Building H.O.U.S.E (Healthy Outcomes Using a Supportive Environment): Exploring the Role of Affordable and Inclusive Housing for LGBTQIA+ Older Adults

Little is known about how permanent, inclusive, affordable, and supportive long‐term housing may affect the health of low‐income lesbian, gay, bisexual, transgender, queer, intersex, asexual and/or another identity (LGBTQIA+) older adults. Focus group interviews were conducted with 21 older adults to explore the lived experiences and potential health benefits of living in a new LGBTQIA+‐welcoming senior housing. Participants reported that moving into the housing was associated with benefits for health and well‐being, especially for psychological health. Community, social support, and in‐house services were particularly important. However, the combined nature of LGBTQIA+‐welcoming and older adult only housing evoked mixed feelings. Appropriate and accessible housing solutions are essential for LGBTQIA+ older adults and may help address health disparities for these populations

A National Study on the Physical and Mental Health of Intersex Adults in the U.S.

Objectives: To describe the health of intersex adults (people with differences of sex development) in the U.S. using community-based research methods. Methods: In July–September 2018, we conducted a national health study of intersex adults aged 18 and older in the U.S., using a survey hosted on Qualtrics. The study describes the physical and mental health experiences of intersex adults, including differences by age (18 to 39 vs. 40 and older). Questions were derived from national (Behavioral Risk Factor Surveillance System) and intersex-related health studies. Results: A non-probability sample of 198 intersex adults completed the survey over three months. Over 43% of participants rated their physical health as fair/poor and 53% reported fair/poor mental health. Prevalent health diagnoses included depression, anxiety, arthritis, and hypertension, with significant differences by age. Nearly a third reported difficulty with everyday tasks and over half reported serious difficulties with cognitive tasks. Conclusions: To our knowledge, this is the first national study of intersex adults in the U.S. Greater understanding of intersex health over the life course is essential. Findings highlight the need for longitudinal studies and further examination of potential health disparities experienced by intersex populations

A qualitative study of the experiences of people who are homebound in the Bay Area: “It’s all limited, everything is limited.”

An estimated two million older adults in the United States are homebound, higher than the number living in nursing homes. Older people, people of color, and women are more likely to be homebound, as well as those on low incomes and with lower education levels. Being homebound is associated with higher rates of depression, cognitive impairment, and mortality. Despite the many challenges faced by homebound people, few qualitative studies exploring their experiences have been published. There is also a lack of conceptual clarity around the meaning of being homebound; multiple definitions have been used in previous research, making it difficult to compare and synthesize findings across studies.The purpose of this dissertation was to explore what it is like to be homebound, and to contribute to the conceptual literature on both aging in place and homeboundness. The aims of this dissertation were: 1) to synthesize and evaluate the existing qualitative evidence on experiences of aging in place in the US; 2) to explore experiences of homebound adults living in the San Francisco Bay Area and to build a conceptual understanding of what it means to be homebound; and 3) to explore experiences of homebound older adults during the COVID-19 pandemic. The primary finding of my systematic review and meta-ethnography was that aging in place is a dynamic process driven by tension between threats and agency across three core experiences – identity, connectedness, and place. In my qualitative analysis, I found that being stuck was at the core of the experiences of being homebound. Participants felt stuck in place, stuck with inadequate help, and stuck with the limited range of choices available to them. Homebound people also emphasized the ways in which they retained their independence, distancing themselves from negative images of aging and being homebound while demonstrating their autonomy and resilience. While most people around the world felt restricted by being stuck at home during COVID-19 shelter-in-place orders, homebound people were struggling most with decisions about who to allow into their homes. They weighed risk of infection against their abilities to cope alone or with reduced levels of help at home. Most were offered virtual services; experiences of these were mixed. The findings of this dissertation research provide new insights into the lives of homebound people and those aging in place They also indicate important directions for future research, clinical practice, and policy, such as improvements to home care workforce policy, support related to aging in place and maintaining social connectedness, and access to healthcare for homebound people. Improving the supports and services available to homebound people, with a particular focus on safeguarding autonomy, could help enhance quality of life and alleviate the frustration and pain associated with feeling stuck at home

Building H.O.U.S.E (Healthy Outcomes Using a Supportive Environment): Exploring the Role of Affordable and Inclusive Housing for LGBTQIA+ Older Adults

Little is known about how permanent, inclusive, affordable, and supportive long-term housing may affect the health of low-income lesbian, gay, bisexual, transgender, queer, intersex, asexual and/or another identity (LGBTQIA+) older adults. Focus group interviews were conducted with 21 older adults to explore the lived experiences and potential health benefits of living in a new LGBTQIA+-welcoming senior housing. Participants reported that moving into the housing was associated with benefits for health and well-being, especially for psychological health. Community, social support, and in-house services were particularly important. However, the combined nature of LGBTQIA+-welcoming and older adult only housing evoked mixed feelings. Appropriate and accessible housing solutions are essential for LGBTQIA+ older adults and may help address health disparities for these populations

Experiences of aging in place in the United States: protocol for a systematic review and meta-ethnography of qualitative studies

Abstract Background By 2035, older adults will outnumber children for the first time in the United States (US). In light of its aging population, the US has supported services focused on enabling older adults to continue living in their current homes, a model commonly described as “aging in place.” The lived experience of aging in place is not well documented in existing systematic reviews. The aims of this systematic review are to synthesize and evaluate the existing qualitative evidence on experiences of aging in place in the US and identify knowledge gaps and directions for future studies. Methods Six electronic bibliographic databases (PubMed, PsycINFO, CINAHL, Web of Science, EMBASE, and Sociological Abstracts) will be searched. Studies presenting qualitative data on the experiences of older adults currently aging in place in the US will be included. Covidence software will be used to screen studies and extract data. The Joanna Briggs Institute checklist for qualitative research will be used to assess quality and risk of bias of included studies. We will use meta-ethnography, following the method described by Noblit and Hare, to synthesize and evaluate the results of the included studies. Discussion To the best of our knowledge, this is the first systematic review to integrate and synthesize the findings of qualitative studies of aging in place focusing on older adults in the US. The findings of this review will provide in-depth knowledge on lived experiences of aging in place and address important gaps in existing work. Systematic review registration International Prospective Register of Systematic Reviews (PROSPERO): CRD4201810284

A new conceptual model of experiences of aging in place in the United States: Results of a systematic review and meta-ethnography of qualitative studies.

ObjectivesThe purpose of this systematic review was to synthesize the evidence on experiences of aging in place in the United States.DesignSystematic review and meta-ethnography of qualitative studies.Data sourcesWe searched six bibliographic databases (PubMed, Embase, PsycINFO, CINAHL, Web of Science, Sociological Abstracts), with no limits on publication date. Eligible studies reported peer-reviewed qualitative research on experiences of aging in place in the United States with full-text available in English.Review methodsThree reviewers independently used Covidence software to screen titles and abstracts followed by full texts. We assessed quality and risk of bias using a modified version of the Joanna Briggs Institute Checklist for Qualitative Research. Qualitative data analysis was conducted using meta-ethnography, following Noblit and Hare's seven-step method of translation and synthesis to generate a novel conceptual model.ResultsOf 2659 papers screened, 37 unique studies were eligible for inclusion, reported in 38 publications. The studies were conducted in 16 states and published between 1994 and 2018. The included samples represented 1199 participants in total, with mean ages ranging from 48 to 91 years. The gender of the samples ranged from 20% to 100% female, with a median of 77%. One-third of the included studies did not report participants' race/ethnicity, and half of the remaining study samples were at least 90% white; however, 20% of the studies focused exclusively on experiences of racial/ethnic minority older adults. Using meta-ethnography, we developed a new conceptual model of aging in place in the United States as a dynamic process of balancing threats and agency in relation to experiences of identity, connectedness, and place. We found that people aging in place were engaged in significant work to cope with unpredictable needs and challenges by changing their mindset, adapting their home environment to accommodate new needs, and finding different ways to connect with important people in their lives. Agency was shaped by resources and restrictions on choice, and where threats to aging in place outweighed an individual's sense of agency, the consequences included feelings of uncertainty, isolation, and dislocation.ConclusionsTo the best of our knowledge, this is the first systematic review of qualitative studies to evaluate experiences of aging in place in the United States. The findings of our meta-ethnographic synthesis led to the development of a new conceptual model of aging in place highlighting the dynamic tensions involved in balancing threats and agency