Differential Aging-in-Place By Person-Environment Fit
Aging-in-place refers to older adults’ living independently in the community as opposed to relocating to institutional facilities such as nursing home. Accumulated research examined various influencing factors leading to nursing homes such as socioeconomic factors, health conditions, and formal or informal support. However, in order to better identify the causing factors for institutionalization, there are two concerns that need more careful examination. First, we need to examine comorbidity of various health conditions among older adults. Older adults often have several different health conditions, which might differently affect their aging-in-place process. Second, although many studies have demonstrated individual factors associated with institutionalization, not much is known about the role of environmental contexts in nursing home admission.
Based on the ecological theory of aging and the person-centered perspective, this study aims to examine the effect of person-environment fit on nursing home admission. To do so, we empirically identified heterogeneous group of older adults with different health conditions and discernible clusters of living environment. Then, we examined to what extent the person’s differential health conditions and the environmental context affect nursing home admission, and how the effects of health conditions on nursing home admission differ between supportive and unsupportive environments.
Our analytic sample was drawn from seven waves (1998-2010) of the Health and Retirement Study (HRS). We focused on older adults 65 years or older who has at least one functional limitation (N =6,041). Latent class analysis was used for identifying health and environment clusters. For health clusters, six health indicators were used including functional difficulty, ADL, IDAL, chronic diseases, cognitive function, and self-rated health. For physical environment clusters, we included eight characteristics of living environment: presence of ramp, railing, wheelchair access, grab bar, emergency call button, accessibility, physical condition of house, and physical condition of neighborhood. The dependent variable, nursing home admission, was defined as whether or not having more than three-month-stay in a nursing home between the waves. Hierarchical linear model (HLM) was used to determine how health and environment clusters affect the likelihood of nursing home admission for old age, controlling for socio-demographic attributes.
Four groups of health competence were identified: both physically and cognitively impaired, cognitively impaired, physically impaired, and overall healthy. Two environmental groups were derived: supportive and unsupportive environment. Respondents in supportive environment were less likely to be institutionalized than those in unsupportive environment. Having both physical and cognitive impairments and having only cognitive impairments were associated with greater odds of institutionalization. Those having both physical and cognitive health problems and those only with physical impairments were less likely to be admitted into a nursing home in a supportive environment than in an unsupportive environment.
This study reveals the moderating role of a environmental context in the effect of comorbidity of older adults on nursing home admission, using innovative theoretical and methodological approach. It highlights the importance of understanding the effects of different contexts of aging-in–place.