Adaptive strategies after health decline in later life: increasing the person-environment fit by adjusting the social and physical environment.

Following the press-competence model (PCM) of Lawton and associates, we tested two expectations as to the adaptations older adults make to their socio-physical environment following health decline: (1) depending on the change in their functional limitations, older adults use adaptive strategies ranging from mobilizing informal care to moving into a residential setting; (2) the more people succeed in realizing suitable adaptations, the higher their wellbeing, measured as depressive symptoms, after a health decline. Data come from two waves of a longitudinal study among Dutch people aged 60-85 and living independently at baseline (Longitudinal Aging Study Amsterdam, LASA). The 819 respondents with a decline in self-reported functional disability within 3 years time were selected for analysis. Results of multivariate logistic and regression analyses show that (1) all adaptive strategies under study occur in response to health decline; (2) mobilization of informal care and moving to a care setting alleviates the negative effect of health decline on depressive symptoms. Furthermore, mobilization of professional home care was associated with more depressive symptoms independent of health decline, whereas adjustment of the home had no effect on depressive symptoms. We argue that some support was found for Lawton's PCM, but that evidence can be improved by studying more closely which adaptive strategies alleviate the environmental stress induced by specific physical disabilities.