What Changed Your Mind? Influencers of Older Adults Changing Decisions About Aging-In-Place Versus Long-Term Care.

Background: As individuals experience age-related changes, such as cognitive decline or hospitalizations, their ability to live independently at home may be impacted. Decision-making and planning are essential in order to support successful aging-in-place (AIP), which is defined as continuing to live in one's home and community. Despite making plans at one single time-point, prior research has demonstrated that decision-making among older adults is not stagnant.

Aims: The objective of this qualitative study was to understand what influences older adults to change their plans about AIP versus living in long-term care (LTC) settings.

Methods: We analyzed a subset of the PlanYourLifespan study subjects (a longitudinal cohort study of community dwelling older adults) who have shown a fluctuation in their AIP/LTC decisions over a 6-month period and surveyed what influenced their decisions to change. Decisions related to support needed in the case of a hospitalization and Alzheimer's disease/memory loss (rehabilitation preferences, caregiver support, living preferences, and LTC facilities) were assessed. Three investigators individually coded open-ended survey responses to identify emerging themes using constant comparative analysis with triangulation of themes.

Results: Of the 293 PYL study subjects, 134 expressed a change to at least one of their decisions. Through a qualitative analysis of survey responses, five overarching themes emerged that influenced fluctuating decision-making: (1) personal health experience, (2) health experience of a loved one, (3) increased contemplation, (4) social support network influences, and (5) denying change.

Discussion: This study was the first to examine the factors that influence fluctuating AIP/LTC decision-making among older adults. The key influencers identified highlight the importance of ongoing discussions to revisit AIP/LTC planning in the case of changing or unexpected life events. Having a strong understanding of what influences seniors in their AIP/LTC decision-making processes will enable us to include these factors and people in decision-making discussions.