The process of mediated aging-in-place: a theoretically and empirically based model.

Aging-in-place is a complex geographical process mediated by institutions and other social forces. Two relatively under-studied services based on an aging-in-place strategy are adult day centers (ADCs) and assisted living residences (ALRs). This paper begins by re-casting aging-in-place as a process of place integration, based on a combination of geographical theory and John Dewey's philosophy of experience. Using empirical evidence from qualitative fieldwork and analysis of that evidence, the paper then introduces a theoretical model of the place integration process for older adults using ADCs and ALRs. The analysis describes how the domains of home and community are central to the originating problematic situation of these persons. It suggests that 'socio-geographical differentiation of older adults' situations' is involved in these domain problems and describes how the process works to influence the core processes of place integration generated by the ADC or ALR setting. The analysis then explains three core processes of the model: 're-shaping the experiential context through space and place', 'creating meaning through place-centered activity', and 'contesting space and place'. The model also includes two final component processes. One is the distillate of the core processes, termed 'approximating home and community'. The other is 'instability as ongoing challenge' to place integration. A brief conclusion discusses theoretical and policy implications drawn from the study.