THE ROLE OF ENVIRONMENTAL CONTEXT IN NURSING HOME ADMISSION: ASSESSING THE EXPERIENCE OF DIFFERENT HEALTH PROFILES / El rol del contexto ambiental en la admisión a asilos de ancianos: evaluando la influencia de diferentes perfiles de salud
Main Article Content
Section: Artículos de investigación empírica
Abstract
Based on the Ecological Theory of Aging and the person-centered perspective, this study examines the effect of person-environment fit on nursing home admission. To do so, we empirically identified heterogeneous group of older adults with different health conditions. Then we examined to what extent the person’s differential health conditions and their environmental context affected nursing home admission, and how the effects of health conditions on long-stay nursing home admission differed older adults’ physical environment contexts. Data are from seven waves of the Health Retirement Study (1998-2010). We used a two-step cluster analytical approach to identify subgroups of health limitations profiles. Hierarchical linear modeling was used to determine how health profiles and environmental factors affected the likelihood of nursing home admission controlling for socio-demographic attributes. In terms of result, four health profiles were identified: physical-sensory impaired, physically healthy-cognitively impaired, frail, and relatively healthy. The most vulnerable subgroup, frail, was more affected by the environment. Members of the frail group living at home with supportive features such as ramps, railings, and grab bars in the restroom and those who lived in a safe neighborhood, were less likely to enter a nursing home. For respondents in the physically healthy-cognitively impaired group, in-home supportive features were negatively associated with nursing home admission. For respondents in the physical-sensory impaired group, a higher level of neighborhood safety was negatively associated with nursing home admission.We demonstrated that multidimensional health conditions of older adults can be examined in distinctive health profiles: physical-sensory impaired, physically healthy-cognitively impaired, frail, and relatively healthy. Findings regarding health profiles and the associations between person-environment profiles or fit and nursing home admission highlight the importance of understanding the effects of different contexts on aging-in–place and have important policy and intervention implications.Keywords:Environmental gerontology, Person-centered perspective, nursing home admission, health profiles Basado en la Teoría Ecológica del Envejecimiento y la perspectiva centrada en la persona, este estudio examina el efecto de la persona y el medio ambiente en forma de ingreso (admisiones) en hogares de ancianos. Para ello, hemos identificado empíricamente grupos heterogéneos de adultos mayores con diferentes condiciones de salud. Luego analizamos en qué medida las condiciones diferenciales de salud de la persona y su contexto ambiental afectaban sus probabilidades de admisión en el hogar de ancianos; finalmente, se analizó cómo los efectos de las condiciones de salud en hogares de larga duración hacían variar los contextos físicos del entorno de los adultos mayores. Los datos proceden de siete mediciones del Retirement Health Study (1998 - 2010). Se utilizó un enfoque analítico de análisis de clúster (de dos pasos) para identificar subgrupos de perfiles limitaciones de salud. Se aplicó luego una modelación lineal jerárquica (HLM) para determinar cómo los perfiles de salud y los factores ambientales afectan la probabilidad de ingreso en el hogar de ancianos de controlar por atributos sociodemográficos. En términos de resultados, se identificaron cuatro perfiles de salud: física-sensorial alterada, deteriorada físicamente sano-cognitivamente, frágil, y relativamente saludable. El subgrupo más vulnerable, frágil, fue el más afectado por el medio ambiente. Los miembros del grupo frágil que viven en casa con características de apoyo tales como rampas, barandillas y pasamanos en el baño y los que vivían en un barrio seguro, eran menos propensos a entrar en un hogar de ancianos. Para los encuestados en el grupo físicamente sano - cognitivamente deteriorados, las funciones de apoyo en el hogar se asociaron negativamente con la admisión al asilo de ancianos. Para los encuestados en el grupo deterioro físico-sensorial, un mayor nivel de seguridad del vecindario se asoció negativamente con admisión. A través de nuestro estudio demostramos que las condiciones de salud multidimensionales de los adultos mayores pueden ser examinados a través de distintos perfiles de salud y que, asimismo, los hallazgos sobre los perfiles de salud y las asociaciones entre los perfiles persona-ambiente y el ingreso en un hogar de ancianos releva la importancia de comprender los efectos de los diferentes contextos sobre el envejecimiento y tienen importantes implicaciones de política pública y de intervención.Palabras clave: gerontología ambiental, perspectiva centrada en la persona, admisión a hogar de ancianos, perfiles de salud
Article Details
Park, S., & Kim, B. (2016). THE ROLE OF ENVIRONMENTAL CONTEXT IN NURSING HOME ADMISSION: ASSESSING THE EXPERIENCE OF DIFFERENT HEALTH PROFILES / El rol del contexto ambiental en la admisión a asilos de ancianos: evaluando la influencia de diferentes perfiles de salud. TS Cuadernos De Trabajo Social, (14), 121-149. Retrieved from https://tscuadernosdetrabajosocial.cl/index.php/TS/article/view/91
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References
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Hair, J., Black, W. (2000). Cluster analysis. In Grimm, L.G. & Yarnold, P.R. (eds), Reading and understanding more multivariate statistics. APA, Washington DC, pp. 147-205.
Hwang, E., Cummings, L., Sixsmith, A. & Sixsmith, J. (2011). Impacts of home modifications on aging-in-place. Journal of Housing for the Elderly, 25, pp. 246-257.
Iwarsson, S. (2005). A long-term perspective on person–environment fit and ADL dependence among older Swedish adults. The Gerontologist, 45(3), pp. 327-336
Iwarsson, S., Horstmann, V. & Slaug, B. (2007). Housing matters in very old age- yet differently due to ADL dependent level differences. Scandinavian Journal of Occupational Therapy, 14(3), pp. 3-15.
Kendig, H. (2003). Directions in Environmental Gerontology: A Multidisciplinary Field. The Gerontologist, 43(5), pp. 611-615.
Lafortune, L., Beland, F., Bergman, H, & Ankri. (2009). Health state profiles and service utilization in community-living elderly. Medical Care, 47(3), pp. 286-294.
Lawton, M. P. & Nahemow, L. (1973). Ecology and the aging process. In C. Eiserdorfer & M. P. Lawton (Eds.), Psychology of adult development and aging (pp.619-674). Washington, DC: American Psychological Association.
Lawton, M. P. (1989). Environmental proactivity in older people. In V. L. Bengtson & K. W. Schaie (Eds.), The course of later life (pp. 15–23). New York: Springer.
Lawton, M. P. (1990). Residential environment and self-directedness among older people. American Psychologist, 45(5), pp. 638-640.
Choi, N. G. (2004). Stability and changes in living arrangement among unmarried older persons: The influence of housing environments. Journal of Housing for the Elderly, 18(2), pp. 69-89.
Coward, R. T., Horne, C., & Peek, C. W. (1995). Predicting nursing home admissions among incontinent older adults: a comparison of residential differences across six years. The Gerontologist, 35(6), pp. 732-743.
Coward, R. T., Netzer, J. K., & Mullens, R. A. (1996). Residential differences in the incidence of nursing home admissions across a six-year period. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 51(5), S258-S267.
Dwyer, J. W., Barton, A. J., & Vogel, W. B. (1994). Area of residence and the risk of institutionalization. Journal of Gerontology, 49(2), S75-S84.
Elo, I. T. (2009). Social class differentials in health and mortality: Patterns and explanations in comparative perspective. Annual Review of Sociology, 35, pp. 553-572.
Fischer, L. R., Green, C. A., Goodman, M. J., Brody, K. K., Aickin, M., Wei, Feifei.,Phelps, L.W., & Leutz, W. (2003). Community-based care and risk of nursing home placement. Medical care, 41(12), pp. 1407-1416.
Fonda, S., & Herzog, A. R. (2004). Documentation of physical functioning measured in the Health and Retirement Study and the Asset and Health Dynamics among the Oldest Old Study. Ann Arbor, Michigan: Survey Research Center.
Gaugler, J. E., Duval, S., Anderson, K. A., & Kane, R. L. (2007). Predicting nursing home admission in the US: a meta-analysis. BMC geriatrics, 7(1), 13.
Hair, J., Black, W. (2000). Cluster analysis. In Grimm, L.G. & Yarnold, P.R. (eds), Reading and understanding more multivariate statistics. APA, Washington DC, pp. 147-205.
Hwang, E., Cummings, L., Sixsmith, A. & Sixsmith, J. (2011). Impacts of home modifications on aging-in-place. Journal of Housing for the Elderly, 25, pp. 246-257.
Iwarsson, S. (2005). A long-term perspective on person–environment fit and ADL dependence among older Swedish adults. The Gerontologist, 45(3), pp. 327-336
Iwarsson, S., Horstmann, V. & Slaug, B. (2007). Housing matters in very old age- yet differently due to ADL dependent level differences. Scandinavian Journal of Occupational Therapy, 14(3), pp. 3-15.
Kendig, H. (2003). Directions in Environmental Gerontology: A Multidisciplinary Field. The Gerontologist, 43(5), pp. 611-615.
Lafortune, L., Beland, F., Bergman, H, & Ankri. (2009). Health state profiles and service utilization in community-living elderly. Medical Care, 47(3), pp. 286-294.
Lawton, M. P. & Nahemow, L. (1973). Ecology and the aging process. In C. Eiserdorfer & M. P. Lawton (Eds.), Psychology of adult development and aging (pp.619-674). Washington, DC: American Psychological Association.
Lawton, M. P. (1989). Environmental proactivity in older people. In V. L. Bengtson & K. W. Schaie (Eds.), The course of later life (pp. 15–23). New York: Springer.
Lawton, M. P. (1990). Residential environment and self-directedness among older people. American Psychologist, 45(5), pp. 638-640.