Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations.
This mixed-methods study classified new residents in an assisted living facility (ALF) for frailty and explored each resident's occupational needs upon their transition to the ALF. Results revealed a spectrum of personal narratives, functional abilities, and psychosocial needs among new residents. Findings implicate the need for standardized data collection upon admission, followed by program development and refinement, to best meet the needs of new ALF residents.
Primary Author and Speaker: Nicole A. Fidanza
Additional Authors and Speakers: Nicole Baker, Rachel Brown, Hope Gallagher, and Kiera Godusky
PURPOSE: The assisted living facility (ALF) is the fastest growing senior living option nationwide, currently housing over 835,000 Americans (National Center for Assisted Living, 2018). A previous study found newly transitioned ALF residents at risk for social isolation due to decreased social participation upon move-in (Fidanza, Bondoc, & Kowal, 2018). This can lead to an increase in frailty, placing new residents at a higher risk for further isolation, falls, disability, hospitalization, and death (Fried et al., 2001). If new residents are at risk for social isolation and frailty, and if there is no standardized protocol to gather resident data upon intake, then the profession needs to better understand how to gather pertinent data and ultimately provide improved supports to new ALF residents. This study served as a pilot experience for standardized data collection within the ALF.
DESIGN: This embedded mixed-methods study utilized occupational profile interviews and seven frailty assessments to determine the needs and interests of new residents. Recruitment took place via phone calls to potential participants whose contact information was provided by the ALF. Purposive sampling was used to increase the likelihood of response saturation. To qualify, participants must reside in the ALF for less than 12 months and be able to give their own consent.
METHOD: Data was first collected through semi-structured occupational profile interviews conducted in-person. Interviews were based off a guide organized into two categories: occupational history and a typical day in the ALF. Occupational profile narratives were written for each resident, which were coded for common themes. Participants were then evaluated for frailty based on the following categories and assessments: physiology (self-reported weight loss), strength (Timed Up and Go or Jamar dynamometer), activity of daily living (ADL) (Barthel Index), psychosocial (Geriatric Depression Scale and Lubben Social Network Scale), and cognition (Montreal Cognitive Assessment). These were scored per each assessment's standardized guidelines, with set frailty criteria for each test. Each resident's frailty status was determined based on these results; residents were deemed Frail if they met three or more frailty criteria, Pre-Frail if they met one or two frailty criteria, or Not Frail if they met no frailty criteria.
RESULTS: Twelve new residents, with time in the ALF ranging from one to 11 months, participated in this study. Occupational profiles revealed a spectrum of personal narratives and interests of new residents. A desire to decrease feelings of isolation, via connecting with peers and increased transportation options, was expressed by most residents. Frailty assessments found 50% of participants as Frail, 42% as Pre-Frail, and 8% as Not Frail. Most failed each frailty category except for physiology, which 100% passed. In the strength category, 75% were frail; in the ADL category, 50% were frail; in the psychosocial category, 58% were frail; and in the cognition category, 67% were frail. Frailty status was not correlated with age, gender, or time in the ALF. Data collection using this mixed-methods approach took 90-120 minutes and the process was well-received.
CONCLUSION: Most new ALF residents were deemed Frail or Pre-Frail, placing their health and quality of life at risk. There is a need for standardized data collection upon admission, followed by program development/refinement, to best meet the occupational and frailty needs of new residents. Occupational therapists in ALFs should increase their efforts to address the frailty and social participation of new ALF residents—via both assessment and intervention—to better support this population upon move-in.
References
National Center for Assisted Living. (2018). Facts and figures. Retrieved from https://www.ahcancal.org/ncal/facts/Pages/default.aspx.
Fidanza, N. A., Bondoc, S., & Kowal, J. (2018). Short, spontaneous, and superficial: An exploration of social participation amongst older adults in assisted living facilities. ConnOTA 2018 Fall SIS Conference, Wallingford, CT.
Fried, L.P., Tangen, C. M., Walston, J., Newman, A.B., Hirsch, C., Gottdiener, J., & McBurnie, M. (2001). Frailty in older adults: Evidence for a phenotype. Journal of Gerontology: Medical Sciences, 56(3), M146-M156. https://doi.org/10.1093/gerona/56.3.M146
