Assessing the health impact of age-specific housing

Changes in hospitalisation rates in older people before and after moving to a retirement village

OBJECTIVES

An increasing proportion of older people live in Retirement Villages ('villages'). This population cites support for health-care issues as one reason for relocation to villages. Here, we examine whether relocation to villages is associated with a decline in hospitalisations.

METHODS

Retrospective, before-and-after observational study.

SETTING

Retirement villages, Auckland, New Zealand.

PARTICIPANTS

466 cognitively intact village residents (336 [72%] female); mean (SD) age at moving to village was 73.9 (7.7) years. Segmented linear regression analysis of an interrupted time-series design was used.

MAIN OUTCOME MEASURES

all hospitalisations for 18 months pre- and postrelocation to village.

SECONDARY OUTCOME

acute hospitalisations during the same time periods.

RESULTS

The average hospitalisation rate (per 100 person-years) was 44.9 (95% confidence interval [CI] = 36.3-55.6) 18-10 months before village relocation, 58.9 (95% CI = 48.3-72.0) 9-1 months before moving, 47.9 (95% CI = 38.8-59.1) 1-9 months after moving and 62.4 (95% CI = 51.2-76.0) 10-18 months after moving. Monthly average hospitalisation rate (per 100 person-years) increased before relocation to village by an average of 1.2 (95% CI = 0.01-1.57, p = .04) per month from 18 to 1 month before moving, and there was a change in the level of the monthly average hospitalisation rate immediately after relocation (mean difference [MD] = -18.4 per 100 person-years, 95% CI = -32.8 to -4.1, p = .02). The trend change after village relocation did not differ significantly from that before moving.

CONCLUSIONS

Although we cannot reliably claim causality, relocation to a retirement village is, for older people, associated with a significant but non-sustained reduction in hospitalisation.

"We are good neighbours, but we are not carers!": Lived experiences of conflicting (in)dependence needs in retirement villages across the United Kingdom and Australia

BACKGROUND AND OBJECTIVES

This study sought to qualitatively explore the lived experiences of 80 older people living in retirement villages across the UK and Australia. We focused on residents' narratives around the themes of independence/dependence.

RESEARCH DESIGN AND METHODS

Qualitative semi-structured interviews permitted in-depth exploration of how older people understood and experienced issues related to independence/dependence in the context of retirement living.

RESULTS

Core themes identified strikingly different and often competing needs and narratives around independence/dependence. Of note was the fact that narratives and needs around independence/dependence frequently collided and conflicted, creating a sense of 'us' and 'them' in the retirement community. The primary source of such conflict was reflected by the fact that residents seeking a 'prolonged midlife' often felt that frailer and more dependent residents were a burden on them and were not suited to an 'independent living community.'

DISCUSSION AND IMPLICATIONS

Our findings are discussed in relation to the challenges such competing narratives create for retirement villages as living environments for a group of people that are far from homogenous.

Research in the retirement village community-The problems of recruiting a representative cohort of residents in Auckland, New Zealand

OBJECTIVES

Retirement villages are semi-closed communities, access usually being gained via village managers. This paper explores issues recruiting a representative resident cohort, as background to a study of residents, to acquire sociodemographic, health and disability data and trial an intervention designed to improve outcomes.

METHODS

We planned approaching all Auckland/Waitematā District villages and, via managers, contacting residents ('letter-drop'; 'door-knocks'). In 'small' villages (n ≤ 60 units), we planned contacting all residents, randomly selecting in 'larger' villages. We excluded those with doubtful or absent legal capacity.

RESULTS

We approached managers of 53 of 65 villages. Thirty-four permitted recruitment. Some prohibited 'letter-drops' and/or 'door-knocks'. Hence, we recruited volunteers (23 villages) via meetings, posters, newsletters and word-of-mouth, that is representative sampling obtained from 11/34 villages. We recruited 578 residents (median age = 82 years; 420 = female; 217:361 sampled:volunteers), finding differences in baseline parameters of sampled vs. volunteers.

CONCLUSION

Due to organisational/managers' policy, and national legislation restrictions, our sample does not represent our intended population well. Researchers should investigate alternative data sources, for example electoral rolls and censuses.

Social capital in retirement villages: a literature review

Retirement villages are a model of extra-care housing, offering purpose-designed housing that incorporates both care services and a range of non-care-related facilities and activities. These generate opportunities for formal and informal social activity, and promote community engagement, solidarity between residents, and active and independent ageing. Providers suggest that retirement villages are able to foster an environment rich in social capital. This study's purpose is to review and summarise key findings on the topic of social capital in retirement villages in the gerontological literature. Social capital is defined as both an individual attribute of single actors and a feature of communities as a whole. A clear conceptualisation of social capital is used to organise the reviewed studies along different dimensions: on an individual level, social networks, trustworthiness and obligations are differentiated, while the collective level distinguishes between system control, system trust and system morality. Thirty-four studies are reviewed. While retirement villages are generally described as friendly places with widespread helping behaviour where new friends are made, research has also highlighted the difficulty of socially integrating the frail and very old. While, in particular, social networks and system morality have received much attention, there is a clear need for future research into the other domains of social capital.

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.

New perspectives from technology adoption in senior cohousing facilities

Purpose

The purpose of this paper is to analyse the integration of industry 4.0 related technologies of telehealth within innovative housing models addressed to senior population, in order to facing the growing issue of a sustainable management of the population ageing.

Design/methodology/approach

A qualitative exploratory analysis of four case studies of senior cohousing facilities located in different countries was performed. The cases analysed were selected as pioneering cases in the adoption of innovative and economically sustainable organizational solutions.

Findings

The study made it possible to identify which are the common characters that successful experiences have highlighted. Although each facility needs to adapt to the social, cultural, demographic and economic context in which it is located, there are some recurring aspects, which have proved to be key success factors.

Research limitations/implications

This research analyses only four cases. This suggests that the sample does not provide an exhaustive representation of the models adopted in this field. However, the study is an exploratory research and it can provide a basis for further analyses.

Practical implications

This study provides valuable indications for the design and management of senior cohousing facilities, as regards the services to be offered, the network of services and facilities that can be complementary to the residences, the activities to be conducted and organized, the degree of involvement of the elderly in the planning of activities and services. With regard to the adoption of telehealth-related technologies, the study provides indications on which new technologies resulting from the industry 4.0 revolution are going to be adopted, that is, remote surveillance, remote diagnostics and the use of sensors and video. These technologies, thanks to the artificial intelligence, can detect anomalies and provide predictive analyses on the behaviour and health of the elderly.

Originality/value

The study made it possible to identify the key success factors for senior cohousing facilities regardless of the characteristics of the context in which they are located. In addition, it provides a first analysis of the potential of telehealth-related technological solutions, paving the way for further studies aimed at assessing how, thanks to new technologies, the level of economic sustainability of senior cohousing solutions can be improved.

Emotional distress mediates the relationship between cognitive failures, dysfunctional coping, and life satisfaction in older people living in sheltered housing: A structural equation modelling approach

OBJECTIVES

Little is known about the relationship between cognitive failures, emotional distress, and life satisfaction in late life. Experiencing cognitive failures is a known risk for declining life satisfaction in older people, although the mechanisms that may explain cognitive failures remain unclear. This study investigated the associations between psychosocial factors, cognitive failures, and coping strategies and their influence on life satisfaction in older people living in sheltered housing.

METHODS

A total of 204 older people living in sheltered housing in London were recruited (mean age = 75.08 years). We used structural equation modelling path analysis to test several hypotheses based on theories of emotional distress (anxiety and depression) and cognitive failures and their influence on life satisfaction.

RESULTS

Self-reported depressive symptoms (29.5%), anxiety symptoms (33%), and cognitive failures (41%) were common. The final model had a good fit (X²  = 2.67; DF = 2; P = 0.26; NFI = 0.99, CFI = 0.99; RMSEA = 0.04); analyses showed that both cognitive failures and dysfunctional coping were significantly associated and exerted a moderate effect on emotional distress. Cognitive failures and dysfunctional coping had an indirect effect on life satisfaction through emotional distress which directly decreased levels of life satisfaction (β = -0.70, P ≤ 0.001).

CONCLUSIONS

This study found that experiencing emotional distress helped to explain the association and negative effects of cognitive failures and dysfunctional coping on life satisfaction in older people living in sheltered housing. These findings contribute to our understanding of the key mechanisms of experiencing cognitive failures in late life and can help guide future interventions of well-being in later life.

Stigma and Discontinuity in Multilevel Senior Housing's Continuum of Care

PURPOSE OF THE STUDY

This article presents data from 2 qualitative studies, confirming what gerontologists observed 30 years ago. Multilevel senior housing residents experience stigma and distress in an environment where people are grouped by levels of functioning.

DESIGN AND METHODS

Qualitative, interview-based (N = 367) studies were conducted in senior housing settings offering multiple levels of care (N = 7). Analyses involved revisiting coded narrative data, ethnographers' field-based knowledge, and identification of pattern saturation.

RESULTS

Residents and places reflecting the highest levels of care are stigmatized in a context where people are monitored for health changes and required to relocate. Consequently, residents self-isolate, develop a diminished sense of self, and hide health and cognitive conditions out of fear of relocation.

IMPLICATIONS

Developers, operators, staff, and potential residents need to recognize the personal and social challenges typically experienced even in within-site relocation. It is important to rethink the predominant model of senior housing that requires residents with changing needs to move and adapt to the setting.

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.

The characteristics of residents in extra care housing and care homes in England

Extra care housing aims to meet the housing, care and support needs of older people, while helping them to maintain their independence in their own private accommodation. It has been viewed as a possible alternative, or even a replacement for residential care. In 2003, the Department of Health announced capital funding to support the development of extra care housing and made the receipt of funding conditional on participating in an evaluative study. This paper presents findings on the characteristics of the residents at the time of moving in, drawing on information collected from the 19 schemes in the evaluation, and a recent comparable study of residents who moved into care homes providing personal care. Overall, the people who moved into extra care were younger and much less physically and cognitively impaired than those who moved into care homes. However, the prevalence of the medical conditions examined was more similar for the two groups, and several of the schemes had a significant minority of residents with high levels of dependence on the Barthel Index of Activities of Daily Living. In contrast, levels of severe cognitive impairment were much lower in all schemes than the overall figure for residents of care homes, even among schemes designed specifically to provide for residents with dementia. The results suggest that, although extra care housing may be operating as an alternative to care homes for some individuals, it is providing for a wider population, who may be making a planned move rather than reacting to a crisis. While extra care supports residents with problems of cognitive functioning, most schemes appear to prefer residents to move in when they can become familiar with their new accommodation before the development of more severe cognitive impairment.

Deciding to move into extra care housing: residents’ views

Extra care housing aims to meet the housing, care and support needs of older people, while helping them to maintain their independence in their own private accommodation. In 2003, the Department of Health announced capital funding to support the development of extra care housing, and made the receipt of funding conditional on participating in an evaluative study. Drawing on information collected directly from residents in 19 schemes, this paper presents findings on the factors motivating older people to move to extra care housing, their expectations of living in this new environment, and whether these differ for residents moving to the smaller schemes or larger retirement villages. In total, 949 people responded, 456 who had moved into the smaller schemes and 493 into the villages. Of the residents who moved into the villages most (75%) had not received a care assessment prior to moving in, and had no identified care need. There was evidence that residents with care needs were influenced as much by some of the attractions of their new living environment as those without care needs who moved to the retirement villages. The most important attractions of extra care housing for the vast majority of residents were: tenancy rights, flexible onsite care and support, security offered by the scheme and accessible living arrangements. The results suggest that, overall, residents with care needs seem to move proactively when independent living was proving difficult rather than when staying put is no longer an option. A resident's level of dependency did not necessarily influence the importance attached to various push and/or pull factors. This is a more positive portrayal of residents’ reasons for moving to smaller schemes than in previous UK literature, although moves did also relate to residents’ increasing health and mobility problems. In comparison, type of tenure and availability of social/leisure facilities were more often identified as important by those without care needs in the villages. Therefore, as in other literature, the moves of village residents without care needs seemed to be planned ones mostly towards facilities and in anticipation of the need for care services in the future.

Comparison study: the impact of on-site comprehensive service access on self-reported health and functional status of older adults

OBJECTIVE

To evaluate the impact of on-site comprehensive service access by comparing functional outcomes and self-rated health between 2 older adult samples.

METHODS

Data came from 131 randomly selected residents living independently in 2 retirement communities that provided on-site comprehensive service access and 1723 community-dwelling older adults from the second Longitudinal Study on Aging, Wave 3 (LSOA II), who did not have compatible services access. All subjects were age 70+, white, with intact cognitive function, and had 12 or more years of education. We applied regressed measures of functional status and self-rated health on on-site comprehensive service access (yes versus no) in multivariate models that adjusted for covariates.

RESULTS

After adjusting for covariates, results indicated that residents with access to on-site comprehensive service settings is significantly associated with less risk for activities of daily living (ADL) limitations (beta = -0.40, P < .001) and Nagi impairments (beta = -0.62, P <or= .001), and better self-rated health (OR = 4.3; 95% CI 2.03-9.15) than the comparison group.

CONCLUSION

On-site comprehensive service access appears to have positive association on functional outcomes and self-rated health. Future studies should explore specific components of on-site comprehensive service access (eg, home health, social activities) that may account for these desirable outcomes.

Sheltered housing compared to independent housing in the community

BACKGROUND

With elderly people desiring to live independently as long as possible, traditional homes for the elderly are increasingly being transformed into sheltered accommodations. In order to assess the importance of housing for frail elderly people, elderly people at risk for institutionalization were studied in two living conditions: sheltered accommodation and living independently in the community.

METHODS

A total of 317 elderly people at risk for institutionalization [91 men and 240 women, mean age = 83.3 (SD = 6.0)] were interviewed using a structured questionnaire with questions regarding home care and social service use, quality of life, subjective well-being, life satisfaction, autonomy, functional status, feelings of insecurity and loneliness.

RESULTS

Exactly 56.5% of the respondents were living in sheltered accommodation (n = 179) and 43.5% (n = 138) were living in regular houses. Although both groups were similar in demographic details and functional status, those in sheltered accommodation had a higher perceived autonomy, sense of security and quality of life. No differences were found with regard to subjective well-being or feelings of loneliness. Elderly people in regular houses needed more hours of housekeeping assistance. Those in sheltered accommodation participated more frequently in services like social activities and social restaurants, but made less use of day care facilities.

CONCLUSIONS

Affordable, decent and suitable noninstitutional housing with service provision play a vital role in the lives of elderly people. Compared with independent living in the community, sheltered accommodations provide added value. Sheltered housing should therefore be an integral part of long-term care policy.

A survey of psychological wellbeing in an adult population

The British government has called on all NHS staff to help promote good psychological wellbeing in the population. This article reports results from a survey conducted in Merseyside, England, into the prevalence of poor psychological wellbeing across a large part of the region. People registered with one of five Merseyside primary care trusts were stratified by age group and deprivation, and a questionnaire was mailed to 28,000 who had been randomly selected from those aged 15 or over. A total of 11,168 (45%) completed questionnaires were returned. Of these, 2,442 (21.9%) respondents rated their psychological wellbeing as fairly poor or very poor. Mean levels of psychological wellbeing were significantly worse in a number of readily identifiable groups within the population, but overall, the lowest wellbeing ratings were concentrated in the most socioeconomically deprived quartile. We make a number of practical suggestions for the role of the community nurse in promoting good psychological wellbeing in patients. We also highlight our finding that socioeconomic deprivation was strongly associated with poor psychological wellbeing, which was in turn associated with a lifestyle high in risk factors for non-communicable diseases.

Factors affecting the mental health of residents in a communal-housing project for seniors in Japan

The aim of this study was to investigate mental health status and the factors related to it in residents of a communal-housing project for independently living elderly in Japan. Two hundred and seven persons (average age: 74 years) residing in the Silver Peer Housing Project, a seniors' communal-housing project designed for independent living, were interviewed face-to-face using a general health questionnaire (GHQ-28), mental status questionnaire (MSQ) and other questionnaire containing items on personal, social, and building/facility parameters. Using a GHQ score of 7 or over to indicate poor general mental health, approximately half of the residents (45.7%) were shown to have some psychiatric problems. Independent contributors to a high GHQ score were attendance of hobby-club meetings (odds ratio (95% CI): 0.4; range, 0.2-0.8); difficulty in laying out or putting away the bedding (odds ratio (95% CI): 2.0; range, 1.0-4.2); difficulty in standing up from a sitting position on a mat (odds ratio (95% CI): 2.0; range, 1.0-4.1); and difficulty in reaching bus or train stops (odds ratio (95% CI): 2.5; 1.2-5.2); by the step-wise multiple logistic regression analysis. It was shown that a considerable number of the residents in the Silver Peer Housing facilities studied had mental health problems associated with limitations in the layout of their apartment and/or the location of the housing. Our results suggest that it may be worthwhile to prepare more comfortable housing, and to provide psychogeriatric day treatment and a communal space open to public in the Silver Peer Housing.