The purpose of this literature review is to document the research that examines the predictors of institutionalization of the elderly. The the ideology of “aging in place,” is where I found my research interest; this is a phrase that describes that “older adults wish to live in their own communities for as long as possible,” This also includes that community services will support aging in place while maintaining being cost-effective. Also this review is confounded on the Andersen’s Behavioral Model of Health Services.
The “Andersen’s Behavioral Model of health services”, suggests that people usage of health services is due to their predisposition to use the services, factors can either enable or impede individuals use. This model takes the leading predictors and groups them into three main categories: “predisposing, enabling, need and use characteristics.”
Predisposing characteristics include but are not limited to race, age, and health benefits. It can also include things such as, levels of social support, health related behaviors (attitudes), beliefs, socioeconomic status and expectations.
Enabling characteristics include community resources like income (individual), access to continual care, health insurance status.
Need characteristics, which has been found to account for a large amount of physician variability in use. This concept includes perceived healthcare needs, and other indications of their healthcare status. Use characteristics are simply put, the indicators of the utilization of health care.
Findings
Found Predisposing Characteristics Consistent with Andersen’s predictors of institutionalization: Age, Caucasian, Live Alone, Few or no adult children and low levels of engaging within the community;
Medium-Low level predictors of institutionalization: lower levels of social support, caregiver status( independent vs. constant companion), severe loneliness.
Interventions: targeted for people with highest risk as well as their caregivers, taking advantage of existing care networks;
Future research: Generalize the various aspects of informal support and evaluate their effect on different groups and in different contexts.
Limitations
The predictions made were based upon a single cross sectional measurement.
The predictors measured are “easy” and not many complex predictors such as policy resources are measured.
Predictor within the home setting could differ from those within a institutionalized setting
They author failed to note the entries and exits into the nursing home, to better conceptualize how they got there, and why they returned home.
Did not account for the impact of care on the caregiver and if that consist with the placement outcome.
Introduction
What has lead me to radically change the research topic in which I want to discuss is an article I stubbled upon. The article was discussing the Ontario policy for aging in place. This policy is an important event due too many elders wanting ti age with their own home, to maintain homeostasis and autonomy. The policy however is being viewed as cost-effective when it is compared to Long term care at a nursing facility. On the flip side this policy can bring on dangers as well, such as residents being under-cared for.
Now the exact policy read as following: "Seniors have been contributing to their communities all their lives and they can continue to do so if they have the right services and supports in place.”
You can see here this leaves for a lot of gray areas as to what is expected for the level of care needed in order for the person to age in place.
An American study was conducted using 3,170 adults who lived in a long term nursing facility, it was found that a estimate of around 15%-70% of the residents could actually be cared for in a less restrictive environment(Spector, Reschovsky & Cohen1996). Just from this one sample you see the crazy rate of elderly people receiving too much care in these nursing homes. Now one may think what is wrong with receiving too much care? Well when a family is paying tens of thousands of dollars to these nursing homes when they could save money by allowing the family member to stay home, there is a problem.
Coyte a leading researcher on this topic states “many people are being placed in these long term care nursing homes, could receive care at home or in a supportive house setting” (Coyte et al., 2002 p.9).
Terms
The term “senior” for the purpose of this literature review is defined as individuals who are 65 and older. The words elderly, elder, and senior will all be used interchangeably. “Institutionalization” is used to describe the permeant entry into a restrictive facility or healthcare setting where a person will receive personal care services. Examples include but are not limited to nursing homes, retirement homes, Psycho-geriatrics facility etc.
For the purpose of my literature review, assisted living or day programs will not be included, due to them being too similar to institutions.
Use Characteristics
The most prominent “use” predictor was found to be actually prior to the entry into these institutions. However the question still remains if the effect was in part due to the acceptance of being put into this homes due to previous admission or because of knowing someone who has successfully done so.
All in the this review confirms that elderly adults with low levels of support such as no kids or spouse, and less financial means are at a greater risk to be admitted into these facilities.
The other aspect found to be a predictor as to whether an elder will be admitted or not is if they suffered from a physical disability that prevent their family from better taking care of them.
Need Characteristics
The most significant need predictor was very complex and flexible. The circumstances revolving around the need of the elder depended on individual circumstances. A good example is, diabetes could posed a greater risk in urban areas and not so much in rural areas. Therefore there may be more resources or preventative resources in different areas. Miller and Weissert’s (2000) article , there are only a small amount of need characteristics that actually are predictors. The most surprising finding is that cognitive function is a very higher predictor for being institutionalized.
Enabling Characteristics
The most prominent finding was that this depended largely on the individual’s income and the amount of beds available within a facility. The income results are better viewed from a subjective stand point, versus as an absolute measurement. Whether a person was a homeowner also was shown to have a moderate affect on moving into more restrictive housing. People who own houses were found to be more protective over their homes and less willing to be moved into long term care facilities.
Predisposing Characteristics
Social support was found to have an only a modest determination for institutionalization, and was found to only be predominant when paired with other health issues. Beland and his tea suggest that social support are not typical in health and social services, they are amendable to policy and program interventions (Beland et.al., 2004). Russel and his team go deeper into this and found that while having social support may delay the move into this long term facilities, it may enhance existing relationships, over creating new ones
(Russell et.al.,1997).
Overall within my review I was able to confirm my question that elders with lower levels of informal support and less monetary values are more likely to be placed within these institutions. The presence of cognitive impairments have a huge impact of the admission into these facilities as well as living in an area with a greater supply of beds within a facility.