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Housing Quality and Psychological Well-Being Among the Elderly Population

^a Departments of Design and Environmental Analysis and Human Development, Cornell University, Ithaca, New York

Gary W. Evans, Departments of Design and Environmental Analysis and Human Development, Cornell University, Ithaca, NY 14853-4401 E-mail: gwe1{at}cornell.edu.

Decision Editor: Margie E. Lachman, PhD

	Abstract

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With exponential growth in the number of elderly Americans living independently in the community, it is important to better understand the implications of living conditions for psychological well-being among the elderly population. In a cross-sectional study, housing quality is associated with positive affect among the older adults living independently in the community. Moreover, this relation is mediated by place attachment. Elderly residents of higher quality homes, independent of multiple sociodemographic factors (e.g., income, gender), feel more attached to their home, which, in turn, appears to account for the relation between housing quality and positive affect.

AS the number of people older than 60 years of age increases exponentially, the issue of housing quality and well-being among senior citizens assumes critical importance. We examined the role of housing quality and place attachment in elderly citizens' psychological well-being. Housing quality is related to elderly community residents' sense of community and place attachment (Eshelman and Evans 1998; Kweon, Sullivan, and Wiley 1998), intentions to relocate (Earhart and Weber 1996; O'Bryant and Murray 1986; Rowles 1983), and residential satisfaction (Christensen, Carp, Cranz, and Wiley 1992; Lawton 1980; Windley and Scheidt 1983). Notably absent are assessments of mental health. Several studies have linked housing quality to psychological health among young children and, in some cases, their mothers (Evans, Wells, Chan, and Saltzman 2000; Freeman 1984; Gifford in press; Halpern 1995).

Worries about affordability and hazardous, unsafe conditions, concerns about maintenance, inadequate privacy, restrictions on children's play opportunities, and social stigma are among the hypotheses offered for why housing might affect mental health in families. Another process that could help account for mental health sequelae of housing quality among elders is place attachment. A benefit of good housing may be place attachment—feelings of security, belonging, and expression of self (Brown and Perkins 1992). Housing quality is correlated with elderly people's place attachment (Eshelman and Evans 1998; Kweon et al. 1998). Substandard housing could interfere with the development of place attachment among older adults, thereby diminishing psychological well-being.

Linking environmental quality to mental health and well-being is difficult for several reasons (Evans 1999). User evaluations of the physical environment can be colored by psychological health. Thus housing quality instruments that traditionally have relied upon self-report are vulnerable to shared methods variance. Yet certain aspects of housing quality (e.g., heating) are difficult to assess without querying residents. Our housing index is based primarily on independent ratings, supplementing where necessary with occupants' evaluations. Because people often choose where to live, selection bias is another internal validity threat. We attempt to reduce the plausibility of selection bias by statistically controlling background variables. We hypothesize that housing quality will impact psychological health among senior citizens living independently in the community. Moreover, we believe that this expected relationship will be mediated by attachment to place.

	Methods

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Participants
We conducted in-home interviews of four hundred and ninety seven persons (M = 72.5 years) residing in Tompkins County, a rural upstate New York county. Eligibility for the survey included a minimum age of 60 years, residence in noncongregate housing, living independently, and no clinical signs of dementia. The response rate was 41%. Sixty-two percent of the sample were women, and 37% lived alone. Median income was $40,000 in 1997–1998. Tompkins County 1990 Census Data for those older than age 60 (income for those over 65) indicate the sample was representative (M = 71.2 years, 59% women, 36% lived alone, median income approximately $32,000, in 1997–1998 dollars).

Procedures and Measures
Mental health, place attachment, background data, and housing quality were part of a larger, one-and-a-half-hour battery of instruments from the Pathways to Life Quality Study (Krout and Moen 1996). The experimenter conducted housing observations initially and then conducted the mental health and place attachment measures over an hour later. Pilot work indicated that the results were unchanged whether or not the same person conducted the housing quality observations and the resident interviews.

Housing quality
The housing quality observation measure consisted of 45 items ( = .72), incorporating 3-point rating scales of infrastructure (e.g., home in good repair), amenities (e.g., presence of custom cabinets), support for mobility impairment (e.g., handrails in main hallway), and spatial requirements (e.g., kitchen space adequate for meal preparation). A few items were dichotomous (i.e., yes/no), so all items were standardized and combined into a total continuous index of housing quality. Interobserver agreement exceeded 90%. We derived the initial item pool from previous housing scales (Bureau of the Census 1990; Evans et al. 2000; Lawton 1980) as well as focus group interviews with elderly residents. The item pool was reduced (oblique factor analyses) to the final 45-item scale, which accounted for over 70% of the variance in the total item pool.

Psychological well-being
We measured psychological well-being with a standardized instrument designed to assess positive affect among healthy, elderly adults (Mroczek and Kolarz 1998). This six-item, continuous 5-point scale (e.g., "How often in the past 30 days have you felt cheerful?"; none–all the time) has undergone extensive psychometric work and indicated comparable internal consistency for the present sample ( = .95).

Place attachment
We queried residents about feelings of belongingness, sense of ownership, and ability to personalize (e.g., "I belong in this home") on a 4-point, five-item continuous scale ( = .79). The items were derived from place attachment theory (Brown and Perkins 1992).

	Results and Discussion

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We examined the relation between each independent variable (i.e., housing quality and place attachment) and the outcome of positive affect with multiple regression to maintain the continuous nature of these three variables. For all of the results reported herein, we statistically partialled the effects of gender, needs for assistance in activities of daily living in the past year, years of schooling, income, home ownership, residential status (living alone or with another adult), and years in residence. We included these statistical controls because they relate to psychological health, R² = .09, F(7,490) = 6.50, p < .001, and reduce the plausibility of spurious relations between the physical environment and psychological health given our cross-sectional study design.

After we statistically partialled these seven control variables, we found that housing quality is significantly related to positive affect, partial b = .32, t(489) = 3.65, p < .001 (R² = .11, F(8,489) = 7.49, p < .001; R² = .02, F(1,489) = 13.31, p < .001). Place attachment is also significantly related to positive affect, again net of the seven control variables, partial b = .25, t(488) = 4.26, p < .001 (R² = .11, F(8,488) = 7.89, p < .001; R² = .03, F(1,488) = 18.14, p < .001). To test for mediation, we repeated the first regression equation, adding place attachment as an additional term in the model prior to examining the predictor, housing quality. When this is done, housing quality is no longer a significant predictor of positive affect (partial b = .17, t(487) = 1.66, ns (R² = .12, F(9,487) = 7.34, p < .001; R² = .01, F(1,487) = 2.74, ns. Place attachment fully mediates the association between housing quality and positive affect. As we expected, housing quality is also significantly related to the mediator, place attachment, after we statistically control for the same set of seven factors, partial b = .79, t(488) = 13.84, p < .001 (R² =.39, F(8,488) = 39.54; R² = .24, F(1,488) = 191.62, p < .001). These results are consistent with prior research showing inverse relations between housing quality and mental health among families (Evans et al. 2000; Freeman 1984; Gifford in press; Halpern 1995). Furthermore, the relation between housing quality and psychological well-being appears to be mediated by place attachment.

As a partial check on spuriousness, we reversed the order of inclusion in the third equation above where we tested for mediation. If one or more unspecified variables were accounting for the covariation among housing quality, place attachment, and positive affect, then reversing the terms in the third equation above would have yielded the same pattern of results. However, this did not occur. Place attachment had a significant effect on positive affect after we controlled for the seven background factors and partialled out the effects of housing quality, partial b = .19, t(487) = 2.74, p < .01. As a further check, we reconstituted the housing scale without subjective ratings from the respondents. This revised housing scale remained significantly associated with positive affect (see Appendix, Note 1).

Despite the above precautions, we reiterate that the design of the present study renders causal conclusions impossible. Short of random assignment to housing, probably the best way to strengthen internal validity would be to examine housing quality and psychological health prospectively. It is important to recognize, however, that elderly individuals usually move because of changes in work status or health. Thus a longitudinal analysis of housing and elder well-being would be a complex undertaking. The present findings should be extended to more heterogeneous populations of senior citizens given the present focus on healthy individuals living independently in their community. Perhaps frailer elders would be more vulnerable to poor housing quality (Lawton 1989; Moos and Lemke 1994). Positive characteristics of housing quality may be associated with mental health, too. Interior design (e.g., well-lit wall spaces and built-in display spaces) can foster personalization and remembrances of significant, enjoyable life events and activities.

Housing can play a critical role in maintaining the health and independence of an aging population. We need to learn more about key design variables that contribute to good housing for elders. Better understanding of the underlying psychosocial processes that mediate housing quality and mental health will also enable more effective housing policies for senior citizens.

	Acknowledgments

 
This research is part of the Pathways to Life Quality Study, a collaborative project conducted by the Gerontology Institute at Ithaca College and the Bronfenbrenner Life Course Institute at Cornell University, John Krout and Phyllis Moen, Co-Principal Investigators. We are grateful to the many individuals who permitted us into their homes for interviews and housing quality evaluations. We thank Phyllis Moen, John Krout, and Mary Anne Erickson for assistance.

Received for publication January 9, 2001. Accepted for publication September 27, 2001.

	Appendix

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Note

1. Although residents were interviewed privately, some of the data may not be independent for those living in the same house. We repeated the analyses with only one respondent per house, and the conclusions remained the same. To maximize sample size and the representativeness of our findings, we report the total sample results herein.
   

	References

TOP Abstract Methods Results and Discussion Appendix References

 

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