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Geographical Gerontology: The constitution of a discipline

Gavin J. Andrewsa,�, Malcolm Cutchinb, Kevin McCrackenc,David R. Phillipsd, Janine Wilese

aMcMaster University, CanadabUniversity of North Carolina, USAcMacquarie University, AustraliadLingnan University, Hong Kong

eUniversity of Auckland, New Zealand

Abstract

Health and healthcare have always been central considerations in geographical gerontology. This paper reviews progress

in this part of the field over the past decade (1995–2006) and also looks to the future. It demonstrates how geographical

gerontology is currently constituted of multiple fields of empirical interest studied by multiple academic disciplines.

Specifically, the continuation and development of traditional perspectives on older population health—in terms of

dynamics, distributions and movements—are traced, as well as emerging post-modern perspectives and qualitative

approaches that sensitively investigate the complex relationships between older people and the varied places within which

they live and are cared for. Mirroring theoretical developments and diversity in the social sciences, the future research

challenges that lie ahead will involve the articulation of varied and often hidden cultural practices and social processes, and

hitherto taken-for-granted—as well as new—social and spatial relations, between older people, health and place. If

however geographical gerontology is to meet these challenges most effectively, there has to be greater collaboration and

communication within and between its constituent disciplines and diverse empirical areas. This will help it become

recognized to a greater degree as a distinct discipline.

r 2007 Elsevier Ltd. All rights reserved.

Keywords: Geography; Gerontology; Space; Place; Ageing; Population

Introduction

Geography is clearly only one of numerousdisciplines which are actively involved in geronto-logical work that has a geographical element. Insome cases (such as sociology, demography andenvironmental psychology), the spatial perspectivehas been ongoing and longstanding whereas in

e front matter r 2007 Elsevier Ltd. All rights reserved

cscimed.2007.02.047

ing author. Tel.: +1905 525 9140.

ess: andrews@mcmaster.ca (G.J. Andrews).

s article as: Andrews, G. J., et al. Geographical Geronto

.1016/j.socscimed.2007.02.047

others (such as epidemiology, social medicine andpublic health), place is either a new interest or hasbeen relatively recently (re)discovered, in spite ofearlier interests (Diez-Roux, 1998; 2002). A corol-lary of this multi-disciplinarity is that the geogra-phical perspectives employed and pictures presentedvary greatly, from studies developing and convey-ing a genuine, rich feel for location and place tothose collapsing geography to the broad brushtypologies such as ‘‘rural–urban’’ or concertinaedgeographic classifications such as the USA’s

.

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‘‘Northeast–Midwest–South–West’’ macro-regionalframework (Rogers & Raymer, 2001) or Australia’s‘‘very remote–remote–outer regional–inner regio-nal–major cities’’ remoteness structure (AIHW,2003; Draper, Turrell, & Oldenburg, 2004). Mean-while, on the micro-scale, classifications such asclinical environments, clinical settings or contextsimply some sort of spatial form. While acknowl-edging this variability, this paper attempts to reviewprogress during the last 10 years, and lay somefoundations for future enquiry, in what might bedefined as—albeit not always cohesively recognizedas—‘geographical gerontology’. This research hasalways extended beyond health concerns to otheraspects of older peoples’ social and cultural lives(Andrews, Kearns, Kontos, & Wilson, 2006; Blai-kie, 1997; 2005; Harper & Laws, 1995; Mansvelt,1997). However, because at the scales of bothindividuals and populations, the ageing processnaturally involves declining levels of health, and thedemand for a range of associated services, healthand healthcare have always been central andimportant considerations in this literature. Whilstacknowledging social concerns other than health,the current paper focuses mainly on health andhealthcare research.

We start by reflecting on the key disciplinaryreports on research that have preceded the currentreview paper. The section provides a valuablehistorical context to foreground our own review ofempirical research. Our main review then beginsby considering empirical research focused at themacro-scale, ranging across the global/international–regional–local scale continuum, and finishes at themicro-scale of various accommodations and homes.Obviously, our broad disciplinary inclusion criteriacreates the potential for many hundreds of papersand subjects to be relevant, not to mention createsfuzzy disciplinary boundaries. In response, we had tobe selective at times where too many studies existedto be reviewed or the geographical content becameweak. This diversity we argue simply reflects thecurrent nature and scope of geographical gerontol-ogy. In terms of our approach, following an initialreconnaissance into the literature to establish somebroad categories, each co-author was given one ortwo to review. These eventually formed the basis ofthe sections below. Each author based their search onthe same key journals and health and social sciencesliterature searches. Finally, the lead author collatedthe different sections and edited the entire paper forconsistency, style and approach.

Please cite this article as: Andrews, G. J., et al. Geographical Geronto

(2007), doi:10.1016/j.socscimed.2007.02.047

Progress reporting

Geographical gerontology dates back over threedecades to a number of notable early landmarkstudies (Golant, 1972; Rowles, 1978; Warnes, 1982).Since these early forays, research has expandedconsiderably in terms of both its scope and volume.Four previous reports on the field, published inProgress in Human Geography (Harper & Laws,1995; Rowles, 1986; Warnes, 1981; 1990), togetherwith a recent edited collection (Andrews & Phillips,2005), are testament to, and articulate, this growingcontribution.

Warnes (1981) was the first report that, whilereviewing a number of early studies, set an initialand broad agenda for geographical gerontologyfocused on the spatial aspects of population, and thelocation and movement of older people andassociated services. Five years later, the secondreport (Rowles, 1986) claimed that research hadexpanded but had not extended beyond Warnes’original agenda. Rowles interpreted this as being aphase of empirical accumulation that typicallyprecedes the emergence of a dominant perspectiveor paradigm in any emerging field of research(Andrews & Phillips, 2005). Attempting to set amore cohesive and comprehensive agenda forgeographical gerontology, Rowles’ focus was onageing from a transactional perspective, emphasiz-ing the relationship between the older personsand their environments at various scales. Specifi-cally, Rowles called for research on the meaningof place and place memories, specifically in rela-tion to home. He also called for perspectives tomirror those in social gerontology in terms ofappreciating different ages and cultures of olderpersons (Andrews & Phillips, 2005). These callsmirrored Rowles’ own research perspectives thathad always been particularly sensitive to people andplace.

Soon after, in the third report, Warnes took analternative perspective and argued that geographersneeded to shift their priorities and objectives awayfrom the theoretical needs of human geography(e.g. debating the nature of place) and onto theneeds of older people (Warnes, 1990). Warneshighlighted three issues which had not been givenenough attention by geographers; the global evolu-tion in demographic ageing (and its implications),locational dimensions in the circumstances ofolder people’s lives and temporal change in theinteraction between the environment and older

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people. In many respects then, although refiningand developing them, Warnes returned to some ofthe core subjects of his previous 1981 report.

The fourth and latest progress report on geogra-phical gerontology was published more than tenyears ago (Harper & Laws, 1995). The authorsacknowledged a varied and growing contributionbut, in contrast to Warnes and returning to thespirit of Rowles’ 1986 report, argued that in orderto open new avenues for research, geographicalgerontology needed to learn theoretical and meth-odological lessons from the cultural turn in humangeography. The authors criticized recent geographi-cal gerontology for a continued unreflective empiri-cism, the dominance of positivistic spatial scientificapproaches, for using a general and unproblematicnotion of ‘old’, and for not exploring the nature,underlying causes of, and social processes involvedin age segregation and marginalization (Andrews &Phillips, 2005). The authors argued for the greateradoption of critical social theory and post-modernperspectives to underpin research, in particularwhen investigating the political economy of care,the role of the state in service provision, gender rolesand stereotypes and peoples’ life courses (Andrews& Phillips 2005).

The differences between these successive reports,and the literatures they represent, reflects a long-standing tension and predicament in geographicalgerontology regarding what disciplines to speakto and draw from. What is also telling is thatthese reports are all written by geographers andpublished in a geography journal. Hence, althoughtheir arguments might conflict, they all talkabout progress and the future from one parti-cular disciplinary perspective. There are few reports,for example, by demographers, sociologists, psy-chologists or economists in either geographicalgerontology as a whole or their own contributionto it (see Gundars, 1984; Wahl, & Weisman, 2003).In response, and building on recent theoreticalobservations of themes and perspectives in geogra-phical gerontology (Andrews & Phillips, 2005;Kearns & Andrews, 2005; Kontos, 2005), theremainder of the current paper indicates both areasof study and the disciplines involved. It highlightssubstantive areas where interdisciplinarity mightbe enhanced in order to meet the dual challengesof understanding an increasing range of environ-ments for older people and keeping place withtheoretical and methodological progress in thesocial sciences.

Please cite this article as: Andrews, G. J., et al. Geographical Geronto

(2007), doi:10.1016/j.socscimed.2007.02.047

Subjects and issues

Population ageing and distributions of older people

This is a field of interest clearly dominated by thework of demographers and population and healthgeographers with expertize in quantitative methods.Together, and often in combination, they havecontinued what is a longstanding and central pillarof geographical gerontology. The global pattern ofageing has been described and analysed in a numberof recent book length publications including Kin-sella and Velkoff (2001) and UN PopulationDivision (2002). A useful visual adjunct to thesetwo reports is the World Atlas of Ageing publishedby the WHO Kobe Centre (1998). An analysis of theglobal and local factors underlying demographicageing and many of the social, economic and policyimplications is provided in Global Aging: the

Challenges of Success (Kinsella & Phillips, 2005).A number of regional studies on the distribution

of older people and related policies have beenpublished and these are especially evident from Asiaand the Pacific, perhaps unsurprisingly as this iswhere over half of the world’s older persons nowlive. The United Nations Economic and SocialCommission for Asia and the Pacific has been a leadinstitute in this respect and, in addition to manyworking papers on the ageing population andvarious health, family and social service issues, theycompiled the Macau Plan of Action on Ageing for

Asia and the Pacific, some years ahead of the UNMadrid meeting mentioned above (UN ESCAP,1999). Most recently, ESCAP has chosen ageing asone of the special topics in its annual economic andsocial survey of Asia and the Pacific (UN ESCAP,2005). Other studies have looked at regional andcountry-specific issues in Asia-Pacific populationageing, distribution, health and welfare, and long-term care policies, many of which have strongspatial and environmental connections (Moore,Rosenberg, & McGuiness, 1997; Chi, Mehta, &Howe, 2001; Phillips, 2000; Phillips & Chan, 2002).

Academic researchers have also been active at theglobal/international scale. A recent study byMcCracken and Phillips (2005) for example, hascharted the geo-historical emergence and pro-gression of population ageing in the context of amodel bringing together the demographic, epide-miological and ageing transitions. Various regionalinternational studies have also been undertaken;for example, Serow and Cowart (1998) on the

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Caribbean nation states and Knodel (1999) on Asia.At the subnational level, there has been consider-able work on the geographical dimensions of ageingat both the broad regional and more local scales. Ina number of studies, several scales are examined inthe one paper. Exemplars of the regional work arestudies on the Russian Federation (Heleniak, 2003),Canada (Moore & Pacey, (2004), Australia (Aus-tralian Bureau of Statistics, 2003; Haberkorn, 2002)and the United States (Rogers, 1999; Rogerson,1998). The last study is noteworthy for its focus onelderly minority populations. As Rogerson argues,these populations often have greater health careneeds than the older population at large and henceit is important to trace their geographical distribu-tion and consequent likely demand for services.

Alongside the regional analyses has been match-ing interest in urban population ageing—bothbetween and within cities. On the inter-urban front,Frey (2001) for instance, has looked at themetropolitan magnets for the elderly in the UnitedStates, Rogerson (1998) has compared the degreesof elderly ethnic segregation across the US’s 15largest metropolitan areas, while Smith (1998) andMoore and Pacey (2004) have examined thepatterns and trends in ageing across the Canadianurban system. Examples in turn of spatial investiga-tions at the intraurban level are Hugo (1998 and2000) on Adelaide, New York City Department forthe Aging (2003) on New York, Lowdell, Evandrou,Bardsley, Morgan, and Soljak (2000) on Londonand Yeh (1999) on Hong Kong. The Adelaide,London and New York studies are significant fortheir attention to older persons from ethnicminorities.

As the studies cited suggest, the subnational levelresearch to date has been very much centred onmore developed nations. The better data availabilityin those countries has been an important part ofthis, along with their more advanced progressionthrough the ageing transition. For most lessdeveloped countries, published geographical geron-tological insights go little beyond broad rural–urbancomparisons. However, with demographic ageingpicking up momentum across the less developedworld, charting the internal geographies of olderpopulations in those countries will become increas-ingly important. A visual snippet of the emerginggeography of ageing population in one suchcountry, Brazil, is presented in Kinsella and Velkoff(2001, p. 15). More generally, HelpAge Interna-

tional, has also been very active in looking at

Please cite this article as: Andrews, G. J., et al. Geographical Geronto

(2007), doi:10.1016/j.socscimed.2007.02.047

regional, country and urban–rural issues involvingolder persons in a range of developing countries.

Health geographies of older populations

As with the above field of interest, this isdominated by the work of geographers and demo-graphers. However, as might be expected, epide-miologists are also involved centrally in this spatialanalysis, in what might be termed landscapeepidemiology. With regard to the analysis of smallerunit areas, health geographers have been mostactive. Surveying geographically oriented researchon the health of older populations produces adualistic picture. On the one hand, there has been aplethora of activity and publications while, on theother, there are some surprising neglects andomissions. Specifically, older age groups have beenexcluded by some major studies in which one mighthave expected them to be featured (see, for exampleSocial Health Atlas of Australia (Glover, Harris, &Tennant, 1999) and the Atlas of Health in Europe

World Health Organization, 2003). Deaths at upperages have similarly often been excluded from studiesin health geography’s ‘spatial patterning of mortal-ity tradition’ (Higgs, Senior, & Williams, 1998;Mitchell, Dorling, & Shaw, 2000) and the epide-miological ‘avoidable mortality’ research effort(Simonato, Ballard, Bellini, & Winkelmann, 1998;Humblet, Lagasse, & Leveque, 2000). Instead,attention has been focused on younger personsand what are seen as the potentially more pre-ventable deaths and greater life years to be saved.

Turning to the work that has been done, themulti-disciplinarity mentioned earlier as a generalattribute of geographical gerontology is particularlypronounced in the health field, researchers comingfrom an array of disciplinary affiliations andorganizations. A reasonable summary picture ofthe patterning of older people health around theglobe has been made possible by the World HealthOrganization’s (2002a) compilation of abridged lifetables for 191 member nations. While the data onwhich these tables are based are of variable qualitythe tables give a useful indicative internationaloverview of the variation in elderly survivorship.McCracken and Phillips (2005) have employed thesetables, along with estimates of healthy life expec-tancy (WHO, 2002b) to show what might be termedthe severe ‘‘double life expectancy whammy’’ ofolder persons in many less developed nations, thatis, substantially lower overall life expectancy than

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their counterparts in more developed nations andthe prospect of a greater proportion of those fewerremaining life years being spent in poor health.

Ideally, this international picture of older popula-tion health would be further dissected through causeof death analyses and there have been some suchefforts. For example, the WHO has recently soughtto shed light on a generally unheralded side ofglobal health, mortality from violence, and presentsdata for the older population along with youngerage groups (Krug et al, 2002). Research on thisfront, however, is limited by severe data constraints,only one-third of WHO member nations having‘‘complete’’ cause of death records available (Math-ers, Fat, Inoue, Rao, & Lopez, 2005). Globalstocktakes of morbidity patterns in older popula-tions face similar problems, although efforts havebeen made. Dementia for example, has attractedquite a deal of attention (Ineichen, 1998; Suh &Shah, 2001; Wimo, Winblad, Aguero-Torres, & vonStrauss, 2003).

Accepting its limitations, not much use has beenmade of the international ‘cause of death’ data thatcertainly exists. One interesting study is by Warnes(1999) on trends in late-age cause-specific mortalityin the UK and western Europe, but the geographicalanalysis is unfortunately collapsed down to a UKversus combined 16 western European countriesand Switzerland comparison. A worthwhile exten-sion here would be an elderly mortality companionvolume to the Atlas of Health in Europe referred toearlier. The published atlas reveals major geo-graphic variations in cause-specific mortality atyounger ages amongst the member states of theWHO European Region, raising the question towhat extent are these inequalities repeated at olderages? A further important issue is the extent towhich longer life is associated with better or worsehealth or with a so-called ‘‘compression of morbid-ity’’ into the final stages of life. Associated questionsrelate to the types of ailments to which olderpersons are subject; for example, are they dispro-portionately affected by new and re-emerginginfectious conditions as well as the more chronicand degenerative conditions usually associated witholder age (McCracken & Phillips, 2005)?

Another strand of comparative work in Europehas focused on the socio-economic inequalities inolder persons’ health within different countries (seeJanssen, Kunst, & Mackenbach, 2006). Socio-economic patterning to mortality has been repeat-edly documented at younger ages and Huisman

Please cite this article as: Andrews, G. J., et al. Geographical Geronto

(2007), doi:10.1016/j.socscimed.2007.02.047

et al. (2004) have recently shown that such varia-tions also persist into old age, the inequalities insome countries in fact being of similar magnitude tothose among the middle aged. A parallel multi-country investigation (Huisman, Kunst, & Mack-enbach, 2003) similarly found substantive inequal-ities persisting in morbidity, the studies jointlyhighlighting the need to improve the socio-economicwell-being of older people in order to improveelderly population health. Patterns and trends in sexdifferences in elderly mortality across the continenthave also been recently scrutinized (GjonBa, To-massini, Toson, & Smallwood, 2005).

Most work on the more explicitly geographicaldimensions of older persons’ health, however, hascontinued to be at the subnational scale (seeLangford & Bentham, 1996). One approach hasbeen via the long established health researchtradition of disease atlases, one of the mostcomprehensive being the Atlas of United States

Mortality (Pickle, Mungiole, Jones, & White, 1996).While not an atlas specifically focused on the olderpopulation, each disease section of the Atlas

contains maps of smoothed death rates for Whitemales, White females, Black males and Blackfemales aged 70 across the coterminous UnitedStates, plus accompanying graphs of regional rates.Maps showing geographic patterns of Alzheimer’sdisease mortality meanwhile have been produced bya number of state health authorities (ArizonaDepartment of Health Services, 2005; FloridaDepartment of Health, 2005). The AustralianBureau of Statistics (2002) also included maps withbrief accompanying commentary of the regionalpatterning of mortality of persons 65–84 years and85 years and over across Australia in a recent atlaspublication. While only involving two maps relatingto the older population the Australian atlas servesas a useful reminder of the advisability of notautomatically treating the 65+ age group as a singleage bloc, the death rate geographies for the‘‘young–old’’ and ‘‘old–old’’ in particular provingto be very different (for other sub-national studiesalso see Draper et al., 2004; Fukuda, Nakamura, &Tacano, 2005; Paes, 2001; Reid & Harding, 2000 forUnited Kingdom, Japan and Brazil).

In reviewing developments in the field of healthgeography over the past decade, almost certainly themost significant trend has been the burgeoninginterest in place effects on health outcomes and thesame growing interest is clearly evident in thegerontological segment of the field as recent articles

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by Cagney, Browning, and Wen (2005), Eschbach,Ostir, Patel, Markides, and Goodwin (2004),Kobetz, Daniel, and Earp (2003), Moore, Rosen-berg, and Mackenzie (2004), Nordstrom, Diez-Roux, Jackson, and Gardin (2004) and Wen andChristakis (2005) testify. In other key sectors ofhealth research (e.g. studies of children, youngadults, all ages combined, etc.), multi-level model-ling techniques have been widely employed inattempts to disentangle individual and contextualplace effects on health outcomes. To date though,and in contrast, only relatively limited use of suchmodels has been made in gerontological researchand the explanatory promise they offer should be apriority for research in coming years.

Alongside the interest in place and health perhapsthe other most significant emerging development inhealth inequalities research over the past few yearshas been the growing interest in and use oflifecourse approaches in recognition of the fact thatfor most serious chronic disorders the present-dayvariations we seek to explain are often theconsequence of experiences accumulated over therespective populations’ whole lifespans. Cross-sec-tional analyses are thus limited in how much realexplanation they can offer. In the case of elderlyhealth inequalities, researchers are thus trying toexplain the cumulative mix of disadvantage andadvantage that has built up over 60, 70, 80 or evenmore years. Lynch and Smith (2005) offer a usefulreview of the lifecourse approach. Little of thelifecourse research to date though has had acontemporary spatial health inequalities outcomesfocus, due to the heavy data demands of such studydesigns. One example however, is Curtis, Southall,Congdon, & Dodgeon (2004) use of data from theONS Longitudinal Study for England and Wales toexamine linkages between socio-economic charac-teristics of area of residence in the 1930s andindividual health outcomes four to five decadeslater. The study obviously only captures part of thelifecourses of the ONS sample members butcertainly suggests the need to consider contextualconditions in early life when trying to explainsubsequent health decades later.

Kinship, mobility and migration

This field has involved a range of disciplinarycontributions including from sociologists and geo-graphers. Moving more squarely into the multi-disciplinary interests of social gerontology, many

Please cite this article as: Andrews, G. J., et al. Geographical Geronto

(2007), doi:10.1016/j.socscimed.2007.02.047

voices have been involved in attempting to explainthe nature, impacts and consequences of geographi-cal movements of older people. A number ofgeographers have continued to work with largedatasets to describe the relationship between geo-graphic proximity of older people to kin and thenature of their interaction (Lin & Rogerson, 1995;Shelton & Grundy, 2000; Smith, 1998b; Karsten,2007). This work shows that greater distance isgenerally related to less interaction, but alsosuggests that both the actual distance and theeffects of distance on the type of support providedby kin may be mediated by characteristics of botholder person and adult child, such as functionalstatus and health (Glaser & Tomassini, 2000;Rogerson, Burr, & Lin, 1998), socio-economicstatus (Smith, 1998a), gender, (Hallman & Joseph,1997; 1999), marital status and family balance,education, age, and employment status (Joseph &Hallman, 1996). Future research seeking to under-stand intergenerational migration using localized,qualitative studies is likely to be revealing inunderstanding the complex nature of such decisionmaking and the processes by which proximity isrelated to different kinds of support (e.g., Atherton,2002; Keeling, 2001), which may contribute furtherto theoretical models explaining the migrationdecision process of older people (Fokkema & VanWissen, 1997).

A closely related body of literature exploresreasons for mobility and migration of older peoplearound retirement, much of this research emphasiz-ing the need to consider different stages of thelifecourse and the distinct migration patterns anddriving factors for groups such as ‘pre-elderly’(55–64) (Bures, 1997) or young and old older people(Longino, Perzynski, & Stoller, 2002). Hays (2002)draws on classic geographical theories relating tomigration to develop a model for understanding thefactors involved in older people’s decisions tochange or relocate their living environments. Sheincorporates push and pull factors as well ascontextual factors to understand potential movers,their motivations, characteristics and their beha-vioural outcomes. Some research is beginning toshow increasing diversity of migration preferencesby older Americans. One study found that late mid-life workers and retirees expect to age in place (notmigrate) and remain independent, thereby notbecoming a burden on children or society (Robison& Moen, 2000). Indeed, a recent analysis suggeststhat overall elderly migration rates in the US are in

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significant decline, but interstate moves by olderadults are stable, albeit lower than younger agecohorts (Wolf & Longino, 2005). Future research inthis area is likely to consider cohort effects inchanging retirement patterns, such as whether ornot the baby-boom generation is likely to displaynew forms of post-retirement migration (Longino,1998). Some research has focused on the place-related factors that influence considerations ofmoving, such as ties to the ‘back home’ communityor to children (Stoller & Longino, 2001). Futureresearch will no doubt begin to bridge gaps betweenunderstandings of retirement migration and otherbodies of geographical theory. For example, the-ories of transnationalism, mobility, and attachmentto place have been applied to retirement migrationamongst older people in Europe and the UnitedStates to reveal different kinds of transnational,circular, pendular, and linear lifestyles in theseasonal migrations of older people (Gustafson2001a, 2001b; King, Warnes, & Williams, 2000;McHugh & Mings, 1996 and a special edition ofInternational Journal of Population Geography,1998, 4(2). We also see a need for analysis of classin the migration literature. Increasing disparitiesbetween the wealthy and poor, particularly in theUS, suggest that the dynamics of migration andremaining in place will have important socialand economic impacts on communities as poorand wealthy older adults become increasinglyclustered across this country.

Ageing in Place

In this field, because of the obvious connectionsto health and health service provision, the perspec-tives of geographers and sociologists are joined bythose of various health professional and healthscience disciplines. Two closely related, even over-lapping concepts which have shown a strongdevelopment in policy and in the literature are‘aging in place’ and ‘attachment to place.’ Theextensively (and often vaguely) used concept ofaging in place has achieved great popularityamongst policy makers and health providers.Geographical gerontologists and others have re-sponded with a more critical, theoretically informedconceptualization of relationships between aging,health, and place. Several build on Rowles’ earlierwork on place and ageing (Rowles, 1983; 1993) byinterpreting detailed, micro-scale studies to explorerelationships of older people to place. The concept

Please cite this article as: Andrews, G. J., et al. Geographical Geronto

(2007), doi:10.1016/j.socscimed.2007.02.047

of attachment to place is used by both Swenson(1998) and Rosel (2003) to show how a physical andemotional sense of self-identity and meaning isattached to the concept of home, which is under-stood both as a central base for care and as thecentre of concentric circles or outwards ‘reach’ usedto organize information regarding each olderperson’s dwelling, neighbourhood and community(also see Mowl, Pain, & Talbot, 2000 on themeaning of homespace). Rosel’s (2003) explorationof elders’ detailed personal knowledge of where andwith whom they are growing old emphasizes thedepth and detail of their familiarity and shows howthis is supportive for elders who age in place. In herstudy of place identification and positive realities ofaging, Taylor (2001) also uses life stories collectedfrom older African Americans to show howexperiences relative to identification with and theattachment to a place (or sense of place) holdpowerful memories for older people, which cumula-tively allow them to maintain a favourable self-image in spite of the contingencies of later life.Tahara and Kamiya (2002) interpret Rowles con-cept of ‘insideness with place’ in an urban Japanesecontext to understand why older people stay in anarea which is experiencing rapid depopulation.Sugihara and Evans (2000) take a more functionalapproach to place attachment in older adults byexamining how relative location of residence in aretirement community affects the development ofconnectedness and social support.

Rowles also has expanded his previous work onageing in place to consider the greater complexityand changes that older adults face in the later partof the life course (Rowles, 2000; Rowles & Ravdal,2002). Cutchin (2001, 2003, 2004) and Cutchin,Owen, and Chang (2003, 2005) have explored theconcept of ageing in place with respect to migration,adult day care centres and assisted living residences.His research suggests that aging in place is acomplex process—involving much more than placeattachment—whereby the older adult continuallyre-integrates with place (home and community) inthe face of change and uncertainty through creativeand social actions that foster meaning and identity.Exploring home further, Hockey, Penhale, andSibley (2001) identify home as having historicalidentity and attachments for older people, thoughmemories of past life events, and to be comfortingparticularly during times of bereavement. Mean-while, Peace and Holland (2001) explore thepossible contradictions in the concept of ‘homely’

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residential care. Their study highlighted that smallerestablishments tended to be home institutionhybrids, containing the best and worst of bothworlds. On a larger scale, Andrews and Kearns(2005) and Andrews et al. (2006) explore olderpeople’s varied and complex historical attachmentsand identities with a small town (home town).

Perhaps some of the most powerful contributionsto understanding attachment to place and aging inplace have come from exploring the perspectives ofthose who are not aging in place in the traditionalsense of remaining in a home or community inwhich they have dwelt all their lives, reflecting thegrowing mobility of people both in old age andbefore old age. Researchers have interpreted placeand space in a much more ‘geographically elastic’way which incorporates dwelling, neighbourhood,community, region, and nation, suggesting thatpeople may reside in and become attached tomultiple locales (McHugh & Mings, 1996). Com-munity context and ageing have been creativelyexplored by a number of non-geographers (Kim &Lauderdale, 2002; Lawrence & Schigelone, 2002;Robert, 2002; Robert & Lee, 2002). Studies ofneighborhood influences on satisfaction, well-being,and mortality of older adults have been produced byothers (Balfour & Kaplan, 2002; Bassuk, Berkman,& Amick, 2002; Glass & Balfour, 2003; Perez et al.,2001). A number of studies examine the impact ofinternational migration for older people, seeking tounderstand intergenerational relationships, support,and the experiences of older people (especially thosewho are or become ‘visible minorities’ in a ‘host’country) in the context of changing place. Research-ers have examined how cultural values such as filialpiety or reciprocity, and personal, group, andgendered identities are (re)negotiated in migratoryor transnational contexts (Montgomery, 1999;Neufeld, Harrison, Stewart, Hughes, & Spitzer,2002; Spitzer, Neufeld, Harrison, Hughes, & Stew-art, 2003). Others examine the impact of seasonalmigration for older people, to show that ‘snowbirds’in the US (McHugh & Mings, 1996) or retirees inEurope (Huber & O’Reilly, 2004) do develop acomplex variety of attachments to different places,groups, and identities. The strength of this researchis to emphasize that the relationship between placeand culture is ongoing and dynamic, exploringprocesses of assimilation and acculturation as olderimmigrants renegotiate their own identities in newcontexts (Pang, Jordan-Marsh, Silverstein, & Cody,2003). Further research may show the impact that

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(2007), doi:10.1016/j.socscimed.2007.02.047

these new groups of older people themselves haveon places.

Emerging research using space and place as aconceptual framework is proving fruitful for under-standing experiences which have been typicallyunderstood in gerontology using individual or sociallevel explanations. For example, Usita (2005)examines the detrimental effects of interpersonalproblems on the wellbeing and health of olderJapanese immigrants in the Midwest United Statesusing social geographical and continuity perspec-tives. She argues that by conceptually situatingnegative social exchanges in a broader contextualand lifecourse perspective we are able to providedifferent explanations for how interpersonal pro-blems arise. Becker (2003) similarly draws on aconceptual framework that encompasses place andspace to show how even complex, problematic anddifficult living arrangements for older immigrantsare sources of intergenerational support and long-term, intimate friendships, and that the meanings ofplace for these older people include social relation-ships, memory, displacement, reworking of identity,and presence of identity politics. There is stillconsiderable potential within the field of geographi-cal gerontology to contribute to this nuanced,theoretically informed understanding of the role ofplace as a multi-layered, dynamic, historically andspatially contextualized process that both shapesand is shaped by the lives and experiences of olderpeople.

Constructions and representations of healthy ageing

This field mirrors the critical turn in socialgerontology, and has involved social geographersand sociologists in considerations of the complexattachments and identities, older people share withplaces (see Mansvelt, 1997; Blaikie, 2005; Peace,Holland, & Kellaher, 2005a,b). Several studies havebuilt on laws work on aging, embodiment, and therepresentation of aged identities (Laws 1993; 1995;1996). These move away from treating older peopleas an object of study, and instead talk with olderpeople to explore their perceptions of health, well-being and ageing. Not surprisingly, most find thatolder people do not necessarily subscribe to‘standardized’ constructs of illness, disability, orinfirmity (Gooberman-Hill, Ayis, & Ebrahim, 2003;Pain, Mowl, & Talbot, 2000) and that theirconstruction of these concepts is highly contextual(de la Rue & Coulson 2003). Grenier’s sensitive

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re-exploration of frailty shows how older women’sexperiences and (re)negotiations of ‘frailty’ areconnected to the contexts in which they experiencedecline (such as home or the bus) and the diversesocial backgrounds they bring to those experiences(Grenier, 2005). Bryant, Corbett, and Kutner (2001)reframe health in older people’s own terms, and findthat health is defined quite specifically as ‘goingsand doings’ or having something meaningful to do,and the ability and resources and attitude to do it, incontrast to more traditional biomedical and policyperspectives that it is health itself that enablespeople to ‘go and do’. This contribution of a senseof activity and achievement to the mental andphysical health and wellbeing of older people isnicely illustrated in Milligan, Gatrell, and Bingley’s(2004) research on the potentially therapeuticcontributions of communal gardening on allot-ments. They show how the ‘inclusionary spaces’ ofcommunal gardens benefit older people throughactivity in a mutually supportive environment thatcombats social isolation and contributes to thedevelopment of their social networks. Similarly,Mansvelt’s (1997) study of ‘working at leisure’shows how older people contest constructions ofaging as idleness, dependency, inactivity and in-firmity by engaging in leisure activities that areactive. She points out, however that this form ofresistance to aging and ageism may be constrainedin that leisure activity that involves idleness isfrowned upon by these older people, to the extentthat metaphors usually related to work (productiv-ity, output value, occupation, time) are pervasivelyemployed with regard to leisure and few felt able toengage in what some of them called ‘real leisure’ or‘unproductive’ use of time. Finally, Andrews’ (2003)study of complementary medicine use by olderpeople, shows this very active consumption to beassociated with holistic lifestyles and self-care andassociated with therapeutic landscapes ranging fromthe clinics to their wider locales.

Others have built on Laws’ work by incorporat-ing a spatiality perspective to understand howrepresentations of ageing and places for ageingreveal social attitudes and values about ageing.McHugh and Larson-Keagy (2005) revisit Laws(1995) paper on embodiment and identity in SunCity Arizona, exploring the narratives of residentsof that community which show retirement commu-nities both as places rich in collective meaning andidentity for older people, and places that are deeplyimplicated in the proliferation of master-planned,

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lifestyle or ‘gated’ communities that ‘engender bothresident well-being and the fragmentation ofsociety’. This emplacement of older people inprivate landscapes (not just retirement villages butprivate homes, pensioner units and other institu-tional settings) may have implications for howageing is represented as the invisibility of olderpeople in public landscapes is reinforced (Mansvelt,1997). Other interpretations of the tropes of ageingused to promote retirement communities show howadvertisements for retirement communities areconstructed to create positive images of a geo-graphic experience of ageing designed to encouragecontinued consumption (Lucas, 2004; McHugh,2003). These representations of retirement commu-nities as places for consumption deny images ofageing as decline, frailty, illness, and insteadpromote positive images of ageing, health andwell-being. Meanwhile, research on RVing, coastalcultures and universities of the third age, makesimilar points about the re-representation of ageingand commodification of healthy ageing (Blaikie,1997; 1999; Katz, 1995). Indeed, they collectivelydemonstrate how mobile and healthy retirementcultures represent a radical fracturing of traditionalspaces of ageing, introducing a socio-spatial dy-namic that is shaping age-identities in a new way.Connecting the relationships between identity,place, aging, and consumption is a highly relevantavenue for continuing research given that diversityof experiences and backgrounds of the growingnumber of older people.

Elsewhere, considerations of interdisciplinarityand methodology have been combined with con-siderations of representation. Andrews et al. (2006)use oral histories to investigate life on the smalltown British home front 1939–1945. Specifically, theauthors argued that giving voice to older people andtheir historical representations of social life, placeand landscape, might unite history and gerontologyin a new common direction and provide uniqueviewing platforms onto some well-trodden socialand historical debates.

Health and social care: provision, experiences and

place

This field of research is more squarely a concernof geographers who have considered a range ofissues and spatial scales. Researchers in this fieldhave pointed towards ways in which economicchanges and restructuring of health services which

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shift the location of service provision have changedolder peoples’ access to, use, and experiences ofhealth care services. Many authors point towardsthe inherent tension between institutionally mana-ged health care spaces and patients’ experiences ofreceiving health services in place, showing howeconomic, political, and institutional changes haverelocated and redefined health services in ways thatdistinctively impact how people experience theplaces where they receive care (Cartier, 2003; Wiles& Rosenberg, 2003). For example, the provision ofincreasing amounts of care to older people at homerather than in institutional settings has significantimpacts for the social and symbolic as well asphysical dimensions of home and those providingcare informally at home (Andrews, Gavin, Begley,& Brodie, 2003; Wiles, 2003a; Milligan, 2006).Moreover, moving the care of older people to themore private, less ‘visible,’ and more isolated spaceof the home has implications for the experiences ofboth paid and unpaid caregivers, many of whom arewomen, and the ways in which they negotiate theirrelationships with each other (Andrews et al., 2003;Angus, Kontos, Dyck, McKeever, & Poland, 2005;Joseph & Hallman, 1998; Wiles, 2003b; Milligan,2006). Cloutier-Fisher and Joseph’s (2000, 1998)work on long-term care restructuring in Ontario, forexample, provides a ‘situated understanding’ ofservice-user and—provider perspectives on long-term care reform (see also Cloutier-Fisher &Skinner, 2006). By examining these narratives inthe context of the particular political and institu-tional frameworks that have structured these re-forms, they demonstrate how increasing diversityand uncertainty for both older people using servicesand service providers lead to greater potentialvulnerability for both groups. The effects of reformto long-term care are also more broadly variableacross space; Joseph and Chalmers (1996) show howthe shift to the private sector for provision of long-term care in New Zealand has led to lesseravailability of services in rural areas relative tourban areas, even though more older people arestaying on in rural communities. They highlight theneed to consider policy issues for rural areas ofincreasing numbers of older residents in servicedepleted communities (see also (Moore & Rosen-berg, 2001; Williams & Cutchin, 2002). Thisenduring theme is picked up later by Hanlon andHalseth (2005) in their review of how to support theneeds of seniors in rural and remote communitieswhich struggle with health care delivery because of

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(2007), doi:10.1016/j.socscimed.2007.02.047

distance, low user densities, low-order facilities andcaregiver shortages. These issues are backed up byFortney, Chumbler, Cody, and Beck (2003) whodemonstrate that because rural elders have lessgeographic access (measured in terms of time travelor perceived awareness) and therefore receive fewerhome/mental health services, they may be at greaterrisk for hospitalization or nursing home placement.This growing body of research on older people inrural areas is notable for the attention that is paidby researchers to the specificities of place, in thatmany researchers are careful to examine how theexperiences of older people in rural places are theoutcome of interconnections of different scales ofplace from local community, to region, to nation,and even global processes.

Most recently, researchers have attempted todirectly articulate the importance of place, and acritical spatial analysis, to health policy and clinicalpractice. Indeed, with regard to clinical practice,arguments mounted in a recent special edition ofInternational Journal of Older People Nursing

(Andrews, Poland, Leheux, & Holmes, 2005b;Cutchin, 2005; Wiles 2005) and elsewhere (Cheek,2004), have attempted to establish more substantialconnections between geographical debates and thehealth sciences, and influence the actual everyday‘doing’ of clinical gerontology (or at least researchon the everyday doing of clinical gerontology). Inparticular, this research attempts to connect geo-graphical concepts and ideas with some fundamen-tal concepts in professional care. With regard topolicy, arguments have been mounted as to theimportance of geographical perspectives butthrough specific empirical research, for example onresidential and nursing homes management (An-drews & Phillips, 2002). Beyond these focusedforays, in many respects, a great deal of the researchreviewed so far in the current paper deals with, orinforms, policy and practice, albeit to a lesser extentor indirectly.

Living environments: from housing to locality

Arguably, this field is the most diverse of all witha full range of social and health sciences perspec-tives being used to explore a variety of spatial scalesand issues. A key policy aspect of the aging in placeconcept is its implications for housing and livingenvironments for older people (Golant & LaGreca,1994; Oswald & Wahl, 2004). Certain studiesconsider how specific environments, such as a

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dwelling (Phillips, Siu, Yeh, & Cheng, 2005), akibbutz (Walter-Ginzburg, Blumstein, & Guralnik,2004), a re-modeled town centre (Gant, 1997), agated retirement community (Townshend, 2002) orneighbourhood (Michael, Green, & Farquhar,2006) can be ‘enabling’ or healthy environments.These researchers link social gerontological ap-proaches to the geographical interpretation of therelationships between older people and their chan-ging social and physical environments, to achieve agreater understanding of how enabling featurescould be applied to other situations. Gant (1997)argues that there is considerable potential to extendthis kind of analysis, and others agree that thismight be enhanced by tools such as GIS whichcould be used effectively for community specificanalyses of older people and their resource environ-ments (Hirshorn & Stewart, 2003). A strength ofthis research is that it moves beyond a focus onolder people as necessarily disabled or havingfunctional limitations to find positive ways to makeliving environments more enabling. There is cer-tainly potential for this kind of literature to engagewith some of the debates in the growing literatureon (dis)abilities and whether research on these issuesis conducted about, for, or with older people or asemancipatory research (Priestley & Rabiee, 2002).

More research in social and geographical ger-ontology has been directed at understanding howand to what effect different combinations ofcongregate housing and care settings shape (andare shaped by) the experience of older adults. In theUS, much attention has been paid to assisted livingor similar forms of congregate housing with services(Ball et al., 2000; 2004a, 2004b; Brandi, Kelley-Gillespie, Liese, & Farley, 2004; Cannuscio,Block, & Kawachi, 2003; Cutchin, 2003; Cutchin,Chang, & Owen, 2005; Dobbs, 2004; Eckert,Zimmerman, & Morgan, 2001; Frank, 2002; Mitch-ell & Kemp, 2000; Sikorska, 1999; Young, 1998). Inthe UK and Canada, research likewise unpacks thecomplexity and nuances of the relationship to placeand the social dynamics in settings that combinehousing and care (Abbott, Fisk, & Forward, 2000;Andrews & Phillips, 2002; Bacon & Lambkin, 1997;Biggs, Bernard, Kingston, & Nettleton, 2000; Bland,1999; Eales, Keating, & Damsma, 2001; Kontos,1998). Much of this work is based on qualitativemethodologies, and the understanding that is emer-ging is rich and critical in that it portrays the positiveand negative dimensions of such places, develops anunderstanding of the intricate processes involving

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older adults, and suggests that such accommodationcan be better than it currently is. There is much left todo in this particular research area, and there will becontinued need for enquiry as the sheltered accom-modation industry continues to evolve and grow. Inparticular, critical work that assesses the commercialaspects of place-making, power-relationships inprocesses, and the exclusion of the less wealthy frommany retirement communities needs to be morecarefully investigated.

Although some work above has alluded to ruralgeographies of ageing, additional work addressesthe challenges faced by older adults in more denselypopulated areas as well as urban contexts. Geo-graphers have written about variations in land-scapes of economic opportunity that differentiallyaffect the experience of ageing for the rural andurban old (Moore & Rosenberg, 2001). Gillanders,Buss, & Hofstetter (1999) suggest that rural–urbandifferences in the health status of older people maynot necessarily be as large as others have suggested(e.g. Gesler, Hartwell, Ricketts, & Rosenberg, 1992;Ricketts, Johnson-Webb, & Randolph, 1999). Glas-gow (2000) reviews the key differences for rural andurban older adults related to caregiving and socialsupport, and others examine the potential for ruralareas to creatively solve long-term care needs(Beaulieu, Rowles, & Kuder, 2001; Kuder, Beaulieu,& Rowles, 2001). Others examine rural livingenvironments in terms of broader social contexts.Joseph and Chalmers (1998), for example, examinehow elderly people themselves contribute to thesustainability of communities, while Stallmann,Deller, & Shields (1999) investigate the effects ofaging retirees on the economics of a rural area.Similarly, Bryant and Joseph (2001) examinedifferent trends in rural areas and their implicationsfor places, and they emphasize need to understandthe backdrop of institutional restructuring andopportunities for local involvement. Joseph andCloutier-Fisher (2005) provide a good review ofsimilar work on rural aging. We note how urbanageing issues have been examined to a much lesserextent, but Phillips et al. (2005) begin to redress thislacunae in the literature.

Rosenberg and Everitt (2001) provide a veryuseful way to view policy-relevant work in geogra-phical gerontology. In their detailed analysis ofplanning issues for older populations in the presentand future, the authors argue that planners respon-sible for housing, services, and transportation haveformed into opposing camps with regard to their

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ideology about older populations. One group worksfor the integration of older adults with the rest ofsociety. The other proceeds under the view thatseniors should (and want to be) segregated from therest of society. Rosenberg and Everitt (2001) alsosuggest that the dichotomous positions of integra-tion-segregation are informed by underlying posi-tions of equity vs. efficiency. In addition, theyconclude that these fundamental dimensions are a‘‘promising way of thinking about planning for theelderlyy[and] could help to focus research on [the]aging, within planning and geography, and enable‘pure’ and ‘applied’ research thrusts to be betterintegrated than may have been the case in the past’’(Rosenberg & Everitt, 2001, p. 165).

Discussion

We believe that Rosenberg and Everitt’s argu-ment can be translated to other important tensionsin the broader literature we are calling geographicalgerontology. While the research we have covereddoes not seem to contain the ideological tension ofthe planning literature, it does exhibit differentthrusts that create other tensions. One is similar tothe planning domain in that much work tends tocover either ‘segregated communities’ such asretirement homes and communities, assisted living,etc. or more integrated populations of community-dwelling adults. Geographical sensibilities tell us,however, that a better understanding of thearticulation of living and care contexts would servepolicy better. Also similar to Rosenberg and Ever-itt’s argument, we see a need for better integrationof theoretical and applied research. Researchstreams in the literature are too often one or theother and therefore do not contribute as much toknowledge and policy as they might otherwise. Solidempirical research that moves beyond the ‘‘micro-fication’’ of much current gerontology (Hagestad &Dannefer, 2001) to also conceptualize and theorizethe numerous issues of geographical gerontologyshould have more value to the academic communityand policy makers. A third tension we see is thechallenge to integrate geographical research onageing with other disciplinary perspectives andconcerns. As suggested earlier, gerontology is auniquely multi-disciplinary field of enquiry, andgeographical gerontology is conducted by geogra-phers, psychologists, sociologists, nurses, etc., whoeach work most frequently with members of theirown discipline. As a result, the research issues and

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approaches within each are fragmented to a largedegree, and a result is a questionable effect onpolicy. The tension between the need for transdisci-plinary research on geographical issues of ageingand the extant walls that separate the differentdisciplines participating in gerontology needs to beresolved. Such resolution would provide the contextfor a more unified and expanded expertize to helpsolve pressing problems facing older populationsacross the globe. To overcome this tension in themost fruitful way for geographical gerontology,however, we suggest an additional need. We still seemany good research studies in geography, butsometimes those from outside of geography usethe concepts of space and place interchangeablywith ‘distance’ and ‘container’ rather than asintricate and active elements in the ongoingconstitution of social relations. Too frequently,there is a tendency to treat place simply as a context(clinical or living), rather than seeing it as produc-tive of particular outcomes for older adults, as wellas being shaped by them. While we find itencouraging that geographers and others workingin geographical gerontology are enthusiasticallyusing these concepts, we think geographers’ workon the more nuanced roles of space and place couldand should be more central to research on the issuesof older adults.

These observations notwithstanding, one can seethat if the net is spread widely (as we haveattempted in this review), during the past ten yearsgeographical gerontology has flourished and diver-sified. Macro-scale research on older populationshas continued and although, as suggested, certaingaps remain in the literature, more varied andsophisticated analysis has occurred. At the sametime, as had been requested in earlier reviews(Harper & Laws, 1995), various micro-scale re-search on ageing and place has emerged, oftendrawing on cultural geography and social theory.In particular, in order to investigate the increasingcomplexity of ageing in society, critical andculturally sensitive perspectives are becoming firmlyembedded. For geographical gerontology, the fu-ture research challenges that lie ahead will involvethe articulation of varied and often hidden culturalpractices and social processes related to olderpeople, and their hitherto taken-for-granted—aswell as new—social and spatial relations withhealth and healthcare. Indeed, we argue that withsuch a diversity of places where older people liveand are cared for, researching their lives might be

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simultaneously ‘relevant’ in a policy and practicesense and, at the same time, might contributetheoretically at the forefront of disciplinary debatesand literatures in the social sciences. Much has beendone, yet much remains to be done, in what—considering ageing populations and the associatedchallenges that lie ahead—surely needs to be agrowth industry?

Our review has revealed geographical gerontologyto be extremely diverse, with multiple disciplines eachengaged in the research of multiple empirical subjects.It exemplifies many of the strengths of multi-disciplinarity including a wide range of perspectives,theories and debates from which to draw on. At thesame time however, it also exemplifies many of theweaknesses of multi-disciplinarity including fractureddebates and absent empirical research that fallsthrough disciplinary cracks. In addition to addressingthese shortfalls, a key question remains. What ideallyshould the discipline look like in another decade? Oneimportant consideration is that, despite a high volumeof research, geographical gerontology currently lacksa clear identity and profile. Consequently, to give itsome sense of unity and collective purpose—and tohelp its constituent disciplines talk—there needs to bemuch greater reflection on defining the main researchpriorities and directions. It is unlikely that a universal,and universally acceptable, plan can be formulatedfor the future, but it might be possible to indicate acomprehensive and compartmentalized future re-search agenda. This, we feel, is a debate worth havingand an invitation we would like to see accepted.

Acknowledgements

The authors would like to acknowledge GlendaLaws who sadly passed away in 1996. Her work hasboth inspired and directed many of the develop-ments in this field over the past decade, particularlyin critical and cultural perspectives. Her legacy is asubstantial part of this discipline.

References

Abbott, S., Fisk, M., & Forward, L. (2000). Social and

democratic participation in residential settings for older

people: Realities and aspirations. Ageing and Society, 20,

327–340.

Andrews, G. J. (2003). Placing the consumption of private

complementary medicine: Everyday geographies of older

people’s use. Health and Place, 9, 337–349.

Please cite this article as: Andrews, G. J., et al. Geographical Geronto

(2007), doi:10.1016/j.socscimed.2007.02.047

Andrews, G. J., Gavin, N., Begley, S., & Brodie, D. (2003).

Assisting friendships, combating loneliness?: Users’ views on

a befriending scheme. Ageing and Society, 23(3), 349–362.

Andrews, G. J., & Kearns, R. (2005). Everyday health histories

and the making of place: The case of an English coastal town.

Social Science & Medicine, 60, 2697–2713.

Andrews, G. J., Kearns, R. A., Kontos, P., & Wilson, V. (2006).

‘‘Their finest hour’’: Older people, oral histories and the

historical geography of social life. Social and Cultural

Geography, 7(2), 153–179.

Andrews, G. J., & Phillips, D. R. (2002). Changing local

geographies of private residential care for older people

1983–1999: Lessons for social policy in England and Wales.

Social Science & Medicine, 55, 63–78.

Andrews, G. J., & Phillips, D. R. (2005). Geographical studies in

ageing: Progress and connections to social gerontology. In G.

J. Andrews, & D. R. Phillips (Eds.), Ageing and place:

Perspectives, policy practice. London: Routledge.

Andrews, G. J., Poland, B., Leheux, P., & Holmes, D. (2005).

‘‘Airplanes are flying nursing homes’’: Geographies in

the concepts and locales of gerontological nursing

practice. International Journal of Older People Nursing, 14,

109–120.

Angus, J., Kontos, P. C., Dyck, I., McKeever, P., & Poland, B.

(2005). The personal significance of home: Habitus and the

experience of receiving long-term home care. Sociology of

Health and Illness, 27, 161–187.

Atherton, I. (2002). The use of multi-methods to investigate the

geography of informal support networks in Scotland. In

British Society of Gerontology annual conference, University

of Birmingham.

Arizona Department of Health Services (2005). Arizona health

status and vital statistics, 2003 report, Division of Public

Health Service /http://www.azdhs.gov/plan/report/ahs/

ahs2003/toc03.htmSAustralian Bureau of Statistics. (2003). Ageing in Australia 2001,

ABS cat. no. 2048.0, Canberra: Australian Bureau of

Statistics.

Australian Bureau of Statistics, Mortality atlas, Australia

1997–2000. (2002). ABS cat. no. 3318.0, Canberra: Australian

Bureau of Statistics.

Australian Institute of Health and Welfare (AIHW) (2003).

Rural, regional and remote health: a study on mortality,

AIHW cat. no. PHE 45, Canberra: AIHW.

Bacon, B., & Lambkin, C. (1997). The relationship between the

delivery of day care services for older people and the design of

day unit premisexs. Ageing and Society, 17, 41–64.

Balfour, J. L., & Kaplan, G. A. (2002). Neighborhood environ-

ment and loss of physical function in older adults: Evidence

from the Alameda County study. American Journal of

Epidemiology, 155, 507–515.

Ball, M. B., Perkins, M. M., Whittington, F. J., Connell, B. R.,

Hollingsworth, C., King, S. V., et al. (2004a). Managing

decline in assisted living: The key to aging in place. Journals of

Gerontology: Social Sciences, 59B(4), S202–S212.

Ball, M. B., Perkins, M. M., Whittington, F. J., Hollingsworth,

C., King, S. V., & Combs, B. L. (2004b). Independence in

assisted living. Journal of Aging Studies, 18(4), 467–483.

Ball, M. B., Whittington, F. J., Perkins, M. M., Patterson, V. L.,

Hollingsworth, C., King, S. V., et al. (2000). Quality of life in

assisted living facilities: Viewpoints of residents. Journal of

Applied Gerontology, 19, 304–325.

logy: The constitution of a discipline. Social Science & Medicine

ARTICLE IN PRESSG.J. Andrews et al. / Social Science & Medicine ] (]]]]) ]]]–]]]14

Bassuk, S. S., Berkman, L. F., & Amick, B. C. (2002).

Socioeconomic status and mortality among the elderly:

Findings from four US communities. American Journal of

Epidemiology, 155, 520–533.

Beaulieu, J., Rowles, G. D., & Kuder, L. (2001). Current research

in rural models of integrated long-term care. The Journal of

Applied Gerontology, 20(4), 379–385.

Becker, G. (2003). Meanings of place and displacement in three

groups of older immigrants. Journal of Aging Studies, 17,

129–149.

Biggs, S., Bernard, M., Kingston, P., & Nettleton, H. (2000).

Lifestyles of belief: Narrative and culture in a retirement

community. Ageing and Society, 20, 649–672.

Blaikie, A. (1997). Beside the sea: Visual imagery, ageing and

heritage. Ageing and Society, 17, 629–648.

Blaikie, A. (1999). Ageing and popular culture. Cambridge:

Cambridge University Press.

Blaikie, A. (2005). Imagined landscapes of age and identity. In G.

J. Andrews, & D. R. Phillips (Eds.), Ageing and Place:

Perspectives, policy practice. London: Routledge.

Bland, R. (1999). Independence, privacy and risk: Two contrast-

ing approaches to residential care for older people. Ageing and

Society, 19, 539–560.

Brandi, J. M., Kelley-Gillespie, N., Liese, L. H., & Farley, W.

(2004). Nursing home vs. assisted living: The environmental

effect on quality of life. Journal of Housing for the Elderly, 18,

73–88.

Bryant, C., & Joseph, A. E. (2001). Canada’s rural population:

trends in space and implications in place. Canadian Geogra-

pher, 45(1), 132–137.

Bryant, L. L., Corbett, K. K., & Kutner, J. S. (2001). In their own

words: A model of healthy aging. Social Science & Medicine,

57, 927–941.

Bures, R. (1997). Migration and the life course: Is there a

retirement transition? International Journal of Population

Geography, 3, 109–119.

Cagney, K. A., Browning, C. R., & Wen, M. (2005). Racial

disparities in self-rated health at older ages what difference

does the neighbourhood make? The Journals of Gerontology

Series B: Psychological Sciences and Social Sciences, 60,

S181–S190.

Chi, I., Mehta, K. K., & Howe, A. L. (Eds.). (2001). Long-term

Care in the 21st century: Perspectives from around the Asia-

Pacific Rim. New York: Haworth Press.

Cannuscio, C., Block, J., & Kawachi, I. (2003). Social capital and

successful aging: The role of senior housing. Annals of Internal

Medicine, 139, 395–399.

Cartier, C. (2003). From home to hospital and back again:

Economic restructuring, end of life, and the gendered

problems of place-switching health services. Social Science &

Medicine, 56, 2289–2301.

Cheek, J. (2004). Older people and acute care: A matter of place.

Illness, Crisis and Loss, 12(1), 52–62.

Cloutier-Fisher, D., & Joseph, A. (2000). Long-term care

restructuring in rural Ontario: Retrieving community service

user and provider narratives. Social Science & Medicine, 50,

1037–1045.

Cloutier-Fisher, D., & Joseph, A.E. (1998). Long term care

restructuring in rural Ontario. In Eighth international

symposium in medical geography, Baltimore, Maryland.

Cloutier-Fisher, D., & Skinner, M. (2006). Levelling the playing

field? Exploring the implications of managed competition for

Please cite this article as: Andrews, G. J., et al. Geographical Geronto

(2007), doi:10.1016/j.socscimed.2007.02.047

voluntary sector providers of long-term care in small town

Ontario. Health and Place, 12(11), 97–109.

Cutchin, M. (2001). Deweyan integration: Moving beyond place

attachment in elderly migration theory. The International

Journal of Aging and Human Development, 52, 29–44.

Cutchin, M. (2003). The process of mediated aging-in-place: A

theoretically and empirically based model. Social Science &

Medicine, 57, 1077–1090.

Cutchin, M. P. (2004). A Deweyan case for the study of

uncertainty in health geography. Health & Place, 10, 203–213.

Cutchin, M. (2005). Spaces for inquiry into the role of place for

older people’s care. International Journal of Older People

Nursing, 14(8), 121–129.

Cutchin, M. P., Chang, P. F., & Owen, S. V. (2005). Expanding

our understanding of the assisted living experience. Journal of

Housing for the Elderly, 19, 5–22.

Cutchin, M., Owen, S. V., & Chang, P. F. (2003). Becoming ‘‘at

home’’ in assisted living residences: Exploring place integra-

tion processes. Journal of Gerontology B: Psychological

Sciences and Social Sciences, 58, S234–S243.

Curtis, S., Southall, H., Congdon, P., & Dodgeon, B. (2004).

Area effects on health variation over the life-course: Analysis

of the longitudinal study sample in England using new data

on area of residence in childhood. Social Science & Medicine,

58, 57–74.

de la Rue, M., & Coulson, I. (2003). The meaning of health and

well-being: Voices from older rural women. Rural and Remote

Health: The International Electronic Journal of Rural and

Remote Health Research, Education, Practice and Policy, 3, 192.

Dobbs, D. (2004). The adjustment to a new home. Journal of

Housing for the Elderly, 18, 51–71.

Diez-Roux, A. V. (1998). Bringing context back into epidemiol-

ogy: Variables and fallacies in multilevel analysis. American

Journal of Public Health, 88(2), 216–222.

Diez-Roux, A. V. (2002). Invited commentary: Places, people and

health. American Journal of Epidemiology, 155(6), 516–519.

Draper, G., Turrell, G., & Oldenburg, B. (2004). Health

inequalities in Australia: Mortality, health inequalities mon-

itoring series no. 1. AIHW cat. no. PHE 55. Canberra:

Queensland University of Technology and the Australian

Institute of Health and Welfare.

Eales, J., Keating, N., & Damsma, A. (2001). Seniors’ experiences

of client-centered residential care. Ageing and Society, 21,

279–296.

Eckert, J. K., Zimmerman, S., & Morgan, L. A. (2001).

Connectedness in residential care: A qualitative perspective.

In S. Zimmerman, P. D. Sloane, & &J. K. Eckert (Eds.),

Assisted living: Needs, practices, and policies in residential care

for the elderly (pp. 292–313). Baltimore: The Johns Hopkins

University Press.

Eschbach, K., Ostir, G. V., Patel, K. V., Markides, K. S., &

Goodwin, J. S. (2004). Neighbourhood context and mortality

among older Mexican Americans: Is there a barrio advantage.

American Journal of Public Health, 94(10), 1807–1812.

Florida Department of Health, (2005). Florida mortality atlas,

Office of Planning, Evaluation and Data Analysis /http://

www.floridacharts.com/charts/atlas.aspxS.

Fokkema, T., & Van Wissen, L. (1997). Moving plans of the

elderly: A test of the stress-threshold model. Environment and

Planning A, 29, 249–268.

Fortney, J., Chumbler, N., Cody, M., & Beck, C. (2003).

Geographic access and service use in a community-based

logy: The constitution of a discipline. Social Science & Medicine

ARTICLE IN PRESSG.J. Andrews et al. / Social Science & Medicine ] (]]]]) ]]]–]]] 15

sample of cognitively impaired elders. Journal of Applied

Gerontology, 21, 352–367.

Frank, J. B. (2002). The paradox of aging in place in assisted

living. Westport, CT: Bergin & Garvey.

Frey, W. H. (2001). Seniors in suburbia. American Demographics,

23(11), 18–21.

Fukuda, Y., Nakamura, K., & Tacano, T. (2005). Municipal

health expectancy in Japan: Decreased healthy longevity of

older people in socioeconomically disadvantaged areas. BMC

Public Health, 5, 9.

Gant, R. (1997). Elderly people, personal mobility and local

environment: An opportunity for fieldwork. Geography, 82,

207–217.

Gesler, W. M., Hartwell, S., Ricketts, T. C., & Rosenberg, M. W.

(1992). Introduction. In W. M. Gesler, & T. C. Ricketts

(Eds.), Health in rural North America: The geography of health

care services and delivery (pp. 1–22). New Brunswick: Rutgers

University Press.

Gillanders, W. R., Buss, T. F., & Hofstetter, C. R. (1999). Urban/

rural elderly health status differences: The dichotomy

reexamined. Journal of Aging and Social Policy, 8, 7–24.

GjonBa, A., Tomassini, C., Toson, B., & Smallwood, S. (2005).

Sex differences in mortality, a comparison of the United

Kingdom and other developed countries. Health Statistics

Quarterly, 26, 6–16.

Glaser, K., & Tomassini, C. (2000). Proximity of older women to

their children: A comparison of Britain and Italy. The

Gerontologist, 40, 729–737.

Glasgow, N. (2000). Rural/urban patterns of aging and caregiving

in the United States. Journal of Family Issues, 21(5), 611–631.

Glass, T. A., & Balfour, J. L. (2003). Neighborhoods, aging, and

functional limitations. In I. Kawachi, & L. Berkman (Eds.),

Neighborhoods and Health (pp. 303–334). Oxford: Oxford

University Press.

Glover, J., Harris, K., & Tennant, S. (1999). A social health atlas

of Australia (2nd ed.). Adelaide: Public Health Information

Development Unit, University of Adelaide.

Golant, S. M. (1972). The residential location and spatial

behaviour of the elderly. University of Chicago.

Golant, S. M., & LaGreca, A. J. (1994). Housing quality of U.S.

elderly households: Does aging in place matter? The

Gerontologist, 34(6), 803–814.

Gooberman-Hill, R., Ayis, S., & Ebrahim, S. (2003). Under-

standing long-standing illness among older people. Social

Science & Medicine, 56, 2555–2564.

Grenier, A. M. (2005). The contextual and social locations of

older women’s experiences of disability and decline. Journal of

Aging Studies, 19, 131–146.

Gundars, R. (1984). Geographical research and gerontology: An

overview. The Gerontologist, 24(5), 536–542.

Gustafson, P. (2001a). Retirement migration and transnational

lifestyles. Ageing & Society, 21, 371–394.

Gustafson, P. (2001b). Roots and routes: Exploring the relation-

ship between place attachment and mobility. Environment and

Behavior, 33, 667–686.

Haberkorn, G. (2002). Ageing in rural and regional Australia.

Rural America, 17(3), 32–39.

Hagestad, G. O., & Dannefer, D. (2001). Concepts and theories

of aging: Beyond microfication in social science approaches.

In R. H. Bistock, & L. K. George (Eds.), Handbook of aging

and the social sciences (5th ed., pp. 3–21). San Diego:

Academic Press.

Please cite this article as: Andrews, G. J., et al. Geographical Geronto

(2007), doi:10.1016/j.socscimed.2007.02.047

Hallman, B. C., & Joseph, A. E. (1997). Exploring distance and

caregiver gender effects in eldercare: Towards a geography of

family caregiving. Great Lakes Geographer, 4, 15–29.

Hallman, B. C., & Joseph, A. E. (1999). Getting there: Mapping

the gendered geography of caregiving to elderly relatives.

Canadian Journal on Aging, 18, 397–414.

Hanlon, N., & Halseth, G. (2005). The greying of resource

communities in northern British Columbia: Implications for

health care delivery in already-underserviced communities.

The Canadian Geographer, 49, 1–24.

Harper, S., & Laws, G. (1995). Rethinking the geography of

ageing. Progress in Human Geography, 19, 199–221.

Hays, J. C. (2002). Living arrangements and health status in later

life: A review of recent literature. Public Health Nursing, 19,

136–151.

Heleniak, T. (2003). Geographic aspects of population ageing in

the Russian Federation. Eurasian Geography and Economics,

44(5), 325–347.

Higgs, G., Senior, M. L., & Williams, H. C. W. L. (1998). Spatial

and temporal variation of mortality and deprivation 1:

Widening health inequalities. Environment and Planning A,

30, 1661–1682.

Hirshorn, B. A., & Stewart, J. E. (2003). Geographic information

systems in community-based gerontological research and

practice. Journal of Applied Gerontology, 22, 134–151.

Hockey, J., Penhale, B., & Sibley, D. (2001). Landscapes of loss:

Spaces of memory, times of bereavement. Ageing and Society,

21, 739–757.

Hugo, G. (2000). South Australia’s ageing population and its

increasingly multicultural nature. Australasian Journal on

Ageing, 19(1), 23–32.

Hugo, G. (1998). Recent trends in the ageing of South Australia’s

population. Adelaide: South Australia Department for Trans-

port, Urban Planning and the Arts and the University of

Adelaide.

Huisman, M., Kunst, A. E., & Mackenbach, P. P. (2003).

Socioeconomic inequalities in morbidity among the elderly: A

European overview. Social Science & Medicine, 57, 861–873.

Huisman, M., Kunst, A. E., Andersen, O., Bopp, M., Borrell, C.,

Costa, G., et al. (2004). Socioeconomic inequalities in

mortality among elderly people in 11 European populations.

Journal of Epidemiology and Community Health, 58, 468–475.

Humblet, P. C., Lagasse, R., & Leveque, A. (2000). Trends in

Belgian premature avoidable deaths over a 20 year period.

Journal of Epidemiology and Community Health, 54, 687–691.

Huber, A., & O’Reilly, K. (2004). The construction of Heimat

under conditions of individualised modernity: Swiss and

British elderly migrants in Spain. Ageing and Society, 24,

327–351.

Ineichen, B. (1998). The geography of dementia. Health and

Place, 4(4), 383–394.

Janssen, F., Kunst, A. E., & Mackenbach, J. P. (2006).

Association between gross domestic product throughout the

life course and old-age morality across birth cohorts: Parallel

analyses of seven European countries, 1950–1999. Social

Science & Medicine, 63(1), 239–254.

Joseph, A. E., & Chalmers, L. (1996). Restructuring long-term

care and the geography of aging: A view from rural New

Zealand. Social Science & Medicine, 42, 887–896.

Joseph, A. E., & Chalmers, A. I. (1998). Coping with rural

change: Finding a place for the elderly in sustainable

communities. New Zealand Geographer, 52, 28–36.

logy: The constitution of a discipline. Social Science & Medicine

ARTICLE IN PRESSG.J. Andrews et al. / Social Science & Medicine ] (]]]]) ]]]–]]]16

Joseph, A. E., & Cloutier-Fisher, D. (2005). Ageing in rural

communities: Vulnerable people in vulnerable places. In

G. Andrews, & D. R. Phillips (Eds.), Ageing and place

(pp. 133–136). London: Routledge.

Joseph, A. E., & Hallman, B. C. (1998). Over the hill and far

away: Distance as a barrier to the provision of assistance to

elderly relatives. Social Science & Medicine, 46, 631–639.

Joseph, A. E., & Hallman, B. C. (1996). Caught in the triangle:

The influence of home, work, and elder location on work–-

family balance. Canadian Journal on Aging, 15, 392–412.

Karsten, H. (2007). Proximity and contacts between older parents

and their children: A European comparison. Journal of

Marriage and Family, 69(1), 157–173.

Katz, S. (1995). Imagining the life-span: From premodern

miracles to postmodern fantasies. In M. Featherston, & A.

Wenick (Eds.), Images of aging: Cultural representations of

later life (pp. 61–75). London: Routledge.

Kearns, R. A., & Andrews, G. J. (2005). Placing ageing:

Positionings in the study of older people. In G. J. Andrews,

& D. R. Phillips (Eds.), Ageing and place: Perspectives, policy

practice. London: Routledge.

Keeling, S. (2001). Relative distance: Ageing in rural New

Zealand. Ageing and Society, 21, 605–619.

Kim, J., & Lauderdale, D. S. (2002). The role of community

context in Immigrant elderly living arrangements: Korean

American elderly. Research on Aging, 24(6), 630–653.

King, R., Warnes, T., & Williams, A. (2000). Sunset lives: British

Retirement migration to the Mediterranean. Oxford: Berg.

Kinsella, K., & Velkoff, V. A. (2001). An aging world: 2001. US

census bureau, series P95/01-1. Washington, DC: US Govern-

ment Printing Office.

Kinsella, K., & Phillips, D. R. (2005). Global aging: The

challenge of success. Population Bulletin, 60(1), 1–40.

Knodel, J. (1999). The demography of Asian ageing: past

accomplishments and future challenges. Asia-Pacific Popula-

tion Journal, 14(4), 39–56.

Kobetz, E., Daniel, M., & Earp, J. A. (2003). Neighbourhood

poverty and self-reported health among low-income, rural

women, 50 years and older. Health and Place, 9, 263–271.

Krug, E. G., et al. (Eds.). (2002). World report on violence and

health. Geneva: World Health Organization.

Kontos, P. C. (1998). Resisting institutionalization: Constructing

old age and negotiating home. Journal of Aging Studies, 12,

167–184.

Kontos, P. C. (2005). Mulidisciplinary configurations in ger-

ontology. In G. J. Andrews, & D. R. Phillips (Eds.), Ageing

and place: Perspectives, policy practice. London: Routledge.

Kuder, L., Beaulieu, J., & Rowles, G. (2001). State and local

initiatives and research questions for rural long-term care

models. The Journal of Applied Gerontology, 20(4), 471–479.

Langford, I. H., & Bentham, G. (1996). Regional variations in

mortality rates in England and Wales: An analysis using

multi-level modeling. Social Science & Medicine, 42, 897–908.

Lawrence, A. R., & Schigelone, A. R. S. (2002). Reciprocity

beyond dyadic relationships: Aging-related communal cop-

ing. Research on Aging, 24(6), 684–704.

Laws, G. (1993). ‘‘The land of old age’’: Society’s changing

attitudes toward urban built environments for elderly people.

Annals of the Association of American Geographers, 83,

672–693.

Laws, G. (1995). Embodiment and emplacement: Identities,

representation and landscape in Sun City retirement commu-

Please cite this article as: Andrews, G. J., et al. Geographical Geronto

(2007), doi:10.1016/j.socscimed.2007.02.047

nities. International Journal of Aging and Human Development,

40, 253–280.

Laws, G. (1996). ‘‘A shot of economic adrenalin’’: reconstructing

‘‘The elderly’’ in the retiree-based economic development

literature. Journal of Aging Studies, 10, 171–188.

Lin, G., & Rogerson, P. A. (1995). Elderly parents and the

geographic availability of their adult children. Research on

Aging, 17, 303–332.

Longino, C. F. (1998). Geographic mobility and the baby boom.

Generations, 22, 60–64.

Longino, C. F., Perzynski, A., & Stoller, E. P. (2002). Pandora’s

briefcase: Unpacking the retirement migration decision.

Research on Aging, 24, 29–49.

Lucas, S. (2004). The images used to ‘‘sell’’ and represent

retirement communities. The Professional Geographer, 56,

449–459.

Lowdell, C., Evandrou, M., Bardsley, M., Morgan, D., & Soljak,

M. (2000). Health of ethnic minority elders in London.

London: East London and The City Health Authority.

Lynch, J., & Smith, G. D. (2005). A life course approach to

chronic disease epidemiology. Annual Review of Public

Health, 26, 1–35.

Mansvelt (1997). Working at leisure: Critical geographies of

ageing. Area, 29(4), 289–298.

Mathers, C. D., Fat, D. M., Inoue, M., Rao, C., & Lopez, A. D.

(2005). Counting the dead and what they died from: An

assessment of the global status of cause of death data. Bulletin

of the World Health Organization, 83(3), 171–177.

McCracken, K., & Phillips, D. R. (2005). International demo-

graphic transitions. In G. J. Andrews, & D. R. Phillips (Eds.),

Ageing and place: perspectives, policy, practice (pp. 36–60).

London, New York: Routledge.

McHugh, K. E. (2003). Three faces of ageism: Society, image and

place. Aging and Society, 23, 165–185.

McHugh, K. E., & Larson-Keagy, E. M. (2005). These white

walls: The dialectic of retirement communities. Journal of

Aging Studies, 19, 241–256.

McHugh, K. E., & Mings, R. C. (1996). The circle of migration:

Attachment to place in aging. Annals, Association of American

Geographers, 86, 530–550.

Michael, Y. L., Green, M. K., & Farquhar, S. A. (2006).

Neighborhood design and active aging. Health & Place, 12(4),

734–740.

Milligan, C. (2006). Caring for older people in the 21st century:

Notes from a small island. Health & Place, 12(3), 320–331.

Milligan, C., Gatrell, A., & Bingley, A. (2004). ‘Cultivating

health’: Therapeutic landscapes and older people in northern

England. Social Science & Medicine, 58, 1781–1793.

Mitchell, J. M., & Kemp, B. J. (2000). Quality of life in assisted

living homes: A multidimensional analysis. Journal of

Gerontology: Psychological Sciences, 55B, P117–P127.

Mitchell, R., Dorling, D., & Shaw, M. (2000). Inequalities in life

and death: What if Britain were more equal?. Bristol: The

Policy Press.

Montgomery, R. J. (1999). The family role in the context of long-

term care. Journal of Aging and Health, 11, 383–416.

Moore, E., & Rosenberg, M. W. (2001). Canada’s elderly

population: The challenges of diversity. The Canadian

Geographer, 45, 145–150.

Moore, E. G., & Pacey, M. A. (2004). Geographic dimensions of

aging in Canada, 1991–2001. Canadian Journal on Aging(-

Suppl.), S5–S21.

logy: The constitution of a discipline. Social Science & Medicine

ARTICLE IN PRESSG.J. Andrews et al. / Social Science & Medicine ] (]]]]) ]]]–]]] 17

Moore, E. G., Rosenberg, M. W., & McGuiness, D. (1997).

Growing old in Canada: Demographic and geographic perspec-

tives. Ottawa and Toronto: Statistics Canada and ITP Nelson.

Moore, E., Rosenberg, M., & Mackenzie, C. (2004). Measuring

the geographic effects in a model of depression among the

elderly in Canada. In P. Boyle, S. Curtis, E. Graham, & E.

Moore (Eds.), The geography of health inequalities in the

developed world (pp. 149–176). Aldershot: Ashgate.

Mowl, G., Pain, R., & Talbot, C. (2000). The ageing body and the

homespace. Area, 32(2), 189–197.

Neufeld, A., Harrison, M. J., Stewart, M., Hughes, K. D., &

Spitzer, D. (2002). Immigrant women: Making connections to

community resources for support in family caregiving.

Qualitative Health Research, 12, 751–768.

New York City Department for the Aging, Office of Manage-

ment and Policy Research Unit. (2003). The older population

in New York City: Changes in race, Hispanic origin and age,

1990 to 2000, New York: New York City Department for the

Aging.

Nordstrom, C. K., Diez-Roux, A. V., Jackson, S. A., & Gardin,

J. M. (2004). The association of personal and neighbourhood

socioeconomic indicators with subclinical cardiovascular

disease in an elderly cohort. The cardiovascular health study.

Social Science & Medicine, 59, 2139–2147.

Oswald, F., & Wahl, H. W. (2004). Housing and health in later

life. Review of Environmnetal Health, 19(3–4), 223–252.

Paes, N.A. (2001). Elderly mortality in Brazil: Trends, differ-

entials, causes and links with socioeconomic indicators. In

Paper presented at 24th IUSSP general population conference,

Salvador, Bahia, Brazil /www.iussp.org/Brazil2001/s10/

S15_02_Paes.pdfS.

Pain, R., Mowl, G., & Talbot, C. (2000). Difference and the

negotiation of ‘old age’. Environment and Planning D—

Society and Space, 18(3), 377–393*.

Pang, E. C., Jordan-Marsh, M., Silverstein, M., & Cody, M.

(2003). Health-seeking behaviors of elderly Chinese Amer-

icans: Shifts in expectations. Gerontologist, 43, 864–874.

Peace, S., & Holland, C. (2001). Homely residential care: A

contradiction in terms? Journal of Social Policy, 30(3),

393–410.

Peace, S., Holland, C., & Kellaher, L. (2005a). Making space for

identity. In G. J. Andrews, & D. R. Phillips (Eds.), Ageing and

place: Perspectives, policy practice. London: Routledge.

Peace, S., Kellaher, L., & Holland, C. (2005b). Environment and

identity in later life. New York: Open University Press.

Perez, F. R., Fernandez-Mayoralas, G., Rivera, F. E. P., &

Abuin, J. M. R. (2001). Ageing in place. Predictors of the

residential satisfaction of elderly. Social Indicator Research,

54, 173–208.

Phillips, D., Siu, O. L., Yeh, A. G. O., & Cheng, K. H. C. (2005).

The impacts of dwelling conditions on older persons’

psychological well-being in Hong Kong: The mediating role

of residential satisfaction. Social Science & Medicine, 60,

2785–2797.

Phillips, D. R. (Ed.). (2000). Ageing in the Asia-Pacific region.

London: Routledge.

Phillips, D. R., & Chan, A. C. M. (Eds.). (2002). Ageing and long-

term care: National policies in the Asia-Pacific. Singapore:

Institute for Southeast Asian Studies and Ottawa, IDRC.

Phillips, D. R., Siu, O. L., Yeh, A. G. O., & Cheng, K. H. C.

(2005). Ageing and the urban environment. In G. J. Andrews,

Please cite this article as: Andrews, G. J., et al. Geographical Geronto

(2007), doi:10.1016/j.socscimed.2007.02.047

& D. R. Phillips (Eds.), Ageing and place: Perspectives, policy,

practice (pp. 147–163). London: Routledge.

Priestley, M., & Rabiee, P. (2002). Same difference? Older

people’s organisations and disability issues. Disability and

Society, 17, 597–611.

Pickle, L.W., Mungiole, M., Jones, G.K., & White, A.A. (1996).

Atlas of United States mortality. Hyattsville, Maryland:

Centers for Disease Control and Prevention, National Center

for Health Statistics /http://www.cdc.gov/nchs/products/

pubs/pubd/other/atlas/atlas.htmS.

Reid, A., & Harding, S. (2000). Trends in regional deprivation

and mortality using the longitudinal study. Health Statistics

Quarterly, 5, 17–25.

Ricketts, T. C., Johnson-Webb, K. D., & Randolph, R. K.

(1999). Populations and places in rural Amercia. In T. C.

Ricketts (Ed.), Rural health in the United States (pp. 7–24).

New York: Oxford University Press.

Robert, S. A. (2002). Community context and aging: Future

research issues. Research on Aging, 24(6), 579–599.

Robert, S. A., & Lee, K. Y. (2002). Explaining race differences in

health among older adults: The contribution of community

socioeconomic context. Research on Aging, 24(6), 654–683.

Robison, J. T., & Moen, P. (2000). A life-course perspective on

housing expectations and shifts in late midlife. Research on

Aging, 22(5), 499–532.

Rogers, A., & Raymer, J. (2001). Immigration and the regional

demographics of the elderly population in the United States.

Journal of Gerontology, 56B(1), S44–S55.

Rogers, C.C. (1999). Changes in the older population and

implications for rural areas. Report no. 90. Washington,

DC: United States Department of Agriculture, Rural Devel-

opment and Research

Rogerson, P. A. (1998). The geography of elderly minority

populations in the United States. International Journal of

Geographical Information Science, 12(7), 687–698.

Rogerson, P. A., Burr, J. A., & Lin, G. (1998). Changes in

geographic proximity between parents and their adult

children. International Journal of Population Geography, 3,

121–136.

Rosel, N. (2003). Aging in place: Knowing where you are. The

International Journal of Aging and Human Development, 57,

77–90.

Rosenberg, M., & Everitt, J. (2001). Planning for aging

populations: Inside or outside the walls. Progress in Planning,

56, 119–168.

Rowles, G. D. (1978). Prisoners of space?. Boulder, CO:

Westview.

Rowles, G. D. (1983). Place and personal identity in Old Age:

Observations from Appalachia. Journal of Environmental

Psychology, 3, 299–313.

Rowles, G. D. (1986). The geography of ageing and the aged:

towards an integrated perspective. Progress in Human

Geography, 10, 511–539.

Rowles, G. D. (1993). Evolving images of place in aging and

‘aging in place’. Generations, 17, 65–70.

Rowles, G. D. (2000). Habituation and being in place. The

Occupational Therapy Journal of Research, 20, 52S–67S.

Rowles, G. D., & Ravdal, H. (2002). Aging, place, and meaning

in the face of changing circumstances. In R. S. Weiss, &

S. A. Bass (Eds.), Challenges of the third age: Meaning and

purpose in later life (pp. 81–114). New York: Oxford

University Press.

logy: The constitution of a discipline. Social Science & Medicine

ARTICLE IN PRESSG.J. Andrews et al. / Social Science & Medicine ] (]]]]) ]]]–]]]18

Serow, W. J., & Cowart, M. E. (1998). Demographic transition

and population aging with Caribbean nation states. Journal of

Cross-Cultural Gerontology, 13, 201–213.

Sikorska, E. (1999). Organizational determinants of resident

satisfaction with assisted living. The Gerontologist, 39,

450–456.

Shelton, N., & Grundy, E. (2000). Proximity of adult children to

their parents in Great Britain. International Journal of

Population Geography, 6, 181–195.

Simonato, L., Ballard, T., Bellini, P., & Winkelmann, R. (1998).

Avoidable mortality in Europe 1955–1994: A plea for

prevention. Journal of Epidemiology and Community Health,

52, 624–630.

Smith, G. C. (1998). Change in elderly residential segregation in

Canadian metropolitan areas, 1981–91. Canadian Journal on

Aging, 17, 59–82.

Smith, G. (1998a). Geographic separation and patterns of social

interaction between residents of senior citizen apartment

buildings and their adult children. The Canadian Geographer,

42, 145–158.

Smith, G. (1998b). Residential separation and patterns of

interaction between elderly parents and their adult children.

Progress in Human Geography, 22, 368–384.

Spitzer, D., Neufeld, A., Harrison, M. J., Hughes, K. D., &

Stewart, M. (2003). Caregiving in transnational context: My

wings have been cut; where can i fly? Gender and Society, 17,

267–286.

Stallmann, J. I., Deller, S. C., & Shields, M. (1999). The economic

and fiscal impact of aging retirees on a small rural region. The

Gerontologist, 39, 599–610.

Stoller, E. P., & Longino, C. F. (2001). ‘‘Going home’’ or

‘‘leaving home’’? The impact of person and place ties on

anticipated counterstream migration. Gerontologist, 41,

96–102.

Sugihara, S., & Evans, G. W. (2000). Place attachment and social

support at continuing care retirement communities. Environ-

ment and Behavior, 32(3), 400–409.

Swenson, M. (1998). The meaning of home to five elderly women.

Health Care for Women International, 19, 381–393.

Suh, G.-H., & Shah, A. (2001). A review of the epidemiological

transition in dementia—cross-national comparisons of the

indices related to Alzheimer’s disease and vascular dementia.

Acta Psychiatrica Scandinavica, 104, 4–11.

Tahara, Y., & Kamiya, H. (2002). Attachment of the elderly to

their home places fostered by their insideness: A case study of

Kamioka Town, Gifu Prefecture. Human Geography, 54,

209–230.

Taylor, S. A. P. (2001). Place identification and positive realities

of aging. Journal of Cross-Cultural Gerontology, 16, 5–20.

Townshend, I. J. (2002). Age-segregated and gated retirement

communities in the third age: The differential contribution of

place-community to self-actualization. Environment and Plan-

ning B: Planning and Design, 29, 371–396.

Usita, P. M. (2005). Social geography and continuity effects in

immigrant women’s narratives of negative interactions.

Journal of Aging Studies, 19, 221–239.

United Nations, Economic and Social Commission for Asia and

the Pacific (ESCAP). (1999). Macau plan of action on ageing

for Asia and the Pacific. New York: United Nations.

United Nations, Economic and Social Commission for Asia and

the Pacific (ESCAP). (2005). Economic and Social Survey of

Asia and the Pacific 2005. Bangkok: United Nations.

Please cite this article as: Andrews, G. J., et al. Geographical Geronto

(2007), doi:10.1016/j.socscimed.2007.02.047

United Nations Population Division. (2002). World population

ageing 1950– 2050. New York: United Nations.

Wahl, H. W., & Weisman, G. D. (2003). Environmental

gerontology at the beginning of the new millenium: reflections

on its historical, empirical, and theoretical development. The

Gerontologist, 43(5), 616–627.

Warnes, A. (Ed.). (1982). Geographical perspectives on the elderly.

Chichester: Wiley.

Warnes, A. M. (1981). Towards a geographical contribution to

gerontology. Progress in Human Geography, 5(2), 317–341.

Warnes, A. M. (1990). Geographical questions in gerontology:

Needed directions for research. Progress in Human Geogra-

phy, 14, 24–56.

Warnes, A. M. (1999). ‘‘UK and western European late-age

mortality: Trends in cause-specific death rates,’’ 1960–1990.

Health and Place, 5, 111–118.

Wen, M., & Christakis, N. A. (2005). Neighborhood effects on

posthospitalization mortality: A population-based cohort

study of the elderly in Chicago. Health Services Research,

40(4), 1108–2005.

Wimo, A., Winblad, B., Aguero-Torres, H., & von Strauss, E.

(2003). The magnitude of dementia occurrence in the world.

Alzheimer Disease and Associated Disorders, 17(2), 63–67.

World Health Organization (WHO). (1998). World atlas of

ageing. Kobe: WHO Centre for Health Development.

World Health Organization (WHO). (2002a). Life tables for 191

countries: World mortality in 2000 /http://www3.who.int/

whosis/S.

World Health Organization (WHO). (2002b). The world health

report 2002. Geneva: WHO.

World Health Organization (WHO). (2003). Atlas of health in

Europe. Geneva: WHO.

Walter-Ginzburg, A., Blumstein, T., & Guralnik, J. M. (2004).

The Israeli kibbutz as a venue for reduced disability in old

age: Lessons from the cross-sectional and longitudinal aging

study (CALAS). Social Science & Medicine, 59, 389–403.

Wiles, J. (2003a). Daily geographies of caregivers: Mobility,

routine, scale. Social Science & Medicine, 57, 1307–1325.

Wiles, J. (2003b). Informal caregivers’ experiences of formal

support in a changing context. Health and Social Care in the

Community, 11, 189–207.

Wiles, J. (2005). Conceptualising the importance of place in the

care of older people: The role of geographical gerontology.

International Journal of Older People Nursing, 14(8b), 100–108.

Wiles, J., & Rosenberg, M. W. (2003). Paradoxes and contra-

dictions in Canada’s home care provision: Informal privatisa-

tion and private informalisation. International Journal of

Canadian Studies: Special Issue, Health and Well-Being in

Canada, 28, 63–89.

Williams, A.M., & Cutchin, M. P. (2002). The rural context of health

care provision. Journal of Interprofessional Care, 16(2), 107–115.

Wolf, D. A., & Longino, C. F. (2005). Our ‘‘increasingly mobile

society’’? The curious persistence of a false belief. The

Gerontologist, 45(1), 5–11.

Yeh, A. G. O. (1999). The changing spatial distribution of elderly

population and its planning implications. In D. R. Phillips, &

A. G. O. Yeh (Eds.), Environment and ageing: Environmental

policy, planning and design for elderly people in Hong Kong

(pp. 81–91). Hong Kong: Centre of Urban Planning and

Environmental Management, University of Hong Kong.

Young, H. M. (1998). Moving to congregate housing: The last

chosen home. Journal of Aging Studies, 12, 149–165.

logy: The constitution of a discipline. Social Science & Medicine