Do Social and Physical Environment Prevent or Delay Institutionalization?

Background/Purpose

Institutionalization as a critical life event for care recipients(CRs) and their family caregivers(CGs) may lead to financial burden and negative outcomes (e.g., increased mortality, restricted quality of life). Studies have shown that the majority of CRs and CGs would prefer home care to institutionalization, which allows CRs to enjoy a higher quality of life (e.g., with their social network).  

As people get older, they may have a higher level of increasing attachment to their living area as well as sensitivity to their social (e.g., sense of community) and physical environment (e.g., person-centered home modification) which may matter more to older people than younger people. Moreover, as studies have shown, both sense of community (e.g., feeling of belonging, attachment to community) and person-centered home modification (e.g, grab bar in bathtub, medical emergent system) might play a significant role in physical and psychological well-being among CRs in a community. 

 However, while predictors (e.g. age, functional & cognitive status) of institutionalization among CRs have been well known, few studies have paid attention to the role of sense of community which may be associated with institutionalization. Also fewer studies have paid attention to CGs' factors which may be associated with institutionalization. Thus, the purpose of the current study was to examine what CGs and CRs’ factors, in particular their sense of community, person-centered home modification influence transition into residential care for community dwelling CRs.  On the basis of the behavioral model (Andersen et al.1986), this study includes Predisposing, Need, and Enabling variables.

Methods

This study was based on secondary analysis of cross-sectional data drawn from the National Study of Caregiving(NSOC) and first and third waves drawn from National Health Aging and Trend Study(NHAT) with 846 CRs and their 846 CGs.  Binary logistic regression was used to identify CGs’ (predisposing: gender; need: lack of energy; enabling: relationship quality with CRs) at wave 1, and community dwelling CR’s characteristics (predisposing: gender, race, living with someone, need:  level of difficulties with laundry, banking, meal preparation, bathing, and eating, feeling of depression, no dementia, and enabling variables:CR’s living arrangement, home modification-grab bar in bathtub, around toilet, medical emergent system, sense of community) at wave1 that might impact residential status change at wave3.

Results

Half of CGs were adult-children (37.1% daughter,13.5% son); 26.6% were spouse CGs. About 23% of the sample was institutionalized during the past 3 years prior to the data collection. Baseline characteristics associated with a status change were predisposing variables (i.e. older age, being white), need variables ( i.e. having no dementia status, CR’s higher level of feeling of depression, & CG’s lack of energy due to  caregiving) , and enabling variables (i.e. CG’s worse relationship quality with CR, CR’s higher level of sense of community, having medical emergent system).

 Conclusion/Implications

It is important to recognize the significant associations among social /physical environment, CGs’ variables and institutionalization. Information about the associations is useful for practioners, CRs and their CGs to implement better care environment for CRs to remain in their community as long as possible.