Elderly feel more in control of lives when they move to a care home earlier

Elderly people feel more in control of their lives when they move into a care home before their physical or cognitive decline takes the decision out of their hands, academics reveal.

Most older people want to live in their own home for as long as possible, but a health crisis means they can end up moving into a care home urgently due to physical or cognitive ill-health, which robs them of the power to choose where they want to live.

New research from the University of East Anglia and the University of Cambridge, reveals very old people would feel more in control of their lives if they thought about a future move to residential care or assisted accommodation before health problems forced them to.

The research paper ‘When Frail Older People Relocate in Very Old Age, Who Makes the Decision?’ was published in Innovation in Aging on 6 September.

Dr Morag Farquhar, from UEA’s School of Health Sciences, said: “A minority of older people choose to move to age-friendly housing before the onset of disability – but the majority prefer to grow old in their own homes and put off moving until a health crisis forces them to.

“We know that in some cases the decision to move an elderly person is made by others who may override the older person’s views and preferences – or even without their full consent."

Dr Farquhar believes thinking about future moves earlier would help older people be more involved in decision-making and may lead to better health outcomes as a result.

The likelihood of moving involuntarily rises the older they get and those over 80 are in the high risk bracket. Moves at this age are often driven by incidents like serious injury from a fall, hospitalisation or the death of a spouse who has been acting as a carer.

Academics studied interviews with people aged over 95 who had moved in later life, most with some level of cognitive impairment. They also interviewed their families.

Researchers identified 26 people who had moved to a care setting in later life - after turning 95, with the oldest interviewee aged 101-years-old.

Dr Farquhar said: “What we found was that when people move at such an old age – they are usually not making the decision themselves because they lack capacity due to poor health or cognitive decline.

“While some older people were philosophical about their move and considered it a part of the aging process, many thought a decision had been made for them, some felt resentment, and later regretted their move.

“Usually the decision is made by other family members or health and social care professionals – and relatives reported being traumatised by events leading up to the move.”

The daughter of Rose Baker who is aged 98, said: ‘{A week before moving} she fell from, she thinks now, from about half way up the stairs. And when I went round at sort of 9 o’clock in the morning I found her at the bottom of the stairs. [...] It was, I mean, it was very traumatic’.

The research involved mostly older women who were widowed who moved to a care home in later life.

Rose Baker aged 98, who moved into sheltered housing and then a care home told researchers: “When I put my name down for here it wasn’t all that long... I should have moved years ago. I could have come here, I think, before.”

Interviewer: “You mean you were beginning to feel it was a bit difficult in your house?”

Rose Baker: “Well,...all the windows, three bedrooms, stairs...”

Gaining agreement for a move into a care home was eased where the older person could feel a connection to the place they were moving into, either by having had a period of respite care there or knowing a person who worked at the care home.

Primrose Turner’s daughter said it was “very difficult” gaining an agreement from her mother about her move into care.

“And I think if my son hadn’t worked at the home, he works at that home [as a chef], that perhaps we still wouldn’t have got her there.

“After she’d been there a couple of weeks, I suppose, I said to her ‘I don’t think you can manage in your flat now’ and she said ‘No, perhaps I can’t, I don’t think I can.’

“And she said ‘It’s nice having the company’.

Researchers recommend relatives get more support to discuss moving and housing options at timely junctures before a health crisis – so that older people can participate in the decision-making process.

Dr Fiona Scheibl from the Primary Care Unit at the University of Cambridge said families could help start discussions about moving using sources of information such as Age UK.