Decision Making and Implementation of Aging-in-Place/Long Term Care Plans Among Older Adults

Many older adults wish to age-in-place but do not have long-term care plans for when they may require more assistance. PlanYourLifespan.org (PYL) is an evidence-based tool that helps older adults understand and plan for their long-term care needs. We examined the long-term effects of PYL use on user perceptions and planning of long-term care services. Individuals who previously accessed PYL were invited to complete an online, nation-wide mixed methodology survey about end-user outcomes related to PYL. Among 115 completed surveys, users found PYL helpful with long-term planning for their future needs. Over half of website users reported having conversations with others because of PYL use. However, 40% of respondents reported not having a conversation with others about their plans; common themes for barriers to planning included procrastination and a lack of immediate support needs. Although PYL helps with planning, many people are still not communicating their long-term care plans.

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The Decision-Making and Communication Capacities of Older Adults with Dementia: A Population-Based Study

The Open Nursing Journal ◽

10.2174/1874434620140512001 ◽

2014 ◽

Vol 8 (1) ◽

pp. 17-24 ◽

Cited By ~ 6

Author(s):

Kazuko Mitoku ◽

Setsu Shimanouchi

Keyword(s):

Older Adults ◽

Decision Making ◽

Long Term Care ◽

Population Based ◽

Term Care ◽

Daily Lives ◽

People With Dementia ◽

Decision Making Capacity ◽

One Year

The present study assessed the decision-making and communication capacities of older adults with dementia who required assistance and care and measured the subsequent changes in these capacities. Of 845 older adults who received long-term care between April 2003 and December 2004, about half of them without dementia were excluded and the remaining 448 were finally included in the analyses. These individuals were completed follow-up for assessment for two years. The data were obtained from the Long-Term Care Insurance Certification Committee for Eligibility in Gujo City. A total of 73.7% of people with dementia were somewhat capable of making decisions (32.4% were reported as being “always capable”; 41.3% were reported as being “sometimes capable”). A total of 93.7% were somewhat capable of communicating with others (78.3% were reported as being “always capable”; 15.4% were reported as being “sometimes capable”). The results indicate that older adults with dementia can participate in their own care decisions, even if they require assistance and support in their daily lives. The present study shows, however, that baseline decision-making capacity declined to about half what they were after one year and to about one-third of what they were after two years, suggesting that earlier efforts are needed to ensure that the preferences of individuals with dementia are reflected in their care.

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Development and Field Testing of a Long-Term Care Decision Aid Website for Older Adults: Engaging Patients and Caregivers in User-Centered Design

The Gerontologist ◽

10.1093/geront/gnz141 ◽

2019 ◽

Vol 60 (5) ◽

pp. 935-946 ◽

Cited By ~ 3

Author(s):

Aubri S Hoffman ◽

Daniel R Bateman ◽

Craig Ganoe ◽

Sukdith Punjasthitkul ◽

Amar K Das ◽

...

Keyword(s):

Older Adults ◽

Decision Making ◽

Decision Aid ◽

Long Term Care ◽

Action Plan ◽

Family Members ◽

Field Testing ◽

Decisional Conflict ◽

Term Care

Abstract Background and Objectives Decisions about long-term care and financing can be difficult to comprehend, consider, and communicate. In a previous needs assessment, families in rural areas requested a patient-facing website; however, questions arose about the acceptability of an online tool for older adults. This study engaged older adults and family caregivers in (a) designing and refining an interactive, tailored decision aid website, and (b) field testing its utility, feasibility, and acceptability. Research Design and Methods Based on formative work, the research team engaged families in designing and iteratively revising paper drafts, then programmed a tailored website. The field test used the ThinkAloud approach and pre-/postquestionnaires to assess participants’ knowledge, decisional conflict, usage, and acceptability ratings. Results Forty-five older adults, family members, and stakeholders codesigned and tested the decision aid, yielding four decision-making steps: Get the Facts, What Matters Most, Consider Your Resources, and Make an Action Plan. User-based design and iterative storyboarding enhanced the content, personal decision-making activities, and user-generated resources. Field-testing participants scored 83.3% correct on knowledge items and reported moderate/low decisional conflict. All (100%) were able to use the website, spent an average of 26.3 min, and provided an average 87.5% acceptability rating. Discussion and Implications A decision aid website can educate and support older adults and their family members in beginning a long-term care plan. Codesign and in-depth interviews improved usability, and lessons learned may guide the development of other aging decision aid websites.

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Factors related to the decision-making for moving the older adults into long-term care facilities in Taiwan

Geriatrics and Gerontology International ◽

10.1111/ggi.12860 ◽

2016 ◽

Vol 17 (9) ◽

pp. 1319-1327 ◽

Cited By ~ 1

Author(s):

Yen-Ping Hsieh ◽

Ying-Chia Huang ◽

Shou-Jen Lan ◽

Ching-Sung Ho

Keyword(s):

Older Adults ◽

Decision Making ◽

Long Term Care ◽

Term Care ◽

Care Facilities

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ORGANIZATION OF WORK AND DECISION-MAKING OF PROFESSIONALS WORKING IN NURSING HOMES IN CATALONIA (SPAIN)

Innovation in Aging ◽

10.1093/geroni/igz038.2573 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S699-S699

Author(s):

Montserrat Gea-Sánchez ◽

Alvaro Alconada-Romero ◽

Roland Pastells-Peiró ◽

Filip Bellon ◽

Lourdes Teres-Vidal ◽

...

Keyword(s):

Decision Making ◽

Nursing Homes ◽

Long Term Care ◽

Holistic Approach ◽

Positive Outcomes ◽

Coordinated Care ◽

Structured Interviews ◽

Term Care ◽

Care Plans

Abstract The long term care environment demands specific requirements of the staff, namely that they provide a holistic approach to care. Providing holistic care leads to complex decision-making processes which go beyond just finding a solution to a specific health problem. It requires that staff are able to respond to the diverse needs expressed by the residents and which, in many cases, are only identified through the relationship that professionals have with them. However, this relationship that staff establishes with the resident often leads to burden for these professionals. The researchers sought to identify characteristics of the nursing homes that lead to positive outcomes for staff. The study involves collecting questionnaires (n=132) and conducting semi structured interviews (n=35) in 9 Catalan nursing homes with number of staff, utilizing a quantitative questionnaire and semi-structured interviews. Practices in organisations that led to positive outcomes for staff included coordinated care that includes processes of support for staff, effective communication and decision making practices, clear responsibilities for staff, and utilization of care plans. Effective long term care practices can favour both patient care and professional practice in residences for elderly.

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Aging-In-Place Preference and Institutionalization Among Japanese Older Adults: A 7-Year Longitudinal Study

10.21203/rs.3.rs-860695/v1 ◽

2021 ◽

Author(s):

Takeshi Nakagawa ◽

Taiji Noguchi ◽

Ayane Komatsu ◽

Masumi Ishihara ◽

Tami Saito

Keyword(s):

Older Adults ◽

Long Term Care ◽

Aging In Place ◽

Place Preference ◽

Community Dwelling ◽

Term Care ◽

Insurance System ◽

Long Term Care Insurance ◽

Japanese Older Adults

Abstract Background In Asia, where autonomous decision-making is not well accepted, little is known about whether and how individuals’ preferences are considered when deciding where they receive care. This study examined the longitudinal association of aging-in-place preference when bedridden with institutionalization among Japanese older adults. Methods We analyzed nationally representative data of 1,290 community-dwelling older adults aged 70 and above, applying the multiple imputation method. Baseline data were collected in 1999, shortly before the long-term care insurance system was introduced. The outcome was measured as self- or proxy-reported years of institutionalization over seven years. The explanatory variable was the aging-in-place preference. Participants were asked about their desired place of care (facility, home, or other) when bedridden. Covariates were sociodemographic and health-related factors. We used Cox proportional hazards models and calculated hazard ratios (HRs) with 95% confidence intervals (CIs) to evaluate the association of aging-in-place preference when bedridden with institutionalization. Results Seventy-eight respondents (6.0%) were institutionalized during the follow-up period. Compared to individuals preferring to reside in long-term care facilities when bedridden (48.7%), those preferring to stay in their homes (39.6%) were less likely to be institutionalized, even after adjusting for relevant covariates (HR = 0.46, 95% CI 0.27–0.79 for model 1 including residential status; HR = 0.45, 95% CI 0.27–0.76 for model 2 including marital status and co-resident children). Conclusions Our findings suggest that individuals’ aging-in-place preferences are considered under the long-term care insurance system. Individuals’ preferences should be shared by families and clinicians when deciding the place of care.

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“I Didn’t Meet My Mother; I Saw My Mother”: The Challenges Facing Long-Term Care Residents and Their Families in the Age of COVID-19

Journal of Applied Gerontology ◽

10.1177/07334648211037099 ◽

2021 ◽

pp. 073346482110370

Author(s):

Sharon Avidor ◽

Liat Ayalon

Keyword(s):

Older Adults ◽

Decision Making ◽

Long Term Care ◽

Qualitative Interviews ◽

Family Members ◽

Term Care ◽

Protective Measures ◽

Routine Treatment

The present research examines the effects of protective measures due to the coronavirus disease 2019 (COVID-19) pandemic within long-term care (LTC) settings on residents and their family members. Open-ended qualitative interviews were conducted with 14 family members of older adults who resided in LTC settings during the first wave of the pandemic in Israel. The first theme identified is Rupture, including the physical disconnect; the disruption in routine treatment to residents; and decline in the satisfaction with the setting. The second theme is Response, including sharing viewpoints and involvement in decision-making, as well as an intense ambivalence shared by family members. Our findings highlight the distress caused to residents and family members by the isolation and restrictions in LTC settings during the pandemic and underscore values and priorities that are central to them and their family members, including maintaining continuity, transparency, and working in unison with their families, staff, and management.

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The Challenges Faced By Long-Term Care Residents and Their Families During COVID-19

Innovation in Aging ◽

10.1093/geroni/igab046.1738 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 450-451

Author(s):

Liat Ayalon ◽

Sharon Avidor

Keyword(s):

Older Adults ◽

Decision Making ◽

Long Term Care ◽

Qualitative Interviews ◽

Family Members ◽

Term Care ◽

Protective Measures ◽

Routine Treatment

Abstract The present research aims to examine the effects of protective measures due to the coronavirus disease (COVID-19) within long-term care (LTC) settings on the residents and their family members. Open-ended qualitative interviews were conducted with 14 family members of older adults who resided in LTC settings during the first wave of the pandemic in Israel. The first theme identified is Rupture, including physical disconnect; the disruption in routine treatment to residents; and decline in the satisfaction with the setting. The second theme is Response, including sharing viewpoints and involvement in decision making, as well as an intense ambivalence shared by family members. Our findings highlight the distress caused to residents and family members by the isolation and restrictions in LTC settings during the pandemic, and underscore values and priorities that are central to them and their family members, including maintaining continuity, transparency, and working in unison with their families.

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