Deciding to move into extra care housing: residents’ views

Do Health and Housing Attributes Motivate Residential Moves Among Older Chinese Adults? Evidence From an 8‑Year Follow‑up Study

Background and Objectives

Despite the widespread belief in aging-in-place as the preferred housing arrangement for older adults, they are increasingly embracing moving. The person-environment fit theory explains that environmental changes due to residential moves can pose health risks, discouraging older people from moving. However, it also suggests that moves may be suitable when living conditions no longer meet their physical needs. The correlation between older people's health, housing, and their subsequent moving or staying actions in China remains underexplored.

Research Design and Methods

Using alternative operating variables of key concepts and the China Family Panel Studies 2012-2018 data sets, this study examines the effects of health and housing status on older people's residential moves in China. The study outlines changes in health indicators and housing characteristics during multiple moves, as well as examines the relationship between the health and housing status of older adults and moving over a relatively long period of time using both regression models with lagged explanatory variables and fixed effects binary choice models.

Results

The results reveal that: (1) higher rates of subsequent moves were observed among older adults with better self-rated health, positive self-rated health changes, and no ADL impairment, but no significant associations were found between most health variables and moving; and (2) the correlation between older persons' house ownership/type and their residential moves was significant and consistent over time, steady and lasting.

Discussion and Implications

Potential mechanisms explaining the association between specific housing types and ownership statuses on moving are discussed. The findings encourage a focus on the positive benefits of moving in later life and how to provide additional housing options for older individuals.

Profiles of Expectations Regarding Aging After Relocation to Assisted Living

This study classified assisted living (AL) residents by expectations for future physical, cognitive, and socioemotional health in later life. The authors analyzed cross-sectional data from 202 AL residents. Study participants completed the 12-item expectations regarding aging survey. A K-means cluster analysis identified three subgroups: "lower expectations" (n = 55), "higher expectations" (n = 70), and "expecting adaptiveness" (n = 77). Subgroups varied by select demographic, health, and relocation-related factors. Results suggest that, despite similarities in physical and cognitive functioning, AL residents reported different expectations for health. Socioemotional functioning may help explain observed discrepancies between current health and future health-related expectations.

Reasons for the Place of Care of the Elders: A Systematic Review

BACKGROUND

Relocation is a very important event in people's lives in general, but really significant in old age. However, some predictors of relocation still need to be improved. The objective of this review was to synthesize qualitative evidence to understand the reasons of the participants to decide on the place of care of the older people.

METHODS

Systematic review of qualitative studies was conducted in six databases: Scopus, SciELO, PubMed, PsycINFO, Web of Science and CINAHL, from its beginning until 29 November 2017. Qualitative or mixed studies, written in English or Spanish and addressing the decision-making process (already experienced by participants) on the place of care of older persons (65 years or older), were included in the review. PROSPERO (registration number: CRD42018084826).

RESULTS

A total of 46 articles were finally included in the analysis. Our main result is the distinction of multiple reasons for each population group involved in the decision-making process, ranking these reasons into three factors: Retention, pull and push.

CONCLUSION

This differentiation allows for a more detailed and in-depth analysis of the motivations of the different groups involved in this process.

Health profile of residents of retirement villages in Auckland, New Zealand: findings from a cross-sectional survey with health assessment

OBJECTIVES

Retirement villages (RV) have expanded rapidly, now housing perhaps one in eight people aged 75+ years in New Zealand. Health service initiatives might better support residents and offer cost advantages, but little is known of resident demographics, health status or needs. This study describes village residents-their demographics, socio-behavioural and health status-noting differences between participants who volunteered and those who were sampled.

DESIGN

Cross-sectional study of village residents. The cohort formed will also be used for a longitudinal study and a randomised controlled trial. Village managers (sometimes after consulting residents) decided if representative sampling could be undertaken in each village. Where sampling was not approved, volunteers were sought.

SETTING

33 RV were included from a total of 65 villages in Auckland, New Zealand.

PARTICIPANTS

Residents (n=578) were recruited either by sampling (n=217) or as volunteers (n=361) during 2016-2018. Each completed a survey and an International Resident Assessment Instrument (interRAI) health needs assessment with a gerontology nurse specialist.

RESULTS

Median age of residents was 82 years, 158 (27%) were men; 61% lived alone. Downsizing (77%), less stress (63%) and access to healthcare assistance (61%) were most common reasons for entry. During the 2 weeks prior to survey, 34% received home supports and 10% personal care. Hypertension, heart disease, arthritis and pain were reported by over 40%. Most common unmet needs related to managing cardiorespiratory symptoms (50%) and pain (48%). Volunteers and sampled residents differed significantly, mainly in socio-behavioural respects.

CONCLUSIONS

Common conditions including hypertension, arthritis and atrial fibrillation, are recorded in interRAI as text, and thus overlooked in interRAI reports. Levels of unmet need indicate opportunities to improve health services to better manage chronic conditions. Healthcare service providers and village operators could cooperate to design and test service initiatives that better meet residents' needs and offer cost benefits.

TRIAL REGISTRATION NUMBER

ACTRN12616000685415.

Push and Pull Factors Surrounding Older Adults’ Relocation to Supportive Housing: A Scoping Review

Supportive housing, including retirement homes and assisted living, is increasingly touted as a suitable living option for Canadian older adults. This scoping review describes the nature and content of studies that explore underlying factors that motivate older adults to relocate to supportive housing. We conducted a search of PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Web of Science, and PsycINFO, which identified 34 articles for review. Articles reviewed employed a variety of methods and guiding theoretical frameworks, of which the push and pull framework appeared to be most common. This review suggests that health and functional deficits are important reasons for relocation to supportive housing for older adults. Further longitudinal data are required to more comprehensively describe medical and social determinants for relocation and its consequences, in order to better describe this growing population and better align policies with the needs of older adults contemplating or undergoing relocation.

Housing options for the future: Older people's preferences and views on villages with care and support

A growing older population worldwide means there is a need to ensure there are sufficient housing options to meet a broad spectrum of need and aspiration. There is little understanding of the relative importance of the "pull factors" that might attract older people to relocate to a new environment. Older people's views of the relative level of attractiveness of potential features of a specialist housing development offering care and support were investigated using Q methodology. Forty-one participants aged 53-89 living in a locality in Northern England rank-ordered 70 statements from April to August 2016. The analysis revealed four viewpoints: adaptation and care seekers, comprising prioritisation of care provision, specialist accommodation and accessibility; care-indifferent luxurians, which encompasses attraction to some "luxury" features and less emphasis on care provision; connected separatists, emphasising a distinct environment with good public transport connections; and independent engagers, comprising attraction towards social opportunities and remaining independent. Broad agreement was found on some topics, such as the generally high prioritisation of safety and security. The research provides a deeper understanding of differences in views towards housing options among older people which developers, planners and funders will need to recognise. While providing high-quality care may be a key objective for some organisations, this may not be the most important concern for some older people contemplating relocation, with many other features considered more attractive.

Ageing in extra-care housing: preparation, persistence and self-management at the boundary between the third and fourth age

Extra-care housing (ECH) has been hailed as a potential solution to some of the problems associated with traditional forms of social care, since it allows older people to live independently, while also having access to care and support if required. However, little longitudinal research has focused on the experiences of residents living in ECH, particularly in recent years. This paper reports on a longitudinal study of four ECH schemes in the United Kingdom. Older residents living in ECH were interviewed four times over a two-year period to examine how changes in their care needs were encountered and negotiated by care workers, managers and residents themselves. This paper focuses on how residents managed their own changing care needs within the context of ECH. Drawing upon theories of the third and fourth age, the paper makes two arguments. First, that transitions across the boundary between the third and fourth age are not always straightforward or irreversible and, moreover, can sometimes be resisted, planned-for and managed by older people. Second, that operational practices within ECH schemes can function to facilitate or impede residents’ attempts to manage this boundary.

Should I've stayed or should I've gone? What residents of continuing care retirement communities and former candidates think and feel one year after their decision: a quantitative longitudinal comparison

The aim of this study was to compare satisfaction with residence, wellbeing and physical health of continuing care retirement community (CCRC) residents with people who considered enrolling in the same CCRCs but elected not to move. A total of 101 participants were recruited from 13 CCRCs located in multiple cities in the United States of America. A phone interview was conducted with participants three months or less from enrolment and one year later. Compared with those who chose not to move, CCRC residents reported lower satisfaction at baseline, but higher satisfaction at one year. Wellbeing declined from baseline to follow-up for both groups, but was higher in CCRC residents both at baseline and at one year. CCRCs might consider giving new residents a longer cancellation period in order to allow sufficient time for the adjustment process. This, in turn, might both prevent an early departure and affect the decision of potential CCRC residents to move into the community.

Choosing between staying at home or moving: A systematic review of factors influencing housing decisions among frail older adults

Background

Most older adults wish to stay at home during their late life years, but physical disabilities and cognitive impairment may force them to face a housing decision. However, they lack relevant information to make informed value-based housing decisions. Consequently, we sought to identify the sets of factors influencing the housing decision-making of older adults.

Methods

We performed a systematic literature search for studies evaluating any factors influencing the housing decisions among older adults over 65 years old without cognitive disabilities. Primary research from any study design reported after 1990 in a peer-reviewed journal, a book chapter or an evaluated doctoral thesis and written in English, French or Spanish were eligible. We extracted the main study characteristics, the participant characteristics and any factors reported as associated with the housing decision. We conducted a qualitative thematic analysis from the perspective of the meaning and experience of home.

Results

The search resulted in 660 titles (after duplicate removal) from which 86 studies were kept for analysis. One study out of five reported exclusively on frail older adults (n = 17) and two on adults over 75 years old. Overall, a total of 88 factors were identified, of which 71 seem to have an influence on the housing decision-making of older adults, although the influence of 19 of them remains uncertain due to discrepancies between research methodologies. No conclusion was made regarding 12 additional factors due to lack of evidence.

Conclusion

A wealth of factors were found to influence housing decisions among older adults. However, very few of them have been studied extensively. Our results highlight the importance of interdisciplinary teamwork to study the influence of a broader range of factors as a whole. These results will help older adults make the best possible housing decision based on their unique situation and values.

‘Pathways to choice’ of care setting

This article aims to encourage critical reflection about the limitations of the rational choice approach as an explanatory insight to understanding older people's choice-making about their health or social care requirements. It develops an interpretive framework examining how older people engage in the process of choice-making when selecting a care option. Choice-making is conceptualised as a temporal, processual phenomenon, influenced by others, and characterised by an individual's behavioural responses to changing circumstance and lifecourse events. Data are from qualitative interviews with 29 older adults whose choice of care option involved moving to an extra-care setting in Wales (United Kingdom). Transcripts were coded using in-case and constant-comparison approaches, and analysis was undertaken using concepts ofengagementandtemporalityas elements of the choice-making process. Using an inductive approach, a typology of six different ‘pathways to choice’ of care setting was identified; these findings suggest that choosing a care option in later life is a diverse, interactive and time-bound social phenomenon, inadequately captured by the rational choice approach where it is understood more as an individualised, linear and logical process. Recognising that choice-making evolves through time as part of a process shaped by others means service providers will be better positioned to offer opportunities for more preventative-focused interventions which empower older consumers to make planned and informed choices about care options.

Refining the push and pull framework: identifying inequalities in residential relocation among older adults

Older people consider moving home when there is a discrepancy between actual and desired living conditions. This study builds on the classic push and pull framework described in the early work of Lee and Wiseman by identifying whether or not individual differences among older people can be predictive for certain push and pull reasons (such as housing, health, neighbourhood and social contact). On the basis of data from the Belgian Ageing Studies (N = 35,402), it was found that 13.9 per cent of older respondents had moved in the last ten years (N = 4,823). An analysis of the movers revealed inequalities in the reasons for moving in later life and raises the question of whether a relocation is voluntary (being able to move) or involuntary (being forced to move). Respondents with lower household incomes and poor mental health were significantly more likely to have moved because of stressors pushing them out of their previous dwelling, whereas older people with higher household incomes or home-owners were mainly pulled towards a more attractive environment.

Feeling in control: comparing older people's experiences in different care settings

The promotion of choice and control for older people is a policy priority for social care services in the United Kingdom and is at the heart of recent drives to personalise services. Increasingly, we are seeing a move away from institutionalised care (e.g. in care homes) towards enablement, with more services being delivered in community-based settings. Extra care housing has been promoted as a purpose-built, community-based alternative to residential care for older people. However, whilst accounts of users' experiences in particular service types are plentiful, the use of different instrumentation and measures makes comparison between settings difficult. We combined data from four studies where participants were older people either living in care homes or extra care housing or receiving care at home. All of these studies asked participants to rate their control over daily life, using the Adult Social Care Outcomes Toolkit (ASCOT). This paper presents the results of an ordinal logistic regression analysis indicating that, after controlling for differences in age, ability to perform activities of daily living and self-rated health, setting had a significant effect on older people's sense of control. Residents in care homes and extra care housing report similar levels of control over daily life but consistently report feeling more in control than older people receiving care at home. Implications for policy and practice are discussed.

Residential relocation by older adults in response to incident cardiovascular health events: a case-crossover analysis

Objective. We use a case-crossover analysis to explore the association between incident cardiovascular events and residential relocation to a new home address. Methods. We conducted an ambidirectional case-crossover analysis to explore the association between incident cardiovascular events and residential relocation to a new address using data from the Cardiovascular Health Study (CHS), a community-based prospective cohort study of 5,888 older adults from four U.S. sites beginning in 1989. Relocation was assessed twice a year during follow-up. Event occurrences were classified as present or absent for the period preceding the first reported move, as compared with an equal length of time immediately prior to and following this period. Results. Older adults (65+) that experience incident cardiovascular disease had an increased probability of reporting a change of residence during the following year (OR 1.6, 95% confidence interval (CI) = 1.2–2.1). Clinical conditions associated with relocation included stroke (OR: 2.0, 95% CI: 1.2–3.3), angina (OR: 1.6, 95% CI: 1.0–2.6), and congestive heart failure (OR: 1.5, 95% CI: 1.0–2.1). Conclusions. Major incident cardiovascular disease may increase the probability of residential relocation in older adults. Case-crossover analyses represent an opportunity to investigate triggering events, but finer temporal resolution would be crucial for future research on residential relocations.

The meaning of "independence" for older people in different residential settings

OBJECTIVES

Drawing on older people's understandings of "independence" and Collopy's work on autonomy, the article elaborates an interpretive framework of the concept in relation to 3 residential settings-the private dwelling-home, the extra-care, and the residential-care settings.

METHOD

Data include 91 qualitative interviews with frail, older people living in each setting, collected as part of a larger Welsh study. Thematic analysis techniques were employed to identify patterns in meanings of independence across settings and then interpreted using Collopy's conceptualizations of autonomy, as well as notions of space and interdependencies.

RESULTS

Independence has multiple meanings for older people, but certain meanings are common to all settings: Accepting help at hand; doing things alone; having family, friends, and money as resources; and preserving physical and mental capacities. Concepts of delegated, executional, authentic, decisional, and consumer autonomy, as well as social interdependencies and spatial and social independence, do provide appropriate higher order interpretive constructs of these meanings across settings.

DISCUSSION

A broader interpretive framework of "independence" should encompass concepts of relative independence, autonomy(ies), as well as spatial and social independence, and can provide more nuanced interpretations of structured dependency and institutionalization theories when applied to different residential settings.