Wellbeing, Space and Society 2 (2021) 100041

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Wellbeing, Space and Society

journal homepage: www.sciencedirect.com/journal/wellbeing-space-and-society

Engagement in the social context of the neighbourhood: A critical

ethnographic study of older adults with age-related vision loss
Colleen McGrath *, Carri Hand
School of Occupational Therapy, Western University, 1201 Western Road, London, N6G 1H1, Ontario, Canada

A R T I C L E I N F O A B S T R A C T

Keywords: Introduction: Previous research has focused on the social environments of older adults with age-related vision loss
Older adults (ARVL) and how support received from close social networks, such as family and friends, can support engage­
Age-related vision loss ment in meaningful occupations, which refer to everyday activities that hold meaning for individuals. Little
Critical ethnography
research attention, however, has been paid to how the social context of neighbourhoods may support or hinder
Neighbourhood
Informal social networks
engagement in community occupations for older adults with ARVL, including the role that neighbours, service
Community occupational engagement personnel, and strangers play in supporting the social lives of older adults with ARVL in the neighbourhood.
Method: This critical ethnographic study engaged ten older adults with ARVL in a narrative interview, participant
observation session, and semistructured in-depth interview. The overarching objective was to explore the ways in
which interactions with informal, neighbourhood-based social networks, relate to community occupational
engagement.
Results: The findings from the study focused on strategies enacted by older adults with ARVL when engaging with
social networks, that supported positive relationships and ultimately supported occupational engagement in the
neighbourhood. These strategies were organized into three main themes including: 1) Enacting control and
establishing boundaries; 2) Seeking out the familiar and; 3) A need for reciprocity.
Conclusion: Study results demonstrated that interactions with neighbours, service personnel, and strangers shape
neighbourhood participation for older adults with ARVL. The quality and nature of these relationships is key to
understanding how the social context of neighbourhoods affects the participants’ community occupational
engagement.

1. Introduction (World Federation of Occupational Therapists 2020). Engagement in

Age-related vision loss (ARVL) refers to a collection of conditions,
including macular degeneration, glaucoma, and diabetic retinopathy
(Watson, 2001), that a growing number of older adults experience in
later life. In fact, one in nine Canadians develop irremediable vision loss
by the age of 75 (National Coalition for Vision Health 2011). ARVL af­
fects multiple areas of daily life and overall well-being (Desrosiers et al.,
2009). For example, individuals with ARVL experience challenges in
personal care (Berger and Porell, 2008), household occupations (Alma
et al., 2011), physical and social function (Knudtson et al., 2011), leisure
and sports (Alma et al., 2011; Boerner and Wang, 2010), as well as social
roles (Desrosiers et al., 2009). In particular, engaging in meaningful
‘occupations’ is critical to well-being in later life, which are “the
everyday activities that people do as individuals, in families, and with
communities to occupy time and bring meaning and purpose to life”
community-based occupations that take place outside of the home
environment and enable “participation in social, economic, cultural,
spiritual and civic affairs” is a further key part of health and quality of
life for older adults (World Health Organization 2002). Support from
family and friends is often key to adapting to vision loss and continued
engagement in meaningful occupations (Girdler et al., 2008; Laliberte
Rudman and Durdle, 2008), and wider, diverse social networks help
older adults with vision loss engage meaningfully in community occu­
pations, including community, social and civic life (Alma et al., 2012).
Community-based occupations, as all occupations, stem from trans­
actions between person and place (Dickie et al., 2006). Place can be
considered as a “rich and complicated interplay of people and the
environment” (Cresswell, 2015) (p. 18) imbued with meaning over time
(Cresswell, 2015). The importance of place in late life is reflected in
discourses regarding aging in place, which is a policy ideal intended on

* Corresponding author.
E-mail addresses: cmcgrat2@uwo.ca (C. McGrath), chand22@uwo.ca (C. Hand).

https://doi.org/10.1016/j.wss.2021.100041
Received 11 August 2020; Received in revised form 14 April 2021; Accepted 8 June 2021
Available online 13 June 2021
2666-5581/© 2021 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).
C. McGrath and C. Hand
“understanding and addressing place within the aging process”
(Johansson et al., 2013) (p. 2). It is often defined as living in the same, or
familiar, place over a prolonged period rather than in residential care
(Johansson et al., 2013; Wiles et al., 2012). An element of place that may
be an important facilitator of participation in community-based occu­
pations for older adults with ARVL is community-based social networks
and support. Social networks are made up of a variety of types of
members such as family, friends, neighbours, and service providers,
with varying degrees of intimacy, frequency of contact, and degrees of
reciprocity (Berkman, 2000). Social network members provide different
opportunities to access social support including instrumental, financial,
informational, and emotional support (Berkman, 2000). For example, in
a study on community-dwelling older adults, Gardner (2011) (Gardner,
2011) found that their health and well-being is promoted through
informal social supports and interactions within their communities.
Further, Litwin & Shiovitz-Ezra (2006) (Litwin and Shiovitz-Ezra, 2011)
found that a greater presence of both formal and informal social support
networks has been associated with positive health outcomes for older
people. The ways in which the social context of communities impact
daily life has, however, been under-explored within the literature on
ARVL. When the impact of social context is addressed in the ARVL
literature, it tends to focus on the difficulties older adults experience in
social interactions due to limited ability to read non-verbal cues (such as
gestures and/or body language), which often results in older adults
backing away from social situations due to embarrassment (Wang and
Boerner, 2008), or the reluctance older adults experience in asking
family and friends for help due to perceptions of being perceived as a
burden (McGrath et al., 2016). Another body of ARVL literature that
addresses social context is focused on social network diversity. For
example, Mick and colleagues (2018) (Mick et al., 2018), in their
cross-sectional population study with 21,241 Canadians, found that
vision loss among men aged 65–85 years old was independently asso­
ciated with reduced social network diversity. In a study examining the
associations between social networks and vision-specific health-related
quality of life among 167 urban Chinese older adults, Wang et al. (2008)
(Wang et al., 2008) found that as visual function decreased, so too did
the number of both friends and neighbours in the social networks of
older adults with vision loss.
In addition to one’s social support network, the neighbourhood
context can provide additional supports to older adults’ engagement in
community occupations, such as nearby resources and recreational fa­
cilities, access to public transportation, and neighbourhood walkability
(Levasseur et al., 2015). Several social features of neighbourhoods also
promote community occupational engagement in older adults, including
low neighbourhood social disorder (Clarke et al., 2011), social cohesion,
safety (Levasseur et al., 2015; Vaughan et al., 2015) and a positive social
environment of destinations within communities, such as staff’s will­
ingness to offer assistance (Yang and Sanford, 2012). Gardner (2011)
(Gardner, 2011) described “natural neighbourhood networks” (p. 269),
or the informal social supports and spontaneous interactions that older
adults experience in daily life with people such as shopkeepers,
strangers, and neighbours. Such interactions often occur within third
places, which can be considered those places that are neither work nor
home, and are informal gathering places, such as bookstores, shopping
centres, and coffee shops (Oldenburg, 1989). Third places are often
considered accessible, inclusive, and neutral. Very little research has
explored how neighbourhoods may relate to engagement in community
occupations for older adults with ARVL. One study showed that among
older adults with ARVL, higher attachment to the neighborhood appears
linked to having closer social contacts (Cimarolli et al., 2017), sug­
gesting the importance of the neighbourhood context to this group.
Other research has shown, however, that older adults with ARVL may
have limited contacts outside of the immediate network of family and
friends (Lind et al., 2003). A further factor that may influence re­
lationships between older adults with ARVL and their neighbourhood
social context is the pervasive sense of fear of bodily harm or losing their
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Wellbeing, Space and Society 2 (2021) 100041
way that many older adults with ARVL experience (Laliberte Rudman
and Durdle, 2008).
Research regarding the daily lives of older adults with ARVL over­
whelmingly focuses on the individual-level characteristics, such as vi­
sual acuity, that impact occupational engagement, and the support
received from close social networks, such as family and friends. Little
attention has been paid, however, to the equally important areas of
community occupational engagement and the ways in which neigh­
bourhood contexts relate to such engagement, either by supporting
participation or creating barriers. More specifically, no research to date
has explored how the social context of neighbourhoods may support or
hinder engagement in community occupations of older adults with
ARVL, including the role that neighbours, local business staff persons,
and strangers play. Thus, the objective of this study was to explore the
ways in which interactions with informal, neighbourhood-based social
networks, relate to community occupational engagement.
2. Material and methods
This study adopted a critical ethnographic approach. Critical
ethnography focuses on the experiences of disadvantaged populations
by examining the cultural context and the political and/or social in­
fluences that impact oppression (Cook, 2005). The goal of critical
ethnography is to identify that which is unjust and suggest tangible ways
in which it can be addressed (Cook, 2005). As Cook (2005) (Cook, 2005)
states, “critical ethnography studies culture to change it” (p. 131). The
data presented in this paper was collected as part of a broader critical
ethnographic study addressing how various aspects of the environment
shape disability for older adults with ARVL. As part of this broader
study, how participants interacted with their informal social networks,
such as neighbours, strangers, and business staff, emerged as an
important factor that influenced the older adults’ opportunities for so­
cial participation and meaningful occupational engagement in their
neighbourhoods.
Ten older adults with low vision were purposively sampled (see
Table 1 for demographic chart), including two males and eight females,
ranging in age from 76 to 91 years old. The participants lived in
apartment buildings (n = 7), retirement homes (n = 2), and a nursing
home (n = 1). This study took place within the Hamilton-Haldimand-
Niagara-Brant region, specifically within the communities of Hamil­
ton, Burlington, Dundas, Dunnville, and Stoney Creek. The region in­
cludes both large urban centres as well as smaller rural regions which
enabled a diverse sample distribution for this study. Further, at the time
of this study the first author resided in this community, as well as
worked or volunteered for those agencies such as the Canadian National
Institute for the Blind (CNIB), the Haldimand Abilities center (HAC), and
the Hamilton Council on Aging (HCoA), which were key in assisting with
recruitment and allowed for greater immersion in the field, which is
essential in an ethnographic study.
To participate in the study, participants needed to: 1) be 75 years of
age and older; 2) have a diagnosis of ARVL (macular degeneration,
glaucoma, and/or diabetic retinopathy); 3) self-identify as experiencing
functional impairments due to ARVL and; 4) be able to communicate
effectively in English. A modified version of Carspecken’s (1996) (Car­
specken, 1996) five stage approach to critical ethnography was adopted
which includes observation (the collection of data through participant
observation), reconstructive analysis (speculations are made regarding
the interactions recorded in the primary record), dialogical data gen­
eration (interviews are used to gain an insider or ‘emic’ position),
determining relationships between social sites (centered on uncovering
relationships between specific social sites), and lastly explaining find­
ings through existing social theories (focus on explaining study findings
through existing macro-level social theories). Three data collection
methods, including a narrative interview, a participant observation
session, and a semi structured in-depth interview, were used to aid in
understanding and contextualizing the experience of living with ARVL
C. McGrath and C. Hand Wellbeing, Space and Society 2 (2021) 100041

Table 1 Table 2
Participant Demographic Characteristics (n = 10). Description of Data Collection Methods.
N= Narrative interview Observation session Semi-structured interview

Age (years) First in-person data Second in-person data Third in-person data
75–80 3 collection session. collection session. collection session.
81–85 3 Using Wengraf’s (2001) Occurred 2–3 weeks Occurred during week 7 or
86–90 3 lightly structured following narrative 8 of the 2-month data
91–95 1 narrative interviewing interview. collection round.
Sex approach, this session Using the observation Session focused on the
Male 2 focused on eliciting the format proposed by influence of the physical,
Female 8 older adult’s story of Spradley (1980), this social, cultural and
Current marital/partnership status their vision loss. session focused on the political/institutional
Married 0 Facilitated by the first observation of an environment on
Divorced 1 author. occupation chosen by participants engagement
Widowed 7 Between 46–100 min in the participant that was in daily occupation within
Single; never married 2 length. meaningful to him/her. the neighbourhood.
Place of birth Seven of the participants Facilitated by the first
North America 6 chose occupations that author.
Europe 4 brought us into the Between 56–110 min in
Current financial situation community including: length.
Excellent 2 going to the mall, going
Good 5 for a walk, taking the
Fair 3 bus to a craft program,
Poor 0 grocery shopping, going
Highest level of formal education completed out to eat at a
Less than grade/elementary school completed 0 restaurant, going to the
Grade school completed 1 pharmacy and going to
Some high school 3 the bank.
High school completed 4 Three participants chose
Some college/university 2 occupations that
College/university completed 0 allowed them to remain
Living situation in their homes
Independently in house or apartment 7 including: attending a
Nursing home 1 Braille lesson, learning
Retirement home 2 to use a Daisy player
Vision loss condition (audio book player), and
Macular degeneration 10 cooking a meal together.
Glaucoma 4 First author was an
Diabetic retinopathy 1 active contributor by
Cataracts 5 engaging in dialog
Age-related vision loss onset during the observation
Gradual 8 session and actively
Sudden 2 participating in the
occupation.
Between 60–90 min in
(see Table 2 for a description of data collection methods). Data collec­ length.
tion occurred over a period of nine months. All interviews were digitally
recorded and transcribed verbatim while observation notes were
participation. The quality and nature of the relationships appear critical
recorded directly after the participant observation session.
to understanding how the social context of neighbourhoods affected the
All data was collected by the first author, however, the two authors
participants’ occupational engagement. A key finding identified was
participated equally in the data analysis process, which focused on
that the older adults with ARVL enacted a variety of strategies to develop
identifying how social interactions with informal neighbourhood-based
positive relationships with informal social networks that ultimately
social networks affected engagement in community occupations. Each
supported occupational engagement in the neighbourhood. Participants
transcript and observation field note were read and coded individually,
actively sought, accepted, and declined support in different ways from
using both low level (open) and high level (theoretical) coding to
different people as they engaged in community occupations. These
develop a rich understanding of the data before codes were compared
strategies are organized into three main themes including: 1) Enacting
across participants to form categories and themes (Carspecken, 1996).
control and establishing boundaries; 2) Seeking out the familiar and; 3)
Team meetings were used as a platform for collective reflexivity, to
A need for reciprocity. Quotes from participants are identified using
enhance transparency of interpretation by bringing awareness to, and
participant codes (P1, P2, etc.). To protect participant anonymity, the
discussion about, researchers’ presuppositions and values, as applied to
names of persons and places, including streets and landmarks, have been
the data. Ethics approval for this study was obtained through the
removed.
Research Ethics Board for Health Science Research Involving Human
Subjects at the University of Western Ontario in 2012.
3.1. Enacting control & establishing boundaries
3. Results
As the participants sought and received help while performing
Participants existed within the social milieu of their neighbourhoods, community occupations, they attempted to enact control and establish
accessing and receiving support from a variety of individuals, taking boundaries in a variety of ways. Participants overwhelmingly demon­
steps to create supportive relationships, and navigating the social strated a reluctance to ask for help from neighbours, stemming from
landscape as they participated in their occupations within the neigh­ their strong desire to maintain their independence. For example, P9,
bourhood. Neighbours, acquaintances, service personnel, and strangers who resided downtown, stated during the narrative interview: “It’s not
often helped to facilitate neighbourhood participation, while at other like me to say, oh I can’t do it myself… I’m stubborn, I’m independent, I
times, support was not provided, or did not foster neighbourhood always had to be.” When help from neighbours was accepted,

3
C. McGrath and C. Hand
participants placed strict limitations on how the support was provided,
such as when neighbours were permitted to enter the home and for
which tasks. The participants did not want neighbours to impinge on
their sense of privacy or independence, and actively worked to establish
boundaries and a sense of control over how they sought outside help. For
example, P1, who resided in a suburban area of the city, recounted
several sub-optimal experiences with a well-intentioned neighbor who
bought her groceries. The neighbor purchased groceries that P1 did not
want and that were too expensive. Although this frustrated P1, she
struggled to enact control as she did not want to seem rude and offend
her neighbor, who she felt she may need help from in the future. P1’s
preference, however, would be to pay a grocery service to deliver her
groceries, thereby allowing her to control all aspects of the shopping
process. During the narrative interview, P1 stated: “I can pay ten dollars
to have my groceries delivered, which is a good service…Now what
could you ask for more than that and you’re independent.
You don’t owe anybody anything, right. You’re standing on your
own feet. So, I like to do that too. I actually like to do that.”
Participants used different strategies to gain support in doing those
tasks that represented an immediate need, such as crossing the street.
They described an expectation that neighbours, as well as strangers,
would automatically offer help in those situations, which participants
described as ‘risky’. If help was not automatically offered, the partici­
pants overwhelmingly reported feeling comfortable asking for help as it
was perceived as a safety issue. In these instances, participants were not
as concerned with their perceived independence, likely because the help
was perceived as ‘too necessary’. For example, as P3, who lived in a
nursing home located in the city center, pointed out during the partici­
pant observation session: “If I can’t, I don’t move. I stop and turn. And
then when somebody comes along, I’ll ask for help.” Although relin­
quishing control and depending on others meant that participants had to
trust someone over themselves, it was necessary for them to engage
successfully in meaningful neighbourhood activities, like shopping or
going for a walk. Less often, strangers were perceived as intrusive,
thereby acting as a barrier to participation by providing unsolicited help.
For example, participants described situations in which strangers would
grab their arm to assist with community mobility or follow them home to
ensure their safety. During the semi-structured interview, P1 admitted
that people don’t listen to her “but rather they do what they want”.
While participants often accepted and sought help from strangers in
navigating their neighbourhoods, at times, these interactions were dis­
orientating and perceived as dangerous. Participants then employed
additional strategies to ensure their personal safety and ability to move
about the neighbourhood. For example, during the narrative interview,
P3 described an incident when a stranger led him astray: “So all of a
sudden somebody grabs me by the arm, and we start walking into an…
walking up into the apartment where I was supposing he lived. And he
started to bring me up to an area that I was not familiar with. I said,
‘Where are you taking me?’ He said, ‘up to the apartment.’ ‘I don’t live
here! This is not my apartment!’ But I know enough to know that.” In
this situation, P3 attempted to retain control by being vigilant to his
surroundings. The focus on enacting vigilance was demonstrated by
other participants as well. For example, P1 described a situation during
the narrative interview, in which her cab driver was driving in circles to
collect a higher fare. In that social situation, P1 confronted the cab
driver: “It makes me mad that they think you’re dumb and they can fool
you that fast. So, like I just let her know that you’re not fooling me.”
A further strategy that participants employed to support their com­
munity occupations was actively controlling the personal information
they shared with community members, particularly related to their
vision diagnosis. While the participants generally valued their privacy,
in many cases information-sharing was necessary. In this study, store
clerks often misunderstood the needs of the participants, requiring the
older adults to disclose their challenges with vision in order to receive
better service. For example, during the participant observation session,
when P7, who resided downtown close to amenities, asks for help at the
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Wellbeing, Space and Society 2 (2021) 100041
grocery store and is told the aisle number or “it’s over there”, she needed
to explain that she can’t see “over there” in order for the store clerk to
retrieve the requested item for her. Other participants recounted similar
experiences in which assistance was provided only after disclosure of
challenges with vision, such as kitchen staff at a local restaurant being
willing to cut up food for take-out for P8, or P10 convincing a postal
employee to write out an envelope address. These situations, which were
not isolated events, demonstrate how older adults with ARVL control the
information disclosed about their vision status to receive better service
from store and restaurant personnel.
One tangible strategy that participants used to control information
they shared about themselves and, in turn, how those in the neigh­
bourhood interacted with them, was through use of the white cane,
which was often seen by participants as a symbol of blindness. Partici­
pants reported that use of the white cane made strangers, in particular,
more understanding, apologetic, and willing to offer assistance. For
example, during the semi-structured interview, P3 stated: “And ah, they
don’t question it, they don’t, I think people if you say, you’re carrying
your white cane, most people accept that you’re blind and they’re
willing to help.” Further, P7 recounted experiences during the semi-
structured interview, where she would accidently bump into strangers
who were initially upset with her, before seeing her white cane: “I just
feel more comfortable that if I accidently hit them, I’ve got an excuse. I
never thought I would get to the stage where I would need euphemis­
tically a crutch. But because I can’t see properly, I don’t want to hit
people.” Use of the white cane, however, is considered an obvious
signifier of vision loss (McGrath and Astell, 2016), and increased par­
ticipants’ sense of vulnerability because it broadcasted the fact that they
were blind. Participants ultimately controlled in what situations, within
the neighbourhood, they would use their white cane, often restricting its
use in public spaces in an effort to control how they portrayed them­
selves, typically wanting to portray a self-image consistent with inde­
pendence, competence, and self-reliance.
3.2. Seeking out the familiar
In their effort to engage in meaningful occupation in the neigh­
bourhood, participants sought out familiar people, places, and spaces.
Perhaps most importantly, participants seemed to seek out people who
were familiar, who they ‘knew’, and who knew them. There was a need
to trust the other person, at a basic level, in that the person would not
harm them, but also at a deeper level, that the person could, and would,
assist the older adult with ARVL in supportive ways. Help was often
contingent on the person knowing that the older adult had difficulty
with their vision and knowing what specific type of assistance was
needed. For example, P6, who moved to a co-op apartment building
after being diagnosed with vision loss due to its proximity to services,
stated during the narrative interview that the bank she uses “is not as
friendly. It’s a much bigger bank and they’re much busier and they don’t
know you.” Similarly, during the narrative interview, P2, who lived in
the downtown core in a high-rise apartment, stated, “I need a lot of help.
Like I like to buy cheese at [name of grocery store]. And the lady knows
my wife always went there, over there too, and they’re helpful they help
me out with the change and stuff like that. Even my debit card.” P8, who
resided in a subsidized high-rise apartment in the downtown core, re­
ported during the participant observation session that she always goes to
the same restaurant for an afternoon coffee, where the owner knows her
needs, escorts her to her table, and brings her order to her. Such re­
lationships were facilitated within familiar and comfortable environ­
ments, such as in banks, grocery stores, busses, or restaurants. Often
these were smaller establishments where employees knew the partici­
pants’ needs and preferred products and were therefore instrumental in
supporting their engagement. This increased sense of comfort with the
store employees also positioned the older adults with ARVL to feel more
at ease in asking for help. Asking for specific assistance was another way
that participants shaped the support that was provided by those in their
C. McGrath and C. Hand
social environment. For example, in the semi-structured interview, P7
stated: “Well, I can’t read labels anymore. So, I only go to shops where
the owner has known me, and I make a point of going to the staff and
asking questions. And usually, they’re very helpful.” Within such
familiar neighbourhood spaces and in interactions with others who
knew their needs, participants were able to independently manage their
neighbourhood occupational engagement.
When relationships with service providers, shop keepers, friends,
and acquaintances did not involve an understanding of what the person
needed, the help was often inconsistent, not provided, or not appro­
priate. For example, during his participant observation session, P2
described his inconsistent interactions with bus drivers who were not
familiar with his needs. City bus drivers were often perceived and
described as helpful, lowering the bus and waiting for him to sit prior to
moving, while at other times the drivers did neither of these things prior
to driving off. This inconsistency in service was further observed during
the participant observation session. A general lack of understanding of
the needs of older adults with ARVL often manifested in underestimating
the person’s abilities along with actions seen by participants as over-
protective and infantilizing, or conversely, overestimating the person’s
abilities and assuming they have no vision difficulty. For example,
during the narrative interview, regarding playing shuffleboard, P6
related: “People at the end score and I can’t see what the score is from
here. They don’t always call it. They don’t understand. They will make
signs, and go like this [gesture waving], but I can’t see this, I can only
hear a voice. We’re all seniors and we’ve all got problems, but I’m the
only one here who has this particular problem. They all have problems
of other kinds. If you don’t have this particular problem, you don’t
understand.” During his semi- structured interview, P3 relayed his ex­
periences of the nursing home, where he resided, misunderstanding his
abilities and assuming his “perceived incompetence” because of his
vision loss: “They wanted, they told me I had to have an escort to go
along and I said no, I don’t need an escort. I can do this on my own, I’ve
done it before, and then they, I got the Social Service women involved.
And I said you better talk to the administration because I just refuse to
accept that I’ve got to go out and find somebody who’ll take me to the
mall or take me here and take me there”. Overall, participants encoun­
tered a lack of understanding regarding the needs of a person with ARVL
and a lack of appropriate support across relationship types.
3.3. A need for reciprocity
Perceptions regarding being a burden on others and reciprocity were
threaded throughout the participants’ stories of accessing support from
others. They expressed a general reluctance to ask for help that not only
stemmed from a desire for independence, as discussed in the first theme,
but also from a sense of fear that reciprocity and/or mutual support
could not be achieved. Participants reported they would often accept
help from neighbours but would not ask for it outright. Even, or perhaps
especially, in the context of a supportive network of neighbours, par­
ticipants were reluctant to burden others that they perceived as having
their own issues to cope with. For example, during the semi- structured
interview, P9 related: “We help each other; they’re [neighbours] always
good. Like, even with the door, they see you coming, and they jump on,
and open the door for you. We do it for each other, you know?”. Then
later, the same participant stated: “Well, we’re all in the same boat, so to
speak. That’s what’s good about a senior building like this.” And finally,
“But I won’t burden them with it. The last thing I want is that.”
Relationships with service providers seemed to be a more straight­
forward business transaction of reciprocity; service providers serve the
customer and the customer pays for the service. Participants seemed to
feel a sense of permission to ask for help and to explain their needs. For
example, during the participant observation session, P9 stated: “The
people in the store get to know you, and once I know them, I don’t mind
asking… it’s their job.” There also seemed to be more muddy situations
where reciprocity was not clear cut and perceptions of burden may
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Wellbeing, Space and Society 2 (2021) 100041
occur. For example, P9 stated: “But some people, even if it’s their job,
and they’re working, they don’t like to be bothered.” Even in situations
where help was available, participants were reluctant to accept it, for
fear of being perceived as a burden. For example, neighbourhood groups
provided social occupations for participants to engage in, such as a craft
group. P5, who resided in a retirement home in a small community
adjacent to a larger urban center, indicated that she was hesitant to
become involved due to her increased age and care needs, which she felt
made the balance of support unfair to other service users. As stated
during her narrative interview: “When it comes to the craft work,
because I feel that I have to keep bothering somebody…But if there was
somebody that had the time to spend with me, I’d love to do it, you
know. But I feel that there are other people that need help, not just me…I
thought, oh no, there are other people that need help. And I can’t take all
their time at one lesson, you know.”
Finally, participants seemed willing to ask for, and accept, small
amounts of help from strangers and did not seem as concerned with
ideas of burden or reciprocating. Strangers were seen as helpful and key
to basic engagement in neighbourhood activities. Participants would
frequently ask for help, or be offered help, such as crossing the street, but
also when paying in stores, and locating public washrooms. Although
these interactions are often overlooked in the literature, they were
perhaps the most frequently occurring interactions described by the
participants. These interactions often occurred in ‘transitory zones’
(Johansson et al., 2013), defined as places that participants passed
through during the course of daily public life, such as sidewalks, bus
stops, or lines at grocery stores/banks. Participants seemed to recipro­
cate when interacting with strangers in the form of a wave, nod, or
expression of thanks. While depending on others meant that participants
had to trust others over themselves, it also allowed them to engage
successfully in meaningful neighbourhood activities.
4. Discussion
Within the gerontological literature, the family is overwhelmingly
identified as the most important type of social support among older
adults; a trend that has been further reinforced within the ARVL liter­
ature. For example, Brennan et al. (2001) (Brennan et al., 2001) collated
narrative data from three previous quantitative studies to develop a
typology of self- reported coping strategies used by older adults expe­
riencing vision impairment. Relying on informal support networks was
one of the proposed coping strategies, which included reliance on family
such as children, siblings, or a spouse, as well as friends. Missing from
this typology, however, are the roles that neighbours, service personnel,
and strangers play in supporting the social lives of older adults with
ARVL. This is particularly concerning given the increasingly significant
role that strangers may take on as family and friendship networks shrink
among older adults (Morrill and Snow, 2005). This study provides a
meaningful contribution to the field by furthering our understanding of
those strategies enacted by older adults with ARVL to ensure positive
interactions with informal social networks that ultimately support
engagement in meaningful neighbourhood activity. In what follows, we
discuss the study findings from a critical gerontological lens, explicating
how the older adults’ experiences and adopted strategies are shaped by
broader socio-cultural structures.
The first theme centered on the idea of the enactment of control and
establishment of social boundaries. Central to this theme was the
overwhelming reluctance of participants to ask for help, stemming from
their strong desire to maintain a sense of independence, which is a
finding heavily reflected in the existing low vision literature (Laliberte
Rudman and Durdle, 2008; Berger, 2012; Laliberte Rudman et al., 2010;
MacLachlan et al., 2007; Moore, 2000; Moore and Miller, 2003). In fact,
this focus on independence is reflected within the broader gerontolog­
ical literature, with many critical gerontologists pointing to how older
adults are overwhelmingly devalued within a society that values eco­
nomic productivity and independence (Angus and Reeve, 2006).
C. McGrath and C. Hand
Furthermore, this desire to maintain independence appears to be shaped
by active aging discourses in which older adults are expected to be
autonomous and act proactively (Higgs et al., 2009). When help was
asked for, there were strict controls placed on what help was requested
and who was asked to provide the help. This establishment of bound­
aries and control was paramount, however, interestingly, there were
circumstances where participants felt more comfortable requesting
assistance. For example, in situations that represented an immediate
need, such as crossing the street, participants were more likely to ask for
help as it was perceived as a safety issue; a finding that is supported in
the existing low vision literature. For example, McGrath et al., (2016)
(McGrath et al., 2016), found that among older adults with ARVL, the
desire to maintain independence was paramount; for some respondents,
maintaining independence was perceived as the ultimate marker of
‘aging well’. McGrath et al., (2016) (McGrath et al., 2016) further found
that participants did not want to ask for help for fear of being perceived
as a burden to family and friends and so would often discontinue
important occupational involvement or, when help was requested, the
participants expressed clear restrictions on who, when, and how help
would be provided. This study adds to the existing literature by focusing
exclusively on help received outside of the typical family and friend
network. This study extends our awareness to the role that informal
neighbourhood-based social networks, such as neighbours, local busi­
ness staff persons, and strangers, play in supporting community-based
occupational engagement.
From a public policy standpoint, there is a growing trend regarding
the importance of informal networks to support the needs of an aging
demographic (van Dijk et al., 2013). In fact, support provided by
informal networks meets a crucial need by supplementing family sup­
port as well as formal support provided by healthcare providers (Shaw,
2005). This is in line with a neoliberal agenda characterized by “em­
phases on fostering individual responsibility, decreasing state de­
pendency, and increasing privatization” (Rudman and Molke, 2009) (p.
377). By downloading the responsibility for providing support onto
informal social networks, governments can increasingly shift re­
sponsibilities and risks from the state onto individuals. For example, in
their qualitative descriptive study with twelve professional support
givers, five volunteers, and nine neighbours (van Dijk et al., 2013), the
authors found that neighbours provided older adults with a variety of
support including social monitoring, instrumental support through
practical tasks such as shopping, picking up mail, and throwing out
garbage, as well as emotional support including engaging in talks,
having coffee together, or participating in leisure activities. Given this
trend, moving forward, it will be important for future research to focus
explicitly on the extensive role that informal social networks including
neighbours can play in supporting the engagement of older adults with
ARVL in meaningful community occupations, and how older adults
aging with vision loss continue to enact autonomy and agency in their
requests for help.
The second study theme was focused on seeking out familiar people,
places and spaces. The study participants spoke about seeking out peo­
ple who they ‘knew’, who were familiar with their visual challenges, and
who knew the specific type of assistance needed to facilitate their
engagement in desired neighbourhood activities. In addition, partici­
pants discussed multiple examples of seeking out familiar and
comfortable spaces, such as banks, grocery stores, busses, or restaurants,
in which the older adults with ARVL felt comfortable navigating the
physical space. In her discussion of third places, which was a term used
to “describe key sites for informal public life including cafes, post offices,
and main streets” (p. 266), Gardner (2011) (Gardner, 2011) similarly
found that older adults felt an overwhelming sense of comfort in those
intimate spaces where they knew staff and had a sense of ease negoti­
ating the space. Unfortunately, in the current study, when relationships
did not involve an understanding of what the older adults with ARVL
needed, the help was often inconsistent, not provided, or not appro­
priate with occupational engagement suffering as a result. Although this
6
Wellbeing, Space and Society 2 (2021) 100041
finding has been discussed in the ARVL literature within the context of
friends and family (Laliberte Rudman et al., 2010; MacLachlan et al.,
2007), this study uniquely highlights the impact when persons in the
social context of the neighbourhood misunderstand the needs of older
adults with ARVL. For example, too often participants described expe­
riences of people in the neighbourhood underestimating the older
adults’ abilities which would typically result in overprotective or
infantilizing interactions or conversely would overestimate the older
adults’ abilities, assuming they had no difficulties with their vision and,
as a result, would withhold basic assistance.
A third important finding of this study relates to how participants
navigated their desire for reciprocity in social relationships. As discussed
in the first theme, participants demonstrated a general reluctance to ask
for help, stemming not only from a desire for independence, but also
from a sense of fear that reciprocity and/or mutual support could not be
achieved. This finding was reflected in the five-year ethnographic study
by Torres (2019) (Torres, 2019) with older adults living in New York
City, when it was found that reciprocal services involving exchanging
information, favours, and gifts were critical for the older adults to
maintain their sense of independence and, in those situations where
exchanges of support were one sided, strain on the relationship
occurred. Our study findings can also be understood in relation to the
neoliberal agenda of individualizing responsibilities and an imperative
for independence. In the current study, a general reluctance to ask for
help was particularly true within participants’ interactions with neigh­
bours, while relationships with service personnel represented a more
straightforward business transaction of reciprocity. Given the nature of
the relationship, in that participants were purchasing a product or ser­
vice, they appeared to feel a sense of permission to ask for help and to
explain their needs. Participants also seemed willing to ask for and
accept small amounts of help from strangers for such tasks as crossing
the street, paying in stores, and locating public washrooms. In those
circumstances, a simple nod, wave, or expression of thanks was suffi­
cient for the participants to feel that reciprocity had been achieved. As it
related to relationships with neighbours, however, participants
demonstrated caution for fear of asking for too much help without the
ability to pay back. Findings from this theme help further our un­
derstandings of social capital, which is a concept used in research and
policy to stress the value of “mutually beneficial social relationships
between citizens characterized by interpersonal trust and norms of
reciprocity” (Walker and Hiller, 2007) (p. 1155). This means that social
relationships need to be premised on feelings of reciprocity as opposed
to a one-sided transfer of support from the perceived ‘capable’ person to
the assumed ‘dependent’ person, such as an older adult with ARVL.
Research, however, has demonstrated that people with disabilities,
including those with visual impairments, experience diminished social
capital, with the neighbourhood existing as an important place in which
social capital is experienced by older adults (Lager et al., 2015). Within
the context of this study, the immediate neighbourhood was central to
the lives of the participants and acted as a place where the receipt of
both social and instrumental support was continually negotiated and
issues of reciprocity were weighed when requesting help to support
community occupational engagement.
Lastly, in line with a neoliberal agenda, older adults are increasingly
responsible for seeking out social support by means of their informal
social networks to support their ongoing independence and autonomy in
neighbourhood activities. In line with a critical disability lens, one could
argue that the very fact that older people need to rely on social support
systems within their neighbourhoods is because we have created spaces
and places that ‘disable’ older adults with vision loss. Moving forward,
future research would benefit from unpacking social capital and its
impact on older adults with ARVL in a more meaningful way. For
example, place is inextricably linked with social capital in that the
design of a neighbourhood can either greatly support or limit social
participation and the social connections forged as a result. As such,
future research would benefit from looking at how the design of the
C. McGrath and C. Hand
neighbourhood serves to support as well as restrict the social capital of
older adults with ARVL, including a specific focus on how commercial
third places, which are often described as accessible, inclusive, and
neutral (Oldenburg, 1989) could be re- imagined to support the full and
equitable inclusion of seniors with vision loss. For example, how can
older adults with vision loss be welcomed into spaces that are intended
to support informal gathering, when the challenges they face with social
interactions are so well documented in the existing literature. Further­
more, the neighbourhood is an important site for the construction of
social identity. As such, future research would also benefit from looking
at how social identity is formed, supported, and, at times, challenged by
the make up of the neighbourhood and the social actors that exist within
it.
5. Conclusions
This study sought to explore the ways in which interactions with
informal neighbourhood- based social networks relate to community
occupational engagement. Study results demonstrated that neighbours,
service personnel, and strangers shape neighbourhood participation,
and that both the quality and nature of those relationships is key to
understanding how the social context of neighbourhoods affects com­
munity occupational engagement for older adults with age-related
vision loss.
Declarations of Competing Interest
None.
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