By the year 2020, there will be more people over the age of 65 than children under the age of five on the planet – for the first time in human history. This poses serious challenges for societies and states throughout the world: How do they meet the needs of the growing number of elderly, possible frail individuals? How will the aging population live, what sort of help will they require, and who will provide it?
There are also academic challenges for people interested in studying new global approaches to aging. One of these people is Dr. Andrew Scharlach, who is Kleiner Professor of Aging at the Center for the Advanced Study of Aging Services at the University of California, Berkeley. In early June, he visited SFI in Copenhagen. Together with SFI’s Tine Rostgaard, he hosted a lecture meeting on new approaches to long term care for the elderly in a comparative perspective.
Dr. Scharlach’s research focus is aging in place, both in American and international contexts. Moreover, he shares an interest in impact evaluation research with SFI and other institutions. “One of our goals is to examine the sustainability of various community models for older adults and determine whether or not in the long run they do allow people to age in place”, Dr. Scarlach explains.
One of the American initiatives studied by Dr. Scharlach’s team is the so-called Virtual Villages –a new community model in the US, in which older adults in a neighbourhood get together and create an organisation, funded by their own membership fees, which then pays for the care and service they need.
“I’m interested in the Village model because of the civic and social engagement aspect of it, the way in which it allows or encourages the elderly themselves to have ownership of their support systems, and the social capital potential that comes from that”, explains Dr. Scharlach.
“Aging in place not only means staying in your own home as long as possible – we look at it now as aging in community. The question is not only whether you receive the services and support you need. We’re also focused on how you engage in the community around you as you grow older – that is, are you still part of the community?”
The study of such Villages poses a methodological challenge.
“These facilities tend to have few resources and little bureaucracy and administration, and since research demands a certain amount of rigor and documentation, it becomes a challenge to take our research methods and translate them into something viable in a system as relatively unstructured as this”, says Dr. Scharlach. The research team have a number of variables with which to assess the effectiveness of the Virtual Villages.
“We look at both short and long term indicators. The short term involve capacity building, both individually and in the community. We examine people’s knowledge and use of various services, their local engagement and participation, and we look at the availability and cost of the services. And in the longer term we look at the health outcomes for the individuals – for how long do people continue to live in their homes? It’s also interesting to look at the social demographic of these organisations – do they match the characteristics of the area they’re located in or is it only a select few who join?”
Control and comparison
Impact evaluation studies demand the establishment of a control group with which to compare findings. This is another challenge for Dr. Scharlach’s team.
“Because these communities are new and still recruiting, they are reluctant to turn people away arbitrarily for research purposes, so it becomes impossible for us to establish a randomized control group. Instead, we now look to senior centres to find a comparison group – like the members of the Virtual Villages, people in these centres tend to be well informed and relatively active in the community. We then have to control statistically for various factors to compare the two groups – a bit of an artificial way of going about it, but do-able.”
“The challenges are not unique to this area, but they are substantial. It’s really the difference between doing research in an artificial setting and doing research in a real environment”, concludes Dr. Scharlach.