Retirement Communities: We Know What They Are … or Do We?

Examining socio-spatial mobility patterns among colon cancer patients after diagnosis

Given the growing number of cancer survivors, it is important to better understand socio-spatial mobility patterns of cancer patients after diagnosis that could have public health implications regarding post-diagnostic access to care for treatment and follow-up surveillance. In this exploratory study, residential histories from LexisNexis were linked to New Jersey colon cancer cases diagnosed from 2006 to 2011 to examine differences in socio-spatial mobility patterns after diagnosis by stage at cancer diagnosis, sex, and race/ethnicity. For the colon cancer cases, we summarized and compared the number of residences and changes in the residential census tract and neighborhood poverty after the diagnosis. We found only minor changes in neighborhood poverty among the cases during the follow-up period after diagnosis. During the follow-up period of up to 10 years after diagnosis, 67% of the patients did not move to a different residential census tract, and 10.8% moved from New Jersey to another state. Cases that moved to a different census tract changed after diagnosis were generally less wealthy than non-movers, but the destination of relocation varied by race/ethnicity and socioeconomic status. We also found a significant association between residential mobility and stage at diagnosis, whereby patients diagnosed with colon cancer at an early stage were more likely to be movers. This study contributes to understanding of the socio-spatial mobility patterns in colon cancer patients and may help to inform cancer research by summarizing the extent to which colon cancer patients move after diagnosis.

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Post-diagnosis socio-spatial mobility is relatively low among colon cancer patients.

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Post-diagnosis, ∼67% of all colon cancer patients in NJ did not change residence.

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Movers spent more time living in high-poverty neighborhoods than non-movers.

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Approximately 10% of all patients left New Jersey for other states.

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Geographic destinations vary by race/ethnicity and socioeconomic status.

"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.

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.

Disability levels and correlates among older mobile home dwellers, an NHATS analysis

BACKGROUND

Although remarkably understudied, manufactured or mobile homes are the housing choice for nearly 20 million Americans and little is known about the health of older persons living in mobile homes.

OBJECTIVE

We sought to investigate disability levels and other health correlates among older adults living in mobile or manufactured homes compared to their counterparts living in other types of homes.

METHODS

We sampled non-institutional adults aged 65 years or older (n = 7609), of whom 344 lived in mobile homes, from the 2011 National Health and Aging Trends Study (NHATS).

RESULTS

Respondents living in mobile homes (average age = 75.1 years; SD = 0.5) had lower education and income and medical insurance than older adults living in other types of community residence (average age = 77.5 years; SD = 0.2). They were more likely to smoke, have lung and heart disease, and report fair or poor general health status. Mobile home dwellers reported more difficulty or inability in performing the following activities of daily living when compared to their counterparts: stooping and kneeling (64.9% vs 60.8%, p = 0.007), walking 6 blocks (46.5% vs 41.5%, p = 0.001), walking 3 blocks (37.7% vs 33.5%, p = 0.002), and climbing up to 20 stairs (39.2% vs 34.8%, p = 0.02). Among those reporting disability, mobile home dwellers had fewer bathroom safety modifications.

CONCLUSION

There is higher prevalence of chronic conditions, functional and cognitive impairment in older mobile home dwellers compared to older adults living in other types of housing.