Factors Influencing Older Persons' Transitions to Facility-Based Care Settings: A Scoping Review.

BACKGROUND AND OBJECTIVES: Older adults (≥65 years) are living longer with complex health needs and wish to remain at home as their care needs change. We aimed to determine which factors influence older persons' transitions from home living to facility-based care (FBC) settings such as long-term care facilities or assisted living. RESEARCH DESIGN AND METHODS: Through a scoping review of 7 databases, we considered all academic literature examining factors influencing transitions from home living to FBC. Only English articles were reviewed. Based on the Meleis' Health Transition (MHT) model, we categorized findings into: (a) transition conditions; (b) patterns of response; and (c) health services and interventions. RESULTS: We included 204 unique studies. Age, cognitive/functional impairments, and caregiver burden were the most consistent risk factors for older persons' transitions to FBC. Caregiver burden was the only consistent risk factor in both quantitative and qualitative literature. Other factors around health service use or nonmedical factors were examined in a small number of studies, or demonstrated mixed or nonsignificant results. Key research gaps relate to transitions to intermediate levels of FBC, research in public health systems, and research employing qualitative and interventional methods. DISCUSSION AND IMPLICATIONS: We expanded the MHT model to capture informal caregivers and their critical role in transitions from home to FBC settings. More research is needed to address practical needs of clients and caregivers while at home, and self-directed care funding models could be expanded. Theory-driven interventional research focusing on caregivers and successful hospital discharge is critically needed.

The Association of Service Use and Other Client Factors with the Time to Transition from Home Care to Facility-Based Care.

OBJECTIVES: People are living longer with complex health needs and wish to remain in their homes as their care needs change. We examined which client factors (sociodemographic, health service use, health, and function) influenced older persons' (≥65 years) time to transition from home living to assisted living (AL) or long-term care (LTC) facilities. DESIGN: Retrospective cohort study. SETTING AND PARTICIPANTS: Long-term services and supports in Alberta, Canada. Long-stay home care clients (≥65 years) who received a Resident Assessment Instrument-Home Care (RAI-HC) assessment between 2014 and 2018. MEASURES: We assessed time from initial receipt of long-term home care to AL and LTC facility transitions, using Cox proportional hazard regressions, and a provincial continuing care data repository (Alberta Continuing Care Information System). We adjusted for client sociodemographic, health, function, and health service use variables. The outcome was time from initial long-term home care receipt to transition to facility living. RESULTS: We included 33,432 home care clients. Clients who were visited by care aides once in the last 7 days transitioned to AL later than those with no care aide visits [hazard ratio (HR) 0.976, 95% confidence interval (CI) 0.852, 0.964]. Clients receiving physical therapy services once or more a week transitioned to LTC later than those who did not receive these services (HR 0.767, CI 0.672, 0.875). Institutionalizations happened sooner if the client's caregiver was unable to continue (AL: HR 1.335, CI 1.306, 1.365; LTC: HR 1.339, CI 1.245, 1.441) and if clients socialized less (AL: HR 1.149, CI 1.079, 1.223; LTC: HR 1.087, CI 1.018, 1.61). CONCLUSIONS AND IMPLICATIONS: The diverse role of care aides needs to be explored to determine which specific services help to delay AL transitions. Physical therapy exercises that require minimal supervision should be integrated early into care plans to delay LTC transitions. Social/recreational programs to improve older adults' socialization and informal caregiver support could delay transitions.

Continuing and ceasing leisure activities in later life: a longitudinal study.

PURPOSE: This study examined changes in leisure activities of older adults over an 8-year period, and associated sociodemographic and health characteristics. DESIGN AND METHODS: Data were from a longitudinal study conducted in Winnipeg, Manitoba, Canada; 380 respondents were interviewed in-person in both 1985 and 1993. Changes in ten specific activities and the overall number of activities continued were examined. RESULTS: Theater/movies/spectator sports and travel were the activities least likely to be continued over the 8-year period; watching television and reading were most likely to be continued. Characteristics significantly related to changes in activities were age, gender, education, and self-rated health in 1985 as well as changes in marital status, self-rated health, and functional ability between 1985 and 1993, although no consistent pattern emerged. IMPLICATIONS: Leisure education is discussed as a means of introducing modifications to enhance older adults' participation in desired activities. Directions for future research are highlighted.