Subjective social isolation or loneliness in older adults residing in social housing in Ontario: a cross-sectional study

BACKGROUND

Older adults face greater risk of social isolation, but the extent of social isolation among low-income older adults living in social housing is unknown. This study aims to explore the rate of, and risk factors contributing to, subjective social isolation or loneliness among older adults in social housing.

METHODS

We conducted a cross-sectional study of data collected from a community program held in the common rooms of 55 social housing buildings in 14 communities across Ontario, Canada, from May 2018 to April 2019. Participants were program attendees aged 55 years and older who resided in the buildings. Program implementers assessed social isolation using the 3-Item Loneliness Scale from the University of California, Los Angeles and risk factors using common primary care screening tools. We extracted data for this study from the program database. We compared the rate of social isolation to Canadian Community Health Survey data using a 1-sample χ² test, and evaluated associations between risk factors and social isolation using univariate and multivariate logistic regressions.

RESULTS

We included 806 residents in 30 buildings for older adults and 25 mixed-tenant buildings. Based on the 3-Item UCLA Loneliness Scale, 161 (20.0%) of the 806 participants were socially isolated. For those aged 65 and older, the rate of social isolation was nearly twice that observed in the same age group of the general population (36.1% v. 19.6%; p < 0.001). Risk factors were age (65-84 yr v. 55-64 yr adjusted odds ratio [OR] 1.99, 95% confidence interval [CI] 1.01-3.93), alcohol consumption (adjusted OR 2.45, 95% CI 1.09-5.54), anxiety or depression (adjusted OR 6.05, 95% CI 3.65-10.03) and income insecurity (adjusted OR 2.10, 95% CI 1.24-3.53). Protective factors were having at least 1 chronic cardiometabolic disease (adjusted OR 0.44, 95% CI 0.24-0.80), being physically active (adjusted OR 0.47, 95% CI 0.30-0.73) and having good to excellent general health (adjusted OR 0.60, 95% CI 0.39-0.90).

INTERPRETATION

The high rate of social isolation in low-income older adults living in social housing compared with the general population is concerning. Structural barriers could prevent engagement in social activities or maintenance of social support, especially for older adults with income insecurity and anxiety or depression; interventions are needed to reduce subjective social isolation in this population.

Application of In-Home Monitoring Data to Transition Decisions in Continuing Care Retirement Communities: Usability Study

BACKGROUND

Continuous in-home monitoring of older adults can provide rich and sensitive data capturing subtle behavioral and cognitive changes. Our previous work has identified multiple metrics that describe meaningful trends in daily activities over time. The continuous, multidomain nature of this technology may also serve to inform caregivers of the need for higher levels of care to maintain the health and safety of at-risk older adults. Accordingly, care decisions can be based on objective, systematically assessed real-time data.

OBJECTIVE

This study deployed a suite of in-home monitoring technologies to detect changing levels of care needs in residents of independent living units in 7 retirement communities and to assess the efficacy of computer-based tools in informing decisions regarding care transitions.

METHODS

Continuous activity data were presented via an interactive, web-based tool to the staff identified in each facility who were involved in decisions regarding transitions in care among residents. Comparisons were planned between outcomes for residents whose data were shared and those whose data were not made available to the staff. Staff use of the data dashboard was monitored throughout the study, and exit interviews with the staff were conducted to explicate staff interaction with the data platform. Residents were sent weekly self-report questionnaires to document any health- or care-related changes.

RESULTS

During the study period, 30 of the 95 residents (32%) reported at least one incidence of new or increased provision of care; 6 residents made a permanent move to a higher level of care within their communities. Despite initial enthusiasm and an iterative process of refinement of measures and modes of data presentation based on staff input, actual inspection and therefore the use of resident data were well below expectation. In total, 11 of the 25 staff participants (44%) logged in to the activity dashboard throughout the study. Survey data and in-depth interviews provided insight into the mismatch between intended and actual use.

CONCLUSIONS

Most continuous in-home monitoring technology acceptance models focus on perceived usefulness and ease of use and equate the intent to use technology with actual use. Our experience suggests otherwise. We found that multiple intervening variables exist between perceived usefulness, intent to use, and actual use. Ethical, institutional, and social factors are considered in their roles as determinants of use.

Older Adult Segmentation According to Residentially-Based Lifestyles and Analysis of Their Needs for Smart Home Functions

Globally, the percentage of older people in the general population is growing. Smart homes have the potential to help older adults to live independently and healthy, improving their quality of life, and relieving the pressure on the healthcare and social care systems. For that, we need to understand how older adults live and their needs. Thus, this study aims to analyze the residentially-based lifestyles (RBL) of older adults and segment them to compare and analyze the real needs of smart home functions for each group. To identify a person's RBL, a questionnaire was designed to include questions about activities at home, social events, quality of life, etc. This study surveyed 271 older Koreans. As a result of the survey on RBL, five groups with different characteristics were clustered. Finally, each groups' features and the differences in their needs for smart home functions were compared and analyzed. The priority of needed functions for each group was found to be significantly different. In a total of 26 smart home functions, there were meaningful differences in the needs for 16 functions among the groups. This study presents the results in South Korea, according to older adults' RBL and their smart home needs.

Single Time-Point Study of the Home Environment and Functionality of Older Adults in Spain

Background: The literature favors discussion on socio-spatial conditions at the macro- (city) and micro- (housing) level that promote healthy aging in place. Objectives: (a) Identify the association between physical and social characteristics of the family home and the functional level and quality of life of older people and (b) provide normative data on adequate/inadequate households based on the Home Observation for Measurement of the Environment (HOME) inventory and the Spanish Informant Questionnaire on Cognitive Decline in the Elderly (S-IQCODE) test. Methods: In total, 79 healthy older adults completed the HOME inventory and the Montreal Cognitive Assessment (MoCA), S-IQCODE, Kessler Psychological Distress Scale (K-10) and ICEpop CAPability measure for Older people (ICECAP-O) tests. A regression model, the effect size and the means of the scores of HOME (adequate/inadequate) test and the cognitive level (optimal/normal) were calculated. Results: The regression model discloses that adequate home scores are associated with cognitive level (odds ratio (OR): 0.955, confidence interval (CI)95%: 0.918-0.955); quality of life (OR: 6.542, CI95%: 1.750-24.457), living with other people (OR: 5.753, CI95%: 1.456-22.733) and level of education (OR: 0.252, CI95%: 0.064-0.991). The normative data between HOME and S-IQCODE scores showed a good adjustment (d = 0.70). Conclusion: There is a significant relationship between the physical environment of the home and personal variables (sociodemographic information, quality of life and cognitive functionality). In addition, from this last variable, the normative data of an adequate/inadequate household for an older person have been established.

Introducing assistive technology into the existing homes of older people: Feasibility, acceptability, costs and outcomes

We examined how far, and at what cost, the housing stock could be modified to accommodate the assistive technology (AT) necessary to enable older people to remain in their own homes. A multidisciplinary team devised seven hypothetical user profiles for 10 case study areas, with five local authorities and five housing associations in England and Wales. Each profile was considered at two times, five years apart, with the users’ functional abilities deteriorating in between. In addition, in-depth interviews were carried out with a sample of 67 older people in the case study areas about their use and experience of a wide range of AT. The interviews showed the need to listen to older people and that they welcomed AT when it addressed a perceived need. The results showed that the extent of adaptation required of buildings to accommodate a user's needs varied greatly. It was also found that there was confusion about the terminology of AT, including the idea of the ‘smart house’. The study shows that the adaptability of the housing depends on a range of factors and costs.

The rote administrative approach to death in senior housing: Using the other door

Understanding death in long-term care (LTC) facilities and the preexisting standards and policies pertaining to the death experience in LTC is essential. Qualitative interviews were conducted with 10 administrators of CCRCs and data analyzed through content analysis. Results of the current study reveal that administrators spoke of approaching death in their facility similar to any other procedural task, removal of the residents' bodies varied by community, and coordination responsibilities ranged from maintenance crews to management. Notification practices for residents and staff were also inconsistent. Differences existed in internal cultures on providing forms of respect. These practices were standard for some facilities while others were flexible to accommodate family requests. The majority of the sites did not offer additional training on death and dying for staff members. Findings suggest the need for consistency regarding how senior housing administrators approach the death of a resident and provide support for staff members.

Comparative study of quality of life of elderly living in condominiums versus community dwellers

OBJECTIVE

To compare the quality of life of elderly living at a geriatric institution with that of elderly living in the community.

METHODOLOGY

Quantitative study in which the quality of life of 50 elderly living in condominiums was compared with that of 173 community dwellers. To assess the quality of life, the instruments WHOQOL-BREF and WHOQOL-OLD were applied. The data were collected between November 2011 and February 2012.

RESULTS

The groups differed significantly with regard to the domains: physical, environment, functioning of the senses and participation, which were better in the condominium residents; while the community dwellers scored higher in the domain intimacy.

CONCLUSION

Different factors can interfere in the elderly's quality of life, including the place of residence, which indicates the need for further monitoring by health professionals, especially nurses, with a view to outlining strategies to maintain the elderly's quality of life.

Boomers' prospective needs for senior centers and related services: a survey of persons 50-59

The future service needs of baby boomers are unclear. A survey addressing work/retirement, family, civic engagement, health, caregiving, leisure, and perceptions of senior services was mailed to 800 addresses randomly selected from a upper Midwestern county voter registration list. The response rate was 28%. Fifty-three percent of the respondents (N = 225) intended to work and increase civic engagement. They expected more time for hobbies and friends, and to travel more. Family will continue to be their highest priority. These findings will be useful to service providers who are invested in providing services that are attractive to boomers.

[Quality of life of elderly subjects living in basic social dwellings]

BACKGROUND

In Chile, the government is providing basic dwellings to poor elderly subjects that do not have a place to live. These dwellings may be located in buildings or in codominiums.

AIM

To assess the quality of life perception of elderly subjects whose dwellings are located in buildings or in condominiums.

MATERIAL AND METHODS

The brief version of the quality of life questionnaire designed for the elderly by the World Health Organization (WHOQoL-BREF) was applied to elderly subjects of seven poor communities of Metropolitan Santiago, that lived in basic dwellings located in buildings or condominiums. The questionnaire includes questions about physical, psychological, social relations and environment domains.

RESULTS

The questionnaire was answered by 124 elderly subjects aged 60 to 90 years, living in condominiums and 152 subjects aged 62 to 94 years, living in buildings. Satisfaction was of moderate or high level for physical, psychological and social relations domains. Those living in condominiums had a better satisfaction level in this last domain. The level of satisfaction of the environment domain was moderate and better for those living in condominiums. The perception of quality of life deteriorated along with age.

CONCLUSIONS

Elderly subjects living in basic dwellings located in condominiums have a better quality of life perception than those living in buildings.

Bath transfers in older adult congregate housing residents: assessing the person-environment interaction

OBJECTIVES

To examine environmental feature utilization (EFU) and the types and prevalence of performance difficulties during a videotaped bath transfer and to determine the personal characteristics associated with total EFU and performance difficulties.

DESIGN

Cross-sectional analysis.

SETTING

Two congregate housing facilities in southeastern Michigan.

PARTICIPANTS

Eighty-nine older adults who reported independence in bathing.

MEASUREMENTS

Trained video coders recorded EFU (defined as upper extremity contact with features in the environment) and rated performance difficulties (defined as lack of fluid movement or difficulty negotiating the environment). EFU was measured by determining whether features used were safe (i.e., designed for use as a transfer support) or unsafe and by total EFU (i.e., number of environmental features used during the transfer). Personal characteristics included self-reported medical conditions, bath transfer difficulty, functional mobility, lower extremity strength, range of motion functional impairment, and falls efficacy.

RESULTS

For participants with a tub-shower, safe EFU was higher than unsafe EFU (85% vs 19%; P<.001). Participants with shower stalls had the same rate of safe and unsafe EFU (71%). In multiple regression analysis, self-reported bath transfer difficulty was associated with total EFU (P=.01). One-third of the sample had performance difficulties. In multivariate analysis, range of motion functional impairment (odds ratio (OR)=13.49, 95% confidence interval (CI)=1.11-163.53) and lowest quartile in falls efficacy scores (OR=5.81, 95% CI=1.24-27.41) were associated with performance difficulties.

CONCLUSION

Unsafe EFU and performance difficulties were common in independently bathing older adults. Self-reported bath transfer difficulty appears to be a good indicator of high total EFU and may be used as a screening question for clinicians. Important strategies to reduce unsafe EFU and to increase falls efficacy include removing shower sliding glass doors and training older adults in safe transfer techniques.

A nurse goes shopping for a continuing care retirement community

The selection of a continuing care retirement community (CCRC) in which to live is not a matter of flipping a coin. It involves serious and time-consuming investigation. For most people, it is a daunting task. Elderly people who decide on a CCRC for their living arrangement need to follow a selection process to arrive at the appropriate choice--the choice that best meets their particular needs and provides quality of life. This personal account gives insight into one person's experience with the process. Nurses who are knowledgeable about the types of CCRCs available are in a position to help their patients make more informed choices.

Contextualizing and assessing the social capital of seniors in congregate housing residences: study design and methods

BACKGROUND

This article discusses the study design and methods used to contextualize and assess the social capital of seniors living in congregate housing residences in Calgary, Alberta. The project is being funded as a pilot project under the Institute of Aging, Canadian Institutes for Health Research.

DESIGN/METHODS

Working with seniors living in 5 congregate housing residencies in Calgary, the project uses a mixed method approach to develop grounded measures of the social capital of seniors. The project integrates both qualitative and quantitative methods in a 3-phase research design: 1) qualitative, 2) quantitative, and 3) qualitative. Phase 1 uses gender-specific focus groups; phase 2 involves the administration of individual surveys that include a social network module; and phase 3 uses anamolous-case interviews. Not only does the study design allow us to develop grounded measures of social capital but it also permits us to test how well the three methods work separately, and how well they fit together to achieve project goals. This article describes the selection of the study population, the multiple methods used in the research and a brief discussion of our conceptualization and measurement of social capital.

Can adapting the homes of older people and providing assistive technology pay its way?

BACKGROUND

Adaptations and assistive technology (AT) have an important role in enabling older people to remain in their own homes.

OBJECTIVE

To measure the feasibility and cost of adaptations and AT, and the scope for these to substitute and supplement formal care.

DESIGN

Detailed design studies to benchmark the adaptability of 82 properties against the needs of seven notional users.

SETTING

Social rented housing sector.

MAIN OUTCOME MEASURES

Measures of the adaptability of properties, costs of care, adaptations and AT, and relationships between these costs.

RESULTS

The adaptability of properties varies according to many design factors and the needs of occupiers. The most adaptable properties were ground floor flats and bungalows; the least were houses, maisonettes and flats in converted houses. Purpose-built sheltered properties were generally more adaptable than corresponding mainstream properties but the opposite was the case for bungalows. Adaptations and AT can substitute for and supplement formal care, and in most cases the initial investment in adaptations and AT is recouped through subsequently lower care costs within the average life expectancy of a user.

CONCLUSION

Appropriately selected adaptations and AT can make a significant contribution to the provision of living environments which facilitate independence. They can both substitute for traditional formal care services and supplement these services in a cost-effective way.

'Not everything that can be counted counts and not everything that counts can be counted'--towards a critical exploration of modes of satisfaction measurement in sheltered housing

This paper reflects on a research project funded by a consortium of leading sheltered housing (SH) providers and their regulatory body, the Housing Corporation. The project aimed to ascertain which aspects of SH older people perceived to be central to their satisfaction and the methods they judged most appropriate to measuring this. We outline key policy developments of importance to SH (specifically the development of performance measurement regimes), and changes in the nature of SH, which are driving providers to re-evaluate how they measure user satisfaction. We discuss the aims of the project, our methodology and findings, and conclude by raising critical questions about the process of measuring satisfaction within an increasingly managerialised housing system. We argue that this favours standardised methods of information gathering (such as questionnaires) rather than engage with clients in order to develop methods and systems capable of eliciting qualitative issues of concern to them. Our conclusions are, we believe, applicable to health and social care provision, where similar tensions exist around performance measurement and user satisfaction.

A cognitive and physical performance assessment of retirees entering a continuing care retirement community: the Moorings Assessment Protocol

Moorings Park Continuing Care Retirement Community (CCRC) screened 267 applicants (115 males; 152 females; mean age 80.22 years) using the Mini-Mental State Examination (MMSE), the 7-Minute Screen, the Geriatric Depression Scale (GDS), and the Physical Performance Test (PPT). They compared mean scores across admission/nonadmission groups to determine the extent to which cognitively impaired persons were effectively redirected from independent living settings inadequate for their needs. Groups differed (p < .05) on 21 test items/scores, including subscales of the 7-Minute Screen. The nonadmission group underperformed the admission group and healthy controls from earlier research, and outscored persons with Alzheimer's disease on all 7-Minute Screen subscales. Researchers concluded that geriatricians had effectively identified those with dementia and mild cognitive impairment (MCI) and placed them into supervised settings more appropriate to their clinical and social needs.

Autonomy, privacy and informed consent 3: elderly care perspective

Despite the growing interest in clinical healthcare ethics, there is a dearth of empirical studies investigating the ethical elements of day-to-day clinical practice from the perspective of either patients or staff. This article, the third in a four-part series, reports the results of a Scottish Study that formed part of a multi-site comparative study funded by the European Commission. It explores patient autonomy, privacy and informed consent in the care of elderly people in long-stay care facilities (i.e. nursing homes and continuing care units). A convenience sample of 101 elderly residents and their nurses (n = 160) participated in the study. Data were collected by means of a self-completion questionnaire for staff and a structured interview schedule for elderly residents. Results indicate marked differences between staff's and residents' responses on three of the four dimensions explored: information-giving, and opportunity to participate in decision-making about care and consent. There was much closer agreement between staff's and residents' responses regarding protection of patient privacy. From the results of this study there is indication of a clear need for further empirical studies exploring issues of patient autonomy, privacy and informed consent in the day-to-day nursing care of older people. Findings to date suggest there is still a significant need to educate staff concerning ethical awareness and sensitivity to the dignity and rights of patients.

The living conditions of elderly Americans

PURPOSE

This article profiles the housing settings of frail elderly individuals, whether their homes are facilitating or impeding their ability to live in the community, and the change in disability and housing status before and after passage of the 1990 Americans with Disabilities Act.

DESIGN AND METHODS

The analysis relies primarily on statistical analysis of the 1995 national American Housing Survey (AHS), with supplementary analysis of the 1978 AHS.

RESULTS

In 1995, roughly 14% of elderly individuals had a "housing-related disability," 49% had at least one dwelling modification, and 23% had an unmet need for modifications. Because half those with dwelling modification also reported unmet need, the match between disabling condition and modification, not the presence of modifications, is key. Multivariate results indicate that although unmet need is greater among the poor, lack of modifications is not. Prevalence of modifications nearly doubled between 1978 and 1995. Overall unmet need declined, but some needs were less likely to be met in 1995 than 1978.

IMPLICATIONS

The analysis highlights the importance of information about housing for understanding the care and service needs of elderly individuals and provides a compelling argument for a minimum dataset on their housing and neighborhood environments.

Bright ideas. Some rules of thumb for interior lighting design and selection

Interior lighting design and selection can be a demanding assignment for a health facilities manager or department head. It requires a balance between conflicting needs, such as providing good task lighting for a nursing station while also shielding luminaires that are visible from patients' rooms to avoid glare.

Assisted living facilities as a site for NP practice

PURPOSE

To describe what an assisted living facility (ALF) is who resides in ALFs, and the benefits of nurse practitioner (NP) practice in an ALF for the client, facility, NP, and practice.

DATA SOURCES

Selected scientific literature, legal and regulatory guidelines, consumer information and guidelines, Internet sites, and the authors' experiences.

CONCLUSIONS

Assisted living facilities are nonmedical residential settings grounded in a philosophy of providing residents with choice, autonomy, privacy, independence, dignity, and respect in a housing environment as homelike as possible. Nationally, ALFs vary considerably by size, services provided, and regulations imposed by states.

IMPLICATIONS FOR PRACTICE

Assisted living facilities are now a popular choice for individuals who desire assistance with selected activities of daily living (ADL) while maintaining maximum independence. They are becoming an excellent site for the provision of in-home primary care in order to facilitate aging in place.

The potential of smart homes for injury prevention among the elderly

Smart homes promise to make the lives of elderly people more comfortable and safe. Today, there is a significant interest from industry and policy makers in developing these technologies. In theory, the emerging technologies make it possible to provide a new range of services. So far, however, the goal has often been to develop new services for young people rather than assisting old people to improve their quality of life. Especially important is the potential for using these technologies to promote safety and prevent injury among old people because this group is at home more than the other age groups. Networked devices can collect data from sensors and aid decision-making on intervention and other measures. Furthermore, these devices can instruct and remind individuals about safety-related issues.

Staff satisfaction and its components in residential aged care

OBJECTIVE

The purpose of this study was to assess the direction and magnitude of the effects among the components of staff satisfaction in residential aged care and to examine whether the relationships among satisfaction components vary according to facility type (i.e. nursing homes and hostels). A hostel is a low care facility in which residents are more independent, have a lower level of care needs, and receive personal but not nursing care.

DESIGN

A cross-sectional survey design was adopted to collect the required information, and a stratified random sampling approach was utilized to select facilities. Structural equation modeling was used to examine relationships among satisfaction components.

SETTING

Seventy residential aged care facilities in Western Australia.

STUDY PARTICIPANTS

The sample includes 610 nursing home and 373 hostel care staff.

RESULTS

The relationships among satisfaction components are different for nursing home and hostel staff. Professional support is found to have a strong and positive effect on all other aspects of staff satisfaction.

CONCLUSION

The findings lead to an improved understanding of the interrelationship among staff satisfaction components, which has important implications through enhancing professional support. This needs to be recognized and emphasized by managers, care providers, and policy makers so as to maintain stable personnel and continuity of care.

Measuring job satisfaction in residential aged care

BACKGROUND

Staff satisfaction has received increasing recognition as an important factor influencing service quality and in particular the quality of residents' lives in residential aged care facilities, where staff typically have a long-term and close relationship with residents. Consequently, a valid and reliable instrument is required to assess staff satisfaction in this particular context.

OBJECTIVE

This paper aims to assess the factor structure, reliability, and validity of the Measure of Job Satisfaction (MJS) instrument when used in residential aged care facilities.

DESIGN

A cross-sectional survey design was used to collect the required information, and a stratified random sampling method was utilized to select facilities. Exploratory and confirmatory factor analyses were conducted to assess the factor structure of staff satisfaction via the MJS.

SETTING

Both high and low care residential aged care facilities in Western Australia.

STUDY PARTICIPANTS

Nine hundred and eighty-three staff (including the Director of Nursing, manager, registered nurses, enrolled nurses, nursing assistants, and therapists) in 70 residential aged care facilities.

RESULTS

An acceptable five-factor (22-item) measurement model was derived. The Cronbach's alpha reliability levels range from 0.86 to 0.95. Convergent and discriminant validity are also satisfactory.

CONCLUSION

This investigation has confirmed that a modified MJS is a reliable and valid instrument for assessing staff satisfaction in residential aged care settings.

Urinary health in eldercare environments: an update from the NAFC

The National Association For Continence elected to cancel its 2001 conference scheduled for October 2001 in Washington, DC in light of national events. Executive Director Nancy Muller has provided Ostomy/Wound Management with a synopsis of key issues, important considerations, and the syllabus. We are grateful for the opportunity to serve as a forum for this worthy organization.

Integration of lucid individuals and agitated individuals with dementia in different care units

The purpose of this study was to illuminate how the integration of lucid individuals and agitated cognitively impaired individuals affects aspects of perceived quality of care. A questionnaire was mailed to hospital wards, nursing home wards and residential homes in Sweden. Nursing staff replied to the questionnaire on behalf of each care unit. Integration of cognitively impaired and lucid patients/residents was identified as a problem, regardless of whether the care unit was a hospital ward, nursing home or residential home. Agitated behaviours in people who were cognitively impaired could result in lucid residents becoming anxious, afraid and irritated. This in turn could lead to an exacerbation of behaviour in residents who were already agitated. Sometimes a lucid patient/resident was required to share a room with an agitated individual. There is a need for staff training specific to the needs of people with dementia. Findings suggest that there is a shortage of units designed specifically for the care of agitated cognitively impaired patients/residents. The findings of this study support the need for healthcare providers in long-term care settings to maintain the rights and well being of all patients/residents.

Needs of frail elderly people in informal settlements

The frail elderly in informal settlements find themselves in an extremely vulnerable position due to a number of factors, namely, their increasing dependency status, limited resources and adverse physical environment. Various aspects that influence the aged in their present environment will be highlighted. A survey method was used to explore and to describe the world in which they live in informal areas. The attitude, expectation and needs of the elderly in respect of their care was also determined. A random cluster sample was taken. Data was collected by means of interviews in terms of a semi-structured questionnaire. It appears that the frail elderly were happy in the environment in which they received care in spite of their unfavourable physical environment and limited resources. The communities where the frail elderly lived were largely unaware of the valuable inputs they can make regarding the care of the aged. This necessitates the development of programs in the heart of communities, owned by communities, where all role players in the care of the aged participate.

Differing perceptions in defining safe independent living for elders

This exploratory study was conducted to determine whether fundamental differences in perceptions exist among elders, young and middle-aged adults, and nurses in their view of what factors constitute a safe independent living arrangement for elders. A convenience sample of 335 was surveyed on perceptions of the importance of situation factors (ie, ADL [activities of daily living] skills, instrumental activities, functional abilities, environmental factors) to independent living and the degree of interference of diseases and symptoms with elder independent living arrangements. The results reveal that there are fundamental differences in perceptions about factors related to safe independent living for elders among the groups. Nurses perceived that certain diseases and symptoms caused more interference with independent living, whereas nonnurses tended to be more concerned about bathing, climbing steps, and home and property maintenance. Age, level of education, gender, and race also were found to be significant predictors of the perceptions of situation factors related to independent living. More specific research is needed to determine whether these fundamental differences hold true when an actual elder living situation is at issue.