Expectations regarding transitioning into long-term care, social connectedness, and mental health of older adults.

Purpose: This study examined the association between perceived likelihood of moving into a nursing home and depressive and suicidal outcomes among adults aged 65+, and explored variation in those associations by two aspects of social connectedness: individual social networks and neighborhood social cohesion.

Methods: Data comes from the 2018 Health & Retirement Study (N = 7,897). Perceived likelihood of moving into a nursing home in the next five years was assessed using a probability scale (0-100%). Past-year elevated depressive symptoms, major depressive episodes (MDE), and passive suicidal ideation (PSI) were indexed by the Composite International Diagnostic Interview. Social networks (e.g., diversity and frequency of contact with social network, number of close relationships) and neighborhood social cohesion (e.g., living close to good friends, neighborhood social cohesion index) were self-reported. Multivariable logistic regression models were used to examine the association between nursing home expectations and depression outcomes; moderation by social connectedness was examined using interaction terms.

Results: The majority of respondents reported low perceived likelihood of moving into a nursing home (median: 5%, IQR: 0-20%). Higher perceived likelihood was positively associated with depressive symptoms (Odds Ratio [OR]: 1.06, 95% CI: 1.01, 1.11), MDE (OR: 1.08, 95% CI: 1.02, 1.15), and PSI (OR: 1.10, 95% CI: 1.04, 1.17). Having a close friend in the neighborhood heightened the association between expectations and mental health; other measures of social connectedness did not moderate this association.

Conclusion: Older adults anticipating transitioning to long-term care may have unmet emotional support needs, particularly if they are socially-integrated in their neighborhood.