Search

Social integration of older adults residing in assisted living facilities (ALF) is not well understood. The purpose of this study is to describe the experience of friendship among ALF residents. Four focus groups with 13 participants were held. The analysis was completed through directed content analysis. The facilitator themes identified are having early connections, positive attitudes, and shared experiences. The barrier themes identified the transitional nature of the environment and policies regarding the protection of privacy (HIPAA). Creating meaningful activity programs and determining how to disseminate health information within federal guidelines are needed to facilitate more meaningful interactions among residents. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To explore differences in having an advance directive among older adults newly transitioned to long term services and support (LTSS) settings (ie, nursing homes [NHs]; assisted living facilities [ALFs]; home and community-based services). Design: Cross sectional survey. Setting: LTSS in New York and Pennsylvania. Participants: Participants were 470 older adults who recently started receiving LTSS. Included in this analyses, N = 442 (ALF: n = 153; NH: n = 145; home and community-based services: n = 144). Measurements: Interviews consisted of questions about advance directives (living will and health care power of attorney), significant health changes in the 6 months before the start of long term care support services, Mini-Mental State Examination, and basic demographics. Results: Sixty-one percent (270/442) of older adults receiving LTSS reported having either a living will and/or an health care power of attorney. ALF residents reported having an advance directive more frequently than NH residents and older adults receiving LTSS in their own home (living will: χ2[2]= 120.9; P < .001; health care power of attorney: χ2[2]= 69.1; P < .001). In multivariate logistic regression models, receiving LTSS at an ALF (OR = 5.01; P < .001), being white (OR = 2.87; P < .001), having more than 12 years of education (OR = 2.50; P < .001), and experiencing a significant health change in past 6 months (OR = 1.97; P = .007) were predictive of having a living will. Receiving LTSS at an ALF (OR = 4.16; P < .001), having more than 12 years of education (OR = 1.74, P = .022), and having had a significant change in health in the last 6 months (OR = 1.61; P = .037) were predictive in having an health care power of attorney in this population of LTSS recipients. Conclusions: These data provide insight into advance directives and older adults new to LTSS. Future research is needed to better understand the barriers to completing advance directives before and during enrollment in LTSS as well as to assess advance directive completion changes over time for this population of older adults. [Copyright &y& Elsevier]

Objectives Advance knowledge about changes in multiple dimensions of health related quality of life (HRQoL) among older adults receiving long-term services and supports (LTSS) over time and across settings. Design A prospective, observational, longitudinal cohort design. Setting Nursing homes (NHs), assisted living facilities (ALFs), community. Participants A total of 470 older adults who were first-time recipients of LTSS. Measurement Single-item quality-of-life measure assessed every 3 months over 2 years. HRQoL domains of emotional status, functional status, and social support were measured using standardized instruments. Results Multivariable mixed effects model with time varying covariates revealed that quality-of-life ratings decreased over time ( P < .001). Quality-of-life ratings were higher among enrollees with fewer depressive symptoms ( P < .001), higher general physical function ( P < .001), enhanced emotional well-being ( P < .001), and greater social support ( P = .004). Ratings also were higher among those with increased deficits in activities of daily living ( P = .02). Ratings were highest among enrollees who received LTSS from ALFs, followed by NHs, then home and community-based services (H&CBS), but only findings between ALFs and H&CBS were statistically significant ( P < .001). Finally, ratings tended to decrease over time among enrollees with greater cognitive impairment and increase over time among enrollees with less cognitive impairment ( P < .001). Conclusions Findings advance knowledge regarding what is arguably the most important outcome of elderly LTSS recipients: quality of life. Understanding associations between multiple HRQoL domains and quality of life over time and directly from LTSS recipients represents a critical step in enhancing care processes and outcomes of this vulnerable population. [ABSTRACT FROM AUTHOR]