The Congruence Model
Another way to consider how people and environments interact is to look for the best fit for a specific person in a particular environment. This is what Kahana (1982) focuses on in her congruence model. Kahana includes the ideas of competence and environmental press but applies them differently. In Kahana’s view people vary in their needs, and environments differ in their ability to satisfy them. According to the congruence model, people with particular needs search for the environments that meet them best. To the extent that a match exists, the person feels content and satisfied; when a mismatch occurs, stress and discomfort result.
Where People Live: Person-Environment Interactions 153
What’s Your Adaptation Level?
Lawton and Nahemow’s competence and environmental press model has wide applicability, as the examples of Hank and Rick in the text indicate. It provides an excellent introduction to the importance of considering people’s capabilities and the environmental demands made of them. To understand how the model works, consider yourself. Make a list of the different aspects of your life, such as school, social activities,
work, and so forth. Think about each of these areas, and rate yourself in terms of your abilities. For example, in the case of school, consider each course you are taking and rate how capable you are in each. Then consider the number and kinds of demands made on you in each area. For instance, in the case of school, think about the many demands put on you in each course. Now look at how your rating of your competence intersects with the kinds and
number of demands. Does it place you in the position of feeling bored? In this case, you would fall in the left side of the graph. Are you feeling stressed out and under pressure? Then you would fall on the right side of the graph. Feeling just about right? You’ve experienced your adaptation level. Doing this analysis for the various aspects of your life may help you understand why you feel more competent in some areas than in others.
Congruence between the person and the environment is especially important when personal or environmental options are limited. Limitations can occur for three reasons: Environmental characteristics are restricted, as when public transportation is unavailable for going shopping; a person’s freedom is limited, as when he or she must always eat at the same time every day; and one believes that one has limited freedom, as when one thinks that there is no way to get around despite a reliable bus system. By these criteria, Hank fits well with his current environment because he has ready access to all his basic necessities. Restricted environments are exemplified most clearly by long-term care facilities such as nursing homes and hospitals. Limits on individual freedom can result from age-related declines in competence. Self-perceptions of limited freedom reflect the belief that one’s life is controlled by external forces, in the ways described in Chapter 9.
When applied specifically to the older adult, Kahana’s congruence model shows that several points should be considered in optimizing the person-environment fit (Kahana & Kahana, 1983).
One must consider not only the kind of situation, such as whether the person is in a single-family, congregate, or institutional living arrangement, but also personal factors. Personal factors are very important, because people vary in their needs. Some of us value autonomy and independence highly, for example, whereas others place less importance on them. When designing programs and interventions for adults, we must be careful to take these individual differences into account. Otherwise, we may unintentionally increase the discrepancy between the person and the environment, resulting in increases in stress for the people we intended to help.
Kahana’s model is especially useful in health care settings such as nursing homes and hospitals. Indeed, most of the research that has examined issues such as autonomy has been done in these settings (Harnett & Greaney, 2008). This makes sense when you realize that in these settings difficult decisions are most often made that involve trade-offs between personal freedom and institutional requirements, and how these decisions interface with personal values
(Mars et al., 2008). Research shows that as many as 80% of dependent behaviors demonstrated by nursing home residents were the result of residents being compliant with instructions from staff, not because they were actually dependent (Zarit et al.,
1999) . Residents also are fully aware that they are not performing behaviors they are competent to perform (Wahl, 1991). The importance of person – environment fit also lies in its ability to account for differences in competence between adults that cannot be attributed to problems with cognition or related abilities (Schaie & Willis, 1999).
What would happen if there were better congruence between residents’ abilities and the nursing home environment? Could residents’ self-efficacy be improved? If so, what would happen to their health?
Through a series of now classic studies, Langer decided to find out. She believed that the important factor in residents’ well-being is the degree to which they perceive that they are in control of their lives (Langer, 1985). To demonstrate her point, she conducted an ingenious experiment that is now one of the classic studies in gerontology. One group of nursing home residents was told that staff members were there to care for them and to make decisions for them about their daily lives. In contrast, a second group of residents was encouraged to make their own decisions about meals, recreational activities, and so forth. The second group showed greater well-being and higher activity levels than the first group (Langer & Rodin, 1976). These differences were still seen 18 months later; in fact, the second group also seemed to have lower mortality rates (Rodin & Langer, 1977).
Based on her findings, Langer became convinced that making residents feel competent and in control were key factors in promoting positive person- environment interactions in nursing homes. Langer
(1985) points to several aspects of the nursing home environment that fail in this regard. First, the decision to place a person in a nursing home often is made by people other than the person involved. Staff members may communicate their belief that the resident is incapable of making decisions or may treat him or her like a child rather than like an adult who is moving to a new home.
Second, the label “nursing home resident” may have strong negative connotations. This is especially true if as a younger adult the person had negative ideas about why people go to nursing homes. A long history of social psychological research shows that the person may begin to internalize these stereotypical beliefs, even if they are unwarranted (Kelley, 1967). Other labels such as “patient” may have similar effects.
Third, what staff consider to be simply the demonstration of tender loving care may reinforce the belief in one’s incompetence. That is, in helping people perform basic tasks such as getting dressed, we run the risk of increasing their level of incompetence and dependence on others. Again, providing assistance where none is needed may be a way in which the staff communicates its belief that the resident cannot fend for himself or herself at all.
The physical aspects of the environment may also reinforce the belief of no control. To the extent that the environment is unfamiliar or is difficult to negotiate, people living in it may feel incompetent. Mastering the environment increases feelings of control, but if this process is not allowed or is made too easy, the outcome may be negative.
Finally, Langer (1985) argues that routine is also detrimental to well-being. If the environment is too predictable, there is little for people to think about; in Langer’s terms, we become mindless. In this state, we are typically not aware of what we do; we behave as if we were on automatic pilot. If nursing home environments promote mindlessness, then residents behave automatically and have difficulty remembering what happened even a short time before. When this occurs, the staff may view the person as incompetent. But because we all engage in mindless activity (e. g., performing a series of complex but automatic functions while driving) about which we have no recollection (one often cannot recall anything about driving the last several miles), we cannot justify considering this same mindlessness as indicative of incompetence in older adults.
Other researchers have replicated Langer’s basic findings in nursing homes (Schulz & Hanusa, 1979) and retirement communities (Slivinske & Fitch,
1987). Buschmann and Hollinger (1994) found that providing affective social support through touching is an effective substitute for residents’ inability to control their environment. Whether the benefits of increased control last over the long run is still an open issue. Whether we should treat nursing home residents with respect is not.