Application of Lawton's Environmental Press Theory

About six months ago as part of my work responsibilities, I co-wrote a grant with several colleagues about building a dementia inclusive community. As part of the development and writing process, we had several discussions about the theoretical frameworks, approaches, methods for evaluation and measuring outcomes for this project. One of the co-authors of the grant was enthusiastic about and advocated that one of the frameworks we would employ as part of the grant application was Lawton and Nahemow’s Environmental Press Theory.

For this application, we would use this theory as a lens we looked to implement, measure outcomes, and evaluate a caregiver intervention. I found this grant writing process interesting, it reinforced to me the importance of deliberately incorporating theory into our proposal, and as a result after some reading and discussions, as a group, we decided that this would be an appropriate framework to incorporate into our grant application.

Recently, in our Introduction to Gerontology class, as part of our readings, Lawton and Nahemow’s theory of environmental press was reviewed within the context of living environments for older adults.

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The coursework from this module broadened my understanding of this theory but also reminded me of my recent grant writing process and caused me to think more deeply about the truly complex underpinnings of this theory. I began to wonder more about what ways and how else this theory has shaped and been applied in the field of gerontology? Intuitively, as a social worker for several years, I like to think that I could identify several elements of this theory in the course of my daily work, but, recognized the importance of reviewing research and literature to gain more insight and understanding.

As I reflected on this theory, I began to question about how else is it being explored, applied and analyzed based upon the individual and the environment? Also, if this theory is being used when examining individual’s aging in place or caregiving, are there similarities and differences based upon these situations or is the theory applied in the same manner? More questions arose as I began to conduct my literature review for this paper, as I was not only finding interesting articles about this theory and how it applies to individuals but also how the theory has been used from a macro perspective. It made me wonder what kinds of research questions, study and implications arise from examining the theory of environmental press from a macro perspective? And how is this theory applied in a meaningful manner from a practice, program, and policy setting, and is it providing support or enriching quality of life?

From an individual practice perspective, it is evident in the literature that the Environmental Press Theory has been applied to study the interactions of older adults within the environment from a variety of areas within the field of gerontology (Gitlin et al, 2003; Hamilton et al, 1996; Perry et al, 2013; Rosenberg et al, 2009; Stark et al, 2009.) The theory has been utilized to explore topics such as aging in place, caregiver interventions, formalized service delivery, and cross-cultural applicability. For instance, Perry et al (2013) discussed living environments of older adults and how various factors within the environment and the competence of the older adult influenced the adaptability of older adult to age in place. In addition, Perry et al (2013) stressed these factors are multiple and complex, such as when considering the individual competence of older adult, there are “varying levels of competence among older adults” which contain “distinct domains such as cognitive abilities, physical health, the capacity for psychological adjustment, and other qualities (p. 2).” Stark el al (2009) and Gitlin et al (2003) utilized this theory to help inform, develop, and study specific interventions for older adults to improve quality of life. Outcomes of these interventions included reducing burden and enhancing caregiver well-being (Gitlin el al, 2003) and improvement in the perception of daily activity performance for older adults (Stark et al, 2009). Another study, using this theoretical framework, explored factors associated with family caregivers not using formalized services. Interestingly, Hamilton et al (1996) found that “personal competence measured as perception of caregiver mastery (p 37)” as significant factor in not using services. Finally, Rosenberg at al (2009), made use of this model to examine if it applies across cultures and suggested that is useful in a variety of settings including rural communities, in societies where there are less options for family-based eldercare, and for the education and training of professionals involved with both direct and indirect services.

From a macro perspective, a number of studies have also been conducted using the Environmental Press Theory as a lens for examining aging. Similar to research conducted on the impact on individuals, the areas of research from a macro level are vast including how environments contribute to cognition (Cassarino & Setti, 2015), impact program initiatives and community development projects (Greenfield, 2012), and influence policy decisions (Greenfield, 2012; Rosenberg et 2019) and organizational culture (Geboy & Moore, 2005). For example, an area of research employing this theory at a macro level by Cassarino & Setti (2015) analyzed characteristics of the environment in relation to cognitive performance of older adults. This study, while fully acknowledging additional research is still needed, noted that the access to communities with opportunities for exercise, social engagement, and cognitive stimulation seems to enhance cognition for older adults (Cassarino & Setti, 2015.) Geboy & Moore (2005) applied the Environmental Press Theory to an organizational context in attempt to explore culture change within a care community. In this study, researchers examined the competence of the organization, how these factors interacted within the environment of the care community and ultimately impacted care. From a macro perspective, competence was defined in terms of “levels of competence” (e.g. Novice, Beginner, Proficient, Expert, and World Class) and “domains of competence” (e.g. Structure, Functions, Knowledge, Resource Use, and Inter-relationships (Geboy & Moore, 2005). The authors also identified the environmental press from two different contexts, internal factors (e.g. people from the care community such as staff, administration, the older adults living in the community, and family caregivers; the program and/or activities of the organization; and the actual physical environment itself) and external factors (e.g. regulation, finances, competition, technology, and the institutional contexts of culture). Furthermore, both Greenfield (2012) and Rosenberg et al (2009) discuss the importance of this theory to help to influence and impact policy decisions and funding levels. Both authors note that this theory can help to inform decision making by providing realistic and logical arguments for the need, development, and continuation of services and supports for older adults.

Finally, the literature also reflects the cross-section of the Environmental Press Theory to micro and macro perspectives. Peace et al (2011) and Schafer & Upenieks both focus in their writings about how this theory explores aging and intersects at the micro and macro levels. Specifically, Peace et al (2011) explored how macro factor such as differences in the environmental factors of rural, small villages, and urban communities and different cultures interplayed with micro factors of competence including control, sense of self, routine and organization of space influenced aging in place and adaptations to living environments. Additionally, Schafer and Upenieks (2015) explored the cross section of the macro-concept of the environment of neighborhoods and how it influences adaptation in relation to the day to day functioning level amongst older adults.

Lawton and Nahemow’s Environmental Press Theory is applicable to inform practice research, and policy. It provides a basis of understanding to support older adults through a variety of avenues including living environments, caregiving, cognition, aging friendly communities, care environments, and formal services. It also provides a systematic method for analyzing complexities which influence behaviors, responses, and adaptations, can be applied to individuals, communities, organizations and programs, and to further practice, research, and policies. In addition, it reinforced to me the importance of theory and that it should be incorporated into daily practice regardless if it is being applied when working with individuals, leading an organization, or seeking funding through a grant proposal.