Intrainstitutional Relocation and Psychological Outcomes

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This proposed research is in response to the NIA Pilot Grant Program request for research of "transitions across long-term care settings." We propose to examine changes in cognitive performance mood, behavior problems, and social engagement as outcomes of intrainstitutional relocations. Relocation is defined as "moving from one environment to another for various reasons." We propose to examine intrainstitutional relocation, which is movement within a facility. This can entail moving from one room to another, from one unit to another, or from one floor to another - and is the definition used in this proposal. Relocation within the same facility may be very disturbing to the elderly. As Everard, Rowles, and High (1994:520) state, "rooms may constitute the equivalent of homes" to long-term care residents. Rooms can "become places imbued with meanings and significance equivalent to those that evolved in their former community residences." Changing rooms may entail loss of connections with familiar staff members, worry of loss/breakages of possessions, wont' over new roommates, to name just a few. There is also a belief that elders' ability to cope with relocation may be limited and may result in a syndrome. Relocation stress syndrome is "a state in which an individual experiences physiological and/or psychological disturbances as a result of a transfer from one environment to another." One problem with many previous studies in this area is the power to detect change. Most studies have low sample sizes. . We propose to use the newly available Minimum Data Set (MDS), representing 50,000 nursing home residents in New Jersey. Thus this study has greater power to detect effects of relocation. Also, many studies are now dated. In a review of the literature we found the majority of relocation studies to be conducted prior to 1985. Nursing homes and residents in nursing homes have changed considerably since this time. Residents are now sicker, this may make them more susceptible to any effects of relocation. Understanding whether intrainstitutional relocation contributes to mental health problems is important. If intra-institutional relocation is shown to promote mental health decline a more powerful rationale for careful relocation may develop. Presumably, with a concomitant reduction in residents with mental health problems, nursing homes may then better provide mental health (and other) services to impaired residents. Residents who undergo interinstitutional relocation often partake in a preparatory program prior to relocation. We do not know the extent of use of these programs for intra-institutional relocation but anecdotal evidence would suggest they are rare. If intra-institutional effects of relocation are found to exist development of these programs would be an appropriate next step.