Characteristics of Older Adults Facilitating Aging in Place

Characteristics of Older Adults Facilitating Aging-in-Place: The Lived Experience Rebecca I. Estes, PhD, OTR/L, CAPS, Judith Olson, PhD, OTR, AOTF

Funding: This study was funded by a NSU College of Health Care Sciences and College of Nursing FY 2013 Faculty Research & Development Grant.

Research Design: The study was a cross-sectional mixed methods design. Only the qualitative portion is reported in this poster.

Background: As the Baby Boom generation ages, the number of older adults over 65 years old is increasing. A 2010 census brief (Howden & Meyer, 2011) reported that since the 2000 census, the 65 years and older population increased 15.1 percent and the 45 to 64 years old population increased 31.5 percent as compared to a 2.6 percent increase in the population under the age of 18 and a 0.6 percent increase for those aged 18 to 44. These numbers indicate that the trend for increasing numbers of adults 65 and older will continue as the 45-64 year old group ages. According to a survey conducted by AARP, 90% of older Americans want to "age in place" by living in their homes for the remainder of their lives (AARP, 2012). A home is more than the physical environment and home modifications can strengthen the personal and social meaningfulness of the home (Tanner, Tilse, & de Jonge, 2008). To assist the growing population of older adults who desire to age in place, occupational therapists need to know what personal, environmental, and occupational characteristics best support aging in place.

Importance: The literature suggests that characteristics of the person (Hardy, Concato, & Gill, 2004; Foster, 1997; Wagnild, 2003; Harris, 2008; Gitlin, Winter, Dennis, Corcoran, Schinfeld, & Hauck, 2006), the environment (Petersson, Lilja, Hammel, & Kottorp, 2008; Petersson, Kottorp, Bergstrom, & Lilja, 2009; Szanton, Thorpe, Boyd, Tanner, Leff, Agree, & Gitlin, 2011; Mathieson, Jacobs-Kronenfeld, & Keith, 2002), and engagement in occupations (Chen, Brown, Hsu, Clem, & Newman, 2008; Marek, Popejoy, Petroski, Mehr, Rantz, & Lin, 2005; Tanner, Tilse, & de Jonge, 2008) all contribute to the ability of an older adult to successfully age in place. No studies incorporated an overall approach to concurrently identify contributions that characteristics of the person, environment and occupation make to aging in place. Therefore, the objective of this study was to explore personal, environmental and occupational characteristics of community dwelling adults 65 and older who are aging in place. The study explored the resiliency and creative thinking characteristics of the person, the home and immediate surroundings characteristics of the environment, and the type, variety and level of independent performance of the occupations of older adults aging in place.

Qualitative Analysis: What is the meaning of home and aging in place for community dwelling adults 65 and older? Responses were audiotaped and then transcribed. Using phenomenological qualitative methods, transcriptions were coded by research team members to discover themes that emerged from the rich variety of participant responses.

Instrument: Interview

Participants: Of the 33 participants, 24 were female and 9 were male, with ages ranging from 67 years to 93 years old. The Mini-Mental scores ranged from 37 to 67 with a median score of 55. They lived in their homes from 3 to 42 years, with a mean of 18 years. Additional clinical data is presented in Tables 1-2 below.

Results: PERSON "Attitude" sums up the themes related to the person element. The three main themes were "I'm a survivor," "It is what it is," and "I do it my way." They related to their perception of self (physical, cognitive, and psychosocial) positively even with chronic conditions; although pain changed the perception of health to fair or poor; cognitive functioning that supports problem solving enables aging in place. Participants reported making adaptations to accommodate changes. A sense of acceptance. ENVIRONMENT Themes related to participants living in Florida, warmth, sunshine, gardens, and golf characterize their everyday living environments and the theme of "My own garden of Eden". Items in the home had meaning and memories, creating the theme of "Memento haven". Again, problem solving enables staying in their homes and having items out for memory recall and convenience resulted in the theme of "Organized clutter". "Friends & Family" was also a strong theme, revolving around the support received from and given to those they were close to. The longer individuals had been in their homes, the stronger was their desire to remain there. OCCUPATION Themes related to maintaining self-care occupations were important to all. The ability to continue cherished occupations

provided satisfaction and meaning to their lives. Resources, both financial and psychosocial support systems, need to be adequate to support declining physical aspects or to purchase services that allow independent living.

Summary: Your own home in which to age in place means safety, security, & independence. Activity participation is important to health; they are "those things that keep me healthy." Creative flexibility is positively connected to activity participation. Resilience, defined by one participant as being "... a survivor," is positively connected to activity participation.

Future Considerations: Teaching about what facilitates people to age in place a) "everything handy" may look cluttered to OTs. How do we support the client and also keep their environment safe? b) many home adaptations are unusual - how are we assessing and teaching OTs to evaluate and keep already in place adaptations rather than introduce something new? c) how are we addressing the need for creative flexibility & resilience to facilitate aging in place?

What does this mean for those who must transition to assisted living? a) that people need to take meaning into their new environment? b) that people need to retain activity participation in activities that are meaningful? c) how are we teaching student to facilitate creative flexibility & resilience to facilitate aging in place?

References: AARP. (2012). The United States of aging survey. Downloaded 09-28-2012 from:

Chen, S., Mefford, L., Brown, J., Hsu, M., Clem, R., & Newman, L. (2008). Predictors of American elders' home stay: A

secondary data analysis. Nursing and Health Sciences, 10, 117-124. Foster, J.R. (1997). Successful coping, adaptation, and resilience in the elderly: An interpretation of epidemiologic data.

Psychiatric Quarterly, 68(3), 189-219. Gitlin, L. N., Winter, L., Dennis, M. P., Corcoran, M., Schinfeld, S., & Hauck, W. W. (2006). A randomized trial of a

multicomponent home intervention to reduce functional difficulties in older adults. The American Geriatrics Society, 54, 809-816. Hardy, S. E., Concato, J., & Gill, T.M. (2004). Resilience of community-dwelling older persons. Journal of American Geriatric Society. 52, 257-262. Harris, P. B. (2008). Another wrinkle in the debate about successful aging: The undervalued concept of resilience and the lived experience of dementia. International Journal of Aging and Human Development, 67, 43-61. Howden, L. M., & Meyer, J. A. (May, 2011). Age and Sex Composition: 2010. Washington, DC: U.S. Department of Commerce Economics and Statistics Administration, US Census Bureau. Marek, K. D., Popejoy, L., Petroski, G., Mehr, D., Rantz, M., & Lin, W-C. (2005). Clinical outcomes of aging in place. Nursing Research, 54(3), 202 -211. Mathieson, K. M., Jacobs-Kronenfeld, J., & Keith, V. M. (2002). Maintaining functional independence in elderly adults: The roles of health status and financial resources in predicting home modifications and use of mobility equipment. The Gerontologist (42)1, 24-31. Petersson, I., Kottorp, A., Bergstrom, J., & Lilja, M. (2009). Longitudinal changes in everyday life after home modifications for people aging with disabilities. Scandinavian Journal of Occupational Therapy, 16, 78-87. DOI 10.1080/11038120802409747 Petersson, I., Lilja, M., Hammel, J., & Kottorp, A. (2008). Impact of home modification services on ability in everyday life for people ageing with disabilities. Journal of Rehabilitation Medicine, 40 (4), 253-260. doi: 10.2340/16501977-0160 Szanton, S., Thorpe, R., Boyd, C., Tanner, E., Leff, B., Agree, E., & Gitlin, L. (2011). Community aging in place, advancing better living for elders: A bio-behavioral-environmental intervention to improve function and health-related quality of life in disabled older adults. Journal of The American Geriatrics Society, 59(12), 2314-2320. doi:10.1111/j.15325415.2011.03698.x Tanner, B., Tilse, C., & de Jonge, D. (2008). Restoring and sustaining home: The impact of home modifications on the meaning of home for older people. Journal of Housing for the Elderly, 22(3), 195-215. Wagnild, G. (2003). Resilience and successful aging: A comparison among low- and high-income older adults. Journal of Gerontological Nursing, 42-49.

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