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2 carmel- assisted living - prague may 20 2012-final

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2 carmel- assisted living - prague may 20 2012-final

  1. 1. Well-being among elderly communitydwellers and assisted living residents: A comparative analysis Sara Carmel, Hava Tovel, Zinovi Shraga The Center for Multidisciplinary Research in Aging Faculty of Health Sciences Ben-Gurion University of the Negev Supported by: The Israel Ministry for Senior Citizens The Abraham and Sonia Rochlin Foundation
  2. 2. Quality of life and subjective well-being – societal needs and challenges Decreased quality of life is one of the phenomena accompanying prolonged life, with significant implications for the elderly, their families, and society as a whole. Finding the best social solutions for this relatively vulnerable population group has become a challenge to all nations.
  3. 3. Purpose of the study The leading worldwide approach for maintaining successful aging is to enable older people to "age in place" – in their homes and communities. The purpose of this study was to question this dominant approach by comparing subjective well-being (SWB) of assisted-living residents (ALR) to that of community dwellers (CD).
  4. 4. Assisted living (AL) in IsraelIn Israel, AL sites (also called “sheltered housing”) are run by for-profit and non-profit organizations. Both provide high quality services. (165 sites/21,000 units)Services provided:- Personal safety arrangements- 24-hour availability of medical services- Immediate assistance for any need- Restaurant services- Home cleaning and repairs- A variety of social, cultural and physical activitiesThe degree of use of each service depends on the resident.
  5. 5. MethodStructured home interviews were conducted with two groups of people aged 75+, living in 3 major Israeli cities - Tel-Aviv, Beer-Sheva, Haifa.1. An ALR group, based on agreement to participate in the study from 8 large facilities (n=215)2. A CD group - of elderly matched for age, gender, family status, economic status, ADL, and IADL (n=215)
  6. 6. Comparison between CD and ALR on health, function, and socio-demographic characteristics CD ALR t 2 df pGender Male Female Male Female 2 =.30, df=1, p=.58 59 (27%) 156 (73%) 54 (35%) 161(75%)Spouse yes no yes no 2 =1.66, df=1, p=.198 80 (37%) 135 (63%) 67 (31%) 147 (69%)Age (M/SD) 83.9 (4.19) 83.9 (5.38) t=-.100, df=428, p=.920Health (M/SD) 3.13 (.94) 3.09 (.84) t= .515, df=428, p=.607IADL (M/SD) 1.39 (.55) 1.33 (.55) t=1.25, df=426, p=.211Education low High low High 15 98 101 21 78 114 (7%) (46%) (47%) (10%) (37%) (53%)Economic Bad good Very bad good Very 2 =4.85, df=2, p=.089status good good 16 171 28 16 154 45 (7%) (80%) (13%) (7%) (72%) (21%)
  7. 7. Comparison between CD and ALR on indicators of SWB Well-being CD ALR M (SD) M (SD) tLife satisfaction (Neugarten) 3.45 (.68) 3.65 (.61) -3.24, p=.001Life satisfaction (Carmel) 3.96 (.66) 4.17 (.55) -3.57, p<.000Successful aging (subjective) 7.58 (1.83) 8.03 (1.62) -2.65, p=.008Loneliness (high score = low loneliness) 4.71 (1.25) 5.03 (1.12) -2.72, p=.007Happiness 5.29 (1.26) 5.50 (1.03) -1.85, p=.064Morale (Lawton et al.) 2.85 (.64) 2.96 (.52) -2.21, p=.032Will to live 3.43 (.88) 3.43 (.72) .105, p=.920GDS (high score = low depression) 11.18 (3.42) 11.96 (2.99) -2.53, p=.012Fear of dying 3.72 (1.19) 4.04 (1.12) -2.86, p=.004Fear of death 1.55 (.81) 1.38 (.63) 2.37, p=.018
  8. 8. Antecedents of different aspects of well-being () LS-N LS-C Success- Loneli- Happin- Morale Will to GDS Fear of Fear ful aging ness ness live dying of deathGender .099* .119** .108* .146* .053 .041 -.089 .067 .142* -.023Spouse -.167** -.124* -.059 -.228** -.058 -.086 -.067 -.110* -.081 -.063Econo. .139** .146* .079 .045 .083 .080 -.014 .069 -.083 .072statusHealth -.331** -.313** -.358** -.125* -.266** -.398** -.291** -.247** .185** .073statusIADL -.134** -.146** -.149** -.095 -.054 -.121* -.025 -.246** -.146* .088Resid- .138** .150** .109** .137** .080 .082 -.004 .104* .143** -.100*enceR2 .26** .25** .24** .11** .11** .26** .10** .22** .08** .02*LS-N – Life satisfaction (Neugarten et al., 1961) , LS-C – Life Satisfaction Carmel, 1997Morale – Philadelphia Geriatric Center Moral Scale (Lawton, 1975), Loneliness – Hughes et al. , 2004,Happiness – Lyubomirsky et al., 1999,GDS – Geriatric Depression Scale (Zalsman et al., 1998).
  9. 9. Addressed needs and satisfaction in ALDegree of addressed needs in AL (on a scale of 0-5): A high degree of response to needs with average scores from 4.84 (SD= .44) to 4.34 (SD=1.38) . Exception – reference to meals (3.00, SD=2.2) due to great variability in use.The highest scores were given for: ability to manage an independent life, to continue life as usual, feeling comfortable in the apartment, physical security, accessibility of medical services, and privacy.Satisfaction with relocation to AL was high – 87% responded as very satisfied.
  10. 10. Experienced changes in ALWhat are the 3 most important changes for you with relocation?(% out of all responses in each category)Positive (202 out of 215 responded – 365 responses):- Social life - 29% - Release from household- Personal security - 22% duties - 7%- Leisure activities - 13% - Easier life - 7%- Personal tranquility - 9% - Medical security - 5% - Housing conditions - 5%Negative (83 out of 215-responded, 23 responded - no negative change, altogether only 49 responses):- Condition of neighbors - 22% - Adjustment difficulties - 10%- Housing conditions - 22% - Loss of neighborhood - 10%- Loss of privacy - 8% - Faraway from town - 6%- Lacking pets - 4%- Other issues - 16%
  11. 11. Summary of results The two groups were similar in socio-demographic characteristics, self-rated health, ADL, and IADL. ALR ranked themselves significantly and systematically higher than CD on indicators of well-being including: Satisfaction with life (two measures) Self-perceived successful aging Happiness Morale Fear of death (inverse direction) Depression (inverse direction) Loneliness (inverse direction) (8 out of 10) ALR ranked themselves worse regarding fear of dying.
  12. 12. Summary of results (cont.) The best predictors of SWB across 10 different measures, in order of importance, were: - self-evaluated health status - type of residence - IADL - gender - having a spouse - self-evaluated economic status.Most of the responses to needs addressed in AL and changes with relocation indicated a high level of satisfaction with relocation
  13. 13. Conclusions Type of residence plays an important role in influencing older adults SWB, assisted living being preferable. The residence effect is stronger than age, gender, economic status, having a spouse, and IADL. These findings and their practical implications shatter the currently dominant beliefs and practices regarding best residence solutions for elderly people. Replications of this study in Israel and other countries are needed in order to ascertain these findings and the derived implications. We must continuously promote evidence-based best responses to the needs of older adults and society.
  14. 14. Life is beautiful
  15. 15. Comparison between CD and ALR on indicators of SWB Men only (n=113) Well-being CD ALR M/SD M/SD tLife satisfaction (Neugarten) 3.41 (.71) 3.70 (.59) -2.32, p=.022Life satisfaction (Carmel) 3.93(.73) 4.18 (.55) -2.06, p<.041Successful Aging (subjective) 7.43 (1.83) 8.04 (1.72) -1.69, p=.093Loneliness (high score = low loneliness) 4.50 (1.35) 5.11 (1.11) -2.59, p=.011Happiness 5.21 (1.32) 5.60 (1.16) -1.64, p=.103Morale (Lawton et al.) 2.89 (.70) 3.01 (.50) -1.00, p=.318Will to live 3.56 (.82) 3.64 (.54) -.650, p=.517GDS (high score = low depression) 11.17 (3.84) 12.26 (2.75) -1.75, p=.084Fear of dying 3.72 (1.19) 4.04 (1.12) -2.16, p=.033Fear of death 1.51 (.70) 1.46 (.74) .380, p=.705
  16. 16. Comparison between CD and AR on indicators of SWB Women only, n=317 Well-being CD ALR M/SD M/SD tLife satisfaction (Neugarten) 3.46 (.67) 3.63(.61) -2.37, p=.018Life satisfaction (Carmel) 3.97 (.63) 4.16 (.56) -2.89, p<.004Successful Aging (subjective) 7.64 (1.74) 8.02 (1.60) -2.04, p=.042Loneliness (high score = low loneliness) 4.80 (1.21) 5.00 (1.13) -1.56, p=.121Happiness 5.32 (1.25) 5.46 (1.00) -1.13, p=.260Morale (Lawton et al.) 2.84 (.61) 2.97 (.53) -1.93, p=.054Will to live 3.39 (.89) 3.36 (.77) .366, p=.714GDS (high score = low depression) 11.18 (3.26) 11.86 (3.01) -1.91, p=.057Fear of dying 3.85(1.16) 4.11 (1.11) -1.94, p=.053Fear of death 1.56 (.86) 1.35 (.59) 2.49, p=.013

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