Wellbeing and Chronic Stress Outcomes for Older

WestminsterResearchhttp://www.westminster.ac.uk/westminsterresearch

An Exploration of Relocation Decision-making and Experience:

Wellbeing and Chronic Stress Outcomes for Older Under-

Occupying Homeowners

Lincoln, G.

A DProf thesis awarded by the University of Westminster.

© Dr Gail Lincoln, 2020.

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i

AnExplorationofRelocationDecision-makingandExperience:

WellbeingandChronicStressOutcomesforOlderUnder-

OccupyingHomeowners.

GAILLINCOLN

Athesissubmittedinpartialfulfilmentoftherequirementsofthe

UniversityofWestminster forthedegreeofProfessionalDoctorate

MARCH 2020

i

ABSTRACT

This largely qualitative research used thematic analysis and somecontextualquantitativedatatosupplementqualitativefindings.Itexploredthe decisions, experience and efficacy of 39 female homeowners, livingalone in or near London, around downsizing to retirement housing. Thefocuswasonwellbeingandchronicstress forparticipantswhomovedordid not. The timespanwas: (1) ‘decision-making’ fivemonths before themove,(2)justaftermoving,(3)‘settling-in’fivemonthslater.‘Mover’and‘NonMover’cohortswereintwoagegroups60-75;76andover.Structuredinterviews explored person-environment fit, quality of life, supportnetworks and personal views and characteristics at Times (2) and (3)togetherwithhair samples, forhair cortisol concentration (HCC)analysisofchronicstress.Depression,anxietyandstressmeasureswerealsotakenretrospectively for Time (1). Two from each cohort had semi-structuredinterviews at Time (3). There were three ‘Overarching Themes’ andthirteensubthemes.Impedimentsandmotivatorstomovewerereportedaseitherfunctional(practical)mattersor‘meaningful’(emotional)matters,whichhadmoreinfluenceforthosedisinclinedtomove.Theinclinationtomovewasdependentuponlifetimecharacteristics,beliefs,experienceandself–efficacy,notageperse.OlderMoversstruggledwithcognitiveaspectsand pressure tomove from family,whichwas uncomfortably high in theresearch.Rolediminishmentwithinthecommunityorfamily,andlevelsofautonomy,affecteddesiretomove, theacceptanceofhelpandtimetakento settle-in. HCC results for chronic stress were interpreted usingcontextualised biographical material. This qualitative approach wasessential in revealing individual delayed reactivity and differentlengths/levelsof response,dependingonperceptionof ‘stressors’.Futureresearch, policy and practice have been recommended, using richer thanpreviousrelocationresearch,forthisgrowingsocialgroup.

ii

ACKNOWLEGEMENTSIwouldliketothankmyresearchdirectorofstudies,DrGillianRhodesandthe research team: Prof FrankHucklebridge, Prof Catherine Loveday andDrJayMacKenzieformuchappreciatedandvaluedsupportanddirection;Jay for providing me with the opportunity to present my research inAustralia, Gill for keepingme grounded and calmwith sound advice andencouragement that sustained me through traumas and bereavementssufferedduringthelongresearchprocess.ThankyoutoDrPatriciaMaitland,DProfcourseleaderandlaterdirectorofstudies;DrMariaWoloshynowychandtoMarkBaldwinforspecificadvicewith statistics and presentation; transfer viva examiners Dr TinaCartwright and Prof Damien Ridge for specific, helpful and essentialfeedback, and to external examiner Ann Netten for detailed and helpfulfeedbackenroutetoafinalversion.Thanks to friends, colleagues and former colleagues for somuch help inidentifyingpotentialparticipants;thevariousdayclubmanagersandmanyretirement-housing managers who tolerated with grace my monthlycontacts about vacancies and sales and made introductions for me topotentialparticipants.Special thanks toNickO’Shea for the confidence shown inmy FreeSpacescheme for older downsizers; including provision of a convincing on-linebusiness case. Also for providingmuchneeded encouragement forme tocontinuewithmyresearchdegreewhenitbecameapparentthatausteritymeasuresmeanttheoriginalschemewouldnotbescaledup.Specialthankstomypartner,son,friendsandfamilywhohavestuckbymedespitemymoodsandsenseofdistraction,suddencancellations,absencesand lapse of duties on many occasions. Thank you Evie dog for yourconstant companionship,withoutwhoseunconditional support thisworkwouldsurelynothavebeencompleted.Lastly and most importantly thanks are due to the participants who sowillingly took part and so openly shared their, often emotional,experiences;forgivinguptheirtimeandofcoursetheirhairsamples!

DedicationsAlbertALincolnBettyJLincoln1927–20171931–2019

FrankHucklebridge1948-2018

iii

DeclarationI declare that all of thematerial presented in this thesis ismyownworkandhasnotbeensubmittedatanyotherUniversity.

iv

SectionTableofContentsChapter1Introduction&thesisoutline

Page1-8

1.0 Introduction 11.2 Ageingpopulationsandhousingdemand 21.3 Benefitsforindividuals,policyandpractice

IndividualpersonalfactorsCommercial,environmentalandsocialpolicyfactors

4

1.4 Summary-keypointsandhousingmission 51.5 Thesisoutline,chaptersthatfollow 5Chapter2Background–Housingpolicyandpractice

9-19

2.0 Introduction 92.1 Home-ownership,olderpeopleandunder-occupation 92.2 Thecostofhousingmismatch

PracticalcostsforolderpeoplePublicsectorhealthcosts

10

2.3 TheWorldHealthOrganisationresponse 112.4 UKPolicy

SocialCareActs2012and20142025/16HousingandHealthMemorandumofUnderstandingandJointActionHousingHealthandSafetyRatingSystem(HHSRS)AllPartyParliamentaryGrouponHousingandCareforOlderPeople–HAPPI1,2,3,4(HousingOurAgeingPopulationPlanforImplementation)

12

2.5 Newretirementhousingsupplyandinnovation 142.6 Blamingtheoldergeneration 162.7 Relocation–Issuesofprovision,uniquetoolderpeople 172.8 Summaryofchapter2keypoints 18Chapter3Literature–Motivation&planningindecisionstomovehome

20-35

3.0 Introduction 203.1 Decisionsandrisk 203.2 Depression,self-esteem,anxietyeffectsandcopingstrategies 213.3 Optimismandpositiveself-cognitionbias 223.4 Locusofcontrolandself-efficacy 223.5 Extrinsicandintrinsicmotivationalfactors 243.6 Temporalityandplanning 263.7 Housingrelocationstudies 273.8 Supportservices,adviceandinformation 293.9 Family,independenceandloneliness 313.10 Summaryofkeypoints 323.11 Gapsinpreviousresearch 333.12 Theoriginalityofthisstudy 343.13 Aimandobjectives 35

v

Chapter4Literature-Neuroendocrinereactivitytostressandhaircortisolconcentration.

36-51

4.0 Introduction 364.1 Cortisol-The‘stresshormone’ 364.2 Habituationtochronicstress 374.3 Healthandageing 384.4 Genderdifferences 394.5 Decision-making,biologicalcomponent 394.6 Clinicalandpublichealthrelevance 404.7 Mediatingeffects,supportandacceptanceofsupport 404.8 Personalityandbiographicaleffects 414.9 Haircortisolconcentration(HCC)asameasureofchronicstress 444.10 Concernsoverreliabilityandhaircharacteristics

4.10.1Hair,ageandgender………………………………………………………4.10.2Hairgrowthrate……………………………………………………………4.10.3Haircolour…………………………………………………………………….4.10.4Time,representativelengthandwash-outeffects…………...4.10.5Externalfactorsaffectinghaircortisol

444445454546

4.11 Concernsaboutprocedures16.11.1Collectionstage……………………………………………………………16.11.2Pre-analysispreparation

464647

4.12 Quantitytocollect 484.13 IndividualdifferenceswithHCCasabiomarker 494.14 Summary–limitations 51Chapter5GeneralMethods:design,materialsandprocess 52-875.0 Introduction

5.0.1Researchpremiseandpropositionsrevisited……………………5252

5.1 ResearchapproachDefinitionoftermsFunctionalandMeaningfulaspects

53

5.2 DesignOverview5.2.1Participants–cohortsummary………………………………………...5.2.2Timeframeandactivity...…….……………………………………………5.2.3Iterativeprocess

55555556

5.3 SamplesizeandselectionrationaleInclusionandexclusioncriteriaDefinitionofcriteria………………………………………………………………...ThepropertyThelocationLonefemalesPerson-environmentfit–avoidingexclusionscreening

5759

5.4 Samplingandrecruitingtheparticipants…………………………………..PurposivesamplingMoversNonMoversStage2semi-structuredinterviewparticipantselectionRecruitmentissuesandoveralltimetakenforfieldworkTheattritionrate

60

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5.5 Materials–Questionnairedevelopmentanduse5.5.1RelocationConsiderationsMeasure(RCM)……………………….DemographicactualquestionandorderofcompletionFunctionalandmeaningfulimpedimentsandmotivators5.5.2RelocatingPsychometrics(RP)………………………………………...Identifying8validatedscales,suitableforolderpeopleresearchHarmonisationwithotherresearchSatisfactionfeedbackquestionnaires5.5.3Pilotingthequestionnaires………………………………

64646667

5.6 ConductingtheStage1interviewswithRCM&RPquestionnaires…………………………RPquestionnaireretrospectivehealthitems–depression,anxietyandstress

68

5.7 DevelopmentandpurposeofStage2semi-structuredInterviews………………………………..InterviewSchedule–planningandfocusThequestions5.7.2Conductingthesemi-structuredinterviews………………………RoleoftheresearcherImpartialityandbiasaffectinganswerCognitiveEffectDemandcharacteristicsandsocialdesirability

7073

5.8 HairCortisolConcentration(HCC)methodandprotocols 755.9 Quantitativedatamanagementandanalysis

5.9.1HCC–Sendingsamplesforanalysistothelaboratory………..5.9.2Interviewdata–Questionnairesscoringconsistency………...TherelocationConsiderationsMeasure(RCM)RelocatingPsychometricsQuestionnaire(RP)

76

5.10 StatisticalmethodsandanalysisQuestionnaireLikertscaledataForcognitive,HCCandotherhealthmeasures

77

5.11 Managementandanalysisofthequalitativedata5.11.1ThematicAnalysis(TA)andwhythismethodwaschosen.5.11.2Familiarisation–perTAprocessstages1and2………………TranscriptionoftheinterviewsOrganisingthedata,readingandrereading5.11.3PreliminarycodingandadditionalcodingofthedataperTAprocessstages3and4………………………………………………5.11.4Groupingcodes,developingthemes,reviewingandnamingthemperTAanalysisstage5………………………………5.11.5Reportingthefindings–perfinalTAstage

80808182848585

5.12 ResearchgovernanceEthicalconsiderationsandapprovalInformedconsentConvidentialityandsecurity

86

5.13 Methodssummaryandfollowingchapters 87

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Chapter6FindingsPartoneParticipantcontexts 88-1076.0. Introduction 886.1 PartOne

6.1.1TheParticipants’currenthomesituation&relocationcontext……………………………….6.1.2Reasonsgivenformovinghome……….………………………………Pressuretomoveandneighbourharassment.Health6.1.3Homeenvironment–functionalityanddesign………………….SizeofpropertyOptionsanddesignSizeofroomsGuestroomsMaintenanceCostsofaccommodationLocation

889798

6.1.4RelocationEfficacy-HealthandlifestyledemographicsCognitivefunctionWeightanddietSmoking&alcoholAcuteself-reportstressorsRestrictivehealthandpain

103

6.1.5SummaryofPartOnefindingsPerson-environmentfit,motivatorsandimpedimentsAgedifferencesforMoversandNonMoversEmotionalandphysicalsupportTemporality

106

Chapter6ParttwoThematicAnalysis 108–1516.2 Introduction 1076.2.06.2.1

OverarchingthemesOverarching Theme One – Ambiguity in decision-makingpredictingfuture&planning…………………………………………………….6.2.1.1Inclinationtoplan(ornot)forage-transitions,changesinperson-environmentfit;contingency,optimismandluck………6.2.1.2Informationalsupport,financialhardshipandbenefitstomoving.Inheritanceaspecialcase……………………………………………6.2.1.3De-clutteringandhoardingasanimpediment……………….6.2.1.4Conflictbetweenfunctionalandmeaningfulmatters………6.2.1.5Enjoymentofandcontentmentwithhome;memoriesandattachmenttoroutinesandlocation…………………………………..6.2.1.6Personalidentityandsenseofpurpose.Gardens,aspecialcase

108109109117120121123131

6.2.2 OverarchingThemeTwo–Personalindependenceandautonomy………………………………………………………………………………..6.2.2.1Acceptinghelpfromfamilyvs.fromothers;beingaburdenandguilt,reversalofrolesinthefamily………………………...6.2.2.2Desireforproximitytofamily’mixedfindings………………..6.2.2.3Pressuretomovefromfamily;well-meaningorself-serving?

134134140142

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6.2.3 OverarchingThemeThree–Localcommunity;needsandsocialidentity………………………………………………………………………….6.2.3.1Lonelinesscompanionship&socialcontactvs.‘outings’.Petsaspecialcase……………………………………………………………………6.2.3.2Communityfacilities,neighboursandcommunityfriendliness……………………………………………………………………………..6.2.3.3Retirementhousing;socialisingandsenseofbelonging6.2.3.4Change;socialidentityansocialintegration

144144147150152

6.2.4SummaryofPartTwofindings 156Chapter7Healthandwellbeing–findingsandinterpretation

152–177

7.0 Introduction. 1527.1 Traumaticeventspriortotheresearchtimetable 1537.2 Haircortisolconcentration(HCC)results

Potentialextraneouseffects7.2.1SummaryofdifferencesinHCC;PeriodBcomparedwithPeriodA

154155

7.3 Depression,anxiety,stressandself-esteemresults7.3.1Depression,anxietyandstressdifferencesbetweengroups;andobservations…………………………………………………………7.3.2Self-esteemdifferencebetweengroups;andobservations...7.3.3Observationsof-Self-esteemassociationswithhaircortisolconcentration……………………………………………………………...

156158159160

7.4 7.4IndividualbiographicalanalysisofHCCeffects-IntroductiontoTables7.4Aand7.4B-7.4Adiscussion-7.4Bdiscussion

162

7.5 HCCandchronicstressconclusions 176Chapter8Overalldiscussionandrecommendations

178-228

8.0 Introduction 1788.1 Originality:keyfindingssummary

8.1.2Originalfindings,findingsthatsupportorchallengepreviousresearch…………………………………………………………………….1.Decison-makingefficacyandplanning2.Autonomy,independence,familypressure3.De-cluttering,roleinfamilyandpersonalindentity4.Practicalconsiderations,,preferences5.Attachment/memories6.Communityandsocialidentity7.Wellbeingandchronicstress

178178

8.2 ThematicAnalysismappingandhowtointerpretthemap 1838.3 OverarchingPlanningEfficacyThemesandsubthemes

8.3.1Ambiguityindecision-makingOverarchingTheme1….……A.Inclinationtoplan(ornot)forage,andpersonalityB.TemporalityC.Optimism/luckD.InertiaE.Informationalsupportandfinance

185185

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F.De-clutteringandhoardingG.Conflictsindecision-making–functionalandmeaningfulinfluencesH.Contentmentwithhome;memoriesandattachmentsI.Personalidentityandpurpose8.3.2Personalindependenceandautonomy.OverarchingTheme2……………………………………..J.Independenceandself-efficacyK.Acceptinghelpfromfamilyvs.fromothersL.DesireforproximitytofamilyM.Pressuretomovefromfamily,wellmeaningorself-serving?8.3.3Localcommunityneedsandsocialidentity.OverarchingTheme3………………………………………N.Loneliness,socialcontactandbelongingO.Communityfacilities,neighboursandcommunityfriendlinessP.Change.Socialidentityandsocialintegration

194197

8.3 Healthandwellbeing-depression,anxiety,stress,self-esteem…. 2008.4 Chronicstressandhaircortisolconcentration(HCC)-Overall

Findings…………………………………….Threatorchallenge,impact,duration,resolvabilityFinding1habituationFinding2DelayedresponseSummary–HCCfindings

202

8.5 Recommendations–forpracticeandpolicy8.5.1Practitioners–assessingneedsandeffectiveinvolvementAmbiguitychallengeStrengtheningplanningefficacy,holisticproblem-solvingMotivatorsandimpedimentsEmotionalsupportandinteragencyworkRespectandautonomy8.5.2RecommendationsPolicydevelopment……………………………JointworkingSchemerequirementsViabilityforhomeownersanddevelopersFinanceAdultabuseCulturalshift–strategicplanning,publichealthandinformation

204204200

8.6 StrengthsandLimitations………………………………………………………...Furtherresearchtoaddresslimitations……………………………………

211212

8.7 Researchconclusion 213 Approx.68,250words ReflexiveStatement………………………………………………………………… 216

x

ListofAppendicesAppendix1 FreeSpacerelocationassistanceschemedetails………….. 220Appendix2 GubaandLincoln2007Paradigmtable……………………….. 221Appendix3 Informationflyerforpotentialparticipants…………………. 222Appendix4 Participantconsentandinformationform…………………... 223Appendix5 RelocatingConsiderationsMeasure(RCM)allitems……. 225Appendix6 RelocationPsychometrics(RP)allitems……………………... 229Appendix7 Itemsinthe(RP)selectedfromotherscales………………... 234Appendix8 Fieldworkprocesschecklist……………………………………….. 238Appendix9 Prioriheadingsforinitialcodingofnarrative……………… 239Appendix 10 Extract from biographical information table ……………….. 241 Appendix 11 Extract from NVIVO narrative analysis system ……………. 244 Appendix12AnalysisandconsiderationofNVIVOcodingoutcomes–

partofreadandre-readprocess…………………………………. 245

Appendix13A Locationfacilitiesofimportance(Table6.1.3C)…………... 248 Appendix13B Physicalactivity,smoking,alcohol,socialstatustable

6.1.4A.................................................................................................... 249

Appendix14 Motivations/impedimentssummarytablewith meaningfulandfunctionalmatters(Table6.1.3D)……..... 251 Appendix15 HCCscoreschangesbetweenperiodAandB.Hair

treatment5mnthspriortoTime1andTime2(Tables7.2A&7.2B)……………………………………………………………….

256Appendix16 Selfesteemitemsand

scores………………………………………….258

Appendix17 BluntedHCCscoresduetohabituation,longstandinginsurmountableordynamicandactive:delayedorconcurrentresponse–forparticipantsnotTable7.4C…

259

Glossary…………………………………………………………………….. 261 List of references ……………………………………………………2 67 Bibliography……………………………………………………………….....283 ListofTablesChapterSectionPageTable1.2 UKandEUpopulationincreasesages65+………………….... 3Table3.5.4 Summaryofquestionsdecision-makersaskthemselves

inrespectofefficacy,intrinsicvalueandexpectancyvalance…………………………………………………………………….....

26

Table5.2.1 CohortGroupbytypeandage……………………………………... 55Table5.2.2 Researchtimeframe…………………………………………............... 55Table5.2.3 Iterativeprocessandcorrespondinganalysis………………. 57Table5.5.2 Researchperceptualandsubjectivedimensionitemsin

theRelocationPsychometrics(RP)questionnaire………...67

Table5.7A Initialinterviewschedule…………………………………………… 71Table5.10 ExampleofQmethodology–GroupBquestionsscoring. 79Table5.11.3 Preliminarycodingforpossesions/de-cluttering 83Table6.1.1 Housingsituationandbasicrelocationcontext……………. 89Table6.1.2

Numberofreasonstomove……………………………………….. 98

xi

Table6.1.3A Sizeofhomebeforeandaftermove;bedroomsmadeavailableduetomove…………………………………………………

99

Table6.1.3B Preferredsizeofhomecomparedwithpresent…………... 99Table6.1.4A Physicalactivity,smoking,alcohol,socialstatusApp.13BTable6.1.4B Restrictivehealthandpain…………………………………………. 105Table6.1.4C Chronichealthconditions.…………………………..………………. 105Table6.2.0 PlanningEfficacy–OverarchingThemes…………………..… 108Table7.0 ResearchTimeframe…………………………………………………… 152Table7.1 Widowhoodandtraumaticeventsinthelasttwoyears,

inadditiontotheordealofmovingforGroupsAandB153

Table7.4A Participant case studies; Assn. between DAS/HCCscoresandbiographies………………………………………………..

155

Table7.4B Blunted HCC scores; habituation; longstandinginsurmountable/dynamicandactive;delayed/current..

174

ListofFiguresChaptersectionPageFigure4.8.1 Lifespaninfluencesonhealthandwellbeing(after

Lutgendorf,2003)……………………………………..…………………43

Figure4.14 Limitationsofsinglemeasuresofimpactonstress(McEwen,2012)..…………………………………………………………

51

Figure5.1 Inductiveandabductiveresearchprocess.………................... 54Figure5.2.3 Inductiveprocess…………………………………………….................. 57Figure8.2 Thematicanalysismap:inclinationtomove,

motivators/impediments…………………………………................185

Figure8.3 NVIVOdiagram.Overarchingthemes..………………….……… 183

ListofChartsChaptersectionPageChart7.2 Haircortisolconcentration(HCC)PeriodAof5months

durationbeforethemove&PeriodBof5monthsafter...154

Chart7.3A DepressionTime2,5monthsbeforethemove,themoveandTime3,5monthslater…………………………………

157

Chart7.3B StressTime2,5monthsbeforethemove,Time3,5monthslater……………………………………………………………….

157

Chart7.3C AnxietyTime2,5monthsbeforethemove,Time3,5monthslater……………………………………………………………….

157

Chart7.3D Self-esteematTime2,themoveandTime3,5monthslater…………………………………………………………………………...

157

Chart7.3.2A MovergroupsAandBself-esteemTime2,themoveandTime35monthsafter;HCC–PeriodA5monthsleadinguptothemoveandPeriodB5monthsafter……..

160

Chart7.3.2B MovergroupsAandBself-esteemTime2,themoveandTime35monthsafter;HCC–PeriodA5monthsleadinguptothemoveandPeriodB5monthsafter……..

161

xii

ListofAbbreviationsAPPGAllpartyparliamentarygroupDASDepression,anxietyandstressDASSDepression,AnxietyandStressScaleDFGDisabledFacilitiesGrantHCCHairCortisolConcentrationHPAHPAaxis-Hypothalamic-pituitary-adrenalaxis,MOS-SSSMedicalOutcomesStudy;SocialSupportSurveyMMoverGroupNMNonMoverGroupOPQOLOlderPeople’sQualityofLifeQuestionnairePEfitpersonenvironmentfitPWB-PTCQPsychologicalWell-Being-PostTraumaticChangesQuestionnaireRCMRelocationConsiderationsMeasureRPRelocatingPsychometrics(Measure)RTBRighttoBuySESSSouthamptonSelf-Esteem&ItsSources(olderpeople)ScaleSPSSocialProvisionsScaleSTPIStanfordTimePerspectiveInventoryTAThematicAnalysisPublications,presentationsandresearchkeydisseminationevents2012–2018PublicationsLincoln,G.(2019)In:Rhodes,Ella(2019)GuidetoRetirement.ThePsychologistpublications,London(November2019)LincolnG.(2019)ThePsychologistGuidetoRetirement–toptipparagraph.ThePsychologist(Seriesofguidesbasedonpsychologicalresearch).DraftapprovedMay

Lincoln,G.(2015)Olderunder-occupyingowners,willtheyevermove?Isthedecisiontorelocateamovingtarget,moredifficultthanthemoveitself?HowCanFreeSpaceschemeshelp?CaseStudypaper102HousingLearningandImprovementNetwork.

PresentationsLincoln,G.(2017)Anexplorationofrelocationanddecision-makingexperienceonwellbeingandchronicstressoutcomesforolderunder-occupyinghomeowners.Posterandrapid-firepresentation:AustralianAssociationofGerontology(AAG)conferencePerth,Australia:8th–10thNovember

xiii

Lincoln,G.(2016)WillFreeSpacestyleinterventionsworkforvulnerableolderpeople;Anexplorationofhealthandwellbeingoutcomesforolderunder-occupyinghomeowners?PosterpresentationHPPHN(HealthPsychologyinPublicHealthNetwork).WelwynGardenCity11thFebruary

Lincoln,G.(2015)Explorationofthehealthandwellbeingconsequencesoflivinginunsuitableaccommodationforunder-occupyinghomeownersage60+whofeeltheyhavenoviablehousingalternative:PosterpresentationCohortStudiesResearchConference;CentreforLongitudinalStudies;(CLS);MaryWardHouse,London16thand17thMarch

DisseminationkeyeventsLincoln,G.(2018)TheFutureofAgeing2018–ILCinnovationsessions:

PhysicalandMentalHealth-HouseofLords;Loneliness–SouthwarkCathedral;9th&12thJuly2019ILC-UKHealthandWellbeingInnovationCommissionInquiry-SocialConnectionsincludingIsolationandLoneliness

Lincoln,G.(2017)WrittensubmissiontoHouseofCommonsCLG–Parliamentaryinquiryintohousingforolderpeople:March,andSeptemberupdate,basedontheresearch.

Lincoln,G.(2015)workshopcontributionwithpotentialfundingagencies-homelessnessHousingforOlderPeopleConference,‘AFestivalofIdeas’HousingLIN4thconference;RiversideParkPlazaLondon11thFebruary

LincolnG.(2012)SeminaratFyvieHallUoWfor70housingorganisations-pre-researchpreparationanddisseminationoftheresearchers‘moveon’scheme,FreeSpace(Appendix1):Researcherorganisedtheeventandchairedthepanel:-ElderlyAccommodationCouncil(EAC)economist,NickO’Shea,nowatKingsFund;RedbridgeFreeSpacepractitionerandRogerWilshaw,DCLGDeputyDirectorofHomelessnessand&SupportnowDirectorofResearchandPublicaffairsatPlacesforPeople.18thJuly

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Definitionofkeyterms–seealsoGlossarypage250Mover–Someonewhohasmovedduringthemonthbeforestartingtotakepartintheresearch(dividedintothoseaged60+andthoseaged76+)Non-Mover – participants who chose to stay put. The timeframe for theresearchandagegroupsmirrorsthatofMovergroupsStaying-put is the accepted term used by practitioners and in academicliteratureforthosewhodonotmove.Downsizing–inthisresearchparticipantsmustbelivinginpropertythatthey own that has at least one room more than their bedroom numberminimum requirement. Movers must be moving into owned or rentedaccommodationthatissmaller.Big Issue – this is a data analysis term introduced into establishedorganisational stress research methodology, where factors with a highlikelihoodofinfluenceareidentifiedas‘bigissues’distinctfromthosethataremerelyperipheral.Motivator –anyaspect thatencouragesaparticipant to lookpositively atmoving, be it to dowith the current situation, the desired situation or apersonalvieworcharacteristic.Impediment – per motivator but looking negatively at and reducing thelikelihoodofmoving.Meaningful–isusedinrecentrelocationliteratureandrelatestoaspectsthathaveapredominantlyemotionalaspect(thatmayalsobefunctional).Functional– isused in recent relocation literatureandrelates toaspectsthathaveapredominantlypracticalaspect(butmayalsobemeaningful).Planning efficacy - is a term used by the researcher for the combinedeffects of personality and environmental factors on the capacity tomakerelocationdecisions.EnvironmentFit–isatermusedinhousingandhealthresearchrelatingtothe suitability of the accommodation for the purpose of the specificoccupant/s.Environmentalmismatchandenvironmentalpress(levelofneedtoadapt,changeormove)

CHAPTER1INTRODUCTION-andthesisoutline

1.0Introduction

Thislargelyqualitativeresearchhasexploredawiderangeofissuesrelated

tomovinghome in later life. The researchhas addressed a shortfall in the

literature by improving the knowledge and understanding of how to

maintain thewellbeing of older people strugglingwithmoving home. This

research examines moving home as a process involving of 1) decision-

making, 2) moving and 3) settling in. Considering relocation as a process

rather than an eventwas considered essential by the researcher since this

cohesive approach had not previously been used successfully in the

literature. There has been a lack of sufficient qualitative investigation into

the thoughts and feelings of individuals, when considering their person-

environment context and the effects of the relocation process on their

wellbeing.

Whethertomovehomeor‘stayput’intheaccommodationandlocationthat

has been their base for many years is a decision that many older people

make at times of major life transition. This might be for example due to

effectsofphysicalormentalhealthchanges,bereavement,orfinancialneeds.

Alternativestomovingsuchashomecareservicesandpropertyadaptations,

mayfullyaddressthepersonalandpracticalissuesfacingsomeolderpeople.

However,insomecasesifthechoiceofmovingwasmoreeasilyachievableit

might be felt to be more beneficial than ‘staying put’ and be pursued in

greater numbers. The research investigates how these decisions are

approached and thepotential positive ornegative consequences fromhow

theprocessismanaged.

In this research, consideration was given to why decisions about moving

could be seen as illogical and experienced as difficult for some individuals

but obvious and easy for others, who appeared to be in broadly similar

situations.Theexperientialconsequences,socialanddomestic,includingthe

potential for chronic stress, were considered in terms of the participants’

1

expressedbenefitorregret,generatedbytheirdecisionsandtheiractionsto

eithermove or ‘stay put’. The participantswere lone females, downsizing

from a property they owned, who were grouped to ascertain their views

according to whether they had moved (‘Movers’) or stayed put (‘Non

Movers’).Participantsfellintotwoageranges:60to75,or76andover.The

innovative research design has added a qualitative, bio-psychosocial

perspective to the debate by considering ‘meaningful’ (emotional)

dimensions rather than primarily focusing on the ‘functional’ (practical)

mattersthathavecharacterisedmuchoftheresearchtodate.

The researcher, a chartered psychologist, with practitioner and strategic

experience working in housing, social care, and counselling therapy, had

become increasingly aware over the years of the issues surrounding the

downsizingaspirationsofolderpeople.Theinnerfeelingsofthoseinvolved

havebeenneglectedinpolicyandpractice.Theresearcherhadexperienced

working in situations where superficial consultation and market research

findings had been used for policy development. These were often based

solelyonfrequencyofamatterbeingmentionedinbasicquestionnairesand

poor sampling of participants, rather than any exploration of participant

feelingsabouttheissues.Insomecasesthisledtoinaccurateassessmentsof

whatwasmost needed or attractive to a potentialmover. This also led to

productionofhomesthatdonotnecessarilysellorletquickly(seech2and

Wood, 2013 p.38). Moreover the published literature lacks holistic,

qualitativeinvestigationintotheemotionalimpactonolderpeopleinvolved

inrelocationdecision-makingaccordingtokeyresearchersofthisliterature

themselves(discussedinch3andch4).Olderpeople’sfeelingsandattitudes

needed to be acknowledged along with contextual aspects such as their

personal relocation history rather than just their practical environment-fit

ormismatch.

1.2Ageingpopulationsandhousingdemand

It is anticipated that the number of people aged 60 and over globallywill

more thandouble from880million to2billionby2050(UN,2012).Those

2

agedover80willmakeupmostoftheincrease.Forthefirsttimetherewill

bemorepeople agedover50 thanunder, globally (Iecovich, 2014). “These

changeswouldaffecteveryaspectofsocietyatmanylevels”(Harper,2008).

Table1.2UKandEUPopulationincreasesforagesover65

UK %ofpopulationover65

UKrankingoutof27EUcountries

1985 17% 2ndhighest

2010 15% 15thhighest

2025 25%(prediction) (noprediction)

2035 25+%(prediction) 23rdhighest(prediction)

ThemortalityrateintheUKolderpopulationisreducingsothenumbersand

percentage of older people compared with other age groups is increasing

according to Eurostat figures (2016, 2017). However, despite these

increases,olderpeopleintheUKwillgraduallyrepresentalowerpercentage

of the population than in most other European countries. This is because

there is a higher birthrate in the UK than in any other European country.

Moreover,birthratesareexpectedtorisefurther. There isalsoaneffectof

largenet increases inmigration into theUKpopulation,mainlyof younger

people(from153,000in2012risingsteadilyto330,000in2015).

Theresponsibilityofprovidingandallocatinghousingspecifically forolder

people falls to both public sector registered providers, such as housing

associations, andprivate sector developers of retirement housing.Housing

and social care practitioners and property developers of housing aimed at

olderpeoplehave longbeen awareof the tendency for them to frequently

changerelocationdecisions.This is thought tobedue toambiguityaround

whethertomoveatall.Thereremainsalackofunderstandingastowhythis

should remain fluid once the decision to move seemed finalised. This has

resultedinpeoplenotmovingwhentheyseemtohavecommittedtodoing

so, with a new suitable location chosen, sometimes very rapidly changing

backandforthonadaytodaybasis.Thisambiguityisseeminglystressfulfor

the individual, isresource intensiveforcarersandpractitioners,andisone

3

ofthereasonsthatbuildingretirementhousingislessviablefordevelopers

(discussed fully in ch2 para 2.7), which then further exacerbates the

situationbyreducingsupplyandchoice.

1.3Benefitsforindividuals,policyandpractice

Therehasbeenamovetowards involvementandconsultationonproperty

design with older people who are considering relocation. A range of

seeminglydesirablepropertyisbeingdeveloped,asapreferableoratleast

acceptable, alternative to ‘staying put’. However, there is still a serious

shortfallandmismatchinwhatisrequiredwithwhatisavailable.Policyand

practice on this issue are detailed in chapter two ‘Background’. The

potential benefits of enabling those who might benefit from moving, and

importantlywhowish todo so if impedimentswere reduced, fall into two

categoriesasfollows:

Individualpersonalfactors:

1) Improved choice of accommodation, quality of life, mobility and

independence

2)Reducedlonelinessandisolationthroughincreasedsocialengagement

3)Benefitsfromimprovedperson-environmentfitandreducedcoststothe

NHS. ShawRuddock in2014 calculated that a 135%returnon investment

wouldbepossibleduetoreducedtripsandfalls,emergencyadmissionsand

delayedreturntohomefromhospital–irreverentlytermed‘bedblocking’

4)Reducedchronicstressandassociatedsubclinicalpathwaystoseriousill

health,foroldermoversandwould-bemovers.Thisisconsideredhereinthe

literaturereviewofhealtheffects inchapter4and the findings forchronic

stressandwellbeinginchapter7.

Commercial,environmentalandsocialpolicyfactors:

5)Greaterconfidenceininvestmentbydevelopersifdecision-making

becomesmoreconsistent

6)Releasingequityintotheeconomythroughsalefollowedbyrentingorthe

purchaseofcheaperaccommodation,includingpotentialprovisionof

4

housingdepositsforyoungerfamilymembers

7)Betteruseofnationalhousingstock,includingreducedhomelessness

in the caseof a ‘FreeSpace’ schemehubbeingdevelopedbetweenhousing

authorityareas(detailsinAppendix1andChapter2)

8)Perceivedincreaseinneighbourhoodsafetythroughreducing

numbersofpoorlymaintainedproperties.

9)Reducedcarbonfootprintandincreasedeffectivenessasservicescanbe

deliveredmoreefficientlyandsustainably toretirementdevelopments; the

distanceornumberofvisitsbyfamilyorcarersisreduced.

1.4Summary–keypoints

ThecurrentclimateofhousingshortageintheUK,combinedwithanageing

population and increasing person-environment mismatch, underlines the

need to supportolderpeoplewith realistic, informed choices and support.

Thiswouldhelp thosewhowant tomovecanand thosewhowish to ‘stay

put’,mayalsodosoincomfort.

Relying solely on improving the design and availability of suitable homes

(para1.3above)isonlyoneelementofchoicethatneedstobeaddressed.

Lack of individual relocation ‘planning-efficacy’ (meaning decision-making

and/or financial, practical or emotional abilities and resources) may be a

reasonwhythosewhomightotherwiseprefertomovedonot.

Importantly, these aspects are neither part of policy discussions nor

substantiallysupportedbyadviceandpracticalservices.Researchonthese

issues has previously lacked the level of qualitative insight required to

informpolicyandpractice.

1.5Thesisoutline–chaptersthatfollow

Chapter2Background:Housingpolicyandpractice

Thebenefits of housing choice and effective relocation to thepublic purse

are discussed. An outline of relevant legislation, current innovation and

successful housing development is provided. The impact of poor person-

5

environment fit is consideredwhen limitations are the result of less than

conducive surroundings. The related increase in intergenerational blaming

for thehousing shortage isdiscussedand financial aspectsof housing that

are more likely to affect older people. The difficulties for new-build

developersareillustrated,specificallywhenconsultingorbuildingforolder

people.

Chapter3Literature:motivationandplanningindecisionstomove

Decision-making is considered within the established frameworks of

motivation and reward, valence, risk and optimism. Links between those

theoriesandperceivedself-efficacywithintherelocationcontextaremade.

Findingsrelatingtorelocationandolderpeople,arediscussedtogetherwith

the most relevant relocation research case studies. Originality of the

research,aimandobjectivesarestated.

Chapter4Literature:neuroendocrinereactivitytostressandhaircortisolconcentration

Hair cortisol concentration (HCC) literature is reviewed in terms of

relevanceandsuitabilityofthemeasureusedinthisresearch,wherelevels

aremeasured tohelpdetermineparticipants’ levels of chronic stress, only

whenconsideredinthecontextoftheirqualitativedata.Thedevelopmentof

HCC methods is captured in this chapter; collection and measurement

standards have relatively recently become agreed internationally as an

improved method for measuring chronic stress over salivary assays. The

review includes literature on established chronic stress effects and

subclinicalpathwaystoillnessmostprevalentinolderagepeopleandtheir

caregivers.

Chapter5Methods:design,materialsandprocess

This chapter provides the overall design and reasons for choosing a

qualitativeapproach,includingthesupplementarybiopsychosocialaspects.

Detailsof the sampleand recruitment strategies areprovided.Governance

matters are addressed here and full details provided of materials and

6

processesused.Theroleoftheresearcher,isillustratedwithexamples.The

useofthematicanalysisisdetailedfortheinitialstructuredandsubsequent

semistructuredinterviews.Thereisanexplanationofhowdemographicand

nomothetic information is collected, analysed and used in support of

qualitative findings, as well as how the collection, storage and analysis of

haircortisolconcentrationismanaged.

Chapter6Findings:Part1Participantgroupsummaries

Part1ofthischapterservesasanintroductiontotheparticipantsandstarts

to tell their stories. Demographic information is provided and the current

homesituationnotedwithpotentialrelocationmotivatorsorimpediments.

Chapter6Findings:Part2ThematicAnalysis

Part2Thefindingsfromqualitativematerialcollectedatbothstagesofthe

researcharethematicallyanalysedtoprovidegreaterinsightintoemotional

(meaningful)aspectsofmoving,arrangedunder threeoverarchingthemes.

Relevantquotations fromallparticipantsandresearchstagesareanalysed

here.

Chapter7FindingsHealthandWellbeing–findingsandinterpretation

Thischapterreportsbio-dataandmoreinnovativelyitseekstoadvocatean

approach, still novel in the international HCC research community. This

innovativeapproachis,theinterpretationofchronicstressresultsbyusing

qualitative biographical information. This along with qualitative

explanationsofthescoresisusedtoindicatethecauseandtypeofstressor

andtherebytheimplicationsforthehealthofthoseindividuals.

Chapter8Discussionandrecommendations

The originality of findings from the research are discussed in detail. A

Thematic Analysismap is provided to illustrate findings from the analysis

process.Theimportanceofusingqualitativemethodsalongsidebio-datafor

interpretation is emphasised. Practical applications of the findings are

7

recommended, linked to theory, including an assessment approach for

practitionersanddevelopers.Socialconcernsfromtheresearchareraised.

8

CHAPTER2BACKGROUND–Housingpolicyandpractice

2.0Introduction

The changing UK demographics and the potential health and wellbeing

benefitsofmovinghome,referredtoinchapter1, leavelittledoubtabout

need to help those older people who would like to move. Provision of

appropriateandappealingsolutionsfordownsizinghomeownersrequires,

policyflexibility,thatisnotcurrentlyavailable,innovativeprovisionanda

deeperunderstandingofpsychologicalaswellandphysicalsupportneeds.

This chapter examines the cost to the public purse of failing to deal

collaboratively with the change in demographics related to older people

andhousing.Someinnovativepolicyapproachesandeffortstomakepolicy

workareintroduced,plussomeinsightsintowhytheyoftendonotwork.

Thegrowingsocialphenomenonofblamingolderpeople forhousingand

health problems is considered. Finally, issues specific to older people in

respectofbothfinanceandrelocationdecision-makingarediscussed.

2.1Homeownership,olderpeopleandunder-occupation

AparticularUKfeature,equallyrelevanttoolderpeopleasitistoyounger

peoplewishing tomove, is themismatch between housing requirements

and housing supply. There is a higher desire for home ownership than

other tenures. The housing market is volatile; it is greatly affected by

interest rates, lackof rent regulationandunrestricted foreign investment

inhousingasacommodityratherthantolet(Savills,2013).

ApotentiallymorehelpfuldifferencefromtherestofEuropeisthatinthe

UK,duetothehighlevelsofhomeownership,thereisthevastamountof

dormant equity in property owned by older people. Dormant equity is

moneythatcouldbereleasedintotheeconomyifpropertiesweresoldand

anewhomepurchasedatalowercost.Thisismostlikelytohappenwhen

olderpeoplearedownsizing(althoughsmaller,desirablepropertycanbe

of disproportionately high cost especially in desirable areas). This

9

unreleasedequityvalueisestimatedtobeinexcessof£756.3bn(Burgess

et al., 2013). This figure fluctuates as house values change and does not

takeaccountof the fact that therehasbeenan increase in equity-release

borrowingbyhomeowners,whichreducesnationalhousingstock,capital

value(Equityreleasecouncilannual2018).Seventysevenpercentofolder

peopleoccupy33%ofallownedproperty,82%of this isownedoutright

andisunder-occupied,(definedashavingoneormoreroomsthanneeded

to sleep in by current occupantsDCLG 2012). This includes 49%by two

bedrooms or more surplus to the occupants personal needs (one

bedroom)(Pannelletal.,2012).

Older homeowners are not necessary well off financially in terms of

income.Interestingly,36%ofthemostrevenue-poorolderpeople,whoare

onbenefits,arehomeowners(BurrowandWilcox2000).Homeownership

automatically excludes them from relocation assistance for downsizing

such as the generous grants or practical assistance that public sector

tenantscanreceive.Homeownersareexpectedtosellandfindalternative

accommodation without assistance from any public body (DCLG 2012;

Localism Act 2011). In effect, older homeowners are left to their own

devices when consideringmoving home. It might not be surprising then

thatveryfewdorelocateeveniftheywishto.Oftheestimated3.8million

olderunder-occupyingownersnationally,twomillioncouldaffordtomove,

25% say they would consider moving but only around 40,000 (2%)

actually do (Pannell et al., 2012). National mortality of older-people

householdsof271,000perannum,naturallyreleases65,000socialhousing

places and 189,000 private homes for purchase or rent (Pannell et al.,

2012).Thesearenotnecessarilyofthesizemostindemand(2bedroom)

orinthelocationswiththehighestdemand(Pannelletal.,2012).

2.2Thecostofhousingmismatch

Practicalcostsofmovingforolderpeople

Costsassociatedwithmovingsuchasfeesandstampdutiesobviouslycan

beprohibitive.Thesefactorstogetherwithheatingandmaintenancecosts

10

inlargerhousing,oftenforcetheworstoffhomeowningowners–thoseon

benefits,toliveinconditionsthatarenotsatisfactoryorconducivetogood

health (Bolton, 2012; Pannell, 2012; Wood, 2014). Having been self-

sufficientformanyyears,olderhomeownersoftenexperiencedifficultiesin

obtaining assistance with social or specialist housing, homecare or

residentialcare.

Publicsectorhealthcosts

Costs to thepublicpurse includegrants forhomeadaptations,home-care

orresidentialcarecosts,andhospitaladmissionsfortripsandfalls inthe

home.Thehomeenvironmentiscriticaltofullmobilityandindependence.

Inappropriately housed older people make up over half of the 6000+

peopleinhospitalatanytime,waitingtobedischargedbecausetheirhome

isnotsuitabletoreturnto(NHS,Feb.2018).

Associated treatment for older people in poorly heated housing is

estimatedtocosttheNHSaround£3.6mperday(AgeUK,2013),a figure

thatisstillcurrent.Thedeathandfuel-povertystatisticsincreasinglyapply

to older owner-occupiers because their homes are often larger andoften

less well insulated than social rented homes. The Decent Homes

programme systematically increased insulation and energy efficiency in

socialhousing.Privatesectorschemestoreducefuelpovertysuchasboiler

replacementandhomeinsulationhavebeenlesseffective.(Nicoletal.,BRE

2015).

2.3TheWorldHealthOrganisationresponse

In a positive response to the global age demographics, theWorldHealth

Organisation is urging nations, through the ‘Age-Friendly Cities Project’

(Iecovich,2014)toprovideenvironmentswithafocusonthephysicaland

psychologicalwellbeingofolderpeople,whichwouldautomaticallybenefit

thewholepopulation.Theirguidanceemphasisestheimportancetoolder

people of appropriate housing, outside spaces, accessible services,

recreation, education and retraining, transport, affordability and

11

opportunity for social and civic participation. This social ecological ethos

(e.g.PowellLawton1974)thatsuggestsattenuatedperformanceattributed

tooldageordisabilitycanbeattributedtodifficulties(defects)createdfor

themintheenvironmentsocietycreates.Thisissimilarinapproachtothe

person-environment fit approach within the home, measured by the

Housing Health and Safety Rating System within UK policy (secn. 2.4

below)

2.4UKpolicy

Relevanthousingpoliciesandinitiativeswillbebrieflysummarisedhere.

SocialCareActs2012and2014

UKlegislationincludingtheCareAct(DCLG,2014)placesanobligationon

housing and health authorities to provide a coordinated and integrated

approach to health, housing and planning and to act early to prevent ill

health. This includes a duty to “promote wellbeing through suitable

accommodation and related support or services”. Local Authorities and

HealthAuthoritiesmustconsiderthefollowinginindividualcareplans:

• Ageneraldutytopromotewellbeingincludingsuitableaccommodation• Includehousingrelatedsupportorservices

• Housingmustbeconsideredaspartofanassessmentprocessthatmayprevent,reduceordelayanadultsocialcareneed

• Informationandadviceshouldreflecthousingoptions,aspartofauniversalserviceoffer.

“…servicesthatpreventcareneedsbecomingmoreseriousandthatprovidehighqualityadviceandinformationtoserviceusersandtheircarersinorderforthemtomakegooddecisionsaboutmattersaffectingfuturehealthand

wellbeing”(ch2,5yearforwardviewNHSEnglandOct2014)ConsultantsMHPHealth revealed in theirHealthReport (April2014) the

difficulties in coordination of resources at a strategic level. It seems that

siloworkingremainsdespiterecentandsimilarearlier legislation.One in

five(21%)jointstrategicneedsassessments(JSNA)didnotrecognisethe

keyroleofhousingatallandmanyothers(73%)didnotconsiderhousing

aspartoftheirintegratedcareservices.31%ofnationalHWBs(healthand

wellbeing boards) had no housing contributor. Austerity measures are

12

affectingtheinfrastructureandnetworkspreviouslyestablishedovermany

yearsinpublicsectororganisations(CentreforLocalEconomicStrategies,

2014). This affects continuity of services in a complex area of service

provision and encourages silo working due to competition between

servicesforfunding.Non-statutorygrantsforolderpeoplesupportgroups

such as luncheon clubs, have reduced and are vulnerable to further cuts.

However, some local areas represent good examples in joint working in

responsetothe2015MemorandumofUnderstanding(Harding,2017)

HousingHealthandSafetyRatingSystem(HHSRS)

This legislation, a regulatory reform to theHousingAct2004 (DCLG) can

now be applied to any residential accommodation. It introduces a new

dimension of assessing a building, not in isolation, but in respect of the

potentialvulnerabilityofthecurrentandfutureoccupiers.Itcouldbeused

more proactively in respect of dwellings that older owners occupy to

underpinsupportforrelocation.

2015/16 Health and Housing Memorandum of Understanding and JointAction.

Thatafurtheredicthasbeenrequiredindicatesalackofwillorresources

given the legal requirements for joint working already in place. The

document is signed at the highest level in 22National Organisations but

essentiallyreiterateslegislativerequirementse.g.that:

“Evidenceabouttheimpactofthehome/housingonhealthandwellbeingismorewidelyunderstood,accessibletoandacceptedby,nationalandlocalpartners”

AllPartyParliamentaryGrouponHousingandCareforOlderPeople

1)HAPPI1excellence indesign (HousingourAgeingPopulationPlan for

Implementation) (Best and Porteus, 2009). The panel of housing experts

withdifferentperspectivestogetherwithpotentialoccupantsexaminedthe

relocation design needs and aspirations of older people and examples of

excellenceindesignacrossEurope.Thisresultedinastandardandvalues

statement.

13

2) HAPPI 2 (Best and Porteus, 2012). The new panel considered design

furtherandurgedtheintroductionofarequirementonlocalauthoritiesto

applya‘homesforlife’standardtonewproperty,includingintowncentres

andrural locations.More information for thosewishing todownsize,was

recommended,notingthebeneficialimpactsthiswouldbringtohealthand

localhousingmarkets.

3)HAPPI3MakingRetirementLivingaPositiveChoice(BestandPorteus,

June 2016). The report again calls for greater numbers of high quality

affordable options for older people and removal of impediments such as

stampduty,makingretirementhousingexemptfromcertainplanningfees

and levies thatapply (thesemakebuilding it lessviable commercially).A

further HAPPI report relates to rural areas that are served less well by

retirementaccommodationbuiltneartolocalneed.

4)HAPPI4(BestandPorteusApril2018)Thereportsuggestsolderpeople

should be considered as viable mortgage customers and benefit from

schemestoencouragepurchase,justasyoungerpeoplebenefit(e.g.Helpto

Buy). Continuing in an age-inclusive direction it asks that policy and

practicemovefromassumingtheneeds,aspirationsandresourcesofolder

people arehomogeneous to recognising that they are individual, just like

any other age group. A further Communities and Local Government all

party review of housing for older people (DCLG 2018/19) is considering

theHAPPIrecommendations.

2.5Newretirementhousingsupplyandinnovation

Allhousingcommentatorshighlighttheneedtoprovideadditionalhousing

for older people. The National Housing Federation (in press 2015) have

statedthat100,000newhomesforolderpeopleneedtobeprovidedinthe

next fifteen years or the impact on the NHS will be ‘catastrophic’. This

primarilyreferstothesometimes-suddeninabilityofolderpeopletolivein

theirownhomesortoreturnhomefollowinghospitaltreatment.

Someprovidersaredevelopingvisionsofproperty,judgedfromsurveysto

be the kind of inspirational living space required for older people, for

14

example ‘Silver Chic’ (Anchor Housing Trust, 2015). There are notable

successes,withmoreretirementhousingschemesbeingbuilt forsaleand

rentinarangeofincomebrackets(mainlyhigh)andmarketniches.Private

organisations such as the Associated Retirement Communities Operators

(ARCO)coordinateapproachestodevelopment.Mostsocialprovidershave

very successfully upgraded their retirement housing, formerly and

sometimesstillknownas,shelteredhousing.Agoodexampleisaflagship

scheme,HaltonCourt in theRoyal Borough of Greenwich. Importantly, it

housedpeoplefromtheimmediatevicinityandincludedfacilitiesopento

thewhole community. It therebyencouragedcloser community cohesion.

Numbers of such developments remain small with limited availability to

existinghomeowners.

Increasingly private developers will offer flats to rent with an Assured

(protected) Tenancy alongside flats for purchase. Older people can ‘try

before they buy’ but only provided they have the financial and practical

supporttodosoandatpresentthechoiceisverylimited.Movingtorented

accommodation still requires effort but can be achieved prior to selling.

Thiseliminatessomeofthestressgeneratedbytheneedtobeoutofyour

homeonacertaindayandtheuncertaintyofbeinginapurchasechainof

buyers. Obviously renting means the property is never owned and a

downside for owners is moving to the payment of rent in addition to

servicecharges, theyhavenotpreviouslyhadtopay.Manyprefertopass

their asset on to their family when they die. These aspects are fully

exploredwithparticipantsinthecurrentresearch.

Somedevelopersandprivateagenciesarebeginningtoprovideelementsof

relocation ‘move-on’ support packages, for purchase by the downsizer.

FreeSpace is a cost neutral ‘move-on’ scheme (detailed in Appendix 1),

designedbythecurrentresearcherforaLondonborough.Itofferstangible

assistance and trusted support to downsizers with every aspect of

decision-making and moving through to settling into alternative

accommodation,inthetenureandareaoftheirchoice.TheLocalAuthority

15

leasetheformerhome,actasatrustedlandlordinlettingittoafamilyin

need but the ownership and the rent is retained by the owner until the

owner’s death when it reverts to their estate. At that point any local

authority grants thatwere provided to cover relocation and upgrades to

theirownedpropertyforlettingarerepaid.

A cost benefit analysis of the FreeSpace scheme was undertaken in

conjunction with the researcher. A business case with on-line links is

provided in the reference list (O’Shea, 2012, 2013). As with all new

concepts, it can be seen as risky unless the idea becomesmainstreamed,

resourcesforwhicharenolongeravailablefromthegovernmentforlocal

authorities,whoarestillthemosttrusted‘notforprofit’source.

2.6Blamingtheoldergeneration

There isa tendency forvalue judgments tobemadeagainstolderpeople

fornot trying toredress thehousingshortage,andevensuggestions they

are the cause of it. Public resources are not available to meet the high

profile need to develop new housing for young people and families.

However, there is an equally urgent but lower profile need for suitable,

desirableandaffordablehousingoptionsforolderpeopletodownsizeinto

from larger social andowner-occupiedhousing that theyno longerneed,

providedtheynolongerwishtooccupyit(Best&Porteus,2012).Despite

this overall shortage, pressure groups such as the Intergenerational

Foundation (2013) suggest that all under-occupying owners should

downsizeandthatnoonewithahomevaluedat£500,000ormoreshould

receiveuniversalbenefits.

Irrespective of the ethical, physical, cognitive and emotional aspects of

relocation for older people, the notion of a ‘chain reaction’ resolving the

housing crisis is naïve, the idea. that older people move to one or two

bedroom homes from larger accommodation, which is then occupied by

overcrowdedfamiliesmovingfromsmallerproperties.Thisdoesnotwork

statistically even within the social rented sector (Pannell et al., 2012).

There would still be a major under-supply of two bedroom housing

nationally, even before taking account of the local preference, individual

16

finance, freedom of choice and imperatives about where to live. Limited

supplyofsuitablehousingthatolderpeoplecanaffordisanotherfactorbut

that reduces the ability of older people to move even if they would

otherwisebeabletodoso.

Formany, includingolderdownsizers, locationispossiblythesinglemost

important factor (Wood, 2013). Moreover a surge in older people

downsizing to one or two bedroom social, private rented or purchased

accommodation, would create more problems for younger single people

and small families. Thus,manyolder andyounger groups are looking for

thesamesizeaccommodation,arecompetingindifferentmarkets,bothof

whichhaveinsufficientsupply.

2.7Relocation–Issuesofprovision,uniquetoolderpeople

Many older people do not need ‘extra-care housing’ but need a type and

style that, because of the lack of knowledge and familiarity with good

examples, they finddifficult todefine. Homeowners,whenresponding to

surveysandacademicresearchprovidearangeofsotermed‘pull factors’

for accommodation they would like to move to, some of which may be

unrealistic.Thequestioniswhethertheyarerelatingtotherealityofthem

actuallymovingorrathertoamoreetherealnotionofwhatseemsperfect

in a property for a certain age group or for themselves at some

indeterminatetimeinthefuture.TheDemosreport,TheTopoftheLadder

(Wood, 2013 p.38) describes one retirement development having to be

soldwith a 30%discount.Despite full consultation, oncebuilt itwasnot

boughtbypurchasersfromtheolderpersonmarketitwasdesignedfor.

TheDemosreport(p27)alsoexplainsthatolderpeoplecannotbeexpected

to purchase ‘off-plan’ as they have more personal needs than younger

groups. Unlike younger people, they cannot justmove on if the property

turnsoutnottobetotheirliking.Therefore,advancedepositsthatusually

helporfullyfunddevelopmentcannotcontributetotheschemeviabilityin

thewaytheywouldwithayoungermarket(Wood,2014).

17

There is a need then to properly understandwhat constitutes a suitable

and desirable home for older people to downsize into, in a way that

removesconnotationsofreducedsocialandpersonalstatus(Wood,2014),

meetthe‘lifetimehomesstandard’.Theyshouldbesituatedintheheartof

thecommunity(Balletal.,2011)andavoidtheneedforadditionalmoves

inlaterlife,withtheupheavalitinvolves.Thesefindingsshouldbecentral

toneighbourhoodplanning(Balletal.,2011).

2.8Summary–ofchapter2keypoints

People over age 60 own77%of homesnationally. Around80% is under

occupied, half of that by two rooms or more. Of the two million older

under-occupyingowners,able toafford tomove,25%say theymightbut

only40,000doeachyear.Around189,000privatelyownedhomesbecome

freeannuallyduetomortality.

A substantial minority of owners (36%) is among the most deprived

nationallyandfinanciallyleastabletomove.

The main benefits to society of assisting older owners to move, who

currentlywant tobut feel theycan’t,wouldbetheir improvedhealthand

wellbeing,withsubsequentreductionofpressuresandcostsestimatedat

3.6mperdayontheNHS.

Intergenerational blaming of older people for the housing crisis is

misplaced, when required accommodation type, size and location are

considered. The negative profile of older adults is not an optimistic

approach that values their knowledge, skills, abilities and longevity;

enablingtheircontributiontosocietyasastrongpotentialsourceofsocial

andeconomiccapital.

Existing government policy allows for relevant assessment and

collaborativeaction.However,resourcesarenotavailabletounderpinthe

18

‘universal service offers’ proposed in the legislation quoted here. Some

innovativeideasdoreachfruition,despitethelackofcohesionandfunding

butsignificantchangeacrossthecountryisslow.

Whilst there isagreatdealofresearchandpolicyaboutphysicalhousing

designforolderpeople,thebio-psychosocialmotivatorsandimpediments

forownersrelocatingandtheinteractionwithpracticalaspectsarestillnot

wellunderstood.

Chapter3reviewsrelevantrelocationanddecision-makingliterature,gaps

intheliterature,theaimandobjectivesofthisstudy.

19

Chapter 3 LITERATURE - Motivation and planning in decisions to

move

3.0Introduction3.0.1 This chapter provides an overview of relevant literature related to

olderpeoplemovinghome,includingtoretirementhousingschemes.This

does not include relocation to accommodation where residential care is

provided. The participants in this study were relocating to retirement

housingandassuchwererelativelyindependentandabletolivealone.The

researchconsiders‘functional’aspectsofrelocation,atermusedinhousing

research to cover a range of practical matters. It also considers the

‘meaningful’aspects,aterminhousingresearchforemotionallyinfluential

matters.

3.0.2 The literature cited in this chapter from established motivational

frameworks that readily transfer to major transitional decision-making

such as housing relocation. They provide a useful perspective in

understanding research findings and the psychological ramifications of

moving home later in life. Motivation includes reward and valence, risk-

takingandoptimism.Inaddition,self-efficacyandlocusofcontrolarelong

establishedinfluencesonaction-planningrelatedto‘personalefficacy’and

‘controllability’(ofcontext),withinatripartitemodeloftemporality–past,

present and future. The literature also finds that depression, anxiety and

self-esteemaffectperceptionofcontrolandrisk,which inturnmayaffect

complexdecision-makingandplanningbehaviour.

3.1Decisionsandrisk

3.1.1Decisionstomovehomearemulti-factorial.Allstudiesreviewedfor

thisresearchsupport thepremise thatrelocation isachallengingprocess

forolderpeople.Studiesshowthatthisincludesareluctancetoplanforthe

worstwhen itmightneverhappen,particularlyat theyoungerendof the

over 60s age group. This leads to potential resentment at taking action

prematurely(Lofqvistetal.,2013).Conversely,attheolderendoftheage

20

scaletherecanberegretat leaving it too lateandlosingthestrengthand

where-with-all to manage a move (Lofqvist et al., 2013). Choi and Jun

(2007) point to intrusive thoughts caused by regret, unfulfilled life and

unattainedgoalsinrelationtoallaspectsof life’smajortransitions.Samsi

etal(2010)reportthatforolderpeopledecision-makingtendstofallinto

just twocamps, thosewhoplanand thosewhodonot.The latterarenot

inclinedtothinkinadvanceaboutillhealth,‘hopingforthebest’and‘facing

thatproblemwhenitcomes’.

3.1.2 Tversky and Kahneman (1986) noted that in overcomplicated or

incomplete situations, underlying simplification and emotional systems

playamajorpartindecision-making.Peoplewilltendtobelessriskaverse

insituationswhere theystand togainandhave little to losebutmoreso

where they have a great deal to lose. The potential emotional loss in

relocating if the former home is cherished, is weighed against the

sometimes unguaranteed benefits of moving. Accordingly Tversky and

Kahneman (1992) suggest that given insufficient information people rely

on transparency and trust but ultimately can sometimes only ‘trust their

gut’ (what they think feels right). Thus in a long and complex relocation

processwithpotentiallackoftransparencyandtrustinadvice,peoplemay

actintuitivelyratherthanuselogic.Assuch,decisionscanberigidly‘safe’

orconfusedandliabletochange.

3.2Depression,self-esteem,anxietyeffectsondecisionmaking

Depressionwhereself-esteemis lowissaidtoaffectdecision-makingina

curiouswayaccording toRaghunathanandPham(1999).Theyrefer toa

‘present-bias’, which often results in a need for instant gratification and

therefore a tendency towards high risk/high-reward options. Conversely

whenanxiouspeopleappeartotakeactiontoimprovetheirsituationthis

decision-makingisnotnecessarilyduetooptimism.Theyaresaidtofavour

low-risk, low-reward options; that is, the action is aimed at anxiety-

reduction rather than present state improvement, is aimed at avoiding

depressionratherthansearchingforhappiness(Veenhoven2001).

21

3.3Optimism,positiveself-cognitivebiasandcopingstrategies

Sharot (2011) proposed that optimism is a coping strategy, providing a

‘cognitivebias’ that ispartof thehumancondition.Whenapplied,weare

less likely to think our situationwill getworse even if toldwe are being

overoptimistic.However,wewilladjustourestimatepositively ifweare

toldwearenotbeingoptimistic enough. Whilst this is adefenceagainst

depression, it can result in restricted planning and decision-making.

AlternativelySharotsuggeststhatinothersituationsoptimismcanleadto

better outcomes through positive reframing of the situation. Taylor and

Brown(1988;1994)alsorefertooptimismandpositiveself-cognitivebias

or ‘positive illusions’ about the future with respect to planning and age.

Theyconcludethatthesetogetherwithpredictivelevelsof‘senseofworth’

andcontrolovermaintaining‘happiness’areadaptivemechanisms,playing

a roleof between70%and80% inmaintaining satisfactionwithpresent

situations,ifthereisnervousnessaboutchange.

3.4Locusofcontrolandself-efficacy

3.4.1HighinternalLocusofcontrol(LoCCraigetal.,1984)islinkedtohigh

optimism.BothLoCandself-efficacyrelatetoassessmentsof internaland

externalfactors(Rotter,1966).Negativepredictionsorperceived‘badluck’

may either be positively reframed or alternatively turned into an

opportunityofadifferenttype(Taylor&Brown,1988;1994).Inareview

of more than forty studies, Cummins and Nistico (2001) observed that

internal LoC when positively correlated with self-esteem led to a more

positive approach to change; that ‘one can change the environment,

optimisticallyinaccordancewithone’swishes’.

3.4.2 Conversely, high external LoC, especially without high self-esteem

may contribute to the vulnerability of decisions via reappraisals

throughout the lengthy, risky and complex relocation process. High

external LoC (thus low internal LoC) is linked to a lack of optimism,

associated with people who typically use expressions that indicate they

generallyfeelunabletomakeadifference,suchas‘itwillprobablybeok’,

22

‘there’s no point in doing something or planning, itwon’t turn outwell’.

Relocation studies have consistently found decisions to move are highly

subject to change (e.g. Hanson and Gottschalk, 2006). Developers of LoC

scales (Craig et al., 1984) noted the highly predictive power of relapse

(failuretopursueanaction)relatedtothisaspectofpersonalidentity.Itis

thoughtthatLoCislearnedveryearlyinlifeandbehaviourislesslikelyto

bemediatedbyusinglogicorsupport(Lockeetal.,1981).

3.4.3 Self-Efficacyby contrast is developed throughout life. The theoryof

self-efficacy (Bandura, 1977; Bandura andWood, 1989) holds thatwhen

assessingtheabilitytoachieveagoal,personaleffectivenessisconstructed

againstpriorexperience,skillsandknowledge,upbringing,societalnorms

and comparisons learned through life (Social Learning Theory, Bandura,

1986a). In developing the STPI (Stanford Time Perspective Inventory)

scale, from which some items are incorporated in the current study,

Zimbardo (1999) observed the tripartite self-regulatory nature of self-

efficacy theory (Bandura, 1997). It relates to past experience, present

appraisalandperspectivesonfuturealternatives(D’Alessioetal.,2003).

Apersonmayfeelmoreeffectiveandconfidentinonesituationcompared

with others. Relocation has stages that involve a range of very different

skills, physical and cognitive abilities. An individual may associate

retirement housing with negative connotations of age and reduced self-

efficacy.Theseeffectsarehighlyinfluentialaccordingtoconsensusstudies

(Cialdini,2007).

3.4.4 Self-efficacy, as with LoC has internal and external self-perceived

components(Rotter,1996).Internalispersonalefficacyaboutoneselfand

external is described as controllability. The difference between these is

likened to asking the questions of oneself a. am I personally capable?

(internal)b.isitpossible?(external).

3.4.5 Perceived high internal self-efficacy is predictive of achieving goals

(Terry and O’Leary, 1995; Armitage and Connor, 2001 etc.) in situations

23

where the goals are technically attainable, albeit in stages e.g. passing

exams,dieting.Thismightbeappliedtothestagesofrelocation.However,

controllability is not independently predictive according to Cheung and

Chan(2000).Theysuggestthatinternalself-efficacyispredictiveofaction

but external self-efficacy is only predictive of action if combined with

internalself-efficacy.Appliedtorelocation,thissuggestsrelocationmustbe

considered possible by the older person but is unlikely to be achieved

without themalsohavingperceivedhigh internal (personal) self-efficacy,

i.e.competence(orpossiblysubstantial,trustedandacceptedassistance).

Inmotivationalgoal-settingtheoryLocke(1968)linksself-efficacytobeing

abletoexpressandvisualiseanoutcomeandthestagesleadingtoit,with

which logic and support fromothers can assist. In the theory of planned

behaviour (Fishbein and Ajzen, 1975), often used by social workers to

assess levels of support needed, self-efficacy is expressed as a person’s

behaviouralbeliefsabouttheextenttowhichtheconsequencescanreally

bedeterminedandachieved.

3.5Extrinsicandintrinsicmotivationalfactors

3.5.1Inadditiontotheself-efficacyquestionsofa.amIpersonallycapable?

b.isitpossible?…Afurtherquestionoccursinrespectofmotivation:c.doI

wanttodoit? Whichnecessitatesbalancingd.howsatisfiedwillIbewith

theoutcome;howdissatisfiedamIwiththepresentsituation;isitreallythat

bad?

3.5.2 When considering the value of staying put against moving,

individuals, their families and service providers tend to primarily assess

extrinsic (physical) needs.Whilst thesemay also address intrinsic needs

(e.g. reduction of distress) the action taken may only be what Herzberg

(1959) terms ‘satisfiers’, meaning they are of immediate value but not

holistic in approach. Motivational rewardhas longbeen studied through

the theories of, for example, Maslow (1943); Herzberg (1968) and

McClelland(1987).Findingsshowthatbeyondmeetingbasicneedsthereis

a limit towhich extrinsic rewards, such asmaterial changes,will remain

24

rewarding and subsequently motivational. It is thought that intrinsic

rewardsareevenmorevaluedoverextrinsicrewardswithincreasingage,

whichisrelatedtoreducedlifespan(Zimbardoetal.,1999).

3.5.3Thuscomplexdecisionsinvolvingbothextrinsicandintrinsicaspects,

suchas relocation,areoften themostdifficult tomakebecause theymay

notalign. Improvements, suchasmoving tomoreappropriatehousingor

makingrepairsandadaptationsthatareextrinsicallyrewarding‘satisfiers’

mayactuallyresultareductioninintrinsicsatisfactionbecauseeffectslast

only until control of the external problem is regained (Herzberg 1959).

Addressing intrinsic elements e.g. lack of companionship and loneliness

havegreaterandmorelastingeffectsbutrequiremoreingenuity.

For example, if the existing environment is friendly or reassuring, the

intrinsic reward predicts any mismatch associated with physical needs

suchaspoor repairwill be less important. In a studybyBaldock (2005),

participantsdidnotcreditgoingtotheirdaycentreaspositivelyasmeeting

newpeople,evenwhenthedaycentrewaswherethenewpeoplehadbeen

met.ThescaleusedintheBaldockstudyisTheSouthamptonSelfEsteem&

its Sources (older people) Scale -SSESS (Coleman, 1984), detailed in

Appendix7. Itemsfromitareused inthecurrentresearch.Thatresearch

involved339peopleagedover65whosemobilitybecameimpaired.Their

experienceof interventionsaddressing theirnewextrinsicneeds, suchas

property adaptations, did nothing to address their discontinuity of self-

esteem.

3.5.4 The final question in the decision-making process is: e. ‘will this be

easy for me or difficult and will the outcome be sufficient to warrant the

emotionalandphysicaleffort?’Theneedformentalandphysicalresilience

to deal with relocation is well understood even in relatively

straightforwardsituations.

25

Forolderpeople,particularlythosewhohavenotmovedintheprevious10

years or who suffer constant pain, moving home is likely to be more

onerous in termsofde-clutteringandpacking(Lofqvistetal.,2013).This

resultsinongoingreappraisalsoftheratioofinputandefforttothevalue

of the expected outcome (question e. Table 3.5.4 below), termed

‘expectancyvalance’(Vroom,1964).

Table3.5.4Summaryofquestionsdecision-makersaskthemselvesinrespectofefficacy,intrinsicvalueandexpectancyvalance.

a.amIpersonallycapable?(internalself-efficacy)b.isitpossible?(Controllability-externalefficacy)c.DoIwanttodoit?

Thesequestionsnecessitatebalancingextrinsicandintrinsicaspects

ofthesituationanddeciding:

d. How satisfied will I be with the outcome in the long term; howdissatisfiedamIwiththepresentsituation;isitreallythatbad?Doesstayingheremeetmyemotionalneedsorwillmovingdothatbetter?

Thisquestionnecessitateshavingavisionofthealternative:

e.willthisbeeasyformeordifficultandwilltheoutcomebesufficienttowarranttheemotionalandphysicaleffort?’CanIcarryon?

An extension to this line of questioning can be repeated throughout a

processe.g.haveIgotenoughstrengthandsupporttocarryon?

3.6Temporalityandplanning

3.6.1Baltesetal (1999) foundolderpeopleuse fewer,simplerstrategies,

conserving energy and resources increasingly as they age,with reducing

lifespan. The nature and enormity of a relocation task would obviously

deterindividualswhoarefeelingthementalandphysicaleffectsofageing.

3.6.2 In his theory of lifespan adjustments, Erikson (1959) proposes the

needforself-evaluationtomaintainself-integrity.Manycommunitiesoffer

insufficient opportunities to adjust to new goals, aspirations or positive

reappraisal of their previous life, an observation still relevant today.

26

Oswaldetal(2006)referstoapresentbiasedinertiainolderold-agethat

canoccurdue tooverwhelmingdecision-makingandreducedenthusiasm

fordealingwithmatters.

Zimbardo&Boyd(1999)developedameasureinrespectofolderpeople’s

mental health. This included five personality approaches to time-

perspective:a‘PastNegative’focusonpreviouseventsthathavethepower

to disturb; ‘Past Positive’ caution through nostalgia and concern about

change; highly ambitious ‘Future Focused’ caused urgency and stress for

some in impossible situations and those with relationship issues. Those

witha‘PresentHedonistic’biaspostponedeventsandthosewitha‘Present

Fatalistic’ bias would not enjoy the present but would feel unable to do

anythingabout it, becoming liable to anxietyordepression.Theseeffects

whenusing theSTPIweremore frequent in lowersocial statusgroups.A

selection of questions from Zimbardo’s Stanford Time Perspective

Inventory(STPID’Alessioetal.,2003)hasbeenincludedintheRelocation

Psychometricsquestionnaireofthepresentresearch(Appendices6&7).

3.7Housingrelocationstudies

3.7.1 Participants in the literature generally wanted to be part of the

communityratherthanadrainonitbut‘home’rangedfrombeingasocial

hub, a comfortable place to live in, to being a lonely isolating prison

(Sixsmith et al., 2007). Social and personal identity was represented by

homeas“apartofme”and“beingpartofasocialnetwork”.Retainingthese

was important, more so than practical help such as grants and care

services.Thisreinforcesthe importanceof intrinsicaspectsoverextrinsic

aspects inmoving.Forthemostpartthesewererespectively ‘meaningful’

mattersover‘functional’matters;termsusedinhousingresearch(Oswald

etal.,2002)andthroughoutthecurrentthesis.Likewise,Balletal(2011)

found remaining in a familiar community and not wanting to leave the

communitywere cited reasons forwanting to stay put. Good neighbours

and friends appeared to be a key determinant in decision-making

outcomes;lackofthemwaslinkedtoareportedfearofloneliness.

27

CASESTUDYAHansonandGottschalk(2006)Whatmakesolderpeopleconsidermovinghouseand

whatmakesthemmove?This Danish study used two terms ‘environmental richness’ and ‘higher

order motivation’ for meaningful aspects and found them stronger than

‘environmental press’, such as the need to leave for practical, functional

(extrinsic)reasons.Despitethis,intheresearchinvolving5684interviews

inDenmark,repeated5yearslater,themostcommonreasonsformoving

were extrinsic needs, to avoid gardening and stairs. Other main reasons

were toreducecostsor theunsuitabilityofhousingdue tohealth.Whilst

mainlyextrinsic, these casesalso included ‘toescape loneliness’. Of40%

considering moving only 20% did. Whilst low, this is much higher than

currentresearchfortheUK(Wood,2013),whichislikelytobeduetothe

inclusionoftenantsaswellasownersintheDanishstudy.

3.7.2HansonandGottschalk (2006)suggested thatownershaveahigher

tolerance threshold and greater efficacy than tenants but there is no

evidenceforthis.Thereisnoreasonwhyhomeownershipmeansgreater

self-efficacy especially in the UK where a property may have been

inherited, have been purchased many years before, or be linked to the

Right to Buy social housing discount purchase scheme. However the

researchersweresuccessfulincontributingtoDanishgovernmentpolicyin

theprovisionofinterest-onlyloanstoolderpeople.

CASESTUDYBKearnsetal(2011)–SocialIdentity Materialandmeaningfulhomes:mentalhealthimpactsand

psychosocialbenefitsofrehousingtonewdwellings.InScottishNHSresearch,334householdswererelocatedbyanumberof

social landlords to new housing developments and another 389 control

participantsdidnotmovefromequallypoorhousingsituations.Theywere

allinterviewedtwoweeksbeforemoving.73%remainedinthestudyand

wereinterviewedtwoyearslater.Therewerequantitativeandqualitative

aspectsinvolvingface-to-faceinterviews.

Thementalhealthsubscaleswere:

Impact on mental health; psychosocial benefits; finding the association

betweenchangesinmentalhealthandpsychosocialbenefits;whatcaused

anychanges.

There were 4 impact dimensions: the dwelling itself; activity and

infrastructure;senseofcommunity;improvedneighbourhood.

Themostpositivefindingswereforfamilieswithyoungchildrenandmixed

results for thosewithworking age second-generation adults. Therewere

negative results for older people, often more negative than the control

group.Olderpeoplewerelesssatisfiedonalldimensions.However,ofmost

interestwasthatpositiveimprovementinsocial-identityandsocialstatus

wasapparentforallrelocatedgroupsincludingtheolderresidents.

28

3.7.3TheKearn’sresearchshowsthe importanceofgoodhousingtoself-

identity and social status. Practical benefits were important but not

sufficient for older people to want to relocate. This again supports the

premise secn. 3.5.3 above, Herzberg’s theory of motivation) that

intrinsically rewarding changes have greater beneficial impact and older

peoplehave less to gain frommoving if they are intrinsicallyhappywith

theircurrentaccommodation.

CASESTUDYCLofqvistetal(2013)Voicesonrelocationandaginginplaceinveryoldage

–acomplexandambivalentmatter.Theresearchersmonitoredtherelocationof80formerhomeownersage80

–89yearsoldacrossdifferentEuropeancountries.Theyobservedanxiety,

perceived stress and ambivalence at high levels across each stage of the

relocationprocess.Doubtsoccurred inrespectofcostsandburdenof the

process.

They concluded thatmoving shouldnotbe considered an isolated event.Furthermore Lofqvist et al (2013) were strongly in favour of an

interventiontoremoveambiguityandreducestressbysupplyingadequate

information,adviceandhands-onassistance.

3.8Supportservices,adviceandinformation

3.8.1TheThetfordandRobinsonresearchisofparticularrelevanceforthe

currentresearchduetoitssimilarstagesofpre,duringandpostrelocation.

Home is described as a place with substantial control as well as where

physicalneedsaremet.

CASESTUDYDThetfordandRobinson(2007)Olderpeople’sexperiencesofdecision-making,participationandmovingas

partofaregenerationprojectinLiverpool.In a Liverpool regeneration project, benefits advice and community

support teamswith social workers and occupational therapists provided

thesupport formoving toolderresidents.Their towerblockswerebeing

demolishedtomakewayfor lower levelnewhousingonthesameestate.

Home-carecouncil teamsprovided thepackingandmovingrequirements

and theorganisersworkedwith friendsand familyof thosemoving. Like

the current research, the research involved a pre- and post-intervention

qualitativedesign.Itwasundertakenwithindividualsbefore,duringand6

monthsafterthemoves.

Participants were all over 70. Themes that emerged included strong

attachment to home over many years including family history. Their

29

‘attachment to home’ had changed and adapted over the years and new

coping strategies developed with age, which involved friends and

neighboursmoresothanfamilies.

Uncertainty and stressover themoveswas “huge” since the fabric of the

communitywasgraduallybrokendown.Keystressors includednotbeing

abletoseethepropertymorethantwoweeksinadvanceinordertoknow

whattopackorgetridof,notsleepingthenightbeforeandbeinginadaze

ontheday.

The Community support team was highly praised but tenants felt

abandonedafter themoveandsomehadnotunpackedweeks laterwhen

thesupportwaswithdrawn.Althoughongoingsupportwasnotthoughtto

be sustainable, inadvertent health costs resulted. Some felt it had led to

premature deaths and entry into residential care homes and, despite the

improvementsinwarmthandupdatedfacilities,thetenantsfeltlesssecure

intheirunfamiliar, lowriseorgroundfloorsurroundings.Manysaidthey

hadnotcopedwellduetotheirageandabilitytodealwithmajorchange.

3.8.2 In the current research participants are asked if they are aware of

FreeSpace (Appendix1),whichhas similar supportaimsas case studyD,

alsothelevelofsupportavailableandutilisedbyolderpeople,fromfriends

and family or charitable services. Social policy researchers Darnton,

(2005) and Gilroy (2005) found older people trusted community service

providerssuchasthecouncilorGPs.

3.8.3Itseemsthatolderpeople,muchlikeeveryoneperhaps,tendtoseek

information aimed at specific problems (Godfrey and Denby, 2007) and

broader questions may not be asked. Examples included asking how to

lowerheatingbillsratherthanconsideringwhethertheaccommodationis

toolarge.Windleetal(2010)inastudyofinformationandadviceservices

foundassessingqualitativeoutcomesratherthanjustoutputsledtobetter

understandingoftherelevanceofaservice.Thoseagedover60benefitted

less from the information, partly because of difficulty in absorbing and

retainingitbutalsowhattheyreallywantedwasmorepracticalassistance

withprocesses,especiallythoselivingalone.Asmoreinformationsources

andmethodsbecomeavailable,knowinghowinformation isreceivedand

how effective it is, are vitally important aspects for developing these

services.

30

3.8.4 Rubinstein and Parmelee (1992) emphasised the key to successful

ageing-in-placeistiming,advice,assistanceandcriticallytheneedforhigh

levelsofconsultationandinvolvement.Baldock’s(2005)researchshowed

thatsourcesofassistancewerenotthoughttoberelatedinsimplewaysto

the respondents’ disabilities or needs and how they “saw themselves”.

Likewise a health impact assessment (Thomson et al., 2003) found that

therewas insufficient evidence that interventions like home adaptations,

often considered as the solutionbyprofessionals and family, alonemade

muchdifferencetomentalhealth.Thesefindingsfurthersupportthevalue

ofmeetingintrinsicneedsaswellasextrinsicprovision.

3.8.5 Cutchin et al (2007) found attachment to community and locations

were necessary but not sufficient for satisfaction, which also applied to

family involvement. Non-familial social involvement was ‘pivotal’ to

settling into extra care retirement housing. Making friendships and

socialisingwereassociatedwithimprovedqualityoflife,ratherthanfamily

contact, in a study by Callaghan et al (2009). It therefore follows that

housing provision needs integral potential for communication and

interaction within the community and socio-emotional support so

“companionship by proximity can naturally flourish” (Harper, 2008). A

number of newer developments are attempting to address this spatially

(Berrington,2013).

3.9Family,independenceandloneliness

3.9.1 There ismixed evidence about the importance of family proximity,

withsomestudiessuggestingelderswishtobenearfamilyandothersthat

most are unconcerned about this. Looking across the literature, it seems

likelythatolderpeoplewanttoremainnearfamiliesbutnottomovetobe

near themor tobeseenasdependentandaburden to families.Theyare

more likely towant to be nearbywhen there are grandchildren because

they then have a defined role as grandparents (Van Diepen andMulder,

2007). Being near to supportive friends and neighbours was oftenmore

31

important toolderpeople, if theydidnotplayasupportiverole to family

members(e.g.VanDiepenandMulder2007;Kearnsetal.,2011).

3.9.2 Sykes andHedges (2008) found that older people generally tended

towards‘I’llgetonwithit’andnotbeaburden,ratherthanasking‘whatdo

I need to find out’. This indicates potential difficulties for information

providers.Hilletal(2007)foundmanyreliedalmostentirelyonfamilyto

‘dowhatwasbestforthem’.Thisputtheolderpersoninapositionofless

controlorautonomyandintoapositionofpassivecompliance,whichare

knowntobeantecedentstodepression.

3.9.3 However, the Victor and Bowling (2012) longitudinal analysis of

lonelinessamongolderpeopledemonstratedthatincreasedfamilycontact

asconfidantsallowedfor58%ofreductioninlonelinessandlackoffamily

contactwasa causeof loneliness in44%ofparticipantswho livedalone.

Family contact alonewas not sufficient to completely address loneliness.

Deterioration in social activity was extremely negatively implicated in

causing loneliness for 42% of participants and caused depression. Poor

quality of life caused loneliness for 43% of participants, whilst

interestingly, health and chronic health rating were relatively low

predictorsoflonelinessat21%–25%.

3.10Summarykeypoints

Moving home may be seen as too much of a risk and insufficiently

intrinsicallyrewarding,whichisfrequentlymoreimportantthanachieving

extrinsicimprovement.

Lackofself-esteemwill result in thesituationseemingbeyondaperson’s

locus of control. Having depressionmay result in rash decisions that are

also vulnerable to change. Even if seen as achievable (self-efficacy

‘controllability’),inpracticebeingachievablewillnotresultinmovingout

ofchoice,ifthepersonlackspersonalself-efficacy.

32

A tendency toprotect cognitive self-bias (natural optimism) can result in

over optimistically ignoring the possibility of future problems or

converselytakingrisks.Incomplexsituationsthereisatendencyto‘trust

yourgut’.Theneedforcontrolofthefutureinanxiouspeoplemaybethe

catalystfortakingactionandmoving.

Movinghomeforolderpeopleisgenerallyanemotional,burdensome,and

stressfulindividualexperience.Howitishandledwillaffect

howrobustthedecisionremainsandhowwellandindividualsettlesin.

Verydifferentskillsandpersonalattributesareneededfordifferentstages

ofmoving. Information and services (public or privately provided) focus

less on ‘meaningful’ aspects. ‘Functional’ information is less valued than

supportiveaction.

3.11Gapsinpreviousresearch

3.11.1 The researcher observed that housing relocation research had

tended towards measures of practical functionality, an objectivist

perspective,duetothesupplyanddemandnatureofhousingstrategyand

thepoliticalneed for immediacy in results.This concurredwithprevious

meta-analysis(e.g.Egan2008).Theemotionalandcognitivecomponentsof

relocation planning-efficacy had not been integrated when the physical

aspects were studied. Oswald (2006) noted the need for more

sophisticated qualitative investigation into the influence of underlying

reasons for decisions to move and the connection to physical and

psychologicalwellbeing.

3.11.2Norelocationstudieswerefoundthathadconsideredpast,present

andfutureperspectives,hadonlyappliedtoowner-occupiersdownsizing-

as opposed to tenants, and had included a wellbeing and qualitative

approach.Thosenearesttothepresentstudyareincludedhereinsection

3.7. Lutgendorf (2001) and ch4 (secn. 4.8.2), is the closest in design and

includes a biomarker. However the researcher noted the need to use a

33

better measure of chronic stress with more biographical detail, more

qualitativeanalysisandasinglesexdesign.

Thelackofrelevantcomparisonstudiesispartlybecausethosefundedby

the EU (European Union) and WHO (World Health Organisation) were

undertakenacrossEuropeancountrieswhererentingisfarmoreprevalent.

Assuch,movingisalesscomplexprocessandforexampledoesnotinvolve

factorssuchasleavinginheritance.Akeymixed-methodstudy(Sixsmithet

al.,2007) inapanEuropestudywithsomeUKparticipants foundawide

rangeofreflectionsandviewsofolderpeopleconsideringhomeinthepast,

presentorfuture.Themeaningof‘home’fortheindividualwassomewhat

different formen than forwomen.Thebulkof relocationstudieswere in

the USA and Canada where the housing systems, and long established

housing alternatives such as condominiums, make the research, whilst

useful,lessrelevant.

3.12Theoriginalityofthisstudy

ThesamplingstrategyinthisresearchfocusedonrecruitmentofUK,single,

under-occupyingfemalehomeownersintwoagegroups,whichisthemost

important and yet under-researched group in terms of relocation

experience. Importantly, in this research the criteria did not include any

factorsthatmightpredetermineorhidemattersofimportance.

This qualitative approach extended to interpretation of biomarker and

health measures (ch7). Using primarily qualitative methods for the

interpretation of biodata represents a change of approach in the field of

HCCdataanalysis(seech4secn.4.13)

Past, present and future perspectives were examined that included

biographical, lifestyle and psychosocial aspects, interpreted thematically

and examined within accepted theoretical frameworks. Gathered

inductively,thedesignincorporatedmanystrandsfromotherstudiesthat

had left one or other of these potentially critical components out, thus

gaining a level of understanding not previously examined. This ensured

synthesis,abreadthanddepthofperspectivebeyondthetypicallystudied

34

aspects(althoughthesewerealsoincluded),tocaptureexperience,views,

attitudes,andfeelings.

3.13Aimandobjectives

Theaimoftheresearchistomakeavaluablecontributiontothiscurrently

under-researchedfield,tobetterunderstandtheunderlyingbeliefsofolder

agehomeowners,whoarefacedwithrelocationdecision-makingandtheir

subsequent experience. Using a qualitative research approach, including

wheninterpretingbiomarkerresults,willgosomewaytofillingthegapin

currentunderstandingoftheseissues,thusinformingelementsofhousing

policyforthisimportantgroupinsociety.

Objectives:

1. Toelicitqualitativeinformationfromolderwomenwho

livealoneandhavemadedecisionsaboutwhetherornot

to downsize from their owner-occupied property. To

ascertain their perceptions of the process, and in some

cases,experienceofactuallymovingthroughtosettling-

inafteramove.

2. Touse life history, recent biographical information and

findings from the thematic analysis to qualitatively

interprettheself-reportwellbeingandchronicstressself

measures (depression, anxiety, stress, self-esteem, and

haircortisolconcentrationassays).

3. Todisseminate the findings so that theymightenhance

collaborative and effective ‘housing and health’ policy

andpractice.

Chapter 4 that follows is a continuation of the literature review linking

chronicstress,suchasmightbeexpectedtoinrelocation,tohealtheffects.

A meta-analysis by the researcher of current hair cortisol concentration

(HCC)literatureisincluded.

35

CHAPTER 4 LITERATURE - Neuroendocrine reactivity to stress andhaircortisolconcentration(HCC)4.0Introduction4.0.1The literaturediscussedaboveshowsthatmovinghome later in life

can be stressful. Therefore, a biomarker has been included in this study,

namely; hair cortisol concentration levels (HCC). This chapter will first

examinethedifferencebetweenacuteandchronicstresseffectsonhealth.

Difficultiesthatcouldoccurintheinterpretationofresultsforhaircortisol

concentration (HCC) are highlighted. These are due to the potential for

habituation effects and blunted scores in response to long-term cortisol

reactivity.

4.0.2 The researcher does not purport to be an expert in

neuroendocrinologybutreliesonthebreadthofrelatedresearchandhas

long observed consequential signs and symptomology of stress, when

providingpsychologicaltherapy.

4.0.3ThepotentialofHCCasarelativelynewmeasureofchronicstressis

considered in the light of existing HCC research and the value of a

qualitativeapproachinconsideringbiographicaldataofparticipants.

4.1Cortisol–The‘stresshormone’

4.1.1 Hormones, known as glucocorticoids, including adrenaline and

noradrenaline, are secreted by the adrenal cortex, from within the

hypothalamic-pituitary-adrenal(HPA)axis.Theirroleistoenablethebody

torespondtoperceivedimmediatestressorssuchastheanticipatedneed

foreffortandreversethatprocesswhentheperceivedchallengesubsides.

The hypothalamus sends corticotropin-releasing hormone (CRH) to the

anterior pituitary gland resulting in the release of adrenocorticotropic

hormone (ACTH) into general circulation, which signals the release of

cortisol. This hormone signals the enhanced supply of nutrients and

oxygen, commonly known as the ‘fight or flight’ response. Bronchi are

dilatedandtheheartrate increased toenhanceoxygenationof theblood.

36

Digestive secretions are reduced and in general the body is prepared for

muscularaction.

Ifastressorisperceivedasaconstantthreat,broadlydefined,ratherthana

challenge, an increased amount of cortisol is released into the blood

stream,whichcanremainwhilstthethreatpersists.Thuscortisol isoften

referredtoasthe‘stresshormone’.

Lackofabilityoropportunitytocontrol long-term,perceivedproblematic

situationscanresultinrepeatedormaintainedraisedlevelsofcortisoland

disruption to the hypothalamic-pituitary-adrenal axis (HPA). Cortisol

depresses inflammatory and immune responses and can eventually

negatively affect these processes as well as skeletal, cardiovascular,

gastrointestinalandneuralfunctions.Thisisknownasallostaticoverload,

the potential negative consequences of which are discussed below (para

4.3).Allostaticloadistheindicatorof‘wearandtear’ontheHPA.Allostasis

isatermthatreferstothemaintenanceofoptimalendocrineresponsesto

asituation.

4.2Habituationtochronicstress

4.2.1 One seemingly paradoxical finding in long term-stress studies, for

example in Generalised Anxiety Disorder (GAD) (Stuedte, 2011b), is that

cortisollevelswerebelowbaselinelevels.Itissuggestedthatthisoccursas

a protective habituation against adverse effects (described in para 4.3

below)ofprolongedhighlevelsofcortisolandtoachievehomeostasis(the

process of returning to a level thatwill not cause damage) in prolonged

stressful situations. Glucocorticoids contribute to dampening levels

(termedhabituation)ofACTHandcortisolinordertoachievehomeostasis

(McEwen, 2006). This down-regulation is usually seen in depressed

patientsasreducedlevelsof5HT(serotonin),whichisimportantformood

regulation (House et al., 1988).However, the extent towhich depression

causesoriscausedbytheloweredlevelsofcortisolisunclear.Houseetal

(1988) examined the ‘wear and tear’ hypothesis that suggests ‘protective

homeostasis’ (Selye, 1974), an optimal level to avoid damage, occurs in

responsetoprogressivedysfunctioninprolongedstresssituations.House

37

(1988)concurredthatchronicstressexperiencedoverprolongedperiods

eventuallyresultsinthehabituationeffect.

4.3Healthandageing4.3.1 Allostatic overload is evidenced as being directly implicated in

increasedratesofageingandtherebyage-associatedillnesses(e.g.Uchino

andCaciappo,1996;Uchino2006;Kiecolt-Glaser,1999).Thiscanadversely

impactphysical,cognitiveandmentalhealthinolderpeopleandtheirlong-

term carers (Kiecolt-Glaser, 1999). Causal pathways have been found in

respect of dementia, cancers, type 2 diabetes and depleted bonemineral

mass,prevalent inolderpeople (McEwen&Seeman,2009).Treatmentof

these is the most costly to society in developed countries and often the

mostdistressingforcarers(Kiecolt-Glaseretal.,1991).

Davidson and Baum (1993), and Esterling et al (1993) point to distress

effects of allostatic overload prevailing after the chronic stressor has

objectively ended. This is of great importance to the current research

because cortisol levels are measured for the time periods following the

stressfulsituationswithaviewtointerpretationaccordingtoperceptions

andcontexts.

4.3.2 Cortisol has an important role the regulation and increase of blood

glucose levels, including using fat and proteins as energy sources, which

reducesmuscleandinhibitsboneformation(Sapolskyetal.,1986)inolder

people who are already vulnerable to osteoporosis. In extreme and/or

prolongedcasesofstressandhighcortisollevels,cognitivecapabilitiescan

benegativelyaffected.Thisisduetoatrophyofthetemporallobe(Herbert

etal.,2006),observedinthehippocampusandprefrontalcortexstructures,

thus affecting verbal recall (Oliveira, 2013). Atrophy of these brain

structures is implicated in diseases such as dementia, although causal

direction is yet to be firmly established (Herbert et al 2006). Dehydro-

epiandrosterone plays a regulatory role against high levels of cortisol. It

decreases from middle age onwards, which has been implicated in age

38

related cognitive decline. Researchers in studies of older people

(Perissinotto 2012; Herbert 2006; Griffin, 2010; Cacioppo 2008) thus

suggestthiscontributestolonelinessandlifecoursedisease.

4.4Genderdifferences

6.4.1Levelsofcortisolarethoughttobehigherin38%ofpeopleagedover

65andgenerallyhigher inwomen(Herbertetal.,2006).However, levels

appeartorisemorequicklywithageinginmen(Feller,2014).Thecurrent

researchuses femaleparticipantswithseparate findings in twoolderage

groups.

A body of evidence since the 1980s (Martin, P., 1997 pp344; Cohen and

Symes,1985;Kennedyetal.1988)has linkedthequalityof interpersonal

relationships with HPA response and health outcomes. For example,

women seem to have ‘costs’ to their social relationships, notably “non-

discretionary kin ties”, referring to the greater propensity in society for

women to become carers and peacekeeperswithin families (Seeman and

McEwen, 1996). In the current research, five of the eleven younger ‘Non

Movers’hadcaregiverresponsibilitiesandsomewidowshad,immediately

priortomoving,nursedtheirhusbandsforlongperiodsofillhealth.

4.5Decision-Making–biologicalcomponent

4.5.1 (Seeman and McEwen, 1996) found that responses to decision-

makinglearnedatatimeofanxietywill‘perpetuateinthememory’.These

thenaffectthedecision-makingprocessatalltimeswhencortisollevelsare

artificiallyhighandmemoriesofresponsestoanxietyaretriggered.Thisis

evidence for the possibility of bidirectional neuroendocrine effects for

somepeoplewhoareanxiousoverpotentiallyemotionaldecisionssuchas

relocation.MRI(MagneticResonanceImaging)scansduringemotional‘loss

andgain’decision-making(DeMartino,2006)haveshowntheinvolvement

ofmedial prefrontal activity aswell as the amygdala,which it integrates

emotion and fear. In the current research participantswere asked about

emotional experience related to their home and previous relocation

experiences.

39

4.6Clinicalandpublichealthrelevance

4.6.1 Ader (2001) concluded that bidirectional neurological and

psychosocial pathways provide an important route for influencing health

and disease. The gradual decline in health andwellbeing associatedwith

chronicstressandhighcortisollevelsisinitiallyasymptomaticthroughsub-

clinicalpathways(McEwen&Seeman,2009;Clow&Hamer,2010).Inthe

1988studies,Kiecolt-Glaserfounda30%increaseinaccesstoGPservices

due to prolonged stress in caregivers. The insidious, rather than acute

natureofchronicstress,ispossiblywhathasledtoinconsistentapproaches

inpublichealthdisease-preventionpolicy.

ClowandHamer(2010),whenconsideringpublichealthaspects,pointto

the need for awareness of psychosocial related impact and the need for

societal interventions to reverse the deteriorating health profiles. These

areneededfrombirthbutarenaturallymoreevidentwithageaslong-term

psychosocial factors generate and sustain pre-clinical disease in

physiologicalsystems.

4.7Mediatingeffects-supportandacceptanceofsupport

4.7.1Yancuraet al (2008) found ina reviewof the literature that coping

and decision-making styles involving ‘seeking information’ and ‘taking

action’ had less negative HPA outcomes than ‘denial’ and ‘avoidance’

strategies.Activeengagementinproblem-solvingthroughseekingsupport,

as well as personal factors such as optimism, are seen to reduce stress

levels in a study of acute stress (Endrighi, et al 2011) as did disclosure

(Pennebaker,Kiecolt-Glaser,&Glaser,1988inpress).However,Yancuraet

al (2008)warnagainstassumingapersonwithgoodcoping strategies in

respect of some lifeproblemswill be goodat coping in all aspects. Some

coping is emotionally based and some problem focused. This is

acknowledged in the current researchby the separationof stressors into

functional and meaningful categories and considering personality

constructssuchasself-efficacyandoptimism.

40

4.7.2 Cancer patients who sought assistance through talking therapy

(Fawzy and Fawzy, 1993) improved their likelihood of living a further 5

years – this is 4 fold longer than a similar group who did not take the

support.Thestrongestmediatingfactorforthosewithdepression,suchas

caregivers,was supportive contacts and social ties (Kohut, 2002)bothof

which were 50% lower in those carers with depression, who tend to

become socially isolated due to the intensity of their tasks. The current

research considers the availability and role of emotional and tangible

support, whether it is readily accepted and the impact of restrictive

responsibilities.Theimpactonqualityoflifethroughsocialisingfollowing

amovetoretirementhousingisalsoconsidered.

4.8Personalityandbiographicaleffects

4.8.1 Irwin (1997) points to the key differences in habituation effects

between anxiety and depression. Personality is important because

perception is to someextent linked towhetherwe consider situationsas

fearful or a challenge. Low self-esteem has been found to be ‘a potent

predictor’ofcortisolresponseattimesofstress,whereasthosewithhigher

self-esteem have greater habituation to stress (Kirschbaum et al., 1995

Pruessner et al., 2004; 2005). Being able to respond to and control

challengesdependssignificantlyonpositiveself-experience.Assuch,high

levels of self-efficacy and self-esteemmediate against ill health (Siegrist,

2010).

4.8.2 The importance of environmental fit (P-E fit) on wellbeing is well

documented as a causal concept for those suffering isolation,withdrawal

fromsocietyandconcomitantreductionofactivityandsocialengagement.

PoorPEfitisalsoassociatedwithlonelinessandfallsinthehome,endemic

in the older population (Aldridge et al., 2012; Lutgendorf and Costanzo,

2003; Bowling, 2008). In the current research consideration is given to

wellbeingatthephysicalandemotional(functionalandmeaningful)levels

ofthehomeenvironment. FindingsfromHCC(haircortisolconcentration

41

assays) are considered qualitatively using the participant’s experience of

environmentalandbiographicalcontexts.

CASESTUDYLutgendorfetal(2001)–ChronicStress;Illnessepisodesandcortisolinhealthyolderadultsduringalifetransition.Vulnerabilitytochangeofrelocationdecision-makinginolderpeoplewas

noted by Lutgendorf et al (2001) where perceived stress levels were

measured and were equally high at the decision-making time as at

relocationitself.Theystudied30olderwhitemiddleclassowner-occupiers

includingmale, female,married or single (mean age 77.8)moving to the

Americanequivalentofshelteredhousing.Theymeasuredcortisollevelsin

saliva a month before moving date and 2 weeks after using blood and

salivaryassaysforDHEAandcortisol.

The cortisol levelswerenot only the sameacross thedifferent timesbut

between thosewhomovedandcontrolswhodidnotmove.The research

showedthatthehighlevelsofstressduringmovingwerealsomatchedat

the decision-making stage. The researchers recognised that the control

group shouldbepeoplewhohad actively consideredmoving rather than

recruited froma newspaper advertisement, and should be allmale or all

female. The timescale and method measured acute rather than chronic

stress.TheyusedanImpactofEventScale(IES,Horowitzetal1979)and

The Life Experiences Survey (LES, Sarason et al 1978) as well as a self-

reportmeasure of ‘intrusive thoughts and avoidant behaviours’ to cover

theprevious7days.

The researchers recommended having more qualitative analysis,

measuringself-efficacyandlocusofcontrol,andusingabettermeasureof

chronicstress.

Figure4.8.2belowillustratesthecomplexitiesofpsychosocialinteractions

andhealth.

42

APsychosocialfactors

Negativeaffect

Optimistic/hostile

Depression/anxiety

Socialsupport

Copingstrategies

Religious/Lifepurpose

Choice/options

Self-efficacy

Decision-makingand

makingplans

Locusofcontrol

Carerresponsibilities

Fear/trust/self-identity

Sociability/loneliness

BBiologicalFactors

Ageing

Gender,race

Ethnicity,Environment

Medicalcondition

Capability/disability

C.Age&Health

Behaviours/Lifestyles

Income

Sleep,diet,BMI

Alcohol

Smoking

Healthchecksand

serviceaccess

Hobbies/interests

Domesticity

Activity

Earlylifeantecedents

Homeenvironment

D.Lifestress

Acute

Chronic

Earlylife

Personality

Perceptions

Environmentmismatch

(UnsuitableHousing)

PotentialIntervention–formal/informal

HousingOptions,facilitationwithautonomy:-

Logistics,practicalandemotionalsupportand

provisionofinformation

Financialcapabilityassessmentandadvice

Incomeincreasedorsustained

Onerousresponsibilityreduced

GOALS

PotentialWellbeingOutcomes-sustainability?

BiologicalReducedanxiety,depression,isolation

PsychologicalIncreasedself-efficacy+LocusofControl

BehaviouralLessdependent,healthandsocialcare

Greaterinputtolocalcommunity,companionship

Diagramdesign:

adaptedfrom

Lutgendorfetal

2003

E1.NeuroendocrineImmuneMechanisms

HPAHumoral&cellulare.g.

CortisolWoundhealingreduction/

Tumourgrowth

MemoryeffectsviaHippocampusatrophy

E2.

Vulnerability

Resiliance

Diseaseonset

progression&

recovery

QualityofLife

Dependence

Survival

Mediating

effects

Lutgendorf et al (2003) integrativemodel illustratedtheneed for research to

consider effects of individual life experience, decision-making styles, self-

efficacy,LoCandsocialsupport.

Figure4.8.2LifeSpanInfluencesonHealthandWellbeing

43

4.9HairCortisolConcentration(HCC)asameasureofchronicstress

4.9.1Measuringpatternsofcortisolsecretionintobloodandnotablysaliva,

havebeenwidelyusedinstress-psychobiologyresearch.Recentlycortisol

determination in scalp hair has found a place in psychobiology social

research. Lutgendorf et al (2001) realised chronic stress was not

determinedwhen salivary assayswere used. Saliva and blood assays are

sensitive to acute levels of stress and therefore require many measures

overthespecifiedperiodforanychronicpatterntoemerge.However,HCC

assays for chronic stress are not influenced by circadian rhythms, or by

occasional episodes of acute stress during the period being measured

(Russell et al 2012). The current research design based on Lutgendorf

(2001)usesHCCratherthansalivaryassays.

4.9.2 Raul et al (2004) proposed hair cortisol concentration (HCC) as a

morepracticalandreliablemeasureofchronicstress.D’AnnaHernandezet

al (2011) foundsalivaryandhair cortisolmeasures rosecorrespondingly

in21pregnantwomenat15,26and36weeksofgestationand3months

postpartum.HighbaselinelevelscanalsobedetectedthroughHCCinthe

case of patients with Cushings syndrome, that is characterised by high

cortisol levels (Thomson, 2010). Correlational data was also found by

Korenetal(2008)inananimalstudywithmultiplesalivaandurineassays.

4.10Concernsoverreliabilityandhaircharacteristics:

HCCconcernsfallintotwomainreliabilitycategories:1)characteristicsof

hairand2)procedures:

4.10.1Hair,AgeandGender

Whilstthereappeartobesomegenderdifferencesincortisol levels(para

4.4above)andsomeHCCstudieshavesupportedthis(Stalderetal.,2013),

no differences have been attributed to gender in most HCC studies (e.g.

Dettenbornetal.,2012;Stalderetal.,2012a;Herbert,2006)butnonehas

focusedonolderpeople.

44

4.10.2Hairgrowthrate

Hair growth varies according to hair type and ethnicity and even at

different times of the year (Randall & Botchkareva, 2009). Van Neste

(2004)alsoshowedgrowthratesvariedinoldersubjectsaccordingtothe

sitewith parietal, versus occipital rates, being faster. Koren et al (2008)

founda24%differencebetweenadjacentareas.Ithasbeenagreedthusfar

(Wennig, 2000; Raul 2004; Gow, 2010), although research is not

conclusive, that hair should be taken from the posterior vertex location,

which has themost consistent growth rate. VanNeste (2004) also found

slower hair growth in some older people, associated with grey hair and

alopecia.Slowgrowthcouldaccountforhighercortisolconcentrationsand

being aware of this potentially confounding factor was important in the

presentresearchbetweenthoseaged60–75andthoseaged76andover.

4.10.3Haircolour

White non-pigmented hair grows faster than pigmented hair, whichwas

theonlyhairfoundbySaitohetal(1969)tobegrowingslowerinoldage.

Most participants in the current study will have grey or non-pigmented

(although likely dyed) hair. The diameter of the hairs is greater inwhite

hairdueto increasedsizeof themedulla(innercoreofthehairstrand)–

where thecortisol is contained.This couldbeanother importantanalysis

factor. Thicker hair might result in fewer hairs per milligram with an

impactonHCCrates.

4.10.4Time-representative,lengthand‘washouteffects’

Wennig (2000) produced a paper for guidance in global procedural

practice for forensic situations.Wennig proposes 1 cm permonth as the

average growth rate, and as mentioned above, to be taken from the

posterior vertex. However this is an approximate measure of growth, it

follows that the longer the hair length being tested, the more likely the

possible variation in growth rates will adversely affect the accuracy of

results. Despite this, the standard has been routinely applied in every

study.This ispossiblybecauseaftermanydebates in the literature ithas

45

beenacceptedthatcortisolgraduallywashesoutandthatthiseffectmeans

assaysofhairlongerthan5to6cmarerejectedasunreliable.Allowingfor

other factors such as hair treatment, the ‘washout’ effect, accounts for

betweena30-40%reductionper3months(3cmsegments)afterthefirst6

cm(e.gKirschbaumetal2009).

4.10.5Externalfactorsaffectinghaircortisol

Thenumberoftimeshairiswashedcanaffectfindings.Hameletal(2010)

pointtoasignificantwashouteffectafter20washeswithplainwaterand

noshampoo.Somestudiesfoundeffectsofhairtreatmentssuchasperming

and bleaching (Manenschijn et al., 2011a) and also chlorine, a bleaching

agentinswimmingpoolwater,aswellasexposuretoultraviolet(UV)light.

Grassetal (2016) foundareductionofbetween7.6%and10.8%in-vitro

due to simulated UV radiation, contrary to previous studies in natural

situations.InthecurrentresearchUVexposureislikelytobemuchlower

andthetoplayerofhairispinnedupsothesampleistakenfrombeneath

(methodsch5para5.10).

The structure of hair is complex but the inner core (medulla) is well

protectedwithinthehairshaftandthisiswherethecortisolislocated.Itis

unclearwhetherhairdyehasanyimpact.Whereasearlierstudiesfoundan

effect, more latterly it has been found not to make a difference in most

studies(e.g.Gowetal2010).However,specifictreatmentsthatstretchor

alterthehair,suchaspermingandbleachingandlaboratorywashes,show

greaterleachingeffectsindistalsections(Manenschijnetal2011a).

4.11Concernsaboutprocedures:

4.11.1Collectionstage

Theguidancestatesthatthehairshouldbesnippedclosetothescalpusing

underneathlayersatthevertex,tiedtowardstheproximalendandkeptin

tin foil in dry, room-temperature conditions supposedly indefinitely,

although there is a need for research to establish this (Abell et al 2016).

46

Samplesusedinsomeearlierstudieswerekeptrefrigeratedorevenfrozen.

Evenasmallamountofmoistureincreasedtheoverallhairshaftsize.

Wennigsuggestsanallowanceofaround4-5daysshouldbemadebefore

thehairaffectedbythestressfulperiodemergesfromthehairfollicle.This

isbecauseofaremarkable find thathair folliclesnotonlyabsorbcortisol

fromthebloodstreambutproducecortisol(Wennig,2000;Itoetal.,2005).

It is therefore important not to inadvertently collect any of the root.

Exogenous cortisolmay also be added by sebum, sweat and for example

steroidcrèmes,transferredbytheparticipantorresearcher.

4.11.2Pre-analysispreparation

Thegeneralconsensusisthatpriortoanalysishairshouldbewashedinthe

laboratorytwice(e.g.Rauletal.,2004;Kirschbaumetal.,2009;Abadehet

al., 2014) although other researchers say 3 times (e.g. Davenport, 2006;

Gow, 2010). There has also been disagreement about the extraction

method. The differentwash chemicals used in ELISA* extraction all have

steroid cross reactivity to different extents (Russell, 2015). Furthermore,

the high reactivity with the steroid medication prednisolone, used for a

numberofconditionssuchasrheumatoidarthritis,wascriticisedbyGow

(2010).Methodsofextractionandanalysishavebeencompared,including

usingmethanol and acetate for extraction andLCMS,GC,MS andRIA for

analysis* (Gow, 2010; Russell, 2015; Slominski, 2015). Others used

methanol and acetate (Slominski, 2015). Procedural variations include

dryingofthehairnaturally(Kirschbaumetal.,2009)orbyincubation–16

hoursat52°(Manenschijneta.,l2011a);21.5hrs(Abadehetal.,2014).

*ELISAEnzymeLinkedImmunosorbentAssay(orEIA=EnzymeImmuno-Assays)GC/MS-GasChromatography/MassSpectrometryLC-MS/MSLiquidChromatography-MassSpectrometryRIA–radioimmunoassay

47

Somemethodsinvolvecuttingthehairintosmallpieces,otherspulverising

it.Theterminologyisnotconsistent(chopping,snipping,cutting,mincing,

pulverizing,powdered).Stalder(2012b)notedacrosstwostudieswiththe

sameparticipantsthatpowderedhairdidnotseemtoproducemoreyield

andSlominski(2015)pointsto‘cutuphair’achievingahigherpercentage,

althoughdifferentlaboratorypreparationwasheswereused.

4.12Quantitytocollect

4.12.1Theamountsofhairusedcanrangeconsiderably,causingdifficulty

in comparisons. In the literature the length of hair used may be given

withouttheweightandsometimeshairiscollectedbydiameter(Abadehet

al., 2014), a difficult process to manage. Alternatively hair has been

collected by number of strands (Manenschijn et al., 2011a; Sauve et al.,

2007). Sauve pointed out the impact on measures of using different

weights. For example, anything that increases the size/weight of thehair

shaft,suchasmoistureorhairtype,willreducethepercentageofcortisol

measuredinthesampleoverall.

4.12.2Gowetal(2010)reviewedtheprocessesinuseandnotedextraction

from LC/MS achieves 74% from 30mg; RIA, 74% from 25mg. Therewas

9.35%steroidcrossreactivityinELISAprocesses.Russelletal(2015)point

to a pressing commercial and academic need for comparable

harmonisationofmethods.Usingfourinternationallaboratories,fourtypes

of ELISA assays, 2 LC-MS/MS assays, testing of 40mg hair samples took

place. They too found LC-MS/MS to be highly reliable with virtually

identicalresultsbetweenlabs.

4.12.3However,realisticallyELISA,ismorelikelytobeeconomicalandthe

recommendationisthataminimumof10mgbeusedanda10%retestrate

(requiringatotalof20mgtobecollectedfor10%ofparticipants).GC-MS

assaymethod,consideredtobethegoldstandard(Wennig,2000) isused

for forensic and sports purposes,where ELISA is deemed not acceptable

duetoconcernsabouthigherfalsenegatives.

48

4.13IndividualdifferenceswithHCCasabiomarker:4.13.1Theresearchhasmainlyconsideredphysicalhealthratherthanlinks

topsychologicalhealthorperson-environmentcontext:

Smoking,ageandobesity(Braig,2014)independentlypredicthigherHCC

levels as do diabetes and alcohol consumption inwomen.However, pain

wasfoundtobeassociatedwithhigherHCConlyifmeasuredtogetherwith

high-perceivedstress(VanUumetal.,2008).Loweducationalbackground

andrecentunemploymentwerepredictiveofhighHCC,andmaybelinked

to self-esteemmentionedhere in respect ofHPA reactivity (Pruessner et

al.,2005para4.8.1).

4.13.2Inastudyofchronicstressandgeneralisedanxietydisorder(GAD),

which also included salivary assays, Steudte et al., (2011b) used a

diagnosticinterviewalongwithquestionnairesonperceivedstress,chronic

stress and depression. There was a 50-60% reduction in expected HCC

levels for those with chronic stress and depression, which is in keeping

with expected HPA habituation to longer-term stress. More recently

Steudte-Schmiedegen et al. (2016) noted a link between cortisol

dysregulationandtraumatisationinposttraumaticstresscases.

4.13.3Ofparticularrelevancetothepresentresearch,WesterandRossum

(2015) found that where blunted scores are in keeping with HPA

habituation, the increased cortisol levels returning to normal after long-

term depression (see also paragraph 4.3 here) but not necessarily

following repeated episodes. Importantly they found there are different

impactsoncortisollevelsdependingonwhetherthelifeeventstressorsare

considered tobechronicoracute.Cortisol levelswerealso influencedby

whether the response separately from the stressor is longstanding/short

termandwhetheritisdynamic(activevs.passive).

4.13.4 Inastudyofhealthystudents (Ullmanetal.,2016)usedscales for

perceived stress, anxiety, depression, sense of coherence, resilience,

acceptance of self and life dimensions. They found therewere significant

49

HCC correlationswith subscales of physical stress, stress perception and

subjectiveperceivedstress.

4.13.5 These recent studies are in contrast to previous findings. Stalder

(2012a)used6cmhairsamplesatthreetimes2monthsapart.Therewas

an online questionnaire for stress in the previous 2 months, a social

support levels index and self-efficacy scale. The only significant results

related to raised HCC and body weight. Study 2 of the same research

includedalongerstressquestionnaireandmeasuresofphysical,emotional

ormentalexhaustionandasubscaleforsocialoverload.Againbodyweight

wassignificant(butcausaldirectionwasnotdetermined).

Importantly, this was deemed at the time to concur with all previous

studies that there was no significant association between HCC and

psychologically perceived stress except in pregnancy or due to chronic

pain.

4.13.6However,laterthesameyeartheintra-stabilityofHCCasameasure

wasfoundbyStalderetal(2012b)aftercontrollingformajorlifesituations

in a study of 30 females average age 37. Statistical outliers were

reconsideredratherthanrejectedforskewingthedata(aflawinstatistical

analysisofhumanfactors).Thoseparticipantswithoutlierscoreshadhad

negative life experiences throughout the research time frame, which

established a possible connection with significantly raised HCC and

chronicallystressfulsituations.

Farasjo et al (2014), whose participants were 112 middle-aged female

nurses,foundthatthosereportinghighlong-termstress,depressionorlow

healthhadsignificantlyelevatedHCC.TheStalderstudies(2011a;2012b)

and Farasjjo et al (2014) demonstrate the need for the inclusion of

qualitative biographical methods within HCC research and deeper

understanding of contextual factors beyond nomothetic data or bio data

alone,particularlyinconsideringcausaldirection.

50

4.13.7 Finally, of possible relevance is an animal relocation study by

Davenport(2006).AgroupofrhesusmonkeyswasrelocatedandtheirHCC

levelsmeasured13weeksbefore relocation for abaselinemeasure, then

14weeks after. Therewere raised levels of HCC that did not completely

subsideuntil52weeks from themove (which reflects the time frame for

subsidenceinKirschbaumetal’s2009studyofpost-partumwomen).The

currentstudymeasures20weekspreand20weekspostmove.A52-week

post-moveanalysisofHCCforthosehumanrelocatorswithhighHCCmight

beausefulareaofresearch.

4.14Summary-limitations

Cautionininterpretationisurgedasdemonstratedinthe

followingfigure4.14

WhilstthesestudiessupporttheuseofHCCasameasureofchronicversus

acutestress,theyshowtheneedforqualitative,within-subjectanalysisto

understandtheindividualeffectsoflifestyle,contextandexperience.

InchaptersevenresultsofHCCassaysarereportedrelatingtoself-esteem,

depression, anxiety and stress. These are considered using qualitative

biographical information to enable a picture for each individual or to

identifycommonalitiesbetweengroupsinrespectofchronicstressandthe

relocationsdecisions theyhavemade.Chapter five,GeneralMethods that

follows,describes thedesign,methodsandmaterialsused in thepresent,

largelyqualitativeresearch.

Exposureto

psychological

stress

Biomarker–

Haircortisol

concentration

Outcomee.g.

morbidity

diabetes,cancer

Imperfectmeasuresofphysiologicalandsocialprocessestakingplace

Figure4.14Effectsofexposureonoutcomenotaccountedforbythemeasurebiomarker

afterLoucksetal2008inMcEwen2012

51

CHAPTER5.GENERALMETHODS:Design,MaterialsandProcess

5.0Introduction

Thiswasa largelyqualitativestudy that involved thecollectionofprimary

interviewmaterialandsecondaryquantitativewellbeingdatatosupplement

andhelpcontextualizethequalitativedata.Thischapterdetailstheresearch

approach,fieldworkandanalysisundertakenfrom2012to2016:Section5.1

providestherationaleforusingaqualitativeapproachandthensection5.2

provides an overview of the innovative design. Sections 5.3 and 5.4 cover

sampling and recruitment. Sections 5.5 to 5.7 detail development of the

questionnaires,interviewschedules,theiruseandtheroleoftheresearcher.

Section 5.8 relates to hair sample collection for cortisol assays and 5.9

details the management and analysis of quantitative data. Section 5.11

examines Thematic Analysis (TA) as a Qualitative data management and

analysismethodanddetailseachstagetakeninthecurrentresearch.Section

5.12coversallgovernancematters.Section5.12summarisesthechapterin

advanceofprogressingtotheresearchfindingsinChapter6.

5.0.1Researchpremiseandpropositionsrevisited

Meta-analyses of older people who relocate (e.g. Egan 2008) indicated a

generallyacceptedpremise thatmovinghome late in life canbea lengthy,

burdensome and often emotional process. The current research was

conducted in order to improve understanding of how participants

experience that relocation process as three stages involving 1. decision-

making,2. themove itselfand3. settling-in;orconverselydeciding tostay

put. Thepotential of this process to cause chronic stresswas awellbeing

componentthatlackedsufficientexaminationintherelocationliterature.

The research propositions were that a lifetime of experience, personal

beliefsandvalueswouldaffect self-efficacy.Moreover,howadecisionwas

envisaged, emotionally and then practically supported by others, would

affecthowrobustthedecisiontomovehomewouldremainthroughoutthe

processandhowsuccessfulitwouldbeforsettlinginaftertherelocation.

52

5.1Researchapproach

Guba and Lincoln (2007) point to methodology being secondary to

paradigm.Theresearchapproachadoptedinthisthesisleanstotherightof

the Guba and Lincoln (2007) paradigm table (Appendix 2), by using

discursive methods of information collection and qualitative methods for

analysing it. Previous relocation studies, discussed here in the literature

reviewhave leanedtowardsobjectivistresearchdesignsmainlybecauseof

the tangible and functional nature of housing. The current research has

attempted to give sufficient regard to tangible (‘functional’) aspectswhilst

concentratingonqualitativeinsightintounderlyingemotional(‘meaningful’)

matters linked to moving. These terms were introduced into relocation

(Oswald 2004) who refers to social and physical aspects but a lack of

emotional insight in the relocation studies of older people. Following

shortfallsinthatresearcher’sownextensivestudy(2002)hispaper(Oswald

2004;2006)highlightstheneedformorequalitativeinsightthathassofar,

been largelymissing from the literature. Thus a qualitative approachwas

adoptedtogainthoughtfulreflectionfromparticipants’abouttheirdecisions

andactions,takenorrejected.

Interviewswereorganisedandrepeatedattwostagesusingquestionnaires

so the researchercouldhear,discussandnoteviewson theexistinghome

situation, previous relocation and other life history, and participants’

perceptionsofthefutureneedsandaspirations,whichmightinfluencetheir

currentfeelingsandperceivedefficacyinrespecttomovinghome.

Additionally questionnaires included scales for depression, anxiety, stress

and self-esteem and hair samples were taken to measure hair cortisol

concentration (HCC) as a biomarker for chronic stress. This introduces

triangulation for the wellbeing measures. The researcher’s review of HCC

studies indicatedusingabiologicalmeasure couldunderpin interpretation

of qualitative information since HCC would not be affected by social

desirabilityorcognitivedissonancethatqualitativeaccountsareproneto.In

theotherdirectionHCCresultscouldbeunderstoodforindividualsusingthe

qualitativecontext(ch7results).

53

Hair cortisol concentration (HCC) analysis had, as far as the current

researcher was aware, never been used as a chronic stress indicator in

relation to older people moving home and thus was considered an

improvement on existing research. The (Lutgendorf et al 2001) research,

(chapter4literaturepara4.8.2),usedsalivaryassaysinastudyofthethree-

stage process of relocation. Lutgendorf et al referred to design shortfalls,

including failing to gain sufficient qualitative data to interpret the

biomarkers.

Aninductive(bottomup)approachwastaken,gatherinformationandcarry

out analysis. Informationwas gathered through face-to-face discussions at

eachinterviewstagedescribedinthenextsection.Ampletimewasmadefor

discussionandverbatimnotestobetaken,aroundtheanswersgivenateach

stage.ThematicAnalysis(secn.5.11.1tofollow)wasusedtodevelopthemes

withinthenarrativeandinterpretthemwiththeaidoftheoreticalconcepts.

Inparticular,anabductive(topdownapproach)emergedfromtheliterature

review.Thisenabledasynthesisof theorywithparticipantexperienceand

potentialhealthoutcomes(Thomas2006).

Figure5.1-Inductiveandabductive processes startwith specific knowledgethat is likely to be or atleast is potentially partlyapplicable.

54

5.2DesignOverview

5.2.1Participants-cohortsummary

Thefullsamplingstrategyandrationaleisexplainedfromsection5.3below.

Table5.2.1ParticipantCohorts–under-occupyinghomeowners Age60–75 Age76+Peoplewhomovedhome

GroupAMovers(n11) GroupBMovers(n12)

Peoplewhodidnotmovehome

GroupCNon-Movers(n8) GroupDNon-Movers(n8)

The sample comprised 39 females, in two age groups, who were sole

residentsof technicallyunder-occupiedproperty (govt.definition ishaving

one roommore than is needed to sleep in). They owned their properties

outrightorwithamortgageandwhoeitherdownsized(Moversgroups)or

had‘stayed-put’(‘NonMovers’groups).

TheMoversandNonMovers’twoagegroupswere65to75years,76years

andover.Thismirroredmostage-relatedresearchtoallowforcognitiveand

physicalhealthdifferences thataremoreprevalent inolderagegroups, as

wellasdifferentsocio-politicallifeexperience.

5.2.2Timeframeandactivity

Table5.2.2Timeframe(time-matchedforNonMovers)

Time1:5monthspremove Time2:moving-in

Time3:5monthspostmove.(settling-in)

PeriodA–5monthsfromTime1toTime2

PeriodB–periodof5monthsfromTime2toTime3

Stage1

AtTime2andTime3theresearcherundertookface-to-facecompletionof

questionnaires.(detailedfrompara5.6andproducedinAppendices5&6)

At Time 2 questionswere asked twice for the psychometric items in the

questionnaires measuring depression, anxiety and stress; Participants

55

were first asked to retrospectively assess these, i.e. Fivemonths prior to

moving,whichrepresentsTime1.Theywerethenaskedtoanswerbased

ontheircurrentthoughtsandfeelings.

Ahairsampleof5cmnearestthescalp(procedurepara5.8tofollow)was

also collected from participants at Time 2 and Time 3 to be used for a

cortisol concentration assay. This is an accepted biomarker for chronic

stress(seech4)witheachcmrepresentingaperiodof1monthintendedto

representthefivemonthsofPeriodAandPeriodB.

Stage2

Eight participants at Time 3, took part in a semi-structured interview,

instead of the Stage 1 questionnaire. They also completed the

psychometrics,cognitivetestsandprovidedhairsamplesinasimilarway

totheotherparticipants).

Stage3

Hair cortisol concentration and questionnaire items for depression,

anxiety, stress and self-esteem were analysed on a participant-by-

participantbasis.Thisanalysiswascontextualisedbythethematicanalysis

findings relating to experience and context (reported and interpreted in

chapter7)

5.2.3IterativeProcess

Theanalysiswasnotlinear,morefullydescribedinsection5.11tofollow.It

involved considering and reconsidering interpretation as information was

gathered, coded and linked to previous codes. Table 5.2.3 illustrates the

overallprocess.

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Table5.2.3Iterativeprocessandcorrespondinganalysis

Stage1toStage2• The information fromthequestionnaireswascollated, including the

explanationsencouragedfromtheparticipantsface-to-faceandnoteddown verbatim, aboutwhy the scorewas given and any associatedissuesoroutcomes.

• Biographies were built up using the data, initial coding andidentifyingpotentialthemes.

• Theparticipants’responseswerethenfedintothedesignofthesemi-structuredinterviewusedatStage2.Thiswastoensurethatthequestionsaskedwererelevantandthelanguagewasfamiliartotherespondents.

éê

Stage2toStage3• Coding and interpretation using Thematic Analysis of the interview

material from Stage 1 and 2. Biographies were completed andoverarchingthemesandsubthemesfinalisedanddiscussedseesecn.5.11.4forexamplesofthemesbeingdeveloped.

Stage1&2informStage3

ê

Stage3• TheHairCortisolConcentration(HCC)indicativeofchronicstress

andscalesfordepression,anxiety,self-esteemandstresswereanalysedbi-directionallywithqualitativeinformationfromStage1&2andinterpretedforindividualparticipantlevels.

The psychosocial demographics and information from Stage 1

questionnaires inform the Stage 2 semi-structured interview design, that

togetherinformthethematicconclusionsandprovideaqualitativebasisfor

thethematicinterpretationofchronicstressdataatStage3.

5.3Samplingsizeandselectionrationale

Theoriginaldesignincludeduseofinferentialstatisticsandlargernumbers

ofparticipantsthatwouldenablethis.Howeverinthelightoftheextensive

literature review the researcher felt thiswould compound themistakes of

previousresearchbydetractingfromthemostexistentialemotionalaspects.

Whilstthephysicalenvironmentneededtobetakenaccountof,thishadnot

previously provided the insight into relocation ambiguity among older

people. The intention was always to focus on individual, qualitative

57

experienceand thegap in the literatureemphasised theneed for this.Ten

participants per cohort was considered a sufficient number to provide

individuals’ socio-demographic, home environment andhealth information

in relation to their decision-making about relocation (ch6 Part 1). The

statisticalanalysiswasthusdescriptiveratherthaninferential(para5.10to

follow).Thiswasintendedtohelpindicateareasofagreementordifference

thatmight inform development of the semi-structured interview schedule

and supplement qualitative interpretation. Health effects data were used

speculatively, and otherwise mainly considered on an individual-by-

individualbasis(chapter7).

Inclusionandexclusioncriteria

Thesamplingdesignallowedforjustfourcriteria:thosewhohavemovedor

not moved, in two age groups, 60 to 75; and 76 and over. The design

screeningwas limited to: theproperty, the location, being currently single

and female.Excludedwere thosewhomayhavewished tomovebutwere

already in a one bedroomproperty orwere younger than60. Participants

shouldnothavechosentomovepreviouslyatover,orapproaching,age60

inordertoretire.TwoparticipantsacceptedintotheNonMoversgrouphad

moved many years before, as part of a couple into accommodation they

thoughtwouldbesuitableforretirement.

Definitionofthecriteria

Theproperty

ThepresenthomeofNonMoversandprevioushomeofMovershadtobeor

havebeenowner-occupied,with orwithout amortgage. Thiswas because

terms of occupation and the mechanisms for moving are completely

different for owners and tenants. Moreover, national policy in relation to

housingandassistanceisverydifferentfordifferenttenures(seechapter2

forbackground).ThenewtenureforMoverscouldberentedorowned,since

bothwereincreasinglyavailableasoptionsinretirementhousing(although

inpracticeonlytwoofthissample,rentedthenewaccommodation).

58

Under-occupationisdefinedaccordingtoanationaltechnicalstandard(one

moreroomthanisneededforoccupantstosleepin). Itseemedlikelythat

participants, all of whom lived alone, would not feel two bedrooms to be

excessive under-occupation. However, imposing this government-defined

criterionensuredthatallcohortshad,asonedecision-makinginfluence,the

considerationoftheaccommodationsizeandthepurposeofitsuse.Because

of the disproportionate cost and shortage of 2 bedroom properties (see

chapter 2), many downsizers realistically, would not have had the choice

financiallyofmovingtoatwobedroomproperty.Participants’viewsonsize

of present and future accommodation were thus important and fully

exploredintheresearch.

Thelocation

ThegeographicalrecruitmentareawasNorthEastLondonandsurrounding

Home Counties in high-density urban or suburban areas. Housing market

influences were deemed to be important for relocation decision-making.

Thesevaryconsiderablybyareanationally,althoughtoamuchlesserextent

within the areas used for this research. These issues are relative and so

would only become an issue if the requirement was to move to a more

expensive area. Other important social factors such as population density,

immigration, migration, provision of facilities and services such as health

andtransport,wererelativelysimilarinthelocationsused.

Lonefemales

Lonefemaleswerethe focusof thisstudy isbecausestatically theyarethe

largestgroupofsingleoccupiersinolderage(ILC2016).Importantlythere

are thought to be baseline cortisol differences between females andmales

(Herbert 2006 ch4 para 4.4) and perceptual differences found in some

researchaboutthemeaningofhome(e.g.Sixsmithetal.,2007,ch3para3.7)

thatmayconfound findings.Womenarealsomore likely tohavesufficient

hairforthehaircortisolconcentrationsampling,whichmakesthemabetter

choiceoverallforthecurrentresearchdesign.

59

Person-environmentfit–avoidingexclusionscreening

The existing literature showed that something was impeding people from

moving even whenmoving seemed beneficial and viable as an option for

them and their carers. Conversely others, who had seemingly obvious

impedimentstomoving,overcameadversityinordertorelocate.

Itwastherefore,importantnottoselectordeselectanyvariablesthatcould

influenceandpreemptfindings,whilstpurportingtokeepanopenmindby,

for example, only including thosewith a certain level of health orwealth.

This would have suggested a hypothesis or assumptions based on what

might seem to be obvious reasons, needs or opportunities for moving or

stayingput.Thiswouldhavecompoundedmistakesintheexistingliterature,

where cohortswere limiteddue to assumptions in sampling (ch1para1.4

and1.5).Nothingcouldbeassumed.Eventheresearchpremisethatamove

is burdensome transpired to be more of an issue for some than others,

despitethemhavingsimilarpracticalcontexts.

5.4SamplingandRecruitingtheparticipantsPurposivesampling

Purposive sampling is the method used in this research. It derives from

purposeful sampling technique, defined as “a technique widely used in

qualitative research for the identification and selection of information-rich

casesforthemosteffectiveuseoflimitedresources”(Patton2002inPalinkas

2015).

The sampling criteria in this researchwerevery specificbutnot extensive

(para5.3.1).Theresearcher tooka ‘PurposiveSampling’approach,defined

byPatton(2002)as“recruitmentfocusedonthejudgementoftheresearcher

astosuitabilityofeachparticipant”.Theemphasiswasongainingdepthof

understanding from those with actual experience, of moving or decision-

makingaboutmoving (Patton2002)and finding thosewho “hadastoryto

tellandwerewillingandavailabletotellit”(Bernard2002).

60

Movers

The researcher in this study used her judgement in cooperation with

retirementschememanagersso thatonly thosepotentialparticipantswho

met the criteria were selected. The researcher’s previous local authority

connectionsandverificationassistedinthisprocess.Themanagersandtheir

organisations were supportive of the research when it was explained to

them.Theyidentifiedindividualswhotheythoughtmightbesuitablebased

on the criteria. Their knowledge about the person was based on the pre

purchase meetings that scheme managers have with potential purchasers

and sometimes their families. Scheme managers were able to say when

purchasecompletiondateswereimminentandgetsomeideafromthenew

residentinadvance,orjustafterthemoveastowhethertheywerelikelyto

considertakingpartintheresearchandwouldbehappyfortheirdetailsto

beprovidertotheresearcher.Thisgradualintroductionwasimportantsince

participants during this difficult transitional period might otherwise have

beenreluctanttotakepart.Posters inretirementhousingvenuesor leaflet

or letter drops would also have required the agreement of the scheme

managers andwould have been less successful than a reassuring personal

approach.

Palinkas (2015) suggestsbeingpurposive rather than randomor stratified

in nature, the researcher in qualitative research makes a somewhat

subjectivedecisionabout theextent towhichacandidatewillproviderich

informationandaddtothecohortasitiscollected.Forexampleaskingnew

retirement scheme owners to take part provided the researcher with

participants who could also discuss the applicability of a scheme the

researcher developed (FreeSpace Appendix 1) for downsizers moving to

retirementhousing,thusaddinganotherusefuldimension.

NonMovers

For the Non Mover cohorts, the sampling was more opportunistic.

Participants were recruited by visiting settings where candidates in the

61

study’solderage rangesmightbe found,whomightbewillingandable to

contribute.

Palinkas(2015)pointstotherangeofvariationsinaqualitativesamplenot

beingknownat theoutsetof the research.Thiswasnotaproblem for the

researcherinthecurrentstudysincetheprimaryapproachtoanalysiswas

inductive (bottomup),meaning that itwas ledby the informationderived

fromparticipants.Althoughtheresearchanalysisstagewouldinvolvesome

topdownapplicationof theory from the literature review, the selectionof

participants did not use the ‘Theory based’ purposeful sampling method

(Patton 2002). Nothing had specifically to be known at the time of

recruitmentaboutthepreviouslivesandthepersonalitiesofthecandidates

beyond the basic criteria. However neither could this be considered a

‘convenience sample’ (Patton 2002) that might be more randomly

opportunistic and easier to achieve. Potential candidates were questioned

carefullyandsensitivelybeforebeingacceptingorrejected,especiallywith

Non Mover cohorts where the less tangible criterion was important, the

notionofhavingthoughtaboutmovingbutultimatelydecidingtostayput.

Flyers (Appendix 3) were put on the notice board of an Age UK drop-in

centreforthoseaged50andaboveandattwoWomen’sInstituteMeetings,

where an announcement was also made as the researcher could not

personally attend. The researcher visited a number of luncheon clubs for

older people to explain the research and gain suitable candidates. Local

authority occupational health and improvement grant sections were

contacted,whereserviceuserswhohadchosenhomeadaptationsinsteadof

moving might become participants. Word of mouth resulted in 4

introductionswhereparticipantsrecommendedtheresearchtofriends,who

metthecriteria.

Stage2semi-structuredinterviewparticipantselection

Two participants were selected from each cohort, based on the Stage 1

interview data. These participants had raised issues expressed bymost of

thegroupbutnotnecessarilythattheissueswereexperiencedinthesame

62

way forall in thegroup.Nocaseswereselectedthatwereveryunusualor

extreme.However, the importanceof themoreunusual andextremecases

wasexploredwithintheoverallanalysis.Duetothelimitednumbersinthe

research, the Stage 2 participants could not be determined as typical

statisticallyintheircohorts.HoweverPatton(2012)describesatypicalcase

sampleinqualitativeresearchas“todescribeandillustratewhatistypicalto

those unfamiliarwith the setting, not tomake generalised statements about

the experiences of all participants”. The cases selected were suited for the

qualitativenatureoftheresearchusingThematicAnalysisdiscussedinsecn.

5.9.1here(BraunandClarke2013).Thisdiscussionaimstoidentifythemes

andpatternsratherthantospecificallyquantifyoutcomes.

Recruitmentissuesandoveralltimetakenforfieldwork

(Ethicalconsiderationsaredetailedinsecn.5.12)

Recruitment took over 18months,meaning the last data collectionwas 5

monthsafterthat,totallingnearly2yearsforfieldwork.Thehousingmarket

determinedhowquicklypeoplecouldsellandmovetoretirementhousing.

Despitemanyvacanciesatthebeginning,thepropertieswerenotbeingsold

very quickly.Within a year themarket changed and therewere plenty of

sales,butthevacancytocompletionperiodwhentheparticipantcouldmove

in,wasstilllengthy.

Theattritionrate

ItwasanticipatedthatdeathordeterioratinghealthcouldaffecttheTime3

interview numbers but it transpired not to be a problem; participant

numberswere stable and therewere few drop-outs. OneNonMover died

beforeTime3andonebecamecognitivelyunabletodothefollowup,having

beenperfectlyabletoparticipateatthefirstvisit.Bothwereinthe76+age

group.Theircommentswere includedbut theirTime2hair samplescores

disregarded.

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5.5Materials-Questionnairedevelopmentanduse

ThequestionnaireswerestructuredindesignatStage1,meaningtheyhad

“aspecificorderandmany,potentiallyclosedquestionswithaLikertscale,in

order tocontrol thebreadthof response ifnecessaryandattain factualdata

such as demographic data”. (Robson, 2011). Established, tried and tested

cognitiveandhealthmeasureswereused(DASSscaleSherbourne&Stewart

(1991)detailedinAppendix6)fordepression,anxietyandstress(perpara.

5.2.2anddiscussedinch7results).

5.5.1-RelocationConsiderationsMeasure(RCM)Using a structured questionnaire ensured discussion of the same topics

across all participants. A Likert scale of 1 – 5 was used. However, the

processwasqualitativeinapproach;itwascarriedoutdiscursivelyandface-

to-face at each participant’s home. Participants were encouraged to

elaborate on or explain their answers. Comments were noted down

verbatimbyhandonthequestionnairepaper.

-Seefulldetailshereat‘conductingStage1interviews’(para5.6).

–ThequestionnaireitemsareprovidedinfullatAppendix5-Thediscussionofdatamanagementstartsfrompara.5.9.2-Detailsoftheanalysisdetailsareinsections5.10and5.11Questionnaire items were compiled to identify widely used markers of

lifestyle,socialandhealthdemographics,cognitivetests,individualhousing

contexts and individual concerns or preferences that motivate or impede

relocation.

Participants were asked, where appropriate, the extent the following

items were an issue (e.g. the need for repairs may be high but not a

worry and thus overall not a ‘big issue’ or motivator to move, when

analysed).

Demographicfactualquestionswerecompletedinthefollowingorder:

Currentage,agewhenlastmovedandcommentonwhatisthoughttobethebestageformoving

64

Factors affecting cortisol measures: chronic illness and medication;

disability;acute illness;andtraumaover last1year,18months,2years. Self report for under weight, over weight or obese; hairtreatments/frequencyofwashing.

Cognitive ability tests, which were Trail A and B; semantic fluency;numberspanrecallandcomplexdrawing(Reytest)

Lifestylebehaviours–whetherdietisconsideredtobehealthy,exercisehoursperweek,sleephoursperweek;levelsofsmokingandalcoholnowandhighestinthepast,howlongceased.

Self report social status, education and employment and extent that

thisisthesameordifferentfromparents.

Detailsofthehouselivedinnow(alsobeforeforMovers)–size,type,level and number of storeys, tenure. Level of repair, Level ofmaintenance,costsassociatedwiththeseandhouseholdcosts.

Preferredsize,type,storey,ifonelevel(nostairs)

OptionsorLackofoptionsavailabletomove

Financial difficulties and financial considerations made to do with

movingandmaintainingthehome.

Functionalandmeaningfulimpedimentsandmotivators:- The items collated here represent the most used items across housing

relocationresearchandwereratedtotheextentthattheywerea‘bigissue’indecidingtomove–usingtheLikertscale(para9.2andAppendix5)

Toomanypossessionstomove;Noonetohelpme;Don’tunderstandtheprocesses; Coping with packing and moving; Garden too large orconverselymust have garden or outside space;Want one level, nostairs;Musthavegroundfloorfacilities;MusthavelesscleaningandDIY;Needcheaperbills.

Loss of confidence or status; Memories in present home; Feeling safe

and secure; Energy levels; Familiarity of surroundings; support offriends,neighbours,family,community;Socializingfacilities;

65

Transportaspects;Localshops,postoffice,bank;Safegreenspaceand

parks;Nearnesstoorretainingcurrentdoctor,healthand/orsocialservices;

Beingabletohavepets;Spareroomforvisitors;Leavinginheritancefor

the family; Level of trust in agents, solicitors, officials; Any othercomments

5.5.2RelocatingPsychometrics(RP)ThequestionnaireanddetailsofthescalestheyweretakenfromcanbeviewedinfullatAppendix6and7 As with the Relocation Considerations Measure questionnaire, the RP

questionnaire gathered free flowingnarrative thatwas collected verbatim,

within a structured but informal, face-to-face approach, where discussion

aroundthequestionnaireanswerswasencouraged(seecodingtheitemsat

para5.6).

Identifyingthe8validatedscales,suitableforresearchwitholderpeople

DetailsofthescalesfromwhichquestionnaireitemsweretakenisincludedintheAppendix7A search was made of relocation literature involving older people’s

wellbeing,feelings,attitudesandpsycho-neuroendocrinologythatmeasured

relocation effects of policy, practice and associated interventions (see lit.

reviewchapters3and4).

Thirty scales were identified that purported to measure the dimensions

considered in this research, including locus of control, self-efficacy, self-

identityandself-esteem.Nineofthesewererejectedasnotsuitableforolder

participants and twelve as not sufficiently relevant. This left 8 highly

validatedscalesforfullorpartialuse,previouslyusedspecificallywitholder

participants(Appendices6and7).

66

EightScalesrepresentingsubjective,perceptualdimensionsofthestudy:-

Table5.5.2ResearchperceptualandsubjectivedimensionitemsintheRP(Chronbach’salpha)1)Self-Efficacy

2)Support 3)LocusofControl

4)Self-Esteem

5)Health&Wellbeing

11itemsrelatingtotemporality(.73)

16itemsrelatingtomoreemotionalaspects(.87)21relatingtopracticaldifficulty(.70-.87)

9itemsrelatingtoviewsandattitudes(.87)

8itemsrelatingtoviewsandself/attitude4itemsrelatingtocontrollability(.70)

7itemseach(21)fordepression,anxietyandstress;(.81)4itemsforphysicalabilityandpain.(.87)

TOTAL94itemsHarmonisationwithotherresearchThe selected scales have been used in qualitative and quantitative studies

witholderparticipants.ForexampletheOPQoL(Appendix7)hasbeenused

inmajor longitudinal studies. This includes since 1999 in epidemiological

social studiesby the InternationalLongevityCentre(UCL -more than1000

subjectsaged65+).

Satisfactionfeedbackquestionnaires

At the final appointment (Time 3) after the questionnaires had been

completed, all participants were asked about their satisfaction with

relocation advice. Participantswere also asked about the information and

supporttheyreceivedorthoughtwasavailable,whoprovideditandatwhat

stage. Suggestions for improvement to policy and services were

incorporatedintherecommendations(chapter8)

5.5.3Pilotingthequestionnaires.

Twoofthethreevolunteersinthepilotwereslightlyyoungerthanthethird,

aged 60, who was a former social worker for older people. Cognitive

dissonance and social desirability aspectswere considered (see also secn.

67

5.7.2 below). This indicated that the Relocating Psychometrics (RP)

questionnaire should be used after theRelocationConsiderationsMeasure

questionnaire,toestablishthehigherlevelofrapportneededfortheRP.Also

bothshouldbecompletedonthesamedayifpossible,inordertomaintain

continuitygiventhenatureofthequestions(thishappenedinpractice,but

theoptiontocompletethemovertwovisitswasalwaysgiven).

5.6ConductingtheStage1interviewswithRCM&RPquestionnaires

Following the informed consent stage of the process (see secn. 5.12), at

Stage 1 the interview process was informal, carried out face-to-face in

participants’ own homes and discursive in nature. This resulted in large

amountsofqualitativeinformationfromparticipants.Answerswerewritten

downverbatimonthequestionnaireforms.

Questions merged in a way normally seen in semi-structured interviews

(Robson2011,p285anddefinedinpara5.7thatfollows).Theparticipants’

contributionwasnot restricted and theywere actively encouraged to give

reasonsfortheiranswersandtodiscusstheimpactonthem,eveninrespect

of functional items, for example the level of disrepair. For instance asking

aboutthenumberofhoursspentoutsidethehousewouldleadnaturallytoa

discussion about the local area and changes relating to safety, physical

health and neighbours, which were also due to be asked later in the

questionnaire. Thus the order of asking questions was not adhered to.

Questionsaboutdietledtodiscussionsaboutchangesinday-to-day“cooking

for one” following bereavement, to discussions of loneliness or isolation

from local facilities, the cost of food, neighbourhood friendliness and so

forth.

The conversations revealed emotional aspects ofmoving such as loss and

changes in personal identity, for example when completing items for

depression, anxiety, stress, self-esteem, restrictive health, emotional and

practical support. One particular aspect the researcher noted was that

participants oftenmade observations about the experience of others who

they knew or knew of, rather than their own direct experience. This was

68

prominentwhendecisionsthatacquaintanceshadmadeturnedouttobea

mistakeandthuswereexperiencedasawarningagainstthataction.

RP questionnaire retrospective health items – depression, anxiety, and stress(DASSscale)

(Chronic stress hair cortisol concentration (HCC)method and protocols iscoveredinfullatpara5.8)Theexperienceofmovinghomeandsettlingin,alternativelyofstayingput

might be affected by the potential for emotional and physical strain in

relocation(researchpara5.01).Thepurposeofthebiomarker(haircortisol

concentration)wastolookatactualcortisolreactionsonanindividualbasis

andtointerpretthesebiologicalreactionsinthelightofqualitativedata(and

as it transpired thequalitativeperceptionsof stress in the lightof cortisol

findings).Cortisol is theso-called ‘stresshormone’ (seechapter4).Results

andinterpretationarereportedinChapter7.

The DASS scale items (App 7) were covered at the last stage of the RP

questionnaire, which followed the RCM questionnaire, ensuring the DASS

itemswere the last to be covered at both interviewTimes (Times 2& 3).

Therefore a high level of rapport hadbeenbuilt upduring the one to two

hour interviews. The questions were first asked retrospectively. This was

intended to reflect participant feelings 5 months before the move (time

matchedforNonMovers).Topreparethem,participantswerefirstaskedif

theycouldremembereventsof5monthsagoandtheresearcheraskedthem

tothinkaboutwhatwashappeninginthenewsandtheirlivesatthattime.

After considering the questions retrospectively, they were then asked the

same questions as they applied in the present time. Thus at Time 2 the

retrospective questions related to Time 1. These were the only items in

eitherquestionnairetospecificallycoverTime1,althoughtherewasplenty

of general discussion about decision-making that would have taken place

somemonthsandyearsearlier, includingforMovers,criticallyat5months

before. Nearly all of the Stage 2 semi-structured interviews were

retrospective,reflectivequestions.

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5.7DevelopmentandpurposeofStage2semi-structuredinterviews.

Semi-structured interviews containmostly prepared questions that can be

supplementedwithadditionalquestions.Theinterviewercanusearangeof

interviewing techniques in order to produce richer qualitative data,

Importantly “the interviewer does not have to follow the sequence on the

schedule, nor does every question have to be asked, or asked in exactly the

samewayofeachparticipant”(Smith2012pp62–65).

The purpose was to set aside sufficient time to better understand the

thinking, emotions and experience behind participants’ beliefs within a

dialogue framework. Smith (2009 p62) refers to entering “as far as is

possible,thepsychologicalandsocialworld”oftherespondent.Thisincludes

observingtheimpactoftheinterviewontheparticipant,acceptingthatthe

participantisthe‘experientialexpert’,ratherthantheresearcher.

QuestionnairesatStage1werebasedonpriorexperienceoftheresearcher

andprevious studies thatwouldbemost likely toprovide theparticipants

functionalandmeaningfulrelocationexperience.ThefindingsfromStage1

interviews informed the design of Stage 2 interviews (Table 5.2.3), thus

ensuringthecontinuityoffranklyexpressedattitudesandbeliefs.

InterviewSchedule–planningandfocus

Thestartingpointtoconstructingpotentialquestionsfortheinterviewwas

the interview schedule (Table 5.7A). The researcher asked ‘how will the

interview help to answer my research question?’ (Braun and Clarke 2013

p81).

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Table5.7AInitialInterviewSchedule–basedonformatSmith(2013p59)

Questionsinsemi-structuredinterviewsshouldbeeithertotallyopenended

or,asinthiscase(Table5.7B),bedesignedtofocusthediscussiontosome

extent.This isreferredtoas ‘controlledreflection’ (Smithetal2012p188;

189)giventhat“implicitintheformationofaquestionisanassumptionabout

whatthedatacantellus”.Inthiscase,ultimatelywhethermovingorstaying

putwasagoodorabadoutcome foreachparticipantandhowtheymade

theirdecision.

Question 1 (Table 5.7B) required an initial definite response, as could

questions6,7,and8tosomeextent.Participantswererequiredtoaffirmor

reject a suggestion at the outset and then the researcher and participant

explored reasons for theanswer toelicitwhether the initial responseheld

firm. The most immediate answer to a closed question can be the most

revealingifaskedface-to-facebecausetheresearchercangaugethestrength

behindit.Ifitseemsweakorstrong,theparticipantmightfeelobliged,orbe

encouragedtoqualifythat.Question1requiredaninitialdefiniteresponse,

ascouldquestions6,7,and8tosomeextent.

1)Goal/planning–questions1to4

-satisfactionwithdecision/s

-personalefficacy

-supportfromothers

-dependencyFocuson:feelings,wellbeingandhealth

2)Influencesfrompastexperienceandthatofothers–question5

-relocationexperienceanddecisionsFocuson:values,attitudes

3)HowAgeaffectsdecisions-questions6to8,(mostsensitiveareas)

-satisfactionwithpresentsituation

-controllabilityofdecisions

-regrets

-lossFocuson:temporality,choiceandhealth

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Thequestions

Table5.7BSemi-structuredinterviewquestionsThe questionswere asked ofMovers in both age groups. The questions inbrackets were asked of Non-movers in both age groups, worded slightlydifferentlytoallowforcontext:-

Q1.‘Doyouseethemove(stayingput)aspositiveoverall?’

Followedwithdiscussionsaskingforreasonsbehindayesornoanswer

Q2.a.Whatoptionsdidyouconsider?(a.Whatoptionsdidyouconsider

aboutmovingagainsttheissuesyoumighthavebystayingput?)

b.Whydidyouchoosetheoneyoudid?(b.Didyoueverthinkthere

mightbeissuesifyoustayedput?)Typicalprompt,‘tellmeaboutthose’.

Q3.a.Didyouhaveagoalandworktowardsitinordertomoveordidit

happendifferently?(Didyoumakeaconsciousdecisionandhaveaplan

foryourfutureorworktowardsmakinganyarrangements?)Typical

promptforyesorno=tellmewhythatwas/howthatworked?

b.Howdidyoustartgoingaboutit?(Howdidyoustart/areyougoingto

startgoingaboutit?)Prompt:E.g.careinthehome,adaptations.

Q4.a.Towhatextentwereyoudependentonothers?

b.Couldyouhavemanageditalone?(Couldyouhavemanagedtoremain

herewithoutsupport?)

Q5.Weretherethingsyouwouldhavepreferredtohavebeendifferentif

startingagaininrespectofthefollowing……

a.…thinkingbackoveryourhousingmovesanddecisions?

b.…thinkingabouttherecentmove?(mostrecentdecisiontostayput?)

Q6.Withwhatyouknownow,whatwouldyousaywouldhavebeen(or

willbe)thebestageformovingforyou?

Q7.Areyouplanningaheadnow?

Q8.Doyouseeyourselfbeingabletolivehereforever?

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The researcher when working with clients in counselling therapy, where

depth and honest insight is important, was experienced in this technique

(RationalEmotionalBehaviouralTherapy,(REBT),AlbertEllis(1957,1973).

Inpractice,participantstendedtoelaboratebeforebeingaskedtodosoand

theconversationflowednaturally.Theimportanceoftheinterviewer’srole

willnowbeexplainedfurther.

5.7.2Conductingthesemi-structuredinterviews

SelectionofparticipantsforStage2wasexplainedatpara5.4

Roleoftheresearcher

Rapport had been established at Stage 1with the participants selected to

takepart,whenquestionnaires tooknearly twohours.Thiswashelpful as

participantsreadilyagreedtoStage2,whereinterviewsalsotookanhouror

more. The interviews were recorded (see para 5.11.2 below, heading

‘Familiarisation’).The researcherwasentrustedwithpersonal information

andthebiographicalbackgroundsthatunderpinneddecisionsandattitudes.

Potter and Hepburn (2005) refer to questions being “aimed at creating a

dialogue, that is modified in the light of responses and probing where

interestingandimportantareasarise.”Notably in this research,elaboration

on family and sociopolitical factors considerably added to findings from

Stage1aboutwhatOswald(2004),intermsofenvironmentalfit,wouldsee

as“social,physicalandautobiographicalinsidedness”.

Houtkoop-Steenstra (2000) suggests guarding against assuming responses

that are “unmediated expressions of respondents real opinions”. Therewere

instanceswherearesponseseemedtobeslightlyguarded,unclearorfeltto

theresearchertobelongestablished,potentialrhetoric.Thisledtofurther

gentle prompting and reassurance by the researcher, to put individuals at

theireaseinordertogainmutualunderstandingoftherealityoftheirlatent

experience, so faras theparticipantsperceived itThis isdiscussed further

belowinrelationtocognitivedissonanceandsocialdesirabilityeffects.

Impartialityandbiasaffectinganswers

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Total impartiality is impossible in qualitative research: for example itwas

implicit in the researchers view that the research,whichwas subject to a

premiseandproposition(para5.0.1),wasnecessary.Theresearcherhashad

to retain anopenmindandbe true to thepointof qualitative research, to

“examine from all angles and discover answers that have not necessarily

becomeavailablethroughotherresearch”(Smith,2009).

The researcher has been what Lincoln (1991) would describe as the

‘passionate participant’, with experience in social policy and practice,

organisationalandcounsellingpsychology,whichwasrelevantandactivein

the design, the use of materials, the fieldwork and interpretation. This is

particularly important when looking at retrospective feelings and events

wherethereisthepotentialtobiasordistortionbysimplyfillingingapsin

memory.Usingrepeatedface-to-facestagesallowedtheparticipants’views

and researcher’s interpretation to be revisited together to gain mutual

understanding. The challenge was to gain insight without influencing the

meaningofanswerswhenobtainingorreportingthedata.Oncethethemes

were developed the professional and theoretical knowledge of the

researcherwasimportantforfurtherinterpretation

CognitiveEffect(Festinger&Carlsmith1959)

Thiswas thought tobe apotential issue at questionnairepilot stage (para

5.5.3);becauseastheresearchrelatestopracticaldecisionsthathavebeen

made there is apotentialneed forpeople to align theirphysical situations

with having made the right choice. Cognitive dissonance can be used to

minimise feelings of regret. Question 5 of the semi-structured, in-depth

interview(secn5.7Thequestions)wasaimedattryingtodetectthisbutitis

not necessarily a conscious reframing and sowas difficult to judge. There

wasevidencetosuggestaneffectinsomecasesandthisisbroughtoutwhen

appropriateintheThematicAnalysisinchapter6part2.

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Demandcharacteristicsandsocialdesirability

The researcherwasmindful of the need to be sensitive in order to attain

genuine answers and how to ask about matters of personal nature or

questions related to social status. For example, the Relocation

Considerations Measure (RCM) questionnaire included questions about

healthbehaviours,suchashowfrequentlyparticipantswashtheirhair.The

questionwasasked‘howmanytimeshaveyouwashedyourhairinthelast5

months?’ This usually led to a more automatic response of the weekly

amount before a calculation was made for 5 months, or in one case an

answersimplyof5(i.e.onceamonth),orinonecase1(oncein5months).

Asking for a weekly figure would have indicated that there should be a

weeklynormandcouldhaveresultedinasocialdesirabilitybiasedresponse

(Orne1962).

5.8HairCortisolConcentrationmethodandprotocols

Hair was collected in accordance with the Anglia University laboratory

requirements.Thiswasthegloballyacceptedmethod(ch4para4.11.2).The

hairwas tiedwith string near to the scalp at the vertex and snippedwith

sharp scissors as close as possible to the scalp. The top layer of hairwas

pinnedupsothatthelayerusedhadbeenlessexposedtoUVlightandthe

barepatchwherethehairwastakenwouldbelesslikelytoshow.

Thesamplewasthenfoldedintoatinfoil ‘parcel’andstoredinadry,even

room temperature location. Where possible the batch of hair taken was

roughlyhalfthediameterofapencil,atleast5cmlongand25mginweight.

Theweightofhairvariedbetweenparticipantsbecauseofthedensityofhair

available.Hair thinswithageingandsomeparticipantshadvery littlehair.

Thesematterswerenotanissueduetothedecisiontohavewithin-subject

analysis.ThesampleswerecollectedatTime2and3measuringaminimum

of 5cms to represent the 5 months prior to moving and 5 months after

moving.Adelayof2to4weeksafterthemoveandaftertheTime3,ensured

thatsufficienttimehadelapsedforthehairaffectedtogrowoutofthescalp

andnotbecontaminatedbyexogenouscortisolproducedat thehair route

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(seech4para4.10.5).TheELISAmethodusedisdetailedinchapter4para

4.11.2

5.9Quantitativedatamanagementandanalysis

5.9.1HCC–Sendingsamplesforanalysistothelaboratory

The labels on the hair sample packages were coded to identify the

participantandindicateatwhichstagethehairwastaken(Time2or3).The

codeswere entered on to formsprovided byAngliaUniversity laboratory.

The researcher provided instructions about how the findings should be

recorded.Themostimportantaspectswerethattheamountofhairanalysed

shouldbe5cmsfromthecutedgetorepresenttheprevious5monthsandbe

ofequalweightforbothsamplesperparticipant.Thelaboratoryrequireda

formal statement fromtheWestminsterUniversityDirectorofStudiesalso

required an example of the consent form to confirm informed participant

consenthadbeengivenandthatthepurposeoftheresearchmetacademic

ethical,legalandlaboratorycodeofpracticerequirements.Thelongesttime

asamplewasstoredwas24months.

5.9.2Interviewdata-QuestionnairesscoringconsistencyTheRelocationConsiderationsMeasure(RCM)TheRCM,detailed inpara5.5.1and itemised inAppendix5asksquestions

using a five point Likert scale for answers about demographics, lifestyle

choices,housingneedsandrelocationpreferences.ThisdiffersfromtheRP

thatseeksaresponsetostatementsfromnegativetofavourablejudgements

inrespectofstatementsratherthanquestions.

RCM examples of questions with potential responses are as follows:

unconcerned/fairly unconcerned/neither concerned or unconcerned/fairly

concerned/veryconcernedOverallhowsatisfiedareyouwiththestateofrepair?Notabigissue12345IsabigissueOveralltowhatextentdoesdisrepairbotheryou?Notabigissue12345Isabigissue

-whereahigherscoreindicatesthemostnegativeanswer.

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RelocatingPsychometricsQuestionnaire(RP)TheRPisdiscussedin5.5.2aboveanditemisedinAppendix6.Itemsbrought

together from a range of scales into one questionnaire required a uniform

Likertscaletomirrordifferingpresentationsintheoriginalscales.

The STPI, Family Mosaic Survey and SPS, (detailed in appendix 6), use a

Likertscale:Veryunlikeme/fairlyunlikeme/neitherlikeorunlikeme/fairly

likeme/verylikeme.

TheOPQoL,PWBPTCQ,MOS-SSS(detailedinappendix6)useaLikertscale:

1. ‘Strongly disagree’ through to 5. ‘Strongly agree’. Both scales were

consistentwiththeRP,whichusesstatementsratherthanquestions:

RP item example: Disagree/disagree somewhat/neither agree or disagree/agreesomewhat/Agree

IhavesomeonetohelpmeifIamconfinedtobedDisagree12345agreeIhavebeenfeelingpartofmycommunityDisagree12345agree

In contrast to the scoring of the RCM above, selecting a high score (i.e. 5)

indicates the most positive answer with negatively phrased questions

reversescoredaftercompletion.

5.10StatisticalmethodsandanalysisThe quantitative data were, as previously stated, gathered in order to

providedemographicsandothercontextualbackgroundandtosupplement

the qualitative data where links were identified (relating to primarily

psychosocialexperienceandperceptionsofhealthoutcomes).Thedatawere

entered initially on an excel database in columns headed up using all

questionnaire items from both the Relocation Considerations Measure

(RCM)andRelocationPsychometric (RP)questionnaires (secn. 5.6 above).

Stage 1 questionnaires. For analysis these were then transferred to SPSS

statisticalanalysissoftware.

77

QuestionnairesLikertscaledata

Thisresearchutilisedanestablishednon-parametricdatamanagementand

analysismethodfromorganisationalstresspsychology(Coxetal.,2005).It

was appropriate because it was specifically designed to differentiate the

mainissuesfromaplethoraofperipheralandlessimportantonesinperson-

environment contexts. These researchers coined the phrase ‘big issues’ to

indicateitemswheremorethanhalfoftheparticipantsscoredthemtobea

problemof 4 or 5 on a Likert scale. Themethod involved removing items

scoring less than4or5 for50%ofparticipants.TypicallyCoxetal (2005)

linked the subsequently emerging ‘big issues’ with qualitative, contextual

evidencecollectedininterviewsfromparticipantstointerpretthelikelihood

(usingchisquaredstatistics)ofparticipants‘feelingill’orwantingto‘leave

their employment’. Notably those two factors would be replaced in the

currentresearchwiththefactors‘wantingtomove’or‘wantingtostayput’

and no chi-squared analysis of likelihood was undertaken. The current

researchalsodiffers in that the level set for indicatingan itemtobea ‘big

issue’washigher at 75%ofparticipants saying itwas a concern.This is a

useful speculative, rather than inferential approach to look at potentially

relatedfactorsandcan’tbesaidtoindicatelikelihoodinthecurrentresearch

duetosmallerparticipantnumbers.

Qmethodologywasusedinthecurrentresearch,tolookatthedistribution

ofanswerslinkedto‘movinghome’or‘healthandwellbeing’.Qmethodology

(Coogan andHerrington 2011) is a basic visualmethod of laying out data

fromasmallnumberofparticipantstoindicatethedistributionofstrength

offeelingamongparticipantsforanyitem.Thequestionnaireitemnumberis

enteredunderapercentageheadingaccordingtothenumberofparticipants

whobyscoringitasa4or5,thushadgaugedittobeabigissue.

Table5.10givesanexampleofQmethodology,usedtoseparatedatainthis

research to indicate ‘big issues’ requiring further understanding through

discussionandqualitativeanalysiswithparticipants.

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Table5.10ExampleofQmethodology–GroupBquestionsscoring

4or5=‘bigissues’

Fromthisexampleitcanbeseenthatofthe15questionsfromthissection,

there were six items where 75% of the participants scored the issue as

beingabigissue:Thefirstfourcolumnswereitems8,14,2,9,10&11:being

housed on one level, affording bills, being less isolated, having fewer

repairs,loweramountsofcleaningandreducedcosts.Thusthecolumnsup

to 75% contain issues thatwere themost likely to be only peripheral or

contributorymotivationalsatisfiers (Herzberg1959ch.3para3.5.2). This

process was carried out for all items, grouped according to areas they

relatedto(summarisedinAppendices5&6).

Forcognitive,HCCandotherhealthmeasuresThebatteryofcognitivetests,andthedepression,anxietyandstressresults,

includedwithin theStage1questionnaireswereseparatelyanalysedusing

non-parametricstatisticssuitableforstudieswithlessthan100participants

(Glover and Dixon, 2004). Again, the number of participants in this study

wasinsufficientforclearinferentialclaimsaboutthedirecteffectsonhealth.

The data were used if they supported qualitative interpretation using

biographicalandcontextualdata.Thefindings,alongwiththeHCCbiodata,

are reported and discussed further in chapter 7 and the final discussion

chapter8.

0–50%(1 to 20people)

51-59%(none)

60+%(23people)

75+%(29people)

80+%(31people)

90+%(53people)

100%(39people)

6 1 8 2 117 3 14 9 12 4 10 13 5

KeytoRelocationConsiderationsMeasurequestionnaireitemsrelatingtothefollowingpropertyitems:1Garden/outsidespace2Lessisolated3SmallerGdn4Outsidespace5SharedGardeacceptable6Balconyonlyacceptable7Mustbesmaller8Mustbeonelevel9Fewerrepairs10Lowercleaning11Reducedcosts12Leasecostok13Billsnottoohigh14Affordbills

79

5.11Managementandanalysisofthequalitativedata5.11.1ThematicAnalysis(TA)andwhythismethodwaschosenThematicAnalysiswasusedtoanalysethenarrativeinformationfromboth

Stage 1 and Stage 2 interviews. It is defined by Braun and Clarke (2013

p174) as “amethod of identifying themes and patterns ofmeaning across a

dataset inrelationtoaresearchquestion” . In the current study thiswould

mean attempting to determine how the three stages of relocation were

experiencedforolderunder-occupiers,withafocusontheirwellbeing.The

methodwaschosenbecauseitallowsfortheoreticalflexibility.Itallowedthe

researchertomakeuseofacontextualistmethod,suitedtothesubjectbeing

studied, which sits between realist and constructionist approaches.

Qualitative information fromboth interviewstagesand thesemi-strucured

interviewswasbroughttogetherandinterpretedinconjunctionwitharange

of descriptive and nomothetic data. Braun and Clarke (2015) point to the

lack of appreciation of the sophistication of themethod but state that the

method is particularly suited tohealth andwellbeing research.Theypoint

outtheneedforanapproachthatisaccessibletopractitionersbutdoesnot

mean it will lack academic rigour provided the work is thorough and

reflexive,withclearargumentsfortheinterpretation.

To be effective the process necessitates thorough familiarity with the

informationandtheparticipants’circumstancessothatpatternsandthemes

canbe found anddeveloped. This involves a specific process of six stages.

Theyarenot strictly sequential as the informationevolved throughout the

collection of information and is iterative in nature, reading and rereading,

definingandredefining,searchingforpatterns,reviewing,naming,renaming

andimprovingdefinitionstodeterminewhetherthereis“anexplanatoryfit

withthenarrativeandotherevidence”(BraunandClarke2014).

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5.11.2 Familiarisation – consistent with process stages 1 and 2 of

ThematicAnalysis

Transcriptionoftheinterviews

TheinterviewswererecordedusingaPhilipsPocketMemo381Dictaphone

with cassette tapes. Theywere subsequently transcribed verbatim, by the

researcher indicating gaps and gestures e.g. ‘shrugs shoulders’, ‘laughs’,

‘smiles’. Data has been kept securely on the researchers pass-worded

computer and USB flash drive (‘memory stick’) to conform to the consent

provisions (para 5.12 to follow and and App. 4). Details captured in the

interview thatmight identifyparticipantswerenotused for theprofiles in

anypartoftheresearchdocuments,norwilltheybeinsubsequentpapers.

Contextualcircumstancesandviewswerereferredtoingeneraltermswhen

viewed by anyone other than the researcher. However, in more than one

situation,thecumulativeeffectofdetailsprovidedindifferentsectionsofthe

thesiscouldresult in identifyingparticipants if inthepublicdomain,andif

those reading thedetailswereaware the individualhad takenpart. Inone

example, a blind participant’s family defrauded her and moved her many

milesfromherhome.Thestorywasimportantinthatextremecaseandthe

participantwasaskedifshewaspreparedtopotentiallybeidentifiable.She

agreedreadilyinthepresenceofatrustedrelative.

Organisingthedata,readingandrereading

Thefieldworkfollowedasetprocessthatwasadheredtobytheresearcher

(Appendix 8) to ensure interviews were set up correctly, second visits

diarised and data collated in different ways to facilitate the Thematic

Analysisstages.

Firstly the interview narrativewas organised verbatim directly after each

interview.At stage1. quotes from thequestionnaire structured interviews

were loaded at both Times 2 & 3 onto four separate (1 per cohort) excel

spreadsheets, on two rows under columns using the code headings

(Appendix 9). Thus quotes fromTime3 could be seenunderneathTime2

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quotesonthesamespreadsheet.Newcodeshadtobeaddedasinformation

wascollected–seethenextsection.

The quotes were attributed on the spreadsheet using the participant’s

individualnumberinbracketsafteraquotefromtheme.g.(1)to(11)forthe

elevenmembersofMovergroupA.(1)to(12)forMoversgroupBetc.The

quotesfromtheStage2semi-structuredinterviewswerealsonotedonthe

secondrowbutinadifferentcolourtodifferentiatethem.

Abiographical informationtablecontainingquotesandbackgroundstories

from each participant was completed after each home visit (example

appendix 10). The biographicalmaterial for events in period A and B and

also,asittranspired,priortoperiodAwerevitalforThematicAnalysisand

laterinthewithin-participantanalysisofhaircortisolconcentration.

Recording the data and text in different ways (Appendix 8) assisted in

furtherfamiliarisationandensurednothingwasoverlooked.

5.11.3Preliminarycodingandadditionalcodingofthedata

Consistentwithprocessstages3and4ofTA

From initial observation and reading of the transcripts, key points were

identifiedrelatingtocurrentperson-environmentfit,relocationhistoryand

viewsonrelocation.Thesetogetherwiththeresearcher’spriorpractitioner

experience,resultedinalistofrelativelyobvious‘semantic’prioricodes,of

initially 12 headings that expanded to over 50 (Appendix 9). For example

simply gathering data in respect of packing andmoving resulted in a rich

arrayofcomments,somepositiveandsomenegativeinrespectofthelevel

ofemotionalsupport,tangiblesupport,independence,guilt,feelingaburden

to family, self-efficacy (bothphysical andmental ability), achievement and

pride, planning and age, emotional attachment to cherished items and

memories. These are indicated in the following small selection, most of

whichwereincludedundermorethanoneheading.

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Table5.11.3Preliminarycodingforpossessions/de-cluttering

Participants’quotes PotentialCodeIfeltguiltysellingmyhusbandsantiques

Respectingmemoryofdeceasedhusband.Guiltatdoingsomethinghewouldn’thavewantedPossessionsholdemotionalmemories

Iwasgraduallyde-clutteringthewholetimemyhusbandwasillinthecarehome

De-clutteringisalengthyprocessPlanning

Ididitallmyself,IguessI’mnotsentimental

SenseofachievementNotaffectedemotionallyaboutpossessions.Autonomy

Ican’texpecttoomuchhelp,don’tliketobeaburden(onthefamily)

NoexpectationoffamilyAwareoffamilypressuresIndependenceisimportant

Icouldn’tmovenow,I’vebeenhere49yearsyouaccumulatealot.HowcouldI,howcouldanyofus?

DealingwithamountofpossessionswhenrelocatingisoverwhelmingAssistancemaynotbesufficient

Movebefore75,afterthatyouhaven’tgottheenergy.Ittookaweektoclearoutonecupboard.

De-cluttering,packingandmovingiseffortfulEnergyandtimearerequiredrelativetoage

IfounditdifficulttothrowoutrecordsofworkI’dbeeninvolvedwithandprojects

AttachmenttopastachievementIsproudofhowsheusedtobe/status&selfIDPreviouslifeisimportantLoss-possessionsareimportanttoselfidentityandsenseofpurpose

These examples are all from different participants taken and fed into sub

coding (Appendix9).Theyareoutof contextand tell thewholestoryonly

when themed. For example no participant achieved amove physically by

themselves but expressed they had done it “all themselves” if they had

autonomy overmoving, the location and de-cluttering. This is reflected in

Overarching Theme 2, Personal Independence and Autonomy (ch6 Table

6.2.0)anditssubthemes.

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5.11.4Groupingcodes,developingthemes,reviewingandnamingthem

ConsistentwithThematicAnalysisstage5.

AlltranscriptswereenteredonNVIVO(narrativeanalysissystemAppendix

11) to further aid the process of defining, redefining and grouping nodes

(NVIVO term for codes). For example the frequency ofwords that express

particularemotionsorsimilareventscaneasilybefoundusingthatsystem.

However, frequency of mention itself does not necessarily indicate

importance or contribution to a pattern. Another example of the theme

development process is provided at Appendix 12 (starting with ‘parent

nodes’).

“Developing themes fromcodeddata isanactiveprocess” (Braun and Clarke

2013).Codes,havinginitiallybeenformedonwhatmightbeexpectedorhad

been found, were deleted altered or added throughout as necessary and

groupedtoexaminepatterns.Codesofparticular interestcouldbecommon

toallgroups,orunpopulatedforoneormorecohortgroups,thustherewere

matters that generateddiscussion and strongviewsor converselyno view.

These,despitebeingdifferentbetweengroups,evolvedaspatternsthatcould

be grouped under a superordinate overarching theme with sub themes to

alsohighlightdifferenceswithinthetheme.

Evidenceof themes,differedbetween thosewhohaddecided tomoveand

thosewhohadnot.Somecodes,however,didnotneatlyparticularlyapplyto

any cohort group and so the interpretation was assisted by a thematic

mapping exercise (fig.8.1 in ch8 discussion). This led, for example, to the

unexpectedfindingthatageperse,whilstrelevant,wasnotakeyinfluence

ondecisionstomove.

As mentioned, quotes could be included under more than one code, for

example‘notfeelingpartofthecommunity’and‘feelinglonely’.Thesewere

often connected in the interview narrative, indicating underlying latent

themesbeingdevelopedfromwithinthenarrative.

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The complexity of links required using one cohesive ‘organising concept’

underwhichtoorganise‘candidatethemes’(BraunandClarke2013p226to

227). As such, it was necessary to have sub themes for each of the

overarching themes in order to reflect the complex nature of the social

interactions.

Intheexamplegiven,theresearcherlookedforindicatorsofhowoftenthey

appliedtogetherorseparately,whatwasthemostdominantviewwas,also

in what way did they co occur with codes such as family, socialising,

facilities, friends and neighbours. This resulted in Overarching theme 3,

LocalCommunity;NeedsandSocial Identity– (ch6.2 table6.2.0),because

clearly communitieswere perceived as becoming less friendly. In addition

the importance of social identity to participants was evident. This was a

sense of belonging, dependent on facilities and good neighbours and non-

familialcontactinrespectofsettlinginafteramove.Lonelinesspersewas

distinctlymorepersonal anddependenton companionship (includingpets

asaspecialcase)andonetoonesocialinteraction.

5.11.5Reportingthefindings–FinalThematicAnalysisstage

Athematicmap “offersamodetovisuallyexploreandrefinetheconnections

between [these] elements” (Braun and Clarke 2013 p232) Visual mapping

helped in this study to identify two discreet sets of characteristics and

pathwaysinthedecision-makingofparticipantswhomovedandthosewho

stayedput.Theprocesshelpedexplainfindings.Thusthevisualmappingin

thisstudyisreproducedandexplainedinthediscussionsection(ch8Table

8.1B).

Chapter 6 Part 2, provides a table of overarching themes and sub themes.

Sub themesmight include aspects of more importance to one group than

anotherorfordifferentreasons. Thechaptercontinueswithexamplesand

interpretation of the qualitative material focusing on differences,

commonalityandstrengthofinfluencebetweensemanticandlatentaspects.

FinalConclusionsandrecommendationsarepresentedinchapter8.

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5.12ResearchGovernanceEthicalconsiderationsandapproval

Giventhevulnerabilityoftheseparticipants,goodresearchgovernancewas

adhered to throughout. The participants were potentially vulnerable by

virtueofage,illnessanddisabilityandbecausetheywerelivingalone.Itwas

agreed by the supervisory team that should extreme scores (high stress

levels) be found from the hair cortisol concentration assays, individuals

wouldbeadvised so they coulddiscuss thesewith theirGP. Full details of

howtheparticipantswouldbeidentifiedandapproached,theformalitiesin

theprocess,theface-to-facemeetingsandhaircollection,wereprovidedto

the University of Westminster Ethical Committee, prior to the start of

fieldwork. This was to comply with the University Code of Practice,

governing the ethical conduct of investigations, research and experiments.

Ethicalapprovalwasgiven,whichallowedforthecollectionofhairanddue

considerationofhealthandsafetyissues,includinginsurancecoverbecause

oftherisksassociatedwithloneresearcheronoff-sitevisits.

InformedconsentAcopyof theconsentand information form(Appendix4)wasprovided to

participants and signed jointly by each participant and the researcher.

Information given on the form was also given verbally. Participants were

advised that theycouldstop the interviewatanypointwithoutneeding to

giveareasonandcouldrefusetotakepartinthefollowup.Theywerealso

advisedthesessionswouldbequitelongandcouldbecompletedovermore

than one visit (in practice all sessions were completed on the same day).

They were advised of measures taken to ensure confidentiality, data and

identity protection (described in transcription of interviews (para 5.9.1).

Participants were given the opportunity to opt out of providing a hair

samplewhen signing the consent form, atwhich point the paragraph that

explained the purpose could be crossed through in pen. In practice two

participants refused, one of whom did not proceed to Time 3. Two

candidatesrefusedtotakepartinthecognitivetestsatTime3becausethey

86

foundthem‘awful’(difficult)andhadonlyagreedtothefollowupvisitifthe

testswereexcluded.

Confidentialityandsecurity

All information was anonomysed and password protected on the

researcher’spersonalcomputerandwhennecessaryapasswordprotected

USB. Information that could identify the participant from the quotes or

transcriptswas removed including any references to names and locations.

Allpapers relating to the studywerekept ina lockedcabinetwhennot in

use.Furtherdetailsarehereintranscriptionoftheinterviews(para.5.11.2)

Authorpermissionsforquestionnairescaleitems

Permissions were requested and gained where necessary; most authors

indicated their scaleswere available for academic use provided theywere

correctlyusedandcited(Appendix7).

5.13Methodssummaryandfollowingchapters

Insummarythemethodwasdesignedtoachieveaqualitativeexamination

ofrelocationdecision-makingasaprocess for thosewhomovedandthose

whodidnot,asexperiencedoverthethreecriticalstagesofdecision-making,

moving, settling-in (timematched forNonMovers).Theseareproposed to

be the process stages when potential relocators subjectively consider

functional as well as meaningful matters, using perceptions of present

conditions,previousandenvisagedexperience.Alldata,includingthehealth

measures for depression, anxiety, stress, self esteem and biomarker for

chronicstressareinterpretedspeculativelyratherthaninferentially,andare

contextualised using qualitative and biographical information from the

interviewswithparticipants.

87

CHAPTER6FindingsPartOne.Participantcontexts

6.0Introduction

Thischapterhastwoparts:

Partone:Informationisprovidedaboutphysicalaspectsofaparticipant’s

homeandlocationandtheextenttowhichparticipantsfinditsuitableto

remain livingthere.The findingsarise fromthestructuredquestionnaire

interviews (Appendices 5 and 6), used at the first stage of the research,

just after relocation and repeated five months later. (ch5, secn. 5.2 and

5.6). Information from the discussions that took place around

questionnaireitemsisincludedwherethisaddsclarity.

Thefindingsaregroupedtoprovide:

• An introduction to the participants as individuals, their relocation

historyandbiographicalcontextofpossiblerelevance(Table6.1.1).

• Reasons given for moving by ‘Mover’ groups (Table 6.1.2) with a

focusonhealth,functionalityanddesign

• ‘Relocation Efficacy’ included: health, social status, education,

cognitiveability,andavailabilityofemotionalandpracticalsupport.

Parttwothatfollows,providesqualitativeinformationfromtheresearch

Stage2, thesemi-structured interviews(ch5paras5.2and5.9), together

withqualitativematerial fromStage1.ThematicAnalysisdrawsoutand

develops latent themes (Braun and Clarke 2006) from the participants’

accounts, and provides insight into themore personallymeaningful and

emotionalaspectsofrelocation.

6.1PARTONE

6.1.1Participants’currenthomesituationandrelocationcontext.

Table 6.1.1 describes the present, and for Movers also the previous,

home environments that affected their choice to move home or avoid

moving if theyhadchosennot to.The findingsprovided in thispartof

the chapter begin to illustrate the complexity of participants’ lives and

housinghistory.

88

Table6.1.1-HousingsituationandbasicrelocationcontextAllMoverswereinretirementhousingwithliftsandwereinterviewedwithin2to3weeksofmoving-in.Shaded=indicatesthesamplewhoalsotookpartinasemi-structuredinterviewatStage2GroupAMoversage60–75Averageage69Name TO:HousingSituation,currenthomeandbasicdetails

DF=disabledfacilitiesFROM:FormerhomeE=emotionalP=practical

A1Gail 1bed.firstfloor.Formerhomeofmanyyearsfollowingdivorceandthenbereavementbecamelikeaprisonwhenherhealthfailed.Shebecameoverwhelmedandfeltunabletosorthersituationoutforherself.

3bed.Highriseprivateflat.HighlevelofE&Pvoluntarysectorsupportateachstage.

A2Beatrice

1bed.groundfloor.Hasmovedseveraltimesbefore.Movedherewhenherhusbandwasinalong-termhospitalstaypriortohisdeath.Sheorganisedeverythingherself.Veryindependent,paidforsupport.

3bed.groundfloormaisonette.WouldnotacceptfamilyhelpbuthadE&paidPsupport.

A3Evie 1bed.firstfloor.Movedhere(tenant)aftertransferringownershipofherhousetohersonandnewdaughterinlaw.Theirsubsequentharassmentledtoherleaving,althoughthesonanddaughterinlawhavesincesplitup..

3bed.formersocialhousingE&Psupportfrom‘churchfamily’ratherthanherown.

A4Jill 2bed.firstfloor.Movedfromanearbyflatwithexternalstaircasewhenherhusbanddiedandshelostconfidence.Daughterandsoninlawpurchasedthisflatasaninvestmentandshelivesrentfree.Importanttostayinsamearea.

2bed.firstfloorovershop.WelcomedextensiveE&Psupportfromfamily.

A5Laura 1bed.firstfloorDidnotwanttoleaveuntilmucholderorofnecessity.Neighbourswerenoisyandcausedproblemswithbuildingworketc.Movedtofriendsduringpurchaseinordernottolosesale.

Large3bed.house.E&Psupportfromfriends.

A6Jane 1bedgroundfloor.Movedtoclearequityreleaseshehadneededafterthesuddendeathofherhusband.Theyhadbeenintendingtoretireandmoveaway.Nowsamearea,saysmovingawaywouldhavebeenamistake.Cleareddebts,refurbished,Disabledfacilitybathroomandboughtaholidaystatichome.

3bed.housewithDFbathroomhadbeeninstalled.FullE&Psupportfromfamily.

A7Annette 1bed.secondfloor.Waspurchasingthisflatwhenhusbandwasinresidentialcarepriortohisdeathandheknew.Annettewaslookingforanewhome.Primereasonwastobeabletosocialisemoreeasilyandnotfeelisolated.Gotridofallpreviouspossessions,doesn’tfeelsheissentimentaltype.

3bed.housePaidforhelpbuthasE&Pfamilysupport.

A8Gloria 1bed.groundfloor.Familypersuadedhertomoveandsheagreesitwastherightthing.Sinceshesawitasbeingdependentonthem.Althoughincharge,shewasfrustratedatherlackofabilitytotakepartinthepackingetc.Graduallysettling-inby2ndvisit.Disabledfacilitybathroom.

3bed.housewithDisabledfacilitiesandstairlift.TotalE&Psupport.

89

GroupBMoversage76andoverAverageage86Name TO:HousingSituation,basicdetails

DF=disabledfacilitiesFROM:FormerhomeE=emotionalP=practical

B1Masie 1bed.groundfloor.Havingfallenonceathomesoonafterherhusbanddied,herdaughtersinsistedshemovetoshelteredaccommodationbutthereisnowarden,orcommunalfacilities.Shefeelsisolated,trappedandbored,nospaceforhercraftsandnodirectaccesstothegarden,akeyregret.Wantstomoveagainbutwastoldsheistoooldbydaughters,whoshesharedtheexcessmoneyfromthesale,between.DFbathroom.

3bed.housewithDFbathroomandstairlift.E&Psupport.

B2Eliza 1bed.firstfloor.Whenherhusbanddiedhersonanddaughterinlawgothertosignpaperstosellherbungalowagainstherwill(sheisblind).Shemovedtotheirs,wasabusedandnearlydied.Whenrescued,sheeventuallygotsomemoneybacktopurchasethisflat,whichisnearasisterbutmanymilesfromprevioushomewhereshewantedtoremain.Upsetanddepressed.

3bed.bungalowE&Psupportfromfamily.

B3Beryl 2bed.firstfloor.Shehadmovedmanytimeswithherhusband’sworkandthecurrentmove,evennearertoadaughterandherchurchthanpreviouslywasdescribedaswellmanaged,notstressful.

3bed.flatTotalE&Psupport.

B4Megan 2bed.firstfloor.Neverwantedtomovebutevenbeforeherhusband’sdeaththehouseandgarden(theybothloved)wasbecomingtoomuchtomaintainandafford.Stayedwithfamilyatonepointbeforecompletionbutwasde-clutteringforyears,evenbeforehusband’sdeath.Importanttobeinchargeofthemove.Theprocess/pressuresbeforeandafterwerethe‘moststressfultimeofherlife’.

3bed.house,exceptionallylargegarden.E&Psupport

B5Meral 1bed.firstfloor.Previouslymovedmanytimeswithhusband’sworkandreliedonhimforallhouse-holdpaperwork.Wantedtostay-about100milesfromLondon.Neededtomoveneardaughterorintoresidentialcare.Foundtheprocessoverwhelming,highlystressful.Untilrecentlywhenshenearlydied,hadbeenintwomindsaboutmoving.Tookalongtimetosettle.DFbathroom.

2bed.Bungalow–retirementsite.

B6Stephanie

2bed.groundfloor.Whenhusbanddied,shecouldnotmanage,couldaffordtomovewithoutsellingsoonerthanfacede-cluttering.Hadpossessionsfromde-clutteringafterdeathsofhersandprevious2husbands’parentssoretainedthehouseaswellasmoving,eventuallygivingittohersonstosortout.

Large4bed.house(retained).E&Psupport

B7Joanna 1bed.groundfloor.Wouldhavemovedyearsago,husbandwasstronglyagainst.Moved2yearsafterhisdeathdespiteadaptations,ashousewastoobig.Took6monthsoffamilygraduallyde-clutteringwithherinchargebutunabletohelp.Fullhandholdingsupport,healthimproved,feelshappy.

3bed.housewithDFbathroomandstairlift.TotalE&Psupport.

B8Bella 1bed.groundfloor.DFbathroom.Wantedtostay.Feltshecouldhavecopedwithsupportandclosefriendneighbours.Movednearsonanddaughterwhochosetheflat.Ithasnoviewfromherwindow,akeyfeatureinlasthome.Feelsdepressed/trapped.Missesfriends,grandchildrenintheformerarea.

2bed.bungalow,DFGBathroom.

90

GroupCNon-Moversage60to75Averageage64Name NOW:HousingSituation,basicdetails

DF=disabledfacilitiesFUTURE:Viewsonmoving;E=EmotionalP=Practical

C1Amelia 3bed.house,purchased15yearsagoondivorceforselfandteenagedaughter.Feelssheshouldhavewaitedandboughtflattosuitherinoldage.Daughtermoved,can’taffordupkeep.Sheprovidesdaycareforgrandsonwithspecialneeds.

Maysellcheaplytoherdaughterandbuysheltered.HasE&Psupport

C2Lee 3bed.house.Widowed4or5yearsago.Livedhere20+years.Poorstateofdecoration,dislikeshomeandassociationswithformerpartner,overwhelmed,self-describedlowself-esteem.Hasformedabusysociallife,needstostaylocally,stateslackofcompanionshipsinceleavingwork.Carerjointlyforparents–regularvisitsofmorethan60miles.Childrenlocal.Self-assessed‘hoarder’

Hopestomoveinnext10years.Dependsonmarket,children’srelocation&carerresponsibilities.HasE&Psupport.

C3Jackie

2bed.groundfloorflatinblockof4.Formersocialhousingwithanexpensivelease.Doesnotfeelsafeasmostneighboursmovedandnewonesweremainlytransienttenantsofthosewhoformerlyowned;theydon’ttalk.DFbathroom.Gardenis‘massive’andaproblemtomaintain.

Wouldliketomove,stayneartolocalfriendandroutine.Can’taffordto.Limitedpracticalsupport.

C4Lisa 3bed.formersocialhousing.MovedfrominnerLondonwhenchildrenwereyoung;theyandgrandchildrenstillnearby.Installingraisedbedsingarden-osteoarthritis,DFbathroom/stairlift.Goodrepair,familymutuallysupportiveandhelpwithmaintenance.Veryactiveinthecommunity,babysits,grandchildstays.

Hopestostayput.Mayrentshelteredandlethercurrenthometotenants(wantsFreeSpaceifavailable).HasE&Psupport

C5Verinda 3bed.formersocialhousing.Previouslyactive.COPDnowconfinesher.Formerplanstomovebuthusbandwouldn’t.Likespresenthome,especiallylargeroomsbecauseofherbreathingdifficulties.Missesoldneighbours,andpreviouscommunity.Feels“afraid”duetochangeincommunityethnicprofile.Stairlift.Couldn’tstandsmallroomsinretirementhousing.

Healthwouldmakemovingdifficult.Couldnotcopewithsmallrooms.Daughtermayreturntosupporther.HasE&Psupport.

C6Avril 2bed.firstfloorconversioninlistedbuilding.Livedalonefor20yearssincedivorce,purchasedthisflat10yearsago.Carerfortwoparentswholivenearby.Rharthritisattributedtostress.Lovesflatbutareadeteriorated;otherresidents(sub-letsandhomelessfamilies)makelivingthereunpleasant.

Can’tmove‘untilparentsdie’.Wantedtostayputbutnowwantsbetterareasowilltake1bedroom.Muststaynearfriends.HasE&Psupport.

C7Jemma 2bed.purposebuiltmaisonette.Livedhereforover30years.Doesn’tfeeloldenoughforretirementhousingandwillworkfulltimeuntil70tobuildpension.Somehealthproblemsnotrelatedtoperson-environmentfit.Parentslivingquitenearby,andimportantinherlife.Talkedaboutdownsizing,convertingandbuyinglargeror2ndhome–uncertain.

Neverconsideredmoving,excepttoupsizetoa3bed.houseorgettinga2ndhome.HasE&Psupport.Veryunclearaboutfuture.

91

C8Sally 3bed.modernhouse.Singleformanyyears.Movedhereonretirementover8yearsagofromlargeformerfamilyhomeandhopestostayput.Tookseveralyearstode-clutter,continuestodoso.Familyatadistance;wouldn’twanttomovenearthemorbecaredforbythem.Activeinthecommunityandhasplannedrehousingsituation.

Movedaspartofaplanratherthanchoice,duetolocation&repairs.Isnowoppositeextra-careretirementhousingwheresheplanstomoveifnecessary.

C9Billie 4bed.house.Movedhereafterworkingabroadseveralyearsagoandintendstostayputindefinitely.Findshoardingpossessionscomforting,letsoutrooms.Isbuyingmorepropertyaspartofherplantoremainfinanciallyindependentifshecannolongerworkorhastodownsize.

Futureplansdonotincludemovingbutnothingisruledout.HasE&limitedPsupport.

C10Sheila 3bed.house.Movedherefromaflat.Wouldnotwanttoliveinaflatagainideally,duetonoiseissues.Worksfulltime.Hopestostayput.Hashadraisedgardenbedsinstalled.

Mightmoveifneighbourschangedandwerenotgoodorareadeteriorated.HasE&Psupport.

C11Marjorie 3bed.house.Widowed2yearsago,workingfulltime.Hadintendedtostayput.Willdountilnotworkingorcarertoparents,unlesstheywillalsomove.However,seesbeingwidowedasenoughchangeinherlife.Houseisfine,areaisbecomingalmostentirelyoneculture,whichshedoesn’tthinkisgoodinanyareaandwouldbotherherifsheweretheonlyoldoutsider.Veryunclearaboutfuture.

Ifmovedwouldwanttobeincentreof3childrenandgrand-children,iftoonear,wouldfeelaburden;converselywantsdiversityandsociallifeofLondon.HasE&Psupport.Ambiguous.

GroupDNon-Moversage76andoverAverageage84Name HousingSituation,basicdetails

DF=disablefacilitiesViewsonmoving;E=EmotionalP=Practical

D1Moira 3bed.house.Movedhereinher50’spropertyissuitable.Severelyharassedbysonwhouseshermoneyanddamagesthepropertyinanger.Depressedduetosituation,won’tconsidermoving.

Doesnotwanttomove,mayhaveto,toavoidson.RefusesE&Psupportbyotherfamilymembers.

D2Jan 2ndfloorofthreestoreyblock,withnolift.Formersocialhousingwithhighleasecostsbecausenewroofandexternaldecs.required.DFbathroom.COPDextremelyrestrictingbutgetsdowntwoflightsofstairsverygraduallyeachweek.Familyvisitandassistwithshoppingandoutingsbutsherefusesanygreaterassistance.

Highlyattachedtoarea,nearschoolshewenttoasaninfant.Seesmovingas‘givingup’diminishedroleinthefamily.HasE&Psupport.

92

D3Rowena 3bed.house.Movedhere30yearsagoonretirementwhendaughtermovedherefromsharedhousewithrelativeswhothendied.Carerscometwiceaday.Paysgardener.Daughter,soninlawandgrandsonliveverynearby.

Onlythesecondhomesincemarriage.Wouldnotmove,attachedtohome&memories.HashighlevelofE&Psupport.

D4Emily 4bed.house.Livedheremostofhermarriedlifeandrecentlywidowed.Hasonesonnearby,othersfurtherawaywhoshevisits.Familyhelpwithdecoratingandmaintenance,paysforgardenerandcleaning.Drives.

Wantedtomovebuthusbandneverdid.Nowfeelsitistoolateasnotmanyyearstolive.Fearsbeingaburden.HasE&Psupport.

D5Amy 2bed.houseRTB.Wasconvertedtothreethenbackwhenchildrenleft.DFbathroom,stairlift.Exceptionallygoodrepairincludingoriginal1960skitchenandgarden(can’tgodownstepstogarden,hasmaintaineditinhonourofhusband).Haspaidhelpwithhousework,jobs,hasgardener.Fiercelyindependent,paysforallherneedshappytoacceptcouncilhelpbutnottoburdenfamilybeyondadmin.matters.

Noquestionofmoving,can’tunderstandwhypeopledo,howeverbaditgets,orwhyneedforbiggerandbetter,alterations.HasE&Psupport.

D6Vanessa 3bed.chaletbungalow.DFbathroom,quiteadistancefromshops.Familyhelpwithrepairs.Livedheresincemarriage.Wouldmakeotherarrangementsifshecouldnotgetshopping.Recentillnessmakesherlessabletotravelforholidays(somefamilyabroad).Drives.

Wouldnotconsidermoving.Livedheresincemarriagewhenparentsgaveittoher.HasE&Psupport.

D7Violet 3bed.bungalow,movedin30yearsagowithhusbandtoretire.DFbathroom–repairsnecessarybutnotatallconcerned.Priorityisbeingnearpeople,childrentakeheroutetc.Likeothersshestatessheislonelyathome.ThinksRetirementHousingisnotnecessarilysociableorthereforetheanswer.Restrictivemobilityanddailycarers.

ConsideredmovingbuttheroomsinRetirementhousingsaidtobetoosmall.HasE&Psupport.

D8Kath 3bed.chaletbungalow,movedin40yearsagowithhusbandtoretire.DFbathroom.Carersdailyandlivesclosebyveryattentivefamily.Activeinthecommunity,gardeningandhobbies.

Wouldnotmove.Communityhasbecomeunfriendlyanddisrespectful.HasE&Psupport.

D9Alison 3bed.largehouse,DFbathroom.Homesincemarriage,husbanddiedyoung.Familyinthesameroad,othersatadistancewhoshevisits.Worriesaboutdecorationbutsomehelpfromfamily.Severeharassmentfromneighbours–councilinvolved.Feelstheyweretryingtoforceherouttoselltothem.Drives.

Hadnotconsideredmovinguntiltheharassment.Doesnotwanttomove.HasE&Psupport.

93

D10Gemima 1bed.flatself-containedbutconnectedwithinplotofthreehouses.Retiredwithhusband40yearsago.Movedhere(initiallya3bedhouse)20years,Becamefearfulofthefutureneedformoremanageablepropertyorresidentialcareandgraduallyboughtneighbouringpropertyandfundedconversionsotwodaughtersandgrandchildrencanallliveunderoneroof.Veryactiveinthecommunity,whenhealthpermits.

Insteadofmovingwhenherhealthdeterioratedshemadeitattractiveforherdaughterstomovetoherandassiststhemwithchildmindingandcooking.Thisfulfillsherneedforausefulrole.HasE&Psupport

D11Molly 3bed.house.RTB.Livedhereallofmarriedlifeandattached.Healthdeterioratedsuddenly.DFbathroomandstairlift.Feelstheareatobequitedangerousforyoungerpeople;neighboursnolongercommunicatewitheachother.Shedoesn’tfeelscared.Somedisrepair,doesn’tworryher.

Couldnotimaginemoving,hasbeenheresolongandsomanypossessions.HaslimitedE&Psupport.

D12Dora 3bed.house.Livedhereover50yearsandbroughtchildrenuphere.Mainattachmentistofriendsandlifebuiltupinthearea.Feelsconfidentinlocalarea.Wouldn’tmove,havingahouseallowsforadaptationsincludingconvertingtoprovidegroundfloorlivingifneeded.

Despiteastrongdesiretostayput,revealedsomehesitationifcommunitycohesionfurtherdeteriorates.HasE&Psupport.

94

6.1.2Reasonsgivenformovinghome

Table6.1.2collatestheresponsesofbothyoungerandolderMovergroups

whenaskedtostatetheirmainreasonsformovinghome.Theywereasked,

toindicatewhichwerethemostinfluentialintheirdecisiontomovehome

usingtenitemsfromthestructuredinterview(Appendix5and6)justafter

relocatingandagainfivemonthslater.Mostofferedfivereasonsalthough

one participant (column B7) felt all ten had been influential and one

(column A3) had only one reason, which unfortunately was ‘family

pressure’andthusnotentirelyofchoice.

Pressuretomoveandneighbourharassment

Group B columns 1, 2 and 8 represent participants who said they had

movedbecauseoffamilypressuretodosoagainsttheirwishes.Afurther

threeparticipants(youngerMoverscolumn5,olderMoverscolumns1and

7)movedduetoharassmentfromneighbours(andthiswasacurrentissue

forthreeparticipantswho,becausetheywereintheNonMovergroups,do

notappearinTable6.1.2).

Health–seealsoTables6.1.4B&C

Healthconcernswerethemostoftenstatedinfluenceonmovinghome(12

outof16participants)Movers.Thiswasfollowedbythecostofrepairsand

maintenance(eightoutofsixteen),thelevelofdisrepair(sevenoutof16),

followed equally by the cost of heating, size of property, loneliness and

wanting to be in a community (six out of 16), lastly, moving from the

community andmovingnearer to family (both threeoutof16).All older

Movers had health issues, but the column 5B participant was the sole

individualacrossbothgroupswhowasmovingneartofamilyoutofchoice

and with no other reason to move. Desire to be nearer family as an

influence on decisions to move is further considered in Part two of this

chapter. ForMover groupswhomoved close to family reluctantly, itwas

rarelyjustduetopoorhealth.FouroftheeightyoungerMovershadhealth

issuesbutnonemovedforthosereasonsalone.Ofthefourwithouthealth

95

grounds,threeofthatgroup’sparticipantshadfiveotherreasonseachfor

moving(column3).Inaddition,onewasmadehomelessbyherfamily.

Table6.1.2NumberofReasonstoMove

Grp.AMovers60+

Participants(n8)Grp.BMovers76+

Participants(n8)

Participants 1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8Total

Health 1 1 1 1 1 1 1 1 1 1 1 1 12

PropertySize 1 1 1 1 1 1 6

Repair 1 1 1 1 1 1 1 7

Costrepair&maint. 1 1 1 1 1 1 1 1 8

Costheating&bills 1 1 1 1 1 1 6

Movenrfamilyetc. 1 1 1 3

Isolation/lonely 1 1 1 1 1 1 6

Beinacommunity 1 1 1 1 1 1 6

Movefrom

community

1 1 1 3

Familypressure 1 1 1 1 1 1 1 1 8

No.ofreasons 3 5 1 3 5 3 5 5 3 2 5 5 3 510 2 65

Adaptations 1 1 1 1 1 1 1 1 1 1

Informationre

adaptations,both

groups

Movers

GroupA3(0.25%)

GroupB7(87.5%)

NonMovers

GroupC-3(27.3%)

GroupD-7(58.3%)

Cautionshouldbeexercisedininterpretationofthistablebecausethemost

often cited items in a questionnaire may not indicate they have the

strongest impact for individuals as can be seen in the more qualitative

analysis inPartTwoof this chapter. Forexample, themost cited reasons

maybethemostreadilyidentifiableandmostdiscussedratherthanmost

urgentorlifechanging.

6.1.3Homeenvironment–functionalityanddesign

Seven property-related reasons were frequently identified during

participants’interviewsacrossallgroups,particularlyindiscussionsabout

whether they might motivate or impede relocation decisions. These are

examinedfurtherbelow:

Sizeofproperty–notamainimpediment-Table6.1.3A shows16participants in theMover groupsdownsized from

having48totalbedroomspaces(line1)to28fewer(Line3).

The 23Non-Movers occupy 65 bedroom spaces (line 1). If they chose to

downsize to 1 bedroom accommodation, this would create a further 42

96

bedroom spaces (line 3). However, preferred accommodation size varied

betweenindividualsasshowninTable5.1.4B.

Table6.1.3A-Sizeofhomebeforeandafter(MoverGroups)

-Bedroomsmadeavailableduetothemove

GroupA

Movers

60+(n8)

GroupB

Movers

76+(n8)

GroupC

NonMovers

60+(n11)

GroupD

NonMovers

76+(n12)1.Pre-move(Movers)

andcurrent(Non

Movers)no.of

bedrooms.Total

8x3

24bedr

8x3

24bedr

7x3

3x2

1x4

31bedr

8x3

3x2

1x4

34bedr

2.Post-move(Movers)

no.ofbedrooms.

Total

7x1

1x2

9bedr

5x1

3x2

11bedr

Nomove Nomove

3.Bedr.alreadymade

available/potentialif

NonMoverschoseto

moveto1bedroom.

Total

made

available

15

made

available

13

potentially

available

20

potentially

available

22

Table6.1.3B:Tenofthe16Moversand15ofthe23NonMoversstateda

clear preference for two bedrooms. However, three Non-Movers who

currently occupied two bedrooms (Table 6.1.3A) said if they decide to

move,theywouldpreferonebedroom.

Table6.1.3BPreferredsizecomparedwithpresent(MoverandNon

MoverGroups).

GroupA

Movers

60+(n8)

GroupB

Movers

76+(n8)

GroupC

NonMovers

60+(n11)

GroupD

NonMovers

76+(n12)Stated

preference

(Moverspre

move/Non

Movers–

current).

7x2bedr

1x1bedr

(15bedr)

3x1bedr

5x2bedr

(13bedr)

9x2bedr

2x1bedr

(20bedr.)

7x2bedr

1x3bedr

4x1bedr

(21bedr.)

Numberof

bedrooms

nowvs.row1

stated

preference

(NonMovers

current)

7=x1less

1=matched

5=x1less

3=matched

2=matched

6=1over

2=2over

1=matched

1=2over

10=1over

12Moverscompromised

byacceptingamoveto1

bedroomsmallerthan

theirstatedpreference

19NonMoversfelttheyhad

1or2bedroomsmorethan

theywouldprefertohave.

(total:22excessbedrooms)

97

It is worth noting here, in the light of these preferred options, that the

demand for smaller homes, especially with two bedrooms,

disproportionately increases the purchase price. Some flexibility was

shown however. Twelve participants moved to one-bedroom homes,

smaller than their stated preference, but later stated that, in hindsight,

compromisinghadnotbeenaproblem.FourMoverswhodidacquiretwo

bedroomhomesusedthesecondroomvariouslyasahobbyroom;aplace

tokeeptheirdeceasedhusband’sprized itemsandfortwoparticipants,a

diningroomcomeguestroom.

Optionsanddesign–notamainimpedimentforthispartofthecountry

Half of the youngerNonMovers andoneparticipant in eachof theother

groupswereconcernedaboutlackofoptionsinthehousingmarket,butno

one stated it to be a main cause for not being able to move. If the

accommodationwas dark, or the view fromwindowswas poor or there

wasnowarden,thesefactorsimpededacceptingamoveforthoseselecting

amoveoraffectedoutcomesforthosewhomoved.

Sizeofrooms–animpedimenttomovingifsmall,darkornoview

Ofgreaterimportancethanthenumberofroomswastheirsize.Halfofthe

16Moversandsixofthe24NonMoversmentionedthedifficultyofmoving

from larger airy rooms to small rooms as being important in deciding

whethertomovewhenlookingatavailableproperty.

BothyoungerandolderMoverswerehappywiththesizeof thekitchens,

whichweresmall,andsituatedwithinasectionedareaofthelivingroom.

Bathrooms inretirementhousingare large toenabledisabled facilities to

befittedandcarerstoassist.

Guestrooms–animpedimenttomovingifnoneinthenewlocation

Six of the younger NonMovers and one participant in each of the other

groupshadsomeonetostayregularly.Othersdidnotdeemtheoccasional

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needthattheyhadasimportanttothemwhenconsideringmovingtoaone

bedroom flat. AllMovers had access to a bookable guest room,with the

exceptionofonepersonwhosaid theeffectsofnothavingpeople tostay

were lonelinessanddepression.Others statedproblemswith therebeing

onlyonebookableguestroom. Onlyonehousingdevelopmenthadmore

thanoneguestroom.

Maintenance–costsratherthanimpactofdisrepairamotivatortomove

Threequartersofparticipantsfeltthestandardofrepairintheirpre-move

property (or existing property for NonMovers) needed to be improved.

However, only half of thosewhomentioned repairs reallyworried about

themandoneMoveraddedthatsaidshewouldnothavebeenabletocope

with getting repairs done if she had stayed put sowas not complaining.

MostoftheeightolderMoversandsixofthe12olderNonMoverspaidfor

cleaningservicesorqualifiedforfundingduetotheirhealth.

Thus, repairs, maintenance and cleaning were important considerations

andwereexpectedtobeeasierasaresultofanymove.However,formost

participants these appeared to be contributory factors in considering

relocation,which,alonewouldnotbesufficienttomotivateamove.Thisis

alsologicalasthecostanddisruptionofgettingrepairsdoneisoftenless

comparedwiththecostandupheavalofmoving.

Gardens as a motivator or impediment to moving represented a more

complex picture. Discussions went beyond maintenance and costs into

emotional aspects and generated substantial material and strong views,

whichareanalysedinparttwoofthischapter.

Costsofaccommodation–notamainmotivatortomoveBoththeyoungerandolderMoverswillhavehadsomedisposablesavings

fromtheirpropertysale.TheyoungerNonMovershadagenerallyhigher

income as halfwere still employed full or part time, although two of the

younger Non Movers were on benefits and only heated their homes

partially due to low income. Older Non Movers were likely to be facing

highermaintenanceandrunningcostsduetothesizeoftheirproperty,and

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sixofthetwelveindividualsinthatgroupreportedproblemswithbills,or

lackofincomerestrictingtheirlife.Movinghomewouldbetheonlywayof

reducing housing costs (all had adequate insulation). Unaffordable costs,

alongsideperceiveddeteriorationincommunitycohesionandfriendliness

(exploredinparttwo)werethetworeasonsmostoftengivenbytheolder

NonMoversthatwouldmakethemconsidermovingwhentheyotherwise

wouldnot.

Location

Differences between groups included transport facilities. This was not

essential overall for older NonMovers butwas a big issue for the other

groupswhotravelmore,sometowork,someusingfreetravelconcessions.

Both younger Movers and Non Movers cited safe parks as a priority,

variousreasonsweregivenincludingthatitindicatesagoodenvironment,

togotowithgrandchildren,forexerciseandfourwantedaparktoexercise

theirdog.

DatainAppendix13Ashowsthatintheareatheyhadmovedto,orforNon

Moverswhere they remained, shops,medical services and facilitieswere

functionalaspectsofimportanceforallparticipants.Neighbourhoodsafety

wasalsoconsideredimportant,andtheyweresaidtobeacceptableinthe

urbanareas theywerecurrently in.SomeMovers inbothagegroupshad

however,moved from areaswhere safety, health facilities or shopswere

not as good. Staying near to existing health support was the most

important aspect for the older Non Movers and change in community

cohesionwas,asalreadymentioned,alongsidecosts,theonlystatedcause

forthisgrouptopotentiallychangetheirmindsaboutmoving.Thetablein

Appendix14showsthattheolderNonMoversinolder(n12)andyounger

NonMovers(n11)rankedsevenandtenlocationitemsofhighimportance

tothemrespectively.Conversely,theyoungerandolderMovers(bothn8)

rankedeighteenandsixteenitemsrespectivelyofhighimportancetothem

forlocationsatisfaction.

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6.1.4‘RelocationEfficacy’Healthandlifestyledemographics

Factors identified in the literature (ch3) as associated with successfully

moving home include social status, level of education, cognitive ability,

emotionalandpracticalsupport.Thusthisinformationwasgatheredalong

withstandardhealthinformation(Table6.1.4AAppendix13B).

Cognitivefunction

The younger Non Movers had on average three years more education

comparedwiththeothergroupsandscoredmorehighlyonsocialmobility

than the other groups (Appendix 13B). Age appears to be important in

terms of educational attainment, which in turn may have an affect on

cognitive efficacy and confidence, although this would need further

researchwithgreaternumberstobeestablished.

Therewasaclearcognitiveadvantageofageoncognitivetestsforyounger

groups facing this complex situation as might be expected. Seven of the

eightolderMoversreportedthatunderstandingtheprocess,theamountof

paperwork involved and high number of decisions caused confusion and

stress during the move. They had considerable support in overcoming

theseproblems.InyoungerMovers,threeoftheeightparticipantsalsofelt

thisandreceivedoutsidesupport.Theimprovementonmemorytestsfrom

Time2toTime3forallgroups,remarkablysoforsemanticmemory,may

result from a familiarity effect for the task and possibly participants at

Time3werefeelingmoreateasewiththeresearcherorlessstressedsince

themove.

Weightanddiet(self-assessed)

Obesitywasnotprevalentinanygroup,Sevenofthe11participantsinthe

youngerNonMoverswere overweight. Lowweightwas a higher feature

across the groups due to illness and poor diet. Each group, except older

NonMovers had one participantwho lackedmotivation to ‘cook for one

person’ following bereavement. Two participants in both younger and

olderMovergroupsandolderNonMoversmentioneddifficulty ingetting

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theirshopping.YoungerMoversandNonMovers,inadditiontoolderNon

Movers,hadoneparticipantineachwhoreportedalackoffundingtobuy

food. Eight of the total of 16 Movers – of any age- said that their

opportunitytosocialisehadimprovedintheirnewsurroundingsandthey

weremorelikelytoeatlunches,makefriendsandmeetforcoffee.

Smoking&alcohol

For thoseparticipantswhopreviously smoked, the average time inyears

theyhavegivenupwasrelativelyrecent,atjustoverfouryears.

NeitheryoungernorolderMovershadbeenhighconsumersofalcohol.One

olderMover and one older NonMover consumed above the UKmedical

officer for health recommendation of no more than 14 units per week.

However, in younger Non Movers more than half the 11 participants

consumed alcohol above the guidance (group range six – 41 units per

week)andtheywerealsopreviouslytheheaviestsmokers.

Acuteself-reportstressors

For those relocating, sleep was disrupted but otherwise poor sleep

patterns in participants were reported to be longstanding. Younger Non

Movers compared with same age Movers reported relatively high acute

stressorsfromworkaswellaschronicstressorsfromcarerroles.

Restrictivehealthandpain

Thereweremoreailmentsintheolderparticipants,asmightbeexpected,

butperceptionofrestrictivehealthasreflectedinthescores(Table6.1.4B)

isworseforthosewithCOPD(youngerandolderNonMovers).Pain(older

NonMovers) such as arthritis wasmore concentrated in NonMovers in

both age groups. However, physical mobility problems were also high

among the older Movers. The nature of the health conditions was also

important(Table6.1.4C).

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Table6.1.4BRestrictivehealthandpain

Numberineachgroupreportingadifficultyat4or5ona1to5LikertScale

wherehigherismoreproblematic.

Age

GroupA

Movers

60-75(n8)

GroupB

Movers

76+(n8)

GroupC

NonMover

60-75(n11)

GroupD

NonMoves

76+(n12)

‘Healthyenough

tobe

independent’

7 7 10 7

‘HealthRestricts

mylife’

1 3 2/4* 7

‘Physical

mobility

problems’

4 6 1 8

‘Painaffectsmy

wellbeing’

3 3 2 7

‘Healthyenough

togetout’

1 5 3 3

Totaland

maximumscore

16of40 24of40 20of55 32of60

*differencefromTime2to3=2newincidentsofcancer.

Table6.1.4CChronichealthconditions

AtTime2(Time3isonlyreportedifthereisachange)

GroupA

Movers

60+(n8)

GroupB

Movers

76+(n8)

GroupC

NonMovers

60+(n11)

GroupD

NonMovers

76+(n12)Resp’tory/COPD 0 1 3 4

Osteoarthritis 1 3 2 7

Rh.arthritis 0 1 3 1

Cancer 1/0 1/2 0/1 3/4

HeartDisease 3 4 1 3

Stroke 1 0 0 0

Digestive 1 3/4 0 3

Diabetes 2 3/4 3 3

Thyroid 3hypo

0 1hyper

1hypo

1hypo

Disability 0 2 0 1

Depression 2 3 1 1

Time1/Time2

Totalillnesses

14/13

21/24

15/16

28/29

Distribution

ofhealth

conditionfor

individuals

3had1

5had2

1had2

6had3

1had4

7had1

3had2

1had3

2had1

3had2

4had4

1had5

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However,healthasasoleormainmotivatortomovecanbeoverstatedin

research(Egan2008meta-analysis),ifnotfullyconsideredalongsideother

factors. Restrictive illness was as prevalent or more prevalent in Non-

Moverswhohadtakenfulladvantageofadaptationsinordertostayput.In

addition, itwasthe familywho instigatedamove insixof theeightolder

Moversgroup,againsttheirparent’swishesinfivecases(albeitwithgood

intentionandultimatelyfavourableoutcomesinthreeofthosecases).

6.1.5SummaryofPartOnefindings

Person-environmentfit,motivatorsandimpediments

Partoneof this chapterhasprovidedan introduction to theparticipants,

their housing environment both past and present and has focused on

functional(practical)aspectsthatmightbeaffectingrelocationefficacy.

Unlikeassumptionsoftenmadebypolicymakersandthemedia,property

size, availability of retirement housing options, poor repair or mobility

difficulties within their present homes, were not given as the main and

mostinfluentialfactorsinmovingorstayingputfortheparticipantsinthis

research.

However,concernsabout the lackof largeairyrooms insomeretirement

housing and lack of adequate guest rooms were highlighted across the

groupsasimportantconsiderationsandpotentialimpedimentstomoving,

aswere costs and any reduction in local health, shopping or community

facilitiesinanewlocation.

AgedifferencesforMoversandNonMovers

DifferencesbetweenyoungerMovers(GroupA)andyoungerNonMovers

(GroupC).Theserelatedmainlytolifestyle.

- Five of the eight younger NonMovers had people to staywith them

regularlyandalsohadcarer,familyandworkcommitments.Noonein

the younger Movers group had this level of complexity or

responsibilityintheirdailylives,althoughtwohadbeencarerstotheir

recentlydeceasedhusbands.

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- YoungerMoverswere on average five years older than youngerNon

Movers. This could indicate the years between 60 and 65 to be a

transitional period, with initially higher levels of commitments,

impedingrelocationchoice.

- YoungerNonMoverswerealsoofinterestinthattheyshowedgreater

upward mobility and educational attainment than any other group,

requiring further interpretationas towhether thiswouldbe relevant

torelocationdecisions.

DifferencesbetweenolderMovers(GroupB)andolderNonMovers(Group

D).Theserelatedmainlytohealthandfamilymatters:

- SixoftheeightolderMoversrelocatedduetopressurefromothersand

the same number appear to have been more heavily influenced by

illnessorpainaffectingmobility.

- Converselysixofthe12olderNonMoverscitethesamereasonsfornot

beingabletomoveandthereforewerestayingput.

Beyond these fundamental practical aspects of person-environment fit,

relocationdecision-makingbecomescomplex,forexample,inrespectof

- attachmenttothecurrenthome

- previousimperativestomoveforworkorfamilyreasons

- proximity toandchangingperceptionsof theneed foremotionaland

practicalsupport

- theneighbourhoodandtheimpactofchangeinthecommunity

Forsomeindividualsthechangingphysicalneedsinrelationtotheirhome

and community begin to conflict with their personal attachment to their

locationandhome.Clearlylevelsofcognitivefunctionthatdeterioratewith

ageaddtothephysicalneedforsupport.

EmotionalandPhysicalsupport

Familyinfluencesbothnegativeandpositive,starttoemergeasimportant

atthethreestages,decision-making,relocatingandsettlingin.Supportwas

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oneofthemostcomplexissuesbecauseofneedsrelatingtoperceivedself-

efficacy,healthandmanypracticalaspects.Thisincludedtheamounttobe

done if moving and proximity to assistance, but also acceptance of help,

familydynamics, therelationshipwithself-identity.Theseareexploredin

Parttwoofthischapter.

Temporality

Whilst some participants seemed to look to the past and did not see the

needtodealwithpresentchangesandneeds,othersseemedtobeplanning

for assumed future needs. This provided a potential binary temporal

element to how moving home is approached that required deeper

understanding.

The introductory material in this chapter is already indicates complex

factors that might contribute to ambiguity in decision-making. These

matters are analysed thematically in Part Two using the qualitative

materialfrominterviewsatStages1and2oftheresearch.

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CHAPTER6Parttwo-ThematicAnalysis6.2Introduction

ChaptersixissplitintoPart1andPart2:Part one of this chapter provided an introduction to the participants’housing situation and recent relocation history. This included relevanthealthand lifestyledemographicsandparticipants’ views thatpotentiallyaffected decision-making about the design, size, condition and physicalusefulnessoftheirhome.Part two aims to provide a greater understanding of individualexperiences and the lived reality of relocation. It begins with a table of‘Overarching Themes’ and subthemes that have been developed throughThematicAnalysisofthequalitativeinformationfromStages1and2oftheresearch.Thesearethenusedasastructureforgroupingfindings.Thereaderisadvised:NAMES IN BOLD CAPITALS: these are used alongside quotations toidentifytheeightindividuals(twofromeachgroup)whoatStage2tookpartinsemi-structuredinterviews.Names are given in italics within paragraph text – for ease of cross-referencing.Participant reference numbers are given next to their names(pseudonyms)The terms practical/functional and emotional/meaningful are usedinterchangeably.The term self-efficacy (defined ch3 secn. 3.4) comprises ‘personalefficacy’and‘controllability’(feasibility).The term ‘planning-efficacy’ was devised by the researcher toencompass the full spectrum of relocation considerations, and theresearch dimensions (ch3 para 5.6.2), consistentwith housing being alifetimeplanningneed.

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Table6.2.0Overarchingthemes

Subthemes

6.2.1Ambiguityindecision-making,predictingthefuture&planning

6.2.1.1Inclinationtoplan(ornot)forage-transitionsandchangesinperson-environmentfit,contingency,optimismandluck.6.2.1.2Informationalsupport,financialhardshipandbenefitstomoving.Inheritanceaspecialcase6.2.1.3De-clutteringandhoardingasimpediments6.2.1.4Conflictbetweenfunctionalandmeaningfulmatters6.2.1.5Enjoymentofandcontentmentwithhome;memoriesandattachmenttoroutinesandlocation6.2.1.6Personalidentityandpurpose.Gardens,aspecialcase

6.2.2Personalindependenceandautonomy

6.2.2.1 Accepting help from family versus fromothers; feeling of being a burden and guilt,reversalofrolesinthefamily6.2.2.2 Desire for proximity to family, mixedfindings6.2.2.3 Pressure to move from family, wellmeaningorself-serving?

6.2.3Localcommunity;needsandsocialidentity

6.2.3.1 Loneliness companionship and socialcontactversus‘outings’.Pets,aspecialcase6.2.3.2 Community facilities, neighbours andcommunityfriendliness6.2.3.3Retirementhousing,socialisingandsenseofbelonging6.2.3.4 Change, social identity and socialintegration

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6.2.1OVERARCHINGTHEMEONE-Ambiguityindecision-makingandpredictingthefuture

6.2.1.1 Subtheme: Inclination toplan (ornot) forage-transitionsandchangesinperson-environmentfit,contingency,optimismandluckParticipantsdidnotciteageperseasacleardeterminingfactorformoving

home.Participantsacknowledgedthatagereduceslevelsofcontrollability,

in terms of physical and mental self-efficacy, but those were the only

factorsdirectly related toage in their reasonsgiven formoving.Whether

age might intensify needs and force a decision rather than being a sole

reasonformovingisdiscussedfurtherinchapter8.

GroupAYoungerMovers

The youngerMovers expressed little ambiguity around relocating. There

wasasenseof‘planningfortheworst’inthisgroup,anexpressionusedby

more than one participant, in contrast, younger NonMovers more often

expressed feelings that portrayed a sense of being prepared, rather than

assumingtheworst.Althoughtherewerepressinghealthreasonstomove

for only two participants in the younger Movers group (A1 Gail andA8

Gloria)discussions in this groupgenerally expressedurgency to relocate.

Veenhoven,(2001,ch3para3.2)referstoanxiety-drivendecision-making

aimedatanxietyreductionratherthanpresentstateimprovementandthis

isdiscussedfurtherinchapter8inrespectoftheyoungerMovers.

Participantsinthisgroupsaidtheyhadthoughtaboutwhethertomovefor

some considerable time andhad continued topreparebybeing awareof

optionsandmakingplans.Thus intermsof temporality, theywerefuture

orientatedandtheyplanned.

A4.JillTellpeopletothinkaboutitsooner!A6.JaneWeweregoingtomoveto[]whenheretired.I’mgladwestayedin the area. He said goodbye and went out, had a heart attack, neverreturned.IhadthelastplaceadaptedincaseIneededitandpullchords,aftermyheartattack.IwishI’dmovedtheninstead.

109

A7.AnnetteA lot say you shouldn’t do anything for a year or twoafterbereavement.ButIdon’tagreewiththat.MyhusbandknewwhatIwantedtodoandapprovedofitsoIthoughtwhywait?Ifyouwaitforayearhowisitgoingtohelpyou:ifyou’vegotyourmindandhealthwhynot?A2.BEATRICE Well I was looking for a flat while he was in the homebecauseIknewhewasnevercominghome.A1.GAIL....Ithinkprobably70to75wouldprobablybeagoodtimebecauseasyougetolderit’sharderto,tomove,it’shardertogettoknowwhereyouare.

Younger Movers’ motivation was expressed more in terms of them

visualising potentially difficult times ahead, of being ‘left on their own’

throughwidowhoodorbecomingillinolderage.Theywereconcernedthat

the homewould become too big and burdensome. Conversely five of the

eleven youngerNonMovers talked aboutplanning tohave adaptations if

managingtheirhomebecametoodifficultforthemtomanagethere.

GroupB:OlderMovers

Theolderparticipantsinthisgroupalsosaidthefamilyhomeandgarden

could become burdensome and too big but expressed more ambiguity

about having moved; issues among them varied. Five of the eight

participants had not wanted to move and another was reluctant to. For

example, B1.Masie and B8.Bella felt they had been coerced by family,

having had no inclination tomove and subsequently regretted their new

situation; they expressed being lonely and depressed. B2.Eliza, was

fraudulently deprived of her home by family and was distressed at the

move. B5.Meral expressed having little choice medically and thus

reluctantlymovedcloser toherdaughter.B5.Meral felt thiswas the right

decisionintheendbutstillexperiencedsadnessatthe lossofherformer

home. This was in direct contrast to views expressed in the younger

MoversinGroupA.However,inhindsight,sheregrettednotthinkingabout

movingsoonerafterherhusbanddiedtwoyearsearlier,andfeltsheshould

havemovedthenwhenherhealthstartedtodeteriorate.

B5.MERAL You need to think in your 60s but you don't know what'saroundthecorner,…thethingistobeabletomovequicklywhenyouneedto.Youneedhelp,youneedfamily.

110

An unusual case, B6.Stephanie, felt it was necessary to move when her

husbanddiedonlybecause,havingdependedoneachotherpreviously,she

could no longer cope alone in the house. She could not face having

adaptationstoprovideadownstairstoilet,duetotheamountofclutterthat

hadaccumulatedinthehouse.Dealingwithclutterwhenrelocatingwasan

issueforseveralparticipantsandisexploredinsubthemethree.

ThusfiveoftheeightparticipantsinGroupBweredisinclinedMoversand

expressed that theyhadnever intendedtomoveandhadnotmadeplans

and preparations tomove. Of the remaining three, B3.Beryl, aged in her

90s,hadmovedmanytimeswithherhusband’sjobandsaidshewashappy

tomoveafewmilesfromoneflattoasmalleronenearertoherdaughter

andherchurch.B7.Joanneagedinher80sexpressedarealisationthatshe

should have moved many years earlier when her husband died. He had

prevented them frommovingbeforebut shehadalwaysbeen inclined to

move.

B7.Joanne Idon’tknowwhypeopledon’twanttoleavethefamilyhomewhen it isn’t that anymore, I would have moved sooner but for myhusband. You can't keep thinking for all those years, 'we might havesomeonetostay';andthere'savisitor'sroomhere. Ipaid foragardenerandgrandsonshelpedwithrepairsbutitwascluttered.Ihadastairliftfora year. My health stoppedme looking after my house before; it doesn'tnow….Ididn'trealisehowmuchIcouldbenefit.Lifeismarvelloushere.

Citedbelow,B4.Meganmovedbecauseshefeltshehadnochoice.Shehad

wantedtomoveforsomeyears froma largehousethatwasexpensiveto

maintainwithaverylargegarden.However,shefeltemotionallyattached

to the house because of memories of her husband and their love of the

garden.This ledtoambivalencetowardsrelocatinganddelay indecision-

making. She felt that the move put a strain on her physical and mental

health:

B4.Megan IthinkitwouldbegoodifI'ddoneitabityoungerbutsinceImanageditIdon'tsupposeit'snotdonememuchharm.Iwouldn'tadviseleavingittill…83wasn'tI?It'sbeenthemoststressfultimeofmylife.Istillsay the phrase ‘I know itwas right but that doesn'tmean to say itwaseasy’becauseitwasn'teasy.

111

GroupC:YoungerNonMoversFortheyoungerNonMovers,ambiguitywasfarhigherthanforanyother

group. There were those who seemed to be generally inclined towards

movingandthosewhoweredisinclined.Noonehadruledoutmovingand

therewassomesenseofplanningbutnotthesameurgencyastheyounger

Movers inGroupA. Six of the eleven youngerNonMovers expressed the

probabilitythattheywouldmoveassoonascommitmentspermitted.This

cohort included fourparticipantswhowere still in full timeemployment,

and half the Group had carer or family support responsibilities, one of

whomalsoworkedfulltime.

The five-year average age difference between the younger Movers and

youngerNonMovers couldhavebeen a confounding aspect in respect of

freedom to take immediate action. The lives of the younger NonMovers

seemed complexwith less claritywhen comparedwith those of younger

Moverswhohad fulfilled theirdesire tomovehome.Distracting thoughts

intrudeintotheirthoughtswhenconsideringrelocation.

C7.JemmaYouhavetothinkwhatyoucando,finenowbuthavingthatatthebackof yourmind.They’re soermnicewhen they (retirement flats)comeupforsalebecauseIseethem.Theylooknicesowhysocheap?ThenIthinkretirementhome.Wowcheaper,notreallysurewhyIwouldwantchargesbutI’mnotoldenoughyet,Iwouldbeeligibleandfreeupmoneybutthenit’sstillnot…Icouldhaveasecondhomeandaretirementflat,ahomeinNorfolkaswell!ButIhavetocarryonworking.Therearemajorchangescoming,myparentsarestillalive,they’reprevalentinmylife;repersonalissues,IgotoMumandDad.Ihavetoworkuntil70becauseofnopension….Icouldconvertthisflatintotwoandsellorletitout!

Ambiguitywasduemainlytoparticipants’ inabilitytovisualisethefuture

based on current information. They expressed ambiguity aroundmoving

from ‘thehomeyou love’ in order to cater for futurehealth eventualities

and then finding that you did not need to, which is also reflected in the

literature(Lofqvistetal2013,ch3para3.1.1)

However, having foresight is especially difficult with respect to health,

physicalneedsandexternalaspectssuchaschangesinlocalfriends,family,

neighbourcontacts,localareaorcommunity.

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C5.VerindaInyourheadyou’restill30.Movingalldependsonhealth–IfIhadallmyhealth,Iwouldlovelivinghere.Youalwaysassumeyouwon’tgetill,willdoyourgardenwhenyouretireandgoonholidaywithyourmates.Youdon’tthinkyou’regoingtobeill;ifyoumovedthendidn’tneedto,you’dregretthattoo.

Unlike youngerMovers,whomovedmainly as away of planning for the

worst, younger Non Movers were mainly optimistic and expressed

contingencies, the last of which might be to move. This suggested they

expectedorhopedtheirrestrictivecommitmentswouldberesolvedintime

tomakechoicesabout their future.Thus,planning for theworstcouldbe

important in planning-efficacy, either for moving immediately or for

contingencies.

C8.SallyIfyouleaveittoolongsheerphysicalstrengthwillbeaproblem.You’vegottohaveaplanA,BandCandhopeyouneverhavetobookC.

Younger Non Movers often mentioned leaving it too late to plan. For

example, as highlighted in the third quote above C7.Jemma who felt

retirementhousingwassomethingtoconsideronceapersonhadretired,

notbefore.SomeyoungerNonMoversdidfeeltheyhadalreadyleftittoo

late to plan because they were deterred by negative age-related

connotations that theyassociatedwith ‘retirementhousing’ or ‘sheltered’

housing. Othersfelttheywerestilltooyoung(e.g.againC7.Jemmaabove,

andC6.Avrilquotedbelow).

The fourparticipants in theyoungerNonMovergroupwhohadthemost

definite intentions to move, even then stated that these were mainly

contingentuponotherthingshappening,beyondtheircontrol.Allfourhad

carerresponsibilitiesandC11.Marjorieworkedfulltimetoo.

C1.Amelia Iusedtoplanforfiveyears,bigmistake,Iwon'teverdothatagain.Whatyouthinkoffirstisn'talwaystherightthinginfiveyearsC2.Lee Iknowwhatmyplansareforthefuture,whichdependsonhousepricesandfamilycircumstancesatthetime.C6.AVRILThebeststagewouldbenow…butIcan’tduetoneedingtolivenearmyparents.IwillwhenIhaven’tgotparentstolookafter.C11.MarjorieMymainproblemismyparentslivenearbyandthey’renotwell.I’vegottodoitbeforeIretire,atleasthaveanidea.

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Personalinclinationtomoveorstayput,appearstoreflectlongheldviews

and experiences. C11.Marjorie, had expected to remain in the same

location;her lifechangeddue tobeingwidowed,becomingacarer toher

parents, childrenmoving away and changes in the area’s age and ethnic

demography, none of which had she anticipated. She expressed some

anxietyfeelingshemight‘have’tomove.C6.Avril,incontrast,whilstbeinga

carer, had never viewed her current or previous locations as necessarily

permanent.

C11.Marjorie I don’t like to think it could, it would be a new start, adifferentpartofyourlife.C6.AVRILLookingafterpeopleasacarermakesyouthink…whowouldcareforme?You’vegottobeprepared.Atthisage,currentlybeinginsomekind of retirement home [sheltered housing with extra care] doesn’tappealbutIdothinkthereisachangeinthetypeofofferavailable…Thewebsite...shows no worries about repairs, gardening…..all looks veryinvitingandtheknowledgethatshouldbythetimeyougetto80youneedsomelevelofcarethatyouhaven’tgottomovetogetit.

OverallyoungerNonMovers’decisionstomoveappeartobeguidedboth

by emotionally meaningful aspects that are intrinsically motivating in

decisions to remain or tomove, aswell as by functional (practical) ones

that provide the extrinsic motivational element in the decision-making.

Thisuncertaintyofpredication concurswith literature (Sharot, 2011 ch3

from para 3.3), and is discussed fully in chapter 8. Thus, the emotional

componentcouldmake it less likely thatall individuals,givenchoice,will

move,evenaftertheyhavefewerfamilyandworkcommitments.

GroupD:OlderNonMoversAswiththeyoungerMovers,therewaslittleambiguityaboutthedecision

tostayputthatolderNonMovershadmade.Theypresentedclearandfirm

decisions.Theseweresometimesmadeasearlyaswhentheysettledinto

their home after marriage. The following three participants had home

adaptations to assistwith their changingmobilitydifficulties, rather than

relocating.

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D5.AMYYoumoveintoapropertyandyoushouldkeepit.Neveroccurredtome, never given it a thought.Moving out is not always the answer. IcamehereafterImarriedfrommymum’s;it’spartofme.D6.VanessaIthasneveroccurredtometomove.I’vebeenhere54years.Myparentsgaveusthehousewhenwegotmarried.It’spartofme.D9.Alison I don’t plan.My father saidwhen your times up you go.Welived in the East End during the war but never went down theundergroundwhenthebombsweredropping.It’saquestionofluck.

Locusofcontrolandtrustingtoluckwhenreframingnegativesituationsof

change were important to the older Non Movers’ decision-making and

werediscussedinchapter3(Sharot2011,secn.3.3TverskyandKanneman

ch3secn3.1.2)andfurtherinchapter8.

The older Non Movers had not just drifted into their situation. Their

statements show they had been proactive in planning adaptations and

services in order to stay put. Some had previously given serious

consideration as to whether they would move at a later stage due to

widowhoodorhealthreasonsanddecidedagainst it.Theyrecognisedthe

enormityofthetaskandwhenconsideringthebestagetomovewereclear

aboutthelimitationsagecanbring.

Older Non Movers’ questionnaire answers indicated they perceived

themselvestobeincontroloftheirlivesandlucky.Howevertheywerenot

optimisticaboutthefutureandweremorereluctantthantheothercohorts

toconsidermajorchange.

D12.DORAWeputalimitonitof65tomoveorstayput…andstayed.Idon'tmakelongtermplansunlessIthinkit's likely,equallyImakeplansonan'allbeingwell'basis.Wellyouhavetothinkaboutit…justafterthechildrenhaveleftornotatall.D10.GemimaPeopledon’tthinkaheadandthentheyhavetomoveagain.For other people they leave it too late. They’re not strong enough. Theywon’taccepthelpandthinktomorrowI’llfeelbetterandwon’tneeditbutthey’rewrong.

Gemimaplannedaheadmeticulouslysince2003forheroldage.Shemoved

beforeage60ontheearlyretirementofherhusband,toathreebedroom

house in a location with “good shops and near the station” next to her

daughter’s house. Instead of moving when both her and her husband’s

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physical health deteriorated, she eventually acquired the other

neighbouring house. Eventually both daughters and their children were

livingwithintheirownconvertedspacesacrossthethreepropertiesunder

one roof (that had also been converted for extra space).Gemima had an

adaptedgroundfloorarea.Allfamilymembersweremutuallysupportive:

D10.GemimaWhenIwasillrecentlytheywerebothhere.Inowcookforeveryone, it'sworkedoutperfectly. I can'tdoasmuch in the community[wasoncommitteesetc.]butIhelpwiththechildren.D12.DORA If for any reason I can’t cope here [a 3 bedroom house], IwouldhaveabathroomputindownstairsandIwouldusethisroomasabedroom.Thebackroomwouldbemylivingroombecauseitoverlooksthegarden.I’dhaveagardenerIsuppose;Ineedonenowandacleaner!D5.AMY I’ve got a cleaner; she does washing and ironing. I pay for agardenerandhairdresser.…wellsomeoneknowssomeoneandthat’showIgotdecorated,theneighboursaregoodtome.Alterations?ohthat’sthecouncil, occupational health take care of that. A walker and frame,bathroomandstairliftandthat’showImanagedallthemyears.

Only one participant of the 12 older Non Movers (D4.Emily) would

previouslyhave liked tomovebutherhusbanddidnotwant to. Shewas

now reluctant tomove she said due to age particularly when coming to

termswithanewlocationanddifferentroutines.

D4.Emily I should have moved years ago, I’m too old to get used to achange. In seven years time I’ll be90, don’t think it’sworth selling forashorttime.Ihavethoughtaboutitforyears.Iwouldliketohavemovedtothecountrywithmyhusband.

Having made the decision to remain and adapt, older Non Movers had

sometimes required remarkable resilience and determination despite

knowing that therewere local relocation options they could consider. In

some cases they faced pressure tomove from family or due to financial

difficultiesthatwouldberesolvedbymovingbutchosetoremain.

D2.JanDeterminationgetsmeout.Icangetout.Igetdown[topfloorofa3 storeyblockwithno lift]acoupleoftimesaweek.Iwalkafewpacesandsit.Getabusto[ ]wherethereareseatsintheHighStreet.Walkafewpacesandsit.

Thesefindingsindicatethatmeaningful/emotionalaspects,evenintheface

ofmore obvious functional/practical benefits ofmoving, were important

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for older Non Movers, and this was accompanied by a longstanding

disinclinationtowardsrelocation.

6.2.1.2 Subtheme: Informational support, financial hardship andbenefits of moving. Inheritance – a special case (because a relativelysmall numbers of participants discussed this but did sowith very strongfeeling)Alackofknowledgeandinformationaboutretirementhousingwasevident

across the interviews. Itcanbeassumedthataccurate informationwould

be useful in aiding decision-making, particularly for those inclined to be

influenced by functional matters because moving might resolve some of

thosesuchasmobilityandfinancialproblems.Thegeographical locations

covered by the research (North East London and surrounding counties)

werewellservedbyarangeofretirementhousingbutasidefromyounger

NonMovers,whousedtheInternetforinformation;participantswerenot

knowledgeableaboutrelocationfinancialmattersandpotentialbenefits.

EvenyoungerMoverssaidtheyhadmovedtoretirementaccommodation

andlocationsalreadyknowntothemorfoundthroughfriendsorrelatives.

MostoftheolderMovershadaccommodationineffectchosenforthemby

family.MostolderNonMoverparticipantshadnot actuallybeen insidea

retirementschemeanddidnotknowofanyonewholivedinone.

Mostparticipantsgathered information from friendsor informal sources.

YoungerNonMoversC4.LisaandC6.Avril,whohadresearchedtheoptions,

liked the idea of renting in a retirement scheme in order to have capital

fromselling,orincomefromrentingouttheirpresenthome:

C4.LISA Idon’tknowwhysomeonemovingatthisagewouldbuyagain.Iwouldrentandkeepthehouseandlet itout, I’dusethatcouncilscheme[FreeSpace–Appendix1]ifit’sgoing.Youdon’tknowwithagents.C6.AVRIL Renting retirement housing might be better and leave memoneyincaseanewcarisneeded.

Somewerewaryof renting forexampleyoungerNonMoverC9.Billie andyoungerMoverA1.Gail:

C9.BillieI’mbuying,buying,buyingasmanypropertiesaspossible.Whenmy parents died theywere actually in debt, I guess that’swhy I need toownandIkeepbuyingmoreandmoreproperty.Idon’tfeelsecureformy

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oldage.Iwouldexpecttocashupandtie it inwithmyreducingincome.I’velookedatequityreleaseandthat’snotgoodwhenweighingitup.A1.GAILIwasfrightenedofrenting,thelossofsecurity.Rentsarehighandthemoneymightrunout.Ididn’tknowwheretostart.

Noparticipanthadreceivedimpartialadviceandinformation,providedby

knowledgeableothers,exceptfortwoparticipantswhohadreceivedafirst

stageFreeSpace scheme (Appendix1) interview. YoungerMoverA6.Jane

delayedmovingwhen her husband died, hoping to be able to copewith

billsusinganequityreleaseloan.

A6.JaneAftermyhusbanddied, Iborrowed£36,000and3yearslaterowed£51,000.Theytriedtochargeme£8,000tocloseitbuttheagentsawitwasacon.Ididn’thavetopayit.They[friendsandneighbours]said ‘whydoyouwanttomove’buttheydidn’tknowabout thedebt.Peoplesay ‘Iwouldn’tpaythat’[£203pmlease]butit’sswingsandroundabouts–therearenobills.

The experience of A6.Jane illustrates the vulnerability of individuals left

with financialdifficulties followingseparation fromordeathofapartner.

She did not want to “bother people” or let them know she was having

financial difficulties. Moving home resolved her financial problems and

completely changed her life for the better. When she sold her marital

home, she had sufficient money to buy a retirement flat within easy

distance of her former home, refurbish it and buy new goods aswell as

invest in a caravan in anareawhere shepreviously renteda caravan for

justonemonthoftheyear.

Whilst half of the older Movers had been reluctant to move, they had

benefittedintermsoffinance.OlderMoversB4.Meganwhogainedfinancial

freedom for the first time inher life, andB2.Beatrice,were typical of the

opinionofMoverGroupsregardingfinance:

B4.MEGAN ‘I've been used to living frugally but now there areproceeds from the sale, I've spent a great dealmodernising theflatandhaveboughtsomeclothes’.B2.BEATRICE IknowI’vegottopaymaintenanceherebuttheyclean the halls, but now, they do the gardens, they’re going toreplace the windows, they’ve got a window cleaner, you know.Some saywhy have amonthly payment?.. but for a pensioner, I

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didtherightthing.If Iwasstill inthehouse,I’dhavehadtogetother people to do all that…. better off moving than havingconstantupkeep.

OlderNonMovers, asdiscussed inPart1 (6.1.3)have themost concerns

about bills and that was one of the their, only two, key motivators for

moving. Interestingly, despite this, no one in that group contemplated

movingforfinancialreasons,eventhoughitisdifficulttoseehowelsethey

mightreducecosts.

Itisusualforpurchasepriceswithinneighbouringareastovarygreatly,in

theUK.Ashortfallinfundingwasnotaproblemforthosewishingtobuyin

thesameneighbourhoodbutwouldbeiftheywishedtolivenearerfriends

inamoredesirablearea.Itislikelytobemoreofaproblemforthosewho

havebeendivorcedatsomepoint:

C6.AVRIL The home I had before for 10 years was all I couldaffordatthetimeandImovedonwhenIcould.Atonetimeitwasinnegativeequityforfiveyears.ItdependscriticallyoncostinanicerareaIwouldhavetodownsizeorrent...orI'dbemovingtoofarawayfrompeopleIwanttobenearto.

SomeparticipantsintheyoungerandolderNonMovergroupsmentioned

the importance of leaving an inheritance for loved ones,which for those

whomentionedit,wasakeyimpedimenttomoving.

FouryoungerNonMoversandtwooftheolderNonMoverswhowantedto

leaveinheritance,citedthedifficultiesyoungpeoplehadaffordinghousing,

beingoldfashioned,orjustthatitisanicethingtodo,asreasonstoleave

inheritance. Two favoured the FreeSpace scheme (Appenidx 1) to use if

theymoved,sincethehousecouldberetainedandrentedoutbythelocal

authorityuntiltheirdeathandthiswouldsafeguardtheinheritancewhilst

enablingthemtomoveandrentelsewhere.

C1.LeeIfImoveIwillalwayshaveahousetosellI’vearrangedthatforthemandafuneralplanC10.SheilaIdon’twanttospenditall(ifsellingandrepurchasing)andhavenothingleftformynephewandniece.D3.Rose They’re good to me, they’re alright but I’d like to leave themsomething(daughterandgrandson)

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C4.LisaI’dusethatFreeSpaceschemeifthecouncilwerestilldoingit,thenIcould rent this place out to pay for the rent on the sheltered block alongthere.Thentheywouldstillhavetheirinheritance.

6.2.1.3Subtheme:De-cluttering,animpediment

A further impediment to relocation, was the challenge of de-cluttering.

AlthoughonlytheolderMoversindicatedthisinitially,itbecameapparent

for both younger Movers and older Movers alike that de-cluttering had

beenvery challenging.AllMovers found theprocess exhausting. Younger

Moversperceivedmovingas theirchoice,unlikehalfof theolderMovers,

andthuswhilstdifficultandtiringyoungerMoversexpressedmovingasa

major rewarding achievement, which enabled them to overcome the

challenge.

By thesecond interview,atTime3,mostNonMovers inbothagegroups

acknowledgedde-clutteringas an important influenceondecisionsabout

whether to move. Three younger Non Movers described themselves as

hoarders whilst others who appeared to the researcher to have similar

quantities of possessions did not. Younger NonMover C8.Sallyhad been

taking steps to reduce her possessions for months. Younger non Mover

citedbelow,C9.Billie,verydifferently, fearedpoverty in later lifeandsaw

activelyincreasingherpossessionsasapositiveapproachtofeelingmore

secure.Others, forexampleyoungernonMoverC11.Molly(quotedbelow)

and older Non Mover D2.Jan (featured in sub theme 6.2.1.4 to follow),

seemedresignedtotheirinabilitytomove,asde-clutteringwassomething

theycouldnotdealwith.

C2.LeeI’mahoarder.MybiggestfearisIwilldieandmykidswillhavetodealwithit.Iwon’tevenhavemymotherandfatherinmyhouse,asit’ssobad.C8.SallyIttookus3yearstogetridofthatbungalow,asithadbeenourhomeandMumandDad’sbeforethat. WhydoIwanttowastemytimewhenI’msobusy,lookingafterpossessions?Icouldwalkawaybutwouldwantittogototherightplace.I’mtryingtogetridofstuff.Mydaddiedsuddenly, it could happen any time. I’ve got beautiful stuff thatmy girlsdon’twantbelongingtomyMum.

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C9.Billie.ThelasttimeIsawmyMumshewasinahomewithdementiaanditbreaksmyheart;shedidn’thaveanyofherfamiliarthingsaroundher.That’swhyI’mabitofahoarderbecauseshehadtoleaveeverything.D11.Molly I couldn't move from here, I've been here 49 years, youaccumulatealot.HowcouldI,howcouldanyofussortitout?

Possessions passed on in families have been problematic to participants.

Unlikeotherparticipants,B6.Stephanie,anolderMover,whohadphysical

mobilityproblems,hadsufficientfundstobuyherretirementflatoutright

andretainherformerlargehouse.Thisenabledhertoavoidde-cluttering

by continuing to house possessions including those inherited from her

family,husband’sandhusband’sfamily.Thescaleofthejobphysicallyand

emotionallyhadbecometoomuchforhertodealwith.

B6.StephanieWhenmyhusbanddiedIknewIhadtomove.Ihadtoclearmymum'shouseoutandbelievemeyoudon'twanttodoit.Idon'tknowifit'sagoodthingornottokeepthehouseandI’vestillgottofindwaystogetridofthestuff.

Thismadeher relocation the least stressful of all theMoverparticipants.

Shestatedthatshewouldnothavemovedifshehadhadtode-clutterfirst

andby the second interviewhad given thehouse and its contents to her

sonstosortout.

6.2.1.4 Subtheme: Conflict between functional (practical) andmeaningful(emotional)mattersIntrinsicallymeaningful aspects of the current home and its location are

usually perceived to be more important for those who are disinclined

towardsmoving, discussed in Chapter 3 and again in Chapter 8. D2.Jan’s

situation,asanolderNonMover,illustratesthis:

Janhadsufferedwitharthritis andCOPD, familymemberswantedher to

move fromher threebedroomex localauthority flatonthe top floorofa

three storeyblockwithno lift. She insteadopted foradaptations,despite

havinganunaffordablemonthly leaseandoutstandingmaintenancecosts

shecouldnotaffordtopay.New,desirableretirementblockswereashort

walk away, with lower expenses. Support with moving was readily

availablefromfamily.Janhadmadenocontingenciesapartfromhavingan

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adapted bathroom installed. She said that before age 75 she started the

process of de-clutteringwith a view tomovingbut overall she remained

determined to stay.Beingattached to theareaandher self-identitywere

paramountinfluencesdespitetheobviouspracticalreasonstomove:

–Functionalissues:

Jan D2. Some rooms need doing desperately. I might not be able tomanagethestairsforever.Iwouldlikearetirementflat,butitwouldhavehighservicechargesthough. Ican'tpackthisflatup;I'vealreadyclearedout a lot. I took a week to do out the kitchen cupboards. Two to threeweeksforthedrawers,ittakesmonths.Idon’t lookatpapersIputthemononesidemysongetsannoyedaboutthat.

-MeaningfulIssues:Alltheoriginalresidentsdied,Ionlyknowthepersonopposite.They'realloutmostoftheday.Everyoneofthemcomestoseeme[family,nonelivenearby]yetImightnotseesomeonefordays.It's important tohave the2nd floorandbeingable toviewwhat'sgoingon.Iknoweveryoneandtheyknowmebysight.IcanseetheschooloutofmybackwindowthatIwenttoasachildandwatchthemallcomingandgoing.

Jan’s storywas typicalofolderNonMovers inGroupD in thestrengthof

feeling and desire for continuity with the past in participants whowere

disinclinedtomove.InadditionD2.Jan,aswithmostparticipantsacrossall

groups (discussed further in overarching theme. 6.2.2 that follows), had

reservationsabouther self-efficacybutwasadamantaboutnotaccepting

thesupportoffamilymembers.

D2. JanIcan'texpectthem[family]tobehereallthetime.Iwouldn'ttellthemifsomethingwaswrong.TheysayI'mstubborn. TheyofferedmeabuttonroundtheneckbecauseIfellandcouldn'tgetup.Ididn'ttakeit.Ican'texpecttoomuchhelp,don'tliketobeaburden.

Jan and others in Group D expressed difficulty in coming to terms with

changesinindependenceassociatedwithageing,prideandpreservationof

self-identity. She associated moving with giving up and giving-in to her

illnessandtheeffectsofage:“Idon'tgiveup”.ForJan,maintainingherself-

identity seems to be associated with showing she can stay where she is

with it’smanyconnections toherpast.However,herultimate conclusion

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seems to showsomeregrets and resignation “Youshouldmovebyage75,

afterthatyoucan'tbebothered”.

6.2.1.5Subtheme:Enjoymentofandcontentmentwithhome;memoriesandattachmenttoroutinesandlocationAsdiscussedintheprevioussection,participantsprovidedaninsightinto

theirattachmenttothepast,totheirhome,locationandexistingroutines,

and how this relates to their disinclination to move. This could be

interpreted as an individual’s reluctance to change. However, with the

exceptionoftheolderNonMovers,therewerejusttwoindividualsineach

ofthegroups,whosaidthey‘preferredoldandfamiliarplacesandpeople’

inanswertothatquestionnaireitem.FortheyoungerMovers,thischanged

to four individuals after the move. In comparison ten of the twelve

participants in olderNonMovers said they preferred familiar places and

people. YoungerNonMovers C3.Jackie andC7.Jemmaquoted belowwere

verysettled.OlderNonMoversD7.VioletandD5.Amyweretypicaloftheir

group.

C3.Jackie I know some people here. I have a routine, I drive to friendswiththedog,shewalksthembothintheparkandIwatch,Igetanybits(ofshopping)Ineedonthewayhome.C7.JemmaIneedtostaylocallyforfriendsandroutines.D7.Violet I lovetobewarm,keeptheheatingonall thetimeeven if it'sexpensiveandIhaveafantasticbathroom [adaptation]Iloveit.Ilookedatsheltered,somanydoorsoffthehall.D5.AMYI’mhappyhere.Youmeanifitgotworse,no,Idon’t’eventhinkaboutthat(moving).Ican'tseepeoplewhytheymovearound,Idon't,tokeepongoing intosomewhereandsettle intosomewhere, I’vebeenhereforsolongit'spartofme,Iwouldn't,Idon’twanttoknow,Ineverthoughtaboutgoinganywhereelse!

The greatest impediment to moving for both younger and older Non

Moverswasfoundtobesimplythattheylikedandenjoyedtheirhome,felt

comfortable and safe in the familiar surroundings. This had mediated

againstmanydrawbacksintheirpresenthomes.OlderMoverB5.Meralhad

tomove near to family for health reasons andwas anxious tomake her

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homeascomfortableastheoneshe left.Sevenof thesixteenparticipants

whomoved,immediatelymadeimprovements.

B5.MERALThenewbathroomisgoingin,intwoweeks.I'mdreadingthemessbutI'll feelmoreathomethen.ThenextstepisthedecoratingandthenIcan'thavetheradiatorsrenewed‘tilafterthatandthatwillbethat.

Individuals such as youngerMover A4Jill whowere disinclined tomove

considered moving after all, when the enjoyment of home was

substantially jeopardised. Younger Mover A2.Beatrice, attributes her

decisiontomoveafterherhusband’sdeathmainlytonothavinglikedher

former home and not being comfortable, experiencing enjoyment nor

wantingtospendmoneyonchangingit.

A4.JillIreallywantedtomove,didn'tfeelsafeat[formerarea]duetoallthenewpubsandbars [previous high street location]. I'mnotakilljoybutallthehighstreetsarefullofthemreallylateatnightnow.A2.BEATRICE I'mactually….content. Ifyou'vegotanicehomeandyoulikeit,ifyou'vepaidforit,it'syourprerogativetostayinitunlessit'stoomuchtomanage.Ihatedwherewelivedbeforeandalotofmoneyneededtobespent.

OtherexamplesquotedbelowarefromolderNonMoverandyoungerNon

Mover (D12.Dora and C5.Verinda) who feature in subtheme 6.2.3.4 to

follow,relatingtochangesincommunity.

Whether it is perceived to be physically and emotionally possible to

recreate a comparably pleasing or better environment is important for

decision-making and later adjustment and settling-in. This could be even

more important for those forced to relocate. OlderMovers, B1.Masieand

B8.Bella, are featured in section 6.2.3.1 below. This is because of the

negative effects causedwhen, in addition to beingmovedby family from

homes they loved, they did not choose the new accommodation and had

subsequentlynotfelt‘athome’there.

Memoriesassociatedwith their lifeandhomewereexpressedbyeightof

the12olderNonMoversasbeinganimportantreasonfornotwantingto

leave. For several participants, the thought of leaving their home created

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fear anduncertaintyabout loneliness and their self-identity.Threeof the

youngerNonMovers(GroupC)andhalf(four)ofolderMovers(GroupD),

alsosawmemoriesasapotentiallyimportantimpedimenttomoving.This

left half of the olderMovers (Group B) andmost of the youngerMovers

(Group A) who could manage moving away from the location of their

memories:

D4.AMY It’s a comfort, thememoriesand familiarity.Theygo tohomesthatarenottheirsurroundingsandtheydie.Ilookaroundandremember[husband]didthisandthishappenedinthisroom.

C5.VerindaFriendsmovedwithintwoyearstheyweredead.Theyalldieonce theymove. Theymove to the countryside and the coast and don'tknowanyone,thenonedies.D12.DORA Imoved inherewithmyhusbandwhenwegotmarriedandwe had to save hard to get it and have a mortgage. We brought ourchildrenuphere.Thehousehasa lotofmemoriesand it'sbigenoughtochangeifIneedthat.A4.JillMemoriesofmyhusbandareintheotherflat.Hewouldhavelovedthisplaceandit'sthesamesizeinroomsbuttheyaresmaller.WhenIsitherealoneImissmyhusband,movingtonearbywasimportant-keepingeverythingelsethesame.B4.MEGANWhen I reflecton that, of coursewhenyou're in yourhome,whenyoubothworked56years,…you'vegotallthememoriesallaroundyou.I'vestillgotthememoriesbutit'snotquitethesame.

ConverselyolderMovers:

B2.BEATRICETherewerenogoodmemoriesinthatlastplace.

B7.JoanneMemoriesareintheheadandhavingthechildrenaround

6.2.1.6Subtheme:PersonalidentityandsenseofpurposeThe effect of change in self-identity that comes with ageing, was clearly

expressed by older Non Movers. Several participants expressed a

connection between their home, their status and their personal identity.

OlderNonMovers,D6.VanessaandD5.Amybothreferredtohomeas‘part

ofme’.They,aswitholderNonMoversD9.Alison,D4.Emily andD12.Dora

associated home with their former role as wives, mothers and

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grandparents. Home was very much a part of their identity and

representedachievements.

They, also indicated they were less open to change and were not

comfortablewiththewaytheywerenowseenbyothers,primarilyfamily.

The changing roleswere expressed as positive or negative depending on

how individuals perceived and adjusted to change. Autonomy and choice

wereseentofollowandthisplayedakeypartinmakingadjustments.

The first fourquotesbelow, twoeach fromGroupAyoungerMoversand

Group B older Movers are typical of those who felt that a loss of self-

identity had led to theirmove. This is the opposite for the last twoNon

Moversquoted,oneyoungerandoneolder,whohavepreservedtheirself-

identityinotherways.

A1.GAIL [health imposedmove] People think I'm too old and frail andprobablylostmymarblesbutI'musedtobeingtheonetosolveproblems.Imissnothavingapurpose.Theydon'tliketobothermebyringingiftheyhaveaproblembutIwishtheywould.A3.Evie [fraudulent, imposed move] When I lost my house I lost myconfidence.When I had a house everybody came tome, now I've lost itnobodywantsto.B2.Eliza [fraudulent imposed move] I wish it never happened and Istayedinmymaritalhome. Ihateithere; it'saplacenotahome.Idon'tfeelusefultoanybody…Myaim?Yes,todie.Idon'tdoanythingnow.Iwasa[profession]before.B8.Bella [lackofautonomyoverprocess]MydaughterthinksIcan'tdoanythingbut I don'twant to sit downand lookat the fourwalls. I needpeaceofmind,I'veneverhadthatkindoflife.

Conversely….NonMoversyoungerC8.SallyandolderD10.Gemima(below)hadplannedandcontrolledtheirmoves,priortonecessitytodoso,manyyearspreviously.

C8.Sally I'mhavingthetimeofmylife.WhenI'mnotfittodothatI'llbehappynottobehere!Ivolunteer,theygivemeresponsibility.D10.Gemima I found it difficult to throw out records of work I'd beeninvolved with and projects. That was my life, so I've just kept themcontainedinacoupleofboxesandwhenIgotheycanthrowthemontheskip!

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Gardenswere said in some cases to relieve loneliness and lowmood by

providingpurposeandexercise,forthosestillabletocarryoutgardening,

plus itprovided increasedhours insunlight.Severalparticipantsreferred

tobeingemotionallyattachedtotheirgardenduetomemories,oftenwhen

gardeninghadbeentheirhusband’shobby.Theimportanceplacedonthe

gardencontributed todelaying thedecision tomove inat least twoolder

Mover cases (B5.Meral andB4.Megan). They felt they needed to come to

termswithlosingtheirgardenbutfounditverydifficult.

B4.MEGANErmIthinkthegardenstartedtooverwhelmme.Becauseweadored,webothadoredthegarden.B5.MERAL It's difficult you can't see forward. I loved my garden butcouldn'tdoitanymore.Iwasneverhappywithwhatthegardenerdid.

Alternatively, seeing the decline of the garden, the cost and exertion of

maintainingitthatcanemphasiseddeclineinphysicalabilityandhastened

decisionstomove.Tenparticipantsintotalalreadyhadagardenerbutthe

costcanbehighandthereforeforthenumberofhoursthatareaffordable,

thestandardcannotalwaysbemaintained.

Younger Non Movers generally require their own garden if moving,

althoughC3.Jackiehadahugegardenanditishermainreasonforwanting

to move, despite also owning a dog. Younger Non Mover, C4.Lisa was

havingraisedflowerbedsbuiltandC10.Sheilaalreadyhadraisedbedsbuilt.

Bothareintheirearly60sandalreadyfeelingthestrainofgardeningwork,

a reminder of failing strength and mobility. However, older Non Mover

D8.Kath, inher90sandD4.Emily inher80swerestillenjoyinggardening

themselvesaswellashavingsomepaidassistance.

C3.JackieWhat's changed [since first visit] is that I would move nowbecauseofthegardenbutIcan’taffordto.C5.Verinda I used to garden for hours, now I need a small garden orbalcony.D3.RowenaIpaysomeonetodothegarden,iftheygowhatwouldIdo?D8.Kath It[garden]keepsmebusy,andthehouse. Ido thingseverydayandIgooutaswell.

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A paid gardener maintains the garden for older Non Mover D5.Amy in

memoryofherhusband.Sheisunabletogetintothegardenbutcanseeit

from her kitchen window. Older Movers B4.Megan and B1.Masie from

GroupBwereemotionallyaffectedbythe lossoftheirgardens,especially

becauseoftheconnectionwiththeir latehusbands.Meanwhile,B4.Megan

tookthedecisiontomovebutitremainedasourceofloss.

TheretirementschemegardenwhereyoungerMoverA6.Janemovedto is

largebutbasicandsheistryingtosetupacommunitygrouptoimproveit.

Whilstretirementhousinggardensmayappearunderused,havingthemas

anoutlookandtheenhancementtheybringtoanyblockwasimportantfor

bothMover group participants,when considering their decision tomove

andoptionsavailable.Movingtoamoredesirablelocation,associatedwith

improved status was the only thing that mediated against the

dissatisfactionofhavingtomoveoutofnecessityforolderpeople(Kearns

ch3para3.7.3).

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6.2.2 OVERARCHING THEME TWO - Personal independence andautonomy6.2.2.1Subtheme:Acceptinghelpfromfamilyversusfromothers;beingaburdenandguilt;reversalofrolesinthefamilyGroupAYoungerNonMoversEmotional and practical supportwas provided to youngerMover A1.Gail

from volunteers; “they literally saved my life”. Due to isolation and

loneliness she actively sought voluntary sector help in order to avoid

asking forhelp fromher familyand feelsguiltyabout the levelofday-to-

day assistance the family previously gave her. A1.Gail felt the loss of her

role within the family where she had previously been the person who

othersturnedtoforhelpandadvice.

A1.GAIL …that was actually when I phoned … (voluntary sector daycentre)Socomfortingtohavesomeonetotalkto,tobeabletohelpwiththedecisions,lovely.SometimesIprefernottosayanythingtoanyone[tofamily].Theyallhaveproblems.IreliedonmysonandIthoughtthisisnotgood,he'sgotafamilyandhe’dhadaheartattack.I had no neighbours; I used to have. I could have lain there for days.EveryoneIspoketosaidyoudon'twanttogothereit'sforoldpeopleandIsaid…you'relivinganormallifeandI'mnot.She [socialworker] saidwe'vehadameetingandwe'reallgoing togettogetherandhelpyou.…..andwemadeadayandbringboxesandstarttopackthingsandthat'showitstarted.Thesupportteamhelpedme,toseetheflat,sortoutsolicitors,mostlyIworriedabouttheutilities.Ihadbeentryingfor10years.Ishouldhavegoneearlier,didn'tknowwhattodo…Icouldn'tgooutlookingatplaces,Ineededsomeonetotakeme…soIleftitandleftit.

Interestingly,theactiontakenforyoungerMoverA1.Gailbythevoluntary

sector group mirrors the FreeSpace scheme in Appendix 1, which is

proposed as a model of trusted, autonomous ‘move-on’ assistance from

outside of the family. Further, A1.Gail said that she had settled in

“remarkablyquickly”.

Inacontrastingapproach,A4.Jill,anotheryoungerMover,wasoneof just

twoparticipantsinthisresearchwhowerehappytototallytrustandrely

onfamilytorelocatethem.Shefreelyadmitsshedidnotfeelcompetentto

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resolve the situation herself. Her family purchased a property as an

investment that she now rents from them. Her only stipulation was

remaininginthesamearea,movinghomebut“keepingeverythingelsethe

same”.Herlackofperceivedself-efficacyandherattachmenttotheformer

home and routines would otherwise have been an impediment. In

hindsightA4.Jillwishesshehadplannedsooner,de-clutteredandmovedto

amoresuitableflatforbothofthem,whenherhusbandwasalive.

A4.JillMyhusbandwasolderthanme-itaffectsalotofwomen.Ithoughtwhen he died, what's the point of going on? Packing up home after somanyyearswasthehardestthing.IworrymorenowI'molder.Notifyingtheutilitiesandeverysinglepersonyouhaveto inform. I'mveryhappyImoved,can't thankthem[family] enough. Iwouldn'thavedone itonmyownbutIwouldhavebeenhouseboundaftermyhusbanddied.

All participants received extensive support from family, friends or

purchased services. Younger Mover A3.Evie is one of four individuals

across both Mover age groups who specifically refer to substantial help

from their religious community friends, rather than family. Her son had

beenresponsibleforherhomelessness.Shereferredtofamilynothelping

butalsothatshewouldnothaveletthem.

A3.Evie My son was abusive as if I was the enemy as soon as his wifemovedinandIputhisnameonthehouse,nowIhavetopayrent[movedto rented retirement housing].Myother childrenwouldn'tget involved,stopped coming around. I cry when I think of what happened. All myconfidencewent.Iwon'taskthefamilyforhelp.I'maverystubbornlady,Idon'twantforthemtosayIgaveyouthisorgaveyouthat.

Anindependentandcapablepersonthroughoutherlife,theyoungerMover

citedbelow,A8.Gloriaexpressedfrustrationanddifficultyinacceptingher

dependency on others, particularly family. After a lifetime in work and

familyroleswhereothersweredependentonher,shesettled-inslowlyand

wasanxioustoregainprivacy,controlandautonomy.

A8.Gloria, At first I thought I don't like it. Second time I visited it wasempty and I thought, OK I like it but it's different. I'm quite contentedreally; they ring up and seeme everyweek. Everyone's done everythingand it was impossible. I stayed with a friend for a week. I don't knowwhereanythingis.Iftheyfoundabeltloopinadrawertheythought'shedoesn'tneedthat'butIknewitwasthereanditfitsabeltonafavourite

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dress - now I can't wear it. I'm angry I can't do what I want to do. Itworriesmeabit[that]Iwillneedhelp,itgetsmedown.My familywouldcomeout in themiddleof thenightbutwould Iask forhelp?WhatwouldIhavedonewithoutthem?Ilikethingsdone.Iwillsoonget controlofmy life…..They saidmoveout foraweekwhen thework’sdone(bathroom)Iwouldlikeeveryoneelsetoleaveus[referstoselfanddog]toitandletmegetonwithit.

YoungerMovers,A8.Gloria,andA1.Gail (fourthpriorquoteabove)agreed

theirphysicalandmentalwellbeingwouldhavebeenseriouslyatriskhad

they not moved. They both acknowledged that the provision of home

serviceswouldnothaveachievedthefreedomtoremainindependentthat

theydesired.Theyalsostatedtheycouldnothavemovedwithoutthelevel

of practical and emotional support provided. NotablyA1.Gailand A4.Jill

(thirdpriorquoteabove)bothsettledinquickly,havingbeencontentwith

theprocess,albeitoneassistedbyfamilyandonebythevoluntarysector.

However,A8.Gloria (above)hadsettled lessquickly thanA1.GailorA4.Jill

becauseoffeelingsoffrustrationathavingtomoveandacceptfamilyhelp.

A3.Evie(secondpriorquoteabove)saidshedidnotfeelsettledinthenew

location fivemonths aftermoving,which she attributed to the traumaof

themove“IstillcrywhenIthinkofwhathappened”.Settling-infollowinga

movewasconsistentlyevidencedthroughouttheresearchasdependenton

thelevelofautonomyandchoiceintheprocess.

TheremainingfouryoungerMoversinGroupAproactivelyorganisedand

planned, taking the lead on decision-making and actions such as de-

cluttering:

Younger Mover participants A2.Beatrice and A7.Annette (quoted below)

were planning to move whilst their husbands were terminally ill in

hospital,onewiththeencouragementofherhusband,onewhosehusband

haddementiaanddidnotknow.Meaningfulissuesintheirformerlocation

didnotholdthemback;theyfocusedonaddressingfunctionalissues.

A2.BEATRICE I have friends and family here.When you come from athree-bedroomplace..you'vegottogetrid;NoIdidn'tdependonanybody.Nomydaughter'sgot twochildren…andshe’sgotherown life to lead. IknewwhatIhadtodo.Ipackedup,photosandthethingsthatwerereallyprecioustome.Iletthem[removalservice]dotherest.No,I'mapersonwho doesn't depend on anybody. Getting rid of my husband's stuff wasemotionalbutgettingridofmystuffno.

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A7.AnnetteIwentthrougheverycupboardandthrewawaysomuchandgaveaway.Ipackedeverythingmyself.I'vedoneeverythingonmyown.IneverthoughtIwould.Itwasalotofhardworkbutworthit.Ilovemyflat.Iwondered if I'ddone theright thingbuthe [husband]wouldbeproud.MysonisimpressedI’veputnothinginthelofthere[topfloorflat].IthinkImaynotbesentimental!

Despite accepting a lot of practical help, A2.Beatrice and A7.Annette

describedthemselvesashavingmovedontheirownbecauseoftheirlevel

of control and autonomy over the situation. Thiswas also because of an

importantdistinctionthatthehelpwasfromnon-familymembersandwas

assistancethattheyhadorganisedandpaidforindependently.

GroupBOlderMovers

B4.Megan’scaseillustratesthelevelofphysicalandmentalinputrequired

to move and that it was a greater strain than she had anticipated, even

when substantial assistance was given. She felt she had autonomy and

independenceindealingwiththemoveB4.Megan–“Iwasalwaysincontrol

ofmylifeandIstillam,I'mmoresecurenow”.Shewasrelievedatchanging

from a “somewhat frugal” life to onewhere she can purchase services to

avoid being a burden to her family. Despite these factors, the assistance

wasnotintrusiveandwasmanagedbyher,albeitslowlyoveralongperiod

of time. Her medical symptoms however, increased substantially in the

periodafterthemove,whichsheandherdoctorattributedtothestrainof

moving.

B4.MEGAN I started turningoutand I thoughtwell ifever Idomoveatleast I've started something and that took me ages. Once I knew I wasmovingsomewhileafterhisdeathIfinishedallthephotographs,Istartedgetting rid. I don't know how someone without family or a group whosupport them would cope, it would be chaos. My family helped withpackingandunpacking. I didall thede-clutteringmyself. Mydaughterswereproudofmeandtheysaymyhusbandwouldbeproudofme.I stayed with my daughter and her husband for a month. My churchfamilywereverysupportive,veryverylovingandcaring.Itwasthemoststressful time ofmy life,moving froma family home of 56 years… I lostweight,IwassotiredandifIwokeupinthenightIwasthinkingwhatI'dgottodothenextday,andsoIwastired-outwhenImovedalthoughyoustillkeepgoing.Changeistiring,painistiring.

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Whereas younger Movers A2.Beatrice and A7.Annette (2nd prior quotes

above) settled quickly, olderMover B4.Megan was still trying to recover

fromthestrain.Theyallhadthesameleveloforganisation,lead-intimeto

the move, assistance and high level of autonomy. However, B4.Megan,

despitebeingrealisticinplanningtomoveovertheyears,andstatingshe

feltincontrol,leftahomeshewasdeeplyattachedto,soeffectivelyitwas

notachoice.Shestruggledwiththedecisiontomove,andwithrestrictive

mobility and pain. Interestingly whilst both older Mover B4.Megan and

youngerMoverA7.Annette had also both lived in their former homes for

many years, A7.Annette suffered no detrimental effects from leaving it

behindasshehadnotfeltattachedtoherhome.Shedescribeditonlyasa

basewhereherhusbandworkedandthey travelled theworld from.Both

B4.Megan and A7.Annette expressed a sense of relief and pride in their

achievement of moving, but A7.Annette found it easy to settle-in and

expressedhappinesswhereasB4.Meganwhofounditdifficult tosettle-in,

expressedreliefandexhaustion.

There were two participants who readily accepted family help with

relocation; younger MoverA4.Jill (quoted 2 pages previously) and older

MoverB7.Joanne (quoted below). B7.Joanne, likeB4.Megan (above), said

her home was cluttered and difficult to maintain. Unlike B4.Megan,

B7.Joannewasnotattachedtoherhomeand inhindsightwishedshehad

movedsooner.Anothermajordifferenceisthatshedidnotdoanyphysical

workduringthemoveandwhilstbeingfrustratedbythisphysicalinability

she,aswithMegan(above),hadtotalcontroloveralldecisions.B7.Joanne

reported recovering immediately and had substantially benefitted

medicallysincemoving.Shebeganusingamobilityscooter togooutand

socialise. Shechoseadevelopmentequidistant fromeachofher children,

whonowvisit.Herdiabetesmedicationwasreducedalmost immediately,

andshemadeadecisiontohavetreatmentforhercataracts.Sheattributes

allofthesehealthimprovementstothemove“it’smarvelloushere,beforeI

couldn’tdomyhousework,nowIcan”.

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B7.JoanneImadeallthedecisions.Newthingswereboughtbutnothingthrownawayinthosedays.ThechildrenhaditallundercontrolIjusthadto sit there andwatch and felt frustrated. You can’t just bash yourwaythrough it. Packing took seven months with everyone helping. Mygranddaughter was the project manager and did all the paperwork.Impossiblejustimpossibletodoitallatonce;Ifeltpositiveasifsomethingwasshiftinganditwastakeninstages.

ConverselyB5.Meral,alsoanolderMover(quotedbelow)founditdifficult

to accept her only choice was to move nearer to family in retirement

housing or to move to residential care. B5.Meral, like some other older

participants, had been more dependent on her husband for things that

womenwouldbejustaslikelytodealwithnow.

B5.MERAL I literally couldn't think straight, my family were gettingworried. He (husband) did everything. After a day's work he dealt withbuyingahouse. It's difficult you can't see forward. I know it's twoyearssincehediedbuthedideverything-itwasmostlydowntomen.

B5.Meralwasindependentinnaturebutnotconfidentinherefficacy.She

hadnotpreparedforthepossibleneedtomoveandwasnotincontrolof

theprocess,despitereluctantlyhavingtoagreetoit.Shefelttotallyoutof

control:

Itwashorrendoustome[themove].IfIhadn'thadmydaughterandherhusbandIdon'tknowwhatIwouldhavedone,Idon'tthinkIwouldhavecoped.Istoodthereandheldmyheadandsaid'thisisnogood,I'vegottolivenearyou'.IthoughtIwasgettingdementia.IhadsuchaniceplacebeforeandgotitjustasIwanteditandjustwalkedaway.Istillthink'youarecrazy'butIcanjustpickthephoneupandtheycomeover.Mydaughtercanbehere insidethehouronthetube. Ididn'twanttomove,Ihadtobitethebullet,stillnotsettled,Istayquietanddon'topenmymouth.Ishouldhavesaidmore.….butintheendIdon'twanttogointoahomeandsoyouneedaplacelikethis,andneartopeoplethathelpyou.

B5.Meral’sambivalenceaboutmovingisevident.Thisincreasedthetrauma

andhastakenalongtimetosettlein.Whilstrecognisingthebenefitsfully

she still strays back in conversations to disbelief at leaving the original

home she loved. The move had to be quickly organised and she missed

basic attachments to place such as her garden, the number of birds to

watchfromthewindowandbeingnearthesea.However,overallshehad

benefittedmore thanmost inherolderMovercohort.Heractualsurvival

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has, not unreasonably, been accredited to the move, support within her

newcommunityandproximitytofamily(evidencedinsections6.2.3.3and

6.2.3.4subsectionstofollow).

6.2.2.2Subtheme:Desireforproximitytofamily

Participantsexpressedmixedfeelingsintermsoftheirdesireforproximity

tofamilyandfamilypressurestomove.Inthisresearchandintheexisting

literature(e.g.VanDiepenandMulder2007;Kearnsetal.,2011ch3para

3.9) day to day support was preferred compared to formal services,

sourced independently. Participants valued the companionship of family

currentlylivingnearby,andwouldnotwanttomoveaway(orforfamilyto

moveaway)buttheydidnotwishtomoveneartofamilyoutofchoice.The

followingquotesarefromaGroupBolderMover,GroupCyoungerMover

andfourGroupDolderMovers.OneGroupAyoungerMoverhadrelocated

nearerto familybutshewas independentand insistentonmakingall the

arrangementsherself.

B7.Joanne Theysaid livewithmewhenhedied, in thegranny flatbut IwantedtostayinthemiddleofthemallandbeindependentC2.LeeIt’snotthatthere’snoonewhowouldhelpme,it’sthatIwouldn’tletthem.Idon’texpectmykidstolookaftermewhenI’mold.That’snotwhyIhadthem.D9.Alison I want my own independence and they need their privacy. Iwouldn't ask them. They do minor jobs. We work together aroundproblems.D12.DORAWellthey[family]askedus….weweren’tdependentonthemandIwouldn'twanttobe.Ihavealotoffriendsinthisareaandmylifeishere.Whychangewhenyou'rehappyjusttosuityourfamily.It would be like losing everything you have built up over the years andyour independence. At the end of the day you're doing that for theirbenefit.Thegrandchildrenaregrownup.ThehelpchildrengavemewhenIwasill,wouldbebetteriftheyhadbeennearerbutonlyforthem!D8.Kath …the daughters don't think thatwhen the grandchildren havegrown up you're on your own again in a strange place. Another had tomoveastheysaiditwastoofartokeepcomingdown.Shelivesoppositethembutthey'reoutallday…TheyhaveheronceaweekfordinnerbutallIget[onthephone]isIwishIwasbackinmylittleplace.

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A diminishing role within the family, from being a provider to being

dependent,mentionedpreviously,addstothesenseofbeingaburdenand

feelingsofdisruptingthelivesofothers.Itisathemecommontoallbutis

particularly prominent for two participants who see close proximity to

familyaspotentiallycausingintrusionforbothpartiesifthereisnospecific

purposeforthemtobenearby.Thisdoesnotvarybetweencohorts,byage

or inclinationtomove; forexample, inthefollowingquotesfromyounger

NonMoversinGroupCandolderNonMoversinGroupD.

D4.Emily It'salwaysbeenushelpingthem,I'muselessalwaysaskingforhelp, they'reallgettingsickofme.The familydoa lot forme. I think if Imovednearertomyotherson, it'sabitremoteandI'dbecomeaburdenyouknowifanythinghappened,they'vegottheirownlivestolive.D7.VioletMydaughterstayedhereforawhilebutitdidn'tworkout.Theysay you changed our nappies as children, now it's our turn to changeyours.C8.SallyIwouldfeelawfulgettingthem[daughters]totravel.Iwouldn'twanttolivewiththem.BothmysisterandIareterrifiedofhavingtolivewith the children. You want your own privacy. You don't want a rolereversal.Almoststrangerswouldbebetterthanyourownfamily.C11.MargorieI’mtryingtobeasindependentaspossiblewithoutpushingthemaway.IfmyhusbandhadbeenaliveIwouldhavemovednearbyasIwouldn’tfeeldependentorimposing

Many younger Non Movers (Group C) have responsibilities to family

members that keep them from fulfilling their own housing and other

aspirations.Forexample,oneparticipantvisitsparentslivinglocallythree

timesadayaswellasworking,andanother travelsa significantdistance

once a week to visit family. Three participants had few or no family

members.

GenerallyyoungerNonMoverGroupCparticipantsweremoreconcerned

withbeingnear to friends than family.BothMovergroupsexpressed the

importanceofstayingneartofriendswhentheyrelocatedandthisadded

tothenegativeimpactofbeingmovedwhennotofchoice,tonewlocations:

C6.AVRILWhenIamonmyownasparentsaredead,itwillleaveahugegap,soeventhoughherearelotsoffriends,Imayfeellonelyandtherighthousing environment couldalleviate that. I had thought I'dmoveout tothecountry,Iwouldn'tnow,asfriendsaresoimportant.

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Interestingly the importance of staying near to friendswas expressed by

nineoftheelevenyoungerNonMovers,butwasveryimportanttoonlytwo

ofthetwelveolderNonMovers.Theyseemtohaveletfamilyorhusbands

take the lead sociallypreviously and some refer to friendshavingmoved

awayordied.

6.2.2.3Subtheme:Pressuretomovefromfamily,wellmeaningorself-serving?Pressure from family to move was evident in different forms. It ranged

fromopendiscussionswith familyaboutoptions,due tomutualconcerns

that didnotnecessarily result in amove (e.g. olderNonMoverD2.Jan in

section6.2.1.4above),towellmeaningbutillthoughtoutimposedmoves,

mainly carried out for thepeace ofmindof family. The latter resulted in

distressandlonelinessforolderMoversB8.BellaandB1Masie(featuredin

section6.2.3.1 subthemebelowon loneliness, rather than in this section,

since loneliness is the key outcome of their moves). More appropriate

movesinstigatedbyfamilybenefittedtheindividualgreatly(suchasolder

MoverB7.Joanneinprevioussections6.2.1.1and6.2.2.1subthemesabove).

Essentialmoves saved lives in twocases, irrespectiveof the initialdesire

nottomoveandsubsequentdifficultyinadapting(B5.Meralfeaturedabove

and youngerMover A8.Glenys.Both stories feature in section 6.2.3.3 and

6.2.3.4 to follow). There were those where plans to move were without

doubtmaliciousandfinanciallyself-servingforthefamilysuchinthecase

of youngerMover A3.Evie,section 6.2.1.1 above andB2.Eliza featured as

theexamplehere,sinceitisthemostextremecase:

B2.ElizaWhenmyhusbanddiedayearagomysonandpartnersaidyoucan'tstophereasthere'sno-onetolookafteryou.You'reblind,you'vegottocometo[].Nextthingthebungalowwasonthemarket-itwasalovelyplace (cries) and the neighbours looked out for one another. I'm blindtheybroughtapieceofpapertosign.Ineversawasolicitor.Theyputallmystuffintostorageandnoweversuchalotofstuffismissing.

B2.Elizaendedupsleepingintheconservatoryatherson’shouse.Attempts

weremadetogiveherfoodshewasallergicto,heraccesstoinsulinanda

private phone were removed. Following this social workers and doctors

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werecalledinabidgethermovedtoacouncilnursinghome,whichfailed.

Eventuallyshewas‘rescued’“mygrandsoncametogetmeoutofawindow

andIhadtostayatmysister’s[nearthepresentlocationthatismanymiles

fromherformerhome]. AlthoughElizapursuedthereturnofhermoney

atcourtanddidnotpressothercharges,theeffectonherwasdevastating

to thepoint of her feeling suicidal (GPwas aware). Shewaspreviously a

verycapableprofessionalandfounditdifficult tocometotermswithher

lossof independenceandalso lossof trust inherson.Shereferredtothe

new retirement housing that she found with the help of her sister as ‘a

place,notahome’andfeltshewouldneversettle.Sheparticularlymissed

being in the marital home and her former neighbours who had become

friends. (explicit consent was obtained to tell her story per ethical

considerationCh5section5.11.2retranscribingofinterviews)

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6.2.3OVERARCHINGTHEMETHREE-Localcommunity;needsandsocialidentity6.2.3.1Subtheme:Loneliness,companionshipandcontactversusvisitsand outings; Pets a special case (because a relatively small numbers ofparticipantsdiscussedthisbutdidsowithverystrongfeeling)FiveolderNonMoverparticipantsattendedluncheonclubsandthosewho

were less able generally had relatives who arranged outings for them.

Participants made the point that whilst these contacts were welcomed,

loneliness occursmost often due to lack of daily companionship, despite

organisedevents.Sixparticipantsmovedtoretirementhousingspecifically

tocombatlonelinessandtobepartofacommunity.However,fortwoolder

Movers(B8.BellaandB1.Masiebelow),inappropriatemovescausedgreater

loneliness,withnootherapparentbenefitstothem:

B8.Bella Time 1 Sometimes I feelmiserable,when you're on your ownyouwantcompany.Ifyoudon'ttalkyougoabitmad.Before,Icouldseelifegoingby,Ican'tseepastthewall[outside]Ilikedmyoldneighbours.Imissthem.ImustgoouteverydayifIcan,Ican'tsitstill…….Idon'tgooutnow,Ihavetowaitformydaughtertotakemeoutit'suphill.Theypushedmetoosoon.Weknowthatnow.Mysonchosethis,he livesnearby and calls in a couple of times aweek,mydaughter comes, everyweek, the station is nearby. Imissmy [adult] grandchildrenwho live in[neartoprevioushome,30milesaway].Theymovedmetoosoondidn'tthey?

B8.Bella’sfamilymayhaverushedaftertheirfather’sdeathintowhatthey

saw as keeping her safe. Despite an effort to sound positive at having

movedagainstherwishes “movingsomegoodthings,somebad”,B8.Bella,

aged inher90scouldnoteasily listgoodthings.Shesaid“theneighbours

are nice here”’ but she desperately missed her old neighbours,

grandchildren and the passing community who she saw daily out of her

window. She mentioned having an outside space as being good but the

outlook is a brick wall. The new location is on a slight hill and her

confinementresultedinhersittingforhours.Bythesecondmeetingwith

the researcher, she had swollen feet; she said she felt “odd” (obtrusive)

when exercising by walking up and down the corridors. Which, she

complained, were long and straight with nowhere to sit “people wonder

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whatyouaredoing”.Shewasmoredepressedthanatthefirstvisit,andher

summary;“It'slikeaprison,Ican’tgooutandIcan’tseeout”.

Another older Mover, B1.Masie, experienced a similar situation. Her

seeminglywell-meaningdaughters,wholiveabroad,misjudgedherneeds

toallaytheirownfearsabouthersafety,withdetrimentaleffectsonher.

B1.MasieAftermyhusbanddiedmydaughtercameover from [abroad]andwhenshesawmeshesaidIdon'tlikeleavingyouhereyoucouldfall.I'mnevergoingtogoinaflatIsaid.Ihadastairlift…WhenIfirstcame[groundfloor1bedr.flat]hereIthoughtI'mnotgoingtolastlong.Ifthey'dlookedaroundmoretheywouldhavegotabetterplacewithmoretodo.IwouldmovetoabetteronenowbuttheysaidI'mtoooldnowandIsplitthemoneyleftoverbetweenthemsoprobablycouldn'taffordit……It'salongdayjustsittinghereworryingaboutyourillness.Thecleanerislike a daughter; she takes me out instead of cleaning if it doesn't needdoing. There's no communal room, guest room or laundry. I somiss thegarden,can'tgetoutdirectlytothesharedone;it'snotthesame.Ifeeltiedhere.Whenmydaughters comeover there'snoguest room.Theymovedmetoosoon.Iwasinturmoil.I'dbeenthere60years.Idon'tlikebeinganuisancetoanybody.Ineveraskanyoneforhelp.Iwouldn'thavemovedatall.

B1.Masie immediately produced photographs of the previous house and

garden at her interviews and stressed she would still be capable of

maintaining them. This participant, like others in the research, does not

regularlywearher securitypendantaroundherneckand there isnoon-

site warden. She is effectively no safer than when living at her former

address.Thedaughtersmayhavepeaceofmindbuttheyhavemissedthe

opportunitytomakehermoresecureandlesslonely.Shehadlesspurpose

andsaidshehadbecomedepressedasaresult.Sheexpressedbitterregret

about complyingwithherdaughters’wishes tomoveher at a timewhen

she felt in turmoil but did not like toworry them. Theymoved her to a

place that she dislikes; she blamed the lack of a garden and familiar

neighboursforher loneliness. Shewasattendinga luncheonclubtwicea

week but missed the companionship she had had previously from

neighboursandsenseofcommunityfromhavingastreetviewwithplenty

goingon.Shewishedshestillhadasparebedroomforhercraftsand for

herdaughterstostay.

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ThestoriesofolderMoversB1.MasieandB8.Bellaareincontrasttothatof

youngerMoverA1.Gailwhosewell-managedmoveandautonomyoverthe

processisdescribedabove(secn.6.2.2.1).ThisisdespiteA1.Gailfeelingher

identityandpurposehadsufferedduringtheyearsbeforeshemovedand

hermentalhealthpreviouslybeingaffectedbyloneliness.Shedescribeda

desolatepicturepriortohermove,andacompleteturnaboutaftermoving,

including that her high blood pressuremedication needed to be reduced

immediatelyfollowinghermovebecauseherhighbloodpressurereduced.

A1. GAIL Iwasgettingveryisolated, livingabitofanoddlife.I losttheabilitytotalk.IfsomeonephonedupIwantedtotalkbutcouldn't.IgottothepitchIwasfrightenedtoanswerthephone.IcouldbetheretwoweeksbeforeIcouldevergetoutandnotseeasoul…Itwasactuallyquitetiringto startwith [mixingwith people] as Iwasn'tused to it [laughs]. Iwasgettingupinthemorning[before]andwashinganddressingandthenIwasmovingaroundtheflatandwatchingthetelevisionandIthoughtI'velostmyself, I'm not there anymore, I'm just this funny old person erm,reallymostodd.ItwasmorelikeI’dbeenbeatenintoacornerlikeasickoldladythatnoonelistenstowhateveryousaynoonetakesanynotice.NowI'vetakencontrolofmylife.Well strangelyenoughthemostpositive thing, it's talkingtopeoplehereand also in the street…It seems like there's quite a lot of older peoplearound and they stop you in the street and they say 'oh goodmorning,hello,howareyou'andit'snotpeoplethatIknow,whichislovely.

Lackofdailyinteractionhadledtoamentalstateresemblingdementiafor

A1.Gail. In a number of participant stories, isolation came from loss and

bereavement,whentheirpartnerswhoweretheirmainsourceofhuman

interactiondied.Therefore,asmightbeexpected,bereavementwasakey

causeoflonelinessbutasdiscussedinsection6.2.2.2above,bereavement

and loneliness didnot create a generalwish tomovenear to family in a

different area. Neither was there an expectation that doing so would

reducelonelinessfollowingbereavementasGroupDolderMovers,Group

AyoungerMoverandCyoungerNonMoverexplain:

D12.DORASomewanttomovetotheirchildren'sarea…butifyouleaveittoolateyoucanbeverylonelyevennearyourfamily. I'vespentalotofmytimehelpingotherssoIwouldaccepthelp.Nottobedependentbutabitofcompanyandmaybealifttothedoctors.

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A2.BEATRICEIsithereandthinkabouthimahellofalot,IdoandIgetupsetbutIdon'tthinkthat'sdepressionIjustthinkImisshim.C2.LeeIenjoyindependencebutdespiteallthesocialisingitcanbelonelyintermsofcompanionshipandhavingapartnertogoplaceswith.D9.Alison Idon'tmakeitmybusinesstobealonelyperson….butInevergotoverlosingmyhusbandinhis60's.D7.VioletThefamilytakemeouteveryweekbutit'swhenyou'rebackonyourown,ithitsyou.It'snotgoingout,it'shavingsomeonetostayinwith.Mydaughterstayedforawhilebutitdidn'tworkout.

Beingabletokeepapetwasextremelyimportantforthefourparticipants

whomoved,totheextentthattheywouldnothavemovedwithoutthem.At

least twoyoungerNonMoversexpressedthe intentiontogetadogwhen

theyretire,whichispossiblyonereasonformoreindividualsinthatgroup

requiringagardenandtobeneartoapark.

6.2.3.2 Subtheme: Community facilities, neighbours and communityfriendlinessThelocalcommunityisextremelyimportantinchoosingtostayinormove

from a location. Participants connected this to getting exercise, having a

goodqualityof lifeandwellbeing,andhavingnearbyfacilities.Goodlocal

facilitiesresultedinamorenaturalintegrationandsocialconnectivitythan

might occur purely within retirement housing itself, in which some

exclusionoccurred(seesubtheme6.2.3.3tofollow).OlderMoverB5.Meral

has benefitted despite her initial resistance to moving home, as has

youngerMoverA1.Gail.NonMovers canbecome isolated if local facilities

changeortheybecomeunabletodrive.

B5.MERAL I go to the shops everyday for foodand theyknowme.Thegreengrocer said he wondered where I’d got to [when she was inhospital].IonlybuyalittlebecauseIcan’teatmuch;itgetsyoutalkingtopeople.Registeringwithanewdoctorismind-blowing.Ihadthelastdoctorfor10years…Ihavealaughwiththatdoctor[newone]…Hewasreallygoodtome; he said if youwon’t go intohospital today, youwill tomorrow! So Iagreed, he actually walked me home. It’s only around the corner, howcouldIgetacab?Butitwasoneofthosereallywindydays.

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A1.GAILEverythingissonear,theshopsarehereandjustacrossthereisthe doctor’s, there are buses and trains to everywhere you need to go. Idreadtothinkofitnow,whatmighthavehappened.Icouldn'tcopethereD6.VanessaWhenthelocalshopscloseddownitwasarealproblem.D12.DORA I try to go out every day. You get used to an area and feelmoreconfident.

As reported in Part One of this chapter, transport was said to be of key

importance for participants and their visitors; for example older Movers

B5.MeralandB8.Bellahadmovedneartoatubestationfortheconvenience

ofrelatives.A1.Gailgainedindependencebymovingtoahighstreetlocation

with good transport links and older Non Mover D2.Jan would be

housebound without the bus stop outside. Free travel passes were

considered to be essential to participants, for example Sally and Megan

(youngerandolderNonMovers)whodescribedasociallifethatseemedto

centreongoingout,usingthepasstotravel.

All of the participants in various contexts mentioned neighbours. Bad

neighbourswere a source of harassment, severe in two cases, cited as a

sourceofstressbythreeolderNonMoversandactuallyresultedinamove

by another in the youngerMover group. However, participants generally

recognised that reliance on neighbours was not sustainable. Frequently

participants referred to the loss of previous neighbourly support when

neighboursdieormove.Having to leavegoodneighbours,however,does

notfeatureasanimpedimenttoparticipants’movingexceptinthecasesof

olderMoversB2.ElisaandB8.Bella.Aspreviouslymentioned,theymoveda

considerabledistancefromneighbourswhohadbecomeveryclosefriends,

andthisfactorcontributedtotheirdepression.

Neighboursdroppedbywith shoppingduringoneof the semi-structured

interviews, not intruding, not close friends but leaving shopping on the

doorstep,havingknockedonD5.Amy’sdoor,anolderNonMover,tocheck

ifsheneededanything.AnotherolderMoverD6.Vanessawas“fetchedtosit

withneighbours”whoshedidn’tknowwell,whentherewasapowercut.

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Therewas,however,alsoanegativeside.Severalparticipantstalkedabout

marketchangesthathadledtoownersmovingoutandlettingtheirformer

propertytoshort-termtenantsratherthansellingit.Newneighbourswere

thereafteroftentransient.Severalparticipantsmentionedtheyhadasense

thatrelativelynewneighbourswhoownedpropertywerejustwaitingfor

them to die in order to get their property too. This was expressed by

younger Mover A5.Laura in addition to several younger and older Non

Movers:

A5.Laura I loved thehouse, Iwanted to stay forever.Newpeople came,knockeddownchimneybreastsandbuiltabigshed.Otherneighboursbuiltanextensioncausingadisputeasitblockedmylight.C3.Jackie The ones renting, they're transient so you don't get to knowthem.Itwouldbeifsomeonediedweusedtoallputinacollectionbutnoonewouldknownow.C8.SallyHerfamily[anAunt]weren'tclosebybutatonetimethere,allofherneighboursknewherbutbythetimeshewas90therewasno-oneleft.D5.AMY....youknowitwillbesoldandthey'llspendthousandsaddingbitsandbuildingatthebottomofthegarden,itdisturbsyouandyouwonderwhoisgoingtomovein.Idon'tgetit,besatisfiedwithwhatyou'vegot.D8.KathAlltheneighboursarenewpeople…Iagreednextdoorcouldusethedriveway topark.Nowthebrotherdrives rightup to thedoorand Iaskedpolitelythree3times,theytooknonotice…..Alotofneighbourshavegone, when a wife or husband dies. The other side is 97, they [otherneighbours]arejustwaitingforhertodie.D12.DORAThisroadhaschangedalotofcourse,everyoneobsessedwithmakingtheirhousesbiggerandbetter,neversatisfiedD9.Alison Neighbours die and others move in, they don't respect us.Everyone wants more and more. Next door cut down the rose tree myhusband planted in my garden and put a kango [large electric drill]throughthewall.

When older Mover D9.Alison suffered harassment and damage to her

property,thecounciltookenforcementactionagainstherneighbourswho,

also during their refurbishment used of their back garden as a rubbish

dumpforbuildinganddomesticwaste.Shehadbecomeuncomfortable in

herhome;shesaidthiswasbecausethelargefamilylivingnextdoorwere

watchingherandtryingtobefriendher,onlytobesureofbuyingherhome

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whenshemovesordies,astheywantedtojointhetwohouses.Ontheday

of the researcher’s second visit, refurbishment work started on the

property neighbouring her on the other side and D9.Alisonwas visibly

distressed.

6.2.3.3 Subtheme: Retirement housing; socialising and sense ofbelongingOneimportantfeatureofmovingtoretirementhousingisthatneighbours

aremorelikelytobeofasimilaragegroupand‘like-minded’aphraseused

byseveralparticipants,referringtoageandculture.

In older Mover B5.Meral’s case [featured in secn. 6.2.3.1 above], the

beneficial difference that social environment made to settling-in was

apparent,particularly inconjunctionwithhavinggood local facilities that

wereusedtosharesocialexperiences.

B5.MERALTheyarereallynicehere,wehavecoffeemorningsandotherthings.MyneighbourknockseverydaytoseehowIam…IsaidI'dliketolightacandle formyhusbandandshetookme [to the church] I'veonlybeen twice because then I got ill but I really enjoyed it and on thewayback, it'sonlydowntheroad,westoppedatthecafe forcoffeeandcake.Shesaiddon'tworry,comeagainwhenyou'rebetter.That'swhyshelteredhousingisidealbecauseyou'recheckedonandsomeonewouldknow.

Non-familial socialising (Cutchin et al. (2007); Callaghan et al. (2009) in

ch3 para 3.8.5) is crucial for older people settling into a new communal

setting and for effective inclusion. Thus facilities at the retirementblock

wereimportantforfosteringasenseofbelonging,thelackofwhichcaused

problems. For example, another olderMover B1.Masie,mentioned in this

sectionpreviouslyinthediscussionofloneliness,hadnocommunalareas,

guestroomforherdaughterstostayorgarden.

Noteveryonewantstobeinvolvedinorganisedsocialactivities.D4.Emilya

NonMoveragedinher80shadanoutgoingnatureandbutforherhusband

wouldhavemovedsooner.However,shedidnotwanttobelivingwithall

olderpeoplesowasagainstmovingtoretirementhousing.

D4.Emily I’mnotcommunal, I likepeoplebutI’mnotcommunal.Halfofthem[olderpeople]onlygotothedoctorstositandtalkabouttheirpills.

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A8.GloriaintheyoungerMovergroup,whomovedofnecessityratherthan

choicewas taking awhile to settle in (para 6.2.2.1 above). Although she

wascontentnottojoininatpresentanddidnotfeelpressuretodoso,she

wasstartingtofeelthemovehadbeennecessaryandadvantageoustoher

health.

A8.GloriaThere'sallthosethingsyoucandoherebutI'mnotinterested.Quite a lot going on. There are one or two people [shrugs]. Since I'vemovedhereIgetmorevisitors.I'mquitecontentedreallytheyringupandseemeeveryweek.

Negative connotations associated with age and thereby retirement

housing,werementionedby four youngerNonMovers,who thought age

differencewouldbetoogreat.ConverselyC2.Lee,oneoftheyoungestNon

Moversandmostsociableparticipantshadnoqualmsaboutmovingwhilst

still in her early 60s. A5.Laura, a younger Mover, who moved due to

harassment from neighbours found she could join in at an appropriate

levelandnotfeeloutofplace.

C2.Lee Iwouldliketofindasmallgroundfloorapartmentorbungalowinoneofthoseretirementvillages.Somewhereyouknowsomeoneisthereif you need them. Opportunity for social life, easy access to bank,hairdressingsalononsite.WantingtosocialisebutknowI’msafe.A5.Laura I thought I’m too young for fish and chip suppers and bingo,mostofthemareolder,butitwasok;noregretsexcepteveryonehasacarandtherearen’tenoughspaces.

Older Non Mover D8.Kath had family visits and outings with them but

companionship was mainly through friendships at the local authority

funded luncheon club and a range of organised events. She was visibly

changed by the time of the researcher’s second visit; shewas negatively

affectedwhen fundingwas cut back,which reduced the daily interaction

availabletoher.

D8.KathThereareoutingsonceamonth,Ineversaynotoanouting.I'minthechoir…Ican'tsingbuttheytakemetherefromtheclub,andwedoashow.Theysay,ifyoucan'tsingjustopenyourmouththeaudiencewon'tknow[laughs].Second visit:They'veput thepricesup [luncheon club] and stopped thechoir. He (council officer at discussion forum) said the council has nomoneyanymore,thatwasn'tadiscussion.

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Social events at retirement housing can be less circumstantial and

vulnerable tochangeand funding isnotnecessary forroutinesocialising.

However, the social make up or age mix cannot be guaranteed to work

well,asyoungerMoverA6.JaneandolderMoverB8.Bellaexperienced:

B8.BellaThepeoplehereareniceandthemanagerisanicelady.Igotothecoffeemornings;Idon'tfeelIcanjoinin.Thepeopleherearenicebuttheysittogether.A6.Jane They're very set in theirways, I had some complaintwhen theworkwasdone.They’repolitebuttheydolikeamoan.Itneedslookingatwhentheygetto90,ifitcanbecheckedifthey'reontheirown.Usyoungerones are trying, the elderly ones aren't interested enough. They havenothingtolookforwardtoandarestuckinarut.Theystarttojustsit itout. They come in younger thanme thenwhen they get to 90 theyneedmorebecausetheycan'tgetout.

TheirexperiencecontrastswithyoungerMoverA7.Annettewhochosethe

development especially for the social advantages and is critical of those

whodonotjoinin:

A7.Annette I'm in the inner circle. I love my flat, I've made one goodfriend, somegood friends, Iget invited to lunches.One ladyheredoesn'tendearpeople toher.Whymovehere if youdon'twant tomix? I'dhavegonetothehouseIlivedin,[afterhersixweekholiday]madeafewcallsandthat'sit.Hereseveralnewfriendswerepleasedtowelcomemeback.

6.2.3.4Subtheme:Change,socialidentityandsocialintegrationMost participants in all the groups had strong views on housing issues.

They sometimes discussed these at length and expressed real concern

about housing costs for young people and the lack of proper job

opportunities,orlocaljobsthathadbeenavailabletopreviousgenerations

and had contributed to community cohesion. Although not specifically

asked, at least three participants challenged the value, other than

commercially,oftheincreaseinnighttimesocialculturetothecommunity.

Morethanhalfofallparticipantsthinktheimpersonalnatureoftechnology

ismakingsocietylessfriendly.YoungerMoverGloriaexpressedthis:

A8.Gloria You could go into the bank and talk to a person.Where arepeople going to work? I think of young people. It drives me madautomation.Ican’tstandtheaggravation,it’swrong.

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The threat of disruption to familiaritywithin the community and rapidly

changing community profileswas expressed in terms of concern or fear,

amidstgenuineexpressionsoftoleranceandappreciationofthebenefitsof

diversityandchange.Nearlyallparticipants said theywouldnotwant to

see a ‘return to before, mainly white British’. However, there were

expressedfearssuchasfromyoungerNonMoverVerinda,abouthowshe

mightbeaffectedbystayingput.

C5.Verinda There's no community anymore because you haven't gotsecondandthirdgenerationfamilieslivingintheareanow,thekidscan'taffordto livehereandthere'snocouncil tenancies left.Astheoldpeoplemoveoutordie....itwasjustlovely[before]….[now],Idon'tfeellikeI'minacommunity…plusnooneisEnglish,itisfrightening.

The declining sense of community from C5.Verinda’s perspective did not

necessarilymeantherewasnotalocalcommunitybutiftherewas,itwas

notonetowhichshefeltaffinityandshefeltshehadbecomeanoutsider.

She,likeseveralothers,pointedtotheincreaseinprivaterentedproperty

resulting inmoretransienceandpeoplegoingoutof theareatosocialise

withthereductionoflocalsocialhubssuchaspublichouses.

Themajority of participants were white-British with two participants of

Asian heritage and one of Caribbean heritage. The neighbourhoodswere

mainlyculturallydiverseincludingsome,wherewhite-Britishwasnotthe

largestethnicgroup.Whilstsomeareashadbeenhighlyethnicallydiverse

formanyyears,otherswererelativelyrecentlyadjusting tohigh levelsof

inward migration, which also changing the age demographic to a lower

averageage.

Whilstpositiveresponsescanbebiasedasaresultofsocialdesirabilityor

‘politicalcorrectness’,participantsappearedtotheresearchertohavebeen

honest and frank. They accepted and valued diversity whilst having

concerns about local community diversity in respect of age, religion and

ethnicityinthatorder.Nogrouprateddiversityissuesasastrongreasonto

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move or stay. However, perceived imbalance was a potential reason to

moveinthefuture.

Social changewas citedbynearly allparticipants as a reason for anarea

deterioratingintheirappraisaloffriendliness.Participantsrecognisedthat

mixing with neighbours was often dependent upon common language,

meeting through children or religion and other aspects that might be

affectedbyage,religiousprofileorethnicmakeupofanarea.YoungerNon

MoverVerindaadded:

C5.VerindaMy [ethnicity]next-doorneighboursarenice…they talkso loudly,wealways think they're rowingand it'sweird sitting in thebackgardenwithsoundsofalldifferentlanguagesaround.Pleasedon'tput down that I'm racist, it would just be nice to hear Englishsometimes.Myfrontdoorwasalwaysopen,everyone'swas[before].

B7.Joanne,anolderMover,whomade the followingstatement,moved for

health reasons and, despite her statement, would not have moved for

reasonsofdiversity.Shemissedthecohesiontheareahadhad,asaformer

councilestate(nowalmostcompletelyowner-occupied).This,shefeltwas

due to therebeing somanynationalities and languages and so fewolder

peopleforcontinuitywiththepast.

B7.JoanneWewere the only twowhite ones left. Therewas nothingwrong with them, kept their houses nice and all that. Differentneighboursall different andweredifficult tounderstandand chat to.Theywere nice people andwould come to help you if you fell in thestreetsortofthing.Immediateneighbourswerefabulous;shecriedtheday I left. But once [at one time] everyonewent in and out of eachother’sbackdoors.

Therewasarealconcern,insomecasesexpressedasfearandafeelingof

threattoculturalidentityandvalues,aboutthelevelandpaceofsocialand

culturalchangeanditsimpactonparticipants’individualwellbeing.

Other younger Non Movers (for example C3 and C6 quotes below) and

some in older Non Movers (for example D12 below) were disappointed

withwhattheysawasagradualdeclineincohesionandstandards.Again,

thiswasassociatedwiththelackofappropriate,morepermanenthousing.

C3.JackieEverypropertythatwasupforsale,[ethnicity]buyitandletitout.Upstairs tenantbought it [Right to Buy] and lets it out for£850pmnow.Thegardensarelargeandeveryoneisputtingshedsintoletout.

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C6.AVRILTheflatitselfI’mveryhappywith,Ifeelsafe,likethesizeofit.It'sthebuildingthatisnicebuttheresidentshavechangedoverthelastsixmonths a lot of property's gone up for rent [including by the localauthority for homeless families]. It's thenoise levels,generalanti-socialbehaviour.Theseflatsaren’tsuitableforfamilies.D12.DORA This road has changed a lot of course. We have so manydifferent nationalities which is good in someways but some types don’twant to saygoodmorning. Idon’tknowwhat they thinkyou’regoing todemandof them for sayinggoodmorning.They’rehappy foryou to taketheirparcelsinthough.Somearequiteweird,youneverseethemwalkinthestreet,justfromthehousetothecarandcreepbackin.

Othersfelttheywerebecomingoutsiders,whichcouldbecomeanissuein

thelongertermandwouldaffecttheirdecisionsaroundmoving.D12Dora

anolderNonMoverwaspreviouslyquotedduetohercarefulplanningto

stay put (2.6.1.1 above). Shemade a clear decision to adapt if the need

arose rather than ever moving from the area where she had previously

always felt she belonged. However, during her second interview, she

reflected thatolderpeoplecanbecome“invisible” in society.Therewasa

level of concern fromyoungerNonMovers (for example C2, C8 andC11

quotes below) who seemed to be content for the moment but cautious

aboutapotentiallossofidentityinthefuture,inthelightofchange.

D12.DORA I wouldn't want to be the last older person in the street....movingwouldbeanupheavalbutI'dcope.Theneighbourtheothersideisveryold,Ineverseehernow.C2.LeeIpreferdiverseneighbourhoods,doesn’tbotherme,don’twantallwhiteBritish.It’sfriendlyonlybecauseIsayhello–somegoodneighboursthough.Thisarea is supposed tobe improving I’vewaited30yearsof itbeingchangedfortheworse!Moreyoungpeoplearemovingin,previouslythey were low income and houses converted to flats, now young whitecouples with kids and young middle class pubs…They can’t afford [twoLondonareasquoted]anymoresotheycomehere.Iwouldn’twantitalltobewhite,mykidsaremixedraceofcourse…Mysocial lifeisoutsideofmyphysicalcommunity.

C8.Sally I love it here [diversity] a complete mix. I enjoy thecolourfulness.But Iwouldhate togo intoaroadwhereeveryonewasofone ethnicity– including allwhiteBritish. Someareas, one culture takesoverandthatisn’tgood.C11.Marjorie diversity is not a problem now but to be old in an areawhere I haven't got like-minded people frightens me I have so many

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differentethnic friendsbutcertainethnicgroupsdon'tmix.HowwouldIfit in? Iwouldn'twant to be the onlywhite British person in the street,which is a real possibility now. I'm worried about not being part of acommunity.

Insomelocationssocial integrationwasworkingat itsbest,withbenefits

tohealthandwellbeing,suchasforolderMoversB7.JoanneandB4.Megan,

YoungerMoversA2.Beatrice,A4.Jill,A6.JaneandA7.Annette.Thelastword

goestotwoparticipantswhofeltstronglythatbutfortheirrelocation,they

wouldnothavesurvived(A4.JillandB5.Meral).

B5.MERAL The neighbours care, the doctor cares, that makes such adifference.Idon'twanttogointoahomebutIcanseefromthecareIhadhereafterIwasillandtheamountthatpeoplenoticeiftheydon'tseeyouthat I'd be okay. She [daughter] says and so does the doctor, I have torealiseInearlydied.

6.2.4SummaryofPart2findings

The research proposition that moving is generally a complex, lengthy,

burdensome and often emotional process, was supported by the

discussions held with these participants. Physical, cognitive, emotionally

meaningful and functional aspects combined to make unique scenarios.

However, previous research reported here in chapter three (for example

Samsi2010ch3para3.1)suggeststherearepredominantlyjust“twotypes

ofolderpeople,thosewhoplanandthosewhodon’t” inrespectofplanning

tomoveandthishasbeensupportedbytheparticipants’viewsexpressed

inthecurrentresearch.Yet,whatleadssometoplanandothersnottoplan

is complex, it is determined by outlook on life, previous experience,

personalself-efficacyandcontrollabilitywithintheirdevelopingsituations

as health, social status and environment change. Levels of autonomyand

independence interact in complex ways with family interventions and

these factors influence the time taken to settle in aswell as thedepthof

integration following a move. Findings relating to chronic stress and

wellbeingeffectsarereportedanddiscussedinChapter7thatfollows.

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CHAPTER7HEALTHANDWELLBEING-Findingsandinterpretation7.0Introduction–qualitativeanalysisofstressmeasures

Considerationoftheparticipants’experienceinthisresearchhadahealthand

wellbeing focus for the reasons given and explained inChapters1 to4. This

included the research premise that relocation can be emotionally and

physicallydemanding, involving inmany cases aprolongedprocesswith the

potential forchronicstress. Itseemedclear to theresearcher fromwhatwas

known about cortisol reactivity that the numerical data alone is somewhat

redundantwithout context and qualitative information about an individual’s

feelings and perceptions of the situation they are in. Thus the qualitative

approach, used throughout the research extends to examining thewellbeing

measures - depression, anxiety, stress, self-esteem and hair cortisol

concentration (HCC). Since there was some commonality between views on

relocationwithinthegroups,thereweresomediscernablepatternswithinthe

cortisolreactivityofparticipantgroups.

Moreover, contextual interpretation shows differences discussed in the

literature (chapter 4), depending on the type of stressor. Due to the low

numbersofparticipantspergroup, these speculatively support the theory in

the literature but the findings are primarily useful for interpretation on an

individual-by-individualbasis.

Thehealthmeasureswereintroducedaspartofdiscussionsattheendofthe

Relocating Psychometrics (RP) structured questionnaire (ch5 para 5.5.2 and

5.6RPquestionnaire).Depression,anxietyandstressquestionnaireitemswere

the only questions asked retrospectively. This was so that at Time 2 scores

weregainedrelatingtofeelingsatTime1beforetheresearchfieldwork.Time

2.Time3answerswereconcurrent.

Table7.0ResearchTimeframe-Time-matchedforNonMovers.Time1

5monthsbeforethemoveTime2themove

Time3settling-in5monthsafter

PeriodA-periodof5monthsfromTime1toTime2

PeriodB-periodof5monthsfromTime2toTime3

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Hair samples for (HCC) occurred at Time 2 and Time 3 tomeasure cortisol

reactivity for Period A the whole five month period before the move and

PeriodBthewholefivemonthperiodafter.

7.1Traumaticeventspriortotheresearchtimetable

Table7.1showsthetraumaticeventsexperiencedbytheparticipantsofeach

group thatmight be expected to have an impact on self-esteem, depression,

anxiety,stressandthusthecortisollevels.

Table7.1Widowhoodandtraumaticeventsoccurringinthelasttwoyears,inadditiontotheordealofmovingforGroupsAandB.GroupAYoungerMovers

6werewidowed,(5inthelast2years)1hashadseriousmentalhealthissues1hadbeenfraudulentlydisplacedfromherformerhome1hadaserious,asyetundiagnosedailment1movedbecauseofharassmentfromneighbours.

GroupBOlderMovers

8werewidowed,(6inthelast2years)3 were moved with insufficient autonomy toaccommodationtheyremainunhappywith.1 lost her property fraudulently and suffered a relatedattackonherlife.2werediagnosedwithlifethreateningillness.

GroupCYoungerNonMovers

3wererecentlywidowedordivorced3werediagnosedwithaseriousillness.5 feel restricted currently by work and carercommitments.

GroupDOlderNonMovers

5wererecentlywidowed1 was being severely harassed in her own home by arelative

Itisclearthatcopingstrategiesandadaptivemechanisms(TaylorandBrown

1988; 1994), discussed in chapter 3 paragraphs 3.3 and 3.4, and further in

Chapter8,helpdefinetheextenttowhichtraumaticeventsareprocessedand

thusthisshouldbetakenintoaccountwhenassessingpsychometricsandbio

data. For example, not all participants were suffering trauma from their

situation.OneyoungernonMoverstatedinherinterview:“I’mhavingthetime

ofmylife.WhenI’mnotfittodothatI’llbehappynottobehere!”

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7.2Haircortisolconcentration(HCC)resultsSupportingdata for section7.2 is contained inAppendix15.Chart7.2below

provides the mean HCC scores for each cohort, in picograms per milligram

(pg/mg).TheHCCcollectionandanalysisprocedureisinch5para5.8to5.10).

PotentialextraneouseffectsNoreliableHCC reference rangehasyetbeenestablished for specific groups

(Russell, et al., 2015). Extreme scores were removed and those participants

advisedtoconsulttheirGPinaccordancewithethicalconsiderations(ch5para

5.12).OlderagegroupsinthisresearchgenerallyhadhigherHCCrateswhen

considered as a whole than the younger age groups (see discussion in

literaturech4frompara4.10.1).Otherthanthis,anyextraneouseffectsonhair

cortisolconcentrationcouldnotbedetectedbecauseofinsufficientnumbersof

participantstakingparttorepresentvariousconditions,forexampleeffectsof

dyes,bleach (ammonia) and treatments, includingperms (ch4para4.10.1 to

4.10.5).However, the general consensus in the literaturepoints to thesenot

reaching the core of the hair (medulla)where the cortisol resides (ch4 para

4.10.4and4.20.5).Any‘washouteffects’fromfrequencyofwashes,wouldnot

affect the results since the samplesusedwere5cm from the scalp (ch4para

4.10.4).There isaknownaffectofweightonscoresHCCscores(ch44.13.5).

GroupA GroupB GroupC GroupDPeriodA 7.79 18.32 5.52 13.35PeriodB 8.46 40.29 4.96 11.56

051015202530354045

HCCpg/mgscores

Chart7.2

Haircortisolconcentration(HCC)PeriodAof5mnthsdurationbeforethemoveandPeriodBof5mnthsdurationafter

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Whilstitmightbeassumedoverweightparticipantsmighthaveslightlyhigher

HCCscores,therewereinsufficientoverweightparticipantsforgeneralisation.

Therewasawiderangeofmedicalconditionsandprescribedmedicationtaken

across the participants. However, there appeared to be no obviously wide

variation inHCC scores for individuals takingmedication, including steroids,

fromthosenotonmedications.Similarlytherewasnowidevariationofscores

forUV light exposure,when therewas insufficienthair to avoidusing layers

exposedtoUVlight(methodch4para4.10.5).

7.2.1SummaryofdifferencesinHCC;PeriodBcomparedwithPeriodA

YoungerMovers(GroupA)hada9%increaseinHCCduringPeriodB,thefive

monthsafterthemove.ConverselyolderMover(GroupB)scoreswerehighand

changeable, having more than doubled in Period B. This is despite a less

dynamicchange indepression,anxietyandstressscores thanyoungerMovers

(GroupA)(charts7.3Ato7.3D).

Observationbasedonhabituation,delayedresponseandtypeofstressor

No generalisation can be drawn from the scores, not only due to the small

numbers involved but because of the individual nature or HPA reactivity, in

responsetostressors.AlsodelayedreactivityoftheHPAcanresult inincrease

and subsequent decreased cortisol in chronic stress situations (versus

immediate up regulation or down regulation in acute stress situations).

Therefore the type of threat is important andwhether it is perceived as long

term (chronic) and whether retrievable or insurmountable (i.e. dynamic or

static).

Older Movers (Group B) (featured in section 7.4 case studies that follow)

represent chronic situations that remaindynamic.Conversely fiveof theeight

participantsweremovingfromlongertermstressfulcircumstanceswhereHPA

responsemayhavebeenblunted,priortoPeriodA,beforethefieldworkstarted.

Takingaccountofdelayedreactivity,anincreaseinPeriodBrepresentedanup-

regulationinHPAcortisolresponsethatmayhaveoccurredwhentheirsituation

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improved in Period A. If so increased HCC indicates improvement, despite

addingtotheoverallmeanforincreasedlevelsofcortisol. Individualcasesare

examinedherefurtherinsection7.4tables7.4AandB.

YoungerNonMovers’HCCscoreswerestableacrossbothperiods,asweretheir

stress scores. Half the participants in this groupwere dealingwith long-term

carerandworkcommitments.Levelsofcortisolwerelikelytobeanappropriate

responsetoacuteday-to-dayeventsthatriseandfallquickly,donotenterthe

hairmedullaandwouldnotbereflectedbyHCClevels inthewaythatchronic

stresswouldbe.

OlderNonMovers’overallscoresshowedadropinHCClevelsof9%.Fourofthe

twelveparticipantsinGroupDexpressedregretatnothavingmovedwhenthey

had more opportunity to do so, potentially blunting scores to represent

resignation. However one of those had a raised rather than lowered cortisol

result, likelyduetoveryrecentbereavement.Anotherhadahighincreasedue

to renewedharassment (caseD7) thatwhilst chronic is an active situation so

habituationwouldnotoccur.These resultsemphasize thedifficulty in reading

toomuchintostatisticaloutputforsmallcohorts.

7.3Depression,anxiety,stressandself-esteemresults

Charts 7.3A to 7.3D on the following page provide the group scores for

depression, anxiety and stress for specific points in time: Time 1, collected

retrospectivelyTime2, justafterthemoveandTime3, fivemonths later.Self-

esteemmeasureswerenotcollectedretrospectivelysotheyareconcurrentwith

Time2andTime3.

156

GroupA GroupB GroupC GroupDTime1 3.75 5.75 2.18 1.9Time2 2.88 5.25 1.91 2.3Time3 0.88 5.75 2.91 2.4

01234567

anxietyscores

AnxietyTime1,5mthsbeforethemove;Time2,themoveandTime3,5mthsafter

7.3.C

GroupA GroupB GroupC GroupDTime1 9.63 8.75 4.5 5.6Time2 5.88 8.75 4.5 5.9Time3 2.88 8.88 4.8 6.1

024681012

stressscores

StressTime1,5mthsbeforethemove;Time2,themoveandTime3,5mthsafter7.3B

GroupA GroupB GroupC GroupDTime2 4 5.5 7.09 6.33Time3 5.88 5.88 7.09 5.9

02468

Selfesteem

scores

Self-esteematTime2,themoveandTime3,5mnthsafter7.3.D

groupA groupB groupC groupDTime1 9.75 5.88 2 3Time2 4 5.75 1.46 3.1Time3 2.38 6 2.27 3.5

024681012

depressionscores

DepressionTime1,5mthsbeforethemove;Time2,themoveandTime3,5mthsafter7.3.A

7.3Depression,anxietyandstressresults

157

7.3.1Depression,anxietyandstressdifferencesbetweengroups(Charts7.3AtoD)Thenumberofparticipantsinthisstudyisinsufficienttomakeinferencesin

respect of the self-assessed psychological states and connections to the

biodata.However,sincethemovewasthemainlifeeventhappeningatthe

timeforyoungerMovers, theself-assessedreductions indepression,stress

and anxietywere persuasive that themove itself had at least been partly

responsibleforthepositivechanges.

YoungerMovers(GroupA)hada24%reduction indepressionscoresover

thetimeframeoftheresearch;areductionof23%foranxietyscoresanda

reductionof30%forstressscores.Fivemonthsafterthemove,theirscores

werethelowestacrossallgroups,closetoyoungerNonMovers(GroupC)in

respectofdepressionbutlowerintermsofanxietyandstress.

OlderMover (Group B) depression, anxiety and stress scores started high

and, in contrast to younger Mover (Group A), remained high five months

afterthemove.Participantsinthisgrouphadmoredebilitatingillnessesand

five of the eight participants had less choice and autonomy, in contrast to

youngerMovers.

.

YoungerNonMovers (Group C) reported a rise in depression and anxiety

scoresof13%and33%respectively.However,GroupCstressscoresdidnot

increase, so were stable compared with younger Movers (Group A). They

werelowerthantheotherNonMovers(GroupD).

OlderNonMover(GroupD)depression,anxietyandstressscoresroseover

thetimeframe(17%,26%and9%respectively).However,theystartedwith

andmaintainedmuch lower levelsofdepression,anxietyandstressscores

thanolderMovers(GroupB),despiteasimilarageandhealthprofile.

158

7.3.2Self-esteemdifferencesbetweengroups;observationsChart7.3Daboveshowsthemarkeddifferencebetweengroupsoncombined

questionnaireitemsrelatingtoself-esteem–atTime2andTime3.

Self-esteem is important because of its generic nature as a measure of

wellbeing. Low self-esteem predicts depression (ch3 para 3.2) and

continuity of self-esteem is adversely affected by life changes that reduce

control (ch3 para 3.0.2). Moreover it is a strong predictor of positive

response to high levels of stress, including inclination to early habituation

(ch4para4.8.1).

Scoresneededtobeinterpretedinthelightofqualitativethematicanalysis,

reported in chapter 6 Part 2. The comments herewere adduced from the

viewsandfeelingsexpressedinthatanalysis.Thepotentialexplanationfor

patternsbetweenwellbeingbasedonself-esteemgroupscoresandHCCare

consideredinsection7.3.3.

YoungerMover (GroupA) scores improvedonall self-esteem itemsby the

second visit, fivemonths after themove (see Table 7.3.2 inAppendix 16).

Thisgroup’sdepressionscoresatTime1decreasedbyTime2.

Therewasverylittlemovementinself-esteemscoresforolderNonMovers

(GroupD).Self-esteemscoresslightlyreducedanddepressionscoresslightly

rose.

GroupBolderMovers’ self-esteem item ‘aim in life’had slightly improved,

with some of the participants expressing theirmove as having achieved a

challenge. However, three participants in this group said they were still

depressedfivemonthsafterthemoveandthisrelatedmainlytonothaving

wantedtomove.

NotablyyoungNonMover(GroupC)self-esteemscoresdidnotchangebut

theywerehightostartwith.Responsetotheitem‘Confidenceinthefuture’

159

was higher than for other groups. Ambiguity about the futurewas due to

currentrestrictivecommitments,ratherthantoanylinktolowself-esteem.

7.3.3 Observations of self-esteem associations with hair cortisolconcentration

This technical aims to considermatters raised in theHCC literature about

delayed cortisol reactivity used for interpretation in the remainder of this

chapter.

Pruessner et al. (2005, per ch4 para 4.8.1) observed that “self-esteem is a

potentpredictorofcortisol” and thosewithhigh self-esteemhaveagreater

habituation to stress. Thiswouldmediate against high levels of cortisol in

stressful situations and predict lower cortisol scores (HCC) in those with

highself-esteem,converselycortisolscorestobehigherifself-esteemscores

werelower.

On first examination, there were no associations to support Pruessner’s

findings. Instead the reverse applied forMover Groups A and B – cortisol

appearedtobehigherwhenself-esteemwaslow.However,seeninthelight

ofadelayedreactionthatappliesinlonger-termchronicstress,versusday-

to-dayacutestress fluctuation, interpretationof theresultscanbedeemed

tobemoresupportiveofthePruessneretal(2005)findings.

4 5.88 5.5 5.887.79 8.46

18.32

40.29

051015202530354045

7.3.2A

GroupAMoveT2PeriodA

GroupA5mthsafter,T3PeriodB

GroupBMoveT2PeriodA

GroupB5mthsafter,T3PeriodB

MOVERGROUPSA&BSelf-esteemTime2,themoveandTime3,5mthsafter.HCC-PeriodA5mthsleadinguptothemove;PeriodB5mthsafter

Self-esteem

HCCPeriodsA&B

Self-esteemTimes2&3

160

Chart 7.3.2A shows self-esteemandhair cortisol concentration together in

ordertoconsidertheeffectsofdelayedreactivity.ThatiswhetherPeriodA

HCC results for Group A (7.79 pg/mg) and Group B (18.32 pg/mg) were

deemedtoberespondingtoaperiodbeforePeriodA,leadinguptoTime1,

(theperiodbeforetheresearchcommenced)thatwouldlendsupporttothe

theory.

Unfortunatelyself-esteemwasnotmeasuredretrospectivelyforatTime1in

the way that depression, anxiety and stress were. Thus the extent that

PeriodAHCCresultsforeachgroupreflecttheself-esteemintheresearch,

andsupportthetheoryofadelayedreaction,canonlybeadducedusingthe

biographical informationaboutwhatwasbeingexperiencedbeforeTime1

(per secn. 7.4 to follow), which indeed does support Pruessner’s 2005

findings.

Regarding PeriodB, ifHCC forGroupA (8.46 pg/mg) andGroupB (40.29

pg/mg) aredeemed to reflect the self-esteemmeasure taken atTime2, at

the end of Period A, it could be interpreted that HCC is higherwhen self-

esteem is lower and HCC is lower when self-esteem is higher. This is

intuitiveandsupportsPruessner’s findingsand theposition that there isa

delayedresponse.

7.09 7.09 6.33 5.95.52 4.96

13.3511.56

0246810121416

7.3.2BNONMOVERGROUPSC&DSelfesteemtimematchforthemoveand5mthsafter.HCCforPeriodA-5monthsleadinguptomove;PeriodB5mthsafter

GroupCMoveT2(matched)PeriodA

GroupC5mthsafter,T3PeriodB

GroupDatMoveT2(matched)PeriodA

GroupD5mthsafter,T3(matched)PeriodB

SelfEsteemTime-matchedforTimes1&2

HCCtime-matchedforPeriodsA&B

161

Table7.3.2BhasbeenincludedforcompletenessfortheNonMoverGroups

C and D where, as expected there was much less reactivity since most

individuals did not experience new, prolonged stressors. However, it can

proposedthatthelowerGroupDHCC(11.56pg/mg),relatesasexpectedtoa

higher self-esteem score (6.33), occurs in the period that follows. If HCC

decreases as self-esteem rises these changes again support findings of

delayedreaction

7.4IndividualbiographicalanalysisofHCCeffects

IntroductiontoTables7.4Aand7.4BTable 7.4A contains ten illustrative cases to show the health effects

accordingtoperceptionandlongevityofthesituation.HCCscoresindicatea

cortisol concentration average for each cohort for Period A and Period B

(timescale-table7.0);

Effects have been interpreted, using knowledge about HPA reactivity

(chapter4secn.4.2)alongside thequalitativematerial frombothstagesof

theresearchwhenparticipantsexpressedtheirperceivedabilitytocopeand

theirperceptionofoutcomes.

A discussion of the findings follows the table. Table 7.4B – provides a

summaryoftheHCCreactivityforthe10cases,followedbyanexplanation.

162

TABLE 7.4A PARTICIPANT CASE STUDIES Association Depression, Anxiety and Stress scores, HCC scores and biography Participant reference/age group

Time 1 Raw scores DAS scale 1-5


Period A (T1 - T2) HCCpg/mg


PeriodB(T2-T3)HCCpg/mg

A2 Beatrice Mover 60 - 75

Time 1 to Time 3 HCC increased 2.77 (45%)

Time 2: Once I knew I was moving then I started planning…. Getting rid of my husband’s things was emotional, mine no. Time 3: I’m quite happy as things are at the moment. I don’t expect a wonderful life, I’ve got a nice life. I can’t complain.

D A S

1 1 2

Pre Period A – she was getting ready to move when husband

was in a nursing home.

D A S

1 1 1

HCC 6.14

Period A – Husband died and move finalised. Self-managed move – autonomy re location, control over packing, paid for

assistance as fiercely independent. Family gave emotional support

D A S

1 1 1

HCC 8.91

Relatively settled and content with decisions and

outcomes.

Interpretation The cortisol for Period B is higher at a time when the participant is said to be feeling more settled and her

stress score has reduced. This appears to be a delayed cortisol reaction to the more stressful Period A.

Cortisol for Period A appears to be blunted response (other recently bereaved participants score around

10+) to Pre-Period A - long term illness of her husband, a situation with lower control. Although not

especially low, she had already started to take action in his last months. Thus cortisol levels rise from the

blunted level, even though the stress score has dropped, as action enables her to regain control.

0246810

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T3BT2AT1

163

Association DAS/HCC scores and biography Participant reference/age group

Time 1Raw scores DAS scale 1-5




PeriodB(T2-3)HCCpg/mg

A6 Jane Mover 60 - 75

Time 1 to Time 3 HCC increased 115.14 (29%)

Time 2. At first I wondered if I’d done the right thing. I lay awake, not knowing how I would cope… the caravan, was the bed too big, now it’s all fallen into place. I thought what have I done? Now I have money to make myself comfortable. Time 3. I feel so rested. I feel like something’s lifted off me. I think thank god I’m here not to be frightened. I was frightened. He would be proud of what I managed.

D A S

0 5 5

Pre Period A was in debt for long period following death of

husband and took equity release loan. Extremely worried about

taking the step to move and lost sleep over the complex process.

D A S

0 1 1

HCC 1392.26

Period A - Relocation had removed debt, allowed refurbishment of new home and purchase of holiday static caravan. Had

completed move with considerable practical assistance friends, family and

estate agents. Remains near friends, utter relief from worries.

D A S

0 1 0

HCC 2507.4

Period B - Increase in self-esteem and pride in

achievement.

Interpretation

Period A HCC is lower than Period B despite obvious major improvements on DAS in Period B. The HCC

score for Period B seems to reflect activity during Period A – the move. This was the stage of her maximum

anxiety and stress; whereas Period A cortisol appears to fit the difficult but less stressed situation pre-Period

A. Note no blunted scores, participant has ‘never been depressed’ despite the high anxiety & stress, has

always been active in addressing problems and not seen them as insurmountable. (cortisol figures used

13.92 ; 25.07). These HCC results were excluded from the group results tables – as extreme scores.

051015202530

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T3B

T2AT1

164







B2 Eliza Mover 76+

Time 1 to Time 3 HCC decreased – 5.5 (19%)

Time 2 I wish it never happened and I stayed in my marital home. I hate it here, it’s a place not a home. I don’t feel useful to anybody… I would go to Switzerland (assisted euthanasia) but It would affect the insurance.

Time 3 I don't feel useful to anybody, My aim? yes, to die. I don't do anything now. I was a [profession] in [ ]. I hate it here, it's a place not a home. I don't feel useful to anybody… The people here are very friendly but I hate it.

D A S

5 5 5

Pre Period A, on the sudden death of her husband she was

asked to sign papers by son and daughter-in-law. Being almost blind, she did not realise they

were for sale of her home. She was moved into the conservatory at her son’s, not allowed to use

the telephone alone. They asked for her to be sectioned but social workers & doctors realised she

was denied insulin & substances she is allergic to put in her food.

D A S

4 4 4

HCC 28 Period A - She was ‘rescued’ by a nephew

and moved to her sister’s miles from her former home. After a court case she was able to purchase her retirement housing.

She is now completely blind but independent and goes out despite not

knowing the area. She misses her former neighbours and her new housing doesn’t feel like home despite the flat and people being pleasant. She receives support from RNIB and nearby sister. Many valuables &

mementos in storage were never found.

D A S

5 5 5

HCC 22.5

Period B - Whilst more settled she is depressed and expresses a wish to

die.

Interpretation Although the situation has been ongoing for some time, it has been dynamic throughout and there is no

indication of habituation or blunting of HCC. The HCC scores again suggest a delay, being reflective of high

DAS scores for the preceding periods (graph cortisol figures at 50%).

0

10

20

30

D A S cort

T3BT2A

T1

165







B4 Megan Mover 76+

Time 1 to Time 2 increased 56.69 (97%)

Time 2 I mean it brought it home when I was turning out. I lost weight, I was so tired and if I woke up in the night I was thinking what I’d got to do the next day. Time 3 It was the most stressful time of my life, moving from a family home of 56 years. It was the right thing but it wasn’t easy….. I’ve felt tired ever since. Stress is very tiring, pain is very tiring.

D A S

1 1 1

Pre Period A - participant and her husband became unable to cope with their beloved garden

and home. She began de-cluttering over months. Shortly

after his death an opportunity to move arose.

D A S

1 1 1

HCC 58.51 Period A – The move was relatively

independent of the family. Difficulty with work done at the new flat. Emotional

support from church friends and family, who she stayed with awaiting completion of contracts. She expressed exhaustion.

D A S

1 1 1

HCC 115.2 Period B - settling-in was ongoing it was felt to be

the right decision, a proud achievement. Infections

and pain now due to stress & exertion.

Interpretation DAS for this case suggest a stoic period of resignation to the inevitable, but though she was actively taking

action to move she was sad at doing so, recently widowed and feeling the physical strain. Her cortisol

scores seem to reflect the situation more than this participants self-assessed DAS. The participant

describes a difficult mission refusing help until it was over. Period A was definitely her most stressful time so

period B scores again appear to be a delayed reaction to Period A. However, Period B is linked to increased

ongoing tiredness and pain so could be concurrent. Although not entirely clear, future HCC measures, if

taken and returning to well below 50 would indicate recovery from the ordeal (graph cortisol figures used

10%). It appears the cortisol measures are a more accurate reflection of the strain than the participant

expresses in the scores, but does reflect the qualitative material gained from her.

024681012

D A S cort

T3BT2A

T1

166







B6 Stephanie Mover 76+

Time 1 to Time 3 HCC decreased – 5.04 (42%)

Time 2 I thought I don’t want to leave all the de-cluttering to my sons. I haven’t cleared much stuff, his stuff and my mother’s stuff. … I knew I had to move… I had to clear my mum’s house out and believe me, you don’t want to do it. I don’t know if it’s a good thing or not to keep the house, I’ve got to find ways to get id of the stuff. Time 3 The hardest thing is holidays … we both liked our holidays 3 or 4 times a year.

D A S

1 1 1

Pre –Period A - the death of her

second partner left her with a house she could not manage

and overwhelmed by possessions of many years

belonging to deceased relatives of hers and former partners.

D A S

1 1 1

HCC 12.16

Period A - The move was financed separately and the former home retained

to avoid the de-cluttering that was still worrying her. Her other main concern was

not having a partner to holiday with.

D A S

1 1 1

HCC 7.12

Period B - The house was given to her sons on the

basis they would de-clutter sympathetically. Another resident had become a

friend to travel with.

Interpretation Period A scores are typical of post bereavement HCC levels (that full for most around 10 pg/mg) and could

be a response to pre Period A or to Period A the move, although this was not a stressful process given it

was not dependent upon a sale and de-clutter of the former home. Thus it is not clear whether this is

concurrent or delayed. Period B does appear to reflect Time 2 to 3 rather than a delayed effect in this case

so over all these scores can be interpreted as concurrent.

0

10

20

30

D A S cort

T3BT2A

T1

167







B7 Joanne Mover 76+

Time 1 to Time 3 increase 7.89 (231%)

Time 2 Everyone is so nice here… before I couldn’t do the housework, I just had to sit and watch and felt frustrated. I’ve no regrets, life is marvelous here. It’s impossible to move without a family the children had it under control, you can’t just bash your way through it. My grand-daughter did all the paperwork.

D A S

1 1 1

Pre Period A – Depressed by many years of wishing to move, husband wouldn’t & many years after his death of trying to cope with a larger house/adaptations.

De-cluttering started.

D A S

1 1 1

HCC 3.41 Period A - Given total autonomy and

assistance in location/property choice and long slow period of de-cluttering by family, overseen by her. All legal matters covered. Problems with kitchen refurb. at new flat.

D A S

1 1 1

HCC 11.3

Period B - Totally happy, increased social life and outside using scooter.

Diabetes under control.

Interpretation

This participant is happy, relaxed and healthy in her new home. It seems highly likely the HCC scores are a

delayed reaction and her low initial HCC score is due to Pre Period A habituation. Period B score reflects

Period A, activity and could be predicted to stabilise later at a level below 10. 3.41 is a low score, suggesting

it is blunted due to a long term seemingly insurmountable situation. Thus in this case, an increase to 11.3

could be considered a healthier indication of her situation that reflects her ‘new lease of life’.

024681012

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T3BT3B

T3BT2A

T1TT

T1

168




Period A (T1 - T2) HCCmg/pg



B8 Bella Mover 76+ Time 1 to Time 3 HCC increased 81.31 (549%) Time 2 They all (sic.) brought boxes, it was sad to throw away. I don’t like anyone telling me what to do I get fed up. It’s like a prison, I can’t see out and I can’t go out. I can’t see what’s going on. I miss my grandchildren and neighbours, if you don’t talk you go a bit mad. Before I could see life going by, I can’t see past the wall. My daughter thinks I’m helpless, I don’t want to sit down and look at the four walls. I need peace of mind. I’ve never had that kind of life. I don’t feel I can join in. I mustn’t give up or I’ll be finished.

D A S

3 2 3

Pre Period A – property was a bungalow with good contact from neighbours and passers-by plus nearby grandchildren (adult). Felt part of the community. Husband died and very soon after family

decided she should move nearer to son and daughter.

D A S

4 3 4

HCC 14.81 Period A - Family are well meaning but made all decisions re area/property, to

meet their concerns and proximity of one son but daughter has to travel across London. All decisions were made by

family including packing and disposal of possessions. The flat has no outlook, she

feels cut off from the community.

D A S

5 5 5

HCC 96.12 Period B - Slight hill

outside; walking is difficult even with daughter.

Neighbours are nice but she had no hearing aid to start with and it was hard to mix. Has less exercise, ankles swollen; sad/lonely.

Interpretation The effect of reduced autonomy results in HCC rising from what would be expected due to bereavement

(Period A score reflects bereavement situation) to a level associated with high frustration and sadness.

Period B HCC reflects activity in Period A; continued frustration/despair. If no action is taken to improve this

participants situation HCC could be expected to habituate to a blunted score in due course.

0

5

10

15

20

D A S cort

T3B

T2AT1

169







D4 Emily Non Mover 76+ Time 1 to Time 3 increased 7.87 (137%) Time 2 People don’t want you. At the funeral they all say we’ll meet up but you don’t. When he died they all (family) said, it’s too big. It’s a comfort (the house), the memories and familiarity. They go to homes that are not their surroundings and they die. If they put me in a home, I’d die. I’m not communal. Time 3 In 7 years I’ll be 90, I don’t want to be 100 I really don’t. It’s always been us helping them, I’m useless always asking for help they’re all getting sick of me. The family do a lot for me . Repairs are a worry.

D A S

1 1 2

Pre Period A - Husband was being treated as an outpatient.

D A S

1 1 3

HCC 4.15

Period A - Husband was in hospital & died. Discussion with the family about moving

and she has concerns as had been dependent on her husband for all aspects of maintaining the house and finances – her role was more concerned with family and domestic aspects, maintaining family

and to a lesser extent social ties.

D A S

1 1 3

HCC 12.19

Period B - Her most difficult situations relate to

having to ask family for help and loneliness on a

day-to-day basis, although visited by family regularly. Had engaged a gardener

and cleaner.

Interpretation Period A, relatively low HCC reflects an extended period pre Period A when her husband was ill. The HCC

for period B is around the level seen for recently widowed participants (10 – 12 mg/pg) reflects the level

expected due to bereavement and therefore more reflective of Period A. In this case a delayed response

can again be seen and the higher level may well be expected to continue beyond the time measured in this

research. The cortisol level seems to be operating to match the context irrespective of the reported level of

stress – which isn’t reported as different from Period A to B.

0

5

10

15

D A S cortT1

T3B

T2A

170







D9 Alison Non Mover 76+

Time 1 to Time 3 increased 13.17 (160%)

Time 2

I was depressed for a while…. I never got over losing my husband in his 60’s. I think of him here, there (around the house). I want my independence and they (family) need their privacy.

D A S

5 5 5

Pre Period A - Widowed in her

60s. Prone to anxiety had never fully come to terms with her loss

despite strong support from friends who she is in daily

contact with and some family who live close by.

D A S

4 4 4

HCC 8.21 Period A – Staying put due to memories but finding house expensive to maintain. Stress caused by new neighbours e.g.

uprooted bushes planted by her husband, put a pneumatic drill through her living

room wall, piled household rubbish so high as to cause rat infestation. She feels they want her to vacate and buy her house too.

D A S

5 5 5

HCC 21.38 Period B - A total

refurbishment of the empty neighbouring house the other side is about to be commenced. Dreads consequences based on her previous experience

and feels threatened.

Interpretation In this case Period A HCC is not especially high given the DAS profile, the neighbour situation is

longstanding but active, it is beginning to subside but there are residual bad feelings. 8.21 for this participant

could be an habituated score or, more likely given it is a moderate level it is due to the return to relative

normality, matching a lowering of the DAS scores. Period B HCC is now high and seems to reflect new,

stressful period B activity, as do the DAS scores at time 3. So the HCC responses in this case are not

delayed but seem concurrent.

0510152025

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T3BT2AT1

171







C6 Avril Non Mover 60 - 75

Time1 to Time 3 increased 12.78 (530%)

Time 2 No, no it’s not going to happen, not while my mum and dad are round the corner. If it was just for me (about me) I’d be looking now. It’s the noise levels and general anti-social behaviour. The best stage would be now while I’m fit and well and able to make considered decisions about what is the best option, but I can’t.

D A S

1 1 5

Pre Period A - she was still

employed in a high-level job role in which she had to remain until

her retirement (5years). She blamed her ailments including active Rheumatoid Arthritis on extreme work stress. Moreover she is a committed carer to her

parents who live nearby and require twice-daily visits.

D A S

1 1 1

HCC 2.41 Period A - Unexpectedly she was offered early retirement, which she took but she

was required to be on standby to appear at an employment tribunal in respect of a

previous, distressing work place dispute. Her carer role prevents her from leaving

the area, which she would like to do as her apartment block is no longer exclusively

owner-occupied and the internal and external environments have deteriorated.

D A S

1 0 0

HCC 15.19 Period B - Her carer role is

no longer challenging in terms of time mgt.,

although she is still cannot move. The tribunal was

held and she did not have to appear. The neighbours are less noisy than before. Her Rheumatoid Arthritis

is in remission.

Interpretation The blunted Period A HCC score show this participant was totally resigned (habituated) to her pre Period A

situation. Again the cortisol levels are raised at a time when previously very disturbing situations have been

resolved and DAS are reduced to low levels. The raised cortisol is initially a positive response, albeit high

due to a temporary residual threatin the previous Period A. 05

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T3BT2A

T3BT2AT1

172

Table7.4Adiscussion

HCC,DASpsychometricsandqualitative interpretationwhenusedtogether

provide an enlightening analysis when applied to individuals. Moreover

patternsspeculativelysupportthequalitativefindingsofnegativeeffectfor

those individuals who felt dependent with little choice and autonomy

(overarching theme 2 ch6 part 2 Table 6.2.0). This mainly applied to the

storiesaboutmovingand itseffects,providedbyolderMoversGroupB, in

contrasttoGroupAyoungerMoversGroup.

Depression, anxiety and stress scores given in the table 7.4A reflected

participants’ownassessmentoftheirlevelofdepression,anxietyandstress.

This was collected face to face and reflects discussion about participants’

experiences then and at other times during the collection of information.

Participantscommentedonhowtraumatictheyfelttheexperiencewasand

the perceived effects on them. However, perception, particularly

retrospectively,canbesubjecttocognitivedissonance,socialdesirabilityor

biased recall, whereas HCC is indicative of an individual’s actual HPA

response to chronic stress. Differences between scores for depression,

anxietyandstresscomparedwithHCCresultsaremostapparentincaseB4

(Megan); a stoical participant who said there was “no difference” in her

feelings of depression, anxiety and stress across the three stages of

relocationwhencompletingthescalesfacetoface.TheHCCscoreshowever,

indicated chronic stress reactivity. Later during her semi-structured

interview, reported in chapter 6 part 2, she noted “this has been themost

stressfultimeofmylife”,whichisreflectedverycloselyinherHCClevels,

Thus the scores are only useful when interpreted with reference to

individual biographical data and environmental context. Therefore HCC

literaturethatseekstogeneralisetogroups,asiscurrentlymainlythecase,

isautomaticallylimitedbytheamountofcommoncontext.Inthisresearch,

the number of participantsmeans the findings are speculative rather than

generalisable beyond people in that groupwith similar situations. Neither

can HCC levels alone be used to compare individuals directly because of

173

differences in everyaspectof their lives andphysiology includingbaseline

levels.

Table7.4Bdiscussion

Table7.4B(below)summarisesthecortisolreactivity,givenindetailforthe

tencases inTable7.4A. InTable7.4C inAppendix17, thesamemethodis

appliedtosummarisethereactivityrelatingtotheremaining29participants

todemonstratethepatternsofexperience.

Table7.4BBluntedHCCscoresduetohabituation,longstandinginsurmountableordynamicandactive,delayedorconcurrentresponse.

1.ParticipantCaserefType:Mover/NonMover&age

2.Bluntedscore:habituation

3.Previouslongstandinginsurmountableproblemornoaction

4.Problem:dynamicsituationoractiveresponse

5.HCCScoresseem:delayedorconcurrent

A2M60-75 yes yes no delayed

B7M76+ yes yes no delayed

D4NM76+ yes yes no delayed

C6NM60-75 yes yes no delayed

A6M60-75 no no yes delayed

B2M76+ no no yes delayed

B4M76+ no no yes possibly

delayed

B6M76+ no no yes concurr

ent

B8M76+ no no yes delayed

D9NM76+ no no yes Possibly

concurr

ent

Key:Bluntedscore=alowHCCscoreduetohabituation.Delayedscore=theHCCscoreappearstoreflect,activityandfeelingsdescribedbytheapplicantrelatingtothepreviousPeriodtothe

onewhenthesamplewastaken

Concurrentscores=reflectingHCCforthePeriodinwhichthesamplewastaken.Dynamic=thechallengingsituationisstillperceivedasactiveinthatresponsetoitremainshigh

Previous,longstanding=aproblemtheparticipantshasbecomeresignedtooracceptsthereisnotlikelyactiontobetaken.

174

1. Where there were blunted scores (column 2), the participant had a

previous longstandingproblem (column3) viewed asnot being addressed

(columns3and4).Scoresweredelayed (column5)unlesshighlydynamic

andrecentrelativetotheproblem.SeealsoAppendix17,wheremostcases

were highly dynamic (Movers) and they were still the subject of action

startingfromwellbeforethehairsamplewastaken.

2.Evenwhenscoresdidnotappeartobeblunted(column2)asthesituation

wasnotlongstanding(column3)andactionwasbeingtaken(column4)the

majorityofHCCscoresweredelayed;scoresinPeriodBreflecttheactivity

and context described for Period A within this group of six cases. This

appearstodemonstratethatinallcasesthereisaprotectivedelayinraised

cortisol levels. Once raised, there may be a later habituation to a below

baseline(bluntedscores), if thestressor isperceivedtobe insurmountable

andnoactionhasorislikelytobetaken.

3.ConcurrentHCCscoresonlyoccurwheretherewasadynamic(changing)

situation and sufficient action (negative or positive) was ongoing. High

cortisollevelsneededtobecurrentwhenthefightorflightsituationhadnot

reducedtooneofhabituationtochronic,inactivesituationthatwouldhave

resultedinbluntedlevels.

4.All4casesofbluntedHCCscores(A2,B7,D4,C6)pointtohabituationand

were linked to prior longstandingproblems, deemedbyparticipants to be

insurmountable and/or where no action had taken place. All four had a

delayedresponseasmightbeexpected,giventhathabituationisaresultof

prolonged stress. However, even in relatively dynamic situations with no

habituation/bluntedscores,theresponsewasadelayed(A6,B2,B4,B7and

B8).

5.Interestingly,onlytwocaseshadHCCsappearedtobeconcurrentwiththe

samePeriodAorBbeingmeasured(casesB6andD9).InthecaseofB6her

worry was very short lived and her move was less stressful than would

175

usuallybethecase(buyingwithoutsellingandtakingveryfewpossessions

withher).Tworesidualproblemswereveryquicklyresolvedsoseemingly

her HCC levels drop concurrently within Period B, having not been

prolonged. Inotherwordsher cortisol stress responsewasmediatedby it

being amore current andactive (dynamic) situation and thusnot chronic.

AcutecortisolreactivitydoesnotreachthehairmedullaandthusaffectHCC.

IncaseD9theremayhavebeensomehabituationinPeriodAtotheoriginal

chronicstressorwhichpre-datesPeriodA(neighbourharassmentoneside,

wherebuildingworkshadcometoanendbutrelationswerestillbad).Then

exactly the same stressor commenced during Period B, in the empty

propertyneighbouringtheothersideofherhome.Thecurrentstressorwas

therefore relatively dynamic again and her concurrent cortisol reactivity

moreimmediatethanmightbeexpectedforachronicstressreaction.

6. CaseB4’s situationwas longstandingwith different prolonged stages of

stress, some seeming insurmountable, some active. She had suffered

infectionsandpainsincethemovethatsheandherdoctorattributedtothe

physicalandmentalstrainofmoving. It is thereforedifficult to judgeif the

highscoresrelateconcurrentlytothemovingandafter-effectsofmovingor

iftheywereadelayedresponsetothepreviousperiod.Onlymeasurementof

afurtherperiodwouldhaveansweredthisquestion.

7.IncasesD9andB4theresearchofWesterandRossum(2015)mayapply.

Theysuggestthatwithrepeatedtraumaticevents,thebaselinehomeostasis

canbecomeloweredandthereforepermanentlymorevulnerabletoamore

immediateresponsetostress.

7.5HCCandchronicstressconclusions

Thesecasesappeartoillustrateisthefollowing:

The relationship between stress and cortisol levels is complex. So that

interpretationofHCCdataisgreatlyenhancedbyqualitativeanalysisofthe

contextualimpactontheindividual.

176

Consideringindividualcasehistoriesqualitativelyhasadvantagesbecauseit

avoids the danger in generalising too simplistically to groups or missing

reactivityalltogether.Evenanindividual’sownperceptionofstressmaybe

different to the initial up-regulated and subsequent protective down-

regulatedendocrineresponseaffectingtheircortisol levelsandreflected in

HCCassays.

This research reflects previous habituation literature, includingwhere the

stressfulsituationismovingfromhabituationtoonethatismoredynamic.

This research supports novel proposals put forward as a result of recent

researchWesterandRossum(2015)(ch4para4.13.3)ondelayedendocrine

responsetochronicstressandvaryingchronicstressresponsesdependent

onthecategoryofstressor.

The apparent delay between the participants’ self-reported recovery from

trauma,theendofthetraumaticeventandloweringofHCClevelshelpsto

explain the lack of conclusive literature, for example Stalder 2012a, (later

revised2012bch3para4.13.5)ontheinteractionbetweenperceivedstress,

personalityandHCC.

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Chapter8OVERALLDISCUSSIONANDRECOMMENDATIONS8.0Introduction

This chapter provides a discussion of the findings from this largely

qualitative study that includes quantitative data where this has helped

contextualiseandsupplement thequalitativedata.Section8.1providesa

summaryoftheoriginalityoftheresearchanditskeyfindings.Athematic

analysis map is then provided in section 8.2, which illustrates the

differencesdiscoveredbetweenthose‘inclined’or‘disinclined’tomove.In

section 8.3 there is a fuller discussion of overarching themes and

subthemes followed by a discussion of specificwellbeing findings in 8.4.

Section8.5providespractical andpolicy recommendationsareprovided.

8.6 considers strengths of the research and potential future research

requirementspriortosection8.7,theresearchconcludingstatement.

8.1.Originality;keyfindings–summaryNote,originalityoftheresearchdesignisoutlinedinsection8.6

Usingaqualitativeapproachinthisresearchhasprovidedgreaterbreadth

of bio psychosocial perspective and relevance to the UK than previous

research to date. This has resulted in greater understanding of personal

experience and efficacy about relocation decision-making, moving and

settling-in using past, present and envisaged experiences. For the first

time, this was examined using UK, female, homeowning downsizers

compared to those ‘stayingput’, in twoolderagegroups.The researcher

accepts that when applied to qualitative findings and health measures

overall, theoretical interpretation is abductive rather than deductive and

healthdataspeculativeratherthanconclusive.

8.1.2Keyfindingssummary

Originalfindings,findingsthatsupportorchallengepreviousresearch.

1.Decision-makingefficacyandplanning

Therewaslittleevidencethatinertia,expressedinpreviousstudiesabout

olderpeoplerelocating,hadledtoparticipantsinthisresearchremaining

178

in the same home. It transpired, contrary to previous literature that

decisionstomovehomeforolderpeopledonot linkmainlytoageor life

transitions but are to do with deeper-rooted views, personality and

personal history. Predisposing characteristics determine if a person is

likelyornottomovehome.ThefactorsforinclinedordisinclinedMovers

are shown and described in thematic analysis mapping section 8.2 that

followsandinsection8.3Athatfollows.

OlderpeoplewerealsodefinedbySamsi(2010ch3para3.1.1)asjusttwo

types;‘thosewhoplan’and‘thosewhodonot’fortheirfuturecareneeds,

irrespective of age. Insight into these opposite decision-making styles is

considerably developed and enhanced in the current research in the

contextofrelocationplanning.

2.Autonomy,independence,familypressure

1.Whatmatteredmosttoallparticipantswhethermovinghomeorstaying

putwastheautonomyandchoiceaboutwhethertomoveandifso,where

and when to move and how this could be managed. This concurs with

relocation research featured in chapter3 to someextent but the current

research doesmore tomeasure the negative effects of lack of autonomy

and choice (discussed in sections K and Q). Failure to find a suitable

location, rushing intomoving following the death of a husband, and not

having control over what to keep or let go of, all led to inappropriate

movesresultinginlonelinessanddepressionforsomeparticipants.

Unfortunately, coercive control, fraud and harassment, relating to home

circumstances or relocation affected 20% of participants, highlighted in

this research. In the UK this is a contemporary issue, on the increase

because of market and socio-economic factors around home ownership

andthissocialgroup,whichisnewlyexploredhere.

3.De-cluttering,roleinfamilyandpersonalidentity

Dealing with possessions was a major difficulty for all participants and

was, or had been a key impediment to moving for some participants,

179

severalofwhomwereself-assessedhoarders.Thisrelocationimpediment

isarelativelynewandpreviouslyunexploredphenomenadiscussedhere

atsection8.3F,becauseof increasing levelsofpossessionownership.De-

cluttering presents emotional and physical challenges to participants’

feelingsof independence, linked to theneed forassistance.Thechanging

role within the family and becomingmore dependent was an issue that

affected relocation and featured in discussions with all but two

participants.The importanceof family supporting relocation, rather than

controllingit,andthepotentialnegativeimpactsfromfamilydynamicsare

notexploredinpreviousliterature.

4.Practicalconsiderations,preferences

Impediments andmotivators cited as key in earlier literature, are in the

current research, shown to be important but not sufficient to impede or

motivate a move. The emphasis in the current research on feelings and

views rather than on obvious physical aspects around the home

environment, reveal more about why individuals in apparently similar

situationsmakedifferentdecisions(discussedfurtherinsection8.3G).

Poor physical and cognitive healthmademovingmore difficult for those

over75yearsoldbutgiven thechoice, theywereas likely tostayputas

move home. This again challenges previous research that attributes

decisions mainly to age and physical needs as the overriding factors in

decisionmakingaroundmovinghome(forexampleHansonandGottschalk

2006). Physicalmismatch,whendiscussed in terms of influencewas not

foundnottobeanoverridingmotivatortomove,unlesscombinedwithlife

threateninghealthreasons.Interestingly,sizeofrooms,lackofaviewora

guest room in thenewaccommodationwere impediments tomoving for

thosewhohadalreadydecidedtomove.

Being near to shops, transport and serviceswere found in this research,

when fully exploredwith participants, to be influential only in so far as

they met more meaningful needs such as enabling independence and

integrationintothecommunity.Oldernonmovershadoneimpedimentto

moving; thiswas their intrinsically rewarding loveof theirpresenthome

180

combinedwithjusttwomotivatorstomove,whichwerethedailycostsof

stayingputandthefragmentationofcommunities..

5.Attachment/memories

Attachmenttoanareaortofriendslivingnearbyandtheimportanceof

belonging in a community were often mentioned factors in decision-

making. The binary nature of decision-makingwas further emphasised

regardingmemoriesformedaroundoccupationofthepropertythatwere

said to either ‘gowith you’ or be ‘part of you’. The latterwas a strong

impediment to leaving. Findings on staying near family have varied in

previousliterature.Whilestayingneartofamilywasimportant,moving

to a new location to be near familywas resisted by the participants in

this research, sometimes even when there were overriding medical

factors,unless therewasapurposeful role in thenew location, suchas

caringforgrandchildren.

Not being able to have a pet was a strong impediment to moving for

those who had or would like them, as was not being able to leave

inheritanceandleavingapreviouslywell-lovedgarden.

6.Communityandsocialidentity

Findings here are new in that they reflect the contemporary situation

relating to high levels of demographic change. Being in (ormoving to) a

sociable, integrated community was of high importance. All participants

saw localcommunitiesaschanging toorapidly, losing friendlinessdue to

levels of transience and automated services that reduce interaction. For

some, thisresulted inareducedsenseofsecurityandconfidenceoutside

the home. Despite older people becoming a greater percentage of the

demographic overall, older and younger NonMovers feared becoming a

minority ‘invisible old person’ within their road, due to rapid and high

levels of demographic change in terms of age, culture and religion,

discussedindetailinsectionP.Theimportanceofnonfamilialsocialising

tosettlingin,concurredwithpreviousresearchinrespectofolderpeople

181

(althoughinthedifferentsettingofmovingtoextracarehousingCutchin

2007).

7.Wellbeingandchronicstress

Health and wellbeing impacts, not previously explored elsewhere to the

same extent show that the decision-making process alone can cause

individualstosufferfeelingsof inadequacyandstress,afinding,explored

and developed usingmore appropriate assays than in previous research

(Lutgendorf 2001). The current research premise (ch5 para 5.0.1) that

relocation is a complex, lengthy and burdensome process is supported.

This fits with the findings clearly supported throughout the research

findingsthatnegativehealthoutcomesoccurifinsufficientthoughtisgiven

torelocation.Ifthemoveisimposedorbadlymanagedand/ortheperson-

environmentfitwiththenewhome,isworseornobetterthanpreviously,

themoveisthennotbeneficialintheshorttomediumtermandsettling-in

may be difficult and/orwas said by some participants to be impossible.

Hair cortisol concentration (HCC) changes could be explained by

qualitative information and conversely positive qualitative statements

abouthealthweresometimesshowntobeaffectedbycognitivedissonance

or social desirability factors, in the light of HCC data. This showed the

importanceofcombiningqualitativeapproach,notusedpreviously inthe

HCCliteraturewhenconsideringphysiologicalmarkersofwellbeing. Itis

rare andvery recent touse this combination tounderstandpsychosocial

effectsinHCCresearch.

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8.2ThematicAnalysismappingandhowtointerpretthemapFig.8.2ThematicAnalysisMap

KeyGreenshadow=keymotivatorstomove;Greenlines-interactiveroute.Redshadow=keyimpedimentstomoving;Redlines-likelyinteractiveroute.Centrepointissuesapplytobothleftandrightbutinheritancemoretotheright.

The thematic Analysis map here (figure 8.1B) is used to illustrate the

themes and interactive decision-making pathways. The two sides of the

map represent the factors involved for those who are inclined to move

(left)andthosewhoaredisinclinedtomove(right).Sothemapdoesnot

refer toagepersebut to factors forandagainstmoving thateachgroup

expressed.

Perceived impediments tomovingaremorenumerous inboth functional

and meaningful matters for participants who are less inclined to move

183

(rightsideof themap). On therightside, ‘costsbeing toohigh’, citedby

participants as a big issuewas said to be unlikely ultimately to result in

movingoutofchoice.Henceonlyonefactorprovidesaseriousmotivator

to move, ‘community alienation’, which involves community and social

needfactorsfromoverarchingtheme3.

Commontobothsidesistheissueofattachmenttohomeandlocationbut

at opposite ends of the scale. That is those who can emotionally detach

from the present home (left) and those who cannot (right). Managing

possessions (de-cluttering), affects both sides and interacts with

attachmenttohomeandthepast.De-clutteringalsointeractswithphysical

abilityandpainbutindividualswithastronginclinationtomoveovercame

the problems, whilst for other individuals who are disinclined to move,

theywerefactorsthatentrenchtheirpositionnottomove.

Itwouldbewrongtoattributethefactorsontherightsideofthemapto

older age, just because they apply strongly to older Non Movers or to

attributefactorsonthelefthandsidetoyoungerage–becausetheyapply

stronglytotheyoungerMovers.NonMovers,alsoyounger,areaslikelyto

be represented on the right as the left, being split in

inclination/disinclination to move in the future. Three of the eight

participants in older Moverswere more representative of the inclined

attitude on the left of the table despite being older. Moreover those

decisionsnottomovebyolderNonMoversweremainlymadewheninthe

youngeragerange,theywereneverinclinedtomoveevenwhenyounger.

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8.3OverarchingPlanningEfficacyThemesandsubthemes

8.3.1Ambiguityindecision-making(Overarchingtheme1)A.Inclinationtoplan(ornot)age,andpersonalityThis research found thatoverall therewere just two typesofparticipant

those‘inclinedtomove’andthose‘disinclinedtomove’,irrespectiveofage.

The ‘inclined’ participants talked about their predisposition to planning,

being open to change, less sentimental, and being anxious to address

current health needs. They also referenced anticipating and planning for

theworstratherthanmovingsimplytoimprovetheirqualityoflife,which

overrodeanysentimentalreasontokeepthefamilyhome.

Converselythe‘disinclined’participantsweredeterminedthattheywould

notneed to relocate,weresomewhataverse to change,moreattached to

their homes, more trusting to luck. However, they were as active in

HomeEnvironment.

Localcommunityneeds&socialiden6ty.

PersIn

depen'ce&Autonomy.

PlanningEfficacy.

Figure8.2ProportionalOverarchingthemes

185

planningandadaptingbychangingtheirenvironmentorroutinesasthose

whomovedwereactiveinmoving.SomeolderNonMoversregrettednot

movingearlierbecausetheirhusband’shadn’twantedtoandnowfelttoo

oldtocopewithmoving.However,mostlytheyhaddecidedintheir60s,or

manyyearsbefore,thatmovingfromthehometheyraisedtheirfamilyin

wasnotsomethingtheywoulddooutofchoice.Decisionsmayhavebeen

fleeting, have involvedhighoptimismand trusting to luckbut for others

meticulousplanningtomeettheintentionofmovingorstaying-put.Forat

least threeolderMovers(casesD5.Amy,D6.VanessaandD9.Alison), their

decision tostayputwas firmlymadesome50yearsearlier, theday they

married andmoved in. Thus it transpired that emotional factors such as

attachmenttohomes,possessions,locationandassociatedmemorieswere

themain influencesagainstmovinghomefor thosewhoweredisinclined

todoso.

Itseemsthatincreasingagestrengthenedexistingdecisionsandcoursesof

action but did not form or alter them. Long-standing decisions did not

necessarily change when age transitions occurred for those individuals

who had decided not to move. The response to life transitions was not

uniform,sinceareasontomoveforsomeindividuals,wasthesamereason

to remain for others. Triggers such as retirement, bereavement and age-

related health, given choice,were as likely to result in adaptation to the

newsituationratherthanmoving.

Younger Non Mover comments were a mix of long held intentions but

therewasalsoagreaterambiguityandflexibilityincontingenciestermed

byoneparticipantas“planningforA,BandC”. JustasmanyyoungerNon

Movers seemed potentially to bemoving in the future as not. Half were

employedandhadcare-giverresponsibilitiestoolderoryoungerrelatives.

Theyhadlessclarityaboutwhattheirfutureoptionswouldbeduetothese

responsibilities.

TherewasanaverageagedifferencebetweentheyoungerMoversandNon

Movers (Groups A and C) of five years. Although these age groups are

186

standardinresearch,theymaynolongerbeacceptableduetoretirement

age changes. None of the younger Movers had work or carer

responsibilities,whereasmostoftheyoungerNonMoversdid.

AmbiguityhadalsoexistedforthoseolderMoverswhohadhealthreasons

orfamilypressurestomoveandhadnotpreviouslyhadaninclinationto.

Thiswasaffecting their ability to settle-in.This is in contrast toyounger

MoversandolderNonMoverswhowerenotambiguousabouttheiralbeit

oppositedecisions.

B.Temporality

ThediscussionswithyoungerMoversshowedthemost futureorientated

responses, especially when giving views on structured interview items

suchastheneedto‘feelsafeathomeinthefuture’,‘avoidlonelinessnow

andinthefuture’and‘notbeingchangeaverse’.Theyexpressedadesireto

takecontrolandtakeactionnowinanticipationofpotentialfutureneed.In

directcontrast,olderNonMoverslargelyexpressedretainingtheirfeeling

ofindependencebystayingputandhopingforthebest,typically:“itnever

occurredtome”[tomove]“Idon’tplan”.

WhilstyoungerMoverssaidtheyhadbenefittedsocially,threeoftheeight

becamesomewhatdeflatedaftertheexhilarationofachievingthemove.

Veenhoven,(2001:atch3para3.2)indicatedthatforhighlyanxiouspeople

motivation to act is linked to anxiety-reduction, rather than to present-

state improvement.Anxiety about the future canoverride anaversion to

changeifdoingnothingisseenasagreaterriskthanmovingandtheywere

not held back by meaningful matters, described by one participant as

‘sentimental’.ThusyoungerMoversmainlyexpressedbeinginfluencedby

functionalaspectsandleastbymeaningfulones.

Intrinsic rewards, emotionally meaningful in nature, were found to be

more greatly valued, as lifespan reduces (Zimbardo, 1999; at ch3 paras

3.5.2and3.6).Thustheinclinationtostayputformeaningfulreasonsmay

have strengthened inolderNonMovers,whohadalready firmlydecided

187

not tomove.Theyalsoexpresseda leaning towardsbeing ‘pastoriented’

and ‘present fatalistic’ when discussing their responses to questionnaire

items about temporality. Functional issues, if they had ever been

important, had declined in importance to them, except for immediate

concernsoverday-to-daycosts.

HalfofolderMoverswhohadmanagedtomoveoutofchoice,oftenwith

somemajorexertionanddespitedebilitatingillnessandpainscoredhighly

on ‘presenthedonistic’questionnaire itemsandused languageassociated

withhavingbeensavedorrescuedB5.Meral“Iwouldhavedied”B7.Joanne

“life ismarvellous here, I couldn’t do…. before”. Older Non Movers in the

researchwithliterallynochangeorexpectationofchangescoredhighlyfor

‘presentfatalistic’questionnaireitemsandintheesurroundingdiscussion

expressed stronger preferences for past and people and places than any

othergroup(discussedfurtherinparaH)

C.Optimism/luck

YoungerMovershadnoneofthecommitmentsyoungerNonMovershadto

takeintoconsiderationbutlackedoptimismforthefutureifnoactionwas

taken. Interestingly younger Non Movers had the highest levels of

optimismdespiterestrictivecommitments,someofwhichwerelong-term

–theyexpresseda ‘greaterconfidence inabetter future’.Asobservedby

Lofqvist et al., (2013; at ch3 para 3.1.1),moving to avoid future person-

environment mismatch might be regretted if good health was sustained

andthemovebecameseenasunnecessary.Thiswas theexactsentiment

expressed by half of the eleven younger Non Movers, adding to their

ambiguity about whether to move. It remains to be seen if the younger

Moverswillregretmovingbutafterfivemonthsmostexpressedimproved

sociallife,senseofachievementandfeelingsettled.

The ‘optimismbias’ that Sharot (2011; at ch3para3.3) refers tomaybe

workingheretoreinforceadecisionineitherdirection,tosupportordefer

achange forMoversandNonMoversalike.TaylorandBrown(1988and

1994ch3para3.3) refer similarly tooptimismas, ‘self cognitionbias’ or

188

‘positive illusions’ used to reframe potentially negative situations. These

were found to be ‘adaptivemechanisms’ playing a role of 70% - 80% in

maintainingpresentsituations,wherethereisnervousnessaroundchange.

InkeepingwiththistheolderNonMoversratherthanbeingunoptimistic

about moving, simply preferred to trust to luck. Thus an alternative

interpretation could be that trusting to luck represents having optimism

thattheywouldbefineiftheystayedput.Theywerethemostlikelytosay

that luck, was extremely important and that they were lucky. This is

claimedintheliteratureasasignofhighexternallocusofcontrolafeeling

that life is largelymappedout inadvance (Craigetal.,1984;at ch3para

3.4.1). However, many had seen plans over the years destroyed by

bereavements, illness and other changes beyond their control and some

referred to never planning, since “it doesn’t work out”. Their personal

history included surviving a wartime period and the post war austerity

‘mend and make do’ period that had influenced their beliefs about

planning. The research found their values reflected the ‘war spirit’ of

ingenuity and ‘sitting it out’. “Wedidn’t go into the tubewhen thebombs

droppedmydadsaidwhenyourtimesupyoudie,peoplediedgoingintothe

underground”(D7.Alison)“Iwasinchargeof50women[inthewar],wedid

whatwehadto,moving isn’talways theanswer”(D5.Amy). It follows that

some of the next generation coming up to 60 may have a different

approachandmoreinthatgenerationmaybeinclinedtomove.

D.Inertia

Despitea levelofresignationolderNonMovers’situationwasnotdueto

inertia,aswaspreviouslyassumed in literature(Oswaldetal (2006)ch3

para3.6.2).Thecurrentresearch found thatolderNonMovers’decisions

were planned, based on determination, independence, optimism or

trusting to luck, a range of coping strategies, and functional adaptations.

The choice to ‘stay put’ and adapt to environmental mismatch, shows

proactiveresilienceratherthaninertia.TheplanninginolderNonMovers

ranged from laissez faire, to meticulously organised adaptation. Their

189

values included being critical of constant striving for bigger and better

housingandhomes,‘neverbeingsatisfiedwithwhatyouhave’.

Itwouldalsobewrongtosaythatlivingsomewhereforalongtimeisthe

causeofpeoplebeingreluctanttoleave.Rather,becausetheywerealways

reluctant to leave, they have been there for a long time. In addition, the

number of previous moves suggested in previous research as being an

indicatoroflikelihoodtomoveinthefuture,wasinthecurrentresearchas

likely to be of necessity, due to work location changes or at a partner’s

request.

E.Informationalsupportandfinance

Informationneeds about relocationoptions andother servicesweremet

bywordofmouth, family,orforyoungerNonMovers,theInternet.Some

participants,who stated theywere aware of options, clearly had limited

information, particularly about the financial aspects of moving.

Interestinglythecouncilwasnolongerconsideredtobethemainsourceof

trusted information.Councilshavebecomereactiveratherthanproactive

providers. This is another contemporary issue, resulting from austerity

measures that. This could be considered a serious social cohesion issue

largelybeyondthescopeofthisresearch.Councilswerecriticised,notjust

forremovingimportantservicesbutfornoteffectivelypromotingschemes

and services that were available. Adaptations whilst administered by

councilshadbeenmainlyinstigatedthroughhealthserviceroutes.

F.De-clutteringandhoarding

De-cluttering as a strong impediment tomovingwasnotonlydue to the

effortinvolvedbuttothereluctancetoaskforhelp,especiallyfromfamily

(see section K). This would not have been elicited without face-to-face

discussions; thus illustrating the value of the qualitative approach over

self-completed survey responses to seemingly straightforward questions

of this sort. All participants strongly expressed the negative physical

and/oremotionalimpactde-cluttering,packingandunpackinghadonthe

viability of moving, which was initially only cited as an issue by older

190

Movers who had recently experienced it. Participants may initially have

felt that to call it a problem could suggest dependency on family or that

therewasnotenoughsupportavailablefromfriendsandfamily.

There were several self-assessed hoarders and others where the visual

evidenceofhoardingwastangible.Oneparticipant,B6.Stephanie,(ch6part

2 secn. 6.2.1.3) who could not cope with adaptations or de-cluttering,

purchased a retirement flat without selling, which she left unoccupied,

solely in order to store possessions. Older peoplewanting tomovewho

becomeoverwhelmedbytheirpossessions,mostofwhomwillnotbeable

toaffordtobuywithoutsellingtheircurrenthome,willsimplynotmove.

This is apooroutcome for themandpooruseofnationalhousing stock.

Services to assist from trustworthy sourcesarenot readily available at a

reasonablecostastheprocesscanbecomplexandlengthy.

G.Conflictsindecision-making–whetherFunctionalormeaningfulmattersaremoreinfluential.GroupAyoungerMovershad15motivatorstomoveandfiveimpediments

against moving, whereas older Non Movers had the opposite; two

motivatorstomoveand16impedimentsagainstmoving.Afullsummaryof

motivators and impedimentsbyGroupandwhether they aremeaningful

orfunctionalinnatureisprovidedatAppendix14)

Theeffectsofmeaningful and functional issues aremore complex thana

simple push/pull approach, much used in previous relocation research.

Establishing ‘big issue’ factors (methodsch5para5.10)revealed that the

mostobviousandmostoftenrehearsedpracticalargumentsformovingby

participants or their families are not necessarily the most influential.

Examples(chapter6Parts1&2)includethecurrentpropertybeingtobig

or proposed property too small, costs, cleaning, difficulty climbing stairs

and moving near to family for support. These in some cases worried

families more than they concerned the older participant, leading to

unwanted moves. Conversely, some things that nearly all participants

initially failed to mention as major concerns, when fully and openly

discussedweredeemed tobe influential. For example, asmentioned,de-

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cluttering,attachmenttohomeandlocation,andself-identitywerestrong

emotionalimpedimentstomovingoraskingforhelp.

Participantswhoweredisinclinedtomove,irrespectiveofage,hadahigh

tolerance level for poor functionality in their present homes, evenwhen

movingwouldhavebeentheonlywaytobecomemoremobileorreduce

costs (ch6 part 2 secn 6.2.1.1 Group D). The ability to appreciate the

intrinsicvalueofthepresenthomeorlocation,playsanimportantpartin

rejecting physical extrinsic needs when deciding to ‘stay put’, and if

moving, of being able to accept the move after it has happened. This

concurswithrewardandmotivationtheories(ch3para3.5)

Functionalneedscausedbyrestrictivemobilityandpain,werefoundbya

Danish studyHanson and Gottschalk (2006; at ch3 para 3.7.1) to be the

most common reasons for moving. They overrode any intrinsically

meaningfulreasonstoremain.Inthecurrentresearchthisappliestofiveof

theolderMoverswhomovedwhentheydidnotwantto.Otherwiseinthe

current research functional health needs are as likely to result in not

movingatall.UnlikeHansonandGottschalk’sstudy, thecurrentresearch

doesnotincluderentedproperty,andtakesaccountoffamilypressureput

on participantswhen their health deteriorates and considers the impact

‘having’tomovehasontheprocessofsettling-in,whichisnotcoveredby

theDanish,orotherstudies.

H.Contentmentwithhome;MemoriesandattachmentsOlder Non Movers valued ‘feeling safe at home’, a context they already

enjoyed, felt a strong sense of attachment to their present home (also

applies tohalf of theolderMoverswhodidnotwant tomove, regarding

theirformerhome).

Attachment tohomewasnot strong in eitherof theyoungeragegroups.

Thus younger Movers, as discussed focused on meeting present and

anticipatedfutureneedsinthenewhome.Theyhaddonethiswithoutany

emotional loss associated with the pre move accommodation. They

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expressed taking action as an achievement that their family was, and

deceased husband would have been proud of. It was important to

continuityofself-identityforparticipantstoachievetheirwishestomove

homeorindeedtostayputifthatwasthegoal,suchasfortheolderNon

Movers.

However,attachment tocommunityandroutinesappeared forallgroups

tobe intrinsically linkedtofeelingsofbelongingandsocial identity.Even

thosewhoexpressedlittleornoattachmenttohomewerekeentoremain

inthesameareawhenmoving“keepingeverythingelsethesame”sticking

towhattheyknew,routinesandfriendsbuiltupoveralifetime.Evenwhen

describing deterioration in the area, for example due it feeling unsafe,

participants felt being well-established in an area gave them a sense of

belongingandinterestinglyconfidence.

I.Personalidentityandpurpose

Individualsmostdisinclinedtowardsmoving,usedtheexpressionhomeis

‘a part ofme’, in respect of the home and its contents. It is the tangible

representationoftheirachievementsandmemoriesandtheyfindcomfort

inmaterial things. For thosemore inclined tomoving, variations on the

expression‘youtakememorieswithyou’weremorecommon.Thefeeling

of ‘presence’ofadeceased lovedonewasstrongest inwidowedwomen,

also a desire to stay put and keep the gardens that had been their

husbands’‘prideandjoy’.

Gardenswereviewedwithstrongfeelingsinequalmeasureasmotivators

tomove or to stay. Gardenswere related to functionality and viewed as

being costly and burdensome to maintain and a reminder of physical

decline. Alternatively theywere described as providing a purpose in life

andsourceofphysicalandmentalwellbeing.Inseveralcasesgardenswere

maintainedasameaningfulmemorialtoformerhusbands.

The need for purpose was equally important for all groups but whilst

youngerNonMoversgenerallystillhadclearusefulrolesinthefamilyand

community, thiswas less apparent in youngerMovers,whoweremostly

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seekingmoresocialsituations.Thereweretwoparticipantsfromtheolder

agegroupswhohadvoluntary roleshelpingat church functionsand two

others had voluntary communitywork. This lack of engagement of older

people’spotentialcontributionappearstobeagreatwaste,anindictment

ofthecommunitysystemandlackofapplicationofnationalstatedvalues

ofequalityandinvolvement.

8.2.2Personalindependenceandautonomy(Overarchingtheme2)

J.Independenceandself-efficacy

Independence is determined by perceived levels of self-efficacy,

comprising personal competence and controllability (Bandura 1977, ch3

para 3.4.3), and is developed according to a tripartitemodel of how the

pastandpresentareexperiencedandhowthefutureisperceived.Cheung

and Chen, (2000; at ch3 para 3.4.5) found that even in fairly highly

‘controllable’situations,actionwouldnotbetakenifpersonalefficacywas

low. In the current research, the reverse was also true: Having high

expressedpersonalefficacy, inbothyoungerNonMoverandolderMover

groupsdidnothelpthemwhentheyfelttherewasalackofcontrollability,

at least for the foreseeable future. These effects were demonstrated in

youngerNonMovers,whereitwasnotfeasibletoactwhilstconstrainedby

carer and work commitments. Similarly, some older Non Movers, when

referring to the impossibilityofmovingnowif theychangedtheirminds.

Theylackedphysicalenergyforde-clutteringanddidnotwanttorelyon

family.

K.Acceptinghelpfromfamilyvs.fromothersParticipants’ personal identity, sense of purpose and role in the family

wereall linkedto theirhomeasarepresentationof their lifehistoryand

personalidentity.Allparticipantshadhigh,oradequate,levelsofavailable

assistancevariously fromfriends, family,social,voluntaryorpaidprivate

service. However, they considered themselves to be independent only if

they personally made the planning decisions and carried out or closely

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supervised, de-cluttering. Those ‘staying put’ considered themselves

independent throughhavingmade thatdecisionandhavingarranged for

property adaptations that enable them to stayput. This is an important

factortounderstand,forthosesupportinganolderpersonwithrelocation,

andpropertyorlifestyleadaptations.

Apartfromtwocasesoutofthe39participants,acceptinghelpfromfamily

withmovingorcaring in thehomewasconsideredtobeaburdento the

family,causingguiltandhumiliation.Theyexpressed,oftenwithemotional

regret, a loss of role and perceived status in the family, moving from

providerandadviser toappearingdependentand lacking incompetence.

Interestingly, all participants were happy to accept help from formal

sourcessuchascouncilsorvoluntarysectoragenciesat remarkablyhigh

levelswithout feeling it compromised their independence. Notably these

servicesdealwithrecipientsdirectlyandinaninclusivemanner.Itwasfelt

byparticipantstobesomethingtheyhadaccessedtofacilitateandthereby

increasetheirindependence.

L.Desireforproximitytofamily

Allparticipantswholivednear familywantedtoremainclose, thosewho

didnotlivenearbyfeltamovenearertofamilywouldbeanintrusionand

aburdenon the family, alternativelyonly for the family’speaceofmind.

Oneexceptionalparticipanthaddevelopedan interdependent familyrole

(D10.Gemima, ch6 secn. 6.2.1.1), not common for the white British

community to which they belong, whereby the extended family have

converted 3 neighbouring properties in order to live in separate units

underoneroofandhelpeachother.Someparticipantsmentionedmoving

near to be of use to relatives or to live roughly equidistant from several

children to be accessible and later so the family could share any burden

theymightcause.

Demographically family sizes have decreased over the years (although

birthratesoverallareincreasingagain)andthismayfurtherchangesocial

dynamics regarding care. Carer responsibilities will increasingly fall to

only-childrenandmanyofthosewillalsobeolderadultsandnotlivevery

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close by. The tendency to live near or provide housingmore collectively

may differ for families in other cultural groups, not represented in the

currentresearch.

M.Pressuretomovebyfamily,wellmeaningorself–serving?

Theleveloffamilyharassmentwasanunexpectedandunpleasantfinding

in the current research. Four cases have resulted in the familymembers

gaining financially. In twocases thiswas theirmain fraudulentobjective.

Withhighhousevaluesbeingacontributoryfactor,itcanbeexpectedthat

therewillbemoreadultabuseofthistype.Thelevelofharassmentfrom

neighboursthatcausedoneparticipanttorelocateandseriousdistressfor

others was also unexpected. Whether the community is less caring or

whether the effect seems greaterwith age is an interesting question not

coveredbythisresearch.Withtheexceptionofsomenotableexamplesof

neighbourlysupport,mostparticipantsdescribedfeelingalienatedbythe

loss of continuity of residents in more transient locations (discussed

further in paragraphs O and P to follow) or themselves having been

removedfromanareatheyidentifiedwith.

Well-meaningfamilieswhofailtorecognisethelevelofpatience,timeand

consideration that isneeded torelocateanolderperson, causealmostas

much harm as those who deliberately impose an unwanted move.

Participants in the current research complain of being rushed “bringing

boxesandbringingboxes, sad to seeall the thingsbeing takenaway” (B8.

Bella).Successful moves involve a decent period of consideration of the

benefits before a decision tomove is taken ‘theymovedme too soon,we

knowthatnow’(B8.Bella).Anadditionalperiodandchoiceaboutwhat to

keep and where to move is essential “it took 6 months with everybody

helping” (B7.Joanne) - for maintaining the sense of autonomy and self-

worth.

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8.3.3Localcommunity;needsandsocialidentity(Overarchingtheme3)N.Loneliness,socialcontactandbelongingSomeinnovativeschemesmentionedinChapter2(para2.5)andvisited

aspartoftheresearchweresuccessful,asparticipantswereabletolive

closetowheretheypreviouslylivedorinacommunitythatwasdesigned

tobeenablingand inclusive forolderpeople.Asenseofbelongingwas

expressedasimportantforcontinuityofself-esteem,statusandidentity.

Settling intoretirementhousingrequiresdailynon-familialsocialcontact

(Cutchin et al. (2007); Callaghan et al. (2009). Participants said this

companionship cannot be replaced by weekly outings and organised

contactorjustbyputtingpeopleincloserproximitytootherpeople.Some

participantsexpressedanegativeviewofmixing,orlackofit,inretirement

housing. Those who failed to settle, cited loss of the daily contact

previously provided by neighbours and loss of feeling connected to the

community they had previously gained from seeing familiar routines or

peopleoutoftheirwindow.Theseaspectshadpreviouslyalsoprovideda

senseofstructuretotheday.

Those who had never intended to move but agreed to (e.g. Ch6 Part 2

B5.Meral,A8.Gloria,B4.Megan) took longer to settle in, even though they

benefittedgreatly. Severalparticipants eventually accreditedmoving,not

unduly,tohavingsavedtheirlives.Converselysomeparticipants(B8.Bella,

B1.Masie) suffered increased loneliness and depression and increased

levels of cortisol after moving, where they felt that their families had

focusedmainlyontheirownconcerns.ThatseveralolderMoversendedup

in accommodation that causes them to suffer speaks to the ineptitudeof

families to look beyond the functional aspects and understand what is

reallyneededforcontentmentandstimulation.Thisseemedtobeinpart

duetoashortfallinknowninformationalsupporttoolderpeopleandtheir

families, particularly when decisions may be considered to be urgently

required, such aswhen a partner dies. Familieswere not interviewed in

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thecurrent researchbutseveralparticipantsreferred to feeling theyhad

“beenmovedtosoon”.

Petswereconsideredaspecialcase,sincethosewhohadorwantedtoget

apetwouldnotmovetoschemesthatwouldnotallowpets.Allthoseinthe

research with pets referred to the important part they play in reducing

lonelinessthroughcompanionship,encouragingcommunication(withthe

neighboursanddirectlywiththeanimal),aidingsocialisationandexercise

Notallretirementschemesintheresearchacceptedpets.

O.Communityfacilities,neighboursandcommunityfriendliness

Improvement in socialisation opportunities were strong motivators to

moveforyoungerMovers,andforthoseinolderMoverswhohadmoved

outofchoice.YoungerNonMovers,alsociteditasamotivatortomoveat

somepointinthefuture.

Local facilities and transport were important in aiding the process of

integration and settling-in and were frequently cited as motivators or

impedimentstomovingdependingonwhethertheywerealreadyavailable

intheexistingarea.Shops,banksandhealthfacilitiesprovidedareasonto

gooutandthecouncil’sFreedomPass(freetravelpass)providedameans

of participating more easily. However, participants saw local amenities

declining and funding for council run facilities such as day centres

reducing.Theyexpressedafeelingofhelplessfrustrationandconcern.The

health impactassessmentsthatallcouncilsaresupposedto include inall

policychangesareclearlyfutileinthecontextofexponentialfundingcuts

over the 10 years preceding the research. Participants feared the loss of

knownmedical or carer staff if theymoved. Relocation research by Ball

(2011:atch2para2.7)emphasisedtheimportanceofaccessibilitytolocal

facilities and also showed that a reducing numbers of friends and social

neighbourswaslinkedtoafearofloneliness.

Locational change can have more impact on mobility, self-identity and

confidence than change within the home. Ensuring these aspects are

acceptable for the person moving is vital to settling-in and a sense of

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belongingaslifespandiminishes.Asstated,participantssawcommunities

as becoming less friendly. Automation, the nighttime economy and

transient neighbours were cited as examples of how communities were

becominglessfriendly.Severalparticipantsfeltthatpeoplewerebecoming

obsessed with wantingmore andmore change to their houses and that

neighbourswerewaitingforolderpeople‘togo’inordertotakeover.

P.Change.Socialidentityandsocialintegration

Thosemovingwantedtomovetowherethereare“likemindedpeople”,a

termusedbymostparticipantsinthisresearchwhoeitherhadmovedor

wantedto.Thiswasexpressedasbeingbecauseofthecomfort,inclusivity

and/or opportunity for socialising providedby living near peoplewith a

similarsocialhistoryandage.Changes inanexistingareacanalsobreak

continuityofself-identity.Therapidchangeindemographicswastheonly

seriousmotivator tomove for older NonMovers apart from daily living

costs. Itwas also a cause of ambiguity aboutwhether tomove or not in

younger Non Movers. It threatened some individuals’ original vision of

growingoldinacommunitywheretheywouldberespectedelderstoone

wheretheywould“feelanoutsider”becauseofage,cultureandreligion.

The social impact of housing markets, rather than migration per se has

causedrapidchangeandtransiencethatcausesconcernsaboutremaining

partofacommunitywhere“sometypesdon’tmix”.Nearlyallparticipants

expressed a dislike of an area or their street being predominately one

culture, includingwhite British. Some participants in all groups felt the

influx of mainly white gentrification, had priced out the younger

generation in their own families. Alternatively therewas concern and in

some cases fear, “it’s frightening”, of being in an area where English is

rarely heard. The age-old fear of being lonely and an outsider in your

community is present and affected by greater speed of change and

transiencethanthoseparticipantshadbecomeusedto.

Thiswas reflected in thediscussionsaround thewellbeingquestionnaire

items and in the biomarkers of whowere against their wishes and said

theyhadbecomemore lonelyordepressed.The researchofKearnset al

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(2001) andThetford andRobinson (2007) in chapter 3 (paras 3.7.3 and

3.8) showed older people did not benefit functionally when moving to

‘more suitable accommodation’ except in respect of social status in the

Kearns’sstudy,duetothesocialidentityofthenewlocation(whichwasa

much more desirable location). Consistent with the current research,

sensitivelymanagedmovestoalocationthatmeetsneedsandvaluesofthe

individual were important for retaining positive self-identity and

confidence.

8.4HealthandWellbeing

Depression,anxiety,stress(DAS),self-esteem

This section discusses findings from the psychometric and biometric,

wellbeing measures that were more fully reported in chapter 7 and

contextuallyinterpretedthereusingqualitativeinformation.

Analysisusingqualitativematerial

YoungerMoverswhosaidtheyhadbenefittedfromthemovesintermsof

increased sociability, were found to also have higher self-esteem scores

after their move. They reported reduced depression, stress and anxiety

(DAS)andhadlowerscoresafterthemove.OlderMoversattheendofthe

research timeframe had slightly higher DAS and HCC (hair cortisol

concentration)scores,havingenteredtheresearchtimeframealreadyina

state of high reactivity on these dimensions. These findings support the

qualitativedata thatyoungerMoversbenefitted fromthemove itselfand

thatlessthanhalfoftheolderMoversfelttheyhad.

Younger and older Non Movers, had low levels of reactivity on these

measures. OlderNonMovers’ scoreswere slightlyhigher at the endbut

theyhadmuchlower levelsandreactivityoverthewholeoftheresearch

periodthantheiragematchedMoversgroup.ThescoresforolderMovers,

as with those for younger Movers, were supportive of the qualitative

analysis of the information they imparted during interviews and their

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reflectionsonrelocation.Formorethanhalfoftheoldergroup,relocation

hadbeenexperiencedastraumaticandunwelcome.

Interestinglyinmorethanonecasetheitemscoresfordepressionanxiety

andstressweremorepositivethantheHCCscoresindicated(e.g.casesB4

and D4, in ch7, Table7.4A and D12 discussed later in that section).

Qualitative analysis of discussions noted when the DAS scores were

completed face to face, and information from other parts of those

interviews, concurredwith theHCC findings rather than theDAS scores.

Thisshowsthebenefitofhavingasecondmeasurewhenquantitativeself

assessed DAS is obtained. In this research the participants scored their

DAS using a Likert scale over the relevant period, secondly they talked

abouttheirexistentialexperienceofDASoverthatperiodandthirdlythe

biological response was measured using HCC. This is particularly

importantwheredemandcharacteristicsarelikelytodominateinonepart

oftheinformationgatheringprocess,suchasinthisresearch.Forexample

thematic analysis indicates in one overarching themewhere participants

liketobeseenasindependentandcapable.Theydreadanyreversalofrole

withinthefamilybywhichtheymaybeseenasneedyandvulnerableora

failurebytheirdecisionsorcourseofaction.

Theresearcherwasawareoftheneedtouseameasureofchronicstress

thatwould not be affected by cognitive dissonance, social desirability or

cognitivebias(Sharot2011ch3para3.3andmethodsch5secn.5.7.2).HCC

appearstoshowthegenuineresponsefortheprecedingperiod.

Delayed response was illustrated when comparing HCC to self-esteem

results (ch7 secn 7.3.3). Self-esteem is an accepted mediator of chronic

stress(Preussneretal.,2004;2005).Whenself-esteemwashigh,HCCwas

low and vice versa but only if considering HCC results in Period B in

respect of self-esteem results in Period A, rather than concurrent self-

esteem.ThusallHCCactivityintheresearchwasinterpretedinthecontext

oftherebeingadelayedresponsetothechronicstressorandtheendofthe

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chronic stressor. This concurred with the individuals experience of and

perceptionofeventsinthoseperiods.

8.4Chronicstressandhaircortisolconcentration(HCC)

Overallfindings

Therewasvery little evidence found in the researcher’smeta-analysisof

the relatively small HCC literature (chapter 4) about habituation and

delayed reaction, or variation in endocrine responses according to

different types of long term stressor. In respect of these, the current

researchsupportsthefindingsofoneseminalpaper,publishedduringthe

courseofthecurrentresearchWesterandRossum’s(2015)(hereatch4,

para 4.13.3; ch7 para 7.4-7). The nature of the perceived threat and its

anticipatedoutcome,affects levelofchronicstressresponseandspeedof

recovery.

Threatorchallenge,impact,duration,resolvability

Theperceptionbyparticipants of the events surrounding relocation as a

challengeversus.achronicthreatisimportantonthreelevels.

1)Lengthofrisk-whetheritisconsideredtobelongterm.

2) Type of risk - whether it is perceived as traumatic and/or adversely

effortful.

3)Typeofactionavailable-whetherthesituationisdynamicinthesense

that participants feel action is/can be taken versus being deemed

insurmountableandactionisnot/cannotbetaken.

Insummary,theresponseisdelayeduntilthethreathasbeenpresentfor

sufficienttimetobeunderstoodandexperiencedaschronic;converselyit

needs to be absent for sufficient time for it to be understood and

experiencedaspassed.Thusthereisadelayforthecortisolleveltochange.

Moreover, the direction will be up regulated or down regulated

(‘habituated’ with ‘blunted’ scores) depending on the previous period

havingbeenasituationperceivedasdynamic(up-regulatedresponse)or

inactiveandinsurmountable(downregulatedresponse).

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Finding1Habituation

In cases of chronic stress there can be a reduction of cortisol reactivity

fromtheinitialhighresponse,whichwouldbecomeharmfulifallowedto

continuewithoutrespite.Habituation, reflected inabluntingof scores, is

thereforeunderstoodtobeaprotectivephysiologicalresponsetoreducing

theallostaticload(e.g.Selye1974;McEwen2006hereatch4secn4.2).

In this research, habituation is evident in a number of participantswith

ongoingfairlystaticsituationstowhichtheyseemresigned.However,for

some participants, the expected habituation and blunting of scores does

not occur, even in chronic situations. In those fewer cases where HCC

remained high, despite a long-standing situation, this was linked to

contextsthatremainedhighlydynamic(ch7secn7.4).Thatis,thesituation

remained active, or action was still expected to be possible and the

situationhadnotbeenacceptedasinsurmountable.Levelsofcortisolwere

thensustainedtosupportaction, justastheywouldbe inanacutestress

situation,eventhoughthat levelofcortisolreactivity, ifprolonged,would

becomeundesirableforgoodhealth.Levelsofcortisolfailedtosubsidein

participantsforsometimeafterthechallengewasover(finding2)

Finding2Delayedresponse

Increases or decreases in HCC for Period B (between the move and

settling-infivemonthslater),reflectedactivitythattookplaceinperiodA

(five months leading up to the move and move itself). Period A scores

reflected what was said by participants to have happened ahead of the

start of the research. The delayed response to chronic stress and the

potentialreversiontopreviouslevelsattheendofchronicstresssupports

WesterandRossum’s(2015)findingsthatareturntonormal levels from

habituation does not happen quickly. The cortisol remains high in the

periodfollowingwhenthechronicstressorhasbeenmanaged.Westerand

Rossum(2015)proposedthat itmayneverreturn to theoriginal level, if

therearerepeatedepisodesofchronicstress.Thiswouldcauseallostatic

overload and subsequent potential health consequences described in

Chapter4.

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Summary–HCCfindings

HCC can be useful in assessing wellbeing for individuals and effects of

social or personal events but only when used in conjunction with

qualitative information. This is because it is crucial to know the type of

stressor event and how it is perceived, which was in this research

participantexperienceofthedecisiontomove,themoveitselfandduring

thesettling-inperiod.Cognitivedissonancecanbeidentifiedinqualitative

studies using HCC and HCC analysis is well served by a qualitative

approach. However, due to biological individuality and differences in

individualperceptions,HCCispossiblybettersuitedforuseinconjunction

with other personal and contextual measures to assess individuals’

recovery from events, perceived as personally traumatic such asmoving

home or bereavement, rather than generalising to groups experiencing

similarevents.

8.5Recommendationsforpracticeandpolicy8.5.1Practitioners–assessingneedsandeffectiveinvolvementAmbiguitychallenge

Practitionersmayfindthemselvesinthepositionoftryingtoassistclients

whoaremovingagainst their inclinationor thosewhowant tomovebut

feelalackofplanning-efficacy(sections8.2and8.3here).Thekeytogood

serviceprovisionisunderstandingindividualdifferences.

Strengtheningplanningefficacy,holisticproblem-solving

Interestingly,participantsrefertofeelingthelogistics,costandupheavalof

havingpropertyadaptationsareunacceptable, rather thanacheaperand

lesstraumaticalternativetomoving.Moreover,adaptationswhenoffered

tooquicklyasapermanentsolutioncanbeanimpedimenttoconsideringa

moreholisticsolutionthatmovinghomemightprovide“Ihadthewetroom

done, IwishI’dmovedearlier instead”(A6 Jane). “Ihadastair liftbutthe

housewastoobigoncethechildrenwent”(B7Joanna).

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Adaptations are not evidenced as key determinants of improvedmental

wellbeing(Thompsonetal2001).Improvedsocialisationisclearlyshown

to be of greater importance tomental wellbeing than home adaptations

(Baldock,2005;RubinsteinandParmalee,1992;atch3para3.8.4).

Thus, beyond an initial emergency situation, practitioners may consider

someofthequalitative,theory-basedfindingsfromthisresearch,usefulin

helping individuals determine the best and most sustainable course of

actionforthem.Planningefficacyandmeaningful(emotionallyrewarding)

as well as functional (practicalities and health) issues should be

establishedwithclients.

This theory-based framework of questions developed by the researcher

(Table8.5.1hereandTable3.5.4discussedatch3secn.3.5)couldbeuseful

for relocation or home adaptation services, for gaining insight fairly

quicklyaboutattitudetomoving,:-

Table 8.5.1 Summary of questions decision-makers askthemselvesinrespectofefficacy,intrinsicvalueandexpectancyvalance.(alsoatch3para3.5.4withexplanatorytheory)

a.AmIpersonallycapable?(internalself-efficacy)b.Isitpossible?(controllability-externalefficacy)c.DoIwanttodoit?….Whichnecessitatesbalancingextrinsicandintrinsicnatureofthesituationanddecidingd.HowsatisfiedwillIbewiththeoutcomeinthelongterm;howdissatisfiedamIwiththepresentsituation; is itreally thatbad?Does staying here meet my emotional needs or will moving dothatbetter?…Whichnecessitateshavingavisionofthealternative.e.Will this be easy for me or difficult and will the outcome besufficient to warrant the emotional and physical effort?’ Can Icarryon?

Beingabletovisualisetheprocess,thedesiredoutcomeandtheviabilityis

essentialformakingandsustainingarelocationdecision(Irvingch3para

3.5.4). Using EAC’s (Elderly Accommodation Council) on-line tools and

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information,andtheincreasingnumberofon-linevideoclipsofretirement

housingmayhelp toprovide realistic informationmorequickly and as a

precursortoactualvisits.Critically,thescenariosshownmaynotrelateto

theperson’sself-identity.Asdiscussedinchapter2,Background,(para2.7)

experience shows that expressing admiration for generally desirable

schemesandactualintentiontomovetothemdonotcorrelate.

Some participants considered living and socialising with other older

peopletobepotentiallyalientotheirself-identity.Reassuranceshouldbe

provided that there is no ‘holiday camp style’ pressure to actively

socialise. Simple aspects frequently mentioned are important for

reassurance, such as the view from a window that provides the

opportunity to observe nature or ‘the world going by’. Provision of

assistance, if needed,with viewing a range of schemes beforemaking a

decision is essential to visualisation of a successful outcome and

encouragingapositivefutureorientation.

Motivatorsandimpediments

Functionalconcerns,suchaspropertymaintenancecanasdiscussedhere

(section8.2.1heading4),beperipheralsatisfierssomayaddweight toa

decisionatonestageandbedisregardedlateron.

Practitioners should explore the latent views of clients and reasons for

moving (see ch6 part 1 section 6.1.2) and be aware that meaningful

(emotional) reasonsmay carry greaterweight over functional (practical)

ones,forindividualswhoaredisinclined.

Emotionalsupportandinter-agencywork

Having established the need for both emotional and practical support in

successfulmoves,thosewithoutfamilyorothersupportcannotdoitalone.

Moving may be rejected as impossible, even if viewed as desirable and

logically the best option. The research has highlighted case studies

(Thetford&Robinson,2007,ch3para3.8)andparticipantcases(A1.Gail,

B8.BellaandB7.Joannach.6Part2)thatcanassistifrelocationsupportis

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going to be provided; especially to ensure the support is not started too

earlyorwithdrawntoosoon.

Adaptations after or instead of moving should be linked to meaningful

aspects thatmake a home a social hub and base, enabling other services

such as befriending that might be needed. Third sector (voluntary and

charitable) assistance is shown in some examples (e.g. A1.Gail) as more

readily available for aspects such as ongoing support that is important

beyond themove itself. Technical support is readily available from some

developers, estate agents and mortgage brokers who made a positive

contributiontoparticipantsdirectlyafterthedecisiontomovewasmade.

Respectandautonomy

Thecontrastinoutcomesforparticipantswhodidordidnothaverespect

and autonomy during the whole process shows the importance of

sufficienttimebeingfactoredinattheoutset,afteranyemergencyaction,

and for this be continued at the settling-in stage. The national home

improvementagency(HIA)hasrecentlyproposeddevelopmentof ‘move-

on’ serviceswithin their remit at local HIA level (Foundations 2019), to

assisthomeownerstodownsize.TheFreeSpacescheme(Appendix1)was

designedbythecurrentresearchertobeadministeredentirelybyexisting

trustedagencies, rolesandexpertise, suchashousingand localauthority

HIAs,healthorvoluntarysectorservices.

8.5.2Recommendations-Policydevelopment

Jointworking

Thereareexamplesofgoodjointworkingintheresearchbutalsolackof

informationabouthousingoptions,andevidenceofneedsleftunidentified.

Demandonservicesandlackofhousingsupplyoftenpreventsexcellence

despitegoodintentionsandsigningofagreements(ch2para2.4).

Jointworkingbetweenlocalauthoritiesand‘notforprofit’,commercial

and voluntary sector resources is key to supporting innovation, for

identifyingpocketsofneedandprovisioninordertofocusonperson-

centredassistance.

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Schemerequirements

Itisbettertohavefewerdevelopmentsthandevelopmentsthatwhenbuilt,

are not occupied or do not improve the intended quality of life of those

moving there. In this research some participants have moved to

accommodationwherethedesignincomparisontotheirprevioushomeis

so lacking in relevance to them, they state this as amain cause of them

becoming depressed as a result (e.g. cases B1, B2, B8). Accommodation

design is the focus ofmost activity and innovation at present, discussed

here in chapter 2. Some basic facilities were lacking at the retirement

housing schemes visited by the researcher. Communal facilities were

underusediftherewasinsufficientwardenorlocalcommunityinput.Some

communalloungesintheresearchwerelockedallday.

Whereoccupantsareseengenerallysocialising,therewereopenplan

areasneartothemainentrancethatcouldbeusedanytime.Moving

to a onebedroom flatwasnot an impediment, provided therewere

sufficientguest facilitiesbutoneschemehadnone.Smallroomsizes

and no outlook onto the street or a green view were named

impediments from the startwhich, if lacking resulted in a feeling it

being‘likeaprison’.

Pets provide a level of companionship, clearly seen to reduce

loneliness in the literature and the present research, so should be

cateredfor.

In one new award-winning scheme (not featured in this research)

residentswereobligedtohavetheirpetsdestroyedbeforemovinginand

theprovidersnotedclearnegativeeffectsonthoseresidents-butdidnot

changethepolicy.PractitionersshouldbeawareoftheEmotionalSupport

Animal(ESA)registrationprocess.

Viabilityforhomeownersanddevelopers

Movingexpensesandviabilityvariedintheresearch.Thosewithvaluable

existing housing can afford to purchase more support and newer, more

relevantretirementvillageaccommodationorexecutivehomes.Thereisa

dangerofinequalityforthosecurrentlylivinginlessvaluableproperty.

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Considerationshouldbegivenforthosewithlowvaluehomestothesort

ofsupportandrelocationgrantsavailabletosocialtenants,togetherwith

relevant tax measures to reduce financial burden. There should be

regulation inducements for developers prepared to build quickly in the

rightlocationswhoincluderelocationpackages(e.g.recommendationsof

HAPPI3&4,ch2para2.4).Allnew,mediumandlargegeneralneedssocial

housingdevelopmentsshouldmakesomespecificprovisionforolderand

disabledpeople,which,ironicallywascommonplaceonestatesbuiltinthe

largebuildingprogrammesofthe1950s.

Changing demographics suggest there will be more people renting than

previously. The availability of Assured Tenancy (protected tenancy)

opportunitiesthatarecosteffectiveforolderpeopleshouldbeincreased.

Theprocessofmovingtorentedaccommodationiseasierthansellingand

buying (see chapter 2) and releases equity. However, a change in the

market,witholderpeopleprimarilyrenting,couldultimatelyresultinhigh

housingbenefitcostsinthelongerterm.

Finance

Opportunities should be available for further downsizing within

retirement schemes (a concept already used in retirement villages)with

more mortgage and shared ownership options available such as those

availabletoyoungerpeople.

There is no reason why lower percentage of value to loan mortgages

shouldstopatanyage,giventhecapitalassetavailableandcurrentlower

costofmortgagepaymentscomparedtorent(seeHAPPI3reportch2para

2.4).Aslightlyhigherbutstilllowinterestratepaymentcouldbeprovided

on a long-term fixed rate or interest-only basis. The work already

undertaken by lenders in respect of this e.g. by the Building Society

Association (Pannell and Jenkins 2018) should be developed in order to

gaincostbenefits.Relaxationofrulestoenablecouncilstolendorprovide

services in conjunction with partners would also improve lending and

borrowingopportunities(seeO’Sheach2para2.5businesscase).

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Adultabuse

Theprevalenceofadultabuseintheresearchrangesfrombeingexcluded

bythecommunityandhavingviewsoverriddenby family, toharassment

from neighbours or family harassment and fraud. Public debate on

coercive control has focused on abuse from partners. Awareness of

coercivepracticeswithindomesticsituationshasgrownandnewspecific

legalpowerswereintroducedinDecember2015(S76oftheseriouscrime

Act2015).Theexamplesofabuseinthecurrentresearchcouldwellcome

withintheremitofthislegislation

Intergenerational blaming (discussed in ch2) needs to be reduced

alongsideanincreaseintheprovisionoffactsforverypublicdiscussionin

ordertodispelthemythsunderlyingtheblaming.Appropriateadviceand

supportshouldbeeasilyavailable tohelp identifyandreducetheriskto

olderownersofbeingmisled, bulliedor excluded.Practitionersworking

witholderpeopleshouldbemadeawareofthescopeofthelegislationand

bepreparedtouseitontheirbehalf.

Culturalshift–strategicplanning,publichealthandinformation

Theparticipantsofallageswereunderinformedaboutoptionsanddetail.

Findings in theresearchsuggest that it is time toaim foracultural shift

towardsbringingaccessibleinformationintocommunities(currentlygood

information is still left for them to discover). It should aim to also help

removethenegativeconnotationsofforexample,termssuchas‘lastmove’

or ‘sheltered housing’. Consideration of downsizing at an earlier age

should be promoted commercially and socially, just as planning for

pensions is considered from the start of employment. This would not

mean moving but planning by understanding the issues. For example,

visualisingthefuturerealisticallyandbeingreadytomoveatamoments

noticeormakingmobility changes tohomeandgardenwhile financially

abletodoso.

In the futureolderpeoplewillmore likelybesingleorhavenobrothers,

sisters or children living nearby. The potential for higher levels of

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lonelinessanddependencythatmightbealleviatedbythemtosomeextent

through individuals forward planning, are reasons enough for public

healthinformationinitiativestoencouragethis.

Thelackofpurposeinthelivesofsomeoftheparticipantsespeciallywhen

compared to their lifetime of being useful is reflected in the research

through loss of self-identity, changing relationship with the family and

withinthecommunity.Outsidethescopeofthisresearch, thefindingsdo

supportthoseacademicsandpractitionerswhoareattemptingtopromote

age inclusive societies and invigorate the lives of older people, which in

turnautomaticallybenefittothewholeofsociety.Olderpeoples’valueas

contributors to the community, including in the support of other older

people, is far fromproperly recognisedandharnessed inUKculture.For

example in the area of social ecology (Powell Lawton 1974), briefly

mentionedhereinchapter2andHarper(2008)discussageingsocietyand

opportunities for human capital. Reducing loneliness, improving

communityengagementandhomefromhospitalperson-environment fit,,

hasbeenestimatedwouldprovidea135%returnoninvestment(Ruddock

2014)viareductionofuseofNHSservices.

8.6StrengthsandlimitationsofthisstudyandfutureresearchStrengths:This researchachieves aqualitative approach, supportedbyeffectivebio

psychosocial factors. The lack of this has long been identified by

established researchers in older age relocation and health research

(Oswald2006),discussedinch3secn.3.11,Lutgendorf(2011)inch4para

4.8.2.Aqualitativeapproachhasalsobeenmissingintheinterpretationof

HCC(Stalder2012aand2012b)–discussedfromch4para4.13.5ch4para

4.8.2.

The research addresses a shortfall (ch1 and2) inqualitative findings to

directlysupportperson-centredUKhousingrelocationpolicyandpractice

forolderpeople,andprovidesrecommendationsbasedonthefindings.

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Theresearchdesignisunique,underpinnedbytheorysothattheinductive

approach(bottomup)andabductive(topdown) interpretiveapproaches

meet, recommended by Braun and Clarke (2006) when the reasons for

design or interpretation need to be explained. The research views

relocation as a three-stage process, uses triangulation for wellbeing

findingsanddrawsuponpsychosocialtheoryrelevanttodecision-making,

such as motivational reward, self-efficacy and locus of control. Greater

understanding has thus been gained of the personal and psychosocial

matters, which either enable or restrict choice in relocation for this

importantsocialgroup.

The term ‘Planningefficacy’ is introducedasausefulnewtermtoreflect

the full spectrum of relocation considerations, consistent with housing

beingalifetimeplanningneed.Theconceptofinclinationvs.disinclination

isintroduced,forwhattranspired,tobethebasisofinfluenceindecision-

making rather than age per se. These explain the little understood

phenomenonresulting in liability inolder relocators’ liability to frequent

changes of decision during the long relocation process (background

chapter2).

This research supports, extends, or challenges previous literature,

indicated throughout this chapter. It specifically improves on the small

body of relevant relocation studies and supports the small body of HCC

research.

Furtherresearchtoaddresslimitations

AnyHCCtime-lapseresearchshouldextendthedesigntoincludeafurther

period to test the delayed response findings. That is, whether having a

Period C HCC would match events at Period B (since in the current

researchPeriodBHCCappears tomatcheventsatPeriodA).Thiswould

reinforce or throw doubt on the assertions of delayed reactivity.

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Subsidencetimesmaybeupto52weeks,whichalsosuggeststhevalueof

longerperiodsofassessment(Davenport2006ch4para4.13.7).

Self-esteem should be measured retrospectively similarly to depression,

anxiety and stress. Participants should also be asked to discuss more

directly whether they feel their decision is being made to maintain

happiness, reduce depression or due to anxiety about the future

(Veenhoven2001ch3para3.2).

ThedifferencesinagebetweentheMoverandNonMoveryoungergroups

averaged five years. This was found to be potentially confounding (per

para 8.3.1 inclination to plan). Possibly future research cohorts should

comprise ages 65 – 75 (instead of 60 – 75); ages 76 and over (as now).

Thiswould fitmore readilywith lifestyle changes like retirement, health

milestonesandtheincreaseinlifeexpectancy.

Theresearchtookplaceinarelativelyaffluentareaofthecountry.Aspects

affectedbymarketvaluesandavailabilityof localretirementhousing, for

example, in rural areas, will affect viability. Using information from this

research, purposive samples with greater contextual and individual

differencescouldberecruited.Forexamplecouplesorsinglemalecohorts;

selectionon cultural identity, private tenants versusowners; consistency

of educationor social statusacrossgroups; andyounger thanolderaged

peopleinrespectofthefactorsrelatedinthisstudythatrelatetoearlyage

inclination and disinclination. Investigations might include perspectives

from family members and could involve views of retirement home

managers.

8.7Researchconclusion

The need for awider range of housing for older people has been better

understoodinthelastfewyears(seech2).Therearetechnicalreasons,not

leastplanningrequirementsandlandavailabilityinthedesiredlocations,

as to why logistically and commercially providing sufficient choice and

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desirable standards will not be easy or necessarily widely affordable.

Importantly therehasbeenno correspondingpolicy recognition,or even

public debate, about the decline of personal efficacy or perceived

controllability in relation to relocation that comeswith ageing.Decisions

are affected by age-related changes in physical and cognitive efficacy,

relationshipsandidentitywithinthefamilyandthecommunity.

Thisresearchrecognisesthatthemajorityofpeoplewillwanttostayput

and should be enabled to do so. This research has been carried out for

single femalehomeownerswhowish todownsize, for thosewhowish to

support them and have a need to understand how to help. It is also for

those who have never wished to move and find they have little choice,

where understanding of their experience is even more important. It

challengesthethinking,enshrinedinlegislation(ch2para2.1)thatsimply

byvirtueofbeingahomeowner,competencyinrelocationisautomaticso

thatassistance isnot required(ch1para1.4).On thecontrary this thesis

considers it as a major issue of community need and cohesion. The

research provides evidence of the need for ‘move-on’ support schemes

suchasFreeSpace(Appendix1).

Generations to comemayapproach the issuedifferently,with changes in

the housing market and housing options. Many older people, currently

under 60 years old, will lean towards a different set of educational and

othersocio-demographicbackgroundsthantheirparents.Thismayresult

inmore confidence for some individuals in decision-making.However, it

maybeadducedfromthisresearchthattheexperiencewillstillbeonerous

andreflectabinarysituationofthosewhoinherentlydoandthosewhodo

notmakerelocationdecisions.Therewillbe largelysimilarpsychological

andphysicalunderlyingmatterstoconsider,thatarecurrentlyonlyatthe

verymarginsof commercial andpublicpolicemakers’ consideration and

understanding. Importantly,negativehealthoutcomes, includingisolation

andchronicstress,areshowntolinktoa.relocationchoiceandviability,b.

independenceandc.autonomy.Thisresearchhasmetit’saimtoenhance

thisunderresearchedandnotwellunderstoodarea; itprovidesevidence

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for these three key components to be the focus of relocation policy,

practiceandpersonalsupportinmattersofolderpeoplerelocating.

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ReflexiveStatement–GailLincolnleadresearcher

WhenIstartedthisresearchitwasbecauseIhadexperienced,ashadcolleagues,

theconstantchangesinviewsandintentions,whichseemeddetrimentaltoolder

people,whenconsideringhousingoptions.As thePrincipalOfficer forHousing

Strategy (and health liaison), in a London borough I was responsible for the

original updating of the borough’s sheltered housing and I designed the

FreeSpace scheme (Appendix 1), aimed at resolving a number of apparent

difficulties in moving home for older downsizing homeowners. The process

included an early financial capability assessment and a wider assessment of

needs to facilitate individual handholding packages for thosewishing tomove

on.

Despiteall-partylocalandnationalbackingforFreeSpaceatgovernmentcabinet

level, with an airing in ‘the Commons’ by the Dept. of Work and Pensions

Secretary, central fundingwas pulled away due to the application of austerity

measures and diversion of staff time to reducing under-occupation in social

housing. The Dept. of Communities and Local Govt. Head of Homelessness

Finance spoke in support of the scheme at a seminar for 70 housing

organisations,which IheldatWestminsterUniversityFyvieHall. I planned to

developaninter-boroughhubtotrialthescheme;thebusinesscasecost-benefit

assessmenthadbeenmade, by an enthusiastic economist andpromoterof the

scheme, funded by the EAC (Nick O’Shea). Having decided an assessment of

FreeSpacewould be a good opportunity for researchwith automatic access to

thoseconsideringmovinghome,andsomewhowouldproceedtomove.Failure

of the scheme to take off in large numbers due to the under resourcing, left a

dilemma.

Creativehousingstrategyismorenecessaryattimesofausteritybutatthesame

timerolesarereduced.Theactivityisdowngradedtothelevelofplanningwith

an emphasis on land management rather than innovative options. This

reductionist approach was a source of personal frustration for me as an

occupational psychologist with strong views on the economies of integrated

systemsandstrategicimprovement,ironicallyoftenabandonedbyorganisations

attimesofpressure.Bynowinyeartwo,havingcompletedthelearningyearof

theresearchdegree,perhapsIshouldhavegivenupbutIwasstillintriguedby

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‘applicantambiguity’,whenexpressingexcitementandcommitment tomoving,

thenchangingtheirmindsonanalmostdailybasis.Hencetheresearchchanged

fromevaluationofrelocationexperienceandFreeSpaceschemeimpact,tooneof

deeperexplorationwherenumberswouldbelower.Thisenabledaredesigntoa

contextualist,qualitativefocus,withwhichIwasmorecomfortable.

Touseprimarilyquantitativemethodsjustbecauseplentyofparticipantswould

have been available would have been to repeat mistakes of the past. Even in

mixed method studies, there appeared to be a lack of synthesis leading to

meaningful recommendations due, I felt to the dominance of quantitative

interpretation.

DrawingonmybackgroundasacharteredoccupationalpsychologistIfeltitwas

appropriate to to consider decision-making in the context of motivation and

rewardliterature,usedsoofteninOcc.Psych.work.Amajoramountofresearch

went into selecting items from validated scales, designed for use with older

people,suitedtotheissuesandparticipantnumbersinvolvedtoconsiderviews

and attitudes. Context, and practicalmatters had to synthesiswith theory and

qualitative material to interpret effects of ‘functional’ and more ‘meaningful’

relocation matters. This would harmonise with the work of Oswald and of

Lutgendorfwhosemixedmethodsapproacheshadbeendeterminedbythemto

lacksufficientqualitativeinput.

It transpired the HCC, my choice to support wellbeing findings at a level of

triangulation,couldnotbedoneinhouse.Next,applicationsforexternalfunding,

caused months of delay to the fieldwork. From further consideration of the

literatureanddiscussionswithFrankHucklebridgewedecidedtoanalysewithin

andnotbetween-subjects,with5cmsegmentsrepresentingfivemonthsrathera

largernumberof 1cm segments for eachmonth. Fortunately this also reduced

costs.WeliaisedwithTobiasStalder,whoFrankpreviouslyworkedwith,akey

international expert in HCC, (whose findings I subsequently challenged in

respectoflackofqualitativeinputandwithwhomwehadintendedtoproducea

paper,saveforFrank’suntimelydeathjustweeksafterprovidingsupporttome

atmyfinalviva).

Havingaqualitativeresearchercomeonboardwascriticaltosuccess.Notleast

because JayMacKenzie is an enthusiastic problem solver and gained in-house

217

funding for the cortisol tests and two (albeit slightly premature) conference

disseminationopportunitiesinyear5.

Fieldworkeventuallystartedattheendofyear3,taking2yearsduetomarket

factorsreducingthenumbersofpeoplerelocating.Interviewingissecondnature

to me through my experience over years of customer facing investigative,

mediation and counselling roles. However, a skill I have never developed

sufficiently, is reporting information in a way that is best understood by the

audience,evenwhenIknowmyaudience.Withthisresearchtherearesomany

different individuals and groupsone iswriting for.Albeit that targetedpapers

canfollow,theinformationhastocomefromtheresearchthesis.Ithastohave

differentperspectivestomakesensetodifferentaudiences.Thiswasadifficult

area for me despite words of wisdom on ‘writing up’ from the team, notably

tutorialsfromCatherineLovedayandMarkBaldwin;commentaryonmywriting

style,howtoapproachthesubjectwithgreaterclarityfromGillRhodes.

I didhowever, always record and store the information effectively indifferent

ways in order to achieve high levels of familiarisation. I began to think of the

participantsaspeopleIhadknownforyears,sofamiliarweretheirstoriestome,

andhowtouchingsometimestoo.IthoughtmaybeIshouldjustwriteanovelto

includesomeofthem,suitedtomywritingstyle.

However,thefindingswerenotleapingoutasclearlyastheyshould,despiteme

gettingthefeelingtheywereinthere,linksweremissing.Thestickingpointwas

delivering an effective integration of nomothetic data and 25,000 words of

qualitativematerial.Helpfulobjectivefeedbackfromthedirectorofstudiesand

at vivas achieved focus. I have tried, considered, redone and learnt from the

process,albeitrelativelylately.Iseparatedthequantitativefromthequalitative

observations. This did not work because the quantitative results cannot tell a

story in themselves but serve mainly to underpin qualitative findings and

theoretical interpretation. This recent and final process resulted in an

integration using only the quantitative data that were important to

understanding the experience within the life stories being told. The most

rewardingaspectsaresimplebuthavecomelikelightbulbsattheend.Iamglad

tosaythismademerealiseIdidnotconfinemyselftotheobviousandkeptan

openminduntilthefinalre-examinationfromallangles.Thisistheprocessand

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purpose of qualitative research and has enabled sufficiently meaningful

informationtoofferrecommendationsforimprovedpracticeandpolicy.

Whilstinteractingwithparticipantswasnaturaltome,workinginsuchisolation,

evenwithagoodsupervisoryteam,wasnot.Itwaspartofthelearningprocess

andverynewtome.Attimesitresultedinseriousissuesofconfidenceandself-

doubt. However, that enhances self-reliance and resilience until the next

breakthroughoccurs!

The process has taughtme that at the risk of sounding like an EU negotiator,

nothingisfinaluntileverythingisfinal.Ifounditdifficultatstagestobeaskedto

commentonfindingsandfinalthoughtsintelligentlythatwouldcomeonlyatthe

end of thewhole process. The process is indeed reflective and circular, not as

linearbetweenstagesasthemodelframeworks(e.g.Gibbs2011)propose.Itisa

questionof3stepsforwardandtwobackbeforethelearningisachievedandisa

testofresilience.Thereareexamples,whereadefeatinonedirectionisawinin

another,orata laterstage. Iusedtheoptimisticbiasandreframingevidentin

manyofmyresearchparticipants.Theprocesshasbeenlengthyandduringthe

process my soap opera life has withstood two operations, family feuds,

bereavements,housemovesandchallengingworkdemands,tomentionafew!

Theses, likehousing strategies canbewritten100 times and indifferentways

andstillnotbequitesatisfactorytotheauthor.Aimingforexcellencemakesthe

concept of ‘good enough’ seem redundant but especially in this context one

should remember learning never ends. I hope I have achieved something

worthwhile when it is presented to those doing the job. I see the socially

functioningworldintermsofhousing;thatshelterismoreimportanttosurvival

thanliterallyanythingelse,whichworkingwithhomelessnessteachesus.

Ifnothingelse, Iknowthat Ihavedonesomegoodbecauseof comments from

participants who felt the process of intimating their situations had been

therapeutic,justfrombeingaskedandproperlylistenedto.

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FreeSpaceschemes–thebasics:forthoseownersof60oroverAPPENDIX1

• TheLocalAuthorityorHousingprovideracquirestheunder-occupiedproperty–TheFreeSpacepropertyonalongtermrenewableleaseinexchangefor‘handholding’theownerthrougheachstageoffindingandmovingtoalternative,smalleraccommodationinthetenureandlocationofchoice.Theownercanbe temporarily livingelsewhere.The scheme isnot confinedby council areaboundaries, aFreeSpaceproperty canbe in any location that familieswouldconsiderbeingrehousedto.Fortheowner,findingtheirnewaccommodationisakeypartofthehandholdingandrequirescreativityandflexibleuseof resources..Financial support is given formoving and settling in and forupgrading theFreeSpaceproperty for letting.This canbe fundedvia aninterest free secured grant, repayable onlywhen the property is sold. Owners can even use the loan towards purchase. E.g. in a cheaper area. Otherfinancialoptionsareavailable.Thecouncilorotherhousingprovideractsaslandlord,managingandlettingtheFreeSpacepropertytoafamilyinneed.Theownerreceivestherentandthehouserevertstotheirestatewithvacantpossessionontheirdeathorendofthelong-termlease,whicheveroccursfirst.

• Allactivityissubjecttoindependentfinancialcapabilityandlegaladvice,thecostofwhichcanbeincludedintherepayablegrant.The aims of FreeSpace over and above empty property home improvement schemes are: to provide rehousing for the older person if movingwouldultimatelybeabetterandpreferredchoicetostayingput;toprovideafamilysizeproperty,toaddforareasonabletime,tothecouncilorotherhousingprovider’slettingportfolio.

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APPENDIX2

ResearchParadigms.BasedonGubaandLincoln(2007).

Positivism PostPositivistMosthousingResearch

CriticalTheoryConstructivism(Currentstudy)

Ontologically‘naïverealism’assumedcauseandeffectmeasurable.Objectiveresearcherexperimentalconditionsaremanipulated.Hypothesesandquantitativemethods.

‘Criticalrealism’probabilityratherthannaïverealisminvestigationisstillobjectivist,morenaturalisticthanpositivismcanincludequalitativefindingse.g.usingquestionnairesorcommonbeliefs

Ontologicallya‘virtualreality’wherehistoricalrealismandeffectsofsocio-economic,political,educationalandsociallearningenvironmentshaveamajoreffectonviewsovertime.Primarilyqualitativetransformationalandinteractivetofindanswers.

Allthingsrelativeandindividuallyconstructed,more‘locally’thuspotentiallyalterable.Personalrealitiesareasimportantormoresothanhistoricalrealism.Focusedontheindividual’sfeltexperienceandtheirrelationshipwiththeresearcher.Realitiescreatedbetweenthem.Hermeneuticalordialecticalapproaches.Iterativeinterchangeagreementonfindings.

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APPENDIX3Are you interested in taking part in some

important research?

We are contacting people on behalf of a researcher from the University of Westminster, who previously worked for our housing service. The research will help to inform government policies about the housing needs and views of older people, focusing on their health and wellbeing. This is important given the rising number of older people who may require assistance now or in the future. About 40 participants are needed and each will stand the chance of a winning a prize draw with one amount of £100 and 2 x £50 To qualify you need to be in all the follow categories:

a. You must be female

b. You must own the property you live in (can be recently lived in if you have moved or you are temporarily staying elsewhere)

c. You must be in the age range 60 and above

The research will take about 2 hours talking to the researcher in your own home. Interested in taking part and want more details? You can contact the researcher by phone (she will take your number and ring you back to save you any expense). You can also email if you prefer. For more details contact the researcher: Gail Lincoln [email protected] 0208 989 5332 - please do leave your name and number if she is not available to answer when you first call.

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Research information and consent form

CONSENT FORM Information about the study: This research will consider feelings, thoughts and behaviours involved in decision making in respect of housing relocation in people aged 60 and over. All participants will be people who own their properties, or who did until recently. Procedures The first stage The researcher will sit with you to answer a number of questions about lifestyle and particularly about your views on your accommodation past and present. Questions will include where you hope to move to or already have moved to. This will include how and why you personally make decisions about your housing situation, how this affects the way you feel and your wellbeing. It could take up to 2 hours. Your answers will be noted directly on paper. 40 people are expected to take part, individually interviewed at home. You can have someone else such as a family member or friend present if you prefer. There will be a prize draw by raffle ticket of 1 x £100 and 2 x £50 A small selection of the participants from stage one, numbering about 12 will be selected to take part in a follow up interview to cover themes that have come out of stage one in more detail. The second stage About 5 months after your first interview, you will be contacted again. The researcher will call on you again to cover some (but not all) of the questions asked at stage one to see if your views or your situation has changed. Measuring wellbeing – hair samples An important part of the research is measuring your wellbeing. A very effective way of doing this is to measure the levels you have of a chemical called cortisol. To do this the researcher will need a few strands of your hair on 2 occassions. This can be collected at the time of your interview. The researcher will cut a few strands from the back of your head and send them off to a laboratory. The analysis will provide

Director of studies: Dr Gillian Rhodes, Faculty of Life Science, University of Westminster 115 New Cavendish Street, LONDON W1W6UW 020 7911 5000 extn. 64626

APPENDIX 4

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information about your wellbeing in terms of chronic stress. The researcher can give you the results if they are unusually high and you would like to know. Confidentiality The only personal details required are your name, contact details and age range. You will also be asked about your current health, as people with certain conditions cannot take part in the hair analysis stage (e.g. diabetes and people taking steroid type drugs as these affect the hair sample tests). You can even use a fictitious name if you like but the data will be coded so that you will appear as a number in the results. Any personal disclosures will be written in such a way to ensure you are not recognisable from the comments. Only the researcher will have full access to the data. Data will be held solely by the researcher and separate from your name and contact details. The data will be stored by the researcher for a maximum of 10 years and you may give consent for it to be used again if the data is required by other researchers. I……………………………………………….. have read the above information and I consent to taking part in the research. I understand that the researcher Gail Lincoln will be collecting the data, which will be anonymised and kept confidentially and securely. I understand that the results are anonymised and treated to ensure it is not possible to attribute views to individuals. I understand that the data will only be used for the purposes of the study but that the study may be published or results of the study may be used to inform other research and potentially public policy. I understand that this research is being supervised at the University of Westminster, whose details are given at the beginning of this document. I understand that I can make a complaint to The Director of Studies if I have cause to do so provided my complaint has not initially been dealt with to my satisfaction by the researcher. I can withdraw from the study and/or remove data provided by me at any time prior to the publication of the research without having to give any reason. SIGNED Participant (Sign and print name) Researcher (Sign and print name) DATE

224

APPENDIX5RCM–RELOCATINGCONSIDERATIONSMEASURE–devisedbytheresearcherSeesection5.5.1,5.6and5.10inMethodschapter5,forfurtherinformationregardingcompletionandanalysis.Itemswerechosentolinkwithpreviousresearchandfromthepriorknowledgeoftheresearcherasapractitioner.Forthe‘MotivatorsandImpediments’section-thepurposewastoestablishtheextenttowhicheachitemwasanissuefortheparticipantandifitwasa‘bigissue’(adefinitionusedbyresearcherCoxetal2005)–firstbymarkingitonaLikertscaleof1to5with5alwaysbeingthemostnegative(4or5indicateitisa‘bigIssue’).Participantswerethenencouragedtodiscussthereasonfortheiranswers.Narrativewastakendownverbatim.

DEMOGRAPHICSOpeningquestionswereaskedintheorderthatfollows.Cognitivetestswereaskedatapointwhenparticipantsweresufficientlyrelaxed,havingdiscussedtheirmedicalsituations.Questionsthatfollowedcontinuedtobeeasytoanswer/discussforthemtorecoverfromtheteststhatsomeparticipantsfounddifficult.EachanswerhadacodeforuseinExcelandSPSSstatisticalsystems.Age–circlechoicefrom3age-rangeoptionsinthe60-75cohorts;3agerangeoptionsinthe76andovercohorts.ChronicillnessPhysicaldisability,cardiovascular,COPD,arthritis,allergies,Thyroid-hyper/hypocortisol,autoimmune,rheumatoidarthritisperceivedhighanxiety,depression,stress/otherpsychologicalrequiringtreatment,cancerand‘other’.Othersdiseaseaddedasnecessary.Majortraumaticevents–bereavement,joblossrelationshipbreakdowninlast6months,year,18months,2yearsAcuteillnessorregularboutsofrecurringillnesse.g.coldsandfluMedicationaskedbytypethatmightaffectcortisol.MedicationmightaccountfordifferencesbetweenfirstandsecondHaircortisoltests,whichwouldhavetobedisregarded.Answerswerecodede.g.forsteroid,moodupordown,anti-inflammatory,hormone(thyroxine,HRT),pain,digestive,HBP/statins,cancer/chemoorradiation,waterretention,insulin,supplementsetc.Weight–selfassessedtoolow/ideal/moderatelyover/high(BMIguidance)

225

Hairtreatments–askednumberofwashesover5months(recalculatedlatertoweeklyaverage),alsobleachingorstraightening,dyeingandfrequencyofswimmingpooluse.Cognitiveability–abatteryof1-minutetestsincludingVerbalfluencyFASscores,categories,numberspanrepeatsandreverserepeats,trailtestandcomplexdrawing.Scoredinaccordancewiththeauthorsandnormativecharts.Diet3categories:OverallSufficient;Vegetables;Fluidintake–self-assessedastowhetheritisvariedandextentitisanissue:-low/medium/high.Exerciseperweek–usingaveragehoursforstandingormoving;walking;aerobic–fastactivity,cleaningetc;specifice.g.sportorhobby;sittingorsedentary.Timeinsunlightagainstrecommended50minsperdaySleepaveragegood/averagebadnight,perweekandrelativehours–againstover41andunder56recommendedSmoking–present,previousandrelativeamountsandtimesincecessationAlcohol–units(nhsdefined)perweekagainst14maximumrecommendedbytheUKmedicalofficerofhealth.Education-maximumattainmentofselfandhighestattainingparent,scoredandcalculateaplusorminusfigurecomparedwithparentCurrentandformeremployment–selfandparent-categoriesscoredfromlowskillmanualtohighskillprofessionalandcalculateplusorminusfigurecomparedwithparentSocialclassmobility–selfassessedasachildandnow-scaleof4,’lowerworking’to‘uppermiddleorhigher’Calculateplusorminusfrompreviousclass.PresenthomeType–bynumberofstoreysandgroundfloororotherlevelSizeandtypeofhome–bybedrooms,storeyanddescriptore.g.house,flatPreferredtypeandsizeofhomenow/futureCondition–levelofrepair–promptsof6areasrangingfromrooftodampness.Overallsatisfaction/levelofconcernCostsassociatedwithhome/location–includestravel,heating,billsBestAgeforMoving–theirview-bydecade–40’s50’setcanddiscussion

226

MOTIVATORSANDIMPEDIMENTS

Stronglydisagree1

Disagreesomewhat2

Neitheragreeordisagree3

Agreesomewhat4

Stronglyagree5

Psychosocial–impedimentstomovingPreviousexperienceofmovingwasstressful………………………………………..Lossofstatusdueto:SizeofhomeorOwnershipvs.rent……………….Memories……………………………………………………………………………………………Feelsafeandsecure–familiarityofsurroundings………………………………..Attachmenttopossessionsandfurniturethatmighthavetogo…………….Sizeofhousehelpsmeoccupymytime………………………………………………Sizeofhousekeepsmefit………………………………………………………………Usesparespaceforvisitors:Occasional/justincase……………………………………………………………………….Regular/frequent…………………………………………………………………………….…Usesparespaceforhobbies………………………………………………………………..Usesparespaceforwork……………………………………………………………...Inheritanceforchildren/grandchild………………………………………….………..Sometrustissueswith………………………………………………….…………………….agents…………………………………………………………………………….………………developersandthoseselling……………………………………………………………council………………………………………………………………………………………….1family……………………………………………………………………………..................Energylevels……………………………………………………………………………………Concentration…………………………………………………………………………………Decisionstoonumerousordifficult…………………………………………………Thegardenisimportanttome…………………………………………………………LocationandfacilitieskeepmeThelocalareahasthefacilitiesIneed………………………………………………Socialsupportfromcareandmedicalservices…………………….……………Doctorandhealthcare………………………………………………………………………Stayingnearfriends…………………………………………………………………………Stayingnearneighbours……………………………………………………………………Stayingnearfamily……………………………………………………………………………Socialising/communityfacilitiesandclubs…………………………………………Diversity(definedasage,ethnicity,beliefs)suitsme…………………………Transport…………………………………………………………………………………….…Localshops………………………………………………………………………………………Postoffice…………………………………………………………………………………………Bank/buildingsociety………………………………………………………………………Safegreenspaceandparks………………………………………………………………Feelingsafeinthearea,safeneighbourhood………………………………..Practicaldifficulty/selfefficacyHavepets/havingpets………………………………………………………………………Lackofoptionstochoosefrom…………………………………………………………..Toomanypossessions………………………………………………………………………Noonetohelpme………………………………………………………………….………5Don’tunderstandalltheprocesses………………………………………………Copingwithpackingandmoving………………………………………………………Copingwithchangeofaddress,Utilitiesandmovingdetails……………5

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227

Copingwithsolicitorsandagents’paperwork……………………………...1Unpackinganddealingwithminorworke.g.curtainrails,washingmachineplumbing…………………………………………………………Packingupallmypossessions…………………………………………………………Effortofclearingoutallofmyclutterandpossessions………………………..Choosinganotherplace–gettingthereandlookingaround……………Can’taffordthecostoffeesandmovingplusrelocating………………….…Don’tthinkitwouldbenefitmemuchfinancially…………………………...…Physicalmobilityandhealthreasonsthatmakeitmoredifficulttocope……………………………………………………………………PsychosocialMotivatorstomove/stayNearertofriends…………………………………………………………………………Nearertofamily………………………………………………………………………….Nearergrandchildren……………………………………………………………………….

Effort&Cost(practical)Requiresmallergardenmanageable………………………………………………………….…gardenoroutsidespaceimportant(musthave)……………………………..sharedgardenacceptable……………………………………………………………….balconyonlyisacceptable………………………………………………………………Idon’tuseallthespace…………………………………………………………..…………Wantonelevel,nostairs……………………………………………………………………WanttoreducerepairsandDIYanddecorating,okformetocopewith……………………………………………………………………………………Concernoverrepairsanddecoration…………………………………………………Cleaningmustbelower……………………………………………………………………CheaperrepairsandDIYimportant……………………………………………………Location–importantfactorsrequiredinNEWlocationFeellessIsolated…………………………………………………………………………….…Newareamustbebetterthancurrent/presentareahasdeteriorated……………………………………………………………………….Localservices:Transport…………………………………………………………………………………...…Medicalandsocialcare……………………………………………………………………Localshops…………………………………………………………………………………Postoffice…………………………………………………………………………….………Bank/buildingsociety…………………………………………………………………Safegreenspaceandparks…………………………………………………………Neighbourhoodissafe…………………………………………………………………….Betteractivities/communityinthearea……………………………………….…Newaccommodation:Costoflease/repairsetc.mustbeless………………………………..……………Billsarenottoohigh..………………………………………………………………….…Canaffordthebills…………………………………………………………………………Cankeeppets…………………………………………………………………………………Haveyouhadanyfinancialcapabilityassessmentsinconnectionwith–a.formalassessmentofyourincomeandhowtomaximiseitb.outgoingsanddownsizing?

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228

APPENDIX6RELOCATINGPSYCHOMETRICS(RP)Items are complete scales, or selected from established scales that aredescribedinmoredetailinAPPENDIX7.The items are arranged here according to the study dimension theyaddress(Appendix7).MethodsChapter5para5.5.2,para5.6and5.10givefurtherexplanationofuseandanalysis.Answersweregivenfacetofaceona1–5Likertscalewith5alwaysbeingthemostpositive(unliketheRCMquestionnairethatisusedpriortotheRP,wherescoringhigherisnegativeandindicatestheitemtobea‘bigissue’).Discussion about answers was encouraged and statements taken downverbatim.Key:R=reversedscored.Numbering-thenumbersrefertothoseusedintheoriginalscale.(SeeAppendix7formoredetailsofthemeasuresused)OPQoL - OlderPeople’sQualityofLifeQuestionnaire.AnnBowlingSTPI -StanfordTimePerspectiveInventoryZimbardoandBoyd

(1999)PWBPTCQ -PWB-PTCQ–PsychologicalWell-Being-PostTraumatic

ChangesQuestionnaireJosephetal2011FamilyMosaic -In-housesurveySPS -SocialProvisionsScale.Cutrona&Russell1987MOS-SSS -MedicalOutcomesStudy.Sherbourne&Stewart(1991)SSESS - SelfEsteemanditsSourcesinElderlyPeople

(Coleman1984)DASS -Depression,AnxietyandStressScale.Generallyused

practitionertooldevelopedbyPsychologicalFoundationofAustralia,UniNewSouthWalesMedicalOutcomesStudy.Sherbourne&Stewart(1991)

229

RELOCATINGPSYCHOMETRICS

HighispositiveunlessR=reversescoredNumberingwheregiven,referstooriginalscale(somewerenotnumbered)Stronglydisagree

1

Disagreesomewhat

2

Neitheragreeordisagree

3

Agreesomewhat

4

Stronglyagree5

PhysicalHealthOPQoL1.Ihavealotofphysicalenergy…………………………………………………..6RPainaffectsmywellbeing………………………………………………………..7RMyhealthrestrictsmelookingaftermyselformyhome..…………8.Iamhealthyenoughtogetoutandabout…………………………………Purpose/reassuranceofworthSPS6ROtherpeopledonotviewmeascompetent…………………………….9RIdonotthinkotherpeoplerespectmyskillsandabilities……….13.Ihaverelationshipswheremycompetenceandskillsarerecognised…………………………………………………………………….…20.Therearepeoplewhoadmiremytalents&abilities………………..Purpose/worthOPQoLSt.1&329.Ihavesocialorleisureactivities/hobbiesthatIenjoydoing….…30.Itrytostayinvolvedwiththings………………………………………….…31.Idopaidorunpaidworkoractivitiesthatgivemearoleinlife..LocusofControl/IndependenceOPQoL13.Iamhealthyenoughtohavemyindependence……………….……....14.IcanpleasemyselfwhatIdo………………………………………………….16.Ihavealotofcontrolovertheimportantthingsinmylife………

ControlanddirectionPWBPTCQ1.Ilikemyself……………………………………………………….……………………2.Ihaveconfidenceinmyopinions………………………………………………3.Ihaveasenseofpurposeinlife………………………………………….……4.Ihavestrongandcloserelationshipsinmylife…………………………5.IfeelIamincontrolofmylife…………………………………………………6.Iamopentonewexperiencesthatchallengeme………………………NeighbourhoodOPQoL17.IfeelsafewhereIlive……………………………………………………………19.Igetpleasurefrommyhome…………………………………………...……20.Ifindmyneighbourhoodfriendly……………………………………………18.Thelocalshops,servicesandfacilitieswere/aregoodoverall….LonelinessFamilyMosaica.RIhavebeenfeelinglonely………………………………………………………b.Ihavebeenfeelingconnectedtomycommunity………………….…

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230

PositiveInteraction/lonelinessOPQoL10RIwouldlikemorecompanionshiporcontactwithotherpeople………………………………………………………………………12RIwouldlikemorepeopletoenjoylifewith…………………………….11RIhavesomeonewhogivesmeloveandaffection……………..……..Sociability/hostilityOPQoL21.Itakelifeasitcomesandmakethebestofthings……………………22.Ifeelluckycomparedtomostpeople……………………………………..23.Itendtolookonthebrightside……………………………………………..24.Ifmyhealthlimitssocial/leisureactivities,thenIwillcompensateandfindsomethingelseIcando……………..

FinanceOPQoLSt.1&3(adjustforMoversvsNonMovers)15RThecostofthingscomparedtomypension/incomerestrictsmylife……………………………………………………………………………….25.Ihaveenoughmoneytopayforhouseholdbills………………………26.Ihaveenoughmoneytopayforhouseholdrepairsorhelpneededinhehouse…………………………………………………………….27.Icould/canaffordtobuywhatIwantto……………………….……….9a.Myfamilywouldhave/willhelpmeifneeded………………….………9b.Myfriendswouldhave/willhelpmeifneeded………………….……9c.Myneighbourswouldhave/willhelpmeifneeded………………....Guidance(Trust)SPS3RThereisnooneIcantrust………………………………………………….…12.There’ssomeoneIcouldtalktoreimportantdecisionsinmylife…………………………………………………………………………16.ThereisatrustworthypersonIcouldturntoforadviceifIwerehavingproblems……………………………………………..19RThereisnooneIfeelcomfortabletalkingaboutproblemswith.......................................................................................................

TangiblesupportMOS-SSSThereissomeonetohelpmeifIwereconfinedtobed………………..…ThereissomeonetotakemetothedoctorifIneedit………….………..Thereissomeonetopreparemymealsifmeifunabletodoitmyself..……………………………………………………………………….ThereissomeonetohelpwithdailychoresifIamsick…………………InformationalSupportMOS-SSSThereissomeonetogivemeinformationtohelpmeunderstandasituation………………………………………………………………………Thereissomeonetogivemegoodadviceaboutacrisis…………….…Thereissomeonetosharemymostprivateworriesandfearswith.Thereissomeonewhounderstandsmyproblems……………………….Thereissomeonetoturntoforsuggestionsrehowtodealwithapersonalproblem……………………………………………………………

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231

Selectresponsefrom:Very

unlikemeFairly

unlikemeNeitherlikeorunlikeme

Fairlylikeme

Verylikeme

Self-efficacySTPITemporalityFuture3.Thinkingaboutthefuturewas/ispleasantforme…………………….4.WhenIwanttogetsomethingdone,Ifirstsetshort-termgoalstoreachthisbigfuturegoal….……………………………………………11.Itrytoberealisticaboutwhatthefutureholdsforme……………13.Ihavefantasiesaboutabetterlifeaheadofme……………………..…Past1RIfindmyselfdaydreamingalotaboutbettertimesinmypast(pastneg)…………………………………………………………………………9RIpreferoldandfamiliarpeople,experiencesandideasinsteadofthenewandchanging(pastNeg)……………………………………………Present3RIdon’tdothingsthatwillbegoodformeiftheydon’tfeelgoodnow(presfatalistic)…………………………………………………………………5.Itakeriskstoputalittlemoreexcitementintomylife(preshedonistic)…..……………………………………………………………..10R.Ibelievethattobesuccessfulyoumustbelucky(preshedonistic)…………………………………………………………………11.It’sfuntogambleonthelottery,ormakesmallbetswhenIhavesparemoney(preshed)……………………………………………………12R.Ithinkthatit’suselesstoplantoofaraheadbecausethingshardlyevercomeoutthewayyouplannedanyway.(presfatalistic)……………………………………………………………………SelfEsteemSSESSSelectonefromeachchoice1.Ifeeluseful/Ifeeluseless2.Igetlittleenjoymentoutoflife/Igetmuchenjoymentoutoflife3.Iamstillcapableofdoingquitealot/Iamquitehelpless4.Ihavenoaimleftinmylife/Ihaveaclearaiminmylife5.Iamofimportancetoothers/Idon’tcountanymore6.Iamratherunsureofmyself/Ihaveconfidenceinmyself7.Iamasbrightandalertasever/Ihavebecomeratherfoolish8.Ihavelittlehopeforthefuture/Ilooktothefuturewithconfidence

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232

Selectresponsefrom:Never1

Sometimes2

Often3

AlmostAlways4

DepressionDASS3RIcan’tseemtoexperienceanypositivefeelingatall…………………5RIfinditdifficulttoworkuptheinitiativetodothings………………10RIfeelthatIhavenothingtolookforwardto…………………………13RIfeeldownheartedandblue…………………………………………………16RIamunabletobecomeenthusiasticaboutanything………………17RIfeelIamnotworthmuchasaperson…………………………………21RIfeelthatlifeismeaningless…………………………………………………AnxietyDASS2RIamawareofdrynessinmymouth*………………………………………4RIexperiencerapidbreathingorpulseracing……………………………7RIexperienceatremblinge.g.inhehands…………………………………9RIworryaboutsituationsinwhichImightpanic&makeafoolofmyself/letpeopledown………………………………………………..…15RIfeelclosetopanic(regularly)…………………………………………….19RIamawareoftheactionofmyheartintheabsenceofphysicalexertion(palpitations)…………………………………………………..…20RIfelt/feelscaredorapprehensivewithoutanygoodreason……

StressDASS1RIfindithardtowinddown………………………………………………….….6RItendtooverreactinsituations…………………………………….………..8RIfeelIhavealotofnervousenergy…………………………………..…….11RIfindmyselfgettingagitated………………………………………..….…….12RIfinditdifficulttorelax……………………………………………….……..…14RIamintolerantofanythingthatkeepsmefromgettingonwithwhatIwasdoing……………………………………………………………18RIfeelrathertouchy………………………………………………………........…

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*Thisquestionwasremovedfromresultsduetothehighnumberofpeopletakenmedicinethatcancausemouth-dryness.

233

APPENDIX7

RelocationsPsychometrics(RP)

Takenfromotherscales

OUTLINEOFSCALESandITEMSSELECTED–chapter5paragraphs5.6.4

and5.7showhowconsistencyofscoringwasachievedbetweenscalesand

howdatawasanalysed.

RelocatingConsiderationsMeasure(RCM)–questionnaire1

The first questionnaireused in this researchwasdesignedby the author

andcoversdemographics.Mostofthequestionnaireisaboutthecondition

and suitability the current housing, the requirements or preferences of

future housing and those push and pull factors in context. Cognitive

functiontestsarealsocoveredinthequestionnaireprocedure.

RelocationPsychometricsMeasure(RP)–questionnaire2

Decision-makingdimensions:

Selfefficacy;SocialSupport;LocusofControl;Self-esteem;Cognitive

function;HealthandWellbeing;(depression,anxietyandhaircortisol

concentrationasaphysicalmeasureofchronicstress)….

Researchperceptualandsubjectivedimensionitems

intheRP(Chronbach’salpha)

1)Self-

Efficacy

2)Support 3)Locus

ofControl

4)Self-

Esteem

5)Health&

Wellbeing

11items

(.73)

4items

re

control-

lability

(.70)

16items

emotional

aspect

(.87)

21practical

difficulty

(.70-.87)

9items

viewsand

attitudes

(.87)

8items

views

and

attitude

7itemseach

(21)for

depression,

anxietyand

stress;

(.81)

4itemsfor

physical

abilityand

pain.

Cognitivetests

The abovematrix helps define the studyparameters and thenumbers in

boxesrefertotheitemsinthe2ndquestionnairedesignedbytheresearcher

forthestudyusingitemsfromthevalidatedscales–perbelow-calledthe

Relocating Psychometrics (RP) Questionnaire, it incorporates the DASS

(depression,anxietyandstressscale)

234

Scalesformeasuringthestudydimensionsusedinthe

RelocationPsychometricsQuestionnaire

AfullversionofthequestionnaireisproducedinAppendix6

1)SelfEfficacy

• STPIStanfordTimePerspectiveInventory–ZimbardoandBoyd(1999)

The11itemsarefromthe32itemshortform,whichisparticularlysuitable

for older people because it measures self-efficacy from various time

orientationsthatdifferbetweenindividualsandevolvewithage.Theitems

used measure dominance of future, present or past perspectives and

thereby this matches the tripartite approach in self-efficacy theory

(Bandura1977etc).

Examples:

• Ithinkthatit’suselesstoplantoofaraheadbecausethingshardlyever

comeoutthewayyouplananyway(presentfatalistic).

• Itisfuntogambleonthelottery,ormakesmallbetswhenIhavespare

money(presenthedonistic)

2)SocialSupport

• OPQoLOlderPeoples’QualityofLifeQuestionnaire(Bowling2008)• SPSSocialProvisionsScale(CutronaandRussell1987)• MOS-SSSMedicalOutcomesStudy;SocialSupportSurvey(Sherbourne&

Stewart1991)

• Loneliness–FamilyMosaicHousingAssn.survey2013/14

All 32 items from the OPQoL short formwere used in this research, 22

relatedspecificallytoemotionalorpracticalsupportasdid4fromtheSPS

and 9 from the MOS-SSS. To mirror a Family Mosaic Housing survey 2

questions were used asking about feeling lonely and community

involvement.

The SPS was developed to look at loneliness and social support in low

incomeminority groups, items relating to general support and others to

trustandsomeonetoconfidein,wereselectedforthecurrentresearch.

TheMOS-SSSdifferentiatesbetweenemotional,tangibleandinformational

supportandpositivesocialinteractionsomeofwhichwereaddedformore

emphasistotheOPQoLitems.

235

Examples:

• IfeelsafewhereIlive(OPQoL)

• Iwouldlikemorepeopletoenjoylifewith(OPQoL)

• IdopaidorunpaidworkoractivitiesthatgivemearoleinlifeOPQoL)

• Ihavebeenfeelinglonely(FamilyMosaic)

• IcanaffordtobuywhatIwant(OPQoL)

• Thereissomeonetoprepareyourmealsifyouareunabletodoit(MOS-SSS)

• Thereissomeonetogivemegoodadviceaboutacrisis(MOS-SSS)

• There isa trustworthyperson I could turn to foradvice if I hadproblems

(SPS)

3)LocusofControl

• OPQoLOlderPeoples’QualityofLifeQuestionnaire(Bowling,2008)• PWB-PTCQ–PsychologicalWell-BeingPostTraumaticChangesQuestionnaire(Josephetal2012)

3itemswerefromtheOPQoLandtheother5fromthePWB-PTCQ,which

wasdesignedtomeasuregrowthfollowingadversityortraumaticchange,

particularlyusefulwhenusedretrospectivelyatthetimeofrelocationand

5monthslater.Movinghasbeendescribedintherelocationliterature(e.g.

Egan2008)asamajor,effortfulandtraumaticlifeexperience.Examples:

• Ihavealotofcontrolovertheimportantthingsinlife(OPQoL)

• Ilikemyself(PWBPTCQ)

• Iamopentonewexperiencesthatchallengeme(PWBPTCQ)

4)SelfEsteem

• SSESS–TheSouthamptonSelfEsteem&itsSources(olderpeople)Scale(Coleman,1984)

• SPSSocialProvisionsScale(CutronaandRussell,1987)

Selfesteem iscloselyrelated todepressionandColeman(1984)used the

SESSwith455olderpeoplein3relocationstudieswithsignificantfindings

inthreecountriesincludedtheUKbeforereducingitto8keyfactors,allof

which are included in the current research. The SPS already mentioned

236

abovehasasubscalerelatingtoreassuranceofworthandthe4itemswere

includedintheRP.

Examples

• Ifeeluseful/useless-yes/no

• Iamofimportancetoother/don’tcountanymore–yes/no

5)Health&Wellbeing

• DASSDepression,AnxietyandStressScale.(PsychologicalFoundationofAustralia)

• OPQoLOlderPeoples’QualityofLifeQuestionnaire(Bowling,2008)• PWB-PTCQPsychologicalwell-beingposttraumaticchangesquestionnaire(Josephetal.,2012)

TheDASS 21 item versionwas used. The Scale has very good utility and

face value, important to participants, especially since they are asked to

answerretrospectively5monthsat theTime1meeting. It iswidelyused

withhighvalidityandreliability.4OPQoLitemswerealsoused,relatingto

physicalabilityandpain.

Examples:

• Iamunabletobecomeenthusiasticaboutanything(DASSdepression)

• I worry about situations in which Imight panic andmake a fool ofmyself

(DASSanxiety)

• Ifindithardtowinddown(DASSstress)

• Painaffectsmywellbeing(OPQoL)

237

FieldworkprocesschecklistAPPENDIX8

Time1&2Order1 Score,adjustandcorrectquestionnaireformsx2

2 Writecomments/quotesfromquestionnairesprocessinparticipantsrecordbook

3 Checkhairsamplelabeliscorrectlycodedandtime1or2isindicated,storecorrectly

4 TypeparticipanthistoryonBiogsrecord

5 OrganisequotesidentifiedbyparticipantnumberunderrelevantcodesontheExcelquotesandthemesworksheets(whicharesetoutastimeoneandtimetwo).Onetabpercohort.

6 CopyandpastequotesandmainbioginfoontoNVIVOsystem

7 Logthescoresfrom1.above(questionnaire)inExcelQuestionnairesworkbookdatabase.(AlsotransfertoSPSSafterlastparticipantwhencomplete)

8 Timeoneonly:Diarisetime2visitonyeartoviewdiarypage

Time2followupvisit(alsoappliesforthe8semi-strucutredinterviews)

1 Repeat1–7perTime1

2 AddfinalFeedbackforminfoontotheQuotesSummariesform

3 RecordFeedbackformcommentsandsuggestionsontheFeedbackSummarysheets

4 LogfeedbackscoresontherelevantExcelQuestionnairesworkbook,new,separatetab

Semi-structuredInterviews(inadditiontoTime1&2procedures…)

1 TranscribefullSemi-structuredtextfromDictaphonerecording2 ReducefulltexttokeyInterviewstructuresummaryofmainthemes

andquotesforeachintervieweetofurtheraidlinebylinecoding.

3 CopyandpastfulltextintoNVIVO

238

APPENDIX9Prioryheadingsforinitialcodingofnarrative

Additionalsubcodesdeveloped

DecisiontoMove • Havetovs.wanttomove• Tootraumatic• Wishedhadmovedearlier• Never considered and

wouldn’t

Memories,attachmentFinancialimperativestomove(nonefinanciallyunabletomove)Age–bestage/agenotrelevant/notagebuthealthWhenpartnerdiesStayaslongaspossibleapproachGardens–memories,memorialattachedexercise,aburden.Formerpartnerwouldbeproud,respectmemoryofhusbandFamilyproud–independentroleinfamilyendorsedIdentitywithincommunityIdentitywithinfamilyFraudtheft,deceitabuse.Otherreasonstomove-familybeneficiariesorrusheddecisiontomoveInheritance

Attitude toPresentSituation

• Positive• Negative• Confused/difficulttodecide

PlanningAhead/selfefficacy/locusofcontrol/selfesteem

• Positive• Negative• Peoples’ views of my

abilities/myopinions• Senseofpurpose

Possessions/de-cluttering

• I’mslowatit• Takesalongtime• Physicallydemanding• Emotional

EmotionalSupport

• Family• Friends• Social support groups, e.g.

church• VolunteryorSocialService

PracticalSupport • dittoIndependence inrelocationdecision-making

• Personality/attitude• Don’twanttobeaburdento:• Friends• Family• Familyhavetheirownlives• Don’t want to ask for official

help• Happytoaskforhelpfrom• Friends• Family• Socialservices

Sociability • Very private person – sharingandmixing.

• EnergyandEnthusiasmLoneliness • Attitude

• Increasedduetomove• Lonelydespitealotofcontacts• Activitiesthathelp/pets

239

Community/Location

• Neighbourspositive• Neighboursnegative• CrimeandSafety• CommunityCohesion• LocalFacilities• Routine and practice

dependentonlocation

Pride,lifetimeandcurrentachievementReductionoffriendlinessincommunitiesCommunitysafeFamiliarityhelpsfeelsafeBelongingCompanionshipPetsAcceptanceandnonfamilialcontactwithinretirementhousing

Family • Wanttobenear• Don’twanttobenear• Friends and community more

important

Adaptations • Can’tcopewithupheaval

• PositiveImpact• NegativeImpact

240

APPENDIX10EXTRACT:FROMBIOGRAPHICALINFORMATIONTABLE-COMPLETEDIMMEDIATELYFOLLOWINGQUESTIONNAIRESESSIONSINONEDOCUMENTFORALL39,PRIORTOFORMATIONOFNODEHEADINGSID Circs.RH=Retirementhousing*=followup

interviewKEYTHEMESEMERGING

60-75Non-movers

BIOGRAPHIES&QUOTES

WTMA–wanted/wantstomoveambiguousWTME–wantstomoveeventuallyWTMM–wantedtomovemissedtheopportunityduetoage,healthorcircschanging.WTMD–wanttomove,dilemmae.g.careroraffordability.S,HS,NSathome–supported,highlysupported,notsupported=familyorpaidforgardener/cleanerA–adaptationsSC-socialcare

NM8age60+ 3bedrS/Dnewishbuild.Smallgarden,newestate.

From3bedrbung.Standardhairsample,nottreated.WTMA(wantstomoveambiguous)NotSupported;volunteers

RetirementtransitionDeclutteringClutterfrompastEmotionalattachtopossessionsPlannerGoals,planab&cEyeonthefuture,PreventeventualityIndep.FromfamilyAnyonebutfamilyPurposeHealthyactiveLikesdiversity,

Visit1)Movedherefromlargebungalowwhichhadpreviouslybeenthefamilyhomewithherparents5yearsagoonretirement.Achievedsomede-clutteringandisstilltryingtoasdaddiedsuddenlyandwantstobepreparedfortheunexpected.Findingitabitdifficulttopartwithsomeitemsofherparents.Isaplannerandopenlydiscussedwithparents,nowwithhersisteranddaughtersaboutthefuture.Hopestostayinthehouseindefinitelybutacceptsgoalsaren’talwaysachieved.Keepsmoneyasideincaseofneedforrespiterecoveryifsheisill,ortofundamovetosheltered.HashereyeontheplaceoppositewhichisalivelyRH‘likeavillage’withplentygoingonbutownprivacy.Worstnightmarewouldbelivingwithfamily–wouldsoonerbeinahome

Lifestyle, autonomy, independence –I’m always busy,can’t seem to get to bed early. Could sleep all the time ifgiventheopportunity.Freedompassisthebestthingever.Havingthatandneverhavingtothinkaboutit.SeniorRoverandC2Callday too. I justdecidedtogo toBrighton–wasthere all day with food it cost £15. I couldn’t go in thedirection of my dtrs. to live beyond Hampton Court(because of the Freedom Pass). I volunteer, they give meresponsibility,Idon’tthinktheyshouldgiveme.Theydon’trealiseasyoudidsomething10yearsagoyoustillcan.Housing in retirement/autonomy -In my head when Icameherethiswasmyfinalhouse,althoughIcamefromabungalow, itwasbigger.Now I thinkwhen I can’tmanage

241

concern‘oneculture’area–socialIDPreparingforfuture-declutterBadmoveinpastNotburdenfamilyConcernforfuturegenerations

orcaredforbystrangers.Enjoysherlife,verybusy,()publicduties,sometimestoomuch–thinkingofslowingdownabitwithcommitmentsbutishealthyandveryactive.LikesFreedompass,andvibrantmultiethniccommunitybutwouldhatethecommunitytobecomedominatedbyanyonecultureandseesthathappeninginareasnearbybutnotherestate.Visit2)Evenmorepositivethan5monthsago,has‘noworries’althoughnaturalconcernsthatdaughtersandgrandchildrengeton.Havingthe‘timeofherlife’,dtr.saysonebigholiday.Feelsifsheissuddenlyillorbecomesunfitwillnothaveregretsandwillbehappynottobehere.ThatwouldinvokeplanC–movingtoshelteredandsheisgraduallyclearingthingsshenolongerneedsasitisadriverforstreamliningherlifeincasetheworstshouldhappen.Willdisplaysomefavouritethingsinacabinetandgetridoftherest.Wouldn’twanttoburdenanyoneinthefamily.Isveryclearthatthelastmovebecamealogisticalnightmarethroughcircumstancesthatwerebeyondcontrol,includinghousenotbeingreadytomoveintooncompletionandlookingafterchildren,animalsandworkcommitments.Shewouldn’twantarepeat,wouldnotbeabletocopeandsayssheonlycopedbeforeasshewasseriouslyillandtakingmorphinewhichcontrolledheranxiety!!Isevenmorecontent,enjoyinglife,hasplansA,B,C–stayingputthroughtoresidentialcarethathopefullywon’thappen.Stillhopingforshelteredacrosstheroadshouldshehavetomoveandstillgraduallyde-clutteringasthat’simportantwhateverhappens.Hasnoworriesforherselfbutworriesforherdaughters,mainlygrandchildrenashousingisabiggerproblemfor

this house – hopefully that’s ok. Iwant to live opposite intheshelteredhousing.They’vegotloveylargebedrooms.Planning - I have told my girls I could have 30 or moreyears here but Iwouldwant to select sheltered accomm Ialwaysplan.I’d liketomovethere.Wetalkopenlyandgetplansinplace.Iwouldn’twanttolivewiththem.Youshouldkeep enough as a safety net e.g. moving into sheltered orresidentialcare–rentingforawhileforconvalescence.Youshouldalwayshaveagoalbutacceptthatmightnothappen.Independence-Mobilityisthebigthing,Iwouldn’twanttothinkIwasdependentonanyoneelse.Everyyearthatgoesbyeverything isa littlebitharder. I’vegotcertain iconsofpeoplewho lived to be old inmy head and those are thepeople I try to emulate. I know someone of 94 who Iadmired. As long as she could walk she went to get herpaperandthat’swhyweneedtogoout,notjustsitindoors.Possessions–inmyheadIcouldwalkawayfromanythingandbealright.Ittookus3yearstogetridofthatbungalowas it had been our home and Mum and Dad’s before. Mygirls know my feelings. I communicated with my parentsand I know how you change. I’m ever so busy, why do Iwant to waste my time when I’m so busy looking afterpossessions?Iusedtohaveroomsfullofbooks,nowit’sallontheinternet.Icouldwalkawaybutwouldwantittogotothe right place. I’m clearingmy house, trying to get rid ofstuff.Mydaddiedsuddenly, itcouldhappenanytime. I’vegotbeautifulstuffthatmygirlsdon’twantbelongingtomymum.Community when retired - Her family weren’t close by

242

youngpeoplenow.

andatonetimethereeverybodyknewherbutbythetimeshewas 90 herewas no-one left. You need people aoundyou.Peopleneedprivacyandtobeabletoseeabitof life.People coming and going and not the ones (RH) wherenothing is going on. It’s like a village over there (RHopposite).Family/independence-MysisterandIarereallycloseandspeakeveryday.BothmysisterandIareterrifiedofhavingto livewith thechildren.Youwantyouownprivacy.Don’twantarolereversal.Almoststrangerswouldbebetterthanourownfamily.IabsolutelylovemyfamilybutIwantthemtogohomeatnight!Iwouldn’texpectmydtrs.tohelpme(ifI’mill)theybothworkandhavefamilies.Iwouldgetbywithhelp from friends andneighbours. Iwould feel awfulgettingdtrtotravel1.5hrstogethereandback.You’duseWiltshireFarms!Age formoving - I’dmoveacross theroadorsomewheresimilar.Ifyouleaveittoolong,sheerphysicaleffortwouldbeaproblem.Youshouldalwayshaveagoalbutacceptthatmightnothappen.N’hood/Communitydiversity-Iloveithere(diversity)acompletemix.Ienjoythecolourfulness.ButIwouldhatetogointoaroadwhereeveryonewasofoneethnicity–includingallwhiteBritish.Someareasoneculturetakesoverandthatisn’tgoodOthersthinkI’mmorecompetentthanIam.

243

APPENDIX11ExtractfromNVIVOnarrativeanalysissystem

244

ANALYSISANDCONSIDERATIONOFNVIVOCODINGOUTCOMES–PARTOFREADANDRE-READPROCESS APPENDIX12 ANDFORMATIONOFQUESTIONSTOASKONESELF/USEASTOOLFORPRACTITIONERSWORKINGWITHPOTENTIALMOVERS.PARENTNODES FAMILY

F=functionalM=meaningful

Definitionforincludingnarrative-examples

SIBLINGS-General

Definitionforincludingnarrative-examples

PLANNINGEFFICACY&AMBIGUITYDoIwanttomove,doIhaveenoughinformationtodecide?Isitpossibleasanidea,doIhavethelevelofphysicalsupportandmoneyIneed?AmIcapable–knowledgeandskills?ShouldIjustwaitandsee?

FBestAgeandTimeforMoving

WishedImovedsooner.Never

moved/willmove.Memoriesprevent

moving.Beenheretoolong.Moved

frequently.Notagebuthealth.When

partnerdies,whenkidsleave.

Vision(ofpotentialbenefitsornone)

Optionsthatmightbeavailableor

necessaryornotnecessaryand/or

available.

FPracticalSupport,AdviceandInfo

Helpde-cluttering,topackandmove,

helptolookatpotential

accommodation,adviceand

information-legalandfinancial

SelfEfficacy–situationdeemedtobecontrollableSelfEfficacy–competenceandpurposeFinanceKeyIssueLocusofcontrol/andcombinedselfesteem

Lackofplacestobuy–lackofpractical

support,infoandadvice.

Purpose,decisionstoocomplex,

processtoocomplexprocess,Iam

capableornotcapableofdoingthis

withmyskillsandapproach.

Notenoughmoneytomove,can’tafford

topayforserviceslikecleaningand

gardening,can’taffordupkeepof

repairsorutilities.Can’taffordfood.

HavemoremoneynowIhavemoved.

Movingwouldnotbenefitfinancially.

Optimism,IsortproblemsoutvsI’ma

luckyperson,Riskaverse.Inthe

present.People’sviewsofmyabilities.

Don’tplanit’sallaboutluck,it’llbeok.

245

246PERSONALINDEPENDENCE,ANDAUTONOMY

WillIcope?DoIwanttoaccepthelporwillthatburdenotherpeople?WillIbeforcedintosomethingIdon’twanttodo?Ishould/mustdowhatotherswantmetodo?

MEmotionalSupport Havingtodisposeofpossessionsis

emotional.Acceptingneedtomove.

Leavinghomeofmanyyears.Support

fromfamily,friends,voluntaryor

churchgroup.Someonetoturntofor

emotionalsupportandunderstanding.

MPersonality Resilient.Don’twanttobeaburden.

Nothappytoreceivehelp.

ReceivingHelp-family,friends,officialandLivingNearFamily

Dutyvs.genuine.Feelaburdento

family.Happytoreceivehelp-family

andfriends.Happytoreceivehelpfrom

voluntaryorofficialsources.Happyto

givehelptofamily.Keyroleinhelping

family.Familyhaveownlives.Don’t

wanttolivenearfamilyifnotalready

nearby.Wouldn’tlivewithfamily.Want

tostaynearfamily.Wanttomovetobe

nearfamily.

MAutonomyofDecision-making

Impactonindividualofautonomyin

decisionstodowithlocation,sizeand

typeofaccommodation,whentomove,

whattokeeporthrowaway,financial

matters.

PressuretoMoveHarassmentandFraud

Pressuretomoveduetohealth,lackof

choiceofarea,possiblywellmeaning

relativesreduceautonomy

Familyorothersbenefittingfromthe

movemorethanparticipant.Familyor

othersforcethemoveagainstwishesor

harasstheparticipantinrespectof

inheritance.

HOMEENVIRONMENTWhatdoesmyhomemeantome?

FSizeandFacilities,andEffectsonHealth

Sizetoolarge,musthaveguestroom,

needtwobedroom,onebedroomok,

layouteffectsmobilityandhealth,can’t

copeduetohealth.

FAdaptationsFBurden

Can’tcope/dislikehavingthemdone

Positive/negativeoutcomes.

Conditionofproperty,cleaning,repairs,

gardening,costtorun,size.Worryover

repairsandcost.

Howbadisitnowreally,isitworththeeffortofmoving?Willitbethatmuchbetterisitworththeeffortandstrain?Howmuchbetterisitnow?(Movers)

MMemoriesandPersonalIdentity

Partofme,memorialtohusband,

activitiesandroutinesinthishome/

homeandgardenthatareimportantto

me.

MSociability

Veryprivateperson.Goodatsharing

andmixing/notgoodatsharingand

mixing.Wantmorepeopletoenjoylife

with.Haveenergyandenthusiasm.

Communalareasandgardenswithin

retirementhousing.Notamixer,don’t

goinotherpeople’shouses.Don’tshare

information.

MLoneliness Lonelyathome,increasedloneliness

duetomove,lonelinessdespitealotof

activities(lackcompanionshipor

contactathome,esp.nonfamilial).

MEnjoymentandContentment

Comfort,familiarroutines,pets,good

neighbours.Loveforhome.

F/MHealth&Wellbeingeffectsofmoving.

Formovers,whatwerethemain

functional&meaningfulbenefitsand

problems.

LOCALCOMMUNITYNEEDSANDSOCIALIDENTITY

MSocialIdentity Levelsofcrimeandsafety,likechange

orfearchangeincurrentlocatione.g.to

onecultureorlackofintegrationof

racesorreligions;gettingoldandbeing

isolationbyage,culture.Agebiasinself

orothers,implicationsofmovingto

‘sheltered’.

AttachmentandRoutines

Friendlyneighbourhood,social

activities,vibrantandgoodcultural

mix.Greenopenspaces‘goodarea’Able

towalktofacilitiesortraveleasily.

FLocationfacilities Neartobanks,PO,shops,transport,

neartodoctorandsocialservices.

247

Locationitemsofimportance(RCMquestionnaire)APPENDIX13AChapter6Part1section6.1.3locationKEYThepercentageofscoresof4&5(scale1-5)for75%ormoreparticipantspres.=presentsituation,relatestopresentarea(NonMovers);prev.=previoussituation,relatestoareatheymovedfrom(appliestoMovers);new=indicatesimportanceofthatitemwhenconsideringthenewlocation(appliestoMovers;alsotoNonMovershypothetically)trans=transport,s’care=socialcare.Table6.1.3CSummaryofRCM&RP(whereindicated)%scoresforlocationitemsofimportance(75%ormoreofparticipantsinthatgroupscoredhighly)GroupAM60+n8

GroupBM76+n8

GroupCNM60+n11

GroupDNM76+n12

RP42Goodshops&facilitiesnew.

RP42Goodshops,&facilitiesprev.

RP42Goodshops&facilitiespres.

21Friendsnearbyhelppres.

20Facilitiesnew. 30Med/s’care.new 28Trans.new 29Dr/healthpres.100%

24Communityisactiveprev.

38Safen’hoodprev.100%

37Safeparksnew RP42Goodshops,facilitiespres.

38Safen’hoodprev./new100%

24Comm.Helpprev. 38Safen’hoodpres.90%

RP41FeelsafewhereIlive.pres.95%

27Transprev 29Drprev. 30Med/s’carenew 20Areafacilitiespres29Dr/s’careprev 30aShopsprev. 30aShopspresent 30Med/s’carenewRP41FeelsafewhereIlivenew.

RP41FeelsafewhereIlivenew.

RP41FeelsafewhereIlivepres

38Safen’hoodnew75%

30Med/s’carenew

39Safen’hoodnew

39Communityisactive*new80%

31Shopsnew 32POprev 20Facilitiesnew 37Safeparksnew 33POnew80% 31Shopsnew75% 39Communityisactivenew80%

20Areafacilities

21Friendsnrnew 27Trans.prev. 23Familynrnew 28Trans.new 28Trans.new 31Shopsnew

30aShopsprev. 34Bankprev.new75%

32POprev/new 34Bankprev.75% A.16itemsofhighimportance

B.14itemsofhighimportance

C.8 itemsofhighimportance

D. 5 items of highimportance

248

APPENDIX13B

Table6.1.4APhysicalactivity,smoking,alcohol,socialstatus

Age

GroupAMovers60-75(n8)

GroupBMovers76+(n8)

GroupCNonMover60-75(n11)

GroupDNonMovers76+(n12)

Current

Smokers

yearssmoked

averageperday

1x30+yrs.

8pd1x30+yrs.

13pd

0 0 1x30+yrs.

2pd

Previous

smokers

yearssmoked;

averageperday

2x20+yrs.

10-20pd1x15+yrs.

10-20pd

3x20+yrs.

10-20pd1x15+yrs.

10-20pd

2x20+yrs.

20+pd3x25+yrs.

20+pd2x5-10yrs.

10pd

4x25+yrs.

20+pd2x20+yrs.

10pd

Alcohol

unitsperweek

1person

8units1person

27unitsAllconsume

R6–41units1person

21unitsPhysicalhours

perweekactivity

average

17.5 15.9 24 25

Sunlighthrs.

pwaverageofSummerand

Winterfigures

8 8 6 5

Awayfromthe

houseaverage

hoursperweek

16 15.5 27 7

Holidaysper

year-range

0-1 0-1 2 1-2

Education;

levelmore/less

thanparents

(plus/minus)

Samelevel

Samelevel

Plus13

Minus4

Status(class)

up/down

comparedwith

parents

Plus5

Plus4

Plus10

Plus6

Giventhelownumbersinvolvedinthisresearchitisnotpossibletodraw

inferenceorgeneralisefromthesesfindings.Howeverthefindingsconcur

withknownhealthrisksforfutureillnessandtypesofillness,reportedin

Table6.1.4C.Muchof it isdebilitatingsomightaffectthenecessarylevels

ofcognitiveandphysicalefficacyneededforrelocation,whichaccordingto

the research premise should be viewed as a lengthy and burdensome

process.Thus thedatashouldbeconsideredaspotentiallyrelevantwhen

249

viewed in conjunctionwith answers to health efficacy questions inTable

6.1.4B and chronic illness Table 6.1.4C orwellbeingmeasures at chapter

sevenasextraneouseffectswhenparticipantsarereportinghowrelocation

hasaffectedthem.

Physicalactivity,holidaysandsunshine

TheolderNon-Movers reporthigher levelsofphysical activity relative to

theother groupsand relative to theirphysicalhealthprofile, the amount

they say they have spent in sunlight or away from the home eachweek.

There may have been a social desirability effect or exercise may be

perceivedintermsofthetimeittakesasopposedtotheamountofactual

activitywithin that time; four of the 12 participants in that group drive.

YoungerNonMovers,whereoverhalfworkfullorparttime,havetwiceas

many holidays as both younger and olderMover groups. They alsowent

outsidemorethantheothergroups,largelyasaresultofworkingandalso

forthatreasonhadslightlymoreexercisealthoughinthewinter,byfarthe

lowestlevelsofsunlightofanygroup.Eightofthe11hadcars.

Upward mobility - Level of education, employment attainment, perceived

changeinsocialclass

The younger Non Movers surpassed their parents’ educational age and

educational attainment, having 20% more time in education and more

qualifications,whichfortheolderNonMoverswasthereverse.Botholder

Movers andNonMoverswere in the exact age range for being educated

duringWWII.

Self-assessedsocialstatusor‘class’hadforallgroupsimproved,compared

with their parents but using a points system for class categories and

employment attainment, the increase for the youngermovers is plus 10,

whereasupwardmobilityrangesfortheothergroupsfromplusfourinthe

olderMoverstoplusfiveandsixforyoungerMoversandolderNonMovers

respectively. Social status and relocationwasmentioned in the literature

review in this research (ch3 para 3.7.3) andwill be discussed further in

Part2ofChapterSix.

250

APPENDIX14

Motivator/ImpedimentsummarytableReflectsfindingsChapter6(Parts1&2)Keyfortext:Bold=meaningfulitalics=functionalnormal=functionalandmeaningfulKeyforsymbols:✓ =motivatortomove✕=impedimenttomovingB=equallybothforthatgroup

A B C D

Age–tooyoung,equateretirementhousingwithgettingold.

✖

Age–toooldtoconsidermoving ✖Ambiguity(unclearaboutfuturesituation)

✖

Attachment(happytoleaveprevioushome)

✔ ✖

Attachmenttocurrenthomethatgivesenjoyment

B ✖

Change(notchangeaverse) ✔ ✔ Change(changeaverse) ✖Carer,beingacarerofparentsorsupporttochildren

✖

Cognitiveability,complexdecisions&process

✖ ✖

Community(mustbehelpful) ✔ Community(newmustbemoreactive) ✔ ✔ Community(involvednow,canstayinvolved)

B

Community(lackofintegration,unfriendlyand/ormayfeelanoutsiderinfuture)

✔ ✔

Costs(ifconsiderablylower) ✔ ✔Declutter,packandmove(wishtobefreefrompossessions)

B ✔

Declutterenormityoftask ✖ Declutterpackandmove,emotionalandaphysicalstrain

✖ ✖

Doctor,wantedtoremainwithpreviousone

✖

Employment(won’tmovewhilstworking)

✖

Family(abletostaynear) ✔ B Family(ifhadtomoveawayfrom) ✖ ✖ ✖Friends(staynear) ✔ B

251

Friendsifhavingtomoveaway ✖ ✖ ✖Garden(havesharedgardenonly) ✔ Garden(musthaveexclusiveuse,for75%)

B

Guestroom(ifnotavailableatnewlocation)

✖ ✖ ✖

Health(poor,movedmainlyoutofnecessitythanchoice,someimposedbyfamily)

B

Home(tofeelsafeindoorsathomenow/inthefuture)

B

Home(tofeelmoresafeindoorsthannow)

✔

Health(ispoornoworjustincaseitmaybecomeso)

✔

Independenceandautonomy–restrictedinimposedcases

B

Independenceandautonomy(owndecisions,don’tburdenfamilywithneedsoracceptfamilyhelp)

✖

Informationlackofoptionandserviceinformation

✖ ✖ ✖

Inheritance(wanttohavesufficienttoleavesome)

✖ ✖

Isolation/lonely(toaddressoravoidforthefuture)

✔

Isolation,loneliness(increasedincasesofnecessityorimposedmovevs.choice

B

Medicalservices(mustremainatleastasgood)

B

Medicalandsocialcaresupportisgenerallybetter

✔

Medicalservicesiftheyfailedinpresentarea

B

Memories(includehouse,gardensandlocalarea)

✖

Optimism–Icanalter,safeguardthefuture

✔

Optimism(futurefocusbutmediatedbycommitments)

✔

Optimism(hopeforthebest,positivereframing/luck)

✖

Neighbours(moveawayfrombadneighboursormustbebetterandsaferthannow)

✔ B

Neighbourhoodsafe(mustremainatleastassafe)

B B B

252

Onefloorlevelisessential ✔ ✔ Onefloorlevelispreferabletostairlift BPainandrestrictiveillness ✖Parks(safe,requirednearby) ✔ ✔ Pastnegative(preferold&familiarplaces&people)

✖

Pets(ifnotallowed) ✖ ✖ Presentfatalistic(needtobelucky,resigned)

✖

Risk(notaverse) ✔ ✔ Risk(averseunderpresentcircs) ✔ Roomsize,outlookandlight(ifsmallroomsanddarkinnewlocation)

✖ ✖

ShopsandPO&facilitites(mustremainatleastasgood)

B B ✖ B

Transport(mustbeatleastasgood) B B Transportbetterthannow) ✔ Useful(feelinguseful) ✔ Widowed(asatriggerorlaterbasedonfeelingisolated)

✔ ✔

Widowed(wishtoremainformemories,gardenmaybememorial)

B

Worth(lowself-worth-purpose) ✖ ()=numberofmeaningful

itemsincluded(i.e.balancearefunctional)

Totalmotivatorstomove 15(11)

9(6)

7(5)

2(1)

Totalimpedimentstomoving 5(4)

8(5)

10(5)

16(12)

Totalthatareboth(causeambiguity) 7(4)

7(5)

4(4)

5(4)

28(10)

24(16)

21(14)

23(17)

PERIPHERAL1.Cleaning(reducedcleaning)2.Disrepair3.Heating(cost)4.Leasecostsnewproperty5.Movingnearfamilyunlessserioushealthneedorgrandchildren

6.Sizeofproperty

7.Neighbours(theirhelpisnotsustainable.Leaving.Ifclosefriends–above6.)8.Options(lackofsuitableretirementhousinginthearea)9.Repairandmaintenancecosts

253

5.3.1InterpretationTable5.3above

ThedatahasbeenassessedaccordingtocombinedinformationfromParts

1 and 2 of chapter 5. Inevitably there is an amount of subjectivity in

assessmentbutthisisconsistentlyapplied.Itemsareincludedwherethey

wereissuesforatleast75%oftheparticipantsinthegroupat4or5ona

scaleof1–5.

Motivatorsandimpedimentscanbe‘twosidesofthesamecoin’

Thus if the Table 5.3was aboutnotmoving, olderNonMover GroupD’s

impediments tomovingwouldbecomemotivators tostay. It is important

to take this into account so that Group D is not automatically viewed as

beingoverlynegativeorlackingindecision-making.

BothMotivatorandImpedimentitems.

Therearesomeitemsthatfall intotheMotivatorandImpedimentareaof

the table. This occurs where the desired item is available already and

available in the moving option so they cancel each other out as a key

decision factor. It can also occur where there are inconclusive scores or

ambiguitywithinthegroup.

HomeEnvironment.

Localcommunityneeds&socialiden6ty.PersIn

depen'ce

&Autonomy.

PlanningEfficacy.

254

Peripheralitems

Theseweredescribedbyparticipantsinawaythatsuggested,irrespective

of scores, that theyare relativelyeasily resolvedor toleratedandarenot

centraltoadecisiontomove.

5.3.2Meaningful;Functional

All bio-psychosocial aspects are brought together for discussion and

conclusion in Chapter 8 including the influence of meaningful vs.

functionalaspects.

It can be seen from table 5.3a that Group A youngerMovers havemore

reasonstomovethanotherGroupsandrelatemainlytotheirresponseto

transitionalchangeandpreemptingproblemsbyplanningfortheworst.

GroupAYoungMovershave15reasonsformoving,11ofthemmeaningful

comparedtoGroupDolderNonMoverswhohad16reasonsnottomove,

i.e.reasonstostayput,12ofthemmeaningful.

GroupB,olderMovers,havegreaterambivalence,weighingupmeaningful

aspectsformovingorstayingagainstfunctionalreasons.Botholdergroups

have functional impediments that tend towards age related concerns,

cognition and health, trusted health services. These do not feature for

younger Non Movers, Group C who have functional aspects such as

employment, financial and carer commitments, ofmore concern.Notably

GroupAdidnothavethoseday-to-dayrestrictionsorastrongattachment

totheirformerhome.

Older groupmeaningfulness inboth groups tends towards attachment to

the home and location, and for older Non Movers, Group D, related

personalityfactors.GroupCyoungerNonMoversaredifferentinbeingless

likelytoberestrictedbymeaningfulaspectsassociatedwiththehomeand

optimistic that their functional commitments will reduce. However, the

uncertaintycausesambiguityaboutthefutureandhowtoplanforit.

255

APPENDIX15

Key–withinthesecohorts:VeryHigh=over30pg/mgSlightlyraised=5–10pg/mgHigh=over20pg/mgLowornochange=under5pg/mgModerate=10to20pg/mg

ThisTablerelatestotextinChapter7para7.2.Notetwoextremescoreshavebeenexcludedfromthedata.YoungeragegroupshavegenerallylowerHCCrateswhenconsideredasawholethanolderagegroups-agreeswithliterature.HCCishighforMovergroupAyoungerMoverscomparedwithyoungerNonMoversofthesameageinGroupCandcortisolishigherforolderMovergroupBcomparedwitholderNonMoversinGroupD.5oftheMoversinGroupBmovedofnecessityorpressureandnotofchoice.MoversscoresincreaseforHCCattime2=1%(60-75age)and120%(76+age)overtheirpremovelevels.TheNonmoversHCCdecreased10%(60-75age)andby13%forGroupD(76+age).

Table 7.2AHair Cortisol Concentration changes betweenTimePeriodA andPeriodB

GroupAM60+(n7)

GroupBM76+(n8)

GroupCNM60+(n10/8)

GroupDNM76+(n10)

HCClevel

PeriodAtoB

periodAtoB

periodAtoB

periodAtoB

Veryhigh 0 0 1

2

0 0 0 0

High 0 0 1

1

0 1

1

1

Moderate 1

2

4

3

2

1

3

4

Slightlyraised

6

5

1

2

5

3

4

4

Lowornochange

0 0 1

0 3

3

2

1

Mean 7.79 8.47 18.32 40.29 5.52 4.96 13.35 11.56PeriodAtoB

Increase1%

Increase120%

Decrease10%

Decrease13%

256

Table7.2BHairtreatment5mthspriortoTime1/Time2(onlyreportedifachange)5mnthsperiod

Group1M60+n8

Group2M76+n8

Group3NM60+n11

Group4NM76+n12

HairwashesRangeMeanMedian

8–7539.441

10–6026.2520

2–14355.9146

1–2013.0018

Swimming 0 0 1person150hrs.

0

Dyed 2 0 3/2 0Perm/straighten 1 2/1 3/2 5/2Bleached 0 0 2 0Approx.UVhrs.5mths.mean

153 162 113 108

ThisTablerelatestothetextinChapter7para7.2

257

APPENDIX16

TheSSESSscalehasonlyyes/noresponseoptionsandassuchtheresultsindicatethenumberansweringpositively‘yes’.

Table7.3.2Southamptonselfesteem&sources(olderpeople)SSESSscale.ThoseansweringYes(positive)vs.No(negative).Arrowsindicatedirectionofchangeatthesecondvisit.

SSESSitemnumber

GroupAM60+n8

GroupBM76+n8

GroupCNM60+n11

GroupDNM76+n12

141.Ifeeluseful

46é

4

10 87ê

142.Igetmuchenjoymentoutoflife

58é

5

11 10

143.Iamstillcapableofdoingquitealot

56é

7

10

1110ê

144.Ihaveaclearaiminmylife.

34é

23é

9 98ê

145.Iamofimportancetoothers

57é

7 11 108ê

146.Ihaveconfidenceinmyself

45é

76ê

10 1110ê

147.Iamasbrightasever

46é

7 10 108ê

148.Ilooktothefuturewithconfidence

36é

65ê

910é

74ê

TheinformationinthistablerelatestoChapter7para7.3.2text.Thearrowshavebeenaddedtohelpillustrateataglancethechanges,whereanyhaveoccurredattimetwo,fromwhichitcanbeseenthattheyoungerMoversarereportingmoretheyhavemorepositivewellbeingfivemonthsafterthemovecomparedwithatthetimeofthemove,asgaugedbythegeneralwellbeingfactorofselfesteem.

258

APPENDIX17RemainderofparticipantsnotreportedatChapter7,table7.4C1.ParticipantCaserefType:Mover/NonMover/age

2.Bluntedscore:habituation

3.Previouslongstandinginsur-mountableproblemornoaction

4.Previousproblem:dynamicsituationoractiveresponse

5.HCCScoresseems:delayedorconcomitant

A3M60+ no yes yes concurrentA4M60+ no yes yes concurrentA5M60+ no yes yes delayedA7M60+ no yes yes concurrentB5M76+ no yes yes concurrentC2NM60+ no yes yes concurrent B3M76+ no no yes concurrentD8NM76+ no no yes concurrent B1M76+ no yes no concurrent D11NM76+ yes yes no delayed A1M60+ yes yes yes delayedA8M60+ yes yes yes delayedC9NM60+ yes yes yes concurrentC3NM60+ yes yes yes concurrent D1NM76+ no n/a n/a delayedD2NM76+ no n/a n/a concurrentD5NM76+ no n/a n/a concurrentD6NM76+ no n/a n/a concurrentD10NM76+ no n/a n/a delayedD12NM76+ no n/a n/a concurrentC4NM60+ no n/a n/a concurrentC5NM60+ no n/a n/a concurrentC8NM60+ no n/a n/a concurrentMissingasnosampleornotimetwosample:C1,C10,C11,D3,D7andC7extremescore

Table 7.4C Further to detailed analysis of selected cases in Chapter Seven, section 7.4 and Table 7.4a and 7.4B. Findings for participants in the above table might be better understood in the context of theory relating to differing cortisol reactivity according to type of stressor and delayed reactivity A – younger Movers; B – Older Movers C – younger Non Movers; D – older Non Movers In this Appendix only Case references are used, the personal biographical summaries are provided at the start of Chapter 6 Part One.

259

Where the perceived threat in long term and insurmountable, cortisol levels that had been raised to deal with the challenge, subsequently become habituated to below normal level reflected in ‘blunted scores’. This is thought to be a health-protective biological response as to maintain high levels for long periods where no action can be taken results in detrimental health outcomes, explained in the literature chapter Four and findings chapter Seven. In Table 7.4C Where the researcher has put ‘no’ in column 2, this indicates that there is no blunting of cortisol response even with a ‘yes’ in column 3 that indicates there are long-term insurmountable problems and habituation might be expected. This is because the situation has become dynamic, is being dealt with (i.e. ‘yes’ in column 4), when cortisol scores would once again be dynamic to reflect the need in active challenging situations. The anomaly in the table is case B1. Not having a blunted score (‘no’ in column 2) despite a long-term seemingly insurmountable problem has, unlikely those preceding that case, not been as a result of a dynamic response to the problem (column 4), there is no activity associated with addressing it. This participant who did not move out of choice has continued to suffer a chronic situation of loneliness and refers to being depressed. It might be expected that the scores would be blunted. The relationship between depression and cortisol is discussed in chapter 4 but the direction of effect is not well understood. For all those with ‘yes’ in column 4, the cortisol response would be expected to be ‘concurrent’ (column 5). However, it could be ‘delayed’ if the action has been recent relative to the problem, for example it hadn’t been commenced in the previous period being measured, so cortisol changes had not been achieved. Cortisol levels will only habituate when a threat has been established to be chronic and likewise will only return reach a more ‘normal’ level when the threat has been clearly perceived as dissipated. Case A5’s long standing issue involved harassment prior to moving and then a period of further prolonging the challenge when, having sold her home, she had to stay with friends, not knowing for certain when and if the new accommodation would be available. Case A1 and Case A8 are the two cases with most serious chronic health issues that remain an issue, irrespective of the perceived benefits of moving to address those. Their cortisol scores remain blunted. Recovery to more ‘normal’ levels if/when that occurs might well be a good indicator of their improved health for them. Case A8 was highly ambiguous about the move and her felt helplessness. Cases D10, D1 - interestingly, these two in the last block of participants in the table, without home relocation issues, were experiencing health and harassment problems of a complex nature where situations might move in and out of the perception as chronic.

260

GLOSSARYOFTERMS5-HT – serotonin hormone, a neurotransmitter that plays a part in moodregulation.

ACTH –Adrenocorticotropichormone,whichhas a regulating role in respectofincreasingcortisol

Allostastis–equilibriumorhomeostasiswithintheimmuneandrelatedsystems,achievedbyHPAaxisandothersystemsresponsibleforupregulatinganddown

regulatingresponsestoperceivedstressandhabituationtochronicstress.

Allostatic Load – ‘Wear and tear’ effects of chronic stress as a result e.g.excessivecortisollevels.Animal emotional support (ESA) scheme – with the support of a healthprofessional individuals can registeron the schemeand it enables them tokeep

animalswiththemwhenmovinghome,oratworkirrespectiveofhouserules,in

somecases.

ANS–Autonomicnervoussystem,withinthesympatheticnervoussystem(SNS)andparasympatheticnervoussystem(PNS)respondstothreatsandchallengesin

theenvironmenttoachievehomeostasis(seeallostastisabove)APPG–Allpartyparliamentarygroup,usuallysetuptooverseeandinvestigationintoamattersofhigh levelconcerntothepublic involvingMPsandmembersof

theHouseofLords.

CAD-CardiovasculardiseaseCarer – Any person who provides a significant amount of support to anotherpersonwhoneedsthathelp.Itcanbepersonalcare,nursing,advice,information

and assistance to another person. It may or may not involve family, friends,

neighboursandmoralorlegalobligationsbutinthecaseofprovisionofservices

by the council or nhs there will be a care plan and services are governed by

legislationsuchastheCareAct2014andlocalcouncilpolicy.

Cortisolassaytypes:ELISA = Enzyme Linked Immunosorbent Assay (or EIA=Enzyme Immuno-

Assays)

LC-MS/MS=LiquidChromatography-MassSpectrometry

RIA–RadioImmuno-Assay

GC/MS=GasChromatography/MassSpectrometry

LIA=LuminescenceimmunoassayChronic Stress - A prolonged period. as distinct from acute stress that usuallylasts for minutes or hours or days, of perceived inability to cope psycho-

physiologicallywithwhat isperceived tobeapressure (stressor). Stressors can

be tangible or psychological and are subjective involving an individual’s

assessment of demands against their resources for coping. There are individual

differencesinresponsesincludingatphysiologicallevelsandthetimeittakesfor

the initial central nervous system (neurochemical) highly activated response to

subside to a position of habituation which, importantly for this study, is

characterisedbylevelsoffreerangingcortisol.

261

CNS–CentralNervousSystemCOPD–ChronicobstructivepulmonarydiseaseCRH – Corticotropin releasing hormone – part of the neuroendocrine feedbacksystem (see ANS above) which helps regulate the release of up regulatory

endocrinesystemhormones.

Cytokine–Immunesystemproteinsreleasedbycellsthataffectinteractionbetweencellssuchasinflammation. DAS–depressionanxietyandstressperseDASS - Depression, Anxiety and Stress Scale. Psychological Foundation ofAustralia,UniNewSouthWalesDecentHomesStandard -Thiswasappliedin1997bythegovernmentandthestandardhasbeenreviewedandupdateregularlywithover3millionhomesbeing

broughtwithin thestandard todate.LocalAuthoritiesandHousingAssociations

acrosstheUKwererequiredtobringtheirpropertiesuptoaminimumstandard

in terms of repair and facilities andwarmth requiring inmost cases renewal of

windows, insulation, bathroom and kitchen facilities. To achieve this councils

often needed to work in partnership with Housing Associations or other

Registered Landlords including Arms Length Management Organisations

(ALMOs),effectively transferringmanagementof theirhousingstockbutnot the

responsibilityforitortheallocationrights.

Demos – this is a politically influential cross-party think tank on contemporaryissues of public importance, dealingwith identifying facts and causes aswell as

innovativeapproaches.Ithasreportedonolderpeopleanddownsizingandageas

wellashousingissuesfortheprovisionofsuitablehousingforolderpeople.DFGs–DisabledFacilitiesGrants,providedforhomeadaptationsbycouncils–seealsoHIAs.

Downsizing–acommontermusedinsocialsectorrentingorprivateownershipforpeoplewholiveinaccommodationthatistoobigfortheirneedswhowantto

moveorhavemoved/areintheprocess.Thisissubjectivetosomeextentbecause

manypeopleviewadditionalspaceasnecessaryfortheirwellbeingandlifestyle.

In social housing there is a penalty for those who ‘under occupy’ and claim

benefits.Apropertyisconsideredtobeofappropriatesizebasedonthenumber

ofroomsexcludingonlykitchenandbathroomand1reception,thatcanbeslept

inagainstthenumberofoccupants.Mostsiblingsareexpectedtosharedepending

onageandgender.

DHEA – Dehydroepioandrosterone, part of a feedback system, which has aregulatoryroleofcortisol.EAC – Elderly Accommodation Council, government funded information andadvice and on line depository of national information on housing schemes and

relatedservices.

Epistemology – knowledge and theoretical approach determined by theparadigm the research is carried out within and the methods that will be

employed.

262

ELISAEnzymeLinkedImmunosorbentAssay(orEIA=EnzymeImmuno-Assays)ESA–AnimalemotionalsupportschemeFreeSpace– (seealsoAppendix1)Designedbythecurrentresearchauthortoprovide greater choice and autonomy for older people. The London Borough of

RedbridgerunsitinordertoacquirepropertiesinandaroundthatareaofLondon

or Essex to let to families in need. It enables older under-occupying owners to

retainownershipandreceiverentwhilsttheirpropertyisletandtotallymanaged

bythecouncilorothertrustedsocialhousingprovider.Itdependsonthecouncil

assisting the older person’s move to accommodation of their choice, be that

privateorsocialrentedorsmallerownedpropertyiftheyhavesufficientsavings.

Every stage of their move is supported from decision-making and decluttering

throughtohandypersonjobsatthenewproperty,whichasstatedcanbearange

oftenuresbutalsolocationsdependingonindividualcircumstances.

GAD–Generalisedanxietydisorder

GC/MS-GasChromatography/MassSpectrometryassaymethods

Hermeneutic–approachtounderstandingbylookingatthewholeevidence,thenatpartsoftheevidenceandhowtheyfittogetherandexaminingthewholeagain

after that in an iterative, inductive process to ‘find evidence for’ and achieve a

synthesis.Thusit issuitableforrelativistparadigmsasopposedtostudiesusing

logicaldeductionbasedonirrefutablefacts.

HCC–Haircortisolconcentration.Thisisamountofcortisolthatcanbedetectedinthecoreofthehair(mostcentralpartofthehairshaft).Higherconcentrations

arethoughttoindicateinmostcases,chronicstress–definedabove.

HPA axis - Hypothalamic-pituitary-adrenal axis, responsible for the chemicalresponsetotheenvironment,particular immuneresponseand ‘fightor flight’or

effortfulactivity.LC-MS/MSLiquidChromatography-MassSpectrometryassaymethod

Lifetime Homes Standard – A requirement that can be placed by LocalAuthoritiesonhousingdeveloperstobuildtoaspecificationthatwouldcontinue

tomeetfutureoccupantsneedsintheeventofdeteriorationofhealth,forexample

due todisabilityorage.Thiscansubstantially increase thecostand thereby the

viabilityofaschemefromthedeveloperspointofview.

Likert Scale–namedafterpsychologistRensisLikert,this isabipolarscaleandtherefore minimum of 2 choices but no upper limit. Used to rate answers to

questionsinsurveysandshowthestrengthofagreementormatch.Usuallyhaving

5numerical choiceswith the centre choiceof 3being ‘don’t know’; ‘noopinion’

butequallycouldbeadaptede.g.forsymptomsinamedicalsurveywherecircling

3wouldindicate‘nosymptoms’.

Nomothetic–inthecontextofthisresearch–whatismeasured(mightappeartobe)sharedbetweenindividualsfromthepsycho-biomeasuresused.

Off-plan purchase – This is usually a legally binding arrangement by which apurchaserputsadepositonahouseorflatthathasyettobebuiltandtherefore

263

their decision is based on the plan and other visual and legal information. It is

important tomany developers as it provides forward funding for schemes that

theywouldotherwisehavetoborrowmorefor.Itthereforemakesschemesmore

attractive tobuild fordeveloperswhooften chargeapremium to allow for cost

increases andmarket price rises but it saves uncertainty and competitionwith

other buyers or price rises for purchasers.NBOlder people rarely buy off-planbecause they have more exacting needs and want to see the accommodation

ratherthanhavetoadapttoanythingthatisn’tquiterightandtheyarelesslikely

tobemovingagain.

LIA-Luminescenceimmunoassay-assaymethodMovers – In the current research: Former under occupying homeowners whohavemovedhome

Non-movers– Inthecurrentresearch:UnderoccupyinghomeownerswhohavenotmovedhomeOPQoL-OlderPeople’sQualityofLifeQuestionnaire.AnnBowling(2008)MOS-SSS – Medical Outcomes Study; Social Support Survey. Sherbourne &Stewart(1991)Paradigm – philosophical term for a group of ideas and way of viewing theworld/topic with established frameworks andmodels, which underpin ways of

understandingphenomena.

Person-Environmentfit–Theextenttowhichtheenvironmentinthecontextoflivingorworkmatchesthephysicalandpsychologicalneedsoftheindividual–so

it is subjective and can be tangible or perceived, the immediate or wider

environment.

pg/mg – pictograms per milligram – the measure used in assessment of

concentrationofasubstances–inthisresearch,cortisol,inhair

POMC–pro-opiomelonocortin,fromthepituitarygland,stimulatesreleaseofupregulatoryhormonessuchasadrenalineandcortisol.

PNS-ParasympatheticnervoussystemseeANSabove

Purchase chain – The ‘chain’ develops when a person sells their property tosomeonewhoalsohastosellapropertyinordertocompletethepurchase,andin

turn their buyer may be waiting for a sale. In theory there is no limit to the

number who can be in a chain. The process is managed by estate agents and

solicitorsbutisfraughtwithdifficulties,moresoinotherpartsofthecountrythan

in Scotland, as in other parts of theUKpeoplemaydecide to vary the amounts

theyareprepared tooffer if theprocessgoeson for too longandmarketprices

change; or people simply opt out of the chain as no deposit is required at the

initial stages. It can be very stressful and particularly difficult for older people

anxiousmakingalastmovetransition.

Push/pull factors – Used regularly in housing research for things turning anoccupier away from their current home and drawing them towards a different

environment(actualorenvisaged).Thedescriptorsuseissimplisticandflawedin

264

that confusion arises because things thatmake occupierswant to remainmight

alsobedescribedaspullfactorsandthingstheydonotlikeaboutaproposednew

location, a push factor. In the current research context ‘motivators’ and

‘impediments’eithertostayingormovingusedforindividualitems.

PWB-PTCQ–PsychologicalWell-Being-PostTraumaticChangesQuestionnaire

RCM–RelocationConsiderationsMeasure–Collectionofquestionsandcognitivetestsusedinthisresearch,designedbytheresearcher

Right to Buy (RTB) - The legal entitlement formost council andnowhousingassociation tenants to purchase the property they rent. Established in many

conservativecouncilsinthe1960’sitbecamelawin1975witharangeoflocaland

minimumnationalandcrossbordercriteriaanddiscountsoverthedecades.Ithas

resulted in the sale of well over 2million properties with the income going to

central government and not ring fenced for replacement of social housing.

Councilsnowhavetoreplacethenumberofhomestheysellbutthebuildingcosts

oftenfaroutweighincomefromthesale.

REBT – Rational Emotive Behavioural Therapy (Albert Ellis 1955) –psychotherapy that challenges and seeks to understand illogical or troublesome

emotions, thoughts and behaviours, typically usingABC (Affect – emotional and

physical,BehaviourandCognition)questioningprocesses.

RIA–RadioImmuno-AssayassaymethodRP–RelocatingPsychometrics(Measure)–collationofpsychometricitemsusedinthecurrentresearch,designedbythecurrentresearcher

SESS-SelfEsteemanditsSourcesinElderlyPeople.PeterColeman(1984).SocialCapital-thisexpressioncomesfromaneconomicapproachtorecognisingthatbyenablinggoodcommunityandsocialnetworkstoflourishthereisasaving

to the public purse through the benefits to health andwellbeing. This includes

infrastructure anddesignof thebuilt environment aswell as carefullydesigned

and integrated services and community collaborations. In the current research

contextitcanrefertothefamiliaritywithanarea,albeitimperfectfromapuristor

technicalperspective,thatgivesconfidence,purposeandafeelingofbelongingto

thelong-termlocalpopulation.

Salimetrics LLC – laboratory carrying out biometric assays of saliva and haircortisolconcentrationwhoworkinajointventurewithStratechScientificLtd.

SAM–Sympatheticadrenalmedulla

SNS–Sympatheticnervoussystem–seeANSabove

SPSSocialProvisionsScale.Cutrona&Russell1987STPI-StanfordTimePerspectiveInventoryZimbardoandBoyd(1999)TA – In this paper it is ThematicAnalysis (not housing abbreviation temporaryaccommodation). A qualitativemethodused in relativist paradigms to code and

themetranscribedinterviews.

265

Under-Occupation – see downsizing above. There is a technical and subjectiveview.Intheresearchhavingonebedroomormorethatisnotneededforsomeone

tosleepinisunder-occupying(govt.definition).UV–Ultravioletlight(daylight)Vertex– inthecurrentresearchcontext, thehighestpointatthetop,backofthehead.

WI–Women’sInstitute

266

Listofreferences

ReferencesAbadeh,D.,Parker,&Bristow,M.,(2014)Perceivedstress,genderandhaircortisolconcentration.Cambridge:AngliaRuskin[Availableon-line]http://salimetricseurope.blogspot.co.uk/2014/09/latest-research-into-hair-cortisol-at.html[AccessedOct.2014]Abell,J.G.,Stalder,T.,Ferried,J.E.,Shipley,M.J.,Kirschbaum,C.,Kivimaki,M.,Kumari,M.,(2016)Assessingcortisolfromhairsamplesinalargeobservationalcohort:TheWhitehallIIstudyPsychoneuroendocrinology73148-156Ader,R.,(2001)PsychoneuroimmunologyJournalofPsychoneuroimmunology103:94-97AgeUK,(2013)Thecostofcold:Whyweneedtoprotectthehealthofolderpeopleinwinter.[Availableon-line]http://www.housinglin.org.uk/Topics/type/resource/?cid=8730&msg=0[AccessedApril2013]Aldridge,A.,Kenway,P.Pannell,J.,(2012)Whocanaffordretirementhousing?:JosephRowntreeTrust&AgeUK[Availableon-line]http://www.npi.org.uk/files/New%20Policy%20Institute/AffordabilityOfRetirementHousingInTheUK.pdf[AccessedMarch2013]AnchorHousingTrust,(2015)SilverChic:Whatwilltheretirementhousingofthefuturelooklike?[Availableonline]http://www.anchor.org.uk/media-centre/latest-news/silver-chic-what-will-retirement-home-future-look[AccessedNov.2015]Armitage,A.,(2007)Mutualresearchdesigns:Redefiningmixedmethods,researchdesign.BritishEducationalResearchAssociationAnnualConfernce,InstituteofEducation,Presentedpaper.UniversityofLondon5-8Sept.Armitage,C.J.&Conner,M.,(2001)Efficacyofthetheoryofplannedbehaviour:ameta-analyticreview.BritishJournalofSocialPsychology40471-499.Baldock,J.,(2005)Howolderpeoplesustaintheiridentitiesandpreferencesinthefaceofalimitingphysicalconditionandtheneedtoaccepthealthandcareservices.ReportforEconomicandSocialResearchCouncil[Availableon-line]www.researchcatalogue.esrc.ac.uk/grants/L480254001/read[AccessedApril2016]Ball,M.,Blanchette,R.,Nanda,A.,&Wyatt,P.,(2011)Housingmarketsandindependenceinoldage:expandingtheopporunities.ForMcCarthy&StoneRetirementLifestylesLtd.HenleyBusinessSchoolReading[Availableonline]http://www.henley.reading.ac.uk/web/FILES/REP/HousingMarketsinOldAge.pdf[AccessedApril2013]Baltes,P.B.,Staudinger,U.M.,&Lindenberger,U.,(1999)Lifespanpsychology:Theoryandapplicationtointellectualfunctioning.AnnualReviewofPsychology,50,471-507.

267

Listofreferences

Bandura,A.,(1977)Sociallearningtheory,Oxford,EnglandPrentice-Hall In: Self-efficacy:Towardaunifyingtheoryofbehavioralchange.PsychologicalReviewMarch197784191-215Bandura,A.&Wood,R.,(1989)Effectofperceivedcontrollabilityandperformancestandardsonself-regulationofcomplexdecisionmaking.JournalofPersonalityandSocialPsychology56805-814Bandura,A.,(1986a)SocialLearningTheory.Prentice-Hall:EnglewoodCliffs,NJInStaintonRogers,R.,Stenner,P.,Gleeson,K.,StaintonRogers,W.(1995)SocialPsychology:ACriticalAgendaISBN0745611834Blackwell:CambridgeBandura,A.,(1997)Self-efficacy:TheExerciseofControl.NewYork,NY,US:WHFreeman,TimesBooks,HenryHolt&Co.Bernard,H.R.,(2002)Researchmethodsinanthropology:Qualitativeandquantitativeapproaches.3rdAltaMiraPress:WalnutCreek,CA:2002InPalinkas,L.A.,Horwitz,S.M.,Green,C.A.,Wisdom,J.P.,Duan,N.,Hoagwood,K.,(2015)Purposefulsamplingforqualitativedatacollectionandanalysisinmixedmethodimplementationresearch.AdmPolicyMentalHealth.425533-544Berrington,J.,(2013)Qualitydesignattractsdownsizers-HaltonCourt,RoyalBoroughofGreenwich,HousingLINCaseStudy77.London:EAC[Availableon-line]http://www.housinglin.org.uk/[AccessedOctober2013]PhysicalsitevisitDecember2013Best,R.&Porteus,J.,(2009)HAPPI–1Housingourageingpopulaton:PlanforimplementionAllPartyParliamentaryGrouponHousingandCareforOlderPeople.[Availableonline]http://www.housinglin.org.uk/_library/Resources/Housing/Support_materials/Other_reports_and_guidance/Housing_our_Ageing_Population_Plan_for_Implementation.pdf[AccessedApril2013]Best,R.&Porteus,J.,(2012)HAPPI–2Housingourageingpopulaton:PlanforimplementionAllPartyParliamentaryGrouponHousingandCareforOlderPeople.[Availableonline]http://www.housinglin.org.uk/_library/Resources/Housing/Support_materials/Other_reports_and_guidance/Housing_our_Ageing_Population_Plan_for_Implementation.pdf[AccessedApril2013]Best,R.&Porteus,J.,(2016)HAPPI–3HousingourAgeingPopulaton:PositiveIdeasAllPartyParliamentaryGrouponHousingandCareforOlderPeople.[Availableonline]http://www.housinglin.org.uk/_library/Resources/Housing/Support_materials/Other_reports_and_guidance/HAPPI3_Report_2016.pdf[AccessedOctober2016]Bolton,P.&Richards,P.,(2012)FuelPoverty–HouseofCommonsbriefing.[Availableonline]http://www.parliament.uk/briefing-papers/SN05115AccessedApril3rd2013

268

Listofreferences

Bowling,A.,Bannister,D.,Stenner,H.,Titheridge,K.,Sproston,K.,McFarquhar,T.,(2008)Qualityoflifeinolderage:PsychometrictestingofthemultidimensionalOlderPeople’sQualityofLife(OPQOL)questionnaireandthecausalmodelunder-pinningit.NDAfindings2.Newdynamicsofageingresearchprogramme[Availableon-line]http://www.newdynamics.group.shef.ac.uk/nda-findings-2.html[AccessedAugust2012]Braig,S.Grabher,F.,Ntomchukwu,D.,Reiter,F.,Stalder,T.,Kirschbaum,C.,Genuneit,J.,Rothenbacher,J.,(2014)Determinantsofmaternalhaircortisolconcentrationatdeliveryreflectingthelasttrimesterofpregnancy.PsychoneuroendocrinologyFeb52289-96Braun,V.,&Clarke,V.,(2006)Usingthematicanalysisinpsychology,QualitativeResearchinPsychology3(20):77-101Braun,V.,&Clarke,V.,(2013)SuccessfulQualitativeResearch:APracticalGuideforBeginners.LAandLondon:Sage.Braun,V.,&Clarke,V.,(2014)Whatcanthematicanalysisofferhealthandwellbeingresearchers?InternationalJournalofQualitativeStudiesofHealthandWell-being9ISSN1748-2623Burgess,G.,Monk,S.,Williams,P.,(2013)Equityreleaseamongstolderhomeowners.CambridgeCentreforHousingandPlanningResearch.CambridgeBurrows,R.,&Wilcox,S.,(2000)Halfthepoor:Homeownerswithlowincomes.CentreforHousingPolicy,fortheCouncilofMortgageLenders.UniversityofYorkISBN187242385XLondon:CMLpublicationsCallaghan,L.,Netten,A.,Darton,R.,(2009)Thedevelopmentofsocialwell-beinginnewextracarehousingschemes.JosephRowntreeTrustreportbyPersonalSocialServicesResearchUnit(PSSRU):UniversityofKent.ISBN:(pdf)978-1-8593572-3-1[Availableon-line]http://www.jrf.org.uk/sites/default/files/jrf/migrated/files/care-and-well-being-full.pdf[Accessed2017]Cacioppo,J.T.,Hughes,M.E.,Waite,L.J.,Hawkley,L.C.,&Thisted,R.A.,(2006)Lonelinessasaspecificriskfactorfordepressivesymptoms:Cross-sectionalandlongitudinalanalyses.PsychologyandAging,21(1),140-151.CentreforLocalEconomicStrategies;ASurveyofAusterityinLondonandaCaseStudyofIslingtoncouncil.Dec.2014Cheung,S.E.,andChan,D.K.S.,(2000)Theroleofperceivedbehavioralcontrolinpredictingbehavior:Ameta-analyticreviewofstudiesonthetheoryofplannedbehavior.UnpublishedHongKongUniversityIn:Ajzen,I.,(2002a)Perceivedbehavioralcontrol,selfefficacy,locusofcontrolandthe‘TheoryofPlannedBehavior’.JournalofSocialPsychology324:665-683Choi,N.G.,Jun,J.,(2009)Liferegretsandprideamonglow-incomeolderadults:Relationshipswithdepressivesymptoms,currentlifestressorsandcopingresources.AgingandMentalHealth132:213-225

269

Listofreferences

Clow,A&Hamer,M.,(2010)Theicebergofsocialdisadvantageandchronicstress:Implicationsforpublichealth.NeuroscienceandBiobehavioralReviews35:1pp1editorial.ElsevierCialdini,R.B.,(2007)InfluenceatWork:Persuasion.HarperCollins:USCohen,S.,andSymes,S.L.,(Eds)(1985)SocialSupportandHealth.SanFransico:AcademicPressColeman,P.G.,(1984)Assessingself-esteemanditssourcesinelderlypeople.AgeingandSociety42117-135(SSESS–scale)Cox,T.,Griffiths,A.J.,Barlow,C.,Randall,R.,Thomson,TandRialGonzalez,E.,(2000)OrganisationalInterventionforWorkStress:ARiskManagementApproach.Sudbury:HSEBooksISBN717618382.Cox,T.,&Griffiths,A.,(2005)Thenatureandmeasurementofwork-relatedstress:theoryandpractice.InJ.R.Wilson&N.Corlett(Eds.),EvaluationofHumanWork(3rded.).London:CRSPress.Craig,A.R.,Franklin,J.A.,Andrews.,(1984)Ascaletomeasurelocusofcontrolofbehaviour.BritishJournalofMedicalPsychology57173-180Cresswell,J.W.,andPlano-Clark,V.L.,(2011)Designingandconductingmixedmethodresearch.2ndSage:ThousandOaks,CA.InPalinkas,L.A.,Horwitz,S.M.,Green,C.A.,Wisdom,J.P.,Duan,N.,Hoagwood,K.,(2015)Purposefulsamplingforqualitativedatacollectionandanalysisinmixedmethodimplementationresearch.AdmPolicyMentalHealth.425533-544Cutchin,M.P.Owen,S.V.,Change,P-F,J.,(2010)Becoming‘athome’inassistedlivingresidences:Exploringplaceintegrationprocesses.JournalofGerontology:2003,Vol.58B,No.4,S234–S243

Cummins,R.A.andNistico,H.,(2001)Maintaininglifesatisfacition:Theroleofpositivecognitivebias.JournalofHappinessStudies337-69

Cutrona,C.E.,andRussell,D.A.,(1987)Theprovisionsofsocialrelationshipsandadaptationtostress.JAIPressInc.[Availableon-line]www.researchgate.net/profile/Daniel_Russell4[AccessedJune2016]D’Alessio,M.,Guarino,A.,DePascalis,V.andZimbardo,P.G.,(2003)TestingZimbardo’sStanfordTimePerspectiveIventory(STPI)Shortform.Time&Society122/3:333-347Sage.LondonD’Anna-Hernandez,K.L.,Randal,R.G.,Natvig,C.L.,Laudenslager,M.L.,(2011)Haircortisollevelsasaretrospectivemarkerofhypothalamic-pituitaryaxisactivitythroughoutpregnancy:Comparisontosalivarycortisol.PhysiologyandBehavior104348-353.Darnton,A.,(2005)CommonGoodResearch:CommunicatingwithOlderPeople:DeskvResearchKeyFindingsforCommunicators,London:CentralOfficeforInformation.

270

Listofreferences

Davenport,M.,Tiefenbacher,S.,Lutz,C.,M.,Novak,M.,Meyer,J.,(2006)Analysisofendogenouscortisolconcentrationsinthehairofrhesusmacaques.Gen.Comp.Endocrinol.147255-261DASS21(depression,anxiety,stress,scale),(2014)PsychologicalFoundationofAustraliaDASS[Availableon-lineonly]http://www2.psy.unsw.edu.au/dass/[AccessedAugust2016]Davenport,M.,Tiefenbachrer,S.,Lutz,C.,M.,Novak,M.,Meyer,J.,(2006)Analysisofendogenouscortisolconcentrationsinthehairofrhesusmacaques.Gen.Comp.Endocrinol.147255-261Davidson,L.M.&Baum,A.J.,(1993)PredictorsofchronicstressamongVietnamveterans:StressorexposureandintrusiverecallJournalofTraumaticStress62195-2121DCLG(dept.ofcommunitiesandlocalgovt)(HousingAct2004)Housinghealthandsafetyratingstandardguidance.[onlyAvailableon-line]https://www.gov.uk/government/collections/housing-health-and-safety-rating-system-hhsrs-guidance[AccessedJanuary2018]DCLG(dept.ofcommunitiesandlocalgovt)(2012)AllocationofAccommodation:GuidanceforLocalHousingAuthoritiesinEnglandS3.23;S4.4;S4.8DeptofCommunitiesandLocalGovernment.HMSO[OnlyAvailableonline]https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/5918/2171391.pdfAccessedJuly2012DCLG(dept.ofcommunitiesandlocalgovt)(2014)CareAct.[Availableon-line]http://www.legislation.gov.uk/ukpga/2014/23/contents/enactedAccessedMay2016DCLG(2018)AllpartyCommonsselectcommitteeonhousingforolderpeoplehttps://www.parliament.uk/business/committees/committees-a-z/commons-select/communities-and-local-government-committee/news-parliament-2017/housing-for-older-people-report-17-19/Dettenborn,L.,Tietze,Kirschbaum,C.,Stalder,T.,(2012)Theassessmentofcortisolinhumanhair;associationswithsocio-demographicvariablesandpotentialconfounders.Stress15578-588.DeMartino,B.,Kumaran,D.,Seymour,B.,Dolan,R.J.,(2006)Frames,biases,andrationaldecision-makinginthehumnanbrain.Science313Egan,M.,Tannahill,C.,Petticrew,M.,Thomas,S.,(2008)Psychosocialriskfactorsinhomeandcommunitysettingsandtheirassociationswithpopulationhealthandhealthinequalities:Asystematicmeta-review.BMCPublicHealth8239Ellis,A(1973)Humanisticpsychotherapy.TheRational-EmotiveApproach.NewYork:McGraw-HIllEndrighi,R.,Hamer,M.,Steptoe,A.,(2011)Associationsoftraitoptimismwithdiurnalneuroendocrineactivity;CortisolresponsestomentalstressandsubjectivestressmeasuresinhealthymenandwomenPsychosomaticMedicine738672-678

271

Listofreferences

Esterling,B.A.,Antoni,M.H.,Kumar,M.,Shneiderman,N.,(1993)Defensiveness,traitanxietyandEpstein-Barrcapsidantigenantibodytitersinhealthcollegestudents,HealthPsychology122132-139Equityreleasemarketreport3rded.(2018)EquityReleaseCouncil.London.[Availableon-line]http://www.equityreleasecouncil.com/document-library/equity-release-market-report-spring-2018/[AccessedMay2018]Erikson,E.,(1959)IdentityAndTheLifeCycle.InternationalUniversitiesPress:NY.Eurostatpopulationstatistics,(2016/2017)https://ec.europa.eu/eurostat/statistids_explained/index.php/Archive:Europe_in_figures_-_Eurostat_yearbookFaresjo,A.,Jullander,M.,Gotmalm,S.,Theodorsson,E.,(2014)Higherperceivedstressandpoorerhealthreflectedinelevatedcortisolconcentrationsmeasuredinextractsofhairfrommiddle-agedhealthywomen.,BMCPsychology230Fawzy,I.,FawzyN.W.,HyunC.S.,Elashoff,R.,Guthrie,D.,Fahey,J.L.,Morton,D.L.,(1993)MalignantMelanoma:Effectsofanearlypsychiatricintervention,copingandaffectivestateonrecurrenceandsurvival6yearslater,ArchGenPsychiatry1993;509681-689Feller,S.,Vigi,M.,Bergmann,M.M.,Boeing,H.,Kirschebaum,C.,Stalder,T.,(2014)Predictorsofhaircortisolconcentrationinolderadults.Psychoneuroendocrinology39;132-140Festinger,L.,&Carlsmith,J.M.,(1959)Cognitiveconsequencesofforcedcompliance.TheJournalofAbnormalandSocialPsychology,582203.Festinger,L.,(1957).ATheoryofCognitiveDissonance.Stanford,CA:StanfordUniversityPress. Fishbein,M.,&Ajzen,I.,(1975)Belief,Attitude,IntentionandBehaviour:AnIntroductiontoTheoryandResearch.Reading.MA:Addison-WesleyFoundations,(2019)Housingoptions,downsizingmove-onservicesfromstayingputtomovingon:AnewroleforHIAs.[Availableon-line]https://www.housinglin.org.uk/Topics/type/Housing-Options-Downsizing-Move-On-Services/[AccessedMarch2019]Gibbs,G.,(1988)inDye,V.,(2011)Reflection,reflection,reflection.‘Imthinkingallthetime,whydoIneedatheoryormodelofreflection?’InMcGregor,D.andCartwright,L.(eds.)DevelopingReflectivePractice:AguideforBeginningTeachers.Maidenhead:McGraw-HillEducation(pp.217-234)Gilroy,R.,(2005)‘Meetingtheinformationneedsofolderpeople:achallengeforlocalgovernance’,LocalGovernmentStudies,31(1),pp.39-51.

272

Listofreferences

Glover,S.,andDixon,P.,(2004)Likelihoodratios:asimpleandflexiblestatisticforempiricalpsychologists.PsycholBullRevOct:115791-806Greene,J.C.,Caracelli,V.J.,Graham,W.F.,(1989)Towardaconceptualframeworkformixed-methodevaluationdesigns.EducationalEvaluationAndPolicyAnalysis198911255Godfrey,M.andDeny,T.,(2007)OlderPeopleAccessingInformationandICTsCentreforHealthandSocialCare;UniversityofLeeds,LeedsGow,R.,Thomson,S.,Rieder,M.,VanUum,S,Koren,G.,(2010)Anassessmentofcortisolanalysisinhairanditsclinicalapplications.ForensicScienceInternational19632-37Grass,J.,Miller,R.,Carlitz,H.D.E.,Patrovsky,F.,Gao,W.,Kirschbaum,C.,Stalder,T.,(2016)Invitroinfluenceoflightradiationonhairsteroidconcentrations.Pscychoneuroendocrinology07221Griffin,J.,(2010)TheLonelySocietyMentalHealthFoundationISBN978-1-906162-49-8GubaandLincoln,Y.S.,(2007)Competingparadigmsinqualitativeresearch.TheHandbookofQualitativeResearch.N.K.DenzinandY.SLincoln.London:SageHamel,A.F.,Meyer,J.S.,Henchey,E.,Dettmer,A.M.,Suomi,S.J.,Novak,M.A.,(2010)Effectsofshampooandwaterwashingonhaircortisolconcentrations.ClinicaChimicaActa412382-385Hanson,E.B.,Gottschalk,G.,(2006)Whatmakesolderpeopleconsidermovinghouseandwhatmakesthemmove?Housing,TheoryandSociety23134-54HardingR.,(2017)Asharedunderstanding;LocalisingtheintegrationofhousingandhealthatNottinhamthroughamemorandumofunderstanding.HousingLINcasepaper134.London:EACHarper,S.,(2008)Generationsandlifecourse:theimpactofdemographicchallengesoneduction2010-2050.OxfordInstituteofAgeing:UniversityofOxford.Herbert,J.,Goodyer,I.M.,Grossman,A.B.,Hastings,M.H.anddeKoeet,E.R,Lightman,S.L.,Lupien,S.J.,Roozendaal,B.,Seckl,J.R.,(2006)Docorticosteroidsdamagethebrain?JournalofNeuroendocrinolgoy18393-411Oxford:BlackwellHerzberg,F.,MausnerB,andSnyderman,B.,(1959)TheMotivationToWork:Granada;LondonHerzberg,F.,(1968)Onemoretime:howdoyoumotivateemployees?HarvardBusinessReviewJan/Feb53-62Hill,K.,Kellard,K.,Middleton,S.,Cox.,L.,Pound,E.,(2007)Undertandingresourcesinlaterlife:Viewsandexperiencesofolderpeople.JosephRowntreeFoundation.Houtkoop-Steenstra,H.,(2000)InteractionandtheStandardizedSurveyInterview:TheLivingQuestionnaire.CambridgeUniversityPress.Cambridge:InC.,(2011)RealWorldResearch3rded.279Wiley:Chichester

273

Listofreferences

Horowitz,M.,Wilner,N.,Alvarez,W.,(1979)Impactofeventscale.PsychosomaticMedicine41209-218House,J.S.,Landis,K.R.,Umberson,D.,(1988)SocialRelationshipsandhealth,Science241540-545Iecovich,E.,(2014)Aginginplace:Fromtheorytopractice.AnthropologicalNotebooks;201:21-33IntergenerationalFoundation,(2013)Overviewfactsheet.[Availableonline]http://www.if.org.uk/fact-sheet[AccessedMay3rd2013]ILC,(InternationalLongevityCentreUK)(2016)Thestateofthenation’shousing.AnILC-UKfactpack.www.ilcuk.org.ukIrwin,M.,(1997)Alzheimercaregiverstress:Basalnaturalkillercellactivity,pituitary-adrenalcorticalfunction,andsympathetictone.AnnalsofBehavioralMedicine19283-90Ito,N.,Ito,T.,Kromminga,A.,Bettermann,A.,Takigawa,M.,Kees,F.,Straub,R.,Paus,R.,(2005)Humanhairfolliclesdisplayafunctionalequivalentofthehypothalamic-pituitary-adrenal(HPA)axisandsynthesizecortisolFASEBJ.101332-1334Joseph,S.,Maltby,J.,Wood,A.M.,Stockton,H.,Hunt,N.,,RegelS.,(2012)Psychologicaltrauma.Theory,Research,Practice,andPolicy44420-428Kearns,A.,Whitley,E.,Mason,P.,(2011)Materialandmeaningfulhomes:mentalhealthimpactsandpsychosocialbenefitsofrehousingtonewdwellings.InternationalJournalofPublicHealth56597-607Kennedy,S.,Kiecolt-Glaser,J.K.,Glaser,R.,(1988)Immunologicalconsequencesofacuteandchronicstressors:Mediatingroleofinterpersonalrelationships.BritishJournalofMedicalPsychology6177-85Kiecolt-Glaser,J.K.,Dyer,C.S.,Shuttleworth,E.C.,(1988)UpsettingsocialinteractionsanddistressamongAlzheimer’sdiseasefamilycaregivers:areplicationandextension.AmericanJournalofCommunityPsychology16825-837Kiecolt-Glaser,J.K.,Dura,J.R.,Speicher,C.E.,Trask,O.J.,Glaser,R.,(1991)SpousalCaregiversofDementiaVictims:LongitudinalChangesinImmunityandHealth.PsychosomaticMedicine53:345-362Kiecolt-Glaser,J.K.,Glaser,R.,(1999)Chronicstressandmortalityamongolderadults.JAMA282232259Kirschbaum,C.,Pruessner,J.,Sone,A.A.,Federenko,I,Gaab,J.,Lintz,D.,Schommer,N.,Hellhamer,D.H.,(1995)Persistenthighcortisolresponsestorepeatedpsychologicalstressinasubpopulationofhealthymen.PsychosomatMed57468-474

274

Listofreferences

Kirschbaum,C.,Tietze,A.,Skoluda,N.,Dettenborn,L.,(2009)Hairasaretrospectivecalendarofcortisolproduction–Increasedcortisolincorporationintohairinthethirdtrimesterofpregnancy.Psychoneuroendocrinology3432-37Kohut,M.L.,Cooper,M.M.,Nickolaus,M.S.,Russell,D.R.,Cunnick,J.E.,(2002)Exerciseandpsychosocialfactorsmodulateimmunitytoinfluenzavaccineinelderlyindividuals.JournalofGerontology.57A9M557-M562Koren,L.,Mokady,E.G.,(2008)Socialstatusandcortisollevelsinsingingrockhyraxes.HormonesandBehavior54212-216Levy,B.R.,(1996)Improvingmemoryinoldagebyimplicitselfstereotyping.JournalofPersonalityadSocialPsychology711092-1107.In:Adams-Price,C.E.andMorse,L.W.,(2009)DependencyStereotypesandAging:Theimplcationsforgettingandgivinghelpinlaterlife.JofAppliedSocialPsychology39122967-2984Lincoln,Y.S.,(1991)Thedetachedobserverandthepassionatepaticipant:Discourseininquiryandscience.PaperpresentedtothecouncilmeetingoftheAmericanEducationalResearchAssociation:ChicagoIL.In:GubaandLincoln,Y.S.,(2007)Competingparadigmsinqualitativeresearch.TheHandbookofQualitativeResearch.N.K.DenzinandY.SLincoln.London:SageLocke,E.A.,(1968)Towardatheoryoftaskmotivationandincentives.Organizationalbehaviorandhumanperoformance32157.189 Locke,E.A.,Shaw,K.N.,Saari,L.M.&Latham,G.P.,(1981)Goalsettingandtaskperformance:1969-1980PsychologicalBulletin90125-152Lofqvist,C.,Granbom,M.,Himmelsbach,I.,Iwarsson,S.,Osward,F.,Haak,M.,(2013)Voicesonrelocationandaginginplaceinveryoldage–acomplexandambivalentmatter.(Mar2013)TheGerontologist034101093Loucks,E.B.,Juster,R.P.,&Pruessner,J.C.,(2008)Neuroendocrinebiomarkers,allostaticload,andthechallengeofmeasurement:AcommentaryonGersten.SocialScienceandMedicine,66,525-530.Lutgendorf,S.,Tripp-Reimer,Schlecte,J.,Rubinstein,L.M.,(2001).Illnessepisodesandcortisolinhealthyolderadultsduringalifetransition.AnnBehavMed23(3)166-176Lutgendorf,S.K.,Costanzo,E.S.,(2003)Psychoneuroimmunologyandhealthpsychology:AnintegrativemodelBrain,Behavior,andImmunity17225-232Manenschijn,L.,Koper,J.W.,Lamberts,W.J.,VanRossum,E.F.C.,(2011a)Evaluationofamethodtomeasurelongtermcortisollevels.Steroids7610-111032-1036Maslow,A.,(1943)ATheoryofhumanmotivationPsychologicalReview50370-396McEwen,B.S.,(2006)Protectiveanddamagingeffectsofstressmediators:centralroleofthebrain.DialoguesClinNeurosci84367-381

275

Listofreferences

McEwen,B.S,&Seeman,T.,(2009)Allostaticloadandallostasis.ResearchNetworkonSES&Health.AllostaticLoadWorkingGroup[Availableon-line]www.macses.ucsf.edu/research/allostasis[AccessedAugust2015]McEwen,B.S.,Nasveld,P.,Palmer,M.,Anderson,R.,(2012)AllostaticLoad:Areviewoftheliterature.Deptofveterensaffairs:CanberraMcClelland,D.C.,(1987)HumanMotivation.CUP:Cambridge.MemorandumofUnderstanding:Pioneering,HealthandHousingMemorandumofUnderstanding,(2015)HousingLIN(learningandimprovementnetwork)[Availableon-line]http://www.housinglin.org.uk/Topics/browse/HealthandHousing/HealthPolicy/Policy/?parent=8683&child=9425[AccessedJan2015]MemorandumofUnderstanding(MoU)deliveryplan(2015)[2ndquarteroffirstyear[Availableon-line]http://www.nhs.uk/NHSEngland/keogh-review/Documents/quick-guides/background-docs/66-MoU_JointActionImprovingHealth.pdf[AccessedOct2016]MHP/Health,(2014)Healthandhousing:Fromconsensustopractice.Areviewofhowpioneerandwhole-personcarecouncilsareconsideringhousingintheplanningoflocalhealthandcareservices–April2014.[Availableon-line}www.housingline.org.uk/pagefinder.cfm?cid=o9215orhttp://www.hmpc.com/wp-content/uploads/2015/07/Health-and-housing-from-consensus-to-practice.pdfNationalAuditOffice–DeptofHealth,(2016)Dischargingolderpatientsfromhospitalhttps://www.nao.org.uk/wp-content/uploads/2015/12/Discharging-older-patients-from-hospital.pdf[AccessedSept.2017]NationalHousingFederation(NHF)(2015)inpress,InsideHousing[Availableonline]http://www.insidehousing.co.uk/nhf-build-100000-homes-for-older-people/7008500.article[AccessedApril2016]NHS(2014)FiveYearForwardPlan.[Availableon-line]https://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdfOctober2014[AccessedSept.2017]Nicol,S.,Roys,M.,Garrett,H.(2015)BritishResearchEstablishment(BRE)Watford.[Availableon-line]https://www.bre.co.uk/filelibrary/pdf/87741-Cost-of-Poor-Housing-Briefing-Paper-v3.pdf[AccessedMay2016]Oliveira,J.F.,Dias,N.S.,Correia,M.,Gama-Pereira,F.,MoraisSardinha,V.,Lima,A.,Oliveria,A.F.,RicardoJacinto,L.,Ferreira,D.S.,Silva,A.M.,Reis,J.S.,Cerqueira,J.J.,Sousa,N.,(2014)Chronicstressdisruptsneuralcoherencebetweencortico-limbicstructures.FrontiersinNeuralcircuits2014.

276

Listofreferences

Orne,M.T.,(1962)Onthesocialpsychologyofthepsychologicalexperiment:Withparticularreferencetodemandcharacteristicsandtheirimplications.AmericanPsychologist,1711:776-783.http://psycnet.apa.org/doi/10.1037/h0043424O’Shea,N.,(2012)Helpingolderpeoplechoosetherighthomeforthem;anintroductiontothecostsandbenefitsofprovidngadviceandsupport:RedbridgeCouncilFreeSpacecostbenefitexamplepp8EAC(ElderlyaccommodationCouncil)FirstStop:{Availableon-line]http.//www.housingcare.org/downloads/kbase/3243.pdf[AccessedJan2012;March2018]O’Shea,N.,(2013)InformingthebusinesscaseforaFreeSpacemodel.EACFirstStop:(ElderlyaccommodationCouncil)[Availableon-line]http://www.housingcare.org/downloads/kbase/3301.pdf[AccessedJan2012;March2018]Oswald,F.,Schilling,O.,Wahl,H-W.,Gang,K.,(2002)Troubleinparadise?Reasonstorelocateandobjectiveenvironmentalchangesamongwell-offolderadults.J.EnvironmentalPsychology22273-288Oswald,F.,Schilling,O.,Wahl,H-W.,(2004)Housingandhealthinlaterlife.Reviewsonenvironmentalhealth193-4Oswald,F.,&Rowles,G.D.,(2006)Beyondtherelocationtraumainoldage:Newtrendsinelders’residentialdecisions.InH-W.Wahl,C.Tesch-Romer,&A.Hoff(Eds.),NewDynamicsinOldAge:EnvironmentalandSocietalPerspective(pp127-152)Amityville,NewYork:BaywoodPubl.Palinkas,L.A.,Horwitz,S.M.,Green,C.A.,Wisdom,J.P.,Duan,N.,Hoagwood,K.,(2015)Purposefulsamplingforqualitativedatacollectionandanalysisinmixedmethodimplementationresearch.AdmPolicyMentalHealth.425533-544Pannell,J.,Aldridge,H.,Kenway,P.,(2012)Marketassessmentofhousingforolderpeople.AreportforShelterandtheJosephRowntreeFoundation.NewPolicyInstitute–OxfordBrookes[Availableonlineonly]AccessedJuly2013http://www.housinglin.org.uk/Topics/browse/Housing/Commissioning/?&msg=0&parent=3693&child=8518Patton,M.Q.,(2002)QualitativeResearchandEvaluationMethods,3dEdition.ThousandOaks,CA:SagePublications.InPalinkas(2015)Purposefulsamplingforqualitativedatacollectionandanalysisinmixedmethodimplementationresearch.AdmPolicyMentalHealth.425533-544 Pennebaker,J.W.,Kiecolt-Glaser,J.K.,Glaser,R.,(1988)Disclosureoftraumasandimmunefunction:healthimplicationsforpsychotherapy.J.ConsultClinPsychol562239-245Perissinotto,C.M.,StijacicCenzerI.,Covinsky,K.E.,(2012)Lonelinessinolderpersons:apredictoroffunctionaldeclineanddeath.ArchInternMed141078-83

277

Listofreferences

Potter,J.andHepburn,A.,(2005)Qualitativeinterviewsinpsychology:problemsandpossibilities,QualitativeresearchinPsychology2281-307.InC.Robson(2011)RealWorldResearch3rded.pp279Wiley:ChichesterPowellLawton,M.,(1974)Socialecologyandthehealthofolderpeople.SocialEcologyandHealth,643Pruessner,J.C.,Lord,C.,Meaney,M.,Lupien,S.,(2004)Effectsofself-esteemonage-relatedchangesincognitionandtheregulationofthehypothalamic-pituitary-adrenalaxis.Locusofcontrol,hippocampalvolume.AnnNYAcadSci1032186-194Pruessner,J.C.,Baldwin,M.W.,Dedovic,K.,Renwick,R.,Mahanit,NK.,Lord,C.,Meaney,M.,Lupien,S.,(2005)Self-esteem,locusofcontrol,hippocampalvolume,andcortisolregulationinyoungandoldadult-hood.Neuroimage28815-826.Raghunathan,R.andPham,M.T.,(1999)Allnegativemoodsarenotequal:Motivationalinfluencesofanxietyandsadnessondecision-making.Organ.Behav.HumDecisProcess79(1)56-77Randall,V.A.andBotchkareva,V.,(2009)Thebiologyofhairgrowth;Cosmeticapplicationsoflaserandlightbasedsystems.CentreofSkinSciences,SchoolofLifeSciences,UniversityofBradfordUK.[Availableon-line]http://www.horizonti.net/clanki/the%20biology%20of%20hair%20growth.pdf[Accessed2013]Raul,J.S.,Cirimele,V.,Ludes,B.,Kintz,P.,Goulle,J.P.,Ludes,B.,(2004)Detectionofphysiologicalconcentrationsofcortisolandcortisoneinhumanhair,Clin.Biochem.371105-1111Robson,C.,(2011)RealWorldResearch3rded.Wiley:ChichesterRotter,J.B.,(1996)Generalizedexpectanciesforinternalversusexternalcontrolofreinforcement,PsychologicalMonographs,GeneralandApplied80119661-8Rubinstein,R.L.andParmelee,P.A.,(1992)Attachmenttoplaceadrepresentationoflifecoursebytheelderly.In:AttmanandS.M.Low(Eds.)HumanBehaviorandEnvironmentVol.12:PlaceAttachment139-163NewYork:PlenumRussell,E.,Koren,M.R.,VanUum,S.,(2012)Haircortisolasabiologicalmarkerofchronicstress:Currentstatus,futuredirectionsandunansweredquestions.Psychoneuroendocrinology37589-601Russell,E.,Kirschbaum,C.,Laudenslager,M.L.,Staldr,T.,DeRijke,Y.,VanRossum,E.F.C.,VanUum,S.,Koren,G.,(2015)Towardstandardizationofhaircortisolmeasurement:Resultsforthefirstinternationalinter-laboratoryroundrobin.TherapeuticDrugMonitoring10.1097Saitoh,M.,Uzuaka,M.,Skamoto,M.,Kobori,T.,(1969)Rateofhairgrowth.Advancesinbiologyofskinandhairgrowth.Pergamon,Oxford,pp183-201Samsi,K.,Kritika.,Manthorpe,J.,(2011)‘Ilivefortoday’aqualitativestudyinvestigatingolderpeople’sattitudestoadvanceplanning.HealthandSocialCareintheCommunity191:52-59

278

Listofreferences

Sarason,I.G.,Johnson,J.J.,Siegel,J.M.,(1978)Assessingtheimpactoflifechanges:DevelopmentoftheLifeExperiencesSurvey.JournalofConsultingandClinicalPsychology46932-946Sarason,I.G.,(Ed.)(2013)SocialSupport:Theory,ResarchandApplications.NatoScienceSeriesDvol.24ch9Sapolsky,R.M.,Krey,L.C.,McEwen,B.S.,(1985)Prolongedglucocorticoidexposurereduceshippocampalneuronnumber:implicationsforaging.TheJournalofNeuroscience,1May198551222-1227Sauve,B.,Koren,G.,Walsh,G.,Tokmakejian,S.,VanUum,S.H.M.,(2007)Measurementofcortisolinhumanhairasabiomarkerofofsystemicexposure.Clin.Invest.Med.30E183-E191SavillsWorldResearch,(2013)UKResidentialSpotlight:TheWorldinLondon.[Availableon-line]http://pdf.euro.savills.co.uk/residential---other/spot-worldlondon-lr.pdf[Accessed2016]Seeman,T.E.,&McEwen,B.S.,(1996).ImpactofSocialEnvrionmentCharacteristicsonNeuroendocrineRegulation.PschosomaticMedicine58459-471Selye,H.,(1974)StressWithoutDistress.Signet:NY.SharotT.,(2011)Theoptimismbias.CurrentBiology.2123SharotT.,Korn,C.W.andDolan,R.J.,(2011)Howunrealisticoptimismismaintainedinthefaceofreality.Nat.eurosci.141475-1479ShawRuddock,J.,(2014).Creatingcommunityhubsandreducingsocialisolationamongstolderpeopleinthesecondhalfoflifeyieldsanetrateofreturnofover135%totheNHS;TheSecondHalfFoundationWhitePaper[Availableon-line]http://www.thesecondhalfcentre.com/white-paper/[AccessedFeb.2014]Sherbourne,C.D.,andStewart,A.L.,(1991)TheMOSSocialSupportSurvey(MOS-SSS).SocialScienceandMedicine326705-714.Siegrist,J.,(2010)Socialdeterminantsofhealth–ContributionsfromEuopeanhealthandmedicalsociology.PoliticaySociedad482:249-258Sixsmith,J.,Sixsmith,A.,Green,S.,Kennedy,V.,Griffiths,J.,Ball,M.,Pimor,A.,(2007)Enable-Agein-depthstudy(EuropeanCommissionsponsored).NationalreportUnitedKingdom(D6,basedonWP).JournalCompilation:BlackwellPublishing.Slominski,R.I.,Rownaghi,C.R.,Anand,K.J.,(2015)Methodologicalconsiderationforhaircortisolmeasurementinchildren(2015).Innewsblog.Salimetrics.CambridgeSmith,J.S.,(2009)(Ed.)2ndeditionQualitativePsychology:APracticalGuidetoResearchMethods.London:Sage

279

Listofreferences

Smith,J.A.,Flowers,P.,andLarkin,M.,(2012)InterpretativePhenomenologicalAnalysis:Theory,MethodandResearch.LA:Sage(SSESS–scaleseeColeman)Stalder,T.,Stuedte,S.,Alexander,N.,Miller,R.,Gao,W.,Dettenborn,L.,Kirschbaum,C.,(2012a)Cortisolinhair,bodymassindexandstress-relatedmeasures.SciVerse37602-610Stalder,T.,Steudte,S.,Miller,R.,Skoluda,N.,Dettenborn,L.,Kirschbaum,D.,(2012b)Intraindividualstabilityofhaircortisolconcentrations..SciVerse37602-610Stalder,T.,Kirschbaum,C.,Alexander,N.,Bornstein,S.R.,Gao,W.,Miller,R.,Stark,S.,Bosch,J.A.,Fischer,J.E.,(2013)Cortisolinhairandthemetabolicsyndrome.J.Clin.Endocrinol.Metab.982573-2580Steudte,S.,Stalder,T.,Dettenborn,L.,Klumbies,E.,Foley,P.,Beesdo-Baum,Kirschbaum,C.,(2011b)DecreasedhaircortisolconcentrationsingeneralisedanxietydisorderPsychoneuroendocrinology361193-1200Steudte-Schmiedgen,D.,Kirschbaum,D.,Alexander,N.,Stalder,T.,(2016)Anintegrativemodellinkingtraumatization,cortisoldysregulationandposttraumaticstressdisorder:Insightfromrecenthaircortisolfindings.NeuroscienceandBiobehavioralReviews69124-135Sykes,W,Hedges,A,Groom,CandColeman,N.,(2008)OpportunityAgeinformationindicatorsfeasibilitystudy.DepartmentforWorkandPensionsWorkingPaperNo.47[Availableon-line]http://www.dwp.gov.uk/asd/asd5/wp47[AccessedMay2017]Taylor,S.E.,andBrown,J.D.,(1988)Illusionandwell-being:Asocialpsychologicalperspectiveonmentalhealth:PsychologicalBulletin10321-27Taylor,S.E.,andBrown,J.D.,(1994)Positiveillusionsandwell-beingrevisited:SeparatingfactfromfictionPsychologicalBulletin11621-27Terry,D.J.,&O’Leary,J.E.,(1995)Thetheoryofplannedbehaviour:Theeffectsofperceivedbehaviouralcontrolandself-efficacy.BritishJournalofSocialPsychology34199-220Thetford,C.,andRobinson,J.,(2007)OlderPeople’sexperiencesofdecision-making,participationandmovingaspartofregenerationprojectinLiverpool.HealthandCommunityCareResearchUnit,UniversityofLiverpool[Availableon-line]ordirectfromauthors.http://www.liv.ac.uk/haccru[Accessed2015]

Thomas,D.R.,(2006)Ageneralinductiveapproachforanalysingqualitativeevaluatiaondata.AmericanJournalofEvaluationvol272237-246Thomson,H.,Petticrew,M.,Morrison,D.,(2001)Healtheffectsofhousingimprovement:stystematicreviewofinterventionstudies.BMJ28323(7306):187-190

280

Listofreferences

Thomson,H.,Petticrew,M.,Douglas,M.,(2002)Healthimpactassessmentofhousingimprovements:incorporatingresearchevidence.JournalofEpidemiologicalCommunityHealth.5711-16Thomson,S.,Koren,G.,Fraser,L.A.,Rieder,M.,Friedman,T.C.,VanUum,S.H.M.,(2010)HairanalysisprovidesahistoricalrecordofcortisollevelsinCushing’sSyndrome.ExpClinEndorcrinolDiabetes.1182:133-138Trustmark,(2015)HousehuntersruledbyheartoverheadGovt.endorsedresearchtradeandresearch:pressrelease22.04.15[Availableon-line]https://www.trustmark.org.uk/newsroom/press-releases/house-hunters-ruled-by-heart-over-head-(2)/[AccessedApril2015]Tversky,A.,Kahneman,D.,(1986)Rationalchoiceandtheframingofdecisions.JournalofBusiness,594:2Tversky,A.,Khaneman,D.,(1992)AdvancesinProspectTheory:Cumulativerepresentationofuncertainty.JournalofRiskandUncertainty,5297-323.Uchino,B.N.,CacioppoJ.T.andKiecolt-Glaser,J.K.,(1996)Therelationshipbetweensocialsupportandphysiologicalprocesses:Areviewwithemphasisonunderlyingmechanismsandimplicationsforhealth.PsychologicalBulletin1193488-531Uchino,B.N.,(2006)Socialsupportandhealth:Areviewofphysiologicalprocessespotentiallyunderlyinglinkstodiseaseoutcomes.JournalofBehavioiuralMedicine294Ullmann,E.,Barathel,A.,Petrowski,K.,Stalder,T.,Kirschbuam,C.,Bornstein,S.R.,(2016)Pilotstudyofadrenalsteroidhormonesinhairasanindicatorofchronicmentalandphysicalstress.ScientificReports625842UN(2012)In:Lecovich,E(2014)Aginginplace:Fromtheorytopractice.AnthropologicalNotebooks;201:21-33VanDiepen,A.M.,&Mulder,C.H.,(2007)Distancetofamilymembersandrelocationsofolderadults.JournalofHousingandTheBuiltEnvironment241:31-46VanNeste,D.,Tobin,D.J.,(2004)Haircycleandhairpigmentation:dynamicinteractionsandchangesassociatedwithaging.Micron353193-200VanUum,S.H.,Sauve,B.,Franser,L.A.,Morley-Forster,P.,Paul,T.L,Koren,G.,(2008)Elevatedcontentofcortisolinhairofpatientswithseverechronicpain:anovelbiomarkerforstress.Stress11(6):483-8

Veenhoven,R.,(1999)Qualityoflifeinindividualisticsociety:SocialIndicatorsResearch48157-187Victor,C.R.,Bowling,A.,(2012)AlongitudinalanalysisoflonelinessamoungolderpeopleinGreatBritain.TheJournalofPsychology,TaylorandFrancisVroom,V.H.,(1964).WorkandMotivation.Oxford,England:Wiley.

281

Listofreferences

Wennig,R.,(2000)Potentialproblemswiththeinterpretationofhairanalysisresults.ForensicSci.Int1075-12Wester,V.G.,andRossum,E.F.C.,(2015)Clinicalapplicationsofcortsolmeasurementsinhair.EuropeanJournalofEndocrinology173M1-M10WHOglobaldatabaseofage-friendlypracticesandaguidetocreatingage-friendlycities.http://apps.whoint/iris/bitstream/0665/43755/1/9789241547307Windle,K.,Netten,A.,Caiels,J.,Masrani,R.,Welch,E.andForder,J.,(2010)Measuringtheoutcomesofinformationandadviceservices:Finalreport,DiscussionPaper2713,PSSRU,UniversityofKent,Canterbury.Wood,C.,(2013)Thetopoftheladder.Anewgenerationofretirementhousingcouldsetoffapropertychainreaction.DEMOS(crosspartythinktank)Eindhoven,LecturisISBN9781909037397[Availableon-line]www.demos.co.uk[AccessedAugust2013]Wood,C.,(2014)Theaffordabilityofretirementhousing.DEMOSallpartyparliamentarygrouponhousingandcareforolderpeople[Availableonline]www.housinglin.org.uk/_library/Resources/Housing/OtherOrgahisationn/Demmos_APPG_REPORT.pdf[AccessedNovember2014]Yancura,L.A.andAldwin,C.M.,(2008)Copingandhealthinolderadults.CurrentPsychiatryReports1010-15Yardley,L.,(2000)Dilemmasinqualitativehealthresearch.PsychologyandHealth15pp215-228ZimbardoP.andBoydJ.,(1999)Puttingtimeinperspective:Avalid,reliableindividual-differencemetric.TheJournalofPersonalityandSocialPsychology,77pp.1271-88.

282

Bibliography

BIBLIOGRAPHYAbrahams,C.,(2016)InImprovinglaterlife.VulnerabilityandresilienceinolderpeopleAgeUk(2016)[Availableon-line]http://www.ageuk.org.uk/Documents/EN-GB/For-professionals/Research/Final_Improving_Later_Life_4-Vulnerability.pdf?epslanguage=en-GB?dtrk=true[AccessedJanuary2016]Abell,J.G.,Stalder,T.,Ferried,J.E.,Shipley,M.J.,Kirschbaum,C.,Kivimaki,M.,Kumari,M.,(2016)Assessingcortisolfromhairsamplesinalargeobservationalcohort:TheWhitehallIIstudyPsychoneuroendocrinology73148-156AgeUK,(2014)Advancedecisions,advancestatementsandlivingwills.Factsheet72lJanuary2014[Availableon-line]http://www.housingcare.org/downloads/kbase/2052.pdf[AccessedMay2014]AgeUK,(2015)2.4mbeddayslostin5yearsfromsocialcaredelays.[Availableon-line]http://www.healthwatchbucks.co.uk/news/24m-bed-days-lost-5-years-social-care-delays[AccessedJune2015]Ajzen,I.,(1985)Fromintentionstoactions:Atheoryofplannedbehavior.InJ.Kuhl&J.Beckmann(Eds),ActionControl:FromCognitiontoBehavior.Berling,Hedelber,NewYork:Springer-VerlagAjzen,I.,(1991)TheTheoryofPlannedBehaviour.Org.Behav.Hum.Decis.Process.50179-211.Ajzen,I.,(2002a)Perceivedbehavioralcontrol,selfefficacy,locusofcontrolandthe‘TheoryofPlannedBehavior’.JournalofSocialPsychology324:665-683Ajzen,I.&Fishbein,M.,(2005)Theinfluenceofattitudesonbehavior.InAlbarrain,D.,Johnson,B.R.,Zanna,M.P.(Eds.)Thehandbookofattitudes.LawrenceErlbaumAssociates.Alexandrova,A.,(2005)Subjectivewell-beingandKahnemans‘objectivehappiness’.JournalofHappinessStudies.6301-324Alvesson,M.,(2202)PostModernismandSocialResearch.MaidenheadOpenUniversityPress16Appleyard,L.,Rowlingson,K.,(2010)Home-ownershipandthedistributionofpersonalwealth.Areviewoftheevidence.JRFprogrammepaper:HousingMarketTaskforceISBN9781859357651UniofBirminghamApter,M.J.,(2001)(Ed.)MotivationalStylesinEverydayLifeAPA;WashingtonDCApter,M.J.,Fontana,D.,Murgatroyd,S.,(2014)ReversalTheoryApplicationsandDevelopment(Eds.)PsychologyPress:TaylorandFrancisGroup:LondonandNewYorkAronson,E.,&Mills,J.,(1959).Theeffectofseverityofinitiationonlikingforagroup.TheJournalofAbnormalandSocialPsychology,592177.

283

Bibliography

Ashley,N.T.,Barboza,P.S.,Macbeth,B.J.Janz,D.M,Cattet,M.R.,Booth,R.K.,Wasser,S.K.,(2011).Glucocorticosteroidconcentrationsinfeacesandhairofcaribouandreindeerfollowingadrenocorticotropichormonechallenge.Gen.Comp.Endocrinol172382-391Ashton,J.R.,(2015)Puttingpublichealth,planningandhousingonnationalandlocalagendas.PracticeBriefingforHousingLIN(learningandimprovementnetwork)[Availableon-line]www.housinglin.org.uk[AccessedFebruary2016]Baltes,M.,(1996)TheManyFacesofDependencyinOldAge.CambridgeUniversityPress:NY.In:Adams-Price,C.E.andMorse,L.W.,(2009).DependencyStereotypesandAging:Theimplcationsforgettingandgivinghelpinlaterlife.JofAppliedSocialPsychology39122967-2984BBCbusinessnews,(2013)MargaretThatcher,howherchangesaffectedyourfinances.[Availableon-line]http://www.bbc.co.uk/news/business-22064354[AccessedJune28th2013]Beach,B.,(2015)VillageLife:Independence,Loneliness,andQualityofLifeinRetirementVillageswithExtraCarebriefingforILC(InternationalLongevityCentre)Beaumont,J.,(2013)Measuringnationalwell-being–olderpeopleandloneliness.EnglishLongitudinalStudyofAgeing(ELSA)2009-2010forages52andover.[Availableon-line]http://www.ons.gov.uk/ons/dcp171766_304939.pdfBennett,K.,(2016)inImprovinglaterlife.Vulnerabilityandresilienceinolderpeople.AgeUk(2016)[Availableon-line]http://www.ageuk.org.uk/Documents/EN-GB/For-professionals/Research/Final_Improving_Later_Life_4-Vulnerability.pdf?epslanguage=en-GB?dtrk=true[AccessedJanuary2016]Bennett,A.,Hayssen,V.,(2010)Measuringcortisolinhairandsalivafromdogs:coatcolorandpigmentdifferences.DomesticAnimalEndocrinology39171-180Bernard,H.R.,Killworth,P.,Kronenfeld,D.,Sailer,L.,(1984)Theproblemofinformantaccuracy–thevalidityofretrospectivedata.Ann.Rev.Anthropol13495-517.In:Bandura,A.,(1991)Socialcognitivetheoryofself-regulation.OrganisationalBehaviourandHumanDecisionProcesses50248-287Bevan,M.&Croucher,K.,(2011)LifetimeNeighbourhoods.Dept.ofCommunitiesandLocalGovt.(CLG)London:HMSOBlaikie,N.,(2007)ApproachestoSocialEnquiry:AdvancingKnowledge.2ndedn.Cambridge:Policy16,21,60.In:Robson,C.(2011)RealWorldResearch3rdEd.Wiley:ChichesterBligh,J.,&Derslake,A.,(2001)Strategichousingforolderpeople,sectionA29:HousingLIN&InstituteofPublicCare(IPC):OxfordBrookes.London:EAC

284

Bibliography

Blood,I.andPannell,J.,(2012).Mutualsupportandbuildingsocialcapitalinretirementcommunities.Viewpoint22HousingLIN[Availableon-line]www.housinglin.org.uk[AccessedJan.2013]Blood,I.,Copeman,I.,Pannell,J.,(2015)Theanatomyofresilience:helpsandhindrancesasweage.Areviewoftheliterature.[Availableon-line]http://www.housinglin.org.uk/_library/Resources/Housing/OtherOrganisation/150721-ssia-older-people-barriers-evidence-review--final.pdf[AccessedMay2016]Bodnur,E.,Cohen-Fridel,S.,Yaretzky,A.,(2011)Peceivedqualityoflifeandageismamongelderlypeoplelivinginshelterdhousingandinthecommunity.Europeanpsychiatry:ThejournaloftheAssociationofEuropeanPychiatrists.261:1172Bosch,J.A.,(2013)Psychoneuromicrobiology:Cytomegalovirusinfectionasaputativelinkbetweenstress,aging,andImmunity.InBosch,J.A.,Philips,A.C.,Lord,J.M.,(eds.)Immunosenescence:Psychosocialandbehavioraldeterminants.pp81-100NewYork.SpringerBowling,A.,(2001)GoodNeighbours;MeasuringQualityofLifeinOlderAge.SummarypreparedbyPamelaReadhead.ESRC.[Availableon-line]http://www.ilcuk.org.uk[AccessedAugust2014]Bradley,D.E.,LonginaJr.,C.F..,Stoller,E.P.,Hass,W.H.,(2008)Actuationofmobilityintentionsamongtheyoung-old:Anevent-historyanalysis.TheGerontologist482:190-202Brandtstadter,J.,&Renner,G.,(1990)Tenaciousgoalpursuitandflexiblegoaladjustment:Explicationandage-relatedanalysisofassimilativeandaccommodativestrategiesofcoping.PsychologyandAgeing558-67.In:Choi,N.G.,Jun,J.,(2009)Liferegretsandprideamonglow-incomeolderadults:Relationshipswithdepressivesymptoms,currentlifestressorsandcopingresources.AgingandMentalHealth132:213-225Brehm,J.W.,(1956)Postdecisionchangesinthedesirabilityofalternatives.TheJournalofAbnormalandSocialPsychology,523384.Brehm,J.W.,(1956)Post-decisionchangesinthedesirabilityofalternatives.TheJournalofAbnormalandSocialPsychology522177.In:McLeod,S.A.(2008,updated2014)Cognitiveconsequencesofforcedcompliance.[Avaiableon-line]www.simplypsychology.org/cognitive-dissonance.htmlBroad,R.,(2015)People,Places,Possibilities:ProgressonLocalAreaCoordinationinEnglandandWalesISBN978-1-907790-71-3Brocki,J.andWearden,A.,(2006)Acriticalevaluationoftheuseofinterpretativephenomenologicalanalysis(IPA)inhealthpsychology.PsychologyandHealth,21,1:87-108

285

Bibliography

BRE,(BuildingResearchEstablishment)(2014)Housinghealthcostindicator[Availableon-line]https://www.bre.co.uk/page.jsp?id=3021[AccessedJan2015]Burgess,G.,Monk,S.,Williams,P.,(2013)Equityreleaseamongstolderhomeowners.CambridgeCentreforHousingandPlanningResearch.CambridgeBury,R.,(2012)outlineplansforelderlydownsizing.InsideHousingJan.2012[Availableon-line]http://www.insidehousing.co.uk/shapps-outlines-plans-for-elderly-downsizing/6519980.article[AccessedJanuary2012,May2014]Bury,R.,(2014)ShappsoutlinesplansforelderlydownsizingInsideHousing25.10.14Cairncross,E.,(2016)Activeageingandthebuiltenvironment.PracticeBriefingforHousingLIN(learningandimprovementnetwork)OxfordBrookes[Availableon-line]www.housinglin.org.uk[AccessedFebruary2016]Chen,G,Gully,S.M.,Eden,D.,(2004)Generalself-efficacyandself-esteem:towardtheoreticalandempiricaldistinctionbetweencorrelatedself-evaluations.JournalofOrganizationalBehavior25375-395Cialdini,R.B,Goldstein,N.J.,(2004)SocialInfluence:Complianceandconformity.AnnualReviewofPsychology55591-621Clare,L.,(2002)We’llfightitaslongaswecan:CopingwiththeonsetofAlzheimer’sdisease.AgingandMentalHealth6139-148Cobb,S.,(1976)SocialsupportasamoderatoroflifestressPsychosomaticMedicine38(5)Connolly,S.,O’Reilly,D.,Rosato,M.,(2009)Housevalueasanindicatorofcumulativewealthisstronglyrelatedtomorbidityandmortalityriskinolderpeople:acensus–based,cross-sectionalandlongitudinalstudy.InternationalJournalofEpidemiology201039383-391Cohen,S.,Kamarck,T.,Mermelstein,R.,(1983)Aglobalmeasureofperceivedstress.In:Stalder,T.,Steudte,S.,Miller,R.,Skoluda,N.,Dettenborn,L.,Kirschbaum,D.,(2012).Intraindividualstabilityofhaircortisolconcentrations.SciVerse37602-610Conservativehome.blogs.comhttp://conservativehome.blogs.com/thecolumnists/2012/01/jill-kirby-why-on-earth-does-grant-shapps-want-to-give-the-state-a-bigger-role-in-housing-the-elderl.htmlDavies,B.,(2014)Forfutureliving:Innovativeapproachestojoininguphousing&health.IPPRNorth:Newcastle

286

Bibliography

Davis,S.,(2013)Creatinghousingchoicesforlife;Theroleofretirementhousingindevelopingabetterofferforolderpeople.CasestudyHousingLIN(learningandimpovement)andCIH(charteredinstituteofhousing)[Availableon-linewww.housinglin.org.ukpublications.[AccessedJuly2013]Davis,H.andRitters,K.,(2013)Activeageingthroughwellbeing–theroleofinformationin‘thatlittlebitofhelp’Research,PolicyandPlanning30(1),23-35©SocialServicesResearchGroupCoventryUniversity2013allrightsreservedDavies,K.,&Craig,L.,(2012)Prettyvacant:Vacancychainsandextracarehousing.Stimulatinglocalhousingmarkets.HousingLIN(learningandimprovement)factsheet33London:EAC[Availableon-line]http://www.housinglin.org.uk/[AccessedOctober2013]DCLG,(dept.ofcommunitiesandlocalgovt)(2008)LifetimeHomes,LifetimeNeighbourhoods.ANationalStrategyforHousinginanAgeingSociety.DeptofCommunitiesandLocalGovernmentDecember2008.ISBN978-1-4098-0955-5Wetherby:HMSO[Availableonline]http://webarchive.nationalarchives.gov.uk/20120919132719/http://www.communities.gov.uk/documents/housing/pdf/deliveringlifetimehomes.pdfAccessedMay2016DeptofHealth,(2011)HealthLives,HealthyPeople;updateandwayforward,HealthandSocialCareAct2012.[Availableon-line]DeptofHealthJuly2011.ISBN97800101813426Wetherby:HMSOhttp://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_129334.pdf[AcessedMay2016]Dean,A.,Kolody,B.,Wood,P.,Ensel,W.M.,(1989)Theeffectsoftypesofsocialsupportfromadultchildrenondepressioninelderlypersons.JournalofCommunityPsychology17Deary,I.,(2016)Cognitiveandmentalhealthinimprovinglaterlife.Servicecost-effectiveness;Isitworthit?[Availableon-line]http://www.ageuk.org.uk/Documents/EN-GB/For-professionals/Research/Services-what_works_spreads.pdf?dtrk=true[AccessedJanuary2016]Dettenborn,L.,Tietze,Kirschbaum,C.,Stalder,T.,(2012)Theassessmentofcortisolinhumanhair;associationswithsocio-demographicvariablesandpotentialconfounders.Stress15578-588.DeWitte,H.,Hooge,J.,Vanbele,E.,(2010)Dothelong-termunemployedadapttodisease?Nat.Rev.Neurosci.6463-475Douglas,D.,(2015)Housinghealthsectorssignlandmarkagreement.InsideHousing20.01.15

287

Bibliography

Dowlati,U.,Herrman,N.,Swardfager,W.,Thomson,S.,Oh,P.I.,VanUum,S.,Koren,G.,Lanctot,K.L.,(2010)Relationshipbetweenhaircortisolconcentrationsanddepressivesymptomsinpatientswithcoronaryarterydisease.NeuropsychiatrDisTreat.6393-400Dunn,J.,(2002)Housingandinequalitiesinhealth:astudyofsocioeconomicdimensionsofhousingandselfreportedhealthfromasurveyofVancouverresidents.JEpidemioCommunityHealth569:671-681Easton,M.,(ed.)(2013)Care4CareSchemeInsideOutwww.bbc.co.uk/programmes/b01ndhk4EAC,(ElderlyAccommodationCouncil)(2013).Governmentfundedadviceandinformationservice[Availableonline]http://www.firststopcareadvice.org.uk/[AccessedFeb.2016]EAC,(2013)Housingoptionsforolderpeople:Howwelldoesyourhomesuityou?Ifyouareunsure,thisshortquestionnairemayhelpyoudecide.Leaflet.[AlsoAvailableinteractively}www.HousingCare.orgEdwards, J.R.,Caplan,R.D.,&Harrison,R.V., (1998)Person-environment fit theory:Conceptual foundations, empirical evidence, and directions for future research.chapter C.L. Cooper (Ed.). Theories of Organizational Stress (pp 28-67) Oxford:OxfordUniversityPress.Egan,M.,(2013)Healtheffectsofneighbourhooddemolitionandhousingimprovement:Aprospectivecontrolledstudyof2naturalexperimentsinurbanrenewal.AmericanJournalofPublicHealth103:6June2013ELSA(2009/10).EnglishLongitudinalStudyofAgeing.UniversityCollegeLondon.[Availableon-line]http://www.ifs.org.uk/elsa/report10/ch4.pdf[AccessedJuly2012]Elliott,J.,Gale,C.,Kuh,D.,Parsons,S.,(2011)ThedesignandcontentoftheHALCyonqualitativestudy;Aqualitiativesub-studyoftheNationalStudyofHealthandDevelopmentandtheHertfordshireCohortStudy.InstituteofEducation;UCLLondon.Engel,G.A.,(1977)Theneedforanewmedicalmodel:Achallengeforbiomedicine.Science196no.4286Engeland,C.GandMarucha,P.T.,(2009)Woundhealingandstress.InNeuroimmunologyoftheskin,Springer-VerlagBerlinErnser-Herschfield,M.,Garton,R.,Ballard,K.,Samanez-Larkin,Knutson,B.,(2009)Don’tstopthinkingabouttomorrow:Individualdifferencesinfutureself-continuityaccountforsaving.JudgementandDecisionMakingVol44280-286

288

Bibliography

Evans,H.,(2013)Welfarebenefitreforms2012.WelfareReformsAct2012-HilaryEvans,HeadofPublicAffairsdiscussestheimpactofpolicychangesonoldercouples.[Availableonline]http://www.ageuk.org.uk/professional-resources-home/public-affairs/reportage/past-issues-of-reportage/reportage/viewpoint-welfare-reform/[AccessedApril3rd2013]Evans,P.,Bristow,M.,Hucklebridge,F.,Clow,A.,Walters,N.,(1993)TherelationshipbetweensecretoryimmunoglobuinAinstudentsundergoingassessment.BritishJournalofClinicalPsychology.32227-236Evans,P.,Huckleridge,F.,Cow,A.,(2000)Mind,ImmunityandHealth.AthenaeumPress,Gateshead.Evans,S.,(2014)Adultsocialcareenvironmentsandsettings.ASSETTprojectUoWorcester.[Availableon-line]http://www.worcester.ac.uk/discover/dementia-asset.html[AccessedMay2015]Fairbanks,L.A.,Jorgensen,M.J.,Bailey,J.N.,Breidenthal,S.E,,Grzywa,R.,Laudenslager,M.L.,(2011)Heritabilityandgeneticcorrelationofhaircortisolinvervetmonkeys,inlowandhighersressenvironments,Psychoneuroendocrinology361201-1208.Foundations,(2016)Housing,Health&CareIntegrationToolkit.[Availableon-line]withoutpermissions,viewonlyAstralPSLimitedhttp://www.foundations.uk.com/media/4328/integration-toolkit.pdf[AccessedJanuary2016]Foundations–TheNationalbodyforHomeImprovementAgenciesandHandypersonServices.http://www.foundations.uk.com/home/Friborg,O.,Hjemdal,O,Rosenvinge,J.J.,Martinussen,M.,(2003)Anewratingscaleforadultresilience:whatarethecentralprotectiveresourcesbehindhealthadjustment?InternationalJournalofMethodsinPsychiatricResearch12.2Francis,J.J.,Eccles,M.P.,Johnston,M.,Walker,A,,Grimshaw,J.,Foy,R.,Kaner,E.F.S.,Bonetti,D.,(2004)ConstructingQuestionnairesBasedonTheTheoryofPlannedBehaviour;AManualforHealthServicesResearchers.CentreforHealthServicesResearch,UniversityofNewcastle.ISBN:0-950161-5-7 French,J.R.P.,Jr.,Caplan,R.D.andHarrison,R.V.,(1982)TheMechanismofJobStressandStrain.Wiley:London.Gainsbury,S.,andNevill,S.,(2015)Austerity’s18bnimpactonlocalservices.FinancialTimes19.7.15Gao,W.,Xie,Q.,Jin,J.,Qiao,T.,Wang,H.,Chen,L.,Dng,H.,Lu,Z.,(2010)Detectionofcortisoldistributioninhumanhair.Clin.Biochem.43677-682

289

Bibliography

Gardner,M.P.,Lightman,S.L.,Gallaher,J.,Hardy,R.,Kuh,D.,Ebrahim,S.,Bayer,A.,Ben-Shlomo,Y.,(2011)DiurnalcortisolpatternsareassociatedwithphysicalperformanceintheCaerphillyProspectiveStudy.TheHalcyonstudyteam.InternationalJournalofEpidemiology401693-1702Gerber,M.,Brand,S.,Lindwall,M.,Elliot,C.,Kalak,N.,Herrmann,C.,Uwe,P.,Ingibjorg,H.J.,(2012)Concernsregardinghaircortisolasabiomarkerofchronicstressinexerciseandsportscience.JournalofSportsScience&Medicine.11.571-581Gibson,M.,Thomson,H.,Kearns,A,Petticrew,M.,(2011).Understandingthepsychosocialimpactsofhousingtype:Qualitativeevidencefromahousingandregenerationintervention.HousingStudies264:555-573Gidron,Y.,Hassid,A.,Yisrael,H.,Biderman,A.,(2005).Dopsychologicalfactorspredictoccurrenceofinfluenza-likesymptomsinvaccinatedelderlyresidentsofashelteredhome?BritishJournalofHealthPsychology10411-420Gillsjo,C.,Schwartz-Barcott,D.,VonPost.,I(2011)Home:Theplacetheolderadultcannotimaginelivingwithout.BMCGeriatrics1110GLA,(2013)GreaterLondonAssemblydevelopmentsiteshttp://www.london.gov.uk/priorities/housing-land/land-assets/barking-riversideselectBarkingriversidefromlefthandmenutheninvestors:-http://meadowlandlondon.com/investorsGlover,S.,andDixon,P.,(2004)Likelihoodratios:asimpleandflexiblestatisticforempiricalpsychologists.PsycholBullRevOct:115791-806Godfrey,M.andDeny,T.,(2007)OlderPeopleAccessinginformationandICTsCentreforHealthandSocialCare;UniversityofLeeds,LeedsGolant,S.M.,(2011)Thequestforresidentialnormalcybyolderadults:Relocationbutonepathway.JournalofAgingStudies25193-205Goodyer,I.M.,Park,R.J.,Herbert,J.,(2001)Psychosocialandendocrinefeaturesofchronicfirst-episodemajordepressionin8-16yearolds.Biol.Psychiatry50351-157.In:Staufenbiel,S.M.,Penninx,B.W.J.H.,Spijker,A.T.,Elzinga,B.M.,VanRossum,E.F.C.,(2012)Haircortisol,stressexposure,andmentalhealthinhumans:Asystematicreview.Psychoneuroendocrinology381220-1235Greene,J.C.,Caracelli,V.J.,Graham,W.F.,(1989)Towardaconceptualframeworkformixed-methodevaluationdesigns.EducationalEvaluationAndPolicyAnalysis198911255Halpern,R.,Hill,R.,(2011)TheLocusofControlconstruct’svariousmeansofmeasurement:Aresearcher’sguidetosomeofthemorecommonlyusedLocusofControlscalesISBN978-0-9833464-3-2WillToPowerPress,BeachHaven,NJHambly,M.,andAdams,S.,(2003)ShouldIstayorshouldIgo?CareandRepairEngland[Availableon-line]http://www.housingcare.org/information/detail-2043-should-i-stay-or-should-i-go.aspx[AccessedMay2014]

290

Bibliography

Hawkley,L.C.,Berntson,G.G.,Engeland,C.G.,Marucha,P.T.,Masi,C.M.,Cacioppo,J.T.,(2005)Stress,aging,andresilience:Canaccruedwearandtearbeslowed?CanadianPsychology463:115-125Het,Serken,Wolf,Olover,T.,(2007)Moodchangesinresponsetopsychosocialstressinhealthyyoungwomen:Effectsofpretreatmentwithcortisol. BehavioralNeuroscience1211:11-20HMTreasury,(2015)Pensionfreedomstobeextendedtopeoplewithannuities.BudgetMarch2015[Availableon-line]https://www.gov.uk/government/news/pension-freedoms-to-be-extended-to-people-with-annuities[AccessedApril2016]Hogg,M.A.,Terry,D.J.,White,K.,(1995)Ataleof2theories:AcriticalcomparisonofIdentityTheorywithSocialIdentityTheory.SocialPsychologyQuarterly584:255-269Holsboer,F.,(200)Thecorticosteriodreceptorhypothesisofdepression.Neuropsychopharmacology.23477-501In:Staufenbiel,S.M.,Penninx,B.W.J.H.,Spijker,A.T.,Elzinga,B.M.,VanRossum,E.F.C.(2012)Haicortisol,stressexposure,andmentalhealthinhumans:Asystematicreview.Psychoneuroendocrinology381220-1235Horowitz,M.,Wilner,N.,Alvarez,W.,(1979).Impactofeventscale.PsychosomaticMedicine41209-218HousingandAgeingAlliance,(2013)Whyhousingandageingshouldbehighonthehealthagenda.PolicyPaperHealth,HousingandAgeing:HousingLIN[Availableon-line]http://www.housinglin.org.uk/_library/Resources/Housing/HAA/HAAllianceTopic_Statements_Health.pdf[AccessedOctober2013]Hughes,N.,(2012)Abetterfit?CreatinghousingchoicesforanageingpopulationSummaryPolicyreportLondon:Shelter[Availableon–line]http://england.shelter.org.uk/__data/assets/pdf_file/0006/427731/4461.1_older_people_summary.pdf[AccessedMay2016]Iecovich,E.,(2014)Anthropologicalnotebooks20121-33IPC,(InstituteofPublicCare)OxfordBrookesUniversity(Dec2012).Health,wellbing,andtheolderpeoplehousingagenda.HousingLINbriefingpaper2.London:EAC[Availableon-line]http://www.housinglin.org.uk/[AccessedOctober2013]IPC,(InstituteofPublicCare)OxfordBrookesUniversity(Dec2012).Makingbestuseofourshelteredhousingasset..HousingLINbriefingpaper3.London:EAC[Availableon-line]http://www.housinglin.org.uk/[AccessedOctober2013]

291

Bibliography

Irwin,M.,(2002)Psychoneuroimmunologyofdepression:ClinicalImplications.Brain,Behaviorandimmunity1611-16 Johnson,S.l,Burrows,A.,andWilliamson,I.,(2004)‘Doesmybumplookbiginthis?’Themeaningofbodilychangesforfirsttimemothers-to-be.JournalofHealthPsychology9361-374Karasek,R.A.,&Theorell,T.,(1990).Healthywork:stress,productivityandthereconstructionofworkinglife.NewYork:BasicBooks.Kawachi,I.,andBerkman,L.F.,(2003B)SocialCohesion,SocialCapitalandHealthinSocialEpidemiology(Eds)NewYork,OxfordUniversityPress2000174-194Kenessary,A.,Zhumadilov,Z,Nurgozhin,T.,Kipling,D.,Yeoman,M.,Cox,L.,Ostler,E.,Faragher,R.,(2013)Biomarkers,interactionsandhealthyaging.NewBiotechnology304373-377Kiecolt-GlaserJ.K.,Marucha,P.T.,Malarkey,W.B.,Mercado,A.M.,&Glaser,R.,(1995)Slowingofwoundhealingbypsychologicalstress.TheLancet,3461194-1196.

Kiecolt-Glaser,J.K.,Glaser,R.,Gravenstein,S.,Malarkey,W.B.,Sheridan,J.,(1996)Chronicstressalterstheimmuneresponsetoinfluenzavirusvaccineinolderadults.MedicalSciences933043-3047

Kite,M.E.,Stockdale,G.D.,Whitley,B,EJohnson,B.T.,(2005)Attitudestowardyoungerandolderadults:Anupdatedmeta-analyticreview.JournalofSocialIssues,61241-266Knapp,M.,(2016)inImprovinglaterlife.Servicecost-effectiveness;Isitworthit?[Availableon-line]http://www.ageuk.org.uk/Documents/EN-GB/For-professionals/Research/Services-what_works_spreads.pdf?dtrk=true[AccessedJanuary2016]KnightFrankLLP(2016)RetirementHousing,[Availableon-line]http://content.knightfrank.com/research/696/documents/en/2016-3770.pdf[AccessedMay2016]Kral,E.A.,Grad,B.,Berenson,J.,(1968).Stressreactionsresultingfromtherelocationofanagedpopulation.JournaloftheCanadianPsychiatricAssociation.13201-209Kuh,D.,Cooper,R.,Richards,M.,Gale,C.,vonZglinicki,T.,Guralnik,J.,(2012)Alifecourseapproachtohealthyageing:TheHALCyonprogramme.PublicHealth126193-195Kumari,M.,Badrick,E.,Sacker,A.,Kirschbaum,C.,Marmot,M.,Chandola,T.,(2010).Identifyingpatternsincortisolsecretioninanolderpopulation.FindingsfromtheWhitehalliistudy.Psychoneuroendocrinology351091-1099Larkin,M.,Watts,S.,&Clifton,E.,(2006)Givingvoiceandmakingsenseininterpretativephenomenologicalanalysis.QualitativeResearchinPsychology3:102-120

292

Bibliography

Laudenslager,M.J.,Jorgensen,R.G.andFaribansk,L.A.,(2011)Anoveltyseekingphenotypeisrelatedtochronichypothalamic-pituitary-adrenalactivityreflectedbyhaircortisol.Physio.Behav.1042291-295Lee,F.,(2002)Thesocialcostsofseekinghelp.JournalofAppliedBehavioralScience3817-35.In:Adams-Price,C.E.andMorse,L.W.,(2009).DependencyStereotypesandAging:Theimplcationsforgettingandgivinghelpinlaterlife.JofAppliedSocialPsychology39122967-2984LegalandGeneral,(2014)LastTimeBuyers.AreportbyLegalandGeneral,inconjunctionwiththeCentreforEconomicsandBusinessResearch(CEBR)[Availableon-line]http://www.legalandgeneralgroup.com/_pdfs/press-release/LTB_Front_Cover_Report_Final.pdf[AccessedMay2016]Leng,G.,(2011)Publichealthandhousing:wecangetitright.HousingLIN(learningandimprovment)packLondon:EAC[Availableon-line]http://www.housinglin.org.uk/[AccessedOctober2013]Leng,G.,(2012)OnthePulse:Housingroutestobetterhealthoutcomesforolderpeople.NHFNationalHousingFederation[Availableon-line]www.housing.org.uk/publications.aspx[AccessedJanuary2013]Lincoln,G.,(2015)Olderunder-occupyingowners,willtheyevermove?Isthedecisiontorelocateamovingtarget,moredifficultthanthemoveitself?HowCanFreeSpaceschemeshelp?HousingLIN(learningandimprovement)CaseStudy102[Availableon-line]http://www.housinglin.org.uk/_library/Resources/Housing/Practice_examples/Housing_LIN_case_studies/HLIN_CaseStudy_102_FreeSpace.pdfLine,B.,(2013)Incentivesfordownsizing-oilingthewheelsofthehousingmarketsystem.HousingLIN(learningandimprovementnetwork)viewpoint54[Availableon-line]http://www.housinglin.org.uk/[AccessedMay2016]Litwak,E.,&LonginoJr.,C.F.,(1987).Migrationpatternsamongtheelderly:Adevelopmentalperspective.TheGerontologist,27,266–272.In:Oswald,F.,Schilling,O.,Wahl,H-W.,Gang,K.,(2002)Troubleinparadise?Reasonstorelocateandobjectiveenvironmentalchangesamongwell-offolderadults.J.EnvironmentalPsychology22273-288Litwak,E.,&LonginoJr.,C.,F.,(2012)Thechainisonlyasstrongastheweakestlink:Olderadulsmigratingandthefirstmove.Research on Aging 35 5 507–532 Lorentz,M.M.,(2006)StressandPsychoneuroimmunologyrevisited:Usingmind-bodyinterventionstoreducestress.AlternativeJournalofNursing11

293

Bibliography

Lupien, S. J., & McEwen, B. S., (1997) The acute effects of corticosteroids on cognition: Integration of animal and human model studies. Brain Research Reviews, 24 1-27. Lutgendorf,S.K.,Garand,L.,Buckwalter,K.C,Reimer,T.T,Hong,S.,Lubaroff,D.M.,(1999)Lifestress,mooddisturbance,andelevatedinterleukin-6inhealthyolderwomen.JournalofGerontology54A9M434-M439Lutgendorf,S.K.,Tripp-Reimer,T.T.,Harvey,J.H.,Lubaroff,D.M.,(1999).SenseofcoherencemoderatestherelationshipbetweenlifestressandNaturalKillerCellactivityinhealthyolderadults.PsychologyandAging.144552-563

Macintyre,S.,Ellaway,A.,Der,G.,Ford,G.,Hunt,K.,(1998)Dohousingtenureandcaraccesspredicthealthbecausetheyaresimplymarkersofincomeorselfesteem?AScottishstudy.JEpidemiolCommunityHealth852657-664doi:10.1136/jech.52.10.657Majeed,F.,(2012)Apatient’shomeisahugedeterminantofhealthandwellbeing.InFoundationsNewsletter12.05.12[Availableon-line]http://www.foundatons.uk.com/news-pr/a-patients-home-is-a-huge-determinant-of-health-and-wellbeing/[AccessedMay2012]Manenshijn,L.,Spijker,A.T.,Kper,J.W.,Jetten,A.M.,Giltay,E.J.,Haffmans,J.,Hoencamp,E.,VanRossum,E.FC.(2012c)Long-termcortisolinbipolardisorder:associationswithageofonsetandpsychiatriccomorbidity.psychoneuroendocrinolgy,121060-1968.InStaufenbiel,S.M.,Penninx,B.W.J.H.,Spijker,A.T.,Elzinga,B.M.,VanRossum,E.F.C.(2012)Haircortisol,stressexposure,andmentalhealthinhumans:Asystematicreview.Psychoneuroendocrinology381220-1235Manenschijn,L.,Schaap,L.,vanderPas,C.S.,Peeter,G.M.,Lips,P.,Koper,J.W.,vanRossum,E.F.,(2013)Highlong-termcortisollevels,measuredinscalphair,areassociatedwithahistoryofcardiovasculardisease.J.Clin.Endocrinol.Metab.982078-2983.In:Feller,S.,Vigi,M.,Bergmann,M.M.,Boeing,H.,Kirschbaum,C.,Stalder,T.,(2014)Predictorsofhaircortisolconcentrationinolderadults.Psychoneuroendocrinology(2014)39;132-140

Marmot,M.,Bosma,H.,Hemingway,H.,Brunner,E.,Stansfeld,S.,(1997)Contributionofjobcontrolandotherriskfactorstosocialvariationsincoronaryheartdiseaseincidence.Lancet350235-239Marmot,M.,(2004)Statussyndrome.Significance,1:150–154.Marmot,M.,Wilkinson,R.G.,(eds.)(2006)SocialDeterminantsofHealth.OxfordUniversityPress:Oxford.Marmot,M.,(2008)(chair)FairSocietyHealthLives.For:Strategicreviewofhealthinequalities;TheMarmotReviewFeb2010ISBN978-0-9564870-0-1

Martin,P.,(1997)TheSickeningMind:Brain,Behaviour,ImmunityandDisease.Flamingo,HarperCollins:London.

294

Bibliography

Matthews,C.,(2014)Ishousingtheanswertoourpublichealthcrisis?PressreleaseRiversideHousing02.07.14Mayhew,LandSmith,D.,(2014)TheUKequitybanktowardsincomesecurityinoldage.CassBusinessSchool.UCLLondonMaxwell,J.A.,(2010)Usingnumbersinqualitativeresearch.QualitativeInquiry166475-482Mayring,P.,(2000)QualitativeContentAnalysis[28paragraphs].ForumQualitativeSozialforschung/Forum:QualitativeSocialResearch,12Art.20McCarthy,M.,(2009)Marketing‘ExtraCareHousing’:Asummary.ForDeptofHealthandHousingLIN(learningandimprovementnetwork)[Availableon-line]www.dhcarenetworks.org.uk/IndependentLivingChoices/Housing/Topics/type/resource/?cid=5396[AccessedOctober2013]McLeod,S.A.,(2008,updated2014)Cognitiveconsequencesofforcedcompliance.[Availableon-line}www.simplypsychology.org/cognitive-dissonance.html[AccessedSept2015]McEwen,B.S.,(2003)Mooddisordersandmedicalillness:Mooddisordersandallostaticload.BiolPsychiatry54:200-207SocietyofBiologicalPsychiatryMcGovern,,P.O.,Sasaki,A.,D’Alessio,A.C.,Dymov,S.,Labonte,B.,Szyf,G.,Turecki,M.,Meaney,M.J.(2000)Epigeneticregulationoftheglucocorticoidreceptorinbrainassociateswithchildhoodabuse.Nat.Neurosci.12342-348.In:Staufenbiel,S.M.,Penninx,B.W.J.H.,Spijker,A.T.,Elzinga,B.M.,VanRossum,E.F.C.,(2012)Haircortisol,stressexposure,andmentalhealthinhumans:Asystematicreview.Psychoneuroendocrinology381220-1235McKee,S.,(2016)MeetinglifestyleaspirationsofolderconsumersHousingLIN(learningandimprovementnetwork)Viewpoint77[Availableon-line]www.housinglin.org.uk[AccessedMay2016]Means,R.,(2007)SafeasHouses?AgeinginPlaceandvulnerableolderpeopleintheUK.SocialPolicyandAdministration20074165-68Oxford:BlackwellMHP/health,(2014)Healthandhousing:Fromconsensustopractice.Areviewofhowpioneerandwhole-personcarecouncilsareconsideringhousingintheplanningoflocalhealthandcareservices-April2014.[Availableon-line]www.housinglin.org.uk/pagefinder.cfm?cid=9215[AccessedJune2014]orhttp://www.mhpc.com/wp-content/uploads/2015/07/Health-and-housing-from-consensus-to-practice.pdfMorseandNiehaus,L.,(2009)Mixedmethoddesign:principlesandprocedures(extract):WalnutCreekCA.USA,LeftCoastPressInc.193pagespaperback.

295

Bibliography

Mottet,N.K.,Body,R.L.Wilkins,V.,Burbacher,T.M.,(1987)Biologicalvariablesinthehairuptakeofmethylmercuryfrombloodinthemacaquemonkey.EnvironRe198742509-23InHamel,A.F.etalEffectsofshampooandwaterwashingonhaircortisolconcentrations.ClinicaChimicaActa412382-385MiddletonS.,Hancock,R.,Kellard,K.,Beckhelling,J.,Viet-Hai,P.,Perren,K.,(2007)Measuringresourcesinlaterlife:areviewofthedata.InJRFISBN9781859355602UniofLoughborough.[Availableon-line]www.yps-publishing.co.ukAccessedOctober1013Miller,G.,Chen,E.,Zhou,E.S.,(2007)In:Staufenbiel,S.M.,Penninx,B.W.J.H.,Spijker,A.T.,Elzinga,B.M.,VanRossum,E.F.C.(2012)Haircortisol,stressexposure,andmentalhealthinhumans:Asystematicreview.Psychoneuroendocrinology381220-1235Miller,L.&Russell,C.,(2012).AStrength-basedApproachtoAgeingWell:thehousingdimension.HousingLIN(learningandimprovementnetwork)viewpoint30London:EAC[Availableon-line]http://www.housinglin.org.uk/[AccessedOctober2013]Murray,P.,(2014)TheCareActbriefing.NationalHousingFederation(NHF).[Availableonline]www.housing.org.uk/publications/browse/the-care-act-2014[AccessedMay2014]NationalHousingFederation(NHF)(2010)Righthome,rightplace,righttime,researchonunder-occupationintheEastofEngland.Taskforcereport.July2010CPGTonbridge[Availableon-line]http://www.housing.org.uk/publications/browse/right-home-right-place-right-time/[AccessedApril2013]NationalHousingFederation,(NHF)(2011)Re-visioningolderpeople’shousing.NationalHousingFederation[Availableon-line]www.housing.org.uk/publications.aspx[AccessedJan.2013]NationalHousingFederation,(NHF);HousingandImprovementNetwork(HousingLIN);McCarthy&Stone;ContactConsulting;TetlowKingPlanning(2012)Housinginlaterlife:planningaheadforspecialisthousingforolderpeople.[Availableon-line]http://www.housinglin.org.uk/housinginlaterlife_planningtoolNationalHealthService(NHS),LondonBoroughofWalthamForest,UCLInstituteofHealthEquity,(2010)Ahealthier,fairerWalthamForest;WalthamForest’shealthinequalitiesstrategy2010-2015[Availableon-line]file:///Users/gaillincoln/Downloads/a-healthier-fairer-waltham-forest-waltham-forests-health-inequalities-strategy%20(4).pdf[AccessedMay2016]

NationalHealthService,(NHS)(2011)FutureForumReport[Availableon-line]https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/216422/dh_132085.pdf[AccessedMay2016]

296

Bibliography

NHBCFoundation,(2016)Retirementhousing.residents’experiences.NationalHouseBuildingCouncil,FoundationHousingResearchandGuidance[Availableon-line]http://www.housinglin.org.uk/_library/Resources/Housing/OtherOrganisation/Retirement_Housing_report.pdf[AccessedApril2016]NottinghamCityhousingstrategy.[Availableon-line]www.housinglin.org.uk/_assets/Resources/Housing/Practice_examples/Housing_LIN_case_studies/HLIN_CaseStudy_134_Nottingham-MOU.pdf[AccessedMarch2017]OfficeofNationalStatistics(ONS),(2013)TheimpactofageandlocationontotalhouseholdwealthMainreport-wealthdistribution.[Availableonline]http://www.ons.gov.uk/ons/taxonomy/index.html?nscl=Ageing[AccessedApril15th2013]Ong,A.D.,&Bergeman,C.S.,(2004).Resilienceandadaptationtostressinlaterlife:Empiricalperspectivesandconceptualimplications.AgeingInternational293:219-246O’Looney,B.A.&Barrett,T.,(1983).Apsychometricinvestigationofthemultidimensionalhealthlocusofcontrolquestionnaire.BritishJournalofClinicalPsychology22217-218Olstad,D.L.,Ball,K.,Wright,C.,Abbott,G.,Brown,E.,turner,A.I.,(2016)Haircortisollevels,perceivedstressandbodymassindexinwomenandchildrenlivinginsocioeconomicallydisadvantagedneighborhoods:theREADIstudy.Stress:TheInternationalJournalontheBiologyofStress192O’Shea,N.,(2012)Helpingolderpeoplechoosetherighthomeforthem;anintroductiontothecostsandbenefitsofprovidingadviceandsupport:RedbridgeCouncilFreeSpacecostbenefitexamplespp8EACFirstStop:[Availableon-line]http://www.housingcare.org/downloads/kbase/3243.pdf[AccessedJan2012,May2014]O’Shea,N.,(2013)InformingthebusinesscaseforaFreeSpacemodel.EACFirstStop[Availableon-ine]http://www.housingcare.org/downloads/kbase/3301.pdf[AccessedApril2013andJune2014]Pannell,J.&Blood,I.,(2014)Themissingoption?Expandingprivate/marketrentedhousingforolderpeopleBriefingHousingLIN(learningandimprovementnetwork)London:EAC[Availableon-line]http://www.housinglin.org.uk/Topics/browse/HousingExtraCare/ExtraCareStrategy/SHOP/SHOPAT/DeliveringKeyOutcomes/Downsizing/?&msg=0&parent=9229&child=9108[AccessedMay2016]

297

Bibliography

Pannell,J.&Blood,I.,(2014)Qualityandchoiceforolderpeople’shousing:whatcananewprivaterentedsectoroffer?HousingLIN(learningandimprovementnetwork)[Availableon-line]http://www.housinglin.org.uk/_library/Resources/Housing/Support_materials/Practice_briefings/HLIN_PRS_Briefing1.pdf[AccessedMay2016]Parrott,A.C.,Sands,L.,Jones,L.,Clow,A.,Evans,P.,Downey,L.A.,Stalder,T.,(2013)IncreasedcortisollevelsinhairofrecentEcstacy/MDMAusers.EuropeanNeuropsychopharmacology.Pennebaker,J.W.,(1997)Writingaboutemotionalexperiencesasatherapeuticprocess.PsychologicalScience,83162-166Pierce,C.S.,(1986)PhilosophicalWritings,orig.1955NewYork:Dover.37In:Robson,C.(2011)RealWorldResearch3rdEd.Wiley:W.Sussex.Persson,R.,Anne,H.,Hansen,A.m.,Osterberg,Kl,Larsson,B.,Orbaek,P.,(2008)Seasonalvariationinhumansalivarycortisolconentration.Chronobiol.Int.25923-937.In:Stalder,T.,Pert,C.B.(1997)MoleculesofEmotion:WhyYouFeelTheWayYouFeelSimon&Schuster:LondonPatterson,T.L.,Lawrence,W.S.,Grant,I.,(1990)Internalvs.externaldeterminantsofcopingresponsestostressfullife-eventsintheelderly.BritishJournalofMedicalPsychology63149-160Phillips,A.C.,Carroll,D.,Evans,P.,Bosch,J.A.,Clow,A.,Hucklebridge,F.,Der,G.,(2005).StressfullifeeventsareassociatedwithlowsecretionratesofimmunoglobulinAinsalivainthemiddleagedandelderly.Brain,Behavior,andImmunity20191-197Porteus,J.,(2012)Livinglabs:abravenewworldofcustomerdrivenextracarehousing.HousingLIN(learningandimprovement)viewpoint32London:EAC.[Availableon-line]http://www.housinglin.org.uk/[AccessedOctober2013]Porteus,J.,(2015)Aspoonfulofhousingletsthemedicinegofurther.HousingLIN(learningandimprovementnetwork][Availableon-line]http://www.housingln.org.uk/HeatlhandHousing[AccessedMay2016]Potter,J.&Wetherell,M.,(1987)DiscourseandSocialPsychology:BeyondAttitudesandBehaviour.London:SagePragst,F.,&BalkocaM.A.,(2006)Stateofthearthairanalysisfordetectionofdrugandalcoholabuse.ClinicaChimicaActa·September2006Rabbitt,P.,(2015)TheAgingMind:AnOwner’sManual.Routledge,London/NYRobbins,T.,(2011).Neighbourhoodapproachestoloneliness.JosephRowntreeFoundation[Availableon-line]www.jrf.org.uk/neighbourhood-loneliness[AccessedAugust2013]

298

Bibliography

Reiners,G.M.,(2012)UnderstandingthedifferencesbetweenHusserl’s(descriptive)andHeidegger’s(interpretive)phenomenologicalresearch.NursingandCare.1:5Robertson,L.,(2014)Londonhas75%ofEngland’shouseholdsintemporaryaccommodation:InsideHousing18.12.14Roe,J.J.,Thompson,C.W.,Aspinall,P.A.,Brewer,M.J.,Duff,E.I.,Miller,D.,Mitchell,R.,Clow,A.,(2013)Greenspaceandstress:Evidencefromcortisolmeasuresindeprivedurbancommunities.InJ.Environ.Res.PublicHealth104086-4103Rossi,E.L.,(1993)ThePsychobiologyofMind-bodyHealing.Norton&Co.NY:London Salimetrics,(2013)Measurementofcortisolinhair:Somerecentinvestigations.[Availableon-line]http://www.salimetrics.com/spit-report/archives/march-2009-cortisol-and-current-research[AccessedDecember2013]Schaefer,C.Coune,J.C.,Lazarus,R.S.,(1981).Thehealth-relatedfunctionsofsocialsupport.JournalofBehavioralMedicien4,4Scharf,D.,(2014)Seniormomentum:Whathavetheplannerseverdoneforus?HousingLIN(learningandimprovementnetwork)Viewpoint59[Availableon-line]www.housinglin.org.uk[AccessedFeb2014]Scholtz,W.,Kumsta,R.,Layes,I.,Entringer,S,Jones,A.,Wust,S.,(2008)Covariancebetweenpsychologicalandendocrineresponsestopharmacologicalchallengeandpsychosocialstress:aquestionoftiming.PsychosomaticMedicine707787-796In:Steudte,S,Stalder,T.,Dettenborn,L.,Klumbies,E.,Foley,P.,Beesdo-Baum,Kirschbaum,C.,(2011)DecreasedhaircortisolconcentrationsingeneralisedanxietydisorderPsychoneuroendocrinology361193-1200Schnall,P.,Dobson,M.,Rosskam,E.,(2009)Unhealthywork:Causes,consequencesandcures(Eds.).BaywoodPress:Amityville.In:Siegrist,J.,(2010).Socialdeterminantsofhealth–ContributionsfromEuropeanhealthandmedicalsociology.PoliticaySociedad482:249-258Schwandt,T.,(2007)DictionaryofQualitativeEnquiry.ThousandOaks,CASage24.In:Robson,C.,(2011)RealWorldResearch3rdEd.Wiley:W.Sussex.Searle,B.A.,(2014)Achanginghousingmarketforproviders.HousingLIN(learningandimprovement)viewpoint56London:EAC.[Availableon-line]http://www.housinglin.org.uk/[AccessedOctober2014]Seligman,M.E.P.(2006)LearnedOptimism.VintageBooksNewYork.In:SharotT.,TheOptimismBias.CurrentBiology,2123

299

Bibliography

Shanks,D.,(2016)Hatchingaplanforolderpeople’shousing.HousingLIN(learningandimprovementnetwork)Viewpoint78[Availableon-line]www.housinglin.org.uk[AccessedMay2016]Shankardass,K.,(2012).Place-basedstressandchronicdisease:Asystemsviewofenvironmentaldeterminants.InO’Campo,P.,andDunn,J.R.,(eds.)TowardsaScienceofChange.Netherlands;Springerpp.113-136Sharply,C.F.,Kauter,K.G.,McFarlane,J.R.,(2009)Aninitialexplorationofinvivohaircortisolrepsonsestoabriefpainstressor:Latency,localizationandindependenceeffects.Physio.Res.58757-761In:Russell,E.,Koren,M.R.,VanUum,S.(2011)Haircortisolasabiologicalmarkerofchronicstress:Currentstatus,futuredirectionsandunansweredquestions.Psychoneuroendocrinology37589-601Sherman,B.,Wysham,W.,Pfoh,B.,(1985).Age-relatedchangesinthecircadianrhythmofplasmacortisolinman.TheJournalofClinicalEndocrinology&Metabolism.613:439-443Simpson,M.,(2013)Anintegratedapproachtodeliveringpersonalisation,orapersonalisedapproachtodeliveringintegration.HousingLIN(learningandimprovement)Viewpoint44[Availableon-line]http://www.housinglin.org.uk/[AccessedOctober2013]Sixsmith,J.,Fang,M.L.,Woolrych,R.,Canham,S.,Battersby,L.andSixsmith,A.,(2016)Place-makingwitholderpeople:buildingpartnershipstoachievemeaningfulaffordablehousing.InvitedPresentationBritishPsychologicalSociety(BPS)AgeinginPlace:IndependenceandCommunities,Keele,UK,10February2016.[Availableon-line]http://www.caeh.ca/wp-content/uploads/2014/11/RP2_Woolrych-and-Fang.pdf[AccessedApril2016]SmithJ.A.,(1996)Beyondthedividebetweencognitionanddiscourse.PsychologyandHealth261-271Soravia,L.M.,Heinrichs,M.,Aerni,A.,Maroni,C,Schelling,G.,Ehlert,Ul,Roozendaal,B.,deQuervain,D.J.,(2006)Glucocorticoidsreducephobicfearinhumans.ProceedingoftheNationalAcademyofSciencesoftheUnitedStatesofAmerica103145585-5590In:Steudte,S.,Stalder,T.,Dettenborn,L.,Kumbies,E.,Foley,P.,Beesdo-Baum,K.,Kirschbaum,C.,(2011).Decreasedhaircortisolconcentrationingeneraliseanxietydisorder.PsychiatryResearch.186310-314StaintonRogers,R.,Stenner,P.,Gleeson,K.,StaintonRogers,W.,(1995)SocialPsychology:ACriticalAgendaISBN0745611834Blackwell:CambridgeStalder,T.,Kirschbaum,C.,(2012).Analysisofcortisolinhair–Stateoftheartandfuturedirections..Brain,Behavior,andImmunity.261019-1029Starks,H.,andBrownTrinidad,S.,(2007)Chooseyourmethod:Acomparisonofphenomenology,discourseanalysis,andgroundedtheory.QualitativeHealthResearch17,10:Dec20071372-1380 300

Bibliography

Stevens,J.(2013)Growingoldertogether:Thecaseforhousingthatisshapedandcontrolledbyolderpeople.HousingLIN(learningandimprovement)CaseStudyReport.London:EAC.[Availableon-line]http://www.housinglin.org.uk/[AccessedOctober2013]Staufenbiel,S.M.,Penninx,B.W.J.H.,Spijker,A.T.,Elzinga,B.M.,VanRossum,E.F.C.,(2012)Haicortisol,stressexposure,andmentalhealthinhumans:Asystematicreview.Psychoneuroendocrinology381220-1235Steudte,S.,Stalder,T.,Dettenborn,L.,Kumbies,E.,Foley,P.,Beesdo-Baum,K.,Kirschbaum,C.,(2011).Decreasedhaircortisolconcentrationingeneraliseanxietydisorder.PsychiatryResearch.186310-314Steudte,S.,Miller,R.,Skoluda,N.,Dettenborn,L.,Kirschbaum,D.,(2012).Intraindividualstabilityofhaircortisolconcentrations.SciVerse37602-610Stewart.R,Prince,M.,Harwood,R.,Whitley,R.,Mann,A.,(2002)Qualityofaccommodationandriskofdepressioninlaterlife:AnanalysisofprospectivedatafromtheGospelOakproject.InternationalJournalofGeriatricPsychiatry171091-1098Stowell,J.R.,Kiecolt-Glasaer,J.K.,Glaser,R.(2001)Perceivedstressandcellularimmunity:Whencopingcounts.JournalofBehavioralMedicine.244Sutherland,J.,(2013)Puttingtenantsatthecentre:Integratingspecialistservicestoenabletenantstoliveindependently.HousingLINcasestudy70.[Availableon-line]www.housinglin.org.uk][AccessedOctober2013]Sutherland,J.,(2010)ViewpointonDownsizing.HousingLIN(learningandimprovementnetwork)Viewpoint17[Availableon-line]www.housinglin.org.uk[AccessedOctober2014] Sweing,D.,andWilletts,M.,(2012)AttitudestoageinBritain2010/2011.London:DepartmentforWorkandPensions:DWPin-houseresearchno.7HMSOTerry,D.J.,&O’Leary,J.E.,(1995)Thetheoryofplannedbehaviour:Theeffectsofperceivedbehaviouralcontrolandself-efficacy.BritishJournalofSocialPsychology34199-220Terry,R.,andGibson,R.,(2012).Assessmentofequityreleasepilotschemes.JosephRowntreeFoundation:York[Availableon-line]https://www.jrf.org.uk/report/assessment-equity-release-pilot-schemesAccessedMay2016Terry,R.,(2015)Gettingdowntoit:Apossiblewayoffacilitatingdownsizingforolderpeople.CharteredInstituteofHousing(CIH).[Availableon-line]PracticeBriefingforHousingLIN(learningandimprovementnetwork)www.housinglin.org.uk[AccessedOctober2015]

301

Bibliography

TetlowKingplanning,(2016)StarterHomesconsultationandimpactonretirementhousing.BriefingforHousingLIN(learningandimprovementnetwork)[Availableon-line]http://www.housinglin.org.uk/_library/Resources/Housing/OtherOrganisation/Starter_Homes.pdf[AccessedApril2016]ThisisMoney,(2016)Couldthisspelltheendofmortgageageism:BuildingSocietiessettorelaxagecaponmoreloans.Inon-linepress:http://www.thisismoney.co.uk/money/mortgageshome/article-3310288/Could-end-ageism-mortgage-lending.html[AccessedApril2016)Tversky,A.andKahneman,D.(1974)Judgementunderuncertainty:HeuristicsandbiasesScience1851124-1131Ukgovernment,(2012).Housingrevenueaccountreform.[Availableonline]https://www.gov.uk/government/policies/improving-the-rented-housing-sector--2/supporting-pages/housing-revenue-account-reform-self-financingVardi,A.,(2009)Humanuniquenessandthedenialofdeath.Nature4607256-7268Victor,R.,Bowling,A.,(2012)ALongitudinalanalysisoflonelinessamongolderpeopleinGreatBritain.TheJournalofPsychology1463313-331Viney,L.L.,Benjamin,Y.N.,Preston,C.A.,(1989)Anevaluationofpersonalconstructtherapyfortheelderly.BritishJournalofMedicalPsychology.6235-41Wanous,J.P.,Keen,T.L.,&Latack,J.C.(1983).Expectancytheoryandoccupational/organizationalchoices:Areviewandtest.OrganizationalBehaviorandHumanPerformance3266-86.Walton,D.,(1996)ArgumentSchemesforPresumptiveReasoning.1996.ErlbaumNJWatts,T.,(2014)Safe,warm,decenthousingforolderpeople–whyitreallymatters.HousingLIN(learningandimprovementnetwork)Viewpoint64[Availableon-line]www.housinglin.org.uk[AccessedOctober2015]Weber,R.P.,(1990)BasicContentAnalysis(extract).BeverlyHills,CA:SageWeijters,B.,Geuens,M.,(2006).Evaluationofage-relatedlablesbyseniorcitizens.PsychologyandMarketing,239:783-798Wilcox,S.,Perry,J.,Stephens,M.,Williams,P.,(2016)UKHousingReview2016.CIH(CharteredInstituteofHousing)[Availableon-line]http://www.cih.org/resources/images/publications/UKHR%20Briefing%202016.pdf[AccessedMay2016]

302

Bibliography

Williams,S.,(2013)BuildingPositiveFuturesinThurrock.HousingLIN(learningandimprovementnetwork)CaseStudy72.[Availableon-line]www.housinglin.org.uk[AccessedOctober2013]Wilson,K.,Mottram,P.,Sixsmith,A.,(2007).Depressivesymptomsintheveryoldlivingalone:prevalence,incidenceandriskfactors.Internationaljournalofgeriatiricpsychiatry224:361-366WiltshireCouncil,(2015)GoodNeighbourSchemebiannualreport.[Availableon-line]http://www.communityfirst.org.uk/attachments/article/1644/GNS%20-%20Bi-annual%20Report%20Apr%202015%20-%20Sept%202015.pdf[AccessedMay2016]

WiltshireCouncil,(2016)GoodNeighbourSchemeclosurenotification[Availableon-line]http://www.communityfirst.org.uk/community-first-services/access-and-well-being/good-neighbours-scheme[AccessedMay2016]

Windle,G.S.,Burholt,V.,Edwards,R.T.,(2006).Housingrelateddifficulties,housingtenureandvariationsinhealthstatus:evidencefromolderpeopleinWales.Health&Place12267-278Woolfe,RandDryden,W.,(1996)HandbookofCounsellingPsychologySage:LondonWosu,A.C.,Valdimarsdottir,U.,Shields,A.E.,Williams,D.R.,Williams,M.A.,(2013)Correlatesofcortisolinhumanhair:implicationsforepidemiologicstudiesonhealtheffectsofchronicstress.AnnalsofEpidemiology23797-811Wrosch,C.,andHeckhausen,J.,(2002)Perceivedcontrolofliferegrets:Goodforyoungandbadforoldadults.PsychologyandAging17340-350In:Choi,N.G.,Jun,J.,(2009).Liferegretsandprideamonglow-incomeolderadults:Relationshipswithdepressivesymptoms,currentlifestressorsandcopingresources.AgingandMentalHealth132:213-225Wust,S.,Federenko,I.,Hellhammer,D.H.,Kirschbaum,C.,(2000)Geneticfactors,perceivedchronicstress,andthefreecortisolresponsetoawakening.Psychoneuroendocrinology25707-720Yap,S.D.Y.,Anusic,I.,Lucas,R.E.,(2012)Doespersonalitymoderatereactionandadaptationtomajorlifeevents?EvidencefromtheBritishHouseholdPanelSurvey.JournalofResearchinPersonality46477-488Yardley,L.,(2000)Dilemmasinqualitativehealthresearch.PsychologyandHealth15pp215-228Zaninotto,P.&Steptoe,A.,(2004)Healthdomaintables.EnglishLongitudinalStudyofAgeingELSAreport12UCL:London[Availableon-line]www.ifs.org.uk/elsa/report12/rf3.pdf

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