Integration of the Aged: A Social and Physical Problem M. Powell Lawton, Ph.D. Philadelphia Geriatric Center One of the leading American gerontologists, Ethel Shanas, has characterized the major issue for older people to be the degree to which they are integrated into the fabric of society (1979) . To the extent that people 65 and over in fact differ from others--for example, in the prevalence of chronic illness or the visible signs of aging skin--they will be at risk of de-integration. even more frequent source of the loosening of bonds with the mainstream of life of society is the segregating process initiated by society itself, beginning with mandatory retirement, lowered income, more difficult access to medical care and elaborated in the more subtle but insidious negative social stereotypes that have been called "ageism." These are familiar concerns for all of us with any sensitivity to the needs of the generation that has created our countries as we know them today and has nurtured us personally. For our purpose today, however, time prevents What An the elaboration of the social integration theme in its greatest breadth. concerns the professionals and committed citizens assembled here is the nexus between the problems of social integration and the planning and design disciplines. Specifically I shall discuss some of the complex social ramifications of policy and planning decisions that relate to the residences of older people. I shall suggest, first, that there is a world of difference between the outcomes associated with self-chosen social segregation as compared to externally-imposed segregation. Keynote address given at the conference, Planning for People, South African Institute of Town and Regional Planners, Pretoria, R.S.A., 24 April, 1980. (C) 2006 Polisher Research Institute Second, that the potentially integrating or segregating outcomes of policy and planning decisions must be considered. Finally, I shall suggest that physical segregation is not necessarily equivalent to social segregation. Physical and social aspects of integration As a preliminary observation, it is worth noting that social integration and physical integration are highly, but not perfectly, related. This somewhat obvious statement has special meaning for older people, however, in that for many purposes physical proximity between the person and a social or physical resource is a considerably stronger determinant of behavior in relation to that resource for older people than for younger people. I have generalized this principle in what I have called "the environmental docility hypothesis,11 which states that as the individual's health, psychological, or social competence declines, environmental factors, as compared to personal factors, exert an increasingly strong effect on the individual's behavior and psychological wellbeing (Lawton, 1970). Biological changes and social deprivations do occur with age and make older people more susceptible to environmental barriers such as distance than is the case for younger people, who may have the vigor to walk further or to drive a car, the social resources to pay for transportation, or the psychological motivation to make a longer trip in search of a product that suits their preferences better than does one available closer by. Nonetheless, we must acknowledge that physical proximity does not in itself integrate nor does physical distance segregate. Psychological adaptive A processes mediate this relationship between the social and the physical. person may will to interact with near-neighbors or may use a variety of psychological distancing mechanisms to reduce the impact of proximate others. Those who are physically distant may maintain involvement through television or reading, telephone and letters, or through memories or a purely internal feeling of relatedness to the world. People maintain a sense of identity, autonomy, and even happiness by transforming outer reality into a world that is more consonant with their needs and expectations. Turning from the general to the specific, two types of residential choices, the dwelling unit and the planned housing environment, have frequently been thought of as critical conditioners of the degree of social integration experienced by the older person. The discussion to follow will examine the evidence relevant to whether physical segregation by age within the dwelling unit or the planned housing estate leads to de-integration in a social sense. The dwelling unit The primary point of physical relatedness to others is likely to be in one's residence and the medium for the relatedness likely to be the family. Clearly, substantial variation in the texture of the day will occur as the result of the particular composition of one's household, and there is every reason to feel that longer-term effects on behavior and mood may follow. As a beginning, let us look at some of the facts about the living arrangements of older people. I regret deeply not having had access to Census data for the RSA; please do reinterpret my figures in light of what you know about trends of differences between our two countries. In the USA the mode is for older people to live as Sex differences are highlighted 38 percent of women but only The residue includes the husband and wife with no others in the household. by the proportions who live alone in a household: 15 percent of men (U.S. Bureau of the Census, 1979). few who live with nonrelatives (about 3%) and those who live with other relatives; while exact figures are difficult to determine, it has been estimated that in 1975 only about 14 percent lived in the same household as children (Shanas, 1978). The first element of de-integration commonly noted by critics of the way older people are treated in society today is the separation of the generations in their living arrangements. I can pause only briefly to note the myths First, "the extended family" surrounding the historical development of the family. going beyond the family of origin and the family myth in industrial societies. of procreation is largely a Second, historical research on the family is beginning to document the many costs of multigenerational living early in this century, such as the inability to determine autonomously the timing of life transitions such as going to work, marriage, child-bearing, or the establishment of an independent household (Hareven, 1975). In our country and others, however, there has been a trend through the 20th century, accelerating over the past several decades, for fewer elderly parents to share their households with their children, younger relatives, or non-kin (Dahlin, 1980). Rather than accept the quick conclusion that separate living arrangements constitute externally-imposed segregation from the family, let us consider some relevant data. All attempts to learn what older people wish by asking standard survey questions reveal that overwhelmingly they want to maintain separate households: In the words of Rosenmayr and Kockeis (1963), older people seek "intamcy at a distance," meaning that neither instrumental nor affective interchanges depend completely for their occurrence on the two- or three-generation household. The theory of shared functions of Litwak and Szelenyi (1969), in fact, suggests that some forms of exchange, such as economic or psychological assistance, depend very little on proximity for their delivery; those functions for which proximity is critical, such as assistance in a time of emergency, can be adequately served by near-neighbors. Sustained assistance, however, is the function either Despite the infrequency of intergenerational of a family, an agency, or an institution. family living in the USA, separate studies demonstrated that 80 percent of the costs of in-home services received by the elderly are borne by the informal network, primarily family (Comptroller General, 1977). The need for health care and its provision by the family ultimately are reflected in national data on health by living arrangements. Older people living in the household of another are substantially less healthy than those living alone or those living with spouse only. One can infer that a large number of families exercise their options for mutual autonomy through choosing separate living arrangements while the older member is healthy, but when her health declines below some threshold value, the younger family steps in to offer the required support. Another motivation for sharing households is, not unexpectedly, economic. Our Census data show a tendency for greater affluence to be associated with living in independent households. Ethnicity overlaps to some extent with socioeconomic status, so that Black and Spanish-American elderly are more likely to live with kin than are whites. The degree to which cultural factors that choose multiIn a generational living operate independently of income is not fully known. very rough way, if we compare countries in terms of their economic health, or more generally, their degree of modernization, separate living arrangements seem to increase with modernization. 1970, fully80% of One major exception is Japan, where in older people lived with their children, certainly a convincing demonstration of the power of Japan's tradition of family-centeredness and attitudes toward the aged (Palmore, 1975). I suggest, however, that the human motive toward independence is even stronger than cultural tradition. The steepest growth in rate of living alone came after the USA's Social Security program had become widespread and a variety of other services and income supports had become available. programs have been very minimal until recently. Japan's social Despite the gains for young and old that may come from enriching one another's lives with their diversity of experience, the evidence seems unmistakeable that with the freedom of good health and adequate income, the majority will opt for a lifestyle where they are free to arrange their households and their activities to their own convenience. Because living alone has become so frequent, it seems worthwhile to indicate very briefly that research shows that people living alone do have somewhat different patterns of social interaction from others. While research findings are not consistent, older people living alone appear to have an equal or sometimes higher level of interaction with friends than do those sharing their dwelling units, given similar levels of health. People who live alone almost by definition have However, since many studies lower frequency of contact with relatives, of course. have failed to find any relationship between frequency of family contact and other measures of wellbeing, the lower contact in this case is not clearly a negative expedience. Being neglected by family is clearly negative, but the work of Shanas et al. (1968) clearly establishes that most older people do not fit in this extreme category. Thus, the weight of the evidence indicates that living alone is at least tolerable for most, and in no way more negative than living in another's household. Where does social planning come into this picture? substantial segment of the influential In our country, some citizenry is. still concerned that both our social programs and our free enterprise are undermining the multigenerational family by such endeavors as building small housing units, reducing welfare payments when elderly live with non-poor family, and providing too-easy access to social services and especially to institutions. concern. To some extent, the data belie this Only 5 percent of the 65+ population is in institutions (reviewed in There is good evidence that the pathway to institutions for most Lawton, 1978). residents was marked by previous attempts to work out a non-institutional solution (Lowenthal, 1964). Add to these facts the previously-quoted data on the family's place in health care and in-home services and one sees that the "informal support system11 is alive and well despite our anxiety. It seems to me that the maximum favorable impact on living arrangements will come from social programs that enlarge the choices that older people can make for the way they live, and this usually means providing choices that are obtainable only through assuring an adequate income level. Beyond the basic enablement of income, to date there is no evidence that providing specialized housing for older people has enticed older people to leave family surroundings or younger family to rid their households of older relatives. There have been many suggestions that younger families might be more willing to care for marginally capable older relatives if a direct subsidy for their care were to be offered to the family. The effects of such a subsidy are difficult to predict, since as we noted above, low-income and minority families for whom the subsidy would be most helpful are already caring for older relatives in their homes more often than more affluent groups. One investigator (Sussman, 1977) has suggested that the incentive of the family subsidy might recruit a new group of family caretakers whose motive was economic rather than affectional, with negative consequences for the older person. My feeling on this issue is that a demonstration program might be useful to tell us who would be recruited and what the possible effects of such extensions of multigenerational living would be. It does seem clear, however, that it is clearly a disincentive to continued community living to remove income supports from an older person simply because the person moves into the household of a more solvent relative. Unquestionably, the size of more recently-built housing acts as a delimiter to the number who can occupy it. The primary determinant of small-sized dwelling units is building costs, and to that extent, one can say economic pressures are undermining the possibility of shared-generation living* For the reasons outlined above, however, I feel that both the preference for independent households and smaller dwelling units are products of social change, rather than having any causal relationship to one another. What is important for planners is to insure that options are kept open for the minority who wish to live together intergenerationally. This choice can be served variously by attending to the preservation of older and larger housing stock, by flexible zoning where a family wishes to create an independent dwelling unit for an older relative, by facilitating the use of the "granny flat11 or the mobile home, and finally by judicious experimentation with the family subsidy. Social segregation in planned housing The next larger scale is that of the dwelling-unit cluster, which consists almost completely of relatively recently-built or recently rehabilitated housing estates, either high-rise or low-rise. In the USA, we have about 800,000 such units that have been designated for people 62 and over, and it is fair to say that older tenants, planners, and research evaluators all agree in the verdict that this program has been on the whole rather successful, especially w h e n judged by the standard of most social programs. The substantial question has been raised again regarding whether their age-segregated nature is forcing older people to dissolve their ties with the rest of society. In the USA, about three-quarters of all publicly-assisted planned housing units for the elderly are located in age-segregated settings. The remainder either mix units for the elderly throughout the estate or designate specific floors, buildings, or blocks for older residents. The first age-segregated Around the same public housing was evaluated very positively by Carp (1966). time, very influential findings from a study of older people living in unplanned apartment buildings were disseminated, showing very conclusively that the amount of social interaction experienced by older people increased directly as the percentage of other aged apartment-dwellers in the same building increased (Rosow, 8 1967). Later work of my own in 100 different public housing estates showed that older tenants in age-segregated housing were more satisfied with their housing, participated in more activities, were higher in general life satisfaction, and had less fear of crime than those living in age-integrated housing (Lawton and Yaffe , in press; Teaff, Lawton, Nahemow, and Carlson, 1978). Thus, judged on the basis of these relatively hard research findings, those older people who live in settings of high age concentration are better off by a number of criteria. As Finlays.on, But how do older people perceive this issue? (1978) has argued in another context, doing what is "good11 for a client group is not necessarily perceived as good for them by the clients themselves; participatory planning, which includes determining clients' attitudes toward the issue of interest, is frequently a necessary component. For this reason, we surveyed the attitudes of applicants before they moved into age-segregated planned housing and after they had been tenants for a year or more, as well as community residents who had never applied for planned housing (Lawton, 1980a). Among those for whom the age-segregated environment was not currently a salient feature of their lives, only a little over one-third thought that they might choose age-segregated housing if they were going to move. Among those who were about to move into such a setting, 39% said they preferred age segregation, 40% were undecided, and 21% would prefer living with younger people. After occupancy, while fully 91% indicated that age segregation did not bother them, 31% if they had a choice would like to have younger adults without children as neighbors (but only 11% would want young children). It is not difficult to understand the wish to mingle with people one's own age. "Age grading11 characterizes every period of life, from age two onward. First, age peers have experienced the same historical experiences, experiences that form the basis for easy conversation. Second, cultural values are more likely to be shared, leading to more conversation about the iniquities of those who do not share these values. Third, the behavior of one's age peers is likely to be perceived as more predictable than that of others. find the noise and exhuberance of children bothersome. Fourth, many simply Perhaps most importantly, age-segregated environments foster the development of age-appropriate norms rather than inappropriately imposing on the aged behavioral norms that favor the young. Finally, and very regrettably, in urban areas in the USA, fear of crime and the greater ease of establishing physical security in age-segregated settings make age-segregated planned housing more appealing. Despite these reasons favoring age segregation, our survey shows that remaining within the mainstream of people of all ages is the wish of the majority. How do we account then for the overwhelming approval of those who have experienced living only with their age peers? I suggest first that those who move to such settings have first screened themselves for their willingness to tolerate an age-homogeneous environment. apply to such housing. On this basis, the majority probably would never Another segment would clearly have preferred more age mixing, but accepted the segregation by age because of the other favorable aspects of planned housing. After having experienced the age texture of this type of living, either they come to like it actively or at least establish a form of cognitive balance that allows them to tolerate it. Thus in terms of both the effect of age segregation and its congruence with the wishes of those who live there, living only with those of one's own age range still appears to have favorable consequences. of the larger society? But what about the needs It has been argued that there are several consequences whose negative quality may transcend the gains to the specific tenants for whom age segregation is salutory: 10 Opportunities for children and younger adults to be enriched by contact with the aged are restricted The motivation for society to use the cumulated expertise and sound judgement of the aged may be reduced "Ageism" increases in direct proportion to the extent that society sets the aged apart as a physically separated group Younger people's interacting with older people provides the opportunity to "rehearse" their own aging; this process of socialization to later life is impeded by age-segregated living. Research so far has been silent on these larger social issues. At least until contradictory evidence becomes available, it seems prudent to accept age segregation to the extent that by the individual and population. Planners must be very careful to see that the success of age-segregated planned housing does not lead to such enthusiastic building in this style that other options become foreclosed. This result has occurred in the USA, where (a) it occurs under conditions of free choice (b) it accounts for only a small proportion of the aged currently it is difficult for an older person to find a housing unit that is simultaneously of good quality (new), inexpensive (federal and secure from personal or household crime. subsidy), age mixed, It clearly is possible to provide such housing, but to do so requires planners x f o forsee potential problems and ri provide for solutions, architects sensitive to the neighborhood location issues and structural design features that can condition success, administrators who are committed to make age mixing work, and tenants who freely choose the age-integrated style of life. 11 With an assured supply of both age-segregated and age-integrated alternatives, it seems very likely that older people themselves will see to the maximizing of person-environment congruence in response to their own needs; this course means that most will continue to choose the residential solution that keeps them in touch with people of all ages. In much more cursory fashion we must acknowledge that issues over other types of segregation may arise. In a society that is not totally planned, income There is so mixing is likely to be minimized by the rules of the marketplace. little mixing of people from low and high economic positions that research on its effects has not been possible. In the case of race, public housing for the elderly in the USA has accomplished racial mixing with few problems, so long as the situation was not further complicated by the presence of young families living in the same buildings. My research (Lawton and Nahemow, 19 79; Nash, Lawton, and Simon, 1968) has shown that while Blacks tend statistically to choose Blacks and Whites choose Whites as friends in racially integrated settings, fully 30 percent of all friendship choices were cross-racial in the 4 housing sites that we studied. This fact is somewhat remarkable when one considers that this generation of elderly had had little earlier experience with racially integrated forms of living. A hypothesis for future testing is that homogeneity by age tends to de-fuse tensions in other areas. Finally, a major question in planned Evidential environments concerns the range of health that can be accomodated within a single bounded physical area. The enormity of this problem can only be sketched here by indicating that while healthy tenants themselves seem to prefer to live in the midst of others who are healthy, the reality is that the health of a group of tenants changes at unequal rates. No matter how much a planner may aspire to the construc- tion of an environment for the "well elderly;" the "marginally capable," or any other group, time and the changes time produces will undermine the initial homo12 geneity. Thus, planning must take account of the fact that new services and new spaces and facilities must be allowed for over the lifespan of a planned housing environment if tenants are not to be moved about from place to place, with risk to their physical and psychological wellbeing (Lawton, 1980b). The question remaining to be answered is what the optimal range of health may be for people housed in a single physical location, accepting the desirability of some variation. Conclusion In summary, the research evidence seems to suggest, first, that older people vary greatly in their personal preferences for and willingness to tolerate separation from other segments of society. In the case of the dwelling unit, generational segregation seems to be a self-chosen expression of the need for independence and the maximizing of the opportunity to set one's own pace and lifestyle. Compromises with this need become acceptable primarily where economic or health needs intrude, though for some , cultural tradition or purely personal needs for closeness to family dictate multigenerational living arrangements. By contrast, in planned housing the choice of an age-homogeneous environment seems to represent a move away from independence--a mild retreat, to be sure, one that results in a smoother pace of everyday life for some without committing them to being totally cloistered. In both cases, we have solid research evidence that the segregation is predominantly self-chosen. This conclusion is not totally consistent with our Yet society's ideals of pluralism, involvement of everyone, and equality. w e do an injustice to the wishes of a substantial sector of the aged if we impose our values on them. Furthermore, resources will be wasted if we make 13 inevitably hopeless attempts to turn back history to a time when by default the young were under the compulsion to assume all burdens of care for the old or the old to continue to have grown children in their homes. The relationship between young and old is no less meaningful when its basis is affection and a readiness to help if needed, as opposed to a shared residence or an imbalance in the direction of dependence of the older person* The conclusion is that planners must heed the overtly expressed wishes of older people and their implied wishes as they choose for themselves. The task is best characterized as one of providing options in approximate proportion to the frequency of matching needs to the extent that we can estimate them.. 14 REFERENCES Carp, F.M. A future for the aged. Austin: University of Texas Press, 1966. Comptroller General of the United States. Home health--the need for a nationReport to Congress. U.S. al policy to better provide for the elderly. General Accounting Office, Washington, B.C., 1977. Dahlin, M. Perspectives on the family life of the elderly in 1900. Gerontologist, 1980, 20, 99-107. Finlayson, K.A. The role of community involvement in low-income housing. Man-Environment Systems, 1978, 8_, 113-125. Hareven, T.K. The discovery of the last stage: Historical discontinuities Clark in adulthood and old age. University, 1975. Lawton, M.P. Unpublished ms. Worcester, MA: Ecology and aging In L.A. Pastalan and D.H. Carson (eds.). Ann Arbor: University of The spatial behavior of older people. Michigan, Institute of Gerontology, 1970. Lawton, M.P. Institutions and alternatives for older people. Health and Social Work, 1978, J3, 109-134. Lawton, M.P. Social and medical services in housing for the elderly. U.S. Government National Institute of Mental Health, Washington, DC: Printing Office, 1980a. Lawton, M.P. The lifespan of housing environments for the aging. Gerontologist, 1980b,2?, 56-64. Lawton, M.P. and Nahemow, L. Social areas and the well-being of tenants in Multivariate Behavioral Research, planned housing for the elderly. 1979, 14, 463-484. 15 REFERENCES (continued) Lawton, M.P. and Yaffe, S. Victimization and fear of crime in elderly Journal of Gerontology, in press. Primary group structure and their functions: American Sociological Review, 1969, J^4, 465-481. New York: Basic Books, 1964. public housing tenants. Litwak, E. and Szelenyi, I. K i n , neighbors, and friends. Lowenthal, M. Lives in distress. Nash, G., Lawton, M.P. and Simon, B. the elderly. Blacks and whites in housing for Paper presented at the annual meeting of the Gerontological Society, Denver, October, 1968. Palmore, E. The status and integration of the aged in Japanese society. Journal of Gerontology, 1975, 30>, 199-208. Rosenmayr, L. and Kockeis, E. Propositions for a sociological theory International Social Science Journal, 1963, of aging and the family. 1 5 , 410-426. Rosow, I. Shanas, E. Social integration of the aged. National survey of the aged. New York: Free Press, 1967. Final report to the Administration on Aging, U.S. Department of H.E.W., 1978. Shanas, E. Social myth as hypothesis: The case of the family relations of old people. Gerontologist, 1979, 19^, 3-9. Shanas, E., Townsend, P., Wedderburn, D., Friis, H., Milh^j, P., and Stehouwer, J. Old people in three industrial societies. Sussman, M.B. New York: Atherton, 1968. Final Incentives and family environments for the elderly. Greensboro, NC: report to the Administration on Aging. of Medicine, 1977. Bowman-Grey School 16 REFERENCES (continued) Teaff, J.D., Lawton, M.P., Nahemow, L., and Carlson, D. Impact of age integration on the wellbeing of elderly tenants in public housing. Journal of Gerontology, 19 78, 33, 126-133. U.S. Bureau of the Census, March, 1978. Marital status and living arrangements, Current Population Reports, Series P-20, No. 338. Washington, DC: Government Printing Office, 1979.
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