Well-being among elderly community Well-being among elderly community dwellers and assisted living residents: dwellers and assisted living residents:

A comparative analysisA comparative analysis

Sara Carmel, Hava Tovel, Zinovi ShragaSara Carmel, Hava Tovel, Zinovi ShragaThe Center for Multidisciplinary Research in AgingThe Center for Multidisciplinary Research in Aging

Faculty of Health SciencesFaculty of Health Sciences

Ben-Gurion University of the NegevBen-Gurion University of the Negev

Supported by: The Israel Ministry for Senior Citizens

The Abraham and Sonia Rochlin FoundationThe Abraham and Sonia Rochlin Foundation

Quality of life and subjective well-being – Quality of life and subjective well-being – societal needs and challengessocietal needs and challenges

Decreased quality of life is one of the Decreased quality of life is one of the phenomena accompanying prolonged life, phenomena accompanying prolonged life, with significant implications for the elderly, with significant implications for the elderly, their families, and society as a whole.their families, and society as a whole.

Finding the best social solutions for this Finding the best social solutions for this relatively vulnerable population group has relatively vulnerable population group has become a challenge to all nations. become a challenge to all nations.

Purpose of the studyPurpose 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).

Assisted living (AL) in IsraelAssisted living (AL) in Israel

In Israel, AL sites (also called “sheltered housing”) In Israel, AL sites (also called “sheltered housing”) are run by for-profit and non-profit organizations.are run by for-profit and non-profit organizations.

Both provide high quality services.Both provide high quality services.

(165 sites/21,000 units)(165 sites/21,000 units)

Services provided: Services provided: - Personal safety arrangements Personal safety arrangements - 24-hour availability of medical services24-hour availability of medical services- Immediate assistance for any needImmediate assistance for any need- Restaurant servicesRestaurant services- Home cleaning and repairsHome cleaning and repairs- A variety of social, cultural and physical activitiesA variety of social, cultural and physical activities

The degree of use of each service depends on the residentThe degree of use of each service depends on the resident. .

Method

Structured 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)

Comparison between CD and ALR on health, function, Comparison between CD and ALR on health, function, and socio-demographic characteristicsand socio-demographic characteristics

CDALRt 2 df pGenderMaleFemaleMaleFemale2 =.30, df=1, p=.58

59 (27%)156 (73%)54 (35%)161(75%)

Spouseyesnoyesno2 =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=.920

Health (M/SD)3.13 (.94)3.09 (.84)t= .515, df=428, p=.607

IADL (M/SD)1.39.) 55(1.33.) 55(t=1.25, df=426, p=.211

EducationlowHighlowHigh

15 )7%(

98 )46%

(

101 )47%

(

21 )10%

(

78 )37%

(

114 )53%

(

Economic status

BadgoodVery good

badgoodVery good

2 =4.85, df=2, p=.089

16 )7%(

171)80%

(

28 )13%

(

16 )7%(

154 )72%

(

45 )21%

(

Comparison between CD and ALR on indicators of SWBComparison between CD and ALR on indicators of SWB

Well-beingCD M (SD)

ALRM (SD)

t

Life satisfaction (Neugarten)3.45.) 68(3.65.) 61(-3.24 ,p=.001

Life satisfaction (Carmel)3.96.) 66(4.17.) 55(-3.57 ,p<.000

Successful aging (subjective)7.58) 1.83(8.03) 1.62(-2.65 ,p=.008

Loneliness (high score = low loneliness)4.71) 1.25(5.03) 1.12(-2.72 ,p=.007

Happiness5.29) 1.26(5.50) 1.03(-1.85 ,p=.064

Morale (Lawton et al.)2.85.) 64(2.96.) 52(-2.21 ,p=.032

Will to live3.43.) 88(3.43.) 72(.105 ,p=.920

GDS (high score = low depression) 11.18) 3.42(11.96) 2.99(-2.53 ,p=.012

Fear of dying3.72) 1.19(4.04) 1.12(-2.86 ,p=.004

Fear of death1.55.) 81(1.38.) 63(2.37 ,p=.018

Antecedents of different aspects of well-being (Antecedents of different aspects of well-being ())

LS-NLS-CSuccess-ful aging

Loneli-ness

Happin-ness

Morale

Will to live

GDSFear of dying

Fear of

death

Gender.099*.119**.108*.146*.053.041.-089.067.142*.-023

Spouse.-167**.-124*.-059.-228**.-058.-086.-067.-110*.-081.-063

Econo. status

.139**.146*.079.045.083.080.-014.069.-083.072

Health status

.-331**.-313**.-358**.-125*.-266**.-398**.-291**.-247**.185**.073

IADL.-134**.-146**.-149**.-095.-054.-121*.-025.-246**.-146*.088

Resid-ence

.138**.150**.109**.137**.080.082.-004.104*.143**.-100*

R2.26**.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).

Addressed needs and satisfaction in ALAddressed needs and satisfaction in AL

Degree of addressed needs in AL Degree of addressed needs in AL (on a scale of 0-5)(on a scale of 0-5): :

A high degree of response to needs with average A high degree of response to needs with average scores from 4.84 (SD= .44) to 4.34 (SD=1.38) . scores from 4.84 (SD= .44) to 4.34 (SD=1.38) . Exception – reference to meals (3.00, SD=2.2) due to Exception – reference to meals (3.00, SD=2.2) due to great variability in use.great variability in use.

The highest scores were given for: ability to manage an The highest scores were given for: ability to manage an independent life, to continue life as usual, feeling independent life, to continue life as usual, feeling comfortable in the apartment, physical security, comfortable in the apartment, physical security, accessibility of medical services, and privacy. accessibility of medical services, and privacy.

Satisfaction with relocation to AL was high – Satisfaction with relocation to AL was high –

87% responded as very satisfied87% responded as very satisfied..

Experienced changes in AL

What 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%

Summary of resultsSummary 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.

In

Summary of results (cont.)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

ConclusionsConclusions 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.

Life is Life is

beautifulbeautiful

Comparison between CD and ALR on indicators of SWBComparison between CD and ALR on indicators of SWB

Men only Men only (n=113)(n=113)Well-beingCD

M/SDALR

M/SDt

Life satisfaction (Neugarten)3.41.) 71(3.70.) 59(-2.32 ,p=.022

Life satisfaction (Carmel)3.93.)73(4.18.) 55(-2.06 ,p<.041

Successful Aging (subjective)7.43) 1.83(8.04) 1.72(-1.69 ,p=.093

Loneliness (high score = low loneliness)4.50) 1.35(5.11) 1.11(-2.59 ,p=.011

Happiness5.21) 1.32(5.60) 1.16(-1.64 ,p=.103

Morale (Lawton et al.)2.89.) 70(3.01.) 50(-1.00 ,p=.318

Will to live3.56.) 82(3.64.) 54(.-650 ,p=.517

GDS (high score = low depression) 11.17) 3.84(12.26) 2.75(-1.75 ,p=.084

Fear of dying3.72) 1.19(4.04) 1.12(-2.16 ,p=.033

Fear of death1.51.) 70(1.46.) 74(.380 ,p=.705

Comparison between CD and AR on indicators of SWBComparison between CD and AR on indicators of SWBWomen only, n=317Women only, n=317

Well-beingCDM/SD

ALRM/SD

t

Life satisfaction (Neugarten)3.46.) 67(3.63.)61(-2.37 ,p=.018

Life satisfaction (Carmel)3.97.) 63(4.16.) 56(-2.89 ,p<.004

Successful Aging (subjective)7.64) 1.74(8.02) 1.60(-2.04 ,p=.042

Loneliness (high score = low loneliness)4.80) 1.21(5.00) 1.13(-1.56 ,p=.121

Happiness5.32) 1.25(5.46) 1.00(-1.13 ,p=.260

Morale (Lawton et al.)2.84.) 61(2.97.) 53(-1.93 ,p=.054

Will to live3.39.) 89(3.36.) 77(.366 ,p=.714

GDS (high score = low depression) 11.18) 3.26(11.86) 3.01(-1.91 ,p=.057

Fear of dying3.85)1.16(4.11) 1.11(-1.94 ,p=.053

Fear of death1.56.) 86(1.35.) 59(2.49 ,p=.013