Urban Environment, Aging, and Quality of Life: Kayseri Case
Işıl Avşar ArıkThis study aimed to investigate the quality of life of the elderly living in urban environments from the perspective of environmental gerontology, which examines the association between the individual and the environment. Studies have examined the relationship between quality of life and the environment in old age in terms of the physical characteristics of the environment in the field of health and quantitative methodology. Conversely, the present study focuses on the perspectives of the elderly, considering the quality of life as a phenomenon that can be shaped by the socio-physical and socio-cultural environment in which individuals live. This study selected Kayseri, one of the most developed cities in Central Anatolia with a culturally conservative social structure, as the environment and used a basic qualitative research design. A total of 20 participants, including 7 women and 13 men, aged between 65 and 80 years, underwent in-depth interviews using semi-structured interview forms. The study result indicated that the quality of life was interpreted in the context of economic status, health status, perception of old age, physical-built environment, and cultural environment. The quality of life among the elderly means having the opportunity to socialize in their known and familiar environment, preserving their cultural and traditional values, being respected, accessing health institutions easily, obtaining physical health and economic competence, and having their opinions considered in urban decision-making processes. Additionally, it indicates that all these processes are accompanied by the preservation of Kayseri’s traditions and identities.
Kentsel Çevre, Yaşlanma ve Yaşam Kalitesi: Kayseri Örneği
Işıl Avşar ArıkBu çalışma birey-çevre ilişkisini inceleyen çevresel gerontoloji perspektifiyle kentte yaşayan yaşlıların yaşam kalitelerini araştırmaktadır. Yaşlılıkta yaşam kalitesi ve çevre arasındaki ilişki genellikle çevrenin fiziksel özellikleriyle, sağlık alanında ve nicel metodoloji etrafında incelenmiştir. Bu çalışma ise yaşam kalitesinin bireylerin içerisinde yaşadığı sosyofiziksel ve sosyokültürel çevreyle şekillenebilecek bir olgu olmasından hareketle, yaşlıların kendi perspektiflerine odaklanmaktadır. Evren olarak Orta Anadolu’nun en gelişmiş kentlerinden biri olan ve kültürel olarak da kapalı bir toplumsal yapıya sahip olan Kayseri’nin seçildiği çalışmada temel nitel araştırma deseni kullanılmıştır. Yaşları 65 ile 80 arasında değişen, 7’si kadın, 13’ü erkek olmak üzere toplam 20 kişiyle yarı yapılandırılmış görüşme formları ile derinlemesine mülakatlar gerçekleştirilmiştir. Çalışmanın sonunda yaşam kalitesinin ekonomik durum, sağlık durumu, yaşlılık algısı, fiziksel-yapılı çevre ile kültürel çevre bağlamında anlamlandırıldığı görülmüştür. Yaşlılar açısından yaşam kalitesi; bildikleri ve alışık oldukları çevrede sosyalleşebilecek imkânlarının olması, kültürel ve geleneksel değerlerinin korunması, saygı görme, rahat bir şekilde sağlık kuruluşlarına ulaşabilme, bunun için fizikî sağlık ve ekonomik yeterliliklerinin yerinde olması ve kentsel karar alma süreçlerinde kendi fikirlerinin de alınması anlamına gelmektedir. Ayrıca tüm bu süreçlere Kayseri’nin geleneklerini ve benliklerini yansıtan bir çevre olarak sahiplenilmesi, ona aidiyetlik hissedilmesi ve korunmaya değer bir çevre olarak görülmesi de eşlik etmektedir.
The proportion of the elderly population is rapidly increasing globally. The United Nations’ World Aging Report in 2019 indicated that 1 in every 11 people was ≥65 years of age, while 1 in every 6 people is expected to be ≥65 years of age by 2050 in line with population projections (UN, 2019). The majority of this population will age in cities with increased urbanization rates. The urban environment creates both advantages and disadvantages for the quality of life of the elderly.
Quality of life refers to the difference between the life that an individual desires to live and his/her current life. A smaller difference indicates a higher quality of life. However, studies revealed that factors, such as age, gender, educational status, health (Baş, 2019; Pamuk, 2017), marital status, economic status (Baş, 2019; Gobbens & Assen, 2018), loneliness, and social security, are directly related to the quality of life (Baş, 2019). Especially, economic status is an important determinant (Keleş, 2012; Levasseur et al., 2009).
The living environment plays a crucial role in the quality of life of the elderly. Studies have revealed that elderly people who are satisfied with their living environment have a higher quality of life (Stephens et al., 2018, p. 681). First and foremost, the quality of the physical environment determines the quality of life. An environment that will meet the needs (Düzenli & Alpak, 2017, p. 6) and demands of the elderly (Gobbens & Assen, 2018, p. 102; Levesseur et al., 2009, p. 96; Yabuwaki et al., 2008, p. 66) or the existing and perceived barriers and opportunities in the physical environment (Rantakokko et al., 2010, p. 2157) are crucial for the quality of life. However, the environment should not only be considered as a physical entity but should also be placed in a broader framework of meaning, including socio-cultural, political, and economic requirements, when addressing the relationship between environment and quality of life (Keleş, 2012, p. 24). The social, organizational, political, and societal environment is extremely important in the quality of life of the elderly (Richard et al., 2005, p. 28).
This study focuses on the quality of life from the perspective of environmental gerontology, which is a multidimensional evaluation of the individual-environment relationship following both intrinsic and social-normative criteria in the past, present, and future (Lawton, 1991, p. 6). However, two important issues are thought to be addressed similar to the relationship between environmental gerontology and quality of life. The theories and empirical studies conducted within the framework of environmental gerontology demonstrated that the focus is mostly on the physical dimensions of the environment (Wahl & Oswald, 2010, p. 119). These studies are mainly concerned with the physical environment, as well as attempting to explain the individual-environment interaction. Concurrently, the theoretical and practical studies conducted in this field were notably centered in North America (Smith, 2009, p. 31) or Europe (Scheidt & Windley, 2006, p. 106). Additionally, studies on the quality of life, which similarly focus on the physical dimension, are usually embedded in the field of health (Richard et al., 2005). These studies, which are predominantly based on quantitative methodology, considered the quality of life as a health status outcome.The relationship between environment and quality of life is limited in the Turkish literature (Öztürk & Turan Kızıldoğan, 2017, p. 11), but very few studies go beyond the physical meaning of the environment (Pamuk, 2017, p. 19).
The present study aimed to provide an overview from the perspective of Turkey, starting from such a theoretical and methodological sensitivity. The study examined the association of the physical, social, and cultural environment of the elderly living in urban areas with their quality of life from the perspective of environmental gerontology. The issues problematized here are attempted to be understood through the eyes of the elderly themselves.
The study followed Diaz Moore’s (2014) Ecological Framework of Place approach. The study considered the importance of the person, environment, and personenvironment cohesion in shaping the quality of life, and the meaning of the environment is affected by the subjects’ meaning of worlds and thus may have subjective meanings. Therefore, the study approaches the older adult in a relational reality with his/her socio-cultural and socio-physical environment. This study used a basic qualitative research design. The researcher is interested in the following questions in this design: “How do people interpret their experiences?”; “How do they construct their world?”; “What meanings do they attribute to their experiences?” These questions aimed to understand how people make sense of their lives and experiences (Merriam & Tisdell, 2016, pp. 23-24). This study has two main problems: (i) How do older adults living in Kayseri perceive and make sense of the quality of life?; (ii) How do older adults living in Kayseri experience quality of life in terms of their socio-physical and sociocultural environments?
This study selected Kayseri as the environment for the study. On the one hand, Kayseri is a conservative urban place that strictly preserves cultural values, and on the other hand, it is a modern city that attempts to maximize its economic profits through the urban environment. However, this understanding ignores the social dimensions of cities and negatively affects the social relations and quality of life of urban dwellers who provide socio-cultural meaning to the environment (Ergun & Dericoğulları Ergun, 2020, p. 135). TÜİK’s (2015) provincial life index reported Kayseri to rank forty-ninth. This indicates the low quality of life in the city.
This study used a purposive sampling technique. Accordingly, this study included 20 people aged between 65 and 80 years. The inclusion criteria were suitability for the interview, bothphysically and psychologically, and being a resident of Kayseri for many years or being born and raised in Kayseri to capture the socio-cultural context. The study first analyzed the socio-demographic characteristics of the participant group. Accordingly, of the participants aged between 65 and 80 years, 7 were female and 13 were male. The educational and economic status of the participants is quite low. The thematic analysis revealed that themes emerged under three themes: “availability and accessibility,” “perception of self and old age,” and “change, adaptation, and conflict.”
The thematic analysis revealed three main factors to be discussed. The first factor is related to the physical environment. Public transportation in Kayseri is generally adequate, convenient, and usable for the elderly. Additionally, free public transportation for those aged ≥65 years was an important factor that improves the quality of life. However, access to health services, which are perhaps the first in terms of importance in the quality of life for the elderly, is not always easy. Moreover, the difficulties inmeeting the examination fees of private hospitals, which are an alternative, may prepare the environment for risky conditions in terms of elderly health. Lack of clean and sufficient space to meet water and toilet needs is an important point that reduces thequality of life in public spaces, thereby reducing the contact of the elderly with theirsocio-physical environment. The study generally mentioned that walking areas are inconvenient, and uneven and therefore cause fall hazards.
The second factor is related to the social aspect. Both ageism and internalized ageism are directly related to the interaction with the environment as a reflection of selfperception. Another important factor in the quality of life of the elderly in urban environments is the rapid change and transformation of cities, gentrification efforts,increased migration rates, and security issues. These factors, which reduce the qualityof life of the participant group, demonstrated the participants’ limited management ability. The elderly stated that they made some attempts to both the mukhtars and the relevant units of the municipality on the issue, but their opinions were not considered.
Finally, the third factor is the changed understanding of the quality of life due to social and cultural environment changes caused by urbanization and modernization. Additionally, the relationship established with the cultural environment is perceived within the framework of respectability. Finally, the sense of belonging and cultural attachment to Kayseri is an effective factor in the quality of life.
