Aging-in-place preferences and institutionalization among Japanese older adults: a 7-year longitudinal study

Abstract

Background In Asia, where autonomous decision-making is not well accepted, little is known about whether and how individuals’ preferences are considered when deciding where they receive care. This study examined whether individuals preferring to age in place if confined to bed were less likely to be institutionalized, using longitudinal data of Japanese older adults. Methods We analyzed nationally representative data of 1,290 community-dwelling older adults aged 70 and above. Baseline data were collected in 1999, shortly before the long-term care insurance system was introduced. The outcome was measured as self- or proxy-reported years of institutionalization over seven years. The explanatory variable was whether individuals preferred to age in place if they were confined to bed. Participants were asked about their desired place of care (facility, home, or other) if confined to bed. Covariates were sociodemographic and health-related factors. We used Cox proportional hazards models and calculated hazard ratios (HRs) with 95% confidence intervals (CIs) to evaluate the association of aging-in-place preferences if confined to bed with institutionalization. We applied multiple imputation to deal with missing data. Results Seventy-eight respondents (6.0%) were institutionalized during the follow-up period. Compared to individuals preferring to reside in long-term care facilities if confined to bed (48.7%), those preferring to stay in their homes (39.6%) were less likely to be institutionalized, even after adjusting for relevant covariates (HR = 0.47, 95% CI 0.27–0.79 for model 1 including residential status; HR = 0.45, 95% CI 0.27–0.76 for model 2 including marital status and co-resident children). Conclusions Our findings suggest that individuals’ aging-in-place preferences tend to be considered under the long-term care insurance system. Individuals’ preferences should be shared with families and clinicians when deciding the place of care.

Does the community service environment affect the willingness of older adults people to socialize for older adults care?

“…Second, social support and family relationships have a significant impact on the willingness of older adults individuals to receive care ( 45 ). The presence of close family relationships ( 46 ), support from children or other relatives ( 47 ), living arrangements with spouses and children ( 48 , 49 ), proximity to children ( 50 ), community support and services ( 51 ), interpersonal relationships, and spiritual needs ( 52 ) can influence individuals’ willingness to receive care. Additionally, the individual characteristics of older adults people also play a role in their willingness to receive care.…”

“What If I Die and No One Notices?” A Qualitative Study Exploring How Living Alone and in Poverty Impacts the Health and Well-Being of Older People in Hong Kong

“…The number of older people living alone is rising, in Hong Kong [ 1 ], and elsewhere around the world, such as Canada and the United States [ 2 ], the United Kingdom [ 3 ], Japan [ 4 ], and South Korea [ 5 ]. Changing family structures and increases in life expectancies are contributing to this global phenomenon [ 6 ].…”

“…Additionally, the decrease in the number of wage earners in a household increase the risk of poverty. Despite the growing number of older people living alone and in poverty [ 1 , 2 , 3 , 4 , 5 , 14 , 17 , 20 ], the intersection of these two social risk factors and the impacts on older adults’ health and well-being have not been widely examined, and the limited existing research has been oriented narrowly toward the challenges and negative outcomes associated with living alone and in poverty.…”

Aspects of cognition that impact aging‐in‐place and long‐term care planning

“…Older adults frequently defer decisions about their aging‐in‐place/long‐term care (AIP‐LTC) needs 1–3 . As a result, when older adults experience worsening Alzheimer's disease and are unable to provide their AIP‐LTC preferences, loved ones become surrogate decision makers 4,5 .…”

“…Older adults frequently defer decisions about their agingin-place/long-term care (AIP-LTC) needs. [1][2][3] As a result, when older adults experience worsening Alzheimer's disease and are unable to provide their AIP-LTC preferences, loved ones become surrogate decision makers. 4,5 If the older adult has not communicated their AIP-LTC preferences, surrogate decision makers attempt to make best guesses about their older adult loved one's goals.…”