Well-being among elderly community

dwellers 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

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.

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).

Assisted living (AL) in Israel

In 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 activities

The 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, and socio-demographic characteristics

t 2 df p ALR CD

2 =.30, df=1, p=.58 Female Male Female Male Gender

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

2 =1.66, df=1, p=.198

no yes no yes Spouse

147 (69%) 67 (31%) 135 (63%) 80 (37%)

t=-.100, df=428, p=.920 83.9 (5.38) 83.9 (4.19) Age (M/SD)

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

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

High low High low Education

114 (53%)

78 (37%)

21 (10%)

101 (47%)

98 (46%)

15 (7%)

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

Very good

good bad Very good

good Bad Economic status

45 (21%)

154 (72%)

16 (7%)

28 (13%)

171 (80%)

16 (7%)

Comparison between CD and ALR on indicators of SWB

t ALR M (SD)

CD M (SD)

Well-being

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

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

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

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

-1.85, p=.064 5.50 (1.03) 5.29 (1.26) Happiness

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

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

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

-2.86, p=.004 4.04 (1.12) 3.72 (1.19) Fear of dying

2.37, p=.018 1.38 (.63) 1.55 (.81) Fear of death

Antecedents of different aspects of well-being ()

Fear

of

death

Fear of

dying

GDS Will to

live

Morale

Happin-

ness

Loneli-

ness

Success-

ful aging

LS-C LS-N

-.023 .142* .067 -.089 .041 .053 .146* .108* .119** .099* Gender

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

.072 -.083 .069 -.014 .080 .083 .045 .079 .146* .139** Econo.

status

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

status

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

-.100* .143** .104* -.004 .082 .080 .137** .109** .150** .138** Resid-

ence

.02* .08** .22** .10** .26** .11** .11** .24** .25** .26** R2

LS-N – Life satisfaction (Neugarten et al., 1961) , LS-C – Life Satisfaction Carmel, 1997

Morale – 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 AL

Degree 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.

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 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.)

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

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.

Life is beautiful

Comparison between CD and ALR on indicators of SWB

Men only (n=113)

t ALR M/SD

CD M/SD

Well-being

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

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

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

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

-1.64, p=.103 5.60 (1.16) 5.21 (1.32) Happiness

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

-.650, p=.517 3.64 (.54) 3.56 (.82) Will to live

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

-2.16, p=.033 4.04 (1.12) 3.72 (1.19) Fear of dying

.380, p=.705 1.46 (.74) 1.51 (.70) Fear of death

Comparison between CD and AR on indicators of SWB

Women only, n=317

t ALR M/SD

CD M/SD

Well-being

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

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

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

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

-1.13, p=.260 5.46 (1.00) 5.32 (1.25) Happiness

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

.366, p=.714 3.36 (.77) 3.39 (.89) Will to live

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

-1.94, p=.053 4.11 (1.11) 3.85(1.16) Fear of dying

2.49, p=.013 1.35 (.59) 1.56 (.86) Fear of death