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Index A Activities of daily living, 106, 111, 117, 121, 165 American Institute of Architects, research on housing for elderly persons, 3 American National Standards Institute, standards for facilities for the physically handicapped, 3, 226 Annual Housing Survey, 158, 159, 164 Architectural Barriers Act, 180 B Black elderly age composition of population, 58-59, 63 dwelling-use problems, incidence, 139 economic status, 5 educational levels, 5 gender composition of population, 59-60 with housing deficiencies, 137-139 population growth, 58 problems in demographic tracking of, 56, 60 regional distribution of, 63 survivorship rates, 59 Bureau of the Census low-mortality projections, 97 middle-mortality/middle-fertility projections, 94-96 Byerts, Thomas O., 2 C Community-based housing implementation issues, 134 long-term care and, 12, 100 support services for, 14, 34 Comparative Study of Midwestern Retirement Communities, 123, 125 Congregate housing Beverly Hills, California, project, 240-242 Captain Eldridge Congregate House, 222-223, 242-243 characteristics, 29, 153-154 community-based services in, 34, 38, 143, 147, 152, 155-156, 161 costs, 13, 154, 161-162 demand for, 99 demonstration programs, 11, 147, 154-155 design determinants, 21 design problems, 226 effectiveness, 154,155, 161-162 FHA insurance of, 143 long-term care through, 154 prevalence, 29 281

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282 D problems, 155-156 small-scale, 30, 222-223, 242-243 state programs, 154 transportation services, 187 Demography of aging cohorts aggregates of concern in, 42-47 aging in, 50-51 components of change in, 49-51 data deficiencies, 6 economic status, 1, 4-6, 16, 26, 44-45 educational attainment, 1, 4-6, 16 health status trends, 1, 16 index of redistribution, 61 policymaking applications of, 36-37, 43-44, 46, 104 problems in tracking ethnic/racial groups, 56, 60 projections, 1 retirement trends, 16 sources of data on the old old, 74 see also Elderly populations Design, see Environmental design Disability/disabled elderly adaptation of housing for, 117-118, 121, 127 affordability of housing for, 141 age and, 27-29,107,110 cognitive, 107,118, 210-211 community awareness of, 127 disease-related, 107-108, 119 functional, 22, 106-108, 111-120 gender differentials in, 107, 110 housing entitlement and, 28-29 links to socioeconomic resource deficiencies, 118 and living arrangements, 111, 116- 117, 121 longevity and, 1, 22,108-110 measures of, 106, 120, 138 and mobility, 40, 170 projections, 108-110 retarding transition to, 116 risk markers for, 115-116 screening methods, 106, 120, 138, 210-211 severe, 112 see also Health status; Vulnerability/ vulnerable elderly Dwelling modifications costs, 156-157 INDEX effectiveness in delaying institutionalization, 129, 136, 138-139, 156, 159 federal assistance for, 143, 144, 145, 149, 150-152 goals, 201 incidence of, 117-118, 157-158 nonstructural adjustments, 123, 157 perceived need for, 114 purpose of, 13 qualification criteria for, 30 quality-of-life enhancement through, 32, 121 research and demonstration efforts/ needs, 38,118, 227 supportive service reduction through, 140-141 Swedish housing policy, 20, 199 types, 158 EEconomic status age differentials in, 82-84, 91 attitudinal effects of changes in, 37 demographic trends, 1, 4-6, 16, 26, 90 and dwelling-specific problems and solutions, 12, 150-151 educational attainment and, 82 and equity in services, 99-100, 104, 116, 128-129, 213 factors affecting, 44, 82 gender differentials in, 82-84 health status and, 90-91, 94 labor force opportunities and, 5 longevity and, 5, 44-45, 94 marital status and, 88 peak income years, 82-85 problem areas, 204 productivity implications, 20 projections, 90, 94,127 quality of life and, 113 savings patterns, 5 see also Poor elderly Educational attainment attitudinal effects of changes in, 37, 82 demographic trends, 1, 4-6, 16, 81-82 economic status and, 82 Elderly persons ability of adult children to care for, 4, 5-6, 88; see also Living

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INDEX arrangements attitudes about service improvements, 186 automobile-related deaths, 186 behavior determinants, 37 chronic diseases, 106; see also Health status computer use by, 21, 210-211 crime victimization, 16, 114, 124, 177-178, 185, 186-187 driving ability, 172-173, 179; see also Mobility exchange of services by, 149, 160-161 home ownership, 8, 12, 32; see also Housing; Living arrangements independence, see Independence of elderly persons isolation of, 15 mobility, see Mobility; Transportation number with housing-related problems, 136 obligation/indebtedness feelings, 176 physical security measures for, 16, 33 relocation to alternative housing, 13, 120, 158, 180 security of familiar surroundings, 14 service needs, see Social support services stereotypes, 172-175, 210, 254 stigmatization of, 181, 214 suprapersonal environment, 37 training programs for, 38 with unmet care needs, 122 volunteer work by, 19, 214, 250, 253 vulnerable, see Vulnerability/ vulnerable elderly Elderly persons (55+) age composition trends, 52-53, 56- 59, 61-63, 80, 95-96 blacks, 58-59, 63 contrasted with old old cohort, 79-92 economic status, 91 educational attainment, 80-81 ethnic/racial differentials, 56-59, 63 gender differentials, 45, 53-55, 79 health status, 90-91 labor force participation rates, 88 mortality rates, 52, 78, 97-98 regional distribution of, 61-63 size of population, 46, 48, 94, 96-98 support of old old by, 44, 88 survivorship, 78, 79 see also New old 283 Elderly persons (65 +) age composition trends, 52, 55-59, 61-64, 66-67, 70, 76-77, 95-96 automobile-related deaths, 186 blacks, 58, 59, 63 co-morbidity, 104 components of population change, 49-50 composition of population, 4-5, 46, 53, 56 disease-related disability in, 107 economic status, 4-5, 91 educational attainment, 4, 81 ethnic/racial differentials, 56-59, 63 functional dependency among, 106 107, 115 gender differentials, 54-55, 70-73? 76-77, 79, 107 as heads of households, 71-73 health status, 90-91, 105-106 with housing deficiencies, 137 in-home service needs, 12, 139 living arrangements, 71-74, 193 longevity of, 50 marital status trends, 68-71 mortality rates, 50, 51, 52, 78, 80, 97-98 occupancy of low-income housing, 9 regional distribution of, 61-67 size of population, 94-95, 97 survivorship, 78, 79 in Sweden, 193 urban-rural distribution of, 64, 66 67 Elderly persons (75 +) age composition trends, 59, 62-63, 66-67, 95 automobile-related deaths, 186 blacks, 59, 60, 63 economic status, 91 educational attainment, 4, 81 ethnic/racial differentials, 57, 59, 63 functional dependency among, 107, 115 gender differentials, 46, 54, 79, 107 global patterns of change, 191-193 health status, 90-91 in-home service needs, 12, 139 marital status trends, 68-69 mortality rates, 78, 97 population growth, 46, 48, 53, 55, 97 regional distribution of, 62-63, 66 67 survivorship, 78, 79

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284 urban-rural distribution of, 66-67 Elderly persons (85 +) age composition trends, 59, 62-63, 66-67, 74-77, 95 blacks, 59, 60, 63 characteristics, 6 data sources on, 74 disease-related disability in, 108 economic status, 6 ethnic/racial differentials, 57-59, 63 family resources to care for, 6, 44, 88, 100 functional dependency among, 107- 109, 115 future differences in cohort composition, 6-7 gender differentials, 6, 46, 53-55, 75-77, 79, 107-109 lack of data on, 6, 74 marital status trends, 68-71 mortality rates, 78, 97 population growth, 6, 46, 48-49, 53, 55, 74-78, 79, 96-99, 104, 110 regional distribution of, 62-63, 66- 67 survivorship, 78-79, 104 in Sweden, 193 urban-rural distribution of, 66-67 vulnerability, 7-8 Elderly populations age composition, 1, 4, 6, 16, 46-47, 51-53, 55, 65-67, 68-69, 95 baby boom cohorts, 94, 130, 214 components of change in, 49-51 definition of, 48 demand determinants, 44 dependency status, 26 determinants of needs of, 4, 12, 44- 45 differentiation between age groups and cohorts, 79-92, 214-215 emigration, 4, 43 ethnic/racial composition, 5, 16, 56- 60, 176; see also Black elderly; Hispanic elderly; Women evolution of, 48-74 family size trends, 90 future characteristics, 215 gender differentials, 1, 5-6, 16, 45- 47, 53-56, 59-60, 68-69, 70-73, 75-77, 79, 82-84 immigration, 4, 43 importance of changes in, 36-37 INDEX I:ivin,~,, arrangement trends, 71-74 longevity, 54, 58, 74, 92 male-to-female ratios, 55, 59, 60, 76 77 marital status trends, 68-71 projected trends, 92-100 public support determinants, 5, 42 45 redistribution of, 45 regional U.S. distributions, 60-64, 65-67 research needs on, 36-37 resource allocation issues, 99-100, 104, 116, 128 size determinants, 4, 43-44 size distribution, 46-47, 48, 94 studies of, 2-3 survivorship, 4, 6, 44, 51, 59, 78-79 urban-suburban differences, 64-67, 174-175 see also specific populations Environmental design adaptable housing, 13, 32, 114, 226- 227, 264-265; see also Dwelling modifications age-irrelevant, 32-33 age-targeted, 33 application gap between designers and researchers, 219-220 autonomy and self-determination in, 262 barrier-free, 226-227 behavioral research and, 218-225 branch arrangements, 231-232 budgetary constraints, 246 communication of research, 223-225, 226, 243-245, 247 of community for enhancing the productivity of elderly people, 263-267 congregate housing, 21, 222-223 corridor arrangements, 231-232 cul-de-sac arrangements, 231-232 development spiral, 220-221 empathetic model, 228-229 expertise, lack of, 246-247 failures, 225 gerontological material, 3 impediments to, 22, 223-225, 245- 247 life-span perspective, 31-33, 37, 129 light diffusion, 227-228 management and, 237-239

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INDEX manufacturers' hesitancy to adopt, 246 neighborhood setting considerations, 21, 234-237 physiological considerations, 225- 227 postoccupancy evaluations, 21, 222- 223, 224-225, 226, 228, 245 primary pathways, 230-231 privacy in, 262-263 productivity maximization in, 260- 267 professional recognition-for research, 223-225 publication of behavioral impacts of, 224-225, 244 redundant cueing, 229 regulatory conflicts in, 22, 245-246 for safety, 210 sensory aspects, 227-229 of shared spaces, 230-232, 260 for social interaction/exchange, 230- 231, 262-263 standards, 3, 226 studies, 2-3, 239-243 training, 243 types of information used in, 220-221 user-friendly, 21, 32, 33 way-finding, 231-234 Environmental Design Research Association, 3, 218 F Federal Housing Act of 1964, Section 202, 9 Federal Housing Administration home equity conversion mortgages, 145, 153 mortgage insurance, 143 private market-facilitating programs, 143 Federal housing policies age equity issue, 28, 31, 35 aims, 201, 205-206 choice maximization criterion, 149, 201 cost-effectiveness criterion, 148-149 current, 27,142-148, 162 definition of entitlement, 28 design of, 148-163 flexibility needed in, 12, 149 historical trends, 8-11, 26-27 285 life-span perspective, 31-33 major issues, 30-35, 134, 162 population issues, 37, 130 projections, 11, 129 Federal housing programs alternatives for marginally independent individuals, 30 budget cuts and, 10, 14 community development block program, 145 congregate housing services program, 147, 154-156 deficiencies in, 9 demand for, 9 demonstration projects, 38, 147, 154 156 design and range of, 134-135 entitlement to, 9, 27-29, 145-146 financing arrangements with local governments, 9 future trends, 10 gaps in, 143 home adaptation assistance, 30 integration of support service programs, 9-10,14, 29-30,119, 143, 146, 147, 149 mechanisms, 9 needs, 14 new construction, 9-10, 20, 26, 27, 28, 145, 201 open-enrollment voucher program, 146 participation rates, 145-146 private market-facilitating programs, 143 Pruitt-Igoe development, 225 rental assistance, 9 repair and maintenance, 30 Section 202, 27, 145, 147 studies of, 2, 230 subsidies, 8-9, 28, 30, 31, 35, 145, 146, 153 target populations, 8-9, 35 units provided, 9, 146-147 weatherization and fuel payment assistance programs, 145 see also Dwelling modifications; Housing; Low-income housing Financial status, see Economic status G Gerontological Society of America,

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286 H Health care research on aging-related environment, 2-3, 219-220 assessments of requirements for, 104, 119 capitated systems, 213, 239-240 for chronically sick people, 196-197, 200, 202 costs, 11, 251 demand determinants, 110 demographic determinants of needs. 45 end-stage renal disease, 212 entitlement to, 27 equity questions, 213 in-home, 20 policy role in shaping disability profile, 110 preventive technologies, 209 psychiatric institutions, 198 quality-of-life improvements, 212 rationing, 208-209, 212, 213 in residential communities, adequacy of, 124-125 resource allocation, 110, 116, 119 strain on caregivers, 251, 258 in Sweden, 196-198 transplants and biomedical implants, 208-209, 211-212 see also Long-term care Health Care Financing Administration, 106 Health status age and, 91 assessment of, 105-106 changes, causes and effects of, 110 chronic diseases, 106 demographic trends, 1, 16, 90-91 and housing policy, 35 income and, 90-91 indicators, 91 longevity and, 91-92, 108-109, 215 projections, 94 rates of change, 7, 26-27 retardation of functional loss, 7, 103, 125 scales of functional disability, 106 sensory losses, 227, 228-229 variation in, 27 see also Vulnerability/vulnerable elderly INDEX Hispanic elderly problems in demographic tracking of, 56 Housing accessory apartments, 153 age-focused, 123 age-irrelevant, 32-33 alternative, relocation to, 13, 120, 123, 158, 180 board-and-care facilities, 143, 153 changes, factors motivating, 125-126 community-based, 12,14, 34,100,134 costs, 13, 15, 175 deficiencies, 137-138,141,144, 150- 151, 163-164 design, 2, 3,13, 21-22, 32-33,149 determinants of needs, 5, 6-7, 12, 43- 45 dwelling-specific problems/needs, 12, 135-138, 141-144, 148, 150, 163 dwelling-use problems/needs, 12, 136, 138-142, 148, 163 excessive expenditures on, 136-137, 138, 144, 148, 163 gender differentials in needs, 139 goals, 201 granny flats, 34, 153 group homes, 153, 159-161 health component in, 30 institutionalization because of lack of, 197 intermediate residential models, 27 life care centers, 143 life safety codes, 210 life-span perspective, 31-33, 37, 129 maintenance and repairs, 12, 14, 30, 38, 150, 201 management of, 237-239 match-up services, 38, 145 minimum quality levels, 28-29 minority differentials in needs, 139 mobility and, 15, 114, 185-188 modification/adaptation of dwellings, see Dwelling modifications needs, 12,135-143, 149 neighborhood setting, 21, 234-237 old-age homes, 18, 26, 74, 193, 195- 196, 198, 200 pensioners' flats, 18-19, 194-195 pensioners' homes, 193-195 policies, see Federal housing policies programs, see Federal housing programs prosthetic effects assessment, 124

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INDEX quality of life and, 113, 124 research needs on, 37-38, 185-188 retirement communities, 123-126, 127, 187, 239-240 service blocks, 19, 38, 193, 194-196, 197 service flats, 194-195 shared, 13, 38,153,159-161 state and local government interventions, 152-153 strategies for improving, 150-152 studies of, 2, 3, 21 support services linked with, 19; see also Social support services in Sweden, 14, 17-20, 193-198 user-friendly designs, 21, 32, 33 veterans' homes, 73 see also Congregate housing; Low- income housing Housing Act of 1937, 9 Housing and Community Development Act, 184 Independence of elderly persons barriers to, 34, 204 cultural interpretations, 17-18, 192 in living arrangements, 7, 13, 15, 18, 149 policy needs, 20, 33-34 prevalence, 118 private sector promotion of, 11 research needs on, 37 self-supporting communities, 22-23, 254-257 strategies to enhance, 15, 22-23, 149; see also Dwelling modification Swedish policy, 192, 194, 199 Instrumental activities of daily living, 106-107, 111, 117, 121, 165 J Japan cultural norms for care of parents, 18, 192-193 L Labor force participation age differentials in, 85-87 future patterns, 88 gender differentials, 5, 6, 85-87, 90 287 influence of needs of elderly, 45 opportunities, 5 travel and, 171 Living arrangements with adult children, 4, 31, 37, 44, 71 73, 128 alone, 111,116,118,139-140, 172 barriers to care in, 126 determinants of, 18, 45 disability by type of, 111 gender differentials in, 71-74, 160, 194 global differences in, 192-193 gradient of need across types of, 112 head-of-household trends, 71-73 independence in, 7, 13, 15, 18, 37 nonhousehold facilities, 73-74 with nonrelatives, 71-73, 111, 113, 116 quality of, 112, 116-117 with relatives, 5, 71-73, 111, 113, 116, 128; see also Marital status research needs on, 37 retirement communities, 123-126, 127, 187, 239-240 satisfaction with, 32, 124, 161, 234, 251 shared, 112 social service needs by type of, 121 122 studies of, 2 trade-offs in, 118 unmet needs by type of, 112 see also Housing; Physical environments Long-term care community-based, 11,12, 27, 30, 119, 122, 154 costs, 13, 22, 99, 161 demand for, 8, 92, 99, 122 experimentation with, 27 familial resources for, 6, 44, 88, 90 in-home, 199 institutional, 119,139,142, 195-199; see also Nursing homes longevity and, 92-93, 99 public policies, 26, 27, 122 responsibility for providing, 90, 99, 122 unmet needs for, 8, 112, 122 Longevity as determinant of population needs, 4, 5 disability and, 1, 22, 108-110

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288 economic status and, 5, 44-45 ethnic/racial differentials, 58 gender differentials in, 54, 58, 74, 94 health status and, 91-92, 108-109, 215 mobility and, 177 population size and, 50 productivity implications, 20 projections, 94, 96 vulnerability and, 7 Low-income housing federal initiation of, 8 occupancy rates, 9 private/philanthropic initiatives, 10 state and local government contributions to, 10 M Marital status age and, 70 composition of elderly populations, 5, 45, 68-69 economic status and, 88 gender differentials in, 70 mobility and, 171, 176 and satisfaction of functional care needs, 111,113,116-118, 122, 128, 159, 252 Medicaid entitlement to, 27 savings through in-home programs, 11 waiver for homeowners, 150-152 Medicare end-stage renal disease coverage, 212 N savings through in-home programs, 11 Minorities demographic trends, 16 see also Black elderly; Hispanic elderly Mobility ability to drive, 172-173, 179, 185 186 age and, 171 car ownership, 16-17, 173-174, 179 costs, 15, 188 definition, 15 disability and, 40 door-to-door services, 188 within dwellings, 114 gender differentials in, 173 INDEX housing location and, 15, 175-180, 185-188, 235-237 industrialization and, 18, 169-170, 193 inner-city, 15,175-178, 179 life style and, 17 longevity and, 177 migration, 37, 45, 49-50, 176 national policy on, 180-185 needs, 172-175, 180-185 patterns, 60-67, 70,172 planning for, 15 problems, 175-180, 235-237 and quality of life, 169 requirements, determinants of, 17 research needs on, 40, 185-188 spontaneity in, 176, 178 travel pattern assessments, 17, 170- 172 see also Transportation Mortality rates age and, 4, 53, 70, 75-76, 78, 96-98 areal differentials in, 45 consequences of reduction in rates, 78-79 crossover effect, 58 as determinant of population needs, 4,44,45,92 ethnic/racial differentials, 58 gender differentials, 70, 79, 122 independence and, 4 projections, 93, 96 survivorship and, 4, 44, 78 trends, 50-52, 75-76 National Center on Housing and Living Arrangements for Older Americans, 3 National Health Interview Survey, 139, 165 National Long-Term Care Survey assessment of functional capacity, 106 unmet functional dependencies, 112, 118 Nationwide Personal Transportation Study, 171, 172 New old age differentials, 6 contrasts with behavior and needs of old old, 79-90

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INDEX economic status, 6 educational level, 6 gender differentials, 6, 88 labor force participation rates, 88 mortality rates, 78 support of old old by, 44, 88, 100 survivorship, 78 Nursing homes alternatives, 160; see also Dwelling modifications demand for, 113, 251, 258 federal policies concerning, 2, 26, 27, 122, 143 FHA insurance of, 143 projected population, 92, 93, 99 social supports, 119 in Sweden, 197, 200 o Old old, see Elderly persons (85 +) Older Americans Act, 27, 184 p Physical environments challenge vs. security, 33 choice maximization, 34-35, 149 Quality of life critical aspects, 225 cross-national perspectives on, 190 206 design, see Environmental design homogeneity of status, 263 impediments to care in, 126 inner-city, 15,174-178, 188 neighborhood dynamics, 34, 175, 234-237 physiological barriers, 225-226 planned communities, novel framework for, 255-267 quality of life and, 113 retirement communities, 123-126, 239-240 security measures in, 16, 34, 124-125 shared spaces, 230-231 strategies for improving, 127; see also Environmental design suburban, 15,174-175, 179-180 way-finding in, 231-234 Poor elderly adequacy of housing for, 40 demographic trends, 1, 5, 16 expenditure burdens on housing, 138 289 gender differentials, 5 housing strategies for, 35 old old, 6 public support, 5, 143 quality-of-life policy dilemmas, 30- 31, 35 Productivity of elderly people barriers to, 253, 260 community framework for enhancing, 22-23, 160-161, 254- 267 concept, 252-254 economic status and, 20 economic strategies for increasing, 22-23, 254-257, 259, 263 housing and, 250 importance of, 252 lack of data on, 250 living arrangements and, 250 longevity and, 20 research needs on, 22, 39, 253-254 social/organizational strategies, 22- 23, 149, 160-161, 257-259 Psychiatric institutions, 198 Q R components of, 104, 124-125 deficiency index, 8, 113-115 for healthy low-income elderly, 30-31, 35 housing design adaptations and, 32, 114 in-home services to enhance, 11 mobility and, 169 policy dilemmas, 30-31, 35 technology and, 21 Recreation and leisure demographic determinants of demand, 45 new technology for, 211, 215-216 Research on elderly environments adaptive housing modifications, 118 community-based long-term care, 27 current framework, 3-23 dissemination of results, 203, 223- 225, 226, 243-244, 247 empathetic model, 228-229 goals, 202-203, 205, 251

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290 housing/mobility trade-offs, 185-188 housing programs, 37-38, 39, 147, 154-156, 160, 201 interdisciplinary nature of, 36 methods development, 202-203 needs, 36, 160, 230, 247 population issues, 36-37 previous studies, 2-3 productivity of older people, 39 relocation trauma, 233-234 social prerequisites, 200-202, 230- 231 technological improvements, 38-39 transportation, 40 through volunteerism, 250 vulnerable aged, 39-40 way-finding, 233-234 see also Environmental design Retirement age trends, 6, 45, 88 communities, 123-126, 239-240, 255-267 decisionmaking, 5, 211 early, 211, 214, 252, 254 gender trends, 16 reasons for, 211, 214, 250, 252, 254- 255 satisfaction with, 252 stereotypes about, 254-255 transportation needs and, 17, 173 S Social environments design enhancement of, 230-231 of disabled elderly, definition of, 111 life style and mobility patterns, 17 neighborhood setting, 21, 114 problem areas, 204 productivity strategies for, 149, 160- 161, 257-259 quality of life and, 113, 124 Social Security Act, 27, 184, 212 Social Security Administration Comparative Study of Midwestern Retirement Communities, 123, 125 Social Security benefits program early retirement and, 254-255 effect on poor elderly, 5 increases in, 85 viability, 47 Social support services INDEX access to, 8, 15, 29, 176-177, 188, 235-237, 263 automated home care, 210 community-based, 8, 23 congregate housing services program, 147, 150-151 determinants of needs, 5, 12, 139-140 eligibility standards, 119 exchange of, by elderly persons, 149, 160-161, 257-259 federal housing and, 9-10, 142 formal, 120,121-122,139-140, 148, 162 . goals of, 201-202 informal, 120-121,139-140,148, 162, 202 in-home, 11-13, 34,148,188,195, 199, 201-202 integration with housing programs, 29-30, 119, 143, 146, 147 need for, 12-13, 165 nursing services, in-home, 199-200 personal care, 113, 121, 199 planning for, 5, 38, 150-151 quality of life and, 113, 125 reducing demand for, 121 in service blocks, 195 in Sweden, 195, 199-200 unmet needs, 10, 30, 113 Steinfeld, Edward, 3 Sweden cultural norms for care of parents, 18, 191-193 health care, 196-198 housing policy, 14, 19-20, 190, 193- 195, 198-200, 204 in-home services, 34, 199-200 institutional population, 195-198 living arrangements for elderly, 18- 19 psychiatric care, 198 T Technology, new accessibility, 38-39 computer applications, 21, 210-211, 215-216 forecasts of change, 210, 211-214 health-related, 208-210, 211-212 housing applications, 21-22 implications of, 211-214 interaction of older persons with, 38

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INDEX for leisure and recreation, 211, 215- 216 obsolescence of older workers, 213- 214 and quality of life, 21, 38, 212 research needs on, 38-39, 216 supplying and financing responsibilities, 207-208 value questions, 209-210 Transportation access to, 15, 176-177, 180 by automobile, 170, 172-174, 176, 177, 184, 187 car ownership, 16-17, 173-174, 179 concerns, 32 cost and cost-benefit issues, 40, 175, 182, 184, 185, 188 crime victimization and, 177-178, 185 dependency on friends and relatives, 15-16, 176, 178 design, 210 determinants of needs, 17 evolution of, and urbanization, 169 170 fare reductions, 183-184, 185 federal assistance for, 183-184, 187 inner-city, 15-16,174-178,179, 188 mainstreaming vs. door-to-door service, 181-185 national policy on, 180-185 neighborhood dynamics in planning for, 40 physical barriers, 16, 177, 180-181, 183, 185, 186 public transit, 15-16, 172, 176-178, 180, 182-183, 186-187 research projects and needs, 3, 40 security in, 16, 33 social/psychological barriers, 186-187 social services sector, 184-185 specialized paratransit services, 17, 183-184, 185, 187 suburban, 179-180 taxis, 176 voucher approach, 40 wheelchair access, 180, 182 work-oriented, 17 U Urban Mass Transportation Act of 1964, 180 U.S. Administration on Aging 291 research on aging-related environments, 2, 3 U.S. Department of Health and Human Services lack of integration of services, 29-30 U.S. Department of Housing and Urban Development congregate housing services program, 147, 154-156 integration of services, 29-30, 147- 148 research on aging, 3 role in evaluating housing strategies, 163 targeting of services for older persons, 38 U.S. Department of Transportation Urban Mass Transportation Administration survey, 177 V Volunteers elderly persons as, 19, 214, 250, 253 home-help program, 14 Vulnerability/vulnerable elderly age and, 7,103 alternative care pathways, 39 assessment of, 7 community awareness of, 127 disability, 111-113 environmental deficiencies and, 114- 115 environmental responses to, 122-123, 125 functional dependency, 7, 103, 105- 111, 125 home-help program, 14 housing for, 12 in-home supportive services for, 13- 14 living arrangements, 111-112 long-term care for, 12 longevity and, 1, 7 markers of, 7-8, 104, 111-119 measurement problems, 113 mobility of, 15, 179-180, 186 multidimensionality of, 114, 120 policy issues concerning, 31, 39-40 research needs on, 39-40 service responses to, 120-122 size of population, 29, 127 during travel, 178 unmet needs, 30

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292 W Women demographic trends, 1 dwelling-use problems, incidence, 139 economic status, 5, 82-84 fertility trends, 89, 94 functional disability projections, 109 labor for participation, 85-86, 90 INDEX licensed drivers, 173 living arrangements, 71-73, 160 longevity, 54, 58, 74, 94 marital status trends, 70 mortality rates, 70, 79 ratios of men to, 55, 59, 60, 76-77 retirement age trends, 16