What factors influence the decision older adults make about their care and living plans?

What factors influence the decision older adults make about their care and living plans?

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Ron Dorr, right, leads an exercise class for older adults.

For many older adults, aging-in-place, or remaining in their own home as they age, is a priority. Decision making and planning is critical to successful aging-in-place, yet often older adults defer decisions about their aging-in-place and long-term care needs. As a result, when seniors experience a health crisis, loved ones often must step in as surrogates to make emergent decisions about their medical care and living situation.

The National Institute on Aging (NIA) recently awarded $3.9 million to fund research by Northwestern Medicine that aims to better understand how older adult aging-in-place and long-term care decision making and implementation is impacted by age-related changes, social influences and environmental factors.

"We know that the majority of seniors do not want to leave their home as they age, yet very few people plan for their home-based needs required to safely age-in-place," said principal investigator Lee Lindquist, M.D., M.P.H., M.B.A., chief of geriatrics at Northwestern Memorial Hospital and Northwestern University Feinberg School of Medicine. "The most important decision that most people navigate is how to balance age-related changes, such as worsening cognition and decreasing mobility, with their needs. Many older adults underestimate how much support they'll need as they age, while others outright dismiss planning for home support. Without planning, aging-in-place is not a safe option for many older adults."

Through earlier research funded by the Patient-Centered Outcomes Research Institute (PCORI), Lindquist led a team of seniors, geriatricians, university researchers, social workers, communication experts and home care specialists in developing PlanYourLifespan.org, a web-based tool that facilitates making decisions and planning to age-in-place. The tool addresses later-in-life issues including hospitalizations, falls and memory loss, as well starting conversations with loved ones and financial planning for future needs.

"Through education about future health and home-based needs, as well as access to these resources, older adults can make choices and share them with loved ones for their future needs," said Lindquist. "Our earlier research found that the Plan Your Lifespan tool is effective in improving decision making about aging-in-place for older adults. However, we still don't know if having these plans has translated into seniors achieving their aging-in-place goals."

With the NIA funding, Lindquist seeks to answer that question, as well as to better understand how decision making for aging-in-place is influenced by older adults' age-related changes, social factors and environments and how these things may impact timely adoption of these plans and the ability for seniors to successfully age in place.

"Do age-related changes like cognitive decline or increased disability have a greater impact than social influence from a spouse, adult offspring or friends? Does where seniors live, such as a city or rural environment or in a house versus apartment, make a difference in if older adults actively plan for their future needs," said Lindquist. "All of these factors likely play a role and by understanding those influences, we can better support older adults in making decisions and implementing plans that will support them in aging-in-place successfully and safely."

Lindquist and her team will conduct a 42-month longitudinal study of older adults who are using Plan Your Lifespan. Surveys will be conducted every six months in conjunction with cognitive, social, functional and health literacy data collection. In addition, data will be collected on decision changes, resource use, timing of plan implementation and goal concordance.

(A Wellness Update is a magazine devoted to up-to-the minute information on health issues from physicians, major hospitals and clinics, universities and health care agencies across the U.S. Online at www.awellnessupdate.com.)


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