 1988), (d) insecurity and insufficient privacy at nursing homes (Firestone, Lichman, & Evans, 1980), and (e) loss of contact with family and friends (Millet, Pon, Guibud, & Auriol, 1980). One limitation of this study is that subjects came from a small urban and a rural area. Our subjects might have quite d i f f e ~ n characteristics t from elderly persons living in large metropolitan cities. I n addition, although the retirement homes and nursing homes used may be typical, there is variance in how these living environments are staffed and maintained (VandenBos & Buchanan, 1983; Wright, 1988).
S. QASSIS & D. C. HAYDEN REFERENCES B L A N DF. , (1987) Living arrangement preferences among elderly people. The Gerontologist, 27, 797-803. BERKOWITZ,M. W., WAXMAN,R., & YAFFE, L. (1988) The effects of a resident self-help model on control, social involvement and self-esteem among the elderly. The Gerontologist, 28, 620-624. BUTLER,R. N. (1980) Ageism: a forward. Jozrrnal of Social Issues, 36, 8-11. ESTES,C. L. (1980) Construction of reality. Journal of Social Issues, 36, 117-132. FAZIO,A. F. (1977) A concurrent validation study of the NCHS General Well-being schedule. (Vital and Health Statistics Series 2, No. 73, DNEW Publication No. HRA78-1347) Hyattsville, MD: National Center for Health Stat~s~ics. FIRESTONE, I. J., LICHMAN,C. M., & EVANS, J. R. (1980) Privacy and solidarity. International Journal of Aging and Human Development, 10, 230-241. HENDRICK, C., WELLS,K. S., & FALETTI, M. V. (1982) Social and emotional effeccs of geographical relocation on elderly retirees. Journal of Pe~sonalityand Social Psychology, 42, 951-962. LAWTON, M. P (1977) The impact of the environment on aging and behavior. In J. E. Buren & K. W. Schaie (Eds.), Handbook of the psychology of aging. New York: Van Nostrand Reinhold. Pp. 276-301. LAWTON,M. l?, & COHEN,J. (1974) The ,generality of housing impact on the well being of older people. Journal of Gerontology, 29, 194-204. LIEBERMAN, M. (1974) Relocation research and social policy. The Gerontologist, 14, 494-501. LIEBERMAN, M., & TOBIN,S. (1983) The experience of old age. New York: Basic Books. MLLLET,L. J., PON,J., GUIBUD, J. M., & AURIOL,G. (1980) Moving: psychopachological reactions to a change of house. Annales Medico-Psycholagigues, 138, 212-221. NATIONALCENTERFOR HEALTHSTATISTICS.(1973) The psychological section of the current health and nutrition examination survey. Proceedings of the Public Health Conference on Records and Statistics, meeting jointly with the National Conference on Mental Health Statistics, 14th national meeting June 12-15, 1972. [DHEW Pub. No. (HRA) 74-1214, Health Resources Administration] Washington, DC: U.S.Government Printing Office. No-, L. S., & HAREL,2. (1981) Residential choice and the well-being of the aged and disabled public housing residents. Journal of Gerontological Social Work, 4(2), 17-29. O'BRIEN, J. S., & HOLBORN, S. W. (1979) Verbal and non-verbal expressions as reinforcers in verbal conditioning of adult convenation. Journal of Behavior Therapy and Experimentul Psychiatry, 10, 267-277. U.S. SENATE'SCOMMITTEE ON AGING. (1965) Developments in aging. (Report No. 124) Washington, DC: U.S. Government Printing Office. VANDENBOS, G. R., & BUCHANAN, J. (1983) Aging, research on aging, and national policy. American Psychologist, 38, 300-310. WRIGHT,L. K. (1988) A reconceptualization of the "negative staff attitudes and poor care in nursing homes" assumption. The Gerontologist, 28, 813-820.
Accepted January 17, 1990.
