Influence of Late Life Stressors on the Decisions of Older Women to Relocate into Congregate Senior Housing

Abstract

Late-life stressors often require individuals to make substantial alterations in behavior and lifestyle and can affect their overall health and well-being Relocation is a significant life stress regardless of age. The primary aim of this study is to elucidate the push-pull factors associated with moving into congregate senior housing. The secondary aim is to investigate the decision-making processes and stresses associated with moving into a congregate living environment. Interviews were conducted with 26 women who were new residents in congregate senior housing. Relocation, as expected, was considered to be stressful although individual differences were found among perceptions of relocation stresses. Women who had made the decision to relocate on their own showed evidence of better psychosocial well-being at the time of the move. One-quarter of the sample chose to move in order to provide care to another person. As the options for senior housing continue to evolve and the numbers of adults reaching advanced age continue to increase, it is important to understand the factors that contribute to successful adaptation. This knowledge will enable facility administrators to implement programs and procedures to assist incoming residents with acclimating to their new homes.

Introduction and Background

Relocation from one’s home to congregate senior housing is a complex process; many individuals report planning years in advance for such a transition while others move quickly, typically following a health care crisis (Oswald & Rowles, 2007). Key factors that influence the decision to relocate from a community setting to such an environment includes situational factors such as decline in health (including health crises), desire to be free from home maintenance, need for companionship, and desire to avoid becoming a burden on adult children (Bekhet, Zauszniewski, &Nakhla, 2009; Krout, Moen, Oggins, Holmes, & Bowen, 2002), as well as external factors such as finances, social and instrumental support from family, or loss of a spouse (Oswald & Rowles, 2007). Extant research has sought to identify influences on the decision making process and has provided conceptual frameworks for elucidating the personal and environmental factors that pull older adults from their homes and lead them to a new environment (Groger & Kinney, 2006; Krout, Moen, Holmes, Oggins, & Bowen, 2002). However, understanding how these influences shape the complex decision-making process requires greater understanding of the extent to which relocation is perceived as a stressor and the interconnected physiological and psychosocial sequelae that result from this decision.

Factors that encourage a person to move into a congregate senior housing can vary depending on societal, cultural, and personal beliefs. An individual’s gender has also been proven to have a major impact on one’s desire to relocate. Men tend to move due to a decline in health, whereas women are more likely to relocate in efforts of seeking friendships after experiencing a transition into widowhood (Erickson, Dempster-McClain, Whitlow, & Moen, 2000). Due to the fact that many of the current generation of women already experience a loss in identity resulting from the death of a spouse, it is likely that they will experience additional stress after their move, resulting from a loss in marital companionship; which has been suggested to “moderate the impact of life events on health” (Wethington, 2003, p. 170). The typical resident of senior housing (independent and assisted living) is a widowed women in her late 70s with chronic, yet manageable, health conditions (Morgan, Gruber-Baldini, & Magaziner, 2001). Additionally, gender differences not only influence the decision-making process to move, they also affect the choices individuals make in taking particular items to their new homes, in efforts of creating a sense of meaning and connection to their new environment. Women tend to cherish objects that provide personal meaning and evoke memories of various life events (Rowles & Chaudhury, 2005). Therefore, by having a better understanding of the existing gender differences associated with relocation, facilities will be able to help women better adapt and provide meaning to their new environment by providing opportunities that can both alleviate additional stress and create new forms of social support.

Decision-Making and Adaptation

There are two related frameworks that describe the factors that shape whether older adults relocate and the stress response related to that decision. The most commonly recognized framework is the push-pull model (Ryff & Essex, 1992; Lawton 1977, 1983; Lee, 1966). This model describes the extent to which the decision to relocate is shaped by various factors that both push an individual out of their current environment and pull them toward a new environment. For example, factors such as an inability to maintain one’s current residence or the fact that there have been substantial changes in one’s neighborhood may make it less safe or navigable. These factors push an individual toward relocation because the environment no longer supports that individual’s independence. Furthermore, the availability of amenities and desirable features of a new home may pull them toward a new environment that may more adequately facilitate independence.

Relocation as a Stressor

Research on life events, as defined by Holmes and Rahe (1966) and includes such events as marriage, widowhood, and health changes, includes relocation as an event that requires adjustment and is considered stressful. The influence of stress in shaping the outcome of relocation among older adults has been well established with most prior research linking relocation stress to a number of negative physical (e.g. increased mortality) and psychological (e.g. declines in perceived control) outcomes in later life (Cairney & Krouse, 2008; Cohen-Mansfield, 2002; Mallick & Whipple, 2000; Lawton, 1977). Lack of control before and after a move, as well as difficulties in making necessary adjustments to different levels of care, are responsible for high levels of relocation stress and trauma, particularly among those who are in poorer health (Oswald &Rowles, 2007). Indeed, the negative outcomes of relocation for older adults are termed, “Relocation Stress Syndrome” a formal nursing diagnosis which is defined as “physiologic and/or psychosocial disturbances as a result of transfer from one environment to another” (Mallick & Whipple, 2000).

A minority of research has also noted positive stress responses related to relocation. Rossen & Knafl (2007) found that women reported better quality of life and increased engagement in social activities post-move. Another study on relocation found that among older women who were relocating, those who used more problem-focused rather than emotion-based coping strategies showed increases in well-being following a move (Kling, Seltzer, & Ryff, 1997). Within this study, the “stressor” of relocation was planned in advance and afforded the opportunity for anticipatory coping, meaning that the relocation experience included expectance in scope, duration, and resources, Anticipatory coping affords the opportunity to plan for coping strategies and employ the use of instrumental and social support. Coping, as explored by Kling, et. al, is defined as expectancy.

Personal control and the choice to relocate are factors that have also been shown to shape transitions to a new environment. In general, moves that are made by choice, rather than due to uncontrollable circumstances or insistence of others, are perceived as being less stressful and result in an easier adaptation (Lee, Woo, & Mackenzie, 2002; Mikhail, 1992; Reinardy, 1992). Similarly, exposure to major life events in which an individual has little control, such as health crises, is associated with increased stress (Cairney & Krouse, 2008); adaptation involves adjustment to changes in environment, lifestyle, and social context, and has an effect on an individual behaviorally, biologically, and/or psychologically(Olff, 1999). Although research has not thoroughly examined the stresses associated with relocation, chronic stress is known to cause or exacerbate chronic health conditions, suggesting that older adults experiencing significant life transitions like relocation are likely to elicit a physiological stress response that may aggravate co-morbid health conditions.

The primary aim of this study is to elucidate the push-pull factors associated with moving into congregate senior housing. The secondary aim is to investigate perceived and experienced stresses associated with moving into a congregate living environment. Semi-structured research interviews allowed for in-depth questioning regarding the decision-making process and measures of perceived stress, coping and coping effectiveness. Given that stress and perceived control have influence on health and well-being, this study is poised to provide new information on the most influential factors associated with relocation and its relationship to perceived stress.

Research Questions and Hypotheses

The research questions within this study are : (1) What are the “push-pull” factors surrounding the decision to relocate? (2) What, if any, life events are key to such a decision? (3) What are the experiences of movers with regard to the stresses of relocation and their coping abilities. The first two goals utilized qualitative methodologies for analysis. The third goal used quantitative analyses. For the third goal, it is hypothesized that women (1) who had experienced multiple life events and who had been influenced by others in the choice to move would report higher levels of stress; (2) women who alone made the decision to relocate would have higher scores on measures of well-being and health at the time of the move and three months post-move.

Methods

The study was conducted with women who were new residents of senior housing within a Southern US city (population 295,000). The study was designed to be a smaller study in order to gain more detailed information on participants’ experiences. An a-priori power analysis was used in order to ascertain the appropriate sample size for detecting moderate to mild effects in the quantitative analysis and indicated that 25 to 50 cases would acceptable. Participation entailed completion of two a mixed-methods in-depth, semi-structured research interviews on relocation decision-making, anticipated lifestyle changes, health, social relationships and connectedness, perceived stress and coping strategies. Within the interview, open-ended questions allowed for qualitative analyses. Also embedded in the interview protocol were established scales for measuring psychosocial well-being. These response categories were given to the participants to indicate their response as the PI read each scale item. Participants were interviewed within the first month of residence and again three months later. The facility managers provided information about the study to prospective residents on the waitlist with contact information for the principal investigator. If the women were interested and gave consent for their contact information to be shared with the PI, the managers would send that information to the PI. The initial interviews were scheduled in the women’s new homes within the first four weeks in residence.

The Study Sample

The sample is comprised of 26 older women who had recently moved to congregate senior housing that included both independent and assisted living populations. Demographic information about the sample is presented in Table 1. The study was approved by the University of Kentucky Medical IRB, protocol #05-0044.

Table 1.

Demographic Characteristics of the Sample

	Mean (SD) n%
Age	76 (11.11)
Marital Status
Married	2 (7%)
Widowed	15 (58%)
Divorced	7 (28%)
Never Married	2 (7%)
Children
Yes	23 (89%)
No	3 (11%)
Number	3.1 (1.32)
Within 30-min drive	1.6 (.89)
Education
Grade School	2 (7%)
High School	8 (31%)
Some College	9 (35%)
College Degree	5 (19%)
Graduate Degree	2 (7%)
Health
Self-Rated (1–10)	6.5 (2.7)
MOS Physical Function	17.9 (7.4)

Measures

Many items in the interview were open-ended, allowing for coding into categories of responses. Specifically, questions relating to push-pull factors were open-ended and included process of making the decision to move, amenities attracting participants to their new home, and perceived stresses and benefits associated with the relocation. The questions included, “What were the main reasons for leaving your home?; What were the main reasons for choosing *facility name*?; What do you believe will be the best about living at *facility name*? What do you anticipate as being the most stressful part of this transition for you?; and How do you anticipate you will approach these stresses?” The answers were entered into the database verbatim. Data were analyzed for common responses and then categorized. “Did anyone help in your decision to move?” was open-ended and then coded into “yes” and “no” responses for quantitative analyses.

Measures of psychological well-being, stress perceptions, and coping strategies were imbedded in the semi-structured research protocol. Each scale had a set of of likert response choices which were presented to the participants on a separate card as the research read each item aloud and marked the response given. The scale measures included the Positive and Negative Affect Scales (PANAS), Proactive Coping Inventory, Perceived Stress Scale, and the Holmes-Rahe Social Readjustment Scale.

The Positive and Negative Affect Scales (Mroczek & Kolarz, 1998) are comprised of ten items with a 5-point likert response choice for each item. The PANAS yield scores indicative of levels of happiness and stability in mood and were included as an index of well-being. The scale exhibits a robust comparative fit (.94) and has demonstrated reliability across demographic subgroups (Crawford & Henry, 2004).

The Proactive Coping Inventory (Greenglass, Schwarzer, & Tauber, 1999) yields scores on active, problem-focused coping. Individuals scoring high on the Proactive Coping Inventory (PCI) are seen as having beliefs that are rich in potential for change particularly in ways that would result in improvement of oneself and one’s environment. The reliability estimates range from .80 to .85 as reported in the literature (Taubert, 1999; Greenglass, et. al, 1999). This scale was used to measure participants’ subjective views of their ability to make changes necessary for adaptation. Research using this scale with older adults has yielded insights into the role of coping on health outcomes, particularly disability. People who score high on the measure of proactive coping often perceive difficult events as “challenges” to overcome rather than a “stressor” and those who use proactive coping are better at mobilizing resources in anticipation of or response to a difficult situation (Greenglass, 2002; Greenglass, Fiksenbaum, & Eaton, 2006).

In addition to the PCI, a list of common coping behaviors was presented and each participant was asked if she had engaged in this behavior. The data were dummy coded as yes/no answer choices. If participants indicated they engaged in a coping behavior, they were asked to rate the general effectiveness (Very, Somewhat, Not at All) of the behavior in alleviating stress. These measures were included to assess the actual behavioral responses employed to manage stress. Table 3 presents the self-reported coping behaviors and their perceived effectiveness regarding the move.

Table 3.

Significant Life Events Preceding the Move

Life Event	Percentage Reporting	N
Change in eating habits	77%	20
Death of friendsa	62%	16
Change in social activities & recreation	62%	16
Personal illness or injurya *	54%	14
Revise personal habits	54%	14
Change in health of family membera	50%	13
Change in financial status	50%	13
Change in sleep patterns	50%	13
Change in church activities	50%	13
Change in number of family gatherings	50%	13
Death of family membera **	38%	10

^aThese life events were associated with the decision to relocate.

^*Two-thirds (64%) of those having experienced an illness or injury had recovered by the time of the first interview.

^**Includes the death of a spouse for two participants

Self-reported levels of stress were measured with the Perceived Stress Scale (PSS), which assesses the degree to which participants perceived their lives as uncontrollable, unpredictable, or overwhelming over the last month (Cohen, Kamarck, & Mermelstein, 1983). Eskin and Parr (1996) reported acceptable reliability estimates of .84 for the 14-item and 4-item versions of the PSS. Holmes and Rahe’s (1966) Social Readjustment Scale (SRS), which is comprised of a series of events that one may encounter during the course of an adult lifetime, has been used as an index of the amount of adaptation to significant life changes over the course of a year. A modified version of the scale, allowing for the collection of data on dates of occurrence and additional information, was used in the first interview to determine the amount of social and behavioral changes occurring in the year preceding the move.

Demographic Information

Participants were asked about their marital status, family structure (e.g. number of children and proximity), and educational attainment. In addition to this basic demographic information, participants provided in-depth information on self-reported health history, and conditions for which they were under the care of a physician. They were asked to rate their perceived health using a Cantrell ladder. A schematic of a ladder with a numeric value at each rung was presented to participants and they were asked to rate their current health using the numeric values with 10 representing “very best possible health” and zero representing “worst possible health”. Self-rated health has been shown to be reliable in predicting health outcomes and mortality in older adult samples (Eriksson, Unden, & Elofsson, 2001).

Research Questions

Both qualitative and quantitative approaches were employed to answer the research questions. Guided by the push-pull model, a phenomenological approach was used to explore the similarities and differences that resulted from these women’s shared experience of moving into congregate senior housing. The qualitative inquiries were:

• (1)What are the common push and pull influences on the decision to relocate to senior housing?
• (2)In what ways are significant life events associated with the push-pull influences on decision making?
• (3)What were the movers’ perceptions of the stresses associated with moving and their coping abilities?

Quantitative hypotheses based upon the push-pull model and extant literature on relocation outcomes included:

• (4)Women who had experienced multiple life events and had not alone made the choice to move would report higher levels of stress. This hypothesis will be tested with a multiple regression.
• (5)Women who made the decision to relocate would have higher scores on measures of pro-active coping, well-being and health both at the time of the move and three months afterward. This hypothesis was tested using an independent samples t-test.

Analyses

Qualitative data gathered from the interviews was analyzed using horizonalization, creating clusters of meaning, and developing themes to reduce the meanings of the participant’s lived experiences to their essential, invariant structure, or essence (Creswell, Hanson, Clark, & Morales, 2008; Creswell, 2007; Moustakas, 1994). Two raters, the authors, conducted the qualitative analyses. Each performed the horizonalization and clusters, then worked together on the thematic analyses. Quantitative analyses included multiple regression analysis and t-tests using SPSS software.

Results

The results are presented in three sections. First, the demographic characteristics and self-reported co-morbid health conditions are discussed. Next, the qualitative research findings are presented, followed by the quantitative results.

Demographic Characteristics of the Sample

With an average age of 78 (+11), the majority of the women in this study were widows (53%). Eight percent (n=2) were married and had been married for an average of 57 (+3.5) years. Approximately one-quarter (n=7) were divorced and two participants had never married. Participant self-rated health ratings were diverse with an average rating of 6.3 (+2.2) out of a possible ten and reported an average of 5 (+2.8) health conditions for which they were receiving treatment from a physician. Thus the women in this study were in fair health and requiring care for co-morbid health conditions of disparate severity. The majority of conditions are common among older adults: hypertension (65%), arthritis (57%), gastric reflux (39%), heart disease (39%), angina (31%), thyroid dysfunction (23%), and stomach upset (23%).

Qualitative Analyses

Interview data was read several times to identify significant phrases that related directly to the phenomenon. Meanings from each of the phrases were clustered into overarching themes that emerged from the participants’ experiences.

Reasons for Relocation: “Push and Pull” Factors

Horizonalization was used to identify “push-pull” influences on participants’ decision to relocate to congregate senior housing. Participants were asked their reasons for relocation, the factors that influenced their decision to move, and the amenities that were most appealing in the new home. Participants could mention more than one reason, which were clustered into themes: (a) encouraged by children, (b) freedom from home maintenance, (c) to be closer to a relative needing care, (d) health issues “I had several falls and broke my hip” [Mrs. C]; “I’m not stable to walk yet. I’ve had two mini strokes” [Mrs. P]; and (e) no desire or unable to live alone. [“I am no longer able to live alone” – Ms. L] Eleven of the women said the decision to relocate was their own whereas the remainder (n=15) said others were influential. For many, their families were involved, including adult children, grandchildren, extended family and friends. “My children wanted me to move because they worry about me. They fear I’ll die and won’t be found. I just tell them what they want to hear and then I do my own thing. I lie to them” [Mrs. E]. “I moved to be nearer four of my five children. They’ve been needling me for two years to come up here. I miss Florida. I miss my condo. I miss my friends. But, I love my kids most of all” [Mrs. R]. The data on the decision to move were coded into a quantitative dummy variable, for use in t-tests and regression analyses, with values representing “own choice” and “other influence”.

Participants were asked for the reasons they selected the facility to which they were moving (i.e., pull factors). Responses were analyzed for structural descriptions and then clustered into categories: (a) having friends and companions already at the facility “I’ve known it all my life…lived in *city* all my life. I knew women who had lived in both buildings” [Mrs. B]; (b) availability of supportive services onsite, people associated with the facility, (including management, staff members and the current residents), “My friends are here…it’s easy for them to visit” [Mrs. E]; (c) reduced cost of rent and utilities, and (d) amenities (such as multiple levels of care, neighborhood appearance, and convenience and location). Additionally, the option of residence in faith-based facilities operated or overseen by area churches was also mentioned.

The participants were asked what they believed was going to be the best part of living in the facility. Their answers were very similar to their reasons for selecting the facility: (a) companionship, “My neighborhood was mostly young couples with children. I need companionship with others my own age” [Mrs. A]; (b) privacy of individual apartments/living units, (c) onsite services, (d) ability to maintain independence, and (e) activities. These answers reflect the strongest “pull” factors toward their new homes and knowledge of the anticipated changes lends itself to “expectant” coping strategies.

Life Events and the Relocation Decision

A modified version of the Holmes-Rahe scale (1966) was embedded in the first interview as an index of the number of changes requiring adaptation prior to the move. Participants had experienced an average of 10 (+3) life events in the year preceding the move (See Table 2) which would require them to make substantial adjustments, both behaviorally and cognitively. Of these life events, participants were asked which had been the most stressful during the preceding year and had contributed to the decision to relocate. The participants were allowed to mention more than one life event. Themes emerging from cluster of meanings on the most stressful events included: (a) Health issues, (b) moving and selling a residence, (c) health of a family member and caregiving, (d) deaths of loved ones, and (e) finances.

Table 2.

Phenomenological Themes on Push and Pull Factors Associated with Relocation

Push Factors (Open-ended Responses)

Encouraged by adult children

Freedom from home maintenance

Nearer relative needing care/caregiving

Health issues

No desire/ability to live alone

Push Factors (Life Event Responses)

Health Issues

Selling a home

Health of another/caregiving

Death of family

Pull Factors (Open-ended Responses)

Friends/Companions at facility

Supportive Services onsite

People associated with facility

Multiple care levels

Neighborhood appearance

Convenience and location

Experienced life events were perceived quite differently among participants. One participant commented, “When my husband died, I could see it coming. I could prepare for his passing. This move has been one BIG nightmare. It has been worse than my husband’s death.” Another recent widow commented, “[Preparing for] the move hasn’t been my biggest stress. The loss of my spouse was the worst. I am still grieving. The first year is shock, the second year is grief.”

One-fifth of the participants relocated to be closer to a relative needing care. For these women, family issues were considered to be more stressful than the move. These women were caring for a variety of family members, including parents, children, and spouses. One participant, who relocated to the same senior housing facility as her mother who had dementia, commented, “It’s been hard being a caregiver to my mother. I’ve become a parent to my own parent.” Another woman, who had been in a caregiving role for several years, said “My husband gets angry. He has dementia so it’s not really him anymore. My doctor says I’m holding up well for all I’ve been through.” Other participants whose middle aged children were severely ill and dying made the following comments, “I moved here from the country. I had lived in the city for 84 years prior. I returned for my daughter. She’s in the nursing home dying of Huntington’s chorea.” Yet, another stated “My life has been stressed since my oldest son died and another son became ill. They both had brain cancer.”

Health issues were another common theme regarding life events surrounding the decision to move. Over half of the participants had experienced a significant injury or illness in the year preceding the move and of those, one-third had not yet recovered. These health conditions varied in intensity and severity, and they included back problems, pneumonia, lung disease, broken bones, and cancer See Table 3. “The fact that my health causes problems interferes an awful lot…fixing meals. It’s not bad but I expected to do more yet I’m doing less. I’m afraid I’ll stop completely sometimes” [Mrs. S].

Perceptions of Relocation Stress

Horozonilazation was used to investigate the experiences of the stresses associated with relocation. The details of moving, such as sorting items, packing, organizing the move and helpers, and the accompanying physical exertion was one emergent theme. A second theme of “divestment” emerged. Divestment is the process of downsizing and parting with personal possessions. “Now there are things I know I could have brought with me, but it’s too late now. He [son] packed but he didn’t pick what I would have” [Mrs. C]. “…trying to decide what not to bring here. This place is a lot smaller. I’m still sorting things now” [Mrs. S.]. “I sorted and packed. I gave things to the kids and sold the furniture. I just want it to be over.” [Ms. W]. “I was attached to my possessions. I had taken care of the antiques given to me by my grandparents” [Ms. V].

Disruptions in place attachment was a third theme and included details such as leaving former communities and churches, and adjusting to living near so many others. Mrs. S stated, “It was hard to leave the neighborhood where I lived, my life, my friends.” Two additional themes, transitional issues and health, emerged. Transitional stresses included complicating factors such as selling the house while settling into the new home. Health issues, either for oneself or a relative, were common.

Participants were asked how they had anticipated they would handle these stresses. Answers indicated a combination of strategies: continue sorting and dispersion of possessions with the assistance of family “I’m still disseminating some. I’ve given to family and donated some things to charity’ [Ms. V]; seek out new friends and socialize with others; rely on their common sense or just “be myself” “I’ve adjusted to transitions all of my life. I’m good at it. I enjoy every step” [Mrs. H]; or behavioral strategies such as prayer, staying busy, seeking activities or part-time jobs as distractions “I keep busy. I do genealogy complete with pictures for each son. It’s been 20 years worth of work” [Mrs. S]. “As long as I have a good book and visitors, I’m happy. It’s an escape” [Mrs. B].

Quantitative Results

Testing of Hypotheses

Multiple regression analysis yields support for the first hypothesis, that women who had experienced multiple life events (β = .68, p ≤.01) and had not alone made the choice to move (β =−0.72, p ≤ .01) would report higher levels of stress (R² = .55, F = 7.6, p≤.05). T-tests were used to test the second hypothesis that women who made the decision to relocate would have higher scores on measures of pro-active coping, well-being and health both at the time of the move and three months afterward. Results yield partial support for this hypothesis, with significant differences in positive affect and negative affect, but not proactive coping or health. Women making the decision alone had higher scores on positive affect and lower scores on negative affect at the time of the move. Three months post-move, there was no difference in affect or self-rated health between the two groups, yet positive affect increased in both groups from time of move to three months in the new residence (See Table 4).

Table 4.

Differences in Well-Being, Coping, and Health between Self Decision and Influence of Others on Decision to Relocate

	Self Decision (N=11)	Others Influence (N=15)	t	Mean (SD) df_
Time One
Positive Affect*1	3.03 (.63)	2.57 (.58)	−1.79	24
Negative Affect**	2.21 (.61)	2.89 (.58)	2.61	24
Proactive Coping	34.18 (7.36)	34.86 (7.24)	−0.23	13
Self-Rated Health (0–10)	6.12 (2.36)	7.00 (3.27)	.56	21
Three Months Post Move
Positive Affect	3.71 (.46)	3.24 (.55)	−1.65	22
Negative Affect	2.05 (.50)	2.49 (.50)	1.57	24
Self-Rated Health (0–10)	6.33 (2.0)	6.40 (3.04)	−1.30	14

^*p≤.05,

^**p≤.01;

¹Positive affect increased significantly from time of move to three months post-move for both groups. There were no differences in negative affect or self-rated health.

Discussion

Relocation is a major life event that elicits both positive and negative stress responses. It not only entails a change in where one lives, but may also impact patterns of social interactions, engagement in the community, and daily lifestyle habits (such as eating and sleeping patterns). On the one hand, relocating can be a physical and financial relief in that they no longer have to maintain a house, and yet it may also elicit grief responses to losing a home, which holds memories of happy times and the comfortable, familiar community surrounding it. Conversely, relocation can be a relief from an isolating or fearful existence in a once familiar neighborhood going through a metamorphosis. Leaving one’s home may evoke fears of losing independence and freedom or the move may appear as a wonderful opportunity for increasing social contact with peers. If relocation is perceived as a challenge, then it affords an opportunity to cope with the new situation through personal growth thereby creating a positive stress response.

As expected, relocation was considered to be a stressful experience for the women who participated in the study, although there were individual differences in perceptions of the factors causing the stress. Some did not actively desire the move whereas others were struggling with additional significant life events, changes in health status, and lifestyle changes in parallel with their move. In accordance with Lee’s “push-pull” model (1966), factors leading to the move as well as amenities within the senior housing facility contributed to their decision to relocate. Health and functional decline were the most cited “push” factors for relocating. A surprising number (one-fifth of women) relocated to be nearer a relative who needed care. The continued responsibility for home maintenance (push factor) and availability of onsite services (pull factor) allow these women to dedicate their time and energies into their caregiving responsibilities. This could be indicative of a new trend in elder relocation, particularly for the baby boom generation: relocating to supportive environments in order to provide a source of care to ailing family members. This also could be viewed as a proactive coping strategy that may serve the caregiver well. The caregiver relinquishes responsibilities to a home, finds instrumental support in housekeeping and food service provisions within the facility, and has access to social and recreational outlets when time and desire permit. Such an arrangement may allow for the development of a medical and social support network. Caregiving is a stressful experience in itself (Vitaliano, Zhang, & Scanlan, 2003; Lutgendorf, Garand, Buckwalter, Reimer, Hong, & Lubaroff, 1999; Aneshensel, Pearlin, Mullan, Zarit, & Whitlatch, 1995) and relocation may be a way of coping with the demands of maintaining a home and providing care to a relative. Relocation, therefore, would be a solution and not necessarily a stressor.

The women of this sample, on average, were widows in their late 70s who had experienced multiple significant life changes in the year preceding the move. The sample is demographically similar to the current population of older adults residing in congregate senior housing (Morgan, Gruber-Baldini, & Magaziner, 2001). Women who had made the decision to relocate on their own showed evidence of better psychosocial well-being at the time of the move and trends toward lower physiological stress responses, which supports previous research findings that perceived control leads to increased well-being (Lee, Woo, & Mackenzie, 2002; Mikhail, 1992; Reinardy, 1992). Despite health declines and fears of losing independence, these women have been making decisions that affect all aspects of their lives and shown that they are capable in doing so. Given the homogeneity of the sample, it is not surprising to see similarities in coping behaviors. Their coping strategies, within the context of expectance of the stressors, contributed to their success in acclimation.

Limitations

This study, although innovative and comprehensive in scope, has limitations that must be noted. The sample is small and demographically homogenous. The small sample size was deliberate given the exploratory nature of the study. Despite a priori power analyses indicating that a large effect could be detected with a sample of 26, significant differences were not detected. The lack of difference may be due to the homogenous sample from a single location within the United States. While this could be a limitation to the study, it is likely that the demographic similarities and desire for companionship would lead to greater social support within the retirement community.

The data on the reasons for relocation and the appeal of the new housing were retrospective in nature and may be influenced by recent interactions and the acclimation processes the participants were in the midst of experiencing. However, given the recency of the move, it is likely that their recollection of the decision-making process were a source of recent ruminations and, therefore, more accurate than retrospective responses given after significant time had passed. The study does not include a control group of older adults who have either not relocated or have resided in congregate senior housing for several years.

As the options for senior housing continue to evolve and the numbers of adults reaching advanced age continue to increase, it is important to understand the factors that contribute to successful adaptation. This knowledge will enable facility administrators to implement programs and procedures to assist incoming residents with acclimating to their new homes. Transition programs and assistance would likely be of greatest benefit to those who are relocating to care for an ailing loved one, as they are at increased risk of failing to socially integrate with others in the facility due to caregiving demands and time constraints. Therefore, this is one of the most salient results of this study: women relocate to supportive housing in order to provide care for an ailing relative.