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%) [30
]. Understanding how neighborhoods and other places affect older adults from different ethnic backgrounds could contribute to policies to address ethnic health disparities.
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) [31
]. The age, race/ethnicity, and language composition of others in the neighborhood contributed to whether these factors were perceived to be part of the press that the environment imposed, and that limited engagement in the neighborhood or, conversely, as a resource residents could used to be meet environmental demands.
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 [22
]. With our participants, chronological age did not clearly correspond to physical function or limitations. The youngest three participants, all African American, were in the poorest health. This is consistent with the trend that African Americans develop chronic conditions at younger ages than their White counterparts [35
]. On the other hand, one of the oldest participants, also African American, had no chronic conditions, and was extremely active, visiting people in the hospital, attending community meetings, and active in her church. Chronological age is not necessarily the most optimal categorization for these participants. These complexities further corroborate the Wahl-Oswald conceptual framework (2010), especially the pathway from agency to identity. Moreover, the arrows along this pathway could potentially also be bidirectional, with the possibility that identity affects behavior, and in turn agency. For our participants, “identity” is tied to group identity, which is informed by social definitions and positions, often less tied to geography, and which motivate behaviors through which individuals seek to affirm and reinforce those identities.
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 [38
], has found, namely, that older people felt more comfortable if there were other older persons living nearby. There was a sense among our participants that younger neighbors were busy with their lives, coming and going, with not much time or interest in older people or any of the other neighbors.
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 [40
]. Other studies have reported that older Latinos who lived in areas with higher proportions of Latinos have better health than Latinos who live in areas with lower proportions of Latinos [42
]. The participants in this study did report tensions or uncomfortable interactions with people from other countries or who spoke other languages. Feeling different than, being taken advantage of, or overlooked by racially and ethnically dissimilar neighbors appeared to constitute sources of environmental press with negative effects on neighborhood engagement. Ethnic diversity can be experienced as dissimilarity, as not belonging, as the opposite of place attachment, when residents perceive it to stand in the way of forming social ties to neighbors. The literature also clearly shows that racial/ethnic concentration, when it is a product of segregation, marginalization, and disinvestment in particular communities, is not conducive to health. Our qualitative data support the notion that rather than neighborhood racial/ethnic composition, in and of itself, being important to health, it is a combination of a neighborhood's composition and attendant social, economic, and political resources—or a lack thereof—that are meaningful for residents' health.
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 [44
] and consider the possibility that older adults find and experience place attachment in these more geographically distant places as well as close to home. To date, modest associations have been reported for the neighborhood influence on health status for older adults. Investigating other activity spaces for their resources, demands, and attachments could suggest other mechanisms through which place influences health for older adults.