The interrelationship between place and critical life transitions in later life social exclusion: A scoping review

Health & Place 60 (2019) 102234

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Review Essay

The interrelationship between place and critical life transitions in later life social exclusion: A scoping review Anna Urbaniak *, Kieran Walsh Irish Centre for Social Gerontology, Institute for Lifecourse and Society, National University of Ireland, Galway, Ireland

A R T I C L E I N F O

A B S T R A C T

Keywords: Old-age exclusion Older people Knowledge synthesis place critical life transitions Social isolation

Understanding the role of place in protecting against social exclusion (SE) and risk during critical life transitions (CLTs) in older age is essential to create effective community-level ageing policies. However, existing knowledge is diffuse across a range of literatures and lacks coherency. Through a two-stage scoping review, this paper aims to synthesise state-of-the-art international research linking place, old-age SE and CLTs. Findings show that: (1) place serves as a setting for, and as a mediator of exclusion resulting from CLTs and (2) theoretical con­ ceptualisation to address the intersection of CLTs, place and SE in later life is underdeveloped. The implications of the state of scientific knowledge on this topic are discussed in relation to future research needs and ageing in place policy.

1. Introduction Place is now a central concept within national and international ageing policy. This is evident in relation to ageing in place and com­ munity care agendas, and age-friendly (World Health Organization, 2007; World Health Organization, 2015) and liveable community implementation programmes (Guzman and Harrell, 2015). Given the increased emphasis on local settings, particularly for promoting active and healthy ageing, it is necessary that we maximise the capacity of places to support older people when they are most in need, and most at-risk of social exclusion (SE). Otherwise, neighbourhoods and com­ munities are likely to struggle to be effective, positive agents in the ageing process. Critical life transitions (CLT) in older age, encapsulating frequent but less normative life events – such as relocation, bereavement and the onset of ill-health – not only produce such needs, but can give rise to SE and other forms of disadvantage accumulation (Dannefer, 2003; Cavalli et al., 2007; Mortimer and Moen, 2016). However, current place-orientated policies and initiatives fail to adequately consider these periods of transition when risks to health and well-being can sometimes be most acute (Alwin, 2012). There is certainly growing acknowledgement of the linkages be­ tween place and these major transitions occurring in people’s lives. But scientific knowledge on this topic remains fragmented, and somewhat disconnected across disparate literatures on transitions, SE and place, and, to a lesser extent, social epidemiology and public health. There has

not, to our knowledge, been a review of research that explores the links between CLTs and place in later life, and the consequences for exclusion and well-being outcomes. This article aims to address this deficit. The potential for transitions to shape well-being outcomes at any age is well documented (Mortimer and Shanahan, 2007). There is recogni­ tion though that later life transitions are of particular importance, and can sometimes serve as junctures of significant risk (Grenier, 2012). While research on these transitions remains underdeveloped, and we continue to lack understanding of their multifaceted impact, there is evidence that some transitions can increase susceptibility to multidi­ mensional SE (Scharf et al., 2005b). Others represent more substantial, perhaps even traumatic ruptures, in people’s life courses (Diewald, 2016). Again, although knowledge of specific mechanisms is limited, the potential for exclusion, and subsequent health effects, can be considered to arise from: the transition itself; the transition’s management (e.g. specialised services); and the transition’s symbolic and structural posi­ tioning (e.g. stigmatisation/segregation) (O’Rand, 2006). It is these different dimensions that place may need to interact with in order to support/protect older people during such critical periods. Reviews of the international literature on older adult SE (Van Regenmortel et al., 2016; Author, 2017) have pointed to a number of CLTs that can serve as significant sources of adversity for older people. This is particularly in relation to relocation and migration, bereavement, and the on-set of ill-health, primarily in terms of dementia. While some of these life changes have attracted more attention than others, the

* Corresponding author. E-mail address: [email protected] (A. Urbaniak). https://doi.org/10.1016/j.healthplace.2019.102234 Received 27 May 2019; Received in revised form 7 October 2019; Accepted 17 October 2019 Available online 28 October 2019 1353-8292/© 2019 Elsevier Ltd. All rights reserved.

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potential significance of each for SE is clear. Relocation and migration, encompassing internal and trans-national moves, have been linked to deficient social connectivity (Fokkema and Naderi, 2013; Gierveld et al., 2015), difficulties in accessing services and, for transnational migrants, longer-term exclusion based on cultural identity (Lissitsa and Chachashvili-Bolotin, 2015). Forced migration, as the most intense form of this transition, amplifies many of these challenges (Loi and Sundram, €ls€ 2014; Mo a et al., 2014). Building on an extensive body of work on widowhood in gerontology (Martin-Matthews, 1991), and a burgeoning literature on psycho-social consequences, bereavement has been shown €veling, 2015) and feelings of loneliness to impact social well-being (Do (Fried et al., 2015). It has also been found to impact on economic out­ comes relating to income and material wealth (Richardson, 2014). Research on dementia has demonstrated how the care system and social and cultural representations (Beard et al., 2009; Bond et al., 2004; € Osterholm and Samuelsson, 2015) can exclude older people living with dementia leading to homogenisation and othering. To understand how places might help support older people during such transitions there is a need to consider how place can play a role in inclusion/exclusion. While still a developing field there has in recent years been a significant growth in the number of studies investigating place and SE in later life (Wanka et al., 2018; Author, 2017; Abbott and Sapsford, 2005). Here, place is conceived as possessing multiple in situ dimensions, including spatial/geographic features (Oswald et al., 2011; Ryvicker et al., 2012), embedded service infrastructure (Dwyer and Hardill, 2011), and social and cultural aspects (Buffel et al., 2012; Gale et al., 2011). It also embodies subjective and symbolic elements, linked to an individual’s roles, attachments, and belonging (Oswald and Wahl, 2005; Rowles, 1978; Wiles et al., 2012), that cross-cut these dimensions and reflect a mutually constitutive relationship arising from older peo­ ple’s negotiation of place. As noted by Andrews et al. (2013) for gerontology in general, place can possess ‘basic agency’, with respect to in situ infrastructure, technologies and people, which can overlay ‘far more intimate processes concerning place experiences, attachments and identities’ (Andrews et al., 2013: p. 1344–1345). As such, places can be understood as processes that implicate material/physical, social and symbolic aspects (Wiles, 2005). There are still many questions remain­ ing about the mechanisms by which place intersects with exclusion (Dahlberg, 2019; Walsh et al., 2019). Nevertheless, place is likely not only to function as an important life domain where people are included and excluded in situ (e.g. area-based services; relational communities), but can, often perhaps through older people’s relationship with place, serve to mediate wider experiences across a range of life areas – exac­ erbating or buffering against exclusion (Author, 2018). There have been examples of where place and transitions intersect in terms of exclusion. For example: lack of service access in rural areas significantly impacts on people with dementia (Blackstock et al., 2006); bereavement can be approached differently depending on whether someone is a rural (collective coping strategies) or urban (individual coping strategies) resident; and an intersection between migration and perceived neighbourhood characteristics is linked to loneliness (Gier­ veld et al., 2015). There is a substantial neighbourhood context litera­ ture that testifies to the impact of neighbourhood effects on well-being outcomes, including the on-set of ill-health (Freedman et al., 2011; Marquet and Miralles-Guasch, 2015). Additionally, a number of con­ ceptual frameworks within environmental gerontology point to the intersection of life transitions and place, – albeit not explicitly in terms of SE – such as place integration theory (Cutchin, 2001), and residential normalcy (Golant, 2011, 2014). However, there have not been sufficient efforts to draw this knowl­ edge together and to explore the different place and exclusionary mechanisms at work. Given that such circumstances has implications for our capacity to identify the appropriate form and timing of in­ terventions, our ability to meaningfully inform ageing in place policies and implementation programmes is impeded. Therefore, the aim of this article is to conduct a scoping review of the

international literature to investigate the role of place in SE arising from CLTs. We first conduct a review of the general literature on place, SE and CLTs to capture a broader picture of the international literature on this topic and the range of CLTs being considered. We then focus specifically on bereavement, dementia and forced migration as CLTs that have been strongly linked to social exclusion within the international literature on ageing and exclusion (Author, 2017). For the purpose of this analysis we consider SE to involve the multidimensional separation of individuals and groups from mainstream society (Moffatt and Glasgow, 2009), across the domains of social relations (Ogg and Renaut, 2012), material and financial resources (Prokos and Keene, 2012), services, amenities and mobility (Shergold and Parkhurst, 2012), socio-cultural aspects (e.g. � ska and Henning, 2011), civic discrimination; identity exclusion – Wilin participation (Craig, 2004) and neighbourhood and community (Scharlach and Lehning, 2013).1 In addition to viewing place as a multifaceted, processual construction, it is understood as being subject to a set of dynamic relationships, pointing to linkages to external pro­ cesses (e.g. macro-economic conditions) and other scalar levels of place and power (Phillipson, 2007; Author, 2018). 2. Method A scoping review methodology was employed in this article. A scoping review is a form of knowledge synthesis that addresses an exploratory research question aimed at mapping key concepts and gaps in state-of-the-art research knowledge (Armstrong et al., 2011). This review applies a five-step process (Arksey and O’Malley, 2005; Levac et al., 2010) that involves: (1) identifying the research question; (2) identifying relevant studies; (3) study selection; (4) charting the data; and (5) collating, summarising and reporting results. We followed a two-stage review methodology (conducting four re­ views in all) to capture state-of-the-art knowledge on the interrelation­ ship between place and CLTs in older adult SE. Stage I was based on a broad question with the aim of capturing studies on transitions in gen­ eral: What is the role of place in multidimensional exclusionary pro­ cesses arising from CLTs in later life? Stage II was based on this same question but in relation to (1) bereavement; (2) dementia on-set; and (3) forced migration, and enabled a targeted search with the intention of unearthing more detail concerning the links between place, SE and these transitions. Study selection followed a team approach (Levac et al., 2010) where search parameters, inclusion/exclusion criteria and data sources were agreed. Keywords were refined from an initial ‘long-list’ based on search returns. For stage I and stage II keywords relating to place, SE and ageing remained the same while keywords for transitions differed. Keywords relating to ageing included: ag*ing; old* people; elder*; senior citizens. Keywords relating to place included: place; neighbourhood; community; home; rural; urban. Keywords relating to exclusion included: social exclusion; disadvantage; marginalisation; vulnerability. Despite a recent review of old-age SE demonstrating the growing prevalence of publi­ cations emanating from South America, North America, Australasia, Asia and Eastern Europe (Author, 2017), it was recognised that the concept of SE is not widely adopted in some jurisdictions (approximately 25% UK studies). Efforts were made to include proxy terms to capture general forms of multidimensional disadvantage. While consideration was given to using domain specific keywords (e.g. poverty and depri­ vation (economic); isolation and loneliness (social)), it is likely that separate reviews would have been necessary for each of the six domains of exclusion for each transition, requiring 18 reviews overall. Addi­ tionally, this approach may have compromised the goal to capture multidimensional forms of disadvantage. Stage I keywords relating to transitions were broad in nature and 1 See Author et al. (2017) for a more comprehensive definition of SE of older people.

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included: critical event; major life event; life change; transition*. Stage II keywords were specific to each transition enabling more targeted searches. Keywords for bereavement included: bereavement; widow*; grief; loss; mourning; death. Keywords for dementia included: dementia; Alzheimer*; cognitive impairment; memory loss. Keywords for forced migration included: forced migra*; migra*; refugee*; asylum seek*. To reflect the focus of the scoping review on state-of-the-art knowl­ edge, the reviews concentrated on literature from the previous 15 years (2003–2018) and were conducted from March–September 2018. Other inclusion criteria included: peer-reviewed journal articles, books, and research reports; a focus on older people (aged 50 years and over). Excluded from the review were: dissertations; theses and conference papers; policy documents; studies that did not address exclusion, place and transitions together; other reviews; texts in languages other than English. Gray literature was not included, as the focus was on scientific empirical and conceptual research. Six electronic journal databases were searched: AgeLine (EBSCO), Applied Social Sciences Index and Abstracts (ASSIA), Science Direct, Scopus, PsycINFO, Web of Science. Searches using Google Scholar and Google books were also employed. Different combinations of keywords were used until a saturation point was reached, i.e. where duplicate results were returned, or material was no longer relevant. Data charting, analysing and reporting was supported by Endnote and Nvivo 11. Key information was extracted from the final sample documents by qualitative content analysis and charted using a descrip­ tive analytical method and Microsoft-Excel data charting forms.

health and migration. One study focused specifically on homelessness in later life, and referred to bereavement as a risk factor for homelessness. Out of the 23 publications identified in stage II, 12 examined bereavement, eight investigated dementia onset, and three focused on forced migration. Five of the bereavement articles and one of the de­ mentia articles were also identified in Stage I. With reference to Table 1, across these 36 publications the majority of identified sources comprised of journal articles. Over 70% of these studies used qualitative approaches, employing techniques varying from in-depth interviews, to case studies, to participant observation. Apart from one study, quantitative studies used secondary data analysis and typically concentrated on a single country. The majority of publications came from the UK (9), followed by Australia (4), Canada (3) and the US (3). The remaining texts were generally evenly distributed across pre­ dominantly European countries. Reflecting the general place and exclusion literature (Author, 2017), urban environments dominated studies as the most common environ­ mental setting, with almost half of these focusing on urban deprived settings. 4. Findings Across stage I and II, three different roles of place were evident within the literature on exclusion and CLTs. In some instances, more than one role was described within a single source. First, place was identified as a setting of CLT related SE within (4) publications. In these sources, this role acknowledged how place was a spatial, cultural and community context, and bound, within which SE takes place. Typically, either as a result of the publications’ focus or conceptual perspective, place appeared to be conceived as a static formulation with limited links made to the nature of SE outcomes or processes related to CLTs. Second, across stage I and Stage II, place emerged as a SE domain in (7) publi­ cations. Here, place is conceived explicitly, or often implicitly, as an area of life from which people may be excluded due to CLTs. In the main, these sources highlighted how exclusion from different aspects of place in situ, such as services, relationships, and safety, could serve as objec­ tive and subjective outcomes arising from processes related to CLTs. Third, place was identified as a mediator, between exclusionary pro­ cesses arsing from CLTs and exclusion outcomes, in (29) sources. In these texts, place could protect against SE resulting from CLTs, or intensify its impacts, or effectively do both, through different mecha­ nisms or at different times. Place, therefore, fulfilled a more dynamic influential role, intersecting processes that resulted in exclusion across different domains (e.g. social relations; material and financial resources; services, amenities and mobility). Mediating mechanisms emerged from in situ dimensions of place, e.g. spatial/geographic features, embedded service infrastructure, social and cultural aspects, but also from an older person’s subjective experiential interpretation of these dimensions. These mechanisms were thus often reflective of an individual’s rela­ tionship with place, its processual construction over time, and the in­ dividual’s assessment of that relationship. We begin by examining these roles within the broader literature captured in Stage I. We then consider these roles in relation to the specific transitions of bereavement, dementia and forced migration.

3. Identified sources Across stage I and stage II, 36 original texts were included in the final review sample, with stage I capturing a broader literature encompassing a greater range of life transitions, and stage II gathering material specific to the transitions of bereavement, dementia onset and forced migration. Figs. 1 and 2 summarises the number of texts included in each step of the stage I and stage II reviews respectively. Out of the 19 publications identified in stage I, seven focused on migration/relocation, nine referred to multiple CLTs, two considered the on-set of ill-health, one looked at bereavement and one examined per­ manent job loss (i.e. retirement/job-loss). Of the nine articles on mul­ tiple CLTs, seven highlighted different combinations of bereavement, ill-

4.1. Stage I findings It was evident from the 19 sources identified in stage I, that research unpacking the relationship between place, CLTs and SE in old age was not extensive. Nonetheless, this sample did illustrate evidence of the three different roles of place. 4.1.1. Setting Only one paper highlighted place as a setting within which SE and CLTs occur (Song, 2017). In a quantitative study of older adults living in 296 rural communities, Song (2017) presents impoverished areas as the

Fig. 1. Stage I breakdown of review process. 3

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Fig. 2. Stage II breakdown of review process. *Among these sources 5 were identified also at stage 1, **Among these sources 1 was identified also at stage 1.

serious illness or a loss of a partner could change the sort of accom­ modation that someone needed or qualified for. Some individuals, often indigenous older people, were no longer able to access suitable housing and were forced to relocate to larger centres. In a comparative study of Brussels and Manchester, Buffel et al. (2013) identified older migrants as being particularly susceptible to feelings of insecurity and community disconnection within urban deprived neighbourhoods. Due to concerns about personal safety, participants reported avoiding particular areas of the locality.

Table 1 Breakdown of key characteristics of the final review sample. Document type Journal article Research report Book Methodology Qualitative Quantitative Mixed methods Descriptive analysis Region of focus Single European country Single non-European country Cross national comparison Type of environment Urban (among these: urban deprived) Rural More than one type of environment Not specified (focussed on community)

32 3 1 25 7 1 3

4.1.3. Mediator With reference to Table 3, 15 sources recognised place as possessing the potential to either reinforce or ameliorate exclusionary processes resulting from CLTs. While all these studies implicitly acknowledged how place influenced older people’s exclusionary experiences, the de­ gree of elaboration on the exact mechanisms at work differed across sources. Where the level of detail was greater, the links between place and exclusion were typically central to the paper’s aim. Four main mediating mechanisms of place were identified, with most articles acknowledging more than one. First, and as reflected in 12 sources, articles noted the subjective and symbolic elements of place, focusing in particular on how individuals’ sense of belonging, derived from individual experiences of place, can shape feelings of exclusion (e.g. Warburton et al., 2017; Smith, 2009). Devik et al. (2015), in their study of older cancer patients in a small rural community in Norway, highlighted that a strong place attachment helps to transform home care settings into advantageous healthcare environ­ ments, outweighing possible disadvantages of traditionally weak rural service infrastructure. Whereas Wanka (2017) found that a sense of dislocation from local neighbourhoods in Vienna could exacerbate feelings of exclusion (from social relations; personal identity) that resulted from loss of work (i.e. forced retirement; job loss). Environ­ mental change, in terms of population turnover and neighbourhood development, created for some older people a sense of being effectively expelled in practical and symbolic terms from the locality. Second, and as referenced in 11 documents, sources noted how social and cultural aspects of place can influence the impact of exclusion arising from certain transitions. These articles typically focused on the presence, or lack of, supportive networks and collective place-based social culture (Heikkinen, 2011; Phillipson, 2015). For example, Walker and Hiller (2007) in their study of metropolitan Adelaide showed how neighbourhood social capital might protect older women’s

16 12 8 16 (7) 10 5 5

context within which rural dwelling older people experience the out migration of their adult children. The analysis highlights the conse­ quences for relational networks, and the subsequent onset of depressive symptoms. Place is recognised as an important factor to consider when analysing the exclusionary experiences resulting from CLTs, but for the most part was used as a spatial, and cultural bound for the research, with little elaboration on the specific meaning of those bounds. 4.1.2. Domain With reference to Table 2, seven sources highlighted how place can serve as a SE domain, representing different exclusionary outcomes of CLTs (e.g. Smith, 2009; Buffel et al., 2012; Scharf et al., 2005a). Here, place is presented as an important areas of participation that can be impacted by exclusionary processes, where outcomes focus on the deficiency or absence of such elements as service infrastructure, rela­ tional communities and safety. Adorno et al. (2018) in their study of Arlington, Texas found that older adults who stop driving due to phys­ ical and mental health declines encounter difficulties in accessing appropriate public transportation. This is reinforced by long-standing structural marginalisation to exacerbate issues with respect to access­ ing health care, goods and other services. Similarly, Petersen et al. (2014), in their study examining older adult homelessness, noted that a 4

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Table 2 Place as domain (stage I findings). Reference

Source

Transition(s) referenced

Type of exclusion

Study aim

Sample

Source Country/ Place type

Research design

Findings

Smith (2009)

Book

Bereavement

NC

55 participants aged 60þ

Canada and UK/urban deprived

Qualitative

Bereaved older people living in urban environments can experience feelings of insecurity.

Buffel et al. (2012)

Journal Article

Relocation (national and cross-national); Dementia

NC

To further understanding of the older person’s relationship with urban environments in order to inform social policy/ practice. Provides a critical perspective on what has been termed ‘age-friendly cities’ by shifting the focus to the question of ‘How age friendly are cities?’

n/a

Belgium/ urban

Descriptive review

Scharf et al. (2005a)

Research Report

Bereavement

NC

93 participants aged 60þ

Journal Article

Onset of ill-health

NC

UK (England)/ urban deprived US/low density urban

Qualitative

Adorno et al. (2018)

Explores the experiences of older people whose lives are affected by multiple forms of social exclusion. Examine older adults’ experiences and perspectives regarding transportation mobility.

Petersen et al. (2014)

Research Report

Homelessness; Bereavement

NC

561 participants aged 50þ

Australia/ urban

Mixed methods

Buffel et al. (2013)

Journal Article

Relocation (national and cross- national)

NC

244 participants aged 60þ

Belgium, Denmark/ urban deprived

Qualitative

Phillipson (2007)

Journal Article

Relocation (national and cross- national)

NC

Aims to contribute to the evidence base about homelessness prevention for older people experiencing homelessness or housing crises. Explores conceptual and empirical aspects of the social exclusion/inclusion debate in later life, focusing on issues of place and space in urban settings. Examines the changing nature of community attachments in later life, and their impacts on the quality of old age lives.

Bereaved older people, particularly living with dementia, or migrants, might experience difficulties in accessing services and feelings of insecurity in some urban neighbourhoods. Older people living in urban deprived environments can feel unsafe in their homes and neighbourhood. Older adults, who experience ill-health and live in low density urban environments, can experience difficulties in accessing appropriate public transportation services. Older individuals, particular Indigenous older people, can due to illness or loss of a partner may no longer be able to access suitable housing and are forced to relocate to larger centres Older migrants can be particularly susceptible to feelings of insecurity and community disconnection within urban deprived neighbourhoods.

n/a

UK

Descriptive review

60 participants aged 55þ

Qualitative

Older adults, including those who have migrated from other countries, may experience rejection or exclusion from their locality.

Note: Type of exclusion: NC ¼ neighbourhood and community.

psychological and physical health in relation to experiences of bereavement. Women’s stories demonstrated that they were able to draw on both existing neighbour networks and local relational com­ munities to sustain positive wellbeing. Third, five publications noted how locally embedded service infra­ structure can be an important determinant of how an older person copes with a transition. Some articles noted this at a general infrastructure level (Van der Greft et al., 2016). For example, in a study of three case-study sites across Ireland and Northern Ireland O’Shea et al. (2012) demonstrated the impact of declining service infrastructure (e.g. social outlets; health and social care services) on those at risk of exclusion, including new-comer residents. Fourth, one publication noted the influence of environmental change on people’s capacity to respond to CLTs. In a study of three case-study sites in Ireland, authors (Author, 2012b) noted the significance of such transitions as bereavement and ill-health, demonstrating how changing community contexts could shape inclusionary and exclusionary experi­ ences, sometimes negatively and sometimes positively, in terms of: service access, community-based social relations, community meanings and attachments and community engagement.

two studies considered place as a setting of SE (De Koning et al., 2017; Mba, 2006), two sources recognised place as both a domain and medi­ ator of SE, and eight presented place as a mediator. All eight dementia papers, summarised in Table 5, considered how place mediated exclu­ sion, but with one of these also recognising the domain role. Of the three publications on forced migration (see Table 6), one considered place as a setting while two focused on its mediating role. With the exception of the findings from the forced migration review, we will focus on those studies that document the mediator role of place for each transition. A description of how each transition is conceived within the literature is also presented. 4.2.1. Role of place in SE resulting from bereavement In reviewed material, bereavement was conceptualised as a process resulting from the death of a significant other. Four publications addressed general bereavement, seven the loss of a spouse, one friends and one considered spousal and friend loss. Papers testified to a range of different exclusions that could occur due to bereavement, including in relation to material and financial resources, social relations, civic participation, and services, amenities and mobility with two or more types of exclusion typically highlighted. Three mediating mechanisms were apparent. First, social and cultural aspects of place was the most common dimension of place noted by authors in seven sources to influence

4.2. Stage II findings With reference to Table 4, of the 12 papers included on bereavement, 5

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Table 3 Place as mediator (stage I findings). Reference

Source

Transition(s) referenced

Type of exclusion

Mediating mechanism

Study aim

Sample

Country/ Place type

Research design

Findings

Author et al. (2013)

Journal Article

Bereavement

SAM; SR; NC

SUB; SOC; SERV

To explore community perceptions of the relationship between age and social exclusion.

62 community stakeholders

Ireland/ Northern Ireland/rural

Qualitative

Buffel et al. (2012)

Journal Article

Relocation (national and cross- national); Dementia

NC

SUB

n/a

Belgium/ urban

Descriptive review

Scharf et al. (2005a)

Report

Bereavement

NC

SUB; SOC

Provides a critical perspective on what has been termed ‘agefriendly cities’ by shifting the focus to the question of ‘How age friendly are cities?’ Explores the experiences of older people whose lives are affected by multiple forms of social exclusion.

Community responses to bereavement can reinforce a sense of belonging for widowers. Some members of community (especially new residents) may not be able to access supports. Environmental change impacts on the capacity of people living with dementia to adjust to their condition.

93 participants aged 60þ

UK (England)/ urban deprived

Qualitative

Smith (2009)

Book

Bereavement

NC

SUB

To further understanding of the older person’s relationship with urban environments in order to inform social policy/ practice.

55 participants aged 60þ

Canada and UK/urban deprived

Qualitative

Walker and Hiller (2007)

Journal Article

Bereavement

SR; NC

SUB; SOC

20 women aged 75–93 (17 widows)

Australia/ urban

Qualitative

Warburton et al. (2017)

Journal Article

Relocation (national and cross- national); Onset of ill health; Bereavement

SAM; SR

SUB; SOC

To explore, from the perspective of older women living alone, the social and physical dimensions of neighbourhoods and variations according areas being higher or lower socioeconomic status. To explore rural community stakeholders’ perceptions of the construction of, and responsibility for, risk of old-age social exclusion.

84 stakeholders

Crossnational/ Rural

Qualitative

Author (2012b)

Journal Article

Relocation (national and cross- national); Onset of ill health

SAM; SR; NC

SUB; SOC

Presents a comparative analysis of how changing community contexts have shaped the lives of rural-dwelling older people.

39 participants aged 59þ

Ireland/ Northern Ireland/Rural

Qualitative

Devik et al. (2015)

Journal Article

Onset of ill health

SAM

SUB; SERV

To illuminate the lived experience and to interpret the meaning of receiving

9 participants aged 70þ

Norway/ Rural

Qualitative

Long-term older community residents are likely to experience difficulty in developing social ties with new-comer residents. Attachment to the neighbourhood can mitigate negative consequences of environmental press on well-being of bereaved older adults in urban deprived environments. Close and trusting relationships with neighbours resulted in older widows perceiving physical environments as liveable.

Social environment, specifically a ‘tightknit community’, was considered by stakeholders to outweigh possible disadvantages of weak rural service infrastructure for key CLT risk groups. Changing community contexts can shape inclusionary and exclusionary experiences of CLT groups in terms of: service access, community-based social relations, community meanings and attachments and community engagement. Strong place attachment helps to transform home care settings into (continued on next page)

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Table 3 (continued ) Reference

Source

Transition(s) referenced

Type of exclusion

Mediating mechanism

Study aim

Sample

Country/ Place type

Research design

home nursing care when being old and living with advanced cancer in a rural area. Heikkinen (2011)

Journal Article

Relocation (national and cross- national)

SR

SOC; SERV

To discuss factors that affect the exclusion of older immigrants in Finland.

Five threegeneration families

Finland/ urban

Qualitative

Phillipson (2007)

Journal Article

Relocation (national and cross- national migration)

NC

SOC

To examine the changing nature of community attachments in later life, and their impacts on the quality of old age lives.

n/a

UK

Descriptive review

Phillipson (2015)

Journal Article

Relocation (national and cross- national)

SR

SOC

n/a

UK/urban

Descriptive review and argumentation

Scharf et al. (2005b)

Journal Article

Relocation (national and cross- national); Bereavement

MFR; CP

SUB; SOC

To explore how a focus on minority ethnic issues provides a reminder of the complexity of the lifecourse, and of the diversity of ageing as a cultural, economic and social construction. To develop indicators to represent five dimensions of exclusion and to assess the nature of social exclusion faced by older people in deprived neighbourhoods.

581 participants aged 60þ

UK (England)/ urban deprived

Quantitative

Van der Greft and Fortuijn (2017)

Journal Article

Bereavement; Relocation (national and cross- national)

SAM; SR

SUB; SOC; SERV

To explore how multiple disadvantages can be explained in relation to life and residential histories and neighbourhood changes

85 participants aged 55þ

Netherlands/ Urban deprived

Qualitative

Van der Greft et al. (2016)

Journal Article

Relocation (national and cross- national)

SAM; NC

SUB; SOC; SERV

To present the urban conditions that older migrants live in and how these compare to those of their native Dutch counterparts.

400,000 households of migrants aged 55þ

Netherlands/ Urban

Quantitative

Wanka (2017)

Journal Article

Job loss (redundancy; retirement)

NC

SUB

Explores why some older adults withdraw from the public, and the role that (urban) environments play in spatial (dis) engagement?

13 participants aged 50þ

Austria/ Urban deprived

Qualitative

7

Findings advantageous healthcare environments, moderating effects of weak rural service infrastructure. Older migrants can experience exclusion in civic activities as they tend to meet only other immigrants in their localities, impeding their capacity to learn the language and engage with wider society. Older migrants might experience diminishing sense of belonging to their neighbourhoods due to global change forces, compounding feelings of exclusion. The rise of transnational communities, and changes to neighbourhoods and communities within urban environments, might lead to the othering of different ethnic groups. Widowed older people, who often had weak relational networks within their neighbourhoods, could be vulnerable to exclusion in terms of material resources and civic participation. Having a support network or access to ethnic services within the neighbourhood can diminish the risk of SE for older migrants (some bereaved) in urban deprived neighbourhoods. Segregation of migrants can cause social isolation and low levels of social integration with other groups in urban environments. Access to health services and urban mobility makes it easier to address health and social exclusion issues. Some older people (who experience job loss) might feel effectively expelled from the locality due to environmental change (in terms of population turnover and neighbourhood development).

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Health and Place 60 (2019) 102234

Note: Type of exclusion: NC ¼ neighbourhood and community; SR ¼ social relations; SAM ¼ services, amenities and mobility; MFR ¼ material and financial resources. Mediating mechanisms: SUB ¼ subjective and symbolic elements; SOC ¼ social and cultural aspects; SERV ¼ embedded service infrastructure.

exclusion arising from bereavement. Scharf et al. (2005b) found that widowed older people, who often had weak relational networks within their neighbourhoods, could be vulnerable to exclusion in terms of material resources and civic participation. Feldman et al. (2013) pre­ sented differences between the experiences of rural and urban older women in widowhood and their sense of loneliness, where the resi­ dential location was described as affecting social expectations of others in relation to grief and grieving. Whereas Thompson et al. (2017) identified that bereaved older men were a particularly vulnerable group especially in relation to accessing adequate meals. The authors found that neighbourhood relations could protect against poor health out­ comes, with neighbours helping with food purchases and encouraging socialisation. Second, six papers highlighted that the subjective and symbolic el­ ements of an older person’s relationship with place, specifically placebased identity and a sense of belonging, may help protect against SE resulting from bereavement (e.g. Smith, 2009; Scharf et al., 2005a). As noted in a study of rural areas (Author, 2012a), attachment to place appeared to shape people’s perception of the degree to which they experience exclusion, including for those who were bereaved. Commu­ nity responses to bereavement, in terms of well-attended funerals and the assistance given to families after bereavement, were noted to rein­ force notions of belonging. Third, locally embedded service infrastructure was a core determi­ nant of how some older people could adjust to bereavement in four studies. For instance, in a study of active ageing in Puerto Rico, �n et al. (2015) noted that restricted transportation systems Orellano-Colo in local areas limited the capacity of widows to engage socially, and the kinds of social opportunities of which they could avail. Marsh et al. (2017) found that locally embedded community gardens compensated for the lack of more formal activities for those experiencing bereave­ ment. Authors conclude that community gardens are emblematic of a liminal space of a ‘community-embedded’ voluntarism that provide an exemplar framework for formal service development.

the countryside, in terms of exercise activity and maintaining social relations with friends and neighbours, helped them to cope with a de­ mentia diagnosis. However, it was clear that within the majority of the eight articles more than one mediating mechanism was operational. For example, Forbes et al. (2011) in their study of sites in rural Canada noted that: dementia can be ‘hidden’ due to local social and cultural stigmatisation; local social relations can create supportive networks and compensate for the lack of services; and spatial/geographic characteristics can contribute to the lack of choice regarding services. Blackstock et al. (2006) also noted that someone’s relationship with place might change as dementia progresses. For example, while rural landscapes were found to offer comfort and affirm a sense of belonging at the early stages of the condition, in more advanced stages such environments can become more hazardous and disorientating. 4.2.3. Role of place in SE resulting from forced migration The small number of studies (n ¼ 3) on forced migration, exclusion and place in later life reflects the general paucity of research on ageing and this topic. These articles, which all considered health-related issues, focused on single-host country contexts and concentrated on the expe­ riences of forced migrants after arriving in these nations. In this sample, exclusion encompassed the domains of social relations, socio-cultural aspects, services, amenities and mobility, as well as neighbourhood and community. Nielsen et al. (2018) primarily represented place as a setting of exclusion. In a qualitative study of forced migration in Denmark, the authors analysis implies the weight of local settings in accentuating exclusionary experiences for older refugees, who perceived themselves as outsiders due to language, history, and cultural norms of their Danish communities. However, the paper does not elaborate on the explicit mechanisms by which place is implicated in these exclusions. The other two papers go further with their respective analyses sug­ gesting some elements of the mediating role of place. In their quanti­ tative study on the distribution and deprivation of asylum seekers in Germany, Bozorgmehr et al. (2017) note that an older subgroup of the asylum seeker population tends to be settled in deprived neighbour­ hoods resulting in higher health risks and healthcare needs within these areas. Authors point to the role of locally embedded service infrastruc­ ture in mediating these health inequalities, and to how settlement pro­ cesses can alter the nature of some host neighbourhoods. Oglak and Hussein (2016), in a qualitative study of older Alevi/Kurdish refugees in England, also note the role of place-based services in SE resulting from forced migration. The findings suggest a dual role of local community centres, where on the one hand these centres provide a supportive space that helps build relational and information exchange networks for mi­ grants and on the other hand, they can impede older migrants’ capacity to learn English, access services outside the community, and engage with wider society.

4.2.2. Role of place in SE resulting from dementia Of the eight sources on dementia, papers generally addressed two or more forms of exclusion with articles highlighting a range of domains including, services, amenities and mobility, social relations, civic participation, socio-cultural aspects and material and financial re­ sources. Three dimensions of place were visible in this sample as inter­ connected mediating mechanisms. Five articles highlighted locally embedded service infrastructure. For €derman and Rosendahl (2016) in their study on services example, So available to Finnish older people in Sweden noted that in some com­ munities, Finnish community workers were recruited to deliver services to better support Finnish migrants with dementia, enhancing language and cultural understanding in service use exchanges. Similarly, Tilki et al. (2010) in their study of older Irish people with dementia in En­ gland also point to the role of Irish community workers recruited locally to provide culturally-sensitive support within local contexts. Four sources referenced social and cultural aspects of place. In their study of dementia service delivery in rural Canada, Herron et al. (2016) noted that pre-existing non-clinical relationships with local dementia service staff may compound issues of access, with many individuals reporting having to drive to larger centres to maintain their sense of privacy and to access a greater range of supports. Forbes et al. (2011) also showed that the lack of anonymity in these small communities could discourage the uptake of home care, or prevent people from attending memory clinics. Three publications were found to note the spatial/geographical characteristics of place as factors mediating SE. As observed by Herron and Rosenberg (2017) people with dementia indicated that walking in

5. Discussion The aim of this article was to conduct a scoping review of the in­ ternational literature to investigate the role of place in SE arising from CLTs, and specifically in relation to bereavement, dementia and forced migration. While there has been a longstanding interest in place in the scientific research across disciplines, existing evidence on the interre­ lationship between these constructs had not been sufficiently captured. Our analysis demonstrates that within the international literature place fulfils three roles in relation to exclusion arising from CLT: place as a setting (Song, 2017); place as a domain (e.g. Adorno et al., 2018); and place as a mediator (e.g. Forbes et al., 2011). Nevertheless, it was the mediator role that was most frequently described, indicating a 8

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Health and Place 60 (2019) 102234

Table 4 Role of place in SE resulting from bereavement (stage II findings). Place role

Reference

Source

Type of exclusion

Mediating mechanism

Aim

Sample

Source country/ Place type

Research design

Findings

Setting

De Koning et al. (2017)

Journal Article

SR

n/a

884 British rural-living older adults aged 60þ

UK/rural

Quantitative

Presents rural areas as setting within which being widowed increased the odds of loneliness.

Mba (2006)

Journal Article

SR

n/a

To explore the predictors of loneliness; isolation from one’s family and isolation from one’s community. To characterize the general health condition of older women in Accra; Ghana’s capital city.

590 women from Accra aged 50þ

Ghana/ urban

Quantitative

Scharf et al. (2005a)

Report

NC; SR

SUB; SOC

Explores the experiences of older people whose lives are affected by multiple forms of social exclusion.

93 participants aged 60þ

UK (England)/ urban deprived

Qualitative

Smith (2009)

Book

NC; SR

SUB

To further understanding of the older person’s relationship with urban environments in order to inform social policy/practice.

55 participants aged 60þ

Canada and UK/urban deprived

Qualitative

Author (2012a)

Report

SAM; SR; NC

SUB; SOC; SERV

To explore how age and rurality combine over the life-course to impact on the likelihood of exclusion in later life in contrasting rural contexts.

62 community stakeholders; 106 older people aged 59þ

Ireland/ Northern Ireland/ rural

Qualitative

Author et al. (2013)

Journal Article

SAM; SR; NC

SUB; SOC; SERV

To explore community perceptions of the relationship between age and social exclusion.

62 community stakeholders

Ireland/ Northern Ireland/ rural

Qualitative

Feldman et al. (2013)

Journal Article

SR

SOC

30 urban widows, 28 rural widows

Australia/ urban and rural

Qualitative

Marsh et al. (2017)

Journal Article

SAM

SERV

To describe how the research findings of a doctoral thesis was translated into a unique and professionally developed theatrical production. To explore how a community garden

Presents Accra as a setting within which widowed older women experience lack of emotional; financial and social exchanges with spouses. Domain - Older people living in urban deprived environments can feel unsafe in their homes and neighbourhood. Mediator - Long-term older community residents are likely to experience difficulty in developing social ties with new-comer residents. Domain - Bereaved older people living in urban environments can experience feelings of insecurity. Mediator Attachment to the neighbourhood can mitigate negative consequences of environmental press on well-being of bereaved older adults in urban deprived environments. Community responses to bereavement can reinforce a sense of belonging in rural environments bolstering against exclusion. Declining service infrastructure in rural environment can impact on those at risk of exclusion, especially newcomer residents. Community responses to bereavement can reinforce a sense of belonging for widowers. Some members of community (especially new residents) may not be able to access supports. Living location might affect social expectations of others in relation to grief and grieving for older widows in urban and rural environments.

78 participants (service

Australia/ urban

Qualitative

Domain & Mediator

Mediator

Community gardens might compensate for the (continued on next page)

9

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Health and Place 60 (2019) 102234

Table 4 (continued ) Place role

Reference

Source

Orellano-Col� on et al. (2015)

Type of exclusion

Journal Article

Puerto Rico/ urban

Warburton et al. (2017)

Mediating mechanism

SAM; SR

Qualitative

Thompson et al. (2017)

Journal Article

SR

SOC

Walker and Hiller (2007)

Journal Article

SR; NC

SUB; SOC

Journal Article

SAM; SR

SUB; SOC

To explore rural community

Aim

Sample

might function as a place of end-of-life and bereavement support.

providers, volunteers, carers and people grieving)

SERV

To present a qualitative comparison of gender differences regarding environmental barriers to participation from the perspectives of older adults who live alone in Puerto Rico. Restricted transportation systems in local areas might limit the capacity of older widows to engage socially, and the kinds of social opportunities of which they could avail in urban environments. To understand the 20 bereaved potential for issues man aged 65þ around food vulnerability to arise in bereaved older men and to characterize that vulnerability, if present. To explore, from the 20 women aged perspective of older 75–93 (17 women living alone, widows) the social and physical dimensions of neighbourhoods and variations according areas being higher or lower socioeconomic status. stakeholders’ 84 stakeholders perceptions of the construction of, and responsibility for, risk of old-age social exclusion.

Source country/ Place type

Research design

Findings

lack of more formal activities for those experiencing bereavement and provide an exemplar framework for formal service development. participants aged 70þ

26

England/ not specified

Qualitative

Close relationship with neighbours who help with food purchases might help accessing adequate meals for older bereaved men.

Australia/ urban

Qualitative

Close and trusting relationships with neighbours resulted in older widows perceiving physical environments as liveable.

Crossnational/ Rural

Qualitative

Social environment, specifically a ‘tight-knit community’, was considered by stakeholders to outweigh possible disadvantages of weak rural service infrastructure for risk groups, including those bereaved.

Note: Type of exclusion: NC ¼ neighbourhood and community; SR ¼ social relations; SAM ¼ services, amenities and mobility; MFR ¼ material and financial resources. Mediating mechanisms: SUB ¼ subjective and symbolic elements; SOC ¼ social and cultural aspects; SERV ¼ embedded service infrastructure.

recognition that where someone lives can be significant in intensifying or protecting against exclusion arising from these transitions. Accord­ ingly, places not only function as a location for such transitions, or as another aspect of life where people can be excluded as a result of the transitions (e.g. in terms of relational communities), but where it can serve to mediate experiences across a range of life domains – both in­ ternal and external to someone’s community. From the 36 publications included in this review, existing research suggests that place may or may not serve to: mobilise instrumental support (e.g. Warburton et al., 2017); provide adaptable service struc­ tures (e.g. Tilki et al., 2010); offer a safe residential environment (e.g. Buffel et al., 2012); present flexible civic and social opportunities (e.g. Buffel et al., 2013); support individual agency (e.g. Wanka, 2017); and sustain feelings of belonging and home (e.g. Van der Greft et al., 2016)

for older people undergoing a CLT. Represented to some degree across all types of transitions, these sorts of mechanisms encompassed different place dimensions and, while less explicitly detailed, often implicated older person’s interpretation and experience of these dimensions. They illustrate how place is increasingly considered as a multidimensional and processual entity. Many studies highlighted one or more mecha­ nisms as being operational in relation to SE and CLTs – even if these are sometimes only superficially noted. Nevertheless, it is evident that there are differences in the extent to which mechanisms were featured across the transitions. For bereave­ ment, while a number of place dimensions were referenced, there was typically a primary focus on a single aspect, most commonly social and cultural characteristics, e.g. how place-based relational networks can support people during bereavement (Walker and Hiller, 2007). In 10

11

Journal Article

Journal Article

S€ oderman and Rosendahl (2016)

Tilki et al. (2010)

SAM; SR

SAM; SR

SAM; SR

SAM

SAM; SR

SAM; SC

SAM; SR; NC

Journal Article

Type of exclusion

SUB; SERV

SUB; SOC; SERV

SERV

SOC; SERV

SOC; SPAT

SOC; SERV; SPAT

SUB; SPAT

NC

Mediating mechanism

To analyse the challenges associated with dementia service delivery and examination of how these challenges are experienced by people with dementia and partners in care in rural and small town settings. How are reports of elder mistreatment distributed across neighbourhoods? Are reports of elder mistreatment cases involving Alzheimer’s-dementia clients distributed differently than other cases? Are services for Alzheimer’s-dementia caregivers distributed across cities in a practical way? Does service utilization vary across neighbourhoods? Does neighbourhood disadvantage affect burden? To explore and describe the nursing staff’s experiences of caring for non-Swedish speaking persons living with dementia in a Finnish speaking group home in Sweden. To consider what cultural sensitivity means to older Irish migrants living in the UK.

To examine how people with dementia relate to and within their communities as well as their perceptions of community support services.

Environmental change impacts on the capacity of people living with dementia to adjust to their condition. To understand the positive and negative aspects of rural service provision from the perspective of people with dementia and their informal carers. To examine ways in which place (rural), political, economic, and social issues contribute to social inclusion and exclusion at the micro level through the experiences of rural dementia care networks.

SUB

Aim

People with memory problems, carers and staff providing specific services

27 nursing staff (12 Finnish speaking, 15 Swedish speaking)

751 mistreatment cases (270 related to person living with Dementia)

20 service providers, 43 partners in care 46 people with dementia (aged 55þ)

46 community-dwelling people with dementia (aged 55þ) and 43 partners in care

20 participants in 3 rural dementia care networks (3 persons with dementia)

45 participants (15 service users and 30 carers)

Provides a critical perspective on what has been termed ‘agefriendly cities’ by shifting the focus to the question of ‘How age friendly are cities?’

Sample

UK/not specified

Sweden/not specified

USA/urban

Canada/ rural

Canada/ rural

Canada/ rural

Scotland/ remote rural

n/a

Source country/ Place type

Qualitative

Qualitative

Quantitative

Qualitative

Qualitative

Qualitative

Qualitative

Belgium/ urban

Research design

Older Finish migrants with dementia, who got support from Finnish community workers experienced improved language and cultural understanding in service use in Sweden. Older Irish migrants living with dementia, who got support from Irish community workers experienced improved language and cultural understanding in service use in England.

Rural landscapes might offer comfort and affirm a sense of belonging at the early stages of dementia, in more advanced stages, such environments can become disorientating. Lack of anonymity in small rural communities could discourage the uptake of home care, or prevent people living with dementia from attending memory clinics, additionally they might experience the lack of choice regarding services. For people with dementia living in rural environments walking in the countryside can help support exercise activity and maintaining social relations. They identified their neighbours as being potential resource for support. Lack of anonymity in rural communities might discourage the uptake of services by older people with dementia. In order to access a greater range of services they might need to travel to larger urban centres. The presence of support groups do not necessarily appear to reduce the likelihood of maltreatment of older people living with dementia in different urban neighbourhoods.

Descriptive review

Findings

Note: Type of exclusion: NC ¼ neighbourhood and community; SR ¼ social relations; SAM ¼ services, amenities and mobility; MFR ¼ material and financial resources; SC ¼ socio-cultural aspects. Mediating mechanisms: SUB ¼ subjective and symbolic elements; SOC ¼ social and cultural aspects; SERV ¼ embedded service infrastructure; SPAT ¼ spatial/geographical characteristic.

Journal Article

Payne and Gainey (2009)

Journal Article

Herron and Rosenberg (2017)

Journal Article

Journal Article

Forbes et al. (2011)

Herron et al. (2016)

Journal Article

Blackstock et al. (2006)

Mediator

Buffel et al. (2012)

Source

Mediator

Reference

Domain &

Place role

Table 5 Role of place in SE resulting from dementia (stage II findings).

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Health and Place 60 (2019) 102234

contrast, dementia studies generally gave more equal consideration to two or more dimensions and often recognised the interconnection be­ tween these dimensions. Blackstock et al. (2006), for instance, noted that geographic/spatial characteristics and experiential aspects not only impacted separately on rural people living with dementia, but were intertwined in terms of how local landscapes could reaffirm memories and a sense of belonging. Whereas for forced migration it was locally embedded service infrastructure, which was almost exclusively high­ lighted (Oglak and Hussein, 2016). This variation is likely to reflect both the nature of particular transitions, or how they are typically conceived (e.g. bereavement as a driver of psychosocial experiences; dementia as an influence on self and temporal orientation), and, in the case of forced migration, the general lack of research in the area. But assuming that place is only implicated in the exclusion process is a narrow simplification. Some studies included in this review pointed to the potential for the direct involvement of local environments in tran­ sitions themselves. In our analysis, examples primarily concerned migration, where studies highlighted how push factors within homenation settings could drive relocation (e.g. Phillipson, 2007). Outside of this review, there are studies that implicitly implicate place within transitions, such as how environmental disasters can result in displace­ ment and bereavement experiences (e.g. Kristensen et al., 2009). It is also perhaps necessary to consider how one aspect of place can be involved in the transition, while others are involved in mediating the resulting consequences. As noted in the introduction to this paper, there are increasing efforts to enhance the relationship and congruency between older people and their environments (Guzman and Harrell, 2015). While many of these programmes emphasise the multiple domains of city/community structures that need to be considered, such as the eight topic areas within the WHO age-friendly framework (World Health Organization, 2007), these models have been critiqued for possessing an homogenising approach and generating little in the way of tangible impact (Lui et al., 2009; Buffel et al., 2012). Exploring the interlinkages between place,

CLT and SE provides a more focused means to identify how specific mechanisms within such place structures can function to exclude or protect older people at critical points in their lives. Ultimately, however, our knowledge of the role of place in SE resulting from CLTs remains significantly underdeveloped. Often, reviewed studies engaged in exploring this interrelationship in tangential ways. It is for this reason that place, SE and CLT are sometimes not explicitly addressed and unpacked in sufficient detail. It is for this reason that the interrelation­ ship between these three constructs may also appear to be understood as a more static interchange then a dynamic set of relationships. This lack of consideration has implications for our scientific knowledge, but also for our capacity to inform meaningful practice and policy interventions. Based on our review, it is possible to identify four critical gaps in the international literature that need to be addressed. Three of these gaps relate to fundamental issues concerning the conceptualisation of place, SE and CLT as separate constructs that interact with the ageing process. First, our findings indicate that mechanisms through which place can mediate SE continue to be poorly understood, reflecting a deficit regarding the linkages between place and exclusion (Wanka et al., 2018; Buffel et al., 2013). While it was not our intention in this review, the mechanisms by which place can mediate CLT related exclusion may as a result of our categorisation, and their representation within the litera­ ture, appear as overly objective and fixed features of place. Instead, they are likely to shift in nature and influence in accordance with the mutually constitutive and dynamic interaction between older people and their contexts. Similarly, conceiving a neat distinction between when an aspect of place functions as a mediating force of exclusion and when it serves as an outcome of exclusion is likely to be too static, and not reflect a complex more blurred reality or the nature of places as processes. Accounting for this distinction, along with the variation in causal influence, and how these roles might shift over time and alter depending on older residents’ characteristics, indicates the sort of con­ ceptual challenge that needs to be unpacked.

Table 6 Role of place in SE resulting from forced migration (stage II findings). Place role

Reference

Source

Type of exclusion

Mediating mechanism

Aim

Sample

Source country/ Place type

Research design

Findings

Setting

Nielsen et al. (2018)

Journal Article

SR; CA

n/a

16 refugees aged 55 þ and 5 family members)

Denmark/ not specified

Quantitative

Presents Denmark as a setting within which older refugees do not understand the language; history; and cultural norms.

Mediator

Bozorgmehr et al. (2017)

Journal Article

NC

SERV

224 993 asylum seekers (among those 44 548 aged 64þ)

Germany/ urban

Quantitative

Older asylum seekers are exposed to more deprived places of residence, which may further increase their health risks and healthcare needs.

Oglak and Hussein (2016)

Journal Article

SAM; SR

SOC; SERV

To gain a better understanding and insight into the care needs of refugee families with aged relatives who are vulnerable in a resettlement country. To assess the association between regional deprivation of the place of residence and the distribution of asylum seekers who receive social transfers and could be considered as vulnerable. To investigate the following: current experience of older refugees within the context of their immigration and community participation trajectories; perceptions of healthy ageing within the context of active ageing; lifestyle and health indicators

30 participants aged 55þ

England/ urban

Qualitative

Community centres in England might provide a supportive space that helps build relational and information exchange networks for migrants but at the same time they can impede older migrants’ capacity to engage with wider society.

Note: Type of exclusion: NC ¼ neighbourhood and community; SR ¼ social relations; SAM ¼ services, amenities and mobility; MFR ¼ material and financial resources; SC ¼ socio-cultural aspects. Mediating mechanisms: SUB ¼ subjective and symbolic elements; SOC ¼ social and cultural aspects; SERV ¼ embedded service infra­ structure; SPAT ¼ spatial/geographical characteristic. 12

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Second, despite an increasing number of peer-review articles on the topic, and a burgeoning literature on some transitions (e.g. Martin-­ Matthews, 1987, 1999), there continues to be a lack of theoretical exploration of CLT in later life (Grenier, 2012; Grenier, 2019). Findings from our review suggest that as a research community we are not used to looking at how CLTs intersect with the ageing process to generate multi-faceted and multi-layered impacts. More focused efforts to develop theoretical perspectives in this field need to be pursued. Thirdly, and perhaps most broadly, further work is required to advance conceptual innovation with respect to multidimensional SE in older age. We continue to lack detailed frameworks that explain indepth how exclusion and ageing processes are interconnected across the older adult life course (Author, 2017). We also lack conceptual knowledge of the drivers and mediators of exclusion and how and when these factors begin to emerge and take hold in the lives of older adults. Fourthly, there is a need for empirical research that explicitly ad­ dresses the intersection of place, exclusion and transitions. For studies of SE, understanding the construction of disadvantage in the context of environmental and personal change is more likely to ground analyses in the everyday dynamic realities of older adult lives (Author, 2018). For research on transitions, actively exploring their spatial linkages and their implications for multidimensional exclusion is likely to produce a more multifaceted and layered view of such transitions (Diewald, 2016). Targeted research programmes would help in effect to illuminate the reciprocal unfolding of place and individual life trajectories. The findings of this paper also need to be framed within three limi­ tations of our analysis. First, our review did not capture materials published in languages other than English, or gray literature, and as a result is likely to have missed significant insights from these publica­ tions. Second, there is likely to be relevant research that sits outside the scientific discourse on SE that has not been adequately captured by our selection of keywords. This includes works from the sizable literatures on transitions (Van den Hoonaard, 2006; Antonucci et al., 2013; House et al., 1988), and neighbourhood effects (Van Ham et al., 2012; Berkman et al., 2000). Future reviews could usefully target this literature specif­ ically. Third, it is important to note that the concept of ‘social exclusion’ has not been well adopted in some jurisdictions, including the United States, with other terms (e.g. social isolation) used more commonly to capture similar experiences and outcomes. As such this may have limited our analysis to a regionalised academic body of work.

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6. Conclusion This article explored current knowledge on the role of place in SE arising from CLTs. In doing so it marks a first effort to review and unify dispersed evidence on how place and life transitions intersect in SE amongst older people. The article’s central contribution has been to chart the relevant scientific literature, identifying the different roles that place can fulfil, and the underlying mechanisms that support these roles. The review has illuminated critical gaps in our scientific knowledge and marks a first step in developing a more directed research agenda on this topic. Unpacking some of the complexities around the interrelationship between place, critical times of need and SE, and translating these in­ terrelationships into practicable and actionable policy and practice, re­ mains a significant challenge. But overcoming this challenge is not only likely to improve the lives of older people, but also the very fabric of their local places. Acknowledgements The original research, on which this article is based, was funded by the Atlantic Philanthropies (Grant no. 22072). Appendix A. Supplementary data Supplementary data to this article can be found online at https://doi. 13

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