in Europe: A multidimensional approach to independent living in later life

308 Pages·2013·4 MB·English

PhD THESIS
DOCTORAL PROGRAMME IN DEMOGRAPHY

Centre d’Estudis Demogràfics / Departament de Geografia
Universitat Autònoma de Barcelona

‘Ageing in Place’ in Europe:
A multidimensional approach to
independent living in later life

Celia Fernández-Carro

Supervisors:
Dr. Juan A. Módenes
Dr. Jeroen Spijker

September 2013
This PhD Thesis has been carried out as part of the I+D Project Demographic analysis of housing needs in Spain,
2005-2015 funded by the Ministry of Science and Innovation of Spain (SEJ2007-60119) and directed by Dr. Juan
A. Módenes. This thesis has also been funded by the 2013 call of the Centro de Investigaciones Sociológicas (CIS)
research programme Ayudas a la Investigación .
This thesis uses data from SHARE wave 4 release 1.1.1, as of March 28th 2013 or SHARE wave 1 and 2 release
2.5.0, as of May 24th 2011 or SHARELIFE release 1, as of November 24th2010. The SHARE data collection has
been primarily funded by the European Commission through the 5th Framework Programme (project QLK6-CT-
2001-00360 in the thematic programme Quality of Life), through the 6th Framework Programme (projects
SHARE-I3, RII-CT-2006-062193, COMPARE, CIT5- CT-2005-028857, and SHARELIFE, CIT4-CT-2006-028812)
and through the 7th Framework Programme (SHARE-PREP, N° 211909, SHARE-LEAP, N° 227822 and SHARE
M4, N° 261982). Additional funding from the U.S. National Institute on Aging (U01 AG09740-13S2, P01
AG005842, P01 AG08291, P30 AG12815, R21 AG025169, Y1-AG-4553-01, IAG BSR06-11 and OGHA 04-064) and
the German Ministry of Education and Research as well as from various national sources is gratefully
acknowledged (see www.share-project.org for a full list of funding institutions)
Agradecimientos
Me gustaría comenzar este trabajo expresando mi gratitud a todas aquellas instituciones y personas
que han contribuido a que esta tesis viese la luz.
En primer lugar, quiero agradecer el soporte continuado que he recibido del Centre d’Estudis
Demogràfics, lugar que he considerado mi casa durante todos estos años. En especial agradecer a su
directora, la Dra. Anna Cabré, la confianza depositada en mí al plantearme el reto de realizar esta tesis
doctoral y el haberme brindado todas las oportunidades que lo han hecho posible. Ese agradecimiento
lo hago extensivo a todas las personas con las que he tenido la oportunidad de trabajar durante estos
años en el centro, por su calidad humana y profesional. También al Departament de Geografía de la
Universitat Autònoma de Barcelona por haberme permitido completar mi formación académica al
admitirme en el Programa de Doctorado en Demografía.
Dada la dedicación exclusiva a la que muchas veces obliga la investigación, me gustaría agradecer la
financiación recibida tanto del Ministerio de Economía y Competitividad (antiguo Ministerio de
Ciencia e Innovación) a través de la concesión de una ayuda pre-doctoral FPI en 2009 adscrita al
proyecto I+D Análisis demográfico de las necesidades de vivienda en España, 2005-2015 (SEJ2007-
60119), como del Centro de Investigaciones Sociológicas, a través de la concesión de una Ayuda para
la Finalización de Tesis Doctorales en su convocatoria 2013.
Del mismo modo, quiero destacar la excelente labor de mis dos directores el Dr. Juan Antonio
Módenes y el Dr. Jeroen Spijker. Ambos habeis sido imprescindibles para que esta tesis llegara a buen
puerto. Os agradezco toda la implicación que me habéis mostrado durante el proceso de elaboración
de este trabajo, tanto en su fondo como en su forma. Vuestro rigor y sensatez analítica han hecho de
este un trabajo mejor. De corazón, gracias por toda vuestra generosidad en lo académico y en lo
personal.
Una buena parte de este trabajo se realizó durante varias estancias de investigación en otras
universidades españolas y europeas. Mi gratitud al Departamento de Análisis Social (antiguo
departamento de Ciencia Política y Sociología) de la Universidad Carlos III de Madrid y en especial a la
Dra. Constanza Tobío. También al Centre for Population Research (University of Groningen) y al que
por aquel entonces era su director Dr. L.J.G van Wissen por las sugerencias sobre el tratamiento de
datos. A su vez, al Centre for Population Change de la University of Southampton en Reino Unido, y a
su directora la Prof. Jane Falkinham, por aceptar mi visita y poner todos los recursos centro a mi
disposición. Ese agradecimiento lo hago extensivo a Yvonne Richarson y Teresa McGowan. También
quiero agradecer al Centro for Ageing Research de la University of Southampton, y a su directora la
Prof. Maria Evandrou, el haber aceptado mi estancia como estudiante predoctoral. A María Evandrou,
a quién debo buena parte del enfoque de esta tesis, le agradezco especialmente todo el tiempo
dedicado a la lectura de los capítulos, sus sugerencias y el entusiasmo que supo transmitirme a la hora
de abordar el tema de estudio.
A mi director Jeroen Spijker, a Cecilia di Lauro, a Eliane Lilly y a Sonia Chager por su excelente labor de
corrección del idioma.
Mi incursión en el mundo académico se la debo a la Dra. Laura Lorenzo, que me guió en mis inicios
como investigadora mucho antes de mudarme a Barcelona.
Dada la formalidad que reviste cualquier tesis, me concedo un breve espacio, para dedicarles unas
palabras aquellos que en el plano personal han hecho las veces de motor y de puntal. Gracias a todos y
a todas por el amor en mayúsculas que he recibido de vuestra parte, más aún por vuestro esfuerzo
para hacérmelo llegar en los momentos de derrota.
De Barcelona me llevo amistades perfectas, como la que me une a Victoria y Madelín. Los mejores
recuerdos que me llevo de esta etapa son inseparables de vuestra imagen y compatir con vosotras este
proceso de de crecimiento personal y académico os han convertido en parte de mi familia. Gracias por
todo chicas, no sabeis cuanto os voy a echar de menos. También a Thais y a Juan Parejo por estar ahí a
pesar de la distancia.
La movilidad que exige la vida académica me ha convertido en una nostálgica crónica. Parte de la
culpa la tiene mis amigos y amigas de Madrid, que nunca me han permitido olvidar donde está mi casa.
A Laurita por ser una tormenta de vida a lado de la cual es imposible rendirse. Caminar contigo desde
hace tantos años me hace darme cuenta de que hay cosas que cambian pero permanecen, y a las que
aún merece la pena aferrarse. A Lore, que me hizo mucho más dulce el aterrizaje, por todo el calor y la
ternura que he recuperado con ella en tan poco tiempo. A Marta y Nora por hacer que la distancia y el
tiempo sean anécdotas en nuestras biografías de idas y venidas constantes. Gracias a las cuatro por
hacer que, después de tantos años, todo siga siendo como siempre y de verdad. También, a Desfa, a
Pichi, a Laura-Lucía-Viki (siempre iréis en trío), a Jimena, a Blanca, y a Carmen. Gracias a todos y a
todas por hacer que en los momentos de agotamiento, desorientación y desánimo siempre haya
habido una sonrisa que me decía “adelante”.
A Edu, por contagiarme de su espíritu indomable. Gracias por compartir conmigo tus sueños y querer
formar parte de los míos. Estaba escrito en alguna parte que lo nuestro solo podía ser una carrera de
fondo.
A mis padres, Rosa y Ángel, que han creído en mi más que yo misma. Gracias por sentiros partícipes de
cada paso que he dado y hacer vuestra cada una de mis ilusiones. Sin vuestro esfuerzo, sacrificio y
empuje pocas cosas en mi vida habrían sido posibles. Por eso, se me hace realmente difícil expresar en
palabras cuanto os debo y cuanto os quiero. A mis tíos, Ana, Esteban, Julián, Montse, a María y Rober, y
los recién llegados Diego y Mario. A todos y cada uno de los miembros de mi familia por estar a mi
lado siempre y sin condiciones.
Por último, me gustaría dedicar esta tesis a mi abuela Sara. Desde que recuerdo y sin quererlo, ella me
ha enseñado a apreciar ese otro conocimiento que no está en los libros, que no se aprende en ninguna
escuela, que no se encorseta ni normativiza. Gracias abuela por compartir conmigo esas
extraordinarias lecciones de intrahistoria que nunca me canso de escuchar. Eres mi tesoro.
Table of Contents
CHAPTER I. PRESENTATION OF THE RESEARCH ...................................................... 17
I.1. BACKGROUND AND AIMS OF THE STUDY ............................................................................................... 17
I.2. SCIENTIFIC AND SOCIAL RELEVANCE ..................................................................................................... 20
I.3. WHY EUROPE? WHY NOW? EXPLAINING TEMPORAL AND SPATIAL COORDINATES ...................... 21
I.4. RESEARCH OBJECTIVES ............................................................................................................................ 22
I.5. OUTLINE OF THE STUDY ........................................................................................................................... 24
CHAPTER II. CONCEPTUAL FRAMEWORK ....................................................................... 27
INTRODUCTION ......................................................................................................................... 27
PART I: FROM THE STIGMA OF DEPENDENCE TO A POSITIVE AGEING PARADIGM ............. 29
II.1. Introduction Part I ............................................................................................................................................. 29
II.2. Unravelling the meaning of old age ............................................................................................................ 30
II.3. Discursive interpretations of demographic change ............................................................................ 33
II.3.1. The structural stigmatisation of older population ...................................................................... 33
II.3.1. Negative old-age stereotypes ............................................................................................................... 35
II.3.1. Theoretical roots of ageing discourses ............................................................................................. 36
II.4. The emergence of a new global policy strategy .................................................................................... 43
II.4.1. Active ageing: What it does propose? ............................................................................................... 43
II.4.2. The dissemination of the concept in Europe .................................................................................. 46
II.4.3. Criticism and warnings to consider for the development of the active ageing paradigm
.......................................................................................................................................................................... 48
PART II: WHAT ARE WE TALKING ABOUT WHEN WE TALK ABOUT ‘AGEING IN PLACE’?.. 51
II.5. Introduction Part II ............................................................................................................................................ 51
II.6. An attempt to defining Ageing in Place ..................................................................................................... 52
II.7 Characteristics of ageing at home experience ....................................................................................... 55
II.7.1 Private domain ................................................................................................................................................ 55
II.7.2 Independence in later life ............................................................................................................................ 59
II.8 Ecological models of relationship among older adults and their living environment ......... 62
II.9 The twofold application of ‘Ageing in Place’ concept ......................................................................... 66
II.9.1. Institutional application ........................................................................................................................ 67
II.9.2. Scientific application ............................................................................................................................... 67
II.9.3. Institutional-scientific dialectics. The emergent debates ......................................................... 69
II.10. Synthesis of the chapter................................................................................................................................... 71
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CHAPTER III. STATISTICAL SOURCES FOR CROSS-NATIONAL ANALYSES OF
AGEING IN EUROPE ................................................................................................................. 73
III.1. INTRODUCTION ..................................................................................................................................... 73
III.2. RENEWING THE CROSS-NATIONAL OLD AGE SURVEYS IN EUROPE .............................................. 74
III.3. DATA SOURCES FOR THE STUDY OF AGEING IN PLACE FROM A CROSS-NATIONAL VIEW .......... 75
III.4. THE STRUCTURAL DIMENSION: EU SILC ......................................................................................... 77
III.4.1 Sample composition ............................................................................................................................................ 79
III.4.2 Survey design ......................................................................................................................................................... 80
III.4.3 Information modules .......................................................................................................................................... 82
III.5. THE INDIVIDUAL DIMENSION: SHARE PROJECT ............................................................................ 84
III.5.1 Sample composition ............................................................................................................................................ 85
III.5.2 Survey design ......................................................................................................................................................... 88
III.5.3 Information modules .......................................................................................................................................... 90
CHAPTER IV. AGEING AT HOME: THE UBIQUITOUS PATTERN AMONG OLDER
EUROPEANS ............................................................................................................................ 95
IV.1. INTRODUCTION ......................................................................................................................................... 95
IV.2. CONTEXTUALISING THE ESTIMATION: THE DEMOGRAPHIC AGEING ON EUROPE ...................... 96
IV.3. WHO IS AGEING IN PLACE? SOME PREVIOUS CONCEPTUAL CONSIDERATIONS ........................... 99
IV.4. QUANTIFYING THE ‘AGEING IN PLACE’ POPULATION ................................................................... 101
IV.4.1. Factor I: Type of domain ................................................................................................................................ 102
IV.4.2. Factor II: Degree of autonomy .................................................................................................................... 110
IV.4.2.1. How many elderly people are householders of their homes?................................................ 113
IV.4.2.2. Measuring the independent living: aggregated indicators ................................................... 114
IV.5. SYNTHESIS OF THE CHAPTER ........................................................................................................... 120
CHAPTER V. THE ‘AGEING IN PLACE’ CONTEXT. LIVING CONDITIONS AND
RESIDENTIAL SATISFACTION IN LATER LIFE ..............................................................121
V.1. INTRODUCTION ....................................................................................................................................... 121
V.2. MAPPING THE TERRITORY: LIVING CONDITIONS OF OLDER EUROPEANS IN THE BEGINNING OF
ST
21 CENTURY ........................................................................................................................................................ 122
V.2.1. Type of tenure .................................................................................................................................................... 123
V.2.2. Type of dwelling ................................................................................................................................................ 126
V.2.3. Adaptation of the accommodation ............................................................................................................ 128
V.2.4. When housing does not meet needs: residential problems of older households ............... 131
V.2.4.1. Basic facilities deprivation ................................................................................................................. 132
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V.2.4.2. The size of the accommodation ........................................................................................................ 134
V.2.4.3. Self-reported problems ........................................................................................................................ 137
V.3. LIVING CONDITIONS AS PREDICTOR OF RESIDENTIAL SATISFACTION IN OLD AGE ....................... 139
V.3.1. The assessment of living environments .................................................................................................... 140
V.3.2. Data and methods ............................................................................................................................................ 142
V.3.2.1. Principal Components Analysis with categorical data ........................................................... 143
V.3.2.2. Binary logistic regression ................................................................................................................... 145
V.3.3. Analysis ................................................................................................................................................................. 147
V.3.2.1. Predictors of residential satisfaction ............................................................................................. 147
V.4. SYNTHESIS OF THE CHAPTER .............................................................................................................. 162
CHAPTER VI. RESIDENTIAL DYNAMICS IN LATER LIFE: SHOULD I STAY OR
SHOULD I GO? ..........................................................................................................................165
VI.1. INTRODUCTION ................................................................................................................................... 165
VI.2. BACKGROUND ..................................................................................................................................... 166
VI.2.5. Permanence as living strategy in later life: the neglected topic .................................................... 168
VI.2.6. Conceptual frames to explain mobility decisions in older ages ...................................................... 170
VI.1. ANALYSIS ............................................................................................................................................. 172
VI.1.1. Looking behind: Duration of the residential trajectories of older Europeans .......................... 172
VI.3.1.1. Data ............................................................................................................................................................. 173
VI.3.1.2. How long in the same dwelling?....................................................................................................... 174
VI.3.1.3. The moment of settling down ........................................................................................................... 176
VI.1.2. Determinants of residential stability in older ages .......................................................................... 180
VI.3.2.1. Data and Methods.................................................................................................................................. 180
VI.3.2.2. Stability rates of older Europeans ................................................................................................... 184
VI.3.2.3. Discrete choice model of permanence ........................................................................................... 186
VI.2. SYNTHESIS OF THE CHAPTER ........................................................................................................... 191
CHAPTER VII. SUPPORT MECHANISMS TO LIVING INDEPENDENTLY AT OLDER
AGES ..........................................................................................................................193
VII.1 INTRODUCTION ................................................................................................................................... 193
VII.2 BACKGROUND ..................................................................................................................................... 194
VII.2.1. The concept of care .......................................................................................................................................... 195
VII.2.2. Home as care setting in later life ................................................................................................................ 197
VII.2.3. The link between formal and informal care at home ......................................................................... 197
VII.3 DATA AND METHODS ........................................................................................................................ 198
VII.4 ANALYSIS ............................................................................................................................................. 201
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VII.4.1. Public policies to living independent in Europe. An overview. ........................................................ 202
VII.4.1.1. European perspectives in ‘Ageing in Place’ housing policies .......................................... 204
VII.4.1.2. Home care provision in Europe ................................................................................................... 205
VII.4.2. Informal and Informal support at home in later life .......................................................................... 209
VII.4.2.1. Sources and types of support inside home .............................................................................. 211
VII.4.2.2. Determinants of support provided at home in later life.................................................... 219
VII.4.2.2.1. Specification of the model ................................................................................................................... 219
VII.4.2.2.2. Results .......................................................................................................................................................... 221
VII.4.3. The effect of home care over living independent duration............................................................... 227
VIII.4.3.1. Specification of the model ....................................................................................................................... 228
VIII.4.3.2. Results ............................................................................................................................................................. 229
VII.5 SYNTHESIS OF THE CHAPTER ........................................................................................................... 231
CHAPTER VIII. AGEING IN PLACE AS PREFERENCE: A CASE STUDY OF OLDER
SPANISH POPULATION. .......................................................................................................233
VIII.1. INTRODUCTION ................................................................................................................................... 233
VIII.2. BACKGROUND ..................................................................................................................................... 235
VIII.2.1. Ageing in Place in Spain: Between the choice and the lack of alternatives ............................... 235
VIII.2.2. Collective homes: the last resort? ............................................................................................................... 238
VIII.3. ANALYSIS ............................................................................................................................................. 240
VIII.3.1. Data and Methods ............................................................................................................................................ 241
VIII.3.1.1. Logit regression model ................................................................................................................... 242
VIII.3.1.2. Multinomial Logit Regression Model ........................................................................................ 244
VIII.3.2. Where and whom do Spanish elderly reside? ........................................................................................ 245
VIII.3.3. Where and with whom do Spanish elderly prefer to reside? ........................................................... 247
VIII.3.3.1. The starting point: frailty as conditioning factor of stated preferences..................... 248
VIII.3.3.2. Determinants of stated preferences in case of healthy old age ...................................... 251
VIII.3.3.4. Congruence between stated and revealed preferences ..................................................... 263
VIII.3.4. What will the future bring? ....................................................................................................................... 265
VIII.4. SYNTHESIS OF THE CHAPTER ........................................................................................................... 272
CHAPTER IX. CONCLUSIONS AND DISCUSSION ...........................................................275
BIBLIOGRAPHY .......................................................................................................................291

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List of Tables

Table II.1. Summary of Successful Ageing definitions ............................................................................................................................ 41
Table II.2. Basic features of collective-private settings .......................................................................................................................... 56
Table II.3. Residential modes in older ages regarding to type of domain and assistance degree ..................................... 62
Table II.4. Characteristics of ‘place’ concept ................................................................................................................................................ 63
Table III.5. EU SILC sample size by country, gender and age (individuals). ................................................................................ 80
Table III.6. Information modules in EU-SILC survey, primary target variables ......................................................................... 83
Table III.7. Example A. Countries which had a refreshment sample at wave 2 .......................................................................... 86
Table III.8. Example B. Countries which had not refreshment at wave 2...................................................................................... 86
Table III.9. Example C. Countries which had a refreshment at wave 2 and full age range refreshment at wave 4 .. 86
Table III.10. SHARE sample size by country, gender and age (individuals)................................................................................. 87
Table III.11.Basic information of SHARE waves ........................................................................................................................................ 89
Table III.12. Data modules included in each wave of SHARE by theme ......................................................................................... 91
Table IV.13. Demographic indicators in EU15 countries focused on elderly population, selected years (1971, 1991,
and 2011). .................................................................................................................................................................................................................... 98
Table IV.14. Percentage of 65+ population living at home and in institutions (prevalence data; different years in
the early 1990s) ......................................................................................................................................................................................................103
Table IV.15. Distribution of population aged 65 and over by type of domain, EU15 projections 2050 (%)..............110
Table IV.16. Proportion of 65+ individuals heading their households by age group and gender. ..................................113
Table IV. 17. Functional assessments domains ........................................................................................................................................115
Table IV.18. Ranking of Independent Living indicator, 55+ population, EU15 countries, 2010 (%). ...........................118
Table IV.19. Ranking of Independent Living indicator, 65+ population, EU15 countries, 2010 (%). ...........................119
Table V.20. Tenure rates by group of age in 2007, EU15 countries, (%).....................................................................................126
Table V.21. Distribution of population aged 65 and over by dwelling type, EU15 countries, 2004 (%). ....................127
Table V.22. Older people self-reported problems by socio-economic status, EU15 countries, 2007 (%) ..................137
Table V.23. Living conditions variables included in the analysis (EU SILC 2007) ..................................................................149
Table V.24. PCA output using tetrachoric correlation matrix ...........................................................................................................150
Table V.25. Overall residential satisfaction of population aged 65 and over, by country and socioeconomic status
(4-point scale). .........................................................................................................................................................................................................153
Table V.26. Predictive potential of residential satisfaction regression models; pseudo-R² values of adjusted
variance. ......................................................................................................................................................................................................................156
Table V.27. Binary Logistic Regression results for Elderly population residential satisfaction NOT AT RISK OF
POVERTY, EU SILC 2007 .....................................................................................................................................................................................157
Table V.28. Binary Logistic Regression results for Elderly population residential satisfaction AT RISK OF
POVERTY, EU SILC 2007 .....................................................................................................................................................................................158
Table VI.29. Mean proportion of time-life residing in current dwelling by age group (%), EU15 countries. ............176
Table VI.30. Description of the longitudinal sample (number of individuals that remain in the panel during the
studied period) ........................................................................................................................................................................................................181
Table VI.31. Stability/mobility rates of older population for the period 2004-2012, by country and age group (%).
.........................................................................................................................................................................................................................................185
Table VI.32. Description of explanatory variables..................................................................................................................................186
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