Date Presented 03/27/20
This study compares aggregate data from two cohorts of older adults moving into independent living at an LPC to determine differences in acuity levels. Scores from established measures of cognition and physical quality of life, percent needing hospitalization, and percent moving to a higher level of care were compared. Results show residents are moving in at higher levels of acuity, thus demonstrating a need for OT intervention with older adults for better transition to LPCs.
Primary Author and Speaker: Jessica Meyer
Additional Authors and Speakers: Chad Arnette, Linh Lam, Emily Schulz
Contributing Authors: Mary Voytek, Marissa Bartosch, Jessica Selland, Madeline Thueson, Alice Kang, Elizabeth Brooks, Stephanie Hernreich
PURPOSE: As the numbers of older adults increase, there is a trend to help them maintain their independence for as long as possible1. Approximately 5-7% of age and income qualified older adults move into independent living (IL) in a life plan community (LPC), to benefit from the availability of activities and services they may not have had access to at home. However, there has been a national trend in needs-driven transitions, suggesting that older adults are moving into LPCs based on needs and declining health, rather than lifestyle-driven factors2. The purpose of this study was to compare the aggregate data from 2 cohorts of older adults moving into IL at a LPC at 2 different periods of time to determine if there were differences in acuity levels. Scores from various assessments that measure aspects of quality of life, cognition, health status, activity involvement, and meaningfulness were compiled into a comprehensive assessment conducted by an occupational therapist (OT) called the Empowerment Platform (EP), which is a part of the Success Matters (SM) program. SM is a non-traditional, OT-based program at a LPC for older adults, which provides holistic screenings, interventions, support groups, and wellness programming, in order to ensure optimal quality of life for residents as they transition to the LPC and throughout the aging process. The data gathered from the EP can serve as an indicator of the need for OT working with older adults transitioning to LPCs. The research question for this study was “Are seniors who are currently moving in to a LPC at a higher level of acuity, and thus require more OT support, when compared to those who moved in 4 years ago?”
DESIGN: In this ex-post facto descriptive study, we used pre-existing data collected from the EP to compare the changes in acuity levels from two different cohorts at the LPC. Older adults moving to IL from the community were invited to voluntarily complete the EP.
METHOD: Survey data from the EP were collected from June 2015-March 2019, 6-8 weeks after the participants moved to the LPC. Data from the first 50 people to complete the EP in 2015 (Cohort 1) and the last 50 people to complete the EP in 2019 (Cohort 2) were compiled. Instruments were established measures, and included the Montreal Cognitive Assessment (MOCA) and the World Health Organization Quality of Life (WHOQOL-BREF). Number of hospitalizations and moves to a higher level of care within the first 6 months for both cohorts were gathered. Descriptive statistics were calculated comparing the scores of the 2 cohorts.
RESULTS: Results from the EP showed that residents are moving into the LPC with higher levels of acuity. Mean (M) scores decreased on the MOCA: Cohort 1 (M = 23.44), Cohort 2 (M= 21.91) and the Physical component of WHOQOL: Cohort 1 (M= 69.47), Cohort 2 (M= 66.34). Coinciding with the decline in cognition and physical skills, the mean age between the cohorts increased from Cohort 1 (M=80.5 years) to Cohort 2 (M= 82.8 years). Percent of hospitalizations increased from Cohort 1 (7.1%) vs Cohort 2 (14.5%) within the first 6 months. Percent of new residents requiring higher level of care within first 6 months increased: Cohort 1 (1.2%) vs Cohort 2 (7.9%). CONCLUSION: With the increasing age of older adults moving into the LPC who have lower cognition and physical skills, along with increased rates of hospitalization and quicker transitions to higher levels of care, OT is indicated to support their successful maintaining of independence in the new setting.3,4.
IMPACT STATEMENT: This research demonstrates the increased need for interventions with older adults to facilitate safer, smoother transitions from home into LPCs. This can be a non-traditional emerging practice area for occupational therapists.
References
1. De Blok, C., Merten, H., Verver, D. & Wagner, C. (2019). A cross sectional study on the different domains of frailty for independent living older adults. Biomedical Central of Geriatric Medicine, 19(1), 1-12. doi:10.1186/s12877-019-1077-3.
2. National Investment Center. (2018). NIC investment guide: Investing in seniors housing and care properties (5th ed.) (pp.13-14). Retrieved from https://info.nic.org/2018-investment-guide-executive-summary
3. Milinac, M. E., & Feng, M. C. (2016). Assessment of activities of daily living, self-care, and independence. Archives of Clinical Neuropsychology, 31(6), 506–516. doi:10.1093/arclin/acw049
4. Chen, S., Chen, T., Haeunchi, Y., Honda, T., Kishimoto, H., Kumagai, S. & Narazaki, K. (2018). Physical frailty is associated with longitudinal decline in global cognitive function in non-demented older adults: A prospective study. Journal of Nutrition, Health & Aging, 22(1), 82-88. doi: 10.1007/s12603-017-0924-1.
