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AMERICA'S AGING
The Soci
In
al and Baill
Environment
lea
Committee on an Aging Society
ply
Institute of Medicine and National Research Council
NATIONAL ACADEMY PRESS
Washington, D.C. 1988
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National Academy Press · 2101 Constitution Avenue, NW · Washington, DC 20418
NOTICE: The project that is the subject of this report was approved by the
Governing Board of the National Research Council, whose members are drawn
from the councils of the National Academy of Sciences, the National Academy
of Engineering, and the Institute of Medicine. The members of the committee
responsible for the report were chosen for their special competences and with
regard for appropriate balance.
This report has been reviewed by a group other than the authors according to
procedures approved by a Report Review Committee consisting of members of
the National Academy of Sciences, the National Academy of Engineering, and
the Institute of Medicine.
The Institute of Medicine was chartered in 1970 by the National Academy of
Sciences to enlist distinguished members of the appropriate professions in the
examination of policy matters pertaining to the health of the public. In this,
the Institute acts under both the Academy's 1863 congressional charter respon-
sibility to be an adviser to the federal government and its own initiative in
identifying issues of medical care, research, and education.
This study has been supported by funds from the National Research Council
Fund, a pool of private, discretionary, nonfederal funds that is used to support
a program of Academy-initiated studies of national issues in which science and
technology figure significantly. The NRC Fund consists of contributions from a
consortium of private foundations including the Carnegie Corporation of New
York, the Charles E. Culpeper Foundation, the William and Flora Hewlett
Foundation, the John D. and Catherine T. MacArthur Foundation, the Andrew
W. Mellon Foundation, the Rockefeller Foundation, and the Alfred P. Sloan
Foundation; the Academy Industry Program, which seeks annual contributions
from companies that are concerned with the health of U.S. science and technol-
ogy and with public policy issues with technological content; and the National
Academy of Sciences and the National Academy of Engineering endowments.
The study was also supported by the Charles A. Dana Foundation and the
Retirement Research Foundation.
Library of Congress Cataloging in Publication Data
Committee on an Aging Society (U.S.)
The social and built environment in an older society / Committee
on an Aging Society, Institute of Medicine and National Research
Council.
p. cm. - (America's aging)
Bibliography: p.
Includes index.
1. Aging-United States-Social conditions-Congresses. 2. Aged-
Services for-United States-Congresses. 3. Quality of life-
United States-Congresses. I. Title. II. Series.
HQ1064.USC535 1988
305.2'6'0973-dcl9
ISBN 0-309-03780-8
Cover photograph: (I) by Ron Blakeley/UNIPHOTO.
Printed in the United States of America.
88-17837
CIP
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COMMITTEE ON AN AGING SOCIETY
FREDER~cK C. Rosins (Chairman), Professor Emeritus, Case
Western Reserve University School of Medicine, Cleveland,
Ohio
LAWRENCE K. ALTMAN, Medical Correspondent and "The
Doctors' World" columnist, The New York Times, New York,
New York
WILLIAM G. BELL, Professor Emeritus, Institute on Social
Research, Florida State University, Tallahassee, Florida
ROBERT H. BINSTOCK, Henry R. Puce Professor of Aging,
Health, and Society, Case Western Reserve University School
of Medicine, Cleveland, Ohio
A~ExANDER M. CAPRON, Norman Lopping Professor of Law,
Medicine and Public Policy, University of Southern
California, Los Angeles
CARRo~ L. ESTES, Chairman, Department of Social and
Behavioral Sciences, School of Nursing, University of
California, San Francisco
JAcos d. FELDMAN, Associate Director for Analysis and
Epidemiology, National Center for Health Statistics,
Hyattsville, Maryland
JOSEPH HENRY, Associate Dean, Professor, and Chairman,
Department of Oral Diagnosis and Radiobiology, Harvard
School of Dental Medicine, Boston, Massachusetts
M. Powers LAWTON, Philadelphia Geriatrics Center,
Philadelphia, Pennsylvania
F. PETER LIBASSI, Senior Vice-President, Travelers Insurance
Company, Hartford, Connecticut
Rosen L~NDHE~M,* Professor of Architecture, College of
Environmental Design, University of California, Berkeley
THOMAS W. Mo~oNEY, Senior Vice-President, The
Commonwealth Fund, New York, New York
JAMES N. MORGAN, Program Director and Professor of
Economics, Survey Research Center, University of Michigan,
Ann Arbor
GEORGE C. MYERS, Professor of Sociology and Director, Center
for Demographic Study, Duke University, Durham, North
Carolina
*Deceased.
· · -
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iv
COMMITTEE ON AN AGING SOCIETY
BERNICE L. NEUGARTEN, Professor of Education and Sociology,
School of Education and Social Policy, Northwestern
University, Evanston, TIlinois
ALAN PIFER, President, The Carnegie Corporation of New York,
New York, New York
E~zAsETH Russets, Senior Staff Scientist, Jackson
Laboratories, Bar Harbor, Maine
BERT SEIDMAN, Director, Department of Occupational Safety,
Health, and Social Security, AFL-CIO, Washington, D.C.
T. FRANKLIN Wits, Medical Director, Monroe Community
Hospital, Rochester, New York
M~cHAE~ ZUBKOFF, Professor and Chairman, Department of
Community and Family Medicine, Dartmouth Medical
School, Hanover, New Hampshire
Study Staff
ENR~QuETA C. BOND, Study Director and Director, Division of
Health Promotion and Disease Prevention
LINDA DEPUGH, Administrative Assistant
Consultant
ROGER EGEBERG
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Preface
Substantial increases in the number and proportion of older
persons in the decades ahead portend significant changes in
American society. Indeed, demographic projections of a popula-
tion rapidly growing older have led some observers to character-
ize the United States as an "aging society."
The ways in which an aging society might be a different soci-
ety, in other than demographic characteristics, are not entirely
clear. But it is evident that the changing age distribution of the
population will have major implications, at the very least for
the following:
· financing, development, organization, and use of health care
systems;
· patterns of family life, social relations, cultural institutions,
living arrangements, and physical environments;
· distribution of jobs among older and younger workers, as
well as the earnings, status, and satisfaction that these jobs may
provide, within the context of age discrimination laws, seniority
practices, and technological innovation;
· economic aspects of providing retirement income through
various public and private mechanisms;
· quality of life of the population throughout the life course
including functional status, well-being, legal status, and per-
sonal autonomy; and
· an ever-shifting agenda of related public policy issues.
v
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V1
PREFACE
If we are to deal effectively with these issues, our current under-
standing of the specific implications-for older and younger per-
sons, for age relations, and for the institutions of our society-
must be expanded.
The Committee on an Aging Society was organized to identify
selected issues that need to be confronted, both soon and over
the longer term. Recognizing that many organizations and ad
hoc groups have been addressing a range of issues associated
with aging and with older persons as an age group, the commit-
tee has attempted to emphasize broader societal issues as well.
From among those issues the Committee on an Aging Society
suggests topics that warrant systematic investigations fostered
by the National Research Council, the Institute of Medicine, and
other organizations. It is the committee's belief that such inves-
tigations of these topics will provide a basis for action by policy-
makers in both the private and public sectors.
This volume is the third report in a series, called America's
Aging, in which the committee calls attention to issues that
emerged from symposia convened to explore selected topics.
Other reports or proposed symposia focus on health in an aging
society, productive roles, and legal and ethical issues.
This report summarizes the conferees' recommendations and
the discussions on which they were based and presents the pa-
pers commissioned for the December 1985 Symposium on the
Social and Built Environment in an Aging Society.
FREDERICK C. ROBBINS
Chairman
Committee on an Aging Society
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Acknowledgments
As with many reports issued by the Institute of Medicine, this
report represents the collaborative efforts of the committee, the
project staff and individuals who contributed specific papers in
this report. Several participants at the meeting also contributed
to the report. We wish especially to thank Michael Rodgers, then
Staff Director of the Subcommittee on Housing and Consumer
Interests, Select Committee on Aging, U.S. House of Represen-
tatives, for his contribution on federal legislation on housing for
older persons now part of the first summary chapter. Two com-
mittee members, William G. Bell and M. Powell Lawton, made
major contributions to the planning, convening, and summari-
zation of the symposium. Without their continuing contribu-
tions, this volume would not have been possible.
·e
V11
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Contents
SUMMARY . . . ....
introduction,
Previous Studies, 2
The Current Framework, 3
References, 23
PROPOSALS FOR PoLIcY AND FURTHER RESEARCH
Age an] Disability, 27
Environmental Services an] the Weil-Being
of Older People, 29
Person an] Environment in ~ife-Span
Perspective, 3i
Seif-Determination in Environmental
Decision Making, 33
Research an] Policy Needs, 35
Conclusion, 4i
References, 41
THE DEMOGRAPHY OF CURRENT AND FUTURE
AGING COHORTS ...........................
William J. Serow an] David ~ Sly
ix
.
.
.... 26
.... 42
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x
SOCIAL AND PHYSICAL ENVIRONMENTS
FOR THE VULNERABLE AGED ............
Beth A. Soldo and Charies F: Longino, Jr.
CURRENT AND EMERGING ISSUES IN HOUSING
·
·
ENVIRONMENTS FOR THE ELDERLY ..............
Raymond J. Struyk
THE ROLE OF TRANSPORTATION IN THE SOCIAL
INTEGRATION OF THE AGED ......................
Martin Wachs
CROSS-NATIONAL PERSPECTIVES ON ENVIRONMENTS
FOR THE AGED .................................
Sven Thiberg
TECHNOLOGY AND THE NEW ENVIRONMENT
FOR THE ELDERLY ..............................
Robert L. Kcrne
DESIGN PROBLEMS IN ENHANCING PRODUCTIVITY
AND INDEPENDENCE IN HOUSING FOR THE ELDERLY
Victor Regnier
THE RELATION OF HOUSING AND LIVING
ARRANGEMENTS TO THE PRODUCTIVITY
OF OLDER PEOPLE .................
James N. Morgan
INDEX
CONTENTS
..... 103
... 134
. 169
190
. 207
.. 218
.. 250
.... 281
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.
AMERICA'S AL
GThe Social and Buill
Environment
in an Older Society
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