When frail older people relocate in very old age, who makes the decision?

Background and objectives: Older people are likely to transition to a new home closer to family who can provide assistance or to long-term residential care as their health declines and their care needs increase. A minority choose to move to ‘age friendly’ housing before the onset of disability, but the majority prefer to ‘age in place’ and defer moving until health crises compel a transition. Older people living with dementia are likely to move into residential care, but not much is known about the role they play in decision making around these moves. This qualitative study addresses this gap in knowledge by examining how a rare cohort of “older old” people, most with some level of cognitive impairment, were involved in decisions surrounding assistance seeking and moving to a care home.
Research Design and Methods: Thematic analysis of qualitative interview data from Cambridge City over-75s Cohort (CC75C) study participants aged ≥95-years-old who had moved in later life and their proxy informants (n=26).
Results: Moves at such an old age were made due to a complexity of push and pull factors which had layered dynamics of decision making. In most cases (n=22) decision making involved other people with varying degrees of decision ownership. Only four older people, who moved voluntarily, had full ownership of the decision to move. Many relatives reported being traumatised by events leading up to the move.
Discussion and Implications: “Older old” people are sometimes unable to make their own decisions about moving due to the urgency of health crisis and cognitive decline. There is a need to support relatives to discuss moving and housing options at timely junctures before health crises intervene in an effort to optimise older people’s participation in decision making.
Translational Significance: This article presents qualitative data from a rare cohort of the oldest old (>95+) to illustrate the complex interacting push and pull factors triggering a move to long term residential care. These data illustrate the different, albeit limited, ways that people with dementia are involved in decisions and explains the varying degrees and types of involvement.