Village life: Independence, Loneliness, and Quality of Life in Retirement Villages with Extra Care

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The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. Village Life: Independence, Loneliness, and Quality of Life in Retirement Villages with Extra Care Brian Beach, Research Fellow International Longevity Centre – UK @ilcuk

Transcript of Village life: Independence, Loneliness, and Quality of Life in Retirement Villages with Extra Care

Page 1: Village life: Independence, Loneliness, and Quality of Life in Retirement Villages with Extra Care

The International Longevity Centre-UK is an independent, non-partisan think-tank

dedicated to addressing issues of longevity, ageing and population change.

Village Life:Independence, Loneliness, and Quality of Life in Retirement Villages with Extra Care

Brian Beach, Research Fellow

International Longevity Centre – UK

@ilcuk

Page 2: Village life: Independence, Loneliness, and Quality of Life in Retirement Villages with Extra Care

The International Longevity Centre-UK is an independent, non-partisan think-tank

dedicated to addressing issues of longevity, ageing and population change.

ILC-UK Planning Tomorrow, Today

Westminster based think tank Evidence based research organisation Focussed on policy Independent Experts in ageing, demography and longevity Broad remit in research Take a balanced approach to intergenerational fairness Well respected Well networked – part of an international alliance

www.ilcuk.org.uk

Page 3: Village life: Independence, Loneliness, and Quality of Life in Retirement Villages with Extra Care

The International Longevity Centre-UK is an independent, non-partisan think-tank

dedicated to addressing issues of longevity, ageing and population change.

Explored the experiences among residents of retirement villages with extra care support

Primary data collection through a survey to residents

Comparison with similar sample taken from ELSA

Page 4: Village life: Independence, Loneliness, and Quality of Life in Retirement Villages with Extra Care

The International Longevity Centre-UK is an independent, non-partisan think-tank

dedicated to addressing issues of longevity, ageing and population change.

Topics for Today

Setting the scene– Housing with care, retirement villages, and extra care

Why is this important?

What did we do?

Findings:– Independence & Choice

– Isolation & Loneliness

– Quality of Life

How do the findings compare to other settings?

Implications & Recommendations

Page 5: Village life: Independence, Loneliness, and Quality of Life in Retirement Villages with Extra Care

The International Longevity Centre-UK is an independent, non-partisan think-tank

dedicated to addressing issues of longevity, ageing and population change.

Understanding “Housing with Care”

Housing with care is one area that has evolved in response to the expected increase in future care needs resulting from an ageing population

A range of definitions cover what the term means, which has evolved over time

At its core: a purpose-built, community-based alternative to residential care for older people that seeks to fill their housing, care, and support needs simultaneously, while promoting their independence within private accommodation

Page 6: Village life: Independence, Loneliness, and Quality of Life in Retirement Villages with Extra Care

The International Longevity Centre-UK is an independent, non-partisan think-tank

dedicated to addressing issues of longevity, ageing and population change.

Retirement Villages and Extra Care

The market for retirement villages has grown in recent years

Retirement villages are designed around a central hub, where amenities including a health club, swimming pool, GP surgery, restaurants and cafés are available

Extra Care – also called very sheltered housing or assisted living – a particular approach to housing with care, recognised as more of a concept rather than a specific type of housing

Housing first, providing private self-contained homes

Care services are available in a flexible and tailored way, provided on-site and available 24 hours a day

Page 7: Village life: Independence, Loneliness, and Quality of Life in Retirement Villages with Extra Care

The International Longevity Centre-UK is an independent, non-partisan think-tank

dedicated to addressing issues of longevity, ageing and population change.

Why is extra care important?

Often promoted as providing a “home for life”

Offers a compromise or third way between residential care and staying in one’s previous home

Broadly harmonises with government policy aims in two ways:

Finding new, innovative ways to manage the financial implications of the growing demand for care

Enhancing quality of life through independence and choice in housing with care

Page 8: Village life: Independence, Loneliness, and Quality of Life in Retirement Villages with Extra Care

The International Longevity Centre-UK is an independent, non-partisan think-tank

dedicated to addressing issues of longevity, ageing and population change.

Why is extra care important?

More recently, three other aims have emerged:

Promote greater independence by offering on-site amenities and care services, while also giving greater choice in planning for later life

Reduce social isolation by bringing people into a more communal living environment

Enhance residents’ quality of life compared to what they would experience in the general community or a traditional residential care setting

Page 9: Village life: Independence, Loneliness, and Quality of Life in Retirement Villages with Extra Care

The International Longevity Centre-UK is an independent, non-partisan think-tank

dedicated to addressing issues of longevity, ageing and population change.

Conducting the Research

Anonymised survey questionnaires

Caution in over-generalising the results

Non-response bias; Results only apply to this particular type of housing with care, i.e. retirement villages (with extra care)

Page 10: Village life: Independence, Loneliness, and Quality of Life in Retirement Villages with Extra Care

The International Longevity Centre-UK is an independent, non-partisan think-tank

dedicated to addressing issues of longevity, ageing and population change.

The Residents

Almost two-thirds (62.8%) were women

Only 14 reported being single, separated, or divorced, and over half (54.8%) were married or cohabiting

Over half (51.3%) were aged 75-84, with 17 (8.5%) aged 90+

Only 11 reported ‘Poor’ or ‘Very poor’ current health

Over two-thirds (67.5%) reported no change in health since moving in

Over a quarter (27.9%) indicated a decline; only around 1 in 10 of these ended up in ‘Poor’ or ‘Very poor health’

Page 11: Village life: Independence, Loneliness, and Quality of Life in Retirement Villages with Extra Care

The International Longevity Centre-UK is an independent, non-partisan think-tank

dedicated to addressing issues of longevity, ageing and population change.

Independence & Choice: Discovering the housing

6.1%

33.8%

19.2%

9.1%

20.7%

9.6%

13.6%

0% 5% 10% 15% 20% 25% 30% 35% 40%

someone living in your current housing at thetime

a friend or relative

(you were) living in the local area

word of mouth

an advertisement (print, radio, TV, etc.)

direct marketing (leaflets in the post)

the internet

Thinking back, did you find out about your current housing from…

Page 12: Village life: Independence, Loneliness, and Quality of Life in Retirement Villages with Extra Care

The International Longevity Centre-UK is an independent, non-partisan think-tank

dedicated to addressing issues of longevity, ageing and population change.

Independence & Choice: Discovering the housing

Many respondents referenced their (grand)children as bringing the housing option to their attention

I had been looking for a suitable flat for a long time as my husband was finding the stairs more and more difficult, and I was finding it more necessary to call for help. My grandson phoned on a Saturday afternoon and we drove straight down…and bought that afternoon.

Advertising I was very tempted by the promises…in the marketing literature…I

have no intention of moving house again!... The fact that I could be completely independent in my own environment and with a small garden [was] important.

Living in the local area

Page 13: Village life: Independence, Loneliness, and Quality of Life in Retirement Villages with Extra Care

The International Longevity Centre-UK is an independent, non-partisan think-tank

dedicated to addressing issues of longevity, ageing and population change.

Independence & Choice: Deciding to move

1.5%

6.5%

30.2%

13.1%

48.2%

24.6%

52.8%

53.3%

36.7%

0% 10% 20% 30% 40% 50% 60%

you had a sudden need for care

your spouse/partner had a sudden need for care

you expected to have care needs in the future

your spouse/partner expected to have care needs…

you wanted a smaller home (downsizing)

you didn’t want to go into a typical care home

you liked the independence of your current housing

you wanted to maintain an active lifestyle

you wanted to be nearer to your family and/or…

When you decided to move into your current housing, was this because…

Page 14: Village life: Independence, Loneliness, and Quality of Life in Retirement Villages with Extra Care

The International Longevity Centre-UK is an independent, non-partisan think-tank

dedicated to addressing issues of longevity, ageing and population change.

Independence & Choice: Deciding to move

Independence (52.8%), an active lifestyle (53.3%), and the desire to downsize (48.2%) feature prominently

But have perceptions changed since moving in? Over half of the respondents left responses, with a vast majority

indicating no change or improvement

Better than anticipated. It provides a lot of feel good factor.

Negative comments related to concerns around the building (e.g. fixtures or size) or management

The flat is suitable for our needs, but I do miss the view (garden) and larger rooms.

Page 15: Village life: Independence, Loneliness, and Quality of Life in Retirement Villages with Extra Care

The International Longevity Centre-UK is an independent, non-partisan think-tank

dedicated to addressing issues of longevity, ageing and population change.

Independence & Choice: Deciding to move

Sudden needs for care were the least reported options

Expectations of future care needs influenced around a third of the respondents

Including the desire to avoid a care home (24.6%), over half (51.0%) mentioned at least one care-related reason

Perhaps people are not ‘leaving it too late’ to move into this kind of extra care housing

Page 16: Village life: Independence, Loneliness, and Quality of Life in Retirement Villages with Extra Care

The International Longevity Centre-UK is an independent, non-partisan think-tank

dedicated to addressing issues of longevity, ageing and population change.

Isolation & Loneliness

Social isolation refers to the absence of contact with others

Loneliness reflects one’s feelings

Reducing social isolation may be one stated aim of good housing with care, but understanding their subjectiveexperiences may be more useful

Page 17: Village life: Independence, Loneliness, and Quality of Life in Retirement Villages with Extra Care

The International Longevity Centre-UK is an independent, non-partisan think-tank

dedicated to addressing issues of longevity, ageing and population change.

Experiences of Isolation & Loneliness

73.6%

79.1%

81.7%

5.7%

78.4%

(54.7%)

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

How often do you feel you lack companionship?

How often do you feel left out?

How often do you feel isolated from others?

How often do you feel in tune with the peoplearound you?

How often do you feel lonely?

Hardly ever or never Some of the time Often

Page 18: Village life: Independence, Loneliness, and Quality of Life in Retirement Villages with Extra Care

The International Longevity Centre-UK is an independent, non-partisan think-tank

dedicated to addressing issues of longevity, ageing and population change.

Experiences of Isolation & Loneliness

The vast majority of respondents (81.7%) ‘hardly ever or never’ feel isolated from others

Only around 1% ‘often’ do

A large proportion (78.4%) ‘hardly ever or never’ feel lonely

3.6% ‘often’ do

Page 19: Village life: Independence, Loneliness, and Quality of Life in Retirement Villages with Extra Care

The International Longevity Centre-UK is an independent, non-partisan think-tank

dedicated to addressing issues of longevity, ageing and population change.

Looking More Closely at Loneliness

We used the three-item score for loneliness

Ranges from 3 to 9, with 9 being the loneliest

64.2%

15.0%

10.2%

7.0%

2.7%

0.0%

1.1%

3 (not lonely) 4 5 6 7 8 9 (loneliest)

Page 20: Village life: Independence, Loneliness, and Quality of Life in Retirement Villages with Extra Care

The International Longevity Centre-UK is an independent, non-partisan think-tank

dedicated to addressing issues of longevity, ageing and population change.

Looking More Closely at Loneliness

Responses resemble those for the single-item question

Must consider impact of widowhood on feelings of companionship (e.g. look at scores 3 and 4 – 79.2%)

The highest levels of loneliness (7-9) represent 3.8%, similar to the 3.6% of ‘often’ feeling lonely

Around 1 in 5 respondents do feel lonely at least some of the time

But overall, a large proportion of respondents avoid the negative subjective experiences of both isolation and loneliness.

Page 21: Village life: Independence, Loneliness, and Quality of Life in Retirement Villages with Extra Care

The International Longevity Centre-UK is an independent, non-partisan think-tank

dedicated to addressing issues of longevity, ageing and population change.

Measuring Quality of Life

While existing research on extra care housing suggests it does confer enhanced quality of life, many have drawn on expressions of satisfaction and contentment rather than a more robust or detailed measure of quality of life

CASP-19: 19 questions, each score 0-3; full scale 0-57

OPQOL: 35-item covering range of topics; reliable and valid short form of 13 items

Home and neighbourhood domain

Page 22: Village life: Independence, Loneliness, and Quality of Life in Retirement Villages with Extra Care

The International Longevity Centre-UK is an independent, non-partisan think-tank

dedicated to addressing issues of longevity, ageing and population change.

Quality of Life: CASP-19

Control: “I feel free to plan for the future.”

Never (0), Not Often (1), Sometimes (2), Often (3)

Autonomy: “I look forward to each day.”

Self-realisation: “I enjoy the things that I do.”

Pleasure: “I feel that life is full of opportunities.”

Page 23: Village life: Independence, Loneliness, and Quality of Life in Retirement Villages with Extra Care

The International Longevity Centre-UK is an independent, non-partisan think-tank

dedicated to addressing issues of longevity, ageing and population change.

Quality of Life: CASP-19

Average score: 43.73 (76.7% of the full scale)

Median score: 45

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Page 24: Village life: Independence, Loneliness, and Quality of Life in Retirement Villages with Extra Care

The International Longevity Centre-UK is an independent, non-partisan think-tank

dedicated to addressing issues of longevity, ageing and population change.

Domains of CASP-19: A focus on control

Offering control has been an important objective in the context of health and social care services

On the CASP-19 domain, the average score for Control was 13.37 (Scale 0-18)

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Page 25: Village life: Independence, Loneliness, and Quality of Life in Retirement Villages with Extra Care

The International Longevity Centre-UK is an independent, non-partisan think-tank

dedicated to addressing issues of longevity, ageing and population change.

Another Quality of Life Measure: OPQOL

Measured on a scale of 13-65

Average score: 55.9 – Median score: 56

82.5% of the scale

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Page 26: Village life: Independence, Loneliness, and Quality of Life in Retirement Villages with Extra Care

The International Longevity Centre-UK is an independent, non-partisan think-tank

dedicated to addressing issues of longevity, ageing and population change.

Another Quality of Life Measure: OPQOL

97.0% agree or strongly agree with “I feel safe where I live”

Two items referring to health had the largest proportions disagreeing or strongly disagreeing

“I am healthy enough to have my independence.” (6.2%)

“I am healthy enough to get out and about.” (11.7%)

Page 27: Village life: Independence, Loneliness, and Quality of Life in Retirement Villages with Extra Care

The International Longevity Centre-UK is an independent, non-partisan think-tank

dedicated to addressing issues of longevity, ageing and population change.

Comparing Our Sample with People in the Community

Using Wave 6 of the English Longitudinal Study of Ageing (ELSA)

Propensity Score Matching: gender, age group, marital status, self-reported health (but not care), and home values ≥£200,000

Identifies a sample similar to our respondents based on these characteristics and outcome(s) of interest

Allows identification of “treatment” effects

Page 28: Village life: Independence, Loneliness, and Quality of Life in Retirement Villages with Extra Care

The International Longevity Centre-UK is an independent, non-partisan think-tank

dedicated to addressing issues of longevity, ageing and population change.

Comparing Our Sample with People in the Community

Quality of Life (CASP-19): higher among our residents, but significant only at p<0.1

43.73 versus 41.23

Control was the only different domain, higher among residents

13.37 versus 11.59

On the 0-18 scale, reflects an idea of 74.3% v 64.4% of total possible Control

Residents scored lower on the loneliness scale (3-9)

0.64 points lower (3.73 v 4.37)

Akin to 12.2% v 22.8% of total possible loneliness

Page 29: Village life: Independence, Loneliness, and Quality of Life in Retirement Villages with Extra Care

The International Longevity Centre-UK is an independent, non-partisan think-tank

dedicated to addressing issues of longevity, ageing and population change.

Implications and Recommendations

For Government:

Central and local government should identify ways of working with the private sector to stimulate the building of new good quality retirement housing

For Providers:

Marketing strategies: include aspects of indepdence and control, think about younger groups (potential residents’ children)

For Researchers:

More extensive data collection, greater attention to subpopulations in care settings (dementia, multiple conditions)

Page 30: Village life: Independence, Loneliness, and Quality of Life in Retirement Villages with Extra Care

The International Longevity Centre-UK is an independent, non-partisan think-tank

dedicated to addressing issues of longevity, ageing and population change.

Many thanks

Brian Beach

Research Fellow

International Longevity Centre – UK (ILC-UK)

[email protected]

+44 (0)20 7340 0440

Twitter: @ilcuk