Bringing Together the Past
Multi-Level Perspective Mapping
Elders in Pittsburgh encompass approximately 25% of the population, and of that percentage 13.8% are 65 and older (Age-Friendly Greater Pittsburgh, 2017). In a more recent survey conducted by AARP, research has found that the 65+ group has grown to be roughly 20% of the Pittsburgh population. This encourages the city to design and develop services, initiatives, and studies that focus on the elderly community; however, efforts have been largely scattered and incoherent. According to the Greater Pittsburgh Report, isolation of the elderly is a widely known phenomenon yet the city struggles to quantify and deeply understand such experiences causing efforts to address the issue to be ad hoc and disconnected.
Prior to concluding on a single intervention, we, Team Holarchy, expanded our research to understand the historical underpinnings of the issue and its multiple dimensions. We did this by applying the Multi-Level Perspective (MLP) methodology and framework; this encompassed understanding the histories tied to the issue through three key lenses — landscape (large-scale events that mark or shift epochs), regime (perceived to be the status quo in that era), and niche (emergent qualities of a time and/or initially small-scale innovations that will likely spur change).
Though the issue of the isolation of the elderly intersects with multiple genres and issues, we found that the deep correlation of several strands, such as, Anglo-centric Christianity, Individualism, Disabilities Movement, are deeply woven together to set age-ism to be the driving force that profoundly shapes the lived experiences of the elderly in isolation.
Process
We approached the MLP through both asynchronous and virtual (in-real-time) workflows and sessions. The process of developing and identifying insights from our MLP consisted of three key phases.
Phase one: Build upon past work
- Refer to the initial feedback loops as a way to identify avenues to begin with for the MLP.
- Map key insights from the feedback loops to extend efforts further.
Phase two: Expand understanding of the issue
- Discuss with the team on several occasions to identify primary and second drivers to delve further into.
- Work asynchronously to add to the MLP map.
Phase three: Identify the primary narrative(s)
- Identify key drivers that shape and influence the wicked problem as it stands.
- Highlight the most influential variable and discuss how this may forge hidden connections and/or how other drivers may connect to this variable
- Identify the shape of the narrative (focal point) and visualize the added emphasis (based on our hypothesis and analysis)
Our Multi-Level Perspective Map Overview
Our MLP builds upon the categories used in the wicked problem map — political, environmental, social, economic/business, and infrastructure/technology — to illustrate the complexity of the experiences of the elderly in isolation. This is done by demonstrating how events gradually evolve across the landscape, regime, and niche levels.
Each category is denoted by its designated color:
Political events— Orange
Environmental events— Green
Social events — Purple
Economic/business events— Pink
Infrastructure/Technology events — Blue
We also distinguished the three levels of the MLP by shape.
Landscape — circle
Regime — rectangle
Niche — pentagon
Additionally, we identified seven key threads that shape the issue of elders in isolation and identified them each with their own colored line. These lines connect them across the MLP.
The major trends that we identified include:
- Family (purple): the impact of the rise and decay of nuclear families on elders’ personal networks
- Christianity (light blue): the emphasis on individualism due to the rise of Anglo-centric Christianity
- White supremacy (dark grey): the continued influence of coloniality and dominant narratives on the lives of marginalized elders
- Beauty (peach): youth-centered standardization leading to the mis and under-representation of elders
- Ableism (navy blue): discrimination against elders and the natural process of aging
- Ageism (canary yellow): the marginalization of elders because of their age
- Housing (kelly green): the birth of nursing homes and its impact on housing affordability and access
The map tells the story of how events began, evolved, and shape the current iteration of the issue of isolation for the elderly in Pittsburgh. The legend in the upper righthand corner will help guide the reader as they make sense of the relationships between micro and macro narratives. Finally, we break down such evolutions below with maps per category for reference.
Map Themes
Family
In the Victorian Era, society perceives the extended family as a moral compass; this means ethics, morality, and the difference between right and wrong are taught by the elders that are part of a family unit that extended the immediate network (Brooks, 2020). Towards the end of the 18th and early 19th century, the industrial revolution spur the concept of leaving one’s nest to pursue a better life in the US. This materializes the idea of a nuclear family, a single five-member family unit of a husband, wife, and two and a half kids, and standardizes it as a marker of personal success and achieving happiness (PBS, 2017). With the expansion of suburbanization, where families, typically of anglo-descent, leave urban centers for urban sprawls, families of a higher economic status made nuclear families a fixture of a booming ‘America.’ In 1950, the post war era following World War ll, nearly 75% of children under the age of 18 live in a nuclear family. According to the Atlantic Monthly’s The Nuclear Family Wasn’t Built to Last, the concept of togetherness added pressure to build and be part of a nuclear family.
The practice of individual liberty and freedom, how democracy is perceived, is also first practiced in the home; thus, the dissonance between the forging of familial ties and the pursuit of individualism results in fractures in areas where such praxis began — the family unit (Andre and Valasquez, 1992). Its impact on social structures include the development of wage increase, domesticated roles, church attendance, and union membership (Brooks, 2020). Each sustain the notion of a high-quality life. Through this perception, the nuclear family becomes the primary goal — solely relying on a single-family household.
Towards the latter half of the 1960s, the idea of a nuclear family begins to lose its grip on US culture. Emergent qualities that begin to destabilize its stronghold include higher divorce rates, older newlyweds, and prolonged periods of living alone. The trajectory of a nuclear family — from an emergent quality of the postwar era to a mainstay of suburbanization to its gradual demise — have direct ties to the surge in individuals that continue to live alone and far from their families. The social tolerance and upholding of individualism by way of the familial structure lead to its demise.
Such fractures shape the isolation of the elderly due to the absence of familial networks for those who acutely experience isolation. Their lives in the margin are deeply impacted by the lack of intimate, personal relationships in their lives, whether due to the departing of their family-like friend network and/or the distance experienced between family members. The deep fracture created by the flawed concept of a nuclear family sees its reflection in elders who yearn for companionship yet are unable to attain it.
Christianity
The Second Great Awakening is rooted in efforts to reform the antebellum era. Antebellum is historically known as a period in southern US history leading up to the civil war in 1861; this is typically seen as the birth of the abolition movement as the stark divide between abolitionists and supporters of slavery was clearly drawn. Thus, antebellum is an era that upheld and laid its foundation on the belief that the enslavement of humans (Tate, 1998) is a way to live a dignified life. The Second Great Awakening utilizes the Protestant church to propel Anglo-centric Christianity through the framework of safeguarding one’s personal salvation (Schatz, 2021). There is added emphasis on Christianity as the Union (what the US is referred to at the time) developed. Its implementation consists of two minds as slave owners begin to question its potential cognitive shift should slaves, too, have access to a belief founded in personal salvation. They fear that slaves would congregate and eventually revolt. However, slave owners are convinced that the conversion to Christianity would deepen the work ethic of slaves making them diligent, loyal, and committed. This brought forth an emergence of a different approach to worship in the form of music and organizational makeup. In such case, the slave owners worst fear came to fruition — pursuit of emancipation (Schatz, 2021).
This ties deeply to individualism, a paradigm that further isolates many groups that are othered including the elderly, as the birth and growth of Christianity instilled the sense of personal freedom. The two deeply rooted a mechanistic way of living divorced from a collective mindset and rooted in the achievement of happiness or personal fulfillment. Additionally, to tie this back to the evolution of the American family, the boom of the nuclear family sees the uptick in church membership (Brooks, 2020). This illustrates that Christianity and establishments associated with it are seen more so as vessels to further root the ideals of individualism.
The paradigm of individualism upheld by Christianity perpetuates a mindset that centers self interests, self worth, and self indulgence. This places vulnerable members of the community, such as the elderly, in a position where they are marginalized and prone to an onslaught of disparities that can be avoided. The neglect is palpable in the design of services, environment, and resources for the elderly in Pittsburgh.
White Supremacy
Colonization — the act of establishing control over indigenous land and communities — is one of the foundational components of the societies that developed throughout, at first, the Union, and later, the United States of America. Through this conscious act of domination, the ideology of white supremacy becomes insidious and grew into social, political activities. This has a deep-rooted influence on the evolution of how the elderly are isolated.
White supremacy in Pittsburgh begins through the Jim crow eras — state and local laws that enforced racial segregation — has ties to the growth of Christianity. However, White Supremacy is firmly established when the Ku Klux Klan is formed. With the spread of white-centered ideologies, White supremacy questioned any family that deviated from the idea of the white-nuclear family. With the growing immigrant community in the US, especially during the early 20th century, these colonial and white-centric views that profoundly shape US culture impacts the ways elderly of minority groups become isolated. It wasn’t until the 1950’s when overtly racist doctrines faced significant dissent. Supreme court decisions, like Brown v. Board of Education of Topeka (1954), The Civil Rights Act (1964), and Voting Rights Movement (1965), resulted in a revival of White Supremacy in the early 1970s (Jenkins, 2016). This revival was a reaction to the changing views on race and ideas on interracial families.
The ideology of white supremacy deepens the compounding effect of health disparities for elders of color due to additional barriers such as language injustice and differences in perceived cultural norms (Miyawaki, 2015). Additionally, elders of color have limited networks and face discrimination and age-ism leading to increased isolation and feelings of loneliness as they age (Miyawaki, 2015).
Beauty
The popular narrative of the elderly, especially how they are portrayed in the media, greatly influences how the elderly population is received by the larger community. Throughout history, there is a tendency to define beauty narrowly. While its definition poses social challenges to people of all ages it also leads to the development of visual agism — the elderly are always stereotyped to be the opposite of beauty. Thus, they are often misrepresented or underrepresented by the media and gradually fade away from the public’s attention. Upon realizing this trend and identifying stereotypes, the seniors are brought back on television and advertisement beginning in the 1950s. Elders in the younger age group are widely portrayed as healthy and treated as potential consumers enjoying their “golden years”. The older population, elders who are in the fourth age group, continue to be underrepresented. Since 2020, this mis or under-representation intensified due to the rising millennial population to whom the media contributes most of its attention.
At the regime and local level, visual ageism feeds into multiple other problems like housing (Rial, 2018). Without being adequately represented, elders and their needs are often neglected and not prioritized.
Ableism
The thread of Ableism through U.S history is still prevalent. Bound to the ideas of disease, disability, and functional loss. Ableism sets up the older adult population for failure. Ableism, as it pertains to the isolation of the elderly, follows the historical thread of disability. While the forced sterilization of people with disabilities in the 1880s did not specifically identify disabilities related to aging, this established a social construct of othering those who are not able, including looking at the value of the elderly through the lens of their functional abilities. Throughout the early 20th century, there have been vital developments of political and social groups to increase awareness of ability that leads to regime level understanding of the concept of Ableism. Together with the Civil Rights Movement, the awareness of ableism help establish the Rehabilitation act in 1973, leading to the Americans with Disabilities Act in 1990.
While the Americans with Disabilities Act protected people with disabilities from discrimination within employment, transportation, and public accommodations, the industrial revolution and the increase in steel manufacturing within Pittsburgh led to large amounts of pollution, resulting in an environmental and infrastructural impact on the older community. While the economy was booming, the housing infrastructure does not supporting the aging community. This results in the need to mandate handicap accessible units within buildings and increase multi-generational homes to help the older community. However, an overall lack of infrastructure to support the working class and their multi-generational families also decrease elderly care in public aid. The Nursing Home Act of 1987 is established to assist in the quality of care and of life for the elderly. Even with social and infrastructural changes to support the senior community, we still see the remanence of Ageism today and the continued othering of the aging population.
Ageism
Age-ism has deep roots in the origins of the othering of people with disabilities: eugenics. Disability studies forerunner in the US, Lennard Davis, continually articulates that the apparatus for medical diagnosis stems from members of the Nazi party utilizing eugenics as a means for othering and measuring deviation from what was deemed as the norm (Davis, 2006). Age-ism finds its roots here due to the process of aging, particularly the diminishment of cognitive health, seen as a state of impairment. Due to its correlations with this particular type of othering, the elderly find themselves housed in facilities where mentally ill and the physically disabled were placed for the purposes of hiding them from mainstream culture — a common part of discourse in the disabilities rights movement yet not as prevalent in age-ism discourse.
This framework propels the ostracization of those who reach a certain age from key facets of life, such as the workplace, entertainment, family networks, and built environment. This disregard and neglect are seen through the deprioritization of the needs of the elderly, such as emotional support, sufficient housing, sufficient technical services, and the like to avoid living in isolation. All of these factors lead elders into isolation during a time in their lives when they need support, of all types, the most.
Housing
Convalescent homes begin as almshouses — an idea imported by English settlers. Almshouses are homes for the elderly, orphans, and mentally ill. As mentioned in the Age-ism section, the process of aging and those of old age are viewed as being in a state of impairment (amfm, 2021). This framework causes the elderly to be part of the demographic that are housed in almshouses. Leading to WWl, almshouses gain prevalence yet receive much criticism during the Great Depression due to their poor conditions and inability to upkeep their facilities. From this rupture — of the Great Depression and sharp critique — convalescent homes, board-and-care facilities, rise. Around 1987, the Nursing Home Act is introduced and begin outlining the particular needs of the elderly. This provides a two-pronged shift: more federal funding towards services that support the elderly (e.g., Medicaid, Medicare, convalescent homes) and carving out a place for the growth of an industry dedicated to services for elders (amfm, 2021).
In present days, economically and infrastructurally accessible housing hasn’t been made available to elders both due to historical reasons and new signs of progress since the COVID-19. Historically, Pittsburgh has been a city with roads, rivers, and canals since the early 1900s. With emotional attachment to built bridges, residents prioritize maintaining instead of rebuilding the infrastructure (Regan, 2016). Added with varying types of senior transportation services provided by local companies like the Port Authority, there is difficulty for elders to travel alone within the city. This fuels the shortage of accessible housing as well as the rising need for nursing homes. Another historical reason that contribute to the inaccessibility of housing for the elders is the shortage of existing houses that meet the elders’ needs. In 1937, the Housing Authority of the City of Pittsburgh is created, responding to the signing of the U.S. Housing Act, and a series of programs like the Urban Renewal project are taken to acquire and develop houses (HACP). Later special housing is made available for people with low income or special accessibility needs in the 1980s.
Despite these efforts, Pittsburgh’s population expansion outgrew its housing provision, and the elders’ needs are largely neglected. The lack of senior housing has been intensifying since the COVID-19. With the rising trend of work from home patterns evolving from the niche level, young populations like the millennials started moving back to Pittsburgh (Calugar, 2021). The housing market thus became increasingly competitive for elders as the price rose.
Insights
Our MLP map focuses on seven key threads: family, christianity, White Supremacy, beauty, ableism, ageism, and housing. Each outline how the three main layers — landscape, regime, and niche — are results of events within the five main categories listed in our wicked problem map and articulates what has exacerbated the issue of elders experiencing isolation. These categories are politics, infrastructure and technology, economics, and the natural environment. From such investigation and thorough parsing of historical events that impact the issue of isolation of the elderly, we identified several high-level insights on the MLP and how to best move forward.
Dynamic between landscape, regime, and niche
Deep seeded issues often find themselves entangled throughout particular moments in history. In the case of our wicked problem, isolation of the elderly, the Industrial Revolution, WWll, the Great Depression, and the Great Recession are markers in time, prior to COVID, that disrupted status quos and deepened existing complexities that existed prior to such ruptures. What surfaced are new ways of being, ways of relating, and sets of knowledge in tandem with tighter knots in aforementioned entanglements. For example, ageism as a whole is seen as a prominent issue in contemporary times reflected in an ableist-centric built environment and low public funding streams for services that provide for the elderly; however, the prominence of ageism is also influenced by a youth-centered standardization of beauty; the birth of Almhouses (eventually convalescent homes) that served the elderly, mentally ill, and physically handicap; and the perpetuation of individualism through an Anglo-centric depiction and practice of Protestant Christianity in the US. Each of these threads, respectively, hold distinct narratives all the while profoundly shaping prominent contemporary frameworks, such as ageism. This underscores the deeply interwoven nature of events while highlighting the importance of identifying the emergent qualities that may cause such transitions.
Impact on the issue
The interwoven nature across the three layers — the large scale event that cause a dramatic rupture (landscape) to the stabilization of such ruptures (regime) to the emergent qualities that percolate which then shift across all layers (niche) — is evident in our MLP. All of these threads help deconstruct the issue of isolation of the elderly causing us to understand the interconnected nature between perception, action, infrastructure, and livelihood. For instance, homes for the elderly being rooted in a particular type of othering that the mentally ill and physically disabled experience is particularly jarring. The roots of such prejudice is found partly in the practice of eugenics, which we still see dominating our understanding of, ergo attitude towards, elders — especially those that experience isolation in the Greater Pittsburgh area. This MLP and our insights reveal the conditioning that societies over time undergo to continually reduce the standing of elders. This, ultimately, profoundly impacts their path that led them to isolation and the extremely poor conditions when isolated.
Elements that are missing
The MLP is a helpful tool to delve into the fractures in existing sets of knowledge in how the wicked problem, isolation of the elderly, came to be and sustained, if not worsened. However, as Professor Frank Geels states in a recent talk, several aspects still need to be taken into consideration as the MLP evolves and as one utilizes this tool. Two that stuck out were dynamics of power and social and cultural movements. If such relationships can be added to the MLP, it would deepen our understanding of a wicked problem while allowing users of it to articulate the multiple dimensions of transitions that take place across multiple scales. It would make the MLP three-dimensional and challenge the visual indicator that transitions happen in a linear fashion.
What to focus on next
While our mapping only illustrates seven key threads, we are cognizant of additional threads that would have impacted the evolution of the isolation of the elderly. Visually, we can see how the frequency of specific threads during a period of time fluctuates throughout history. The mapping of these events allowed us to create a timeline that underscores the natural interdependencies of these themes and the future’s needs.
From our map, we believe there will be a need for:
- Intergenerational mindset
- Ecologies of care
- Address ableism and ageism
This post was collaboratively written by Isabel Ngan, Esther Kang, & Yu Jiang
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