Aging in Place and Environmental Press

 

Environmental Press: Forces in the environment that together with individual need, evoke a response.

The Environmental Press Model

The EP model was developed by the country’s first environmental gerontologist, M. Powell Lawton and is a monumental contribution to aging and the home environment. The EP model is fundamentally depicting ADAPTATION; it languages the individual’s experience and gives professionals terms to help clients/patients with aging in place.

This model is operationalized as the outcome of the transaction or interaction between the person and the environment.  Optimal fit occurs when someone’s capacities are consistent with the demands and opportunities within that person’s environment.  However, if the demands of the environment exceed those of the person and their abilities, there is a person-environment misfit.  This model can help key the treating therapist into determining the types of environmental changes that must be made in order to match the individual’s abilities.
The Y-axis of the graph depicts an individual’s competencies that are a result of their functional, biological, sensory/perceptual, cognitive, and social abilities as well as behavioral skills. 
The X-axis represents the amount of environmental press or how accommodating their current environment is to their abilities.

Things to Consider in Regards to case study Jim:

Jim’s Y-Axis: Intrinsic Factors and Abilities

Functional: What tasks are currently difficult for Jim to perform?
Biological: Test functioning through ROM and manual muscle testing.  What position hurts most / hurts least, etc.
Sensory/perceptual: Sensory deficits in his hands – temperature, light and heavy touch, paresthesias, numbness
Cognitive: There do not appear to be deficits in this area of function.
Social: How has the hand injury affected his social experience?  Attending events?  Being with friends? 
Behavioral skills: How is Jim handling his situation?  How does he feel about himself?  How does he feel others perceive him?

Jim’s X-Axis: The Environment

The environment can be made up of 2 conceptualized terms: the physical and the psychosocial.
Physical:
His home environment: Investigate his living situation.  A 2-story house.  What does he do around the house – cook?  What utensils does he use?  Trouble opening containers? Opening doors?  Typing on a computer – replying to emails, writing papers, reviewing notes, transcribing lectures, etc.  Falls asleep studying before he can apply splint – where does he study, until when?
His environment at school: Opening doors, opening lockers, how does he take notes in class, does he carry around books, required to flip through papers, etc.
His work environment: What position does he sit in to dissect – what is he sitting on / when is he standing / what position is he doing these things in?  What tools does he use?  Can their handles be built up?  Can the positions of the bodies be changed?  When does he take breaks?  Does he have anything to support his hand during this?
His community environment:  How does he get to school – drive?  When he goes out for drinks, how does he grip his glass?  How does he carry grocery bags?

Psychosocial:

Consider the attitudes of those around them: housemates, friends, those in positions of authority, professors, strangers, health professionals, etc.

Compare the tasks Jim performs and how he performs them to the environmental support he currently has. Then ask:

What in the environment can be altered to help Jim?

What compensations can be made for Jim in order to help him function better in current living situations?

What adaptations can be provided to help him continue to participate in his roles, tasks, and activities?

 The Environmental Press Model is a theoretical framework around which to problem solve as an Aging-in-place professional; to manage and or design the physical environment to fit the needs of the occupant. 

The EP is a theoretical framework used to inform practical design intervention strategies for aging in place. Thus you have practical interventions informed by strong theoretical frameworks. 

Choice/control must be congruent with competence.

Goal: Provide an environment that is safe, yet challenging.

Environmental Press/Ecological Theory of Aging (Lawton and Nahemow, 1973)

Theory looks at 2 things:

1) A person’s Personal Competence

Rated LOW to HIGH levels

Deals with the level of personal ability the older adult has and encompasses:

-Their Social

-Their Physical

-Their Psychological

-Intellectual Abilities

2) Environmental Press

Rated WEAK to STRONG

The demands or levels of stimulation and challenges the environment provides

*The problem with Institutional and LTC environments is that they often maintain a level of HOMOGENITY of environmental press.

Environmental Press Theory recognizes that individuals have different levels of competencies.

To maintain an optimal level of challenge that continues to stimulate the older adult, the environment has to be adjusted to EACH INDIVIDUAL level of DYNAMIC competency.

The EP Model assumes that there’s an optimal level of adaptation (AL) that needs to exist to nurture the personal competencies of each individual.

Too few environmental challenges for the individual with HIGHER levels of personal competencies = Negative/Maladaptive behaviors.

Too few (LOW) individual competencies and existing in an environment with too many challenges = maladaptive behaviors.

The Process

“Titrating” Each individual’s dynamic level of competencies to the correct level of environmental stimulation and challenges is labor intensive and ongoing. Takes work.

Nutshell: Each individual has to be matched to the appropriate type of environmental challenges that will optimize their experience.

More complex than just adding rails, roll-in shower, and grab bars; takes a systems approach—sensitizing professionals to understand and be vigilant about “best-fit” environments.

Empathetic LifeSpan Design is informed by theory; could be your unfair competitive advantage (difference between a technician and a professional).

*Avoid Institutional Homogeneity of Environmental Press; untailored and unvarying in its ability to properly sensitize the environment to the varying capacities of the residents in Institutional housing. (Contractors team up with HC pros)

Adaptation Level is a RANGE and shows a continual oscillation around a central point.

“An individual will normally seek his/her own level of Environmental Press.”

Highly Competent Individuals will be adapted to COMPLEX environments with HIGH PRESS.

Low Competent Individuals will be adapted to SIMPLER environments with LOW PRESS.

EP can be both:

A) OBJECTIVE (alpha press)

Reflecting factors like COMPLEXITY

B) SUBJECTIVE (beta press)

Reflecting the perceived demand character of the environment

(When there is a wide divergence between alpha and beta press we speak of delusion)

“Independence has at its core, the element of choice.”

-Patrick Roden

You’re home by choice.

 

See

These are notes shared for talk on EP at ASA2013 (note reference below)

Christiansen, C. H. & Baum C. M. (2005). Occupational Therapy: Performance, Participation, and Well-Being.

Assessment of Physical Functioning: A Conceptual Model Encompassing Environmental Factors and Individual Compensation Strategies

Comments 2

  1. Kathleen Haisley
    November 18, 2015

    I like this language as it applies to my 89yo mother who is in assisted living. The focus in optimizing her life is not only on comfort or simple safety, but on the exercise of her remaining competence to the extent I can create such opportunities. The duty to this aspect of life in a person with cognitive impairments or even Alzheimer’s is essential. We hire a companion to take her shopping for a couch several times, talk about it, let her decide, don’t expect any actual couch buying. We buy a new curio cabinet she can barely fit in there so she can go shop for curios at the thrift stores with her friend. We don’t force her to go learn to listen to books on tape or go to group outings she does not do as well in as one to one. Best life is not just that ‘comfort’ part of the curve. Comfort alone cultivates apathy and hopelessness. Individualized stimulation matters.

    1. Patrick Roden PhD
      November 19, 2015

      Kathleen, your mother is fortunate to have you; you get it on all levels. The best life is not just comfort…

      Thanks for posting.
      Patrick

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