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When Frail Older People Relocate in Very Old Age, Who Makes the Decision?

Published version
Peer-reviewed

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Article

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Authors

Farquhar, Morag 
Buck, Jackie 
Barclay, Stephen 
Brayne, Carol 

Abstract

BACKGROUND AND OBJECTIVES: Older people are likely to transition to a new home closer to family who can provide assistance or to long-term residential care as their health declines and their care needs increase. A minority choose to move to "age-friendly" housing before the onset of disability, but the majority prefer to "age in place" and defer moving until health crises compel a transition. Older people living with dementia are likely to move into residential care, but not much is known about the role they play in decision making around these moves. This qualitative study addresses this gap in knowledge by examining how a rare cohort of "older old" people, most with some level of cognitive impairment, were involved in decisions surrounding assistance seeking and moving to a care home. RESEARCH DESIGN AND METHODS: Thematic analysis of qualitative interview data from Cambridge City over-75s Cohort (CC75C) study participants aged 95 years and older, who had moved in later life, and their proxy informants (n = 26). RESULTS: Moves at such an old age were made due to a complexity of push and pull factors which had layered dynamics of decision making. In most cases (n = 22), decision making involved other people with varying degrees of decision ownership. Only four older people, who moved voluntarily, had full ownership of the decision to move. Many relatives reported being traumatized by events leading up to the move. DISCUSSION AND IMPLICATIONS: "Older old" people are sometimes unable to make their own decisions about moving due to the urgency of health crisis and cognitive decline. There is a need to support relatives to discuss moving and housing options at timely junctures before health crises intervene in an effort to optimize older people's participation in decision making.

Description

Keywords

Decision making, Dementia, Oldest old, Relocation

Journal Title

Innov Aging

Conference Name

Journal ISSN

2399-5300
2399-5300

Volume Title

3

Publisher

Oxford University Press (OUP)
Sponsorship
East and North Hertfordshire NHS Trust (PB-PG-0906-11387)
Abbeyfield Society (5)
We thank all the past CC75C sponsors for financial support spanning the decades since the Medical Research Council enabled the first follow-up survey (see website for full list of grants: http://www.cc75c.group.cam.ac.uk/background/grants/). A BUPA Foundation grant supported data collection and Abbeyfield Research Foundation funded analysis for this paper. A Welcome Trust Small Arts Fund for Engaging Science funded CC75C’s collaboration in a theatre production, about moving into a care home, which enabled wider public engagement with the research topic. CC75C was a member study of the National Institute for Health Research-funded Collaboration for Leadership in Applied Health Research & Care (CLAHRC) for Cambridgeshire and Peterborough. No funder played any role in the study design; collection, analysis, and interpretation of data; or in writing the report or the decision to submit the article for publication. All researchers were independent from funders.